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PURPOSE: Structural valve deterioration (SVD) remains a limitation on the use of bioprosthetic valves, with patient and valve-related factors contributing to early SVD. The Trifecta valve has been reported to have excellent hemodynamics but studies have highlighted early failure. We present a review and case series at a New Zealand tertiary hospital defining early SVD as failure within 3 years of implant. METHODS: A retrospective review from January 2015 to July 2019 included 525 patients undergoing surgical aortic valve replacement with 263 patients receiving an Abbott Trifecta or Trifecta Glide Technology (GT) valve. Our review found an acceptable safety profile for the valve with excellent hemodynamics, with a low mortality, stroke, and permanent pacemaker rate. RESULTS: Three patients out of 263 were identified from the study period as having early SVD requiring reintervention within 3 years of valve implantation leading to a 1.14% failure rate. One of the valves that had early SVD was a new generation Trifecta GT. An additional four patients were identified to have valves implanted prior to the study period and had valve failure at greater than 3 years post implantation. Five cases had cusp tears as their mechanism of failure, raising concerns about durability. CONCLUSION: The Trifecta valve has an acceptable safety profile and offers good hemodynamics due to the externally mounted leaflets. However, our experience of early SVD and failure is concerning for valve durability. Further comparison to other bioprosthetic valves and longer term follow-up are required to characterize the mechanism of failures.
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BACKGROUND: It is well known that breastfeeding has a significant impact on the health of mothers and children. With the growing importance of breastfeeding, the present study aimed to investigate the relationship between breastfeeding and the prevalence of diabetes in Korean parous women. METHODS: The data of 5,448 premenopausal parous women aged 20-49 years who agreed to participate in the 5th- 6th Korea National Health and Nutrition Examination Survey were analyzed in this study. Control group included women who had not breastfed. The subjects who had breastfed were classified into three groups based on the duration of breastfeeding: 0-6 months, 6-12 months, and >12 months. The variables included age, body mass index, education level, income, alcohol drinking, smoking, family history of diabetes, use of oral contraceptives, the number of pregnancies, and regular exercise. RESULTS: Among the subjects, the prevalence of diabetes was significantly lower in women who had breastfed compared to those who had not, with an odds ratio of 0.534 (95% confidence interval [CI], 0.289-0.976) in women who breastfed for 0-6 months and 0.575 (95% CI, 0.321-0.990) in women who breastfed for 6-12 months (both P<0.05). CONCLUSION: The present study found a reduced prevalence of diabetes in women who had breastfed compared to those who had not. However, no association between the duration of breastfeeding and the prevalence of diabetes could be found.
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BACKGROUND: This study aimed to identify and examine the effects of weight control behaviors correlated with weight loss in obese individuals who attempted to lose weight within the past year. METHODS: In this cross-sectional study, data from 9,461 obese individuals were collected from the fifth and sixth Korean National Health and Nutrition Examination Survey (2010-2014). Three of nine verified methods of weight control suggested in the survey were selected: diet therapy (reduced food intake), exercise therapy (exercise), and medication therapy (prescribed weight loss medications). Participants were divided into one of seven groups (diet therapy alone; exercise therapy alone; drug therapy alone; combined diet and exercise therapy; combined exercise and drug therapy; combined diet and drug therapy; or combined diet, exercise, and drug therapy). Logistic regression analysis was used to determine whether the group that tried to lose weight in the past year had indeed lost weight compared to the group that did not. RESULTS: The odds ratios for weight loss (≥3 but <6 kg vs. ≥6 but <10 kg) for the combined therapies were 2.05 (95% confidence interval, 1.23-3.41) for combined diet and exercise therapy and 5.43 (1.74-16.92) for combined diet, exercise, and drug therapy. CONCLUSION: All levels of weight loss were significantly associated with combined diet and exercise therapy. Weight loss ≥6 kg but <10 kg was significantly associated with combined diet and exercise therapy as well as with combined diet, exercise, and medication therapy among individuals who tried to lose weight in the past year.
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BACKGROUND: This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women. METHODS: Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013-2014), 3,225 women aged 40-69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis. RESULTS: The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861-6.002; P<0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432-3.199; P<0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141-0.431; P<0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant. CONCLUSION: In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.
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Prefrontal layer 6 (L6) pyramidal neurons play an important role in the adult control of attention, facilitated by their strong activation by nicotinic acetylcholine receptors. These neurons in mouse association cortex are distinctive morphologically when compared to L6 neurons in primary cortical regions. Roughly equal proportions of the prefrontal L6 neurons have apical dendrites that are "long" (reaching to the pial surface) vs. "short" (terminating in the deep layers, as in primary cortical regions). This distinct prefrontal morphological pattern is established in the post-juvenile period and appears dependent on nicotinic receptors. Here, we examine dendritic spine densities in these two subgroups of prefrontal L6 pyramidal neurons under control conditions as well as after perturbation of nicotinic acetylcholine receptors. In control mice, the long neurons have significantly greater apical and basal dendritic spine density compared to the short neurons. Furthermore, manipulations of nicotinic receptors (chrna5 deletion or chronic developmental nicotine exposure) have distinct effects on these two subgroups of L6 neurons: apical spine density is significantly reduced in long neurons, and basal spine density is significantly increased in short neurons. These changes appear dependent on the α5 nicotinic subunit encoded by chrna5. Overall, the two subgroups of prefrontal L6 neurons appear positioned to integrate information either across cortex (long neurons) or within the deep layers (short neurons), and nicotinic perturbations differently alter spine density within each subgroup.
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Maternal smoking during pregnancy repeatedly exposes the developing fetus to nicotine and is linked with attention deficits in offspring. Corticothalamic neurons within layer VI of the medial prefrontal cortex are potential targets in the disruption of attention circuitry by nicotine, a process termed teratogenesis. These prefrontal layer VI neurons would be likely targets because they are developmentally excited and morphologically sculpted by a population of nicotinic acetylcholine receptors (nAChRs) that are sensitive to activation and/or desensitization by nicotine. The maturational effects of these α4ß2* nAChRs and their susceptibility to desensitization are both profoundly altered by the incorporation of an α5 subunit, encoded by the chrna5 gene. Here, we investigate nicotine teratogenesis in layer VI neurons of wildtype and α5(-/-) mice. In vivo chronic nicotine exposure during development significantly modified apical dendrite morphology and nAChR currents, compared with vehicle control. The direction of the changes was dependent on chrna5 genotype. Surprisingly, neurons from wildtype mice treated with in vivo nicotine resembled those from α5(-/-) mice treated with vehicle, maintaining into adulthood a morphological phenotype characteristic of immature mice together with reduced nAChR currents. In α5(-/-) mice, however, developmental in vivo nicotine tended to normalize both adult morphology and nAChR currents. These findings suggest that chrna5 genotype can determine the effect of developmental in vivo nicotine on the prefrontal cortex. In wildtype mice, the lasting alterations to the morphology and nAChR activation of prefrontal layer VI neurons are teratogenic changes consistent with the attention deficits observed following developmental nicotine exposure.
