Search

Abstract Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril–valsartan, beta‐blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.

Left main coronary artery disease (LMCAD) is associated with high morbidity and mortality due to the large myocardial mass at risk. Although medical treatment may be an option in selected low-risk patients, revascularisation is recommended to improve survival in the majority of patients presenting with a significant left main stenosis. In the past decade, multiple randomised clinical trials and meta-analyses have compared coronary artery bypass grafting surgery (CABG) versus percutaneous coronary intervention (PCI), finding controversial results. The strategy for LMCAD revascularisation is still challenging. Coronary anatomy complexity, clinical features and patient preferences are key elements to be considered by the heart team. The current guidelines define CABG as standard therapy, but the continuous improvements in PCI techniques, the use of intracoronary imaging and functional assessment make PCI a feasible alternative in selected patients, particularly in those with comorbidities and contraindications to CABG. This review analyses the most important studies comparing CABG versus PCI in patients with LMCAD.

Abstract Circulating tumor DNA (ctDNA) levels may predict response to anticancer drugs, including CDK4/6 inhibitors and endocrine therapy combinations (CDK4/6i+ET); however, critical questions remain unanswered such as which assay or statistical method to use. Here, we obtained paired plasma samples at baseline and week 4 in 45 consecutive patients with advanced breast cancer treated with CDK4/6i+ET. ctDNA was detected in 96% of cases using the 74-gene Guardant360 assay. A variant allele fraction ratio (VAFR) was calculated for each of the 79 detected mutations between both timepoints. Mean of all VAFRs (mVAFR) was computed for each patient. In our dataset, mVAFR was significantly associated with progression-free survival (PFS). Baseline VAF, on-treatment VAF or absolute changes in VAF were not associated with PFS, nor were CA-15.3 levels at baseline, week 4 or the CA-15.3 ratio. These findings demonstrate that ctDNA dynamics using a standardized multi-gene panel and a unique methodological approach predicts treatment outcome. Clinical trials in patients with an unfavorable ctDNA response are needed.

Intelligent transportation systems will play a key role in the smart cities of the future. In particular, railway transportation is gaining attention as a promising solution to cope with the mobility challenges in large urban areas. Thanks to the miniaturisation of sensors and the deployment of fast data networks, the railway industry is being augmented with contextual, real-time information that opens the door to novel and personalised services. Despite the benefits of this digitalisation, the high complexity of railway transportation entails a number of challenges, particularly from security and privacy perspectives. Since railway assets are attractive targets for terrorism, coping with strong security and privacy requirements such as cryptography and privacy-preserving methods is of utmost importance. This article provides a thorough systematic literature review on information security and privacy within railway transportation systems, following the well-known methodology proposed by vom Brocke et al. We sketch out the most relevant studies and outline the main focuses, challenges and solutions described in the literature, considering technical, societal, regulatory and ethical approaches. Additionally, we discuss the remaining open issues and suggest several research lines that will gain relevance in the years to come.

The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world’s population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a very contagious virus, has led to the coronavirus disease 2019 (COVID-19) pandemic. The clinical manifestations of this virus in humans vary widely, from asymptomatic to severe, with diverse symptomatology and even death. The substantial transmission from asymptomatic people has facilitated the widespread transmission of SARS-CoV-2, hampering public health initiatives to identify and isolate infected people during the pre-symptomatic contagious period. COVID-19 is associated with cardiac complications that can progress from mild to life-threatening. The aim of this article is to analyse the present knowledge of COVID-19 and cardiac involvement, the development of arrhythmia risk and its treatment.

The advances in the miniaturisation of electronic devices and the deployment of cheaper and faster data networks have propelled environments augmented with contextual and real-time information, such as smart homes and smart cities. These context-aware environments have opened the door to numerous opportunities for providing added-value, accurate and personalised services to citizens. In particular, smart healthcare, regarded as the natural evolution of electronic health and mobile health, contributes to enhance medical services and people’s welfare, while shortening waiting times and decreasing healthcare expenditure. However, the large number, variety and complexity of devices and systems involved in smart health systems involve a number of challenging considerations to be considered, particularly from security and privacy perspectives. To this aim, this article provides a thorough technical review on the deployment of secure smart health services, ranging from the very collection of sensors data (either related to the medical conditions of individuals or to their immediate context), the transmission of these data through wireless communication networks, to the final storage and analysis of such information in the appropriate health information systems. As a result, we provide practitioners with a comprehensive overview of the existing vulnerabilities and solutions in the technical side of smart healthcare.

Critically ill patients that stay in Intensive Care Units (ICU) for long periods suffer from Post-Intensive Care Syndrome or ICU Acquired Weakness, whose effects can decrease patients’ quality of life for years. To prevent such issues and aiming at shortening intensive care treatments, Early Mobilisation (EM) has been proposed as an encouraging technique: the literature includes numerous examples of the benefits of EM on the prevention of post-operative complications and adverse events. However, the appropriate application of EM programmes entails the use of scarce resources, both human and technical. Information and Communication Technologies can play a key role in reducing cost and improving the practice of EM. Although there is rich literature on EM practice and its potential benefits, there are some barriers that must be overcome, and technology, i.e., the use of sensors, robotics or information systems, can contribute to that end. This article reviews the literature and analyses on the use of technology in the area of EM, and moreover, it proposes a smart health-enhanced scenario.

The emerging paradigm of the cognitive city, which augments smart cities with learning and behavioral change capabilities, is gaining increasing attention as a promising solution to the challenges of future mega-cities. Cognitive cities are built upon artificial learning and behavioral analysis techniques founded on the exploitation of human-machine collective intelligence. Hence, cognitive cities rely on the sharing of citizens’ daily-life data, which might be considered sensitive personal data. In this context, privacy and security of the shared information become critical issues that have to be addressed to guarantee the proper deployment of cognitive cities and the fundamental rights of people. This article provides a thorough literature review using the recommendations for systematic reviews proposed by Vom Brocke et al. and the PRISMA statement. We analyze peer-reviewed publications indexed in ACM Digital Library, IEEE Xplore, Scopus, and Web of Science until July 2020. We identify the main challenges on privacy and information security within cognitive cities, and the proposals described in the literature to address them. We conclude that many challenges remain open and we suggest several research lines that will require further examination in the years to come.

La situación del Campus de la UIB, aislado de la ciudad, ligado al tema de la escasez del agua ha permitido el desarrollo de un sistema de depuración in situ de las aguas residuales producidas en las propias instalaciones universitarias. El proceso se desarrolla íntegramente con sistemas de depuración natural en un diseño que combina 3 tecnologías existentes: el lagunaje, los humedales construidos y los filtros verdes arbolados. La innovación se produce en un sistema de regulación térmica del lagunaje para evitar la inversión térmica, que provoca situaciones puntuales de malos olores. Se trata de aprovechar el calor residual de una instalación de climatización solar en un edificio cercano a la laguna, de tal manera que la laguna ejerza de refrigerador del sistema y a la vez aproveche el calor para potenciar la estratifi cación térmica.

In-hospital cardiac arrest remains a major problem but new technologies allowing fully automatic external defibrillation are available. These technologies allow the concept of external therapeutic monitoring of lethal arrhythmias. Since early defibrillation improves outcome by decreasing morbidity and mortality, the use of this device should improve the outcome of in-hospital cardiac arrest victims. Furthermore, the use of these devices could allow safe monitoring and treatment of patients at risk of cardiac arrest who not necessarily must be in conventional monitoring units (Intensive or Coronary Care Units) saving costs with a more meaningful use of resources. The capability to provide early defibrillation within any patient-care areas should be considered as an obligation (standard of care) of the modern hospital.

The loss of consciousness has been a subject of wonder and uncertainty in humans, and for this reason it has been the object of medical investigation since the beginning of time. Even actually, it is certainly an unresolved clinical problem. Many centuries ago, complicated exorcisms and remedies were used on these unfortunate patients, who upon regaining consciousness would find themselves soaked in miraculous liquids, ingesting curative potions, and often on the way to be burned accused of being possessed. In the seventeen century, physicians began to relate loss of consciousness and haemodinamic changes. William Harvey was perhaps the first to describe a circulatory response (vasovagal reaction) during a phlebotomy in the year 1628: ...Yet it fear or any other cause, or something do intervene through passion of the mind, so that the heart do beat more faintly, the blood will be no means pass through but drop after drop…1. During the nineteenth century, loss of consciousness was the object of studies and research, and the vagally mediated cardioinhibition, as a primary cause, was noted by Foster who proposed that profound bradycardia diminished cerebral perfusion to a level inadequate to maintain consciousness2. At this time, it was reported the first use of the tilt-table test3. Commonly referred to as fainting or loss of consciousness, from last century the preferred medical term is syncope, which itself is derived from the Greek term syncoptein meaning to cut short. Syncope is defined as the sudden loss of consciousness and postural tone with spontaneous recovery. In 1907, Gowers was the first person to use the term vasovagal syncope4. In 1918 was published the work in which Cotton and Lewis described for the first time the clinical characteristics that are still used today to recognize the syncopal reaction5. However, it was not till 1932 when Lewis described this reaction as being characterized by a combination of bradycardia, hypotension, and syncope, and he coined the term vasovagal syncope for the first time6.