Abstract
Aims
Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT ...attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD).
Methods and results
Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (−82.3 ± 5.5 HU) compared with patients with stable CAD (−90.6 ± 5.7 HU, P < 0.001) and controls (−95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation.
Conclusion
PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.
A limitation of right ventricular (RV) apical pacing is far-field R-wave oversensing, that is, processing of signals originating from myopotentials from nearby muscular structures such as the ...diaphragm, 1 which can result in either inappropriate inhibition of pacing, or overcounting of ventricular or atrial events. ...when positioning the cardiac pacemaker we carefully explored several locations to find an optimal site for the RV lead without stimulating the diaphragm or causing diaphragmatic myopotential.
Highlights • Magnetic resonance cholangiopancreatography facilitated accurate identification of acute biliary abnormalities in an otherwise clinically vague patient presentation of biliary symptoms. ...• Magnetic resonance cholangiopancreatography should be considered as a complementary imaging modality particularly in cases where ultrasound is equivocal or inconclusive, and computer tomography is contraindicated. • Timely assessment with magnetic resonance cholangiopancreatography expedited the patient’s urgent laparoscopic cholecystectomy.
With advances in technology, more health information is readily available to the public. Individuals with disabilities rely on online healthcare-related resources to access educational information ...and promote informed decision-making in their care. The Web Content Accessibility Guidelines (WCAG) were created to provide universal web practices which complement the needs of all individuals, such as those with low vision or screen readers users. However, many websites and the resources within them (e.g., PDFs) do not prioritise WCAG, leaving individuals with disabilities at a disadvantage in terms of their autonomy and health literacy. The objective of this study is to investigate and describe the common web accessibility errors present on international occupational therapy and pediatric websites and the resources within them. This mixed methods study evaluates compliance to WCAG success criteria using automatic web accessibility evaluation tools, specifically WAVE and AChecker, and manual checks to capture the human element. Descriptive statistics were used to examine the frequency of errors across several success criteria within the sample websites and PDFs. A subsequent thematic analysis was used to further examine how and why these errors violate the WCAG success criteria. Through automatic evaluation tools, many websites and resources did not comply with numerous WCAG 2.0 success criteria. Through manual checks of the web pages and resources within them, 5 themes were identified: inaccessible images, challenges accessing additional resources, poor structural formatting, lack of tagging in PDFs, and minimal colour contrast. The results of this study can inform web developers and contributors (e.g., Occupational Therapists) on how to successfully produce accessible websites and PDFs to provide equal access to health information. In conclusion, this study adds to the current understanding that many public-facing websites and the resources within them (e.g., PDFs) are not accessible, including healthcare-related websites meant to support informed decision-making among individuals with disabilities.
Abstract
Background
Microbial-derived uremic toxins, p-cresyl sulfate (PCS), indoxyl sulfate (IS) and indole 3-acetic acid (IAA), have been associated with the burden of chronic kidney disease (CKD). ...Prebiotics have emerged as an alternative to modulate the gut environment and to attenuate toxin production. This trial aims to investigate the effect of a prebiotic fructooligosaccharide (FOS) on uremic toxins of non-dialysis-dependent CKD (NDD-CKD) patients.
Methods
A double-blind, placebo-controlled, randomized trial was conducted for 3 months. In all, 50 nondiabetic NDD-CKD patients estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2, aged 18–80 years, were allocated to prebiotic (FOS, 12 g/day) or placebo (maltodextrin, 12 g/day) groups. Primary outcomes were changes in serum (total and free) and urinary (total) PCS. Secondary outcomes included changes in IS, IAA, serum markers of intestinal permeability (zonulin), gut-trophic factors (epidermal growth factor and glucagon-like peptide-2), eGFR, inflammation (high sensitive c-reactive protein and interleukin-6), homeostatic model assessment-insulin resistance, lipid profile and gastrointestinal symptoms.
Results
From 50 participants (54% men, 57.3 ± 14.6 years and eGFR 21.4 ± 7.6 mL/min/1.73 m2), 46 completed the follow-up. No changes in dietary intake or gastrointestinal symptoms were observed. There was a trend in the difference of serum total ΔPCS (treatment effect adjusted for baseline levels: −12.4 mg/L; 95% confidence interval (−5.6 to 0.9 mg/L; P = 0.07) and serum-free Δ%PCS intervention −8.6 (−41.5 to 13.9%) versus placebo 3.5 (−28.8 to 85.5%); P = 0.07 between the groups. The trend in the difference of serum total ΔPCS was independent of eGFR and dietary protein:fiber ratio intake. No difference was found in urinary PCS. Aside from the decreased high-density lipoprotein cholesterol in the intervention, no differences were observed in the change of IS, IAA or other secondary outcome between the groups.
Conclusions
Our result suggests the potential of FOS in reducing serum total and free PCS in nondiabetic NDD-CKD patients.
The Coronavirus disease (COVID-19) pandemic has created unprecedented acute global health challenges. However, it also presents a set of unquantified and poorly understood risks in the medium to long ...term, specifically, risks to children whose mothers were infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Infections during pregnancy can increase the risk of atypical neurodevelopment in the offspring, but the long-term neurodevelopmental impact of in utero COVID-19 exposure is unknown. Prospective, longitudinal studies are needed to evaluate children exposed in utero to SARS-CoV2 to define this risk.
We have designed a prospective, case-controlled study to investigate the long-term impacts of SARS-CoV2 exposure on children exposed in utero. Women infected with SARS-CoV-2 during pregnancy will be recruited from Monash Health, the Royal Women's Hospital and Western Health (Melbourne, Australia) and Londrina Municipal Maternity Hospital Lucilla Ballalai and PUCPR Medical Clinical (Londrina, Brazil). A control group in a 2:1 ratio (2 non-exposed: 1 exposed mother infant dyad) comprising women who gave birth in the same month of delivery, are of similar age but did not contract SARS-CoV-2 during their pregnancy will also be recruited. We aim to recruit 170 exposed and 340 non-exposed mother-infant dyads. Clinical and socio-demographic data will be collected directly from the mother and medical records. Biospecimens and clinical and epidemiological data will be collected from the mothers and offspring at multiple time points from birth through to 15 years of age using standardised sample collection, and neurological and behavioural measures.
The mapped neurodevelopmental trajectories and comparisons between SARS-CoV-2 exposed and control children will indicate the potential for an increase in atypical neurodevelopment. This has significant implications for strategic planning in the mental health and paediatrics sectors and long-term monitoring of children globally.
Loot boxes are a purchasable video-game feature consisting of randomly determined, in-game virtual items. Due to their chance-based nature, there is much debate as to whether they constitute a form ...of gambling. We sought to address this issue by examining whether players treat virtual loot box rewards in a way that parallels established reward reactivity for monetary rewards in slots play. Across two sets of experiments, we show that loot boxes containing rarer items are more valuable, arousing, rewarding and urge-inducing to players, similar to the way slots gamblers treat rare large wins in slots play. Importantly, we show in Experiment 2 that the duration of Post Reinforcement Pauses, an index of reward reactivity, are longer for boxes with rarer items. Boxes containing rarer rewards also trigger larger Skin Conductance Responses and larger force responses—indices of positive arousal. Findings of Experiment 2 also revealed that there was an increase in anticipatory arousal prior to the reveal of loot box rewards. Collectively, our results elucidate the structural similarities between loot boxes and specific gambling games. The fact that players find rarer game items hedonically rewarding and motivating has implications for potential risky or excessive loot box use for some players.
•This systematic review identified 91 studies that assessed parental ER in parenting contexts.•Different facets and processes of ER were captured in different assessments, highlighting the importance ...of conceptual clarity and caution when synthesizing findings.•Most assessments relied on parental self-report, but options are available for a multi-informant, multi-method approach.•Assessing parental ER in parenting contexts allows researchers to capture specific parenting demands and developmental characteristics of parent–child relationship.
Despite a need for developmental and clinical research to understand how parents regulate their emotions in the context of parent–child interaction, empirical studies of parental emotion regulation (ER) have predominantly relied on general models and measures of adult ER. To address this gap, the present systematic review aimed to identify studies that examined parental ER in the context of parenting, and to evaluate how ER was defined and operationalized, how specific measurement contexts were established, what types of methods were involved, and the state of evidence on their reliability and validity. A systematic search in five databases yielded 91 studies that adopted assessments capturing different facets and processes of parental ER, highlighting the importance of conceptual clarity in integrating empirical findings and developing new research. Results also suggested that most studies relied on a single method or source to assess parental ER, and further evidence is needed to support the reliability and validity of many measures. Compared to general measures of adult ER, the assessments identified in this review were situated within the recollection of past parenting experiences and real-time actual or hypothetical parenting situations, allowing researchers to capture parenting demands and accommodate developmental characteristics in parent–child relationships. This review presents a toolbox for researchers interested in examining parental ER as context-specific processes and provides recommendations to move the field in a more conceptually sound and methodologically rigorous direction.
Pantothenate kinase-associated neurodegeneration (PKAN) is a rare, neurodegenerative disorder that manifests with progressive loss of ambulation and refractory dystonia, especially in the early-onset ...classic form. This leads to osteopenia and stress on long bones, which pose an increased risk of atraumatic femur fractures. The purpose of this study is to describe the unique challenges in managing femur fractures in PKAN and the effect of disease manifestations on surgical outcomes.
A retrospective case review was conducted on 5 patients (ages 10 to 20 y) with PKAN with a femur fracture requiring surgical intervention. Data regarding initial presentation, surgical treatment, complications, and outcomes were obtained.
All patients were non-ambulatory, with 4 of 5 patients sustaining an atraumatic femur fracture in the setting of dystonia episode. One patient had an additional contralateral acetabular fracture. Postoperatively, 4 of the 5 patients sustained orthopaedic complications requiring surgical revision, with 3 of these secondary to dystonia. Overall, 4 required prolonged hospitalization in the setting of refractory dystonia.
Femur fractures in PKAN present distinct challenges for successful outcomes. A rigid intramedullary rod with proximal and distal interlocking screws is most protective against surgical complications associated with refractory dystonia occurring during the postoperative period. Multidisciplinary planning for postoperative care is essential and may include aggressive sedation and pain management to decrease the risk of subsequent injuries or complications.
Level IV.
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