Pulmonary hypertension incidence based on echocardiographic estimates of pulmonary artery systolic pressure in people living with HIV remains unstudied. We aimed to determine whether people living ...with HIV have higher incidence and risk of pulmonary hypertension than uninfected individuals.
In this retrospective cohort study, we evaluated data from participants in the Veterans Aging Cohort Study (VACS) referred for echocardiography with baseline pulmonary artery systolic pressure measures of 35 mm Hg or less. Incident pulmonary hypertension was defined as pulmonary artery systolic pressure higher than 35 mm Hg on subsequent echocardiogram. We used Poisson regression to estimate incidence rates (IRs) of pulmonary hypertension by HIV status. We then estimated hazard ratios (HRs) by HIV status using Cox proportional hazards regression. We further categorised veterans with HIV by CD4 count or HIV viral load to assess the association between pulmonary hypertension risk and HIV severity. Models included age, sex, race or ethnicity, prevalent heart failure, chronic obstructive pulmonary disease, hypertension, smoking status, diabetes, body-mass index, estimated glomerular filtration rate, hepatitis C virus infection, liver cirrhosis, and drug use as covariates.
Of 21 314 VACS participants with at least one measured PASP on or after April 1, 2003, 13 028 VACS participants were included in the analytic sample (4174 32% with HIV and 8854 68% without HIV). Median age was 58 years and 12 657 (97%) were male. Median follow-up time was 3·1 years (IQR 0·9–6·8) spanning from April 1, 2003, to Sept 30, 2017. Unadjusted IRs per 1000 person-years were higher in veterans with HIV (IR 28·6 95% CI 26·1–31·3) than in veterans without HIV (IR 23·4 21·9–24·9; p=0·0004). The risk of incident pulmonary hypertension was higher among veterans with HIV than among veterans without HIV (unadjusted HR 1·25 95% CI 1·12–1·40, p<0·0001). After multivariable adjustment, this association was slightly attenuated but remained significant (HR 1·18 1·05–1·34, p=0·0062). Veterans with HIV who had a CD4 count lower than 200 cells per μL or of 200–499 cells per μL had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·94 1·49–2·54, p<0·0001, for those with <200 cell μL and HR 1·29 1·08–1·53, p=0·0048, for those with 200–499 cells per μL). Similarly, veterans with HIV who had HIV viral loads of 500 copies per mL or more had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·88 1·46–2·42, p<0·0001).
HIV is associated with pulmonary hypertension incidence, adjusting for risk factors. Low CD4 cell count and high HIV viral load contribute to increased pulmonary hypertension risk among veterans with HIV. Thus, as with other cardiopulmonary diseases, suppression of HIV should be prioritised to lessen the burden of pulmonary hypertension in people living with HIV.
National Heart, Lung, and Blood Institute (National Institutes of Health, USA); National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health, USA).
In Asia, young-onset type 2 diabetes (YOD) is characterized by obesity and increased risk for cardiovascular disease (CVD). In a genome-wide association study (GWAS) of 99 Chinese obese subjects with ...familial YOD diagnosed before 40-year-old and 101 controls, the T allele of rs1408888 in intron 1 of DACH1(Dachshund homolog 1) was associated with an odds ratio (OR) of 2.49(95% confidence intervals:1.57-3.96, P = 8.4 × 10(-5)). Amongst these subjects, we found reduced expression of DACH1 in peripheral blood mononuclear cells (PBMC) from 63 cases compared to 65 controls (P = 0.02). In a random cohort of 1468 cases and 1485 controls, amongst top 19 SNPs from GWAS, rs1408888 was associated with type 2 diabetes with a global P value of 0.0176 and confirmation in a multiethnic Asian case-control cohort (7370/7802) with an OR of 1.07(1.02-1.12, P(meta) = 0.012). In 599 Chinese non-diabetic subjects, rs1408888 was linearly associated with systolic blood pressure and insulin resistance. In a case-control cohort (n = 953/953), rs1408888 was associated with an OR of 1.54(1.07-2.22, P = 0.019) for CVD in type 2 diabetes. In an autopsy series of 173 non-diabetic cases, TT genotype of rs1408888 was associated with an OR of 3.31(1.19-9.19, P = 0.0214) and 3.27(1.25-11.07, P = 0.0184) for coronary heart disease (CHD) and coronary arteriosclerosis. Bioinformatics analysis revealed that rs1408888 lies within regulatory elements of DACH1 implicated in islet development and insulin secretion. The T allele of rs1408888 of DACH1 was associated with YOD, prediabetes and CVD in Chinese.
IntroductionThe incidence and factors associated with acute kidney injury (AKI) development after lower extremity bypass (LEB) are not well defined. The objective of this study is to determine the ...incidence and characteristics associated with the development of AKI in patients undergoing infrainguinal LEB.MethodsA retrospective review of all LEB surgeries in the Vascular Quality Initiative (VQI) registry from January 2003 to April 2015 was performed. AKI was defined as post-operative rise in creatinine (Cr) > 0.5 mg/dl or new renal impairment requiring dialysis. Demographic, procedural and clinical variables were collected. Patients on dialysis and those missing pre and post-operative Cr values were excluded. Multivariate logistic regression analysis was performed to identify variables associated with the development of AKI following LEB.Results12,564 patients were included in the analysis; 509 (4%) developed AKI. Comparison of baseline characteristics between patients that developed AKI and those that did not are shown in the Table. In multivariate analysis, diabetes (OR 1.57, p<0.01), history of heart failure (OR 1.60, p<0.01), emergency surgery (OR 1.34, p<0.01), need for blood transfusion (OR 2.41, p<0.01) and chronic kidney disease (CKD) stages 2 (OR 1.39, p<0.01), 3(OR 2.85, p<0.01), and 4(OR 5.46, p<0.01) were all significantly associated with AKI. Factors associated with a lower incidence of AKI included smoking (OR 0.72, p<0.05), female gender (OR 0.69, p<0.01) and higher hemoglobin levels (OR 0.92, p<0.01).ConclusionsOverall, the development of AKI in a large contemporary database was 4%. Multiple clinical characteristics are associated with development of AKI, including history of heart failure, diabetes, CKD, emergency surgery and need for blood transfusion, and may help to identify at-risk patients. Further studies are needed to prospectively validate these findings and determine if postoperative AKI increases the mortality risk.
Introduction: Diabetes mellitus is an established modifiable risk factor for periprosthetic joint infection (PJI). Haemoglobin A1c (HbA1c) is a glycaemic marker that correlates with diabetic ...complications and PJI. As diabetes and prediabetes are frequently asymptomatic, and there is increasing evidence to suggest a correlation between dysglycaemia and osteoarthritis, it is reasonable to provide HbA1c screening before total knee arthroplasty (TKA). The aim of the present study was to determine the prevalence of dysglycaemia in patients who underwent TKA and investigate whether HbA1c screening and optimisation of glycaemic control before TKA affects the incidence of PJI after TKA. Methods: Patients who underwent primary TKA before and after routine HbA1c screening was introduced in our unit were reviewed. Prediabetes and diabetes were defined according to the American Diabetes Association. Patients with HbA1c ≥7.5% were referred to an endocrinologist for optimisation of glycaemic control before TKA. The inciden
We propose a texture-less object detection and 3D tracking method which automatically extracts on the fly the information it needs from color images and the corresponding depth maps. While ...texture-less 3D tracking is not new, it requires a prior CAD model, and real-time methods for detection still have to be developed for robust tracking. To detect the target, we propose to rely on a fast template-based method, which provides an initial estimate of its 3D pose, and we refine this estimate using the depth and image contours information. We automatically extract a 3D model for the target from the depth information. To this end, we developed methods to enhance the depth map and to stabilize the 3D pose estimation. We demonstrate our method on challenging sequences exhibiting partial occlusions and fast motions.
Increased blood-brain barrier (BBB) disruption can be found in patients with neuromyelitis optica (NMO); however, its clinical implication and association with disability at acute attack remains ...obscure. The purpose of the study was to evaluate the clinical significance of BBB disruption and the subsequent cerebrospinal fluid (CSF)/serum IgG gradient in NMO. Retrospective analysis was made of acute-stage CSF samples from NMO (
n
= 40) and multiple sclerosis (MS;
n
= 26) patients. The CSF/serum IgG gradient (QIgG), albumin ratio (Qalb), and IgG index were calculated. Multivariate regression analysis was used to identify clinical and CSF variables associated with disability at acute attacks (extended disability scale score, EDSS) in both groups. The EDSS was significantly associated with the QIgG (
p
< 0.001), Qalb (
p
= 0.012), and number of cumulative attacks (
p
= 0.012) in NMO but not in MS with univariate analysis. Length of spinal cord involvement was also associated with EDSS in NMO (
p
= 0.030). However, multivariate analysis revealed that the QIgG was only significantly associated with EDSS in NMO (0.580; 95% CI −0.257, 0.961;
p
= 0.002). The QIgG was also highly associated with the Qalb in NMO (
p
< 0.001). The QIgG may reflect systemic IgG leakage into the CNS and is strongly associated with disability at acute attacks in NMO, suggesting that BBB disruption can aggravate disease activity by facilitating systemic IgG infiltration into the CNS.
The purpose of this study is to examine follow-up rates and maturation rates after dialysis access surgery using a fistula-first approach in a county hospital with an indigent population.
A ...prospectively maintained dialysis access database was queried for cases performed between August 1, 2009 and September 30, 2011. The follow-up period ended on December 31, 2011. An attempt was made to contact patients who did not have complete follow-up data recorded to the point of fistula maturation for arteriovenous fistulas (AVF). Patients were contacted directly or through their dialysis center. Maturation was defined by successful use of the AVF for hemodialysis for at least 2 weeks for patients who are dialysis dependent or by the clinical assessment of an attending vascular surgeon for those not on dialysis.
Two hundred three dialysis access cases were performed. The mean age was 51.4 years. One hundred twenty-six (62%) were male and 175 (86%) were Hispanic. Of these, 194 (95.6%) were AVF. Three AVF were ligated in the postoperative period for steal. Of the remaining 191 AVF, 94 (49%) patients completed their scheduled follow-up appointments. Sixty-six (35%) patients did not come to clinic but were contacted. Twenty-six (14%) patients were completely lost to follow-up and 5 (2.6%) died. Maturation data was obtained on 160 AVF. Of those, 123 (77%) reached maturation with a mean maturation time of 112 ± 99 days (range, 21-483). Twenty patients who completed follow-up underwent at least 1 additional surgical or endovascular procedure in an attempt to achieve maturation. Seventeen (85%) patients who underwent a secondary procedure went on to achieve maturation. There was no significant difference in maturation between the group that completed follow-up and those who were contacted by phone (69 73% vs. 54 81%, P = not significant).
In this indigent population, follow-up does not influence maturation rates of AVF. Despite poor compliance with follow-up in the setting of a public hospital, the maturation rate of an aggressive fistula-first approach is acceptable.
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