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JAMA Network Open May 2022Little is known about the long-term outcomes of mild valvular lesions.
IMPORTANCE
Little is known about the long-term outcomes of mild valvular lesions.
OBJECTIVE
To examine the associations of 3 major types of valvular lesions (aortic stenosis, trace or mild aortic regurgitation, and trace or mild mitral regurgitation) with risk of cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, and atrial fibrillation.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study analyzed data from the ongoing Atherosclerosis Risk in Communities study and focused on Black participants in the Jackson, Mississippi, site who underwent echocardiography at visit 3 from 1993 to 1995. Data analysis was conducted between April 2021 and February 2022.
EXPOSURES
Three valvular lesions were analyzed: aortic sclerosis, aortic regurgitation (trace or mild), and mitral regurgitation (trace or mild).
MAIN OUTCOMES AND MEASURES
The outcomes were cardiovascular mortality, coronary heart disease, heart failure, stroke, and atrial fibrillation. Multivariable Cox proportional hazards regression models were used to examine the independent associations between the 3 valvular lesions and these outcomes.
RESULTS
A total of 2106 Black participants were included, with a mean (SD) age of 59.1 (5.6) years and 1354 women (64.3%). The baseline prevalence was 7.7% for aortic sclerosis, 15.1% for aortic regurgitation (6.1% with trace, and 9.0% with mild), and 43.0% for mitral regurgitation (29.4% with trace, and 13.6% with mild). During a median (interquartile interval) follow-up of 22.5 (15.6-23.5) years, 890 participants developed at least 1 cardiovascular outcome. Each valvular lesion was significantly associated with at least 1 cardiovascular outcome: aortic sclerosis was associated with cardiovascular mortality (adjusted hazard ratio [HR], 1.54; 95% CI, 1.06-2.22), mild mitral regurgitation was associated with atrial fibrillation (HR, 1.47; 95% CI, 1.09-1.99), and trace or mild aortic regurgitation was associated with all outcomes (HRs ranging from 1.45 [95% CI, 1.17-1.81] to 1.75 [95% CI, 1.29-2.37]) except stroke. The total number of valvular lesions had graded associations with all cardiovascular outcomes except stroke: the HR of cardiovascular mortality was 1.77 (95% CI, 1.18-2.65) for those with 2 to 3 lesions and was 1.44 (95% CI, 1.05-1.96) for those with 1 lesion vs no lesions.
CONCLUSIONS AND RELEVANCE
Results of this study indicate an association between valvular lesions, even at mild stage, and a long-term risk of cardiovascular events, suggesting the importance of recognizing and monitoring these valvular conditions.
Topics: Adult; Aortic Valve Insufficiency; Atrial Fibrillation; Cohort Studies; Female; Heart Failure; Humans; Middle Aged; Mitral Valve Insufficiency; Sclerosis; Stroke
PubMed: 35552723
DOI: 10.1001/jamanetworkopen.2022.11946 -
Meat Science Sep 2018The objective of this study was to assess the effects of captive bolt length and breed type on post-stun leg activity in cattle. A total of 2850 Holstein (HOL) and...
The objective of this study was to assess the effects of captive bolt length and breed type on post-stun leg activity in cattle. A total of 2850 Holstein (HOL) and non-Holstein British/Continental bred (NHOL) steers and heifers were observed post-stunning at a large commercial slaughter facility. A pneumatically powered penetrating captive bolt stunner was used with three different bolt lengths: CON, 15.24 cm; MED, 16.51 cm; and LON, 17.78 cm. Hind limb kicking, forelimb activity, take away belt stops, carcass swing and number of knife sticks during exsanguination were recorded for each animal from video recording. Hind limb and forelimb kicks observed ranged from 0 to 25 and 0 to 8, respectively. Analysis of post-stun hind limb and forelimb activity indicated that increasing pneumatically powered penetrating captive bolt length does not decrease post-stun leg activity. There was a higher percentage of cattle experiencing take away belt stops and carcass swing in HOL as compared with NHOL.
Topics: Abattoirs; Animals; Animals, Inbred Strains; Cattle; Colorado; Endangered Species; Exsanguination; Female; Firearms; Forelimb; Hindlimb; Immobilization; Male; Random Allocation; Video Recording
PubMed: 29753218
DOI: 10.1016/j.meatsci.2018.05.003 -
Frontiers in Rehabilitation Sciences 2023Outdoor physical activity (PA) contributes to the physical and mental health and well-being of individuals with a mobility impairment. However, individuals are commonly... (Review)
Review
INTRODUCTION
Outdoor physical activity (PA) contributes to the physical and mental health and well-being of individuals with a mobility impairment. However, individuals are commonly excluded from outdoor PA because of accessibility challenges. No reviews summarizing evidence on factors that facilitate/hinder participation and inclusion of individuals with mobility disabilities in adaptive outdoor PA were identified.. This makes it challenging to establish the key components for implementing inclusive outdoor PA interventions. A scoping review was conducted to identify barriers and facilitators to participation in adaptive outdoor PA and identify suggestions for adaptive outdoor PA design.
METHODS
A scoping review of qualitative and quantitative studies was conducted based on the methodological framework of Arksey and O'Malley with modifications by Levac. Barriers and facilitators were categorized into four levels based on a Social Ecological Model (SEM). Suggestions for interventions designed to overcome accessibility issues of outdoor PA were classified based on Universal Design (UD).
RESULTS
Thirty-seven factors regarding barriers and facilitators of outdoor adaptive PA were extracted from 19 studies published between 2002 and 2023. Barriers and facilitators were identified primarily in four levels of the SEM, including intrapersonal, social-environmental, physical-environmental, and policy-related. Eleven design suggestions were identified and categorized according to the seven principles of UD. This study identified gaps in the presented barriers and facilitators and the design suggestions of the included studies, mainly at the social and environmental level, such as a lack of innovation in program delivery and logistics.
CONCLUSION
This study identified gaps in knowledge about facilitators and barriers to outdoor adaptive PA and in the design of interventions addressing them. Future research should focus on the strategies addressing these gaps by involving individuals with mobility disability in designing interventions to gain a better insight into their needs.
PubMed: 38259872
DOI: 10.3389/fresc.2023.1331971 -
PloS One 2021Fungal hyphal growth and branching are essential traits that allow fungi to spread and proliferate in many environments. This sustained growth is essential for a myriad... (Comparative Study)
Comparative Study
Fungal hyphal growth and branching are essential traits that allow fungi to spread and proliferate in many environments. This sustained growth is essential for a myriad of applications in health, agriculture, and industry. However, comparisons between different fungi are difficult in the absence of standardized metrics. Here, we used a microfluidic device featuring four different maze patterns to compare the growth velocity and branching frequency of fourteen filamentous fungi. These measurements result from the collective work of several labs in the form of a competition named the "Fungus Olympics." The competing fungi included five ascomycete species (ten strains total), two basidiomycete species, and two zygomycete species. We found that growth velocity within a straight channel varied from 1 to 4 μm/min. We also found that the time to complete mazes when fungal hyphae branched or turned at various angles did not correlate with linear growth velocity. We discovered that fungi in our study used one of two distinct strategies to traverse mazes: high-frequency branching in which all possible paths were explored, and low-frequency branching in which only one or two paths were explored. While the high-frequency branching helped fungi escape mazes with sharp turns faster, the low-frequency turning had a significant advantage in mazes with shallower turns. Future work will more systematically examine these trends.
Topics: Ascomycota; Basidiomycota; Biological Phenomena; Crowdsourcing; Fungi; Hyphae; Microfluidic Analytical Techniques; Species Specificity
PubMed: 34587206
DOI: 10.1371/journal.pone.0257823 -
Structural Heart : the Journal of the... Aug 2022Reshaping the dilated left ventricle using a surgically implanted papillary muscle sling has been shown to provide long-term improvement in cardiac function compared to...
BACKGROUND
Reshaping the dilated left ventricle using a surgically implanted papillary muscle sling has been shown to provide long-term improvement in cardiac function compared to annuloplasty alone in patients with systolic heart failure. A papillary muscle sling which can be implanted via a transcatheter approach has the potential to make this treatment more widely available to patients.
METHODS
The Vsling transcatheter papillary muscle sling device was evaluated in a chronic animal model (sacrificed at 30 and 90 days), in a simulator, and in a human cadaver.
RESULTS
The Vsling device was successfully implanted in 10 pigs, 6 simulator procedures, and 1 human cadaver. Procedure complexity and device usability were rated as reasonable or better by 6 interventional cardiologists. Gross and histological analysis in chronic pigs through 90 days demonstrated near-complete endothelial coverage with mild inflammation and small hematoma formation but without adverse tissue reactions, thrombi, or embolization.
CONCLUSIONS
Preliminary feasibility and safety of the Vsling implant and implantation procedure have been demonstrated. Human trials are planned to begin in the summer of 2022.
PubMed: 37288331
DOI: 10.1016/j.shj.2022.100075 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2022There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority...
BACKGROUND
There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority of any of these distal locking options. In our study, comparing nails with distal bolt locking screw (DSBLS) and conventional nails; we aimed to compare the clinical and radiological results of intramedullary nail models in fixing tibial distal diametaphyseal fractures.
METHODS
In our orthopedics and traumatology department, 117 tibial distal diametaphyseal fractures of 116 patients treated with intramedullary nails between August 2007 and May 2015 were retrospectively evaluated. Forty-six tibial distal diametaphyseal fractures of 45 patients who came to regular visits to outpatient clinic controls and who had a minimum follow-up of 18 months and whose fracture distance was between 3 and 12 cm were included in the study. The average follow-up period of the study group consisting of 28 males and 17 females with an average age of 44 (16-76 years) which was 48 months (18-100 months). The group using the DSBLS locking intramedullary nail was considered the first group and the group using the conventional distal locking intramedullary nail was considered the second group. Radiological union times, coronal, sagittal, and axial plan angulations and malunion presence were com-pared between the two groups. In addition, the two groups were compared clinically with length of time spent on weight-bearing and return to work, Olerud-Molander ankle score, and American Orthopedic Foot and Ankle Society Score scores.
RESULTS
We found that the first group was superior in terms of length of time spent on partial and full weight-bearing between the two groups (p=0.00031 and p=0.00007). In addition, the union time of the first group was shorter (p=0.0149). Other radiological or clinical results did not differ significantly between the two groups. In addition, no significant correlation was found between the distance of the fracture from the tibial plate and its angulation. In cases with malunion alone, the fracture line was more distal than those without malunion (p=0.0411).
CONCLUSION
Newly developed DSBLS intramedullary nails give as good results as conventional nails in tibia distal diametaphyseal fractures. Due to its ability to loading bone early and have a shorter union time, DSBLS can be safely preferred in distal diametaphyseal fractures and reduce complications from immobilization.
Topics: Adult; Ankle Fractures; Bone Nails; Female; Fracture Fixation, Intramedullary; Humans; Male; Retrospective Studies; Tibia; Tibial Fractures
PubMed: 35485463
DOI: 10.14744/tjtes.2020.24152 -
Medical Decision Making : An... Jan 2021Generic preference-based measures (GPBMs) such as the EQ-5D are valid across many conditions, but in some cases, "bolting on" additional dimensions may improve validity....
BACKGROUND
Generic preference-based measures (GPBMs) such as the EQ-5D are valid across many conditions, but in some cases, "bolting on" additional dimensions may improve validity. The selection of "bolt-ons" has been based on the psychometric impact of individual dimensions, but preferences provide another important way to select them. This study aims to test the potential of using pairwise choices to inform the selection of bolt-ons for the EQ-5D-5L.
METHODS
General population preferences were collected using an online survey of 1040 UK residents. Three EQ-5D-5L health state pairs were selected based on pairs that had a 50:50 split in respondent preferences from a previous pairwise survey. Participants were presented with pairwise choices of EQ-5D-5L health states without and with bolt-ons of hearing, sleep, cognition, energy, and relationships, each added individually. Logistic models were used to assess the impact of bolt-ons, as well as bolt-ons at different severity levels, on the log odds of responders choosing between health states.
RESULTS
Preferences varied according to the bolt-ons and their severity level (only levels 1, 3, and 5 were used). Additions of bolt-ons at level 1 generally resulted in nonstatistically significant differences while additions of bolt-ons at level 3 and level 5 produced a negative and statistically significant impact on preferences for the health state with the bolt-on. At level 5, hearing had the largest impact, followed by cognition, relationships, energy, and sleep. At level 3, cognition produced the largest impact, followed by hearing and sleep with similar impacts, energy, and relationships. This ordering offers information for bolt-on selection, with hearing and cognition appearing as the most important. The weight placed on the different health problems is not constant across severity levels between bolt-ons.
CONCLUSIONS
Pairwise choices provide a cost-effective approach of generating information on preferences to support bolt-on selection.
Topics: Adult; Cognition; Female; Hearing; Humans; Male; Middle Aged; Patient Preference; Psychometrics; Surveys and Questionnaires; United Kingdom; User-Centered Design
PubMed: 33256502
DOI: 10.1177/0272989X20969686 -
Europace : European Pacing,... Jun 2023Pulsed field ablation (PFA) has emerged as a promising alternative to thermal ablation for treatment of atrial fibrillation (AF). We report performance and safety using...
AIMS
Pulsed field ablation (PFA) has emerged as a promising alternative to thermal ablation for treatment of atrial fibrillation (AF). We report performance and safety using the CENTAURI™ System (Galvanize Therapeutics) with three commercial, focal ablation catheters.
METHODS AND RESULTS
ECLIPSE AF (NCT04523545) was a prospective, single-arm, multi-centre study evaluating safety and acute and chronic pulmonary vein isolation (PVI) durability using the CENTAURI System in conjunction with the TactiCath SE, StablePoint, and ThermoCool ST ablation catheters. Patients with paroxysmal or persistent AF were treated at two centres. Patients were analysed in five cohorts based upon ablation settings, catheter, and mapping system. Pulsed field ablation was performed in 82 patients (74% male, 42 paroxysmal AF). Pulmonary vein isolation was achieved in 100% of pulmonary veins (322/322) with first-pass isolation in 92.2% (297/322). There were four serious adverse events of interest (three vascular access complications and one lacunar stroke). Eighty patients (98%) underwent invasive remapping. Pulsed field ablation development Cohorts 1 and 2 showed a per-patient isolation rate of 38% and 26% and a per-PV isolation rate of 47% and 53%, respectively. Optimized PFA Cohorts 3-5 showed a per-patient isolation rate of 60%, 73%, and 81% and a per-PV isolation rate of 84%, 90%, and 92%, respectively.
CONCLUSION
ECLIPSE AF demonstrated that optimized PFA using the CENTAURI System with three commercial, contact force-sensing, solid-tip focal ablation catheters resulted in transmural lesion formation and high proportion of durable PVI with a favourable safety profile, thus providing a viable treatment option for AF that integrates with contemporary focal ablation workflows.
Topics: Humans; Male; Female; Atrial Fibrillation; Prospective Studies; Focal Adhesions; Treatment Outcome; Catheters; Catheter Ablation; Pulmonary Veins; Recurrence
PubMed: 37335976
DOI: 10.1093/europace/euad147 -
American Journal of Veterinary Research Feb 2017OBJECTIVE To use MRI and CT to compare the amount of tissue damage (soft tissue and bone) to the heads of goats after administration of a nonpenetrating or penetrating... (Comparative Study)
Comparative Study
OBJECTIVE To use MRI and CT to compare the amount of tissue damage (soft tissue and bone) to the heads of goats after administration of a nonpenetrating or penetrating captive bolt. ANIMALS Cadavers of twelve 1- to 5-year-old mixed-breed goats that had been euthanized with an overdose of pentobarbital as part of an unrelated study. PROCEDURES Cadavers were randomly assigned to receive a nonpenetrating (n = 6) or penetrating (6) captive bolt. The head of 1 cadaver was imaged via CT and MRI. The muzzle of a device designed to administer either a penetrating or nonpenetrating captive bolt was then placed flush on the dorsal midline of each head at the level of the external occipital protuberance (poll) and aimed downward toward the cranialmost portion of the intermandibular space, and the assigned bolt was administered. Heads were removed, and CT and MRI of each head were performed. After imaging, each skull was transected along the sagittal plane to permit gross evaluation of central nervous tissue and obtain digital photographic images. In addition, 1 head that received a nonpenetrating captive bolt was further evaluated via blunt dissection and removal of adnexa from the external surface of the calvarium. RESULTS MRI, CT, and dissection of skulls revealed severe skeletal and soft tissue damage after impact with the penetrating and nonpenetrating captive bolts. CONCLUSIONS AND CLINICAL RELEVANCE The nonpenetrating captive bolt appeared to cause damage similar to that of the penetrating captive bolt in the cranium and soft tissues of the head in caprine cadavers. This damage suggested that administration of a nonpenetrating captive bolt as described here may be an acceptable method of euthanasia in goats.
Topics: Animals; Brain Injuries; Euthanasia, Animal; Goats; Random Allocation; Wounds, Gunshot; Wounds, Nonpenetrating
PubMed: 28140642
DOI: 10.2460/ajvr.78.2.151 -
Journal of Shoulder and Elbow Surgery Jan 2023Morse taper junction tribocorrosion is recognized as an important failure mode in total hip arthroplasty. Although taper junctions are used in almost all shoulder...
BACKGROUND
Morse taper junction tribocorrosion is recognized as an important failure mode in total hip arthroplasty. Although taper junctions are used in almost all shoulder arthroplasty systems currently available in the United States, with large variation in design, limited literature has described comparable analyses of taper damage in these implants. In this study, taper junction damage in retrieved reverse total shoulder arthroplasty (RTSA) implants was assessed and analyzed.
METHODS
Fifty-seven retrieved RTSAs with paired baseplate and glenosphere components with Morse taper junctions were identified via database query; 19 of these also included paired humeral stems and trays or spacers with taper junctions. Components were graded for standard damage modes and for fretting and corrosion with a modified Goldberg-Cusick classification system. Medical records and preoperative radiographs were reviewed. Comparative analyses were performed assessing the impact of various implant, radiographic, and patient factors on taper damage.
RESULTS
Standard damage modes were commonly found at the evaluated trunnion junctions, with scratching and edge deformation damage on 76% and 46% of all components, respectively. Fretting and corrosion damage was also common, observed on 86% and 72% of baseplates, respectively, and 23% and 40% of glenospheres, respectively. Baseplates showed greater moderate to severe (grade ≥ 3) fretting (43%) and corrosion (27%) damage than matched glenospheres (fretting, 9%; corrosion, 13%). Humeral stems showed moderate to severe fretting and corrosion on 28% and 30% of implants, respectively; matched humeral trays or spacers showed both less fretting (14%) and less corrosion (17%). On subgroup analysis, large-tapered implants had significantly lower summed fretting and corrosion grades than small-tapered implants (P < .001 for both) on glenospheres; paired baseplate corrosion grades were also significantly lower (P = .031) on large-tapered implants. Factorial analysis showed that bolt reinforcement of the taper junction was also associated with less fretting and corrosion damage on both baseplates and glenospheres. Summed fretting and corrosion grades on glenospheres with trunnions (male) were significantly greater than on glenospheres with bores (female) (P < .001 for both).
CONCLUSIONS
Damage to the taper junction is commonly found in retrieved RTSAs and can occur after only months of being implanted. In this study, tribocorrosion predominantly occurred on the taper surface of the baseplate (vs. glenosphere) and on the humeral stem (vs. tray or spacer), which may relate to the flexural rigidity difference between the titanium and cobalt-chrome components. Bolt reinforcement and the use of large-diameter trunnions led to less tribocorrosion of the taper junction. The findings of this study provide evidence for the improved design of RTSA prostheses to decrease tribocorrosion.
Topics: Male; Female; Humans; Hip Prosthesis; Arthroplasty, Replacement, Shoulder; Prosthesis Failure; Prosthesis Design; Arthroplasty, Replacement, Hip; Corrosion
PubMed: 36202200
DOI: 10.1016/j.jse.2022.08.018