bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women
Authors: Gewalt Senta M. , Helde Sandra M. , Ibrahim Tareq , Mayer Katharina , Schmidt Roland , Bott-Flügel Lorenz , Hoppe Katharina , Ott Ilka , Hieber Julia , Morath Tanja , Byrne Robert A. , Kufner Sebastian , Cassese Salvatore , Hoppmann Petra , Fusaro Massimiliano , Schunkert Heribert , Laugwitz Karl-Ludwig , Kastrati Adnan , Schüpke Stefanie ,   for the Instrumental Sealing of Arterial Puncture Site—CLOSURE Device Versus Manual Compression (ISAR-CLOSURE) Trial Investigators
Published: September 2018

Background:

The value of vascular closure devices (VCD) in women undergoing transfemoral catheterization has not been sufficiently investigated.

Methods and Results:

This is a sex-specific analysis of 1395 women enrolled in a large-scale, randomized, multicenter trial, in which patients undergoing transfemoral diagnostic coronary angiography were randomly assigned in a 1:1:1 ratio to arteriotomy closure with an intravascular VCD, extravascular VCD, or manual compression (MC). Primary objective was to assess the safety and efficacy of 2 different VCD compared with MC regarding vascular access-site complications at 30 days. A secondary comparison was between 2 different types of contemporary VCD. Overall, women were at higher risk for vascular access-site complications compared with men (9.0% versus 6.4%;
P
=0.002). Vascular access-site complications were comparable in women assigned to VCD and MC (8.6% versus 9.8%;
P
=0.451). There was no interaction of treatment effect and sex (
P
interaction
=0.970). Time to hemostasis was significantly shortened with VCD compared with MC (1 [interquartile range, 0.5–2.0] minutes) versus 11 [interquartile range, 10–15] minutes;
P
<0.001); however, more women with VCD required repeat MC (2.4% versus 0.6%;
P
=0.018). The use of the intravascular compared with the extravascular VCD was associated with a numerical reduction in vascular access-site complications (6.6% versus 10.7%;
P
=0.027) and significant reductions in time to hemostasis and VCD failure.

Conclusions:

In women undergoing diagnostic coronary angiography via the common femoral artery, VCD and MC provided comparable safety, while time to hemostasis was reduced with VCD.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01389375.
The Extent of Aortic Atherosclerosis Predicts the Occurrence, Severity, and Recovery of Acute Kidney Injury After Transcatheter Aortic Valve Replacement
Authors: Shishikura Daisuke , Kataoka Yu , Pisaniello Anthony D. , Delacroix Sinny , Montarello Joseph K. , Nicholls Stephen J. , Worthley Stephen G.
Published: September 2018

Background:

Acute kidney injury (AKI) can be a major complication of transcatheter aortic valve replacement (TAVR). Atheroembolization of debris during catheter manipulation has been considered as a potential factor causing AKI. This study investigates the impact of aortic atheroma burden on AKI post-TAVR and evaluates the potential of preoperative multislice computed tomographic (MSCT) imaging for the assessment of AKI in these patients.

Methods and Results:

Preoperative multislice computed tomographic images were analyzed in 278 patients with symptomatic severe aortic stenosis who underwent TAVR. AKI was defined as an absolute increase in serum creatinine ≥0.3 mg/dL. Aorta vessel and lumen areas in each 1-mm cross-sectional image were measured. Percent atheroma volume above (PAV
above renal arteries
) and below (PAV
below renal arteries
) renal arteries were calculated by the following formula: PAV={Σ (vessel area−lumen area)/Σ(vessel area)}×100. AKI occurred in 92 patients (33.1%) after TAVR. AKI was associated with a greater PAV above (30.4±8.2 versus 21.3±5.8%;
P
=0.02) but not below (28.9±7.7 versus 25.8±6.1%;
P
=0.41) the renal arteries. Greater PAV
above renal arteries
was associated directly with AKI severity (
P
=0.008) and inversely with recovery in serum creatinine level from peak to discharge (
r
=0.78;
P
=0.002). Multivariate analysis demonstrated that PAV
above renal arteries
was a significant predictor of AKI (
P
=0.02). Receiver-operating curve analysis identified PAV
above renal arteries
>29.5% as an optimal threshold to predict AKI.

Conclusions:

Suprarenal aortic atheroma burden is associated with the occurrence, severity, and recovery of AKI after TAVR. This highlights the utility of preoperative assessment of aortic atherosclerosis on multislice computed tomography to identify patients at high-risk for AKI.
Intentional Fracture of Bioprosthetic Valve Frames in Patients Undergoing Valve-in-Valve Transcatheter Pulmonary Valve Replacement
Authors: Shahanavaz Shabana , Asnes Jeremy D. , Grohmann Jochen , Qureshi Athar M. , Rome Jonathan J. , Tanase Daniel , Crystal Matthew A. , Latson Larry A. , Morray Brian H. , Hellenbrand William , Balzer David T. , Gewillig Marc , Love Jon C. , Berdjis Farhouch , Gillespie Matthew J. , McElhinney Doff B.
Published: September 2018

Background:

Percutaneous transcatheter pulmonary valve replacement (TPVR) has good clinical and hemodynamic outcomes in treating dysfunctional bioprosthetic valves (BPV) in the pulmonary position. Valve-in-valve therapy can further decrease the inner diameter (ID), potentially resulting in patient-prosthesis mismatch in patients with smaller BPVs.

Methods and Results:

To evaluate feasibility and outcomes of intentional BPV fracture to enlarge the pulmonary valve orifice with TPVR, 37 patients from 13 centers who underwent TPVR with intended BPV fracture were evaluated. A control cohort (n=70) who underwent valve-in-valve TPVR without attempted fracture was evaluated. BPV was successfully fractured in 28 patients and stretched in 5 while fracture was unsuccessful in 4. A Melody valve was implanted in 25 patients with fractured/stretched frame and a Sapien (XT 3) valve in 8. Among patients whose BPV was fractured/stretched, the final ID was a median of 2 mm larger (0–6.5 mm) than the valve’s true ID. The narrowest diameter after TPVR in controls was a median of 2 mm smaller (
P
<0.001) than true ID. Right ventricular outflow tract gradient decreased from median 40 to 8 mm Hg in the fracture group. Cases with fracture/stretching were matched 1:1 (weight, true ID) to controls. Post-TPVR peak gradient was lower but not significant (8.3±5.2 versus 11.8±9.2 mm Hg;
P
=0.070). There were no fracture-related adverse events.

Conclusions:

Preliminary experience shows intentional fracture of BPV frame can be useful for achieving larger ID and better hemodynamics after valve-in-valve TPVR.
Human Cardiac Gene Therapy
Authors: Ishikawa Kiyotake , Weber Thomas , Hajjar Roger J.
Published: September 2018

In the past 10 years, there has been tremendous progress made in the field of gene therapy. Effective treatments of Leber congenital amaurosis, hemophilia, and spinal muscular atrophy have been largely based on the efficiency and safety of adeno-associated vectors. Myocardial gene therapy has been tested in patients with heart failure using adeno-associated vectors with no safety concerns but lacking clinical improvements. Cardiac gene therapy is adapting to the new developments in vectors, delivery systems, targets, and clinical end points and is poised for success in the near future.
Sirtuins and NAD
+
in the Development and Treatment of Metabolic and Cardiovascular Diseases
Authors: Kane Alice E. , Sinclair David A.
Published: September 2018

The sirtuin family of nicotinamide adenine dinucleotide–dependent deacylases (SIRT1–7) are thought to be responsible, in large part, for the cardiometabolic benefits of lean diets and exercise and when upregulated can delay key aspects of aging. SIRT1, for example, protects against a decline in vascular endothelial function, metabolic syndrome, ischemia-reperfusion injury, obesity, and cardiomyopathy, and SIRT3 is protective against dyslipidemia and ischemia-reperfusion injury. With increasing age, however, nicotinamide adenine dinucleotide levels and sirtuin activity steadily decrease, and the decline is further exacerbated by obesity and sedentary lifestyles. Activation of sirtuins or nicotinamide adenine dinucleotide repletion induces angiogenesis, insulin sensitivity, and other health benefits in a wide range of age-related cardiovascular and metabolic disease models. Human clinical trials testing agents that activate SIRT1 or boost nicotinamide adenine dinucleotide levels are in progress and show promise in their ability to improve the health of cardiovascular and metabolic disease patients.
Cardiorenal Syndrome Revisited
Authors: Zannad Faiez , Rossignol Patrick
Published: September 2018

Cardiorenal syndromes have been categorized into 5 clinical subtypes based on which organ is perceived to be the primary precipitant of the vicious and interrelated cycle of declining function in both organs. This clinical classification has broadened interest in cardiorenal interactions, but it is merely descriptive, does not rely on or inform predominant pathophysiology, and has produced little change in either practice or the research agenda. In contrast, recent scientific work identifies common pathophysiological pathways for several categories of cardiorenal syndromes, suggesting a unifying pathogenesis. Fibrosis is a common consequence of inflammation- and oxidative stress–related endothelial dysfunction in aging, hypertension, diabetes mellitus, obesity, ischemia, and organ injury. It is a common feature in heart failure and chronic kidney disease. Therefore, we suggest that fibrosis may be not only a marker but also the primary driver of pathophysiology in several cardiorenal syndromes. Interstitial fibrosis in the heart, large arteries, and kidneys may play a key role in the pathophysiology of the cardiorenal syndrome continuum. Focusing on fibrosis as a disease mediator might enable the identification of fibrosis-related biotargets that could potentially be modulated with renin-angiotensin-aldosterone system inhibitors, mineralocorticoid receptor antagonists, or other novel antifibrotic agents in development. This conceptual approach may be an effective new strategy for the prevention and treatment of fibrosis within the cardiorenal syndrome continuum.
Primary Aldosteronism
Authors: Byrd James Brian , Turcu Adina F. , Auchus Richard J.
Published: September 2018

Primary aldosteronism (PA) is the most common form of secondary hypertension. In many cases, somatic mutations in ion channels and pumps within adrenal cells initiate the pathogenesis of PA, and this mechanism might explain why PA is so common and suggests that milder and evolving forms of PA must exist. Compared with primary hypertension, PA causes more end-organ damage and is associated with excess cardiovascular morbidity, including heart failure, stroke, nonfatal myocardial infarction, and atrial fibrillation. Screening is simple and readily available, and targeted therapy improves blood pressure control and mitigates cardiovascular morbidity. Despite these imperatives, screening rates for PA are low, and mineralocorticoid-receptor antagonists are underused for hypertension treatment. After the evidence for the prevalence of PA and its associated cardiovascular morbidity is summarized, a practical approach to PA screening, referral, and management is described. All physicians who treat hypertension should routinely screen appropriate patients for PA.
Novel Phenotype–Genotype Correlations of Restrictive Cardiomyopathy With Myosin‐Binding Protein C (
MYBPC3
) Gene Mutations Tested by Next‐Generation Sequencing
Authors: Wu Wei , Lu Chao‐Xia , Wang Yi‐Ning , Liu Fang , Chen Wei , Liu Yong‐Tai , Han Ye‐Chen , Cao Jian , Zhang Shu‐Yang , Zhang Xue
Published: September 2018

Background

MYBPC
3

dysfunctions have been proven to induce dilated cardiomyopathy, hypertrophic cardiomyopathy, and/or left ventricular noncompaction; however, the genotype–phenotype correlation between

MYBPC
3

and restrictive cardiomyopathy (
RCM
) has not been established. The newly developed next‐generation sequencing method is capable of broad genomic
DNA
sequencing with high throughput and can help explore novel correlations between genetic variants and cardiomyopathies.

Methods and Results

A proband from a multigenerational family with 3 live patients and 1 unrelated patient with clinical diagnoses of
RCM
underwent a next‐generation sequencing workflow based on a custom AmpliSeq panel, including 64 candidate pathogenic genes for cardiomyopathies, on the Ion Personal Genome Machine high‐throughput sequencing benchtop instrument. The selected panel contained a total of 64 genes that were reportedly associated with inherited cardiomyopathies. All patients fulfilled strict criteria for
RCM
with clinical characteristics, echocardiography, and/or cardiac magnetic resonance findings. The multigenerational family with 3 adult
RCM
patients carried an identical nonsense

MYBPC
3

mutation, and the unrelated patient carried a missense mutation in the

MYBPC
3

gene. All of these results were confirmed by the Sanger sequencing method.

Conclusions

This study demonstrated that

MYBPC
3

gene mutations, revealed by next‐generation sequencing, were associated with familial and sporadic
RCM
patients. It is suggested that the next‐generation sequencing platform with a selected panel provides a highly efficient approach for molecular diagnosis of hereditary and idiopathic
RCM
and helps build new genotype–phenotype correlations.
Hypothyroidism Is Associated With Coronary Endothelial Dysfunction in Women
Authors: Sara Jaskanwal D. , Zhang Ming , Gharib Hossein , Lerman Lilach O. , Lerman Amir
Published: September 2018

Background

Hypothyroidism is associated with an increased risk of coronary artery disease, beyond that which can be explained by its association with conventional cardiovascular risk factors. Coronary endothelial dysfunction precedes atherosclerosis, has been linked to adverse cardiovascular events, and may account for some of the increased risk in patients with hypothyroidism. The aim of this study was to determine whether there is an association between epicardial and microvascular coronary endothelial dysfunction and hypothyroidism.

Methods and Results

In 1388 patients (mean age 50.5 [12.3] years, 34% male) presenting with stable chest pain to Mayo Clinic, Rochester,
MN
for diagnostic coronary angiography, and who were found to have nonobstructive coronary artery disease (<40% stenosis), we invasively assessed coronary artery endothelial‐dependent microvascular and epicardial function by evaluating changes in coronary blood flow (% Δ
CBF
Ach) and diameter (% Δ
CAD
Ach), respectively, in response to intracoronary infusions of acetylcholine. Patients were divided into 2 groups: hypothyroidism, defined as a documented history of hypothyroidism or a thyroid‐stimulating hormone (
TSH
) >10.0 
mU
/
mL
, n=188, and euthyroidism, defined as an absence of a history of hypothyroidism in the clinical record and/or 0.3<
TSH
≤10.0 
mU
/
mL
, n=1200. Subjects with a history of hypothyroidism had a significantly lower % Δ
CBF
Ach (48.26 [80.66] versus 64.58 [128.30]) compared to patients with euthyroidism, while the % Δ
CAD
Ach did not vary significantly between groups. After adjusting for covariates, females with hypothyroidism still had a significantly lower % Δ
CBF
Ach (estimated difference in % Δ
CBF
Ach [
SE
]: −16.79 [8.18]).

Conclusions

Hypothyroidism in women is associated with microvascular endothelial dysfunction, even after adjusting for confounders, and may explain some of the increased risk of cardiovascular disease in these patients.
Nationwide Hospitalization Trends in Adult Congenital Heart Disease Across 2003–2012
Authors: Agarwal Shikhar , Sud Karan , Menon Venu
Published: September 2018

Background

We aimed to assess trends in hospitalization, outcomes, and resource utilization among patients admitted with adult congenital heart disease (
ACHD
).

Methods and Results

We used the 2003–2012
US
Nationwide Inpatient Sample for this study. All admissions with an
ACHD
were identified using standard
ICD
codes. Resource utilization was assessed using length of stay, invasive procedure utilization, and cost of hospitalization. There was a significant increase in the number of both simple (101%) as well as complex congenital heart disease (53%)–related admissions across 2003–2012. In addition, there was a considerable increase in the prevalence of traditional cardiovascular risk factors including older age, along with a higher prevalence of hypertension, diabetes, smoking, obesity, chronic kidney disease, and peripheral arterial disease. Besides miscellaneous causes, congestive heart failure (11.8%), valve disease (15.5%), and cerebrovascular accident (26.1%) were the top causes of admission to the hospital among patients with complex
ACHD
, simple
ACHD
without atrial septal defects/patent foramen ovale and simple atrial septal defects/patent foramen ovale patients, respectively. In‐hospital mortality has been relatively constant among patients with complex
ACHD
as well as simple
ACHD
without atrial septal defects/patent foramen ovale. However, there has been considerable increase in the average length of stay and cost of hospitalization among the
ACHD
patients during 2003–2012.

Conclusions

There has been a progressive increase in
ACHD
admissions across 2003–2012 in the United States, with increasing healthcare resource utilization among these patients. Moreover, there has been a change in the cardiovascular comorbidities of these patients, adding a layer of complexity in management of
ACHD
patients.
Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study
Authors: McAreavey Dorothea , Vidal Jean‐Sébastien , Aspelund Thor , Eiriksdottir Gudny , Schelbert Erik B. , Kjartansson Olafur , Cao Jie J. , Thorgeirsson Gudmundur , Sigurdsson Sigurdur , Garcia Melissa , Harris Tamara B. , Launer Lenore J. , Gudnason Vilmundur , Arai Andrew E.
Published: September 2018

Background

Associations of atherosclerosis risk factors with unrecognized myocardial infarction (
UMI
) are unclear. We investigated associations of midlife risk factors with
UMI
and recognized
MI
(
RMI
) detected 31 years later by cardiac magnetic resonance.

Methods and Results

The Reykjavik Study (1967–1991) collected serial risk factors in subjects, mean (
SD
) age 48 (7) years. In
ICELAND
‐
MI
(2004–2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without
MI
. At baseline midlife evaluation, a modified Framingham risk score was significantly higher in
RMI
and in
UMI
versus no
MI
(7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%,
P
<0.001).
RMI
and
UMI
were more frequent in men (65%, 64% versus 43%;
P
<0.0001). Baseline systolic and diastolic blood pressure were significantly higher in
UMI
(138 (17) mm Hg versus 133 (17) mm Hg;
P
<0.006; 87 (10) mm Hg versus 84 (10) mm Hg;
P
<0.02). Diastolic
BP
was significantly higher in
RMI
(88 (10) mm Hg versus 84 (10) mm Hg;
P
<0.02). Cholesterol and triglycerides were significantly higher in
RMI
(6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L;
P
=0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L;
P
<0.003). Cholesterol trended higher in
UMI
(
P
=0.08). Serial midlife systolic
BP
was significantly higher in
UMI
versus no
MI
(β [
SE
] = 2.69 [1.28] mm Hg,
P
=0.04). Serial systolic and diastolic
BP
were significantly higher in
RMI
versus no
MI
(4.12 [1.60] mm Hg,
P
=0.01 and 2.05 [0.91] mm Hg,
P
=0.03) as were cholesterol (0.43 [0.11] mmol/L,
P
=0.0001) and triglycerides (0.3 [0.06] mmol/L,
P
<0.0001).

Conclusions

Midlife vascular risk factors are associated with
UMI
and
RMI
detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later
UMI
.
Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology
Authors: Paris Yvonne , Toro‐Salazar Olga H. , Gauthier Naomi S. , Rotondo Kathleen M. , Arnold Lucy , Hamershock Rose , Saudek David E. , Fulton David R. , Renaud Ashley , Alexander Mark E. ,   the New England Congenital Cardiology Association (NECCA)
Published: September 2018

Background

Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (
SCAMP
s).

Methods and Results

Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a
SCAMP
. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of
ECG
s and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.

Conclusions

SCAMP
methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.
Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis
Authors: Ekström Kaj , Lehtonen Jukka , Hänninen Helena , Kandolin Riina , Kivistö Sari , Kupari Markku
Published: September 2018

Background

Cardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.

Methods and Results

Our work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (
P
<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95%
CI
1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.

Conclusions

Findings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.
Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Authors: Bravata Dawn M. , Sico Jason , Vaz Fragoso Carlos A. , Miech Edward J. , Matthias Marianne S. , Lampert Rachel , Williams Linda S. , Concato John , Ivan Cristina S. , Fleck J. D. , Tobias Lauren , Austin Charles , Ferguson Jared , Radulescu Radu , Iannone Lynne , Ofner Susan , Taylor Stanley , Qin Li , Won Christine , Yaggi H. Klar
Published: September 2018

Background

Obstructive sleep apnea (
OSA
) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for
OSA
among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.

Methods and Results

This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of
OSA
versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced),
OSA
prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used;
P
=0.46) patients. In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0;
P
=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2;
P
=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (
P
=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).

Conclusions

Although changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with
OSA
.

Clinical Trial Registration

URL:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
01446913.
Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men
Authors: Schousboe John T. , Kats Allyson M. , Langsetmo Lisa , Vo Tien N. , Taylor Brent C. , Schwartz Ann V. , Cawthon Peggy M. , Lewis Cora E. , Barrett‐Connor Elizabeth , Hoffman Andrew R. , Orwoll Eric S. , Ensrud Kristine E. ,   for the Osteoporotic Fractures in Men (MrOS) Study Research Group
Published: September 2018

Background

Visceral adipose tissue (
VAT
) and other measures of central obesity predict incident atherosclerotic cardiovascular disease (
ASCVD
) events in middle‐aged individuals, but these associations are less certain in older individuals age 70 years and older. Our objective was to estimate the associations of
VAT
and the android–gynoid fat mass ratio, another measure of central obesity, with incident
ASCVD
events among a large cohort of older men.

Methods and Results

Two thousand eight hundred ninety‐nine men (mean [
SD
] age 76.3 [5.5] years) enrolled in the Outcomes of Sleep Disorders in Older Men study had rigorous adjudication of incident
ASCVD
events (myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke). We used proportional hazards models to estimate the hazard ratios for incident
ASCVD
per
SD
increase of
VAT
or android–gynoid fat mass ratio (measured at baseline with dual‐energy absorptiometry), adjusted for age, race, education, systolic blood pressure, smoking status, oxidized low‐density lipoprotein level, treatment for hypertension, statin use, aspirin use, presence of diabetes mellitus, and study enrollment site. Over a mean (
SD
) follow‐up period of 7.9 (3.4) years, 424 men (14.6%) had an incident
ASCVD
event. Neither
VAT
nor android–gynoid fat mass ratio were associated with incident
ASCVD
events, either unadjusted or after multivariable‐adjustment (hazard ratios [95% confidence interval ] per
SD
increase 1.02 [0.92–1.13] and 1.05 [0.95–1.17], respectively).

Conclusions

Central adipose tissue, as measured by
VAT
or android–gynoid fat mass ratio, was not associated with incident
ASCVD
events in this study of older men.
Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study
Authors: Gardener Hannah , Caunca Michelle , Dong Chuanhui , Cheung Ying Kuen , Alperin Noam , Rundek Tatjana , Elkind Mitchell S. V. , Wright Clinton B. , Sacco Ralph L.
Published: September 2018

Background

The American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume.

Methods and Results

A subsample of stroke‐free participants from the population‐based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=−0.047;
P
=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72–0.97) and positively associated with cerebral volume (beta per factor=0.300;
P
=0.002).

Conclusions

An increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.
Determinants of Long‐Term Outcomes and Costs in the Management of Critical Limb Ischemia: A Population‐Based Cohort Study
Authors: Mustapha Jihad A. , Katzen Barry T. , Neville Richard F. , Lookstein Robert A. , Zeller Thomas , Miller Larry E. , Jaff Michael R.
Published: September 2018

Background

The optimal treatment for critical limb ischemia remains controversial owing to conflicting conclusions from previous studies.

Methods and Results

We obtained administrative claims on Medicare beneficiaries with initial critical limb ischemia diagnosis in 2011. Clinical outcomes and healthcare costs over 4 years were estimated among all patients and by first treatment (endovascular revascularization, surgical revascularization, or major amputation) in unmatched and propensity‐score–matched samples. Among 72 199 patients with initial primary critical limb ischemia diagnosis in 2011, survival was 46% (median survival, 3.5 years) and freedom from major amputation was 87%. Among 9942 propensity‐score–matched patients (8% rest pain, 26% ulcer, and 66% gangrene), survival was 38% with endovascular revascularization (median survival, 2.7 years), 40% with surgical revascularization (median survival, 2.9 years), and 23% with major amputation (median survival, 1.3 years;
P
<0.001 for each revascularization procedure versus major amputation). Corresponding major amputation rates were 6.5%, 9.6%, and 10.6%, respectively (
P
<0.001 for all pair‐wise comparisons). The cost per patient year during follow‐up was $49 700, $49 200, and $55 700, respectively (
P
<0.001 for each revascularization procedure versus major amputation).

Conclusions

Long‐term survival and cost in critical limb ischemia management is comparable between revascularization techniques, with lower major amputation rates following endovascular revascularization. Primary major amputation results in shorter survival, higher risk of subsequent major amputation, and higher healthcare costs versus revascularization. Results from this observational research may be susceptible to bias because of the influence of unmeasured confounders.
Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization
Authors: Hussain Mohamad A. , Saposnik Gustavo , Raju Sneha , Salata Konrad , Mamdani Muhammad , Tu Jack V. , Bhatt Deepak L. , Verma Subodh , Al‐Omran Mohammed
Published: September 2018

Background

Statins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization.

Methods and Results

In this population‐level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002–2014). The primary outcome was a composite of 1‐year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five‐year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate‐ or high‐dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1‐year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70–0.83). Patients who were on persistent long‐term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71–0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose.

Conclusions

Continuous statin therapy was associated with a 25% lower risk of long‐term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.
The Theory and Practice of Property in Premodern South Asia: Disparities and Convergences
Authors: Lubin Timothy
Published: September 2018

This article reviews the main scholastic norms relevant to property and land rights in ancient and medieval India, and then surveys a range of inscriptions that illustrate the contours of land law in practice. The evidence suggests that India developed a sophisticated concept of landed property from earliest history, with conceptual tools and legal instruments to define the rights of owners vis-à-vis rulers, rival claimants, and holders of subordinate interests (such as tenants, cultivators, mortgagees, etc.). It further shows that although earlier inscriptions deployed those tools and instruments in a narrow range of transfers between rulers and Brahmins or other religious groups, subsequent periods provide evidence of an increasingly wider application, including gifts by non-elite donors, ordinary contractual land transfers, and resolution of property disputes. In some cases, the implication seems to be that the legal framework was more widespread in practice but generated durable records (in metal or stone) only for elite actors; in many cases, it seems likely that elite legal resources became more widely available over time. This survey also notes how documents bring to the fore aspects of property law—the role of councils and arbitrators in administering the law (rather than the king or his officers), or the use of documents to carve out special rights—that are less prominent in scholastic treatments such as Dharmaśāstra.
Cross-Cultural Differences in Informal Argumentation: Norms, Inductive Biases and Evidentiality
Authors: Karaslaan Hatice , Hohenberger Annette , Demir Hilmi , Hall Simon , Oaksford Mike
Published: September 2018

Cross-cultural differences in argumentation may be explained by the use of different norms of reasoning. However, some norms derive from, presumably universal, mathematical laws. This inconsistency can be resolved, by considering that some norms of argumentation, like Bayes theorem, are mathematical functions. Systematic variation in the inputs may produce culture-dependent inductive biases although the function remains invariant. This hypothesis was tested by fitting a Bayesian model to data on informal argumentation from Turkish and English cultures, which linguistically mark evidence quality differently. The experiment varied evidential marking and informant reliability in argumentative dialogues and revealed cross-cultural differences for both independent variables. The Bayesian model fitted the data from both cultures well but there were differences in the parameters consistent with culture-specific inductive biases. These findings are related to current controversies over the universality of the norms of reasoning and the role of normative theories in the psychology of reasoning.
Receiver female body size and distances affect the claw-waving rate of signaller males in fiddler crabs (Brachyura, Ocypodidae)
Authors: Tina Fahmida W. , Jaroensutasinee M. , Jaroensutasinee K.
Published: September 2018

We tested for the first time howAustruca bengaliCrane, 1975 signaller males adjusted their waving rates based on receiver female body sizes and their distances. We video recorded the waving display of 46 males (9–12 mm carapace width) for 30 s, and counted their waving rate. Receiver females were categorised as small (8–10 mm carapace width) and large (>10 mm). Distances between males and females were categorised as short (⩽12 cm) and long (>12 cm) distances. Our results indicate that males are able to measure distances and female sizes, and adjust their waving display by actively reducing waving rate (1) towards small females, as usually small females have lower fecundity compared to large ones and (2) towards females at very close distance because at this point, the females would make their mating decision, and thus males start to lead/hit the females towards their burrow rather than waving vigorously.
Neutrality before Grotius: A City, a State and Seven Salt Ships in the Baltic (1564-1567)
Authors: Wubs-Mrozewicz Justyna
Published: September 2018

The article argues on the basis of a case from the 1560s in Danzig that prior to the formulation of the legal concept of neutrality by Hugo Grotius, there was a practice of neutrality. It was expressed in various terms and manners. This practice pertained to both cities and states, and the case discloses the first documented instance when the Netherlands explicitly strove for neutrality also by legal means. The choice for neutrality was rooted in political and economic interests and as such had advantages, but it was also fraught with difficulties. The analysis shows that the actual extent of neutrality depended on the acceptance (or lack thereof) of the warring parties. Also, by excluding the possibilities of the use of violence or economic means of pressure like blockades, neutrals were limited to diplomacy and law during conflicts. This lay the ground for the development of a legal concept of neutrality.
The Birth of the Annual Grafting Pear: Peasant Household Economy and Agricultural Technology Innovation in Dongshi, Taiwan
Authors: Yeh Shou-li
Published: September 2018

This article discusses the relationship between the contemporary Taiwanese peasant household economy and agricultural technology innovation, taking the economic development process involving the Dongshi annual grafting pear as an example. The “annual grafting pear” is the result of a fruit cultivation model pioneered by the peasants of Dongshi in order to overcome the constraint of climate. Temperate pears have a high market value, but raising them in a subtropical region comes at the cost of a several fold increase in labor. Although the government’s local agricultural extension station generally believes that growing annual grafting pears is not in line with the trend of modern agricultural development, peasants have stuck with this labor-intensive fruit cultivation model. Today, annual grafting pears have become the mainstay of Taiwan’s pear industry. Combining participant observation, oral history, and ethnography, this article analyzes the tensions between household consumption needs and labor self-exploitation. It argues that the peasant family economy does not operate according to a purely capitalistic business logic, and that Dongshi’s grassroots agricultural technology innovation will move in the direction of labor-intensifying diversified crops rather than labor-saving single crops. This direction of development is a response to Taiwan’s agricultural crisis, the urban-rural relationship, and the market structure. The birth of annual grafting pears as a product of the collective creation of the peasants in Dongshi reflects a situation common in Taiwan’s rural areas and helps us to rethink the “hidden agricultural revolution” and urban-rural relationships in East Asian industrialized societies.
A review of the spider genus Porrhomma (Araneae, Linyphiidae)
Authors: RŮŽIČKA VLASTIMIL
Published: September 2018

The spider genus Porrhomma has been revised; it now includes 24 species. Two new species are described: Porrhomma altaica new species from the Altai Mountains, and Porrhomma nekolai new species from eastern Asia and North America. Bathyphantes charpentieri Lebert, 1877 was removed from synonymy with Porrhomma microphthalmum (O. Pickard-Cambridge, 1871). The following new synonymies are proposed: Bathyphantes charpentieri Lebert, 1877 is a junior synonym of Porrhomma convexum (Westring, 1851) new synonymy; Porrhomma gertschi Hackman, 1954 is a junior synonym of Porrhomma terrestre (Emerton, 1882) new synonymy; Porrhomma myops Simon, 1884 is a junior synonym of Porrhomma rosenhaueri (L. Koch, 1872) new synonymy; Porrhomma ocella Chamberlin & Ivie, 1943 is a junior synonym of Porrhomma convexum (Westring, 1851) new synonymy; Porrhomma omissum Miller, 1971 is a junior synonym of Porrhomma egeria Simon, 1884 new synonymy; Porrhomma pallidum affinis Miller & Kratochvíl, 1940 is a junior synonym of Porrhomma pallidum Jackson, 1913 new synonymy; Porrhomma sodonta (Chamberlin, 1949) is a junior synonym of Porrhomma convexum (Westring, 1851) new synonymy. The synonymy of Porrhomma macrochelis (Emerton, 1917) with Macrargus multesimus (O. Pickard-Cambridge, 1875) is supported. Porrhomma subterraneum Simon, 1884 is considered a nomen dubium, because it was described according to a juvenile specimen. To date, Porrhomma indecorum Simon, 1910 and Porrhomma marphaense Wunderlich, 1983 are only known from findings of females; they are considered to be species inquirenda, and their names are declared nomina dubia. Keys are provided for males and females. Vulvae are drawn in dorsal, ventral and caudal views to understand their spatial structure.
Features of Extreme Precipitation at Progress Station, Antarctica
Authors: Yu Lejiang , Yang Qinghua , Vihma Timo , Jagovkina Svetlana , Liu Jiping , Sun Qizhen , Li Yubin
Published: September 2018

Observed daily precipitation data were used to investigate the characteristics of precipitation at Antarctic Progress Station and synoptic patterns associated with extreme precipitation events during the period 2003–16. The annual precipitation, annual number of extreme precipitation events, and amount of precipitation during the extreme events have positive trends. The distribution of precipitation at Progress Station is heavily skewed with a long tail of extreme dry days and a high peak of extreme wet days. The synoptic pattern associated with extreme precipitation events is a dipole structure of negative and positive height anomalies to the west and east of Progress Station, respectively, resulting in water vapor advection to the station. For the first time, we apply self-organizing maps (SOMs) to examine thermodynamic and dynamic perspectives of trends in the frequency of occurrence of Antarctic extreme precipitation events. The changes in thermodynamic (noncirculation) processes explain 80% of the trend, followed by the changes in the interaction between thermodynamic and dynamic processes, which account for nearly 25% of the trend. The changes in dynamic processes make a negative (less than 5%) contribution to the trend. The positive trend in total column water vapor over the Southern Ocean explains the change of thermodynamic term.
Mechanisms for Generation and Development of the Ningaloo Niño
Authors: Zhang Lei , Han Weiqing , Li Yuanlong , Shinoda Toshiaki
Published: September 2018

Generation and development mechanisms of the Ningaloo Niño are investigated using ocean and atmospheric general circulation model experiments. Consistent with previous studies, northerly wind anomalies off the West Australian coast are critical in generating warm sea surface temperature (SST) anomalies of the Ningaloo Niño, which induce SST warming through reduced turbulent heat loss toward the atmosphere (by decreasing surface wind speed), enhanced Leeuwin Current heat transport, and weakened coastal upwelling. Our results further reveal that northerly wind anomalies suppress the cold dry air transport from the Southern Ocean to the Ningaloo Niño region, which also contributes to the reduced turbulent heat loss. A positive cloud–radiation feedback is also found to play a role. Low stratiform cloud is reduced by the underlying warm SSTAs and the weakened air subsidence, which further enhances the SST warming by increasing downward solar radiation. The enhanced Indonesian Throughflow also contributes to the Ningaloo Niño, but only when La Niña co-occurs. Further analysis show that northerly wind anomalies along the West Australian coast can be generated by both remote forcing from the Pacific Ocean (i.e., La Niña) and internal processes of the Indian Ocean, such as the positive Indian Ocean dipole (IOD). Approximately 40% of the Ningaloo Niño events during 1950–2010 co-occurred with La Niña, and 30% co-occurred with positive IOD. There are also ~30% of the events independent of La Niña and positive IOD, suggesting the importance of other processes in triggering the Ningaloo Niño.