Short‐Term Outcomes of Patent Ductus Arteriosus Closure With New Occlutech® Duct Occluder: A Multicenter Study

Aim

Over the past 2 decades, transcatheter occlusion of patent ductus arteriosus (PDA) with coils and the duct occluders evolved to be the procedure of choice. A new device, the Occlutech PDA® occluder (ODO) device has been designed. Herein, we aimed to evaluate the characteristics and short‐term results of patients who underwent transcatheter closure of PDA using the ODO.

Methods

We reviewed the clinical records of 60 patients from different centers in Turkey between December 2013 and January 2016. The medical records were reviewed for demographic characteristics and echocardiographic findings. Device size was selected on the narrowest diameter of PDA.

Results

The median patient age was 2.5 years (6 months–35 years), and median PDA diameter was 2.5 mm (1.2–11 mm). Fifty‐eight of 60 patients (96.6%) had successful ODO implantation. The occlusion rates were 37/58 (63.7%) at the end of the procedure, 51/58 (87.9%) at 24–48 hours post‐procedure, and 57/58 (98.2%) on echocardiography at a median follow‐up of 7.6 months.

Conclusion

Our results indicate that transcatheter closure of PDA using the ODO is effective. Larger studies and longer follow‐up are required to assess whether its shape and longer length make it superior to other duct occluders in large, tubular, or window‐type ducts. (J Interven Cardiol 2016;29:325–331)

     

Percutaneous mitral valvuloplasty in the adult. Apropos of 5 cases

The results of percutaneous mitral valvuloplasty in 5 adult patients with mitral stenosis are presented. The average age was 55 years (37-72 years); 4 patients were in functional Class III and 1 in Class IV. The three oldest patients were in atrial fibrillation, and 2 of them had severe valvular and subvalvular lesions. Valvuloplasty was carried out with a "Trefoil" balloon (3 X 12 mm; effective cross sectional area at maximal inflation: 3.8 cm2). The procedure was successful in 4 patients. In the other patient, it was not possible to position the balloon across the stenotic valve. After valvuloplasty, the mean mitral gradient decreased (14 +/- 5 to 6 +/- 2 mmHg, p less than 0.05) without a significant change in cardiac index (2.9 +/- 0.5 vs 2.7 +/- 0.4 l/mn/m2; NS): this indicated an increased mitral valve surface area (1.1 +/- 0.2 to 1.8 +/- 0.05 cm2, p less than 0.05). In parallel, echocardiographic measurements of mitral valve surface area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2, p less than 0.05, and Doppler pressure halt time fell from 220 +/- 50 to 116 +/- 13 ms, p less than 0.05. There were no operative complications and, in particular, no resulting angiographic mitral regurgitation. These preliminary results suggest that percutaneous mitral valvuloplasty may be a valuable alternative therapeutic procedure to surgery in selected patients.     

Hemodynamic and angiographic results following surgical correction of mitral insufficiency. Apropos of 51 repeated catheterizations

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43.5 +/- 12.3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 +/- 22 months after surgery. The following angiographic parameters were measured : indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient : HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgery comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 +/- 5 compared to 17 +/- 6 mmHg, p less than 0.09) and mean pulmonary artery pressures (19 +/- 7 compared to 27 +/- 11, p less than 0.01) and increase in cardiac index (2.8 +/- 0.7 compared to 2.3 +/- 0.6 l/min/m2, p less than 0.01). There was an associated decrease in ventricular volumes (EDV : 115 +/- 44 compared to 165 +/- 43, p less than 0.01) (ESV : 60 +/- 39 compared to 77 +/- 22, p less than 0.001). The reduction in myocardial mass was less spectacular (129 +/- 40 compared to 148 +/- 32, p less than 0.01) with a resulting increase in the HC (1.10 +/- 0.26 compared to 0.88 +/- 0.17, p less than 0.001). The geometry of the LV was less spherical in diastole (DE 0.76 +/- 0.08 compared to 0.70 +/- 0.08, p less than 0.001) and in systole (SE = 0.83 +/- 0.06 compared to 0.77 +/- 0.08, p less than 0.001). The EF fell slightly but this was not statistically significant (0.51 +/- 0.13 compared to 0.53 +/- 0.09 NS). The surgical result of 14 patients with PCP greater than or equal to 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2.4 +/- 0.5 compared to 3.0 +/- 0.7, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)     

PPARβ/δ attenuates palmitate-induced endoplasmic reticulum stress and induces autophagic markers in human cardiac cells

Background

Chronic endoplasmic reticulum (ER) stress contributes to the apoptotic cell death in the myocardium, thereby playing a critical role in the development of cardiomyopathy. ER stress has been reported to be induced after high-fat diet feeding in mice and also after saturated fatty acid treatment in vitro. Therefore, since several studies have shown that peroxisome proliferator-activated receptor (PPAR)β/δ inhibits ER stress, the main goal of this study consisted in investigating whether activation of this nuclear receptor was able to prevent lipid-induced ER stress in cardiac cells.

Methods and results

Wild-type and transgenic mice with reduced PPARβ/δ expression were fed a standard diet or a high-fat diet for two months. For in vitro studies, a cardiomyocyte cell line of human origin, AC16, was treated with palmitate and the PPARβ/δ agonist GW501516. Our results demonstrate that palmitate induced ER stress in AC16 cells, a fact which was prevented after PPARβ/δ activation with GW501516. Interestingly, the effect of GW501516 on ER stress occurred in an AMPK-independent manner. The most striking result of this study is that GW501516 treatment also upregulated the protein levels of beclin 1 and LC3II, two well-known markers of autophagy. In accordance with this, feeding on a high-fat diet or suppression of PPARβ/δ in knockout mice induced ER stress in the heart. Moreover, PPARβ/δ knockout mice also displayed a reduction in autophagic markers.

Conclusion

Our data indicate that PPARβ/δ activation might be useful to prevent the harmful effects of ER stress induced by saturated fatty acids in the heart by inducing autophagy.     

What do Australian patients with inflammatory arthritis value in treatment? A discrete choice experiment

Clinical Rheumatology - The purpose of this study was to develop an understanding of treatment preferences in patients with inflammatory arthritis (IA) [rheumatoid arthritis (RA), ankylosing...     

Risks and Benefits of Green Spaces for Children: A Cross-Sectional Study of Associations with Sedentary Behavior,Obesity, Asthma,and Allergy

Background: Green spaces have been associated with both health benefits and risks in children; however, available evidence simultaneously investigating these conflicting influences, especially in association with different types of greenness, is scarce.Objectives: We aimed to simultaneously evaluate health benefits and risks associated with different types of greenness in children, in terms of sedentary behavior (represented by excessive screen time), obesity, current asthma, and allergic rhinoconjunctivitis.Methods: We conducted a cross-sectional study of a population-based sample of 3,178 schoolchildren (9–12 years old) in Sabadell, Spain, in 2006. Information on outcomes and covariates was obtained by questionnaire. We measured residential surrounding greenness as the average of satellite-derived Normalized Difference Vegetation Index (NDVI) in buffers of 100 m, 250 m, 500 m, and 1,000 m around each home address. Residential proximity to green spaces was defined as living within 300 m of a forest or a park, as separate variables. We used logistic regression models to estimate associations separately for each exposure–outcome pair, adjusted for relevant covariates.Results: An interquartile range increase in residential surrounding greenness was associated with 11–19% lower relative prevalence of overweight/obesity and excessive screen time, but was not associated with current asthma and allergic rhinoconjunctivitis. Similarly, residential proximity to forests was associated with 39% and 25% lower relative prevalence of excessive screen time and overweight/obesity, respectively, but was not associated with current asthma. In contrast, living close to parks was associated with a 60% higher relative prevalence of current asthma, but had only weak negative associations with obesity/overweight or excessive screen time.Conclusion: We observed two separable patterns of estimated health benefits and risks associated with different types of greenness.Citation: Dadvand P, Villanueva CM, Font-Ribera L, Martinez D, Basagaña X, Belmonte J, Vrijheid M, Gražulevičienė R, Kogevinas M, Nieuwenhuijsen MJ. 2014. Risks and benefits of green spaces for children: a cross-sectional study of associations with sedentary behavior, obesity, asthma, and allergy. Environ Health Perspect 122:1329–1335; http://dx.doi.org/10.1289/ehp.1308038     

Ethnic Density and Depressive Symptoms Among African Americans: Threshold and Differential Effects Across Social and Demographic Subgroups

Objectives. We examined the association between Black ethnic density and depressive symptoms among African Americans. We sought to ascertain whether a threshold exists in the association between Black ethnic density and an important mental health outcome, and to identify differential effects of this association across social, economic, and demographic subpopulations.Methods. We analyzed the African American sample (n = 3570) from the National Survey of American Life, which we geocoded to the 2000 US Census. We determined the threshold with a multivariable regression spline model. We examined differential effects of ethnic density with random-effects multilevel linear regressions stratified by sociodemographic characteristics.Results. The protective association between Black ethnic density and depressive symptoms changed direction, becoming a detrimental effect, when ethnic density reached 85%. Black ethnic density was protective for lower socioeconomic positions and detrimental for the better-off categories. The masking effects of area deprivation were stronger in the highest levels of Black ethnic density.Conclusions. Addressing racism, racial discrimination, economic deprivation, and poor services—the main drivers differentiating ethnic density from residential segregation—will help to ensure that the racial/ethnic composition of a neighborhood is not a risk factor for poor mental health.Recent years have seen an increase in the number of studies examining the association between the residential concentration of racial/ethnic minorities (ethnic density) and health, with increasingly sophisticated statistical techniques and theoretical frameworks helping to identify the relevance of ethnic density effects. Despite these improvements, the association between ethnic density and health, given the concentration of poverty in areas of higher ethnic density, is still a puzzling phenomenon.The literature is characterized by inconclusive findings in both the direction and the size of ethnic density effects. Reviews have asserted that ethnic density effects are stronger for mental health1 than for physical health, mortality, and health behaviors,2 but even among the latter set of outcomes, protective ethnic density effects are more common than adverse associations.2 One common finding among ethnic density studies, regardless of health outcome, is the variation in results across and within racial/ethnic groups. For example, US studies often report protective associations among Latinos but mostly detrimental associations for African Americans,2 and the few studies that have examined subgroups among broad “US Black” ethnic categories have found differences by age,3 gender,4,5 and nativity.6,7 Determining the specific populations for which ethnic density effects are protective or detrimental can help in achieving a greater understanding of the potential mechanisms by which ethnic density is associated with health.Another methodological improvement that would clarify the association between ethnic density and health is adequate adjustment for area resource deprivation. The positive correlation that exists between ethnic density and deprivation, and the established association between area deprivation and poor health,8 may have a twofold effect in concealing ethnic density effects: first, by overriding protective effects of ethnic density; second, by complicating analytical attempts at disentangling harmful deprivation effects from protective ethnic density benefits, even with the use of multilevel methods. Reviews of the literature have highlighted the inadequate adjustment for area deprivation as one of the main limitations in current studies, most of which control for only 1 measure of area deprivation (e.g., median income) or, in some cases, do not adjust for any relevant confounders.1,2Although the appropriate adjustment for area deprivation is critical for detecting ethnic density effects, it is not sufficient. To properly capture the associations between ethnic density, area resource deprivation, and health, the potential suppressing effects of area deprivation in the association between ethnic density and health should be modeled. Detrimental ethnic density effects may not be due to the concentration of ethnic minorities in an area but to the concurrent concentration of poverty and social adversity,9 and appropriate modeling can portray the relative contribution of ethnic density and area deprivation to health.In addition to differentiating ethnic density effects between subgroups and accurately modeling and adjusting for area deprivation, the possible nonlinearity in the association between ethnic density and health, and the potential thresholds at which ethnic density exerts protective or nonprotective effects on health, need to be addressed.10 The combination of methods and theoretical frameworks aiming to understand the importance of concentrated poverty and threshold effects for ethnic density might also be useful in clarifying the difference between ethnic density and residential segregation. Although ethnic density is framed in terms of social support, racial/ethnic diversity, and a stronger sense of community, residential segregation is a direct consequence of current and historical racism and discrimination, and is recognized as a determinant of racial/ethnic health inequalities.11 However, both ethnic density and residential segregation are conceptualized through use of a measure of racial/ethnic residential concentration, and it is unclear at what point the hypothesized protective benefits of ethnic density are overcome by the pernicious effects of racial residential segregation. Understanding this difference and its drivers has important implications for social and public health policy, as it would allow the promotion of factors that harness the protective effects of ethnic density while targeting the factors related to racial residential segregation.We examined the association between Black ethnic density and depressive symptoms among African Americans in the National Survey of American Life (NSAL), to ascertain (1) the differential effects of ethnic density across subgroups of African American NSAL respondents and (2) the protective or detrimental thresholds of Black ethnic density. We addressed these 2 study aims while accounting for, and adequately modeling, the potential suppressing effects of area resource deprivation on the association between ethnic density and an important mental health outcome.We selected depressive symptoms as the mental health outcome in this study because the literature is consistent regarding the ethnic density effects of outcomes such as psychoses, but not about the association between Black ethnic density and depression.5 Although the prevalence of major depression is lower among African Americans than among the White majority, the prevalence of depressive symptoms and chronic low mood is high among this population,12–14 and understanding any protective or risk factors of psychological distress, including at the neighborhood level, remains a priority.We focused on African Americans because most ethnic density studies have been conducted in this population, and it is the group in which ethnic density effects have been found to be the most detrimental.1,2 Some previous studies have modeled nonlinear associations between Black ethnic density and several physical health indicators,15–18 but not mental health ones. In all of these prior studies, potential cutoff points have not been based on formal threshold examinations. In addition, prior studies have analyzed non-Hispanic Black respondents. In this study, we focused specifically on African Americans because of the documented heterogeneity of sociodemographic characteristics,19 health profiles,20–22 and ethnic density effects23 in the non-Hispanic Black population.