Plasma Metabolites and Life's Simple 7 in REGARDS.

BACKGROUND: The American Heart Association's Life's Simple 7 (LS7) is a health metric that captures important factors associated with cardiovascular and cerebrovascular health. Previous studies highlight the potential of plasma metabolites to serve as a marker for lifestyle and health behavior that could be a target for stroke prevention. The objectives of this study were to identify metabolites that were associated with LS7 and incident ischemic stroke and mediate the relationship between the two. METHODS: Targeted metabolomic profiling of 162 metabolites by liquid chromatography-tandem mass spectrometry was used to identify candidate metabolites in a stroke case-cohort nested within the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Weighted linear regression and weighted Cox proportional hazard models were used to identify metabolites that were associated with LS7 and incident ischemic stroke, respectively. Effect measures were based on a 1-SD change in metabolite level. Metabolite mediators were examined using inverse odds ratio weighting mediation analysis. RESULTS: The study comprised 1075 ischemic stroke cases and 968 participants in the random cohort sample. Three out of 162 metabolites were associated with the overall LS7 score including guanosine (ß, -0.46 [95% CI, -0.65 to -0.27]; P=2.87×10-6), cotinine (ß, -0.49 [95% CI, -0.70 to -0.28]; P=7.74×10-6), and acetylneuraminic acid (ß, -0.59 [95% CI, -0.77 to -0.42]; P=4.29×10-11). Guanosine (hazard ratio, 1.47 [95% CI, 1.31-1.65]; P=6.97×10-11), cotinine (hazard ratio, 1.30 [95% CI, 1.16-1.44]; P=2.09×10-6), and acetylneuraminic acid (hazard ratio, 1.29 [95% CI, 1.15-1.45]; P=9.24×10-6) were associated with incident ischemic stroke. The mediation analysis identified guanosine (27% mediation, indirect effect; P=0.002), cotinine (30% mediation, indirect effect; P=0.004), and acetylneurminic acid (22% mediation, indirect effect; P=0.041) partially mediated the relationship between LS7 and ischemic stroke. CONCLUSIONS: We identified guanosine, cotinine, and acetylneuraminic acid that were associated with LS7, incident ischemic stroke, and mediated the relationship between LS7 and ischemic stroke.

Imaging intact human organs with local resolution of cellular structures using hierarchical phase-contrast tomography.

Imaging intact human organs from the organ to the cellular scale in three dimensions is a goal of biomedical imaging. To meet this challenge, we developed hierarchical phase-contrast tomography (HiP-CT), an X-ray phase propagation technique using the European Synchrotron Radiation Facility (ESRF)'s Extremely Brilliant Source (EBS). The spatial coherence of the ESRF-EBS combined with our beamline equipment, sample preparation and scanning developments enabled us to perform non-destructive, three-dimensional (3D) scans with hierarchically increasing resolution at any location in whole human organs. We applied HiP-CT to image five intact human organ types: brain, lung, heart, kidney and spleen. HiP-CT provided a structural overview of each whole organ followed by multiple higher-resolution volumes of interest, capturing organotypic functional units and certain individual specialized cells within intact human organs. We demonstrate the potential applications of HiP-CT through quantification and morphometry of glomeruli in an intact human kidney and identification of regional changes in the tissue architecture in a lung from a deceased donor with coronavirus disease 2019 (COVID-19).

Population-average mediation analysis for zero-inflated count outcomes.

Mediation analysis is an increasingly popular statistical method for explaining causal pathways to inform intervention. While methods have increased, there is still a dearth of robust mediation methods for count outcomes with excess zeroes. Current mediation methods addressing this issue are computationally intensive, biased, or challenging to interpret. To overcome these limitations, we propose a new mediation methodology for zero-inflated count outcomes using the marginalized zero-inflated Poisson (MZIP) model and the counterfactual approach to mediation. This novel work gives population-average mediation effects whose variance can be estimated rapidly via delta method. This methodology is extended to cases with exposure-mediator interactions. We apply this novel methodology to explore if diabetes diagnosis can explain BMI differences in healthcare utilization and test model performance via simulations comparing the proposed MZIP method to existing zero-inflated and Poisson methods. We find that our proposed method minimizes bias and computation time compared to alternative approaches while allowing for straight-forward interpretations.

Prevalence of iron deficiency and anemia in pediatric heart transplant recipients.

INTRODUCTION: The prevalence of iron deficiency and anemia in the setting of modern-day maintenance immunosuppression in pediatric heart transplant (HTx) recipients is unclear. The primary aim was to determine the prevalence of iron deficiency (serum ferritin < 30 ng/mL ± transferrin saturation < 20%) and anemia per World Health Organization diagnostic criteria and associated risk factors. METHODS: Single-center, cross-sectional analysis of 200 consecutive pediatric HTx recipients (<21 years old) from 2005 to 2021. Data were collected at 1-year post-HTx at the time of annual protocol biopsy. RESULTS: Median age at transplant was 3 years (IQR .5-12.2). The median ferritin level was 32 ng/mL with 46% having ferritin < 30 ng/mL. Median transferrin saturation (TSAT) was 22% with 47% having TSAT < 20%. Median hemoglobin was 11 g/dL with 54% having anemia. Multivariable analysis revealed lower absolute lymphocyte count, TSAT < 20%, and estimated glomerular filtration rate <75 mL/min/1.73 m2 were independently associated with anemia. Ferritin < 30 ng/mL in isolation was not associated with anemia. Ferritin < 30 ng/mL may aid in detecting absolute iron deficiency while TSAT < 20% may be useful in identifying patients with functional iron deficiency ± anemia in pediatric HTx recipients. CONCLUSION: Iron deficiency and anemia are highly prevalent in pediatric HTx recipients. Future studies are needed to assess the impact of iron deficiency, whether with or without anemia, on clinical outcomes in pediatric HTx recipients.

Microbial Sources and Sinks of Nitrous Oxide during Organic Waste Composting.

Composting is widely used for organic waste management and is also a major source of nitrous oxide (N2O) emission. New insight into microbial sources and sinks is essential for process regulation to reduce N2O emission from composting. This study used genome-resolved metagenomics to decipher the genomic structures and physiological behaviors of individual bacteria for N2O sources and sinks during composting. Results showed that several nosZ-lacking denitrifiers in feedstocks drove N2O emission at the beginning of the composting. Such emission became negligible at the thermophilic stage, as high temperatures inhibited all denitrifiers for N2O production except for those containing nirK. The nosZ-lacking denitrifiers were notably enriched to increase N2O production at the cooling stage. Nevertheless, organic biodegradation limited energy availability for chemotaxis and flagellar assembly to restrain nirKS-containing denitrifiers for nitrate reduction toward N2O sources but insignificantly interrupt norBC- and nosZ-containing bacteria (particularly nosZ-containing nondenitrifiers) for N2O sinks by capturing N2O and nitric oxide (NO) for energy production, thereby reducing N2O emission at the mature stage. Furthermore, nosZII-type bacteria included all nosZ-containing nondenitrifiers and dominated N2O sinks. Thus, targeted strategies can be developed to restrict the physiological behaviors of nirKS-containing denitrifiers and expand the taxonomic distribution of nosZ for effective N2O mitigation in composting.

Plasma proenkephalin A and incident chronic kidney disease and albuminuria in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.

BACKGROUND: Plasma proenkephalin A (PENK-A) is a precursor of active enkephalins. Higher blood concentrations have been associated with estimated glomerular filtration rate (eGFR) decline in European populations. Due to the significant disparity in incident chronic kidney disease (CKD) between White and Black people, we evaluated the association of PENK-A with incident CKD and other kidney outcomes among a biracial cohort in the U.S. METHODS: In a nested cohort of 4,400 participants among the REasons for Geographic And Racial Differences in Stroke, we determined the association between baseline PENK-A concentration and incident CKD using the creatinine-cystatin C CKD-EPI 2021 equation without race coefficient, significant eGFR decline, and incident albuminuria between baseline and a follow-up visit 9.4 years later. We tested for race and sex interactions. We used inverse probability sampling weights to account for the sampling design. RESULTS: At baseline, mean (SD) age was 64 (8) years, 49% were women, and 52% were Black participants. 8.5% developed CKD, 21% experienced ≥ 30% decline in eGFR and 18% developed albuminuria. There was no association between PENK-A and incident CKD and no difference by race or sex. However, higher PENK-A was associated with increased odds of progressive eGFR decline (OR: 1.12; 95% CI 1.00, 1.25). Higher PENK-A concentration was strongly associated with incident albuminuria among patients without diabetes mellitus (OR: 1.29; 95% CI 1.09, 1.53). CONCLUSION: While PENK-A was not associated with incident CKD, its associations with progression of CKD and incident albuminuria, among patients without diabetes, suggest that it might be a useful tool in the evaluation of kidney disease among White and Black patients.

Regional and rural-urban patterns in the prevalence of diagnosed hypertension among older U.S. adults with diabetes, 2005-2017.

BACKGROUND: Hypertension prevalence among the overall US adult population has been relatively stable during the last two decades. However, whether this stabilization has occurred across rural-urban communities and across different geographic regions is unknown, particularly among older adults with diabetes who are likely to have concomitant cardiovascular risk factors. METHODS: This serial cross-sectional analysis used the 5% national sample of Medicare administrative claims data (n = 3,516,541) to examine temporal trends (2005-2017) in diagnosed hypertension among older adults with diabetes, across urban-rural communities and US census regions (Northeast, Midwest, South, and West). Joinpoint regression was used to obtain annual percent change (APC) in hypertension prevalence across rural-urban communities and geographic regions, and multivariable adjusted regression was used to assess associations between rural-urban communities and hypertension prevalence. RESULTS: The APC in the prevalence of hypertension was higher during 2005-2010, and there was a slowdown in the increase during 2011-2017 across all regions, with significant variations across rural-urban communities within each of the regions. In the regression analysis, in the adjusted model, older adults living in non-core (most rural) areas in the Midwest (PR = 0.988, 95% CI: 0.981-0.995) and West (PR = 0.935, 95% CI: 0.923-0.946) had lower hypertension prevalence than their regional counterparts living in large central metro areas. CONCLUSIONS: Although the magnitudes of these associations are small, differences in hypertension prevalence across rural-urban areas and geographic regions may have implications for targeted interventions to improve chronic disease prevention and management.

Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study.

OBJECTIVES: Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN: A simulation study. METHODS: We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS: In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS: A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.

[Early experience with mechanical hemodynamic support for catheter ablation of malignant ventricular tachycardia].

Objective: To explore the role of mechanical hemodynamic support (MHS) in mapping and catheter ablation of patients with hemodynamically unstable ventricular tachycardia (VT), report single-center experience in a cohort of consecutive patients receiving VT ablation during MHS therapy, and provide evidence-based medical evidence for clinical practice. Methods: This was a retrospective cohort study. Patients with hemodynamically unstable VT who underwent catheter ablation with MHS at Beijing Anzhen Hospital, Capital Medical University between August 2021 and December 2023 were included. Patients were divided into rescue group and preventive group according to the purpose of treatment. Their demographic data, periprocedural details, and clinical outcomes were collected and analyzed. Results: A total of 15 patients with hemodynamically unstable VT were included (8 patients in the rescue group and 7 patients in the preventive group). The acute procedure was successful in all patients. One patient in the rescue group had surgical left ventricular assist device (LVAD) implantation, remaining 14 patients received extracorporeal membrane oxygenation (ECMO) for circulation support. ECMO decannulation was performed in 12 patients due to clinical and hemodynamic stability, of which 6 patients were decannulation immediately after surgery and the remaining patients were decannulation at 2.0 (2.5) d after surgery. Two patients in the rescue group died during the index admission due to refractory heart failure and cerebral hemorrhage. During a median follow-up of 30 d (1 d to 12 months), one patient with LVAD had one episode of ventricular fibrillation at 6 months after discharge, and no further episodes of ventricular fibrillation and/or VT occurred after treatment with antiarrhythmic drugs. No malignant ventricular arrhythmia occurred in the remaining 12 patients who were followed up. Conclusions: MHS contributes to the successful completion of mapping and catheter ablation in patients with hemodynamically unstable VT, providing desirable hemodynamic status for emergency and elective conditions.

Risk Factors for Incident CKD in Black and White Americans: The REGARDS Study.

RATIONALE & OBJECTIVE: Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 4,198 Black and 7,799 White participants aged at least 45 years, recruited from 2003 through 2007 across the continental United States, with baseline estimated glomerular filtration rate (eGFR)>60mL/min/1.73m2 and eGFR assessed again approximately 9 years later. EXPOSURES: Age, sex, race (Black or White), region ("stroke belt" or other), education, income, systolic blood pressure, body mass index, diabetes, coronary heart disease, hyperlipidemia, smoking, and albuminuria. OUTCOMES: (1) eGFR change and (2) incident CKD defined as eGFR<60mL/min/1.73m2 and≥40% decrease from baseline or kidney failure. ANALYTICAL APPROACH: Linear regression and modified Poisson regression were used to determine the association of risk factors with eGFR change and incident CKD overall and stratified by race, sex, and region. RESULTS: Mean age of participants was 63±8 (SD) years, 54% were female, and 35% were Black. After 9.4±1.0 years of follow-up, CKD developed in 9%. In an age-, sex-, and race-adjusted model, Black race (ß =-0.13; P<0.001) was associated with higher risk of eGFR change, but this was attenuated in the fully adjusted model (ß=0.02; P=0.5). Stroke belt residence was independently associated with eGFR change (ß =-0.10; P<0.001) and incident CKD (relative risk, 1.14 [95% CI, 1.01-1.30]). Albuminuria was more strongly associated with eGFR change (ß of-0.26 vs-0.17; P=0.01 for interaction) in Black compared with White participants. Results were similar for incident CKD. LIMITATIONS: Persons of Hispanic ethnicity were excluded; unknown duration and/or severity of risk factors. CONCLUSIONS: Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals. Albuminuria was a stronger risk factor for eGFR decrease and incident CKD in Black compared with White individuals. Living in the US stroke belt is a novel risk factor for CKD.

GPU-enabled real-time optical frequency comb spectroscopy and a photonic readout.

We describe a GPU-enabled approach for real-time optical frequency comb spectroscopy in which data is recorded, Fourier transformed, normalized, and fit at data rates up to 2.2 GB/s. As an initial demonstration we have applied this approach to rapidly interrogate the motion of an optomechanical accelerometer through the use of an electro-optic frequency comb. We note that this approach is readily amenable to both self-heterodyne and dual-comb spectrometers for molecular spectroscopy as well as a photonic readout where the approach's agility, speed, and simplicity are expected to enable future improvements and applications.

Single-modulator, direct frequency comb spectroscopy via serrodyne modulation.

Traditional electro-optic frequency comb spectrometers rely upon the use of an acousto-optic modulator (AOM) to provide a differential frequency shift between probe and local oscillator (LO) legs of the interferometer. Here we show that these modulators can be replaced by an electro-optic phase modulator (EOM) which is driven by a sawtooth waveform to induce serrodyne modulation. This approach enables direct frequency comb spectroscopy to be performed with a single dual-drive Mach-Zehnder modulator (DD-MZM), allowing for lower differential phase noise. Further, this method allows for simpler production of integrated photonic comb spectrometers on the chip scale.

Promoting transportation safety in adolescence: the drivingly randomized controlled trial.

BACKGROUND: The impact of young drivers' motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens' risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases. METHODS: Eligible participants are aged 16-17.33 years of age, have a learner's permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children's Hospital of Philadelphia's Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation's online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation. DISCUSSION: Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence. TRIAL REGISTRATION: ClinicalTrials.gov # NCT03639753.

Joint Clustering and Resource Allocation Optimization in Ultra-Dense Networks with Multiple Drones as Small Cells Using Game Theory.

In this study, we consider the combination of clustering and resource allocation based on game theory in ultra-dense networks that consist of multiple macrocells using massive multiple-input multiple-output and a vast number of randomly distributed drones serving as small-cell base stations. In particular, to mitigate the intercell interference, we propose a coalition game for clustering small cells, with the utility function being the ratio of signal to interference. Then, the optimization problem of resource allocation is divided into two subproblems: subchannel allocation and power allocation. We use the Hungarian method, which is efficient for solving binary optimization problems, to assign the subchannels to users in each cluster of small cells. Additionally, a centralized algorithm with low computational complexity and a distributed algorithm based on the Stackelberg game are provided to maximize the network energy efficiency (EE). The numerical results demonstrate that the game-based method outperforms the centralized method in terms of execution time in small cells and is better than traditional clustering in terms of EE.

[Shifts in the diameter of continuous circular capsulorhexis based on the Gullstrand eye model with the Callisto Eye System during cataract surgery].

Objective: To investigate the disparity between the set value of the capsulorhexis ring diameter in ophthalmic surgical navigation systems and the actual capsulorhexis ring diameter projected onto the lens surface. Methods: It was a cross-sectional study. Based on the Gullstrand eye model, the theoretical diameter of the capsulorhexis ring projected onto the lens plane through the cornea was calculated using the law of refraction in the Callisto Eye System. When the anterior chamber depth (ACD) ranged from 2.0 to 4.0 mm and the corneal curvature ranged from 40.00 to 48.00 D, the capsulorhexis ring diameters were calculated after projecting capsulorhexis rings with set diameters of 5.5 mm and 6.0 mm onto the lens plane. Additionally, 40 patients (40 eyes) aged 40 to 85 years who underwent cataract phacoemulsification combined with intraocular lens implantation at the Sixth People's Hospital of Shanghai Jiao Tong University School of Medicine were selected to validate the theoretical calculations. Among them, 15 were male, and 25 were female, and they were divided into three groups based on the ACD: group A (13 eyes) with ACD<3.0 mm; group B (16 eyes) with 3.0 mm≤ACD<3.5 mm; group C (11 eyes) with ACD≥3.5 mm. One week after surgery, anterior segment images of the eyes were taken, and the actual capsulorhexis ring diameter was measured using the Photoshop image processing software and compared with the set and calculated values. Results: When the capsulorhexis ring diameters were set at 5.5 mm and 6.0 mm and the corneal curvature was calculated based on the Gullstrand Eye model at 43.05 D, a linear negative correlation was found between ACD and the capsulorhexis ring diameter projected onto the lens plane (P<0.001). When the ACD was set at 2.5, 3.0, and 3.5 mm, and the capsulorhexis ring diameters were set at 5.5 and 6.0 mm, a linear negative correlation was observed between corneal curvature and the capsulorhexis ring diameter projected onto the lens plane (P<0.001). When the capsulorhexis ring diameter was set at 5.5 mm and the patient ACD and corneal curvature data were used for calculations, the capsulorhexis ring diameters projected onto the lens plane for groups A, B, and C were (5.09±0.05) mm, (4.97±0.05) mm, and (4.91±0.07) mm, respectively. When the capsulorhexis ring diameter was set at 6.0 mm, they were (5.56±0.05) mm, (5.44±0.05) mm, and (5.37±0.08) mm, respectively. One week after surgery, the actual measurements of capsulorhexis ring diameters for groups A, B, and C were (5.44±0.20) mm, (5.27±0.28) mm, and (5.25±0.41) mm, respectively, and the differences compared to the calculated values were not statistically significant (all P>0.05), but the differences compared to the set values were statistically significant (all P<0.001). Conclusion: The capsulorhexis ring diameter projected onto the lens surface by the Callisto Eye system was reduced by 7.33% to 10.48% compared to the set value, and the degree of reduction increased with the increase of ACD and corneal curvature.

[Association between atrial fibrillation reoccurrence and new-onset ischemic stroke among patients with nonvalvular atrial fibrillation].

Objective: Explore the association between atrial fibrillation (AF) reoccurrence and new-onset ischemic stroke (IS) in patients with nonvalvular AF, and explore whether there is a high-risk period of IS after recurrent episodes of AF. Methods: A nested case-control study design was used. A total of 565 nonvalvular AF patients with new-onset IS after a follow-up of at least 2 years in the China-AF cohort were enrolled as the case group, and 1 693 nonvalvular AF patients without new-onset IS were matched as the control group at a ratio of 1∶3. Frequency and types of recurrent AF in the previous 1 or 2 years were compared between two groups, and the adjusted associations of AF reoccurrence with new onset IS were explored using conditional logistic regression analysis. The proportion of recurrent AF was compared between the case period and control period, and conditional logistic regression analysis was performed to calculate adjusted associations of case-period AF with IS. Results: The nested case-control study design results showed that the proportion of at least one record of recurrent AF in the previous 1 year was higher in the case group than in the control group (72.0% vs. 60.8%, P<0.05), and the recurrent AF was positively correlated with new-onset IS (adjusted OR=1.80, P<0.001). Similar results were also observed in the previous 2 years period. The case-crossover study design analysis showed that among 565 patients with new-onset IS, recurrent AF in the case period was positively correlated with IS (adjusted OR=1.61, P=0.003). Conclusion: Recurrent AF is associated with IS, and there may be a high-risk period of IS after recurrent episodes of AF.

[Current use of oral anticoagulation therapy and influencing factors among coronary artery disease patients with nonvalvular atrial fibrillation in China].

Objective: To investigate current use of oral anticoagulant (OAC) therapy and influencing factors among coronary artery disease (CAD) patients with nonvalvular atrial fibrillation (NVAF) in China. Methods: Results of this study derived from "China Atrial Fibrillation Registry Study", the study prospectively enrolled atrial fibrillation (AF) patients from 31 hospitals, and patients with valvular AF or treated with catheter ablation were excluded. Baseline data such as age, sex and type of atrial fibrillation were collected, and drug history, history of concomitant diseases, laboratory results and echocardiography results were recorded. CHA2DS2-VASc score and HAS-BLED score were calculated. The patients were followed up at the 3rd and 6th months after enrollment and every 6 months thereafter. Patients were divided according to whether they had coronary artery disease and whether they took OAC. Results: 11 067 NVAF patients fulfilling guideline criteria for OAC treatment were included in this study, including 1 837 patients with CAD. 95.4% of NVAF patients with CAD had CHA2DS2-VASc score≥2, and 59.7% of patients had HAS-BLED≥3, which was significantly higher than NVAF patients without CAD (P<0.001). Only 34.6% of NVAF patients with CAD were treated with OAC at enrollment. The proportion of HAS-BLED≥3 in the OAC group was significantly lower than in the no-OAC group (36.7% vs. 71.8%, P<0.001). After adjustment with multivariable logistic regression analysis, thromboembolism(OR=2.48,95%CI 1.50-4.10,P<0.001), left atrial diameter≥40 mm(OR=1.89,95%CI 1.23-2.91,P=0.004), stain use (OR=1.83,95%CI 1.01-3.03, P=0.020) and ß blocker use (OR=1.74,95%CI 1.13-2.68,P=0.012)were influence factors of OAC treatment. However, the influence factors of no-OAC use were female(OR=0.54,95%CI 0.34-0.86,P=0.001), HAS-BLED≥3 (OR=0.33,95%CI 0.19-0.57,P<0.001), and antiplatelet drug(OR=0.04,95%CI 0.03-0.07,P<0.001). Conclusion: The rate of OAC treatment in NVAF patients with CAD is still low and needs to be further improved. The training and assessment of medical personnel should be strengthened to improve the utilization rate of OAC in these patients.

High dynamic range electro-optic dual-comb interrogation of optomechanical sensors.

An interleaved, chirped electro-optic dual comb system is demonstrated for rapid, high dynamic range measurements of cavity optomechanical sensors. This approach allows for the cavity displacements to be interrogated at measurement times as fast as 10 µs over ranges far larger than can be achieved with alternative methods. While the performance of this novel, to the best of our knowledge, readout approach is evaluated with an optomechanical accelerometer, this method has a wide range of applications including temperature, pressure, and humidity sensing as well as acoustics and molecular spectroscopy.

Persistence of Depressive Symptoms and Risk of Incident Cardiovascular Disease With and Without Diabetes: Results from the REGARDS Study.

BACKGROUND: Baseline depressive symptoms are associated with subsequent adverse cardiovascular (CV) events in subjects with and without diabetes but the impact of persistent symptoms vs. improvement remains controversial. OBJECTIVE: Examine long-term changes in depressive symptoms in individuals with and without diabetes and the associated risk for adverse CV events. DESIGN: REGARDS is a prospective cohort study of CV risk factors in 30,000 participants aged 45 years and older. PARTICIPANTS: N = 16,368 (16.5% with diabetes mellitus) who remained in the cohort an average of 11.1 years later and who had complete data. MAIN MEASURES: Depressive symptoms were measured using the 4-item Centers for Epidemiologic Study of Depression (CES-D) questionnaire at baseline and again at a mean follow-up of 5.07 (SD = 1.66) years. Adjudicated incident stroke, coronary heart disease (CHD), CV mortality, and a composite outcome were assessed in a subsequent follow-up period of 6.1 (SD = 2.6) years. METHODS: The association of changes in depressive symptoms (CES-D scores) across 5 years with incident CV events was assessed using Cox proportional hazards modeling. KEY RESULTS: Compared to participants with no depressive symptoms at either time point, participants without diabetes but with persistently elevated depressive symptoms at both baseline and follow-up demonstrated a significantly increased risk of incident stroke (HR (95% CI) = 1.84 (1.03, 3.30)), a pattern which was substantially more prevalent in blacks (HR (95% CI) = 2.64 (1.48, 4.72)) compared to whites (HR (95% CI) = 1.06 (0.50, 2.25)) and in those not taking anti-depressants (HR (95% CI) = 2.01 (1.21, 3.35)) in fully adjusted models. CONCLUSIONS: The persistence of depressive symptoms across 5 years of follow-up in participants without diabetes identifies individuals at increased risk for incident stroke. This was particularly evident in black participants and among those not taking anti-depressants.

Spike-and-slab least absolute shrinkage and selection operator generalized additive models and scalable algorithms for high-dimensional data analysis.

There are proposals that extend the classical generalized additive models (GAMs) to accommodate high-dimensional data ( p ≫ n $$ p\gg n $$ ) using group sparse regularization. However, the sparse regularization may induce excess shrinkage when estimating smooth functions, damaging predictive performance. Moreover, most of these GAMs consider an "all-in-all-out" approach for functional selection, rendering them difficult to answer if nonlinear effects are necessary. While some Bayesian models can address these shortcomings, using Markov chain Monte Carlo algorithms for model fitting creates a new challenge, scalability. Hence, we propose Bayesian hierarchical generalized additive models as a solution: we consider the smoothing penalty for proper shrinkage of curve interpolation via reparameterization. A novel two-part spike-and-slab LASSO prior for smooth functions is developed to address the sparsity of signals while providing extra flexibility to select the linear or nonlinear components of smooth functions. A scalable and deterministic algorithm, EM-Coordinate Descent, is implemented in an open-source R package BHAM. Simulation studies and metabolomics data analyses demonstrate improved predictive and computational performance against state-of-the-art models. Functional selection performance suggests trade-offs exist regarding the effect hierarchy assumption.