QT peak prolongation predicts cardiac death following stroke

Cardiac death has been linked in many populations to prolongation of the QT interval (QTe). However, basic science research suggested that the best estimate of the time point when repolarisation begins is near the T-wave peak. We found QT peak (QTp) was longer in hypertensive subjects with LVH. A prolonged “depolarisation” phase, rather than “repolarisation” (T peak to T end) might therefore account for the higher incidence of cardiac death linked to long QT. Hypothesis: We have tested the hypothesis that QT peak (QTp) prolongation predicts cardiac death in stroke survivors. Methods and Results: ECGs were recorded from 296 stroke survivors (152 male), mean age 67.2 (SD 11.6) approximately 1 year after the event. Their mean blood pressure was 152/88 mmHg (SD 29/15mmHg). These ECGs were digitised by one observer who was blinded to patient outcome. The patients were followed up for a median of 3.3 years. The primary endpoint was cardiac death. A prolonged heart rate corrected QT peak (QTpc) of lead I carried the highest relative risk of death from all cause as well as cardiac death, when compared with the other more conventional QT indices. In multivariate analyses, when adjusted for conventional risk factors of atherosclerosis, a prolonged QTpc of lead I was still associated with a 3-fold increased risk of cardiac death. (adjusted relative risk 3.0 [95% CI 1.1 - 8.5], p=0.037). Conclusion: QT peak prolongation in lead I predicts cardiac death after strok

How tidal processes impact the transfer of sediment from source to sink : Mekong River collaborative studies

Author Posting. © Oceanography Society, 2017. This article is posted here by permission of Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 30, no. 3 (2017): 22–33, doi:10.5670/oceanog.2017.311.Significant sediment transformation and trapping occur along the tidal and estuarine reaches of large rivers, complicating sediment source signals transmitted to the coastal ocean. The collaborative Mekong Tropical Delta Study explored the tidally influenced portion of the Mekong River to investigate processes that impact mud- and sand-sized sediment transport and deposition associated with varying fluvial and marine influences. Researchers participating in this 2014–2015 project found that as sand and mud progress down the tidal portion of the river, sands in suspension can settle during reduced or slack flows as river discharge becomes progressively more affected by tides in the seaward direction. Consequently, deposits on the tidal river bed are connected to sand transport in the channel. In contrast, fine mud particles remain in suspension until they reach an interface zone where waters are still fresh, but the downstream saline estuary nonetheless impacts the flows. In this interface zone, as within the estuary, fine particles tend to settle, draping the sand beds with mud and limiting the connection between the bed and suspended sand. In the Mekong system, the interface and estuarine zones migrate along the distributary channels seasonally, resulting in variable trapping dynamics and channel bed texture. Therefore, the signature of fluvial-sediment discharge is altered on its path to the coastal ocean, and the disconnected mud and sand supply functions at the river mouth should result in distinct offshore depositional signatures.This research was funded by the US Office of Naval Research (grant numbers: N00014-15-1-2011, N00014- 13-1-0127, N00014-13-1-0781, N00014-14-1-0145)

Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Sediment dynamics in the lower Mekong River : transition from tidal river to estuary

Author Posting. © American Geophysical Union, 2015. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Oceans 120 (2015): 6363–6383, doi:10.1002/2015JC010754.A better understanding of flow and sediment dynamics in the lowermost portions of large-tropical rivers is essential to constraining estimates of worldwide sediment delivery to the ocean. Flow velocity, salinity, and suspended-sediment concentration were measured for 25 h at three cross sections in the tidal Song Hau distributary of the Mekong River, Vietnam. Two campaigns took place during comparatively high-seasonal and low-seasonal discharge, and estuarine conditions varied dramatically between them. The system transitioned from a tidal river with ephemeral presence of a salt wedge during high flow to a partially mixed estuary during low flow. The changing freshwater input, sediment sources, and estuarine characteristics resulted in seaward sediment export during high flow and landward import during low flow. The Dinh An channel of the Song Hau distributary exported sediment to the coast at a rate of about 1 t s−1 during high flow and imported sediment in a spatially varying manner at approximately 0.3 t s−1 during low flow. Scaling these values results in a yearly Mekong sediment discharge estimate about 65% smaller than a generally accepted estimate of 110 Mt yr−1, although the limited temporal and spatial nature of this study implies a relatively high degree of uncertainty for the new estimate. Fluvial advection of sediment was primarily responsible for the high-flow sediment export. Exchange-flow and tidal processes, including local resuspension, were principally responsible for the low-flow import. The resulting bed-sediment grain size was coarser and more variable during high flow and finer during low, and the residual flow patterns support the maintenance of mid-channel islands.Office of Naval Research Grant Numbers: N00014-12-1-0181 , N00014-13-1-0127 , N00014-13-1-0781, and National Defense Science and Engineering2016-03-2

Tailored second line therapy in asthmatic children with the arginine-16 genotype

The arginine-16 beta-2 receptor genotype confers increased susceptibility to exacerbations in asthmatic children taking regular long acting beta-2 agonists. We therefore evaluated using montelukast as an alternative to salmeterol as tailored second line asthma controller therapy in children expressing this susceptible genotype. 62 persistent asthmatic children with the homozygous arginine-16 genotype were randomized to receive salmeterol 50ug bid or montelukast 5/10mg od as add on to inhaled fluticasone for 1 year. School absences (the primary outcome) were reduced with montelukast arm compared to salmeterol: difference in score = 0.40 (95%CI 0.07-0.87) p=0.005. Albuterol use was also reduced with montelukast compared with salmeterol: difference in score = 0.47 (95%CI 0.16-0.79) p<0.0001. Greater improvements occurred in both symptom and quality of life scores with montelukast vs salmeterol, while there was no difference in FEV1. Montelukast may be suitable as tailored second line controller therapy instead of salmeterol in asthmatic children expressing the susceptible arginine-16 genotype - moving towards a personalised medicine approach to management

Chemotherapy-Response Monitoring of Breast Cancer Patients Using Quantitative Ultrasound-Based Intra-Tumour Heterogeneities

© 2017 The Author(s). Anti-cancer therapies including chemotherapy aim to induce tumour cell death. Cell death introduces alterations in cell morphology and tissue micro-structures that cause measurable changes in tissue echogenicity. This study investigated the effectiveness of quantitative ultrasound (QUS) parametric imaging to characterize intra-tumour heterogeneity and monitor the pathological response of breast cancer to chemotherapy in a large cohort of patients (n = 100). Results demonstrated that QUS imaging can non-invasively monitor pathological response and outcome of breast cancer patients to chemotherapy early following treatment initiation. Specifically, QUS biomarkers quantifying spatial heterogeneities in size, concentration and spacing of acoustic scatterers could predict treatment responses of patients with cross-validated accuracies of 82 ± 0.7%, 86 ± 0.7% and 85 ± 0.9% and areas under the receiver operating characteristic (ROC) curve of 0.75 ± 0.1, 0.80 ± 0.1 and 0.89 ± 0.1 at 1, 4 and 8 weeks after the start of treatment, respectively. The patients classified as responders and non-responders using QUS biomarkers demonstrated significantly different survivals, in good agreement with clinical and pathological endpoints. The results form a basis for using early predictive information on survival-linked patient response to facilitate adapting standard anti-cancer treatments on an individual patient basis

Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial

Date of acceptance: 01/07/2015 © 2015 Witham et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements UK NIHR HTA grant 10/71/01. We acknowledge the financial support of NHS Research Scotland in conducting this trial.Peer reviewedPublisher PD