[The research of liver failure in Banna miniature pigs caused by amanita exitialis].

Objective: To explore the characteristics of Banna miniature pig liver failure induced by amanita exitialis. Methods: From September to October 2020, a reverse high performance liquid chromatography (RP-HPLC) method was used to determine the toxin content of amanita exitialis solution, and 2.0 mg/kg amanita exitialis solution (α-amanitins+ß-amanitins) was administered orally to Banna miniature pigs. Toxic symptoms, blood biochemical indexes and histopathological changes of liver, heart and kidney were observed at each time point. Results: All Banna miniature pigs died within 76 h of exposure, and different degrees of digestive tract symptoms such as nausea, vomiting and diarrhea appeared between 6 and 36 h. The biochemical indexes of alanine aminotransferase, aspartate aminotransferase, total bilirubin, lactate dehydrogenase, myoglobin, creatine kinase isoenzyme, blood urea nitrogen and creatinine increased significantly at 52 h after exposure, and the differences were statistically significant compared with 0 h (P<0.05). The bleeding of liver and heart was obvious under macroscopic and microscopic observation, hepatocyte necrosis, renal tubule epithelial cell swelling. Conclusion: Large dose of amanita exitialis can cause acute liver failure of Banna miniature pigs, which is in line with the pathophysiological characteristics of acute liver failure, and lays a foundation for further research on the toxic mechanism and detoxification drugs of amanita exitialis induced liver failure.

[Investigation on a case of Amanita neoovoidea poisoning].

This paper reported a case of poisoning caused by ingestion of Amanita neoovoidea. The patient experienced nausea, vomiting, oliguria, acute renal function injury, and was discharged after symptomatic support treatment and blood purification treatment. Given the different toxicity of different mushrooms, species identification of poisonous mushrooms can help clinicians in diagnosis and treatment.

[Three cases of mushroom poisoning caused by lethal Amanita species].

Mushroom poisoning with amatoxins can cause liver dysfunction in patients, and death in severe cases. The amatoxins detection by enzyme-linked immunosorbent assay (ELISA) can help early clinical diagnosis. Three patients were identified as α-amatoxin containing mushroom poisoning by ELISA. The first symptoms of patients was gastrointestinal symptoms, and liver function damage occured later. One patient gave up treatment and died. After received supportive treatments such as adsorption of toxins, catharsis, fluid supplementation to promote toxin metabolism and liver protection, 2 patients were recovered and discharged.

Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients.

BACKGROUND: Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. However, levofloxacin-resistant S. maltophilia (LRSM) are emerging worldwide. AIM: To investigate LRSM risk factors in hospitalized patients and to determine antibiotic susceptibility patterns of LRSM isolates. METHODS: In a retrospective matched case-control-control study, LRSM patients (the case group) were compared with two control groups: levofloxacin-susceptible S. maltophilia (LSSM) patients (control group A) and non-S. maltophilia-infected patients (control group B). Conditional logistic regression was used to analyse risk factors for LRSM occurrence. Tigecycline, ceftazidime, colistin, and trimethoprim/sulfamethoxazole (TMP/SMX) susceptibilities in collected LRSM clinical isolates were determined. FINDINGS: A total of 105 LRSM, 105 LSSM, and 105 non-S. maltophilia-infected patients were analysed. The first multivariate analysis (cases vs group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariate analysis (cases vs group B) revealed that previous fluoroquinolone use, previous intensive care unit stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic susceptibility, ceftazidime, TMP/SMX, tigecycline, and colistin resistance rates were 42.0, 99.0, 78.0, and 40.0%, respectively. CONCLUSION: LRSM antibiotic susceptibility patterns revealed multiple-drug resistance, which further limits treatment options for clinicians. To reduce LRSM occurrence, proper use of antibiotics, especially fluoroquinolones, is mandatory.

Effect of anti-mullerian hormone on stem cell factor in serum, follicular fluid and ovarian granular cells of polycystic ovarian syndrome patients.

OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a common disorder in gynecological practice. Anti-mullerian hormone (AMH) and ovarian granular stem cell factor (SCF) participate in the occurrence and progression of PCOS. This study aimed to investigate the expression of AMH and SCF in PCOS patients and attempt to analyze the effect of AMH on SCF. PATIENTS AND METHODS: Both PCOS and non-PCOS patients who received in vitro fertilization (IVF) in our hospital were recruited for measuring AMH and SCF levels in serum, ovarian follicular fluid and granular cells by using enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry (IHC) and Real-time PCR were employed to quantify mRNA and protein levels of SCF in ovarian granular cells after treatment using different dosages of AMH. RESULTS: AMH levels in serum, follicular fluid and granular cells in PCOS patients were significantly elevated, whilst SCF level was significantly decreased (p<0.05 in both cases). Therefore, there was a negative correlation between AMH and SCF level (p<0.05). In 5 ng/ml, 10 ng/ml and 15 ng/ml group, SCF protein positive rate was gradually decreased and was significantly lower compared to that of blank control (p<0.05). After treatment using AMH for 12, 24 and 48 h, SCF mRNA expression in the granular cell was significantly decreased (p<0.05). With higher dosage, SCF mRNA was gradually down-regulated in granular cells (p<0.05). CONCLUSIONS: High level of AMH and low level of SCF existed in serum, follicular fluid, and granular cells in PCOS patients. AMH exhibited negative regulatory effects on SCF.

Peritoneal dialysis effectively removes toxic substances and improves liver functions of liver failure patients.

OBJECTIVE: Liver failure (LF) is a clinically complex disorder that characterizes with hepatic dysfunction. This study aimed at observing the therapeutic effects of peritoneal dialysis on liver function in LF patients. PATIENTS AND METHODS: This study involves 62 patients diagnosed as LF hospitalized from February 2005 to December 2016. The 62 LF patients were randomly divided into 3 groups, including artificial liver applying plasma exchange group (PE, n = 28), peritoneal dialysis group (PD, n = 22), and conservative treatment group (CT, n=12). Laboratory indexes, including serum total bilirubin (TBiL), alanine aminotransferase (ALT), albumin (ALB), blood ammonia (AMMO), international normalized ratio (INR), and creatinine (Cr) were evaluated. Inflammatory cytokines, including tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and procalcitonin (PCT) were examined using enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: Peritoneal dialysis significantly improves clinical outcomes, including decreased mortality, increased survival rate and total effective rate, compared to conservative treatment (p < 0.05). Peritoneal dialysis reduced hospitalization expenses compared to PE method and conservative treatment (p < 0.05). Peritoneal dialysis significantly removed toxic substances (including TBiL, AMMO, Cr) compared to conservative treatment (p < 0.05). The post-treatment level of Cr in peritoneal dialysis group was significantly lower compared to post-treatment level of Cr in PE group (p < 0.05). Peritoneal dialysis significantly improved liver function compared to conservative treatment (p < 0.05). Peritoneal dialysis prevented bleeding tendency compared to conservative treatment (p < 0.05). Peritoneal dialysis alleviated inflammatory response compared to conservative treatment (p < 0.05). CONCLUSIONS: Peritoneal dialysis effectively removed toxic substances and improved liver functions of liver failure patients and with a lower therapeutic cost.

Empyema caused by Anaeroglobus geminates, a case report with literature review.

Little is known about the virulence and clinical impact on humans from infection with Anaeroglobus geminates, an anaerobic gram-negative coccus belonging to the family Veillonellaceae. We report the first case of an Anaeroglobus geminates invasive infection in humans characterized by pneumonia complicated with empyema. The pathogen was initially identified as Veillonella spp. by an automatic identification system (Becton-Dickinson and Company, Franklin Lakes, NJ, USA) and definitively identified following 16S ribosomal RNA gene sequence analysis. The patient was cured by surgical decortication and antimicrobial therapy. In this case, the combination of effective antibiotics, surgical intervention, and adequate drainage successfully cured the patient.

The effectiveness of metoprolol versus atenolol on prevention of all-cause and cardiovascular mortality in a large Chinese population: a cohort study.

BACKGROUND: Existing trials almost exclusively used atenolol to represent the entire ß-blocker class, and it is unknown whether there are intra-class differences. We compared the incidence of all-cause and cardiovascular mortality, blood pressure (BP) control and adherence levels between patients newly prescribed atenolol vs. metoprolol tartrate. METHODS: This cohort study included all public, clinical settings in Hong Kong between 2001 and 2005, followed up till 2010. We compared outcomes between 22,479 new atenolol users and 29,972 new metoprolol tartrate users. Cox proportional hazard regression analysis was used to evaluate the difference in mortality between drugs. Binary logistic regression analyses were used to compare the BP control rates and adherence levels. RESULTS: 7.0% and 13.1% died of any causes among atenolol and metoprolol users, respectively (p<0.005). The incidence of cardiovascular mortality among atenolol users was lower than metoprolol users (1.4% vs. 3.7%, p<0.001). When compared with atenolol users, metoprolol users were 1.13-fold (95% C.I. 1.06-1.20) and 1.56-fold (95% C.I. 1.27-1.90), respectively, more likely to experience all-cause and cardiovascular mortality; less likely to be drug adherent (adjusted relative risk [aRR]: 0.95, 95% C.I. 0.90-0.99, p=0.013); and less likely to achieve optimal overall BP control (aRR 0.94, 95% C.I. 0.90-0.99, p=0.023) and diastolic BP control (aRR 0.86, 95% C.I. 0.77-0.97, p=0.013). CONCLUSIONS: These findings imply an intra-class difference for beta-blockers when used as first-line antihypertensive prescriptions in real-life clinical settings which inform future clinical guidelines. More outcome studies on the effectiveness of different subtypes within other major antihypertensive drug classes are warranted.

Development of EST-SSR markers related to salt tolerance and their application in genetic diversity and evolution analysis in Gossypium.

Salt stress is becoming one of the major problems in global agriculture with the onset of global warming, an increasing scarcity of fresh water, and improper land irrigation and fertilization practices, which leads to reduction of crop output and even causes crop death. To speed up the exploitation of saline land, it is a good choice to grow plants with a high level of salt tolerance and economic benefits. As the leading fiber crop grown commercially worldwide, cotton is placed in the moderately salt-tolerant group of plant species, and there is promising potential to improve salt tolerance in cultivated cotton. To facilitate the mapping of salt-tolerant quantitative trait loci in cotton so as to serve the aims of salt-tolerant molecular breeding in cotton, it is necessary to develop salt-tolerant molecular markers. The objective of this research was to develop simple sequence repeat (SSR) markers based on cotton salt-tolerant expressed sequence tags. To test the efficacy of these SSR markers, their polymorphism and cross-species transferability were evaluated, and their value was further investigated on the basis of genetic diversity and evolution analysis.

Wearable cuff-less PTT-based system for overnight blood pressure monitoring.

A wearable cuff-less pulse transit time (PTT) based monitoring device is developed for ambulatory blood pressure (BP) monitoring. Ten healthy subjects (aged 27 ± 4 years old) underwent 24-hour ambulatory BP monitoring using 1) a standard brachial cuff-based oscillometric device as reference and 2) the proposed cuff-less PTT measuring system. Raw PTT and BP measurements were linearly interpolated and then smoothed by a low-pass filter to remove aliasing effect caused by the low sampling rate and synchronized. Resampled PTT and BP were assessed for correlation using correlation coefficients and Bland-Altman plots. Our study showed that PTT estimated systolic BP most accurately within 4.8 ± 4.3 mmHg on healthy young subjects during sleep time. We conclude from this study that the proposed cuff-less PTT-based BP monitoring system has potential to be a less intrusive alternative to standard oscillometric method for long-term overnight BP monitoring.

Predictors of the incidence of all-cause mortality and deaths due to diabetes and renal diseases among patients newly prescribed antihypertensive agents: a cohort study.

BACKGROUND: Randomized trials have shown that the major antihypertensive drug classes are similarly effective to reduce mortality, but whether these drug class difference exists in clinical practice has been scarcely explored. This study evaluated the association between antihypertensive drug class, all-cause mortality and deaths due to diabetes or renal disease in real-life clinical settings. METHODS: A clinical database in Hong Kong included all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and grouped according to the initial antihypertensive prescription. The associations between antihypertensive drug class, all-cause mortality or combined diabetes and renal mortality, respectively, were evaluated by Cox proportional hazard models. RESULTS: From 218,047 eligible patients, 33,288 (15.3%) died within five years after their first-ever antihypertensive prescription and among which 1055 patients (0.48%) died of diabetes or renal disease. After adjusted for age, gender, socioeconomic status, service settings, district of residence, medication adherence, and the number of comorbidities, each drug class was similarly likely to be associated with mortality due to diabetes or renal disease [Adjusted Hazard Ratios (AHR) ranged from 0.92 to 1.73, p=0.287-0.939] and all-cause mortality (AHR ranged from 0.83 to 1.02) except for beta-blockers (AHR=0.815, 95% C.I. 0.68-0.87, p=0.024) when ACEI was used as a reference group in propensity score-adjusted analysis. CONCLUSIONS: These findings provide real-life evidence reinforcing that any major antihypertensive drug class is suitable as a first-line agent for management of hypertension as recommended by international guidelines.

Initial antihypertensive prescription and switching: a 5 year cohort study from 250,851 patients.

PURPOSE: Adverse effects of antihypertensive therapy incur substantial cost. We evaluated whether any major classes of antihypertensive drugs were significantly associated with switching as a proxy measure of medication side effects in a large Chinese population in Hong Kong. METHODS: From a clinical database, all adult patients newly prescribed an antihypertensive mono-therapy in Hong Kong between the years 2001-2003 and 2005 were included. Those who paid only one visit, died or stayed in the cohort for <180 days after the prescription, or prescribed more than one antihypertensive agent were excluded. The factors associated with switching at 180 days were evaluated by multivariate regression analyses. Age, gender, payment status, service type, district of residence, drug class, systolic and diastolic blood pressure levels were predictor variables. RESULTS: From 250,851 subjects, 159,813 patients were eligible. A total of 6,163 (3.9%) switched their medications within 180 days. Patients prescribed thiazide diuretics had the highest switching rate (5.6%), followed by ACEIs (4.5%), CCBs (4.4%) and beta-blockers (3.2%). When compared with ACEIs, patients on thiazide diuretics were significantly more likely to be switchers (adjusted odds ratio [AOR] 1.49, 95% C.I. 1.31-1.69, p<0.001), whilst patients prescribed CCBs and beta-blockers were similarly likely to have switching. Following these patients up for 5 years showed that thiazide had the most marked increase in switching rate. CONCLUSIONS: The higher rates of switching among thiazide diuretics in this study might raise a probably greater incidence of their adverse effects in this Chinese population, yet other factors might also influence switching rates. Patients prescribed thiazide diuretics for longer term should be observed for their intolerability.

Drug adherence and the incidence of coronary heart disease- and stroke-specific mortality among 218,047 patients newly prescribed an antihypertensive medication: a five-year cohort study.

BACKGROUND: Randomized trials have shown that optimal adherence to antihypertensive agents could protect against cardiovascular diseases, but whether adherence reduces cardiovascular deaths in community settings has not been explored so fully. This study evaluates the association between antihypertensive adherence and cardiovascular (coronary heart disease and stroke) mortality in the primary care settings. METHODS: From a territory-wide database in Hong Kong, we included all patients who were prescribed their first-ever antihypertensive agents in the years between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and assigned as having poor (Proportion of Days Covered [PDC]<40%), intermediate (40-79%), and high (≥ 80%) adherence to antihypertensive agents. The association between antihypertensive adherence and cardiovascular mortality was evaluated by using the Cox proportional hazard models. RESULTS: From a total of 218,047 eligible patients, 3825 patients (1.75%) died of cardiovascular disease within five years after having received their first-ever antihypertensive agents. The proportions of patients having poor, intermediate, and high medication adherence were 32.9%, 12.1%, and 55.0%, respectively. Higher adherence levels at PDC 40%-79% (HR=0.46, 95% C.I. 0.41-0.52, p<0.001) and ≥ 80% (HR=0.91, 95% C.I. 0.85-0.98, p=0.012) were significantly less likely to be associated with mortality than the poor adherence (PDC0.040) group. CONCLUSIONS: Better antihypertensive adherence was associated with lower cardiovascular mortality. This highlights the need to promote adherence through strategies which have been proved to be effective in clinical settings.

SLICC/ACR damage index independently associated with left ventricular diastolic dysfunction in patients with systemic lupus erythematosus.

Left ventricular (LV) diastolic dysfunction has been reported in both active and inactive systemic lupus erythematosus (SLE) patients without clinical evidence of cardiovascular disease. However, the relationship between the long-term inflammatory burden reflected by the SLICC/ACR damage index and LV diastolic function has not been studied. Eighty-two SLE patients and 82 controls matched for age, sex, body mass index, blood pressure and heart rate underwent echocardiography with tissue Doppler imaging (TDI). LV diastolic function was estimated by the myocardial early diastolic velocity (E') at the lateral annulus. There were 51 patients (62.2%) with nephritis, 23 patients (28.0%) with hypertension, 21 patients (25.6%) with vasculitis, 16 patients (19.5%) with pulmonary hypertension, 4 patients (4.9%) with cerebrovascular disease and 2 patients (2.4%) with diabetes mellitus. Sixty-two patients (75.6%) were taking prednisone and 35 patients (42.7%) used a immunosuppressant. Forty-five patients (54.8%) had active disease and suffered from disease-related end-organ damage. Patients with SLICC/ACR damage index ≥1 had more evidence of LV diastolic dysfunction with lower lateral annulus E' (9.6 ± 3.4 vs 12.9 ± 3.5 cm/s, p < 0.001) than those without. In addition, the proportion of patients with abnormal LV myocardial relaxation (defined as lateral E' < 10.0 cm/s) (51.1% vs 16.2%, χ(2) = 10.8, p = 0.001) were significantly higher. Multivariate analysis showed that the SLICC/ACR damage index ≥1 was independently associated with LV diastolic dysfunction (OR = 3.80, 95%CI: 1.21-11.95, p = 0.023) after adjusting for hypertension, disease duration and medical therapy. This may suggest that the overall inflammatory burden in SLE, as reflected by SLICC/ACR damage index, is associated with the development of diastolic dysfunction in SLE patients.

Effects of rosuvastatin on subclinical atherosclerosis and arterial stiffness in rheumatoid arthritis: a randomized controlled pilot trial.

OBJECTIVE: To ascertain the effect of rosuvastatin on carotid atherosclerosis and arterial stiffness in patients with rheumatoid arthritis (RA). METHODS: Fifty RA patients were randomized in a double-blind placebo-controlled trial to receive 10 mg rosuvastatin (n = 24) or placebo (n = 26). Patients were followed prospectively every 3 months for 12 months. Intima-media thickness (IMT), augmentation index (AIx), and subendocardial viability ratio (SEVR) were measured at baseline, 6 and 12 months. RESULTS: Rosuvastatin resulted in statistically significant reductions of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and urate levels vs. placebo. However, rosuvastatin had no significant effect on changes in inflammatory markers, including C-reactive protein (CRP) levels [from 2.9 (1.4-11.0) to 3.1 (0.9-13.3) mg/L in the rosuvastatin group compared with from 5.8 (2.6-14.2) to 4.4 (1.2-12.3) mg/L in the placebo group]. Nonetheless, a significant improvement in the Disease Activity Score (DAS) and a reduction in fibrinogen level was observed at 6 and 12 months compared with baseline in the rosuvastatin group. The treatment group exhibited a significant increase in SEVR (from 157 ± 28% to 163 ± 33% in the rosuvastatin group compared with from 143 ± 18% to 143 ± 26% in the placebo group, p = 0.023), but no significant effect was observed in the changes in IMT and AIx. CONCLUSION: Our data suggest that rosuvastatin has a modest anti-inflammatory effect in RA patients with low disease activity in terms of reduction in DAS and fibrinogen level. Rosuvastastin may also improve subendocardial perfusion and lower the urate level.

Genotoxicity of fenpropathrin and fenitrothion on root tip cells of Vicia faba.

The genotoxicity of fenpropathrin and fenitrothion on root tip cells of Vicia faba was studied. The symptoms were investigated about the mitotic index, the micronucleus frequency and chromosomal aberration frequency of root tip cells of Vicia faba which were induced by different concentrations of fenpropathrin and fenitrothion (1 × 10(-10)-1 × 10(-2) g L(-1)). Results showed that fenpropathrin and fenitrothion could induce the micronucleus of root tip cells of Vicia faba. It occurred in a dose-dependent manner. Peaks were observed at 1 × 10( -6) g L(-1) fenpropathrin and 1 × 10(-4) g L(-1) fenitrothion, and micronucleus frequency reached 14.587 ± 1.511‰ and 14.164 ± 1.623‰, respectively. From 1 × 10(-10) g L(-1) to 1 × 10( -6) g L(-1) fenpropathrin and 1 × 10(-4) g L(-1) fenitrothion, the micronucleus frequency increased with the increase of the concentrations, but beyond this range, the micronucleus frequency decreased with the further increase of the concentrations. A similar trend was observed for mitotic index. Moreover, fenpropathrin and fenitrothion could induce various types of chromosome aberration, such as lagging chromosomes, chromosome fragment, chromosome bridge, multipolar, nuclear buds, karyorrhexis, etc.

Effects of cardiac resynchronisation therapy in patients with heart failure having a narrow QRS Complex enrolled in PROSPECT.

INTRODUCTION: Current guidelines recommend cardiac resynchronisation therapy (CRT) in patients with severe symptomatic heart failure, depressed left ventricular (LV) systolic function and a wide QRS complex (>or=120 ms). However, patients with heart failure having a narrow QRS complex might also benefit from CRT. DESIGN SETTING PATIENTS INTERVENTIONS: During the Predictors of Response to Cardiac Resynchronisation Therapy (PROSPECT) trial, 41 patients were enrolled in a 'narrow' QRS sub-study. These patients had a QRS complex <130 ms, but documented evidence of mechanical dyssynchrony by any of seven pre-defined echocardiographic measures. RESULTS: After 6 months of CRT, 26 (63.4%) patients showed improvement according to the Clinical Composite Score, 4 (9.8%) remained unchanged and 11 (26.8%) worsened. In patients with paired data, the 6-min walking distance increased from 334+/-118 m to 382+/-128 m, (p=0.003) and quality-of-life score improved from 44.2+/-19.7 to 26.8+/-20.2 (p<0.0001). Furthermore, there was a significant decrease in LV end-systolic diameter (from 59+/-9 to 55+/-12 mm, p=0.002) and in LV end-diastolic diameter (from 67+/-9 to 63+/-11 mm, p=0.007). CONCLUSION: The results suggest that CRT may have a beneficial effect in heart failure patients with a narrow QRS complex and mechanical dyssynchrony as assessed by echocardiography. The majority of patients improved on clinical symptoms, and there was an evident reduction in LV diameters. Larger studies are needed to clearly define selection criteria for CRT in patients with a narrow QRS complex.

Effect of household passive smoking exposure on the risk of ischaemic heart disease in never-smoke female patients in Hong Kong.

OBJECTIVE: To investigate the relation between household passive smoking exposure and risk of ischaemic heart disease (IHD) among never-smoke female patients by a retrospective case-control analysis. METHODS: This study recruited 314 patients with IHD who had never smoked and 319 controls who were admitted for other reasons in the same hospital during the same period. Subjects were interviewed about their exposure to household passive smoking. The dose metrics of passive smoking exposure were evaluated by using "pack years" and "hour years", which indicated the cumulative amount and duration of exposure. The ORs and 95% CIs were computed by unconditional logistic regression, adjusted for other risk factors. RESULTS: Subjects with passive smoking exposure were associated with higher risk of IHD (OR 1.51, 95% CI 1.01 to 2.27, p = 0.043) when compared to non-exposed subjects. Subjects exposed to an average of > or =1 pack of cigarette per day had an OR of 1.69 (95% CI 1.07 to 2.68, p = 0.025). The OR was 1.52 for those exposed for > or =5 years (95% CI 1.01 to 2.29, p = 0.043) and was 1.82 for those exposed > or =4 h per day (95% CI 1.05 to 3.15, p = 0.032). Similarly, the risk of IHD increased with cumulative exposure duration, with an OR of 1.53 (95% CI 1.01 to 2.32, p = 0.043) at the exposure level > or =5 pack years, and an OR of 1.61 (95% CI 1.03 to 2.52, p = 0.037) at the exposure level > or =20 hour years. There was a significant dose-response association between the exposure measures and risk of IHD (p<0.01 for trend). CONCLUSION: Our data suggested an increased risk of IHD from passive household smoking in female never-smoke subjects, and demonstrated a dose-response association.

Rationale and design of a prospective trial to assess the sensitivity and positive predictive value of implantable intrathoracic impedance monitoring in the prediction of heart failure hospitalizations: the SENSE-HF study.

BACKGROUND: Intrathoracic impedance monitoring is a new diagnostic tool for patients with heart failure that may aid early identification of decompensation and pulmonary congestion. METHODS AND RESULTS: The Sensitivity of the InSync Sentry feature for the Prediction of Heart Failure (ie, SENSE-HF) trial is a prospective multicenter international study designed to evaluate the sensitivity and positive predictive value (PPV) of the intrathoracic impedance diagnostic tool, OptiVol, present in Medtronic implantable devices. A total of 500 patients will be enrolled in the trial, with follow-up for up to 24 months. The study has 3 phases. Phase I is double-blind, and evaluates retrospectively the sensitivity and PPV of the intrathoracic impedance data for the prediction of hospitalization with the signs and/or symptoms of pulmonary congestion. At 6 months, the patient enters Phase II, which evaluates the clinical utility of the nominal "alarm" threshold value for identification of episodes of decompensation. The patient enters the final phase (Phase III) after an episode of decompensation correctly identified by the Fluid Trend data ("true" positive alarm), with data collection on how physicians use the Fluid Trend data to influence management. An end point committee adjudicates health care utilizations events (hospitalizations and doctor visits) for their association with signs and/or symptoms of pulmonary congestion. CONCLUSIONS: The study completed recruitment during 2008.