Effect of prolonged pressure equalization on final drifting during pressure wire studies.

Pressure drifting is a troublesome error in invasive coronary function tests. This study aimed to evaluate the relationship between prolonged and short-time pressure equalizations in pressure drifting. Pressure drifting was defined as the pressure gradient between the mean pressure of the distal wire sensor (Pd) and aortic pressure (Pa) when the wire was withdrawn to the tip of the guiding catheter. Significant drifts 1 and 2 were defined as the absolute values of pressure gradients > 2 and > 3 mmHg, respectively. A logistic regression model was used to evaluate the associations between prolonged pressure equalization and each pressure drifting. The prolonged pressure equalization strategy was associated with a lower incidence of drift 1 than the short-time pressure equalization strategy (6.84% vs. 16.92%, p < 0.05). However, no statistical differences were found in the incidence of drift 2 between the prolonged and short-time pressure equalization strategies (4.27% vs. 7.69%, p = 0.34). In the multivariable regression model, only the prolonged pressure equalization strategy predicted a lower incidence of pressure drift 1. In conclusion, the prolonged pressure equalization strategy was associated with a lower incidence of significant pressure drifting with more stringent thresholds than the short-time pressure equalization strategy.

Subclinical myocardial injury increases the risk of heart failure in patients with and without type 2 diabetes post-acute coronary syndrome.

BACKGROUND: Little is known about the effect of subclinical myocardial injury (sMi) on heart failure (HF) risk after acute coronary syndrome (ACS). We examined the frequency patterns of sMi after ACS among patients with and without diabetes mellitus (DM), and the influence of sMis on HF risk at 1 year. METHODS: Fifty patients with ACS who underwent revascularization were prospectively enrolled. After discharge, serial study visits were conducted and high-sensitivity cardiac troponin T (hs-TnT) levels were checked at 3-month intervals for 1 year. sMi was defined as hs-TnT ≥14 ng/L without clinical symptoms. The primary endpoint was a composite of post-ACS chronic HF or significant left ventricular (LV) dysfunction without HF symptoms. A multivariable logistic regression model was used for risk evaluation. RESULTS: The mean patient age was 58 years, and 90% were men. Overall, 44% of patients had DM, and the median LV ejection fraction at discharge was 56%. Patients with DM had a higher incidence of sMi than those without DM (63.6% vs. 32.1%, P < 0.05). sMi occurred at least twice in most patients, and the prevalence declined over time in DM, but not in non-DM. Fourteen patients (28%) met the primary endpoint at 1 year, and the risk was higher in patients with DM (odds ratio: 4.99) and patients with sMi (odds ratio: 6.26). However, sMi was not a mediator of the association between DM and HF risk. CONCLUSIONS: Patients with DM had a higher incidence of sMi. Nonetheless, sMi increased the risk of HF after ACS, irrespective of diabetes status.

Seeking health information online among U.S. pregnant women: findings from the 2009-2018 National Health Interview Surveys.

Seeking health information online has gained in popularity. However, few studies have investigated seeking health information online among U.S. pregnant women. The aim of this study was to investigate the patterns, trends, and characteristics of pregnant women in the U.S. who seek health information online. We obtained data from the National Health Interview Survey from 2009 to 2018. The study population consisted of women aged 18 to 49 years who self-reported being pregnant. Complex survey weighting and Chi-squared tests were used to evaluate trends and compare characteristics of online users and nonusers. Multivariable logistic regression analyses were used to evaluate characteristics associated with seeking health information online. Significantly more pregnant women sought health information online in 2018 compared to 2009 (72.9 percent, standard error [SE]: 3.3, 95 percent confidence interval [CI]: 66.3 percent-79.5 percent, vs. 60.7 percent, SE: 3.3, 95 percent CI: 54.0 percent-67.4 percent, p < .01). Pregnant women who were identified as white or Black, who had more education, and who had higher incomes were significantly more likely to report seeking health information online. Healthcare providers should actively initiate conversations to address the safety, accuracy, and reliability of online health information for their pregnant patients.

Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.

Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia. Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute. Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest. Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively). Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Coronary Artery Revascularization in Chronic Kidney Disease.

Fractional flow reserve (FFR)-guided percutaneous coronary intervention has shown favorable long-term clinical outcomes. However, limited data exist evaluating the FFR assessment among the chronic kidney disease (CKD) population. The aim of this study was to evaluate the long-term clinical outcomes of FFR-guided coronary revascularization in patients with CKD. A total of 242 CKD patients who underwent FFR assessment were retrospectively analyzed. Patients were divided into two groups: revascularization (FFR ≤ 0.80) and non-revascularization (FFR > 0.80). The primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, and target vessel failure (TVF). The key secondary endpoint was TVF. The Cox regression model was used for risk evaluation. With 91% of the ischemic vessels revascularized, the revascularization group had higher risks for both the primary endpoint (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI], 1.07-3.97; p = 0.030) and key secondary endpoint (aHR: 2.19, 95% CI: 1.10-4.37; p = 0.026), during a median follow-up of 2.9 years. This result was consistent among different CKD severities. In patients with CKD, functional ischemia in coronary artery stenosis was associated with poor clinical outcomes despite coronary revascularization.

High dose escalation of intracoronary adenosine in the assessment of fractional flow reserve: A retrospective cohort study.

Maximal hyperaemia for fractional flow reserve (FFR) may not be achieved with the current recommended doses of intracoronary adenosine. Higher doses (up to 720 µg) have been reported to optimize hyperaemic stimuli in small dose-response studies. Real-world data from a large cohort of patients is needed to evaluate FFR results and the safety of high-dose escalation. This is a retrospective study aimed to evaluate the safety and frequency of FFR ≤0.8 after high-dose escalation of intracoronary adenosine. Data were extracted from the medical databases of two university hospitals. Increasing doses (100, 200, 400, 600, and 800 µg) of adenosine were administered as intracoronary boluses until FFR ≤0.8 was achieved or heart block developed. The percentage of FFR ≤0.8 after higher-dose escalation was compared with those at conventional doses, and the predictors for FFR ≤0.8 after higher doses were analysed. In the 1163 vessels of 878 patients, 402 vessels (34.6%) achieved FFR ≤0.8 at conventional doses and 623 vessels (53.6%) received high-dose escalation. An additional 84 vessels (13.5%) achieved FFR ≤0.8 after high-dose escalation. No major complications developed during high-dose escalation. Borderline FFR (0.81-0.85) at the conventional dose, stenosis >60%, and triple-vessel disease increased the likelihood of FFR ≤0.8 after high-dose escalation, but chronic kidney disease decreased it. For vessels of borderline FFR at conventional doses, 46% achieved FFR ≤0.8 after high-dose escalation. In conclusion, High-dose escalation of intracoronary adenosine increases the frequency of FFR ≤0.8 without major complications. It could be especially feasible for borderline FFR values near the 0.8 diagnostic threshold.

Selective Serotonin Reuptake Inhibitor Use and Risk of Arrhythmia: A Nationwide, Population-Based Cohort Study.

PURPOSE: This study compares the risks of arrhythmia among patients with depression receiving selective serotonin reuptake inhibitors (SSRIs) and those receiving other classes of antidepressants and among patients with depression receiving citalopram-escitalopram and those receiving other SSRIs. METHODS: This retrospective cohort study used data from the 2000-2011 National Health Insurance Research Database in Taiwan. Patients with depression who were new antidepressant users were included in the study sample. Propensity score matching was used to balance the covariates between the comparison groups. Crude incidence rates were generated by Poisson regressions, and Cox proportional hazards regression models were used to assess the rates of arrhythmia among SSRI users and nonusers of SSRI antidepressants as well as between citalopram-escitalopram users and users of other SSRIs. FINDINGS: Neither SSRI (hazard ratio [HR] = 0.95; 95% CI, 0.83-1.08) nor citalopram-escitalopram (HR = 1.20; 95% CI, 0.95-1.51) exposure was associated with a risk of arrhythmia compared with other, newer non-SSRI antidepressants or noncitalopram SSRIs. An increase in mortality was, however, observed among citalopram-escitalopram users (HR = 1.21; 95% CI, 1.08-1.31). IMPLICATIONS: Citalopram, escitalopram, and other SSRIs were not associated with an elevated risk of arrhythmia compared with each other or with non-SSRI antidepressants. Nevertheless, citalopram and escitalopram were associated with an increase in mortality risk compared with other SSRIs and deserve further investigation.

Recent progresses in outcome-dependent sampling with failure time data.

An outcome-dependent sampling (ODS) design is a retrospective sampling scheme where one observes the primary exposure variables with a probability that depends on the observed value of the outcome variable. When the outcome of interest is failure time, the observed data are often censored. By allowing the selection of the supplemental samples depends on whether the event of interest happens or not and oversampling subjects from the most informative regions, ODS design for the time-to-event data can reduce the cost of the study and improve the efficiency. We review recent progresses and advances in research on ODS designs with failure time data. This includes researches on ODS related designs like case-cohort design, generalized case-cohort design, stratified case-cohort design, general failure-time ODS design, length-biased sampling design and interval sampling design.

Statistical inferences for data from studies conducted with an aggregated multivariate outcome-dependent sample design.

Outcome-dependent sampling (ODS) scheme is a cost-effective sampling scheme where one observes the exposure with a probability that depends on the outcome. The well-known such design is the case-control design for binary response, the case-cohort design for the failure time data, and the general ODS design for a continuous response. While substantial work has been carried out for the univariate response case, statistical inference and design for the ODS with multivariate cases remain under-developed. Motivated by the need in biological studies for taking the advantage of the available responses for subjects in a cluster, we propose a multivariate outcome-dependent sampling (multivariate-ODS) design that is based on a general selection of the continuous responses within a cluster. The proposed inference procedure for the multivariate-ODS design is semiparametric where all the underlying distributions of covariates are modeled nonparametrically using the empirical likelihood methods. We show that the proposed estimator is consistent and developed the asymptotically normality properties. Simulation studies show that the proposed estimator is more efficient than the estimator obtained using only the simple-random-sample portion of the multivariate-ODS or the estimator from a simple random sample with the same sample size. The multivariate-ODS design together with the proposed estimator provides an approach to further improve study efficiency for a given fixed study budget. We illustrate the proposed design and estimator with an analysis of association of polychlorinated biphenyl exposure to hearing loss in children born to the Collaborative Perinatal Study. Copyright © 2016 John Wiley & Sons, Ltd.

Comparison of three-implant-supported fixed dentures and two-implant-retained overdentures in the edentulous mandible: a pilot study of treatment efficacy and patient satisfaction.

PURPOSE: The mandibular two-implant overdenture has been shown to be a highly successful treatment. However, overdenture patients who desire a fixed prosthesis may not be satisfied with a removable overdenture. This prospective study sought to compare prosthetic outcomes, patient satisfaction, and survival rates of implants between two-implant-supported overdentures (IODs) and three-implant-supported fixed dentures (ISFDs). MATERIALS AND METHODS: Twenty completely edentulous patients were randomly and equally assigned to two groups. New conventional complete dentures were made, and the mandibular denture was used as a surgical guide during implant placement. Implants were placed in one stage, followed by a mandibular denture soft reline (provisional loading). Ball attachments were inserted at 8 weeks, and ISFDs were delivered at 16 weeks. IODs were connected to the attachments at 8 weeks, using each patients's existing denture. The definitive ISFDs were fabricated using computer-aided design/computer-assisted manufacture milled titanium frameworks and acrylic resin base and teeth. Patient satisfaction and panoramic radiographs were investigated at 6 and 12 months. RESULTS: Both treatments had significant and positive effects on patient satisfaction and quality of life. None of the 50 implants placed had failed at 12 months of follow-up; therefore, the implant survival rate was 100%. Prosthetic complications were generally rare and easily manageable. CONCLUSIONS: Both the treatment modalities-the ISFD supported by three implants and the IOD supported by two implants-significantly and similarly improved patient satisfaction and oral health-related quality of life, and prosthetic complications were relatively rare for both treatments. Three implants can be used to support a mandibular fixed prosthesis; however, a longer observation period is needed to validate this treatment modality.

Phenotypic and physiologic variability in nasal epithelium cultured from smokers and non-smokers exposed to secondhand tobacco smoke.

The emergence of air-liquid interface (ALI) culturing of mammalian airway epithelium is a recent innovation for experimental modeling of airway epithelial development, function, and pathogenic mechanisms associated with infectious agent and irritant exposure. This construct provides an experimental platform for in vitro propagation, manipulation, and testing of airway epithelium in a structural and physiologic state that emulates in vivo organization. In this study, we have cultured nasal epithelial biopsies from human subjects with variable histories of tobacco smoke exposure and assessed ciliary beat frequency (CBF) after an extended interval in vitro relative to CBF determined on biopsies from the same subjects immediately upon acquisition. We observed elevated CBF in nasal epithelial biopsies as well as persistence of accelerated CBF in ALI cultures deriving from biopsies of smokers and non-smokers exposed to environmental tobacco smoke compared to CBF in cultures from biopsies of well-documented non-smokers. Moreover, cultures deriving from smokers exhibited reduced ciliation as the cultures matured. These studies document that nasal epithelium cultured in the ALI system retains physiologic and phenotypic characteristics of the epithelial layer in vivo even through rounds of proliferative expansion. These observations suggest that stable epigenetic factors affecting regulation of ciliary function and phenotype commitment may be operative.

The glutathione-S-transferase Mu 1 null genotype modulates ozone-induced airway inflammation in human subjects.

BACKGROUND: The glutathione-S-transferase Mu 1 (GSTM1) null genotype has been reported to be a risk factor for acute respiratory disease associated with increases in ambient air ozone levels. Ozone is known to cause an immediate decrease in lung function and increased airway inflammation. However, it is not known whether GSTM1 modulates these ozone responses in vivo in human subjects. OBJECTIVE: The purpose of this study was to determine whether the GSTM1 null genotype modulates ozone responses in human subjects. METHODS: Thirty-five healthy volunteers were genotyped for the GSTM1 null mutation and underwent a standard ozone exposure protocol to determine whether lung function and inflammatory responses to ozone were different between the 19 GSTM1 wild type and 16 GSTM1 null volunteers. RESULTS: GSTM1 did not modulate lung function responses to acute ozone. Granulocyte influx 4 hours after challenge was similar between GSTM1 normal and null volunteers. However, GSTM1 null volunteers had significantly increased airway neutrophils 24 hours after challenge, as well as increased expression of HLA-DR on airway macrophages and dendritic cells. CONCLUSION: The GSTM1 null genotype is associated with increased airways inflammation 24 hours after ozone exposure, which is consistent with the lag time observed between increased ambient air ozone exposure and exacerbations of lung disease.

Anemia and iron deficiency in pregnant Ghanaian women from urban areas.

OBJECTIVES: To determine the prevalence and identify risk factors for iron deficiency and anemia in pregnant Ghanaian women from urban areas. METHODS: A cross-sectional study of 452 healthy pregnant women receiving prenatal care in Accra, Ghana, was conducted. A sociodemographic health questionnaire was performed and hematologic parameters were measured. Logistic regression methods were used to identify risk factors for anemia and iron status. RESULTS: Complete data were available for 428 women. Anemia (hemoglobin <11 g/dL) was present in 144 (34%), iron deficiency (ferritin < or =16 microg/L) in 69 (16%), and iron deficiency anemia in 32 (7.5%) women. The adjusted odds ratio (OR) for anemia was 3.4 and 9.8 if iron deficiency and malaria parasitemia were present, respectively; the OR was 0.6 if women were at > or =36 weeks of pregnancy. The adjusted OR for iron deficiency was 2.7 if women were at > or =36 weeks of pregnancy and 0.12 if they had sickle trait. CONCLUSION: Although anemia and iron deficiency remain substantial problems in pregnant Ghanaian women from urban areas, their prevalence is less than previously reported.

Sex and menopausal status influence human dietary requirements for the nutrient choline.

BACKGROUND: Although humans require dietary choline for methyl donation, membrane function, and neurotransmission, choline can also be derived from the de novo synthesis of phosphatidylcholine, which is up-regulated by estrogen. A recommended Adequate Intake (AI) exists for choline; however, an Estimated Average Requirement has not been set because of a lack of sufficient human data. OBJECTIVE: The objective of the study was to evaluate the dietary requirements for choline in healthy men and women and to investigate the clinical sequelae of choline deficiency. DESIGN: Fifty-seven adult subjects (26 men, 16 premenopausal women, 15 postmenopausal women) were fed a diet containing 550 mg choline x 70 kg(-1) x d(-1) for 10 d followed by <50 mg choline x 70 kg(-1) x d(-1) with or without a folic acid supplement (400 microg/d per randomization) for up to 42 d. Subjects who developed organ dysfunction during this diet had normal organ function restored after incremental amounts of choline were added back to the diet. Blood and urine were monitored for signs of toxicity and metabolite concentrations, and liver fat was assessed by using magnetic resonance imaging. RESULTS: When deprived of dietary choline, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage, whereas only 44% of premenopausal women developed such signs of organ dysfunction. Moreover, 6 men developed these signs while consuming 550 mg choline x 70 kg(-1) x d(-1), the AI for choline. Folic acid supplementation did not alter the subjects' response. CONCLUSION: Subject characteristics (eg, menopausal status) modulated the dietary requirement for choline, and a daily intake at the current AI was not sufficient to prevent organ dysfunction in 19 of the subjects.