Accelerated tPA (tissue-type plasminogen activator) dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis improve short-term computed tomographic-measured right ventricular (RV)-to-left ventricular diameter ratio in massive and submassive pulmonary embolism. The impact on RV remodeling, functional status, and quality of life over the long-term remains unclear.

To study 1-year changes in RV remodeling, functional status, and quality of life, we assessed patients with acute submassive pulmonary embolism randomly assigned to 1 of 4 tPA dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis in the OPTALYSE-PE trial (Optimum Duration and Dose of r-tPA With the Acoustic Pulse Thrombolysis Procedure for Intermediate-Risk Pulmonary Embolism; 8 mg/2 hours, 8 mg/4 hours, 12 mg/6 hours, and 24 mg/6 hours). Echocardiographic assessment included RV-to-left ventricular diameter ratio within 4 hours of treatment end, and at 48 hours, 30 days, 90 days, and 1 year. Functional statu recovery of RV-to-left ventricular diameter ratio and tricuspid annular plane systolic excursion and improvements in functional status and quality of life over 1 year. Registration URL https//www.ClinicalTrials.gov. Unique Identifier NCT02396758.

Currently, 2 third-generation transcatheter valves, 29-mm Sapien-3 and 34-mm Evolut-R (ER), are indicated for large sized aortic annuli. We analyzed short and 1-year performance of these valves in patients with large (area ≥575 mm

or perimeter ≥85 mm) and extra-large (≥683 mm

or ≥94.2 mm) aortic annuli undergoing transcatheter aortic valve replacement.

A total of 833 patients across 12 centers with symptomatic aortic stenosis and large aortic annuli underwent transcatheter aortic valve replacement with 29-mm Sapien-3 (n=640) or 34-mm ER (n=193). Clinical, anatomic, and procedural characteristics were collected, and Valve Academic Research Consortium-2 outcomes were reported.

Median aortic annulus area and perimeter were 617 mm

(591-657) and 89.1 mm (87.0-92.1), respectively (704 mm

[689-743] and 96.0 mm [94.5-97.9] in the subgroup of 124 patients with extra-large annuli). Overall device success was 94.3% (Sapien-3, 95.8% and ER, 89.3%;

=0.001), with a higher rate of significant paravalvular letic valve replacement.A regular check up on a 59-year-old man showed a high carcinoembryonic antigen level in his blood. A computed tomography scan showed tumors in the right atrium. We performed tumor resection successfully. The resected specimen was found to be blood cysts that had developed from the right atrium to the inferior vena cava. Intracardiac blood cysts are generally observed in infants, spontaneously disappear during the first 6 months of life, and are located in the left side of heart and on atrioventricular valves. Therefore, this case is extremely rare. Also, it is worth considering the timing of this surgery.

We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution.

From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months.

There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups (

 = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B (

 = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A 83.4% ± 5.9%, group B 72.6% ± 6.9%,

 = 0.010).

Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.Congenital left ventricular aneurysm or diverticulum is very rare. Most congenital left ventricular aneurysms are asymptomatic but some cause systemic embolization, left ventricular free wall rupture, or ventricular arrhythmias causing sudden cardiac death. A 29-year-old woman with congenital left ventricular aneurysm and nonsustained ventricular tachycardia underwent surgical plication of the aneurysm with left ventricular reshaping to improve heart failure symptoms, prevent rupture of the aneurysm wall and the possibility of thrombus formation, and excise the fibrotic tissue of the left ventricular aneurysm, which could be a trigger for left ventricular aneurysm arrhythmias. The postoperative course was unremarkable.

Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting.

This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46 a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed.

Patients in the control group used cigarettes (31.1% vs. 11.1%,

 = 0.020) and opium poppy for recreation (35.6% vs. 8.9%,

 = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h,

 = 0.020), and fewer blood components infused (15.6% vs. 33.3%,

 = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively,

 = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10,

 = 0.001). Multivariable analysis showed significant associations between Neecham score and age (

 = 0.022), ejection fraction (

 = 0.015), myocardial infarction (

 = 0.016), systolic pressure (

 = 0.009), and diastolic pressure (

 = 0.008).

Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

Experimental evidence suggests a close link between PARP (poly[ADP-ribose] polymerase) activation and diabetic endothelial dysfunction. Here, we tested whether PARP activity in circulating leukocytes was associated with coronary artery disease (CAD) among patients with type 2 diabetes mellitus (T2DM). Approach and Results We performed observational and bidirectional Mendelian randomization studies of 3149 Chinese individuals with T2DM who underwent coronary angiography, with leukocyte PARP activity, 16 tag single-nucleotide polymorphisms in

and

, and 17 CAD risk single-nucleotide polymorphisms analyzed. Of 3149 participants, 1180 who further received percutaneous coronary intervention were prospectively followed for 1 year to track major adverse cardiovascular and cerebrovascular events. Overall, greater PARP activity was cross-sectionally associated with an odds ratio of 1.23 for obstructive CAD, and prospectively with a hazard ratio of 1.34 for 1-year major adverse cardiovascular and cerebrovascular events after percutaneous coronary intervention (both

<0.001). Using a genetic score of 5 screened single-nucleotide polymorphisms in

and

as the instrumental variable, genetically predicted elevation in PARP activity showed a causal association with obstructive CAD (odds ratio=1.35,

<0.001). In contrast, the genetic risk of CAD had no significant effect on PARP activity. Ex vivo and in vitro cultures of human monocytes showed that rs747657, as the lead single-nucleotide polymorphism strongly associated with PARP activity, caused the differential binding of transcription factor GATA2 (GATA-binding protein 2) to an intronic regulatory region in

, thus modulating

expression and PARP activity.

Greater PARP activity may have causal roles in the development of obstructive CAD among patients with diabetes mellitus.

Greater PARP activity may have causal roles in the development of obstructive CAD among patients with diabetes mellitus.

Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. Approach and Results In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the

. True HoFH due to

variants had higher total (

=0.015) and LDL (low-density lipoprotein)-cholesterol (

=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (

=0.051) and had a greater frequency of xanthomas (

=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular evardiovascular complications were heterogeneous and associated with the type of molecular defect.

Deep vein thrombosis and pulmonary embolism referred as venous thromboembolism (VTE) are a common cause of morbidity and mortality. Plasma from healthy controls or individuals who have experienced a VTE were analyzed using metabolomics to characterize biomarkers and metabolic systems of patients with VTE. Approach and Results Polar metabolite and lipidomic profiles from plasma collected 3 months after an incident VTE were obtained using liquid chromatography mass spectrometry. Fasting-state plasma samples from 42 patients with VTE and 42 healthy controls were measured. Plasma metabolomic profiling identified 512 metabolites forming 62 biological clusters. Multivariate analysis revealed a panel of 21 metabolites altogether capable of predicting VTE status with an area under the curve of 0.92 (

=0.00174, selectivity=0.857, sensitivity=0.971). Multiblock systems analysis revealed 25 of the 62 functional biological groups as significantly affected in the VTE group (

<0.05 to control). Complementary correlation network analysis of the dysregulated functions highlighted a subset of the lipidome composed mainly of n-3 long-chain polyunsaturated fatty acids within the predominant triglycerides as a potential regulator of the post-VTE event biological response, possibly controlling oxidative and inflammatory defence systems, and metabolic disorder associated dysregulations. Of interest was microbiota metabolites including trimethylamine N-oxide that remained associated to post incident VTE patients, highlighting a possible involvement of gut microbiota on VTE risk and relapse.

These findings show promise for the elucidation of underlying mechanisms and the design of a diagnostic test to assess the likely efficacy of clinical care in patients with VTE.

These findings show promise for the elucidation of underlying mechanisms and the design of a diagnostic test to assess the likely efficacy of clinical care in patients with VTE.

Extracellular vesicles (EVs) have the potential to act as intercellular communicators. The aims were to characterize circulating EVs in patients with pulmonary arterial hypertension (PAH) and to explore whether these EVs contribute to endothelial activation and angiogenesis. Approach and Results Patients with PAH (n=70) and healthy controls (HC; n=20) were included in this cross-sectional study. EVs were characterized and human pulmonary endothelial cells (hPAECs) were incubated with purified EVs. Endothelial cell activity and proangiogenic markers were analyzed. Tube formation analysis was performed for hPAECs, and the involvement of PSGL-1 (P-selectin glycoprotein ligand 1) was evaluated. The numbers of CD62P

, CD144

, and CD235a EVs were higher in blood from PAH compared with HC. Thirteen proteins were differently expressed in PAH and HC EVs, where complement fragment C1q was the most significantly elevated protein (

=0.0009) in PAH EVs. Upon EVs-internalization in hPAECs, more PAH compared with HC EVce activation of hPAECs and in vitro angiogenesis. These effects were partly because of platelet-derived EVs evasion of lysosomes upon internalization within hPAEC and through possible involvement of P-selectin-PSGL-1 pathway.

Apo (apolipoprotein) CIII mediates the metabolism of triglyceride (TG)-rich lipoproteins. High levels of plasma apoCIII are positively correlated with the plasma TG levels and increase the cardiovascular risk. However, whether apoCIII is directly involved in the development of atherosclerosis has not been fully elucidated. Approach and Results To examine the possible roles of apoCIII in lipoprotein metabolism and atherosclerosis, we generated apoCIII KO (knockout) rabbits using ZFN (zinc finger nuclease) technique. On a normal standard diet, apoCIII KO rabbits exhibited significantly lower plasma levels of TG than those of WT (wild type) rabbits while total cholesterol and HDL (high-density lipoprotein) cholesterol levels were unchanged. Analysis of lipoproteins isolated by sequential ultracentrifugation revealed that reduced plasma TG levels in KO rabbits were accompanied by prominent reduction of VLDLs (very-low-density lipoproteins) and IDLs (intermediate-density lipoproteins). In addition, KO rabbits sho for atherosclerosis.

Gender disparities in authorship of heart failure (HF) guideline citations and clinical trials have not been examined.

We identified authors of publications referenced in Class I Recommendations in United States (n=173) and European (n=100) HF guidelines and of publications of all HF trials with >400 participants (n=118) published between 2001 and 2016. Authors’ genders were determined, and changes in authorship patterns over time were evaluated with linear regression and nonparametric testing.

The median proportion of women authors per publication was 20% (interquartile range [IQR], 8%-33%) in United States guidelines, 14% (IQR, 2%-20%) in European guidelines, and 11% (IQR, 4%-20%) in HF trials. The proportion of women authors increased modestly over time in United States and European guidelines’ references (β=0.005 and 0.003, respectively, from 1986 to 2016;

<0.001) but not in HF trials (12.5% [IQR, 0%-20%] in 2001-2004 to 8.9% [IQR, 0%-20%] in 2013-2016;

>0.50). Overall proportions of women as first or last authors in HF trials (16%) did not change significantly over time (

=0.60). North American HF trials had the highest likelihood of having a woman as first or senior author (24%). HF trials with a woman first or senior author were associated with a higher proportion of enrolled female participants (39% versus 26%,

=0.01).

In HF practice guidelines and trials, few women are authors of pivotal publications. Higher number of women authors is associated with higher enrollment of women in HF trials. Barriers to authorship and representation of women in HF guidelines and HF trial leadership need to be addressed.

In HF practice guidelines and trials, few women are authors of pivotal publications. Higher number of women authors is associated with higher enrollment of women in HF trials. Barriers to authorship and representation of women in HF guidelines and HF trial leadership need to be addressed.

The kidneys play an important role in heart failure (HF), but it is unclear if renal biomarkers improve HF risk prediction beyond established risk factors. We aimed to assess whether adding biomarkers of kidney disease to conventional risk factors improved 10-year risk prediction for incident HF in a contemporary community sample.

We included 450 212 participants in the UK Biobank aged 39 to 70 years without HF who had been assessed in 2006 to 2010 with the urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. There were 1701 incident cases of HF during up to 10.3 years of follow-up (mean 8.2±0.7 years). We used the Atherosclerosis Risk in Communities study heart failure risk score excluding natriuretic peptides as the base model to which we added eGFR and urine albumin-to-creatinine ratio. Harrell’s C-statistic of ARIC-HF was 0.845 (95% CI, 0.831-0.859).

Each combination of added kidney measures (creat-eGFR, cysC-eGFR, and urine alburole of impaired kidney function in HF development in asymptomatic persons.

This study evaluates the impact of the 2018 allocation policy change on outcomes of orthotopic heart transplantation (OHT) in patients bridged with intra-aortic balloon pumps (IABPs).

Adult (≥18 years) patients undergoing OHT between 2013 and 2019 who were bridged with an IABP were stratified based on temporal relation to the policy change. Univariate analysis was used to compare baseline characteristics and postoperative outcomes. Multivariate Cox regression analysis was used to estimate risk-adjusted predictors of post-transplant mortality.

A total of 1342 (8.6%) OHT patients were bridged with an IABP during the study period. Rates of bridging with IABP to OHT increased significantly after the policy change (7.0% versus 24.9%,

<0.001). The mean recipient age was 54.1±12.1 years with 981 (73.1%) patients being male. Baseline characteristics were similar between the 2 groups whereas post-policy change patients spent fewer days on the waitlist (15 versus 35 days,

<0.001), had longer ischemic times (3.5 versus 3.0 hours,

<0.001), and received organs from a greater distance (301 versus 105 miles,

<0.001). By multivariable analysis, days on the waitlist (for every 30 days; odds ratio, 1.01 [95% CI, 1.00-1.02],

=0.031) and diabetes mellitus (odds ratio, 1.87 [95% CI, 1.16-3.02],

=0.011) emerged as significant predictors of post-transplant mortality. After the policy change, waitlisted patients requiring IABP support were more likely to survive to transplant (76.4 versus 89.8%,

<0.001).

IABP utilization has increased over 3-fold since the 2018 policy change with improved waitlist outcomes and comparable post-OHT survival. Thus, bridging patients to OHT with IABPs appears to be an effective strategy in the current era.

IABP utilization has increased over 3-fold since the 2018 policy change with improved waitlist outcomes and comparable post-OHT survival. Thus, bridging patients to OHT with IABPs appears to be an effective strategy in the current era.

Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction.

This multi-center, prospective, open-label, observational, single-arm trial of 1200 patients across 104 centers within the United States with New York Heart Association class III HF and a prior HFH within 12 months evaluated patients undergoing PA pressure sensor implantation between September 1, 2014, and October 11, 2017. The primary efficacy outcome was the difference between rates of adjudicated HFH 1 year after compared with the 1 year before sensor implantation. Safety end points were freedom from device- or system-related complications at 2 years and freedom from pressure sensor fice as in clinical trials, PA pressure-guided therapy for HF was associated with lower PA pressures, lower rates of HFH and all-cause hospitalization, and low rates of adverse events across a broad range of patients with symptomatic HF and prior HFH. Registration URL https//www.clinicaltrials.gov. Unique identifier NCT02279888.

In routine clinical practice as in clinical trials, PA pressure-guided therapy for HF was associated with lower PA pressures, lower rates of HFH and all-cause hospitalization, and low rates of adverse events across a broad range of patients with symptomatic HF and prior HFH. Registration URL https//www.clinicaltrials.gov. Unique identifier NCT02279888.

New insights into post-contrast acute kidney injury (PC-AKI) have recently led to the guidelines on the prevention of PC-AKI being updated. However, little is known about the barriers and facilitators involved in guideline adherence by radiology practices.

To evaluate barriers and facilitators to the adherence of PC-AKI guidelines.

Radiologists visiting the European Society of Urogenital Radiology (ESUR) 2018 meeting, as well as ESUR members were contacted to fill in an electronic questionnaire on the implementation of PC-AKI guidelines applying to their local radiology practices.

Of the 145 responding radiologists representing radiology practices, 127 (88%) confirmed having a PC-AKI protocol in place in their radiology practice, of which 61 (48%) used a protocol as specified in a (inter)national guideline. The majority of radiology practices of the respondents used the ESUR guideline (40%). Barriers for not using PC-AKI prevention guidelines were related to a lack of outcome expectancy. Barriers for es.

Death is the most serious complication of intracerebral hemorrhage. Microbleeding can be a precursor of intracerebral hemorrhage. Susceptibility weighted imaging (SWI) should be included in imaging protocols for some specific groups such diabetic hemodialysis patients in terms of prediction of macrohemorrhages.

To investigate intracerebral microbleeding in hemodialysis patients and the correlation between microbleeding and neurocognitive impairment.

Forty-nine hemodialysis cases were involved in the study. Locations of microbleeding, correlation between microbleeding and hypertension, diabetes mellitus (DM), age, and duration of dialysis were analyzed. Standardized mini-mental test was performed. The tested cases were divided into two groups intracerebral microbleeding (group 1, n = 26) and without intracerebral microbleeding (group 2, n = 17).

Incidence of microbleeding and macrohemorrhage was noted as 59% and 14%, respectively, in all cases. All macrohemorrhagic cases also have microbleeding. In grouded in the imaging protocol of diabetic hemodialysis patients with neurocognitive deterioration.

Computed tomography texture analysis (CTTA) provides objective and quantitative information regarding tumor heterogeneity beyond visual inspection. However, no study has yet used CTTA to differentiate metastatic from non-metastatic cervical lymph node in patients with papillary thyroid cancer (PTC).

To evaluate the value of texture analysis of dual-phase contrast-enhanced CT images in diagnosing cervical lymph node metastasis in patients with PTC.

Metastatic (n = 27) and non-metastatic (n = 32) cervical lymph nodes were analyzed retrospectively. Texture analyses were performed on both arterial (A) and venous (V) phase CT images. Texture parameters, including mean gray-level intensity, skewness, kurtosis, entropy, and uniformity, were obtained and compared between groups. Receiver operating characteristic (ROC) curves analyses and multivariate logistic regression analysis were used in our study.

Metastatic lymph nodes showed significantly higher A-mean gray-level intensity, A-entropy, and lower A-kurtosis and V-kurtosis (all

 < 0.001) than non-metastatic mimics. The ROC curve analyses indicated that A-kurtosis demonstrated an optimal diagnostic area under the curve (AUC; 0.884) and specificity (92.59%), while the A-mean gray-level intensity showed optimal diagnostic sensitivity (90.62%). Multivariate logistic regression analysis showed that A-mean gray-level intensity (

 = 0.006, odds ratio [OR] = 24.297) and V-kurtosis (

 = 0.014, OR = 19.651) were the independent predictor for metastatic cervical lymph node.

Dual-phase contrast-enhanced CCTA-especially A-mean gray-level intensity and V-kurtosis-may have the potential to diagnose metastatic cervical lymph node in patients with PTC.

Dual-phase contrast-enhanced CCTA-especially A-mean gray-level intensity and V-kurtosis-may have the potential to diagnose metastatic cervical lymph node in patients with PTC.

Patients with talocalcaneal coalitions (TCC) often undergo computed tomography (CT). However, ultrasonography diagnosis of TCC has been seldom done according to the literature.

To investigate the accuracy of ultrasonography in diagnosing TCC compared to CT.

Ninety-seven consecutive patients with a clinical suspicion of TCC were included. Ultrasonography was used to assess the classification and complication of TCC. The main sonographic criteria for a positive diagnosis in cases of osseous coalition were the joint space between the medial surface of talar head and the underlying sustentaculum tali of calcaneus disappearing and being replaced by a continuous hyperechoic bony structure. In cases of fibrous coalition, ultrasonography revealed a reduced space of the joint associated with an irregular, angular appearance of its outline and hypoechoic fibrous tissue inside. These data were compared with CT findings. κ statistic was applied to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography as a diagnostic method were assessed.

Ultrasonography findings were positive in 20 of 97 patients with a clinical suspicion of TCC. The diagnosis was confirmed by CT in 21 patients. There were one false-positive result and two false-negative results by ultrasonography. The κ value was 0.907. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 90.5%, 98.7%, 95.0%, 97.4%, 96.9%, and 0.892, respectively.

Ultrasonography could be a reliable, accurate, and non-radioactive diagnostic imaging method in diagnosis of patients with suspected TCC.

Ultrasonography could be a reliable, accurate, and non-radioactive diagnostic imaging method in diagnosis of patients with suspected TCC.

To compare the correlation of Visual Analog Scale with pain subsections of Shoulder Pain and Disability Index and Constant-Murley Score in subacromial pain syndrome patients.

Single cross-sectional analysis.

Hospital Rehabilitation Department.

The assessment tools were applied at baseline. Correlations between Visual Analog Scale, Shoulder Pain and Disability Index and Constant-Murley Score pain subsections were assessed by Pearson correlation coefficient. Linear regression models were calculated between scales. Statistical significance was set at two-sided

< 0.05.

Forty-three patients were included. Pearson’s correlation between assessments was for Visual Analog Scale-Shoulder Pain Disability Index-pain (

= 0.61,

< 0.001) and for Visual Analog Scale-Constant Murley Score-pain were (

= -0.74,

< 0.001). Visual Analog Scale-Shoulder Pain and Disability Index-pain determination coefficient was

= 0.37 and

= 0.54 for Visual Analog Scale-Constant-Murley Score-pain.

Visual Analog Scale showed better correlation with Constant Murley Score-pain than with Shoulder Pain and Disability Index-pain in subacromial pain syndrome patients.

Visual Analog Scale showed better correlation with Constant Murley Score-pain than with Shoulder Pain and Disability Index-pain in subacromial pain syndrome patients.

Creating a model to predict Axial Length (AL) growth in paediatric cataract and evaluating influence factors.

Eyes with AL measured at surgery and at least one measurement after a 6-month period, from children with unilateral or bilateral cataract and primary IOL implantation, were evaluated. A „rate of axial length growth” (RALG) was calculated for every single eye using these AL measurements and

age. One average RALG was calculated for All Eyes and for the groups of Bilateral and Unilateral, Gender, Age at the Surgery, different Visual Acuity, Bilateral Excluded and Not-excluded eye, and Affected and Not-affected eye in unilateral, for comparisons.

Average age at surgery from 76 children was 2.83 ± 2.74 (0.11-12.21) years with follow up of 2.84 ± 1.84 (0.52-8.17) years, 29 (37.66%) had unilateral cataract. A total of 357 AL measurements were used, average of 4.70 ± 2.13 (2-10) measurements per eye. The average RALG for all eyes was 4.51 ± 3.06. There were no RALG significant differences comparing Unilateral and Bilateral eyes (

 = 0.51), Male and Female (

 = 0.26), Age at Surgery <0.5 and >0.5 years old (

 = 0.21), both eyes in Bilateral cases (

 = 0.70) and Unilateral Affected and Not-affected eyes (

 = 0.18). The equation Al = initial AL + slope × 

((age + 0.6)⁄(initial age + 0.6)) estimates ALs in different ages.

A model to predict AL growth in paediatric cataract was developed. Different studied factors did not significantly influence AL growth.

A model to predict AL growth in paediatric cataract was developed. Different studied factors did not significantly influence AL growth.

The aim of this study to compare the clinic efficacy and effects of osmotic release oral system-methylphenidate and atomoxetine on executive function in children and adolescents with attention deficit hyperactivity disorder by a open-label, prospective, randomized controlled trial.

The study was performed by 95 cases between ages 6 and 12 years who were diagnosed as attention-deficit/hyperactivity disorder (ADHD) and also 40 control individuals. In this study, Conners’ Teacher Rating Scale (CTRS) was used in order to evaluate the efficacy of the treatment. Executive functions were assessed by the performance-based neuropsychological tests and ecological behavioral rating scales. Stroop test, cancellation test, and serial digit learning test were applied to performance based neuropsychological tests. Behavior Rating Inventory of Executive Function tests (BRIEFs) were used as behavioral assessment scales.

Among the ADHD groups, a reduction of over 40% in the CTRS subtest scores used to evaluate the efficacy of the treatment was considered to be an improvement, and no significant difference was found for both drugs. Both Osmotic Release Oral System-Methylphenidate Hydrochloride (OROS-MPH) and atomoxetine (ATX) significantly improved scores in neuropsychological tests.

Atomoxetine and OROS-MPH treatments have shown similar efficacy in clinical recovery and improvement on executive functions. However, disturbances in executive functions observed in children with ADHD are persistent despite treatment, when compared with the control group.

Atomoxetine and OROS-MPH treatments have shown similar efficacy in clinical recovery and improvement on executive functions. However, disturbances in executive functions observed in children with ADHD are persistent despite treatment, when compared with the control group.

To evaluate the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) measurements using spectral domain optical coherence tomography (SD-OCT) in patients with chiasmal compression and analyze the diagnostic value of a neural network model.

Forty-seven patients with chiasmal compressive disorder were recruited and divided into two groups depending on the visual field defect (perimetric; group 1 and preperimetric; group 2). Fifty-seven normal subjects were also recruited (group 3). Peripapillary RNFL and macular GCIPL were analyzed in each group. A multilayer perceptron was trained using a training dataset and derived a neural network model. The diagnostic performances were compared using the area under the receiver operating curve (AUROC) between each parameters and neural network model.

All macular GCIPL parameters, except inferotemporal GCIPL thickness, were thinner in group 1 than in group 2 and group 3, with barely any difference between group 2 and guggest that neural networks may be helpful in the early diagnosis of chiasmal compression.

To investigate associated factors with optic disc characteristics in high myopia patients.

According to the meta-analysis of pathologic myopia study, patients were divided into groups from categories 1 (C1) to C4. The diameters, tilt ratio, and rotation degree of optic disc, and the diameters of parapapillary atrophy were measured among other morphometric variables.

Totally 147 eyes (84 patients) were included. Longer horizontal optic disc diameter was associated with smaller tilt ratio (

 < 0.001, unstandardized regression coefficient B -0.59), greater rotation degree (

 < 0.001, B 0.01), and longer horizontal delta zone diameter (

 < 0.001, B 0.09). Longer vertical optic disc diameter was associated with smaller rotation degree (

 < 0.001, B 0.01), longer vertical delta zone diameter (

 < 0.001, B 0.16), and longer disc-fovea distance (DFD;

 < 0.024, B 0.14). Generally, the horizontal optic disc diameter of C3 and C4 groups was smaller than C1 and C2, while vertical diameter and tilt ratio was greater than in C1 and C2. After setting axial length (AL) as an independent variable, horizontal diameters and tilt ratio still showed significant differences, while vertical diameters did not show significant differences.

Axial elongation was associated with an increase of vertical optic disc diameter that was correlated with an reduction of optic disc rotation degree. By contrast, horizontal optic disc diameter elongation was correlated with an reduction of optic disc tilt ratio and an increase of optic disc rotation degree, which was independent of axial elongation.

Axial elongation was associated with an increase of vertical optic disc diameter that was correlated with an reduction of optic disc rotation degree. By contrast, horizontal optic disc diameter elongation was correlated with an reduction of optic disc tilt ratio and an increase of optic disc rotation degree, which was independent of axial elongation.Series of thioether derivatives containing 4-methylumbelliferone fused oxazole moiety were designed and synthesised, their structures were fully characterized by 1H NMR, 13C NMR and HR-ESI-MS as well. Moreover, the in vitro antifungal potency of the title compounds were preliminarily evaluated for their possible use as a fungicide. Meanwhile, ethyl thioethers 3aa and 3ba displayed remarkable inhibitory effect against the mycelium growth of Valsa mali and Botrytis cinerea with EC50 of 12-16 μg/mL. Furthermore, compounds 3aa and 3ba also exhibited > 88% protective and curative effect against B. cinerea on tomato fruits at 90 μg/mL. Additionally, the environmental toxicity of the title compounds against the brine shrimp Artemia salina were evaluated as well. The results indicated that most of the title compounds exhibited weak toxic to aquatic organism A. salina.Fusarium graminearum Schw. is associated with diseases in seeds and seedlings, mainly in maize, and causes damage to crops and food production. We determined the chemical compositions of essential oils from Pogostemon cablin (Blanco) Benth and Baccharis dracunculifolia DC., and evaluated their antioxidant and antifungal activity against F. graminearum. The oils were applied to the fungus using disc diffusion technique at concentrations of 8.0, 4.0, 2.0 and 1.0 μL mL-1. Fungistatic effects of P. cablin oil were detectable at 8.0 μL mL-1, with 80.0% inhibition of fungal growth. This oil contains mono and sesquiterpenes that may be toxic to fungal cell structures. P. cablin oil also had antioxidant activity in free radical sequestration experiments, where as oil from B. dracunculifolia had limited effects. We conclude that essential oil from P. cablin has greater anti-phytopathogenic and antioxidant activity than that from B. dracunculifolia.

Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO).

We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases.

There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13,

0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76,

0%) and ⩾15 letters (OR 2.78,

0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months’ follow up (mean difference -0.15,

64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference -2.92,

89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08,

0%). Cataract formation and/or progression was less in RNB (OR 0.53,

75%). The need for rescue laser was similar the two groups.

Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.

Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.This study examined the relationship between information seeking and fear during the Zika-induced global health crisis. A longitudinal survey of women in the Southern U.S. (N = 306) was conducted in 2016, beginning just days after the World Health Organization declared Zika a global crisis. The data showed that time 1 fear stimulated information seeking at time 2 and that time 2 information seeking caused fear at time 3. This pattern held regardless of whether participants were pregnant or planning to become pregnant (high personal relevance) versus neither (low personal relevance). The findings are at odds with most theories of fear appeals and only partially supportive of contemporary models of information seeking. From an applied standpoint, the results suggest (a) that information seeking should not be assumed to produce uniformly attractive outcomes and (b) that, during a disease crisis, health agencies should anticipate proactive behaviors by members of the public and plan accordingly.

There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity.

To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy.

A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale – self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor.

Adiscussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center.

Vissum Instituto Oftalmológico, Alicante, Spain.

A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes.

A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques.

Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

To describe trocar-assisted method of Nonappositional repair of iridodialysis.

The technique described involves placement of a 25 G trocar at the limbus wherein the lumen of the cannula works as a guide to introduce a double arm polypropylene suture attached to the long arm needle thereby preventing any accidental entrapment of corneal fibers into the needle.

The technique was performed in 7 cases and no entrapment of corneal tissue was observed while maneuvering the suture needle through paracentesis incision during an iridodialysis repair procedure. Anterior segment optical coherence tomography demonstrated closure of the limbal trocar wound at 1-week follow-up. No incidence of wound leak or Descemets membrane detachment was observed.

The technique allows performing iridodialysis repair in technically challenging situations by directing the needle appropriately and preventing any undulating movement inside the anterior chamber. The trocar-assisted method serves as an effective method to perform non-appositional iridodialysis repair.

The technique allows performing iridodialysis repair in technically challenging situations by directing the needle appropriately and preventing any undulating movement inside the anterior chamber. The trocar-assisted method serves as an effective method to perform non-appositional iridodialysis repair.

Autism is a condition frequently characterized by social and communication challenges. Because most research focuses on understanding and reducing challenges, less is known about the strengths of autistic individuals. This is especially true of those who are transitioning into adulthood. We designed this research study to provide information about how parents perceive the strengths of their autistic adolescent children prior to the transition. We reviewed 39 parent interviews from previous research about how they prepare their autistic sons and daughters for adulthood. Without prompting, parents identified many strengths of their autistic children. Diverse strengths and skills they identified included intelligence, creativity, physical abilities, and self-care skills. These strengths are interesting, as they cover traits that are often thought of as areas of difficulty for autistic youth. However, parents also talked about strengths alongside challenges, and how specific supports would be needed to help theluded intelligence, creativity, physical abilities, and self-care skills. These strengths are interesting, as they cover traits that are often thought of as areas of difficulty for autistic youth. However, parents also talked about strengths alongside challenges, and how specific supports would be needed to help their sons and daughters fully realize their strengths. These findings are important, as they help us know more about the strengths of autistic youth and how strengths can be supported when preparing for adulthood. Our findings also help reveal strengths that are particularly apparent during the transition to adulthood.The number of systematic reviews and meta-analyses submitted to nursing and allied health journals continues to grow. Well-conducted and reported syntheses of research are valuable to advancing science. One of the common critiques identified in these manuscripts involves how the authors addressed heterogeneity among the studies in their meta-analyses. Methodologically inappropriate approaches regarding heterogeneity introduce error and bias into analyses and may lead to incorrect findings and conclusions. This article will discuss some of the approaches to take as well as avoid when addressing heterogeneity in meta-analyses, including suggestions for how to choose a fixed-effect or random-effects meta-analysis model and steps to follow to address heterogeneity in meta-analysis results.

To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle.

A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated.

A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 (

= 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19)efine the role of MAT for ankle PTOA.Aims A high-salt diet can aggravate oxidative stress, and renal fibrosis via the brain and renal renin-angiotensin system (RAS) axis in chronic kidney disease (CKD) rats. (Pro)renin receptor (PRR) plays a role in regulating RAS and oxidative stress locally. However, whether central PRR regulates salt-induced renal injury in CKD remains undefined. Here, we hypothesized that the reduction of central PRR expression could ameliorate central lesions and thereby ameliorate renal injury in high-salt-load CKD rats. Results We investigated RAS, sympathetic nerve activity, oxidative stress, inflammation, and tissue injury in subfornical organs and kidneys in high-salt-load 5/6 nephrectomy CKD rats after the silencing of central PRR expression by intracerebroventricular lentivirus-RNAi. We found that the sympathetic nerve activity was reduced, and the levels of inflammation and oxidative stress were decreased in both brain and kidney. Renal injury and fibrosis were ameliorated. To explore the mechanism by which central inhibition of PRR expression ameliorates kidney damage, we blocked central MAPK/ERK1/2 and PI3K/Akt signaling pathways as well as angiotensin converting enzyme 1-angiotensin II-angiotensin type 1 receptors (ACE1-Ang II-AT1R) axis. Salt-induced overexpression of renal RAS, inflammation, oxidative stress, and fibrosis in CKD rats were prevented by central blockade of the pathways. Innovation This study provides new insights into the mechanisms underlying salt-induced kidney damage. Targeting central PRR or PRR-mediated signaling pathway may be a novel strategy for the treatment of CKD. Conclusions These results suggested that the silencing of central PRR expression ameliorates salt-induced renal injury in CKD through Ang II-dependent and -independent pathways.Drawing from a sociocultural life course perspective, this study examines the linkages between two age-related family transitions young adult children leaving home and parental retirement. A sample of 580 ethnically diverse parents aged 50+ with at least one adult child aged 19-35 living in Metro Vancouver, British Columbia, Canada, was used in this study based on four cultural groups British-, Chinese-, Persian/Iranian-, or South Asian-Canadian. Separate survival analyses are used to predict the timing of, and associations between children’s leaving home and parents’ retirement. Later timing of adult children’s leaving home is associated with delays in retirement of parents and is influenced by a number of predictors. Main and interaction effects were supported for ethnicity, where belonging to the Persian/Iranian ethnic group (compared to British) delays home leaving, and belonging to Persian/Iranian and South Asian ethnic groups (compared to British) delays retirement timing.

Epilepsy is more common in autistic children compared to children without autism, but we do not have good estimates of how many autistic adults have epilepsy. We used data from a full population of 7513 autistic adults who received Medicaid in Wisconsin to figure out the proportion of autistic adults who have epilepsy, as compared to 18,429 adults with intellectual disability. We also wanted to assess how often epilepsy is first diagnosed in adulthood. Finally, we wanted to see whether antiepileptic drugs are being used to treat epilepsy in autistic adults. We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. Autistic women and autistic adults with intellectual disability were more likely than autistic men and autistic adults without intellectual disability to have both previous and new diagnoses of epilepsy. Finally, we found that antiepileptic medications are commonly prescribed to autistic people who do not have epilepsy potentially to treat mental health conditions or behavior problems, and that antiepileptic medications are not always prescribed to autistic people with epilepsy even though they are indicated as a first-line epilepsy treatment.