ObjectivesThe Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated ...predictor of mortality. We hypothesised that IMRS calculated from prepandemic CBC and BMP predicts COVID-19 outcomes and that IMRS using laboratory results tested at COVID-19 diagnosis is also predictive.DesignProspective observational cohort study.SettingPrimary, secondary, urgent and emergent care, and drive-through testing locations across Utah and in sections of adjacent US states. Viral RNA testing for SARS-CoV-2 was conducted from 3 March to 2 November 2020.ParticipantsPatients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020.Primary and secondary outcome measuresThe primary outcome was a composite of hospitalisation or mortality, with secondary outcomes being hospitalisation and mortality separately.ResultsAmong 3883 patients, 8.2% were hospitalised and 1.6% died. Subjects with low, mild, moderate and high-risk IMRS had the composite endpoint in 3.5% (52/1502), 8.6% (108/1256), 15.5% (152/979) and 28.1% (41/146) of patients, respectively. Compared with low-risk, subjects in mild-risk, moderate-risk and high-risk groups had HR=2.33 (95% CI 1.67 to 3.24), HR=4.01 (95% CI 2.93 to 5.50) and HR=8.34 (95% CI 5.54 to 12.57), respectively. Subjects aged <60 years had HR=3.06 (95% CI 2.01 to 4.65) and HR=7.38 (95% CI 3.14 to 17.34) for moderate and high risks versus low risk, respectively; those ≥60 years had HR=1.95 (95% CI 0.99 to 3.86) and HR=3.40 (95% CI 1.63 to 7.07). In multivariable analyses, IMRS was independently predictive and was shown to capture substantial risk variation of comorbidities.ConclusionsIMRS, a simple risk score using very basic laboratory results, predicted COVID-19 hospitalisation and mortality. This included important abilities to identify risk in younger adults with few diagnosed comorbidities and to predict risk prior to SARS-CoV-2 infection.
Intermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality i.e., Intermountain Mortality Risk Score ...(IMRS) or chronic diseases e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON).
Subjects (N = 71) completing the WONDERFUL trial were aged 21–70 years, had ≥1 metabolic syndrome criteria, elevated cholesterol, and no anti-diabetes medications, statins, or chronic diseases. The intermittent fasting arm underwent 24-h water-only fasting twice-per-week for 4 weeks and once-per-week for 22 weeks (26 weeks total). Analyses examined the IMRS change score at 26 weeks vs. baseline between intermittent fasting (n = 38) and ad libitum controls (n = 33), and change scores for PCRE, ICHRON, HOMA-IR, and a metabolic syndrome score (MSS). Age averaged 49 years; 65% were female. Intermittent fasting increased IMRS (0.78 ± 2.14 vs. controls: −0.61 ± 2.56; p = 0.010) but interacted with baseline IMRS (p-interaction = 0.010) to reduce HOMA-IR (but not MSS) more in subjects with higher baseline IMRS (median HOMA-IR change: fasters, −0.95; controls, +0.05) vs. lower baseline IMRS (−0.29 vs. −0.32, respectively). Intermittent fasting reduced ICHRON (−0.92 ± 2.96 vs. 0.58 ± 3.07; p = 0.035) and tended to reduce PCRE (−0.20 ± 0.22 vs. −0.14 ± 0.21; p = 0.054).
Intermittent fasting increased 1-year IMRS mortality risk, but decreased 10-year chronic disease risk (PCRE and ICHRON). It also reduced HOMA-IR more in subjects with higher baseline IMRS. Increased IMRS suggests fasting may elevate short-term mortality risk as a central trigger for myriad physiological responses that elicit long-term health improvements. Increased IMRS may also reveal short-term fasting-induced safety concerns.
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•Clinical risk scores were evaluated in subjects participating in the 6-month WONDERFUL trial.•Intermittent fasting increased a mortality risk score, but decreased 10-year chronic disease risk scores.•Fasting reduced insulin resistance more in subjects with higher baseline mortality risk.•Fasting may elicit physiologic mechanisms that improve health by increasing mortality risk.•Clinically, safety and benefits should be considered by people engaging in intermittent fasting.
Chitosan nanoparticles are a naturally derived substance with exceptional physicochemical properties and non-toxic bioactivity, making them suitable for extensive applications. This study evaluates ...and compares chitosan nanoparticles and chitosan nanoparticles incorporating antimicrobial agents. Copper ions were incorporated into chitosan matrices using a modified ionic gelation method to form a nano-coating solution. The particle size of chitosan nanoparticles (CN) was 118.23 ± 0.58 nm, and the particle size of chitosan nanoparticles loaded copper ions (CNCu) was 166.65 ± 7.36 nm, with low polydispersity index values and moderate to high zeta potential values. Scanning Electron Microscope (SEM) and Transmission Electron Microscopy (TEM) were used to determine their particle size and morphology. The antioxidant activity of chitosan nanoparticles and chitosan nanoparticles loaded with copper ions was also evaluated. CNCu exhibited superior antimicrobial activity against yeasts and molds. The results suggest CN and CNCu have great pre and post-harvest fruit preservation potential.
This study investigates the internal conditions of laboratory and effectiveness of ventilation system with evaporation of benzene from a hypothetical accident by using a computational fluid dynamic ...program. There are five inlets which moist air enter and exits through four vent hoods connecting with the exhaust fan was placed on the ceiling. The species model and the realizable k-e turbulence model with standard wall function are used to investigate the effects of turbulence. The benzene leakage source in laboratory was modelled as vapour phase with natural evaporation rate and the ventilation system was set up with different modes such as 1,000 m3/h, 2,000 m3/h, 3,000 m3/h, and 4,000 m3/h. The objective of this research is to investigate chemical leakage and dispersion in indoor environments and consider the performance of ventilation system of different exhaust fan modes and various layout designs (single-inlet or multi-inlets). Based on the analysis of air flow patterns and the distribution of pollutant concentrations, the performance of the ventilation system is evaluated and appropriate solutions are proposed to manage the problem. The results show that in both cases of opening all doors and opening only doors, the ventilation rate of 3,000 m3/h is considered to be the most effective in terms of pollutant removal because the benzene concentration meets the safety standard (< 10 ppm), namely 4.6 ppm in the multi-inlets and 2.8 ppm in the single-inlet.
Introduction
Long-chain omega-3 polyunsaturated fatty acids (OM3 PUFA) are commonly used for cardiovascular disease prevention. High-dose eicosapentaenoic acid (EPA) is reported to reduce major ...adverse cardiovascular events (MACE); however, a combined EPA and docosahexaenoic acid (DHA) supplementation has not been proven to do so. This study aimed to evaluate the potential interaction between EPA and DHA levels on long-term MACE.
Methods
We studied a cohort of 987 randomly selected subjects enrolled in the INSPIRE biobank registry who underwent coronary angiography. We used rapid throughput liquid chromatography-mass spectrometry to quantify the EPA and DHA plasma levels and examined their impact unadjusted, adjusted for one another, and fully adjusted for comorbidities, EPA + DHA, and the EPA/DHA ratio on long-term (10-year) MACE (all-cause death, myocardial infarction, stroke, heart failure hospitalization).
Results
The average subject age was 61.5 ± 12.2 years, 57% were male, 41% were obese, 42% had severe coronary artery disease (CAD), and 311 (31.5%) had a MACE. The 10-year MACE unadjusted hazard ratio (HR) for the highest (fourth) vs. lowest (first) quartile (Q) of EPA was HR = 0.48 (95% CI: 0.35, 0.67). The adjustment for DHA changed the HR to 0.30 (CI: 0.19, 0.49), and an additional adjustment for baseline differences changed the HR to 0.36 (CI: 0.22, 0.58). Conversely, unadjusted DHA did not significantly predict MACE, but adjustment for EPA resulted in a 1.81-fold higher risk of MACE (CI: 1.14, 2.90) for Q4 vs. Q1. However, after the adjustment for baseline differences, the risk of MACE was not significant for DHA (HR = 1.37; CI: 0.85, 2.20). An EPA/DHA ratio ≥1 resulted in a lower rate of 10-year MACE outcomes (27% vs. 37%, adjusted
p
-value = 0.013).
Conclusions
Higher levels of EPA, but not DHA, are associated with a lower risk of MACE. When combined with EPA, higher DHA blunts the benefit of EPA and is associated with a higher risk of MACE in the presence of low EPA. These findings can help explain the discrepant results of EPA-only and EPA/DHA mixed clinical supplementation trials.
ABSTRACTThe objective of this study was to describe the diagnostic value of positron emission tomography/computed tomography (PET/CT) and ultrasound (US) for identifying metastatic axillary disease ...in primary breast cancer. This is a retrospective review of 240 patients with treatment-naive unilateral primary breast cancer of at least stage T2. Eighty-five patients met our inclusion criteria. Initial whole-body PET/CT and axillary US examinations were reviewed and compared with the criterion standard of fine-needle aspiration cytology. Sensitivity, accuracy, and positive predictive value (PPV) for each modality were computed. Because of all positive US cases, specificity and negative predictive value of US were not determined. Sensitivity and accuracy between modalities were compared using McNemar test. The majority of the patients were White women with clinical inflammatory breast cancer and with histologically invasive ductal carcinoma. The most common tumor and nodal stage was T4N3. The tumors were predominantly estrogen receptor positive, progesterone receptor negative, and human epidermal growth factor receptor 2 negative. The sensitivities of PET/CT and US were 96.2% and 100%, respectively. The accuracies for PET/CT and US were 91.8% and 94.1%, respectively. The PPV for PET/CT was 95.1%, and for US, the PPV was 94.1%. No significant difference in sensitivity or accuracy was shown between PET/CT and US for the diagnosis of metastatic axillary nodal disease. Three of 85 cases showed discordance between negative PET/CT and positive US and fine-needle aspiration cytology.
Alcohol consumption has long been associated with cardiovascular (CV) benefit, but it also has adverse potential. Statins are currently widely used for CV prevention. We evaluated whether alcohol use ...is associated with lower CV risk in patients on statins. We searched Intermountain Medical Center cardiac catheterization laboratory medical records for patients with a prescription history of statin use or non-use and a self-report of alcohol use or non-use. Alcohol and statin prescription data were available together with long-term (mean SD, 4.4 2.4 years) major adverse CV events (MACE, including death, myocardial infarction, stroke, and heart failure hospitalizations) in 1701 patients at primary and 3266 patients at secondary CV risk. MACE rates were lower for primary prevention alcohol users than non-users not on statins (adjusted hazard ratio adj-HR 0.50 (95% CI 0.33, 0.78, p = 0.002), but not for those on statins (adj-HR 0.84, CI 0.54, 1.32, p = 0.45). MACE rates for secondary prevention were not reduced by alcohol consumption either in statin non-users or users (adj HR 1.18, CI 0.85, 1.64, p = 0.33; adj HR 1.08, CI 0.87, 1.35, p = 0.45, respectively). These findings, together with other recent supportive studies, can help inform personal choices in alcohol consumption and professional society recommendations for CV prevention.
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