scholarly journals Aortic root dimensions as a correlate for aortic regurgitation’s severity

2021 ◽  
Author(s):  
Jan-Per Wenzel ◽  
Elina Petersen ◽  
Julius Nikorowitsch ◽  
Jessica Müller ◽  
Tilo Kölbel ◽  
...  
Keyword(s):  
Aortic Root ◽  
Severe Aortic Stenosis ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Health Study ◽  
Binary Logistic Regression Analysis ◽  
Sinus Of Valsalva ◽  
Sinotubular Junction ◽  
Artery Disease ◽  
The Individual

AbstractTo evaluate the prevalence of aortic regurgitation (AR) and associations between the individual aortic root components and AR severity in the general population. The study included the first 10,000 participants of the population-based Hamburg City Health Study (HCHS) of whom 8259 subjects, aged 62.23 ± 8.46 years (51.3% females), enrolled 2016–2018, provided echocardiographic data. 69 subjects with bicuspid valves and 23 subjects with moderate/severe aortic stenosis were excluded. Aortic root dimensions were measured using state-of-the-art cardiac ultrasound, including the aortic annulus, sinus of Valsalva, sinotubular junction (STJ), and ascending aorta, in diastole and systole. The distribution of AR was: 932 (11.4%) mild, 208 (2.5%) moderate, and 20 (0.24%) severe. Patients with moderate or severe AR were predominantly male at advanced age who had hypertension, coronary artery disease, atrial fibrillation, and renal dysfunction. Increasing AR severity correlated with higher absolute and indexed aortic root diameters (e.g., end-diastolic sinus of Valsalva for no-mild-moderate-severe AR in mm ± standard deviation: 34.06 ± 3.81; 35.65 ± 4.13; 36.13 ± 4.74; 39.67 ± 4.61; p < 0.001). In binary logistic regression analysis, all aortic root components showed significant associations with moderate/severe AR. Mid-systolic STJ showed the strongest association with moderate/severe AR (OR 1.33, 95% confidence interval 1.25–1.43, p < 0.001). AR was prevalent in 14.2%, of whom 2.8% showed moderate/severe AR. All assessed aortic root diameters correlated with the prevalence and severity of AR. STJ diameter had the strongest association with moderate/severe AR possibly reflecting the pathophysiological impact of an increasingly dilated STJ in the context of an ageing aorta.

scholarly journals Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population-based study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rakchanok Boonpiam ◽  
Chanane Wanapirak ◽  
Supatra Sirichotiyakul ◽  
Ratanaporn Sekararithi ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Characteristic Curve ◽  
Binary Logistic Regression ◽  
Normal Growth ◽  
Predictive Performance ◽  
Population Based ◽  
Binary Logistic Regression Analysis ◽  
Aneuploidy Screening ◽  
The Individual

Abstract Background To identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for small-for-gestational-age (SGA) fetuses. Methods Women who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiples of the median (MoMs) of the four biochemical markers for the SGA group and those of normal fetuses were compared. The models for predicting SGA by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting SGA were determined. Results Of 10,155 eligible pregnant women, 578 (5.7%) and 9577 (94.3%) had SGA and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of SGA. The constructed predictive equations had predictive performance for SGA, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively. Conclusion The quad test for aneuploidy screening could also be used as a predictor of SGA, without extra-effort and extra-cost.

scholarly journals Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: A population-based study

2020 ◽  
Author(s):  
Rakchanok Boonpiam ◽  
Chanane Wanapirak ◽  
Supatra Sirichotiyakul ◽  
Ratanaporn Sekararithi ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Characteristic Curve ◽  
Binary Logistic Regression ◽  
Normal Growth ◽  
Predictive Performance ◽  
Population Based ◽  
Binary Logistic Regression Analysis ◽  
Aneuploidy Screening ◽  
The Individual

Abstract Background: To identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for small-for-gestational-age (SGA) fetuses.Methods: Women who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiples of the median (MoMs) of the four biochemical markers for the SGA group and those of normal fetuses were compared. The models for predicting SGA by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting SGA were determined.Results: Of 10,155 eligible pregnant women, 578 (5.7%) and 9,577 (94.3%) had SGA and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of SGA. The constructed predictive equations had predictive performance for SGA, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively.Conclusion: The quad test for aneuploidy screening could also be used as a predictor of SGA, without extra-effort and extra-cost.

scholarly journals Transthoracic echocardiographic reference values of the aortic root: results from the Hamburg City Health Study

2021 ◽  
Author(s):  
Jan-Per Wenzel ◽  
Elina Petersen ◽  
Julius Nikorowitsch ◽  
Juliana Senftinger ◽  
Christoph Sinning ◽  
...  
Keyword(s):  
Reference Values ◽  
Aortic Root ◽  
State Of The Art ◽  
Population Based ◽  
Aortic Annulus ◽  
Health Study ◽  
Sinotubular Junction ◽  
Four Levels ◽  
Aortic Root Disease ◽  
Root Size

AbstractHere we generate up-to-date reference values of transthoracic echocardiographic aortic root dimensions matched by sex, age, and body surface area (BSA) derived from the population-based Hamburg City Health Study (HCHS) cohort. In 1687 healthy subjects (mean age 57.1 ± 7.7, 681 male and 1006 female), derived from the first prospectively-recruited 10,000 HCHS participants, dimensions of the aortic root were measured in systole and diastole using state-of-the-art 2-dimensional transthoracic echocardiography. Diameters were assessed at four levels: aortic annulus, Sinus of Valsalva, sinotubular junction, and ascending aorta. Female sex was associated with significantly smaller absolute aortic root dimensions, while indexing for BSA resulted in a reverse effect at all levels. There was a strong age dependency of all aortic root diameters as well as aortic annulus/sinotubular junction ratio for both sexes. Multivariate analysis revealed age, sex, weight, height, and BSA to be significant determinants of aortic root size. Finally, formulas were generated for the calculation of individual aortic root reference values considering age, sex, weight, and height. We provide population-based reference values of aortic root diameters based on a standardized transthoracic echocardiographic protocol of the population-based HCHS which may support the diagnosis, monitoring, and treatment of aortic root disease.

Use of neutrophil/lymphocyte ratio as a marker in patients with suspicious diaphragmatic attenuation artifact

2021 ◽  
Vol 8 (12) ◽  
pp. 706-710
Author(s):  
Kemal Göçer ◽  
Ahmet Çağrı Aykan ◽  
Bayram Öztürk ◽  
Alihan Erdoğan
Keyword(s):  
Risk Factors ◽  
Binary Logistic Regression ◽  
Myocardial Perfusion Spect ◽  
Binary Logistic Regression Analysis ◽  
Inferior Wall ◽  
Roc Curve Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Significant Difference ◽  
Attenuation Artifact ◽  
Artery Disease

Objective: This study aimed to evaluate whether neutrophil/lymphocyte (N/L) ratio assists in the diagnosis of coronary artery disease (CAD) in patients with suspected diaphragmatic attenuation artifact (DAA) on myocardial perfusion SPECT (MP-SPECT). Material and Methods: A total of 255 patients undergoing coronary angiography between 2015-2020 due to unclear DAA of the inferior wall on MP-SPECT were included in this retrospective study. Patients were divided into two groups (CAD and non-CAD) according to angiographic images. Significant CAD was defined as ≥50% stenosis of coronary arteries feeding the inferior wall. White blood cell count, biochemical parameters, and risk factors for CAD were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of age (p = 0.055), gender (p = 0.482), and body mass index (p = 0.305). N/L ratio (OR = 1.397 p = 0.002 95% Cl = 1.128-1.732) and left ventricle ejection fraction (OR = 0.896 p = 0.023 95% Cl = 0.815-0.985) were independent risk factors for CAD in multivariate binary logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis showed that a cut-off value of ≥2 for N/L ratio predicted the presence of CAD (sensitivity=63.5%, specificity=60.7%, AUC=0.668, 95% CI=0.596 – 0.740, p<0.001). Conclusion: N/L ratio is a simple and accessible test and may increase the diagnostic accuracy of MP-SPECT for CAD in patients with suspicious diaphragmatic attenuation on MP-SPECT.

scholarly journals INDIVIDUAL AND CONTEXTUAL FACTORS AFFECTING DPT IMMUNIZATION IN INDONESIA

2021 ◽  
Vol 2 (1) ◽  
pp. 21-31
Author(s):  
Resti Wahyuni ◽  
Titik Harsanti
Keyword(s):  
Junior High School ◽  
Rural Areas ◽  
Maternal Education ◽  
Contextual Factors ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Factors Affecting ◽  
Poor Households ◽  
The Status ◽  
The Individual

Nowadays, diphtheria cases always increase from year to year. Until now, no drug has been found to cure diphtheria, but there is the most effective way of prevention through immunization. It is known that diphtheria sufferers who don’t get immunizations increase every year. The purpose of this study is to determine the individual and contextual factors that influence the status of DPT immunization in Indonesia and its trends and to know the diversity between cities. The data used in this study are Susenas KOR and consumption and expenditure (KP) modules. The results of multilevel binary logistic regression analysis indicate that individual factors that influence the status of DPT immunization are residence classification, highest maternal education, ownership of immunization cards, birth order, and household poverty status. While the contextual are the ratio of posyandu to 100,000 population and PDRB. Characteristics of children aged 12-59 who do not get immunizations tend to live in rural areas, have mothers with the highest education in junior high school, don’t have immunization cards, who born late in households with many children, and come from poor households. Besides that, there is a diversity of characteristics between cities, which amounted to 22,19%.

scholarly journals The relation between dietary phytochemical index and metabolic syndrome and its components in a large sample of Iranian adults: A population-based study

2020 ◽  
Author(s):  
Aazam ahmadi Vasmehjani ◽  
Zahra Darabi ◽  
azadeh Nadjarzadeh ◽  
masoud Mirzaei ◽  
Mahdieh Hosseinzadeh
Keyword(s):  
Metabolic Syndrome ◽  
Energy Intake ◽  
Lower Risk ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Protective Role ◽  
Food Sources ◽  
Health Study ◽  
Plant Foods ◽  
Logistic Regression Models

Abstract Background: Phytochemicals are natural non-nutritive bioactive compounds in plant foods. There is growing agreement that plant foods-based phytochemicals have a protective role against chronic diseases. The purpose of current study was to appraise Dietary Phytochemical Index (DPI) with the risk of metabolic syndrome (MetS) and its components.Methods: This study was conducted on 2326 participants (1097 men and 1220 women), aged 20-70 years of the recruitment phase of Yazd Health Study (YaHS), a population-based cohort study on Iranian adults. Dietary intake was prepared using a validated and reliable food frequency questionnaire. DPI is calculated based on dietary energy derived from phytochemical-rich food sources (kcal)/ total daily energy intake (kcal). The odds ratio of MetS and its components were assessed across DPI quartiles by binary logistic regression models.Results: After adjustment for all potential confounders, the risk of MetS (OR=0.63, 95% CI=0.41-0.96, P=0.03) and elevated blood pressure (OR=0.62, 95% CI=0.40-0.96, P=0.03) in second category of DPI compared to the first significantly decreased. After full adjustment for confounders, women in the highest quartile of DPI compared with the lowest, had 59% lower risk of MetS (OR=0.41, 95% CI=0.22-0.76, P=0.005). In second quartiles of DPI, the risk of MetS decreased by 62% (OR=0.38, 95% CI=0.16-0.90, P=0.02) in participants with normal BMI and 29% in subjects with high BMI (OR=0.71, 95% CI=0.52-0.99, P=0.04), and also 57% in men (OR=0.43, 95%CI=0.23-0.83, P=0.01). Independent of variables including age, sex and total energy intake, subjects in second and fourth quartiles of DPI had 30% and 25% lower risk of abdominal obesity, respectively.Conclusions: Greater adherence to phytochemical-rich diet could reduce odds of MetS and some components especially in women. Further studies with intervention approaches are required to discover causal relations and relevant underlying mechanisms.

ALS phenotype is influenced by age, sex, and genetics

Neurology ◽  
2020 ◽  
Vol 94 (8) ◽  
pp. e802-e810 ◽  
Author(s):  
Adriano Chiò ◽  
Cristina Moglia ◽  
Antonio Canosa ◽  
Umberto Manera ◽  
Fabrizio D'Ovidio ◽  
...  
Keyword(s):  
Motor Neurons ◽  
Differential Susceptibility ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Older Age ◽  
Binary Logistic Regression Analysis ◽  
Behavioral Impairment ◽  
Younger Age ◽  
Study Population ◽  
Male Sex

ObjectiveTo assess the determinants of amyotrophic lateral sclerosis (ALS) phenotypes in a population-based cohort.MethodsThe study population included 2,839 patients with ALS diagnosed in Piemonte, Italy (1995–2015). Patients were classified according to motor (classic, bulbar, flail arm, flail leg, predominantly upper motor neuron [PUMN], respiratory) and cognitive phenotypes (normal, ALS with cognitive impairment [ALSci], ALS with behavioral impairment [ALSbi], ALSci and ALSbi combined [ALScbi], ALS–frontotemporal dementia [FTD]). Binary logistic regression analysis was adjusted for sex, age, and genetics.ResultsBulbar phenotype correlated with older age (p < 0.0001), women were more affected than men at increasing age (p < 0.0001), classic with younger age (p = 0.029), men were more affected than women at increasing age (p < 0.0001), PUMN with younger age (p < 0.0001), flail arm with male sex (p < 0.0001) and younger age (p = 0.04), flail leg with male sex with increasing age (p = 0.008), and respiratory with male sex (p < 0.0001). C9orf72 expansions correlated with bulbar phenotype (p < 0.0001), and were less frequent in PUMN (p = 0.041); SOD1 mutations correlated with flail leg phenotype (p < 0.0001), and were less frequent in bulbar (p < 0.0001). ALS-FTD correlated with C9orf72 (p < 0.0001) and bulbar phenotype (p = 0.008), ALScbi with PUMN (p = 0.014), and ALSci with older age (p = 0.008).ConclusionsOur data suggest that the spatial–temporal combination of motor and cognitive events leading to the onset and progression of ALS is characterized by a differential susceptibility to the pathologic process of motor and prefrontal cortices and lower motor neurons, and is influenced by age, sex, and gene variants. The identification of those factors that regulate ALS phenotype will allow us to reclassify patients into pathologically homogenous subgroups, responsive to targeted personalized therapies.

scholarly journals Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

2020 ◽  
Vol 30 (11) ◽  
pp. 5794-5804
Author(s):  
G. J. H. Snel ◽  
L. M. Hernandez ◽  
R. H. J. A. Slart ◽  
C. T. Nguyen ◽  
D. E. Sosnovik ◽  
...  
Keyword(s):  
Image Quality ◽  
Aortic Root ◽  
Sinus Of Valsalva ◽  
Motion Artefacts ◽  
Contrast Imaging ◽  
Sinotubular Junction ◽  
Contrast Enhanced ◽  
Key Points ◽  
Impaired Quality ◽  
Aortic Dimensions

Abstract Objectives Assessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA. Methods All patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness. Results Aortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, − 1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences. Conclusions Thoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative. Key Points • SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA. • Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA. • ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.

scholarly journals Scaling to produce size-independent indices of echocardiographic derived aortic root dimensions in elite Rugby Football League players

Ultrasound ◽  
2019 ◽  
Vol 27 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Simon A Oates ◽  
Lynsey Forsythe ◽  
John D Somauroo ◽  
Keith P George ◽  
Michael Papadakis ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Aortic Root ◽  
Allometric Scaling ◽  
Ascending Aorta ◽  
Aortic Annulus ◽  
Linear Scaling ◽  
Sinus Of Valsalva ◽  
Sinotubular Junction

The assessment of aortic root dimensions is important in cardiac pre-participation screening. Scaling of cardiac dimensions removes the impact of body size allowing meaningful inter/intra group comparisons. Developing appropriate scaling approaches, scaling variables and extending the application to major vessels is warranted so underlying pathology can be detected and managed appropriately. The study aims to define relationships between aortic root dimensions and body surface area/height. Two hundred and twenty elite Rugby Football League athletes were recruited. All participants completed anthropometric assessments, a 12-lead ECG and echocardiogram. Aortic root was measured at the aortic annulus, sinus of valsalva, sinotubular junction and the proximal ascending aorta. Linear and allometric scaling were performed on the relationship between aortic measurements and body surface area/height. Absolute aortic root measurements fell within normal population data (mean ± standard deviation (range): aortic annulus: 22 ± 2 (17–28) mm, sinus of valsalva: 28 ± 3 (20–38) mm, sinotubular junction: 22 ± 3 (14–33) mm, proximal ascending aorta: 22 ± 3 (15–31) mm). Linear scaling to height produced size-independent indices at all aortic measurement sites (P < 0.05). Conversely, linear scaling using body surface area did not produce size-independent indices at any site (P > 0.05). Allometric scaling, using both body surface area and height, produced size-independent indices at all sites (P < 0.05). We recommend linearly scaling aortic root dimensions to height in elite Rugby Football League athletes and discourage the use of body surface area as a linear scaling quantity. Allometric scaling is also effective when using both body surface area and height.

High prevalence of neutralizing antibodies after long-term botulinum neurotoxin therapy

Neurology ◽  
2018 ◽  
Vol 92 (1) ◽  
pp. e48-e54 ◽  
Author(s):  
Philipp Albrecht ◽  
Alexander Jansen ◽  
John-Ih Lee ◽  
Marek Moll ◽  
Marius Ringelstein ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Botulinum Neurotoxin ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Binary Logistic Regression Analysis ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Kaplan Meier ◽  
The Individual

ObjectiveTo investigate the prevalence of neutralizing antibodies (NAbs) against botulinum neurotoxin type A (BoNT/A) during long-term BoNT/A treatment in different neurologic indications.MethodsIn this monocentric, observational cross-sectional study, 596 outpatients treated with BoNT/A for different indications were tested for BoNT/A binding antibodies by ELISA. Positive samples were investigated for NAbs with the mouse hemidiaphragm test. The prevalence of NAbs was analyzed for different indications: facial hemispasm, blepharospasm, cervical dystonia, other dystonia, and spasticity. Besides the rate of NAb-positive patients overall and per patient subgroup, a Kaplan-Meier analysis of the probability of remaining NAb negative with duration of treatment is provided, and a stepwise binary logistic regression analysis is performed to identify factors significantly contributing to the induction of NAbs.ResultsOverall, 83 of 596 patients (13.9%) had measurable NAbs. The probability of developing NAbs increased with the single and cumulative dose of treatment and was influenced by the BoNT/A formulation, while all other factors analyzed, including disease entity and treatment duration, had no additional influence.ConclusionsWe present the largest study to date of the prevalence of BoNT/A NAbs in a large unbiased cohort of patients including the relevant neurologic indications. Repeated injections of BoNT/A inevitably bear the risk of developing NAbs. However, in addition to avoiding booster injections and providing short intervals between injections, reducing the individual injected doses may diminish the risk of NAb induction independently of the indication for which BoNT/A is used.

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