Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Objective Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design Nationwide register-based study. Methods We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n  = 800) in 2004 to 3.57% (n  = 1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n  = 20) in 2004 to 0.10% (n  = 56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio: 1.05, 95% CI: 1.05–1.05). Conclusion During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted.publishedVersio

Content of Trace Metals in Medicinal Plants and their Extracts

The heavy metals (Fe, Cu, Zn and Mn) contents of selected plant species, grown in Southeast region of Serbia, that are traditionally used in alternative medicine were determined. Among the considered metals, iron content was the highest one and varied from 137.53 up to 423.32 mg/kg, while the contents of Cu, Zn and Mn were remarkably lower, and ranged from 8.91 to 62.20 mg/kg. In addition, an analysis of plants extracts showed a significant transfer of heavy metals during extraction procedure; therefore, the corresponding extraction coefficients reached values up to 88.8%. Those were especially high in the ethanol based extracts. Moreover, it is was established that such coefficients mostly depend on the solvent nature and also on the treated plant species. The obtained results impose that medicinal plants from Southeast region of Serbia due to rather low content of heavy metals are appropriate for preparation of teas and medicinal extracts

Fractal Nature Bridge between Neural Networks and Graph Theory Approach within Material Structure Characterization

Many recently published research papers examine the representation of nanostructures and biomimetic materials, especially using mathematical methods. For this purpose, it is important that the mathematical method is simple and powerful. Theory of fractals, artificial neural networks and graph theory are most commonly used in such papers. These methods are useful tools for applying mathematics in nanostructures, especially given the diversity of the methods, as well as their compatibility and complementarity. The purpose of this paper is to provide an overview of existing results in the field of electrochemical and magnetic nanostructures parameter modeling by applying the three methods that are "easy to use": theory of fractals, artificial neural networks and graph theory. We also give some new conclusions about applicability, advantages and disadvantages in various different circumstances

Fractal Nature Complex Correction an Inductivity

The microstructures properties predicting are based on their materials characteristics. In ceramic materials, regarding higher miniaturization and integrations, the structure analysis is very important. The main contribution of this research is related to relation between perovscites ceramics electronic properties, especially BaTiO3 and NZT-ceramics and structural characteristics. We applied advanced analysis, based on fractal nature and introduced complex fractal correction in defining the very important electromagnetic parameter inductivity (L). The samples consolidation includes both, powder pressing (cold sintering) and hot sintering. The fractal characterization performs very important role from powders up to the final structures, through which exists structure influence on electro-physical and other ceramic properties. We report the experimental results of BaTiO3 and NZT-ceramics processing. Also, this is the first time that we apply complex fractal correction (influence of grains and pore surface and as well as particles Brownian motion) on fundamental thermodynamic temperature in Currie-Weiss law. This application includes the influence of Housdorff dimension (DH) from the microstructure images and connect fractal corrections in Currie-Weiss law, for relative dielectric constant ϵr and magnetic permeability μr. Through ϵr and μr, on this way, for the first time in this scientific area, we present direct relation to inductivity. This complex relation opens quit new advance understanding in structures and parameters in area of ferroelectic-magnetic applications in telecommunications, by introducing the fractals.acceptedVersionPeer reviewe

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Auto-zero differential difference amplifier

The differential difference amplifier (DDA) is considered as a versatile building block for the analogue processing of floating voltages. An automatic offset compensation scheme is proposed for the DDA structure. A digital successive approximation algorithm is implemented to reduce the offset input voltages. The proposed circuit has been fabricated and tested in a 0.8 mu m CMOS technology