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Myocardial injury after non-cardiac surgery (MINS) is associated with increased morbidity and mortality. It is diagnosed by a perioperative increase in serum troponin levels. However, there is a debate about whether MINS is a genuine myocardial insult or merely a subtle increase in biomarkers. Therefore, we performed post-operative cardiovascular magnetic resonance imaging (CMR) in patients undergoing major non-cardiac surgery to assess if there is an association between troponin defined MINS and acute myocardial injury detected by CMR. In this preliminary report we included six patients from an ongoing clinical trial that investigates MINS. All patients underwent major vascular surgery and were considered to have a high risk for perioperative cardiovascular complications, because of either established coronary artery disease or at least two risk factors for coronary artery disease. In accordance with the study protocol, high-sensitivity troponin T serum levels (hsTnT) were obtained preoperatively, 2h and 24h post-surgery. The diagnostic criteria for MINS were subsequently applied. A CMR scan was acquired postoperatively. The CMRs were either clinically indicated or patients consented to undergo imaging as an additional voluntary sub-study protocol. During the CMR examination standard T2 maps were acquired in both short-axis and long axis views of the heart. A T2 time under 41ms, was considered normal. This cut-off is based on healthy controls older than 50 years of age. T2 times below the cut-off indicate normal myocardial water content whereas T2 times exceeding 41ms indicate myocardial oedema and consequently acute myocardial injury. Six patients, all male and aged between 60-84 years scheduled for aortic surgery, were included in this preliminary report. Two patients had perioperative hsTnT levels that did not meet the MINS definition while four patients were diagnosed with MINS. Subsequent CMR imaging was performed a median of six days postoperatively (IQR:6-13). The two patients without MINS exhibited a global T2 time below the 41ms cut-off indicative of normal myocardial water content. In contrast, all patients with MINS had a higher global T2 time indicating myocardial oedema and consequently acute myocardial injury. A significant correlation was observed between the T2 time and the increase in hsTnT from the preoperative baseline (r=0.84, p= 0.04). The regional differences in T2 time alterations could be impressively visualized in colour-graded myocardial T2. Furthermore, one patient underwent a subsequent clinically indicated coronary angiogram revealing significant stenoses of coronary arteries in the areas with the highest T2 times in the preceding myocardial T2 maps. This finding is suggestive of the culprit of the T2 alteration being a potential perioperative supply and demand mismatch of the myocardium. To our knowledge, this is the first time that CMR imaging has been used to visualise and quantify acute myocardial injury related to MINS. Substantial myocardial oedema was discovered to be present in association with MINS detected by hsTnT. We aim to provide further imaging insights into the pathophysiology of MINS, the quantification of myocardial impact, its correlation to biomarkers, and factors contributing to MINS with ongoing studies and more patients undergoing postoperative CMR imaging. [ABSTRACT FROM AUTHOR]

Beart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality. However, shortfalls in prescribing of proven therapies, particularly mineralocorticoid receptor antagonist (MRA) therapy, account for several thousand preventable deaths per year nationwide. Electronic clinical decision support (CDS) is a potential low-cost and scalable solution to improve prescribing of therapies. However, the optimal timing and format of CDS tools is unknown. We developed two targeted CDS tools to inform cardiologists of gaps in MRA therapy for patients with HFrEF and without contraindication to MRA therapy: (1) an alert that notifies cardiologists at the time of patient visit, and (2) an automated electronic message that allows for review between visits. We designed these tools using an established CDS framework and findings from semistructured interviews with cardiologists. We then pilot tested both CDS tools (n = 596 patients) and further enhanced them based on additional semistructured interviews (n = 11 cardiologists). The message was modified to reduce the number of patients listed, include future visits, and list date of next visit. The alert was modified to improve noticeability, reduce extraneous information on guidelines, and include key information on contraindications. The BETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce CArdiovascular REcommendations for Heart Failure) trial aims to compare the effectiveness of the alert vs. the automated message vs. usual care on the primary outcome of MRA prescribing. To our knowledge, no study has directly compared the efficacy of these two different types of electronic CDS interventions. If effective, our findings can be rapidly disseminated to improve morbidity and mortality for patients with HFrEF, and can also inform the development of future CDS interventions for other disease states. (Trial registration: Clinicaltrials.gov NCT05275920). [ABSTRACT FROM AUTHOR]

Low birth weight (BW) is associated with increased corneal aberrations in childhood and alterations of corneal geometry in adulthood. Increased corneal aberrations may be a factor contributing to decreased visual function in former low BW newborns in later life. Hence, the aim of this study was to analyze the long-term effect of low BW on corneal aberrations in adulthood. In the German population-based Gutenberg Health Study (GHS) participants (age: 40–80 years) were examined with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany). The relationship between self-reported BW and the different types of corneal aberrations was analyzed using linear regression analysis as uni- and multivariable analysis with adjustment for potential confounders. The main outcome measures were corneal aberrations defined as astigmatism (Z 2 −2; Z 2 2), coma (Z 3 −1; Z 3 1), trefoil (Z 3 −3; Z 3 3), spherical aberration (Z 4 0) and root-mean square of higher order aberrations (HOA; 3rd up to 8th order; aperture size: 6 mm). Overall, 5,628 participants were included in this analysis (3,004 women, aged 56.0 +/- 10.3 years). In a multivariable analysis lower BW was associated with decreased horizontal trefoil (B = 0.004 [0.001; 0.006] µm/500 g; p =.008); higher spherical aberrations (B =-0.006 [-0.008;-0.003] µm/500 g; p <.001), higher RMS (B =-0.028 [-0.042;-0.014] µm/500 g; p <.001), increased HOA (B =-0.007 [-0.010;-0.003] µm/500 g; p <.001) and increased LOA (B =-0.027 [-0.041;-0.013] µm/500 g; p <.001). No association was observed between birth weight and the other types of corneal aberrations in multivariable model. Our results indicate an association between BW and spherical aberration in adults aged 40 to 80 years. This indicates that low BW may have an association with an altered corneal shape development which may affect optical image quality and, hence, visual function. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jenvman.2007.04.010 Byline: Pamela L. Nagler (a), Edward P. Glenn (b), Osvel Hinojosa-Huerta (c), Francisco Zamora (d), Keith Howard (e) Keywords: Desert river; Cottonwood; Willow; Saltcedar; Estuary; Remote sensing Abstract: Like other great desert rivers, the Colorado River in the United States and Mexico is highly regulated to provide water for human use. No water is officially allotted to support the natural ecosystems in the delta of the river in Mexico. However, precipitation is inherently variable in this watershed, and from 1981-2004, 15% of the mean annual flow of the Lower Colorado River has entered the riparian corridor below the last diversion point for water in Mexico. These flows include flood releases from US dams and much smaller administrative spills released back to the river from irrigators in the US and Mexico. These flows have germinated new cohorts of native cottonwood and willow trees and have established an active aquatic ecosystem in the riparian corridor in Mexico. We used ground and remote-sensing methods to determine the composition and fractional cover of the vegetation in the riparian corridor, its annual water consumption, and the sources of water that support the ecosystem. The study covered the period 2000-2004, a flood year followed by 4 dry years. The riparian corridor occupies 30,000ha between flood control levees in Mexico. Annual evapotranspiration (ET), estimated by Moderate Resolution Imaging Spectrometer (MODIS) satellite imagery calibrated against moisture flux tower data, was about 1.1myr.sup.-1 and was fairly constant throughout the study period despite a paucity of surface flows 2001-2004. Total ET averaged 3.4x10.sup.8 m.sup.3 yr.sup.-1, about 15% of Colorado River water entering Mexico from the US Surface flows could have played only a small part in supporting these high ET losses. We conclude that the riparian ET is supported mainly by the shallow regional aquifer, derived from agricultural return flows, that approaches the surface in the riparian zone. Nevertheless, surface flows are important in germinating cohorts of native trees, in washing salts from the soil and aquifer, and in providing aquatic habitat, thereby enriching the habitat value of the riparian corridor for birds and other wildlife. Conservation and water management strategies to enhance the delta habitats are discussed in light of the findings. Author Affiliation: (a) US Geological Survey, Southwest Biological Science Center, Sonoran Desert Research Station, BioSciences East Building, Room 125, University of Arizona, Tucson, AZ 85721, USA (b) University of Arizona, Soil, Water and Environmental Science Department, Environmental Research Laboratory, Tucson, AZ 85706, USA (c) University of Arizona, School of Natural Resources, Tucson, AZ 85721, USA (d) Sonoran Institute, Tucson, AZ 85711, USA (e) US Geological Survey, MS 973, Menlo Park, CA 94025, USA Article History: Received 26 June 2006; Revised 23 March 2007; Accepted 21 April 2007