Tag: pubmed

J Am Heart Assoc. 2024 Nov 27:e036596. doi: 10.1161/JAHA.124.036596. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic value of 3-dimensional (3D)-left ventricular global longitudinal strain (LVGLS) in recipients of heart transplant (HT) reremains unknown. This study aimed to determine whether 3D-LVGLS was the more powerful predictor of poor outcomes in recipients of HT compared with 2-dimensional (2D)-LVGLS.

METHODS AND RESULTS: All consecutive adult patients who received HT and underwent at least 1 comprehensive 2D and 3D transthoracic echocardiographic examination for clinical surveillance were retrospectively enrolled. The end point was all-cause mortality. Prognostic model performance was assessed according to the C-statistic. The 3D-LVGLS measurements were feasible in 294 of 342 patients with HT (86%). The median follow-up time was 53 months, and 44 HT redied. Receiver operating characteristic curves revealed that the area under the curve for predicting all-cause mortality was greater for 3D-LVGLS than 2D-LVGLS (0.77 versus 0.67, P=0.012). When HT stratified patients with HT into tertiles according to 3D-LVGLS values, patients with lower 3D-LVGLS had worse outcome (P<0.001). The multivariable Cox analysis showed that the model with 3D-LVGLS (hazard ratio [HR],1.44 [95% CI,1.24-1.68]; P<0.001; C-statistic=0.814) was better in predicting death than the model with 2D-LVGLS (HR, 1.19 [95% CI, 1.06-1.32]; P=0.002; C-statistic=0.772). The best cutoff value of 3D-LVGLS for detecting all-cause mortality was -16.1%, with a sensitivity of 63.6% and a specificity of 84.0%.

CONCLUSIONS: The 3D-LVGLS was a powerful predictor of all-cause mortality in patients receiving HT and provided greater prognostic value than 2D-LVGLS. Our study highlighted the potential of evaluating 3D-LVGLS for risk stratification in recipients of HT.

PMID:39604024 | DOI:10.1161/JAHA.124.036596

J Am Heart Assoc. 2024 Nov 27:e036637. doi: 10.1161/JAHA.124.036637. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with chronic heart failure (HF) show an increased risk for the occurrence of chronic kidney disease and cardiorenal syndrome. Urinary Dickkopf-3 (uDKK3), a stress-induced, tubular profibrotic glycoprotein, may be elevated in HF as early as in New York Heart Association class I HF and may indicate subsequent decline in estimated glomerular filtration rate (eGFR).

METHODS AND RESULTS: uDKK3 levels in patients with HF and controls were measured by enzyme-linked immunosorbent assay. eGFR was determined up to 5 years in HF. Change in eGFR was assessed with respect to baseline uDKK3 using (mixed-effect) linear and logistic regression models. A total of 488 patients with chronic HF and 45 control patients were included. Patients with HF showed higher median uDKK3 levels than controls (259.6 pg/mg creatinine [interquartile range (IQR), 119.2-509.4 pg/mg creatinine] versus 107.5 pg/mg creatinine [IQR, 60.5-181.2 pg/mg creatinine], P<0.001). Regression models demonstrated a significant association between log uDKK3 and the decline in eGFR during a median of 13 months (IQR, 12-59 months) (estimated higher eGFR loss, 0.8039 mL/min per 1.73 m²/year [95% CI, 0.002-1.606 mL/min per 1.73 m²/year], P=0.049; odds ratio, 1.345 [95% CI, 1.049-1.741], P=0.021). uDKK3 levels ≥354 pg/mg creatinine were associated with a significantly higher risk for eGFR decline at 1-year follow-up (estimated higher eGFR loss, 4.538 mL/min per 1.73 m² [95% CI, 1.482-9.593 mL/min per 1.73 m²]), P=0.004). Even patients with HF without chronic kidney disease (n=334) had higher uDKK3 levels compared with controls (233.4 [IQR, 109.0-436.9 pg/mg creatinine] versus 107.5 [IQR, 60.5-181.2 pg/mg creatinine], P<0.001).

CONCLUSIONS: The present findings indicate that uDKK3 is a promising prognostic biomarker for subsequent eGFR decline in patients with HF, irrespective of the presence of chronic kidney disease and even in the early stages of HF. This potential allows for early intervention to mitigate the deterioration of kidney function. Further investigation is warranted to validate its clinical utility.

PMID:39604022 | DOI:10.1161/JAHA.124.036637

Am J Epidemiol. 2024 Nov 26:kwae442. doi: 10.1093/aje/kwae442. Online ahead of print.

ABSTRACT

Although 1990-1991 Gulf War deployment has been linked to worse health outcomes such as chronic multisymptom illness (CMI), often referred to as Gulf War Illness, among deployed Gulf War Veterans, less is known regarding Gulf War service and mortality. Using 20 years of longitudinal data from Gulf War Veteran and Era personnel from the Millennium Cohort Study (2001-2021; n=45381), Cox proportional hazard models estimated the relative effects of Gulf War service status, CMI, and their corresponding interaction on all-cause mortality. Although age- and sex-adjusted mortality ratios suggested that Gulf War Veterans had higher mortality rates than Era personnel, no association was observed between Gulf War service status and mortality risk. Screening positive for CMI was associated with greater risk of all-cause mortality compared with those who did not screen positive across both GWV and Era personnel; interactions between CMI and Gulf War status were not statistically significant. This finding suggests that CMI increases mortality risk regardless of whether the symptomology is associated with Gulf War deployment. Future research is necessary to examine specific occupational and environmental exposures experienced during deployments and service in support of the 1990-1991 Gulf War and their association with mortality in this population.

PMID:39604006 | DOI:10.1093/aje/kwae442

Transpl Infect Dis. 2024 Nov 27:e14407. doi: 10.1111/tid.14407. Online ahead of print.

ABSTRACT

BACKGROUND: Donor screening and antimicrobial management processes are inconsistent across organ procurement organizations (OPOs) and transplant centers. As part of a Controversies Conference addressing the evaluation and management of infectious diseases (ID) in deceased donors sponsored by the American Society of Transplantation (AST), two online pre-meeting surveys were developed to inform conference proceedings and assess current practices and opinions on donor screening and antimicrobial management.

METHODS: Survey 1 addressed the current state of deceased donor ID testing, culture data communication, antimicrobial utilization, and involvement of transplant ID during donor management and was distributed to all 56 United States OPOs. Survey 2 evaluated transplant professionals’ opinions regarding donor antimicrobial use and was sent to the AST Infectious Disease, Kidney Pancreas, Liver and Intestinal, and Thoracic and Critical Care Community of Practice listservs. Descriptive statistics were performed.

RESULTS: Thirty-five (63%) unique responses were received from OPOs for Survey 1. Findings included variability in the timing of donor culture collection, frequent sampling of indwelling catheters, wide variation in the location of culture processing, and availability of additional susceptibility testing. Eighty-eight unique responses were received from approximately 1552 (6%) transplant providers for Survey 2. Of the respondents, 37% would not recommend standard antibiotics prior to organ recovery in the absence of suspected or confirmed infection.

CONCLUSIONS: These surveys demonstrate variability in donor testing, donor antimicrobial utilization, and transplant provider opinions regarding the need for and selection of antimicrobial agents. Findings highlight opportunities for standardized approaches to donor testing and management.

PMID:39603978 | DOI:10.1111/tid.14407

J Prosthet Dent. 2024 Nov 26:S0022-3913(24)00732-7. doi: 10.1016/j.prosdent.2024.10.033. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Challenges persist with conventional polymethyl methacrylate (PMMA) prosthetic materials and conversion protocols for immediate implant-supported interim restorations. Advances, such as the use of fiber-reinforced composites (FRCs), and novel conversion protocols, such as the Smart Denture Conversion (SDC), may mitigate existing prosthetic complications, yet their impact on flexural strength and mode of failure remains unclear.

PURPOSE: The purpose of this in vitro study was to better understand the effect of the conversion method and to characterize the relevance of reinforcing interim implant-supported fixed prosthetics with FRCs. The effect of SDC, compared with a conventional conversion (CC) protocol, and the influence of FRC polymer was assessed on prosthesis flexural strength and mode of failure.

MATERIAL AND METHODS: A total of 100 computer-aided design and computer-aided manufacturing (CAD-CAM) conversion matrices were divided into 4 groups: CC, SDC, SDC with FRC arch bar reinforcement (SDC-FRC bar), and SDC with FRC framework reinforcement (SDC-FRC framework). Flexural strength testing was conducted with a universal testing machine. Modes of failure were qualitatively analyzed. Statistical analysis was performed with 1-way ANOVA and the Tukey multiple comparison test (α=.05).

RESULTS: SDC and SDC-FRC bar specimens demonstrated flexural strength comparable with that of CC (P=.995 and P=.907, respectively), while FRC framework reinforcement significantly increased strength (P<.001). The SDC-FRC framework specimens exhibited the highest flexural strength (144.7 MPa).

CONCLUSIONS: SDC offers a clinically convenient conversion technique with flexural strength comparable with that of conventional conversion methods. FRC framework reinforcement significantly enhances strength and reduces catastrophic prosthetic failure risk. These findings underscore the positive impact of reinforcement materials in interim implant-supported prosthesis fabrication.

PMID:39603970 | DOI:10.1016/j.prosdent.2024.10.033

Farm Hosp. 2024 Nov 26:S1130-6343(24)00173-9. doi: 10.1016/j.farma.2024.10.013. Online ahead of print.

ABSTRACT

OBJECTIVE: To study medication adherence and persistence among heart failure patients, assess the methods utilized for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes.

METHODS: A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalization, emergency visits, and mortality. The I statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42024509542.

DISCUSSION: This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

PMID:39603950 | DOI:10.1016/j.farma.2024.10.013

J Plast Reconstr Aesthet Surg. 2024 Oct 28:S1748-6815(24)00668-5. doi: 10.1016/j.bjps.2024.10.028. Online ahead of print.

ABSTRACT

BACKGROUND: Reduction mammaplasties are among the plastic surgery procedures with the highest rates of patient satisfaction. However, the loss of postoperative sensation in the breast and nipple-areolar complex remains a concern. In light of increasing interest in nerve-preservation techniques, we sought to investigate the relationship between retained sensation with overall satisfaction in reduction mammaplasty in current literature.

METHODS: The authors systematically reviewed all studies that reported postoperative sensation and satisfaction in patients who underwent reduction mammaplasty, using the MEDLINE, Embase, Cochrane, CINAHL, and Scopus databases in October 2023. Studies were evaluated for methodological quality using an NIH Quality Assessment Tool. Meta-analyses of proportions were conducted.

RESULTS: A total of 48 studies met the eligibility criteria. The median quality assessment score was 8/10. For 28 studies eligible for statistical analysis, random effects pooled proportion for patients that retained preoperative sensation was 0.78 (95% CI: 0.67-0.87), and for patients that report postoperative satisfaction was 0.94 (95% CI: 0.91-0.97). Overall, the studies reported a relatively wide range of sensation outcomes with consistently high satisfaction scores.

CONCLUSION: The results of this systematic review suggest that other surgical factors (e.g., relief of macromastia symptoms, aesthetic appearance) play a greater role in patient satisfaction compared to sensation retention in reduction mammaplasty. Wide variability in assessment methodologies for both sensation and satisfaction was noted. Standardizing and objectifying measurement techniques, particularly for sensation, will help further characterize the relationship between sensation and satisfaction in future studies.

PMID:39603925 | DOI:10.1016/j.bjps.2024.10.028

Eur Urol Oncol. 2024 Nov 26:S2588-9311(24)00252-9. doi: 10.1016/j.euo.2024.11.004. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Tailored treatment for prostate cancer (PCa) requires accurate risk stratification. This study examines the effectiveness of the European Association of Urology (EAU) classification in predicting long-term PCa-specific mortality (PCSM) and assesses whether an alternative system can improve the identification of patients with low-risk disease.

METHODS: This study included two cohorts of patients with localized PCa: one with screen-detected PCa (n = 1563; S-cohort) and the other with clinically detected PCa (n = 755; C-cohort), all from a population-based, randomized screening study, who underwent primary radical prostatectomy or radiation monotherapy. Patients were stratified according to the traditional EAU risk classification and an alternative risk classification where low-risk disease is adjusted according to contemporary active surveillance (AS) eligibility criteria. The 15-yr time-dependent area under the curve (AUC) and the cumulative incidence of PCSM at 15 yr after diagnosis were assessed for each risk classification and cohort.

KEY FINDINGS AND LIMITATIONS: With a median follow-up of 20 yr in the S-cohort and 12 yr in the C-cohort, the EAU classification demonstrated 15-yr AUCs of 0.76 (95% confidence interval [CI]: 0.71-0.80) and 0.72 (95% CI: 0.65-0.79), respectively, for predicting PCSM. The alternative classification showed a 15-yr AUC of 0.74 (95% CI: 0.69-0.79) in the S-cohort and 0.75 (95% CI: 0.68-0.81) in the C-cohort. The alternative classification identified 45% more men having a low risk in the S-cohort and 83% more in the C-cohort than the EAU classification, with no statistically significant increase in the 15-yr PCSM incidence (S-cohort subhazard ratio: 1.33 [95% CI: 0.66-2.68]; C-cohort subhazard ratio: 0.99 [95% CI: 0.29-3.38]).

CONCLUSIONS AND CLINICAL IMPLICATIONS: The EAU classification predicts PCSM accurately, but an alternative classification, adjusted for AS eligibility, identifies substantially more men as having a low risk. This could enhance AS acceptance and utilization in clinical practice, reducing overtreatment.

PATIENT SUMMARY: This study shows that while a commonly used pretreatment risk classification for prostate cancer predict disease prognosis accurately, an alternative system based on active surveillance eligibility criteria identifies many more men as having a low risk. Adopting this classification could enhance the acceptance and use of active surveillance, reducing unnecessary treatments.

PMID:39603883 | DOI:10.1016/j.euo.2024.11.004

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Oct 17:S2212-4403(24)00591-1. doi: 10.1016/j.oooo.2024.10.076. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the potential of near-infrared Raman spectroscopy (RS) in distinguishing between various types of bone, dental hard tissues, and bone graft materials, and to determine the correlation between pixel intensity values (PIVs) in cone beam computed tomography (CBCT) and Raman values.

STUDY DESIGN: A thinly sliced section of mandible was utilized to evaluate cancellous and cortical bone. Extracted human teeth were used to prepare the enamel and dentin samples. Bone graft materials were tested by compacting them into edentulous tooth sockets in a dry human mandible. CBCT and RS scans of the samples were performed. The following RS outcomes were evaluated: 960 cm^-1 phosphate peak location and width, carbonate:phosphate ratio, mineral:matrix ratio, and collagen coiling ratio. One-way ANOVA and primary component analysis (PCA) statistics were used to assess RS outcomes.

RESULTS: The 960 cm^-1 phosphate peak location was able to effectively differentiate between various tissues and graft materials. PCA of the spectra successfully differentiated native bone from graft materials, underscoring the tissue characterization capability of RS. Varied correlations between RS outcomes and CBCT PIVs were observed.

CONCLUSIONS: Various parameters of RS can differentiate between cancellous bone, cortical bone, dental hard tissues, and bone graft materials. The varied correlations between Raman parameters and CBCT PIVs warrant further research to clarify the nature of these relationships.

PMID:39603873 | DOI:10.1016/j.oooo.2024.10.076

Clin Ther. 2024 Nov 26:S0149-2918(24)00324-2. doi: 10.1016/j.clinthera.2024.10.015. Online ahead of print.

ABSTRACT

PURPOSE: Females are at increased lifetime risk of stroke and experience worse outcomes compared with males. Tryptophan metabolism through the kynurenine pathway, resulting in decreased tryptophan concentrations, is associated with poor outcomes (larger infarct volume, higher National Institutes of Health Stroke Scale [NIHSS] score, and increased early mortality). This metabolic pathway activity varies by sex in healthy adults. However, evaluation of potential sex differences in tryptophan metabolism after an acute ischemic stroke (AIS) is lacking and could contribute to the disparate outcomes by sex. This study characterized sex differences in tryptophan metabolism via the kynurenine pathway in patients with AIS.

METHODS: Whole blood from patients with AIS enrolled in the University of Colorado Health Emergency Medicine Specimen Bank was analyzed using high-throughput mass spectrometry-based metabolomics at the time of arrival to the emergency department and at 12, 24, and 48 hours thereafter. Descriptive statistics characterized the cohort and metabolite levels. Potential sex differences in tryptophan metabolites at individual time points and their change over time were estimated using linear regression models to control for known factors influencing metabolite levels, initial NIHSS score, therapeutic interventions, and time to last known well (or symptom onset). A multivariable linear regression model examined the interaction effect between sex and metabolite level (at 12 hours after admission) on 24-hour NIHSS score while controlling for initial metabolite level, initial NIHSS score, time to last known well, factors influencing metabolite level, and factors influencing neurologic outcomes.

FINDINGS: After adjusting for covariates, females with AIS had significantly lower levels of tryptophan at 12 hours after admission compared with males (point estimate, -5.80; P = 0.03). Females and males neither differ in levels of tryptophan, kynurenine, quinolinic acid, or kynurenic acid at any other time point nor did they differ in change in metabolite concentration over time. Only increased quinolinic acid levels across both sexes at 12 hours after admission were associated with increased 24-hour NIHSS scores (point estimate, 0.49; P = 0.0002).

IMPLICATIONS: Overall, females and males have similar levels and changes in tryptophan and kynurenine pathway metabolites after an AIS. However, females have lower levels of tryptophan early after a stroke. Increased quinolinic acid levels across both sexes were associated with worsening neurologic function as measured by an NIHSS score. Future evaluation of alternative metabolic pathways downstream of tryptophan is needed to explain differences in tryptophan levels but similar levels of downstream kynurenine metabolites in females and males with AIS.

PMID:39603869 | DOI:10.1016/j.clinthera.2024.10.015