Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

Background

Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden.

Methods

RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit.

Results

Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p<0.001). Multivariate logistic regression analysis revealed that age <75 years or the paroxysmal or persistent form of AF favored the choice of a rhythm-control strategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II.

Conclusions

In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved.     

High-voltage stage of a vacuum arc

An elementary theory of the cathode region at the high-voltage stage of an arc discharge is proposed. The theory is based on the balance equations for the particles in an active plasma layer, the power balance at the cathode, and the equation for the Richardson-Dushman electron emission with allowance for the Schottky effect. The most characteristic features of this type of discharge are considered. A non-Langmuir cathode sheath model is proposed for a low-voltage arc on a tungsten electrode.     

Comparison of the radiosensitizing action of metronidazole administered orally and locally

A local injection of metronidazole dissolved in dimethylsulfoxide reinforces the damaging effect of ionizing radiation on RL-67 adenocarcinoma cells to the same degree as was observed after oral administration thereof. However, with local administration, the dose of the preparation may be 12.5 times reduced.     

Comparison of cytogenetic response of human lymphocytes to in vivo and in vitro exposure to low-dose gamma rays. Translocations and dicentrics detected by the FISH technique

On peripheral lymphocytes of 5 cancer patients undergone wholebody therapeutic irradiation (at daily dose of 10 cGy up to total dose 50 cGy of 60Co gamma-rays) the dose response of unstable and stable chromosomal exchanges detected by FISH was compared with the dose response of the some aberrations in lymphocytes irradiated in vitro. The dose response fitted well to linear function. For dicentrics the lower slope of dose-response curve was found for in vivo irradiated lymphocytes as compared to the dose-response curve obtained for in vitro irradiated lymphocytes of the same patients. No difference between in vivo and in vitro irradiation of lymphocytes was found for translocations. The frequency of translocations increased faster with the dose than the frequency of dicentrics only in lymphocytes irradiated in vivo.     

Mean age of death and longevity for male scientists of different specialties

The article provides information on the mean age of death (MAD) for 54 256 men professionally involved in research work and assigned to one of the six categories, namely, physics, chemistry, medicine and biology, mathematics, economics, and humanities. In addition, the effect of teaching activity on MAD and longevity has been evaluated for scientists of different specialties. Special attention has been paid to the analysis of MAD of the deceased members of the Russian Academy of Sciences, including members of the USSR Academy of Sciences (1724–2013). The minimum MAD has been found for mathematicians (72.1 ± 0.21 years) and the maximum MAD for scientists in economics (74.6 ± 0.26 years). The relative number of surviving ≥90 years and ≥100 years is minimal for mathematicians (7.59 and 0.37%, respectively), whereas those numbers for economists reveal the maximum values (10.26 and 0.96%, respectively). Indicators of MAD and proportion of centenarians among the scientists who received public recognition strongly depend on the specialty. Similarly, the members of the Russian Academy of Sciences and the USSR Academy of Sciences have the highest MAD in economics (74.7 ± 1.05 years) and the lowest in mathematics (70.6 ± 0.74 years). MAD has proven to be 3.5 years higher for scientists involved in teaching at university or college compared to those who were not involved in teaching. In this case, the “gain” is significant, ranging from 3.1 years for economists and humanitarians to 4.9 years for mathematicians. The results of the study lead to the conclusion that intense scientific work contributes to an increase in life expectancy and longevity.     

Concerning arc discharge in a transverse magnetic field

The retrograde motion of an arc in a transverse magnetic field is attributed to the onset of a tangential flow of gas or vapor. The physics of a polarized plasma jet conducting the current between the cathode and anode is discussed.     

Comparison of cytogenic response of human lymphocytes to in vivo and in vitro exposure to low doses of gamma-rays. Unstable chromosomal exchanges detected by FPG techniques

On peripheral lymphocytes of eight cancer patients undergone whole-body therapeutic irradiation (at daily dose of 10 cGy up to total dose of 50 cGy of 60Co gamma-rays) the dose-response of unstable chromosome exchanges (dicentrics and centric rings) was studied. This dose response fitted well linear function. The lower slope of dose-response curve was found for in vivo irradiated lymphocytes as compared to the dose response curve obtained for in vitro irradiated lymphocytes of the same patients. This finding seems to provide evidence that in case of protracted irradiation of individuals an absorbed dose could be underestimated if for biological dosimetry an in vitro dose response curve for unstable chromosome aberrations is used as referent one.