Pregnancy and arterial compliance

OBJECTIVE: To examine the hypothesis that pregnancy is associated with vascular remodeling, leading to an increased vascular compliance that can be observed in subsequent pregnancies. STUDY DESIGN: Chart review of41 multiparous deliveries at our institution from a 2-month period in 2004. Charts examined were from patients with uncomplicated, singleton pregnancies who were nulliparous during their prior delivery. Patients with blood pressure recordings in all 3 trimesters during both pregnancies were included. The mean arterial pressure (MAP) in the index and prior pregnancy was compared. RESULTS: There were no significant MAP differences noted, other than in the late third trimester (MAP, 85.05 vs. 80.15, p < 0.001). When we plotted the difference in >34 weeks MAP against the time between pregnancies, we did not see any statistically significant correlation (Pearson Correlation -0.147, p = 0.35). We examined the mean pulse pressure at >34 weeks. We found no statistically significant differences between the first and second pregnancies (mean pulse pressure, 42.27 vs. 43.55, p = 0.5). CONCLUSION: Our data does not support the hypothesis that pregnancy is associated with vascular remodeling, leading to an increased vascular compliance that can be observed in subsequent pregnancies. This could be due to demographic differences between our population and previously studied populations.     

Short-Term Exposure to Wildfire Smoke and [... formula ...] and Cognitive Performance in a Brain-Training Game: A Longitudinal Study of U.S. Adults

Background: There is increasing evidence that long-term exposure to fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] may adversely impact cognitive performance. Wildfire smoke is one of the biggest sources of PM2.5 and concentrations are likely to increase under climate change. However, little is known about how short-term exposure impacts cognitive function.Objectives: We aimed to evaluate the associations between daily and subdaily (hourly) PM2.5 and wildfire smoke exposure and cognitive performance in adults.Methods: Scores from 20 plays of an attention-oriented brain-training game were obtained for 10,228 adults in the United States (U.S.). We estimated daily and hourly PM2.5 exposure through a data fusion of observations from multiple monitoring networks. Daily smoke exposure in the western U.S. was obtained from satellite-derived estimates of smoke plume density. We used a longitudinal repeated measures design with linear mixed effects models to test for associations between short-term exposure and attention score. Results were also stratified by age, gender, user behavior, and region.Results: Daily and subdaily PM2.5 were negatively associated with attention score. A 10μg/m3 increase in PM2.5 in the 3 h prior to gameplay was associated with a 21.0 [95% confidence interval (CI): 3.3, 38.7]-point decrease in score. PM2.5 exposure over 20 plays accounted for an estimated average 3.7% (95% CI: 0.7%, 6.7%) reduction in final score. Associations were more pronounced in the wildfire-impacted western U.S. Medium and heavy smoke density were also negatively associated with score. Heavy smoke density the day prior to gameplay was associated with a 117.0 (95% CI: 1.7, 232.3)-point decrease in score relative to no smoke. Although differences between subgroups were not statistically significant, associations were most pronounced for younger (18–29 y), older (≥70y), habitual, and male users.Discussion: Our results indicate that PM2.5 and wildfire smoke were associated with reduced attention in adults within hours and days of exposure, but further research is needed to elucidate these relationships. https://doi.org/10.1289/{"type":"entrez-protein","attrs":{"text":"EHP10498","term_id":"372009883","term_text":"EHP10498"}}EHP10498     

Exploring Reticular Pseudodrusen Extent and Impact on Mesopic Visual Sensitivity in Intermediate Age-Related Macular Degeneration

PurposeTo explore the impact of the extent of reticular pseudodrusen (RPD) on mesopic visual sensitivity in individuals with intermediate age-related macular degeneration (AMD).MethodsIn total, 570 eyes from 285 participants with bilateral large drusen underwent microperimetry testing to assess the visual sensitivity of the central 3.6-mm region and multimodal imaging to determine the extent of RPD in the central 20° × 20° region (at the eye level). Mean visual sensitivity within five sectors in the central 3.6-mm region sampled on microperimetry and the extent of RPD in these sectors were derived. Linear mixed models were used to examine the association between the extent of RPD on overall mean visual sensitivity and sector-based mean sensitivity.ResultsAn increasing extent of RPD at the eye level and within sectors was associated with a significant reduction in overall and sector-based mean sensitivity, respectively (P < 0.001 for both). However, when both RPD parameters were considered together in a multivariable model, only an increasing extent of RPD at the eye level (P < 0.001) and not within each sector (P = 0.178) was independently associated with reduced sector-based mean sensitivity.ConclusionsMesopic visual sensitivity is generally reduced in eyes with large drusen and coexistent RPD compared to eyes without RPD, with greater reductions with an increasing extent of RPD. However, reduced sector-based visual sensitivities are explained by the overall extent of RPD present, rather than their extent within the sector itself. These findings suggest that there are generalized pathogenic changes in eyes with RPD accounting for the observed mesopic visual dysfunction.     

Oxidative Balance Score during Pregnancy Is Associated with Oxidative Stress in the CANDLE Study

The objective of this study was to calculate an oxidative balance score (OBS) utilizing diet and lifestyle information collected from 1322 women during the second trimester of pregnancy in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. An energy-adjusted OBS was calculated using nutrient information from a Food Frequency Questionnaire (FFQ), lifestyle measures, and plasma folate and vitamin D levels. Using the least absolute shrinkage and selection operator method, 91 food items from the FFQ were selected and they accounted for 82% of the variance in the OBS, with cruciferous vegetables, citrus fruits, fruit juice, and coffee being among the highest anti-oxidant predictors, and red meats and alcohol among the highest pro-oxidant contributors. Urinary F₂-isoprostane, an objective indicator of oxidative stress, was lower with increasing OBS quintiles in a stairstep manner (p for trend = 0.0003), suggesting the possible utility of the OBS as an indicator of oxidative stress. The OBS was moderately correlated with the Healthy Eating Index (correlation coefficient = 0.6076), suggesting it provides a distinct measure of a healthy diet. In conclusion, the OBS may serve as a valid reflective indicator of urinary F₂-isoprostanes and an epidemiological tool to inform intervention studies, in order to minimize oxidative stress during pregnancy.     

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

Introduction:HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa.Objectives:To compare the prevalence of ischemic ECG findings among Tanzanians with and without HIV and to identify correlates of ischemic ECG changes among Tanzanians with HIV.Methods:Consecutive adults presenting for routine HIV care at a Tanzanian clinic were enrolled. Age- and sex-matched HIV-uninfected controls were enrolled from a nearby general clinic. All participants completed a standardized health questionnaire and underwent 12-lead resting ECG testing, which was adjudicated by independent physicians. Prior MI was defined as pathologic Q-waves in contiguous leads, and myocardial ischemia was defined as ST-segment depression or T-wave inversion in contiguous leads. Pearson’s chi-squared test was used to compare the prevalence of ECG findings among those with and without HIV and multivariate logistic regression was performed to identify correlates of prior MI among all participants.Results:Of 497 participants with HIV and 497 without HIV, 272 (27.8%) were males and mean (sd) age was 45.2(12.0) years. ECG findings suggestive of prior MI (11.1% vs 2.4%, OR 4.97, 95% CI: 2.71–9.89, p < 0.001), and myocardial ischemia (18.7% vs 12.1% OR 1.67, 95% CI: 1.18–2.39, p = 0.004) were significantly more common among participants with HIV. On multivariate analysis, ECG findings suggestive of prior MI among all participants were associated with HIV infection (OR 4.73, 95% CI: 2.51–9.63, p = 0.030) and self-reported family history of MI or stroke (OR 1.96, 95% CI: 1.08–3.46, p = 0.023).Conclusions:There may be a large burden of ischemic heart disease among adults with HIV in Tanzania, and ECG findings suggestive of coronary artery disease are significantly more common among Tanzanians with HIV than those without HIV.     

Use of botulinum toxin in complex regional pain syndrome in the hand

This is the first report of the use of botulinum toxin injected into the hand to treat complex regional pain syndrome (CRPS). Botulinum toxin has been shown to improve pain in Raynaud's syndrome, carpal tunnel syndrome, and CRPS of the lower limb. Botulinum toxin has also been shown to act on pain neurotransmitters directly. A 40-year-old man was referred to us with bilateral CRPS after falling onto his hands. Fifty units of Botox® were injected into the carpal tunnel and 50 units around the digital neurovascular bundles of the left non-dominant hand. Hand assessments were performed before injection, and weekly for 6 weeks post-injection. The dominant hand acted as a control. A steady improvement of power grip strength in the left hand was shown. Power in his left hand was greater than the right, despite him being right handed. Total active movement did not change significantly. He felt the injection was beneficial. Botulinum toxin may have improved the signs and symptoms of CRPS in the hand due to its combined effect on the vascular and nervous systems. Botulinum toxin may block the self-perpetuation cycle of pain and sympathetic stimulation by blocking neurotransmitters and warrants further studies on CRPS.     

Transmission of Brucellosis from Elk to Cattle and Bison,Greater Yellowstone Area,USA, 2002–2012

Bovine brucellosis has been nearly eliminated from livestock in the United States. Bison and elk in the Greater Yellowstone Area remain reservoirs for the disease. During 1990–2002, no known cases occurred in Greater Yellowstone Area livestock. Since then, 17 transmission events from wildlife to livestock have been investigated.