Publications by authors named "David Wood"

1,207 Publications

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Functional versus morphological assessment of vascular age in patients with coronary heart disease.

Sci Rep 2021 Sep 13;11(1):18164. Epub 2021 Sep 13.

Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.

Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VA in 68% of patients; for VA in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VA accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.
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http://dx.doi.org/10.1038/s41598-021-96998-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437950PMC
September 2021

Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a "Real World" Population: Insights From a Prospective Canadian Database.

CJC Open 2021 Aug 24;3(8):1033-1042. Epub 2021 Apr 24.

St. Paul's Hospital and Vancouver General Hospital, Vancouver, British Columbia, Canada.

Background: Documentation of quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI) is a Canadian Cardiovascular Society quality indicator. National results have not been reported to date.

Methods: We conducted an observational cohort study including all TAVI patients, irrespective of surgical risk, treated between January 2016 and June 2019 as documented in the British Columbia TAVI Registry. QOL was measured at baseline, 30 days, and 1 year, using the Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of sustaining a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality.

Results: The cohort included 1706 patients (742 women [43.5%]); median age 83 years (interquartile range [IQR]: 77, 86). Median (IQR) baseline KCCQ-OS was 45 (28.2, 67), indicating severe impairment. Patients alive at 1 year (91.3%) reported a mean improvement of 24.1 (95% confidence interval [CI], 22.7-25.6) points in the KCCQ-OS at 30 days, which was sustained at 1 year (25.3; 95% CI, 23.8, 26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation, and non-transfemoral access were associated with worse 30-day QOL. At 1 year, 65% of patients had a favorable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, New York Heart Association Class IV, severe pulmonary and renal disease, diabetes, and in-patient status.

Conclusions: TAVI is associated with significant early improvement in QOL, which is sustained at 1 year. The inclusion of QOL can support treatment decisions and patient-centred evaluation.
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http://dx.doi.org/10.1016/j.cjco.2021.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413231PMC
August 2021

Setting a benchmark for resource utilization and quality of care in patients undergoing transcatheter aortic valve implantation in Europe-Rationale and design of the international BENCHMARK registry.

Clin Cardiol 2021 Sep 9. Epub 2021 Sep 9.

Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany.

Background: The use of transcatheter aortic valve implantation (TAVI) for treating aortic stenosis (AS) has increased exponentially in recent years. Despite the availability of clinical practice guidelines for the management of valvular heart disease, disparities in quality of care (QoC) for TAVI patients remain widespread across Europe. Tailored QoC measures will help to reduce resource utilization and improve patient outcomes without compromising patient safety. Using a clear set of QoC measures, the BENCHMARK registry aims to document the progress that can be achieved if such tailored QoC measures are implemented.

Methods: The BENCHMARK registry (BENCHMARK) is a non-interventional, multicenter registry in patients with severe symptomatic AS undergoing TAVI with a 1- and 12-months follow-up. BENCHMARK will be conducted at 30 centers across Europe and will enroll a total of 2400 consecutive TAVI patients. Patients suffering from severe symptomatic AS who undergo TAVI with a balloon-expandable transcatheter aortic valve will be included. The registry will comprise four phases: (1) a retrospective baseline evaluation phase; (2) an education phase; (3) an implementation phase; and (4) a prospective effect documentation phase (prospective phase). The registry's primary objectives are to reduce the length of hospital stay and accelerate the post-procedural patient recovery pathway, but without compromising safety. The study started in April 2021 and has an estimated completion date of May 2023.

Discussion: BENCHMARK will establish QoC measures to reduce resource utilization, intensive care unit bed occupancy, and overall length of hospitalization with uncompromised patient safety post-TAVI (ClinicalTrials.gov Identifier: NCT04579445).
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http://dx.doi.org/10.1002/clc.23711DOI Listing
September 2021

Paracetamol toxicity in mild overdose in combination with opioids: a retrospective observational study.

Br J Clin Pharmacol 2021 Sep 5. Epub 2021 Sep 5.

Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.

Aims: Toxicity in paracetamol overdose with opioid co-ingestion is poorly understood. We compared outcomes in both paracetamol-only and paracetamol-opioid overdoses to determine whether toxicity differed significantly between the groups, and to assess the utility of the ratio of measured plasma paracetamol concentration relative to the 4h nomogram-adjusted level (APAP /APAP ).

Methods: We conducted a retrospective observational study of all patients (N = 1159) presenting to two large UK hospitals between 2005 and 2013 with acute single-dose ingestion paracetamol overdose, with (N = 221) or without (N = 938) opioid co-ingestion. Adverse outcomes included biomarkers of hepatotoxicity and the need for extended treatment. Several outcomes were assessed in relation to the APAP /APAP ratio.

Results: Median ingested dose of paracetamol was low in both groups (10g). Statistical comparison of the median APAP /APAP ratios showed a significant difference (0.65 vs 0.56 for the paracetamol-only and paracetamol-opioid groups respectively, p = 0.0329). Although there was a trend towards a lower risk of pre-defined toxic outcomes with opioid co-ingestion, statistical analysis did not show a significant difference, with outcomes for the paracetamol-only and paracetamol-opioid groups including the following: ALT > 2x ULN, 7.7% vs 5.7% (p = 0.6480); ALT > 1000 IU/L, 2.4% vs 0 (p = 0.2145); INR > 1.3, 8.6% vs 4.4% (p = 0.2774); and transfer to tertiary liver unit, 0.2% vs 0 (p NS).

Conclusion: Our study does not support a change in current clinical practise beyond standard testing at four hours or longer post ingestion for mixed low dose paracetamol-opioid overdose.
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http://dx.doi.org/10.1111/bcp.15070DOI Listing
September 2021

An irradiated marrow niche reveals a small non-collagenous protein mediator of homing, dermatopontin.

Blood Adv 2021 Aug 27. Epub 2021 Aug 27.

University of Minnesota, Minneapolis, Minnesota, United States.

Hematopoietic cell homing after hematopoietic cell transplant (HCT) is governed by several pathways involving marrow niche cells that are evoked after pre-HCT conditioning. To understand the factors that play a role in homing, we performed expression analysis on the zebrafish marrow niche cells following conditioning. We determined that the non-collagenous protein extracellular matrix related protein dermatopontin (Dpt) was upregulated seven-fold in response to irradiation. Studies in mice revealed DPT induction both with radiation and lipopolysaccharide exposure. Interestingly, we found that co-incubation of zebrafish or murine hematopoietic cells with rDPT impedes hematopoietic stem and progenitor cell homing by 50% and 86%, respectively. Similarly, this translated into a 24% reduction in long term engraftment (versus control, p = 0.01). We found DPT to interact with VLA-4 and block hematopoietic - endothelial cell adhesion and transendothelial migration. Finally, a DPT knockout mouse displayed a 60% increase in homing of hematopoietic cells versus wildtype (p = 0.03) with slight improvement in long-term LSK-SLAM engraftment (2-fold, p = 0.04). These data show that the extracellular matrix (ECM)-related protein DPT increases with radiation and transiently impedes the transendothelial migration of hematopoietic cells to the marrow.
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http://dx.doi.org/10.1182/bloodadvances.2021004475DOI Listing
August 2021

Dyslipidemia Management in Patients with Coronary Artery Disease. Data from the POLASPIRE Survey.

J Clin Med 2021 Aug 20;10(16). Epub 2021 Aug 20.

Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-066 Kraków, Poland.

Lipid-lowering in patients with coronary artery disease (CAD) is related to a lower risk of cardiovascular events. We evaluated factors related to the management of hypercholesterolemia in patients with established CAD. Patients were interviewed 6-18 months after hospitalization for an acute coronary syndrome (ACS) or a myocardial revascularization procedure. Statins were prescribed at discharge to 94.4% of patients, while 68.1% of the patients hospitalized for an ACS were prescribed a high-dose statin. Hospitalization in a teaching hospital, percutaneous coronary intervention, cholesterol measurement during hospitalization and the male sex were related to prescription of statins at discharge. The intensity of lipid-lowering therapy in the post-discharge period increased in 17.3%, decreased in 11.7%, and did not change in 71.0% of the patients. The prescription of a lipid-lowering drug (LLD) at discharge (odds ratio 5.88 [95% confidence intervals 3.05-11.34]) and a consultation with a cardiologist (2.48 [1.51-4.08]) were related to the use of LLDs, while age (1.32 [1.10-1.59] per 10 years), loneliness (0.42 [0.19-0.94]), professional activity (1.56 [1.13-2.16]), and diabetes (1.66 [1.27-2.16]) were related to achieving an LDL cholesterol goal 6-18 months after discharge. In conclusion, health-system-related factors are associated with the LLD utilization, whereas mainly patient-related factors are related to the control of hypercholesterolemia following hospitalization for CAD.
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http://dx.doi.org/10.3390/jcm10163711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396933PMC
August 2021

Upregulation of 15 Antisense Long Non-Coding RNAs in Osteosarcoma.

Genes (Basel) 2021 Jul 26;12(8). Epub 2021 Jul 26.

Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia.

The human genome encodes thousands of natural antisense long noncoding RNAs (lncRNAs); they play the essential role in regulation of gene expression at multiple levels, including replication, transcription and translation. Dysregulation of antisense lncRNAs plays indispensable roles in numerous biological progress, such as tumour progression, metastasis and resistance to therapeutic agents. To date, there have been several studies analysing antisense lncRNAs expression profiles in cancer, but not enough to highlight the complexity of the disease. In this study, we investigated the expression patterns of antisense lncRNAs from osteosarcoma and healthy bone samples (24 tumour-16 bone samples) using RNA sequencing. We identified 15 antisense lncRNAs (, , , , , , , , , , , , , and ) that were upregulated in tumour samples compared to bone sample controls. Further, we performed real-time polymerase chain reaction (RT-qPCR) to validate the expressions of the antisense lncRNAs in 8 different osteosarcoma cell lines (SaOS-2, G-292, HOS, U2-OS, 143B, SJSA-1, MG-63, and MNNG/HOS) compared to hFOB (human osteoblast cell line). These differentially expressed IncRNAs can be considered biomarkers and potential therapeutic targets for osteosarcoma.
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http://dx.doi.org/10.3390/genes12081132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394133PMC
July 2021

Hierarchically Assembled Type I Collagen Fibres as Biomimetic Building Blocks of Biomedical Membranes.

Membranes (Basel) 2021 Aug 12;11(8). Epub 2021 Aug 12.

Clothworkers' Centre for Textile Materials Innovation for Healthcare, School of Design, University of Leeds, Leeds LS2 9JT, UK.

Wet spinning is an established fibre manufacturing route to realise collagen fibres with preserved triple helix architecture and cell acceptability for applications in biomedical membranes. However, resulting fibres still need to be chemically modified post-spinning to ensure material integrity in physiological media, with inherent risks of alteration of fibre morphology and with limited opportunities to induce fibrillogenesis following collagen fixation in the crosslinked state. To overcome this challenge, we hypothesised that a photoactive type I collagen precursor bearing either single or multiple monomers could be employed to accomplish hierarchically assembled fibres with improved processability, macroscopic properties and nanoscale organisation via sequential wet spinning and UV-curing. In-house-extracted type I rat tail collagen functionalised with both 4-vinylbenzyl chloride (4VBC) and methacrylate residues generated a full hydrogel network following solubilisation in a photoactive aqueous solution and UV exposure, whereby ~85 wt.% of material was retained following 75-day hydrolytic incubation. Wide-angle X-ray diffraction confirmed the presence of typical collagen patterns, whilst an averaged compression modulus and swelling ratio of more than 290 kPa and 1500 wt.% was recorded in the UV-cured hydrogel networks. Photoactive type I collagen precursors were subsequently wet spun into fibres, displaying the typical dichroic features of collagen and regular fibre morphology. Varying tensile modulus ( = 5 ± 1 - 11 ± 4 MPa) and swelling ratio ( = 1880 ± 200 - 3350 ± 500 wt.%) were measured following post-spinning UV curing and equilibration with phosphate-buffered saline (PBS). Most importantly, 72-h incubation of the wet spun fibres in PBS successfully induced renaturation of collagen-like fibrils, which were fixed following UV-induced network formation. The whole process proved to be well tolerated by cells, as indicated by a spread-like cell morphology following a 48-h culture of L929 mouse fibroblasts on the extracts of UV-cured fibres.
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http://dx.doi.org/10.3390/membranes11080620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400969PMC
August 2021

Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium.

J Urol 2021 Aug 26:101097JU0000000000002176. Epub 2021 Aug 26.

Department of Urology, Emory University School of Medicine, Atlanta, Georgia.

Purpose: To evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study.

Materials And Methods: We evaluated men with localized prostate cancer at eleven high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (N=549) and ORP (N=545). We measured longitudinal patient-reported health related quality of life (HRQOL) at pre-treatment, 2, 6, 12, and 24 months, and pathologic and peri-operative outcomes/complications.

Results: Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL, p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep vein thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain.

Conclusions: In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, DVTs, and bladder neck contractures.

Trial Registration: NCT01325506: Effectiveness of Open and Robotic Prostatectomy (PROSTQA- RP2).
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http://dx.doi.org/10.1097/JU.0000000000002176DOI Listing
August 2021

Is the grass always greener? Land surface phenology reveals differences in peak and season-long vegetation productivity responses to climate and management.

Ecol Evol 2021 Aug 22;11(16):11168-11199. Epub 2021 Jul 22.

U.S. Geological Survey Northern Rocky Mountain Science Center Bozeman Montana USA.

Vegetation phenology-the seasonal timing and duration of vegetative phases-is controlled by spatiotemporally variable contributions of climatic and environmental factors plus additional potential influence from human management. We used land surface phenology derived from the Advanced Very High Resolution Radiometer and climate data to examine variability in vegetation productivity and phenological dates from 1989 to 2014 in the U.S. Northwestern Plains, a region with notable spatial heterogeneity in climate, vegetation, and land use. We first analyzed interannual trends in six phenological measures as a baseline. We then demonstrated how including annual-resolution predictors can provide more nuanced insights into measures of phenology between plant communities and across the ecoregion. Across the study area, higher annual precipitation increased both peak and season-long productivity. In contrast, higher mean annual temperatures tended to increase peak productivity but for the majority of the study area decreased season-long productivity. Annual precipitation and temperature had strong explanatory power for productivity-related phenology measures but predicted date-based measures poorly. We found that relationships between climate and phenology varied across the region and among plant communities and that factors such as recovery from disturbance and anthropogenic management also contributed in certain regions. In sum, phenological measures did not respond ubiquitously nor covary in their responses. Nonclimatic dynamics can decouple phenology from climate; therefore, analyses including only interannual trends should not assume climate alone drives patterns. For example, models of areas exhibiting greening or browning should account for climate, anthropogenic influence, and natural disturbances. Investigating multiple aspects of phenology to describe growing-season dynamics provides a richer understanding of spatiotemporal patterns that can be used for predicting ecosystem responses to future climates and land-use change. Such understanding allows for clearer interpretation of results for conservation, wildlife, and land management.
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http://dx.doi.org/10.1002/ece3.7904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366863PMC
August 2021

Systematic review on the use of activated charcoal for gastrointestinal decontamination following acute oral overdose.

Clin Toxicol (Phila) 2021 Aug 23:1-32. Epub 2021 Aug 23.

Emergency Department CISSS Montérégie Centre, Greenfield Park, Canada.

Introduction: The use of activated charcoal in poisoning remains both a pillar of modern toxicology and a source of debate. Following the publication of the joint position statements on the use of single-dose and multiple-dose activated charcoal by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists, the routine use of activated charcoal declined. Over subsequent years, many new pharmaceuticals became available in modified or alternative-release formulations and additional data on gastric emptying time in poisoning was published, challenging previous assumptions about absorption kinetics. The American Academy of Clinical Toxicology, the European Association of Poison Centres and Clinical Toxicologists and the Asia Pacific Association of Medical Toxicology founded the Clinical Toxicology Recommendations Collaborative to create a framework for evidence-based recommendations for the management of poisoned patients. The activated charcoal workgroup of the Clinical Toxicology Recommendations Collaborative was tasked with reviewing systematically the evidence pertaining to the use of activated charcoal in poisoning in order to update the previous recommendations.

Objectives: The main objective was: Does oral activated charcoal given to adults or children prevent toxicity or improve clinical outcome and survival of poisoned patients compared to those who do not receive charcoal?  Secondary objectives were to evaluate pharmacokinetic outcomes, the role of cathartics, and adverse events to charcoal administration. This systematic review summarizes the available evidence on the efficacy of activated charcoal.

Methods: A medical librarian created a systematic search strategy for Medline (Ovid), subsequently translated for Embase ( Ovid), CINAHL ( EBSCO), BIOSIS Previews ( Ovid), Web of Science, Scopus, and the Cochrane Library/DARE. All databases were searched from inception to December 31, 2019. There were no language limitations.  One author screened all citations identified in the search based on predefined inclusion/exclusion criteria. Excluded citations were confirmed by an additional author and remaining articles were obtained in full text and evaluated by at least two authors for inclusion. All authors cross-referenced full-text articles to identify articles missed in the searches. Data from included articles were extracted by the authors on a standardized spreadsheet and two authors used the GRADE methodology to independently assess the quality and risk of bias of each included study.

Results: From 22,950 titles originally identified, the final data set consisted of 296 human studies, 118 animal studies, and 145 studies. Also included were 71 human and two animal studies that reported adverse events. The quality was judged to have a Low or Very Low GRADE in 469 (83%) of the studies. Ninety studies were judged to be of Moderate or High GRADE. The higher GRADE studies reported on the following drugs: paracetamol (acetaminophen), phenobarbital, carbamazepine, cardiac glycosides (digoxin and oleander), ethanol, iron, salicylates, theophylline, tricyclic antidepressants, and valproate. Data on newer pharmaceuticals not reviewed in the previous American Academy of Clinical Toxicology/European Association of Poison Centres and Clinical Toxicologists statements such as quetiapine, olanzapine, citalopram, and Factor Xa inhibitors were included. No studies on the optimal dosing for either single-dose or multiple-dose activated charcoal were found. In the reviewed clinical data, the time of administration of the first dose of charcoal was beyond one hour in 97% ( = 1006 individuals), beyond two hours in 36% ( = 491 individuals), and beyond 12 h in 4% ( = 43 individuals) whereas the timing of the first dose in controlled studies was within one hour of ingestion in 48% ( = 2359 individuals) and beyond two hours in 36% ( = 484) of individuals.

Conclusions: This systematic review found heterogenous data. The higher GRADE data was focused on a few select poisonings, while studies that addressed patients with unknown and or mixed ingestions were hampered by low rates of clinically meaningful toxicity or death.  Despite these limitations, they reported a benefit of activated charcoal beyond one hour in many clinical scenarios.
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http://dx.doi.org/10.1080/15563650.2021.1961144DOI Listing
August 2021

Granzyme A Produced by γδ T Cells Activates ER Stress Responses and ATP Production, and Protects Against Intracellular Mycobacterial Replication Independent of Enzymatic Activity.

Front Immunol 2021 3;12:712678. Epub 2021 Aug 3.

Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, United States.

(Mtb), the pathological agent that causes tuberculosis (TB) is the number one infectious killer worldwide with one fourth of the world's population currently infected. Data indicate that γδ T cells secrete Granzyme A (GzmA) in the extracellular space triggering the infected monocyte to inhibit growth of intracellular mycobacteria. Accordingly, deletion of from γδ T cells reverses their inhibitory capacity. Through mechanistic studies, GzmA's action was investigated in monocytes from human PBMCs. The use of recombinant human GzmA expressed in a mammalian system induced inhibition of intracellular mycobacteria to the same degree as previous human native protein findings. Our data indicate that: 1) GzmA is internalized within mycobacteria-infected cells, suggesting that GzmA uptake could prevent infection and 2) that the active site is not required to inhibit intracellular replication. Global proteomic analysis demonstrated that the ER stress response and ATP producing proteins were upregulated after GzmA treatment, and these proteins abundancies were confirmed by examining their expression in an independent set of patient samples. Our data suggest that immunotherapeutic host interventions of these pathways may contribute to better control of the current TB epidemic.
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http://dx.doi.org/10.3389/fimmu.2021.712678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368726PMC
August 2021

INTERASPIRE: an International Survey of Coronary Patients; Their Cardiometabolic, Renal and Biomarker Status; and the Quality of Preventive Care Delivered in All WHO Regions : In Partnership with the World Heart Federation, European Society of Cardiology, Asia Pacific Society of Cardiology, InterAmerican Society of Cardiology, and PanAfrican Society of Cardiology.

Curr Cardiol Rep 2021 08 19;23(10):136. Epub 2021 Aug 19.

Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland.

Purpose Of Review: To describe the INTERASPIRE scientific protocol-an international survey of secondary prevention of coronary heart disease (CHD).

Recent Findings: This international survey is being conducted through National Societies of Cardiology in selected countries from each of the six WHO regions and has the following overall aims: (i) describe prevalence of cardiometabolic and renal risk factors together with biomarkers in CHD patients; (ii) describe current risk factor management through lifestyle changes and cardioprotective drug therapies; (iii) provide an objective assessment of clinical implementation of preventive care by comparison with the lifestyle and risk factor targets defined in international and national guidelines; (iv) investigate the reasons for variation in preventive cardiology practice between regions and countries; and (v) promote the principles of best preventive cardiology practice. This international survey will provide a unique picture of CHD patients; their cardiometabolic, renal and biomarker status; lifestyle and therapeutic management; and the quality of preventive care provided in all WHO regions.
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http://dx.doi.org/10.1007/s11886-021-01568-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374115PMC
August 2021

Reduced-step composite polishing systems - a new gold standard?

J Dent 2021 Sep 5;112:103769. Epub 2021 Aug 5.

Division of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK. Electronic address:

Objectives: To compare the surface gloss and surface roughness of three contemporary composites when polished with reduced-step polishing systems or a conventional multiple-step technique.

Methods: Fifty Discs (8 mm ø x 2 mm) were each fabricated from three composites; Essentia (ES), BRILLIANT EverGlow (EG), and Filtek Universal, (FU). 5 different polishing systems were randomly assigned 10 specimens from each composite group. The 'gold standard' multiple-step system consisted of Sof-Lex XT discs followed by DiaPolisher diamond paste (GC) (P1). The two-step systems were Polishettes (P2) and DIATECH ShapeGuard (P3) and the one-step systems used were; Opti1Step (P4) and OneGloss (P5). Surface gloss was measured using a glossmeter and surface roughness was measured by a profilometer. Statistical analysis was conducted using one-way ANOVA and Pearson correlation tests. Samples were also imaged across different length scales using scanning electron microscopy and macro-lens photography.

Results: The highest gloss was obtained when P2 and P3 were used in all composite groups (p < 0.05). EG composite showed the lowest Sa (0.08 µm) when polished with P3 and highest gloss when polished with P2 (96.7 GU). Polishing with P5 resulted in highest Sa and lowest surface gloss in all composite groups (p < 0.05). A high correlation was found between Sa and gloss, r = 0.73 (p < 0.05). Both SEM and macro-lens photography supported quantitative data.

Conclusion: Both two-step composite polishing systems produced superior gloss compared to the traditional multiple-step polishing system. Mean surface roughness (Sa) and surface gloss are highly correlated with each other.

Clinical Significance: Some reduced step composite polishing systems tested in this study produced superior gloss outcomes compared to the traditional gold-standard multi-step polishing system. This may enable significant clinical chair-time reduction and faster polishing protocols.
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http://dx.doi.org/10.1016/j.jdent.2021.103769DOI Listing
September 2021

Potential for optimizing management of obesity in the secondary prevention of coronary heart disease.

Eur Heart J Qual Care Clin Outcomes 2021 Jul 27. Epub 2021 Jul 27.

Department of Medicine, Solna, Karolinska Institutet, FoU - Tema Hjärta och Kärl, S1:02, Karolinska Universitetssjukhuset/Solna, SE-171 76, Stockholm, Sweden.

Aims: Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile.

Methods And Results: Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month.

Conclusions: The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.
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http://dx.doi.org/10.1093/ehjqcco/qcab043DOI Listing
July 2021

Current research progress in targeted anti-angiogenesis therapy for osteosarcoma.

Cell Prolif 2021 Sep 26;54(9):e13102. Epub 2021 Jul 26.

Division of Regenerative Biology, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia.

Osteosarcoma (OS) is the most common primary malignant bone tumour with a peak in incidence during adolescence. Delayed patient presentation and diagnosis is common with approximately 15% of OS patients presenting with metastatic disease at initial diagnosis. With the introduction of neoadjuvant chemotherapy in the 1970s, disease prognosis improved from 17% to 60%-70% 5-year survival, but outcomes have not significantly improved since then. Novel and innovative therapeutic strategies are urgently needed as an adjunct to conventional treatment modalities to improve outcomes for OS patients. Angiogenesis is crucial for tumour growth, metastasis and invasion, and its prevention will ultimately inhibit tumour growth and metastasis. Dysregulation of angiogenesis in bone microenvironment involving osteoblasts and osteoclasts might contribute to OS development. This review summarizes existing knowledge regarding pre-clinical and developmental research of targeted anti-angiogenic therapy for OS with the aim of highlighting the limitations associated with this application. Targeted anti-angiogenic therapies include monoclonal antibody to VEGF (bevacizumab), tyrosine kinase inhibitors (Sorafenib, Apatinib, Pazopanib and Regorafenib) and human recombinant endostatin (Endostar). However, considering the safety and efficacy of these targeted anti-angiogenesis therapies in clinical trials cannot be guaranteed at this point, further research is needed to completely understand and characterize targeted anti-angiogenesis therapy in OS.
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http://dx.doi.org/10.1111/cpr.13102DOI Listing
September 2021

Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys.

Eur J Prev Cardiol 2021 Jul 19. Epub 2021 Jul 19.

National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.

Aims : Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective.

Methods And Results : In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour.

Conclusion : Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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http://dx.doi.org/10.1093/eurjpc/zwab115DOI Listing
July 2021

Deep learning to automate the labelling of head MRI datasets for computer vision applications.

Eur Radiol 2021 Jul 20. Epub 2021 Jul 20.

School of Biomedical Engineering & Imaging Sciences, Kings College London, Rayne Institute, 4th Floor, Lambeth Wing, London, SE1 7EH, UK.

Objectives: The purpose of this study was to build a deep learning model to derive labels from neuroradiology reports and assign these to the corresponding examinations, overcoming a bottleneck to computer vision model development.

Methods: Reference-standard labels were generated by a team of neuroradiologists for model training and evaluation. Three thousand examinations were labelled for the presence or absence of any abnormality by manually scrutinising the corresponding radiology reports ('reference-standard report labels'); a subset of these examinations (n = 250) were assigned 'reference-standard image labels' by interrogating the actual images. Separately, 2000 reports were labelled for the presence or absence of 7 specialised categories of abnormality (acute stroke, mass, atrophy, vascular abnormality, small vessel disease, white matter inflammation, encephalomalacia), with a subset of these examinations (n = 700) also assigned reference-standard image labels. A deep learning model was trained using labelled reports and validated in two ways: comparing predicted labels to (i) reference-standard report labels and (ii) reference-standard image labels. The area under the receiver operating characteristic curve (AUC-ROC) was used to quantify model performance. Accuracy, sensitivity, specificity, and F1 score were also calculated.

Results: Accurate classification (AUC-ROC > 0.95) was achieved for all categories when tested against reference-standard report labels. A drop in performance (ΔAUC-ROC > 0.02) was seen for three categories (atrophy, encephalomalacia, vascular) when tested against reference-standard image labels, highlighting discrepancies in the original reports. Once trained, the model assigned labels to 121,556 examinations in under 30 min.

Conclusions: Our model accurately classifies head MRI examinations, enabling automated dataset labelling for downstream computer vision applications.

Key Points: • Deep learning is poised to revolutionise image recognition tasks in radiology; however, a barrier to clinical adoption is the difficulty of obtaining large labelled datasets for model training. • We demonstrate a deep learning model which can derive labels from neuroradiology reports and assign these to the corresponding examinations at scale, facilitating the development of downstream computer vision models. • We rigorously tested our model by comparing labels predicted on the basis of neuroradiology reports with two sets of reference-standard labels: (1) labels derived by manually scrutinising each radiology report and (2) labels derived by interrogating the actual images.
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http://dx.doi.org/10.1007/s00330-021-08132-0DOI Listing
July 2021

Stent Frame Fracture and Late Atrial Migration of a Mitral SAPIEN 3 Transcatheter Valve.

JACC Cardiovasc Interv 2021 Jul 30;14(14):1610-1612. Epub 2021 Jun 30.

Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2021.05.031DOI Listing
July 2021

Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study).

Open Heart 2021 Jun;8(1)

National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland

Background: Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.

Methods: We studied outpatients who had an index CHD event in the preceding 6-24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.

Results: Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.

Conclusions: Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.
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http://dx.doi.org/10.1136/openhrt-2021-001659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237732PMC
June 2021

Gadolinium Concentrations in Biological Matrices From Patients Exposed to Gadolinium-Based Contrast Agents.

Invest Radiol 2021 Jul;56(7):458-464

Viapath Analytics, King's College Hospital NHS Foundation Trust.

Objectives: There is increasing evidence that Gd may be retained within the skin, bones, and solid organs in patients with normal renal function after exposure to Gd-based contrast agents (GBCAs). Here we present clinical data from 19 patients who requested referral to our clinical toxicology service for assessment of potential "Gd toxicity."

Materials And Methods: Patients had undergone a median of 2 (interquartile range [IQR], 1-5) exposures to GBCAs and were reviewed at a median of 5 months (IQR, 2-8 months) after the last GBCA exposure. Patients had a clinical assessment by a clinical toxicologist, and biological samples were taken in 17 patients (89.5%). Gd concentrations were measured in these samples using inductively coupled plasma mass spectrometry.

Results: All patients had significant comorbidities, and after an extensive clinical review, none of the reported symptoms were considered likely to be related to "Gd toxicity." Whole blood, plasma, and urine samples had detectable Gd concentrations in 69.2%, 78.6%, and 95.2% of samples, respectively. Median (IQR) concentrations of Gd were as follows: whole blood, 0.013 ng/mL (IQR, limit of detection [LOD]-0.884 ng/mL); plasma, 0.012 ng/mL (IQR, LOD-0.046 ng/mL); and spot urine, 0.304 μg/g creatinine (IQR, 0.070-3.702 μg/g creatinine). There were positive correlations between whole blood and plasma (P = 0.0024, r = 0.84), whole blood and urine (P = 0.0018, r = 0.82), and plasma and urine (P = 0.0001, r = 0.89) Gd concentrations. There was a negative correlation between Gd concentrations and the period after exposure for whole blood (P = 0.0028, r = -0.80), plasma (P = 0.0004, r = -0.86), and urine (P < 0.0001, r = -0.91).

Conclusions: We identified detectable Gd concentrations in biological matrices from all patients reporting exposure to GBCAs who were reviewed in our clinical toxicology outpatient clinic with concerns regarding potential "Gd toxicity"; however, there were no clinical features of toxicity present in this cohort. Further research is required to explore the pharmacokinetics and pharmacodynamics of GBCAs in patients with normal renal function and to determine the clinical significance of these detectable Gd concentrations.
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http://dx.doi.org/10.1097/RLI.0000000000000762DOI Listing
July 2021

GPCR-mediated YAP/TAZ inactivation in fibroblasts via EPAC1/2, RAP2C, and MAP4K7.

J Cell Physiol 2021 May 28. Epub 2021 May 28.

Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.

Yes-associated protein (YAP) and PDZ-binding motif (TAZ) have emerged as important regulators of pathologic fibroblast activation in fibrotic diseases. Agonism of Gαs-coupled G protein coupled receptors (GPCRs) provides an attractive approach to inhibit the nuclear localization and function of YAP and TAZ in fibroblasts that inhibits or reverses their pathological activation. Agonism of the dopamine D1 GPCR has proven effective in preclinical models of lung and liver fibrosis. However, the molecular mechanisms coupling GPCR agonism to YAP and TAZ inactivation in fibroblasts remain incompletely understood. Here, using human lung fibroblasts, we identify critical roles for the cAMP effectors EPAC1/2, the small GTPase RAP2c, and the serine/threonine kinase MAP4K7 as the essential elements in the downstream signaling cascade linking GPCR agonism to LATS1/2-mediated YAP and TAZ phosphorylation and nuclear exclusion in fibroblasts. We further show that this EPAC/RAP2c/MAP4K7 signaling cascade is essential to the effects of dopamine D1 receptor agonism on reducing fibroblast proliferation, contraction, and extracellular matrix production. Targeted modulation of this cascade in fibroblasts may prove a useful strategy to regulate YAP and TAZ signaling and fibroblast activities central to tissue repair and fibrosis.
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http://dx.doi.org/10.1002/jcp.30459DOI Listing
May 2021

TRAQ Changes: Improving the Measurement of Transition Readiness by the Transition Readiness Assessment Questionnaire.

J Pediatr Nurs 2021 Jul-Aug;59:188-195. Epub 2021 May 18.

Department of Pediatrics, East Tennessee State University, United States of America.

Objective: The purpose of the current study was improving the measurement precision of the Transition Readiness Assessment Questionnaire (TRAQ 5.0-20 item) in order to gain better decimation of transition readiness skills across the 5 Stages of Change-from Precontemplation to Mastery.

Methods: In stage 1, starting with the TRAQ 5.0 20-item, 5 domain subscale questionnaire, we eliminated the five lowest discriminating items using Item response theory (IRT) in MPlus v7.4,which eliminated the domain subscale Managing Daily Activities, and we e added 15 more difficult and better discriminating items. We added items to both to the remaining 4 domain subscales and created a new domain subscale entitled Future Planning. The revised 30-item TRAQ was piloted among 386 youth between 16 and 24 years old (mean = 20 years; 54% female; 87% White).

Results: After examining the model fit, discrimination and difficulty coefficients, and modification indices, we eliminated 10 items and the new Future Planning domain subscale we eliminated. The resulting questionnaire has 4 domain subscales and 20 items. It exhibited good to excellent fit to the data, χ(164) = 887.239, p < .001, CFI = 0.943, TLI = 0.93, RMSEA = 0.0942 (90% CI: 0.090, 0.114), WRMR = 1.111. All items have acceptable discrimination coefficients. Each of the 4 domain subscales have improved reliability as compared with the original TRAQ 5.0 20 item scale.

Conclusions: The revised 20-itemTRAQ 6.0 has 4 domains subscales; Managing medications, keeping appointment, tracking health issues, and Talking with providers and has good construct validity as demonstrated by model fit. By adding more difficult items to the 4 resulting domain subscales, we have demonstrated improved item discrimination and difficulty, and therefore can better measure acquisition of transition readiness skills across the five stages of change from pre-contemplation to contemplation to initiation to action and finally to mastery.
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http://dx.doi.org/10.1016/j.pedn.2021.04.019DOI Listing
July 2021

COVID-19 pandemic and coronary angiography for ST-elevation myocardial infarction, use of mechanical support and mechanical complications in Canada; a Canadian Association of Interventional Cardiology national survey.

CJC Open 2021 May 12. Epub 2021 May 12.

Division of cardiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON.

Background: As a result of the COVID-19 pandemic first wave, reductions in STEMI invasive care ranging from 23% to 76% have been reported from various countries. Whether it had any impact on coronary angiography (CA) volume or on mechanical support device use for ST-elevation myocardial infarction (STEMI) and post-STEMI mechanical complications in Canada is unknown.

Methods: We administered a Canada-wide survey to all Cardiac Catheterization Laboratory Directors seeking the volume of CA for STEMI performed during 01/03/2020-31/05/2020 (pandemic period) and from two control periods (01/03/2019-31/05/2019 and 01/03/2018-31/05/2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects or papillary muscle rupture cases diagnosed, were also recorded. We also assessed if the number of COVID-19 cases recorded in each province was associated with STEMI CA volume.

Results: Forty-one out of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (Incidence Rate Ratio or IRR 0.84; 95%CI 0.80-0.87) in CA for STEMI during the first wave of the pandemic compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95%CI 0.61-0.89) in the use of intra-aortic balloon pump in STEMI. Use of Impella® and mechanical complications from STEMI were exceedingly rare.

Conclusion: We observed a modest 16% decrease in CA for STEMI during the pandemic first wave in Canada, lower than reported in other countries. Provincial COVID-19 caseload did not influence this reduction.
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http://dx.doi.org/10.1016/j.cjco.2021.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114614PMC
May 2021

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries.

Front Psychiatry 2021 28;12:676224. Epub 2021 Apr 28.

Hospital del Mar, Institut de Neuropsiquiatria i Addiccions (INAD), Barcelona, Spain.

Non-medical use (NMU) of prescription GABA analogs (pregabalin and gabapentin) has been reported especially in opiate dependent persons. However, by now the prevalence of NMU of gabapentinoids in the general population has not been sufficiently evaluated. The aim of this research paper is to determine the prevalence of prescription GABA analog NMU and associated demographics in five European countries with special detail of Spain. The RADARS Survey of Non-Medical Use of Prescription Drugs Program (NMURx) is a harmonized series of contemporaneous cross-sectional surveys of adults conducted in multiple countries. NMURx collects data from the general population in each participating country about NMU of prescription drugs, illicit drugs, and associated demographics. NMU was defined as "using a medication without a doctor's prescription or for any reason other than what was recommended by their doctor." Responses from Spain (4Q2017, =10,062) were analyzed in detail. Comparative data were available from France, Germany, Italy, and UK. Responses were collected using non-probability quota sampling and post-stratification population weighting was applied to reflect the national distributions of adults, based on age, gender, and census region. Rates of NMU and associated demographics were reported as rate of past 90-day NMU per 100,000 adult population with 95% confidence intervals. Germany (1,197 per 100,000 adult population [95% CI: 1,004.3-1,379.1]) and United Kingdom (1,067 per 100,000 adult population [95% CI: 851.3-1,283.2]) presented the highest prevalence of gabapentinoids NMU. In Spain the prevalence of past 90 days GABA analog NMU was: 344.4, 95% (CI 204.8-484.0), with male predominance. Those who non-medically use GABA analogs had a higher prevalence of lifetime chronic pain, lifetime illicit drug use, and previous substance abuse treatment. In Spain, 20% of respondents who ever have used gabapentinoids, reported a lifetime NMU; the prevalence was higher for pregabalin 624 (6.2%) than for gabapentin 444 (4.4%). The main reasons for use were to self-treat pain and other medical conditions. The risk of NMU of gabapentinoids should not be neglected. Subjects with a history of chronic pain and lifetime substance use disorders had an increased risk of NMU of gabapentinoids.
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http://dx.doi.org/10.3389/fpsyt.2021.676224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113698PMC
April 2021

Journey-Deuce bicompartmental knee arthroplasty with the addition of computer navigation achieves good clinical outcomes and implant survival at 10 years.

Knee Surg Sports Traumatol Arthrosc 2021 May 11. Epub 2021 May 11.

School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, WA, 6009, Australia.

Purpose: To report 10-year outcomes and survivorship in patients undergoing bicompartmental knee arthroplasty (BCKA) using the Journey-Deuce prosthesis in a consecutive prospective case series.

Methods: Between November 2006 and November 2009, 41 patients with a mean age of 69.6 years (range 51-86) underwent 51 bicompartmental knee arthroplasties with the Journey-Deuce knee prosthesis. All patients presented with symptomatic medial and patellofemoral compartment osteoarthritis, with intact cruciate ligaments and a preserved lateral compartment on plain radiographs and Magnetic Resonance Imaging. Clinical assessment was undertaken pre-surgery and at 1, 2, 5 and 10 years post-surgery using the Oxford Knee Score (OKS), EuroQol Group 5-Dimension self-reported questionnaire (EQ-5D) and maximal active range of motion (ROM).

Results: 30 patients (37 knees) were followed-up at a mean time of 11.4 years (SD 1.1; range 10.5-14.0). Eight patients (ten knees) were deceased and three could not be contacted at final review. No major component revision was performed. Pre-operative OKS 25.4 (SD 5.2; range 15-40), knee flexion 116.4° (SD 10.3°; range 100°-140°) and EQ-5D 70.5 (SD 19.9; range 25-95). 10-year OKS 43.5 (SD 4.1; range 32-48), knee flexion 127.3° (SD 11.1°; range 105°-144°) and EQ-5D 77.4 (SD 9.3; range 60-100). The OKS (p < 0.0001), EQ-5D (p = 0.024) and active knee flexion ROM (p < 0.0001) all significantly improved from pre-surgery to 1-year post-surgery, with no further significant changes in these scores between any post-operative time period up until 10 years. 32% (7/22) of tibial and 45% (10/22) of femoral components showed progressive radiolucencies between 2 and 5-year and 10-year follow-up.

Conclusions: This is the largest cohort of patients having undergone BCKA (with the Journey-Deuce prosthesis) with longest follow-up described in the literature. At 10 years, patients presented with significantly improved clinical outcomes, comparable to other surgical arthroplasty options. No major component revision was performed. Progressive radiolucencies were noted in 32% of tibial and 45% of femoral components without corresponding clinical signs of loosening.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-021-06579-8DOI Listing
May 2021

Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries.

Eur J Prev Cardiol 2021 May;28(4):370-379

National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland.

Background: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice.

Methods: The method used was a cross-stional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication.

Results: A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%.

Conclusion: The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.
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http://dx.doi.org/10.1177/2047487320908698DOI Listing
May 2021

Balancing patient-centered care and evidence-based medicine in patients needing coronary revascularization.

J Thorac Cardiovasc Surg 2021 Apr 16. Epub 2021 Apr 16.

Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.116DOI Listing
April 2021

Evaluation of the Microba Community Profiler for Taxonomic Profiling of Metagenomic Datasets From the Human Gut Microbiome.

Front Microbiol 2021 20;12:643682. Epub 2021 Apr 20.

Microba Life Sciences Limited, Brisbane, QLD, Australia.

A fundamental goal of microbial ecology is to accurately determine the species composition in a given microbial ecosystem. In the context of the human microbiome, this is important for establishing links between microbial species and disease states. Here we benchmark the Microba Community Profiler (MCP) against other metagenomic classifiers using 140 moderate to complex microbial communities and a standardized reference genome database. MCP generated accurate relative abundance estimates and made substantially fewer false positive predictions than other classifiers while retaining a high recall rate. We further demonstrated that the accuracy of species classification was substantially increased using the Microba Genome Database, which is more comprehensive than reference datasets used by other classifiers and illustrates the importance of including genomes of uncultured taxa in reference databases. Consequently, MCP classifies appreciably more reads than other classifiers when using their recommended reference databases. These results establish MCP as best-in-class with the ability to produce comprehensive and accurate species profiles of human gastrointestinal samples.
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http://dx.doi.org/10.3389/fmicb.2021.643682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093879PMC
April 2021
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