RWMAs in critically ill patients with non-obstructed coronary arteries

Introduction

Left ventricular (LV) dysfunction is estimated to occur in 10%–25% of the general intensive care unit (ICU) population and is frequently seen as regional wall motion abnormalities (RWMAs). Although RWMA is mostly attributed to myocardial ischemia or infarction, some studies have suggested that nonischemic RWMA might also be prevalent. We sought to establish that RWMA can be seen in critically ill patients with normal coronary arteries and to explore reasons for RWMA in this population.

Methods

In this retrospective study, data from the hospital angiography register and the ICU register were collated between 2012 and 2019. Patients were identified who underwent angiography in conjunction with their ICU stay and had RWMA on echocardiography. Patients were divided into either those with non-obstructed or those with obstructed coronary arteries. Cardiac magnetic resonance imaging (cMRI) examinations were reviewed if they had been performed on patients with non-obstructed coronaries.

Results

We identified 53 patients with RWMA and non-obstructed coronary arteries and 204 patients with RWMA and obstructed coronary arteries. Patients with non-obstructed coronary arteries were more often female, younger, and had fewer cardiovascular risk factors. They less commonly had ST elevation, but more frequently had T-wave inversion or serious arrhythmias. Troponin levels were higher in patients with obstructed coronary arteries, but NT-proBNP was similar between the groups. There were no differences in risk-adjusted 90-day mortality between patients with non-obstructed versus obstructed coronary arteries (OR 1.21, [95% CI 0.56–2.64], p = .628). In those with non-obstructed coronary arteries, follow-up echocardiography was available for 38 patients, of whom 30 showed normalization of cardiac function. Of the 14 patients with non-obstructed coronary arteries on whom cMRI was performed, 7 had a tentative diagnosis of Takotsubo syndrome or myocardial stunning; 4 had a myocardial infarction (preexisting in 3 cases); 1 patient had acute myocarditis; 1 patient had post-myocarditis; and 1 patient was diagnosed with dilated cardiomyopathy.

Conclusion

RWMA can be seen to occur in critically ill patients in the absence of coronary artery obstruction. Several conditions can cause regional hypokinesia, and cMRI is useful to evaluate the underlying etiology.     

An Adaptation of the Children’s Hope Scale in a Sample of Spanish Adolescents

The aim of this study was to analyze the psychometric properties of a Spanish version of the Children’s Hope Scale (CHS), developed by Snyder et al. The sample included 388 adolescents between 12 and 18 years of age. The results of a confirmatory factor analysis validated the original theoretical structure with two factors, agency and pathways, with a cross-loading of one of the items (CFI?=0?.98; RMSEA?=0?.07; SRMR?=0?.03; CAIC?=??29.52). The instrument showed adequate internal consistency, with a Cronbach’s alpha of 0.76. Regarding convergent validity, significant correlations were found between the CHS and overall satisfaction with life, subjective happiness, dispositional optimism and positive affect. The Spanish version of the CHS therefore demonstrates adequate psychometric properties and can be used, along with other instruments, in educational contexts.     

Breastfeeding attenuates the effect of low birthweight on abdominal adiposity in adolescents: the HELENA study

The aim of this study was to examine whether breastfeeding may reduce the programming effect of birthweight on abdominal adiposity. Abdominal (in three regions: R1, R2 and R3) adiposity was measured by dual energy x‐ray absorptiometry in 314 adolescents. Breastfeeding duration, birthweight, duration of gestation and maternal educational level were obtained from questionnaire. Physical activity was objectively measured. We detected significant interactions between breastfeeding and birthweight on abdominal adiposity (Ps = 0.02–0.07). We observed that birthweight was associated with abdominal adiposity in the group who had never been breastfed (β = ?0.19 to ?0.23; Ps < 0.05), while no association was found in adolescents who had breastfeeding for ≥3 months (β = ?0.03 to ?0.07). The results were independent of duration of gestation, age, sex, maternal educational level and physical activity. Breastfeeding may reduce the adverse influence conferred by low birthweight on abdominal adiposity in adolescents.     

Physical fitness in relation to later body composition in pre-school children

Objectives

Although physical fitness is considered a marker of health in youth, little is known whether physical fitness in pre-school age is related to later body composition. Thus, this study investigated (i) associations of physical fitness at 4.5 years of age with body composition 12 months later and (ii) whether improvements in physical fitness during the 12-month follow-up were associated with changes in body composition.

A growth model of human papillomavirus type 16 designed from cellular automata and agent-based models

ObjectiveThis paper presents a conceptual model that is developed upon a characterization of human papillomavirus type 16 (HPV16) which is used to build a simulation prototype of the HPV16 growth process.MethodologyThe human papillomavirus type 16 is the principal virus detected in invasive lesions of cervical cancer, and associated with the greater persistence and prevalence in pre-malignant and malignant lesions. The probability of acquiring an infection with HPV16 is extremely high in sexually active individuals. However, an HPV16 infection can disappear after becoming a histological confirmed case. According to the characterization of HPV16 proposed in this paper, cells as compared to a society behaves as a complex system, i.e., cells behave in a cooperative manner, following a set of rules defined by local interactions among them. Such complex system is defined by combining a cellular automaton and agent-based models. In this way, the behavior of the HPV16 is simulated by allowing the cellular automaton to follow such parameterized behavior rules.ResultsBoth cross-sectional and prospective studies indicate that HPV16 infection persistence increase the risk of high-grade CIN, as observed in the results provided by the growth simulation model of HPV16. The average growth rate extrapolated over 52 weeks (12 months) and calculated by the model showed a 37.87% growth for CIN1, 35.53% for CIN2 and 16.92% for CIN3. Remarkably, these results are similar to the results obtained and reported by clinical studies. For example, the results obtained using the proposed model for CIN2 and the results obtained by Östör [36], have a differential of 0.53 percentage points while have a differential of 2.23 percentage points with the results obtained by Insinga et al. [51]. Also, for the CIN3, the results obtained using the proposed model, have a differential of 2.92 percentage points with the Insinga et al. [52], results.ConclusionThrough the specification of parameterized behavior rules for HPV16 that are simulated under the combined technique of cellular automata and agent-based models, the HPV life cycle can be simulated allowing for observations at different stages. The proposed model then can be used as a support tool in the investigation of HPV16, in particular (as part of our future work) to develop drugs as agents in the control of the HPV16 disease.     

The Handgrip Strength Test as a Measure of Function in Breast Cancer Survivors: Relationship to Cancer-Related Symptoms and Physical and Physiologic Parameters

OBJECTIVE: The aim of this study was to examine the relationship of muscular strength, as measured by the handgrip strength (HGS) test, with pain, fitness, fatigue, mood, and autonomic nervous system function in breast cancer survivors. DESIGN: A cross-sectional study comprising 95 breast cancer survivors was conducted. HGS; heart rate variability; pressure pain threshold of the neck, shoulder, hand, and tibia of the affected side; and fitness level (6-min walk test, neck-shoulder mobility, vertical jump, sit-to-stand test, and trunk curl test) were assessed as outcomes. Participants completed the Fatigue Piper Scale and Profile of Mood States questionnaires and the neck-shoulder visual analog scale. Correlation was conducted to examine the relationship of HGS with pain, fitness, fatigue, and mood. RESULTS: We observed a fair relationship of HGS with shoulder pain and a moderate to fair relationship with fitness (all P < 0.01; ρ range, 0.24-0.56). The relationship between HGS and heart rate variability (high-frequency domain) was weak (P = 0.049, ρ = 0.23). Likewise, the relationship between HGS and Profile of Mood States subscales ranged from weak to fair (all P < 0.001; ρ range, -0.22 to -0.36). HGS showed a weak relationship with Fatigue Piper Scale (all P < 0.01; ρ range, -0.28 to -0.35). Passive shoulder flexion, fatigue, and vertical jump were independent and significant predictors of HGS (P < 0.01; R = 0.466). CONCLUSIONS: These results suggest that the HGS test might be an important correlate of health in breast cancer survivors. This finding suggests that HGS could be recommended as an adjuvant method of evaluation, which may help with efficiency of clinical practice. Further research on breast cancer patients is needed to confirm or refute these findings.     

Pathophysiologic mechanisms in diabetic kidney disease: A focus on current and future therapeutic targets

Diabetic kidney disease (DKD) is the primary cause of chronic kidney disease around the globe and is one of the main complications in patients with type 1 and 2 diabetes. The standard treatment for DKD is drugs controlling hyperglycemia and high blood pressure. Renin angiotensin aldosterone system blockade and sodium glucose cotransporter 2 (SGLT2) inhibition have yielded promising results in DKD, but many diabetic patients on such treatments nevertheless continue to develop DKD, leading to kidney failure and cardiovascular comorbidities. New therapeutic options are urgently required. We review here the promising therapeutic avenues based on insights into the mechanisms of DKD that have recently emerged, including mineralocorticoid receptor antagonists, SGLT2 inhibitors, glucagon-like peptide-1 receptor agonist, endothelin receptor A inhibition, anti-inflammatory agents, autophagy activators and epigenetic remodelling. The involvement of several molecular mechanisms in DKD pathogenesis, together with the genetic and epigenetic variability of this condition, makes it difficult to target this heterogeneous patient population with a single drug. Personalized medicine, taking into account the genetic and mechanistic variability, may therefore improve renal and cardiovascular protection in diabetic patients with DKD.