Frequency of Arrhythmias and Postural Orthostatic Tachycardia Syndrome in Patients With Marfan Syndrome: A Nationwide Inpatient Study.

Background Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting multiple systems, particularly the cardiovascular system. The leading causes of death in MFS are aortopathies and valvular disease. We wanted to identify the frequency of arrhythmia and postural orthostatic tachycardia syndrome, length of hospital stay, health care-associated costs (HAC), and in-hospital mortality in patients with MFS. Methods and Results The National Inpatient Sample database from 2005 to 2014 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for MFS and arrhythmias. Patients were classified into subgroups: supraventricular tachycardia, ventricular tachycardia (VT), atrial fibrillation, atrial flutter, and without any type of arrhythmia. Data about length of stay, HAC, and in-hospital mortality were also abstracted from National Inpatient Sample database. Adjusted HAC was calculated as multiplying HAC and cost-to-charge ratio; 12 079 MFS hospitalizations were identified; 1893 patients (15.7%) had an arrhythmia; and 4.9% of the patients had postural orthostatic tachycardia syndrome. Median values of length of stay and adjusted HAC in VT group were the highest among the groups (VT: 6 days, $18 975.8; supraventricular tachycardia: 4 days,$11 906.6; atrial flutter: 4 days, $11 274.5; atrial fibrillation: 5 days,$10431.4; without any type of arrhythmia: 4 days, $8336.6; both P=0.0001). VT group had highest in-patient mortality (VT: 5.3%, atrial fibrillation: 4.1%, without any type of arrhythmia: 2.1%, atrial flutter: 1.7%, supraventricular tachycardia: 0%; P<0.0001) even after adjustment for potential confounders (without any type of arrhythmia versus VT; odds ratio [95% CI]: 3.18 [1.62-6.24], P=0.001). Conclusions Arrhythmias and postural orthostatic tachycardia syndrome in MFS were high and associated with increased length of stay, HAC, and in-hospital mortality especially in patients with VT

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator

AbstractBackgroundImplantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias.MethodsA multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD).ResultsPatients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8.ConclusionsIn our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality

A sleep-like state in Hydra unravels conserved sleep mechanisms during the evolutionary development of the central nervous system

Sleep behaviors are observed even in nematodes and arthropods, yet little is known about how sleep-regulatory mechanisms have emerged during evolution. Here, we report a sleep-like state in the cnidarian Hydra vulgaris with a primitive nervous organization. Hydra sleep was shaped by homeostasis and necessary for cell proliferation, but it lacked free-running circadian rhythms. Instead, we detected 4-hour rhythms that might be generated by ultradian oscillators underlying Hydra sleep. Microarray analysis in sleep-deprived Hydra revealed sleep-dependent expression of 212 genes, including cGMP-dependent protein kinase 1 (PRKG1) and ornithine aminotransferase. Sleep-promoting effects of melatonin, GABA, and PRKG1 were conserved in Hydra. However, arousing dopamine unexpectedly induced Hydra sleep. Opposing effects of ornithine metabolism on sleep were also evident between Hydra and Drosophila, suggesting the evolutionary switch of their sleep-regulatory functions. Thus, sleep-relevant physiology and sleep-regulatory components may have already been acquired at molecular levels in a brain-less metazoan phylum and reprogrammed accordingly

Improvement of Visual Acuity as An Aftereffect of Blur Adaptation through a Defocusing Lens

Our previous study has shown that blur adaptation through a foggy filter temporarily improved visual acuity (VA). Here we report the influence on VA from the adaptation to blurred images by a defocusing lens. In the experiment, a subject adapted to the blurred visual field by observing motion pictures through a trial lens either of 2.5D, 3.0D, 4.0D, or 5.0D. The visual acuity was measured in the periods of pre- and post-adaptation by a quick and simplified staircase method with Landolt C. The moment the lens was removed, subject's VA was obviously higher than the original VA and then gradually returned to the original level in a few minutes. However the degree of transient improvement in VA was not necessarily larger with longer period of adaptation. The enhancement in VA demonstrated here is presumably caused by blur adaptation and its aftereffect. The usual VA might not be the optimum performance of the hardware of an eye, or rather, be suppressed by the visual system in the level of the cortex

Identifying subgroup characteristics of adult ambulance users with nonurgent medical conditions in Japan: A population‐based observational study

Abstract Aim In Japan, approximately 60% of adult ambulance users are diagnosed with minor injuries or diseases in the emergency department and thus do not require hospitalization. This study aimed to determine the distinct subgroup (segment) characteristics of adult ambulance users with nonurgent medical conditions by interpreting quantitatively derived segments through the segmentation approach. Methods This population‐based observational study used the ambulance transportation and request call records databases of the Higashihiroshima Fire Department, Japan, between January 1, 2016, and December 31, 2020. The participants were ambulance users aged 18–64 years diagnosed with minor injuries or diseases in the emergency department (defined as adult ambulance users with nonurgent medical conditions). A soft clustering method was used to divide the participants based on 13 variables. Results This analysis included 5,982 adult ambulance users. Six segments were obtained: (1) “users with neurological diseases or other injuries occurring late at night on weekdays”; (2) “users injured or involved in fire accidents, with increased on‐scene time and multiple hospital inquiries”; (3) “users transferred between hospitals”; (4) “users with acute illnesses and transported from home”; (5) “users involved in motor vehicle accidents”; and (6) “users transferred to hospitals outside of the area during the daytime on weekdays.” Conclusion These findings indicate that adult ambulance users with nonurgent medical conditions can be divided into distinct segments using population‐based ambulance records. Further research is warranted to address the ambulance user needs of each segment

Nocturnal Blood Pressure Fluctuations in Patients with Rapid Eye Movement-Related Obstructive Sleep Apnea

Rapid eye movement-related obstructive sleep apnea (REM-related OSA) is a polysomnographic phenotype. Nocturnal blood pressure (BP) fluctuations remain unclear in patients with REM-related OSA. We studied 27 patients with REM-related OSA, categorized as having REM-apnea-hypopnea index (REM-AHI) ≥ 5/h, REM-AHI/non-REM-AHI ≥ 2, and non-REM-AHI &lt; 15/h. Beat-to-beat systolic BP (SBP) variability and nocturnal SBP fluctuation patterns using pulse transit time (PTT) were investigated. The maximum increase and average nocturnal SBP were significantly higher in males than in females (p = 0.003 and p = 0.008, respectively). The rate of non-dipping patterns in nocturnal SBP fluctuations was 63% in all patients (males, 70%; females, 50%). Epworth Sleepiness Scale (ESS) and Self-rating Depression Scale (SDS) scores in females were higher than those in males (8.4 ± 6.1 vs. 13.4 ± 5.4 points, p = 0.04; 43.8 ± 7.9 vs. 52 ± 11.6 points, p = 0.04, respectively). A high proportion of patients with REM-related OSA had a non-dipping pattern. Using PPT, we observed that in patients with REM-related OSA, SBP variability was greater in males. Despite clinical symptoms being slightly more severe in females, nocturnal SBP fluctuations should be considered in male patients with REM-related OSA

Health Care Resource, Economic, and Readmission Implications After Acute Decompensated Aortic Stenosis–A Nationwide Study

Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS). Using the National Readmissions Database between 2016 and 2019, patients with ADAS and non-ADAS were identified using International Classification of Diseases, Tenth Revision codes. Patients with ADAS were propensity-matched to non-ADAS patients (1:2) using age, gender, and Charlson co-morbidity index. We compared in-hospital mortality, length of stay (LOS), health care–associated costs, and 90-day readmission data between the 2 cohorts. A total of 51,498 propensity-matched patients were included in this study: median age 75 years, 64% men. The in-hospital mortality for ADAS was higher than non-ADAS (2.8% vs 1.5%, p <0.0001). The LOS during the index admission was longer for ADAS (9 [5 to 13] vs 4 [2 to 6] days, p <0.0001). The health care–associated costs per patient was greater for ADAS ($55,450.0 [41,860.4 to 74,500.7] vs$43,405.7 [34,218.5 to 56,034.8], p <0.0001). Readmission to hospital within 90 days was more frequent in ADAS (21.1 vs 16.8%, p <0.001). The in-hospital mortality during readmission was higher with ADAS (3.9% vs 2.8%, p = 0.004). The readmission LOS was longer with ADAS (4 [2 to 7] vs 3 [2 to 6] days, p <0.0001). In conclusion, ADAS imposes a significant burden clinically and financially and on health care resources compared with non-ADAS during the index admission and 90-day follow-up. There is an urgent need to predict ADAS and optimize the timing of aortic valve replacement to reduce the incidence and the burden associated with ADAS

A cross-sectional comparison of the prevalence of obstructive sleep apnea symptoms in adults with down syndrome in Scotland and Japan

Small studies in Western populations report a high prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome. To date, ethnic differences have not been explored. A questionnaire sent to 2,752 adults with Down syndrome aged ≥16 years in Scotland and Japan (789 valid responses) estimated OSA prevalence based on reported symptoms. Symptoms were common in both countries, with snoring (p = 0.001) and arousals (p = 0.04) more prevalent in Japan. Estimated OSA prevalence in adults with Down syndrome was similar in the two countries, and raised in comparison with the general adult population (19.6% in Scotland and 14.3% in Japan; p = 0.08), though BMI was a confounder. Identification and treatment of OSA is recommended in adults with Down syndrome, regardless of ethnicity