Cross‐sectional relations of whole‐blood mi RNA expression levels and hand grip strength in a community sample

Summary Micro RNA s (mi RNA s) regulate gene expression with emerging data suggesting mi RNA s play a role in skeletal muscle biology. We sought to examine the association of mi RNA s with grip strength in a community‐based sample. Framingham Heart Study Offspring and Generation 3 participants ( n  = 5668 54% women, mean age 55 years, range 24, 90 years) underwent grip strength measurement and mi RNA profiling using whole blood from fasting morning samples. Linear mixed‐effects regression modeling of grip strength (kg) versus continuous mi RNA ‘Cq’ values and versus binary mi RNA expression was performed. We conducted an integrative mi RNA – mRNA coexpression analysis and examined the enrichment of biologic pathways for the top mi RNA s associated with grip strength. Grip strength was lower in women than in men and declined with age with a mean 44.7 (10.0) kg in men and 26.5 (6.3) kg in women. Among 299 mi RNA s interrogated for association with grip strength, 93 (31%) had FDR q value < 0.05, 54 (18%) had an FDR q value < 0.01, and 15 (5%) had FDR q value < 0.001. For almost all mi RNA –grip strength associations, increasing mi RNA concentration is associated with increasing grip strength. miR‐20a‐5p ( FDR q 1.8 × 10 −6 ) had the most significant association and several among the top 15 mi RNA s had links to skeletal muscle including miR‐126‐3p, miR‐30a‐5p, and miR‐30d‐5p. The top associated biologic pathways included metabolism, chemokine signaling, and ubiquitin‐mediated proteolysis. Our comprehensive assessment in a community‐based sample of mi RNA s in blood associated with grip strength provides a framework to further our understanding of the biology of muscle strength.

Impact of Residual Mitral Regurgitation on Right Ventricular Systolic Function After Left Ventricular Assist Device Implantation

Significant mitral regurgitation (MR) is thought to decrease after left ventricular assist device (LVAD) implantation, and therefore repair of mitral valve is not indicated in current practice. However, residual moderate and severe MR leads to pulmonary artery pressure increase, thereby resulting in right ventricular (RV) dysfunction during follow‐up. We examined the impact of residual MR on systolic function of the right ventricle by echocardiography after LVAD implantation. This study included 90 patients (mean age: 51.7 ± 10.9 years, 14.4% female) who underwent LVAD implantation (HeartMate II = 21, HeartWare = 69) in a single center between December 2010 and June 2014. Echocardiograms obtained at 3–6 months and over after implantation were analyzed retrospectively. RV systolic function was graded as normal, mild, moderate, and severely depressed. MR (≥moderate) was observed in 43 and 44% of patients at early and late period, respectively. Systolic function of the RV was severely depressed in 16 and 9% of all patients. Initial analysis (mean duration of support 174.3 ± 42.5 days) showed a statistically significant correlation between less MR and improved systolic function of RV ( P  = 0.01). Secondary echocardiographic analysis (following a mean duration of support of 435.1 ± 203 days) was also statistically significant for MR degree and RV systolic dysfunction ( P  = 0.008). Residual MR after LVAD implantation may cause deterioration of RV systolic function and cause right‐sided heart failure symptoms. Repair of severe MR, in selected patients such as those with severe pulmonary hypertension and depressed RV, may be considered to improve the patient's clinical course during pump support.

Cross‐cultural adaptation and psychometric study of the Turkish version of the Rapid Assessment of Physical Activity

Aim The Rapid Assessment of Physical Activity (RAPA) is a valid tool for use in clinical practice to provide an easily administered and interpreted means of assessing levels of physical activity among adults older than 50 years. However, there are some concerns about its reliability. The aim was to linguistically and culturally adapt the RAPA into Turkish, and assess its validity and reliability. Methods This methodological and cross‐sectional study included 110 participants (68 women) from the community and a nursing home. The RAPA was translated and culturally adapted into Turkish using established double‐back translation methods. The participants completed the RAPA twice with a 1‐week interval to examine test–retest reliability. The International Physical Activity Questionnaire‐Short Form and Physical Activity Scale for the Elderly were used to examine the validity. Results The mean age of the participants was 70.5 years (SD 10.5 years). The weighted kappa coefficients exceed 0.81 for each of the nine items, the aerobic score and strength and flexibility score, showing that the test–retest reliability was very good. There were positive moderate correlations between the RAPA, International Physical Activity Questionnaire‐Short Form and Physical Activity Scale for the Elderly ( P < 0.01). Additionally, the RAPA was negatively correlated with the International Physical Activity Questionnaire‐Short Form sitting time as prehypothesized ( P < 0.01). The convergent and discriminate validity of the RAPA were acceptable. Conclusions The present study has shown that the Turkish version of the RAPA was an easy‐to‐use, valid and reliable measure of physical activity among adults aged older than 50 years. This study has also provided considerable evidence about the test–retest reliability of the RAPA, which was not investigated in the original validation study. Geriatr Gerontol Int 2017; 17: 1837–1842 .

Real‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study

Objectives To compare the clinical characteristics of and use of oral anticoagulant ( OAC ) therapy in individuals aged 80 and older with atrial fibrillation ( AF ) with those of individuals younger than 80 with AF in clinical practice. Design Observational study. Setting The ReAl‐life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial ( NCT 02344901), a national observational registry. Participants Turkish adults with nonvalvular AF ( NVAF ). Measurements Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non‐octogenarian AF patients. Results Fifty‐seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P  < .001) and had a higher prevalence of persistant or permanent AF , comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex ( CHA 2 DS 2 VAS c) (4.32 ± 1.35 vs 3.04 ± 1.54, P  < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol ( HAS ‐ BLED ) (2.14 ± 1.05 vs 1.54 ± 1.05, P  < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P  < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older ( P  < .001). Higher CHA 2 DS 2 VAS c score and lower HAS ‐ BLED score were independent predictors of OAC prescription in participants aged 80 and older. Conclusion Nearly one‐fifth of individuals with NVAF in this real‐world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual‐level characteristics may explain this difference. When they were prescribed OAC s, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.

Robotic resection of giant left ventricular myxoma causing outflow tract obstruction

We report a 38‐year‐old female, who presented with progressive dyspnea and fatigue. Echocardiography revealed a giant and freely mobile left ventricular myxoma causing left ventricular outflow tract (LVOT) obstruction. The patient underwent totally endoscopic robotic excision of a giant left ventricular myxoma. The tumor was completely removed through the mitral valve orifice with a left atriotomy incision.

Trader Leverage and Liquidity

Does trader leverage drive equity market liquidity? We use the unique features of the margin trading system in India to identify a causal relationship between traders’ ability to borrow and a stock's market liquidity. To quantify the impact of trader leverage, we employ a regression discontinuity design that exploits threshold rules that determine a stock's margin trading eligibility. We find that liquidity is higher when stocks become eligible for margin trading and that this liquidity enhancement is driven by margin traders’ contrarian strategies. Consistent with downward liquidity spirals due to deleveraging, we also find that this effect reverses during crises.

Mannose‐binding lectin gene polymorphism in relation to periodontal infection

Background and Objective Mannose‐binding lectin ( MBL ) plays an important role in innate immunity. MBL deficiency is usually caused by mutations in exon 1 of the MBL structural gene ( MBL 2 ). Our aim was to investigate MBL 2 polymorphisms and their relation to salivary levels of periodontal inflammatory/tissue destruction markers and two major periodontitis‐associated bacteria. Material and Methods Salivary samples from 222 subjects were available for genotyping by pyrosequencing. The subjects between 40 and 60 years of age and having a minimum of 20 teeth were divided into three periodontal groups: 80 had generalized periodontitis, 65 had localized periodontitis and 77 were periodontitis‐free. A comparison between their MBL 2 genotypes and salivary detection rates and levels of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis as well as interleukin ‐1β, matrix metalloproteinase ‐8, and tissue inhibitor of matrix metalloproteinase ( TIMP )‐1 was performed. Results The frequencies of the MBL 2 wild‐type (A/A), heterozygote variants (A/O) and homozygote variants (O/O) were 69.4%, 26.6% and 4%, respectively. In A. actinomycetemcomitans ‐positive subjects having homozygote or heterozygote MBL 2 variants, the salivary concentrations of IL ‐1β ( p = 0.010) were elevated and those of TIMP ‐1 ( p = 0.001) were decreased. In addition their matrix metalloproteinase ‐8/ TIMP ‐1 ratio was higher ( p < 0.001) and they had more pocket teeth ( p = 0.012) than subjects negative for A. actinomycetemcomitans . Conclusion Our findings indicate that the carriage of A. actinomycetemcomitans may facilitate extended periodontal inflammation and destruction in subjects with a variant form of human MBL 2 .

Should deep sedation be used during all catheter ablation procedures as a routine?

Serum oxidative stress parameters and paraoxonase‐1 in children and adolescents exposed to passive smoking

Background Exposure to secondhand smoke is too common in many countries. The mechanism of the detrimental effects of passive smoking on childhood health, however , is poorly described. The purpose of this study was therefore to examine the effect of passive smoking on total antioxidant status ( TAS ), total oxidant status ( TOS ), and paraoxonase‐1 in children compared with healthy non‐passive smokers. Methods This study included 40 children and adolescents passively exposed to cigarette smoke (as verified on urine cotinines) and 40 age‐ and gender‐matched healthy controls not regularly exposed to cigarette smoke. TAS , TOS , and paraoxonase‐1 were all measured, and the oxidative stress index ( OSI ) calculated for each child to determine the degree of oxidative stress. Results Age and gender distribution were not statistically different between the two groups ( P = 0.619 and 0.712, respectively). Urine cotinine/creatinine was significantly higher in the passive smoking group (127.89 ± 57.14 ng/mL) compared with the controls (5.05 ± 16.66 ng/mL; P < 0.001). TAS was not different between the two groups ( P = 0.767), but TOS and OSI were significantly higher for the passive smoke‐exposed children ( P < 0.001), and serum paraoxonase‐1 was significantly lower than in the controls ( P = 0.047). Conclusions Secondhand smoke exposure is associated with increased oxidative stress and decreased paraoxonase‐1 without any change in antioxidant status.

Timing the Use of Breast Cancer Risk Information in Biopsy Decision‐Making

Available clinical evidence is inconclusive on whether radiologists should use the patient risk profile information when interpreting mammograms. On the one hand, risk profile information is informative and can improve radiologists’ performance, but on the other hand, it may impair their judgment by introducing biases in mammography interpretation. Therefore, it is important to assess whether and when profile information use translates into improved outcomes. We model the use of profile information in mammography, using a decision theoretic approach and explore the value of profile information using three process design choices: mammography only, unbiased, and biased reading. We estimate the parameters of our model using clinical data and find that using profile information along with the mammography information can achieve a better performance than not using the profile information. However, the better performance is contingent on the weight assigned to the profile information as well as the extent of bias due to profile information. Translating our findings into clinical practice would require properly designed experiments aiming to quantify the effect of the timing and the use of profile information on performance while accounting for radiologist and patient characteristics. When conducting an experiment is not feasible, a uniform operational sequence for interpreting mammograms and related guidelines may be a useful starting point to improve the quality of mammography operations.