Background Obesity contributes significantly to risk of atherosclerotic cardiovascular disease (ASCVD) and especially for heart failure (HF). An elevated body mass index (BMI) in older adults might ...not carry the same risk as in younger adults, but measured weights at other lifetime points are often not available. We determined the associations of self-reported weights from early- and mid-adulthood, after accounting for measured weight at older age, with incident HF/ASCVD risk. Methods and Results We studied 6437 MESA (Multi-Ethnic Study of Atherosclerosis) participants (aged 45-84, free of baseline HF/ASCVD) with self-reported weights at ages 20 and 40 years (by questionnaire), measured weights at up to 5 in-person examinations (2000-2012), and follow-up for adjudicated HF/ASCVD events. Participant mean±SD age at the baseline examination was 62.2±10.2 years. Over median follow-up of 13 years, 290 HF and 828 ASCVD events occurred. After adjustment for cardiovascular risk factors and baseline BMI, higher self-reported weights at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (95% confidence interval) of 1.27 (1.07-1.50) and 1.36 (1.18-1.57), respectively, per 5-kg/m
higher BMI. For incident ASCVD, only higher BMI at age 20 years was associated after accounting for current BMI (1.13 1.01-1.26 per 5 kg/m
). Obesity during follow-up examinations was also associated with incident HF (1.72 1.21-2.45) but not ASCVD. Conclusions Self-reported lifetime weight is a low-tech tool easily utilized in any clinical encounter. Although subject to recall bias, self-reported weights may provide prognostic information about future HF risk, incremental to current BMI, in a multiethnic cohort of middle-aged to older adults. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00005487.
Planning for the eventual electrification of transport in sub-Saharan Africa requires accurate simulation of its unique transport systems. The few studies that attempt to model electric minibus ...taxis—vehicles extensively used in sub-Saharan Africa’s public transport systems—vary greatly in their results. This paper analyses, compares and corrects the only two existing studies that project energy consumption of electric minibus taxis in the region. One of the studies projected an energy consumption of 0.39 kWh/km, while the other projected 0.93 kWh/km. This paper carefully analyses the simulation tools and models and cumulatively applies corrections from the literature and scientific analyses. As a result, the discrepancy between the two simulation tools is eliminated for a given data input and a final energy consumption is estimated in the range of 0.49–0.52 kWh/km, depending on the input data.
Purpose
Estimating how much of the impact of statins on coronary heart diseases (CHD), cardiovascular disease (CVD), and mortality risk is attributable to their effect on low‐density lipoprotein ...cholesterol (LDL), high‐density lipoprotein cholesterol (HDL), and triglycerides.
Methods
A semi‐parametric g‐formula estimator together with data from the Multi‐Ethnic Study of Atherosclerosis (a prospective multi‐center cohort study) was utilized to perform a mediation analysis. A total of 5280 participants, men and women of various race/ethnicities from multiple sites across the United States, were considered in the current study.
Results
The adherence adjusted total relative risk reduction (RRR) estimate (95% confidence interval) of statins on CHD was 14% (−16%, 37%), and the indirect component through LDL was 23% (−4%, 58%). For CVD, the total RRR was 23% (2%, 40%), and the indirect component through LDL was 5% (−13%, 25%). The total RRR of mortality was 18% (−1%, 35%), and the indirect component through LDL was −4% (−17%, 12%). The estimated indirect components through HDL and triglycerides were close to zero with narrow confidence intervals for all 3 outcomes.
Conclusions
The estimated effect of statins on mortality, CVD, and CHD appeared to be independent of their estimated effect on HDL and triglycerides. Our study provides evidence that the preventive effect of statins on CHD could be attributed in large part to their effect on LDL. Our g‐formula estimator is a promising approach to elucidate pathways, even if it is hard to make firm conclusions for the LDL pathway on mortality and CVD.
In the study of the association of transient drug exposures with acute outcomes, the case-crossover design is an efficient alternative to the case-control approach. This design based exclusively on ...the case series uses within-subject comparisons of drug exposures over time to estimate the rate ratio of the outcome associated with the drug under study. This design inherently removes the biasing effects of unmeasured, time-invariant confounding factors from the estimated rate ratio, but is sensitive to several assumptions. We illustrated the case-crossover design and explored its sensitivity using data from 4028 cases of gastrointestinal bleeding from the General Practice Research Database in assessing the effects of the drug warfarin. We compared the use of different time window lengths to assess exposure and considered the use of a case-time-control design to account for exposure time trends. The case-crossover approach found no excess risk of bleeding with warfarin exposure rate ratio 0.98; 95% confidence interval (CI): 0.74—1.28 using a 1-month time window. When we restricted the analysis to subjects with truly transient drug exposure, defined by 1 to 3 prescriptions in the previous year, the rate ratio was 2.59 (95% CI: 1.42—4.74). To consider the longer 1-year exposure time window, the case-time-control approach was used and resulted in a rate ratio of 1.72 (95% CI: 1.08—2.43). In conclusion, the case-crossover design is potentially a powerful approach to assess the risk of drugs. This design is, however, highly sensitive to assumptions about intermittency of drug use and the length of the exposure time window, as demonstrated with the example of bleeding associated with warfarin use.
Rationale: SAMS syndrome is a rare genetic disorder characterized by midline facial clefting, skeletal anomalies, and other defects. Salient Features: Among the craniofacial manifestations of SAMS ...syndrome is the presence of a median mandibular cleft (MMC). MMC is a rare occurrence and in this syndrome, it poses a complex challenge for both functional and aesthetic reasons. Patient Findings: This rare case report describes the successful correction of an MMC in an 18-month-old child diagnosed with SAMS syndrome. Treatment: This report describes the presentation, diagnosis and treatment. The surgical intervention involved a meticulous, single stage, osseous reconstruction. The mechanism of MMC in SAMS syndrome is discussed. Outcomes: Early intervention for MMC in SAMS syndrome patients can offer promising outcomes.
Abstract Objective We develop a new diabetes CHD risk estimator using traditional risk factors plus coronary artery calcium (CAC), ankle-brachial index (ABI), high sensitivity C-reactive protein, ...family history of CHD, and carotid intima-media thickness and compared it with United Kingdom Prospective Diabetes study (UKPDS), Framingham risk and the NCEP/ATP III risk scores in type 2 diabetes mellitus (T2DM). Methods and Results We combined data from T2DM without clinical CVD in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study ( N = 1343). After a mean follow-up of 8.5 years, 85 (6.3%) participants had incident CHD. Among the novel risk markers, CAC best predicted CHD independent of the FRS hazard ratio: HR (95% CI): log (CAC +25):1.69 (1.45–1.97), p < 0.0001; CAC categories: CAC ≤ 25 as reference, >25 and ≤125:2.29 (0.87–5.95), >125 and ≤400: 3.87 (1.57–9.57), >400: 5.97 (2.57–13.84), respectively). The MESA-HNR diabetes CHD risk score has better accuracy for the main outcome versus the FRS or UKPDS area under curve (AUC) of 0.76 vs. 0.70 and 0.69, respectively; all p < 0.05. The MESA-HNR risk score improved risk classification versus the FRS (net reclassification improvement (NRI) = 0.19 and integrated discrimination improvement (IDI) = 0.046, p < 0.05) and UKPDS (NRI = 0.215 and IDI = 0.046, p < 0.05). Compared with the ATP III guidelines, the MESA-HNR score has an NRI of 0.74 for the main outcome. Conclusions This new CHD risk estimator has better discriminative ability for incident CHD than the FRS, UKPDS, and the ATP III/NCEP recommendations in a multi-ethnic cohort with T2DM.
Introduction: Mandibular condylar resorption (MCR) is a rare pathological entity, often affecting young females. Patient Concerns: It is accompanied by pain, malocclusion and compromised quality of ...life including aesthetic perception. Due to this multiplicity of features, the diagnosis, treatment and management of MCR are always a challenge. Diagnosis: This article reports a 25-year-old female suffering from progressive temporomandibular joint pain and compromised aesthetics. This article describes the clinical and radiological findings of this case. Treatment: The possible aetiopathogenesis and treatment are described.
Background and Aims: Obstetric admissions to the intensive care unit (ICU) are a subject of increasing interest, as it is an indirect indicator of maternal morbidity and mortality. The studies from ...areas reported to have a higher maternal mortality rate are lacking. Thus, we undertook this study to determine the prevalence pattern, clinical characteristics and outcome of obstetric patients admitted to the ICU of a tertiary care hospital. Methods: All obstetric patients (up till 42 days of delivery) admitted to the ICU from 1st October 2015 to 30th September 2016 and from 1st October 2010 to 30th September 2015 were included. Data collected for our study included demographic characteristics, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at the time of admission, obstetric and medical history, provisional diagnosis, the reason for ICU admission, interventions required in ICU and the outcome. Results: The third trimester (46.79%) and postpartum period (40.37%) were the most common time of admission with conditions such as severe pre-eclampsia, eclampsia, HELLP syndrome (Haemolysis, elevated liver enzymes, low platelet count), antepartum haemorrhage, postpartum haemorrhage and anaemia. The mean APACHE II score was 16.89 ± 7.48 with a mortality rate of 17.76%. The mean length of stay in ICU was 3.47 ± 3.16 days, and mean length of stay in our hospital was 8.78 ± 6.76 days Conclusion: Obstetric patients recover well if treated early. A good ICU care with monitoring can save a young productive life.
Grape growing regions are facing constant warming of the growing season temperature as well as limitations on ground water pumping used for irrigating to overcome water deficits. Trellis systems are ...utilized to optimize grapevine production, physiology, and berry chemistry. This study aimed to compare 6 trellis systems with 3 levels of applied water amounts based on different replacements of crop evapotranspiration (ET
c
) in two consecutive seasons. The treatments included a vertical shoot position (VSP), two modified VSPs (VSP60 and VSP80), a single high wire (SH), a high quadrilateral (HQ), and a Guyot pruned VSP (GY) combined with 25%, 50%, and 100% ET
c
water replacement. The SH had greater yields, whereas HQ was slower to reach full production potential. At harvest in both years, the accumulation of anthocyanin derivatives was enhanced in SH, whereas VSPs decreased them. As crown porosity increased (mostly VSPs), berry flavonol concentration and likewise molar % of quercetin in berries increased. Conversely, as leaf area increased, total flavonol concentration and molar % of quercetin decreased, indicating a preferential arrangement of leaf area along the canopy for overexposure of grape berry with VSP types. The irrigation treatments revealed linear trends for components of yield, where greater applied water resulted in larger berry size and likewise greater yield. 25% ET
c
was able to increase berry anthocyanin and flavonol concentrations. Overall, this study evidenced the efficiency of trellis systems for optimizing production and berry composition in Californian climate, also, the feasibility of using flavonols as the indicator of canopy architecture.
The family of nitrogenase enzymes catalyzes the reduction of atmospheric dinitrogen (N2) to ammonia under remarkably benign conditions of temperature, pressure, and pH. Therefore, the development of ...synthetic complexes or materials that can similarly perform this reaction is of critical interest. The primary obstacle for obtaining realistic synthetic models of the active site iron-sulfur-carbide cluster (e.g., FeMoco) is the incorporation of a truly inorganic carbide. This review summarizes the present state of knowledge regarding biological and chemical (synthetic) incorporation of carbide into iron-sulfur clusters. This includes the Nif cluster of proteins and associated biochemistry involved in the endogenous biogenesis of FeMoco. We focus on the chemical (synthetic) incorporation portion of our own efforts to incorporate and modify C1 units in iron/sulfur clusters. We also highlight recent contributions from other research groups in the area toward C1 and/or inorganic carbide insertion.
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