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1.
Physiol Plant ; 176(3): e14311, 2024.
Article in English | MEDLINE | ID: mdl-38715208

ABSTRACT

Although microalgae have only recently been recognized as part of the plant and soil microbiome, their application as biofertilizers has a tradition in sustainable crop production. Under consideration of their ability to produce the plant growth-stimulating hormone cytokinin (CK), known to also induce pathogen resistance, we have assessed the biocontrol ability of CK-producing microalgae. All pro- and eukaryotic CK-producing microalgae tested were able to enhance the tolerance of tobacco against Pseudomonas syringae pv. tabaci (PsT) infection. Since Chlamydomonas reinhardtii (Cre) proved to be the most efficient, we functionally characterized its biocontrol ability. We employed the CRISPR-Cas9 system to generate the first knockouts of CK biosynthetic genes in microalgae. Specifically, we targeted Cre Lonely Guy (LOG) and isopentenyltransferase (IPT) genes, the key genes of CK biosynthesis. While Cre wild-type exhibits a strong protection, the CK-deficient mutants have a reduced ability to induce plant defence. The degree of protection correlates with the CK levels, with the IPT mutants showing less protection than the LOG mutants. Gene expression analyses showed that Cre strongly stimulates tobacco resistance through defence gene priming. This study functionally verifies that Cre primes defence responses with CK, which contributes to the robustness of the effect. This work contributes to elucidate microalgae-mediated plant defence priming and identifies the role of CKs. In addition, these results underscore the potential of CK-producing microalgae as biologicals in agriculture by combining biofertilizer and biocontrol ability for sustainable and environment-friendly crop management.


Subject(s)
CRISPR-Cas Systems , Chlamydomonas reinhardtii , Cytokinins , Disease Resistance , Nicotiana , Plant Diseases , Nicotiana/genetics , Nicotiana/microbiology , Nicotiana/immunology , Cytokinins/metabolism , Plant Diseases/microbiology , Plant Diseases/immunology , Plant Diseases/genetics , Disease Resistance/genetics , Chlamydomonas reinhardtii/genetics , Chlamydomonas reinhardtii/metabolism , Pseudomonas syringae/pathogenicity , Pseudomonas syringae/physiology , Mutation
2.
JACC Cardiovasc Interv ; 17(9): 1106-1115, 2024 May 13.
Article in English | MEDLINE | ID: mdl-38749590

ABSTRACT

BACKGROUND: Unintended deformation of implanted coronary stents can lead to loss of coronary access, stent thrombosis and coronary events during follow-up. The incidence, mechanisms and clinical outcomes of unintended stent deformations (USD) during complex bifurcation stenting are not well characterized. OBJECTIVES: In a prespecified analysis of the OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction) trial, we aimed to: 1) determine the incidence and characterize mechanisms of USD identified by optical coherence tomography (OCT); and 2) evaluate physician's detection and correction of accidental abluminal rewiring and USD. METHODS: OCT scans were analyzed for accidental abluminal rewiring and USD. When USD was identified, the plausible mechanism was determined by analysis of all procedural OCT scans and the corresponding angiograms. RESULTS: USD was identified by the core lab in 9.3% (55/589) of OCT-guided cases. Accidental abluminal rewiring was the cause in 44% (24/55), and guide catheter collision was the cause in 40% (22/55) of cases. USD was found in 18.5% of all cases with left main bifurcation percutaneous coronary intervention. The total incidence of abluminal rewiring was 33 in 32 OCT-guided cases (5.4%) and was corrected by physicians in 18 of 33 appearances (54.5%). The 2-year major adverse cardiac event rate for patients with untreated USD (n = 30) was 23.3%, whereas patients with confirmed or possibly corrected USD (n = 25) had no events during follow-up. CONCLUSIONS: USD was associated with adverse procedural complications and cardiac events during follow-up when not identified and corrected. The predominant mechanisms were undetected abluminal rewiring and guide catheter collision. Left main bifurcation percutaneous coronary intervention was a particular risk with USD detected in 18.5% of cases.


Subject(s)
Coronary Angiography , Coronary Artery Disease , Percutaneous Coronary Intervention , Prosthesis Design , Stents , Tomography, Optical Coherence , Humans , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/adverse effects , Treatment Outcome , Male , Female , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Middle Aged , Aged , Risk Factors , Europe , Time Factors , Prosthesis Failure , Predictive Value of Tests
3.
Eur J Prev Cardiol ; 31(5): 615-626, 2024 Mar 27.
Article in English | MEDLINE | ID: mdl-38057157

ABSTRACT

AIMS: It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS). METHODS AND RESULTS: Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1-7 h, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI concentration change (<20%, >20-50%, or >50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population. A total of 20 609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI concentration (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal hsTnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative hsTnI concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI concentration pattern, 30-day mortality was higher in subjects with a >50% rise compared with those with a less pronounced rise (2.2% vs. <0.1%). CONCLUSION: Among individuals with suspected ACS, those with a persistently elevated hsTnI concentration consistently had the highest risk of death. In subjects with two normal hsTnI concentrations, mortality was very low and not affected by the magnitude of change between measurements.


In this Danish study of >20 000 individuals with suspected heart attack, we confirmed the clinical importance of drawing two consecutive blood samples for measurement of high-sensitivity troponin-I concentrations (a marker of damage to the heart): The risk of death was highest in persons with two elevated high-sensitivity troponin-I concentrations and lowest in those with two normal concentrations.Among persons who had a first normal and a subsequently elevated high-sensitivity troponin-I concentration, a >50% relative rise was associated with significantly higher risk of death at 30 days.


Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , Humans , Troponin I , Acute Coronary Syndrome/diagnosis , Biomarkers , Prognosis
4.
Int J Cardiovasc Imaging ; 40(2): 441-449, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38123868

ABSTRACT

The concept that the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI) is caused by sudden plaque rupture with acute thrombus formation has recently been challenged. While angiography is an old gold-standard for culprit identification it merely visualizes the lumen contour. Optical coherence tomography (OCT) provides a detailed view of culprit features. Combined with myocardial edema on cardiac magnetic resonance (CMR), indicating acute ischemia and thus culprit location, we aimed to characterize culprit lesions using OCT. Patients with NSTEMI referred for angiography were prospectively enrolled. OCT was performed on angiographic stenoses ≥50% and on operator-suspected culprit lesions. Hierarchical OCT-culprit identifiers were defined in case of multiple unstable lesions, including OCT-defined thrombus age. An OCT-based definition of an organizing thrombus as corresponding to histological early healing stage was introduced. Lesions were classified as OCT-culprit or non-culprit, and characteristics compared. CMR was performed in a subset of patients. We included 65 patients with 97 lesions, of which 49 patients (75%) had 53 (54%) OCT-culprit lesions. The most common OCT-culprit identifiers were the presence of acute (66%) and organizing thrombus (19%). Plaque rupture was visible in 45% of OCT-culprit lesions. CMR performed in 38 patients revealed myocardial oedema in the corresponding territories of 67% of acute thrombi and 50% of organizing thrombi. A culprit lesion was identified by OCT in 75% patients with NSTEMI. Acute thrombus was the most frequent feature followed by organizing thrombus. Applying specific OCT-criteria to identify the culprit could prove valuable in ambiguous cases.


Subject(s)
Non-ST Elevated Myocardial Infarction , Plaque, Atherosclerotic , ST Elevation Myocardial Infarction , Thrombosis , Humans , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Non-ST Elevated Myocardial Infarction/therapy , Non-ST Elevated Myocardial Infarction/pathology , Tomography, Optical Coherence , Coronary Angiography , Predictive Value of Tests , Thrombosis/pathology , Plaque, Atherosclerotic/pathology , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/therapy , Rupture/pathology , Magnetic Resonance Imaging , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology
5.
Eur Heart J ; 44(41): 4376-4384, 2023 11 01.
Article in English | MEDLINE | ID: mdl-37634144

ABSTRACT

BACKGROUND AND AIMS: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). METHODS: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). RESULTS: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. CONCLUSIONS: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups.


Subject(s)
Coronary Stenosis , Fractional Flow Reserve, Myocardial , Myocardial Infarction , Humans , Coronary Stenosis/diagnosis , Coronary Vessels , Cardiac Catheterization , Coronary Angiography , Severity of Illness Index , Predictive Value of Tests
6.
N Engl J Med ; 389(16): 1477-1487, 2023 Oct 19.
Article in English | MEDLINE | ID: mdl-37634149

ABSTRACT

BACKGROUND: Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. METHODS: We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. RESULTS: We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P = 0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. CONCLUSIONS: Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.).


Subject(s)
Coronary Angiography , Coronary Artery Disease , Percutaneous Coronary Intervention , Tomography, Optical Coherence , Humans , Coronary Angiography/adverse effects , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Tomography, Optical Coherence/adverse effects , Tomography, Optical Coherence/methods , Treatment Outcome , Europe
8.
Cogn Psychol ; 145: 101591, 2023 09.
Article in English | MEDLINE | ID: mdl-37586285

ABSTRACT

Statements containing epistemic modals (e.g., "by spring 2023 most European countries may have the Covid-19 pandemic under control") are common expressions of epistemic uncertainty. In this paper, previous published findings (Knobe & Yalcin, 2014; Khoo & Phillips, 2018) on the opposition between Contextualism and Relativism for epistemic modals are re-examined. It is found that these findings contain a substantial degree of individual variation. To investigate whether participants differ in their interpretations of epistemic modals, an experiment with multiple phases and sessions is conducted to classify participants according to the three semantic theories of Relativism, Contextualism, and Objectivism. Through this study, some of the first empirical evidence for the kind of truth-value shifts postulated by semantic Relativism is presented. It is furthermore found that participants' disagreement judgments match their truth evaluations and that participants are capable of distinguishing between truth and justification. In a second experimental session, it is investigated whether participants thus classified follow the norm of retraction which Relativism uses to account for argumentation with epistemic modals. Here the results are less favorable for Relativism. In a second experiment, these results are replicated and the normative beliefs of participants concerning the norm of retraction are investigated following work on measuring norms by Bicchieri (2017). Again, it is found that on average participants show no strong preferences concerning the norm of retraction for epistemic modals. Yet, it was found that participants who had committed to Objectivism and had training in logic applied the norm of retraction to might-statements. These results present a substantial challenge to the account of argumentation with epistemic modals presented in MacFarlane (2014), as discussed.


Subject(s)
COVID-19 , Pandemics , Humans , Semantics , Judgment , Uncertainty
9.
Cognition ; 238: 105507, 2023 09.
Article in English | MEDLINE | ID: mdl-37331324

ABSTRACT

In this paper, a novel experimental task is developed for testing the highly influential, but experimentally underexplored, possible worlds account of conditionals (Lewis, 1973; Stalnaker, 1968). In Experiment 1, this new task is used to test both indicative and subjunctive conditionals. For indicative conditionals, five competing truth tables are compared, including the previously untested, multi-dimensional possible worlds semantics of Bradley (2012). In Experiment 2, these results are replicated and it is shown that they cannot be accounted for by an alternative hypothesis proposed by our reviewers. In Experiment 3, individual variation in truth assignments of indicative conditionals is investigated via Bayesian mixture models that classify participants as following one of several competing truth tables. As a novelty of this study, it is found that a possible worlds semantics of Lewis and Stalnaker is capable of accounting for participants' aggregate truth value assignments in this task. Applied to indicative conditionals, we show across three experiments, that the theory both captures participants' truth values at the aggregate level (Experiments 1 and 2) and that it makes up the largest subgroup in the analysis of individual variation in our experimental paradigm (Experiment 3).


Subject(s)
Problem Solving , Semantics , Humans , Bayes Theorem
10.
Pers Soc Psychol Bull ; : 1461672231164888, 2023 Apr 22.
Article in English | MEDLINE | ID: mdl-37086172

ABSTRACT

A number of papers have applied the CNI model of moral judgments to investigate deontological and consequentialist response tendencies. A controversy has emerged concerning the methodological assumptions of the CNI model. In this article, we contribute to this debate by extending the CNI paradigm with a skip option. This allows us to test an invariance assumption that the CNI model shares with prominent process-dissociation models in cognitive and social psychology. Like for these models, the present experiments found violations of the invariance assumption for the CNI model. In Experiment 2, we replicate these results and selectively influence the new parameter for the skip option. In addition, structural equation modeling reveals that previous findings for the relationship between gender and the CNI parameters are completely mediated by the association of gender with primary psychopathy.

12.
Europace ; 25(3): 931-939, 2023 03 30.
Article in English | MEDLINE | ID: mdl-36520640

ABSTRACT

AIMS: Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia. METHODS AND RESULTS: Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07-1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00-1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10-2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05-1.53; P = 0.01). All HRs adjusted. CONCLUSION: Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.


Subject(s)
Atrial Fibrillation , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Tachycardia, Ventricular , Male , Humans , Middle Aged , Female , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/complications , Treatment Outcome , Ventricular Fibrillation/etiology , Tachycardia, Ventricular/etiology , Percutaneous Coronary Intervention/adverse effects , Atrial Fibrillation/complications , Risk Factors
13.
Am Heart J ; 257: 41-50, 2023 03.
Article in English | MEDLINE | ID: mdl-36423733

ABSTRACT

BACKGROUND: Chronic total occlusions (CTO) are frequent among patients with coronary artery disease. Revascularization with percutaneous coronary intervention (PCI) is safe and feasible in experienced hands. However, randomized data are needed to demonstrate symptomatic as well as prognostic effect of CTO-PCI compared to optimal medical therapy alone. METHODS: This trial aims to evaluate the effect of CTO PCI in patients with a CTO lesion and target vessel diameter ≥ 2.5 mm, and myocardial ischemia in the relevant territory. First, all patients are subjected to optimal medical therapy (OMT) for at least for 3 months and non-CTO lesions are managed according to guidelines. Subsequently, prior to randomization myocardial ischemia and quality of life (Seattle Questionnaire (SAQ)) is assessed. Patients are divided into two cohorts based on their SAQ score and randomized to either OMT alone or OMT and CTO-PCI. Cohort A is defined as Low- or asymptomatic patients with a quality-of-life score > 60 and/or CCS class < 2, and more than 10 % ischemia in the left ventricle (LV). Cohort B is symptomatic patients with a quality-of-life score < 60 or CCS class angina > 1 and at least ischemia in 5% of the LV. The primary end-point in cohort A is a composite of major adverse cardiac and cerebral events, hospitalization for heart failure and malignant ventricular arrhythmias. The primary endpoint in cohort B is difference in quality of life 6 months after randomization. IMPLICATIONS: This trial is designed to investigate if CTO-PCI improves QoL and MACCE. Both positive and negative outcome of the trial will affect future guidelines and recommendations on how to treat patients with CTO.


Subject(s)
Coronary Artery Disease , Coronary Occlusion , Percutaneous Coronary Intervention , Humans , Coronary Occlusion/surgery , Coronary Artery Disease/etiology , Quality of Life , Percutaneous Coronary Intervention/adverse effects , Angina Pectoris/etiology , Chronic Disease , Treatment Outcome
14.
EuroIntervention ; 18(14): 1156-1164, 2023 Feb 20.
Article in English | MEDLINE | ID: mdl-36239118

ABSTRACT

BACKGROUND: The detrimental effects of long-standing severe aortic stenosis (AS) often include left ventricular hypertrophy (LVH) and exhaustion of coronary flow reserve (CFR), the reversibility of which is unclear after valve replacement. AIMS: Our aims were to 1) investigate whether CFR in the left anterior descending artery (LAD) would improve following valve replacement, and if the change was related to changes in hyperaemic coronary flow (QLAD) and minimal microvascular resistance (Rµ,LAD); and 2) investigate the relationship between changes in CFR and changes in left ventricular mass (LVM) and stroke work (LVSW). METHODS: We measured intracoronary bolus thermodilution-derived CFR, and continuous thermodilution-derived QLAD and Rµ,LAD before and 6 months after aortic valve replacement. Cardiac magnetic resonance imaging was used to quantify left ventricular anatomy and function for the calculation of LVM and LVSW.  Results: Thirty-four patients were included (17 patients had transcatheter aortic valve implantation; 14 had surgical valve replacement with a bioprosthesis and 3 with a mechanical prosthesis) who underwent invasive assessment in the LAD. CFR increased from 2.5 (interquartile range [IQR] 1.5-3.3) at baseline to 3.1 (IQR 2.2-5.1) at follow-up (p=0.005), despite no significant change in QLAD (230±106 mL/min to 250±101 mL/min; p=0.26) or Rµ,LAD (347 [IQR 247-463] to 287 [IQR 230-456]; p=0.20). When indexed for LVM, QLAD was 39% (IQR 8-98%) higher at follow-up compared with baseline (p<0.001). The improvement in CFR was correlated with ΔLVSW, r= -0.39; p=0.047.   Conclusions: CFR in the LAD increased significantly at follow-up although global hyperaemic flow and minimal microvascular resistance remained unchanged. Thus, a decrease in resting flow was the cause of CFR improvement. CFR improvement was associated with reduction in LVSW.


Subject(s)
Aortic Valve , Heart Valve Prosthesis , Humans , Coronary Circulation/physiology , Blood Flow Velocity/physiology , Coronary Vessels
15.
Eur Heart J Qual Care Clin Outcomes ; 9(3): 268-280, 2023 04 26.
Article in English | MEDLINE | ID: mdl-36036480

ABSTRACT

AIM: We investigated temporal trends in major cardiovascular events following first-time myocardial infarction (MI) and trends in revascularization and pharmacotherapy from 2000 to 2017. METHODS AND RESULTS: Using nationwide registries, we identified 120 833 Danish patients with a first-time MI between 2000 and 2017. We investigated 30-day and 1-year mortality and the 1-year risk of first-time admission for heart failure (HF) and recurrent MI. Patients were younger with a higher prevalence of hypertension and diabetes in 2015-2017 compared with 2000-2002. The patients were predominantly male (65.6%), and the median age declined by 3 years through the periods. Percutaneous coronary interventions within 7 days after first-time MI increased significantly (2000: 11.4% vs. 2017: 68.6%; Ptrend < 0.001). Cardiovascular medication after first-time MI changed significantly in the same period. Absolute risks and adjusted rates of outcomes were significantly lower in 2015-2017 compared with 2000-2002: 30-day mortality: 6.5% vs. 14.1% [hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.48-0.55); 1-year mortality 10.7% vs. 21.8% (HR 0.52, 95% CI: 0.50-0.55); recurrent MI: 4.0% vs. 7.8% (HR 0.56, 95% CI: 0.51-0.62); and first-time admission for HF: 2.9% vs. 3.7% (HR 0.82, 95% CI: 0.73-0.92). The rates of 30-day/1-year mortality and recurrent MI showed significantly decreasing trends (Ptrend < 0.001). The rates of first-time admission for HF were borderline significant (Ptrend = 0.045). CONCLUSION: From 2000 to 2017, we observed a decreasing risk of recurrent MI, first-time admission for HF, and all-cause mortality in patients with a first-time MI. In the same period, we observed a high rate of guideline-recommended pharmacological treatment after first-time MI as well as increasing rate of early revascularization in Denmark. TRANSLATIONAL PERSPECTIVES: The results from the current study portrait the risk of all-cause mortality, recurrent MI, and first-time admission for HF in a real-life setting with a very high utilization of early revascularization and guideline-recommended pharmacological therapy. We observed a temporal trend of improved survival, reduced risk of recurrent MI, as well as reduced risk of first-time admission for HF after first-time MI from 2000 through 2017. We observed an increase in the overall use of revascularization, as well as early revascularization and use of guideline-recommended pharmacotherapy. Our study reveals important results from real-life, nationwide data, showing a reduced risk of cardiovascular outcomes after first-time MI during the past 20 years. Current guidelines are based on results from clinical trials. Our real-life results add additionally important knowledge on patients' prognosis after first-time MI and underline the importance of treating MI according to guideline recommendations.


Subject(s)
Diabetes Mellitus , Heart Failure , Myocardial Infarction , Humans , Male , Child, Preschool , Female , Cohort Studies , Risk Factors , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Heart Failure/therapy , Denmark/epidemiology
16.
Eur Heart J ; 44(6): 502-512, 2023 02 07.
Article in English | MEDLINE | ID: mdl-36329643

ABSTRACT

BACKGROUND: Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome are unknown. METHODS AND RESULTS: Individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity troponin-T (hsTnT) measurements 1-7 h apart were identified through Danish national registries. Absolute and relative risks for death at days 0-30 and 31-365, stratified for whether subjects had normal or elevated hsTnT concentrations, and whether these concentrations changed by <20%, > 20 to 50%, or >50% in either direction from first to second measurement, were calculated through multivariable logistic regression with average treatment effect modeling. Of the 28 902 individuals included, 2.8% had died at 30 days, whereas 4.9% of those who had survived the first 30 days died between days 31-365. The standardized risk of death was highest among subjects with two elevated hsTnT concentrations (0-30 days: 4.3%, 31-365 days: 7.2%). In this group, mortality was significantly higher in those with a > 20 to 50% or >50% rise from first to second measurement, though only at 30 days. The risk of death was very low in subjects with two normal hsTnT concentrations (0-30 days: 0.1%, 31-365 days: 0.9%) and did not depend on relative or absolute changes between measurements. CONCLUSIONS: Individuals with suspected acute coronary syndrome and two consecutively elevated hsTnT concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal hsTnT concentrations, irrespective of changes between measurements.


Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , Troponin T , Humans , Acute Coronary Syndrome/diagnosis , Biomarkers , Logistic Models , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy
17.
Sleep Breath ; 27(4): 1611-1618, 2023 08.
Article in English | MEDLINE | ID: mdl-36178574

ABSTRACT

PURPOSE: We evaluated whether or not changes in body composition following moderate hypoxic exposure for 4 weeks were different compared to sea level exposure. METHODS: In a randomized crossover design, nine trained participants were exposed to 2320 m of altitude or sea level for 4 weeks, separated by > 3 months. Body fat percentage (BF%), fat mass (FM), and fat-free mass (FFM) were determined before and after each condition by dual X-ray absorptiometry (DXA) and weekly by a bioelectrical impedance scanner to determine changes with a high resolution. Training volume was quantified during both interventions. RESULTS: Hypoxic exposure reduced (P < 0.01) BF% by 2 ± 1 percentage points and increased (P < 0.01) FFM by 2 ± 2% determined by DXA. A tending time × treatment effect existed for FM determined by DXA (P = 0.06), indicating a reduced FM in hypoxia by 8 ± 7% (P < 0.01). Regional body analysis revealed reduced (P < 0.01) BF% and FFM and an increased (P < 0.01) FFM in the truncus area. No changes were observed following sea level. Bioelectrical impedance determined that BF%, FM, and FFM did not reveal any differences between interventions. Urine specific gravity measured simultaneously as body composition was identical. Training volume was similar between interventions (509 ± 70 min/week vs. 432 ± 70 min/week, respectively). CONCLUSIONS: Four weeks of altitude exposure reduced BF% and increased FFM in trained individuals as opposed to sea level exposure. The results also indicate that a decrease in FM is greater at altitude compared to sea level. Changes were specifically observed in the truncus area.


Subject(s)
Adipose Tissue , Body Composition , Humans , Cross-Over Studies , Absorptiometry, Photon , Electric Impedance , Body Mass Index
18.
New Phytol ; 236(2): 774-791, 2022 10.
Article in English | MEDLINE | ID: mdl-35851958

ABSTRACT

Convolutional neural networks (CNNs) are a powerful tool for plant image analysis, but challenges remain in making them more accessible to researchers without a machine-learning background. We present RootPainter, an open-source graphical user interface based software tool for the rapid training of deep neural networks for use in biological image analysis. We evaluate RootPainter by training models for root length extraction from chicory (Cichorium intybus L.) roots in soil, biopore counting, and root nodule counting. We also compare dense annotations with corrective ones that are added during the training process based on the weaknesses of the current model. Five out of six times the models trained using RootPainter with corrective annotations created within 2 h produced measurements strongly correlating with manual measurements. Model accuracy had a significant correlation with annotation duration, indicating further improvements could be obtained with extended annotation. Our results show that a deep-learning model can be trained to a high accuracy for the three respective datasets of varying target objects, background, and image quality with < 2 h of annotation time. They indicate that, when using RootPainter, for many datasets it is possible to annotate, train, and complete data processing within 1 d.


Subject(s)
Deep Learning , Image Processing, Computer-Assisted/methods , Machine Learning , Neural Networks, Computer , Soil
19.
J Clin Endocrinol Metab ; 107(8): e3194-e3205, 2022 07 14.
Article in English | MEDLINE | ID: mdl-35552407

ABSTRACT

CONTEXT: The Arg16 variant in the ß2-receptor gene is associated with increased risk of severe hypoglycemia in subjects with type 1 diabetes mellitus. OBJECTIVE: We hypothesized that the Arg16 variant is associated with decreased metabolic and symptomatic responses to recurrent hypoglycemia. METHODS: Twenty-five healthy male subjects selected according to ADRB2 genotype and being homozygous for either Arg16 (AA; n = 13) or Gly16 (GG; n = 12) participated in 2 consecutive trial days with 3 periods of hypoglycemia (H1-H3) induced by a hyperinsulinemic hypoglycemic clamp. The main outcome measure was mean glucose infusion rate (GIR) during H1-H3. RESULTS: During H1-H3, there was no difference between AA or GG subjects in GIR, counter-regulatory hormones (glucagon, epinephrine, cortisol, growth hormone), or substrate levels of lactate, glycerol, and free fatty acids (FFAs), and no differences in symptom response score or cognitive performance (trail making test, Stroop test). At H3, lactate response was reduced in both genotype groups, but AA subjects had decreased response (mean ±â€…standard error of the mean of area under the curve) of glycerol (-13.1 ±â€…3.8 µmol L-1 hours; P = .0052), FFA (-30.2 ±â€…11.1 µmol L-1 hours; P = .021), and ß-hydroxybutyrate (-0.008 ±â€…0.003 mmol L-1 hour; P = .027), while in GG subjects alanine response was increased (negative response values) (-53.9 ±â€…20.6 µmol L-1 hour; P = .024). CONCLUSION: There was no difference in GIR between genotype groups, but secondary outcomes suggest a downregulation of the lipolytic and ß-hydroxybutyrate responses to recurrent hypoglycemia in AA subjects, in contrast to the responses in GG subjects.


Subject(s)
Glycerol , Hypoglycemia , 3-Hydroxybutyric Acid , Epinephrine , Fatty Acids, Nonesterified , Glucose Clamp Technique , Humans , Lactates , Male
20.
J Chem Phys ; 156(19): 194502, 2022 May 21.
Article in English | MEDLINE | ID: mdl-35597661

ABSTRACT

Dynamic shear-modulus data are presented for two silicone oils DC704 and DC705 for frequencies between 1 mHz and 10 kHz at temperatures covering more than five decades of relaxation-time variation. Data are fitted to the alpha part of a phenomenological model previously shown to describe well the dynamic shear modulus of squalane, which has a large beta process [Hecksher et al., J. Chem. Phys. 146, 154504 (2017)]. That model is characterized by additivity of the alpha and beta shear compliance and by a high-frequency decay of the alpha process in proportion to ω-1/2, where ω is the angular frequency. The fits of the alpha part of this model to the DC704 and DC705 data are compared to fits by a Havriliak-Negami type model, a Barlow-Erginsav-Lamb model, and a Cole-Davidson type model. At all temperatures, the best fit is obtained by the alpha part of the squalane model. This strengthens the conjecture that so-called t-relaxation, leading to high-frequency loss decays proportional to ω-1/2, is generic to the alpha relaxation of supercooled liquids [J. C. Dyre, Phys. Rev. E 74, 021502 (2006); Nielsen et al., J. Chem. Phys. 130, 154508 (2009); and Pabst et al., J. Phys. Chem. Lett. 12, 3685-3690 (2021)].

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