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The fastest growing demographic in the U.S. at the present time is those aged 65 years and older. Accompanying advancing age are a myriad of physiological changes in which reserve capacity is diminished and homeostatic control attenuates. One facet of homeostatic control lost with advancing age is glucose tolerance. Nowhere is this more accentuated than in the high proportion of older Americans who are diabetic. Coupled with advancing age, diabetes predisposes affected subjects to the onset and progression of cardiovascular disease (CVD). In the treatment of type 2 diabetes, hypoglycemic episodes are a frequent clinical manifestation, which often result in more severe pathological outcomes compared to those observed in cases of insulin resistance, including premature appearance of biomarkers of senescence. Unfortunately, molecular mechanisms of hypoglycemia remain unclear and the subject of much debate. In this review, the molecular basis of the aging vasculature (endothelium) and how glycemic flux drives the appearance of cardiovascular lesions and injury are discussed. Further, we review the potential role of the serum response factor (SRF) in driving glycemic flux-related cellular signaling through its association with various proteins.

The microRNAs and microRNA clusters have been implicated in normal cardiac development and also disease, including cardiac hypertrophy, cardiomyopathy, heart failure, and arrhythmias. Since a microRNA cluster has from two to dozens of microRNAs, the expression of a microRNA cluster could have a substantial impact on its target genes. In the present study, the configuration and distribution of microRNA clusters in the mouse genome were examined at various inter-microRNA distances. Three important microRNA clusters that are significantly impacted during adult cardiac aging, the miR-17-92, miR-106a-363, and miR-106b-25, were also examined in terms of their genomic location, RNA transcript character, sequence homology, and their relationship with the corresponding microRNA families. Multiple microRNAs derived from the three clusters potentially target various protein components of the cdc42-SRF signaling pathway, which regulates cytoskeleton dynamics associated with cardiac structure and function. The data indicate that aging impacted the expression of both guide and passenger strands of the microRNA clusters; nutrient stress also affected the expression of the three microRNA clusters. The miR-17-92, miR-106a-363, and miR-106b-25 clusters are likely to impact the Cdc42-SRF signaling pathway and thereby affect cardiac morphology and function during pathological conditions and the aging process.

This study examined the extent to which polyaniline– Mucuna composite (PMC) can remove hydroquinone, hydrazine, and tolyltriazole (HHT), potentially hazardous drugs, from pharmaceutical effluent by adsorption. Batch adsorption with varying PMC dosages (0.004–0.02 g), contact periods (10–40 min), and pH levels (3–9) was employed. The optimal conditions for HHT uptake by PMC were determined. The process was predicted using response surface methodology (RSM) and artificial intelligence algorithm models. The pH effect revealed that HHT was better adsorbed at pH 3 and pH 5. Of the three drugs investigated, the 0.02 g adsorbent dosage provided the best HHT uptake at an equilibrium time of 40 min. Though HHT uptake followed second‐order kinetic models, hydroquinone and tolyltriazole aligned with the Freundlich isotherm, while hydrazine aligned with the Langmuir isotherm model. The three optimization strategies were compared in terms of their predictive power using the regression coefficient ( R 2 ) and mean square error (MSE). The RSM ( R 2 : 0.9854, MSE: 0.0002), ANN ( R 2 : 0.9979, MSE: 2.9779E − 24), and ANFIS ( R 2 : 0.9932, MSE: 2.22802E − 7) model indices are observed for hydroquinone uptake; RSM ( R 2 0.9970, MSE 0.0001), ANN ( R 2 : 0.9998, MSE: 2.9779E − 24), and ANFIS ( R 2 : 0.9968, MSE: 3.40990E − 7) for hydrazine; and RSM ( R 2 : 0.9924, MSE: 0.00015), ANN ( R 2 : 0.9987, MSE: 2.9779E − 24), and ANFIS ( R 2 0.9973, MSE 1.32860E − 5) for tolyltriazole, respectively. The generated results clearly illustrate the potential of PMC in removing the HHT from pharmaceutical wastewater and the superiority of the ANN model over the ANFIS and RSM in accurately predicting the uptake of HHT.

Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. Funding Wellcome Trust.

Additive manufacturing (AM) technologies and advances made globally in medicine, construction, aerospace, and energy sectors are discussed. The paper further explores the current state of AM innovation and development landscape in Africa as a late comer to this area of smart manufacturing. Peer-reviewed and published literature were retrieved from Scopus database from 2005 to 2021 and analysed. In Africa, out of 500 published articles, South Africa has the highest research throughput, whereas about two-thirds of the continent is not actively participating in this burgeoning field. The main AM techniques most widely used are selective laser melting, fused deposition modelling, and direct energy deposition. Globally, there is an interplay of computational (machine learning and mechanistic models) and experimental approaches to understanding the physical metallurgy of AM techniques and processes. Though this trend is consistent with global practices, Africa lags the world in AM technologies, a niche that could leapfrog the manufacturing sector. Thus, Africa need to foster collaborative partnership within and globally to become an active global player in this industry.

ObjectiveWe aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL).MethodsCryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy.ResultsTrial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61–71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000).ConclusionCryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF.Trial registration number NCT03401099.

PurposeAdverse left atrial (LA) remodeling is known to be associated with persistent atrial fibrillation (PeAF). The time course and pattern of reversal of LA remodeling following catheter ablation is poorly understood. We aimed to evaluate LA chamber volumes and dimensions, LA conduction velocities, and LA bipolar voltages at baseline and at 2 months after catheter ablation for PeAF.MethodsTwenty-three patients with PeAF underwent detailed LA mapping during fixed rate atrial pacing using the CARTO3 navigation system prior to undergoing pulmonary vein isolation. All patients returned for protocol-mandated repeat electrophysiology study at 2 months, irrespective of symptoms or arrhythmia recurrence, during which all measurements were repeated using an identical mapping protocol. Patients then underwent daily ECG monitoring for 12 months.ResultsNineteen out of twenty-three (83.6%) patients had durable PVI of all veins at repeat electrophysiology study, while 4 (17.4%) patients had late reconnection of a single vein each. In the blinded offline analysis, LA volume at follow-up was significantly lower as compared with baseline (55 ± 14 mL/m2 vs. 65 ± 15 mL/m2, P < 0.001). LA conduction velocities were significantly greater at 2 months (0.90 ± 0.13 m/s vs. 0.78 ± 0.13 m/s, P = 0.01). There was non-uniform regional LA voltage evolution, with a significant increase in bipolar voltages observed on the LA posterior wall (2.18 ± 0.85 mV vs. 1.83 ± 0.49 mV, P = 0.04), but not elsewhere. Individual variables of remodeling were not associated with AF recurrence.ConclusionSignificant structural and electrical reverse remodeling of the LA can be seen as early as 2 months following successful catheter ablation for PeAF.

IntroductionThe safety and efficacy of Standalone video assisted thoracoscopic surgical (VATS) ablation for atrial fibrillation (AF) has not been established. In particular, comparative data with catheter ablation (CA) are scarce.MethodsWe prospectively collected data on 30 consecutive VATS AF ablations (mean age 58±10 years, 26 male) performed by an a single surgeon, the first 20 of which were proctored by external surgeons. We compared peri-procedural complications and medium-term arrhythmia free survival to those of 90 propensity-matched patients who underwent RF CA during the same time period.ResultsVATS and catheter patients were well matched with regard to all measured demographics (table 1). 6 (20.0%) patients undergoing VATS experienced 1 major complication (death n=1, stroke n=2, conversion to sternotomy n=3, phrenic nerve injury n=2). This was significantly higher than the 1 (1.1%) major complication rate (tamponade requiring drainage) seen with CA; p<0.001. The median hospital stay with VATS (7 days) was significantly greater than with CA (2 days), p<0.001. Over the follow up period, 12 (42.9%) and 5 (17.9%) patients in the VATS group and 16 (18.6%) and 13 (15.1%) patients in the CA group needed electrical cardioversion and repeat CA respectively (p=0.009 and p=0.13 respectively). At a mean follow up of 15.6 months, single procedure pragmatic arrhythmia-free survival was 50% in the VATS and 66% in the CA cohort, p=0.18 (figure 1).Abstract 28 Table 1 Surgical (n= 30) Catheter (n= 90) p Age (years) 58±9.9 57.9±9.8 0.95 Male (%) 86.7% 80.0% 0.41 BMI (kg.m2) 31.7±4.3 30.5±4.4 0.19 eGFR 66.7±12.8 68.7±17.1 0.60 CHA2DS2VASc 1.1±0.9 1.5±1.3 0.18 EuroScore II 0.9%±0.3% 0.8%±0.3% 0.61 pAF (%) 6.7% 8.9% 0.92 perAF (%) 50.0% 47.8% 0.92 LSperAF (%) 43.3% 43.3% 0.92 AF duration (years) 4.3±3.7 4.5±5.3 0.82 DCCV (%) 83.3% 67.8% 0.10 Catheter ablation (%) 6.7% 6.7% 1.00 Ejection fraction (%) 52.3%±6.5% 49.6%±8.3% 0.11 LA diameter (mm) 46.1±5 46.1±5.2 0.96 LA volume (mL) 90.8±18.4 98.1±32.6 0.46 Follow up (months) 17.4±7.1 15.3±8.2 0.21Abstract 28 Figure 1ConclusionsStandalone VATS AF ablation is associated with similar success rates to catheter ablation, but with a significantly higher rate of major complications.

In military recruits, sudden cardiac death rates have been reported as varying from 2 to 13 per 100,000 per year which are mostly related to exercise. However, the development of structural heart changes that may be associated with ventricular arrhythmias have not been reported among this cohort, despite them undergoing endurance training similar to athletes. Here, we report two cases where military personnel were found to have life-threatening cardiac arrhythmias associated with structural heart disease, highlighting the importance of early recognition and treatment of these arrhythmias.

South Africa is a highly mobile country characterized by historical displacements and contemporary mobilities, both social and demographic. Getting to grips with diversity, dislocation, relocation and anomie, as well as pursuing aspirations of mobility, is part of people’s daily experience that often takes place on the margins of conventional politics. A politics of conviviality is one such form of politics of the popular that emerges in contexts of rapid change, diversity, mobility, and the negotiation and mediation of complex affiliations and attachments. The questions in focus for this paper thus pertain to how forms of talk, born out of displacement, anomie and contact in the superdiverse contexts of South Africa, allow for the articulation of life-styles and aspirations that break with the historical faultlines of social and racial oppression. We first expand upon the idea of (marginal) linguistic practices as powerful mediations of political voice and agency, an idea that can be captured in the notion of linguistic citizenship , the rhetorical foundation of a politics of conviviality. We then move on to analyze the workings of linguistic citizenship in the multilingual practices of two distinct manifestations of popular culture, namely hip hop and a performance by a stand-up comedian in Mzoli’s meat market in Gugulethu, Cape Town. The paper concludes with a general discussion on the implications for politics of multilingualism and language policy.