Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

Purpose: There is no report on the reproducibility of the ultrasound-navigated MANTA deployment (US-MANTA) technique and little is known about predictors for US-MANTA-related vascular complication (VC). This study aimed to assess the incidence and predictors of access-site VC using the US-MANTA technique and report insights of MANTA-related VC from consecutive cases following large-bore arteriotomy. Materials and Methods: Consecutive patients who underwent transfemoral transcatheter aortic valve replacement with the US-MANTA technique from November 2018 to February 2020 were evaluated. MANTA-related VC was defined as access-site complications leading to major or minor VCs based on Valve Academic Research Consortium-2 criteria. Results: Among 378 patients, 23 cases (6.1%) of MANTA-related VC (major VC: n=7 [1.9%], minor VC: n=16 [4.2%]) were identified. No significant difference was observed in the incidence of MANTA-related VC over the observational period (first quartile: 5.3%, second: 5.4%, third: 7.4%, and fourth: 6.3%, p>.50). In 7 patients with MANTA-related major VC, 4 (57.1%) of complications resulted from incomplete apposition of the toggle due to anterior wall calcification of the common femoral artery (CFA). Anterior calcification of the CFA determined by computed tomography was identified as an independent predictor of MANTA-related VCs. Conclusions: The US-MANTA technique sustainably provides a low rate of access-site VCs following large-bore arteriotomy. Incomplete apposition of the toggle due to anterior calcification of the CFA may lead to ongoing vascular and bleeding complications.Peer reviewe

Analyzing Unsteady-state of NbTi-superconductor by Measuring Resistivity

Suprajohtimien tärkein kaupallinen sovelluskohde on magneettikuvauslaitteistojen suprajohdinmagneetit. Ylivoimaisesti suurin osa magneettien johtimista valmistetaan niobititaanista. Valmistusmäärien kasvaessa tuotantotehokkuus ja raaka-aineiden mahdollisimman täysi hyödyntäminen korostuvat. Valmistusprosessin tuottavuus ja saanto on oltava tuotteen laatua vaarantamatta parempi kuin kilpailijoilla. Kuumapursotus on eräs NbTi-suprajohtimen valmistusvaihe, jossa tuotteen molempiin päihin syntyvän epäkurantin osuuden, ns. muutosvyöhykkeen, taloudellinen ja tehokas poistaminen on kilpailukyvyn kannalta tärkeää. Liian suuret poistot huonontavat saantoa ja aiheuttavat näin ollen ylimääräisiä kustannuksia. Liian pienet poistot taas teettävät turhaa työtä ja aiheuttavat mahdollisia laatuongelmia. Muutosvyöhykkeen poistot on määritelty gravimetrisesti tehtävillä testeillä, jotka ovat vieneet paljon aikaa ja resursseja sekä ovat välillä aiheuttaneet liian suuria yksittäisiä poistoja. Tässä työssä suunniteltiin ja toteutettiin suprajohtimen muutosvyöhykkeen analysointiin ja poistoon laitteisto, joka toimii langan resistiivisyyttä mittaamalla. Kyseisellä menetelmällä on mahdollista tutkia ainetta rikkomatta muutosvyöhykkeen tilaa reaaliajassa. Laitteistoon toteutettiin myös mittausohjelmisto käyttämällä LabVIEW-ohjelmointiympäristöä. Mittausohjelmistosta pyrittiin tekemään mahdollisimman helppokäyttöinen ja vähällä perehdytyksellä omaksuttava. Laitteisto otettiin nopeasti tuotantokäyttöön ja aiemmin keskeneräisille tuotteille tehdyistä gravimetrisista mittauksista on luovuttu kokonaan. Järjestelmän tarkkuus on osoitettu olevan lähes gravimetrisen mittauksen tasoa, mutta reaaliaikainen muutosvyöhykkeen tarkkailu tekee siitä saannon kannalta ylivoimaisen verrattuna aikaisempaan käytäntöön. /Kir1

TAVI vai avosydänleikkaus aorttastenoosipotilaalle?

Teema : aortt

A longitudinal follow-up study of a type 2 diabetes “lost to follow-up” cohort–positive effect on glycaemic control after changes in medication

The aim of this study was to evaluate whether patients with type 2 diabetes (T2D) who had stopped attending their diabetes treatment system (referred to as “lost to follow-up”, LTF) but who succeeded in improving their glycaemic control after returning to the diabetes treatment system had changes in their diabetes medication when compared with similar patients who did not show improvement. “LTFs” who had baseline haemoglobin A1 c (HbA1 c) ≥53 mmol/mol and succeeded in reducing HbA1 c ≥ 6 mmol/mol during a 12–30 month follow-up period after adhering again to their diabetes treatment system were compared with “LTFs” who had an unsatisfactory change in HbA1 c or with “LTFs” who maintained good glycaemic control throughout the 12–30 month follow-up period. Unsatisfactory change in HbA1 c was determined as HbA1 c ≥ 53 mmol/mol and change <6 mmol/mol after the 12–30 month follow-up period in their diabetes treatment system or HbA1 c < 53 mmol/mol when returning to the diabetes treatment system but ≥53 mmol/mol at the end of the 12–30 month follow-up period. “LTFs” with improvement in glycaemic control used a higher number of different anti-hyperglycaemic agents (P < 0.001) and their dosages of metformin increased (P < 0.05) when compared with “LTFs” without improvement or “LTFs” with satisfactory glycaemic control. Cholesterol-, LDL-cholesterol- and triglyceride-concentrations decreased during the 12–30 month follow-up period (P < 0.05) in “LTFs” with improved glycaemic control, but not in the other groups. “LTFs” with T2D who had poor glycaemic control seemed to require an increase in their anti-diabetic medication when attempting to improve their glycaemic control. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Peer reviewe

CMR derived left ventricular septal convexity in carriers of the hypertrophic cardiomyopathy-causing MYBPC3-Q1061X mutation

This manuscript has not been published before and is not currently being considered for publication elsewhere. Increased septal convexity of left ventricle has been described in subjects with hypertrophic cardiomyopathy (HCM)-causing mutations without left ventricular hypertrophy (LVH). Our objective was to study septal convexity by cardiac magnetic resonance (CMR) in subjects with the Finnish founder mutation Q1016X in the myosin-binding protein C gene (MYBPC3). Septal convexity was measured in end-diastolic 4-chamber CMR image in 67 study subjects (47 subjects with the MYBPC3-Q1061X mutation and 20 healthy relatives without the mutation). Septal convexity was significantly increased in subjects with the MYBPC3-Q1061X mutation and LVH (n = 32) compared to controls (11.4 +/- 4.3 vs 2.7 +/- 3.2 mm, P <0.001). In mutation carriers without LVH, there was a trend for increased septal convexity compared to controls (4.9 +/- 2.5 vs 2.7 +/- 3.2 mm, P = 0.074). When indexed for BSA, septal convexity in mutation carriers without LVH was 2.8 +/- 1.4 mm/m(2) and 1.5 +/- 1.6 mm/m(2) in controls (P = 0.036). In all mutation carriers, septal convexity correlated significantly with body surface area, age, maximal LV wall thickness, LV mass, and late gadolinium enhancement. Subjects with the MYBPC3-Q10961X mutation have increased septal convexity irrespective of the presence of LVH. Septal convexity appears to reflect septal remodeling, and could be useful in recognizing LVH negative mutation carriers.Peer reviewe

Impact of sunshine on the risk of gestational diabetes mellitus in primiparous women

ABSTRACTThere is a lack of data about the influence of sunshine hours on the prevalence for gestational diabetes mellitus (GDM). The aim of this study was to evaluate whether the prevalence of GDM varied according to hours of daily sunshine during the first trimester. The study cohort (N = 6189) consists of all primiparous women with a Finnish background who delivered between 2009 and 2015 living in Vantaa city, Finland. Data on births and maternal characteristics were obtained from National Health Registers. Data on sunshine hours were obtained from the Finnish Meteorological Institute. Individual daily sunshine hours during the first trimester of pregnancy were calculated for each woman. Diagnosis of GDM was based on a standard 75-g 2-h glucose tolerance test (OGTT). No relationship was observed between month of conception and GDM. Daily sunshine hours during the first trimester and GDM showed a U-shaped association (adjusted p-value 0.019). In OGTT, a U-shaped association was observed between 0-h glucose value and daily sunshine hours during the first trimester (p = 0.039) as well as with the 1-h glucose value (p = 0.012), respectively. In primiparous women daily sunshine hours during the first trimester showed a U-shaped association with the prevalence of GDM independent of pre-pregnancy risk factors.Abbreviations: BMI: body mass index; GDM: gestational diabetes mellitus; OGTT: standard 75 g 2-h glucose tolerance test; SD: standard deviationPeer reviewe

Impact of gestational diabetes mellitus on the duration of breastfeeding in primiparous women : an observational cohort study

Background The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes and offspring risk for overweight or obesity later in life. The aim of our study was to evaluate in primiparous women whether GDM had an influence on the duration of breastfeeding, and further, to evaluate the factors that influenced on the duration of breastfeeding. Methods The study cohort (N = 1089) consisted of all primiparous women with a Finnish background excluding women with pre-existing diabetes mellitus who lived in the city of Vantaa, Finland, gave birth to a singleton living child between 2009 and 2015, and with valid data on breastfeeding available. The diagnosis of GDM was based on a standard 75 g 2-h oral glucose tolerance test. Data were obtained from Finnish national registers and from the medical records of the city of Vantaa. Results No differences were observed in the duration of breastfeeding between women diagnosed with GDM and without GDM, 7.5 (Standard Deviation [SD] 3.7) months versus 7.9 (SD 3.5) months (p = 0.17). Women diagnosed with GDM breastfed boys for a longer duration than girls (maternal age, pre-pregnancy body mass index, marital status, educational attainment, duration of pregnancy, and smoking habits adjusted p = 0.042). Women who breastfed <6 months were younger, were more likely smokers, had shorter education, and higher pre-pregnancy body mass index than women who breastfed over 6 months (p <0.001 for linearity). Conclusions In primiparous women GDM did not influence breastfeeding duration. The positive health effects of breastfeeding should be emphasized especially in young, overweight and less educated women in order to minimize the risk of obesity and type 2 diabetes for themselves and their offspring.Peer reviewe

Drug purchases prior to conception and the risk of gestational diabetes mellitus

Publisher Copyright: © The Author(s) 2022.Objective: Some drugs have adverse effects on glucose metabolism, but it is unknown whether prescription drugs used prior to conception influence the future risk of gestational diabetes mellitus (GDM). Our study evaluated whether the purchase of prescription drugs 6 months prior to conception was associated with the occurrence of GDM. Methods: This cohort study enrolled women with a Finnish background who delivered between 2009 and 2015 in the city of Vantaa, Finland (N = 10,455). Data on maternal characteristics and prescription drug purchases were obtained from national health registers. The use of a unique personal identification number enabled us to combine the register data on an individual level. Results: Six months prior to conception, women who had pregnancies complicated by GDM purchased more prescription drugs than women without GDM (1.38 ± 2.04 vs. 1.11 ± 1.80). The GDM risk was higher in women with higher numbers of prescription purchases and those with more than three deliveries. Conclusions: Multiparous women who purchase several prescription drugs should be given personalized counseling to prevent GDM.Peer reviewe