Low-density lipoprotein aggregation predicts adverse cardiovascular events in peripheral artery disease.

BACKGROUND AND AIMS: Peripheral artery disease (PAD) is a systemic manifestation of atherosclerosis that is associated with a high risk of major adverse cardiovascular events (MACE). LDL aggregation contributes to atherosclerotic plaque progression and may contribute to plaque instability. We aimed to determine if LDL aggregation is associated with MACE in patients with PAD undergoing lower extremity revascularization (LER). METHODS: Two hundred thirty-nine patients with PAD undergoing LER had blood collected at baseline and were followed prospectively for MACE (myocardial infarction, stroke, cardiovascular death) for one year. Nineteen age, sex and LDL-C-matched control subjects without cardiovascular disease also had blood drawn. Subject LDL was exposed to sphingomyelinase and LDL aggregate size measured via dynamic light scattering. RESULTS: Mean age was 72.3 ± 10.9 years, 32.6% were female, and LDL-cholesterol was 68 ± 25 mg/dL. LDL aggregation was inversely associated with triglycerides, but not associated with demographics, LDL-cholesterol or other risk factors. Maximal LDL aggregation occurred significantly earlier in subjects with PAD than in control subjects. 15.9% of subjects experienced MACE over one year. The 1st tertile (shortest time to maximal aggregation) exhibited significantly higher MACE (25% vs. 12.5% in tertile 2 and 10.1% in tertile 3, p = 0.012). After multivariable adjustment for demographics and CVD risk factors, the hazard ratio for MACE in the 1st tertile was 4.57 (95% CI 1.60-13.01; p = 0.004) compared to tertile 3. Inclusion of LDL aggregation in the Framingham Heart Study risk calculator for recurrent coronary heart disease events improved the c-index from 0.57 to 0.63 (p = 0.01). CONCLUSIONS: We show that in the setting of very well controlled LDL-cholesterol, patients with PAD with the most rapid LDL aggregation had a significantly elevated MACE risk following LER even after multivariable adjustment. This measure further improved the classification specificity of an established risk prediction tool. Our findings support broader investigation of this assay for risk stratification in patients with atherosclerotic CVD.

Internal Consistency and Convergent Validity of the Personality Assessment Inventory English and European-Spanish Version with English/Spanish Bilinguals.

Practitioners have few personality inventory options when assessing Spanish-speakers, despite professional guidelines that encourage them to administer measures that are validated with their populations of interest. To build on research in this area, we examined the internal consistency and convergent validity of the Personality Assessment Inventory (PAI) and the Personality Assessment Inventory European-Spanish (PAIE-S) version among bilingual Latin American Spanish-speakers (final n = 53). For the PAI, 72.72% of scales and 35.48% of subscales had alphas above .70. For the PAIE-S, 50.00% of scales and 25.81% of scales met this alpha. Participants tended to score lowest on the PAI Alcohol Problems scale (T = 47.19) and the PAIE-S Warmth scale (T = 45.49). On average, participants scored highest on the PAI's Paranoia-Hypervigilance scale (T = 61.15) and the PAIE-S's Paranoia scale (T = 57.64). We identified 10 scales and subscales on which participants were significantly more likely (p < .00094) to score higher on one measure than the other. Participants more often scored higher on the PAI than the PAIE-S. All parallel scales and subscales converged at p < .00094 with the exception of the Antisocial Features-Egocentricity scale. Taken together, findings suggest taking caution when administering these measures to Latin American bilingual Spanish-speakers.

Invasive monitoring after resection of epileptogenic neocortical lesions in multistaged epilepsy surgery in children.

OBJECTIVE: Incomplete resection of neocortical epileptogenic foci correlates with failed epilepsy surgery in children. We often treat patients with neocortical epilepsy with a staged approach using invasive monitoring to localize the focus, resect the seizure onset zone, and, in select cases, post-resection invasive monitoring (PRM). We report the technique and the outcomes of children treated with staged surgery including PRM. METHODS: We retrospectively reviewed the charts of pediatric patients with neocortical epilepsy who underwent resective surgery with PRM. RESULTS: We identified 71 patients, 5 patients with MRI-negative epilepsy and 66 patients with MRI-identified neocortical lesions; 64/66 (97%) patients had complete lesionectomy. In 61/71 (86%) patients PRM was associated with positive outcomes. Those findings were: 1) clinical seizures with electrographic involvement at resection margins (47%); 2) subclinical seizures and interictal discharges at resection margins (29%); and 3) clinical and subclinical seizures revealing a new epileptogenic focus (20%). In 55/71 (77%) patients, PRM data led to additional resection (re-resection; RR). Six additional patients had no further resection due to overlap with eloquent cortex. Histopathology showed tuberous sclerosis complex (TSC; n = 46), focal cortical dysplasia (FCD; n = 16)), gliosis (n = 4), tumors (n = 4), and Sturge-Weber syndrome (n = 1). There were no major complications. Seizure-free outcome in children with TSC was 63% at 1-year follow-up and 56% at 2-year follow-up. In FCD, seizure freedom after 1 and 2 years was 85%. SIGNIFICANCE: Post-resection monitoring may provide additional information about the extent of the epileptogenic zone, such as residual epileptogenic activity at the margins of the resection cavity, and may unmask additional seizure foci. This method may be especially useful in achieving long-term stable seizure-free outcome.

Time to Resolution of Symptoms After Suboccipital Decompression with Duraplasty in Children with Chiari Malformation Type I.

BACKGROUND: Duraplasty is a technique successfully used to treat Chiari malformation type I (CM-I). This study describes the timely manner of clinical outcomes and the postoperative course after craniectomy and duraplasty for the treatment of symptomatic CM-I in children. METHODS: A retrospective chart review was performed in 105 consecutive children who underwent surgical decompression of symptomatic CM-I with dural opening by a single surgeon between 1999 and 2015. RESULTS: In 16 of 28 children (57%) with typical Valsalva-related/tussive and mixed headaches, the symptoms resolved before discharge; by 6 months, all children were headache-free. Two of 28 children (7%) had recurrent headaches 9 months after surgery. Among the 78 children with syrinx, syrinx resolved or decreased in 68 (87%), recurred in 8 (10%), and was stable in 2 children (3%). Syrinx was resolved or decreased by 3 months in 51 children (65%) and by 6 months in 62 children (79%). Complications included aseptic meningitis requiring reoperation in 3 children (3%) and infection in one child (1%). Twelve children underwent reoperation, none within the first 30 days. No child had a major morbidity or mortality. CONCLUSIONS: In carefully selected children with CM-I, a high success rate can be achieved with suboccipital decompression and duraplasty. Valsalva-related/tussive headaches resolved by the time of discharge from the hospital in the majority of children, and syrinx resolved or decreased in two-thirds of the children by 3 months. By 6 months, headaches were resolved in all cases, and syrinx was resolved or decreased in 79% of cases.

Internal consistency and convergent validity of the Personality Assessment Inventory English and European-Spanish version with English/Spanish bilinguals

Practitioners have few personality inventory options when assessing Spanish-speakers, despite professional guidelines that encourage them to administer measures that are validated with their populations of interest. To build on research in this area, we examined the internal consistency and convergent validity of the Personality Assessment Inventory (PAI) and the Personality Assessment Inventory European-Spanish (PAIE-S) version among bilingual Latin American Spanish-speakers (final n = 53). For the PAI, 72.72% of scales and 35.48% of subscales had alphas above .70. For the PAIE-S, 50.00% of scales and 25.81% of scales met this alpha. Participants tended to score lowest on the PAI Alcohol Problems scale (T = 47.19) and the PAIE-S Warmth scale (T = 45.49). On average, participants scored highest on the PAI's Paranoia-Hypervigilance scale (T = 61.15) and the PAIE-S's Paranoia scale (T = 57.64). We identified 10 scales and subscales on which participants were significantly more likely (p < .00094) to score higher on one measure than the other. Participants more often scored higher on the PAI than the PAIE-S. All parallel scales and subscales converged at p < .00094 with the exception of the Antisocial Features-Egocentricity scale. Taken together, findings suggest taking caution when administering these measures to Latin American bilingual Spanish-speakers

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