Efficacy of Commonly Used 3D Mapping Systems in Acute Success Rates of Catheter Ablation Procedures.

Introduction: This systematic review aims to summarize the procedural arrhythmia termination rates in catheter ablation (CA) procedures of atrial or ventricular arrhythmias using the commonly used mapping systems (CARTO, Rhythmia and EnSite/NavX). Materials and Methods: A systematic search in MEDLINE and Cochrane databases through February 2021 was performed. Results: With regard to atrial fibrillation ablation procedures, acute success rates ranged from 15.4 to 96.0% and 9.1 to 100.0% using the CARTO and EnSite/NavX mapping systems, respectively; acute atrial tachycardia (AT) termination to sinus rhythm ranged from 75 to 100% using the CARTO system. The acute success rate for different types of AT ranged from 75 to 97% using Rhythmia, while the NavX mapping system was also found to have excellent efficacy in the setting of AT, with acute arrhythmia termination rates ranging from 73 to 99%. With regard to ventricular tachycardia, in the setting of ischaemic cardiomyopathy, acute success rates ranged from 70 to 100% using CARTO and 64% using EnSite/NavX systems. The acute success rate using the Rhythmia system ranged from 61.5 to 100.0% for different clinical settings. Conclusions: Mapping systems have played a crucial role in high-density mapping and the observed high procedural success rates of atrial and ventricular CA procedures. More data are needed for the comparative efficacy of mapping systems in acute arrhythmia termination, across different clinical settings.

The 15-minute city concept: The case study within a neighbourhood of Thessaloniki.

Cities, crucial cultural hubs, mould individual and group identities. The global urban expansion, with over half the population in urban areas, presents interconnected challenges such as pollution, poverty, inequality, ageing infrastructure, resource overconsumption, land use changes, biodiversity impact and climate change. Addressing these demands ambitious actions targeting political, social and economic systems for transformative change. The theoretical framework guiding city transformation centres on an interdisciplinary approach influenced by the Smart and Green Transition. The '15-minute city' concept, emphasizing human scale and urban experience, proposes that cities enable residents to meet daily needs within a short walk or bike ride. The aim of this study was the exploration of its implementation in Greek cities, particularly Thessaloniki, which reveals inherent characteristics supporting the 15-minute concept. Through an interdisciplinary approach rooted in the Smart and Green Transition framework, the research provides concrete guidance for policymakers in tailoring urban planning strategies, allocating resources effectively and crafting policies conducive to successful and sustainable urban transformations. Moreover, prioritizing public engagement highlights the significance of community involvement in shaping urban development plans, ensuring that proposed initiatives align with residents' needs and desires. In essence, this research contributes tangible insights and actionable recommendations for Greek cities, paving the way for more liveable, resilient and sustainable urban environments.

Early-Onset or Premature Coronary Artery Disease.

The aim of this review was to examine the literature regarding younger individuals without classical risk factors for atherosclerosis who develop coronary artery disease (CAD) prematurely at an early age. An extensive literature review was undertaken in Pubmed, Scopus, and Google Scholar regarding early-onset or premature atherosclerosis, CAD, its diagnosis, management, and prophylaxis. There are individuals of both genders, particularly in the younger age group of 20-40 years of age, who lack the traditional/ classical risk factors and still develop CAD and other manifestations of atherosclerosis. Even the 10-year age gap in manifesting CAD that is noted between women and men ascribable to a cardioprotective effect of sex hormones may not be noted under these circumstances. This indicates that the risk profile differs in young patients with non-- classical atherosclerotic risk factors, and factors such as genetics, inflammation, thrombosis, psychosocial, environmental, and other parameters play an important role in atherosclerosis and other mechanisms that lead to CAD in younger individuals. These patients are at risk of major adverse cardiac events, which determine their prognosis. Unfortunately, current major guidelines do not acknowledge that many patients who manifest premature CAD are at high risk, and as a consequence, many of these patients may not be receiving guideline-directed hypolipidemic and other therapies before they present with symptoms of CAD. Caretakers need to be more vigilant in offering efficacious screening and strategies of prevention for early-onset or premature CAD to younger individuals.

Are We Using Ezetimibe As Much As We Should?

Lipid-lowering therapies, particularly non-statin regimens, are underutilized as ~2/3 of patients with atherosclerotic cardiovascular (CV) disease (CVD) are not optimally managed, and do not attain target low-density lipoprotein cholesterol (LDL-C) concentrations, despite statin treatment. Statins have been the mainstay of hypolipidemic therapies; however, they are plagued by adverse effects, which have partly hindered their more widespread use. Ezetimibe is often the first added mode of treatment to attain LDL-C goals as it is efficacious and also allows the use of a smaller dose of statin, while the need for more expensive therapies is obviated. We herein provide a comprehensive review of the effects of ezetimibe in lipid lowering and reducing CV events and improving outcomes. Of the hypolipidemic therapies, oral ezetimibe, in contrast to newer agents, is the most convenient and/or affordable regimen to be utilized as mono- or combined therapy supported by data from CV outcomes studies attesting to its efficacy in reducing CVD risk and events. When combined with a statin, the statin dose could be lower, thus curtailing side-effects, while the hypolipidemic effect is enhanced (by ~20%) as the percentage of patients with target level LDL-C (<70 mg/dL) is higher with combined treatment versus a high-intensity statin. Ezetimibe could also serve as an alternative treatment in cases of statin intolerance. In conclusion, ezetimibe has an excellent safety/tolerability profile; it is the first added treatment to a statin that can attain LDL-C targets. In the combined therapy, the hypolipidemic effect is enhanced while the dose of statin could be lower, thus limiting the occurrence of side-effects. Ezetimibe could also serve as an alternative mode of treatment in cases of statin intolerance.

Data Interoperability for Ambulatory Monitoring of Cardiovascular Disease: A Scientific Statement From the American Heart Association.

Wearable devices are increasingly used by a growing portion of the population to track health and illnesses. The data emerging from these devices can potentially transform health care. This requires an interoperability framework that enables the deployment of platforms, sensors, devices, and software applications within diverse health systems, aiming to facilitate innovation in preventing and treating cardiovascular disease. However, the current data ecosystem includes several noninteroperable systems that inhibit such objectives. The design of clinically meaningful systems for accessing and incorporating these data into clinical workflows requires strategies to ensure the quality of data and clinical content and patient and caregiver accessibility. This scientific statement aims to address the best practices, gaps, and challenges pertaining to data interoperability in this area, with considerations for (1) data integration and the scope of measures, (2) application of these data into clinical approaches/strategies, and (3) regulatory/ethical/legal issues.

Managing chronic coronary syndrome: how do we achieve optimal patient outcomes?

INTRODUCTION: Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management. AREAS COVERED: This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms. EXPERT OPINION: CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.

Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study.

Background: Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods: In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings: In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation: Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS. Funding: The ESRC, MRC, NIHR, and Wellcome Trust.

Food-Energy-Water Nexus in compliance with Sustainable Development Goals for integrating and managing the core environmental verticals for sustainable energy and circular economy.

Food, energy, and water resources are intricately interconnected, and nexus provides a holistic approach for addressing these complex links to minimize inefficiencies and waste. Nexus approach and circular economy are considered as effective solutions for sustainability. Quantification of these relations is the first step towards incorporating nexus modeling which helps sustainable production and consumption. For achieving the Sustainable Development Goals, understanding and effectively managing the FEW nexus becomes imperative. With an integral performance perspective, there is a need to address the interdependencies and trade-offs among food, energy, and water systems and challenges of economic, social and environmental sustainability. The aim of this study is to provide a comprehensive analysis of the FEW nexus, identify key opportunities and challenges, and propose integrated strategies for managing these core environmental verticals sustainably. The study addresses the accomplishment of these goals through nexus approaches and outlines the need for technological advancements for shared benefits among resources, contributing to conceptual development of nexus and circular economy. The results highlight the critical importance of adopting a nexus approach to advance sustainable development goals, enhance resource efficiency, and promote synergistic solutions across food, energy, and water systems.

Microalgae to biodiesel: A novel green conversion method for high-quality lipids recovery and in-situ transesterification to fatty acid methyl esters.

Greenhouse gases (GHGs) emissions due to increasing energy demand have raised the need to identify effective solutions to produce clean and renewable energy. Biotechnologies are an effective platform to attain green transition objectives, especially when synergically integrated to promote health and environmental protection. In this context, microalgae-based biotechnologies are considered among the most effective tools for treating gaseous effluents and simultaneously capturing carbon sources for further biomass valorisation. The production of biodiesel is regarded as a promising avenue for harnessing value from residual algal biomass. Nonetheless, the existing techniques for extracting lipids still face certain limitations, primarily centred around the cost-effectiveness of the process.This study is dedicated to developing and optimising an innovative and cost-efficient technique for extracting lipids from algal biomass produced during gaseous emissions treatment based on algal-bacterial biotechnology. This integrated treatment technology combines a bio-scrubber for degrading gaseous contaminants and a photobioreactor for capturing the produced CO2 within valuable algal biomass. The cultivated biomass is then processed with the process newly designed to extract lipids simultaneously transesterificated in fatty acid methyl esters (FAME) via In Situ Transesterification (IST) with a Kumagawa-type extractor. The results of this study demonstrated the potential application of the optimised method to overcome the gap to green transition. Energy production was obtained from residuals produced during the necessary treatment of gaseous emissions. Using hexane-methanol (v/v = 19:1) mixture in the presence KOH in Kumagawa extractor lipids were extracted with extraction yield higher than 12% and converted in fatty acid methyl esters. The process showed the enhanced extraction of lipids converted in bio-sourced fuels with circular economy approach, broadening the applicability of biotechnologies as sustainable tools for energy source diversification.

Comprehensive investigation of recycled PVC powder.

This study constitutes a comprehensive investigation centred on comprehending the behaviour and characteristics of recycled polyvinyl chloride (PVC) powders. The overarching objective is to successfully conclude the initial research phase, during which PVC-coated fabric offcuts undergo a transformation into PVC powder while achieving complete separation from polyethylene terephthalate fibres. The study entails a qualitative description of the morphology of PVC powder particles, employing an optical microscope to distinguish the diverse shapes exhibited by these particles. The optical microscope observations of PVC powder reveal a distinct array of non-spherical particles characterized by flat, elongated shapes. These high-magnification images unveil the intricate morphological features of the particles, highlighting their irregular shapes. Subsequently, a quantitative analysis of PVC particle size distribution is performed, comparing results from optical microscopy with those obtained through mechanical sieving. The qualitative and quantitative findings obtained provide robust evidence supporting the correlation and confirm that most particles are smaller than 600 µm (93.6%) using an optical microscope and the sieving process (96.39%). The greatest fraction (83.44%) is in the size range between 200 and 600 µm. Assessing flowability, another significant aspect in the evaluation of powders, provides insights into its behaviour and interparticle interactions. The flowability results indicate a Compressibility Index of approximately 26.84%, which suggests poor flowability. This means that the powder is likely to encounter difficulties in flowing freely. This finding is in line with the Hausner ratio, which measures 1.37. This investigation of recycled PVC powder will offer insights into the potential applications and processing considerations of this powder. More concretely, the use of recycled PVC powder shows promise as a viable alternative to conventional PVC resin in plastisol formulations, offering the potential to maintain the properties of the final PVC product without adverse effects.

The concept of food waste and food loss prevention and measuring tools.

Food waste (FW) has become a global concern, with an estimated 1.3 billion tonnes lost annually, costing about $1 trillion. Environmental and social consequences of FW are significant, contributing to 6% of European Unions' greenhouse gasemissions and affecting global food security. FW occurs is a complex issue occurring at various stages of the food supply chain (FSC) and is influenced by multiple factors such as infrastructure, available knowledge and socio-economic conditions. Developed countries FW is more prevalent at the consumption stage, whereas in the developing countries losses occur in agricultural production, post-harvest and distribution stage. Accurate quantification of FW across the supply chain is crucial and monitoring key performance indicators helps identify areas for improvement. The European Union mandates FW measurement, aligning with sustainable development goals, emphasizing the need for effective waste prevention measures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was utilized to conduct a systematic literature review on FW key performance indicators (KPIs) and monitoring tools. The research identified 22 KPIs, categorized into three levels of the FSC: primary, secondary and tertiary. The most common KPIs included FW per capita, FW per portion and FW percentage. The study further discusses FW prevention measures and essential monitoring tools for addressing FW throughout the supply chain.

Cardiac contractility modulation in patients with heart failure - A review of the literature.

Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF. Clinically, CCM therapy is indicated to improve the 6-min hall walk, quality of life, and functional status of HF patients who remain symptomatic despite guideline-directed medical treatment without an indication for cardiac resynchronization therapy (CRT) and have a left ventricular ejection fraction (LVEF) ranging from 25 to 45%. Although there are promising results about the role of CCM in HF patients with preserved LVEF (HFpEF), further studies are needed to elucidate the role of CCM therapy in this population. Late gadolinium enhancement (LGE) assessment before CCM implantation has been proposed for guiding the lead placement. Furthermore, the optimal duration of CCM application needs further investigation. This review aims to present the existing evidence regarding the role of CCM therapy in HF patients and identify gaps and challenges that require further studies.

Use of Artificial Intelligence in Improving Outcomes in Heart Disease: A Scientific Statement From the American Heart Association.

A major focus of academia, industry, and global governmental agencies is to develop and apply artificial intelligence and other advanced analytical tools to transform health care delivery. The American Heart Association supports the creation of tools and services that would further the science and practice of precision medicine by enabling more precise approaches to cardiovascular and stroke research, prevention, and care of individuals and populations. Nevertheless, several challenges exist, and few artificial intelligence tools have been shown to improve cardiovascular and stroke care sufficiently to be widely adopted. This scientific statement outlines the current state of the art on the use of artificial intelligence algorithms and data science in the diagnosis, classification, and treatment of cardiovascular disease. It also sets out to advance this mission, focusing on how digital tools and, in particular, artificial intelligence may provide clinical and mechanistic insights, address bias in clinical studies, and facilitate education and implementation science to improve cardiovascular and stroke outcomes. Last, a key objective of this scientific statement is to further the field by identifying best practices, gaps, and challenges for interested stakeholders.

The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities.

Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities. Training in these approaches is important to create the next generation of scientists and practitioners in precision prevention. This state-of-the-art review is based on a workshop convened to identify current gaps in knowledge and methods used in precision prevention intervention research, discuss opportunities to expand trials of implementation science to close the health equity gaps, and expand the education and training of a diverse precision prevention workforce.

Urbanization and solid waste production: prospects and challenges.

The increasing urban population and the restructuring of urban economies are the main aspects that determine urban development in the twenty-first century. Rapid urbanization is among the most significant anthropogenic factors that impact ecosystems and sustainability. Urbanization is a "double-edged sword." Even though it contributes to economic prosperity and social development, at the same time, it poses severe challenges to the natural environment and social system. The scientific community emphasizes the need to investigate the relationship between cities and the environment to comprehend their dynamic interactions related with problems such as climate change, consumption of natural resources, and life quality degradation. Population growth and urbanization are central considerations of the 2030 Agenda of the United Nations Sustainable Development Goals, particularly SDG 11, dealing with making cities inclusive, safe, resilient, and sustainable. Moreover, the new circular economy model is receiving increasing attention globally as a solution to the current production and consumption model, which is based on constant growth and increasing resource input. The objective of this paper was to identify the major challenges occurred due to the rapid urbanization in a coastal city though a qualitative and quantitative waste compositional analysis. The ultimate goal is to propose the waste compositional analysis as a new indicator in the literature for determination of the degree of metabolism in an island region. According to the compositional analysis, the higher the population density in a region, the greater the volume of garbage produced and, consequently, the infrastructure necessary for waste management. Also, the increased seasonal tourist activity leads to an increase in the number of tourist accommodations and services. The results provided may also be applicable in other cities with similar characteristics related with tourism habits and the challenges they may face as a result of the waste production.

Mobilisation of textile waste to recover high added value products and energy for the transition to circular economy.

The textile industry is a major contributor to global waste, with millions of tons of textiles being discarded annually. Material and energy recovery within circular economy offer sustainable solutions to this problem by extending the life cycle of textiles through repurposing, recycling, and upcycling. These initiatives not only reduce waste but also contribute to the reduction of the demand for virgin materials (i.e. cotton, wool), ultimately benefiting the environment and society. The circular economy approach, which aims to recreate environmental, economic, and societal value, is based on three key principles: waste reduction, material circulation, and ecological restoration. Given these difficulties, circularity incorporates the material recovery approach, which is focused on the conversion of waste into secondary raw resources. The goal of this notion is to extract more value from resources by prolonging final disposal as long as feasible. When a textile has outlived its functional life, material recovery is critical for returning the included materials or energy into the manufacturing cycle. The aim of this paper is to examine the material and energy recovery options of main raw materials used in the fashion industry while highlighting the need of close observation of the relation between circularity and material recovery, including the investigation of barriers to the transition towards a truly circular fashion industry. The final results refer to the main barriers of circular economy transition within the industry and a framework is proposed. These insights are useful for academia, engineers, policy makers and other key stakeholders for the clear understanding of the industry from within and highlight beyond circular economy targets, SDGs interactions with energy and material recovery of textile waste (SDG 7, SDG 11, SDG 12 etc.).

Compost-assisted revegetation of highly phytotoxic sulfidic tailings with Medicago sativa L. plants grown from the seed to seedpod stage under greenhouse experimental mesocosms conditions.

The revegetation of highly phytotoxic sulfidic tailings is a challenging task which may often be successfully accomplished only following the addition of soil amendments. This study evaluated the use of green compost at increasing rates (10, 25 and 50% v/v) for the revegetation of extremely acidic sulfidic tailings of the North Mathiatis mine, Cyprus, with the use of alfalfa (Medicago sativa L.) plants, under greenhouse conditions. Alfalfa seeds were successfully germinated in tailings amended either with 25% or 50% (v/v) compost (52 and 85%, respectively). Plants managed to complete their life cycle and produce seeds only in the tailings amended with 50% (v/v) compost, since plants grown in tailings amended with lower rates of compost (i.e., 10 or 25% v/v) showed severe symptoms of phytotoxicity and eventually died. The amendment of tailings with 50% (v/v) green compost resulted in increased pH values, water holding capacity and organic content levels, soil respiration rates, as well as changes in soil elemental composition compared with tailings alone treatment, which in turn facilitated the growth and development of alfalfa plants during the whole experimental period (140 days). Plants managed to reach the late seedpod growth stage, indicating their potential regeneration and continual existence to the amended tailings, simultaneously uncovering the development of favorable conditions in the rhizosphere for the successful revegetation of studied tailings.

Neurohumoral Activation in Heart Failure.

In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic vascular resistance. Furthermore, sustained neurohormonal activation plays a key role in the progression of HF and may be responsible for the pathogenetic mechanisms leading to the perpetuation of the pathophysiology and worsening of the HF signs and symptoms. There are biomarkers of activation of these neurohormonal pathways, such as the natriuretic peptides, catecholamine levels and neprilysin and various newer ones, which may be employed to better understand the mechanisms of HF drugs and also aid in defining the subgroups of patients who might benefit from specific therapies, irrespective of the degree of left ventricular dysfunction. These therapies are directed against these neurohumoral systems (neurohumoral antagonists) and classically comprise beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and vaptans. Recently, the RAAS blockade has been refined by the introduction of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan, which combines the RAAS inhibition and neprilysin blocking, enhancing the actions of natriuretic peptides. All these issues relating to the neurohumoral activation in HF are herein reviewed, and the underlying mechanisms are pictorially illustrated.