Days Of Monitoring Research Articles

Differences in Stroke Recurrence Risk Between Atrial Fibrillation Detected on ECG and 14-Day Cardiac Monitoring.

Ischemic stroke and transient ischemic attack (TIA) standard-of-care etiological investigations include an ECG and prolonged cardiac monitoring (PCM). Atrial fibrillation (AF) detected after stroke has been generally considered a single entity, regardless of how it is diagnosed. We hypothesized that ECG-detected AF is associated with a higher risk of stroke recurrence than AF detected on 14-day Holter (PCM-detected AF). We conducted a retrospective, registry-based, cohort study of consecutive patients with ischemic stroke and TIA included in the London Ontario Stroke Registry between 2018 and 2020, with ECG-detected and PCM-detected AF lasting ≥30 seconds. We quantified PCM-detected AF burden. The primary outcome was recurrent ischemic stroke, ascertained by systematically reviewing all medical records until November 2022. We applied marginal cause-specific Cox proportional hazards models adjusted for qualifying event type (ischemic stroke versus TIA), CHA₂DS₂-VASc score, anticoagulation, left ventricular ejection fraction, left atrial size, and high-sensitivity troponin T to estimate adjusted hazard ratios for recurrent ischemic stroke. We included 366 patients with ischemic stroke and TIA with AF, 218 ECG-detected, and 148 PCM-detected. Median PCM duration was 12 (interquartile range, 8.8-14.0) days. Median PCM-detected AF duration was 5.2 (interquartile range, 0.3-33.0) hours, with a burden (total AF duration/total net monitoring duration) of 2.23% (interquartile range, 0.13%-12.25%). Anticoagulation rate at the end of follow-up or at the first event was 83.1%. After a median follow-up of 17 (interquartile range, 5-34) months, recurrent ischemic strokes occurred in 16 patients with ECG-detected AF (13 on anticoagulants) and 2 with PCM-detected AF (both on anticoagulants). Recurrent ischemic stroke rates for ECG-detected and PCM-detected AF groups were 4.05 and 0.72 per 100 patient-years (adjusted hazard ratio, 5.06 [95% CI, 1.13-22.7]; P=0.034). ECG-detected AF was associated with 5-fold higher adjusted recurrent ischemic stroke risk than PCM-detected AF in a cohort of ischemic stroke and TIA with >80% anticoagulation rate.

159-OR: Greater Sleep Variability Is Associated with Less Time in Range of Glucose Levels in Patients with Type 1 Diabetes

Background: Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations between sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. Methods: Baseline data of 76 non-shift working adult T1D patients participating in a randomized study to optimize sleep health (NCT04506151) were analyzed. Glycemic assessments were derived from blinded 7-day continuous glucose monitoring (CGM) and A1C. Percentages of time-in-range (TIR of glucose levels between 70-180 mg/dL) and %CV were calculated from CGM. Sleep was recorded using 7-day actigraphy, yielding sleep duration and efficiency. Variability (SD) of mid-sleep time (MST) was used to represent sleep variability. Non-parametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by the Diabetes Self-Management Questionnaire (DSMQ-R). Multiple regression analyses were performed to identify independent predictors of glycemic parameters. Results: Mean (SD) age was 36.3 (11) years, 48 (63.2%) female, and median (IQR) A1C 6.8% (6.2, 7.4). Sleep duration, efficiency, and non-parametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in SD of MST was associated with 9.64 % less TIR (B= -9.64, 95% (CI) [-16.29, -2.99], p=<0.001). Higher DSMQ score was an independent predictor of lower A1C (B = -0.18, 95% CI -0.32, -0.04). Conclusion: Greater sleep variability is independently associated with less time spent in desirable glucose range in this modern T1D cohort, with clinically important effect sizes. Sleep optimization to reduce variable sleep schedule could potentially lead to improved metabolic control and should be explored in future research. Disclosure P.Martyn-nemeth: None. L.T.Quinn: None. M.Clark withington: None. A.H.Saleh: None. B.Loiacono: None. D.Mihailescu: None. S.Reutrakul: Speaker's Bureau; Eli Lilly and Company. G.Abu irsheed: None. M.Park: None. A.D.Steffen: None. L.Burke: None. S.Pratuangtham: None. K.Baron: Other Relationship; National Sleep Foundation, Research Support; Google. J.Duffecy: Consultant; Chorus Health, K Health, Stock/Shareholder; Healent Health, My Alloy. R.Perez: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121726)

Bedtime extended release cornstarch improves biochemical profile and sleep quality for patients with glycogen storage disease type Ia.

Patients with glycogen storage disease type Ia (GSDIa) are prone to hypoglycemia. Uncooked cornstarch (CS) is the treatment, but maintaining nighttime blood glucose levels is still difficult. The study enrolled patients with GSDIa to investigate the benefits of bedtime extended release CS (ER-CS, Glycosade®) versus regular CS. The daytime CS schedule was not altered. A 7-day continuous glucose monitoring (CGM) was performed at the baseline and 12 weeks after using ER-CS. Biochemical profile, sleep quality (Pittsburgh Sleep Quality Index, PSQI), and quality of life (SF-36 questionnaire) were measured at the baseline and 24 weeks after using ER-CS. Nine patients (9 to 33 years of age) were enrolled. Compared with the baseline (80.0 ± 6.33 mg/dL), the 12-week evaluations revealed higher mean morning glucose levels (86.5 ± 8.26 mg/dL, p = 0.015). Twenty-four weeks after the use of bedtime ER-CS, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels both decreased (from 69.3 ± 77.8 to 41.1 ± 40.4 U/L and from 78.8 ± 99.6 to 37.8 ± 28.81 U/L, respectively, p = 0.013 for both analyses), and sleep and fasting time both elongated (from 7.8 ± 0.87 to 8.6 ± 1.02 h and from 6.5 ± 1.22 to 7.6 ± 1.02 h, respectively, p = 0.011 for both analyses). The mean PSQI score in the five adult patients decreased significantly (from 5.8 ± 1.29 to 3.0 ± 1.71, p = 0.042). This study provides evidence of clinically meaningful improvements by shifting only bedtime regular CS to ER-CS in patients with GSDIa. As ER-CS is considerably more expensive than regular CS, this approach presents a cost-effective alternative.

Salinity and pH effects on survival, growth, and reproduction of quagga mussels.

In recent decades, invasive quagga mussels have expanded to the Western United States from the Great Lakes region of North America. Most studies that evaluate the invasion potential of quagga mussels in western water bodies have utilized physiological and life history information from zebra mussels, a related taxon. Few studies have assessed the potential for invasion using specific information from quagga mussel life history or experiments that test for their survival in the fresh and saline waters of the western United States. We investigated quagga mussel survival, growth, and reproduction using semi-natural experiments under temperature and light controlled conditions across a gradient of water salinity (fresh to brackish) and pH (8.4-11). Water from Lake Mead was used as a positive control in our experiment, and water from Pyramid Lake and the Truckee River was used as brackish and freshwater treatments, respectively. The mussels used in the experiments were collected from Lake Mead. After 12 h in brackish water (4 ppt, pH 9.3), we observed 100% mortality of adult mussels. The swelling and disintegration of body tissues and high mortality rates indicated that high potassium, sodium, and chloride concentrations were the likely causes of death in brackish water treatments. In contrast, mussels were able to survive, grow, and reach sexual maturity in freshwater (0.1 ppt) with a low calcium concentration (17 mg L-1) after 57 days. Mussels died after 2 days at pH 11 and after 12 days at pH 10; during the 14-day monitoring period, no mortality was detected at pH 9.0, 9.3, or 9.5 and mussels did not exhibit any visual indications of stress. Understanding quagga mussel physiological and environmental tolerances appears to be essential for assessing their invasion potential in aquatic habitats.

Radiofrequency ablation for longstanding persistent atrial fibrillation: long-term outcome of a prospective randomized comparison of mapping with multipolar catheter vs. 4-pole ablation catheter

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with longstanding persistent atrial fibrillation (LSPAF), mapping with multipolar catheter can enhance identification of arrhythmogenic sources during ongoing AF/converted atrial tachycardia (AT), reduce procedure time, and improve outcome of catheter ablation. Purpose To compare procedural characteristics and long-term outcome of radiofrequency catheter ablation (RFA) for LSPAF between two mapping approaches in a prospective randomized bi-centric study. Methods Between 1/2019-9/2021, RFA was performed in in 172 patients with LSPAF. Mapping with multipolar catheter Pentaray (group 1, n=85) vs. mapping with ablation catheter Navistar STSF (group 2, n=87) were compared. Stepwise ablation to the desired AF termination included pulmonary vein isolation (PVI), electrogram guided left atrial (LA) ablation, CS isolation, and right atrial electrogram guided ablation. PVI, mitral isthmus, LA roof, and CTI block were Intermediate endpoints proved at the procedure end. Sinus rhythm (SR) restoration by ablation was the desired procedure endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards. Results In groups 1 vs. 2, AF was terminated (into SR or AT) in 70 (82%) vs. 68 (78%) patients (p=0.81); and SR was restored by ablation in 54 (64%) vs. 46 (53%) patients(p=0.46), respectively. Procedure, fluoroscopy, and RF delivery times (min) were 251±46 vs. 257±45 (p=0.35); 10,4±2,8 vs. 11,0±3,1 (p=0.17), and 70±21 vs. 70±24 (p=0.98), respectively. At the end of 13-45 months follow-up, stable SR was present in 72 (85%) vs. 69 (79%), patients following repeat ablation in 42 (49%) vs. 42 (48%) patients. Only 29 (34%) vs. 26 (30%) patients remained free from any AF/AT recurrence (>30 s) after single ablation (all p=NS). Conclusion Mapping with multipolar catheter vs. standard ablation catheter was associated with nonsignificant differences in procedural characteristics and clinical results of RF catheter ablation for LSPAF.

Interim analysis of a prospective randomized comparison of pulsed field ablation vs. radiofrequency ablation for longstanding persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Benefits of pulsed field ablation (PFA) compared to radiofrequency ablation (RFA) are not known in patients with longstanding persistent atrial fibrillation (LSPAF). Purpose To present interim procedural and short-term clinical results of an ongoing prospective randomized comparison of PFA vs. RFA in patients with LSPAF. Methods In 9/2021-10/2022, 125 patients underwent catheter ablation for LSPAF using PFA (n=64, 69±8 years, 11 F, continuous AF 32±20 months) vs. RFA (n=61, 68±8 years, 17 F, continuous AF 29±23 months). PFA included pulmonary vein isolation (PVI) and extra-PV left atrial (LA) ablation. RFA included stepwise PVI, electrogram-guided LA ablation, CS isolation, and electrogram-guided right atrial ablation. Intermediate endpoints were PVI, mitral isthmus, LA roof and CTI blocks); sinus rhythm (SR) restoration by ablation was the desired procedural endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards. Results In groups PFA vs. RFA, procedure and fluoroscopy times were 116±32 vs. 204±44 minutes, and 17±5 vs. 8±2 minutes, respectively (both p<0.001). AF termination (into intermediate AT or directly into SR) and SR restoration by ablation were achieved in 30 (47%) vs. 42 (69%) patients (p=0,19), and in 23 (36%) vs. 35 (57%) patients (p=0,15). Of those 48 vs. 50 patients with follow-up ≥3 months (≥6 months in 37 vs. 39 patients), freedom from any AF/AT (>30 s) was achieved in 38 (79%) vs. 23 (46%) patients. Conclusion Interim results of ongoing comparison suggest procedure time reduction and improved AF/AT free survival after PFA as compared to RFA in patients with LSPAF.

Relationship between continuous glucose monitor (CGM)-assessed glycemic health and biological markers of cardiovascular health in adults

BackgroundAdults with overweight or obesity have a higher risk of the development of impaired glycemic health and cardiometabolic disorders. Glycemic variability acts as a more sensitive assessment of glycemic health compared to other clinical measures. Oxidative stress and diminished vascular health play a key role in the development of cardiometabolic disorders.ObjectiveTo examine the relationship between glucose concentrations and glycemic variability with biological markers of vascular health and oxidative stress.MethodsAdults (n = 28; body mass index = 32.3 ± 6.3 kg/m2) completed 7-day continuous glucose monitoring. Percentage of time each day glucose concentrations were < 70 mg/dL, 70–180 mg/dL, and > 180 mg/dL was evaluated. Means of 24-h, waking and night sleep hours, maximum, minimum, and difference between maximum and minimum (Max–Min) glucose concentrations were determined. Measurements of intra- and inter-day glycemic variability were calculated. Fasting concentrations of glucose, vascular health marker nitric oxide (NO), and oxidative stress marker myeloperoxidase (MPO) were measured, and the ratio of NO concentration to MPO concentration (NO:MPO) was calculated (propensity to vasodilate).ResultsMPO concentration negatively correlated with glycemic variability measured as the mean amplitude of glycemic excursion (r2 = 0.23, β = − 0.62, p = 0.03), while the NO:MPO ratio positively correlated with fasting glucose concentration (r2 = 0.22, β = 3.79, p = 0.01).ConclusionsOur findings suggest that an increased propensity to vasodilate relates to increased fasting glucose concentration, while increased oxidative stress relates to decreased glycemic variability. These findings were unexpected and necessitates further research into the potential mechanisms of these findings for cardiometabolic health in adults having overweight or obesity.

The efficacy of detecting arrhythmia is higher with 7-day continuous electrocardiographic patch monitoring than with 24-h Holter monitoring.

Detecting high-risk arrhythmia is important in diagnosing patients with palpitations. We compared the diagnostic accuracies of 7-day patch-type electrocardiographic (ECG) monitoring and 24-h Holter monitoring for detecting significant arrhythmias in patients with palpitations. This was a single-center prospective trial with 58 participants who presented with palpitations, chest pain or syncope. Outcomes were defined as the detection of any one of six arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter lasting more than 30 s, pauses of more than 3 s, high-degree atrioventricular block, ventricular tachycardia (VT) >3 beats, or polymorphic VT/ventricular fibrillation. The McNemar test for paired proportions was used to compare arrhythmia detection rates. The overall arrhythmia detection rate was higher with 7-day ECG patch monitoring than with 24-h Holter monitoring (34.5% vs. 19.0%, p = .008). Compared with the use of 24-h Holter monitors, the use of 7-day ECG patch monitors was associated with higher detection of SVT (29.3% vs. 13.8%, p = .042). No serious adverse skin reactions were reported among the ECG patch-monitored participants. The results suggest that a 7-day patch-type continuous ECG monitor is more effective for the detection of supraventricular tachycardia than is a 24-h Holter monitor. However, the clinical significance of device detected arrhythmia should be consolidated.

PO-03-223 EXTENDED AMBULATORY ECG MONITORING ENHANCES IDENTIFICATION OF HIGHER-RISK PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

In the 2020 AHA/ACC hypertrophic cardiomyopathy (HCM) guidelines, a 24 or 48 hour continuous ambulatory ECG monitor is recommended for risk stratification to detect nonsustained ventricular tachycardia (NSVT), with greatest weight placed on frequent, long, and/or rapid runs as a sudden death (SD) risk marker. ECG monitoring devices with extended wear capability are now available, although the utility of longer monitoring in HCM is uncertain. To evaluate the prevalence, burden and clinical significance of NSVT identified during initial 48 hours of continuou ambulatory monitoring compared to 14 days. We evaluated 236 HCM patients (49 ± 12 years; 72% male) without primary prevention ICDs judged previously to be at low or intermediate SD risk with 14-day continuous ambulatory monitoring (Zio-patch XT, iRhythm Technologies). Episodes of NSVT were evaluated during the initial 48 hours of monitoring and compared to NSVT identified in subsequent 2 to 14 days. NSVT episodes with ≥1 of the following criteria was considered higher risk as a SD marker: ≥ 200 bpm, ≥ 8 beats, ≥ 3 runs within consecutive 48 hour period. Among the 236 patients, 114 (48%) had ≥ 1 runs of NSVT, with a median of 2 runs (IQR: 1-4) during the complete monitoring period, including 86 patients with ≤ 4 runs (36%), 13 with 5-9 runs (6%), and 15 with ≥10 runs (7%). Median length of NSVT was 7 beats (5-13) at 167 bpm (148-186). Diagnostic yield of detecting NSVT was 18% during the first 48 hours of monitoring compared to 48% at 14 days, with 63% of the initial NSVT episodes occurring after the first 48 hours (72 of 114). Similarly, diagnostic yield of detecting high risk NSVT episodes was 8% during the first 48 hours as compared to 24% at 14 days, with 64% of the initial high-risk NSVT runs occurring after the first 48 hours (36 of 56). There was no significant difference in clinical profile between patients with NSVT at < 48 hours and those with NSVT from 2-14 days, including age or presence of ≥1 major SD risk markers. In HCM, prevalence of NSVT is common, occurring in nearly half of patients over 14 days of continuous monitoring. Diagnostic yield for detecting NSVT was substantially increased using 14 days of monitoring, with 48 hours of monitoring missing nearly two-thirds of patients with high risk NSVT episodes that impact risk stratification. These data support 14-day ambulatory monitoring periods to enhance identification of higher risk HCM patients.

PO-04-223 ASSOCIATION BETWEEN ANTIPARASITIC TREATMENT AND VENTRICULAR ARRYTHMIAS IN PATIENTS WITH CHAGAS DISEASE

Benznidazole and Nifurtimox are the two currently available antiparasitic treatments available for Chagas disease (CD), an important cause of cardiomyopathy and arrhythmias. There are limited data available describing impact of antiparasitic treatment on arrhythmia outcomes. Compare the incidence of ventricular arrhythmias in Chagas patients treated with anti-parasitic medication versus those who did not receive treatment. Patients treated at a Chagas disease center of excellence were retrospectively analyzed for ambulatory rhythm monitoring data (Holter and 14-day patch monitor). Patients with implantable cardiac devices were excluded. Significant ventricular arrhythmias were defined as either a PVC burden >/=1% or non-sustained ventricular tachycardia (NSVT) ≥4 beats. Patients were analyzed based on CD treatment: Benznidazole, Nifurtimox, or no treatment. Patients with incomplete treatment courses were excluded from analysis. A Fisher exact test was used to compare categorical variables. There were 191 patients with CD between 12/2014 and 8/2022 available for analysis, of whom 66 patients underwent ambulatory rhythm monitoring. Of these, 20 were male and 46 were female with an average age of 55.3 ± 12.6 years, and ejection fraction of 56.7 ± 10.5%. Of the 66 patients, 42 (63.6%) received treatment, 22 (33.3%) had no treatment, and 2 (3.0%) received incomplete treatment for CD. Among patients that received treatment for CD, 11/42 (26.2%) had significant ventricular arrhythmias on ambulatory rhythm monitoring. In comparison, among patients who did not receive CD treatment, 12/22 (54.5%) had significant ventricular arrhythmias (p = 0.031). No significant difference in the number of ventricular arrhythmias was observed between the Benznidazole (7/29, 24.1%) and Nifurtimox (4/12, 33.3%) treatment groups. These data demonstrate that treatment of CD is associated with a reduction in ventricular arrhythmias on ambulatory rhythm monitoring. Further studies are needed to determine if CD treatment can lead to reduced incidence of sudden death.

PO-03-205 ARRHYTHMIA BURDEN REVEALED BY AMBULATORY CARDIAC MONITORING IN A MEDICARE ADVANTAGE POPULATION

Medicare Advantage plans enroll an increasing proportion of Medicare beneficiaries annually. The capitation payment model for Medicare Advantage plans is dependent on prompt and accurate coding of Hierarchical Condition Categories (HCCs) that impact risk-adjusted payments. Reporting of disease is critical for clinics to estimate expenditures of Medicare Advantage populations with significant cardiac comorbidities. To quantify arrhythmia burden and potential risk adjustment impact in a Medicare Advantage population. We reviewed ambulatory electrocardiogram (ECG) monitors of 909 patients insured under a Medicare Advantage plan across 19 states. Each patient was enrolled in 14-day electrocardiogram monitoring according to clinical indication. Specialists evaluated recorded abnormal events and provided final interpretations. Standardized specialist-derived criteria were developed to assess for atrial arrhythmias, heart block, sick sinus syndrome, supraventricular tachycardia, and ventricular arrhythmias. Each patient with atrial fibrillation, supraventricular tachycardia, or sick sinus syndrome was assigned HCC96 (Specified Heart Arrhythmias). An additional monthly Medicare payment was calculated by multiplying the HCC96 coefficient of 0.268 by $750 (the approximate monthly Medicare payment corresponding to one point in risk adjustment). The average age of the sample population was 71.2 +- 0.3 (SE) years and 65.6% of patients were female. Common indications for ambulatory cardiac monitoring included palpitations (21.8%), syncope (15.4%), concern for atrial arrhythmia (9.5%), tachycardia (6.5%), and bradycardia (5.0%). Patients wore the ECG monitor for an average of 13 days. Abnormal findings included supraventricular tachycardia (59.4%), nonsustained ventricular tachycardia (6.7%), atrial fibrillation (3.0%), second- or third-degree heart block (1.2%), and sick sinus syndrome (2.6%). A majority (61.4%) had a diagnosis that could impact risk adjustment, leading to a potential increase of $1.35 million in annual Medicare reimbursement assuming this is the first recorded diagnosis of arrhythmia. Ambulatory ECG monitors reveal a high prevalence of arrhythmias that can have a significant risk adjustment impact for Medicare Advantage capitation plans. Additional clinical correlation is necessary to confirm the expected change in annual Medicare reimbursement.

CE-452779-3 RANDOMIZED PLACEBO-CONTROLLED TRIAL OF FLECAINIDE IN PATIENTS WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited arrhythmia disorder with a high risk of ventricular tachycardia (VT) or ventricular fibrillation (VF), and implantable cardioverter defibrillators (ICD) remain the palliative therapy of choice. We conducted an NIH-funded pilot clinical trial hypothesizing flecainide administration is more effective than placebo in reducing the burden of ventricular premature beats (VPBs) in ARVC patients. The study was designed as a randomized double-blinded placebo-controlled crossover trial in ARVC patients with administration of 100 mg bid of flecainide or matching placebo for 4 weeks each with a washout period. The primary specific aim was to determine whether flecainide administration is associated with a significant reduction of number of VPBs in comparison to placebo, measured on 7-day Zio-Patch ECG monitoring. Inclusion criteria required ARVC diagnosis with the 2010 ARVC Task Force Criteria at the age of at least 18 years, implanted ICD, and over 500 VPBs on a diagnostic 24-hour Holter recording. Patients were required to be treated with beta-blockers. Patients on other antiarrhythmic treatment required washout with reconfirmation of over 500 VPBs per 24 hour off antiarrhythmic medication. The effect of flecainide on log2(VPB rate) was analyzed using a weighted linear mixed effects analysis of variance model with fixed effects for treatment and period and a random effect for subject, with wights proportional to teh Zio-Patch monitoring time. There were 22 patients with ARVC and an ICD enrolled with a mean age 45+/-13 years, including 12 females. There were 19 patients with at least one Zio-Patch recording and 17 with both recordings. The Table includes details of arrhythmias on placebo and on flecainide. The mean and median number of VPBs/day was significantly lower on flecainide than placebo. At least 50% reduction in VPBs/day was observed in 79% and at least 75% reduction in 53% of patients. The primary analysis showed that flecainide reduced the VPB rate by 72% (p < 0.0001, 95% CI: 56-82%), adjusted for the period effect. There were 2 subjects with pro-arrhythmic response, but flecainide was safe for most of study patients. This is the first randomized clinical trial testing antiarrhythmic management in ARVC patients. Flecainide signficantly reduced the VPB rate and NSVT/VT/VF rate supporting clinical use of this medication in ARVC patients.

The Effects of Humic Acids on the Early Developmental Stages of African Cichlids during Artificial Breeding.

The aim of this study was to compare the effect of humic acid (HA) obtained by extraction from alginate on the incubation of roes and fry development in African cichlids, Labidochormis caeruleus, as well as their influence on the stabilization of the physicochemical parameters of water in an aquarium during artificial breeding. The roes were obtained by extruding from a female buccal cavity immediately after fertilization. For the experiment, 4 groups of 40 roes were formed in an incubator with an artificial hatchery. Groups 1-3 were exposed to 1%, 5%, and 10% concentrations of HA, respectively. The control group C was not exposed to HA. In all groups, the mortality and size differences of the fry, as well as the temperature, pH, hardness, nitrite, and nitrate levels in the tanks, were determined during a 30-day monitoring period until the resorption of the yolk sac. The results of this study indicated the ability of HA in 5% and 10% concentrations to reduce nitrite and nitrate levels in the aquatic environment, which significantly reduced the mortality of roes and the survivability of the fry. The determination of the morphological measurements of the fry revealed an increased body length in the groups exposed to 5% and 10% HA concentrations compared to the control group by the end of the monitored period. It was also noted that the yolk sac was resorbed two days earlier in the same groups than in the control. Thus, the results showed that HAs are suitable for use in the artificial aquarium incubation of roes and fry development, which are increasingly exposed to adverse environmental factors. The knowledge obtained in this study and its transfer into practice can allow even less experienced aquarists to successfully breed aquarium fish species that could not normally be bred under artificial conditions without the addition of HA.

AI-Based Adherence Prediction for Patients: Leveraging a Mobile Application to Improve Clinical Trials

AbstractIntroductionMedication nonadherence is a public health concern and can impact clinical trial data quality. Traditional compliance collection (pill counts, diaries) can be unreliable in central nervous system trials. As such, strategies such as adherence technologies may play a key role in trial outcomes. AiCure, a computer vision-assisted dosing mobile application (app), collects dosing data and connects patients to sites for dosing support. Phone-based computer vision algorithms confirm dosing and transfer videos for artificial intelligence and human review. Boehringer Ingelheim is partnering with AiCure on pilot trials using AiCure adherence data to improve patient retention and clinical trial data quality. Here we report initial findings.MethodsThis pilot used data from two Phase II trials on the efficacy and safety of BI 409306 in people with schizophrenia (NCT03351244) or Attenuated Psychosis Syndrome (NCT03230097). The AiCure mobile app alerted participants to dosing protocols. The dose event was visually confirmed, providing sites a real-time view of adherence and allowing for targeted outreach and intervention. Adherence data from the first 2 weeks generated quantitative, machine-learning models to predict the individual adherence over the trial. Predictive modeling explored different monitoring periods (7-, 10-, and 14-day) and adherence cutoff points (0.8, 0.7, 0.6).ResultsInitial AiCure assessment identified 43% of participants in NCT03351244 as ≤80% compliant (definition of compliance &gt;80% compliant). Variance in adherence rates between electronic case report forms (eCRF; 78%) and AiCure (26%) data was also observed in the highly compliant/adherent group in NCT03230097. Using the first 2 weeks of adherence data (both studies combined), a participant’s adherence predicted their average adherence for the remainder of the trial. Observation of a participant’s adherence for the latest 4 weeks predicted the probability of premature dropout from the trial. There were further correlations of lower predicted adherence with actual disposition-based dropouts.The early adherence predictive model (0.6 adherence cutoff) identified 22%, 20%, and 19% of patients for trial NCT03351244 (total n=235) as high-risk patients (low-adherence prediction) across 7-, 10-, and 14-day monitoring periods, respectively. Of those high-risk patients, 81%, 90%, and 96%, respectively, were truly nonadherent based on actual adherence data. The 14-day monitoring period model provided the lowest false omission rate, indicative of a better performing model.ConclusionsAiCure data provided insights into patient behavior and adherence patterns which would not be available via CRF. Predictive models developed with AiCure adherence data can identify and predict future poor adherers. This creates opportunities to plan interventions and mitigation strategies to improve patient adherence during trials, thereby providing test drugs the best opportunity at proving efficacy.FundingBoehringer Ingelheim International GmbH (NCT03351244/1289-0049 and NCT03230097/1289-0032)

Clinical trial of home blood pressure monitoring following midodrine administration in hypotensive individuals with spinal cord injury

Background Individuals with spinal cord injury (SCI) above thoracic level-6 (T6) experience impaired descending cortical control of the autonomic nervous system which predisposes them to blood pressure (BP) instability, including includes hypotension, orthostatic hypotension (OH), and autonomic dysreflexia (AD). However, many individuals do not report symptoms of these BP disorders, and because there are few treatment options that have been proven safe and effective for use in the SCI population, most individuals remain untreated. Objective The primary aim of this investigation was to determine the effects of midodrine (10 mg) prescribed TID or BID in the home environment, compared to placebo, on 30-day BP, study withdrawals, and symptom reporting associated with OH and AD in hypotensive individuals with SCI. Design/Methods Participants were randomly assigned to received midodrine/placebo or placebo/midodrine, with a 2-weeks washout period in between, and both the participants and investigators were blinded to randomization order. Study medication was taken 2 or 3 times/day, depending on their sleep/wake schedule, BP, and any related symptoms were recorded before and 1 h after each dosage and periodically throughout the day. Results Nineteen individuals with SCI were recruited; however, 9 withdrew prior to completion of the full protocol. A total of 1892 BP recordings (75 ± 48 recordings/participant/30-day period) were collected in the 19 participants over the two 30-day monitoring periods. Average 30-day systolic BP was significantly increased with midodrine compared to placebo (114 ± 14 vs. 96 ± 11 mmHg, respectively; P = 0.004), and midodrine significantly reduced the number of hypotensive BP recordings compared to placebo (38.7 ± 41.9 vs. 73.3 ± 40.6, respectively; P = 0.01). However, compared to placebo, midodrine increased fluctuations in BP, did not improve symptoms of OH, but did significantly worsen the intensity of symptoms associated with AD (P = 0.03). Conclusion Midodrine (10 mg) administered in the home environment effectively increases BP and reduces the incidence of hypotension; however these beneficial effects come at the expense of worsened BP instability and AD symptom intensity.

Analysis of Abdominal Respiratory Sensor Performance in Sleep Apnea Conditions

Abdominal respiratory sensor is a sensor used to detect sleep apnea that is specifically for neonates, this sensor is specifically for neonates because the use of this sensor does not require a voltage input to activate the sensor. In the absence of voltage input so as not to disturb the heart rhythm in neonates. When the sensor is no longer elastic, the pressure difference generated by the sensor will be unstable so that the sensor cannot work optimally. With these conditions, the period of use of the sensor needs to be known how durable the sensor is when it is used on patients so that the sensor can maximally detect the occurrence of apnea in neonates. How many times have you been in apnea. This study uses an Arduino microcontroller to process the pressure value and RR value generated by the stomach sensor and the MPX5010dp pressure sensor. the research method used is to use a simulator to analyze the combination of abdominal sensors and pressure sensors to monitor apnea. If viewed based on the average error, the error value in the RR 10bpm setting is ±0.185%, the RR 15 setting is ±0.245%, and the setting RR 20bpm is ±0.383%. From the average error value, it can be said that the higher the RR setting value, the higher the average error for each decrease in pressure output. it can be concluded that the performance of the use of the Abdominal Respiratory Sensor and Pressure Sensor on the Apnea Monitoring module functions well in detecting RR according to the settings on the simulator for 3-day monitoring. The development that can be done in this research is to use a more sensitive pressure sensor so that the results obtained are more stable and make the module display more attractive.

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

The presence of microplastics (MPs) reduces the toxicity of cadmium (Cd) to Cirrhinus mrigala larva

Cumulative studies have shown that microplastics (MPs) and cadmium (Cd) co-exist widely, but their combined toxic effects on aquatic organisms are still not well understood. In this study, Cirrhinus mrigala larvae were exposed to single and binary combinations for 7 days, and the growth performance, survival, intestinal contaminant migration, intestinal histopathology, enzyme activity, and expression of antioxidant-related and detoxification-related genes were measured. The results showed that PS-MPs, Cd, and their combined exposure cause intestinal tissue damage, which in turn affects the growth and survival of C. mrigala larvae, and combined exposure of PS-MPs and Cd reduces stagnant growth and death caused by single Cd exposure. Under both single and binary exposure, PS-MPs can accumulate in the intestine of C. mrigala larvae, but Cd-induced damage to intestinal tissues can increase the accumulation of PS-MPs in the intestine of C. mrigala larvae. PS-MPs, Cd and their combined exposure can cause abnormalities in enzyme activity and expression of antioxidant genes and detoxification genes. The results of continuous 7-day dynamic monitoring showed that the relative expression of cat in the Cd exposure group was significantly higher than that of the control group on days 1, 2 and 4; the relative expression of gpx was significantly higher than that of the control group on days 3, 4 and 7; the relative expression of mnsod was significantly higher than that of the control group on days 1, 3 and 7; and the relative expression of cusod was significantly higher than that of the control group on days 4, 6 and 7. These results indicated that the presence of MPs acted as an antagonist, reducing the toxicity of Cd to aquatic organisms. Overall, this study contributes to further understanding of the inter-regulatory relationship between MPs and Cd and the combined toxic effects on aquatic organisms.

Possibilities of Interpreting the Night-to-Day Ratio Specified by 24-Hour Blood Pressure Monitoring.

Specify the risk rate of incorrect patient classification based on the night-to-day ratio specification from singular 24-h ABPM in comparison to the results of 7-day ABPM monitoring. 1197 24 h cycles were enrolled in 171 subjects in the study and divided into 4 groups: group 1 (40 healthy men and women without exercise), group 2 (40 healthy exercise-training men and women), group 3 (40 patients with ischemic coronary artery disease without exercise), and group 4 (51 patients with ischemic coronary artery disease following cardiovascular rehabilitation). The subject of the evaluation was the percentage rate of incorrect subject classification (dipper, nondipper, extreme dipper, and riser) based on the mean blood pressure values for 7 days and from seven independent 24-hour cycles (the mean value mode). In the case of the individuals included in the monitored groups, the mean night-to-day ratio-based (mode for the 7 days versus the individual days of 24-hour monitoring) classification accordance ranged between 59% and 62%. Only in singular cases did the accordance reach 0% or 100%. The accordance size was not dependent on the health or cardiovascular disease (p < 0.594; 56% vs. 54%) or physical activity (p < 0.833; 55% vs. 54%) of the monitored individuals. The specification of the night-to-day ratio of each individual for each day of the 7-day ABPM monitoring would be the most convenient option. In many patients, diagnosing could thus be based on the most frequently occurring values (mode specification).

Comparison of adhesive single-lead cardiac ECG patch device with Holter monitoring for detecting atrial fibrillation after an acute cerebral ischemic event: An interim analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia Background Stroke secondary to atrial fibrillation (AF) is common and often associated with higher risk of stroke recurrence. Detection of AF is challenging due to brief unpredictable episodes of AF runs, especially in patients whose admission electrocardiogram (ECG) demonstrates a sinus rhythm. Probability of AF detection may be higher with early initiation of prolonged ECG monitoring. Purpose To compare diagnostic yield of 7-day cardiac ECG patch versus 24-hour Holter monitoring for detecting AF≥30 seconds; to identify predictors of AF in stroke patients; to determine if 7-day cardiac ECG patch results in a change in clinical practice. Methods In this investigator-initiated prospective study with pairwise comparison of 24-hour Holter and 7-day cardiac ECG patch monitoring, 150 patients who were admitted to a tertiary referral centre with acute ischemic stroke (AIS) or transient ischemic attack (TIA) within 1 week, without known AF, and had sinus rhythm in the admission 12-lead ECG were enrolled. Each patient underwent simultaneous 24-hour Holter and 7-day cardiac ECG patch monitoring. Routine transthoracic echocardiography was performed on each patient to assess cardiac function and exclude intracardiac thrombus. Results There were 102 (68.0%) male patients. 12 (8.0%) patients had underlying history of coronary artery disease; 26 (17.3%) had recurrent stroke or TIA. On admission, median NIH Stroke scale was 4; 18 (12.0%) patients had thrombolysis with alteplase. On transthoracic echocardiography, none had intracardiac thrombus. Both Holter and cardiac ECG patch monitoring were initiated simultaneously at median 2 days after index stroke event. Of 150 patients, 17 (11.3%) detected AF ≥30 seconds. Of these 17 patients, 7 (4.7%) had AF detected within the first 24 hours on both Holter and cardiac ECG patch; 10 (6.7%) were detected after 24 hours on cardiac ECG patch only. Number needed to screen to detect one AF was 6. Compliance to 7-day cardiac ECG patch monitoring was 81.3%. There was no significant difference in age among patients with and without AF. Although left atrium (LA) was not found to be dilated in patients with AF, LA volume index was significantly higher (28.3±15.9 vs 21.8±8.5, p=0.018) and LA emptying fraction (LAEF) was significantly lower (38.0%±30.2 vs 52.6%±16.7, p=0.007). The prolonged 7-day cardiac ECG monitoring patch resulted in 1.5-fold increase in prescription of anticoagulation therapy. Conclusions A 7-day cardiac ECG patch monitoring detected more patients with AF ≥30 seconds than 24-hour Holter monitoring and resulted in increase in prescription of anticoagulation therapy. Higher LA volume index and lower LA emptying fraction were predictors of AF in patients with a recent stroke.