bluuebunny/crossref_metadata_2025 huggingface dataset:
P1522 Long term follow-up after early mitral valve surgery. Role of 3D echocardiographic right chambers evaluation in predicting tricuspid regurgitation development
Authors: Volpato V , Mantegazza V , Manfredonia L , Fusini L , Gripari P , Tamborini G , Pepi M
Published: January 2020

Background

Combined mitral and tricuspid surgery is recommended in patients diagnosed with significant tricuspid regurgitation (TR) or dilatation of tricuspid annulus (TA) undergoing mitral valve (MV) surgery. Despite the prognostic value of significant TR is well known, the role of TA is still debated, due to inaccuracy of 2D measurements. Data about the role of 3D echocardiographic evaluation of TA and right chambers in predicting TR development after early MV surgery are lacking.

Purpose

To test whether a comprehensive 3D evaluation of right chambers and TA may predict TR development after early surgery in patients with MV prolapse, at a long term follow-up.

Methods

Between 2012 and 2015, 100 patients diagnosed with MV prolapse and severe mitral regurgitation, who underwent early MV repair were retrospectively studied. All patients underwent 3D transthoracic examination before surgery; for each patient right atrial (RA) volume and right ventricular (RV) volumes, function and strain were derived. 3D dimensions and function of TA were also measured using commercial software. The median follow-up was 48 months.

Results

9 patients underwent TVR for moderate TR and were excluded. At baseline, our patients showed more than moderate TR, normal 3D RV volumes and function (EDV 67 ±16ml/m2, EF 56 ± 6%, GLS free wall 28 ± 5 %) and RA volume (54 ± 15 ml/m2). Pulmonary artery pressure was 36 ±9 mmHg. Based on 2D evaluation, dilatation of TA (more than 21 mm/m2) was measured in 21 patients over 91. 3D analysis of TA showed a function of 38 ± 12% and a major axis of 46 ± 6 mm no significant differences in 3D values were noted between patients with normal and dilated annuli. Based on 2D. Over the follow-up, none of our patients developed clinically significant TR (more than moderate)

Conclusion

Patients who underwent early MV repair with normal 3D values of right chambers have a low risk of developing TR, regardless of 2D dimensions of TA.
P1546 Reproducibility of right atrial myocardial deformation by two-dimensional speckle tracking
Authors: Shiino K , Mori Y , Kawasaki N , Nakashima C , Nakashima M , Nagahara Y , Kan S
Published: January 2020

Background

Right atrial (RA) deformation by two-dimensional speckle tracking echocardiography has a relatively new technique to evaluate right heart function with pulmonary hypertension and cardiomyopathy. Reproducibility between observers of this technique is important to develop into a robust and reliable tool. Experience may pose significant challenges.

Purpose

The aim of this study is to evaluate reproducibility of RA strain (global and regional) between novice and expert.

Methods

One hundred thirty-three patients (n = 133) underwent 2D-Speckle tracking derived RA strain analysis by 3 independent blinded readers (expert and 2 novices). The novice observers were medical interns with no prior experience in performing strain analysis. Echocardiographic images were acquired from iE33 (Philips Medical System) but were analysed offline using single vendor dependent software (QLAB version 11.0; Philips Medical System). The result of novice observer was calculated by the average of novice observers. RA strain parameters were assessed: global RA strain and segmental (Basal, Mid, Roof). Intraobserver and interobserver analyses were performed using intra class correlation coefficients (ICC) between expert and novice.

Results

Expert and novice observer demonstrated good interobserver reproducibility of global RA strain (ICC 0.88) and segmental parameters (Basal: ICC 0.89, Mid: ICC 0.87, Roof: ICC 0.84). Of all parameters, the basal segment of RA strain showed the greatest interobserver agreement. Intraobserver agreement for novice observer was excellent for global RA strain and segmental parameters (ICC > 0.88).

Conclusions

Global RA strain and segmental parameters were highly reproducible by novice and expert strain observer.
P1547 Left ventricular papillary muscle strain as an indicator of hypertrophic cardiomyopathy
Authors: Ikeda M , Kajikawa Y , Hirota M , Ueda A
Published: January 2020

Background

Although recognized as part of the mitral valve complex, few studies have assessed the left ventricular papillary muscle.

We confirmed during autopsy that papillary muscle consists of longitudinal aligned muscle fibers, and that the papillary muscle originated from the left ventricular oblique muscle. Therefore, papillary muscle contraction was considered only in the longitudinal direction.

Purpose

We previously reported that left ventricular papillary muscle strain (LV-PMS) in 100 patients without organic heart disease was correlated with multiple left ventricular function assessment parameters.

This study aimed to determine whether left ventricular papillary muscle strain (LV-PMS) in patients with hypertrophic cardiomyopathy (HCM) is correlated　with left ventricular function parameters as in non-HCM patients.

Methods

We measured left ventricular papillary muscle strain (LV-PMS) between two points on papillary muscles except where chordae adhere and the left ventricular wall, and compared values between patients without organic heart disease and with hypertrophic cardiomyopathy (HCM).

Among 1,344 patients who were assessed by echocardiography at our hospital between January and June 2018, we selected 42 (mean age, 68.9 ± 17.4 years; male, 67%) who did not have coronary heart disease and in whom left ventricular papillary muscle contraction strain (LV-PMS) could be determined. Obvious anterior and posterior papillary muscles were evaluated. We also analyzed age, EF, e’, s’, E/e’, E/A, left atrial volume index (LAV-I) and global longitudinal strain (GLS) as possibly relevant factors.

Results

Among the 42 patients, 22 (52%) and 17 (40%) had hypertension and HCM, respectively. We measured the strength of linear associations among paired variables (LV-PMS, age, EF, e’, s’, E/e’, E/A, LAV-I and GLS) using Pearson product-moment correlation coefficients.

Age (r = 0.64), e’ (r = -0.76), s’ (r = -0.61), LAV-I (r = 0.61) and GLS (r = 0.57; all p < 0.001), as well as E/e’ (r = 0.44, p < 0.05) significantly correlated in patients without HCM, whereas only GLS correlated in patients with HCM (r = 0.723, p < 0.001).

One-way analyses of variance showed that LV-PMS values significantly differed only among patients without HCM when categorized according to age < 50, ≥ 50 < 75 and > 75 years (p < 0.001), whereas these values significantly differed in all patients (p < 0.05) when categorized according to GLS < -20%, ≥ -20 to < -15% and > -15%.

Conclusions

We found that LV-PMS correlated with five factors including age in patients without HCM, but only with GLS in those with HCM. Despite the small study cohort, we considered that LV-PMS and GLS would be useful for evaluating left ventricular function in patients with HCM.
P1560 Acute changes of mitral annular dimensions after transcatheter egde-to-edge repair: an indirect annuloplasty method?
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Pattakos G , Vardas P , Spargias K
Published: January 2020

Background

Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe and alternative method for treating high-risk patients with severe mitral regurgitation (DMR or FMR). This transcatheter treatment aims at reducing the MR with a so-called "Alfieri stitch" method. However the impact on mitral annular dimensions after the device implantation is not well defined. The purpose of this study is to recognize the acute changes of mitral annular dimensions after transcatheter edge-to-edge repair.

Methods

We retrospectively analyzed 20 consecutive patients (aged 74 ± 10yrs) with degenerative or functional moderate-to-severe and severe mitral regurgitation (EROA 40.8 ± 20.5mm2, RV 52.6 ± 17.5ml) and reduced ejection fraction (EF 36.9 ± 15.4%). These patients were at high surgical risk or even inoperable in certain cases (logistic EuroSCORE 28.9 ± 18.2%) and evaluated by a heart team as candidates for transcatheter repair. All intraoperative transoesophageal echo studies were post processed with EchoPac v.203 or QLAB 9.0. 3D views of the mitral valve before and after the implantation of the device were analyzed with 4D AutoMVQ (GE) or MVQ (Phillips) software.

Results

PMVR was effective in treating the MR at the end of the operation (from 3.8 ± 0.4 to 1.3 ± 0.5 after the implantation, p < 0.05) in all patients. There was a significant reduction of the annulus area (from 12.25 ± 3.0cm2 to 10.18 ± 2.88cm2, p < 0.001) and circumference (from 13.23 ± 1.4cm to 12.18 ± 1.57cm, p < 0.001), in both DMR and FMR cases. The percentage reduction of annulus area and circumference after PMVR was 17.3 ± 0.8% and 8 ± 5% respectively and the number of the clips used for that purpose were 1.55 ± 0.6. Additionally, edge-to-edge repair significantly reduced the anterior-posterior diameter (from 3.49 ± 0.56cm to 3.02 ± 0.55cm, r = 0.86, p < 0.001) and the posteromedial-anterolateral diameter (from 4.15 ± 0.58cm to 3.88 ± 0.60cm, r = 0.9, p < 0.001). The number of the clips used did not play an important role in the percentage difference of the annulus dimensions (20% reduction with one clip vs 14.3 ± 7.6% with two or more, p < 0.05) and one possible explanation could be that patients receiving one clip had smaller annulus area comparing to the patients receiving two or more (11.2 ± 2.9mm2 vs 13.3 ± 2.7mm2 respectively, p < 0.05).

Conclusions

Transcatheter edge-to-edge repair is effective in treating MR in patients with DMR and FMR and has a direct impact on mitral annular dimensions acutely after the implantation.
P1562 Normal reference values of three-dimensional speckle-tracking echocardiography-derived right atrial volumes and volume-based functional properties in healthy adult subjects
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Ambrus N , Lengyel C , Forster T
Published: January 2020

Introduction

The right atrium (RA) has several roles including a systolic reservoir, early diastolic conduit and late-diastolic booster pump functions. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties (stroke volumes, SVs and emptying fractions, EFs) in healthy adult subjects.

Methods

260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset have been included in the present study. However, due to inferior image quality 110 subjects have been excluded. The remaining population comprised 150 cases (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.

Results

While systolic maximum RA volume did not change over age decades, early and late-diastolic RA pre-atrial contraction volume and minimum RA volume increased over time. Significantly larger values could be detected in more than 50 year-old healthy subjects as compared to younger subjects. Total atrial SV remained almost unchanged over age decades with a significant reduction in subjects aged >50 years. Passive atrial SV showed a continuous reduction over age decades and significant difference could be demonstrated between subjects aged 18-29 years and >50 years. Active atrial SV increased over age decades with a significant reduction in subjects aged >50 years. Total atrial EF did not show any changes over age decades, but a significant reduction could be demonstrated in cases aged >50 years. Passive atrial EF showed significant continuous reduction over age decades. Active atrial EF did not change in younger ages, it was the highest at ages 40-49 years with a significant impairment after 50 years. Females proved to have tendentiously higher RA volumes respecting the cardiac cycle regardless of age. No significant differences could be demonstrated between RA stroke volumes between genders except between 40-49 years when females had tendentiously higher values. RA emptying fractions were non-significantly, but tendentiously higher in females as compared to that of males regardless of age.

Conclusions

Normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age- and gender dependency were defined in healthy adult subjects.
P1566 Evaluation of haptic feedback for interaction with volumetric image data in virtual reality
Authors: Deng S , Singh E , Wheeler G , Pushparajah K , Schnabel J A , Simpson J M , Gomez Herrero A
Published: January 2020

Funding Acknowledgements

Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]

Background

3D printing is used for surgical planning of complex congenital heart disease (CHD) because it provides an intuitive 3D representation of the image data. However, the 3D print is static and it can be costly and time consuming to create. Virtual Reality (VR) is a cheaper alternative that is able to visualise volumetric images in 3D directly from the scanner, both statically (CT and MR) and dynamically (cardiac ultrasound). However, VR visualisation is not as tangible as a 3D print - this is because it lacks the haptic feedback which would make the interactions feel more natural.

Purpose

Evaluate if adding haptic feedback (vibration) to the visualisation of volume image data in VR improves measurement accuracy and user experience.

Method

We evaluated the effect of vibration haptic feedback in our VR system using a synthetic cylinder volume dataset. The cylinder was displayed in two conditions: (1) with no haptic feedback, and (2) with haptic feedback. Ten non-clinical participants volunteered in the evaluation. They were blinded to these two test conditions. The participants were asked to measure the cylinder’s diameter horizontally and vertically, and its length, in each test condition. The measurement results were compared to the ground truth to assess the measurement accuracy. Each participant also completed a questionnaire comparing their experience of the two test conditions during the experiment.

Results

The results show a marginal improvement of measurement accuracy with haptic feedback, compared to no haptics (see Figure a). However, this improvement was not statistically significant. The haptic feedback did improve the participants’ confidence about their performance and increased the ease of use in VR, hence, they preferred the haptics condition to the no haptics condition (see Figure b). Moreover, although 70% of the participants reported relying on the visual cue more than on the haptic cue, 90% found that the haptic cue was helpful for deciding where to place the measurement point. Also, 88.9% of the participants felt more immersed in the VR scene with haptic feedback.

Conclusion

Our evaluation suggests that although haptic feedback may only marginally improve measurement accuracy, participants nevertheless preferred it because it improved confidence in their performance, increased ease of use, and facilitated a more immersive user experience.

Abstract P1566 Figure.
P1568 Echocardiographic changes and ventricular mechanics in the indeterminate form of chagas disease
Authors: Del Castillo J M , Mazzarollo C , Diniz J V , Oliveira K B , Araujo D C L , Alencar M P C , Albuquerque E S , Sena A D M , Brindeiro-Filho D , Silveira C A M
Published: January 2020

Introduction

According to the WHO, Chagas disease affects 8 to 10 million people, mainly in the Americas and in some European countries, with more than 10 thousand annual deaths. It presents an acute phase followed by a chronic, categorized as indeterminate, cardiac or digestive forms. After infestation, most patients remain asymptomatic, but 40% progress to symptomatic form at the rate of 1.8 to 5% patients/year. Evidence of myocardial fibrosis in 41% of these patients was found by magnetic resonance imaging.

Objective

To evaluate, by echocardiography, patients with Chagas disease, indeterminate phase, analysing dimensions, function and parameters of deformation and mechanical dispersion in left and right cardiac cavities.

Method

The study included 44 asymptomatic patients, 36 female, mean age 51 ± 10 years with positive Chagas serology and a control group of 44 healthy individuals, 35 female, mean age 52 ± 10 years. Left and right cavitary dimensions were evaluated, systolic and diastolic function, global myocardial deformation and mechanical dispersion. The groups were compared by the paired "t" test with significance level <5%.

Results

Demographic data (age, body surface area) with no significant differences. Left ventricular (LV) diameters (p <0.0001), septal thickness (p = 0.01), mass index (p <0.0001) and diameters and indexed volume of left atrium (LA) were higher in Chagas patients (p <0.0001). Left ventricular ejection fraction (EF) showed no significant difference between groups. The mitral E wave velocity showed no significant difference, but the e" wave velocity of tissue Doppler (p = 0.02) and the E/e" ratio (p = 0.002) were higher in Chagas patients. Global longitudinal strain (GLS) (p <0.0001) and mechanical dispersion of the LV (p <0.0001) were lower in Chagas patients. Basal right ventricular (RV) diameter, tricuspid annulus excursion (TAPSE) and tricuspid regurgitation velocity did not show differences and fractional area change of the RV (p = 0.03) was lower in Chagas patients. Longitudinal strain of the RV free wall (p = 0.01) was lower in Chagas patients and mechanical dispersion of RV (p =0.002) was higher.

Conclusion

Asymptomatic patients with Chagas disease (undetermined phase), when compared with healthy individuals of the same age group, presented larger cavitary diameters, diastolic disfunction and, deformation parameters of the left and right ventricles, with increased mechanical dispersion in both chambers. These data seem to corroborate recent results obtained by magnetic resonance imaging with gadolinium, suggesting areas of myocardial fibrosis in these patients.
P1569 Left ventricle structure and function relations with renin-angiotensin-aldosteron system activity and plasma markers of fibrosis in patients with ACS underwent PCI
Authors: Krestjyaninov M , Razin V A , Gimaev R H
Published: January 2020

Renin-angiotensin-aldosterone system (RAAS) plays significant role in development of myocardial fibrosis and LV remodelling which may increase severity of stroke and myocardial infarction.

The purpose of the study is to evaluate relations between activity of RAAS and left ventricle structure and function in patients with acute coronary syndrome (ACS) underwent PCI.

We examined 204 patients (both men and women) with ACS which were undergoing PCI.

The mean age of patients was 51.0 (11) years.

In all patients was performed

ECG in 12 leads; EchoCG; evaluation plasma levels of aldosterone, angiotensin 2 (AT2), angiotensin-converting enzyme (ACE), tissue inhibitor of metalloproteinases-1 (TIMP-1) and insulin-like growth factor 1 (IGF-1). Statistical significance was defined at the level of methods for p < 0,05.

Results of correlative analysis revealed relations between ILV mass and aldosterone (R = 0.57; p < 0.001), ACE (R = 0.59; p < 0.001), AT2 (R = 0.58; p < 0.001) and TIMP-1 (R = 0.54; p < 0.001). There were relations between E/A and AT2 (R = 0.23; p = 0.049), TIMP-1 (R = 0.22; p = 0.038); between IGF-1 and DT (R = 0.21; p = 0.045). This could be due to the growth in fibroblasts and cardiaomyocytes and increase in myocardial stiffness.

The results of the comparison of RAAS activity markers, structural and functional parameters of the LV in patients with different LV geometry can be seen in Table 1.

Thus, the results of the study show that activation of RAAS leads to increase in myocardial stiffness; and that RAAS activity and plasma markers of fibrosis was significantly higher in patients with concentric and eccentric LV hypertrophy.

RAAS activity & LV geometry and function Parameters LV geometry models Normal Geometry n = 25 Concentric Remodelling n = 18 Concentric Hypertrophy n = 89 Eccentric Hypertrophy n = 72 Angiotensin 2 (pg/ml) 36.2 (11.6) 28.2 (5.5) 58.4 (46.; 64.5)*†‡ 45.8 (13.2)*† ACE (u/l) 44.4 (17.4) 30.3 (20.1; 33.0)* 67.6 (28.3)*† 57.1 (39.0; 68.0)† Aldosterone (pg/ml) 111.0 (76.8; 136.6) 101.2 (80.0; 120.5)* 152.4 (135.2; 177.3)*†‡ 136.0 (129.0; 152.0)*† TIMP-1 (ng/ml) 222.9 (80.9) 237.5 (140.0; 322.0)* 358.0 (259.0; 493.0)*†‡ 329.2 (102.5)*† IGF-1 (ng/ml) 174.2 (25.1) 174.5 (160.0; 179.0) 146.0 (129.0; 167.0)*† 148.9 (20.7)*† ILV mass (g/m²) 85.0 (79.1; 92.4) 94.7 (92.4; 97.9)* 146.3 (127.0; 171.1)*†‡ 127.0 (115.7; 149.0)*† E/A 0.7 (0.1) 0.8 (0.7; 0.9) 0.9 (0.8; 1.2)* 0.9 (0.8; 1.1)*† DT (ms) 194.3 (22.2) 185.4 (19.5) 198.9 (44.3)† 179.1 (26.8) E/e" 8.0 (0.9) 6.1 (5.4; 8.6)* 6.9 (5.5; 9.2)* 8.8 (3.0)† * - p < 0.05 in comparison with patients with normal geometry; † - p < 0.05 in comparison with patients with concentric remodelling; ‡ - p < 0.05 in comparison with patients with eccentric hypertrophy.
P1578 The prognostic value of left ventricle longitudinal strain and cardiac biomarkers in asymptomatic patients with chronic severe aortic regurgitation
Authors: Verseckaite R , Vaiciuliene D , Laukaitiene J , Jonkaitiene R , Mizariene V , Jurkevicius R
Published: January 2020

Background

Because of adaptive remodelling of the left ventricle (LV), patients with chronic severe aortic regurgitation (AR) can remain asymptomatic for prolonged periods. The main clinical challenge is to avoid irreversible damage to the myocardium and LV dysfunction, but the time of surgery should be such that the benefits of surgery outweigh the risks at that particular time. We aimed to evaluate the predictive value of global LV longitudinal strain (GLS) and natriuretic peptide in severe AR.

Methods

Comprehensive and 2D speckle tracking echocardiography was performed in 84 patients with severe AR. Patients were divided into the asymptomatic group (n = 56; 41 men; mean age 46.1 ± 15.4 years) and the group with indications for AV surgery (n = 28; 27 men; mean age 49.0 ± 14.3 years). Asymptomatic patients were followed for about 4.4 ± 2.4 years. The primary endpoint was to detect the development of HF symptoms, deterioration in the LVEF(≤50%) and/or severe LV dilatation (EDD > 70mm or ESS > 50mm).

Results

Patients with the need of AV surgery showed a significantly larger impairment in GLS and higher increase in the values of NT-proBNP compared to asymptomatic patients (-17.2 ± 2.6 vs. -19.1 ± 2.4%, and 149.4 [86.6–500] vs. 112.5 [45.3–180.8]pg/mL, P < 0.05, resp.). Of the 56 patients who were initially asymptomatic, 49 patients were prospectively monitored. The primary endpoint was reached in 16 (33%) patients with AR. Despite the preserved LVEF at baseline, patients in need of AV surgery had lower GLS compared to those who remained stable while being monitored (-17.1 ± 2.3 vs. -20.1 ± 1.8%, P < 0.05). The baseline levels of NT-proBNP were higher among patients who progressed to needing AV surgery in comparison to that in no need of AV surgery at follow-up (194 [135-421.8] vs. 75.9 [34.1-136.7]pg/ml, P < 0.05). In multivariate analysis, GLS and NT-proBNP were independent predictors of AV surgery. ROC analysis showed that the probability of primary endpoint occurrence was greater in patients with GLS >-18.5% (AUC:0.85, P < 0.05) and NT-proBNP >130pg/ml (AUC:0.81, P < 0.05).

Conclusion

GLS and NT-proBNP may be used as independent prognostic predictors of optimal timing of operation in asymptomatic severe AR during follow-up.

Multivariate analysis Variables OR (95% CI) P Age 0.97 (0.89-1.06) 0.54 LV ESD 1.02 (0.78-1.34) 0.87 LV EF 1.07 (0.74-1.56) 0.71 GLS 3.36 (1.09-10.36) 0.035 NT-proBNP 1.02 (1.0-1.04) 0.049
Relaxant and antiadrenergic effects of ranolazine in human saphenous vein
Authors: Marchio Patricia , Guerra-Ojeda Sol , Aldasoro Martín , Valles Soraya Lilian , Martín-Gonzalez Iván , Martínez-León Juan Bautista , Mauricio Maria Dolores , Vila Jose Maria
Published: January 2020

OBJECTIVES

Ranolazine improves vascular function in animal models. We evaluate the effects of ranolazine on vascular function and adrenergic response in human saphenous vein.

METHODS

Rings from 53 patients undergoing coronary artery bypass grafting were mounted in organ baths. Concentration–response curves to ranolazine were constructed in rings precontracted with phenylephrine, endothelin-1, vasopressin, KCl and the thromboxane A2 analogue U-46619. In rings precontracted with phenylephrine, relaxation to ranolazine was tested in the absence and presence of endothelial factors inhibitors, K+ channel blockers and verapamil. The effects of ranolazine on frequency–response and concentration–response curves to phenylephrine were performed in the absence and presence of endothelial factors inhibitors and K+ channel blockers. Endothelial nitric oxide synthase, α1 adrenergic receptor and large conductance Ca2+-activated K+ channel protein expressions were measured by Western blotting.

RESULTS

Ranolazine (10−9–10−4 M) produced a concentration-dependent relaxation only in rings precontracted with phenylephrine that was reduced by endothelial denudation, NG-nitro-l-arginine methyl ester (10−4 M), charybdotoxin (10−7 M) and verapamil (10−6 M). Ranolazine diminished adrenergic contractions induced by electrical field stimulation (2–4 Hz) and phenylephrine (10−9–10−5 M) that were prevented by tetraethylammonium (10−3 M) and charybdotoxin (10−7 M). Ranolazine significantly decreased α1 adrenergic receptor and increased large conductance Ca2+-activated K+ channel protein expression in the saphenous vein.

CONCLUSIONS

Ranolazine diminishes the adrenergic vasoconstriction, acting as α1 antagonist, and by increasing large conductance Ca2+-activated K+ channel involvement. The relaxant effects of ranolazine are partially mediated by endothelial nitric oxide, large conductance Ca2+-activated K+ channels and the blockade of voltage-dependent Ca2+ channels.
The Dutch influenza vaccination policy and medication use, outpatient visits, hospitalization and mortality at age 65
Authors: Van Ourti Tom , Bouckaert Nicolas
Published: January 2020

Background

Our objective was to obtain estimates of the impact of the Dutch vaccination programme on medication use, outpatient visits, hospitalization and mortality at age 65.

Methods

We linked population-wide mortality, hospitalization and municipality registries to identify influenza-related deaths and hospitalizations, and used health interview surveys to identify medication use and outpatient visits during 1996–2008. We applied a regression discontinuity design to estimate the intention-to-treat effect of the personal invitation for a free influenza vaccination sent to every Dutch inhabitant at age 65 years on each of the outcomes, separately in influenza-epidemic and non-epidemic months.

Results

Invitation receipt for free influenza vaccination at age 65 led to a 9.8 percentage points [95% confidence interval (CI) = 3.5 to16.1; P < 0.01] rise in influenza vaccination. During influenza-epidemic months, it was associated with 1.5 fewer influenza/pneumonia deaths per 100 000 individuals (95% CI = −3.1 to −0.0; P = 0.05), a 15 percentage point lower probability to use prescribed medicines (95% CI = −28 to −3; P = 0.02) and 0.13 fewer General Practitioner (GP) visits per month (95% CI = −0.28 to 0.02; P = 0.09), while the association with hospitalizations due to influenza/pneumonia was small and imprecisely estimated (seven more hospitalizations per 100 000 individuals, 95% CI = −20 to 33; P = 0.63). No associations were found with any outcomes during non-epidemic months.

Conclusions

Personal invitations for a free influenza vaccination sent to every Dutch inhabitant at age 65 took pressure off primary health care but had small effects on hospitalizations and mortality.
High mortality in manual occupations and the role of alcohol in 2001–15
Authors: Rinne Hanna , Laaksonen Mikko , Notkola Veijo
Published: January 2020

Background

The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality.

Methods

A register-based study of employees aged 30–64 years, followed for mortality 2001–15. Age standardized mortality ratios (SMRs) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol-related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol.

Results

Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared with all employees. Mortality rates were highest among building construction labourers (SMR 180) among men and building caretakers (SMR 155) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared with all employees was over 10% in half of the high-mortality occupations. The contribution was highest among welders and flame cutters (50%) and lowest among farmer’s locums (−50%). Among women the contribution was highest among building caretakers (15%).

Conclusions

High-mortality occupations had high mortality even without alcohol-related deaths. However, alcohol-related mortality was generally higher than mortality for other causes; therefore, alcohol-related mortality increased further the excess mortality. Diminishing the alcohol-related mortality would level excess mortality of these occupations but not eliminate it.
Mathematical modeling of the ‘inoculum effect': six applicable models and the MIC advancement point concept
Authors: Salas Jessica R , Jaberi-Douraki Majid , Wen Xuesong , Volkova Victoriya V
Published: January 2020

Antimicrobial treatment regimens against bacterial pathogens are designed using the drug's minimum inhibitory concentration (MIC) measured at a bacterial density of 5.7 log10(colony-forming units (CFU)/mL) in vitro. However, MIC changes with pathogen density, which varies among infectious diseases and during treatment. Incorporating this into treatment design requires realistic mathematical models of the relationships. We compared the MIC–density relationships for Gram-negative Escherichia coli and non-typhoidal Salmonella enterica subsp. enterica and Gram-positive Staphylococcus aureus and Streptococcus pneumonia (for n = 4 drug-susceptible strains per (sub)species and 1–8 log10(CFU/mL) densities), for antimicrobial classes with bactericidal activity against the (sub)species: β-lactams (ceftriaxone and oxacillin), fluoroquinolones (ciprofloxacin), aminoglycosides (gentamicin), glycopeptides (vancomycin) and oxazolidinones (linezolid). Fitting six candidate mathematical models to the log2(MIC) vs. log10(CFU/mL) curves did not identify one model best capturing the relationships across the pathogen–antimicrobial combinations. Gompertz and logistic models (rather than a previously proposed Michaelis–Menten model) fitted best most often. Importantly, the bacterial density after which the MIC sharply increases (an MIC advancement-point density) and that density's intra-(sub)species range evidently depended on the antimicrobial mechanism of action. Capturing these dependencies for the disease–pathogen–antimicrobial combination could help determine the MICs for which bacterial densities are most informative for treatment regimen design.
Effect of tuber sections and processing conditions on the physicochemical properties of sweet potato (Ipomoea batatas L. (Lam)) flour
Authors: Iheagwara M C , Chibuzo I H , Ibeabuchi J C
Published: January 2020

Objective

The study was conducted to ascertain the effect of tuber sections, heat treatment, and rehydration with process chemicals of varying concentrations on the physicochemical properties of sweet potato (Ipomoea batatas L. (Lam)) flour.

Materials and Methods

The flour samples were generated as raw, boiled, and steamed from the head, middle, and tail sections of the tuber. These were compared with their whole tuber counterpart. The magnitude and extent of the factorial influence were measured using the effects on swelling index (SI), water absorption capacity (WAC), oil absorption capacity, total soluble solids (TSS), blue value index (BVI), gelling point temperature (GPT), boiling point temperature (BPT), and pH.

Results

The results obtained showed that the proximate composition from the tuber sections and the whole did not differ significantly (P < 0.05). The tuber processing method (TPM) and tuber processing duration (TPD) effected significant differences (P < 0.05) in all the test parameter except for pH respectively.

Conclusion

From the investigation, it was observed that the test variables have significant effects on the physicochemical properties of the sweet potato flour.
Compression waves reflection from the low-velocity azimuthally anisotropic medium: a physical model study
Authors: Kolesnikov YuI , Fedin K V , Ngomayezwe L
Published: January 2020

Interest in azimuthal anisotropy of rocks is mainly associated with fractured reservoirs, which may contain hydrocarbon deposits. Cracks in such deposits in most cases have a subvertical orientation, which is caused by the predominance of vertical stresses in rocks over horizontal ones. To determine the azimuthal direction of fractures, one can use, in particular, the dependence of the reflection coefficients of elastic waves on the boundaries with such media on the azimuth. This paper presents the results of physical modelling, demonstrating this dependence. To conduct experiments, we developed a technology for manufacturing models of azimuthally anisotropic (HTI) media with a high degree of anisotropy by 3-D printing. The features of the reflection of compression waves from the boundary of water and low-velocity azimuthally anisotropic media were experimentally investigated on the example of the model HTI medium produced by this method. Experiments have shown that at angles of incidence less than 25°, the reflection coefficients are practically independent from the azimuth. However, at larger angles of incidence, an azimuthal dependence of the reflection coefficients is observed, most pronounced at azimuths from 45° to 75°. The results of measurements in the direction of the isotropy plane agree well with the theoretical reflection coefficients for the boundary of isotropic media.
Robust wavefield inversion via phase retrieval
Authors: Aghamiry H S , Gholami A , Operto S
Published: January 2020

Extended formulation of full waveform inversion (FWI), called wavefield reconstruction inversion (WRI), offers potential benefits of decreasing the non-linearity of the inverse problem by replacing the explicit inverse of the wave-equation operator of classical FWI (the oscillating Green functions) with a suitably defined data-driven regularized inverse. This regularization relaxes the wave-equation constraint to reconstruct wavefields that match the data, hence mitigating the risk of cycle skipping. The subsurface model parameters are then updated in a direction that reduces these constraint violations. However, in the case of a rough initial model, the phase errors in the reconstructed wavefields may trap the waveform inversion in a local minimum leading to inaccurate subsurface models. In this paper, in order to avoid matching such incorrect phase information during the early WRI iterations, we design a new cost function based upon phase retrieval, namely a process which seeks to reconstruct a signal from the amplitude of linear measurements. This new formulation, called wavefield inversion with phase retrieval (WIPR), further improves the robustness of the parameter estimation subproblem by a suitable phase correction. We implement the resulting WIPR problem with an alternating-direction approach, which combines the majorization-minimization (MM) algorithm to linearise the phase-retrieval term and a variable splitting technique based upon the alternating direction method of multipliers (ADMM). This new workflow equipped with Tikhonov-Total variation (TT) regularization, which is the combination of second-order Tikhonov and total variation regularizations and bound constraints, successfully reconstructs the 2004 BP salt model from a sparse fixed-spread acquisition using a 3 Hz starting frequency and a homogeneous initial velocity model.
An objective methodology capturing online commodity marketing and other harms
Authors: Vaipuna Tevita , Allison Lucy , Bhasin Abhinav , Choi Kimberley , Chu Agnes , Grice Karl , Hay Alice , Huang Stephanie , Jarvis Ellie-May , Laing Bridie , Lewis Alexandra , Moriarty Ripeka Huitau , Obafemi Tobi , Rajendra Prishita , Simpson James , Tay Albertina , Yang Anne , Smith Moira , Gage Ryan , Chambers Tim , Lyons Antonia , Ormandy Jeff , Signal Louise
Published: January 2020

Increasingly life is lived online, yet little is known about the actual nature and extent of online content that people view due to the difficulty of recording real time exposure. This includes people’s exposure to harmful commodity marketing. This study aimed to develop a methodology to assess the nature and extent of exposure to, and engagement with, unhealthy commodity marketing and other public health harms online, particularly children’s exposure. A convenience sample of 16 young adult participants (aged 21–29) recorded their device usage for 2 days using Zoom software. Data were coded and analysed to assess the nature and extent of marketing for alcohol, gambling, junk food and smoking products. Four focus groups were conducted with participants to explore their data collection and coding experiences, and results assessed using thematic analysis. The study found that, with some modifications, this method was feasible for gathering real-time objective data from the online world that can be analysed for a range of public health harms, including marketing of unhealthy commodities. Larger studies are recommended to build global evidence for public health action in the online world.
NHP2 deficiency impairs rRNA biogenesis and causes pulmonary fibrosis and Høyeraal–Hreidarsson syndrome
Authors: Benyelles Maname , O’Donohue Marie-Françoise , Kermasson Laëtitia , Lainey Elodie , Borie Raphael , Lagresle-Peyrou Chantal , Nunes Hilario , Cazelles Clarisse , Fourrage Cécile , Ollivier Emmanuelle , Marcais Ambroise , Gamez Anne-Sophie , Morice-Picard Fanny , Caillaud Denis , Pottier Nicolas , Ménard Christelle , Ba Ibrahima , Fernandes Alicia , Crestani Bruno , de Villartay Jean-Pierre , Gleizes Pierre-Emmanuel , Callebaut Isabelle , Kannengiesser Caroline , Revy Patrick
Published: January 2020

Telomeres are nucleoprotein structures at the end of chromosomes. The telomerase complex, constituted of the catalytic subunit TERT, the RNA matrix hTR and several cofactors, including the H/ACA box ribonucleoproteins Dyskerin, NOP10, GAR1, NAF1 and NHP2, regulates telomere length. In humans, inherited defects in telomere length maintenance are responsible for a wide spectrum of clinical premature aging manifestations including pulmonary fibrosis (PF), dyskeratosis congenita (DC), bone marrow failure and predisposition to cancer. NHP2 mutations have been so far reported only in two patients with DC. Here, we report the first case of Høyeraal–Hreidarsson syndrome, the severe form of DC, caused by biallelic missense mutations in NHP2. Additionally, we identified three unrelated patients with PF carrying NHP2 heterozygous mutations. Strikingly, one of these patients acquired a somatic mutation in the promoter of TERT that likely conferred a selective advantage in a subset of blood cells. Finally, we demonstrate that a functional deficit of human NHP2 affects ribosomal RNA biogenesis. Together, our results broaden the functional consequences and clinical spectrum of NHP2 deficiency.
Inflammatory bowel disease in Africa: what is the current state of knowledge?
Authors: Hodges Phoebe , Kelly Paul
Published: January 2020

Inflammatory bowel disease (IBD) is increasingly recognized as a global disease in the twenty-first century; however, little is known about its epidemiology in Africa. We conducted a literature review in order to assess what is currently known on this subject, the results of which are reported here. Based on available observational studies, it appears that the incidence of IBD in Africa is rising, although comprehensive epidemiological data are lacking. This is likely due to multiple factors, including shifting trends in diet and exposure to environmental pathogens. Many challenges relating to IBD exist for healthcare systems in Africa, including the need for improved access to diagnostic facilities such as endoscopy and histopathology, and the potential economic burden of treatment. Intestinal TB also represents a significant confounding factor in the diagnosis of IBD in Africa.
In vitro activities of acetylmidecamycin and other antimicrobials against human macrolide-resistant Mycoplasma pneumoniae isolates
Authors: Wang Na , Zhou Yunheng , Zhang Hong , Liu Yang
Published: January 2020

Objectives

To assess the in vitro activities of acetylmidecamycin, a 16-membered macrolide, and 11 other antimicrobial agents against human mycoplasmas.

Methods

A total of 187 clinical isolates, Mycoplasma pneumoniae (n = 110), Mycoplasma hominis (n = 26) and Ureaplasma species (n = 51), were included in this study. The MICs of 12 antimicrobial agents, including acetylmidecamycin, thiamphenicol, chloramphenicol and some other macrolides, fluoroquinolones and tetracyclines, for these clinical isolates were determined by the broth microdilution method.

Results

For M. pneumoniae, the MIC90 values of the tested macrolides were: acetylmidecamycin (1 mg/L)<josamycin (4 mg/L)<midecamycin (8 mg/L)<azithromycin (16 mg/L)128 mg/L). Thiamphenicol and chloramphenicol had the same MIC90 (2 mg/L). For Ureaplasma species, the MIC90 values were: acetylmidecamycin (0.25 mg/L)<josamycin (0.5 mg/L)=midecamycin<azithromycin (1 mg/L)=erythromycin. Chloramphenicol had a lower MIC90 (2 mg/L) than that of thiamphenicol (4 mg/L). For M. hominis, the MIC90 values were: acetylmidecamycin (0.25 mg/L)<josamycin (0.5 mg/L)<midecamycin (2 mg/L)128 mg/L)=erythromycin. The MIC90 values of chloramphenicol and thiamphenicol were 2 and 4 mg/L, respectively.

Conclusions

The results indicated that acetylmidecamycin and thiamphenicol are active in vitro against the most common mycoplasma species infecting humans, including those resistant to macrolides and fluoroquinolones. Acetylmidecamycin and thiamphenicol might be a promising option for clinicians to treat infections caused by Mycoplasma and Ureaplasma spp., particularly macrolide-resistant M. pneumoniae in paediatrics and fluoroquinolone-resistant M. hominis in adults. Further investigation of their clinical roles in treating infections caused by these organisms is warranted.
Simple Laboratory Test-Based Risk Scores in Coronary Catheterization: Development, Validation, and Comparison to Conventional Risk Factors
Authors: Gerling Michael E , Dong Yuan , Abdalla Beelal , James Matthew T , Wilton Stephen B , Naugler Christopher T , Southern Danielle A , Galbraith P Diane , O’Neill Blair , Knudtson Merril , de Koning Lawrence ,   for the APPROACH Investigators
Published: January 2020

Background

We developed and validated laboratory test–based risk scores (i.e., lab risk scores) to reclassify mortality risk among patients undergoing their first coronary catheterization.

Methods

Patients were catheterized between 2009 and 2015 in Calgary, Alberta, Canada (n = 14 135, derivation cohort), and in Edmonton, Alberta, Canada (n = 12 143, validation cohort). Logistic regression with group LASSO (least absolute shrinkage and selection operator) penalty was used to select quintiles of the last laboratory tests (red blood cell count, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red cell distribution width, platelet count, total white blood cell count, plasma sodium, potassium, chloride, CO2, international normalized ratio, estimated glomerular filtration rate) performed <30 days before catheterization and by age and sex that were significantly associated with death ≤60  and >60 days after catheterization. Follow-up was until 2016. Risk scores were developed from significant tests, internally validated in Calgary among bootstrap samples and externally validated in Edmonton after recalibration using coefficients developed in Calgary. Interaction tests were performed, and net reclassification improvement vs conventional demographic and clinical risk factors was determined.

Results

Lab risk scores were strongly associated with mortality (29–40× for top vs bottom quintile, P for trends <0.01), had good discrimination and were well calibrated in Calgary (C = 0.80–0.85, slope = 0.99–1.01) and Edmonton (C = 0.80–0.82; slope = 1.02–1.05)—similar to demographic and clinical risk factors alone. Associations were attenuated by several comorbidities; however, scores appropriately reclassified 11%–20% of deaths (both follow-up periods) and 6%–9% of survivors (>60 days) after catheterization vs demographic and clinical risk factors.

Conclusions

In 2 populations of patients undergoing their first coronary catheterization, risk scores based on simple laboratory tests were as powerful as a combination of demographic and clinical risk factors in predicting mortality. Lab risk scores should be used for patients undergoing coronary catheterization.
Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs
Authors: Cohen Deborah J , Wyte-Lake Tamar , Dorr David A , Gold Rachel , Holden Richard J , Koopman Richelle J , Colasurdo Joshua , Warren Nathaniel
Published: January 2020

Objectives

To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs.

Materials and Methods

In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users’ information needs, which were then used to produce EHR design principles.

Results

Analyses of > 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information.

Conclusion

Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.