The reliability and validity of triceps surae muscle volume assessment using freehand three-dimensional ultrasound in typically developing infants.

This study assessed the intra-acquirer, intra- and inter-processor reliability, and validity of the in vivo assessment of the medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volumes using freehand 3D ultrasound (3DUS) in typically developing infants. Reliability assessments of freehand 3DUS were undertaken in infants across three ages groups: three, six and twelve months of age, with validity testing completed against magnetic resonance imaging (MRI) in infants at 3 months of age. Freehand 3DUS scanning was carried out by a single acquirer, with two independent processors manually segmenting images to render volumes. MRI images were segmented independently by a separate processor, with the volumes compared to those obtained via freehand 3DUS. Reliability was assessed using intraclass correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC) across each assessment time point. Validity was assessed using the limits of agreement. ICCs for intra-acquirer reliability of the acquisition process for freehand 3DUS ranged from 0.91 to 0.99 across all muscles. ICCs for intra-processor and inter-processor reliability for the segmentation process of freehand 3DUS ranged from 0.80 to 0.98 across all muscles. Acceptable levels of agreement between muscle volume obtained by freehand 3DUS and MRI were found for all muscles; however, freehand 3DUS overestimated muscle volume of MG and LG and underestimate the SOL compared with MRI, with average absolute differences of MG = 0.3 ml, LG = 0.3 ml and Sol = 1.2 ml. Freehand 3DUS is a reliable method for measuring in vivo triceps surae muscle volume in typically developing infants. We conclude that freehand 3DUS is a useful tool to assess changes in muscle volume in response to growth and interventions in infants.

Effects of neoadjuvant chemotherapy on the contralateral non-tumor-bearing breast assessed by diffuse optical tomography.

BACKGROUND: The purpose of this study is to evaluate whether the changes in optically derived parameters acquired with a diffuse optical tomography breast imager system (DOTBIS) in the contralateral non-tumor-bearing breast in patients administered neoadjuvant chemotherapy (NAC) for breast cancer are associated with pathologic complete response (pCR). METHODS: In this retrospective evaluation of 105 patients with stage II-III breast cancer, oxy-hemoglobin (ctO2Hb) from the contralateral non-tumor-bearing breast was collected and analyzed at different time points during NAC. The earliest monitoring imaging time point was after 2-3 weeks receiving taxane. Longitudinal data were analyzed using linear mixed-effects modeling to evaluate the contralateral breast ctO2Hb changes across chemotherapy when corrected for pCR status, age, and BMI. RESULTS: Patients who achieved pCR to NAC had an overall decrease of 3.88 µM for ctO2Hb (95% CI, 1.39 to 6.37 µM), p = .004, after 2-3 weeks. On the other hand, non-pCR subjects had a non-significant mean reduction of 0.14 µM (95% CI, - 1.30 to 1.58 µM), p > .05. Mixed-effect model results indicated a statistically significant negative relationship of ctO2Hb levels with BMI and age. CONCLUSIONS: This study demonstrates that the contralateral normal breast tissue assessed by DOTBIS is modifiable after NAC, with changes associated with pCR after only 2-3 weeks of chemotherapy.

Diffuse optical tomography breast imaging measurements are modifiable with pre-surgical targeted and endocrine therapies among women with early stage breast cancer.

PURPOSE: Diffuse optical tomography breast imaging system (DOTBIS) non-invasively measures tissue concentration of hemoglobin, which is a potential biomarker of short-term response to neoadjuvant chemotherapy. We evaluated whether DOTBIS-derived measurements are modifiable with targeted therapies, including AKT inhibition and endocrine therapy. METHODS: We conducted a proof of principle study in seven postmenopausal women with stage I-III breast cancer who were enrolled in pre-surgical studies of the AKT inhibitor MK-2206 (n = 4) or the aromatase inhibitors exemestane (n = 2) and letrozole (n = 1). We performed DOTBIS at baseline (before initiation of therapy) and post-therapy in the affected breast (tumor volume) and contralateral, unaffected breast, and measured tissue concentrations (in µM) of total hemoglobin (ctTHb), oxyhemoglobin (ctO2Hb), and deoxyhemoglobin (ctHHb), as well as water fraction (%). RESULTS: We found consistent decreases in DOTBIS-measured hemoglobin concentrations in tumor volume, with median percent changes for ctTHb, ctHHb, ctO2Hb, and water fraction for the entire cohort of - 27.1% (interquartile range [IQR] 37.5%), - 49.8% (IQR 29.3%), - 33.5% (IQR 47.4%), and - 3.6% (IQR 10.6%), respectively. In the contralateral breast, median percent changes for ctTHb, ctHHb, ctO2Hb, and water fraction were + 1.8% (IQR 26.7%), - 8.6% (IQR 29.3%), + 6.2% (IQR 29.5%), and + 1.9% (IQR 30.7%), respectively. CONCLUSION: We demonstrated that DOTBIS-derived measurements are modifiable with pre-surgical AKT inhibition and endocrine therapy, supporting further investigation of DOTBIS as a potential imaging assessment of response to neoadjuvant targeted therapies in early stage breast cancer.

Total FDG lesion number on PET/CT predicts survival of esophageal carcinoma patients with recurrence following curative surgery.

BACKGROUND: Total lesion number is a prognostic determinant in recurrent esophageal cancer, but this requires multiple tests. Here, we investigated the prognostic value of total FDG lesion number obtained from a single PET/CT study. METHODS: Subjects were 153 esophageal squamous cell carcinoma patients with loco-regional or distant recurrence following curative surgery. FDG PET/CT performed within 30 days was inspected for abnormal FDG uptake lesions using a SUVmax of 3.0 as threshold for significance. Prognostic associations were assessed by Cox proportional hazards regression and Kaplan-Meier analysis. RESULTS: PET/CT showed significant local FDG lesions in 49.0%, regional lesions in 78.4%, and distant lesions in 44.4% of patients. Among 73 patients with loco-regional recurrence, 54 had 0-3 and 19 had ≥4 FDG lesions. Among 80 patients with distant recurrence, 31 had 0-3 and 49 had ≥4 FDG lesions. During a median follow-up of 11.8 months, 99 deaths occurred. Univariate variables associated with poor survival included ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence. Kaplan Meier analysis showed worse survival for ≥4 than 0-3 FDG lesions in patients with loco-regional recurrence (15.6 vs. 32.1 months; P=0.009), but not in those with distant recurrence. Significant independent predictors of poor survival were ≥4 FDG lesions and no treatment for loco-regional recurrence and no treatment for distant recurrence. CONCLUSIONS: Total FDG lesion number assessed by PET/CT is a significant independent prognostic factor in esophageal cancer patients with loco-regional recurrence following curative surgery.

Myofibroblastoma of the breast in postmenopausal women: Two case reports with imaging findings and review of the literature.

Myofibroblastoma is a rare benign mesenchymal tumor of the breast, which tends to affect postmenopausal women and older men. It usually presents as a unilateral, well-circumscribed, firm, nontender, and freely mobile mass. We report two cases of myofibroblastoma in postmenopausal women with the imaging findings of mammography, ultrasonography, computed tomography, 18 F-Fluorodeoxyglucose-positron emission tomography computed tomography, and pathologic findings and review the relevant literature.

A text message intervention to support women's physical and mental health after breast cancer treatments (EMPOWER-SMS): a randomised controlled trial protocol.

BACKGROUND: Breast cancer is the most common cancer diagnosed in women worldwide. In developed countries, 80-90% of women will survive five years after diagnosis but the transition from hospital-based care to health self-management and self-efficacy can be difficult. Text messaging programs offer a simple and proven way to provide support to people with chronic diseases. This study aims to test the effectiveness of a text message support program at improving women's health self-efficacy, and physical and mental health outcomes after breast cancer treatments compared to usual care at 6-months and to understand the barriers and enablers to widespread implementation. METHODS: Single-blind randomised control trial (RCT; N = 160) comparing a text message support intervention to usual care in women with breast cancer (recruited from a large tertiary referral hospital in Sydney, Australia). The intervention group will receive a six-month text message support program, which consists of semi-personalised, supportive, lifestyle-focused text messages (4 messages/week) in addition to usual care. The control group will receive usual care without the text message program. Outcomes will be assessed at 6-months. The primary outcome is change in self-efficacy for managing chronic disease. Secondary outcomes include change in clinical outcomes (body mass index), lifestyle outcomes (physical activity levels, dietary behaviours), mood (depression and anxiety scales), quality of life, satisfaction with, and usefulness of the intervention. Analyses will be performed on the principle of intention-to-treat to examine differences between intervention and control groups. DISCUSSION: This study will test if a scalable and cost-effective text-messaging intervention is effective at improving women's health self-efficacy, as well as physical and mental health outcomes. Moreover, this study will provide essential preliminary data to bolster a large multicentre RCT to helpsupport breast cancer survivors throughout recovery and beyond. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12618002020268 , 17 December 2018.

Do psychosocial variables mediate the relationship between menopause symptoms and sexual function in middle-aged perimenopausal women?

AIM: To test a hypothetical path model evaluating the influence of menopause symptoms on sexual function among middle-aged perimenopausal women, as well as identify the mediating roles of body image, depression and sexual communication in this relationship. METHODS: We used a cross-sectional, correlational design. We included one exogenous variable (menopause symptoms) and four endogenous variables (body image, depression, sexual communication and sexual function) in the proposed model. All data were collected between January 19 and March 11, 2016, and analyzed using spss statistics 25.0 and AMOS 23.0. RESULTS: Eight of the nine hypothesized paths in the model were significant. Specifically, menopause symptoms were significantly associated with sexual function via the effects of body image, depression and sexual communication. CONCLUSION: This study may provide basic data for counseling and nursing programs to help improve sexual function in middle-aged perimenopausal women. Particularly, these programs should focus on the indirect paths via body image, depression and sexual communication, such as by improving body image and sexual communication and reducing depression.

Identifying Traffic Context Using Driving Stress: A Longitudinal Preliminary Case Study.

Many previous studies have identified that physiological responses of a driver are significantly associated with driving stress. However, research is limited to identifying the effects of traffic conditions (low vs. high traffic) and road types (highway vs. city) on driving stress. The objective of this study is to quantify the relationship between driving stress and traffic conditions, and driving stress and road types, respectively. In this study, electrodermal activity (EDA) signals for a male driver were collected in real road driving conditions for 60 min a day for 21 days. To classify the levels of driving stress (low vs. high), two separate models were developed by incorporating the statistical features of the EDA signals, one for traffic conditions and the other for road types. Both models were based on the application of EDA features with the logistic regression analysis. City driving turned out to be more stressful than highway driving. Traffic conditions, defined as traffic jam also significantly affected the stress level of the driver, when using the criteria of the vehicle speed of 40 km/h and standard deviation of the speed of 20 km/h. Relevance to industry: The classification results of the two models indicate that the traffic conditions and the road types are important features for driving stress and its related applications.

Dynamic Diffuse Optical Tomography for Monitoring Neoadjuvant Chemotherapy in Patients with Breast Cancer.

Purpose To identify dynamic optical imaging features that associate with the degree of pathologic response in patients with breast cancer during neoadjuvant chemotherapy (NAC). Materials and Methods Of 40 patients with breast cancer who participated in a longitudinal study between June 2011 and March 2016, 34 completed the study. There were 13 patients who obtained a pathologic complete response (pCR) and 21 patients who did not obtain a pCR. Imaging data from six subjects were excluded from the study because either the patients dropped out of the study before it was finished or there was an instrumentation malfunction. Two weeks into the treatment regimen, three-dimensional images of both breasts during a breath hold were acquired by using dynamic diffuse optical tomography. Features from the breath-hold traces were used to distinguish between response groups. Receiver operating characteristic (ROC) curves and sensitivity analysis were used to determine the degree of association with 5-month treatment outcome. Results An ROC curve analysis showed that this method could identify patients with a pCR with a positive predictive value of 70.6% (12 of 17), a negative predictive value of 94.1% (16 of 17), a sensitivity of 92.3% (12 of 13), a specificity of 76.2% (16 of 21), and an area under the ROC curve of 0.85. Conclusion Several dynamic optical imaging features obtained within 2 weeks of NAC initiation were identified that showed statistically significant differences between patients with pCR and patients without pCR as determined 5 months after treatment initiation. If confirmed in a larger cohort prospective study, these dynamic imaging features may be used to predict treatment outcome as early as 2 weeks after treatment initiation. © RSNA, 2018 Online supplemental material is available for this article.

Diffuse optical tomography changes correlate with residual cancer burden after neoadjuvant chemotherapy in breast cancer patients.

PURPOSE: Breast cancer (BC) patients who achieve a favorable residual cancer burden (RCB) after neoadjuvant chemotherapy (NACT) have an improved recurrence-free survival. Those who have an unfavorable RCB will have gone through months of ineffective chemotherapy. No ideal method exists to predict a favorable RCB early during NACT. Diffuse optical tomography (DOT) is a novel imaging modality that uses near-infrared light to assess hemoglobin concentrations within breast tumors. We hypothesized that the 2-week percent change in DOT-measured hemoglobin concentrations would associate with RCB. METHODS: We conducted an observational study of 40 women with stage II-IIIC BC who received standard NACT. DOT imaging was performed at baseline and 2 weeks after treatment initiation. We evaluated the associations between the RCB index (continuous measure), class (categorical 0, I, II, III), and response (RCB class 0/I = favorable, RCB class II/III = unfavorable) with changes in DOT-measured hemoglobin concentrations. RESULTS: The RCB index correlated significantly with the 2-week percent change in oxyhemoglobin [HbO2] (r = 0.5, p = 0.003), deoxyhemoglobin [Hb] (r = 0.37, p = 0.03), and total hemoglobin concentrations [HbT] (r = 0.5, p = 0.003). The RCB class and response significantly associated with the 2-week percent change in [HbO2] (p ≤ 0.01) and [HbT] (p ≤ 0.02). [HbT] 2-week percent change had sensitivity, specificity, positive, and negative predictive values for a favorable RCB response of 86.7, 68.4, 68.4, and 86.7%, respectively. CONCLUSION: The 2-week percent change in DOT-measured hemoglobin concentrations was associated with the RCB index, class, and response. DOT may help guide NACT for women with BC.

Assessment of Infantile Hemangiomas Using a Handheld Wireless Diffuse Optical Spectroscopic Device.

BACKGROUND/OBJECTIVES: Infantile hemangiomas (IHs) are vascular tumors with the potential for significant morbidity. There is a lack of validated objective tools to assess IH severity and response to treatment. Diffuse optical spectroscopy (DOS), a noninvasive, nonionizing imaging modality, can measure total hemoglobin concentration and hemoglobin oxygen saturation in tissue to assess IH vascularity and response to treatment. Our objective was to evaluate the utility of a wireless, handheld DOS system to assess IH characteristics at selected points during their clinical course. METHODS: Thirteen subjects (initial age 5.8 ± 2.0 mos) with 15 IHs were enrolled. IHs were classified as proliferative, plateau phase, or involuting. Nine patients with 11 IHs were untreated; four patients with 4 IHs were treated with timolol or propranolol. Each IH was evaluated by placing the DOS system directly on the lesion as well a normal contralateral skin site. IH vascularity and oxygenation were scored using a newly defined normalized hypoxia fraction (NHF) coefficient. Measurements were recorded at various intervals from the initial visit to 1 to 2 years of age. RESULTS: For the nine untreated IHs, the NHF was highest at 6 months of age, during proliferation. Differences in NHFs between the proliferation and the plateau (p = 0.02) and involuting (p < 0.001) stages were statistically significant. In treated patients, the NHF normalized to 60% after 2 months. One treated IH came within 5% of the NHF for normal skin after 12 months. CONCLUSIONS: DOS can be used to assess the vascularity and tissue oxygenation of IHs and monitor their progression and response to treatment.

Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes.

BACKGROUND: Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long-term glycaemic control in diabetes. AIMS: To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge. METHODS: This registry-based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis. RESULTS: Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7-87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST-Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence-based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19-1.18). CONCLUSION: Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.

Preparation of alpha-bisabolol and phenylethyl resorcinol/TiO2 hybrid composites for potential applications in cosmetics.

OBJECTIVE: Bifunctional alpha-bisabolol and phenylethyl resorcinol/TiO2 hybrids were prepared to apply in cosmetic fields, particularly in anti-ageing and hyperpigmentation treatment. The synergistic effect of combined antioxidant and UV filtering properties was achieved through functionalization of TiO2 particles with skin-lightening materials such as alpha-bisabolol and phenylethyl resorcinol. METHODS: TiO2 microspheres with a diameter of about 1 µm were synthesized through surfactant-assisted sol-gel method for use as supporting materials in the formation of hybrid composites. Carboxylation treatment was performed for surface modification of the TiO2 surface with carboxyl groups as chemical binders. Esterification reaction between carboxyl groups of carboxylated TiO2 and hydroxyl groups of alpha-bisabolol or phenylethyl resorcinol was performed. The hybrids were characterized using various techniques such as FE-SEM, DLS, EDS, ATR-FTIR, XPS and TGA. For application of prepared TiO2 composites in the field of cosmetics, the anti-radicular antioxidant abilities were evaluated using ABTS and DPPH colorimetric antioxidant assay. RESULTS: Organic/inorganic hybrid composites were successfully formed using esterification reaction between the carboxyl groups at TiO2 surface and the hydroxyl groups of the skin-lightening materials. The results demonstrate that both functionalized microspheres show scavenging ability towards the ABTS(•) and DPPH(•) radicals. Specifically, the phenylethyl resorcinol/TiO2 composites exhibited the highest antioxidant ability among the prepared samples owing to the presence of phenolic groups to scavenge free radicals. CONCLUSION: Using this strategy, it could be possible to prepare not only inorganic UV filter but also hybrid organic/inorganic materials with multifunctions and advantages which would be in a great demand for cosmetic applications.

Comparison of the management and in-hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit.

BACKGROUND/AIMS: We aimed to assess differences in patient management, and outcomes, of Australian and New Zealand patients admitted with a suspected or confirmed acute coronary syndrome (ACS). METHODS: We used comprehensive data from the binational Australia and New Zealand ACS 'SNAPSHOT' audit, acquired on individual patients admitted between 00.00 h on 14 May 2012 to 24.00 h on 27 May 2012. RESULTS: There were 4387 patient admissions, 3381 (77%) in Australia and 1006 (23%) in New Zealand; Australian patients were slightly younger (67 vs 69 years, P = 0.0044). Of the 2356 patients with confirmed ACS, Australian patients were at a lower cardiovascular risk with a lower median Global Registry Acute Coronary Events score (147 vs 154 P = 0.0008), but as likely to receive an invasive coronary angiogram (58% vs 54%, P = 0.082), or revascularisation with percutaneous coronary intervention (32% vs 31%, P = 0.92) or coronary artery bypass graft surgery (7.0% vs 5.6%, P = 0.32). Of the 1937 non-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP) patients, Australian patients had a shorter time to angiography (46 h vs 67 h, P < 0.0001). However, at discharge, Australian NSTEMI/UAP survivors were less likely to receive aspirin (84% vs 89%, P = 0.0079, a second anti-platelet agent (57% vs 63%, P = 0.050) or a beta blocker (67% vs 77%, P = 0.0002). In-hospital death rates were not different (2.7% vs 3.2%, P = 0.55) between Australia and New Zealand. CONCLUSIONS: Overall more similarities were seen, than differences, in the management of suspected or confirmed ACS patients between Australia and New Zealand. However, in several management areas, both countries could improve the service delivery to this high-risk patient group.

Fast linear solver for radiative transport equation with multiple right hand sides in diffuse optical tomography.

It is well known that radiative transfer equation (RTE) provides more accurate tomographic results than its diffusion approximation (DA). However, RTE-based tomographic reconstruction codes have limited applicability in practice due to their high computational cost. In this article, we propose a new efficient method for solving the RTE forward problem with multiple light sources in an all-at-once manner instead of solving it for each source separately. To this end, we introduce here a novel linear solver called block biconjugate gradient stabilized method (block BiCGStab) that makes full use of the shared information between different right hand sides to accelerate solution convergence. Two parallelized block BiCGStab methods are proposed for additional acceleration under limited threads situation. We evaluate the performance of this algorithm with numerical simulation studies involving the Delta-Eddington approximation to the scattering phase function. The results show that the single threading block RTE solver proposed here reduces computation time by a factor of 1.5~3 as compared to the traditional sequential solution method and the parallel block solver by a factor of 1.5 as compared to the traditional parallel sequential method. This block linear solver is, moreover, independent of discretization schemes and preconditioners used; thus further acceleration and higher accuracy can be expected when combined with other existing discretization schemes or preconditioners.

Differences in cardiovascular and hypothalamic-pituitary-adrenal axis functions between high-altitude visitors and natives during a trek on the Annapurna circuit.

OBJECTIVE: Differences in the cardiovascular and hypothalamic-pituitary-adrenal (HPA) axis functions at high altitudes (HAs) between visitors to and natives of HA were examined. METHODS: The cardiovascular functions and peripheral oxygen saturation (SPO2) were monitored, and the cortisol awakening response (CAR) and nighttime cortisol concentration (NCC), as indices of the HPA axis function, were determined in 25 trekkers and 21 Sherpas during an Annapurna circuit trek. RESULTS: SPO2 decreased less in the Sherpas than in the trekkers at HAs (3,540, 3,800, and 4,800 m). Blood pressure and heart rate in the Sherpas changed concurrently during the trek; however, a tachycardic response occurred without changes in blood pressure in the trekkers at HAs. The CAR and NCC at HAs in the trekkers differed from those observed at 1,100 m and those observed at HAs in the Sherpas. The trekkers exhibited an elevated morning cortisol level at 3,540 and 3,800 m, a heightened CAR at 4,800 m, and an elevated NCC at 3,800 m. Alteration of the CAR resulted in an increase in the integrated volume of cortisol released within the first hour after awakening (CARauc) in the trekkers. The changes in SPO2 occurred concurrently with the changes in the CARauc and the heart rate in the trekkers. CONCLUSIONS: The alterations of CAR occurred at HAs where blood pressure levels reached a peak plateau, which is associated with an increase in heart rate at HAs in the trekkers. The CAR was unaltered in the Sherpas during the trek.

Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia between 2011-2019.

Background: Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 2016-2018 advised that: 1. Stroke risk be estimated using the CHA2DS2-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants. Aim: To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011-2019. Method: De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA2DS2-VA score. High risk patients (i.e. CHA2DS2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management. Results: Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy. Conclusions: Stroke risk management among patients with AF has improved between 2011-2019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients.

ADAMTS7 Promotes Smooth Muscle Cell Foam Cell Expansion in Atherosclerosis.

Human genetic studies have repeatedly associated SNPs near the gene ADAMTS7 with atherosclerotic cardiovascular disease. Subsequent investigations in mice demonstrated that ADAMTS7 is proatherogenic, induced in response to vascular injury, and alters smooth muscle cell function. However, the mechanisms governing this function and its relationship to atherosclerosis remain unclear. Here, we report the first conditional Adamts7 transgenic mouse in which the gene can be conditionally overexpressed in smooth muscle cells, mimicking its induction in atherosclerosis. We observed that smooth muscle cell Adamts7 overexpression results in a 3.5-fold increase in peripheral atherosclerosis, coinciding with an expansion of smooth muscle foam cells. RNA sequencing of Adamts7 overexpressed primary smooth muscle cells revealed an upregulation in the expression of lipid uptake genes. Subsequent experiments in primary smooth muscle cells demonstrated that increased Spi1 and Cd36 expression leads to increased smooth muscle cell oxLDL uptake. To uncover ADAMTS7 expression in human disease, we have interrogated the largest scRNA-seq dataset of human carotid atherosclerosis. This analysis discovered that endothelial cells had the highest expression level of ADAMTS7 with lesser expression in smooth muscle cells, fibroblasts, and mast cells. Subsequent conditional knockout studies in smooth muscle cells surprisingly showed no change in atherosclerosis, suggesting redundant expression of this secreted factor in the vessel wall. Finally, mice overexpressing Adamts7 in endothelial cells also exhibit increased atherosclerosis, suggesting that multiple vascular cell types can contribute to ADAMTS7-mediated foam cell expansion. In summary, Adamts7 is expressed by multiple vascular cell types in atherosclerosis, and ADAMTS7 promotes oxLDL uptake in smooth muscle cells, increasing smooth muscle foam cell formation and peripheral atherosclerosis in mice.

Organochlorine pesticides and polychlorinated biphenyls in Korean human milk: contamination levels and infant risk assessment.

The levels of persistent organic pollutants (POPs) were determined in 50 samples of Korean human milk. POPs include organochlorine pesticides (OCPs) [aldrin, chlordanes, dieldrin, dichlorodiphenyltrichloroethanes (DDTs), endrins, heptachlors, hexachlorobenzene (HCB), hexachlorocyclohexanes (HCHs), mirex, and toxaphenes] and marker PCBs (PCB28, PCB52, PCB101, PCB138, PCB153 and PCB180). In all samples, p,p'-DDE were determined as 75.5-1115.3 ng/g fat. The compounds ß-HCH and p,p'-DDT were detected at 72% and 60% of the samples, respectively. Chlordanes (nd-84.9 ng/g fat) heptachlors (nd-40.1 ng/g fat), HCB (nd-42.9 ng/g fat) and PCBs (nd-38.3 ng/g fat) were detected in several samples. The ratio of dichlorodiphenyltrichloroethylene (DDE)/DDT was 6.8, which explained that exposure of volunteers to DDT did not occur recently. Compared with the previous monitoring data, the level of marker PCBs generally decreased in the milk samples. The levels of OCPs are significantly correlated to the residential periods of the mothers but not with their dietary habits. Considering the daily intake of each OCPs, 18% of infants would ingest the amount of heptachlor exceeding the acceptable daily intake (ADI) proposed by World Health Organization (WHO). There was no sample surpassing the WHO ADI for DDTs, HCB and chlordanes.

Application of artificial intelligence in medical technologies: A systematic review of main trends.

Objective: Artificial intelligence (AI) has been increasingly applied in various fields of science and technology. In line with the current research, medicine involves an increasing number of artificial intelligence technologies. The introduction of rapid AI can lead to positive and negative effects. This is a multilateral analytical literature review aimed at identifying the main branches and trends in the use of using artificial intelligence in medical technologies. Methods: The total number of literature sources reviewed is n = 89, and they are analyzed based on the literature reporting evidence-based guideline PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for a systematic review. Results: As a result, from the initially selected 198 references, 155 references were obtained from the databases and the remaining 43 sources were found on open internet as direct links to publications. Finally, 89 literature sources were evaluated after exclusion of unsuitable references based on the duplicated and generalized information without focusing on the users. Conclusions: This article is identifying the current state of artificial intelligence in medicine and prospects for future use. The findings of this review will be useful for healthcare and AI professionals for improving the circulation and use of medical AI from design to implementation stage.