bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of novel risk factors of atherosclerosis on severity of coronary artery disease in young Indian patients suffering from Myocardial Infarction
Authors: Chaturvedi A M I T , Mukherjee A , Sharma R A N J A N , Samanta B I A U S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Asian Indians are affected at least a decade earlier with cardiovascular diseases (CVD), in their most productive midlife years as compared to people of European ancestry. This is the first study from Indian sub-continent assessing the impact of novel risk factors of atherosclerosis on angiographic severity of coronary artery disease (CAD) in terms of SYNTAX scores in young patients (<40 years) suffering myocardial infarction (MI).

Purpose

This study was undertaken to evaluate the association of novel risk factors of atherosclerosis with severity of CAD at the index hospitalization in young MI patients.

Methods

In this single center observational study, 75 consecutive young MI patients were included. Patients having previous CVD, chronic kidney disease, chronic Liver disease and any bleeding diathesis were excluded. Homocysteine, highly sensitive C- reactive protein (hs-CRP) and lipoprotein- a (Lp-a) were measured and correlated with SYNTAX I and SYNTAX II.

Results

Smoking (85.5%) was the most common traditional risk factor for MI while other traditional risk factors did not have significant effect on severity of CAD in young patients with MI. The mean homocysteine level was 24.43± 10.02 micromole/L, hs-CRP 8.2± 1.44 mg/L and Lp(a) 59± 23.10 mg/dL. The sensitivity and specificity of hs-CRP ³8.5 mg/L for prediction of multivessel disease was 67% and 70% respectively while that of Lp(a) ³ 66.5 mg/dL was 71% and 67% respectively. On further analysis, the sensitivity and specificity of hs-CRP value ³8.5 mg/L for prediction of SYNTAX I score > 22 was 75% and 65% respectively while that of Lp(a) ³ 66.5 mg/dL was 75% and 60% respectively. On multivariate linear regression, hs-CRP was the significant predictor of SYNTAX I score (p=0.03) when adjusted for homocysteine and Lp (a).

Conclusions

hs-CRP and Lp(a) levels are significantly associated with the severity of CAD in young MI patients. hs-CRP and Lp(a) should be evaluated along with routine risk factors of atherosclerosis in young patients at risk of CAD for early detection, timely management and prevention of major cardiac events.
Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients
Authors: Shaharuddin S , Thuraisingam S , Daud N A , Shafie S D , Zulkifly H H
Published: January 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Monash University Malaysia

Background

Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD.

Purpose

This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (<10 years vs. ≥10 years)

Materials and Methods

A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist.

Results

A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having <10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=<0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=<0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=<0.001] compared to those with <10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016].

Conclusion

IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.
A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death
Authors: Bang H J , Jeong W J , Cha K , Oh S H , Park K N , Youn C S , Kim H J , Lim J Y , Kim H J , Song H
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy.

Purpose

In this study, we derived and validated a novel scoring system to predict hypoxic-ischaemic brain injury (HIBI) and in-hospital death (IHD).

Methods

We retrospectively analysed Korean Hypothermia Network prospective registry data collected from in Korea between 2015 and 2018. Patients without neuroprognostication data were excluded, and the remaining patients were randomly divided into derivation and validation cohorts. HIBI was defined when at least one prognostication predicted a poor outcome. IHD meant all deaths regardless of cause. In the derivation cohort, stepwise multivariate logistic regression was conducted for HIBI and IHD scores, and model performance was assessed. We then classified patients into four categories and analysed associations between the categories and cerebral performance categories (CPCs) at hospital discharge. Finally, we validated our models in the internal validation cohort.

Results

Among 1373 patients, 240 were excluded, and 1133 were randomised into derivation (n=754) and validation cohorts (n=379). In the derivation cohort, 7 and 8 predictors were selected for HIBI (0–8) and IHD scores (0–11), respectively, and the area under the curve (AUC) was 0.85 (95% CI 0.82–0.87) and 0.80 (95% CI 0.77–0.82), respectively. Applying optimum cutoff values of ≥6 points for HIBI and ≥7 points for IHD, patients were classified as follows: HIBI (-)/IHD (-), Category 1 (n=424); HIBI (-)/IHD (+), Category 2 (n=100); HIBI (+)/IHD (-), Category 3 (n=21); and HIBI (+)/IHD (+), Category 4 (n=209). CPCs at discharge were significantly different in each category (p<0.001). In the validation cohort, the model showed moderate discrimination (AUC 0.83, 95% CI 0.79–0.87 for HIBI and AUC 0.77, 95% CI 0.72–0.81 for IHD) with good calibration. Each category of the validation cohort showed a significant difference in discharge outcomes (p<0.001) and a similar trend to the derivation cohort.

Conclusions

We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.
Effects of medical therapy, transcatheter intervention, and surgery on outcomes of patients with functional mitral regurgitation: a systematic review and network meta-analysis
Authors: Teoh S E , Tan E W X , Teo Y N , Basker G , Teo Y H , Chai P , Wong R C C , Yip J W L , Kuntjoro I , Lim Y H , Poh K K , Yeo T C , Kong W K F , Sia C H
Published: January 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme.

Background

Functional mitral regurgitation (FMR) is the most common valvular heart disease worldwide. Despite recent major trials, the relative efficacy between medical therapy, transcatheter intervention, and surgery for the treatment of FMR remains poorly understood.

Purpose

We performed a systematic review and network meta-analysis of all published randomised controlled trials (RCTs) and observational studies to compare the efficacy between medical therapy, transcatheter intervention, and surgery on the clinical outcomes of patients with FMR.

Methods

Four electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) were searched from inception to March 13, 2022, for studies reporting clinical outcomes in patients with FMR and comparing the efficacy between either medical therapy, transcatheter intervention, or surgery. Frequentist network meta-analysis models were utilised to summarise the studies. This study was registered in the International Prospective Register of Systematic Reviews.

Results

10 articles were included in the analysis, comprising a combined cohort of 1,981 patients. Network meta-analysis demonstrated that compared to medical therapy, transcatheter intervention achieved a lower relative risk in the composites of all-cause mortality (risk ratio [RR]: 0.43; 95% confidence interval [CI] 0.22-0.82) and mitral regurgitation (MR) severity grade ≥3+ (RR: 0.06; 95% CI 0.01-0.42). Compared to surgery, transcatheter intervention achieved a lower relative risk in the composites of cardiovascular death (RR: 0.36; 95% CI 0.17-0.75) and MR severity grade ≥3+ (RR: 0.25; 95% CI 0.09-0.70) and higher relative risk in the composite of heart failure hospitalisation (RR: 2.94; 95% CI 1.26-6.82). Compared to medical therapy, surgery achieved a higher relative risk in the composite of cardiovascular death (RR: 2.54; 95% CI 1.18-5.47) and lower relative risks in the composites of all-cause mortality (RR: 0.56; 95% CI 0.34-0.91) and heart failure hospitalisation (RR: 0.28; 95% CI 0.13-0.61).

Conclusion

Medical therapy, transcatheter intervention, and surgery in patients with FMR displayed differing effects on the various clinical outcomes. Further head-to-head trials are required to better understand the optimal treatment modality in this population.
Multicenter review of a tadalafil suspension formulation in infants and children with pulmonary hypertension: a north american experience
Authors: Youssef D , Handler S , Richards S , Sheppard C , Smith J , Tillman K , Pietrosanu M , Kirkpatrick E , Bates A
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary arterial hypertension (PAH) is a disease characterised by an increase in pulmonary vascular resistance and pulmonary artery pressure. Phosphodiesterase type 5 (PDE5) inhibitors, with sildenafil the earliest among them, are widely used in the management of pediatric PAH. There has more recently been a transition to once-daily tadalafil suspensions. Herein, we present a multicenter experience detailing safety, tolerability and haemodynamic data utilizing tadalafil suspension alone or in combination for the management of pediatric PAH.

Methods and materials

We performed a retrospective review of all infants and children at two North American paediatric PH centres between December 2013 and April 2022. We included all patients less than 9 years of age who were treated with a tadalafil suspension after an initial treatment with sildenafil. Demographic, clinical, imaging, and laboratory data were collected.

Results

Over the study period, 158 children were treated with tadalafil therapy: 41 (25.9%) had group 1 PAH, 81 (51.3%) had group 3 PH, and 33 (20.9%) had group 5 PH. The median initial dose of tadalafil was 1.0 mg/kg once daily with a median time to maximum dose of 1 day. The majority of patients required the suspension formulation due to an inability to take oral tablets or the need for nasogastric or nasojejunal feeding. We observed improvements in median echocardiographic parameters in the six months following initiation, namely, in RVFAC from 34.7% (Q1 = 31.0%, Q3 = 42.0%) to 37.0% (Q1 = 31.0%, Q3 = 44.0%) and in TAPSE from 1.0 (Q1 = 0.8, Q3 = 1.7) cm to 1.3 (Q1 = 1.0, Q3 = 1.7) cm. We observed median decreases in RVSp from 51.0 (Q1 = 35.0, Q3 = 69.0) mmHg to 37.0 (Q1 = 30.0, Q3 = 50.0) mmHg and in NT pro BNP levels from 439.0 (Q1 = 217.0, Q3 = 2051.0) ng/L to 313.0 (Q1 = 193.0, Q3 = 1110.0) ng/L. Tadalafil therapy was well tolerated over the six-month period: at baseline, only four patients (2.5%) reported gastrointestinal side effects, two (1.3%) reported adverse skin adverse effects (i.e., rash and flushing), and one (0.6%) reported adverse neurological effects. At six months, 150 patients (94.9%) reported no adverse effects.

Conclusion

Tadalafil, a long-acting PDE5 inhibitor, when administered in a suspension formulation, has a safe and tolerable adverse effect profile once patients are established on sildenafil therapy. Following 6 months of once daily tadalafil suspension, alone or in combination, showed a trend towards improvement in clinical parameters, echocardiographic measurements, and laboratory results for pediatric PAH. All patient adverse effects were managed with non pharmacological measures and there was good patient compliance.
Arterial thromboembolism (ATE) and mortality among COVID-19 patients in the intensive care unit (ICU): prevalence and risk factors
Authors: Zulkifly H , Mansor F , Abdul Halim Zaki I , Kiok L C , Ravi T , Pathmanathan M
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Objective

To investigate the prevalence of arterial thromboembolic (TE) complications including stroke, peripheral arterial disease (PAD) and myocardial infarction (MI) and mortality among COVID-19 patients admitted to an ICU at a single centre hospital in the area of Klang Valley, Malaysia. The proportions of patients with ATE complication who died, and factors associated with the occurrence of ATE were explored.

Methods

Patients admitted to a single centre ICU with PCR confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included in this retrospective Malaysian cohort study. ATE event is a combination of ≥1 stroke, PAD and MI.

Results

Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2 % and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, only 58 (10.9%) developed ATE event during their ICU admission. Significantly higher proportions of COVID-19 patients admitted to ICU who developed complications of stroke (12.3% vs. 1.5; p<0.001) and MI (16.4% vs. 4.6%; p<0.001) died. Age, duration of ICU admission, proportion of underlying hypertension, stroke, IHD, diabetes, kidney disease, troponin, D-Dimer were significantly greater among those with ATE events. Predictors of ATE event on multivariate logistic regression analysis were duration of ICU admission [OR 1.0 (95% CI 1.00-1.04)] and troponin [OR 1.3 (95% CI 1.1-1.4)] level.

Conclusion

The overall prevalence of ATE complication among the severely ill COVID-19 patients was low (10.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of ATE events included increased troponin level and duration of ICU admission. Perhaps a more aggressive preventive strategies can be undertaken to prevent further increase in the prevalence of arterial thromboembolism and death.
Angiography alone versus angiography plus intracoronary imaging to guide emergency percutaneous coronary intervention: outcomes from a single-centre retrospective analysis
Authors: Wong S F , Ching S , Yue C S , Chung T S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is emerging evidence showing improvement in clinical outcomes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS)-guided elective percutaneous coronary intervention (PCI). Yet data supporting their use in emergency setting are still conflicting.

Purpose

We aim to compare the immediate angiographic outcomes, short and long-term clinical outcomes in patients undergoing emergency PCI with intracoronary imaging to those with angiography guidance only.

Methods

We included 426 patients from May 2012 to December 2020 who presented with ST-elevation myocardial infarction (STEMI) and underwent emergency PCI within 24 hours of hospital admission. Intracoronary imaging was used in 196 of them to guide PCI. Immediate angiographic outcomes in terms of TIMI flow grade (TFG), myocardial blush grade (MBG) and corrected TIMI frame count (CTFC) are compared. Clinical outcomes including major adverse cardiac events (MACE), target vessel revascularization (TVR), hospitalization for heart failure and all-cause mortality were also compared.

Results

196 patients (46%) underwent intracoronary imaging-guided PCI. Use of imaging was associated with a higher post procedural CTFC (27.0 vs. 25.8, p=0.11), yet it failed to reach statistical significance. Comparing with angiography-guided PCI, imaging-guided PCI was associated with significantly larger proportion of high CTFC post procedure (slow coronary flow) (OR, 0.62; 95% CI: 0.38-1.0, P=0.05), and this result was consistent after adjustment of variables (adjusted OR, 0.57; 95% CI 0.34-0.98, P=0.04). Subjective measures of TIMI flow grade and MBG, however, were not different between the 2 groups. In the subgroup of patients with high Syntax score and American Heart Association (AHA)/American College of Cardiology (ACC) type C culprit lesion morphology, imaging guided PCI was associated with significantly worse post procedural MBG (OR, 0.36; 95% CI 0.17-0.78, P=0.01 vs. OR, 0.40; 95% CI 0.18-0.94, P=0.04), and the results were consistent after adjusting for variables. In the subgroup of patients with high Syntax score, imaging guided PCI was associated with significantly worse post procedural TIMI flow grade (adjusted OR, 0.35; 95% CI 0.12-0.95, P=0.05) and a trend towards higher CTFC (adjusted OR, 0.26; 95% CI: 0.06-0.94, P=0.05) after adjusting for variables. The cumulative incidences of all clinical outcome measures were not significantly different between the 2 groups before and after adjusting for confounders.

Conclusions

Imaging-guided PCI was not associated with improved angiographic or clinical outcomes in patients with STEMI who underwent emergency PCI. Use of intracoronary imaging in emergency PCI may associate with worse immediate angiographic outcomes.
Comparison of transcatheter, minimally invasive and conventional surgical aortic valve replacement: a systematic review and network meta-analysis
Authors: Fong K , Yap J J L , Chan Y H , Ewe S H , Chao V T T , Rizwan M , Govindasamy S P , Aziz Z A , Tan V H , Ho K W
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but long-term outcomes have yet to be comprehensively explored.

Purpose

To compare long-term mortality among three AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional surgical AVR (CAVR).

Methods

An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI to CAVR, and RCTs or propensity score-matched (PSM) studies comparing MIAVR to CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality was derived from graphical reconstruction of digitized Kaplan-Meier curves. Pairwise comparisons followed by network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk as well as transfemoral (TF-TAVI) patients.

Results

A total of 27 studies involving 16,554 patients were included. In the pairwise comparison of TAVI versus CAVR, TAVI showed superior mortality to CAVR until 39.5 months, beyond which there was no significant difference in longer term mortality. When restricted to TF-TAVI versus CAVR, consistent mortality benefit favoring TAVI was seen (shared-frailty hazard ratio [HR]=1.17, 95%CI=1.03-1.33, p=0.016). In the network meta-analysis involving majority PSM data, MIAVR was associated with significantly lower mortality than TAVI (HR=0.69, 95%CI=0.59-0.82) and CAVR (HR=0.68, 95%CI=0.58-0.80); this significant association was not seen when compared to TF-TAVI patients.

Conclusions

An initial short-medium term mortality benefit for TAVI over CAVR was noted but this benefit was attenuated over the longer term. In the subset of TF-TAVI patients, this long-term mortality benefit persisted, suggesting that non-TF techniques are associated with higher mortality. Amongst majority PSM data, MIAVR showed improved mortality compared to TAVI and CAVR but this was not seen in the TF-TAVI subset. This suggests that MIAVR may have a role in treating patients who are ineligible for TF-TAVI in experienced centers, and future RCTs are needed to conclusively validate this.
Comorbidity patterns in older patients with diabetes in primary care: a cross-sectional study
Authors: Wong W J , Nguyen T N , Harrison C
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Diabetes is a well-known risk factor for cardiovascular diseases and continues to be a global public health challenge. In Australia, prevalence rates of diabetes increase with age with almost 1 in 5 older people reported being diagnosed with diabetes. Older persons with diabetes are also more likely to have multiple comorbidities adding to their complexity. A better understanding of comorbidity patterns and their associated factors in older people with diabetes is instrumental to identify groups of individuals that differ in healthcare needs, resources utilized, and health trajectories.

Purpose

To identify comorbidity patterns in community-dwelling older adults with type 2 diabetes attending general practice settings in Australia.

Methods

This is a cross-sectional study based on the Bettering the Evaluation And Care of Health (BEACH) data. The BEACH program was a continuous, national study of the state of general practice clinical activity in Australia from 1998 to 2016. As part of the program, General Practitioners (GPs) would collect additional patient information during patient visits through structured paper-based recording sheets. For the purposes of this sub-study, a random sample of 1800 participating GPs were invited to record all diagnosed chronic conditions for 30 consecutive patients over twelve five-weeks recording periods between November 2012 and March 2016. The dataset was analyzed with descriptive analysis and exploratory factor analyses were applied to examine comorbidity patterns.

Result

From the dataset, there were 14 042 patients aged ≥65 with recorded chronic conditions. Of these, 2688 reported to have other comorbidities in addition to the diagnosis of diabetes. Hypertension was present in 67.33% (95% CI: 64.62 – 70.04) of these participants, followed by hyperlipidemia, 44.85% (95% CI: 41.80 –47.90), ischemic heart disease, 22.81% (95% CI: 20.74 – 24.87), atrial fibrillation, 10.25% (95% CI: 8.86 – 11.63), congestive heart failure, 7.03% (95% CI: 5.99 – 8.09), stroke/cerebrovascular accident, 6.76% (95% CI:5.36 -8.16) and peripheral vascular disease 5.26% (4.36 – 6.15). Top non-cardiovascular co-morbidities included arthritis, 51.78% (95% CI: 48.80–54.77) and depression, 15.52% (95% CI 13.78 –17.27). We identified two comorbidity patterns among older people with diabetes. The first were primarily psychological and musculoskeletal (Depression, Anxiety, Insomnia, Chronic Back Pain, Arthritis, Gastroesophageal Reflux Disease, Osteoporosis) and the second were cardiovascular conditions (Congestive Heart Failure, Ischaemic Heart Disease, Atrial Fibrillation, Peripheral Vascular Disease) and Chronic Renal Failure.

Conclusion

The prevalence of cardiovascular and non-cardiovascular comorbidities in older patients with diabetes was high. These findings highlight the need for elaborating primary care strategies to reduce cardiovascular risk and improve long-term care for this population.
Pre-diabetes is associated with increases cardiac event in cancer patients treated with anthracyclines
Authors: Cheang I F , Li X L , Yiu K H
Published: January 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University of Hong Kong, Queen Mary Hospital

Objective

To evaluate the association between pre-diabetes and cardiovascular events in patients treated with anthracyclines containing chemotherapy (ACT).

Methods

Patients treated with ACT between 2000 and 2019 were divided into diabetes, pre-diabetes, and normoglycemia groups based on the baseline glycemic status. Primary outcome was the major adverse cardiovascular composite events (MACE) of heart failure hospitalization and cardiovascular death. Kaplan-Meier, multivariable COX regression, and Fine and Gray model analysis were applied.

Results

Among 12649 patients treated with ACT, 3997 (31.6%, median age 61 years old) had pre-diabetes and 5622 (44.45%, median age 67 years old) had diabetes at baseline. Over a median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in normoglycemia group, 358 (9.0%) in pre-diabetes group, and 728 (12.9%) in diabetes group. Compared with normoglycemia group, both pre-diabetes (adjusted HR=1.20, 95%CI 1.01-1.43) and diabetes (adjusted HR=1.46, 95% CI 1.24-1.70) were significantly associated with an increased risk of MACE. Further analysis showed that there were 475 (18%) progressed to overt diabetes in the pre-diabetes group after 2 years of the index date and were at greater risk of MACE (Adjusted HR=1.76, 95% CI 1.31-2.36).

Conclusions

Pre-diabetes was significantly associated with an increased risk of MACE in patients treated with ACTs. Among, those who progressed to diabetes after 2 years demonstrated an increased risk of MACE. Findings support that pre-diabetes as a risk factor for cardiovascular events might optimize management.
Skeletal muscle area predicts the outcomes of non-small-cell lung cancer after trimodality therapy
Authors: Watanabe Kenji , Kinoshita Fumihiko , Takenaka Tomoyoshi , Nagano Taichi , Oku Yuka , Kosai Keisuke , Ono Yuki , Haratake Naoki , Kohno Mikihiro , Kamitani Takeshi , Yoshitake Tadamasa , Okamoto Tatsuro , Shimokawa Mototsugu , Ishigami Kousei , Yoshizumi Tomoharu
Published: January 2023

OBJECTIVES

Sarcopenia correlates with poor prognosis in various malignancies. However, the prognostic significance of sarcopenia remains to be determined in patients with non-small-cell lung cancer who undergo surgery after receiving neoadjuvant chemoradiotherapy (NACRT).

METHODS

We retrospectively reviewed the patients with stage II/III non-small-cell lung cancer who underwent surgery following NACRT. The paravertebral skeletal muscle area (SMA) (cm2) at the 12th thoracic vertebra level was measured. We calculated the SMA index (SMAI) as SMA/squared height (cm2/m2). Patients were divided into low and high SMAI groups, and the association of SMAI with clinicopathological factors and prognosis was assessed.

RESULTS

The patients’ [men, 86 (81.1%)] median age was 63 (21–76) years. There were 106 patients including 2 (1.9%), 10 (9.4%), 74 (69.8%), 19 (17.9%) and 1 (0.9%) patients with stage IIA, IIB, IIIA, IIIB and IIIC, respectively. Of the patients, 39 (36.8%) and 67 (63.2%) were classified in the low and the high SMAI groups, respectively. Kaplan–Meier analysis showed that the low group had a significantly shorter overall survival and disease-free survival than the high group. Multivariable analysis identified low SMAI as an independent poor prognostic factor for overall survival.

CONCLUSIONS

Pre-NACRT SMAI correlates with poor prognosis; therefore, assessing sarcopenia based on pre-NACRT SMAI may help determine optimal treatment strategies and suitable nutritional and exercise interventions.
Uniform Resolvent Estimates for Critical Magnetic Schrödinger Operators in 2D
Authors: Fanelli Luca , Zhang Junyong , Zheng Jiqiang
Published: January 2023

We study the $L^{p}-L^{q}$-type uniform resolvent estimates for 2D-Schrödinger operators in scaling-critical magnetic fields, involving the Aharonov–Bohm model as a main example. As an application, we prove localization estimates for the eigenvalue of some non–self-adjoint zero-order perturbations of the magnetic Hamiltonian.
A Nationwide Survey of Training Pathways and Practice Trends of Endoscopic Submucosal Dissection in Canada
Authors: Li Suqing , Mosko Jeffrey , May Gary , Teshima Christopher
Published: January 2023

Background

Endoscopic submucosal dissection (ESD) has become an established standard for endoscopic removal of large gastrointestinal (GI) lesions and early GI malignancies. However, ESD is technically challenging and requires significant health care infrastructure. As such, its adoption in Canada has been relatively slow. The practice of ESD across Canada remains unclear. Our study aimed to provide a descriptive overview of training pathways and practice trends of ESD in Canada.

Methods

Current ESD practitioners across Canada were identified and invited to participate in an anonymous cross-sectional survey.

Results

Twenty-seven ESD practitioners were identified; survey response rate was 74%. Respondents were from 15 different institutions. All practitioners underwent international ESD training of some type. Fifty per cent pursued long-term ESD training programs. Ninety-five per cent attended short-term training courses. Sixty per cent and 40% performed hands-on live human upper and lower GI ESD, respectively, before independent practice. In practice, 70% saw an increase per year in number of procedures performed from 2015 to 2019. Sixty per cent were dissatisfied with their institution’s health care infrastructure to support ESD. Thirty-five per cent perceived their institution as supportive of expanding the practice of ESD.

Conclusions

Several challenges exist to the adoption of ESD in Canada. Training pathways are variable, with no set standards. In practice, practitioners express dissatisfaction with access to necessary infrastructure and feel poorly supported in expanding the practice of ESD. As ESD is increasingly the accepted standard for the treatment of many neoplastic GI lesions, greater collaboration between practitioners and institutions is crucial to standardize training and ensure patient access.
Incarcerated inguinal hernia containing urinary bladder and bladder calculi
Authors: McLain Sarah , Cecire Jack , Mekisic Allan
Published: January 2023

Inguinoscrotal herniation of the bladder is an uncommon condition. Clinicians should have a high index of suspicion for involvement of the bladder within a hernia when the lower urinary tract urinary symptoms are concurrently present in patients presenting with a painful groin lump. We report the case of a patient who presented with an inguinoscrotal hernia involving the urinary bladder, which was irreducible due to the fact that the herniated portion of the bladder contains multiple containing calculi. The patient underwent successful operative repair of the hernia and had an uncomplicated post-operative course. Key takeaway messages for clinicians are that the presence of lower urinary tract symptoms in a patient concurrently presenting with a groin lump should raise suspicion of bladder involvement within the hernia and that pre-operative imaging is valuable to identify the contents of the hernia to allow safe operative planning and to reduce the risk of bladder injury during surgery.
Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis
Authors: Huang Hsiao-Ching , Szwerinski Nina K , Nasrallah Catherine , Huang Qiwen , Chopra Vidita , Venditti Elizabeth M , Azar Kristen M J , Romanelli Robert J
Published: January 2023

Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21–25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants’ withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations.
Factors influencing the implementation of the EuroFIT lifestyle change program in professional football clubs in Europe: a qualitative study in four European countries
Authors: van Nassau Femke , Huis Anita , van de Glind Irene , Andersen Eivind , Bunn Christopher , Gray Cindy M , Hunt Kate , Jelsma Judith G M , van Mechelen Willem , Morgan Heather , Røynesdal Øystein , Pereira Hugo V , van der Ploeg Hidde P , Roberts Glyn C , Silva Marlene N , Sørensen Marit , Wyke Sally , Nijhuis-van der Sanden Maria W G , van Achterberg Theo
Published: January 2023

This paper investigated facilitators and barriers to implementing the European Football Fans in Training program (EuroFIT) in professional sports clubs in England, the Netherlands, Norway, and Portugal. We analyzed qualitative data collected at clubs that delivered EuroFIT, based on semi-structured interviews with coordinating staff (n = 15), coaches (n = 16), and focus group interviews with participants (n = 108), as well as data from clubs that considered delivering EuroFIT in the future, based on interviews with staff (n = 7) and stakeholders (n = 8). Facilitators for implementation related to the content and structure of the program, its evidence-base, and the context for delivery in the football stadia. Financial and human resources were both facilitators and barriers. Further barriers were mostly practical, relating to human resources and infrastructure. Major differences between countries related to experience and commitment to running community projects, and differences in infrastructure, financing, and human resources. Professional football clubs’ ability to support health promotion efforts depended on their ethos and the financial and human resources available to them. Overall, the EuroFIT program was well received by clubs, coaches, participants, and stakeholders, which was reflected by the many facilitators supporting sustained implementation. For sustainable implementation, it is crucial that clubs and their stakeholders engage fully with the EuroFIT program and understand that for an adequate program delivery their views (ethos) and ways of working influence the implementation and thereby the effectiveness of EuroFIT. An important prerequisite for future roll out of EuroFIT would be a strong EuroFIT delivery partner organization to ensure financial and human resources while overseeing and guiding the quality of delivery in clubs.
Implementing universal suicide screening in a large healthcare system’s hospitals: rates of screening, suicide risk, and documentation of subsequent psychiatric care
Authors: Dillon Ellis C , Huang Qiwen , Deng Sien , Li Martina , de Vera Ernell , Pesa Jacqueline , Nguyen Tam , Kiger Anna , Becker Daniel F , Azar Kristen
Published: January 2023

Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and χ2 tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.
Genome Sequence of the Streptomyces Strain AgN23 Revealed Expansion and Acquisition of Gene Repertoires Potentially Involved in Biocontrol Activity and Rhizosphere Colonization
Authors: Gayrard Damien , Nicolle Clément , Veyssière Marine , Adam Kévin , Martinez Yves , Vandecasteele Céline , Vidal Marie , Dumas Bernard , Rey Thomas
Published: January 2023

Streptomycetes are gram-positive actinobacteria largely represented in the plant root microbiota. The genetic determinants involved in the adaption of Streptomyces in the rhizosphere environment are mostly unknown but can rely on the ability to release phytohormones, degrade plant cell-wall polysaccharides, and produce specialized metabolites notably involved in microbial competition. Here, we sequenced the genome of the rhizospheric and plant defense-stimulating strain Streptomyces sp. AgN23. We found that it belongs to the soil- and plant root-dwelling S. violaceusniger clade. The genome annotation of AgN23 revealed the genetic potential of the bacterium to degrade the plant cell wall with a large repertoire of carbohydrate degrading enzymes, to synthesize auxin, a major regulator of plant development, and to produce antimicrobials (rustmicin, mediomycin, niphimycin, nigericin) and plant bioactive compounds (nigericin, echosides, elaiophylin) through a set of biosynthetic gene clusters. We also found that these genomic features are well conserved among members of the S. violaceusniger clade. In addition, AgN23 displays original events of biosynthetic gene cluster acquisitions and losses, which may account for its interaction with plants. Taken together, our work supports the hypothesis that evolution of a large set of conserved hydrolytic enzymes directed against plant polymers and specialized metabolite repertoires can mediate the adaptation of S. violaceusniger strains to the rhizospheric ecological niches.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy
Authors: Liu Mei-Ying , Wang Chao-Hui , Lee Shu-Hui , Chang Wen-Cheng , Wu Chiao-En , Liu Hsueh-Erh
Published: January 2023

Background

Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer.

Objective

This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction.

Methods

This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0.

Results

The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group.

Conclusion

For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia.

Implication for Practice

The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.
Realistic three-dimensional avian vocal tract model demonstrates how shape affects sound filtering (
Passer domesticus
)
Authors: Kazemi Alireza , Kesba Mariam , Provini Pauline
Published: January 2023

Despite the complex geometry of songbird's vocal system, it was typically modelled as a tube or with simple mathematical parameters to investigate sound filtering. Here, we developed an adjustable computational acoustic model of a sparrow's upper vocal tract (
Passer domesticus
), derived from micro-CT scans. We discovered that a 20% tracheal shortening or a 20° beak gape increase caused the vocal tract harmonic resonance to shift toward higher pitch (11.7% or 8.8%, respectively), predominantly in the mid-range frequencies (3–6 kHz). The oropharyngeal-oesophageal cavity (OEC), known for its role in sound filtering, was modelled as an adjustable three-dimensional cylinder. For a constant OEC volume, an elongated cylinder induced a higher frequency shift than a wide cylinder (70% versus 37%). We found that the OEC volume adjustments can modify the OEC first harmonic resonance at low frequencies (1.5–3 kHz) and the OEC third harmonic resonance at higher frequencies (6–8 kHz). This work demonstrates the need to consider the realistic geometry of the vocal system to accurately quantify its effect on sound filtering and show that sparrows can tune the entire range of produced sound frequencies to their vocal system resonances, by controlling the vocal tract shape, especially through complex OEC volume adjustments.
Does wing use and disuse cause behavioural and musculoskeletal changes in domestic fowl (
Gallus gallus domesticus
)?
Authors: Garant Renée C. , Tobalske Bret W. , Ben Sassi Neila , van Staaveren Nienke , Tulpan Dan , Widowski Tina , Powers Donald R. , Harlander-Matauschek Alexandra
Published: January 2023

Domestic chickens may live in environments which restrict wing muscle usage. Notably, reduced wing activity and accompanying muscle weakness are hypothesized risk factors for keel bone fractures and deviations. We used radio-frequency identification (RFID) to measure duration spent at elevated resources (feeders, nest-boxes), ultrasonography to measure muscle thickness (breast and lower leg) changes, radiography and palpation to determine fractures and deviations, respectively, following no, partial (one-sided wing sling) and full (cage) immobilization in white- and brown-feathered birds. We hypothesized partially immobilized hens would reduce elevated resource usage and that both immobilization groups would show decreased pectoralis thickness (disuse) and increased prevalence of fractures and deviations. Elevated nest-box usage was 42% lower following five weeks of partial immobilization for brown-feathered hens but no change in resource usage in white-feathered birds was observed. Fully immobilized, white-feathered hens showed a 17% reduction in pectoralis thickness, while the brown-feathered counterparts showed no change. Lastly, fractures and deviations were not affected in either strain or form of wing immobilization; however, overall low numbers of birds presented with these issues. Altogether, this study shows a profound difference between white- and brown-feathered hens in response to wing immobilization and associated muscle physiology.
Multi-scale analysis of concentration distribution in unsteady Couette–Poiseuille flows through a porous channel
Authors: Karmakar Timir , Barik Swarup , Raja Sekhar G. P.
Published: January 2023

A multiple-scale perturbation analysis is presented to analyse the two-dimensional concentration distribution of passive contaminant released in an incompressible viscous fluid flowing between two parallel plates filled with a porous medium. The flow is driven by the combined effect of the upper plate oscillation in its own plane moving with a constant velocity, and the periodic pressure gradient. Mei’s homogenization technique is used to find the concentration distribution up to third order, complemented with the dispersion coefficients for four different situations, namely, steady, pulsatile, oscillatory and the combined effect of all these. We observe that when the flow is under the combined effect of wall oscillation and pressure pulsation, then the respective frequency (Womersley number) and amplitude parameters oppose each other while influencing the dispersion coefficient. Our analysis reveals that for a fixed amplitude of oscillation and pulsation, the frequency of pressure pulsation has a stronger effect on the dispersion coefficient compared with the wall oscillation. On the other hand, when the Womersley number is kept fixed, amplitude of the wall oscillation dominates the pressure pulsation. This behaviour is more prominent for higher values of the Darcy number. The transverse concentration distribution and its dependency on porous medium parameters are also discussed in detail.