Carotid versus coronary atherosclerosis burdens in acute compared with chronic symptomatic coronary artery disease.

Prediction of coronary events remains elusive. Carotid atherosclerosis may be a surrogate for coronary risk, as carotid and coronary diseases occur simultaneously - albeit at times with a weak association - depending on clinical presentation. We investigated carotid and coronary atherosclerosis in men with new-onset unstable coronary artery disease (CAD) presenting with acute ST-segment elevation myocardial infarction (STEMI) vs. long-standing severe chronic stable angina (CSA). Bilateral carotid artery and 3-vessel coronary artery atherosclerosis burdens were measured within 1 month, respectively, by 3D-volumetric carotid magnetic resonance imaging and coronary angiography-derived modified CASS-50 score. Men with STEMI (n = 50) and long-standing CSA (n = 50), matched for age, were enrolled (58.6 ± 8.8 years). All of them had carotid atherosclerosis. Atherosclerosis burden was greater in the carotid arteries of STEMI vs. CSA (wall volume: 196.2 ± 44.4 vs. 169.2 ± 38.0 mm3/4 mm, p = 0.002), but greater in the coronary arteries of CSA vs. STEMI (modified CASS-50 score: 3 vs. 1, p < 0.0001). Normalized wall index (NWI) of internal carotid was associated with modified CASS-50 score in STEMI (ρ = 0.40, p = 0.022) and in CSA (ρ = -0.39, p = 0.031). Carotid atherosclerosis was observed in all CAD patients, and atherosclerosis burden in carotid and in coronary arteries varied according to clinical presentation.

Novel Z Scores to Correct Biases Due to Ventricular Volume Indexing to Body Surface Area in Adolescents and Young Adults.

BACKGROUND: Reference values for cardiac magnetic resonance imaging (cMRI) in children and young adults are scarce. This leads to risk stratification of patients with congenital heart diseases being based on volumes indexed to body surface area (BSA). We aimed to produce cMRI Z score equations for ventricular volumes in children and young adults and to test whether indexing to BSA resulted in an incorrect assessment of ventricular dilation according to sex, body composition, and growth. METHODS: We retrospectively included 372 subjects aged < 26 years with either normal hearts or conditions with no impact on ventricular volumes (reference group), and 205 subjects with repaired tetralogy of Fallot (TOF) aged < 26 years. We generated Z score equations by means of multivariable regression modelling. Right ventricular dilation was assessed with the use of Z scores and compared with indexing to BSA in TOF subjects. RESULTS: Ventricular volume Z scores were independent from age, sex, and anthropometric measurements, although volumes indexed to BSA showed significant residual association with sex and body size. In TOF subjects, indexing overestimated dilation in growing children and underestimated dilation in female compared with male subjects, and in overweight compared with lean subjects. CONCLUSIONS: Indexed ventricular volumes measured with cMRI did not completely adjust for body size and resulted in a differential error in the assessment of ventricular dilation according to sex and body size. Our proposed Z score equations solved this problem. Future studies should evaluate if ventricular volumes expressed as Z scores have a better prognostic value than volumes indexed to BSA.

Health research and innovation: Can we optimize the interface between startups/pharmaceutical companies and academic health care institutions or not?

Although France has numerous assets in the realm of health care, such as the excellence of its research teams, the reputation of its healthcare system, and the presence of many startups, all of which are necessary to become a leader in innovation, it also has combined cultural and regulatory barriers that limit the flexibility and efficiency of interactions between companies/startups and public health institutions. Therefore, the aim of the roundtable discussion was to optimize the interface between those businesses and institutions. Several institutions have successfully implemented teams and procedures which aim to facilitate this interface, with regard to assessments of technology, services provided, the transfer of biological material, R&D collaboration, and licensing agreements. However, there is still a notable absence of entrepreneurial culture among hospital and academic research practitioners; their training regarding innovation remains insufficient and business-related value-creation is non-existent in their career evolution. Pharmaceutical companies, and particularly startups, often lack knowledge about hospital environments and their constraints. As a result, the recommendations of the roundtable participants are as follows: (1) promote reciprocal acculturation between public health institutions and startups through multidisciplinary training in innovation, promoting project development and staff recognition within the institution, and improving pharmaceutical companies' understanding regarding the health care system; (2) provide those involved with means and resources dedicated to innovation by reserving time for innovation at work, securing the status of the staff involved, and aiding in the search for funding; (3) develop and use standard methodologies and tools; and (4) co-design and co-construct innovative health solutions, encouraging the emergence of participatory and interdisciplinary creative spaces. All of these recommendations should help to make the interface between startups/companies and public health institutions more fluid and attractive for those in the health sector.

Hypertriglyceridemic Waist: A Simple Marker of High-Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat.

BACKGROUND: Subclinical atherosclerosis identification remains challenging; abdominal visceral adiposity may improve risk stratification beyond traditional cardiovascular risk factors. Hypertriglyceridemic waist, a visceral adiposity marker combining elevated triglycerides (≥2 mmol/L) and waist circumference (≥90 cm), has been related to carotid atherosclerosis, although associations with high-risk features, including lipid-rich necrotic core (LRNC), remain unknown. We tested the hypothesis that hypertriglyceridemic waist is an independent marker of high-risk atherosclerosis features. METHODS AND RESULTS: In this cross-sectional study including 467 white men (mean age, 45.9±14.8 years; range 19.4-77.6 years), carotid atherosclerosis characteristics were examined by magnetic resonance imaging and associations with hypertriglyceridemic waist and benefits beyond Framingham Risk Score (FRS) and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) were determined. Subclinical carotid atherosclerosis was present in 61.9% of participants, whereas 50.1% had LRNC. Hypertriglyceridemic waist was associated with carotid maximum wall thickness (P=0.014), wall volume (P=0.025), normalized wall index (P=0.004), and Carotid Atherosclerosis Score (derived from wall thickness and LRNC; P=0.049). Hypertriglyceridemic waist was associated with carotid LRNC volume beyond FRS (P=0.037) or PDAY (P=0.015), contrary to waist circumference alone (both P>0.05). Although 69.7% and 62.0% of participants with carotid atherosclerosis and/or LRNC were not high-risk by FRS or PDAY, respectively, hypertriglyceridemic waist correctly reclassified 9.7% and 4.5% of them, respectively. Combining hypertriglyceridemic waist with FRS (net reclassification improvement=0.17; P<0.001) or PDAY (net reclassification improvement=0.05; P=0.003) was superior to each score alone in identifying individuals with carotid atherosclerosis and/or LRNC. CONCLUSIONS: Hypertriglyceridemic waist is an independent marker of carotid high-risk atherosclerosis features in men, improving on FRS and PDAY risk score.

Physical Health Problems and Environmental Challenges Influence Balancing Behaviour in Laying Hens.

With rising public concern for animal welfare, many major food chains and restaurants are changing their policies, strictly buying their eggs from non-cage producers. However, with the additional space in these cage-free systems to perform natural behaviours and movements comes the risk of injury. We evaluated the ability to maintain balance in adult laying hens with health problems (footpad dermatitis, keel damage, poor wing feather cover; n = 15) using a series of environmental challenges and compared such abilities with those of healthy birds (n = 5). Environmental challenges consisted of visual and spatial constraints, created using a head mask, perch obstacles, and static and swaying perch states. We hypothesized that perch movement, environmental challenges, and diminished physical health would negatively impact perching performance demonstrated as balance (as measured by time spent on perch and by number of falls of the perch) and would require more exaggerated correctional movements. We measured perching stability whereby each bird underwent eight 30-second trials on a static and swaying perch: with and without disrupted vision (head mask), with and without space limitations (obstacles) and combinations thereof. Video recordings (600 Hz) and a three-axis accelerometer/gyroscope (100 Hz) were used to measure the number of jumps/falls, latencies to leave the perch, as well as magnitude and direction of both linear and rotational balance-correcting movements. Laying hens with and without physical health problems, in both challenged and unchallenged environments, managed to perch and remain off the ground. We attribute this capacity to our training of the birds. Environmental challenges and physical state had an effect on the use of accelerations and rotations to stabilize themselves on a perch. Birds with physical health problems performed a higher frequency of rotational corrections to keep the body centered over the perch, whereas, for both health categories, environmental challenges required more intense and variable movement corrections. Collectively, these results provide novel empirical support for the effectiveness of training, and highlight that overcrowding, visual constraints, and poor physical health all reduce perching performance.

Use of emergency departments by known epileptic patients: An underestimated problem?

BACKGROUND AND PURPOSE: Seizure is a frequent reason of admission in emergency department (ED) but little is known about the proportion and the characteristics of known epileptic patients (KEPs) who used emergency services. METHODS: Over a 12-month period, we prospectively recruited adults admitted for seizure to a tertiary hospital ED. For KEPs, clinical epilepsy features and characteristics of the admission were collected. RESULTS: Of the 60,578 ED admissions, 990 were related to seizure; 580 of these admissions concerned 448 different KEPs (257 males; median age: 44); 339 were residents in the health district. Epilepsy was structural/metabolic in 268 (59.8%) patients, genetic in 44 (9.8%) and unknown/undetermined in 136 (30.3%); 218 (48.7%) patients were under a single antiepileptic drug and 135 (30.1%) were followed by an epileptologist. Of the 580 KEP admissions, 440 (75.8%) concerned patients who had called the emergency medical assistance number, 252 (43.4%) with a discharge diagnosis of usual seizure and 43 (7.4%) of a status epilepticus. Half the KEPs were discharged without hospitalization. We estimated that 9.0% of KEPs residing in the district had used the ED during the period. CONCLUSION: Proportion of KEPs using ED is high. Most of the admissions concerned usual seizures suggesting that staff training and educational programmes for patients and for their relatives need to be improved. The organization of the prehospital and of the emergency medical services should also be adjusted to this specific need. Further research should be conducted to optimize the seizure care pathway for KEPs.

Exploring the factors influencing discontinued hearing aid use in patients with unilateral cochlear implants.

Studies have shown that unilateral cochlear implant users who have residual hearing in the contralateral ear can benefit from combining a hearing aid in the nonimplanted ear with their cochlear implant. The purpose of this study was to better understand the factors influencing decision making by adults. Adults who had discontinued hearing aid use shortly after cochlear implantation were selected from one Canadian cochlear implant program. An examination of hearing aid use revealed that of 96 patients, who used hearing aids preimplant, 49 had discontinued hearing aid use. Patient perspectives on the decision and experience of combining a hearing aid and a cochlear implant were collected through 12 individual semistructured interviews. The interviews were analyzed qualitatively to identify key themes. Questionnaires, based on the interview findings, were developed and sent to the 49 adults to further explore the factors affecting hearing aid decisions. Interview and questionnaire findings from 28 adults indicated that three factors primarily influenced patients' decision to discontinue hearing aid use: their perceptions of the experience with hearing aids prior to implantation, their views of superiority of a unilateral cochlear implant in comparison with hearing aids, and their perceptions of interference with sound quality when a cochlear implant and hearing aid were combined. This study provides information about patient perceptions, experiences, and understanding of the potential difficulties of a bimodal fitting that may assist clinicians in pre- and postimplant counseling.