Patient radiation dose during diagnostic and interventional cardiology procedures: A study in a tertiary hospital

BackgroundFluoroscopy-guided diagnostic and interventional cardiology (IC) procedures help to identify and treat several problems associated with the heart. However, these procedures expose patients, cardiologists, radiographers, and nurses to radiation doses. Due to the risk that ionizing radiation poses, concerns have been raised and studies are continually being done to ensure that optimization is achieved during such procedures. This study assessed patient radiation dose during diagnostic and interventional cardiology procedures as well as right heart studies at a tertiary hospital in Ghana to formulate the facility's diagnostic reference levels (DRLs) for optimization purposes. As this study was the first of its kind in Ghana, it was a vital step towards dose optimization within the local department, as well as contributing to future DRLs in Ghana.MethodsThe study collected dose (air kerma, and kerma area product (KAP) and procedural data, and assessed any correlation between parameters such as fluoroscopy time and KAP, and between body mass index (BMI) and KAP. The DRL values were determined as the 75th percentile level for the dose distribution for the various IC procedures including percutaneous coronary interventions (PCI), coronary angiography (CA), and right heart catheterization (RHC). Data were analyzed using SPSS version 23.ResultsCA was the most frequently performed IC procedure (77.3%), while RHC was the least recorded (3.3%). The highest mean KAP was observed during the PCI procedure. The proposed diagnostic reference levels (DRLs) were 162.0 Gy.cm² (PCI), 69.4 Gy.cm² (CA), 39.8 Gy.cm² (RHC) and 159.9 Gy.cm² (CA+PCI). Patients who presented for the CA+PCI and RHC procedures received the highest and lowest mean KAP of 159.9 Gy.cm² and 39.8 Gy.cm² of radiation respectively.ConclusionThis study, therefore, concludes that there is a need for dose optimization of radiation exposures for IC procedures at the cardiothoracic center in Ghana.     

Local diagnostic reference levels (LDRLs) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) procedures in Morocco

IntroductionThe objective of this study was to establish local diagnostic reference levels (LDRLs) for the full-field digital mammography (FFDM) and tomosynthesis (DBT) in Moroccan health facilities.MethodsData from 146 women were collected from three facilities. The proposed DRLs were defined as the 75th percentile of the mean average glandular dose (AGD) distribution.ResultsThe mean AGD recorded in this study for the three centers was 1.47 mGy for all centers, and 1.42 mGy and 1.64 mGy for the CC and MLO projections, respectively. The mean compressed breast thickness (CBT) values recorded in this current study were 55 mm, the LDRLs reported for all centers was 1.7 mGy, the CC projection was 1.6 mGy, and the MLO projection was 1.8 mGy. In addition, the LDRLs reported in the current study were compared with those from previous studies for other countries, including the United Kingdom, Japan, Ghana, and Sri Lanka.ConclusionThis work provides an assessment of local DRLs for mammography in Morocco and is suggested as a starting point that will allow professionals to evaluate and optimize their practice. Furthermore, the definition of national DRLs is a necessary process in optimizing Moroccan medical exposures.     

Effect of head and shoulder positioning on the cross-sectional area of the subclavian vein in obese subjects

ObjectiveHead and shoulder positioning may affect cross-sectional area (CSA) and location of the subclavian vein (SCV). We investigated the CSA of the SCV and the depth of the SCV, depending on the head and shoulder positions.MethodsIn 24 healthy obese volunteers, the short axis ultrasound images of the SCV and adjacent structures were obtained in three different head positions (neutral, 30° turned to the contralateral side, and 30° turned to the ipsilateral side) and two different shoulder positions (neutral and lowered). Images of the right and left SCVs were obtained in the supine and Trendelenburg positions. Subsequently, the CSA and depth of the SCV were measured.ResultsSignificant differences were found in the CSA of the SCV in different head positions (30° turned to contralateral side vs. neutral: −0.06 cm², 95% confidence interval [CI], −0.10 to −0.02; P_corrected = 0.002, 30° turned to contralateral side vs. 30° turned to ipsilateral side: −0.16 cm², 95% CI, −0.22 to −0.11; P_corrected < 0.001, Neutral vs. 30° turned to ipsilateral side: −0.10 cm², 95% CI, −0.14 to −0.07; P_corrected < 0.001). The CSA of the SCV was significantly different, depending on shoulder positions (neutral vs. lowered: 0.44 cm², 95% CI, 0.33 to 0.54; P_corrected < 0.001), and body position (supine vs. Trendelenburg: −0.15 cm², 95% CI, −0.19 to −0.12; P_corrected < 0.001). However, the depth of the SCV did not differ with respect to head, shoulder, and body positions.ConclusionsIpsilateral 30° head rotation, neutral shoulder position, and Trendelenburg position significantly enhanced the CSA of the SCV in obese participants.     

Pharmacokinetics of FT218, a Once-Nightly Sodium Oxybate Formulation in Healthy Adults

PurposeFT218 is an investigational, once-nightly, modified-release formulation of sodium oxybate (SO). SO effectively treats excessive daytime sleepiness and cataplexy in patients with narcolepsy. Current approved SO formulations, at effective doses of 6, 7.5, and 9 g, require twice-nightly divided dosing, with the first dose taken at bedtime and the second 2.5–4 h later. The purpose of the following studies was to evaluate the pharmacokinetic properties, safety profile, and tolerability of FT218 in healthy adults.MethodsFour crossover, single-dose studies were conducted. The first was a pilot study (n = 16) that compared 3 prototype formulations of FT218 4.5 g to twice-nightly SO 4.5 g (2 divided doses of 2.25 g); the second, a dose-proportionality study (n = 20) that evaluated FT218 4.5, 7.5, and 9 g; the third, a relative bioavailability study (n = 28) that compared FT218 6 g with twice-nightly SO 6 g (2 divided doses of 3 g); and the fourth, a food-effect study (n = 16) of FT218 6 g.ResultsIn the pilot study, FT218 prototype 2 had a lower C_max, lower plasma concentration 8 h after dosing (C_8h), similar exposure (AUC), and comparable interperson variability to twice-nightly SO 4.5 g. Exploratory pharmacodynamic data indicated similar sleep quality and morning alertness between FT218 and twice-nightly SO. Prototype 2 was selected for further development. In the dose-proportionality study, FT218 had dose proportionality for C_max and slightly more than dose proportionality for AUC. The relative bioavailability study confirmed that FT218 6 g had lower C_max and C_8h than twice-nightly SO 6 g but equivalent AUC and comparable variability. In the food-effect study, FT218 6 g had longer t_max (1 h later), lower C_max (67%), and decreased AUC (86%) in fed versus fasted states. For all studies, adverse events with FT218 were mostly mild or moderate in severity, nonserious, and known to be associated with SO. Most common adverse events included somnolence, dizziness, and nausea. Safety profiles of FT218 and twice-nightly SO at 4.5 and 6 g were similar.ImplicationsOnce-nightly FT218 at 4.5 and 6 g had lower overall C_max and C_8h and similar exposure and variability compared with twice-nightly SO. FT218 was generally well tolerated and comparable to twice-nightly SO.     

Matrix metalloproteinase 9 gene haplotypes affect left ventricular hypertrophy in hypertensive patients

BackgroundMatrix metalloproteinases (MMPs) are involved in cardiac remodeling and are encoded by genes showing genetic polymorphisms that have functional implications. We examined whether MMP-9 genetic polymorphisms are associated with hypertension and with left ventricular (LV) remodeling in hypertensive patients.MethodsWe studied 173 hypertensive patients and 137 age, race and gender matched healthy controls. Heart echocardiography was performed in all patients and the following MMP-9 genetic polymorphisms were analyzed: C^? 1562T (rs3918242), ? 90 (CA)_14–24 (rs2234681) and Q279R (rs17576). Haplo.stats analysis was used to assess whether MMP-9 haplotypes are associated with hypertension. Linear regression analysis was performed to assess whether MMP-9 haplotypes affect LV mass index (LVMI) and other echocardiography parameters.ResultsMMP-9 ? 90 (CA)_14–24 “HH” genotype (H allele defined by number of CA repeats ≥ 21) was associated with hypertension (P = 0.0085; OR = 2.321, 95% confidence interval = 1.250 to 4.309). While one MMP-9 haplotype (“C, H, Q”) protects against LVMI and end-diastolic diameter increases due to remodeling (P = 0.0490 and P = 0.0367), another MMP-9 haplotype apparently has detrimental effects over both parameters in hypertensive patients (“T, H, Q”, P = 0.0015 and P = 0.0057, respectively).ConclusionGenetic polymorphisms in MMP-9 gene may modify the susceptibility of hypertensive patients to LV remodeling. Further studies are necessary to examine whether these polymorphisms affect clinical events in hypertensive patients.     

Evaluation of LOCI® technology-based thyroid blood tests on the Dimension Vista® analyzer

ObjectivesTo assess the performance of thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) determinations by luminescent oxygen channeling immunoassay (LOCI®) technology on the Dimension Vista® analyzer (Siemens Healthcare Diagnostics).Design & methodsWe assessed 1) functional sensitivity for TSH (FSe-TSH), and intra- and inter-assay variations for TSH, FT4 and FT3 on Vista®; 2) comparisons of serum and heparin-treated plasma on Vista®; 3) comparisons of a) plasma TSH by Vista® versus electrochemiluminescence (ECLIA) on Roche Modular® analyzer, and b) plasma FT4 and FT3 by Vista® versus Immunotech®-Beckman radioimmunoassay (RIA); and 4) association of albumin and prealbumin levels with free thyroid hormone concentrations on Vista®.Results1) FSe-TSH concentration was below 0.005 mIU/L. Maximum intra-assay CVs (2.1%, 1.4%, 5.2%) and inter-assay CVs (16.5%, 5.1%, 5.8%) were good for TSH, FT4 and FT3 respectively. 2) Heparin-treated plasma samples consistently gave slightly higher values than serum for TSH, FT4 and FT3. 3) Passing–Bablok regression gave: TSH: [LOCI] = 0.91[ECLIA] ? 0.08 (concordance correlation coefficient ρ_c = 0.95); FT4: [LOCI] = 1.05[RIA] ? 1.55 (ρ_c = 0.80); and FT3: [LOCI] = 1.05[RIA] ? 0.06 (ρ_c = 0.81). 4) Both serum albumin and prealbumin concentrations were positively associated with FT3 levels and negatively associated with FT4 levels in patients.ConclusionLOCI® is accurate for TSH, FT4 and FT3 analysis. Despite a slight significant bias compared to ECLIA, LOCI® is precise for TSH and fulfills the third-generation criteria. However, the poor concordance between LOCI® and RIA for FT4 and FT3, and the dependence of these hormones on binding proteins require further investigation.     

Reference intervals for preterm thyroid function during the fifth to seventh day of life

BackgroundDue to the lack of reference intervals for serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) in preterm neonates during the 5th to 7th day of life, we performed a retrospective study using the chemiluminescence immunoassay system.MethodsA total of 2040 preterm neonates with a gestational age (GA) of 26–35 weeks in the neonatal intensive care unit from 2014 to 2019 were included. Their serum FT3, FT4 and TSH values were calculated and analyzed to establish reference intervals for preterm neonates stratified by GA. The comparisons of FT3, FT4 and TSH were made by sex (males and females) and gestational age (26–28 weeks; 29–32 weeks; 33–35 weeks).ResultsThe reference intervals for FT3, FT4 and TSH in preterm neonates with a GA of 26–35 weeks were (1.65~5.21) pmol/L, (8.64~25.41) pmol/L, and (0.406~12.468) mlU/L, respectively. There were significant differences between serum FT3 and FT4 values and GA, while TSH levels were not significantly different (P < 0.01). The serum FT3 values of males were lower than those of females, especially in the 29–32 weeks group. No significant differences in serum values between sexes were found in FT4 or TSH (P > 0.05).ConclusionReference intervals of thyroid function tests were established to determine the early diagnostic criteria of thyroid diseases for neonates with a GA of 26–35 weeks and to avoid unnecessary retesting and interventions. The reference intervals of FT4 can be used as an indicator to regulate the doses of thyroid hormone supplement in the treatments of congenital hypothyroidism.     

Method specific second-trimester reference intervals for thyroid-stimulating hormone and free thyroxine

ObjectiveTo determine second trimester reference intervals for TSH and FT4.DesignSamples from 3102 subjects were tested for TPO and Tg antibodies.MethodsElecsys E170 reference intervals for TSH and FT4 were determined using antibody-negative samples.ResultsSecond trimester reference intervals for TSH and FT4 were 0.18–4.07 mIU/L and 9.5–15.8 pmol/L, respectively. The Elecsys E170 TSH results were positively biased compared to ARCHITECT i2000_SR results for these same samples.ConclusionsMethod-specific reference intervals are required for TSH and FT4.     

Serum 1,5-anhydroglucitol levels in patients with fulminant type 1 diabetes are lower than those in patients with type 2 diabetes

ObjectivesWe investigated clinical relevance of serum 1,5-anhydroglucitol (1,5-AG) levels in fulminant type 1 diabetes mellitus (FT1DM) patients, because 1,5-AG is known to reflect short term glycemic control.Design and methodsSubjects comprised 7 patients with FT1DM and 32 patients with type 2 diabetes mellitus (T2DM) with HbA1c < 8.5%. All of them have never been treated for diabetes.ResultsHbA_1C showed no significant difference between both groups. On the other hand, serum 1,5-AG levels were significantly lower in the FT1DM patients than in the T2DM patients. Serum 1,5-AG levels were < 5.0 μg/ml in 6 of 7 (86%) FT1DM patients, compared with only 1 of 32 (3%) T2DM patients.ConclusionsSerum 1,5-AG levels were lower in the FT1DM patients than in the T2DM patients. Serum 1,5-AG, but not HbA_1C, reflects short-term exacerbation of glycemia in patients with FT1DM.     

Effect of Icosapent Ethyl on Gynoid Fat and Bone Mineral Health in the Metabolic Syndrome: A Preliminary Report

PurposeThe metabolic syndrome (MetS) is a systemic disorder associated with reduced atheroprotective gynoid fat and bone mineral content (BMC). The goal of this pilot study was to assess whether administration of icosapent ethyl (IPE), a purified formulation of eicosapentaenoic acid, would maintain gynoid fat and BMC over a 9-month treatment period.MethodsPatients with MetS aged ≥40 years were randomly assigned to receive 4 g daily of IPE (2 g BID with food) or placebo (paraffin oil 2 g BID with food) for 9 months. Data were collected at baseline and 9 months later. The data included anthropometric measures, biochemical analysis, and whole body fat mass, including gynoid fat. Bone mineral density and BMC were measured by using dual-energy X-ray absorptiometry. A two-tailed P value ≤ 0.05 was considered statistically significant.FindingsThe study sample consisted of 13 patients with MetS (mean age, 61.6 years; age range, 44–77 years; 77% female and 23% male). Compared with the IPE group, the placebo group experienced statistically significant mean reductions in percent gynoid fat (pre/post, 46.8%–43.5%; P = 0.02), BMC (pre/post, 2461 g–2423 g; P = 0.02), and bone mineral density (pre/post, 1.24 g/cm² to 1.22 g/cm²; P = 0.05) over the 9-month study period.ImplicationsThe results of this pilot study raise the possibility that IPE supplementation may preserve gynoid fat distribution and bone mineral health in patients with MetS. Larger, randomized longitudinal studies are necessary to determine the potential long-term metabolic benefits of IPE treatment.     

磁化传递成像及多回波Dixon技术诊断原发性骨质疏松

目的 观察磁化传递成像(MTI)及多回波Dixon技术诊断原发性骨质疏松的价值。方法 回顾性分析206例接受L2～L4定量CT(QCT)及MR(MTI及多回波Dixon定量技术)检查患者,根据QCT所测骨密度(BMD)将其分为骨质疏松组(BMD<80 mg/cm³)、骨量减低组(BMD 80～120 mg/cm³)及骨量正常组(BMD>120 mg/cm³),比较3组一般资料、L2～L4椎体磁化传递率(MTR)及脂肪分数(FF)。将差异有统计学意义的参数纳入多因素二元logistic回归分析,建立回归方程,采用受试者工作特征(ROC)曲线,分析其诊断骨质疏松的效能。结果 QCT诊断骨质疏松64例、骨量减低72例、骨量正常70例,3组间年龄、体质量指数(BMI)、BMD、FF及MTR差异均有统计学意义(P均<0.05)。基于多回波Dixon的回归方程为Logist(P_FF)=0.15×年龄+0.58×BMI+0.04×FF-27.09,基于MTI的回归方程为Logist(P_...     

Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis

BACKGROUNDThere is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent.PURPOSETo perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or quantitative ultrasound (QUS).DATA SOURCESPubMed, Embase, Scopus, and Web of Science from 1 January 1990 to 31 December 2020, limited to humans, without language restriction.STUDY SELECTIONInclusion criteria were as follows: cross-sectional or cohort studies that included BMD measured by DXA, pQCT, or QUS in youth (aged <20 years) with type 1 diabetes and matched control subjects.DATA EXTRACTIONWe collected data for total body, lumbar spine, and femoral BMD (DXA); tibia, radius, and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference was estimated and meta-regression was performed with age, diabetes duration, and HbA_1c as covariates.DATA SYNTHESISWe identified 1,300 nonduplicate studies; 46 met the inclusion criteria, including 2,617 case and 3,851 control subjects. Mean ± SD age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: total body (WMD −0.04 g/cm², 95% CI −0.06 to −0.02; P = 0.0006), lumbar spine (−0.02 g/cm², −0.03 to −0.0; P = 0.01), femur (−0.04 g/cm², −0.05 to −0.03; P < 0.00001), tibial trabecular (−11.32 g/cm³, −17.33 to −5.30; P = 0.0002), radial trabecular (−0.91 g/cm³, −1.55 to −0.27; P = 0.005); phalangeal (−0.32 g/cm³, −0.38 to −0.25; P < 0.00001), and calcaneal (standardized mean difference −0.69 g/cm³, −1.11 to −0.26; P = 0.001). With use of meta-regression, total body BMD was associated with older age (coefficient −0.0063, −0.0095 to −0.0031; P = 0.002) but not with longer diabetes duration or HbA_1c.LIMITATIONSMeta-analysis was limited by the small number of studies with use of QUS and pQCT and by lack of use of BMD z scores in all studies.CONCLUSIONSBone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.     

Walking test procedures influence speed measurements in individuals with chronic stroke

BackgroundWalking speed measurements are clinically important, but varying test procedures may influence measurements and impair clinical utility. This study assessed the concurrent validity of walking speed in individuals with chronic stroke measured during the 10-m walk test with variations in 1) the presence of an electronic mat, 2) the speed measurement device, and 3) the measurement distance relative to the total test distance.MethodsTwenty-five individuals with chronic stroke performed walking tests at comfortable and maximal walking speeds under three conditions: 1) 10-m walk test (without electronic mat) measured by stopwatch, 2) 10-m walk test (partially over an electronic mat) measured by software, and 3) 10-m walk test (partially over an electronic mat) measured by stopwatch. Analyses of systematic bias, proportional bias, and absolute agreement were performed to determine concurrent validity between conditions.FindingsWalking speeds were not different between measurements (P ≥ 0.11), except maximal walking speed was faster when speed was measured with software vs. stopwatch (P = 0.002). Absolute agreement between measurements was excellent (ICC ≥ 0.97, P < 0.001). There was proportional bias between software vs. stopwatch (R² ≥ 0.19, P ≤ 0.03) and between tests with vs. without the electronic mat (R² = 0.27, P = 0.008). Comparisons between conditions revealed that walking speed and concurrent validity may be influenced by walking test distance, presence of an electronic mat, speed measurement device, and relative measurement distance.InterpretationWalking test procedures influence walking speed and concurrent validity between measurements. Waking test procedures should be as similar as possible with normative data or between repeated measurements to optimize validity.     

A Systematic Review and Meta-Analysis of Risk Factors for Unplanned Intraoperative Hypothermia Among Adult Surgical Patients

PurposeUnplanned intraoperative hypothermia (UIH) is a frequent but preventable complication of surgery. Accurate identification of UIH risk factors allows nurses to minimize its negative outcomes. This study aimed to investigate the risk factors for UIH in adult surgical patients.DesignSystematic review and meta-analysisMethodsWe comprehensively searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Ovid Embase, and ClinicalTrials.gov from their inception until December 31, 2020 to identify available, related studies in English. Two authors independently extracted data from these studies. Data analysis was performed using Review Manager Version 5.3.ResultsThis meta-analysis included 12 studies involving 15,010 patients. The combined results showed that age [mean difference (MD) = 4.85, P < .0001; I² = 94%], body mass index (MD = ? 0.76, P = .001; I² = 59%), ambient temperature [odds ratio (OR) = 0.82, P < .001; I² = 54%], preoperative systolic blood pressure (MD = ?14.68, P < .00001; I² = 30%), preoperative heart rate (MD = ? 13.25, P < .00001; I² = 0%), duration of anesthesia (>2 h; OR = 2.67, P < .001; I² = 0%), and intravenous fluid administration >1,000 mL (OR = 2.02, P = .01; I² = 77%) were significantly associated with a higher risk of UIH.ConclusionsOur study demonstrated that various risk factors contribute to the development of UIH. Perioperative nurses should understand these risk factors in order to apply evidence-based procedures and improve patient outcomes. Due to the substantial clinical heterogeneity across studies, further studies are needed to verify these findings.     

Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study

PurposeHigh-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model.Materials and methodsThe MetaNeb® System was used to deliver high-frequency pressure pulses to 3.0, 4.0, 6.0 and 8.0 mm ID ETTs connected to a test lung during mechanical ventilation. The experimental setup included a 3D-printed trachea model and imbedded pressure sensors. The pressure attenuation (P_att%) was calculated: P_att% = [(P_proximal–P_distal)/P_proximal]x100. The effect of pulse frequency on P_distal and P_proximal was quantified.ResultsP_att% was inversely and linearly related to ETT ID and (y = − 7.924x + 74.36; R² = 0.9917, P = .0042 for 4.0 Hz pulse frequency and y = − 7.382 + 9.445, R² = 0.9964, P = .0018 for 3.0 Hz pulse frequency). P_att% across the 3.0, 4.0, 6.0 and 8.0 mm I.D. ETTs was 48.88 ± 10.25%, 40.87 ± 5.22%, 27.97 ± 5.29%, and 9.90 ± 1.9% respectively. Selecting the 4.0 Hz frequency mode demonstrated higher P_proximal and P_distal compared to the 3.0 Hz frequency mode (P = .0049 and P = .0065). Observed P_distal was < 30cmH₂O for all experiments.ConclusionsIn an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased.     

Elevation of carbohydrate antigen 125 in chronic heart failure may be caused by mechanical extension of mesothelial cells from serous cavity effusion

ObjectivesThe practical application of elevated carbohydrate antigen 125 (CA125) to predict clinical outcome in chronic heart failure (CHF) is under debate. The mechanism for this CA125 elevation remains unknown. We hypothesize that mechanical stress on mesothelial cells initiates CA125 synthesis.Design and methodsA total of 191 patients suffering from edema and/or dyspnea were enrolled. 109 patients were diagnosed as CHF, and 82 patients without CHF were assigned as control group. Echocardiography, CA125, N-terminal pro-brain natriuretic peptide (NT-proBNP), and other biochemical parameters were measured. All enrolled patients underwent heart function classification.ResultsPatients with serous cavity effusion (SCE) demonstrated higher serum CA125 than patients without SCE (82.91 (61.90–103.92) vs. 44.98 (29.66–60.30) U/mL, P < 0.001). In the absence of SCE, CA125 levels in CHF patients were slightly higher than non-CHF patients (52.37 (34.85–69.90) vs. 35.15 (23.81–46.49) U/mL, P = 0.017). Additionally, compared with non-CHF patients, CHF patients had higher levels of high-sensitivity C-reactive protein (hsCRP) and lower superoxide dismutase (SOD). In all enrolled patients, CA125 levels were negatively correlated with SOD concentrations (r = ? 0.567, P < 0.001), and positively correlated with hsCRP levels (r = 0.608, P < 0.001). Receiver operating characteristic curve analysis showed that CA125 was better in predicting SCE than NT-proBNP, while NT-proBNP was more suitable for predicting CHF than CA125. The in vitro study demonstrated that MUC16, the CA125 coding gene, was up-regulated by mechanical stretch on human mesothelial cell line (MeT-5A).ConclusionsCA125 elevation in CHF was associated with SCE. Mechanical extension of mesothelial cells from SCE plays an important role in CA125 increase.     

Impact of apheresis automation on procedure quality and predictability of CD34+ cell yield

Success of peripheral blood stem cell (PBSC) collections depends on patient biological parameters and stable apheresis device performance. We investigated product quality and factors influencing main apheresis procedure outcomes including CD34⁺ collection efficiency (CE), product volume or platelet CE. We also assessed different CD34⁺ cell yield prediction algorithms. Autologous PBSC collections by Spectra Optia from myeloma and lymphoma patients were analyzed. Complete blood count (CBC) from patient preprocedure and from collected products were assessed. (1) Product yield was calculated, (2) Product CBC was correlated with patient preprocedure variables, and (3) Predictions of CD34⁺ yields based on (a) product CD34⁺ cell concentration in samples after two or four chamber flushes or (b) traditional CE2 benchmark, were compared. 62 procedures in 41 patients were analyzed. 84% of all procedures were run without operator intervention. Median CD34⁺ CE2 was 56.9% (48.8%‐65.2%) and quite stable irrespective of patient conditions, with minor influence from patient white blood cell (WBC) precounts (r_s = –.47; P < .001). Platelet loss correlated with WBC precount (r_s = .46; P < .001), product volume (r_s = .71; P < .0001) and number of chambers collected (r_s = .72; P < .0001). CD34⁺ cell yield was better predicted based on (a) product CD34⁺ cell concentration from samples after 2 and 4 chamber flushes, respectively (r_s = .969; P < .0001 and r_s = .9648; P < .0001) than based on (b) CE2 formula (r_s = .8262, P < .0001). Spectra Optia provides good quality PBSC products with stable and predictable yield regardless of starting conditions. CD34⁺ sampling of product after few chamber flushes could be used to predict CD34⁺ yield.     

Dose-dependent effect of vinegar on blood pressure: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials

BackgroundThere are controversial findings regarding the effect of vinegar on blood pressure based on the evidence accumulated so far.MethodsA systematic search was conducted through PubMed, Scopus, and ISI Web of Science up to April 2022. We estimated the change in blood pressure for each 30 ml/d increments in vinegar consumption in each trial and then, calculated the mean difference (MD) and 95 %CI using a fixed-effects model. A dose-response meta-analysis of differences in means provided us with the estimation of the dose-dependent effect. The certainty of evidence was rated by the GRADE tool.ResultsEach 30 ml/d increment in vinegar consumption reduced SBP by − 3.25 mmHg (95 %CI: − 5.54, − 0.96; I² = 67.5 %, GRADE = low). Levels of SBP decreased linearly and slightly (P_nonlinearity = 0.69, P_{dose-response} = 0.02) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 3.36, 95 %CI: − 5.77, − 0.94). Each 30 ml/d increment in vinegar consumption reduced DBP by − 3.33 mmHg (95 %CI: − 4.16, − 2.49; I² = 57.1 %, GRADE = low). Levels of DBP decreased linearly and slightly (P_nonlinearity = 0.47, P_{dose-response} = 0.004) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 2.61, 95 %CI: − 4.15, − 1.06)ConclusionsAccording to the findings, vinegar significantly reduces systolic and diastolic blood pressure and may be considered an adjunct to hypertension treatment. Thus, clinicians could incorporate vinegar consumption as part of their dietary advice for patients.     

An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke

ObjectiveTo develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o_2max) of individuals post-stroke.DesignA cross-sectional study.SettingA university laboratory.ParticipantsIndividuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]).InterventionsNot applicable.Main Outcome Measure(s)Step-1 (equation development): multiple linear regression analysis was performed. Dependent variable: V̇o_2max (mL/kg^/min) in the cardiopulmonary exercise test. Independent variables: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m²), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o_2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%).ResultsIn step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R²=0.68, P<.001; ISWT-Equation: R²=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o_2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity.ConclusionsAn equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o_2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.