Test Parameters Research Articles

Effectiveness of pulmonary rehabilitation in post-COVID-19 patients: A pre- and post-interventional study.

The need of pulmonary rehabilitation (PR) for COVID-19 patients with long-term effects was desperately felt. The study's objective was to measure the effect of PR on functional capacity and health-related quality of life (HRQOL) in patients with post COVID conditions. Pulmonary medicine department of a teaching hospital conducted this pre-experimental study. The patient underwent a pre and post-assessment, including a six-minute walk test (6MWT) measuring distance, oxygen desaturation, pulse rate, and HRQOL. The intervention had six components; education to patients and caregivers, breathlessness relieving exercises, postural correction, aerobic training, strength training, and stretching exercises. These activities were carried out twice a week for eight weeks, supervised, unsupervised in homes, and a combination. The study enrolled 155 post-COVID patients (Males, 102 and female, 53), out of which 28 (18.1%) had mild, 55 (35.5%) had moderate and 72 (46.5%) had severe COVID. Paired t-test showed improvement in resting pulse rate (P = 0.001) and resting oxygen saturation (P < 0.0001). Distance walking for six minutes increased after rehabilitation (P < 0.0001). After eight weeks of pulmonary rehabilitation, there was an improvement (P < 0.001) in all domains of quality of life, that is, mobility, self-care, pain and discomfort, usual activity, sleep, anxiety and depression. Pulmonary rehabilitation is beneficial for post-COVID patients in improving their quality of life and six-minute walk test parameters, resulting in improved functional capacity and overall quality of life.

Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

BackgroundBrace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive.MethodsBrace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed.ResultsThe research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup.ConclusionsBrace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

Importance of cardiac rehabilitation on cardiorrespiratory fitness in patients undergoing percutaneous aortic valve replacement

Abstract Background Percutaneous Aortic Valve Replacement (TAVR) significantly improves cardiac function in patients with severe aortic stenosis. However, the vast majority of these patients do not reach an adequate functional class despite the valve change, due to the deterioration of hemodynamic function and the repercussions of afterload over time. Cardiac rehabilitation (CR) program is an interdisciplinary intervention aimed at restoring functionality in Post-TAVR patients and the key to optimizing the recovery and enhancing cardiorrespiratory fitness (CRFit). The Purpose of the study is to provide an analysis of the effects of CR on exercise capacity and CRFit in TAVR patients. Methods Quasi-experimental study in TAVR patients that underwent a 4-6 week CR program, including personalized aerobic and strength training. Outcomes assessed pre- and post-rehabilitation included VO2 max, ventilatory thresholds (VT1 and VT2), and exercise capacity. The study also evaluated METs efficiency by comparing actual to predicted METs values before and after the therapy, alongside expired gas analysis test to examine exercise tolerance and its relation to VO2max gains. Results A total of 28 patients were analyzed, with an average age of 73 years (±8.1), initial weight of 68 kg (±12.32), and final weight of 65 kg (±11.13). The average ejection fraction (EF) from echocardiographic parameters was 62% (±10.1). All patients underwent cardiopulmonary exercise testing (CPET) after post-TAVR with improvements in CRFit. Initial exercise test parameters showed an average METs-load at 8.1 (±1.98), VO2max at 4.75 (±1.86), VT1 at 3.05 (±1.86), VAT at 3.85 (±1.62), VT2 at 4.5 (±2.28), and VE/VCO2 at 38 (±5.32). Final test parameters revealed VO2max at 5.8 (±2.09), VT1 at 3.2 (±1.33), VAT at 4.65 (±1.60), VT2 at 5.15 (±2.3), and VE/VCO2 at 36.4 (±69.95). Pearson's correlation analysis between CPET variables and the percentage improvement of various exercise test parameters found no statistically significant correlation. Except for METs-load and final time in Bruce, which show a significant and inversely proportional correlation (r=-0.67, p&amp;lt; 0.001). Conclusions The study demonstrates the effect of cardiac rehabilitation program in enhancing cardiorespiratory fitness and exercise capacity in post-TAVR patients. Notably, improvements in VO2max and ventilatory thresholds highlight the program's efficacy in promoting cardiovascular health. The inverse correlation between initial time in Bruce and METs improvement underscores the importance of baseline exercise capacity in predicting rehabilitation outcomes. Our results allow us to conclude that training volume is not the only variable to consider for proper CR. This insight could guide personalized rehabilitation strategies, making a significant contribution to the field of cardiac recovery post-TAVR.Measured METsBruce time - METs correlation

Caffeine intake, chronotype, and student sleep quality at Polytechnic of Leiria

Abstract Introduction Higher education students ingest very high doses of caffeine, on average twice the recommended safe dose. This excessive consumption can become problematic, ultimately affecting sleep quality and, consequently, academic performance. The aim of this work is to describe caffeine consumption, sleep quality and to characterize the chronotype and academic performance of students at Polytechnic of Leiria. Methods An online self-completion questionnaire was developed, consisting of several instruments: The Caffeine Consumption Questionnaire; Horne and Ostberg morningness-eveningness Questionnaire; Pittsburgh Sleep Quality Index (PSQI), to describe caffeine consumption, characterize chronotype and assess sleep quality, respectively. The mean, standard deviation, minimum and maximum values were calculated for the quantitative variables. Absolute and relative frequencies were calculated for the qualitative variables. Parametric tests were used to compare groups; when this was not possible, non-parametric tests were used. P &amp;lt; 0.05 was considered statistically significant. Results Of the 261 students (mean age: 23.26 ± 6.60 years), 64.2% had poor sleep quality and 45.3% reported an afternoon chronotype. It was found that men consumed more coffee and energy drinks than women, although women consumed more caffeine-containing food products. The average academic score was 14.56 ± 1.61. There was a statistically significant association (p &amp;lt; 0.01) between the afternoon chronotype and poor sleep quality and between the consumption of coffee and chocolate drinks and poor sleep quality. Conclusions Students at Polytechnic of Leiria tend to have poor sleep quality and an intermediate chronotype. Those with an afternoon chronotype or who drink coffee and chocolate drinks have poor sleep quality. Key messages • Accurately assessing the situation is essential for crafting suitable solutions. • Higher students should adjust their coffee consumption to achieve better sleep quality.

The ventilatory efficiency parameters outperform peak oxygen consumption in monitoring the therapy effects on the right ventricular load in patients with hypertrophic cardiomyopathy

Abstract Aim We sought the cardiopulmonary exercise testing (CPET) parameter that is the most reflective of right ventricular (RV) load and its coupling with pulmonary artery (PA) in patients diagnosed with hypertrophic cardiomyopathy (HCM) undergoing medical therapy. Methods CPET on recumbent bike was performed in adult patients with symptomatic non-obstructive HCM with NYHA class I–III, during phase II, randomised, open-label multicentre study, before and after diverse medical treatment for 16 weeks. Endpoints were the changes in: 1) peak oxygen consumption (peak VO2); 2) minute ventilation (VE)/carbon-dioxide (CO2) production slope during the whole CPET; 3) VE/VCO2 slope before anaerobic threshold (AT); 4) VE/VCO2 slope after AT; 5) VE/VCO2 nadir; 6) VE/VCO2 at AT; and 7) VE/VCO2 intercept. Standard ehocardiography at rest was performed concomitantly with CPET to assess tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), severity of mitral regurgitation (MR) and TAPSE/PASP ratio as a measure of RV-PA coupling. Results Of 115 screened patients, 61 (mean age 52 years [SD 14], 43% women) met the study inclusion criteria and underwent CPET. On regression analysis, among all CPET end-point variables, the best independent predictor of the change in PASP, TAPSE and MR severity after 16 weeks of medical treatment was VE/VCO2 below AT (B=-0.28, -0.01,-0.11; SE=0.10, 0.05, 0.01; CI=-0.48 to -0.08, -0.22 to -0.01; -0.02 to 0.01; p=0.007, 0.035, 0.004, respectively), whereas the best predictor of TAPSE/PASP ratio was intercept of the VE/VCO2 curve (B=0.014, CI=0.01to 0.03, p=0.005). Conclusion The changes in VE/VCO2 slope below anaerobic threshold, and intercept of the VE/VCO2 curve outperform peak VO2 in the monitoring of therapy effects on the right heart load and RV-PV coupling in patients with hypertrophic cardiomyopathy.

Effects of multilevel OSA surgery on patients with poor cardiopulmonary performance: A prospective pilot study

ObjectiveMultilevel airway surgery for obstructive sleep apnea/hypopnea syndrome (OSA) has benefits in improving sleep quality, but its effect on polysomnography (PSG) and 6-minute walk test (6MWT) parameters, including walking distance and cardiopulmonary performance, in patients with poor pre-operative cardiopulmonary performance remains understudied, which should be further investigated. MethodsThis prospective pilot study enrolled 27 consecutive OSA patients with poor pre-operative 6MWT results. All patients received multilevel OSA surgery, and the alterations of sleep parameters and 6MWT profiles were studied. The pre- and post-operative values of polysomnographic data and 6MWT profiles were analyzed using the Wilcoxon signed-rank tests. The relationships among changes of the indices of PSG and 6MWT were further investigated with the Spearman's correlations. ResultsAfter surgery, the sleep parameters and certain cardiopulmonary indices improved. When analyzing the correlations among changes of the indices of PSG and 6MWT, the improvement of daytime sleepiness (with ESS) was found related to farther walking distance (ρ=-0.414, p = 0.032) and higher percentage of “distance/target distance” (ρ=-0.435, p = 0.023). Moreover, the change of maximal expiratory pressure was the only index associated with the changes of AHI (apnea/hypopnea index, /hr.; ρ=-0.407, p = 0.035) and AHI in REM (ρ=-0.502, p = 0.009) among the cardiopulmonary performance parameters. ConclusionThis pilot study showed that OSA patients with poor pre-operative cardiopulmonary status undergoing multilevel sleep surgery could experience improvement in the sleep study and 6MWT to some extent. The relatively better walking distance and cardiopulmonary performance after the operation might potentially result from the improvement of daytime sleepiness and better respiration.

Cardiopulmonary exercise testing predicts risk of progressive heart failure and long term mortality in ambulatory patients awaiting isolated heart transplant

Abstract Introduction Cardiopulmonary exercise testing (CPET) parameters such as peak VO2 ≤ 14ml/kg/min, percentage predicted peak VO2 (ppVO2) ≤ 50% and ventilation equivalent of carbon dioxide (Ve/VCO2) &amp;gt;35 l/min/l/min are recommended thresholds to list for isolated heart transplant. There is minimal data on clinical events after listing to guide clinical management or priority in organ allocation. Purpose To assess the effect of peak VO2, ppVO2, Ve/VCO2 on clinical events after listing for isolated heart transplant. Methods In a single centre retrospective study, we identified patients who were status 6 or status 2 prior to 2018 at time of listing for isolated heart transplant between 2007 and 2021. Clinical data were collected by chart review. Primary outcome of progressive heart failure was defined as death or upgrade in transplant priority status (new inotropes or mechanical circulatory support). Comparison was made between peak VO2 strata (&amp;gt; 14 vs ≤ 14 ml/kg/min), ppVO2 strata (&amp;gt; 50% vs 40-50% vs &amp;lt;40%) and Ve/VCO2 strata (&amp;lt;35 vs &amp;gt;35 l/min/l/min). Secondary outcome was time dependent survival after listing for heart transplant. Results We identified 141 patients of which 133 underwent CPET and follow up was available for 130 who were included in the analysis. Median age was 53 years (interquartile range 41-59 years), 29.1% of patients were female. Median peak VO2 was 14.0 ml/kg/min (11.2-15.7), ppVO2 was 44% (36-52), Ve/VCO2 slope was 34.0 (31.0-37.0) and RER was 1.1 (1.1-1.2). 87 patients had progressive heart failure consisting of 34 deaths and 83 patients having upgrade in priority status. There was a significant difference in risk of progressive heart failure comparing peak VO2 strata (Figure 1) (freedom from event at one year 71.4% with peak VO2 &amp;gt; 14 vs 46.5% with peak VO2 ≤ 14, p=0.00061) and ppVO2 strata (Figure 2) (freedom from event at one year 75.0% with ppVO2 &amp;gt;50% vs 61.2% with ppVO2 40-50% vs 42.6% with ppVO2 &amp;lt;40%, p=0.0015). There was no significant difference with Ve/VCO2 strata (freedom from event at one year 59.8% with Ve/VCO2 &amp;lt;34 vs 54.9% with Ve/VCO2 &amp;gt;34, p=0.52). There were 34 deaths before transplant and 23 deaths after transplant. 87 patients underwent transplant. In a time dependent survival analysis, age, gender and ppVO2&amp;lt;50% (HR 1.65 (0.87-3.12)) were not significant predictors of mortality. Both early transplant (defined as &amp;lt; 1 year after listing, HR 0.14 (0.06-0.34) and late transplant (defined as &amp;gt; 1 year after listing, HR 0.16 (0.08-0.32)) were significant predictors of lower mortality whilst Ve/VCO2&amp;gt;35 (HR 2.09 (1.19-3.68)) was a significant predictor of higher mortality. Conclusions Peak VO2 and ppVO2 stratify risk of progressive heart failure in ambulatory patients awaiting isolated heart transplant. However, Ve/VCO2 is a predictor of significantly higher mortality. These findings should affect clinical management and transplant priority status; and influence revision of future guidelines.Freedom from event by peak VO2 strataFreedom from event by ppVO2 strata

Intraindividual variability in lipoprotein(a): the value of a repeat measure for reclassifying individuals at intermediate-risk

Abstract Background Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease and outcomes. Levels are predominantly genetically determined and repeat measurements are traditionally considered unlikely to be useful. However, the temporal variation of Lp(a) is not well characterized and it is unclear whether a single measure of Lp(a) is sufficient to assess cardiovascular risk in all individuals. Purpose To determine the intraindividual variability of Lp(a) and whether a repeated measure reclassified Lp(a)-specific cardiovascular risk using the European Atherosclerosis Society (EAS) consensus statement risk categories. Methods This retrospective cohort study analyzed initial and repeated Lp(a) measures obtained using the same laboratory assay from 609 individuals in the Nashville Biosciences database accessed through the American Heart Association Precision Medicine Platform. Categorical variables are presented as counts (%) and compared using Fisher’s exact test. Continuous variables are presented as mean ± standard deviation or median (Q1-Q3), tested for normality using the Shapiro-Wilk test, and compared using parametric and nonparametric tests where appropriate. The Spearman’s Rank correlation coefficient was used to assess the relationship between two variables. The significance level was set at p&amp;lt;0.05. Results Median age was 52.5 (37.1-62.8) years, 45% were women, 80.3% were White patients, 13.3% were Black patients, 1.6% were Asian patients, and 4.8% were other/unknown patients. In terms of relevant comorbidities, 41% had ischemic heart disease, 24.1% had chronic kidney disease, and 13.5% had liver disease. The median time between the two Lp(a) measures was 1.07 (0.5-2.1) years. Our analysis shows a significant difference between the paired Lp(a) values (p&amp;lt;0.05), with 38.1% [95% CI 34.2%-42%] changing by ≥10mg/dL, and 40.5% [95%CI 36.6%-44.3%] changing by &amp;gt;25%. There was a positive correlation between the baseline Lp(a) levels and the absolute changes in Lp(a), (r=0.59, p&amp;lt;0.01). The proportions of individuals with variability are similar in those who were never on the potentially Lp(a)-altering agents (statin, niacin, or PCSK9 inhibitor drugs) (n=91), with 32% [95%CI 22.4%-41.6%] changing by ≥10mg/dL, and 34% [95%CI 24.3%-43.7%] changing by &amp;gt;25%. While over 90% of those whose values were initially in the EAS low-risk and high-risk categories remained in those categories, 53% of those in the intermediate "grey-zone" category transitioned to either the low (20%)- or the high (33%)- risk category (Figure). Conclusion(s) Temporal-related changes in Lp(a) variability were present in many individuals and should be included in calculating the expected effect sizes in future studies targeting Lp(a). A repeat Lp(a) measure may allow more precise Lp(a)-specific cardiovascular risk prediction for individuals whose initial value is in the EAS-defined intermediate "grey-zone" category.

Volume-pressure loop hemodynamic characterization of pulmonary hypertension

Abstract Background Pulmonary hypertension (PH) includes a wide spectrum of pathologies with different pathological bases and a variety of clinical scenarios in which right ventricular (RV)-pulmonary artery (PA) coupling has relevant prognostic implications. Currently, diagnosis and hemodynamic severity of PH is typically based on mean pulmonary arterial pressure (mPAP), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVR). However, this conception does not take into consideration the evolution of these parameters throughout the cardiac cycle. We hypothesized that not only the magnitude but also the dynamics over time plays an important role in RV adaptation to pressure overload (i.e., constant fixed resistances throughout the cycle will have a different impact than a fluctuating resistances). Purpose To assess PA hemodynamic patterns throughout the cardiac cycle and their association with RV remodelling, by combining right heart catheterization (RHC) and cardiac magnetic resonance imaging (CMR) data. Methods 66 patients with PH (38 women, aged 63.59±14.70years, BMI 28.49±6.21 kg.m2) who underwent RHC in the supine position with a 7.5-FrSwan-Ganz catheter under fluoroscopic guidance (37 precapillary, 17 combined pre-postcapillary, 12 isolated postcapillary PH) and CMR with flow-encoded phase-contrast sequence were included. Pressure and flow tracings at the level of the main PA were integrated to obtain volume-pressure loops throughout the cardiac cycle. The resulting patterns based on morphology (Image 1) and slope (Pattern 1 mean slope 16,11% vs Pattern 2 mean slope 10,37%) were analysed and classified into 2 groups: Pattern 1 and Pattern 2. RV end-systolic (iRVESV) and end-diastolic volumes (iRVEDV), RV ejection fraction, RV mass and presence of late gadolinium enhancement (LGE) at the RV insertion points were compared between groups using parametric and non-parametric tests. Results Patients with Pattern 1 showed significantly higher mPAP (46.03±11.62 vs. 35.77±8.10 mmHg) and iPVR (746.22±584.54 vs 319.56±306.21 dynes.s.cm-5.m2) and lower PCWP (11.8±7.6 vs 17.7±7.2 mmHg). Precapillary PH patients more frequently presented a Pattern 1 (n=27; 77.1% vs 10; 32.3%). In addition, patients with Pattern 1 had higher RV volumes (iRVEDV= 105.45±34.62 ml/m2 vs 84.22±35.0 ml/m2, p=0,002; iRVESV 65.05±27.59 ml/m2 vs 44.63±25.09 ml/m2, p=0,001), poorer RV function (RVEF 39.81±11.33% vs 48.96±10.90%; p=0,001), larger RV mass (27.95±9.46 vs 23,44±7.46 g/m2, p=0,045) and smaller left atrial size (24.18±11.47 vs 34.06±19.15 cm2, p&amp;lt;0,001) than patients with Pattern 2. The quantification of LGE was also higher in Pattern 1 as compared with Pattern 2 (5.4±2.4% vs 3.0±2.3%, p&amp;lt;0.001). Conclusion Volume-pressure loops at the level of the main PA may differentiate patterns of PA hemodynamic fluctuations that have different impact on RV performance regardless the PH severity within the wide spectrum of PH.Volume-pressure loop patterns

Frailty and MECKI score in predicting mortality in advanced heart failure

Abstract Background Physical frailty (PF), characterized by decreased physiological reserves and increased vulnerability to stressors, has emerged as a significant predictor of adverse outcomes in heart failure (HF). The MECKI (Metabolic Exercise Cardiac Kidney Index) score, a composite index derived from cardiopulmonary exercise testing parameters and renal function, has shown promise in predicting outcomes in HF patients. Purpose The aim of the study is to evaluate the independent prognostic role of the MECKI score and PF on mortality in patients with advanced heart failure (AHF). Methods Ninety-one patients with AHF were enrolled, including 42 on the heart transplant waiting list, 10 undergoing evaluation for listing, and 49 removed from the list due to transplant contraindications or reaching age limits. All patients included in the study were on medically optimized therapy. MECKI score assessment was conducted upon enrollment, along with hematological and biochemical evaluations including creatinine, hemoglobin, Na+, and NT-pro-BNP levels. Patients also underwent echocardiography assessing ejection fraction (EF), TAPSE, Inferior Vena Cava (IVC) diameters, and PASP. Additionally, all patients performed the 6-minute walk test (6MWT) and cardiopulmonary exercise testing with assessment of VO2max and VE/VCO2. Frailty was assessed based on modified Fried criteria. Results The mean age was 56.5±11.2 years. Mean NYHA class was 2.7±0.6, EF was 28.8±7.6, TAPSE was 17.5±4.2, and NT-proBNP was 2912.2±3249.0. Mean VO2max was 12.0±3.5 ml/kg/min, and mean distance walked during 6MWT was 278.8±137.2 meters. Mean frailty score was 3.2±1.2 while mean MECKI score was 15.2±14,2. During a mean follow-up of 32.0±15.3 months, there were 21 deaths, 15 patients received heart transplants, and 1 patient underwent LVAD implantation. Stratified data for mortality showed statistically significant differences in deceased patients compared to survivors regarding NYHA class (3.2±0.3 vs 2.6±0.7; p&amp;lt;0.001), Frailty Index (4.4±0.7 vs 2.7±1.13; p&amp;lt;0.001), NT-proBNP (5425.0±2863.0 vs 1731.0±1618.0; p&amp;lt;0.001), VE/VCO2 (42.7±12.3 vs 35.0±9.1; p&amp;lt;0.003), and MECKI score (29.4±15.2 vs 11.2±11.2; p&amp;lt;0.001). Linear regression analysis demonstrated a significant positive correlation for Frailty Index and MECKI score with age, NYHA class, VE/VCO2, IVC, and NT-proBNP, while showing a negative correlation with TAPSE, VO2max, and 6-minute walk test. Cox regression analysis on mortality demonstrated the predictive role of Frailty (HR=2.121; 95%CI=1.017-4.421; p=0.045) and MECKI score (HR=1.043; 95%CI=1.009-1.079; p=0.014) independently from age, sex, NYHA class, NT-proBNP, EF, TAPSE, VO2max, 6MWT, and IVC diameter. ROC curves demonstrated an AUC of 0.896 for MECKI score and mortality, and 0.884 for Frailty Index and mortality. Conclusions The MECKI score and physical frailty are both valid independent predictors of mortality in patients with advanced heart failure.

Zibotentan in microvascular angina: a randomized, placebo-controlled, crossover trial

Abstract Background/Introduction Microvascular angina is a chronic condition characterized by abnormal myocardial blood flow leading to ischemic symptoms. Endothelin-1, a peptide secreted by endothelial cells, is a highly potent constrictor of the human coronary arterioles. Microvascular angina is associated with elevated circulating concentrations of endothelin-1, and prolonged exposure to ‘excess’ endothelin causes vasoconstriction and vascular remodelling. The chronic elevation of circulating endothelin-1 in microvascular angina may be influenced by genetic factors. Purpose Zibotentan, the most selective antagonist of the endothelin A receptor with no off-target binding to the endothelin B receptor, was evaluated in oncology trials and did not improve survival. We identified zibotentan as a potential disease-modifying therapy for patients suffering from microvascular angina. We hypothesized that zibotentan 10 mg daily for 12 weeks in addition to background medical therapy could be an efficacious and safe treatment for patients with microvascular angina. We further hypothesized that the SNP regulator of EDN1 gene expression, rs9349379 (G allele), could be a novel theragnostic biomarker. Methods The trial involved a prospective, multicentre, randomized, double-blind, placebo-controlled, sequential crossover design to assess the effects of zibotentan 10 mg or matched placebo, once daily for 12 weeks. The primary outcome was treadmill exercise duration (seconds) using the Bruce protocol. The secondary outcomes included exercise test parameters, health status questionnaires, safety (frequency and severity of severe adverse events (SAEs) and adverse events), feasibility (withdrawal rate), and biomarkers of efficacy (pharmacokinetics, pharmacodynamics). Results The study found no significant difference in exercise duration with zibotentan (-4.26 seconds; 95% CI: -19.60 to 11.06; P=0.5871). There was no effect on the secondary outcomes. However, for exploratory (mechanistic) outcomes, zibotentan increased plasma big endothelin-1, endothelin-1, and global myocardial blood flow, while reducing hemoglobin, diastolic, and systolic blood pressure (all p&amp;lt;0.001). Adverse events were more common during the zibotentan period (60.2%) compared to placebo (14.4%, p&amp;lt;0.001). Conclusion(s) In conclusion, daily administration of 10 mg zibotentan for 12 weeks did not enhance exercise duration and was commonly associated with adverse effects related to fluid retention. Further trials exploring lower zibotentan doses in combination with agents to mitigate fluid retention, and longer treatment durations, are warranted.

Association between inflammation indicators (MLR, NLR, SII, SIRI, and AISI) and erectile dysfunction in US adults: NHANES 2001–2004

BackgroundThis study aimed to assess the relationship between multiple indicators of inflammation and erectile dysfunction through an analysis of data from the National Health and Nutrition Examination Survey (NHANES). This represents the first large-scale, cross-sectional investigation that explores this association by jointly analyzing various inflammatory markers.MethodsWe performed a cross-sectional analysis with NHANES data from 2001 to 2004. Erectile dysfunction (ED) was evaluated through a self-reported questionnaire and testosterone levels, while inflammatory markers were derived from standard blood test parameters. Our approach included multivariate logistic regression, subgroup analyses, generalized additive modeling (GAM), and smoothed curve fitting to evaluate the link between inflammatory markers (NLR, MLR, SII, SIRI, AISI) and ED. Additionally, we utilized receiver operating characteristic (ROC) curves to determine the diagnostic utility of these markers, comparing their area under the curve (AUC) values.ResultsA total of 3610 participants were included in this study, and the population-weighted ED patients were 18.91%. In the adjusted model, multiple logistic regression analysis showed a positive association between five inflammatory indicators (Ln-NLR, Ln-MLR, Ln-SII, Ln-SIRI, and Ln-AISI) and ED. Smoothed curve fitting showed a nonlinear positive correlation between the five inflammatory indicators and ED. Furthermore, subgroup analyses showed that this correlation was stronger in people older than 50 year. ROC curve analysis showed the highest diagnostic performance for the study outcome with MLR (AUC = 0.616, 95% CI: 0.5952–0.637), which was significantly better than SIRI, NLR, AISI, and SII.ConclusionMLR is potentially more effective than other biomarkers (NLR, SIRI, AISI, SII) in predicting ED. Men with elevated MLR levels should be particularly aware of their increased risk of developing ED.

Study on the effect of structural parameters of a thermal liner on its thermal protective performance under radiant heat exposure

To comprehend the impact of elementary construction parameters of nonwoven thermal liners on their thermal protective performance, the current research primarily emphasizes on studying the effect of needle penetration depth and needle punch density of the thermal liner. Nonwoven fabrics with three different punch densities and three needling depths were prepared. The air permeability and thermal resistance of the thermal liner were investigated through regression analysis to determine the influence of needle penetration depth and needle punch density. It was observed that both factors had a notable impact on the air permeability and thermal resistance of the thermal liner. An increase in needle penetration depth and needle punch density resulted in a decrease in the air permeability and thermal resistance of the thermal liner. An experiment was carried out utilizing the 33 Box-Behnken designing approach; the factors employed were the radiant heat flux intensity, needle punch density, and needle penetration depth of the thermal liner. The thermal protective performance of thermal liners was measured at three discrete intensities of radiant heat exposures. To investigate the effect of the test and construction parameters and their interaction, an analysis of variance study was carried out. It was observed that protection time rises with the decrease in needling depth and needle punch density at every level of heat flux. With the rise in incident radiant heat flux, protection time declines, irrespective of needle penetration depth and punch density levels.

Development and Validation of a Method for Detecting and Quantifying Mitragynine in Kratom Samples Using HPLC-PDA

Kratom (Mitragyna speciosa Korth) has been identified as a New Psychoactive Substance (NPS) by the United Nations Office on Drugs and Crime (UNODC) and included in the list of prohibited ingredients in food supplements and traditional medicine by Indonesian FDA. Therefore, a rapid, easy, and reliable analytical method is necessary to detect and quantify this plant and its products. This study developed a method for the detection and quantification of kratom products based on a unique compound, mitragynine, as a biomarker. A previous survey of determining mitragynine in Kratom using GC-MS, LC-MS/MS, UPLC, and HPLC-PDA. Previously, the HPLC-PDA method used a C8 column. Yet, for efficiency, it is also necessary to develop a test method using a C18 column. Analysis was performed using an HPLC - PDA system with Waters Atlantis T3-C18 (250 x 4.6 mm, 5 µm) column. The mobile phase comprises acetonitrile and formic acid 0.05%, pH 5.0 (75:25 v/v), delivered at a 1.0 mL/min flow rate. Detection was carried out at a wavelength of 225 nm. The analytical method was validated with test parameters of selectivity, system suitability, accuracy, precision, linearity, detection limit, and quantification limit. The validation study demonstrated an excellent linear concentration range of 1.96 - 6.01 µg/mL with a correlation coefficient of 0.9996; the detection limit is 0.14 µg/mL, while the limit of quantification is 0.45 µg/mL—accuracy method of 98.88 - 101.44% and a bias of 0.27%. The percent relative standard deviation for six independent assay determinations was 0.67%, and the intermediate precision was 1.56% on two days. The mitragynine amounts in these materials ranged from 6.01 to 6.31 mg/g of dried leaf material. Based on the research results, it can be concluded that the method developed provides quick, simple, reliable, accurate, and valid, and has an advantage over existing methods in terms of simplicity of sample preparation, short analysis time, and cost-effectiveness compared to GCMS and LCMS/MS and can be applied for future analysis in Kratom samples.

Exploring the correlation between body mass index and lung function test parameters: a cross-sectional analytical study

PurposeThe correlation between body weight and health is a significant public health concern. While the adverse effects of obesity on pulmonary function are well-known, the impact of being underweight remains debated due to limited research. This study aimed to investigate the correlation between Body Mass Index (BMI) categories and lung function parameters.ResultsA study of 3077 participants found significant differences in gender, age, height, and weight across various Body Mass Index (BMI) categories. The study found non-significant variations in forced expiratory flow (FVC) across BMI categories, with underweight individuals showing lower FVC compared to normal and overweight individuals. BMI significantly impacted mean forced expiratory flow during the middle half of FVC. A significant negative correlation was observed between age and FVC, FEV1, FEV1/FVC ratio, and FEF25-75. A significant positive correlation was observed between weight, height, and lung function parameters. Multiple regression analysis revealed a decrease in lung function with advancing age, while height showed significant positive associations. The study concluded that age, sex, smoking, height, and weight collectively explained 41.0% of the variance in FVC, FEV, and FEF25-75.

The Attitudes of Households for Disaster Risk Management in Fogera, Estie and Ebenat Woredas

The underlining disaster risk management practice translates the combination of knowledge, attitude, and action to maximize the effectiveness of responses against disasters. While knowledge and disaster risk management activities move along simultaneously, attitudes are inherent to individuals posing challenges to easily identify issues and then taking extended time to change. Lack of scientific wisdom on the perception of individuals towards disaster management, and the limited understanding of different factors that influence attitudes, complicates the endeavor in response to the increasingly uncertain future. This study assesses the attitudes of households for disaster risk management in the nine kebeles, the lowest administrative unit in Ethiopia, and 32 villages in Fogera, Ebenat and Estie districts (Woredas, the main administrative unit similar to county). Cross-sectional quantitative method was employed, and attitudinal survey was conducted among 412 households selected through probability simple random sampling. Purposive nonprobability sampling technique was used to identify research kebeles based on disaster prevalence, and to collect supplementary attitudinal data from 64 participants representing academia and local stakeholders. Descriptive statistics and parametric test of variance and covariance have been conducted to determine the attitude levels and to assess major factors influencing households’ attitude for disaster risk management. Results indicated that most of the households (53%) have a fairly positive attitude. Households with negative (27%) and extremely negative (20%) perception are concentrated in rural kebeles that are highly affected by recurrent disasters. Therefore, households in disaster affected areas have negative and unconstructive perception for disaster risk management. This is mainly associated with lack of active community participation and ineffective risk management activities. Households’ attitude is also significantly affected by age (p = 0.0001), and within different age groups (p = 0.001), location by kebeles (p = 0.0237), education levels (p = 0.0016), education status (p = 0.004) and experience in indigenous risk management practices (p = 0.00001). In addition, this study revealed a linear relationship within all the identified factors and households’ attitude levels. Considering the situation in Ethiopia where individual perceptions are deeply rooted, coupled with the results of this study that revealed highly negative attitude among disaster affected households, it is recommended to consolidate efforts and influence attitude through maximizing community participation and enhancing the effectiveness of disaster management.

Impact of STEM Education on Preschool Children's Scientific Process Skills

This study was conducted to reveal the effect on scientific process skills of STEM activities. The study group consisted of 57 children, one experimental group, and two control groups. In this study, a semi-experimental research method was used. In the data collection process, three data tools were used to collect data. Two of them were developed by the researcher "Demographic Information Form," which contained personal information about children and their parents, and the "Scientific Process Skills Test" to evaluate the basic scientific process skills of 60-72-month-old children. developed by Goodenough in 1926, the "Good Enough Harris Test" was used to determine the homogeneous distribution of the research groups. In the analysis of the experimental process of this study, a 3x3 mixed design ANOVA method was used. To show the significant difference between the groups, parametric and nonparametric tests were used depending on whether they showed normal distribution or not. The study findings showed that the scientific process skills of the children who participated in the experimental group differed significantly from those of the children in the control groups. The findings obtained in this study suggest that STEM activities improve the basic scientific process skills of 60-72-month-old children.

The effect of mesoporous silica doped with silver nanoparticles on glass ionomer cements; physiochemical, mechanical and ion release analysis

BackgroundThe purpose of the study was to evaluate the effect of adding mesoporous silica with silver nanoparticles to conventional glass ionomer cements (GIC) on its, physical, chemical, mechanical properties and ion release analysis.MethodsSynthesized mesoporous silica with silver nanoparticles were added in 1, 3 and 5% by weight to the liquid component of GIC forming three experimental groups and compared with plain GIC as control group. Physical and chemical characterization were conducted using nano-computerized tomography (NanoCT) and Fourier transform infrared spectroscopy. Surface microhardness, water sorption and solubility were analyzed. Ion release was investigated using Inductive Coupled Plasma-Optical Emission Spectroscopy and High Performance Liquid Chromatography. Statistical analysis between different groups for the set parameters using parametric and non-parametric tests. The results were analysed using one way analysis of variance (p < 0.05).ResultsSynthesized mesoporous silica with silver nanoparticles were of 7.28 ± 5.0 nm in diameter with a spherical morphology. NanoCT revealed less porosities for 3 wt %. Microhardness showed a statistically significant difference for 5 wt% at day 1 and 21 ( p < 0.0001). Water sorption values decreased significantly on day 14 compared to day 7 for control, 1, 3 and 5 wt%. Control specimens showed highest concentration of fluoride release followed by 5, 3 and 1 wt%.ConclusionMesoporous silica with silver nanoparticles modified glass ionomer cements showed comparable microhardness to conventional GIC. Ion release was evident from the modified specimens. Silver remained within the GIC for atleast four weeks following incorporation.

A modified A* algorithm combining remote sensing technique to collect representative samples from unmanned surface vehicles

Ensuring representativeness of collected samples is the most critical requirement of water sampling. Unmanned surface vehicles (USVs) have been widely adopted in water sampling, but current USV sampling path planning tend to overemphasize path optimization, neglecting the representative samples collection. This study proposed a modified A* algorithm that combined remote sensing technique while considering both path length and the representativeness of collected samples. Water quality parameters were initially retrieved using satellite remote sensing imagery and a deep belief network model, with the parameter value incorporated as coefficient Q in the heuristic function of A* algorithm. The adjustment coefficient k was then introduced into the coefficient Q to optimize the trade-off between sampling representativeness and path length. To evaluate the effectiveness of this algorithm, Chlorophyll-a concentration (Chl-a) was employed as the test parameter, with Chaohu Lake as the study area. Results showed that the algorithm was effective in collecting more representative samples in real-world conditions. As the coefficient k increased, the representativeness of collected samples enhanced, indicated by the Chl-a closely approximating the overall mean Chl-a and exhibiting a gradient distribution. This enhancement was also associated with increased path length. This study is significant in USV water sampling and water environment protection.

Experimental, Numerical, and Analytical Investigation of the Reinforced Concrete Hidden and Wide Beams

AbstractThis research presents an experimental, analytical, and numerical study to predict the flexural behavior of reinforced concrete hidden and wide beams embedded in slabs. The experimentally studied parameters of testing eight specimens include beam depth, beam width, and beam eccentricity from the column. The obtained test results were compared to the predictions of finite element analysis using the ANSYS program. A numerical parametric study was conducted by the ANSYS program to explore other parameters affecting the ultimate flexural strength of beams. The studied parameters encompass concrete compressive strength, steel reinforcement strength, bottom reinforcement ratio, top-to-bottom reinforcement ratio, and web reinforcement ratio. The results revealed that an increase in beam depth led to higher ultimate load and secant stiffness, along with a decrease in deflection. The increase in beam width significantly affected beam depth, resulting in increased ultimate load and secant stiffness and a slight decrease in deflection. The increase in beam eccentricity from the column resulted in a decrease in ultimate load and secant stiffness while increasing the deflection. Comparisons between experimental and numerical results were made against calculations based on the ECP 203-2017 and ACI 318-19 codes, and the comparison yielded satisfactory results.