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Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation.
No full textAIMS
To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains.
METHODS
Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC).
RESULTS
HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines.
CONCLUSION
Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable
Effects of combustible cigarettes and heated tobacco products on immune cell-driven inflammation in chronic obstructive respiratory diseases.
No full textSince long-term effects of heated tobacco products (HTP) on the progression of chronic obstructive pulmonary disease (COPD) are unknown, we used COPD mice model to compare immune cell-dependent pathological changes in the lungs of animals which were exposed to HTP or combustible cigarettes (CCs). We also performed intracellular staining and flow cytometry analysis of immune cells which were present in the blood of CCs and HTP users who suffered from immune cell-driven chronic obstructive respiratory diseases. CCs enhanced NLRP3 inflammasome-dependent production of inflammatory cytokines in lung-infiltrated neutrophils and macrophages and increased influx of cytotoxic Th1, Th2 and Th17 lymphocytes in the lungs of COPD mice. Similarly, CCs promoted generation of inflammatory phenotype in circulating leukocytes of COPD patients. Opposite to CCs, HTP favored expansion of immunosuppressive, IL-10-producing, FoxP3-expressing T, NK and NKT cells in inflamed lungs of COPD mice. Compared to CCs, HTP had weaker capacity to promote synthesis of inflammatory cytokines in lung-infiltrated immune cells. Significantly lower number of inflammatory neutrophils, monocytes, Th1, Th2 and Th17 lymphocytes were observed in the blood of patients who consumed HTP than in the blood of CCs users, indicating different effects of CCs and HTP on immune cells' phenotype and function
Positional accuracy during the sequence of static computer-assisted implant surgery in three alveolar ridge morphologies: an in vitro study.
No full textPURPOSE
This in vitro study aimed to assess the positional accuracy during the sequence of static Computer-Assisted Implant Surgery (sCAIS) according to the anatomical characteristics of the alveolar ridge.
MATERIAL AND METHODS
Maxillary bone models with six single tooth gaps including clinical scenarios of healed alveolar ridge (HR), single-rooted (SRS), and three-rooted socket (TRS) morphologies were used in this study. Positional deviations during implant placement procedures were evaluated after the pilot osteotomy (PD), final osteotomy (FD), and implant placement with respect to the pre-planned implant position by using a software package. ANOVA and post hoc analyses were performed.
RESULTS
Ninety implants were included in this study. Higher mean angular, crestal, and apical deviations were found after the PD and FD (3.5 ±2.4°, 0.7 ±0.3mm, and 1.4 ±0.8mm versus 3.6 ±2.2°, 0.6 ±0.3mm, and 1.2 ±0.6mm) compared to IP (2.8 ±1.6°, 0.7 ±0.3mm, and 1.2 ±0.5mm, p≤0.004). Implants placed in TRS demonstrated higher mean angular, crestal, and apical deviations (4.0 ±1.7°, 0.8 ±0.3mm, and 1.6 ±0.5mm) compared to implants placed in SRS (2.5 ±1.2°, 0.7 ±0.3mm, and 1.1 ±0.4mm) or HR (2.0 ±0.9°, 0.5 ±0.3mm, and 0.8 ±0.4mm, p<0.001).
CONCLUSIONS
Positional deviations during sCAIS procedures are initiated with the first implant osteotomy and persist throughout the drilling sequence. However, deviations slightly decreased after implant placement. The alveolar ridge morphology is strongly associated with positional deviations. Higher deviations were observed in three-rooted and single-rooted sockets simulating an immediate approach compared to healed sites simulating a delayed protocol. This article is protected by copyright. All rights reserved
Practical solutions for including Sex As a Biological Variable (SABV) in preclinical neuropsychopharmacological research.
No full textRecently, many funding agencies have released guidelines on the importance of considering sex as a biological variable (SABV) as an experimental factor, aiming to address sex differences and avoid possible sex biases to enhance the reproducibility and translational relevance of preclinical research. In neuroscience and pharmacology, the female sex is often omitted from experimental designs, with researchers generalizing male-driven outcomes to both sexes, risking a biased or limited understanding of disease mechanisms and thus potentially ineffective therapeutics. Herein, we describe key methodological aspects that should be considered when sex is factored into in vitro and in vivo experiments and provide practical knowledge for researchers to incorporate SABV into preclinical research. Both age and sex significantly influence biological and behavioral processes due to critical changes at different timepoints of development for males and females and due to hormonal fluctuations across the rodent lifespan. We show that including both sexes does not require larger sample sizes, and even if sex is included as an independent variable in the study design, a moderate increase in sample size is sufficient. Moreover, the importance of tracking hormone levels in both sexes and the differentiation between sex differences and sex-related strategy in behaviors are explained. Finally, the lack of robust data on how biological sex influences the pharmacokinetic (PK), pharmacodynamic (PD), or toxicological effects of various preclinically administered drugs to animals due to the exclusion of female animals is discussed, and methodological strategies to enhance the rigor and translational relevance of preclinical research are proposed
The future of Alpine Run-of-River hydropower production: Climate change, environmental flow requirements, and technical production potential.
No full textPast studies on the impacts of climate change (CC) on Alpine hydropower production have focused on high-head accumulation power plants. We provide one of the first comprehensive, simulation-based studies on CC impacts on Alpine Run-of-River (RoR) production, also considering effects of environmental flow requirements and technical increase potential. We simulate future electricity production under three emissions scenarios for 21 Swiss RoR plants with a total production of 5.9 TWh a-1. The simulations show an increase in winter production (4 % to 9 %) and a decrease in summer production (-2 % to -22 %), which together lead to an annual decrease of about -2 % to -7 % by the end of the century. The production loss due to environmental flow requirements is estimated at 3.5 % of the annual production; the largest low-elevation RoR power plants show little loss, while small and medium-sized power plants are most affected. The potential for increasing production by optimising the design discharge amounts to 8 % of the annual production. The largest increase potential is related to small and medium-sized power plants at high elevations. The key results are: i) there is no linear relationship between CC impacts on streamflow and on RoR production; the impacts depend on the usable streamflow volume, which is influenced by the Flow Duration Curve, environmental flow requirements, and design discharge; ii), the simulated production impacts show a strong correlation (>0.68) with the mean catchment elevation. The plants at the highest elevations even show an increase in annual production of 3 % to 23 %, due to larger shares of precipitation falling as rain instead of snow. These general results are transferable to RoR production in similar settings in other Alpine locations and should be considered in future assessments. Future work could focus on further technical optimisation potential, considering detailed operational data
Health-related quality of life in elderly cardiac patients undergoing cardiac rehabilitation and the association with exercise capacity: The EU-CaRE study.
No full textAIMS
The ability to be physically active is pivotal to the quality of life in elderly patients. This study aims to describe the association between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression following an exercise-based cardiac rehabilitation (CR) program in elderly cardiac patients.
METHODS
Patients aged ≥65 years with acute and chronic coronary syndrome or heart valve surgery were consecutively included from 8 CR centers in 7 European countries. Exercise capacity (VO2peak(ml/kg/min)) was assessed with a cardiopulmonary exercise test (97%) or a six-minute walk test. Outcome variables included HRQoL (SF-36 physical and mental component scores (PCS and MCS)), anxiety (GAD-7), and depression (PHQ-9). Mixed models were used to address the association between baseline and the development in VO2peak, and outcome variables stratified on sex, and adjusted for baseline values, age, and CR center.
RESULTS
A total of 1,633 patients were included (T0), 1,523 (93%) completed end-of-CR assessment (T1), and 1,457 (89%) 1-year follow-up (T2). Women had higher % of predicted VO2peak, but poorer scores in HRQoL, anxiety and depression at all time-points. All scores improved in both sexes at follow-up. We found significant associations between VO2peak at baseline as well as development in VO2peak and all outcome variables at T1 and T2 in men (all p < 0.001). In women, VO2peak was only associated with PCS scores (p < 0.001).
CONCLUSIONS
Improvements in exercise capacity was strongly associated with improvements in HRQoL and mental health, however with stronger associations in men. The results highlight the importance of physical fitness for HRQol and mental health. The findings from this study might be useful to better target individual CR programs
NT-proBNP in systemic right ventricles: a new cutoff level for risk stratification?
Get PDFINTRODUCTION AND OBJECTIVES
The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV.
METHODS
The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models.
RESULTS
The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P = .003). In patients with NT-proBNP concentrations > 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72 and 0.71, respectively).
CONCLUSIONS
In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes
Skin Color Match in Autologous Breast Reconstruction: Which Donor Site Gives the Best Result?
No full textBACKGROUND
Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of our study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs.
METHODS
193 patients that underwent a delayed autologous breast reconstruction (DIEP, PAP, LAP, LD) were included. Standardized pictures from 242 flaps at 3 months and 9-12 months postoperative were analyzed and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank-sum tests were used for statistical analysis.
RESULTS
Initially, DIEP flaps had a significant lower dE value compared to LD (p=0.012) and PAP flaps (p < 0.001) when compared with the natural breast. PAP flaps showed a significant decrease after 9-12 months (p=0.003). Perception of color match was in all flaps comparable. Compared to the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared to LD (p=0.017) and PAP flaps (p < 0.001). PAP flaps presented a significant decrease of dE after 9-12 months (p =0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps.
CONCLUSIONS
All analyzed flaps have a comparable color match with the surrounding tissue as well as with the contralateral breast about one year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up
One- Versus Three-Month Dual Antiplatelet Therapy in High Bleeding Risk Patients With Chronic Kidney Disease.
No full textShortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) was shown to be effective and safe in patients at high bleeding risk (HBR). We aimed to investigate the effect of 1-month versus 3-month DAPT on outcomes after DES in HBR patients with or without chronic kidney disease (CKD). Data from three prospective single-arm studies (XIENCE Short DAPT Program) enrolling HBR patients after successful coronary implantation of cobalt-chromium everolimus-eluting stent (Xience, Abbott) were analyzed. Subjects were eligible for DAPT discontinuation at 1 month or 3 months if free from ischemic events. The primary endpoint was all-cause death or any myocardial infarction. The key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after PCI. CKD was defined as baseline creatinine clearance <60 mL/min. Out of 3,286 patients, 1,432 (43.6%) had CKD. One- versus 3-month DAPT was associated with a similar 12-month risk of the primary outcome irrespective of CKD status (CKD: 9.5% versus 10.9%, adjusted HR 0.86, 95% CI 0.60-1.22; no-CKD: 6.6% versus 5.6%, adjusted HR 1.15, 95% CI 0.77-1.73; p-interaction 0.299). BARC 2-5 bleeding rates were numerically but not significantly lower with 1 versus 3-month DAPT in both CKD (9.9 % versus 12%) and no-CKD (6.4% versus 9.0%) patients. In conclusion, in HBR patients, 1- versus 3-month DAPT was associated with a similar risk of ischemic complications and a trend toward fewer bleeding events at 12 months after PCI, irrespective of CKD status
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