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Introduction: Acute right iliac fossa (RIF) pain is a common presenting symptom in surgical patients, with a wide range of differentials, particularly in premenopausal females. This study explores ultrasound usage in the management of women aged 16–55 years presenting with RIF pain. Methods: A total of 1,082 patients who presented to a tertiary hospital over 12 months were included. Data were collected from patients' electronic records, including initial clinical impression, imaging, management, operative findings, histology and subsequent hospital attendances within 6 weeks and within 6 months. Results: Following clinical assessment, 607 (56%) of patients underwent an ultrasound. Of these, 280 (25.9%) patients received no radiological imaging on initial presentation, and 252 (42%) had pathology identified on ultrasound. The most common finding was an ovarian cyst, closely followed by unexplained free pelvic fluid. Of the 607 patients scanned, 29 (4.8%) had an ultrasound diagnosis of appendicitis; 254 of 1,082 (23.5%) patients underwent operative management. Of the 254 patients who had surgery, 179 (70.5%) had preoperative imaging. Of the 29 (11.4%) cases where the intraoperative finding was gynaecological, 15 (51.7%) cases had not had any preoperative imaging. The negative appendicectomy rate was 21.3% (45/211). Of the 45 patients who had a histologically normal appendix, 22 (48.9%) had not had any previous imaging. Ultrasound had a specificity of 78% for diagnosing appendicitis. Conclusions: In patients who underwent operative management, a negative finding or finding not requiring surgical management was associated with no preoperative imaging. This supports the use of ultrasound scans as an adjunct in a multimodal approach to the assessment of women presenting with RIF pain. [ABSTRACT FROM AUTHOR]

The impact of state restriction and surveillance on social media engagement has been widely investigated in communication studies. However, these studies tend not to capture the moment when these restrictions are implemented and citizens experience a high level of uncertainty. Addressing the implementation of a national security law (NSL) in Hong Kong, we used two-wave panel data to understand political engagement on Facebook before and shortly after the law was enacted. We find a serial mediation path in which pan-democratic and localist users (those who tend to oppose the government) showed greater fear of the law; this encouraged more active privacy management which was related to a higher level of engagement after the enactment of NSL, implying that these users responded strategically through restricting the visibility of their engagement. This mediation path is moderated by the level of political disagreement users encountered on Facebook. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

We take a look at the last 70 years of the Welsh Surgical Society, and what its future looks like. [ABSTRACT FROM AUTHOR]

To evaluate the biaxial flexural strength (BFS), Knoop microhardness (KM), degree of conversion (DC) and material waste (MW) of a self-adhesive and self-etching resin cement (RC) (seT PP, SDI) as a function of method/technology of mixture. Six experimental groups (EG) were created for each combination of mixing method/technology: A) T-Mixer (auto-mixer with T-Mixer Technology); B) Helical (auto-mixer with helical technology); C) IOR-Helical (auto-mixer with helical technology associated with plastic intraoral tip); D) IOR-T-Mixer (auto-mixer with T-Mixer Technology associated with plastic intraoral tip); E) IOM-T-Mixer (auto-mixer with T-Mixer Technology associated with metallic intraoral cannula); and F) Manual (manual mixing method with spatula). For BFS and KM tests, discs (n=10) measuring 12x1mm were produced and stored (37°C/24 h). For GC test, discs (n=3) measuring 7x1mm were produced. To calculate the MW, the amount of needed to cement a full-ceramic crown was calculated (0.34 g). The mixing tips (n=10) were weighed before and after use and then the percentage of MW was calculated. BFS and KM discs were tested in a universal testing machine (0.5 mm/min). The fracture fragments were randomly selected and, in a microhardness tester, 10 indentations were made in each specimen (50 g/15 s). For DC, readings were carried out (near-infrared spectroscopy) immediately and 7 days after specimen production. BFS and MW data were analyzed by Kruskall-Wallis test. KM data were analyzed by one-way ANOVA and the DC by 2-way ANOVA and Tukey test (alpha=5%). The Table indicates that, for BFS and DC (immediate and after 7 days) there was not statistical differences among the EG. For the KM, the IOR-Helical group showed the highest mean value, which was statistically similar to that of the IOR-T-Mixer group, which in turn was statistically similar to the mean obtained for the T-Mixer group. IOM-T-Mixer showed KM mean values compared to that of the the Helical group, which in turn showed similar mean in comparison to that of the Manual group, which showed the lowest KM mean value. The MW analysis showed that, numerically, the Helical group showed the highest MW, however, this average was statistically similar to that obtained for the IOR-Helicoidal group. There were not statistical differences among T-Mixer, IOR-T-Mixer, and IOR-Helicoidal groups, the latter being statistically similar to the IOM-T-Mixer group. The mixing method/technology affected the KM and MW of the evaluated EGs. The mixing method/technology used in the IOR-T-Mixer group proved to be an option that combines higher hardness with less material waste. [Display omitted] [ABSTRACT FROM AUTHOR]

The method of pull-out test has been used to identify the mechanical performance of hybrid and fiber-reinforced composite materials. This paper investigates the elastic phase preceding the pull-out of a rigid line inclusion from the polymer matrix with fixed top and bottom surfaces. The mode-III problem is investigated such that the pull-out force is applied from the out-of-plane direction and it can be either transient or static. By applying the singular integral equation technique, the semi-analytical elastic field expressions are obtained. Under the static pull-out force, the stress intensity factor (SIF) near the inclusion tip shows a monotonic increase as the length and height of the matrix increase, whereas for the transient pull-out force, the SIF displays an initial increasing and followed by a decline. The maximum SIF is obtained for (1) the matrix length is 2 to 2.5 times of the inclusion length, and (2) the matrix height is 1 to 2 times of the inclusion length. Moreover, this paper provides a solution approach that incorporates the elasticity of the inclusion, showing that there is an optimal shear stiffness that minimizes the stress singularity of system. The conclusions of this study hold significance for the design and performance evaluation of fiber-reinforced composite materials. [ABSTRACT FROM AUTHOR]

Objective: To assess psychosexual distress over a 12‐month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot. Design: Longitudinal, between‐group study. Setting: Five sites in England where primary HPV testing was piloted. Population: Women aged 24–65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme. Methods: Women were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test. Main outcome measures: Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS‐Q). Results: At all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1–5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96–1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78–1.27) and persistent HPV (B = 0.90, 95% CI 0.70–1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller. Conclusions: Our findings suggest receiving an HPV‐positive result can cause psychosexual distress, particularly in the short‐term. Developing interventions to minimise the psychosexual burden of testing HPV‐positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening. Receiving an HPV‐positive result following primary HPV testing can cause psychosexual distress, particularly in the short‐term. Receiving an HPV‐positive result following primary HPV testing can cause psychosexual distress, particularly in the short‐term. [ABSTRACT FROM AUTHOR]

We apply a maximal likelihood ratio test for the presence of multiple change-points in the covariate effects based on the Cox regression model. The covariate effect is assumed to change smoothly at one or more unknown change-points. The number of change-points is inferred by a sequential approach. Confidence intervals for the regression and change-point parameters are constructed by a bootstrap method based on Bernstein polynomials conditionally on the number of change-points. The methods are assessed by simulations and are applied to two datasets. [ABSTRACT FROM AUTHOR]

Background: Early reports of COVID‐19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified? Objective: To estimate the risk of the neonate becoming infected with SARS‐CoV‐2 by mode of delivery, type of infant feeding and mother‐infant interaction. Search strategy: Two biomedical databases were searched between September 2019 and June 2020. Selection criteria: Case reports or case series of pregnant women with confirmed COVID‐19, where neonatal outcomes were reported. Data collection and analysis: Data were extracted on mode of delivery, infant infection status, infant feeding and mother–infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission. Main results: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated. Conclusions: Neonatal COVID‐19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother. Risk of neonatal infection with COVID‐19 by delivery route, infant feeding and mother‐baby interaction. Risk of neonatal infection with COVID‐19 by delivery route, infant feeding and mother‐baby interaction. This article includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights16362 [ABSTRACT FROM AUTHOR]

Self‐expandable metallic stent (SEMS) is commonly used in treating oesophageal disorders but migration is not uncommon. A special method, the Fishing technique, is introduced in this article to show how it works in a complicated oesophageal perforation case. [ABSTRACT FROM AUTHOR]

Objective: Improving antimicrobial stewardship in the livestock sector requires an understanding of the motivations for antimicrobial use and the quantities consumed. However,detailed information on antimicrobial use in livestock sectors is lacking. This cross‐sectional study aimed to better understand antimicrobial use in the beef feedlot sector in Australia. Design: A self‐administered questionnaire asking about antimicrobial use and reasons for use was designed and mailed to beef feedlot operators in Australia. Respondents were asked to report the percentage of animals treated, purpose of use, and disease conditions targeted for 26antimicrobial agents. Results: In total, 83 of 517 (16.1%) beef feedlot operators completed the survey. Monensin (61.0%of respondents) and virginiamycin (19.5%of respondents) were the most commonly reported in‐feed antimicrobials. In‐feed antimicrobial agents were most frequently used by respondents for treatment of gastrointestinal diseases (52.8%). Antimicrobials were used for growth promotion by 42.1% of respondents, with most (85.7%) reporting the use of ionophores(a group of compounds not used in human medicine). Short‐acting penicillin(69.1%), short‐acting oxytetracycline, and tulathromycin (both 57.3%) werethe most common injectable antimicrobial agents used. Injectable antimicrobials were most frequently used to treat respiratory (72.3%) and musculoskeletal (67.5%) conditions. Conclusion: Overall,the use of antimicrobials was appropriate for the purpose indicated, and there was a strong preference for drugs of low‐importance in human medicine. The data described here stand to be a strong influence on the implementation of an antimicrobial stewardship program in the sector. [ABSTRACT FROM AUTHOR]

Expanding on the zero-inflated Poisson model, the multiple-inflated Poisson model is applied to analyze count data with multiple inflated values. The existing studies on the multiple-inflated Poisson model determined the inflated values by inspecting the histogram of count response and fitting the model with different combinations of inflated values, which leads to relatively complicated computations and may overlook some real inflated points. We address a two-stage inflated values selection method, which takes all values of count response as potential inflated values and adopts the adaptive lasso regularization on the mixing proportion of those values. Numerical studies demonstrate the excellent performance both on inflated values selection and parameters estimation. Moreover, a specially designed simulation, based on the structure of data from a randomized clinical trial of an HIV sexual risk education intervention, performs well and ensures our method could be generalized to the real situation. An empirical analysis of a clinical trial dataset is used to elucidate the multiple-inflated Poisson model. [ABSTRACT FROM AUTHOR]

'Unexplained residuals' models have been used within lifecourse epidemiology to model an exposure measured longitudinally at several time points in relation to a distal outcome. It has been claimed that these models have several advantages, including: the ability to estimate multiple total causal effects in a single model, and additional insight into the effect on the outcome of greater-than-expected increases in the exposure compared to traditional regression methods. We evaluate these properties and prove mathematically how adjustment for confounding variables must be made within this modelling framework. Importantly, we explicitly place unexplained residual models in a causal framework using directed acyclic graphs. This allows for theoretical justification of appropriate confounder adjustment and provides a framework for extending our results to more complex scenarios than those examined in this paper. We also discuss several interpretational issues relating to unexplained residual models within a causal framework. We argue that unexplained residual models offer no additional insights compared to traditional regression methods, and, in fact, are more challenging to implement; moreover, they artificially reduce estimated standard errors. Consequently, we conclude that unexplained residual models, if used, must be implemented with great care. [ABSTRACT FROM AUTHOR]

Background: The newly developed Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) has consistently been shown to be prognostically significant in endometrial carcinomas (EC). Recently, we and others have demonstrated L1 cell-adhesion molecule (L1CAM) to be a significant indicator of high-risk disease in EC. In the current study, it was our aim to determine the prognostic significance of aberrant L1CAM expression in ProMisE subgroups in a large, single centre, population-based EC cohort.Methods: ProMisE (POLE; MMR-D; p53 wt/NSMP; p53 abn) classification results from a cohort of 452 EC were available for analysis. L1CAM expression was studied by immunohistochemistry on whole slides. Correlations between clinicopathological data and survival were calculated.Results: Expression of L1CAM was most frequent in p53 abnormal tumours (80%). L1CAM status was predictive of worse outcome among tumours with no specific molecular profile (p53 wt/NSMP) (p < 0.0001). Among p53 wt/NSMP EC, L1CAM remained a significant prognosticator for disease-specific survival after multivariate analysis (p = 0.035).Conclusion: L1CAM status was able to significantly stratify risk among tumours of the large p53 wt/NSMP ProMisE subgroup of EC. Furthermore, our study confirms a highly significant correlation between mutation-type p53 immunostaining and abnormal L1CAM expression in EC. [ABSTRACT FROM AUTHOR]

Arterial vasculature distributes blood from early embryonic development and provides a nutrient highway to maintain tissue viability. Atherosclerosis, peripheral artery diseases, stroke and aortic aneurysm represent the most frequent causes of death and are all directly related to abnormalities in the function of arteries. Vascular intervention techniques have been established for the treatment of all of these pathologies, yet arterial surgery can itself lead to biological changes in which uncontrolled arterial wall cell proliferation leads to restricted blood flow. In this review we describe the intricate cellular composition of arteries, demonstrating how a variety of distinct cell types in the vascular walls regulate the function of arteries. We provide an overview of the developmental origin of arteries and perivascular cells and focus on cellular dynamics in arterial repair. We summarize the current knowledge of the molecular signaling pathways that regulate vascular smooth muscle differentiation in the embryo and in arterial injury response. Our review aims to highlight the similarities as well as differences between cellular and molecular mechanisms that control arterial development and repair. [ABSTRACT FROM AUTHOR]

SEC14 lipid transfer proteins are important regulators of phospholipid metabolism. Structural, genetic and cell biological studies in yeast suggest that they help phosphatidylinositol (PtdIns)/phosphoinositide (PIP) kinases to overcome their intrinsic inefficiency to recognize membrane-embedded substrate, thereby playing a key role in PIP homeostasis. Genomes of higher plants encode a high number and diversity of SEC14 proteins, often in combination with other domains. The Arabidopsis SEC14-Nlj16 protein AtSFH1, an important regulator of root hair development, plays an important role in the establishment of PIP microdomains. Key to this mechanism is a highly specific interaction of the Nlj16 domain with PtdIns(4,5)P 2 and an interaction-triggered oligomerization of the protein. Nlj16/PtdIns(4,5)P 2 interaction depends on a polybasic motif similar to those identified in other regulatory proteins. [ABSTRACT FROM AUTHOR]

Objective: Induction of labour at 39 weeks for nulliparous women aged 35 years and over may prevent stillbirths and does not increase caesarean births, so it may be popular. But the overall costs and benefits of such a policy have not been compared.Design: A cost-utility analysis alongside a randomised controlled trial (the 35/39 trial).Setting: Obstetric departments of 38 UK National Health Service hospitals and one UK primary-care trust.Population: Nulliparous women aged 35 years or over on their expected due date, with a singleton live fetus in a cephalic presentation.Methods: Costs were estimated from the National Health Service and Personal Social Services perspective and quality-adjusted life-years (QALYs) were calculated based on patient responses to the EQ-5D at baseline and 4 weeks.Main Outcome Measures: Data on antenatal care, mode of delivery, analgesia in labour, method of induction, EQ-5D (baseline and 4 weeks postnatal) and participant-administered postnatal health resource use data were collected.Results: The intervention was associated with a mean cost saving of £263 and a small additional gain in QALYs (though this was not statistically significant), even without considering any possible QALY gains from stillbirth prevention.Conclusion: A policy of induction of labour at 39 weeks for women of advanced maternal age would save money.Tweetable Abstract: A policy of induction of labour at 39 weeks of gestation for women of advanced maternal age would save money. [ABSTRACT FROM AUTHOR]

Alterations in diurnal salivary cortisol patterns have been linked to adverse metabolic health outcomes. We have previously shown that stress-reduction guided imagery (GI) can reduce salivary cortisol levels acutely. We now ask whether addition of GI into a 12-week lifestyle intervention designed to improve eating and physical activity behaviors can alter diurnal salivary cortisol patterns and perceived stress. 232 adolescent participants (ages 14–17 years) were cluster randomized by school into one of four intervention arms: non-intervention Control (C; n = 51), Lifestyle (LS; n=61), Stress-Reduction GI (SRGI; n = 55), and Lifestyle Behavior GI (LBGI; n = 65). LS group received one nutrition and one physical activity class per week after-school for 12 weeks. SRGI and LBGI groups received same LS classes plus an additional weekly GI session. Salivary cortisol was assessed pre- and post-intervention on 3 days, 3 times daily, at awakening, 30-minutes post-awakening, and in the evening to determine Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS). Perceived Stress Scale (PSS) was administered pre- and post-intervention. Mixed effects modeling was used for intent-to-treat analysis and sensitivity analysis was used for those participants adherent to intervention protocol. Analysis of 208 subjects with complete data showed a small between-group increase in CAR in LBGI vs C (p = 0.045, d=0.24), with no significant group differences among other intervention arms. There were no between group differences in change in DCS or change in PSS after 12-weeks. Amongst adherent participants, LBGI showed a small-moderate increase in CAR (p = 0.03, d=0.37), and moderate-large reduction in PSS (p = 0.02, d=−0.66) compared to C. There were no other between group differences in CAR, DCS, or PSS. LBGI led to an increase in CAR, and in adherent subjects, a decrease in PSS, suggesting GI may be a mind-body intervention that can affect both objective and subjective measures of the stress response. Whether changes in cortisol patterns in this population affect measures of mental or physical health remains to be determined. • Chronic stress and altered salivary cortisol patterns are linked to poor metabolic health outcomes. • Guided imagery lifestyle intervention in adolescents led to changes in salivary cortisol patterns. • These changes may promote health in an adolescent population with known health disparities. [ABSTRACT FROM AUTHOR]

The present work describes a biocomposite with thermal and acoustic insulating properties from agricultural or forestry residues using a steam injection molding technique. The biocomposites showed reasonable thermal insulation properties as judged based on their thermal conductivity, thermal diffusivity, and thermal stability data. The biocomposites had also good sound absorption properties. The dimensional stability of the biocomposites under accelerated weathering conditions was almost ideal. Although the flame retardancy of the biocomposites had rating acceptable to building products, it was yet concluded that for the biocomposites to have a wider market share, their flame-retardant capacity should be improved. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The aim of the study was to develop a simplified emergency trauma score ( SETS) for rating injury severity as well as triaging and predicting mortality in Hong Kong. Background Many existing trauma scoring systems require measurements that are not generally available in emergency settings in Hong Kong. As many of these important measures in the scoring systems are not available before the patients are admitted in the hospitals, it may delay treatment because of the extent of a patient's injury is often not clear at the site of accident or in the emergency settings. Design A retrospective cohort analysis of trauma patients' records from Trauma Registry in Hong Kong was performed. Method Potential significant parameters in predicting mortality were identified by univariate analysis. Binary logistic regression then was used to develop an equation for SETS. Four parameters including age, Glasgow coma scale, respiratory rate and American College of Surgeons ( ACS) mechanism of injury were identified, and the reliability and validity of SETS was assessed. Results At cut-off point of a SETS score of 60, the sensitivity and specificity of SETS were 64% and 98% respectively. The area under receiver operating characteristic curve was 0·939 which was comparable with other commonly used trauma scores. Conclusions SETS should be considered a relevant trauma scoring system in Hong Kong emergency settings. It is suggested that similar scoring systems should be developed in other countries based upon obtainable measures in their corresponding emergency settings. Relevance to clinical practice As a trauma scoring system is closely related to the context of its application, a system that can facilitate accurate sorting of patients into treatment hierarchies should be adopted in the congested emergency settings. [ABSTRACT FROM AUTHOR]

The Cawthron Institute Culture Collection of Micro-algae (CICCM) is a unique, nationally and internationally significant collection of 450 strains of approximately 100 micro-algae and 50 cyanobacteria species, both living and cryopreserved. The collection comprises 13 taxonomic classes and underpins research into the ecology and taxonomy of the isolates and the biotoxins they produce and their toxicity. The CICCM expanded significantly in the 1990s after a major harmful algae bloom event in the Hauraki Gulf, New Zealand. Since 2000, it has underpinned development of molecular detection tools and enabled development of new chemical testing methods for biotoxins in seafood. The tropical collection allows research into potential issues for New Zealand as the oceans warm, for example, the risks of ciguatera fish poisoning and palytoxins in seafood. Research results generated from isolates in the cyanobacterial collection have assisted national risk management regarding drinking water and informed the development of the New Zealand guidelines for managing cyanobacteria in recreational fresh waters. The actual living and cryopreserved micro-algae and cyanobacteria collection (without infrastructure) has a current estimated value of NZ$1.6 million. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose of the study was to investigate left ventricular (LV) subclinical systolic and diastolic dysfunction in childhood-onset systemic lupus erythematosus (c-SLE) patients using two-dimensional speckle-tracking (2DST) echocardiography. We also interrogated possible correlations between impairment of myocardial deformation and the SLE Disease Activity Index 2000 (SLEDAI-2K), as well as the presence of traditional and disease-related cardiovascular risk factors (CRFs). Method: A total of 50 asymptomatic patients and 50 controls (age 14.74 vs. 14.82 years, p = 0.83) were evaluated by standard and 2DST echocardiography. Results: Despite a normal ejection fraction (EF), there was reduction in all parameters of LV longitudinal and radial deformation in patients compared to controls: peak longitudinal systolic strain (PLSS) [−20.3 (−11 to −26) vs. −22 (−17.8 to −30.4)%, p < 0.0001], PLSS rate [−1.19 ± 0.21 vs. −1.3 ± 0.25 s−1, p = 0.0005], longitudinal strain rate in early diastole [1.7 (0.99–2.95) vs. 2 (1.08–3.00) s−1, p = 0.0034], peak radial systolic strain [33.09 ± 8.6 vs. 44.36 ± 8.72%, p < 0.0001], peak radial systolic strain rate [1.98 ± 0.53 vs. 2.49 ± 0.68 s−1, p < 0.0001], and radial strain rate in early diastole [−2.31 ± 0.88 vs. −2.75 ± 0.97 s−1, p = 0.02]. Peak circumferential systolic strain [−23.67 ± 3.46 vs. −24.6 ± 2.86%, p = 0.43] and circumferential strain in early diastole [0.37 ± 0.17 vs. 0.41 ± 0.15, p = 0.27] were similar between patients and controls, although peak circumferential systolic strain rate [−1.5 ± 0.3 vs. −1.6 ± 0.3 s−1, p = 0.036] was reduced in c-SLE. Further analysis of patients revealed a negative correlation between LV PLSS and SLEDAI-2K (r = –0.52, p < 0.0001), and also between LV PLSS and the number of CRFs per patient (r = –0.32, p = 0.024). Conclusions: 2DST echocardiography has identified subclinical LV deformation impairment in c-SLE patients. Disease activity and cumulative exposure to CRFs contribute to myocardial compromise. [ABSTRACT FROM PUBLISHER]

When large volumes of macroalgae wash up on beaches, accumulate in coastal areas or within confined bays, there can be significant local impacts. Blooms of macroalgae are being reported throughout the world with increasing frequency in estuarine and coastal areas in both temperate and tropical regions. This review examines examples of nuisance accumulations of macroalgae in New Zealand, the geographic and seasonal distribution of nuisance algal records, available data on impacts on coastal communities, including impacts on human activities, and considers some of the factors that may lead to excessive growth, as well as attempts to ameliorate the associated problems. [ABSTRACT FROM PUBLISHER]

The article presents a study on the prevalence of depression and the impact of health-seeking behavior among migrant workers in Shenzhen, China. The study background and methodology were discussed and cited the role of healthcare services to manage psychological disorders. Key interventions on management and treatment of depression may include matching health needs and access to care.

Objective Document the clinical features, short- and long-term outcomes and prognostic factors in New World camelids with acquired urethral obstruction. Design Retrospective case study. Methods Case data from medical records of 34 New World camelids presenting with acquired urethral obstruction were collected and follow-up information on discharged patients was obtained. Associations with short- and long-term survival were evaluated using Wilcoxon rank-sum tests, exact-logistic regressions and Kaplan-Meier survival curves. Results Of the 34 New World camelids 23 were intact males and 11 were castrated; 4 animals were euthanased upon presentation, 7 were treated medically and 23 surgically, including urethrotomy, bladder marsupialisation, tube cystostomy alone or combined with urethrotomy, urethrostomy or penile reefing. Necrosis of the distal penis was found in 4 animals and all were short-term non-survivors. Short-term survival for surgical cases was 65%, and 57% for medical cases. Incomplete urethral obstruction at admission and surgical treatment were associated with increased odds of short-term survival. Of 14 records available for long-term follow-up, 6 animals were alive and 8 were dead (median follow-up 4.5 years, median survival time 2.5 years). Recurrence of urethral obstruction was associated with long-term non-survival. Conclusions Surgically treated New World camelids with incomplete urethral obstruction have the best odds of short-term survival and those with recurrence of urethral obstruction have a poor prognosis for long-term survival. [ABSTRACT FROM AUTHOR]

Objective To compare the risk of fetal death on the day of childbirth, with the risk of death at other ages, and with the risks of some hazardous activities, on a common scale of risk per day. Design Review of publicly available data. Setting UK. Sample Data extracted from the Office of National Statistics and other sources. Methods Data from the Office of National Statistics and other sources were used to calculate death rates at different ages expressed as rates per day of life. Death rates for different activities were also calculated as risks per day, or risks per activity, as appropriate. All risks were expressed in micromorts, the number of one in a million chances of dying. Figures on life expectancy ( LE) were used to compare potential life years lost. Main outcome measures Daily, or unit of activity, risk of dying for different activities compared with the risk of dying on the day of childbirth. Results The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year. It is comparable with other apparently more dangerous activities, such as undergoing major surgery. For comparison, the average risk of non-natural death per day and the increased risk from smoking one cigarette or travelling 200 miles by car are all about 1 micromort. Conclusions The lifetime risk of death in childbirth is low, but is concentrated in a short period, making being born a high-risk activity. Parents considering interventions to reduce these risks should be made aware of this. [ABSTRACT FROM AUTHOR]

Strains of the chlorophyte genusDunaliellawere isolated from Dominion Salt NZ Ltd evaporation ponds at Lake Grassmere/Kapara Te Hau, New Zealand. Five halo-tolerant groups were characterised using morphology, molecular phylogenetic analysis and physiological response to varying culture conditions. Species identification based on morphological characteristics of cell size, shape and flagella to cell length ratio was supported by molecular internal transcribed spacer one and two regions (ITS-1, ITS-2) and 5.8S ribosomal RNA gene sequences. Investigations into salinity and photostress response were performed using pulse amplitude modulation (PAM) fluorometry, and high-performance liquid chromatography (HPLC) quantification of pigment profiles with an emphasis on carotenoid production are presented. Cryo-preservation storage was successfully applied to all strains. [ABSTRACT FROM AUTHOR]

Objective To study associations between hyperemesis gravidarum ( HG) and birth outcomes. Design Population-based cohort study. Setting Norway. Sample Singleton births in the Norwegian Birth Registry, 1967-2009 ( n = 2 270 363). Methods Multiple logistic regression was applied to study associations between HG and dichotomous outcomes; multiple linear regression to study associations between HG, birthweight and gestational length. Generalised estimating equations were applied to obtain valid standard errors. Sub-analysis on data with available information on smoking was conducted (1999-2009). Main outcome measures Small and large for gestational age ( SGA/ LGA), Apgar score after 5 minutes, very preterm and preterm birth ( VPTB/ PTB), perinatal death, stillbirth, neonatal death, birthweight and gestational length. Results No associations between HG and adverse pregnancy outcomes were observed in crude analyses, except for VPTB (odds ratio [ OR] 0.79, 95% CI 0.67-0.93). In adjusted analysis, HG was associated with perinatal death ( OR 1.27, 95% CI 1.08-1.48). Inverse associations were observed between HG and VPTB ( OR 0.80, 95% CI 0.68-0.94) and LGA ( OR 0.95, 95% CI 0.90-0.99). Sub-analyses showed no associations between HG and perinatal death ( OR 1.29, 95% CI 0.91-1.83). The inverse associations between HG, VPTB and LGA were strengthened ( OR 0.66, 95% CI, 0.48-0.91 and OR 0.86, 95% CI 0.79-0.93, respectively). Exposed babies had reduced birthweight and gestational length compared with unexposed, adjusted difference − 21.4 g and − 0.5 days, respectively. Adjustment for smoking slightly strengthened the impact of HG on birthweight. Conclusions Inverse associations for HG and VPTB and LGA were observed. HG was associated with slight reductions in birthweight and gestational age. [ABSTRACT FROM AUTHOR]

Anophthalmia/microphthalmia (A/M) represent severe developmental ocular malformations. Currently, mutations in known genes explain less than 40% of A/M cases. We performed whole-genome copy number variation analysis in 60 patients affected with isolated or syndromic A/M. Pathogenic deletions of 3q26 ( SOX2) were identified in four independent patients with syndromic microphthalmia. Other variants of interest included regions with a known role in human disease (likely pathogenic) as well as novel rearrangements (uncertain significance). A 2.2-Mb duplication of 3q29 in a patient with non-syndromic anophthalmia and an 877-kb duplication of 11p13 ( PAX6) and a 1.4-Mb deletion of 17q11.2 ( NF1) in two independent probands with syndromic microphthalmia and other ocular defects were identified; while ocular anomalies have been previously associated with 3q29 duplications, PAX6 duplications, and NF1 mutations in some cases, the ocular phenotypes observed here are more severe than previously reported. Three novel regions of possible interest included a 2q14.2 duplication which cosegregated with microphthalmia/microcornea and congenital cataracts in one family, and 2q21 and 15q26 duplications in two additional cases; each of these regions contains genes that are active during vertebrate ocular development. Overall, this study identified causative copy number mutations and regions with a possible role in ocular disease in 17% of A/M cases. [ABSTRACT FROM AUTHOR]

Contents Technical advances and development in the market for genomic tools have facilitated access to whole-genome data across species. Building-up on the acquired knowledge of the genome sequences, large-scale genotyping has been optimized for broad use, so genotype information can be routinely used to predict genetic merit. Genomic selection ( GS) refers to the use of aggregates of estimated marker effects as predictors which allow improved individual differentiation at young age. Realizable benefits of GS are influenced by several factors and vary in quantity and quality between species. General characteristics and challenges of GS in implementation and routine application are described, followed by an overview over the current status of its use, prospects and challenges in important animal species. Genetic gain for a particular trait can be enhanced by shortening of the generation interval, increased selection accuracy and increased selection intensity, with species- and breed-specific relevance of the determinants. Reliable predictions based on genetic marker effects require assembly of a reference for linking of phenotype and genotype data to allow estimation and regular re-estimation. Experiences from dairy breeding have shown that international collaboration can set the course for fast and successful implementation of innovative selection tools, so genomics may significantly impact the structures of future breeding and breeding programmes. Traits of great and increasing importance, which were difficult to improve in the conventional systems, could be emphasized, if continuous availability of high-quality phenotype data can be assured. Equally elaborate strategies for genotyping and phenotyping will allow tailored approaches to balance efficient animal production, sustainability, animal health and welfare in future. [ABSTRACT FROM AUTHOR]

The assessment of biological samples is critical for measuring the ‘health’ of New Zealand aquatic environments. Analysis of these samples commonly requires species identification and enumeration, which usually involves microscopy or microbiological methods. These techniques can be time-consuming, laborious, and are dependent on taxonomic expertise. Recent advances in molecular methods provide promising tools for assessing environmental samples. A range of molecular techniques are now used in New Zealand including: fluorescent in situ hybridisation; automated ribosomal intergenic spacer analysis; quantitative polymerase chain reaction; and, most recently, next-generation sequencing. The organisms (or targets) and environments monitored are equally diverse, ranging from cyanobacteria, rotifers and invasive fish in lakes, to macroinvertebrates, and biofilm communities in rivers, to bacteria, micro- and macro-algae and invertebrates in marine ecosystems. Despite research and validation demonstrating their potential, the application of these tools by monitoring agencies has been limited. Legislative requirements, costs, and a reluctance to change methodologies, are the most likely reasons for this. This review examines molecular tools that have been previously or are currently used for monitoring aquatic environments in New Zealand, and explores how these, and new techniques, may be applied in the future. [ABSTRACT FROM PUBLISHER]

The pregnancy-lactation cycle (PLC) is a period in which the breast is transformed from a less-developed, nonfunctional organ into a mature, milk-producing gland that has evolved to meet the nutritional, developmental, and immune protection needs of the newborn. Cessation of lactation initiates a process whereby the breast reverts to a resting state until the next pregnancy. Changes during this period permanently alter the morphology and molecular characteristics of the breast (molecular histology) and produce important, yet poorly understood, effects on breast cancer risk. To provide a state-of-the-science summary of this topic, the National Cancer Institute invited a multidisciplinary group of experts to participate in a workshop in Rockville, Maryland, on March 2, 2012. Topics discussed included: 1) the epidemiology of the PLC in relation to breast cancer risk, 2) breast milk as a biospecimen for molecular epidemiological and translational research, and 3) use of animal models to gain mechanistic insights into the effects of the PLC on breast carcinogenesis. This report summarizes conclusions of the workshop, proposes avenues for future research on the PLC and its relationship with breast cancer risk, and identifies opportunities to translate this knowledge to improve breast cancer outcomes. [ABSTRACT FROM AUTHOR]

Study Question: Do higher leptin levels and lower adiponectin levels predict subsequent development of endometriosis?Summary Answer: Plasma leptin and adiponectin levels were not associated with laparoscopically confirmed endometriosis when collected prior to disease diagnosis.What Is Known Already: Case-control studies have identified altered levels of the inflammatory adipokines leptin and adiponectin in women with endometriosis, but it remains unclear whether inflammation results in endometriosis or whether the presence of endometriosis creates an inflammatory state.Study Design, Size, Duration: Nested, matched, case-control study within the prospective Nurses' Health Study II (NHS II) cohort. Blood samples were collected between 1996 and 1999 from 29 611 female nurses within the cohort. Women who reported endometriosis before blood collection were excluded.Participants/materials, Setting, Methods: Plasma leptin and adiponectin levels were assayed by ELISA. Three hundred and fifty cases of laparoscopically confirmed endometriosis were matched 1:2 with 694 controls of comparable race, age, infertility history, menopausal status and time of blood draw. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression models adjusting for matching factors and BMI.Main Results and the Role Of Chance: After adjusting for BMI, there were no statistically significant associations between endometriosis and leptin [RR = 1.2; 95% CI = 0.7-2.0; P-value, test for linear trend (P(trend)) = 0.72], adiponectin (RR = 0.8; 95% CI = 0.5-1.2; P(trend) = 0.48) or the leptin to adiponectin ratio (RR = 0.8; 95% CI = 0.4-1.4; P(trend) = 0.14) when comparing the upper with the lower quartile. Results were unaltered when analyses were stratified by BMI or restricted to cases diagnosed ≥ 4 years after blood draw. To evaluate statistical significance and limit the role of chance to the gold standard of 5%, we present 95% CIs about the RRs, and for P-values calculated for linear tests of trend and tests of heterogeneity, we have set the α-level to be 0.05 (i.e. <0.05 is considered to be statistically significant).Limitations and Reasons For Caution: A limitation of this study is the inability to differentiate the time of endometriosis 'diagnosis' from the time of disease 'onset' due to the impossibility in identifying a precise time point at which the disease process was first initiated at a molecular or cellular level. Additional limitations include lack of information regarding stage of endometriosis and the possibility of asymptomatic disease in the control population.Wider Implications Of the Findings: The mean age at diagnosis of endometriosis in the study population is 41.7, ≈ 10 years older than the mean age of diagnosis in the general population. While this may limit the generalizability of the results, there is no reason to suspect that the association between adipokines and endometriosis risk should differ at a younger age of diagnosis in an adult population. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Yu Y, Hanssen K, Kalyanaraman V, Chirindel A, Jenkins A, Nankervis A, Torjesen P, Scholz H, Henriksen T, Lorentzen B, Garg S, Menard M, Hammad S, Scardo J, Stanley J, Wu M, Basu A, Aston C, Lyons T. Reduced soluble receptor for advanced glycation end-products (sRAGE) scavenger capacity precedes pre-eclampsia in Type 1 diabetes. BJOG 2012;119:1512-1520. Objective Increased advanced glycation end-products (AGEs) and their soluble receptors (sRAGE) have been implicated in the pathogenesis of pre-eclampsia (PE). However, this association has not been elucidated in pregnancies complicated by diabetes. We aimed to investigate the serum levels of these factors in pregnant women with Type 1 diabetes mellitus (T1DM), a condition associated with a four-fold increase in PE. Design Prospective study in women with T1DM at 12.2 ± 1.9, 21.6 ± 1.5 and 31.5 ± 1.7 weeks of gestation [mean ± standard deviation (SD); no overlap] before PE onset. Setting Antenatal clinics. Population Pregnant women with T1DM ( n = 118; 26 developed PE) and healthy nondiabetic pregnant controls ( n = 21). Methods Maternal serum levels of sRAGE (total circulating pool), Nε-(carboxymethyl)lysine (CML), hydroimidazolone (methylglyoxal-modified proteins) and total AGEs were measured by immunoassays. Main outcome measures Serum sRAGE and AGEs in pregnant women with T1DM who subsequently developed PE (DM PE+) versus those who remained normotensive (DM PE−). Results In DM PE+ versus DM PE−, sRAGE was significantly lower in the first and second trimesters, prior to the clinical manifestation of PE ( P < 0.05). Further, reflecting the net sRAGE scavenger capacity, sRAGE:hydroimidazolone was significantly lower in the second trimester ( P < 0.05) and sRAGE:AGE and sRAGE:CML tended to be lower in the first trimester ( P < 0.1) in women with T1DM who subsequently developed PE versus those who did not. These conclusions persisted after adjusting for prandial status, glycated haemoglobin (HbA1c), duration of diabetes, parity and mean arterial pressure as covariates. Conclusions In the early stages of pregnancy, lower circulating sRAGE levels, and the ratio of sRAGE to AGEs, may be associated with the subsequent development of PE in women with T1DM. [ABSTRACT FROM AUTHOR]

The KEMRI/Centers for Disease Control and Prevention (CDC) Health and Demographic Surveillance System (HDSS) is located in Rarieda, Siaya and Gem Districts (Siaya County), lying northeast of Lake Victoria in Nyanza Province, western Kenya. The KEMRI/CDC HDSS, with approximately 220 000 inhabitants, has been the foundation for a variety of studies, including evaluations of insecticide-treated bed nets, burden of diarrhoeal disease and tuberculosis, malaria parasitaemia and anaemia, treatment strategies and immunological correlates of malaria infection, and numerous HIV, tuberculosis, malaria and diarrhoeal disease treatment and vaccine efficacy and effectiveness trials for more than a decade. Current studies include operations research to measure the uptake and effectiveness of the programmatic implementation of integrated malaria control strategies, HIV services, newly introduced vaccines and clinical trials. The HDSS provides general demographic and health information (such as population age structure and density, fertility rates, birth and death rates, in- and out-migrations, patterns of health care access and utilization and the local economics of health care) as well as disease- or intervention-specific information. The HDSS also collects verbal autopsy information on all deaths. Studies take advantage of the sampling frame inherent in the HDSS, whether at individual, household/compound or neighbourhood level. [ABSTRACT FROM AUTHOR]

Leucine-rich repeat kinase 2 (LRRK2, PARK8) gene has attracted considerable attention since the variants in this gene are recognized as the most common cause of Parkinson's disease (PD) so far. A number of association studies concerning variants of LRRK2 gene and PD susceptibility have been conducted in various populations. However, some results were inconclusive. To derive a more precise estimation of the relationship between LRRK2 and genetic risk of PD, we performed a comprehensive meta-analysis which included 27,363 cases and 29,741 controls from 61 published case-control studies. Totally, the effect of five LRRK2 variants all within the coding regions, i.e. G2019S, G2385R, R1628P, P755L and A419V, were evaluated in the meta-analysis using fixed effect model or random effects model if heterogeneity existed. There were genetic associations between four variants (G2019S, G2385R, R1628P and A419V) and increased PD risk, while there was no evidence of statistically significant association between P755L and PD. Publication bias and heterogeneity were absent in most analyses. Within its limitations, this meta-analysis demonstrated that the G2019S, G2385R, R1628P and A419V variations are risk factors associated with increased PD susceptibility. However, these associations vary in different ethnicities. [ABSTRACT FROM AUTHOR]

Newton KF, Mallinson EKL, Bowen J, Lalloo F, Clancy T, Hill J, Evans DGR. Genotype-phenotype correlation in colorectal polyposis. Familial adenomatous polyposis (FAP) has been divided into three clinical subtypes: mild, classical and severe. This study aimed to investigate for a correlation between genotype and phenotype. A codon-specific survival difference is unknown. A retrospective longitudinal study of 492 patients on the Manchester Polyposis Registry was conducted. Patients were grouped according to genotypes: 0, unknown mutation; 1, adenomatous polyposis coli ( APC) 0-178 (and 312-412 of exon 9); 2, APC >1550; 3, APC 179-1249; 4, APC 1250-1549; and 5, MutYH. Date of onset of polyposis, incidence of colorectal cancer (CRC), survival and actuarial time to surgery were calculated. Median age of onset of polyposis for genotype 0 was 20.3 years, genotype 1 35.6 years, genotype 2 32.2, genotype 3 15.9 years, and genotype 4 14.8 years (p < 0.0001). Age of onset of CRC was similar between genotypes. Median survival for genotype 0 was 56.6 years, genotype 1 74.9 years, genotype 2 61.0 years, genotype 3 63.0 years, genotype 4 48.1 years, and genotype 5 69.7 years (p = 0.003). This survival difference was also seen when patients who underwent screening and those who did not were analysed separately. Survival in the screened population was 53.9 years in genotype 4 and 72.9 years in genotype 3. Patients with genotype 4 ( APC 1249-1549) have a significantly worse survival despite screening and early prophylactic surgery. This analysis supports a genotype-phenotype correlation. Patients with a mutation APC 1249-1549 develop polyposis at an early age and have a worse survival. Patients with a mutation APC 0-178 or 312-412 develop polyposis later and have an improved survival. This survival difference has not previously been documented. [ABSTRACT FROM AUTHOR]

BACKGROUND: The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome. METHODS AND RESULTS: From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment-elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke. CONCLUSIONS: Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing. [ABSTRACT FROM AUTHOR]

Background: Sepsis impairs hypoxic pulmonary vasoconstriction (HPV) in patients and animal models, contributing to systemic hypoxemia. Concentrations of cysteinyl leukotrienes are increased in the bronchoalveolar lavage fluid of patients with sepsis, but the contribution of cysteinyl leukotrienes to the impairment of HPV is unknown.Methods: Wild-type mice, mice deficient in leukotriene C(4) synthase, the enzyme responsible for cysteinyl leukotriene synthesis, and mice deficient in cysteinyl leukotriene receptor 1 were studied 18 h after challenge with either saline or endotoxin. HPV was measured by the increase in left pulmonary vascular resistance induced by left mainstem bronchus occlusion. Concentrations of cysteinyl leukotrienes were determined in the bronchoalveolar lavage fluid.Results: In the bronchoalveolar lavage fluid of all three strains, cysteinyl leukotrienes were not detectable after saline challenge; whereas endotoxin challenge increased cysteinyl leukotriene concentrations in wild-type mice and mice deficient in cysteinyl leukotriene receptor 1, but not in mice deficient in leukotriene C(4) synthase. HPV did not differ among the three mouse strains after saline challenge (120 ± 26, 114 ± 16, and 115 ± 24%, respectively; mean ± SD). Endotoxin challenge markedly impaired HPV in wild-type mice (41 ± 20%) but only marginally in mice deficient in leukotriene C(4) synthase (96 ± 16%, P < 0.05 vs. wild-type mice), thereby preserving systemic oxygenation. Although endotoxin modestly decreased HPV in mice deficient in cysteinyl leukotriene receptor 1 (80 ± 29%, P < 0.05 vs. saline challenge), the magnitude of impairment was markedly less than in endotoxin-challenged wild-type mice.Conclusion: Cysteinyl leukotrienes importantly contribute to endotoxin-induced impairment of HPV in part via a cysteinyl leukotriene receptor 1-dependent mechanism. [ABSTRACT FROM AUTHOR]

Abstract Recently, a peak at 1.28 ppm in proton magnetic resonance spectroscopy ((1)H-MRS) of neural stem cells (NSCs) was introduced as a noninterventional biomarker for neurogenesis in vivo. This would be an urgently needed requisite for translational studies in humans regarding the beneficial role of adult neurogenesis for the structural and functional integrity of the brain. However, many concerns have risen about the validity of the proposed signal as a specific marker for NSCs. The peak has also been related to cell-type-independent phenomena such as apoptosis or necrosis. Thus, we compared the 1.28-ppm peak in various immature stem cell populations, including embryonic stem cells, mouse embryonic fibroblasts, embryonic stem cell- and induced pluripotent stem cell-derived NSCs, ex vivo isolated embryonic NSCs, as well as mature and tumor cell types from different germ layers. To correlate the integral peak intensity with cell death, we induced both apoptosis with camptothecin and necrosis with sodium azide. A peak at 1.28 ppm was found in most cell types, and in most, but not all, NSCH cultures, demonstrating no specificity for NSCs. The intensities of the 1.28-ppm resonance significantly correlated with the rate of apoptosis, but not with the rate of necrosis, cell cycle phase distribution, cell size, or type. Multiple regression analysis displayed a significant predictive value of the peak intensity for apoptosis only. In this context, its specificity for apoptosis as a major selection process during neurogenesis may suggest this resonance as an indirect marker for neurogenesis in vivo. [ABSTRACT FROM AUTHOR]

Objectives: We sought to determine whether the amount of noncalcified plaque (NCP) in nonobstructive coronary lesions as detected by multidetector computed tomography (MDCT) was a predictor of future coronary events. Background: Patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) frequently have multiple coronary plaques, which may be detected with MDCT. Methods: We included 312 consecutive patients presenting with NSTEMI, who underwent 64-slice MDCT coronary angiography and coronary artery calcium scoring before invasive coronary angiography. All patients were treated according to current guidelines based on an invasive treatment approach. Quantitative measurements of plaque composition and volume were performed by MDCT in all nonobstructive coronary lesions. The endpoint was cardiac death, acute coronary syndrome, or symptom-driven revascularization. Results: After a median follow-up of 16 months, 23 patients had suffered a cardiac event. Age, male sex, and diabetes mellitus were all associated with an increasing amount of NCP. In a multivariate regression analysis for events, the total amount of NCP in nonobstructive lesions was independently associated with an increased hazard ratio (1.18/100-mm(3) plaque volume increase, p = 0.01). Contrary to this, neither Agatston score nor the amount of calcium in nonobstructive lesions was associated with an increased risk. Conclusions: Multidetector computed tomography plaque imaging identified patients at increased risk of recurrent coronary events after NSTEMI by measuring the total amount of NCP in nonobstructive lesions. The amount of calcified plaque was not associated with an increased risk. [ABSTRACT FROM AUTHOR]