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Objective: People living with HIV (PLWH) are at increased risk for cardiac dysfunction. It is unknown how their global longitudinal cardiac function, cardiac structure, and other indices of function progress over time. We aimed to characterize the longitudinal trend in cardiac structure and function in PLWH. Design: Retrospective study of PLWH with clinically obtained echocardiograms at an academic medical center. Methods: We reviewed archived transthoracic echocardiograms (TTEs) performed between 2001 and 2012 on PLWH. The primary outcome measures were progression of global longitudinal strain (GLS, left and right ventricles), LV mass, E/e′ ratio, LV end‐systolic, and ‐diastolic volumes using hierarchical mixed model analysis as a function of CD4+ T cell count and HIV RNA suppression. Models were adjusted for clinical and demographic characteristics. Results: We analyzed 469 TTEs from 150 individuals (median age 46 years, 58% male). Median CD4+ T cell counts at nadir and proximal to first echocardiogram were 85 and 222 cells/mm3, respectively. Over a median of 5 years, LV mass index increased regardless of nadir or proximal CD4+ T cell count or viral suppression status. PLWH with viral suppression at baseline had more normal GLS throughout the follow‐up period. There were no significant trends in LV end‐systolic volume index or E/e′. Conclusions: In PLWH, HIV viral suppression is associated with early gains in echocardiographic indices of cardiac function that persist for up to >5 years. HIV disease control impacts routine echocardiographic measures with known impacts on long‐term prognosis. [ABSTRACT FROM AUTHOR]

Aims: Non-cardiac comorbidities are highly prevalent in patients with heart failure (HF). Our objective was to define the association between non-cardiac comorbidity burden and clinical outcomes, costs of care, and length of stay within a large randomized trial of acute HF patients.Methods and Results: Patients with complete medical history for the following comorbidities were included: diabetes mellitus, chronic obstructive pulmonary disease, chronic liver disease, history of cancer within the last 5 years, chronic renal disease (baseline serum creatinine >3.0 mg/mL), current smoking, alcohol abuse, depression, anaemia, peripheral arterial disease, and cerebrovascular disease. Patients were classified by overall burden of non-cardiac comorbidities (0, 1, 2, 3, and 4+). Hierarchical generalized linear models were used to assess associations between comorbidity burden and 30-day all-cause death or HF hospitalization and 180-day all-cause death in addition to costs of care and length of stay. A total of 6945 patients were included in the final analysis. Mean comorbidity number was 2.2 (± 1.34). Patients with 4+ comorbidities had higher rates of 30-day all-cause death/HF hospitalization as compared with patients with no comorbidities [odds ratio (OR) 3.32, 95% confidence interval (CI) 1.61-6.84; P < 0.01]. Similar results were seen with respect to 180-day death (OR 2.13, 95% CI 1.33-3.43; P < 0.01). Higher comorbidity burden was associated with higher 180-day costs of care and length of stay.Conclusions: Higher comorbidity burden is associated with poor clinical outcomes, higher costs of care, and extended length of stay. Further studies are needed to define the impact of comorbidity management programmes on outcomes for HF patients. [ABSTRACT FROM AUTHOR]

Aims: Patients hospitalized for heart failure (HF) are at high risk for 30-day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization.Methods and Results: Timing and cause of readmission in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial were assessed. Early and late readmissions were defined as admissions occurring within 0-7 days and 8-30 days post-discharge, respectively. Patients who died in hospital or remained hospitalized at day 30 post-randomization were excluded. Patients were compared by timing and cause of readmission. Logistic and Cox proportional hazards regression analyses were used to identify independent risk factors for early vs. late readmission and associations with 180-day outcomes. Of the 6584 patients (92%) in the ASCEND-HF population included in this analysis, 751 patients (11%) were readmitted within 30 days for any cause. Overall, 54% of readmissions were for non-HF causes. The median time to rehospitalization was 11 days (interquartile range: 6-18 days) and 33% of rehospitalizations occurred by day 7. Rehospitalization within 30 days was independently associated with increased risk for 180-day all-cause death [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.93-2.94; P < 0.001]. Risk for 180-day all-cause death did not differ according to early vs. late readmission (HR 0.99, 95% CI 0.67-1.45; P = 0.94).Conclusions: In this hospitalized HF trial population, a significant majority of 30-day readmissions were for non-HF causes and one-third of readmissions occurred in the first 7 days. Early and late readmissions within the 30-day timeframe were associated with similarly increased risk for death. Continued efforts to optimize multidisciplinary transitional care are warranted to improve rates of early readmission. [ABSTRACT FROM AUTHOR]

Background& Purpose: Abnormalities in apparent diffusion coefficient (ADC), fractional anisotropy (FA), and mean diffusivity (MD) values can be used to assess microstructural damage to white matter tracts and could represent a quantitative marker of chronic ischemia and thereby potentially serve as a stroke risk factor or a measure of existing subclinical ischemic disease burden. We performed a systematic review and 3 separate meta-analyses to evaluate the association between unilateral carotid steno-occlusion and ipsilateral ADC, FA, or MD abnormality.Materials& Methods: A comprehensive literature search evaluating the association of carotid disease and quantitative white matter diffusion imaging was performed. The included studies examined patients for ADC, FA, and MD values ipsilateral and contralateral to the site of carotid artery disease. Three meta-analyses using standardized mean differences with assessment of study heterogeneity were performed.Results: Of the 2,920 manuscripts screened, 6 met eligibility for meta-analysis. Of the included manuscripts, 2 studied ADC values, 6 studied FA values, and 2 studied MD values. Our 3 meta-analyses showed standardized mean difference for ADC, FA, and MD values between cerebral hemispheres ipsilateral and contralateral to carotid artery disease site as 1.13 (95% CI: .79-1.47, P < .001), -.42 (95% CI: -.62 to -.21, P < .001), and .23 (95% CI: -.32 to -.77, P = .41), respectively. Measures of heterogeneity showed mild heterogeneity in the 3 meta-analyses.Conclusion: Carotid artery disease is associated with significant ADC and FA value changes, suggesting that carotid disease is associated with quantifiable white matter microstructural damage. [ABSTRACT FROM AUTHOR]

Aims: We aimed to characterize abnormal liver function tests in patients with heart failure (HF), as they are commonly encountered yet poorly defined.Methods and Results: We used data from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) to characterize associations with baseline liver function tests (LFTs). Each LFT was analysed as both a continuous and dichotomous variable [normal vs. abnormal; bilirubin >1.0 mg/dL; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) >35 mmol/L]. Logistic regression assessed the association of LFTs and 30-day all-cause mortality and HF rehospitalization, and Cox proportional hazards assessed the association with 180-day all-cause mortality among patients alive at a 30-day landmark. In ASCEND-HF, 4228 (59%) had complete admission LFT data. Of these, 42% had abnormal bilirubin, 22% had abnormal ALT, and 30% had abnormal AST. Patients with abnormal LFTs were younger, had lower body mass index, and lower left ventricular ejection fraction. In multivariable models, increased total bilirubin was associated with increased 30-day mortality or HF rehospitalization [hazard ratio (HR) 1.17 per 1 mg/dL increase, 95% confidence interval (CI) 1.04, 1.32; P = 0.012], but not with an increase in 180-day mortality (HR 1.10, 95% CI 0.97, 1.25; P = 0.13) per 1 mg/dl increase. Compared with normal bilirubin levels, abnormal bilirubin was associated with increased 30-day mortality or HF rehospitalization (HR 1.24, 95% CI 1.00, 1.54; P = 0.048) and 180-day mortality (HR 1.32, 95% CI 1.08, 1.62; P = 0.007). We found no association with AST or ALT and outcomes.Conclusion: Greater than 40% of patients hospitalized with acute HF had abnormal LFTs. After multivariable adjustment, only elevated bilirubin was independently associated with worse clinical outcomes and may represent an important prognostic variable. [ABSTRACT FROM AUTHOR]

Aims: A longitudinal and comprehensive analysis of health-related quality of life (HRQOL) was performed during hospitalization for heart failure (HF) or soon after discharge.Methods and Results: A post-hoc analysis was performed of the ASCEND-HF trial. The EuroQOL five dimensions questionnaire (EQ-5D) was administered to study participants at baseline, 24 h, discharge/day 10, and day 30. EQ-5D includes functional dimensions mapped to corresponding utility scores (i.e. 0 = death and 1 = perfect health), and a visual analogue scale (VAS) ranging from 0 (i.e. 'worst imaginable health state') to 100 (i.e. 'best imaginable health state'). The association between baseline and discharge EQ-5D measurements and subsequent clinical outcomes including death and rehospitalization were assessed using multivariable logistic regression and Cox proportional hazards regression. A total of 6943 patients (97%) had complete EQ-5D data at baseline. Mapped utility and VAS scores (mean ± SD) increased over time, respectively, from 0.56 ± 0.23 and 45 ± 22 at baseline to 0.67 ± 0.26 and 58 ± 22 at 24 h and to 0.79 ± 0.20 and 68 ± 22 at discharge, and remained stable at day 30. Lower mapped utility scores at baseline [odds ratio (OR) per 0.1 decrease in utility score 1.03, 95% confidence interval (CI) 1.00-1.06] and discharge (OR 1.10, 95% CI 1.05-1.15) and VAS scores at baseline (OR per 10 point decrease 1.05, 95% CI 1.01-1.09) were significantly associated with increased risk of 30-day all-cause death or HF rehospitalization.Conclusions: Patients hospitalized for HF had severely impaired health status at baseline and, although this improved substantially during admission, health status remained abnormal at discharge. [ABSTRACT FROM AUTHOR]

Purpose After observing prominent cisterna chyli in several patients with autosomal dominant polycystic kidney disease (ADPKD), we investigated the potential association of cistern chyli enlargement with ADPKD. Materials and Methods Retrospective, cross-sectional analysis of abdominal and pelvic MRI at 1.5 Tesla (T) in 70 ADPKD patients (male 44.3%, 20-83 years, median = 53 years) were compared with 70 age and gender matched control subjects without ADPKD, cirrhosis, or cholestasis. Cisterna chyli diameter was measured on axial single shot fast spin echo (SSFSE) images at the level of T12-L2 and evaluated by multivariable regression models with covariates including estimated glomerular filtration rate (eGFR), total kidney volume (TKV), renal cyst fraction (cyst volume/kidney volume), and liver volume. Results Subjects with ADPKD had larger median cisterna chyli diameter compared with those without ADPKD (6.1 mm versus 3.4 mm, P < 0.0001). The prevalence of cisterna chyli enlargement more than the median (3.4 mm), was greater in ADPKD than in controls (99% versus 51%, P < 0.0001). On univariate analysis, cisterna chyli diameter was inversely correlated with eGFR (r = −0.41; P < 0.0001) and directly correlated with TKV (r = 0.57; P < 0.0001), total renal cyst fraction (r = 0.61; P < 0.001), and liver volume (r = 0.17; P = 0.040). Multivariable linear regression modeling found a significant association of cisterna chyli diameter with ADPKD diagnosis (B = 2.14; 95% confidence interval [CI]: 0.05-4.23; P = 0.04). Logistic regression analysis confirmed the association of ADPKD with an enlarged cisterna chyli diameter (odds ratio = 68.4; 95%CI: 8.9-524, P < 0.0001). Conclusion Enlarged cisterna chyli is highly prevalent in ADPKD patients but not in age and gender-matched controls. J. Magn. Reson. Imaging 2015;41:142-148. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

ABSTRACT Polynorbornene is a class of polymer that exhibits significant potential as a structural material in microelectromechanical systems owing to its dielectric constant and compatibility with silicon-based microfabrication processes. A commercially available version of PNB (AvatrelTM 2585P) is particularly attractive for bioMEMS applications because of its low moisture absorption characteristics, photodefinability, and potential biocompatibility. This study furthers the advancement of PNB as an enabling structural material for microfluidics and flexible bioMEMS applications by developing the following key processing techniques: (1) oxygen plasma-based surface modification for bonding PNB layers to glass substrates, and (2) the monolithic fabrication of free-standing, mechanically flexible electrode arrays using silicon wafers as mechanical supports during fabrication. To further develop PNB for flexible, implantable bioMEMS applications, this study also includes an evaluation of: (1) the tensile properties of free standing structures after accelerated lifetime testing in phosphate-buffered saline, and (2) the in vitro performance of free-standing, mechanically flexible neural microelectrode array-based neural interfaces. © 2014 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2014, 131, 40969. [ABSTRACT FROM AUTHOR]

Study Type - Decision analysis (based on alternative scenarios) Level of Evidence 2b What's known on the subject? and What does the study add? Several studies have shown that abnormal levels of nuclear matrix protein 22 (NMP22) are associated with bladder cancer, and NMP22 has been approved by the FDA as a urinary biomarker for bladder cancer detection and surveillance. However, the benefit of adding NMP22 to the clinical care of patients remains unclear. Decision curve analysis incorporates the consequences of clinical decisions, such as an increased number of unnecessary cystoscopies or missed cancers. OBJECTIVE [ABSTRACT FROM AUTHOR]

Here, an environmentally‐friendly and scalable process is reported to synthesize reduced graphene oxide (RGO) thin films for printed electronics applications. The films are produced by inkjet printing GO flakes dispersed binder‐free in aqueous solutions followed by treatment with a nonthermal, radio‐frequency (RF) plasma containing only argon (Ar) gas. The plasma process is found to heat the substrate to temperatures no greater than 138 °C, enabling RGO to be printed directly on a wide range of temperature‐sensitive substrate materials including photo paper. Unlike other low‐temperature methods such as electrochemical reduction, plasma reduction is friendly to moisture absorbent materials. Moreover, the plasma treatment can be performed on nonconducting substrates, eliminating the need for film transfer. From an applications perspective, the printed, plasma‐reduced RGO exhibits excellent electrical, mechanical, and electrochemical properties. As a technology demonstrator, the working electrodes of hydrogen peroxide (H2O2) sensors fabricated from plasma‐reduced GO show a sensitivity of 277 ± 80 µA mm−1 cm−2, which is comparable to RGO working electrodes made by electrochemical reduction. [ABSTRACT FROM AUTHOR]