Use of Hand-Held Optical Coherence Tomography during Retinopathy of Prematurity (ROP) Screening demonstrates an increased Outer Retina from early Postmenstrual Age in Preterm Infants with ROP.

PurposeTo identify structural markers of active retinopathy of prematurity (ROP) in foveal and parafoveal retinal layers using hand-held optical coherence tomography (HH-OCT).MethodsWe acquired HH-OCT images (n=278) from a prospective mixed cross-sectional longitudinal observational study of 87 participants (23-36 weeks gestational age (GA); n=30 with ROP, n=57 without ROP) between 31 to 44 weeks postmenstrual age (PMA) excluding treated ROP and features of cystoid macular edema (CME). Six retinal layer thicknesses from the fovea to the parafovea were analysed at five locations up to 1000 µm temporally and nasally.ResultsThe mean outer retinal thickness (OUTRETL) during active ROP increased at the fovea and parafovea from PMA 33 to 39 weeks ( p ConclusionsIncreased foveal and parafoveal outer retina measured using HH-OCT shows potential as a marker for ROP screening

Use of Hand-Held Optical Coherence Tomography during Retinopathy of Prematurity (ROP) Screening demonstrates an increased Outer Retina from early Postmenstrual Age in Preterm Infants with ROP.

PurposeTo identify structural markers of active retinopathy of prematurity (ROP) in foveal and parafoveal retinal layers using hand-held optical coherence tomography (HH-OCT).MethodsWe acquired HH-OCT images (n=278) from a prospective mixed cross-sectional longitudinal observational study of 87 participants (23-36 weeks gestational age (GA); n=30 with ROP, n=57 without ROP) between 31 to 44 weeks postmenstrual age (PMA) excluding treated ROP and features of cystoid macular edema (CME). Six retinal layer thicknesses from the fovea to the parafovea were analysed at five locations up to 1000 µm temporally and nasally.ResultsThe mean outer retinal thickness (OUTRETL) during active ROP increased at the fovea and parafovea from PMA 33 to 39 weeks ( p ConclusionsIncreased foveal and parafoveal outer retina measured using HH-OCT shows potential as a marker for ROP screening

Sex-related trends in mortality after elective abdominal aortic aneurysm surgery between 2002 and 2013 at National Health Service hospitals in England: less benefit for women compared with men

Aims: To quantify the difference in long-term survival and cardiovascular morbidity between women and men undergoing elective abdominal aortic aneurysm (AAA) repair at National Health Service hospitals in England. Methods and results: Patients having elective repair of AAA were reviewed using the Hospital Episode Statistics and Office for National Statistics (ONS) datasets. The primary outcome measure was 30-day mortality and the secondary outcomes were 1-year, 5-year, and aortic-related mortality and post-operative complication rates. We used logistic regression and survival models to assess risk factors on the primary and secondary outcomes. Between 1 April 2002 and 31 March 2013, a total of 31 090 patients (4795 women and 26 295 men) underwent open AAA repair. Between 1 January 2006 and 31 March 2013, a total of 16 777 patients (2036 women and 14 741 men) underwent endovascular aneurysm repair (EVAR). All-cause and aortic-related mortalities at 30 days, 1 year, and 5 years were all higher in women, despite a lower prevalence of pre-operative cardiovascular risk factors. Female sex was a significant independent risk factor for 30-day mortality in both open repair [odds ratio (OR) 1.39; 95% confidence interval (CI) 1.25–1.56; P < 0.001] and EVAR (OR 1.57; 95% CI 1.23–2.00; P < 0.001) groups. Based on an all-cause long-term survival model, conditional on 30-day survival, the estimated hazard for women in the open repair group was significantly (P = 0.006) higher than men, but the sex difference was not significant in the EVAR group (P = 0.356). In the open repair group, women had significantly (P < 0.001) higher cumulative incidence probabilities for both aortic-related mortality and other-cause mortality. In the EVAR group, women had significantly (P < 0.001) higher mean cumulative incidence probabilities for the aortic-related mortality compared with men, but not for the other-cause mortality (P = 0.235). Conclusion: Women undergoing elective AAA repair at National Health Service hospitals in England had increased short- and long-term mortality and post-operative morbidity compared with men. These findings can be used to improve pre-operative counselling for women undergoing AAA repair, and highlight the need for female-specific pre-, peri-, and post-operative management strategies

Additional file 2: of Adult height and risk of 50 diseases: a combined epidemiological and genetic analysis

Table S2. Association of genetically determined height and disease risk factors. Table S3. Association of genetically determined height and risks of diseases excluding SNPs with potential pleiotropic effects. Table S4. Sensitivity analysis for impact of self-reported cases. Table S5. Sensitivity analysis for impact of including prevalent in the case definition for epidemiological analysis. (DOCX 58 kb

Additional file 1: of Adult height and risk of 50 diseases: a combined epidemiological and genetic analysis

Table S1. Case definition and data coverage. Table S6. Pathways identified by height-associated variants. (XLSX 45 kb

Association of smoking and cardiometabolic parameters with albuminuria in people with type 2 diabetes mellitus: a systematic review and meta-analysis.

AIMS: Smoking is a strong risk factor for albuminuria in people with type 2 diabetes mellitus (T2DM). However, it is unclear whether this sequela of smoking is brought about by its action on cardiometabolic parameters or the relationship is independent. The aim of this systematic review is to explore this relationship. METHODS: Electronic databases on cross-sectional and prospective studies in Medline and Embase were searched from January 1946 to May 2018. Adult smokers with T2DM were included, and other types of diabetes were excluded. RESULTS: A random effects meta-analysis of 20,056 participants from 13 studies found that the odds ratio (OR) of smokers developing albuminuria compared to non-smokers was 2.13 (95% CI 1.32, 3.45). Apart from smoking, the odds ratio of other risk factors associated with albuminuria were: age 1.24 (95% CI 0.84, 1.64), male sex 1.39 (95% CI 1.16, 1.67), duration of diabetes 1.78 (95% CI 1.32, 2.23), HbA1c 0.63 (95% CI 0.45, 0.81), SBP 6.03 (95% CI 4.10, 7.97), DBP 1.85 (95% CI 1.08, 2.62), total cholesterol 0.06 (95% CI - 0.05, 0.17) and HDL cholesterol - 0.01 (95% CI - 0.04, 0.02), triglyceride 0.22 (95% CI 0.12, 0.33) and BMI 0.40 (95% CI 0.00-0.80). When the smoking status was adjusted in a mixed effect meta-regression model, the duration of diabetes was the only statistically significant factor that influenced the prevalence of albuminuria. In smokers, each year's increase in the duration of T2DM was associated with an increased risk of albuminuria of 0.19 units (95% CI 0.07, 0.31) on the log odds scale or increased the odds approximately by 23%, compared to non-smokers. Prediction from the meta-regression model also suggested that the odds ratios of albuminuria in smokers after a diabetes duration of 9 years and 16 years were 1.53 (95% CI 1.10, 2.13) and 5.94 (95% CI 2.53, 13.95), respectively. CONCLUSIONS: Continuing to smoke and the duration of diabetes are two strong predictors of albuminuria in smokers with T2DM. With a global surge in younger smokers developing T2DM, smoking cessation interventions at an early stage of disease trajectory should be promoted

The effect of head positioning on cerebral hemodynamics: Experiences in mild ischemic stroke.

BACKGROUND AND PURPOSE: It is generally agreed that optimal head positioning is an important consideration in acute stroke management regime. However, there is limited literature investigating the effect of head positioning changes on cerebrovascular physiology in acute ischemic stroke (AIS). We aim to assess cerebral autoregulation (CA) and associated hemodynamic responses during gradual head positioning (GHP) changes, between AIS and controls. METHODS: Cerebral blood flow velocity (CBFV, transcranial Doppler), blood pressure (BP, Finometer) and end-tidal CO2 (capnography) were recorded between lying flat (0°) and sitting up (30°) head position, in 16 controls (8 women, mean age 57 ± 16 yrs) and 15 AIS patients (7 women, 69 ± 8 yrs). AIS patients carried out three visits at 13.3 ± 6.9 h, 4.8 ± 3.2 days and 93.9 ± 11.5 days from symptom onset, respectively. RESULTS: AIS patients were significantly hypertensive (p = 0.005), hypocapnic (p < 0.001), and had lower CBFV (p = 0.02) compared to controls, in both head positions. When comparing 5-min FLAT to SIT head position, reductions in BP (both AIS and controls, p < 0.001) and CBFV (controls only: dominant hemisphere p = 0.001 and non-dominant hemisphere p = 0.05) were demonstrated. Of note, a reduction in autoregulation index was observed in AIS, after 5-min SIT head positioning, at all 3 visits (p = 0.018). CONCLUSION: Key hemodynamic changes were demonstrated when the head position changes from 5-min FLAT to SIT head position (GHP) in mildly affected stroke patients. Importantly, these were associated with non-significant changes in CBFV but reduced measures of CA following AIS, which may be relevant in determining the optimal head position and the ideal timing of mobilisation. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique Identifier: NCT02932540

Directional sensitivity of dynamic cerebral autoregulation in squat-stand maneuvers

Dynamic cerebral autoregulation (CA), the transient response of cerebral blood flow (CBF) to rapid changes in arterial blood pressure (BP), is usually modelled as a linear mechanism. We tested the hypothesis that dynamic CA can display non-linear behavior resulting from differential efficiency dependent on the direction of BP changes. CBF velocity (CBV, transcranial Doppler), heart rate (HR, 3-lead ECG), continuous BP (Finometer) and end-tidal CO2 (capnograph) were measured in 10 healthy young subjects during 15 squat-stand maneuvers (SSM) with a frequency of 0.05 Hz. The protocol was repeated with a median [IQR] of 44 [35-64] days apart. Dynamic CA was assessed with the autoregulation index (ARI), obtained from CBV step responses estimated with an autoregressive moving-average model. Mean BP, HR, and CBV were different (all p<0.001) between squat and stand, regardless of visits. ARI showed a strong interaction (p<0.001) of SSM with the progression of transients; in general, the mean ARI was higher for the squat phase compared to standing. The changes in ARI were partially explained by concomitant changes in CBV (p=0.023) and pulse pressure (p<0.001), but there was no evidence that ARI differed between visits (p=0.277). These results demonstrate that dynamic CA is dependent on the direction of BP change, but further work is needed to confirm if this finding can be generalised to other physiological conditions, and also to assess its dependency on age, sex and pathology

Longitudinal study to assess changes in arterial stiffness and cardiac output parameters among low-risk pregnant women.

AIM: A single-centre, prospective longitudinal study to assess changes in maternal arterial stiffness and cardiac output parameters among low-risk healthy pregnant women. METHODOLOGY: Thirty low-risk, healthy, pregnant women attending their routine antenatal dating ultrasound scan were recruited. Non-invasive assessment of arterial stiffness and cardiac output was undertaken at five gestational windows from 11 to 40 weeks of pregnancy. Data were analysed using a linear mixed model incorporating time and other relevant predictors as fixed effects, and patient as a random effect. RESULTS: Gestational age had a significant effect on all arterial stiffness parameters, including brachial augmentation index (AIx) (p = .001), aortic AIx (p = .002) and aortic pulse wave velocity (p = .002). The aortic AIx (%) reduced during pregnancy: the lowest mean (standard error, SE) was 4.07 (1.01) at 28 weeks before it increased to 7.04 (SE 1.64) at 40 weeks. Similarly, non-invasive assessments of cardiac output (p < .001), stroke volume (p = .014), heart rate (p < .001) and total peripheral resistance (p < .001) demonstrated significant changes with gestational age. Mean cardiac output (l/m) increased during pregnancy reaching a peak at 28 weeks gestation 6.66 (SE 0.28), but dropped thereafter to reach 5.71 (SE 0.25) around term. CONCLUSION: The current study provides pregnancy normograms for gestational changes in arterial stiffness and cardiac output parameters among low-risk, healthy pregnant women. Further work will be required to assess the risk of placental mediated diseases and pregnancy outcome among pregnant women with parameters outside the normal range