Safety and antibody response of recipients who unexpectedly received undiluted prime dose of BNT162b2 COVID-19 vaccine in Taiwan.

We reported 25 recipients (14 females and 11 males) aged from 18 to 65 years who unexpectedly received a primary dose of undiluted BNT162b2 vaccine (180 µg). The most common adverse reactions included injection site pain (n = 22), followed by fever (9), fatigue (8), chest tightness (6), and dizziness (6). The most common laboratory abnormalities were anemia (n = 4) and elevated liver transaminase level (4), followed by abnormal leukocyte counts (3) and elevated D-dimer level (3). The adverse reactions and laboratory abnormalities of these recipients were mild and spontaneously recovered within a few weeks. Significant elevations of anti-SARS-CoV-2 spike IgG titers after a booster dose of the BNT162b2 were found. Similar to reports of BNT162b2 clinical trials, the adverse reactions and laboratory abnormalities of these recipients were mild, and they spontaneously recovered within a few weeks. These results provide clinical and immunological effects of undiluted BNT162b2 vaccine inoculation.

A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model.

Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.

Left Ventricular Dyssynchrony Predicts Left Main Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: The purpose of our study was to examine whether left ventricular dyssynchrony predicts left main coronary artery stenosis in patients with non-ST-segment elevation myocardial infarction. METHODS: A total of 100 consecutive patients with non-ST-segment elevation myocardial infarction underwent echocardiography and coronary artery angiography. The 3-dimensional echocardiography-derived left ventricular dyssynchrony parameter was determined by using the standard deviation of the time to the minimal systolic volume for the 16 segments. A stenosis ≥ 50% of the diameter of the left main coronary artery or a stenosis ≥ 70% in 1 or more of the major epicardial vessels or their main branches was considered significant. RESULTS: The logistic regression analysis revealed that this parameter (odds ratio 1.2; 95% confidence interval, 1.01-1.42; p = 0.04) was the independent predictor of left main coronary artery stenosis. The receiver operating characteristic curve analysis revealed 8.86 as the optimal cutoff value to predict left main coronary artery stenosis (sensitivity, 71.4%; specificity, 89.2%). CONCLUSIONS: The assessment of left ventricular dyssynchrony by 3-dimensional echocardiography is useful for a noninvasive diagnosis of the left main coronary artery stenosis in patients with non-ST-segment elevation myocardial infarction. KEY WORDS: Dyssynchrony; Left main coronary artery stenosis; Non-ST-segment elevation myocardial infarction.

Risk of major bleeding and thromboembolism in Asian patients with nonvalvular atrial fibrillation using direct oral anticoagulants versus warfarin.

Background Bleeding and thromboembolism prevention is important in patients with nonvalvular atrial fibrillation receiving anticoagulants, including direct oral anticoagulants and warfarin. Asians have higher risks of bleeding complications when taking anticoagulants. However, evidence that considers laboratory parameters is lacking. Objective We aimed to compare the safety and effectiveness between direct oral anticoagulants and warfarin in Asian patients with nonvalvular atrial fibrillation. Setting Retrospective design using hospital-based data. Method This propensity score-matched cohort study included data extracted from the electronic medical records of the En Chu Kong Hospital Research Database. Main outcome measure Outcome measures were major bleeding and thromboembolism. Cox proportional hazard models were applied for evaluating hazard ratios with 95% confidence intervals. Results Among 1075 patients with nonvalvular atrial fibrillation, 687 and 388 were administered direct oral anticoagulants and warfarin, respectively. After propensity score matching, 264 patient pairs were selected. Compared with warfarin use, direct oral anticoagulant use was associated with similar risks for major bleeding and thromboembolism; however, the latter was associated with increased gastrointestinal bleeding risks (adjusted hazard ratio 3.59; 95% confidence interval, 1.31-11.39). Notably, an approximately 10 fold increased risk of gastrointestinal bleeding was observed in 0-6 month direct oral anticoagulant users (adjusted hazard ratio 10.13, 95% confidence interval 1.27-80.89). Conclusion Direct oral anticoagulant use was not associated with major bleeding and thromboembolism occurrence in Asian patients with nonvalvular atrial fibrillation. However, direct oral anticoagulant use was associated with increased gastrointestinal bleeding risks, especially when used within 0-6 months of direct oral anticoagulant use.

Incremental changes in QRS duration predict mortality in patients with atrial fibrillation.

BACKGROUND: The purpose of this study was to evaluate serial changes in QRS duration in the 12-lead electrocardiogram (ECG) and their prognostic value in patients with atrial fibrillation (AF). METHODS: Retrospective evaluation of the 12-lead ECG was performed in 822 patients with AF. Inclusion criteria included AF in two sequential ECGs and an echocardiogram obtained within 7 days of the second ECG. The mean age of the 228 patients enrolled in the study was 71.2+/-12.9 and 45.6% were females. Nearly half of the patients had hypertension (49.5%) and a history of heart failure (44.7%). The patients were followed for 21+/-19 months, and the end point was all-cause mortality. RESULTS: Cox proportional hazards analysis demonstrated that the independent predictors of mortality in AF patients were age, renal insufficiency, a history of stroke, heart rate, incremental QRS prolongation (P=0.0418), and the absence of warfarin use. Patients with QRS prolongation>15 ms had a worse prognosis than those with QRS prolongation

Airflow obstruction and left ventricular filling pressure in suspected chronic obstructive pulmonary disease.

Left ventricular (LV) filling impairment is present in patients with chronic obstructive pulmonary disease (COPD). Airflow obstruction is related to reduced LV end-diastolic volume, stroke volume, and cardiac output. The ratio of peak early diastolic filling velocity of the mitral inflow to peak early diastolic velocity of the mitral annulus (E/e'), an echocardiographic parameter, can be applied as a surrogate marker of LV filling pressures. Forty-seven individuals with suspected COPD underwent pulmonary function tests and echocardiography. The ratio of forced expiratory volume in 1s to forced vital capacity (FEV1/FVC) and the E/e' ratio were determined. Multivariate linear regression analysis showed that the FEV1/FVC ratio (ß=0.01; 95% confidence interval, 0.001-0.019; p=0.036) independently predicted the log transformed E/e' ratio. An increase of FEV1/FVC ratio (in percentage) by 1 unit was associated with an increase of the E/e' ratio multiplied by 1.01. Airflow obstruction inversely predicts LV filling pressure in suspected COPD cases.

Serum vascular adhesion protein-1 level predicts risk of incident cancers in subjects with type II diabetes.

BACKGROUND: Serum vascular adhesion protein-1 (VAP-1) predicts cancer-related mortality in diabetic subjects. However, whether serum VAP-1 predicts cancer incidence or cancer progression remains unclear. We conducted a cohort study to investigate whether serum VAP-1 and related clinical variables predict incident cancers in type II diabetic subjects. METHODS: From 1996 to 2003, we enrolled 568 type II diabetic subjects who were free of cancer at baseline. Serum VAP-1 at enrollment was measured by time-resolved immunofluorometric assay. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2). The subjects were followed until first occurrence of cancer or until December 31, 2011. RESULTS: During a mean follow-up of 11.3 years, 71 subjects developed incident cancers. The HRs for incident cancers in subjects with highest tertile of serum VAP-1 and in subjects with CKD were 2.95 [95% confidence interval (CI), 1.31-6.63; P = 0.009] and 2.29 (95% CI, 1.18-4.44; P = 0.015), respectively, after multivariate adjustment. There was an interaction between serum VAP-1 and CKD on the risk of incident cancers (P = 0.01 for log-transformed VAP-1 × CKD). The relationship among serum VAP-1, CKD, and incident cancers was similar if death was considered in the competing risk models or if subjects with shorter follow-up period were excluded. CONCLUSIONS: Higher serum VAP-1 and CKD can independently predict future development of cancers in type II diabetic subjects. IMPACT: Physicians should be aware of the early signs of cancer in diabetic individuals with elevated VAP-1 or renal dysfunction. More aggressive treatment strategies might be considered.

Irradiation of pyrimidine in pure H2O ice with high-energy ultraviolet photons.

The detection of nucleobases, the informational subunits of DNA and RNA, in several meteorites suggests that these compounds of biological interest were formed via astrophysical, abiotic processes. This hypothesis is in agreement with recent laboratory studies of irradiation of pyrimidine in H2O-rich ices with vacuum UV photons emitted by an H2-discharge lamp in the 6.9-11.3 eV (110-180 nm) range at low temperature, shown to lead to the abiotic formation of several compounds including the nucleobases uracil, cytosine, and thymine. In this work, we irradiated H2O:pyrimidine ice mixtures under astrophysically relevant conditions (14 K, ≤10(-9) torr) with high-energy UV photons provided by a synchrotron source in three different ranges: the 0(th) order light (4.1-49.6 eV, 25-300 nm), the He i line (21.2 eV, 58.4 nm), and the He ii line (40.8 eV, 30.4 nm). The photodestruction of pyrimidine was monitored with IR spectroscopy, and the samples recovered at room temperature were analyzed with liquid and gas chromatographies. Uracil and its precursor 4(3H)-pyrimidone were found in all samples, with absolute and relative abundances varying significantly from one sample to another. These results support a scenario in which compounds of biological interest can be formed and survive in environments subjected to high-energy UV radiation fields.