Reproducibility of global electrical heterogeneity measurements on 12-lead ECG: The Multi-Ethnic Study of Atherosclerosis.

OBJECTIVE: Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed clinical usefulness. We aimed to assess the reproducibility of GEH metrics. METHODS: GEH was measured on two 10-s 12­lead ECGs recorded on the same day in 4316 participants of the Multi-Ethnic Study of Atherosclerosis (age 69.4 ± 9.4 y; 2317(54%) female, 1728 (40%) white, 1138(26%) African-American, 519(12%) Asian-American, 931(22%) Hispanic-American). GEH was measured on a median beat, comprised of the normal sinus (N), atrial fibrillation/flutter (S), and ventricular-paced (VP) beats. Spatial ventricular gradient's (SVG's) scalar was measured as sum absolute QRST integral (SAIQRST) and vector magnitude QT integral (VMQTi). RESULTS: Two N ECGs with heart rate (HR) bias of -0.64 (95% limits of agreement [LOA] -5.68 to 5.21) showed spatial area QRS-T angle (aQRST) bias of -0.12 (95%LOA -14.8 to 14.5). Two S ECGs with HR bias of 0.20 (95%LOA -15.8 to 16.2) showed aQRST bias of 1.37 (95%LOA -33.2 to 35.9). Two VP ECGs with HR bias of 0.25 (95%LOA -3.0 to 3.5) showed aQRST bias of -1.03 (95%LOA -11.9 to 9.9). After excluding premature atrial or ventricular beat and two additional beats (before and after extrasystole), the number of cardiac beats included in a median beat did not affect the GEH reproducibility. Mean-centered log-transformed values of SAIQRST and VMQTi demonstrated perfect agreement (Bias 0; 95%LOA -0.092 to 0.092). CONCLUSION: GEH measurements on N, S, and VP median beats are reproducible. SVG's scalar can be measured as either SAIQRST or VMQTi. SIGNIFICANCE: Satisfactory reproducibility of GEH metrics supports their implementation.

Prophylactic host behaviour discourages pathogen exploitation.

Much work has considered the evolution of pathogens, but little is known about how they respond to changes in host behaviour. We build a model of sublethal disease effects where hosts are able to choose to engage in prophylactic measures that reduce the likelihood of disease transmission. This choice is mediated by utility costs and benefits associated with prophylaxis, and the fraction of hosts engaged in prophylaxis is also affected by population dynamics. When prophylactic host behaviour occurs, we find that the level of pathogen host exploitation is reduced, by the action of selection, relative to the level that would otherwise be predicted in the absence of prophylaxis. Our work emphasizes the significance of the transmission-recovery trade-off faced by the pathogen and the ability of the pathogen to influence host prophylactic behaviour.

Sexual Dysfunction in Gay and Bisexual Prostate Cancer Survivors: A Concept Analysis.

Sexual dysfunction is a common side effect of prostate cancer (PCa) treatment, yet it remains poorly defined in the literature. Current definitions are based on heteronormative assumptions which do not consider the unique experiences of gay and bisexual (GBM) PCa survivors. The purpose of this paper is to use Walker and Avant's method to conduct a concept analysis of sexual dysfunction among GBM in the context of PCa survivorship. The review included 46 articles published between 2002-2019. The following attributes were identified: (1) erectile dysfunction, (2) ejaculatory change (anhedonia/anejaculation), (3) urinary incontinence/climacturia, and (4) anodyspareunia. For GBM PCa survivors, sexual dysfunction involves reduced or abnormal functioning of four core elements of a sexual encounter, which inhibit GBM from engaging in and being satisfied with sexual activity.

Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review.

BACKGROUND AND OBJECTIVES: Establishing peripheral intravenous catheter (PIVC) access in infants and children is a common procedure but can be technically difficult. The primary objective was to determine the effect ultrasound had on first attempt PIVC insertion success rates in the pediatric population. Secondary objectives included overall success rates and subgroups analyses. METHODS: A systematic review of articles using Medline, Embase, CENTRAL, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Randomized trials evaluating ultrasound-guided PIVC insertion against the landmark approach in pediatric patients who reported at least 1 outcome of success rate (first attempt or overall) were included. Methodological quality of the literature was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis using a random-effects model was performed. RESULTS: Nine studies with 1350 patients, from a total of 1033 studies, were included for analysis. Ultrasound showed a statistically significant improvement in PIVC insertion success on first attempt in 5 of 8 studies, with an overall success rate of 78% in the ultrasound group and 66% in the control group. The secondary outcome of overall success was improved by ultrasound in studies that allowed ≥3 attempts (pooled OR 3.57, 95% CI 2.05 to 6.21, P < .001, I2 = 0.0%). CONCLUSIONS: This systematic review suggested that ultrasound improves pediatric PIVC first pass and overall success rates. Subgroup analysis showed improvement in PIVC success rates for patients with difficult intravenous access and a single operator, dynamic, short-axis ultrasound technique.

On maternity and the stronger immune response in women.

Medical research reports that women often exhibit stronger immune responses than men, while pathogens tend to be more virulent in men. Current explanations cannot account for this pattern, creating an obstacle for our understanding of infectious-disease outcomes and the incidence of autoimmune diseases. We offer an alternative explanation that relies on a fundamental difference between the sexes: maternity and the opportunities it creates for transmission of pathogens from mother to child (vertical transmission). Our explanation relies on a mathematical model of the co-evolution of host immunocompetence and pathogen virulence. Here, we show that when there is sufficient vertical transmission co-evolution leads women to defend strongly against temperate pathogens and men to defend weakly against aggressive pathogens, in keeping with medical observations. From a more applied perspective, we argue that limiting vertical transmission of infections would alleviate the disproportionate incidence of autoimmune diseases in women over evolutionary time.

Risk of Cardiovascular Events After COVID-19.

We aimed to determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular (CV) events and all-cause mortality. We conducted a retrospective double cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection (COVID-19+ cohort) and its documented absence (COVID-19- cohort). The study investigators drew a simple random sample of records from all patients under the Oregon Health & Science University Healthcare (n = 65,585), with available COVID-19 test results, performed March 1, 2020 to September 13, 2020. Exclusion criteria were age <18 years and no established Oregon Health & Science University care. The primary outcome was a composite of CV morbidity and mortality. All-cause mortality was the secondary outcome. The study population included 1,355 patients (mean age 48.7 ± 20.5 years; 770 women [57%], 977 White non-Hispanic [72%]; 1,072 ensured [79%]; 563 with CV disease history [42%]). During a median 6 months at risk, the primary composite outcome was observed in 38 of 319 patients who were COVID-19+ (12%) and 65 of 1,036 patients who were COVID-19- (6%). In the Cox regression, adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk for primary composite outcome (hazard ratio 1.71, 95% confidence interval 1.06 to 2.78, p = 0.029). Inverse probability-weighted estimation, conditioned for 31 covariates, showed that for every patient who was COVID-19+, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19-: average treatment effect on the treated -65.5 (95% confidence interval -125.4 to -5.61) days, p = 0.032. In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.

Clinical and Radiological Mid-Term Outcomes of Lumbar Single-Level Total Disc Replacement.

STUDY DESIGN: Prospective single-center case cohort study. OBJECTIVE: Evaluation of clinical and radiographic outcomes of a consecutive 122-patient cohort with discogenic back pain, at 2- to 10-year follow-up periods, treated by a single surgeon, with CHARITÉ Artificial Disc (DePuy Spine, Raynham, MA). SUMMARY OF BACKGROUND DATA: Minimum 2-year clinical and radiographic level 1 data for the first lumbar artificial disc, the CHARITÉ Artificial Disc (DePuy Spine), have recently been published, demonstrating sustained clinical benefit of the device for the treatment of degenerative disc disease. METHODS: Patients were assessed preoperatively using clinical outcome measures, including visual analog scale (VAS) score back and leg, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and Roland-Morris Questionnaires (RMDQ), and further assessed postoperatively, 3-, 6-, 12-months, and yearly thereafter. RESULTS: Average follow-up was 44.9 ±â€Š23.3 months (n = 122). The median age at surgery was 43.0 ±â€Š9.0 years. Preoperative diagnosis included degenerative disc disease in 118 (96.7%) and internal disc disruption in 4 (3.3%). Surgery was performed at L5-S1 in 96 (77.9%) patients and at L4-L5 in 27 (22.1%). Statistically significant clinical improvements from baseline were observed on VAS (back and leg), ODI, SF-36 PCS, SF-36 MCS, and RMDQ 3 months onward. Back VAS scores decreased from 78.2 ±â€Š21.3 preoperatively to 21.9 ±â€Š27.8 by final follow-up. ODI scores decreased from 51.1 ±â€Š17.3 to 16.2 ±â€Š17.9 at last follow-up. The RMDQ scores also decreased from 16.7 ±â€Š4.7 to 4.2 ±â€Š5.8. SF-36 PCS and MCS increased from 25.7 ±â€Š11.0 to 46.4 ±â€Š10.3 for PCS and from 35.5 ±â€Š17.4 to 51.6 ±â€Š10.8 for MCS. Patient satisfaction surveys indicated that 90.56% patients rated their satisfaction with the surgery as "excellent" or "good" at 2 years. Range of motion averaged 8.6 ±â€Š3.5 (median = 8.0°) at the last follow-up time point. CONCLUSION: Outcomes verify the clinical efficacy of total disc replacement for treatment of discogenic back pain with or without radiculopathy. The outcomes instruments demonstrated statistically significant improvements 3 months onward. LEVEL OF EVIDENCE: N/A.