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We sought to investigate the accuracy of remote electrocardiogram (ECG) interpretation using Google Glass (Google, Mountain View, California). Google Glass is an optical head mounted display device with growing applications in medicine. We compared interpretation of 10 ECGs with 21 clinically important findings by faculty and fellow cardiologists by (1) viewing the electrocardiographic image at the Google Glass screen; (2) viewing a photograph of the ECG taken using Google Glass and interpreted on a mobile device; (3) viewing the original paper ECG; and (4) viewing a photograph of the ECG taken with a high-resolution camera and interpreted on a mobile device. One point was given for identification of each correct finding. Subjective rating of the user experience was also recorded. Twelve physicians (4 faculty and 8 fellow cardiologists) participated. The average electrocardiographic interpretation score (maximum 21 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, on paper, and high-resolution photograph on a mobile device was 13.5 ± 1.8, 16.1 ± 2.6, 18.3 ± 1.7, and 18.6 ± 1.5, respectively (p = 0.0005 between Google Glass and mobile device, p = 0.0005 between Google Glass and paper, and p = 0.002 between mobile device and paper). Of the 12 physicians, 9 (75%) were dissatisfied with ECGs viewing on the prism display of Google Glass. In conclusion, further improvements are needed before Google Glass can be reliably used for remote electrocardiographic analysis. [ABSTRACT FROM AUTHOR]

The perioperative outcomes of noncardiac surgery in patients who have received secondgeneration drug-eluting stents (DESs) have received limited study. We reviewed the medical records of 1,748 consecutive patients who received DES at our institution (1,789 procedures) from January 1, 2009, to July 1, 2012, to determine the outcomes of subsequent noncardiac surgery. During a median follow-up of 43 months, 221 patients underwent 345 noncardiac surgeries (138 low risk, 130 intermediate risk, and 77 high risk), of which 278 were in patients with previous second-generation DES implantation. The incidence of noncardiac surgery in patients with previous second-generationDES implantation was 4.5%at 1 year, 11.6% at 2 years, and 15.2% at 3 years. The mean time from stent implantation to surgery was 21±12.9 months. Mean age was 66±8 years, 99% were men, and 11% had a perioperative complication, including 5.8% major bleeding, 2.5% acute kidney injury, 2.2% major adverse cardiac event, and 1.4% stroke. Perioperative stent thrombosis occurred in 2 patients (0.7%, 95%confidence interval 0.2% to 2.6%): 1 patient had received a DES 14months before surgery and had stent thrombosis on the day of surgery and the other had aDES implanted 21months before surgery and developed stent thrombosis the day after surgery. In conclusion, the incidence of perioperative complications with noncardiac surgery after second-generation DES implantation was 11% and consisted mainly of bleeding (5.8%). The incidence of definite stent thrombosiswas 0.7%. [ABSTRACT FROM AUTHOR]

Space is a resource that is constantly being depleted, especially in mega‐cities. Underground workspaces (UGS) are increasingly being included in urban plans and have emerged as an essential component of vertical cities. While progress had been made on the engineering aspects associated with the development of high‐quality UGS, public attitudes toward UGS as work environments (ie, the public's design concerns with UGS) are relatively unknown. Here, we present the first large‐scale study examining preferences and attitudes toward UGS, surveying close to 2000 participants from four cities in three continents (Singapore, Shanghai, London, and Montreal). Contrary to previous beliefs, air quality (and not lack of windows) is the major concern of prospective occupants. Windows, temperature, and lighting emerged as additional important building performance aspects for UGS. Early adopters (ie, individuals more willing to accept UGS and thus more likely to be the first occupants) across all cities prioritized air quality. Present results suggest that (perceived) air quality is a key building performance aspect for UGS that needs to be communicated to prospective occupants as this will improve their attitudes and views toward UGS. This study highlights the importance of indoor air quality for the public. [ABSTRACT FROM AUTHOR]

Indoor environmental quality (IEQ) is a general indicator of the quality of conditions inside a building. We investigated associations of perceived IEQ including air quality, thermal comfort, noise, and light quality with stress at work and the extent to which workplace location modifies these associations. We recruited 464 full‐time workers from four companies in Singapore. Data on socio‐demographic characteristics, lifestyle/health‐related factors, and workplace factors were collected through self‐administered questionnaires. Perceived IEQ satisfaction scores of all four factors were collected using the validated OFFICAIR questionnaire. We fitted a logistic regression model to assess associations between each perceived IEQ score and stress at work, adjusting for potential confounders. The odds ratio for stress at work associated with a 1‐unit increase in perceived air quality score was 0.88 (0.82‐0.94), 0.89 (0.82‐0.97) for thermal comfort, 0.93 (0.87‐0.98) for noise, and 0.88 (0.82‐0.94) for light quality. Significant associations were found in office and control rooms for all four perceived IEQ, except for thermal comfort in office rooms. Higher satisfaction levels of perceived air quality, thermal comfort, noise, and lighting, were significantly associated with a reduction in stress at work. Our findings could potentially provide a useful tool for environmental health impact assessment for buildings. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the association between shift work and sleep quality in a diverse occupational type. Methods: This was a cross-sectional study of self-reported sleep quality in 424 workers aged ≥21 using the Pittsburgh Sleep Quality Index (PSQI). We divided workers into two categories based on their PSQI score: (a) ≤5 (good sleep quality) and (b) >5 (poor sleep quality). We used multiple logistic regressions to assess the association between shift work and sleep quality adjusted for potential confounders. Results: The mean age was 39.2 (SD = 11.3) years, with shift workers being older than their counterparts. Most workers were of Chinese ethnicity (63.9%). Males were significantly more likely to undertake shift work than females (89% v 11%, p-value<0.001), but it should be noted that the majority of workers was male (78.8%) in this sample of workers. Shift workers had a 198% increased odds of poor sleep quality compared to non-shift workers (OR = 2.98; 95% CI:1.53–5.81). Conclusion: Shift work was significantly and independently associated with increased odds of poor sleep quality in this sample of workers. The present findings may inform employment guidelines and help develop workplace health promotion interventions aimed at improving sleep quality among workers and ultimately lead to a healthier workforce. [ABSTRACT FROM AUTHOR]

Faces carry significant social information and, as such, humans need to allocate attention to them. In particular, facial attractiveness is an important dimension that considerably influences social judgment. The allocation of attentional resources to facial attractiveness has been widely examined in social psychology, however mostly by measures of eye movement. While this literature demonstrates the influence of facial attractiveness on overt attention, how facial attractiveness drives covert attention is less known. In two studies, we tracked eye and hand movements while participants were engaged in a numerical task in the presence of faces of various degrees of attractiveness. Results show that both attractive and unattractive faces captured greater visual attention compared to moderate faces, whereas attractive faces attracted hand movement more strongly than both unattractive and moderate faces. The present study suggests that facial attractiveness guides attention for actions differently through eye and hand movements. • Facial attractiveness guides attention for actions differently through eye and hand movement. • Hand movement was found to be mostly driven by attractive (but not unattractive or moderate) faces. • Eye movement was driven by faces on the ends of the attractiveness spectrum (attractive and unattractive but not moderate). • "Being moved" by beauty might not simply be a metaphor. Rather, beauty automatically engages our hand movement. • Besides eye movement, hand movement discloses additional information on facial attention mechanisms. [ABSTRACT FROM AUTHOR]

• A new phase unwrapping method using only two defocused binary patterns for profilometry. • A weighted optimization algorithm to design the special binary patterns. • A normalization-denoising-clustering method to recover the gray codes. • Integration of continuity/geometry constraints with gray-code phase unwrapping. In order to achieve a higher speed for fringe projection profilometry, we propose a quaternary gray-code phase unwrapping method using only two defocused binary patterns. We present a weighted optimization algorithm for the design of special binary code patterns. The designed binary patterns are projected on the object with a defocused projector, and interestingly become quaternary patterns which are more expressive gray codes. After the distorted code patterns are captured by a camera, they will undergo our proposed normalization-denoising-clustering process to recover the ideal gray codes. Besides, continuity/geometry constraints are integrated with this phase unwrapping method to further reduce the number of required patterns. The integrated method can recover a high-quality 3D shape with only five binary patterns including three patterns for three-step phase shifting algorithms and two for our phase unwrapping method. The effectiveness of the proposed method is demonstrated by both simulations and experiments. [ABSTRACT FROM AUTHOR]

Highlights • Studies investigating health effects of underground workplaces are limited. • A few adverse health effects were reported but overall findings were inconclusive. • Hypothetical health effects/exposures are ample, complex and often overlap. • More studies will help understanding the impact of underground spaces on health. Abstract Underground workplaces are an important element in modern urban planning. As a result, an increasing but unquantified proportion of the population is being regularly exposed to them. We narratively reviewed the literature on the range of possible environmental exposures, and the possible health effects, to identify future research directions. There is a large but mainly observational research literature on likely underground exposures, including effects of artificial lighting, shift working and light at night on circadian disruptions and associated health effects. There are five studies comparing underground and aboveground environments. Shift working, artificial lighting and poor sleep quality leading to circadian disruption is one physiologic pathway. Working underground may increase exposure to these risks, and may also be associated with vitamin D deficiency, sick building syndrome, excessive noise, radon exposure, and negative psychological effects. In order to plan appropriate interventions, we need to expand our knowledge of the health effects of underground environments. Larger and longer-term studies are required to measure a range of human factors, environmental exposures and confounders. Controlled trials with health economic analyses of new lighting technologies are also required. [ABSTRACT FROM AUTHOR]

Objective To compare long-term clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the retrograde and antegrade approach. Background There is limited long-term clinical outcomes data on the retrograde approach to CTO PCI. Methods We performed a retrospective analysis of the long-term clinical outcomes of 193 consecutive patients who underwent successful CTO PCI at our institution between March 2008 and December 2011. Results Mean age was 63.6 ± 8.3 years. The target vessel was right coronary artery in 52.6%, left anterior descending artery in 24.5% and circumflex in 21.4% of cases. The retrograde approach was used in 41 patients (21.2%). The mean stent length was longer in the retrograde group (83 ± 32 vs. 64 ± 32 mm, P = 0.001). Two major procedural complications occurred, both in the retrograde group (P = 0.012). During a median follow-up of 2.0 years compared to the antegrade CTO PCI group, patients who underwent retrograde CTO PCI were more likely to undergo target lesion revascularization (TLR) (45.6% vs. 25.7%, P = 0.006). No significant difference was observed in the incidence of all-cause mortality, myocardial infarction, non-target vessel revascularization, or coronary artery bypass graft surgery between the 2 groups. On multivariate analysis, stent length was the only independent predictor of TLR during follow-up. Conclusions Retrograde CTO PCI was associated with higher incidence of TLR, but similar incidence of death and myocardial infarction compared to antegrade CTO PCI. These findings likely reflect the higher complexity of CTO lesions treated with the retrograde approach. (J Interven Cardiol 2014;27:465-471) [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of viscosity on angioplasty balloon deflation times. Background Lower contrast viscosity could result in more rapid coronary balloon deflation times. Methods We performed a bench comparison of coronary balloon deflation times using 2 contrast agents with different viscosity (ioxaglate and iodixanol), 3 contrast dilutions, and 2 inflation syringe filling volumes. Ten identical pairs of coronary angioplasty balloons were used to conduct each comparison after balloon inflation to 12 atmospheres. Simultaneous deflations were performed under cineangiography. The time to full contrast extraction and the area of contrast remaining after 5 seconds of deflation (quantified by opaque pixel count) were compared between groups. Results The mean time to full contrast extraction during balloon deflation was 8.3 ± 2.5 seconds for ioxaglate (lower viscosity) versus 10.1 ± 2.9 seconds for iodixanol (higher viscosity) (17.4% decrease, P = 0.005), with a 35.6% (P = 0.004) reduction in contrast area at 5 seconds. Compared to 1:1 ioxaglate-saline mixture, 1:2 and 1:3 ioxaglate/saline mixes resulted in 26.7% (P < 0.001) and 39.0% (P < 0.001) reduction in mean balloon deflation time, respectively, but at the expense of decreased balloon opacity. Filling the inflation syringe with 5 versus 15 ml of contrast/saline solution was associated with 7.5% decrease in balloon deflation time (P = 0.005), but no difference in contrast area at 5 seconds (P = 0.749). Conclusions Use of a lower viscosity contrast agent and higher contrast dilution significantly reduced coronary balloon deflation times, whereas use of lower syringe filling volume had a modest effect. Rapid coronary balloon deflation could improve the safety of interventional procedures. (J Interven Cardiol 2014;27:177-181) [ABSTRACT FROM AUTHOR]

Abstract: The receptors for calcitonin gene-related peptide (CGRP) and adrenomedullin (AM) are complexes of the calcitonin receptor-like receptor (CLR) and receptor activity-modifying proteins (RAMP). The CGRP receptor is a CLR/RAMP1 pairing whereas CLR/RAMP2 and CLR/RAMP3 constitute two subtypes of AM receptor: AM1 and AM2, respectively. Previous studies identified Glu74 in RAMP3 to be important for AM binding and potency. To further understand the importance of this residue and its equivalent in RAMP1 (Trp74) we substituted the native amino acids with several others. In RAMP3, these were Trp, Phe, Tyr, Ala, Ser, Thr, Arg and Asn; in RAMP1, Glu, Phe, Tyr, Ala and Asn substitutions were made. The mutant RAMPs were co-expressed with CLR in Cos7 cells; receptor function in response to AM, AM2/intermedin and CGRP was measured in a cAMP assay and cell surface expression was determined by ELISA. Phe reduced AM potency in RAMP3 but had no effect in RAMP1. In contrast, Tyr had no effect in RAMP3 but enhanced AM potency in RAMP1. Most other substitutions had a small effect on AM potency in both receptors whereas there was little impact on CGRP or AM2 potency. Overall, these data suggest that the geometry and charge of the residue at position 74 contribute to how AM interacts with the AM2 and CGRP receptors and confirms the role of this position in dictating differential AM pharmacology at the AM2 and CGRP receptors. [Copyright &y& Elsevier]

• We examine active white- (WCW) and blue-collar (BCW) workers in underground (UG) and aboveground (AG) spaces. • Job satisfaction of both WCW and BCW was mostly unaffected by being UG or AG. • Perceived confinement in UG spaces decreased with age. • Underground workspaces can be considered for both manual and office work. Modern technologies have enabled the development of high quality work environments in underground spaces (UGS).Yet, the fundamental issue of whether UGS are suitable for people intensive functions, such as office or manual work, is largely not well understood. Here, we examine whether full-time white collar (office [WCW]) and blue collar (mostly manual [BCW]) workers of UGS have different responses to critical organizational variables when compared to similar workers of aboveground spaces (AGS). Location (underground vs. aboveground) affected neither job satisfaction (overall) nor satisfaction with physical environment (overall, lighting, air quality, temperature, humidity, noise or surrounding greenery). BCW, regardless of location, reported lower satisfaction with temperature, humidity and noise but scored higher in overall job satisfaction. BCW perceived the UGS as more safe and calm; moreover, perceived confinement decreased with age, suggesting that older (or more experienced) workers are less negatively oriented towards working in UGS. These results suggest that assigning UGS to people-intensive functions (manual or office) might be a viable opportunity. [ABSTRACT FROM AUTHOR]

Class B G protein-coupled receptors (GPCRs) are important therapeutic targets for major diseases. Here, we present structures of peptide and Gs-bound pituitary adenylate cyclase-activating peptide, PAC1 receptor, and corticotropin-releasing factor (CRF), (CRF1) receptor. Together with recently solved structures, these provide coverage of the major class B GPCR subfamilies. Diverse orientations of the extracellular domain to the receptor core in different receptors are at least partially dependent on evolutionary conservation in the structure and nature of peptide interactions. Differences in peptide interactions to the receptor core also influence the interlinked TM2-TM1-TM6/ECL3/TM7 domain, and this is likely important in their diverse signaling. However, common conformational reorganization of ECL2, linked to reorganization of ICL2, modulates G protein contacts. Comparison between receptors reveals ICL2 as a key domain forming dynamic G protein interactions in a receptor- and ligand-specific manner. This work advances our understanding of class B GPCR activation and Gs coupling. • Cryo-EM structure reveals how CRF1R interacts with CRF and the Gs signaling protein • Cryo-EM structure reveals interactions of Pac1nR with PACAP-38 and Gs • Evolutionary related GPCRs have greater conservation in peptide and G protein binding New cryo-EM structures for CRF1R and PAC1R, combined with other recent structures of class B GPCRs, provide full structural coverage of the major class B GPCR subfamilies, revealing unique insight into both specific peptide agonist binding and the select nature of peptide-mediated class B GPCR activation. [ABSTRACT FROM AUTHOR]

Dual amylin and calcitonin receptor agonists (DACRAs) show promise as efficacious therapeutics for treatment of metabolic disease, including obesity. However, differences in efficacy in vivo have been observed for individual DACRAs, indicating that detailed understanding of the pharmacology of these agents across target receptors is required for rational drug development. To date, such understanding has been hampered by lack of direct, subtype-selective, functional assays for the amylin receptors (AMYRs). Here, we describe the generation of receptor-specific assays for recruitment of Venus-tagged Gs protein through fusion of luciferase to either the human calcitonin receptor (CTR), human receptor activity-modifying protein (RAMP)-1, RAMP1 (AMY 1 R), human RAMP2 (AMY 2 R), or human RAMP3 (AMY 3 R). These assays revealed a complex pattern of receptor activation by calcitonin, amylin, or DACRA peptides that was distinct at each receptor subtype. Of particular note, although both of the CT-based DACRAs, sCT and AM1784, displayed relatively similar behaviors at CTR and AMY 1 R, they generated distinct responses at AMY 2 R and AMY 3 R. These data aid the rationalization of in vivo differences in response to DACRA peptides in rodent models of obesity. Direct assessment of the pharmacology of novel DACRAs at AMYR subtypes is likely to be important for development of optimized therapeutics for treatment of metabolic diseases. SIGNIFICANCE STATEMENT: Amylin receptors (AMYRs) are important obesity targets. Here we describe a novel assay that allows selective functional assessment of individual amylin receptor subtypes that provides unique insight into the pharmacology of potential therapeutic ligands. Direct assessment of the pharmacology of novel agonists at AMYR subtypes is likely to be important for development of optimized therapeutics for treatment of metabolic diseases., (Copyright © 2024 by The Author(s).)

The class A orphan G protein-coupled receptor (GPCR), GPR3, has been implicated in a variety of conditions, including Alzheimer's and premature ovarian failure. GPR3 constitutively couples with Gαs, resulting in the production of cAMP in cells. While tool compounds and several putative endogenous ligands have emerged for the receptor, its endogenous ligand, if it exists, remains a mystery. As novel potential drug targets, the structures of orphan GPCRs have been of increasing interest, revealing distinct modes of activation, including autoactivation, presence of constitutively activating mutations, or via cryptic ligands. Here, we present a cryo-electron microscopy (cryo-EM) structure of the orphan GPCR, GPR3 in complex with DNGαs and Gβ 1 γ 2 . The structure revealed clear density for a lipid-like ligand that bound within an extended hydrophobic groove, suggesting that the observed "constitutive activity" was likely due to activation via a lipid that may be ubiquitously present. Analysis of conformational variance within the cryo-EM data set revealed twisting motions of the GPR3 transmembrane helices that appeared coordinated with changes in the lipid-like density. We propose a mechanism for the binding of a lipid to its putative orthosteric binding pocket linked to the GPR3 dynamics.

Background: Depression is a prevalent mental disorder that is undiagnosed and untreated in half of all cases. Wearable activity trackers collect fine-grained sensor data characterizing the behavior and physiology of users (ie, digital biomarkers), which could be used for timely, unobtrusive, and scalable depression screening., Objective: The aim of this study was to examine the predictive ability of digital biomarkers, based on sensor data from consumer-grade wearables, to detect risk of depression in a working population., Methods: This was a cross-sectional study of 290 healthy working adults. Participants wore Fitbit Charge 2 devices for 14 consecutive days and completed a health survey, including screening for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), at baseline and 2 weeks later. We extracted a range of known and novel digital biomarkers characterizing physical activity, sleep patterns, and circadian rhythms from wearables using steps, heart rate, energy expenditure, and sleep data. Associations between severity of depressive symptoms and digital biomarkers were examined with Spearman correlation and multiple regression analyses adjusted for potential confounders, including sociodemographic characteristics, alcohol consumption, smoking, self-rated health, subjective sleep characteristics, and loneliness. Supervised machine learning with statistically selected digital biomarkers was used to predict risk of depression (ie, symptom severity and screening status). We used varying cutoff scores from an acceptable PHQ-9 score range to define the depression group and different subsamples for classification, while the set of statistically selected digital biomarkers remained the same. For the performance evaluation, we used k-fold cross-validation and obtained accuracy measures from the holdout folds., Results: A total of 267 participants were included in the analysis. The mean age of the participants was 33 (SD 8.6, range 21-64) years. Out of 267 participants, there was a mild female bias displayed (n=170, 63.7%). The majority of the participants were Chinese (n=211, 79.0%), single (n=163, 61.0%), and had a university degree (n=238, 89.1%). We found that a greater severity of depressive symptoms was robustly associated with greater variation of nighttime heart rate between 2 AM and 4 AM and between 4 AM and 6 AM; it was also associated with lower regularity of weekday circadian rhythms based on steps and estimated with nonparametric measures of interdaily stability and autocorrelation as well as fewer steps-based daily peaks. Despite several reliable associations, our evidence showed limited ability of digital biomarkers to detect depression in the whole sample of working adults. However, in balanced and contrasted subsamples comprised of depressed and healthy participants with no risk of depression (ie, no or minimal depressive symptoms), the model achieved an accuracy of 80%, a sensitivity of 82%, and a specificity of 78% in detecting subjects at high risk of depression., Conclusions: Digital biomarkers that have been discovered and are based on behavioral and physiological data from consumer wearables could detect increased risk of depression and have the potential to assist in depression screening, yet current evidence shows limited predictive ability. Machine learning models combining these digital biomarkers could discriminate between individuals with a high risk of depression and individuals with no risk., (©Yuri Rykov, Thuan-Quoc Thach, Iva Bojic, George Christopoulos, Josip Car. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 25.10.2021.)

To compare the prevalence of and risk factors associated with overweight or obesity between the international (body mass index [BMI] ≥25 kg/m 2 ) and Asian (BMI ≥23 kg/m 2 ) criteria in a working population in Singapore. This was a cross-sectional analysis of a cohort study of 464 employees (aged ≥21 years) conducted at 4 workplaces in Singapore. The prevalence of overweight or obesity was 47.4% and 67.0% with the international and Asian criteria, respectively. With both the criteria, higher age, male sex, Malay ethnicity (vs Chinese), lower white rice intake, and consumption of sugar-sweetened beverages were positively associated with overweight or obesity. Participants with poorer mental health and higher levels of thermal comfort in the workplace were positively associated with overweight or obesity only with the Asian criteria. The use of international criteria alone in this population could have overlooked these risk factors that are highly relevant to the Singapore context.

Underground workplaces (UWS) are increasingly being recognised as a sustainable solution to concerns regarding lack of space facing megacities. UWS can multiply available space by reducing urban sprawl thereby improving quality of life in cities. However, developing workplaces that respond to the needs and preferences of occupants will be a crucial factor in determining the success of this concept. We examine the experiences of existing full-time employees of a large underground facility in North America and analyse how these are related to company policies and other organisational factors. From in-depth interviews of 73 participants, three predominant themes emerged from the analyses: environmental effects (e.g. lack of sunlight), design (e.g. the unique working environment), and organisational factors and social dynamics (e.g. policies regarding breaks). We discuss these themes in relation with interventions that may improve employee comfort and retention and suggest that many factors are within organisational control. Practitioner Summary: Underground workplaces are a sustainable solution to lack of urban space. However, developing effective workplaces is crucial to their success. We examine the experiences of existing employees of an underground facility in North America. We suggest that most negative attitudes towards underground spaces can be mitigated through simple organisational interventions. Abbreviations: UWS: underground workplaces; IRB: institutional review board.

The multicultural experience (i.e., multicultural individuals and cross-cultural experiences) offers the intriguing possibility for (i) an empirical examination of how free-energy principles explain dynamic cultural behaviors and pragmatic cultural phenomena and (ii) a challenging but decisive test of thinking through other minds (TTOM) predictions. We highlight that TTOM needs to treat individuals as active cultural agents instead of passive learners.

Background: Greater adoption of wearable devices with multiple sensors may enhance personalized health monitoring, facilitate early detection of some diseases, and further scale up population health screening. However, few studies have explored the utility of data from wearable fitness trackers in cardiovascular and metabolic disease risk prediction., Objective: This study aimed to investigate the associations between a range of activity metrics derived from a wearable consumer-grade fitness tracker and major modifiable biomarkers of cardiometabolic disease in a working-age population., Methods: This was a cross-sectional study of 83 working adults. Participants wore Fitbit Charge 2 for 21 consecutive days and went through a health assessment, including fasting blood tests. The following clinical biomarkers were collected: BMI, waist circumference, waist-to-hip ratio, blood pressure, triglycerides (TGs), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol, and blood glucose. We used a range of wearable-derived metrics based on steps, heart rate (HR), and energy expenditure, including measures of stability of circadian activity rhythms, sedentary time, and time spent at various intensities of physical activity. Spearman rank correlation was used for preliminary analysis. Multiple linear regression adjusted for potential confounders was used to determine the extent to which each metric of activity was associated with continuous clinical biomarkers. In addition, pairwise multiple regression was used to investigate the significance and mutual dependence of activity metrics when two or more of them had significant association with the same outcome from the previous step of the analysis., Results: The participants were predominantly middle aged (mean age 44.3 years, SD 12), Chinese (62/83, 75%), and male (64/83, 77%). Blood biomarkers of cardiometabolic disease (HDL cholesterol and TGs) were significantly associated with steps-based activity metrics independent of age, gender, ethnicity, education, and shift work, whereas body composition biomarkers (BMI, waist circumference, and waist-to-hip ratio) were significantly associated with energy expenditure-based and HR-based metrics when adjusted for the same confounders. Steps-based interdaily stability of circadian activity rhythm was strongly associated with HDL (beta=5.4 per 10% change; 95% CI 1.8 to 9.0; P=.005) and TG (beta=-27.7 per 10% change; 95% CI -48.4 to -7.0; P=.01). Average daily steps were negatively associated with TG (beta=-6.8 per 1000 steps; 95% CI -13.0 to -0.6; P=.04). The difference between average HR and resting HR was significantly associated with BMI (beta=-.5; 95% CI -1.0 to -0.1; P=.01) and waist circumference (beta=-1.3; 95% CI -2.4 to -0.2; P=.03)., Conclusions: Wearable consumer-grade fitness trackers can provide acceptably accurate and meaningful information, which might be used in the risk prediction of cardiometabolic disease. Our results showed the beneficial effects of stable daily patterns of locomotor activity for cardiometabolic health. Study findings should be further replicated with larger population studies., (©Yuri Rykov, Thuan-Quoc Thach, Gerard Dunleavy, Adam Charles Roberts, George Christopoulos, Chee-Kiong Soh, Josip Car. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 31.01.2020.)

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

Background: As compared with bare metal stents, first-generation drug-eluting stents (DES) improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES in SVGs., Methods: We compared the outcomes of patients who received first- (n = 81) with those who received second-generation (n = 166) DES in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization., Results: Mean age was 66.0 ± 8.1 years and 97.6% of the patients were men. Mean SVG age was 11.1 ± 0.4 years. First-generation DES were sirolimus-eluting (n = 17) and paclitaxel-eluting (n = 64) stents. Second-generation DES were everolimus-eluting (n = 115) and zotarolimus-eluting (n = 51) stents. Median follow-up was 41 months. At 2-years post-procedure, patients with first- and second-generation DES had similar rates of death (20.91% vs. 20.27%, P = 0.916), target lesion revascularization (16.39% vs. 20.00%, P = 0.572), target vessel revascularization (20.97% vs. 23.16%, P = 0.747), myocardial infarction (26.15% vs. 23.00%, P = 0.644), and MACE (43.5% vs. 40.87%, P = 0.707), respectively., Conclusions: Outcomes with first- and second-generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging patient and lesion subgroup. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)

Coronary chronic total occlusions (CTOs) have been associated with higher mortality in patients with ischemic cardiomyopathy and implantable cardioverter defibrillators (ICDs); yet the impact of CTO revascularization on subsequent clinical outcomes has not been studied. We evaluated the clinical characteristics and outcomes of patients with ischemic cardiomyopathy who also received an ICD for primary prevention of sudden death at the Dallas VA Medical Center from January 2002 to December 2013. On the basis of coronary angiography performed before device implantation, patients were divided into 3 groups: no CTOs, revascularized CTOs (with percutaneous coronary intervention or surgery), and unrevascularized CTOs. Primary and secondary outcomes were all-cause mortality and appropriate ICD therapy for sustained ventricular arrhythmias. A total of 307 patients (mean age 64.3 ± 8.1 years, 100% men) were included in the study. At least 1 CTO was present in 213 patients (69%) and was revascularized in 99 patients (32%). During a median follow-up of 4.1 years, 51 patients (17%) died and 98 (32%) had at least 1 episode of sustained ventricular arrhythmia. Mortality and incidence of ventricular arrhythmias were similar in the 3 study groups in both univariate and multivariate analyses. In conclusion, CTOs are commonly found in patients with ischemic cardiomyopathy. In contrast to previous studies, the presence of a CTO was not associated with higher mortality or incidence of ventricular arrhythmias. In addition, revascularization of CTOs was not associated with improved outcomes in this high-risk cohort., (Published by Elsevier Inc.)

Background: The frequency and outcomes of guide catheter extension use during percutaneous coronary intervention (PCI) have received limited study., Methods: We retrospectively examined 1539 consecutive PCIs performed between May 2010 and November 2013 to determine the frequency and outcomes of guide catheter extension utilization., Results: During the study period, a guide catheter extension was used in 83 cases (5.4%; 95% confidence interval, 4.3%-6.6%) in 86 vessels. The PCI target vessel was the left anterior descending artery (11%), circumflex (23%), right coronary artery (50%), left main (1%), or a saphenous vein bypass graft (15%). The indications for use (non-mutually exclusive) were to facilitate equipment delivery or provide vessel support/ engagement (84.7%), thrombus aspiration (10.5%), retrieval of lost devices (2.3%), facilitation of reverse controlled antegrade and retrograde tracking and dissection (1%), and selective vessel visualization with contrast (1%). Guide catheter extension success rate was 73.3% and technical and procedural success rates were 91.6% and 90.4%, respectively. Four patients (4.8%) experienced a guide catheter extension-related complication: vessel dissection/injury in 2 cases (1 case required emergency coronary artery bypass graft surgery and 1 case required stenting) and equipment loss in 2 cases (1 detachment of the distal guide-extension marker and 1 shearing of a guidewire tip that embolized to the renal artery)., Conclusions: In a contemporary patient population undergoing PCI, a guide catheter extension was used in approximately 1 of 20 PCIs. Guide catheter extensions can facilitate procedural success, but also carry low risk for device-related complications.

Background: There are limited data on outcomes after implantation of second-generation drug-eluting stents in coronary chronic total occlusions (CTOs). We aimed to evaluate the frequency of angiographic restenosis and clinical outcomes after implantation of the everolimus-eluting stent (EES) in coronary CTOs., Methods: One hundred patients undergoing successful CTO percutaneous coronary intervention using EES at our institution between 2009 and 2012 were enrolled. The primary study endpoint was binary in-segment restenosis at 8-month follow-up quantitative coronary angiography. Secondary endpoints included death, myocardial infarction, target-lesion and target-vessel revascularization, and symptom improvement., Results: Mean age was 64 ± 7 years and 99% of the patients were men. The successful crossing technique was antegrade wiring in 51 patients, antegrade dissection/reentry in 24 patients, and retrograde in 25 patients. Binary angiographic restenosis occurred in 46% of the patients (95% confidence interval [CI], 35%-57%). The pattern of restenosis was focal, proliferative, and total occlusion in 19 lesions (46%), 14 lesions (34%), and 8 lesions (20%), respectively. At 12 months, the incidences of death, myocardial infarction, target-lesion revascularization, and target-vessel revascularization were 2%, 2%, 37%, and 39%, respectively. At 12 months, symptoms were improved, unchanged, or worse compared with baseline in 89 patients, 8 patients, and 1 patient, respectively (2 patients died before the 12-month follow-up). On multivariable analysis, smaller stent diameter was associated with higher risk for binary angiographic restenosis., Conclusion: High rates of angiographic restenosis and repeat revascularization were observed among patients receiving EES in coronary CTOs, but most had significant symptom improvement.

Background: The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have received limited study., Methods: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs., Results: Mean age was 63.7 ± 8.3 years and 98.9% of the patients were men. Twenty-four patients (6.4%, 95% confidence intervals 4.2% to 9.4%) were found to have a balloon-uncrossable CTO. Compared to the other CTO PCI patients, those with balloon-uncrossable CTOs had similar clinical and angiographic characteristics. Successful crossing of the balloon-uncrossable CTO was achieved in 22 of 24 patients (91.7%) using a variety of techniques, such as successive balloon inflations (43.5%), microcatheter advancement (21.7%), laser (8.7%), techniques that increase guide catheter support (13.0%), and subintimal lesion crossing (13.0%). Patients with balloon-uncrossable CTOs had longer procedure time (184.5 ± 77.9 vs 134.0 ± 69.0 min, P<.01), fluoroscopy time (55.2 ± 24.9 vs 37.9 ± 20.8 min, P<.01), and received high contrast volume (404.4 ± 137.9 vs 351.7 ± 138.5 mL, P=.08), but had similar incidence of major complications (8.3% vs 3.2%, P=.25) as compared with patients who did not have balloon-uncrossable CTOs., Conclusion: Balloon-uncrossable CTOs are encountered in 6.4% of contemporary CTO PCIs and can be successfully treated in most patients using a variety of techniques.

Objective: The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation drug-eluting stent (DES) implantation in chronic total occlusions (CTOs)., Background: The effect of second- vs first-generation DESs on the outcomes after CTO percutaneous coronary intervention (PCI) has received limited study., Methods: As of May 2013, thirty-one published studies reported outcomes after DES implantation in CTOs: thirteen uncontrolled studies (3161 patients), three randomized (220 patients) and ten non-randomized (2150 patients) comparative studies with bare-metal stents (BMSs), and two non-randomized (685 patients) and three randomized (489 patients) comparative studies between first- and second-generation DESs. Data from the five studies comparing first with second-generation DESs were pooled using random-effects meta-analysis models., Results: The median and mean duration of follow-up were 12 and 14.4 months, respectively. Compared to first-generation DESs, second-generation DESs were associated with lower incidence of death (odds ratio [OR], 0.37; 95% confidence intervals [CI], 0.15-0.91), target vessel revascularization (OR, 0.59; 95% CI, 0.40-0.87), binary angiographic restenosis (OR, 0.68; 95% CI, 0.46-1.01) and reocclusion (OR, 0.35; 95% CI, 0.17-0.71), but similar incidence of myocardial infarction (OR, 0.45; 95% CI, 0.10-1.95) and stent thrombosis (OR, 0.34; 95% CI, 0.07-1.59)., Conclusions: Compared to first-generation DESs, second-generation DESs are associated with improved angiographic and clinical outcomes in CTO PCI and are the preferred stents for these challenging lesions.

Opinion Statement: Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) currently accounts for approximately 6 % of all PCIs and is associated with increased risk for distal embolization and subsequent SVG failure compared with native coronary artery PCI. To minimize the risk for distal embolization, embolic protection devices should be used during SVG PCI when technically feasible. To minimize the risk for in-stent restenosis and the need for repeat PCI, drug eluting stents should be utilized in patients without contraindications to long-term antiplatelet therapy. Treating native coronary artery lesions is preferable to SVG PCI when technically feasible.

Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) can be challenging when a bifurcation is present at the distal cap. We describe a case of combined use of the antegrade and retrograde approach for preserving a distal cap bifurcation during CTO PCI.

When making choices under uncertainty, people usually consider both the expected value and risk of each option, and choose the one with the higher utility. Expected value increases the expected utility of an option for all individuals. Risk increases the utility of an option for risk-seeking individuals, but decreases it for risk averse individuals. In 2 separate experiments, one involving imperative (no-choice), the other choice situations, we investigated how predicted risk and expected value aggregate into a common reward signal in the human brain. Blood oxygen level dependent responses in lateral regions of the prefrontal cortex increased monotonically with increasing reward value in the absence of risk in both experiments. Risk enhanced these responses in risk-seeking participants, but reduced them in risk-averse participants. The aggregate value and risk responses in lateral prefrontal cortex contrasted with pure value signals independent of risk in the striatum. These results demonstrate an aggregate risk and value signal in the prefrontal cortex that would be compatible with basic assumptions underlying the mean-variance approach to utility.

Receptor activity-modifying proteins (RAMPs) 1, 2, and 3 are prototypic G protein-coupled receptor accessory proteins that can alter not only receptor trafficking but also receptor phenotype. Specific RAMP interaction with the calcitonin receptor (CTR) generates novel and distinct receptors for the peptide amylin; however, the role of RAMPs in receptor signaling is not understood. The current study demonstrates that RAMP interaction with the CTRa in COS-7 or HEK-293 cells leads to selective modulation of signaling pathways activated by the receptor complex. There was a 20- to 30-fold induction in amylin potency at CTR/RAMP1 (AMY1) and CTR/RAMP3 (AMY3) receptors, compared with CTR alone, for formation of the second-messenger cAMP that parallels an increase in amylin binding affinity. In contrast, only 2- to 5-fold induction of amylin potency was seen for mobilization of intracellular Ca++ or activation of ERK1/2. In addition, in COS-7 cells, the increase in amylin potency for Ca++ mobilization was 2-fold greater for AMY3 receptors, compared with AMY1 receptors and this paralleled the relative capacity of overexpression of Galphaq proteins to augment induction of high affinity 125I-amylin binding. These data demonstrate that RAMP-complexed receptors have a different signaling profile to CTRs expressed in the absence of RAMPs, and this is likely due to direct effects of the RAMP on G protein-coupling efficiency.

We report two cases of compound heterozygote patients for the --(MED I) and Hb Agrinio [alpha29(B10)Le-->uPro (alpha2)] anomalies in two unrelated Greek Cypriot families. The first patient had a serious form of Hb H disease and died at the age of 21 due to complications arising during an operation. The second patient showed a severe hematological picture and has been regularly transfused since an early age. This patient exhibits bone abnormalities as well as hepatosplenomegaly. The severity of these two incidences emphasizes the need for the inclusion of a screening test for the --(MED I)/alpha(Agrinio)alpha genotype among those already offered during prenatal diagnosis. Two homozygotes, as well as a number of simple, compound, and double heterozygotes for Hb Agrinio have been identified in Cyprus and their hematological indices are presented.