Coma Recovery Scale-Revised Predicts Disability Rating Scale in Acute Rehabilitation of Severe Traumatic Brain Injury.

OBJECTIVE: To explore the prognostic value of the Coma Recovery Scale-Revised (CRS-R) in predicting disability outcomes in patients with severe traumatic brain injury using the Disability Rating Scale (DRS). DESIGN: Secondary analysis including linear and logistic regressions were performed. SETTING: Data were collected in a previous clinical trial. PARTICIPANTS: One hundred eighty-four participants across 3 countries (N=184). MAIN OUTCOME MEASURES: Disability Rating Scales. RESULTS: Analyses showed an inverse relation between CRS-R scores obtained at baseline and change in DRS scores at 6 weeks. Similarly, changes in CRS-R scores between baseline and 4 weeks were also found to have an inverse relation to change in DRS scores at 6 weeks. CONCLUSIONS: This study generates a tool that can be used to predict the probability that a patient with severe traumatic brain injury lands in 1 of 3 disability categories. The CRS-R may be useful in prognostication of disability in patients with severe traumatic brain injury.

Glycemic status, non-traditional risk and left ventricular structure and function in the Jackson Heart Study.

BACKGROUND: Left ventricular structure and function abnormalities may be an early marker of cardiomyopathy among African Americans with diabetes (DM) even in the absence of coronary artery disease (CAD), arrhythmia, valvular heart disease and end-stage renal disease (ESRD). This study examined the association of prediabetes (PDM), DM and HbA1c with left ventricular structure and function among Jackson Heart Study (JHS) participants without traditional risk factors. METHODS: Retrospective cross-sectional analyses of the association of PDM, DM and HbA1c with, left ventricular ejection fraction (LV EF), fractional shortening (LV FS), stroke volume index (SVI), cardiac index (CI), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), relative wall thickness (RWT), myocardial contraction fraction (MCF) and left ventricular mass index (LVMI). The study was conducted in 2234 adult JHS participants without preexisting CAD, arrhythmia, valvular heart disease or ESRD. Statistical analyses included descriptive, univariate and covariate adjusted linear regression analyses. Sensitivity analyses to explore the impact of hypertension on study outcomes were also carried out. RESULTS: DM compared with no DM was associated with lower, SVI (- 0.96 ml/m2, p = 0.029), LVEDVI (- 1.44 ml/m2 p = 0.015), and MCF (- 1.90% p = 0.007) but higher CI (0.14 L/min/m2, p < 0.001), RWT (0.01 cm, p = 0.002) and LVMI (2.29 g/m2, p = 0.009). After further control for DM duration, only CI remaining significantly higher for DM compared with no DM participants (0.12 L/min/m2, p = 0.009). PDM compared with no PDM was associated with lower, SVI (- 0.87 ml/m2, P = 0.024), LVEDVI (- 1.15 ml/m2 p = 0.003) and LVESVI (- 0.62 ml/m2 p = 0.025). HbA1c ≥ 8.0% compared with HbA1c < 5.7% was associated with lower SVI (- 2.09 ml/m2, p = 0.004), LVEDVI (- 2.11 ml/m2 p = 0.032) and MCF (- 2.94% p = 0.011) but higher CI (0.11 L/min/m2, p = 0.043) and RWT (0.01 cm, p = 0.035). CONCLUSIONS: Glycemic status is associated with important left ventricular structure and function changes among African Americans without prior CAD, arrhythmia, valvular heart disease and ESRD. Longitudinal studies may further elucidate these relationships.

Gastric Cancer Peritoneal Carcinomatosis Risk Score.

BACKGROUND: Gastric cancer (GC) peritoneal carcinomatosis (PC) is associated with a poor prognosis. Although grade, histology, and stage are associated with PC, the cumulative risk of PC when multiple risk factors are present is unknown. This study aimed to develop a cumulative GCPC risk score based on individual demographic/tumor characteristics. METHODS: Patient-level data (2004-2014) from the California Cancer Registry were reviewed by creating a keyword search algorithm to identify patients with gastric PC. Multivariable logistic regression was used to assess demographic/tumor characteristics associated with PC in a randomly selected testing cohort. Scores were assigned to risk factors based on beta coefficients from the logistic regression result, and these scores were applied to the remainder of the subjects (validation cohort). The summed scores of each risk factor formed the total risk score. These were grouped, showing the percentages of patients with PC. RESULTS: The study identified 4285 patients with gastric adenocarcinoma (2757 males, 64.3%). The median age of the patients was 67 years (interquartile range [IQR], 20 years). Most of the patients were non-Hispanic white (n = 1748, 40.8%), with proximal (n = 1675, 39.1%) and poorly differentiated (n = 2908, 67.9%) tumors. The characteristics most highly associated with PC were T4 (odds ratio [OR], 3.12; 95% confidence interval [CI], 2.19-4.44), overlapping location (OR 2.27; 95% CI 1.52-3.39), age of 20-40 years (OR 3.42; 95% CI 2.24-5.21), and Hispanic ethnicity (OR 1.86; 95% CI 1.36-2.54). The demographic/tumor characteristics used in the risk score included age, race/ethnicity, T stage, histology, tumor grade, and location. Increasing GCPC score was associated with increasing percentage of patients with PC. CONCLUSION: Based on demographic/tumor characteristics in GC, it is possible to distinguish groups with varying odds for PC. Understanding the risk for PC based on the cumulative effect of high-risk features can help clinicians to customize surveillance strategies and can aid in early identification of PC.

Strong Association Between Migraine and Transient Global Amnesia: A National Inpatient Sample Analysis.

The purpose of this article was to explore sex- and race-specific variables and comorbidities associated with transient global amnesia (TGA) using a nationally representative database. Data were obtained from the Nationwide Inpatient Sample using ICD-9 and procedure codes. Descriptive and survey logistic regression analyses were conducted and adjusted for influence of comorbidities, demographic characteristics, and hospitalization-related factors. Patients with migraines were 5.98 times more likely to also have a diagnosis of TGA compared with patients without migraines. Similarly, patients with TGA were more likely to have hypertension, precerebral disease, and hyperlipidemia. The odds of being diagnosed with TGA was lower among African Americans and Hispanics as well as among patients classified as Asian/Other, compared with Caucasians. TGA was associated with lower hospital charges ($14,242 versus $21,319), shorter hospital stays (mean days: 2.49 [SE=0.036] versus 4.72 [SE=0.025]), and routine hospital discharges (91.4% versus 74.5%). Patients with migraines and patients classified as Caucasian had higher odds of being diagnosed with TGA. All minority populations showed a lower rate of diagnosis that fell short of statistical significance.

Are perceptions of community safety associated with respiratory illness among a low-income, minority adult population?

BACKGROUND: Growing evidence suggests social disadvantage magnifies the harmful health effects of environmental hazards; however, there is limited research related to perceptions of risk among individuals who live near such environmental hazard sites. We explored the association between individual-level perception of community safety and respiratory illness among low-income, minority adults who live in a region with routine poor air quality exacerbated by the emissions of a nearby freight railyard. METHODS: Interview-administered household surveys were collected (87% response rate; n = 965) in English/Spanish from varying distances surrounding a freight railyard (analytic total n = 792: nearest region n = 215, middle n = 289, farthest n = 288). Illness outcome was an affirmative response to doctor-diagnosed asthma, bronchial condition, emphysema, COPD, or prescribed-inhaler usage. Respiratory symptoms outcome was an affirmative response to chronic cough, chronic mucus, or wheezing. The independent variable was perceived community safety. RESULTS: Outcome prevalences were similar across environmental hazard regions; 205 (25.9%) were diagnosed-illness cases and 166 (21.0%) diagnosis-free participants reported symptoms. Nearly half (47.5%) of participants reported lack of perceived community safety, which was associated with environmental hazard region (p <  0.0001). In multivariable log-binomial regression models adjusting for covariables (age, gender, race/ethnicity, smoking status, smoke exposure, residential duration, and distance from the railyard) respiratory illness diagnosis was associated with lack of perceived community safety (PR = 1.39; 95% CI 1.09, 1.76). Sensitivity analyses showed a non-significant but increasing trend in the strength of association between safety perceptions and illness diagnoses with closer proximity to the railyard. CONCLUSIONS: Our findings contribute to the literature that individuals' perceptions of community safety are associated with adverse respiratory health among a population living in high air pollution exposure areas.

The association between ambient fine particulate matter and incident adenocarcinoma subtype of lung cancer.

BACKGROUND: Adenocarcinoma (AC) is the most common lung cancer among non-smokers, but few studies have assessed the effect of PM2.5 on AC among never smokers. The purpose of this study was to assess the association between ambient PM2.5 and incident lung AC in the Adventist Health and Smog Study-2 (AHSMOG-2), a cohort of 80,044 non-smokers (81% never smokers) followed for 7.5 years (597,177 person-years) (2002-2011). METHODS: Incident lung AC was identified through linkage with U.S. state cancer registries. Ambient PM2.5 levels at subjects' residences were estimated for the years 2000 and 2001, immediately prior to study start. RESULTS: A total of 164 incident lung AC occurred during follow-up. Each 10 µg/m3 increment in PM2.5 was associated with an increase in the hazard rate of lung AC [HR = 1.31 (95% confidence interval (CI) 0.87-1.97)] in the single-pollutant model. Excluding those with prevalent non-melanoma skin cancer (NMSC) strengthened the association with lung AC (HR = 1.62 (95% CI, 1.11-2.36) for each 10 µg/m3 PM2.5 increment. Also, limiting the analyses to subjects who spent more than 1 h/day outdoors, increased the estimate (HR = 1.55, 95% CI: 1.05, 2.30). CONCLUSIONS: Increased risk of AC was observed for each 10 µg/m3 increment in ambient PM2.5 concentrations. The risk was higher among those without prevalent NMSC and those who spent more than 1 h/day outdoors.

Respiratory Health Risks for Children Living Near a Major Railyard.

Inland southern California is a region of public health concern, especially for children, given the area's perennially poor air quality and increasing sources of local pollution. One elementary school specifically is located only a few hundred yards from the San Bernardino Railyard, one of the busiest goods movement facilities in California, potentially increasing respiratory problems. Through ENRRICH (Environmental Railyard Research Impacting Community Health) Project, we assessed association of proximity to a major freight railyard on adverse respiratory health in schoolchildren. Respiratory screening was provided for children at two elementary schools: one near the railyard and a socio-demographically matched comparison school 7 miles away. Screening included testing for airway inflammation (FE NO), lung function (peak expiratory flow, PEF) and parent reported respiratory symptoms. Parental questionnaires collected additional information. Log-binomial and linear regression assessed associations. Children attending school near the railyard were more likely to exhibit airway obstruction with higher prevalence of abnormal PEF (<80%): prevalence ratio (PR) = 1.59 (95% CI 1.19-2.12). The association with inflammation was less clear. Children at the exposure school, who had lived 6 months or longer at their current address (vs. all children at that school) were more likely to have values suggesting inflammation (FE NO > 20 ppb) (PR = 1.44, 95% CI 1.02-2.02) and present with a trend for increased adverse respiratory symptoms. Children attending school near the railyard were significantly more likely to display respiratory health challenges. Ideally these low-income, low resource communities should be supported to implement sustainable intervention strategies to promote an environment where children can live healthier and thrive.

Outcomes of multimodality therapies for patients with stage II or III rectal cancer in California, 1994-2009.

BACKGROUND: Perioperative chemoradiotherapy is being used for the treatment of locally advanced rectal cancer to improve survival and reduce recurrence. Although several studies have prompted these changes, the survival benefits of additional chemoradiotherapy have not been adequately tested in a large-scale, population-based setting. OBJECTIVE: The purpose of this study was to evaluate survival differences between perioperative chemoradiotherapy and surgery alone for the treatment of rectal cancer. DESIGN: : This was a nonconcurrent cohort study of patients treated for rectal cancer stages II and III between 1994 and 2009. SETTING: The study was conducted through the California Cancer Registry. PATIENTS: Eligible patients were those with rectal cancer stage II or III who received either radical surgery alone (N = 2988) or perioperative chemoradiotherapy (N = 8852) during the study period. MAIN OUTCOME MEASURES: Cox proportional hazards regression was used to assess the risk of mortality associated with perioperative chemoradiotherapy versus surgery alone, adjusting for age, sex, race/ethnicity, socioeconomic status, tumor stage, month/year of surgery, and hospital factors. RESULTS: In multivariable binomial log-linear regression, the adjusted prevalence ratio (PR) for receiving perioperative chemoradiotherapy was lower among patients in the older age groups, especially among those ≥75 years of age (PR = 0.52 [95% CI, 0.49-0.55]), and increased monotonically from lowest (PR = 0.92 [95% CI, 0.89-0.95]) to highest socioeconomic status group (referent). Multivariable Cox proportional hazards regression analysis, adjusting for demographic factors, tumor stage, and hospital identification number, showed that perioperative chemoradiotherapy, relative to surgery alone, was associated with lower mortality during the entire study period, with survival benefit increasing over time (1994-1997: HR = 0.76 [95% CI, 0.66-0.88]; 1998-2001: HR = 0.71 [95% CI, 0.64-0.79]; 2002-2005: HR = 0.63 [95% CI, 0.55-0.71]; 2006-2008: HR = 0.47 [95% CI, 0.39-0.56]). LIMITATIONS: No information was available on comorbidities or specific surgeon factors, which could contribute to survival differences. CONCLUSIONS: Perioperative chemoradiotherapy, compared with surgery alone, was associated with significantly improved survival during the entire study period, with increasing benefit among those treated during the latter years of our studied time period. (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A120).

Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices.

This study aimed to investigate health belief as a major motive for diet and lifestyle behaviors of 100 vegans in the United States; and to determine congruence with selected health and nutrition outcomes. Response data from an administered questionnaire was analyzed. Statistical analyses determined the most common factors influencing diet choice; the number of vegans practicing particular lifestyle behaviors; body mass index; and prevalence of self-reported chronic disease diagnoses. Nutrient intakes were analyzed and assessed against Dietary Reference Intakes. Health was the most reported reason for diet choice (47%). In the health belief, animal welfare, and religious/other motive categories, low percentages of chronic disease diagnoses were reported: 27%, 11%, and 15%, respectively. There were no significant differences in health behaviors and indices among vegan motive categories, except for product fat content choices. Within the entire study population, health-related vegan motive coincided with regular exercise; 71% normal BMI (mean=22.6); minimal alcohol and smoking practices; frequently consumed vegetables, nuts, and grains; healthy choices in meal types, cooking methods, and low-fat product consumption; and adequate intakes for most protective nutrients when compared to reference values. But incongruence was found with 0% intake adequacy for vitamin D; and observation of excessive sodium use.

Effects of walnut consumption on cognitive performance in young adults.

Walnuts contain a number of potentially neuroprotective compounds like vitamin E, folate, melatonin, several antioxidative polyphenols and significant amounts of n-3 α-linolenic fatty acid. The present study sought to determine the effect of walnuts on verbal and non-verbal reasoning, memory and mood. A total of sixty-four college students were randomly assigned to two treatment sequences in a crossover fashion: walnuts-placebo or placebo-walnuts. Baseline data were collected for non-verbal reasoning, verbal reasoning, memory and mood states. Data were collected again after 8 weeks of intervention. After 6 weeks of washout, the intervention groups followed the diets in reverse order. Data were collected once more at the end of the 8-week intervention period. No significant increases were detected for mood, non-verbal reasoning or memory on the walnut-supplemented diet. However, inferential verbal reasoning increased significantly by 11.2 %, indicating a medium effect size (P = 0.009; d = 0.567). In young, healthy, normal adults, walnuts do not appear to improve memory, mood or non-verbal reasoning abilities. However, walnuts may have the ability to increase inferential reasoning.

Are total omega-3 and omega-6 polyunsaturated fatty acids predictors of fatal stroke in the Adventist Health Study 2 prospective cohort?

INTRODUCTION: The effects of omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFA) on cerebrovascular disease remain unsettled. However, most studies have focused on marine sourced n-3 PUFA rather than total n-3 PUFA, of which the majority in the American diet is plant derived. This study therefore intended to investigate these effects in a cohort for which the vegetarian diet was more prevalent than the general public. METHODS: Cox proportional hazards with fatal stroke as the outcome was performed on the approximately 96,000 subject Adventist Health Study 2 prospective cohort. Stratification by race and sex was performed on models with a priori covariables, comparing 90th to 10th percentile daily intakes of energy-adjusted total n-3 PUFA, total n-6 PUFA, and the n-6 / n-3 PUFA ratio as variables of interest. RESULTS: For the main analytical group (78,335 subjects), the hazard ratio (95% confidence interval) for total n-3 PUFA was 0.65 (0.51-0.83), and for total n-6 PUFA was 1.37 (1.02-1.82), while adjusting for both fatty acids in the model. The n-6 / n-3 PUFA ratio was harmful with a HR of 1.40 (1.16-1.69), whereas the inclusion of total n-3 PUFA slightly attenuated the HR to 1.33(1.02-1.74). Effects were similar for the non-black sex-combined and sex-specific analyses. CONCLUSION: In most analytic groups, subjects with greater total n-3 PUFA intakes have lower risk of fatal stroke, and those with a higher n-6 / n-3 PUFA ratio had higher risk. However, the n-6 / n-3 PUFA ratio remains statistically significant even after adjusting for total n-3 PUFA or total n-6 PUFA, suggesting that the ratio is of epidemiologic interest for cerebrovascular disease research.

Ambient air pollutants and risk of fatal coronary heart disease among kidney transplant recipients.

BACKGROUND: There is increasing evidence that specific ambient air pollutants are associated with coronary heart disease (CHD) morbidity and mortality. Because kidney transplant recipients have prevalent traditional and nontraditional risk factors, they may constitute a sensitive subgroup. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: This study includes 32,239 nonsmoking adult kidney transplant recipients who underwent transplant in 1997-2003, identified through the US Renal Data System and living in the United States within 50 km of an air pollution monitoring station. PREDICTOR: Long-term ambient pollutant ozone and particulate matter ≤10 µm (PM(10)), assessed from monthly concentrations of ozone and PM(10) calculated from ambient monitoring data by the US Environmental Protection Agency Air Quality System and interpolated to zip code centroids according to patients' residence. OUTCOMES: Outcomes of interest were death from CHD and natural-cause mortality. RESULTS: For the entire transplant cohort, average pollutant levels for ozone and PM(10) were 25.5 ± 4.4 parts per billion (ppb) and 25.3 ± 6.4 µg/m(3), respectively. Correlation between ozone and PM(10) values was low, but statistically significant (P < 0.001). There were deaths from CHD (n = 267) and natural causes (n = 2,076) during the 7-year study period. For each 10-ppb increase in ozone, the risk of fatal CHD increased by 35% (RR, 1.35; 95% CI, 1.04-1.77) in the single-pollutant model and 34% (RR, 1.34; 95% CI, 1.03-1.76) in the 2-pollutant model. No independent association was found between CHD and PM(10). No significant association was identified for PM(10) or ozone level and natural-cause mortality (RR, 1.09; 95% CI, 0.99-1.21). LIMITATIONS: Exposure assignment based on only residential location. CONCLUSIONS: For kidney transplant recipients, ambient ozone levels potentially are associated with higher risk of fatal CHD. These findings may have implications for regulations governing air pollution and the development of individual CHD risk-reduction strategies.

Dietary Animal to Plant Protein Ratio Is Associated with Risk Factors of Metabolic Syndrome in Participants of the AHS-2 Calibration Study.

BACKGROUND: Few research studies have focused on the effects of dietary protein on metabolic syndrome and its components. Our objective was to determine the relationship between the type of dietary protein intake and animal to plant (AP) protein ratio with metabolic syndrome and its components. METHODS: This population-based study had a cross sectional design and conducted on 518 participants of the Adventist Health Study 2 (AHS-2) Calibration Study. Two sets of three dietary 24-h recalls were obtained six months apart. Anthropometric measures and biochemical tests were performed in clinics. Regression calibration models were used to determine the association of type of dietary protein with metabolic syndrome and its components (raised triglyceride, raised blood pressure, reduced high-density lipoprotein cholesterol (HDL), raised fasting blood glucose and increased waist circumference). RESULTS: The likelihood of metabolic syndrome was lower in those with higher total dietary protein and animal protein intake (p = 0.02).Total protein (ß = 0.004, [95%CI: 0.002, 0.007]), animal protein intake (ß = 0.004, [95%CI: 0.001, 0.007]) and AP protein intake ratio (ß = 0.034, [95%CI: 0.021, 0.047]) were positively associated with waist circumference. Higher AP protein ratio was related to higher fasting blood glucose (ß = 0.023, [95%CI: 0.005, 0.041]). CONCLUSION: Our study suggests that considering a significant amount of plant protein as a part of total dietary protein has beneficial effects on cardiometabolic risk factors.

Real world outcomes of combination and timing of immunotherapy with radiotherapy for melanoma with brain metastases.

INTRODUCTION: Immunotherapy (IT) and radiotherapy (RT) have improved overall survival in patients with melanoma with brain metastasis (MBM). We examined the real-world survival impact of IT and RT combination and timing strategies. MATERIALS AND METHODS: From the facility-based National Cancer Database (NCDB) data set, 3008 cases of MBM were identified between 2011 and 2015. Six treatment cohorts were identified: stereotactic radiosurgery (SRS) + IT, SRS alone, whole brain radiotherapy (WBRT) + IT, WBRT alone, IT alone, and none. Concurrent therapy was defined as IT given within 28 days before or after RT; nonconcurrent defined as IT administered within 28-90 days of RT. The co-primary outcomes were propensity score-adjusted overall survival by treatment regimen and overall survival by RT and IT timing. RESULTS: Median overall survival (mOS) was performed for each treatment category; SRS +IT 15.77 m; (95%CI 12.13-21.29), SRS alone (9.33 m; 95%CI: 8.0-11.3), IT alone (7.29 m; 95%CI: 5.35-12.91), WBRT +IT (4.89 m; 95%CI: 3.65-5.92), No RT or IT (3.29 m; 95%CI: 2.96-3.75), and WBRT alone (3.12 m; 95%CI 2.79-3.52). By propensity score matching, mOS for SRS +IT (15.5 m; 95%CI: 11.5-20.2) was greater than SRS alone (10.1 m; 95%CI: 8.4-11.8) (p = 0.010), and median survival for WBRT +IT (4.6 m; 95%CI: 3.4-5.6) was greater than WBRT alone (2.9 m; 95%CI: 2.5-3.5) (p < 0.001). In the SRS +IT group, 24-month landmark survival was 47% (95%CI; 42-52) for concurrent versus 37% (95%CI; 30-44) for nonconcurrent (p = 0.40). CONCLUSION: Those who received IT in addition to WBRT and SRS experienced longer survival compared to RT modalities alone, while those receiving concurrent SRS and IT trended toward improved survival versus nonconcurrent therapy.

Validity of FFQ Estimates of Total Sugars, Added Sugars, Sucrose and Fructose Compared to Repeated 24-h Recalls in Adventist Health Study-2 Participants.

Sugar intake is a potentially important aspect of diet which has not previously been validated in the Adventist Health Study-2 (AHS-2). We sought to validate the food frequency questionnaire (FFQ) measurement of total sugars, added sugars, sucrose, and fructose against multiple 24-h dietary recalls (recalls) in AHS-2 participants. Food consumption data from a self-administered FFQ and six recalls from 904 participants were combined with nutrient profile data to estimate daily sugar intake. Validity was evaluated among all participants and by race. FFQ and recall means were compared and correlation coefficients (Spearman's, energy-adjusted log-transformed Pearson's, deattenuated Pearson's) were calculated. Mean total energy, total sugars, and fructose intake were higher in the FFQ, whereas added sugars and sucrose were higher in recalls. The energy-adjusted (log-transformed) deattenuated correlations among all participants were: total sugars (r = 0.42, 95% CI 0.32-0.52), added sugars (r = 0.50, 95% CI 0.36-0.59), sucrose (r = 0.32, 95% CI 0.23-0.42), and fructose (r = 0.50, 95% CI 0.40-0.59). We observed moderate validity for added sugars and fructose and low-moderate validity for total sugars and sucrose measured by the AHS-2 FFQ in this population. Dietary sugar estimates from this FFQ may be useful in assessing possible associations of sugars intake with health outcomes.

Racial Difference in the Association of Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients.

Ambient air pollutants are known risk factors for cardiovascular disease (CVD) morbidity and mortality with significant racial disparities. However, few studies have explored racial differences among highly susceptible subpopulations, such as renal transplant recipients (RTRs). Despite improvements in quality of life after transplantation, CVD remains the major cause of mortality, especially among Black recipients. This study aimed to evaluate potential racial differences in the association between long-term levels of PM2.5 and the risk of all-cause, total CVD, and coronary heart disease (CHD) mortality among RTRs. This retrospective study consists of 93,857 non-smoking adults who received a renal transplant between 2001 and 2015. Time-dependent Cox regression was used to assess the association between annual concentrations of PM2.5 and mortality risk. In the multivariable-adjusted models, a 10 µg/m3 increase in ambient PM2.5 levels found increased risk of all-cause (HR = 3.45, 95% CI: 3.08-3.78), CVD (HR = 2.38, 95% CI: 1.94-2.92), and CHD mortality (HR = 3.10, 95% CI: 1.96-4.90). Black recipients had higher risks of all-cause (HR = 4.09, 95% CI: 3.43-4.88) and CHD mortality (HR = 6.73, 95% CI: 2.96-15.32). High levels of ambient PM2.5 were associated with all-cause, CVD, and CHD mortality. The association tended to be higher among Black recipients than non-Blacks.

Platelet and neutrophil responses to Porphyromonas gingivalis in human whole blood.

Porphyromonas gingivalis is a causative agent for periodontal disease. Binding of platelets to this gram-negative anaerobe can regulate host hemostatic (thrombus forming) and immune (neutrophil interacting) responses during bacterial infection. Additionally, in response to bacterial pathogens neutrophils can release their DNA, forming highly prothrombotic neutrophil extracellular traps (NETs), which then further enhance platelet responses. This study evaluates the role of P. gingivalis on platelet expression of CD62P, platelet-neutrophil interactions, and labeled neutrophil-associated DNA. Human whole blood was preincubated with varying P. gingivalis concentrations, with or without subsequent addition of adenosine diphosphate (ADP). Flow cytometry was employed to measure platelet expression of CD62P using PerCP-anti-CD61 and PE-anti-CD62P, platelet-neutrophil interactions using PerCP-anti-CD61 and FITC-anti-CD16, and the release of neutrophil DNA using FITC-anti-CD16 and Sytox Blue labeling. Preincubation with a high (6.25 × 106  CFU/mL) level of P. gingivalis significantly increased platelet expression of CD62P in ADP treated and untreated whole blood. In addition, platelet-neutrophil interactions were significantly increased after ADP stimulation, following 5-22 min preincubation of blood with high P. gingivalis CFU. However, in the absence of added ADP, platelet-neutrophil interactions increased in a manner dependent on the preincubation time with P. gingivalis. Moreover, after ADP addition, 16 min preincubation of whole blood with P. gingivalis led to increased labeling of neutrophil-associated DNA. Taken together, the results suggest that the presence of P. gingivalis alters platelet and neutrophil responses to increase platelet activation, platelet interactions with neutrophils, and the level of neutrophil antimicrobial NETs.

Acute effect of a single high-fat meal on forearm blood flow, blood pressure and heart rate in healthy male Asians and Caucasians: a pilot study.

Research has shown that ingestion of a single high-fat (HF) meal causes postprandial lipemia and produces a reduced brachial artery blood flow response to vascular occlusion in Caucasians. However, the forearm BF response to occlusion in Caucasian and Asian populations after a single HF meal has not been compared. Eleven healthy male Asians, mean age 26.4 (+/- 4.2) years, height 174.2 (+/- 7.4) cm, and weight 73.8 (+/- 5.7) kg and eight Caucasians, mean age 26.8 (+/- 4.6) years, height 182.9 (+/- 5.9) cm, and weight 82.8 (+/- 4.8) kg were studied. A randomized cross-over study design was used with a HF (50.1 g total fat) or low-fat (LF) (5.1 g total fat) test meal 1 week apart. Forearm blood flow was measured over a 2-minute period following a 4-minute occlusion (FBFO) at 2 and 4 hours following ingestion of a test meal. This study found that FBFO was significantly attenuated in Asians (19.3%; p = 0.09) compared to Caucasians after the ingestion of a HF meal. When comparing LF vs. HF meals in Asians, the FBFO were 336.9 ml/100 ml tissue/ minute and 240.8 ml/100 ml tissue/minute, respectively (p = 0.02), whereas in Caucasians, the FBFO were 344.8 ml/100 ml tissue/minute and 287.4 ml/100 ml tissue/minute, respectively. It appears Asians have a more sensitive response to a single HF meal which may be explained, in part, by genotypic variation. These findings suggest that a single HF meal may contribute to the detrimental effects on vascular health in Asian males and raises speculation regarding the cumulative impact of a chronic HF diet in this population.

Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities.

Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities.

Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health Study-2.

The association between dietary patterns and CVD risk factors among non-Hispanic whites has not been fully studied. Data from 650 non-Hispanic white adults who participated in one of two clinical sub-studies (about 2 years after the baseline) of the Adventist Health Study-2 (AHS-2) were analysed. Four dietary patters were identified using a validated 204-item semi-quantitative FFQ completed at enrolment into AHS-2: vegans (8·3 %), lacto-ovo-vegetarians (44·3 %), pesco-vegetarians (10·6 %) and non-vegetarians (NV) (37·3 %). Dietary pattern-specific prevalence ratios (PR) of CVD risk factors were assessed adjusting for confounders with or without BMI as an additional covariable. The adjusted PR for hypertension, high total cholesterol and high LDL-cholesterol were lower in all three vegetarian groups. Among the lacto-ovo-vegetarians the PR were 0·57 (95 % CI 0·45, 0·73), 0·72 (95 % CI 0·59, 0·88) and 0·72 (95 % CI 0·58, 0·89), respectively, which remained significant after additionally adjusting for BMI. The vegans and the pesco-vegetarians had similar PR for hypertension at 0·46 (95 % CI 0·25, 0·83) and 0·62 (95 % CI 0·42, 0·91), respectively, but estimates were attenuated and marginally significant after adjustment for BMI. Compared with NV, the PR of obesity and abdominal adiposity, as well as other CVD risk factors, were significantly lower among the vegetarian groups. Similar results were found when limiting analyses to participants not being treated for CVD risk factors, with the vegans having the lowest mean BMI and waist circumference. Thus, compared with the diet of NV, vegetarian diets were associated with significantly lower levels of CVD risk factors among the non-Hispanic whites.