Nevin Manimala

J Gerontol A Biol Sci Med Sci. 2024 Feb 19:glae055. doi: 10.1093/gerona/glae055. Online ahead of print.

ABSTRACT

BACKGROUND: Body composition can be accurately quantified from abdominal CT exams and is a predictor for the development of aging-related conditions and for mortality. However, reference ranges for CT-derived body composition measures of obesity, sarcopenia, and bone loss have yet to be defined in the general population.

METHODS: We identified a population-representative sample of 4,900 persons aged 20 to 89 years who underwent an abdominal CT exam from 2010 to 2020. The sample was constructed using propensity score matching to an age and sex stratified sample of persons residing in the 27-county region of Southern Minnesota and Western Wisconsin. The matching included race, ethnicity, education level, region of residence and the presence of 20 chronic conditions. We used a validated deep learning based algorithm to calculate subcutaneous adipose tissue area, visceral adipose tissue area, skeletal muscle area, skeletal muscle density, vertebral bone area, and vertebral bone density from a CT abdominal section.

RESULTS: We report CT-based body composition reference ranges on 4,649 persons representative of our geographic region. Older age was associated with a decrease in skeletal muscle area and density, and an increase in visceral adiposity. All chronic conditions were associated with a statistically significant difference in at least one body composition biomarker. The presence of a chronic condition was generally associated with greater subcutaneous and visceral adiposity, and lower muscle density and vertebrae bone density.

CONCLUSIONS: We report reference ranges for CT-based body composition biomarkers in a population-representative cohort of 4,649 persons by age, sex, body mass index, and chronic conditions.

PMID:38373180 | DOI:10.1093/gerona/glae055

ASAIO J. 2024 Feb 19. doi: 10.1097/MAT.0000000000002160. Online ahead of print.

ABSTRACT

Right ventricular failure (RVF) is a significant cause of mortality in patients undergoing left ventricular assist device (LVAD) implantation. Although right ventricular assist devices (RVADs) can treat RVF in the perioperative LVAD period, liberal employment before RVF is not well established. We therefore compared the survival outcomes between proactive RVAD placement at the time of LVAD implantation with a bailout strategy in patients with RVF. Retrospectively, 75 adult patients who underwent durable LVAD implantation at our institution and had an RVAD placed proactively before LVAD implantation or as a bailout strategy postoperatively due to hemodynamically unstable RVF were evaluated. Patients treated with a proactive RVAD strategy had lower Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and a higher proportion of these required temporary mechanical circulatory support (MCS) preoperatively. Preoperative hemodynamic profiling showed a low pulmonary artery pulsatility index (PAPi) score of 1.8 ± 1.4 and 1.6 ± 0.94 (p = 0.42) in the bailout RVAD and proactive RVAD groups, respectively. Survival at 3, 6, and 12 months post-LVAD implantation was statistically significantly higher in patients who received a proactive RVAD. Thus, proactive RVAD implantation is associated with short- and medium-term survival benefits compared to a bailout strategy in RVF patients undergoing LVAD placement.

PMID:38373178 | DOI:10.1097/MAT.0000000000002160

Hepatology. 2024 Feb 19. doi: 10.1097/HEP.0000000000000794. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Existing tools for perioperative risk stratification in patients with cirrhosis do not incorporate measures of comorbidity. The Hospital Frailty Risk Score (HFRS) is a widely used measure of comorbidity burden in administrative dataset analyses. However, it is not specific to patients with cirrhosis and application of this index is limited by its complexity.

APPROACH RESULTS: Adult patients with cirrhosis who underwent non-transplant abdominal operations were identified from the National Inpatient Sample, 2016-2018. Adjusted associations between HFRS and in-hospital mortality and length of stay were computed with logistic and Poisson regression. Lasso regularization was used to identify the components of the HFRS most predictive of mortality, and develop a simplified index, the cirrhosis-HFRS (cHFRS). Of 10,714 cirrhosis patients, the majority were male, median age was 62 years, and 32% of operations were performed electively. HFRS was associated with an increased risk of both in-hospital mortality (OR=6.42; 95%CI: 4.93, 8.36) and length of stay (IRR=1.79; 95%CI: 1.72, 1.88), with adjustment. Using lasso, we found that a subset of 12 of the 109 ICD-10 codes within the HFRS resulted in superior prediction of mortality in this patient population (AUC = 0.89 vs. 0.79, p<0.001).

CONCLUSIONS: While the 109-component HFRS was associated with adverse surgical outcomes, 12 components accounted for much of the association between the HFRS and mortality. We developed the cirrhosis-HFRS, a tool that demonstrates superior predictive accuracy for in-hospital mortality and more precisely reflects the specific comorbidity pattern of hospitalized patients with cirrhosis undergoing general surgery procedures.

PMID:38373139 | DOI:10.1097/HEP.0000000000000794

Annu Int Conf IEEE Eng Med Biol Soc. 2023 Jul;2023:1-4. doi: 10.1109/EMBC40787.2023.10340311.

ABSTRACT

Fiber composition is an important factor influencing force generation and endurance of different skeletal muscles. The analysis of the heterogeneous composition of muscles has gained importance in the field of sports biomechanics and biomedicine. In this work, an attempt is made to analyze the fiber composition of Rectus femoris (type II dominant) and Soleus (type I dominant) muscles using surface electromyography. Isometric signals are acquired from the muscles of 15 participants using a well-defined protocol and are further processed using reduced interference Rihaczek distribution. Instantaneous median frequency (IMDF) is extracted from the non-fatigue (NF) and fatigue (F) segments of the signals and is analyzed. From the distributions, it is found that the spectral power increases in the lower frequencies of the signal recorded from the rectus femoris and in the higher frequencies of signals recorded from the soleus during fatigue. The soleus is showing higher IMDF values than the rectus femoris in both segments. A reduction of 14% and an increase of 10% is observed in the IMDF during fatigue for rectus femoris and soleus, respectively. Thus, the extracted feature is found to be sensitive and statistically significant (p<0.05) to differentiate fiber types as well as the NF and F states of the two muscles.Clinical Relevance- This study may be extended to non-invasively analyze the fiber type shifts in muscles due to athletic training and pathological conditions.

PMID:38373116 | DOI:10.1109/EMBC40787.2023.10340311

Clin Chem Lab Med. 2024 Feb 20. doi: 10.1515/cclm-2023-0977. Online ahead of print.

ABSTRACT

OBJECTIVES: The cardiac biomarkers high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are utilised in paediatric healthcare for the diagnosis and prognostic assessment of many conditions including myocarditis, congenital heart disease, multisystem inflammatory syndrome in children (MIS-C) and heart failure. However, the standardised age-related reference intervals, 99th percentile cut-offs and clinical guidelines are not available, making the interpretation of these biomarkers challenging. This study aimed to generate normative data in a paediatric cohort for the Siemens Atellica^® IM 1300 analyser.

METHODS: Residual plasma samples were collected from children aged up to 17 years attending primary care and out-patient settings and with no apparent evidence of cardiac dysfunction, renal dysfunction or other confounders. Reference intervals were generated using the 2.5th-97.5th percentiles, and 99th percentile cut-offs determined according to CLSI EP28-A3c.

RESULTS: Statistical analysis revealed that partitioning was not required for gender for either biomarker. The reference interval for hs-cTnI for children aged one month to 16 years (n=292, 146 females and 146 males) was <14 ng/L with a 99th percentile cut-off of 19 ng/L. The reference interval for NT-proBNP for children aged one month up to one year was <714 ng/L (n=14) and for children aged 1-16 years (n=339) was <295 ng/L.

CONCLUSIONS: This is the first paediatric reference interval data generated on the Siemens Atellica^® solution. These reference intervals and 99th percentiles will inform clinical decisions in the paediatric cardiology setting.

PMID:38373095 | DOI:10.1515/cclm-2023-0977

J Strength Cond Res. 2024 Feb 20. doi: 10.1519/JSC.0000000000004751. Online ahead of print.

ABSTRACT

Lang, HM, Duffourc, MM, Bazyler, CD, Ramsey, MW, and Gentles, JA. The relationship between cell-free DNA and resistance training volume load. J Strength Cond Res XX(X): 000-000, 2024-The primary purpose of this study was to assess the sensitivity of cell-free DNA (cf-DNA) to different resistance training volume loads. The secondary purpose was to examine the relationship between change in cf-DNA and relative strength. Researchers hypothesized that (a) cf-DNA concentrations would increase with increasing volume load and (b) increases in relative strength would result in predicted decreases to %Δ of cf-DNA. Thirty subjects were recruited for this study, 15 men and 15 women. Blood was collected through venous draws into 4-ml vacutainers at 3 time points: immediately before (T1), after 3 sets (T2), and after 6 sets (T3) of the back squat exercise. A critical alpha of 0.05 was set for inferential statistics. A repeated-measures ANOVA showed that cf-DNA increased significantly from T1 (407.72 ± 320.83) to T2 (1,244.6 ± 875.83) (p < 0.01) and T1 (407.72 ± 320.83) to T3 (1,331.15 ± 1,141.66) (p < 0.01), whereas no difference was found from T2 to T3 (p = 1.00). The linear regression model used to examine the predictive capabilities relative strength had on cf-DNA %Δ from T1 to T3 was found to be significant (p = 0.04; R2 = 0.15). The results of this study demonstrate the short response of cf-DNA in relation to variations in resistance training volume load. Results also demonstrated the positive relationship between relative strength and cf-DNA %Δ. The current study builds on the body of research that cf-DNA provides insight regarding the level of immune response after exercise training.

PMID:38373069 | DOI:10.1519/JSC.0000000000004751

J Wildl Dis. 2024 Feb 19. doi: 10.7589/JWD-D-21-00168. Online ahead of print.

ABSTRACT

The purpose of this study was to determine if the number of pregnancies in naturally infected Brucella abortus-positive bison (Bison bison) cows would be reduced over a period of 5 yr after one treatment with 3000 µg gonadotropin-releasing hormone immunocontraceptive (GonaCon) compared to a similar group of naturally infected B. abortus-positive bison cows not treated with GonaCon. In each of the 5 yr, GonaCon-treated cows produced fewer offspring in relation to number of cows than the nontreated cows. Fisher’s Exact test comparing offspring produced during the first reproductive season showed a significant difference between the two groups (P=0.0028). Differences in number of calves produced in GonaCon-treated and control groups were also noted in remaining years, but statistics were not applied because of data constraints. These data indicate that one treatment with GonaCon in brucellosis-seropositive female bison reduced pregnancies over five reproductive years. Thus, immunocontraception could potentially be used to manage brucellosis in affected herds.

PMID:38373061 | DOI:10.7589/JWD-D-21-00168

J Neuroophthalmol. 2024 Feb 19. doi: 10.1097/WNO.0000000000002090. Online ahead of print.

ABSTRACT

BACKGROUND: Bilateral transverse venous sinus stenosis (TVSS) or stenosis of a dominant venous sinus has been found to be very sensitive radiological findings in patients with intracranial hypertension (IH), yet there is still an ongoing debate whether they constitute reversible or permanent phenomena. Thus, the purpose of this study was to investigate the reversibility of TVSS in patients with IH, including conservatively treated patients with signs of IH as defined by the presence of papilledema.

METHODS: This was a retrospective chart review of all patients diagnosed with IH between 2016 and 2022, assessed from 2 tertiary university-affiliated neuro-ophthalmology practices. Inclusion criteria were the presence of papilledema, as quantified by optical coherence tomography, and bilateral TVSS, which is considered typical of IH on neuroimaging. During follow-up, included patients must have had confirmation of papilledema resolution as well as subsequent neuroimaging after conservative treatment or cerebrospinal fluid flow diversion. Patients with dural sinus vein thrombosis or intrinsic stenosis from sinus trabeculations or significant arachnoid granulations were excluded from the study. Either CT venography or MRI/MR venography was reviewed by a fellowship-trained neuroradiologist, and the degree of stenosis was scored through the combined conduit score (CCS), as described by Farb et al. The primary outcome was to assess TVSS changes after resolution or improvement of papilledema.

RESULTS: From 435 patients, we identified a subset of 10 who satisfied all inclusion criteria. Our cohort comprised entirely women with a median age of 29.5 years and a median BMI of 32.5 kg/m2. Treatment consisted of acetazolamide in 7 patients, of which 1 had additional topiramate and 2 underwent cerebrospinal fluid flow diversion. Furthermore, 6 patients demonstrated significant weight loss during follow-up. For the primary outcome, 5 of 10 patients exhibited no appreciable TVSS change, and 5 patients demonstrated significant improvement in TVSS, of which 4 received conservative treatment only. Papilledema resolution or improvement was statistically significantly associated with increasing average CCS, TVSS diameter, and grade.

CONCLUSIONS: We were able to demonstrate that TVSS can be both irreversible and reversible in patients with resolved papilledema. The finding of TVSS reversibility from conservative treatment alone is novel and has important implications to optimize patient care. Future studies should work to identify factors associated with irreversible TVSS for subsequent targeted intervention and prevention.

PMID:38373047 | DOI:10.1097/WNO.0000000000002090

JMIR Res Protoc. 2024 Feb 19;13:e54446. doi: 10.2196/54446.

ABSTRACT

BACKGROUND: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets.

OBJECTIVE: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region.

METHODS: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children’s BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes.

RESULTS: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024.

CONCLUSIONS: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children.

TRIAL REGISTRATION: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54446.

PMID:38373039 | DOI:10.2196/54446

JMIR Form Res. 2024 Feb 19;8:e52195. doi: 10.2196/52195.

ABSTRACT

BACKGROUND: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race).

OBJECTIVE: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years.

METHODS: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest.

RESULTS: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one’s finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=-0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM.

CONCLUSIONS: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples.

PMID:38373036 | DOI:10.2196/52195