Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

ObjectiveTo assess the in‐hospital and short‐term outcome differences between males and females who underwent high‐risk PCI with mechanical circulatory support (MCS).BackgroundSex differences have been noted in several percutaneous coronary intervention (PCI) series with females less likely to be referred for PCI due increased risk of adverse events. However, data on sex differences in utilization and outcomes of high‐risk PCI with MCS is scarce.MethodsUsing the cVAD Registry, we identified 1,053 high‐risk patients who underwent PCI with MCS using Impella 2.5 or Impella CP. Patients with cardiogenic shock were excluded. A total of 792 (75.21%) males and 261 (24.79%) females were included in the analysis with median follow‐up of 81.5 days.ResultsFemales were more likely to be African American, older (72.05 ± 11.66 vs. 68.87 ± 11.17, p < .001), have a higher prevalence of diabetes (59.30 vs. 49.04%, p = .005), renal insufficiency (35.41 vs. 27.39%, p = .018), and peripheral vascular disease (31.89 vs. 25.39%, p of .05). Women had a higher mean STS score (8.21 ± 8.21 vs. 5.04 ± 5.97, p < .001) and lower cardiac output on presentation (3.64 ± 1.30 vs. 4.63 ± 1.49, p < .001). Although women had more comorbidities, there was no difference in in‐hospital mortality, stroke, MI or need for recurrent revascularization compared to males. Females were more likely to have multivessel revascularization than males. Ejection fraction improved in both males and females at the time of discharge (26.59 to 31.40% and 30.75 to 36.05%, respectively, p < .0001). However, females had higher rate of bleeding requiring transfusion compared with males (9.58 vs. 5.30%, p = .019).ConclusionFemale patients undergoing high PCI were older and had more comorbidities but had similar outcomes compared to males.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162726/2/ccd28509_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162726/1/ccd28509.pd

Is there a gender difference in anatomic features of incisive canal and maxillary environmental bone?

Objectives The effect of gender on anatomic structures and various body systems were illustrated in the literature. The purpose of this study was to identify the influence of gender and tooth loss on incisive canal characteristics and buccal bone dimensions in the anterior maxilla. Materials and methods Computed tomographies ( CTs ) of 417 male and 516 female patients in four dental clinics were included in this study. The diameter and the length of the incisive canal; width and the length of the bone anterior to the canal; palatal bone length, root length, and root width of the central incisor teeth were measured and recorded from CT sections. Results Mean incisive canal length was 11.96 ± 2.73 mm and 10.39 ± 2.47 mm in men and women, respectively, ( P  < 0.05). In men, mean canal diameter was 2.79 ± 0.94 mm whereas in women it was 2.43 ± 0.85 mm and this difference was statistically significant ( P  < 0.05). Men had significant higher buccal bone dimensions (length and width of the bone anterior to the canal) than women. Absence of teeth in the anterior maxilla decreased incisive canal length and buccal bone dimensions; however, canal diameter remain unchanged. Conclusions Present results suggested a gender related differences in anatomic features of incisive canal and surrounding buccal bone. In addition, crestal canal diameter, buccal bone length, and thickness parameters might be different in distinct countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99051/1/clr2493.pd

Short term effects of milrinone on biomarkers of necrosis, apoptosis, and inflammation in patients with severe heart failure

<p>Abstract</p> <p>Introduction</p> <p>Inotropes are associated with adverse outcomes in heart failure (HF), raising concern they may accelerate myocardial injury. Whether biomarkers of myocardial necrosis, inflammation and apoptosis change in response to acute milrinone administration is not well established.</p> <p>Methods</p> <p>Ten patients with severe HF and reduced cardiac output who were to receive milrinone were studied. Blood samples were taken just before initiation of milrinone and after 24 hours of infusion. Dosing was at the discretion of the patient's attending physician (range 0.25–0.5 mcg/kg/min). Plasma measurements of troponin, myoglobin, N-terminal-pro-BNP, interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand were performed at both time points.</p> <p>Results</p> <p>Troponin was elevated at baseline in all patients (mean 0.1259 ± 0.17 ng/ml), but there was no significant change after 24 hours of milrinone (mean 0.1345 ± 0.16 ng/ml, p = 0.44). There were significant improvements in interleukin-6, tumor necrosis factor-α, soluble Fas, and soluble Fas-ligand (all p < 0.05) indicative of reduced inflammatory and apoptotic signaling compared to baseline.</p> <p>Conclusion</p> <p>In conclusion, among patients with severe HF and low cardiac output, ongoing myocardial injury is common, and initiation of milrinone did not result in exacerbation of myocardial injury but instead was associated with salutary effects on other biomarkers.</p

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

A systematic literature review on people with intellectual disability and health

People with intellectual disability (ID) are vulnerable to poorer health outcomes than the general population, yet little is known about the optimal models for health promotion interventions for this population. This literature review was undertaken to identify the evidence base relating to health promotion for people with ID, the challenges experienced by this population and optimal approaches for intervention. Keywords, synonyms and subject headings relating to health promotion and ID were applied to eight electronic databases. Thirty-two studies met the inclusion criteria out of 7,390 research papers, and a narrative synthesis was undertaken to elicit key findings. Evidence to date suggests that the lack of theory-based interventions and an over-reliance on strategies that target cognitive beliefs are substantial challenges for developing effective interventions for the ID research. Whilst there is limited empirical evidence, the included studies suggest that tailored and theory-based interventions may be more successful in creating behavioural changes of the people with ID. The literature base is currently limited by a lack of comparable studies; making generalisations challenging. Greater theoretical and methodological justification to explain the personal, social, economic and behavioural drivers and consequences of health promotion interventions designed for people with ID are required.</p

A systematic literature review on people with intellectual disability and health promotion

People with intellectual disability (ID) are vulnerable to poorer health outcomes than the general population, yet little is known about the optimal models for health promotion interventions for this population. This literature review was undertaken to identify the evidence base relating to health promotion for people with ID, the challenges experienced by this population and optimal approaches for intervention. Keywords, synonyms and subject headings relating to health promotion and ID were applied to eight electronic databases. Thirty-two studies met the inclusion criteria out of 7,390 research papers, and a narrative synthesis was undertaken to elicit key findings. Evidence to date suggests that the lack of theory-based interventions and an over-reliance on strategies that target cognitive beliefs are substantial challenges for developing effective interventions for the ID research. Whilst there is limited empirical evidence, the included studies suggest that tailored and theory-based interventions may be more successful in creating behavioural changes of the people with ID. The literature base is currently limited by a lack of comparable studies; making generalisations challenging. Greater theoretical and methodological justification to explain the personal, social, economic and behavioural drivers and consequences of health promotion interventions designed for people with ID are required

A systematic literature review on people with intellectual disability and health promotion

Sultan, P ORCiD: 0000-0003-3856-4592People with intellectual disability (ID) are vulnerable to poorer health outcomes than the general population, yet little is known about the optimal models for health promotion interventions for this population. This literature review was undertaken to identify the evidence base relating to health promotion for people with ID, the challenges experienced by this population and optimal approaches for intervention. Keywords, synonyms and subject headings relating to health promotion and ID were applied to eight electronic databases. Thirty-two studies met the inclusion criteria out of 7,390 research papers, and a narrative synthesis was undertaken to elicit key findings. Evidence to date suggests that the lack of theory-based interventions and an over-reliance on strategies that target cognitive beliefs are substantial challenges for developing effective interventions for the ID research. Whilst there is limited empirical evidence, the included studies suggest that tailored and theory-based interventions may be more successful in creating behavioural changes of the people with ID. The literature base is currently limited by a lack of comparable studies; making generalisations challenging. Greater theoretical and methodological justification to explain the personal, social, economic and behavioural drivers and consequences of health promotion interventions designed for people with ID are required

Analysis of friction and wear of aluminium AA 5083/ WC composites for building applications using advanced machine learning models

The aluminium composites have gained greater attention, especially in wear resistant applications. However, reinforcing the ceramic particulates in the aluminium matrix is a major factor influencing the tribological characteristics. In this regard, the influence of Fly Ash inoculants on the uniform distribution of reinforcements and the subsequent tribological characteristics are studied. The composite specimens are produced by reinforcing different wt.% (in the range of 3 to 9 wt%) of Tungsten Carbide (WC) and the Fly Ash (FA) in Aluminium AA 5083 matrix by ultrasonic assisted stir casting in a controlled environment. The wt.% of the reinforcements are chosen based on initial trials and related literature reviews. The stir cast aluminium composites are machined in accordance with the specimen standards to accomplish the pin on disc - adhesive wear following the ASTM G99 standards. The results of the wear test clearly depicts that the increase in the wt.% of fly ash upto a threshold limit (6 wt%) improves the wear behaviour of the composites. This is majorly due to the homogeneity brought about by the fly ash inoculants in dispersing the ceramic reinforcements of WC uniformly in the matrix phase. The experimental findings are also ascertained by the statistical validations and correlated. The results of the experiments and the statistical validations and the outcomes of the optimization will be a base for the use of the composites for wear resistant applications, since the wear of the aluminium composite castings are of prime concern for advanced industrial uses. Further, Artificial Neural Network (ANN) and Machine Learning (ML) models are evolved to predict the tribological characteristics of the composite specimens. The predictions of these models are found to be in clore correlation to the experimental outcomes

Mechanical circulatory support for acute right ventricular failure in the setting of pulmonary embolism

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145548/1/joic12503.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145548/2/joic12503_am.pd