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Article ; Online: Non-ischemic rupture of the posteromedial papillary muscle due to

Tunovic, Sanjin / Boateng, Percy / Song, David / Graziano, Rebecca / Silbiger, Jeffrey J

Journal of cardiology cases

2024 Volume 29, Issue 3, Page(s) 101–103

Abstract: Papillary muscle rupture is usually caused by myocardial infarction although rare cases of non-ischemic etiology have also been described. Among these, infective endocarditis represents an important cause. Herein, we report a case due to : Learning ... ...

Abstract	Papillary muscle rupture is usually caused by myocardial infarction although rare cases of non-ischemic etiology have also been described. Among these, infective endocarditis represents an important cause. Herein, we report a case due to Learning objective: Non-ischemic papillary muscle rupture should be suspected when there is no evidence of atherosclerotic coronary artery disease. In the febrile patient, infective endocarditis should be considered in the differential diagnosis.
Language	English
Publishing date	2024-01-19
Publishing country	Japan
Document type	Case Reports
ISSN	1878-5409
ISSN (online)	1878-5409
DOI	10.1016/j.jccase.2023.09.007
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Article ; Online: Thematic Analysis of Alzheimer's Medication Management Discussion in a Non-Moderated Online Forum.

Liu, Jia / Meyer, Kylie / Glassner, Ashlie / Gonzales, Mitzi / Bartlett Ellis, Rebecca J / Park, Hyejin / Song, Lixin / Patel, Neela / Wang, Jing

Western journal of nursing research

2024 Volume 46, Issue 4, Page(s) 307–314

Abstract: Background: Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development.: Objective: This study ... ...

Abstract	Background: Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development. Objective: This study aimed to understand caregivers' medication management experiences by analyzing online community discussions. Methods: Posts were extracted from the ALZConnected Results: Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers' uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications. Conclusions: The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer's disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers' strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses.
MeSH term(s)	Humans ; Alzheimer Disease/drug therapy ; Medication Therapy Management ; Caregivers
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	632788-6
ISSN	1552-8456 ; 0193-9459
ISSN (online)	1552-8456
ISSN	0193-9459
DOI	10.1177/01939459241237671
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Article ; Online: Cerebral blood flow dynamics: Is there more to the story at exercise onset?

Ashley, John / Shelley, Joe / Song, Jiwon / Sun, Jongjoo / Larson, Rebecca D / Larson, Daniel J / Berkowitz, Ari / Yabluchanskiy, Andriy / Kellawan, J Mikhail

Physiological reports

2023 Volume 11, Issue 11, Page(s) e15735

Abstract: A monoexponential model characterizing cerebral blood velocity dynamics at the onset of exercise may mask dynamic responses by the cerebrovasculature countering large fluctuations of middle cerebral artery blood velocity (MCAv) and cerebral perfusion ... ...

Abstract	A monoexponential model characterizing cerebral blood velocity dynamics at the onset of exercise may mask dynamic responses by the cerebrovasculature countering large fluctuations of middle cerebral artery blood velocity (MCAv) and cerebral perfusion pressure (CPP) oscillations. Therefore, the purpose of this study was to determine whether the use of a monoexponential model attributes initial fluctuations of MCAv at the start of exercise as a time delay (TD). Twenty-three adults (10 women, 23.9 ± 3.3 yrs; 23.7 ± 2.4 kg/m
MeSH term(s)	Adult ; Humans ; Female ; Blood Flow Velocity/physiology ; Exercise/physiology ; Cerebrovascular Circulation/physiology ; Middle Cerebral Artery/physiology ; Rest ; Blood Pressure/physiology
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2724325-4
ISSN	2051-817X ; 2051-817X
ISSN (online)	2051-817X
ISSN	2051-817X
DOI	10.14814/phy2.15735
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Article ; Online: Complexes of tubulin oligomers and tau form a viscoelastic intervening network cross-bridging microtubules into bundles.

Kohl, Phillip A / Song, Chaeyeon / Fletcher, Bretton J / Best, Rebecca L / Tchounwou, Christine / Garcia Arceo, Ximena / Chung, Peter J / Miller, Herbert P / Wilson, Leslie / Choi, Myung Chul / Li, Youli / Feinstein, Stuart C / Safinya, Cyrus R

Nature communications

2024 Volume 15, Issue 1, Page(s) 2362

Abstract: The axon-initial-segment (AIS) of mature neurons contains microtubule (MT) fascicles (linear bundles) implicated as retrograde diffusion barriers in the retention of MT-associated protein (MAP) tau inside axons. Tau dysfunction and leakage outside of the ...

Abstract	The axon-initial-segment (AIS) of mature neurons contains microtubule (MT) fascicles (linear bundles) implicated as retrograde diffusion barriers in the retention of MT-associated protein (MAP) tau inside axons. Tau dysfunction and leakage outside of the axon is associated with neurodegeneration. We report on the structure of steady-state MT bundles in varying concentrations of Mg
MeSH term(s)	Microtubules/metabolism ; Scattering, Small Angle ; tau Proteins/metabolism ; Tubulin/metabolism ; X-Ray Diffraction ; Humans
Chemical Substances	tau Proteins ; Tubulin ; MAPT protein, human
Language	English
Publishing date	2024-03-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2553671-0
ISSN	2041-1723 ; 2041-1723
ISSN (online)	2041-1723
ISSN	2041-1723
DOI	10.1038/s41467-024-46438-x
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Article ; Online: Temporal Trends in Incidence of Premature Cardiovascular Disease Over the Past 7 Decades: The Framingham Heart Study.

Vasan, Ramachandran S / Song, Rebecca J / van den Heuvel, Edwin R

Journal of the American Heart Association

2022 Volume 11, Issue 19, Page(s) e026497

Abstract: Background Premature onset of cardiovascular disease (CVD) imposes a significant societal burden and challenges prevention efforts. Methods and Results Trends in the incidence of premature CVD (before age 55, 60, or 65 years, separate analysis for each ... ...

Abstract	Background Premature onset of cardiovascular disease (CVD) imposes a significant societal burden and challenges prevention efforts. Methods and Results Trends in the incidence of premature CVD (before age 55, 60, or 65 years, separate analysis for each threshold) were evaluated in 14 464 Framingham Heart Study participants over 7 decades of observation (1950-2019). The change in the incidence of premature CVD (per decade) in men and women was assessed using overdispersed Poisson regression (accounting for cohort effects), adjusting for age at entry and age at onset of premature CVD within each decade. CVD was defined as a composite of fatal or nonfatal coronary heart disease, stroke or transient ischemic attack, peripheral vascular disease, and heart failure. There were 2223 first CVD events (832 in women) before age 65 years during 282 481 person-years of observations (154 587 in women) between 1950 and 2019. The age-adjusted CVD incidence before age 65 years decreased from 14.8 per 1000 person-years (1950-1959) to 4.69 per 1000 person-years (2010-2019) in men and from 7.23 per 1000 person-years (1950-1959) to 1.73 per 1000 person-years (2010-2019) in women. In adjusted analyses, the incidence of premature CVD decreased per decade in men (18.4% [95% CI, 12.0%-24.0%], for onset before age 55 years; 19.5% [95% CI, 12.0%-27.0%], for onset before age 60 years; 21.3% [95% CI, 16.0%-27.0%], for onset before age 65 years) and women (15.1% [95% CI, 7.0%-22.0%], for onset before age 55 years; 14.0% [95% CI, 6.0%-22.0%], for onset before age 60 years; 18.2% [95% CI, 12.0%-24.0%], for onset before age 65 years). The decline in premature CVD was accompanied by a reduction in smoking and increased use of lipid-lowering treatments across the decades. Incidence of premature coronary heart disease decreased, whereas the contribution of stroke to premature CVD burden increased over time. Conclusions The incidence of premature CVD has decreased among White adults in the Framingham cohort over the past 70 years; the residual burden of premature stroke warrants further study. Additional studies of trends in premature CVD in more racially and geographically diverse populations are warranted to elucidate the generalizability of these findings.
MeSH term(s)	Adult ; Aged ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Coronary Artery Disease/complications ; Female ; Humans ; Incidence ; Lipids ; Longitudinal Studies ; Male ; Middle Aged ; Risk Factors ; Stroke/epidemiology
Chemical Substances	Lipids
Language	English
Publishing date	2022-09-29
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.026497
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Article ; Online: Aortic Root Diameter and Arterial Stiffness: Conjoint Relations to the Incidence of Cardiovascular Disease in the Framingham Heart Study.

Vasan, Ramachandran S / Song, Rebecca J / Xanthakis, Vanessa / Mitchell, Gary F

Hypertension (Dallas, Tex. : 1979)

2021 Volume 78, Issue 5, Page(s) 1278–1286

Abstract: Figure: see text]. ...

Abstract	[Figure: see text].
MeSH term(s)	Aged ; Antihypertensive Agents/therapeutic use ; Aorta/pathology ; Aorta/physiopathology ; Blood Pressure/physiology ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/physiopathology ; Female ; Follow-Up Studies ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/physiopathology ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Pulse Wave Analysis/methods ; United States/epidemiology ; Vascular Stiffness/physiology
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2021-10-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	423736-5
ISSN	1524-4563 ; 0194-911X ; 0362-4323
ISSN (online)	1524-4563
ISSN	0194-911X ; 0362-4323
DOI	10.1161/HYPERTENSIONAHA.121.17702
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Article: Later Midline Shift Is Associated with Better Outcomes after Large Middle Cerebral Artery Stroke.

Song, Jonathan J / Stafford, Rebecca A / Pohlmann, Jack E / Kim, Ivy So Yeon / Cheekati, Maanyatha / Dennison, Sydney / Brush, Benjamin / Chatzidakis, Stefanos / Huang, Qiuxi / Smirnakis, Stelios M / Gilmore, Emily J / Mohammed, Shariq / Abdalkader, Mohamad / Benjamin, Emelia J / Dupuis, Josée / Greer, David M / Ong, Charlene J

Research square

2024

Abstract: Background/Objective Space occupying cerebral edema is the most feared early complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion, and is reported to peak 2-4 days after injury. Little ... ...

Abstract	Background/Objective Space occupying cerebral edema is the most feared early complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion, and is reported to peak 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially when it occurs after 96 hours. We aimed to characterize differences between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (<48 hours), average (48-96 hours), and subacute (>96 hours) groups and determine whether patients with subacute peak edema timing have improved discharge dispositions. Methods We performed a two-center, retrospective study of patients with ≥1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge disposition, adjusting for age, admission Alberta Stroke Program Early CT Score (ASPECTS), National Institute of Health Stroke Scale (NIHSS), acute thrombolytic intervention, cerebral atrophy, maximum MLS, parenchymal hemorrhagic transformation, DHC, and osmotic therapy receipt. Results Of 321 eligible patients with MLS, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than non-subacute swelling, adjusting for confounders (aOR, 1.85; 95% CI, 1.05-3.31). Conclusions Subacute peak edema after large MCA stroke is associated with better discharge disposition compared to earlier peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication.
Language	English
Publishing date	2024-04-18
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-4189278/v1
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Article ; Online: Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study.

Bourdillon, Maximillian T / Song, Rebecca J / Musa Yola, Ibrahim / Xanthakis, Vanessa / Vasan, Ramachandran S

Journal of the American Heart Association

2022 Volume 11, Issue 6, Page(s) e024202

Abstract: Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham ... ...

Abstract	Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 54% women). The prevalence of hypertension subtypes was as follows: nonhypertensive (systolic blood pressure [SBP] <140 mm Hg and diastolic blood pressure [DBP] <90 mm Hg), 79%; isolated systolic hypertension (ISH; SBP ≥140 mm Hg and DBP <90 mm Hg), 8%; isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg), 4%; and systolic-diastolic hypertension (SDH; SBP ≥140 mm Hg and DBP ≥90 mm Hg), 9%. The prevalence of ISH and SDH increased with age. Analysis of a subsample of nonhypertensive participants demonstrated that increasing age, female sex, higher heart rate, left ventricular mass, and greater left ventricular concentricity were predictors of incident ISH and SDH. Higher baseline DBP was associated with the risk of developing isolated diastolic hypertension and SDH, whereas higher SBP was associated with all 3 hypertension subtypes. On follow-up (median, 5.5 years), isolated diastolic hypertension often reverted to nonhypertensive BP (in 42% of participants) and ISH progressed to SDH (in 26% of participants), whereas SDH frequently transitioned to ISH (in 20% of participants). During follow-up (median, 14.6 years), 889 participants developed cardiovascular disease. Compared with the nonhypertensive group (referent), ISH (adjusted hazard ratio [HR], 1.57; 95% CI, 1.30-1.90) and SDH (HR, 1.66; 95% CI, 1.36-2.01) were associated with increased cardiovascular disease risk, whereas isolated diastolic hypertension was not (HR, 1.03; 95% CI, 0.68-1.57). Conclusions Hypertension subtypes vary in prevalence with age, are dynamic during short-term follow-up, and exhibit distinctive prognoses, underscoring the importance of blood pressure subphenotyping.
MeSH term(s)	Blood Pressure/physiology ; Cardiovascular Diseases ; Female ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Prognosis ; Risk Factors
Language	English
Publishing date	2022-03-09
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.121.024202
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Article ; Online: Evaluation of Machine Learning Approaches for Predicting Warfarin Discharge Dose in Cardiac Surgery Patients: Retrospective Algorithm Development and Validation Study.

Dryden, Lindsay / Song, Jacquelin / Valenzano, Teresa J / Yang, Zhen / Debnath, Meggie / Lin, Rebecca / Topolovec-Vranic, Jane / Mamdani, Muhammad / Antoniou, Tony

JMIR cardio

2023 Volume 7, Page(s) e47262

Abstract: Background: Warfarin dosing in cardiac surgery patients is complicated by a heightened sensitivity to the drug, predisposing patients to adverse events. Predictive algorithms are therefore needed to guide warfarin dosing in cardiac surgery patients.: ... ...

Abstract	Background: Warfarin dosing in cardiac surgery patients is complicated by a heightened sensitivity to the drug, predisposing patients to adverse events. Predictive algorithms are therefore needed to guide warfarin dosing in cardiac surgery patients. Objective: This study aimed to develop and validate an algorithm for predicting the warfarin dose needed to attain a therapeutic international normalized ratio (INR) at the time of discharge in cardiac surgery patients. Methods: We abstracted variables influencing warfarin dosage from the records of 1031 encounters initiating warfarin between April 1, 2011, and November 29, 2019, at St Michael's Hospital in Toronto, Ontario, Canada. We compared the performance of penalized linear regression, k-nearest neighbors, random forest regression, gradient boosting, multivariate adaptive regression splines, and an ensemble model combining the predictions of the 5 regression models. We developed and validated separate models for predicting the warfarin dose required for achieving a discharge INR of 2.0-3.0 in patients undergoing all forms of cardiac surgery except mechanical mitral valve replacement and a discharge INR of 2.5-3.5 in patients receiving a mechanical mitral valve replacement. For the former, we selected 80% of encounters (n=780) who had initiated warfarin during their hospital admission and had achieved a target INR of 2.0-3.0 at the time of discharge as the training cohort. Following 10-fold cross-validation, model accuracy was evaluated in a test cohort comprised solely of cardiac surgery patients. For patients requiring a target INR of 2.5-3.5 (n=165), we used leave-p-out cross-validation (p=3 observations) to estimate model performance. For each approach, we determined the mean absolute error (MAE) and the proportion of predictions within 20% of the true warfarin dose. We retrospectively evaluated the best-performing algorithm in clinical practice by comparing the proportion of cardiovascular surgery patients discharged with a therapeutic INR before (April 2011 and July 2019) and following (September 2021 and May 2, 2022) its implementation in routine care. Results: Random forest regression was the best-performing model for patients with a target INR of 2.0-3.0, an MAE of 1.13 mg, and 39.5% of predictions of falling within 20% of the actual therapeutic discharge dose. For patients with a target INR of 2.5-3.5, the ensemble model performed best, with an MAE of 1.11 mg and 43.6% of predictions being within 20% of the actual therapeutic discharge dose. The proportion of cardiovascular surgery patients discharged with a therapeutic INR before and following implementation of these algorithms in clinical practice was 47.5% (305/641) and 61.1% (11/18), respectively. Conclusions: Machine learning algorithms based on routinely available clinical data can help guide initial warfarin dosing in cardiac surgery patients and optimize the postsurgical anticoagulation of these patients.
Language	English
Publishing date	2023-12-06
Publishing country	Canada
Document type	Journal Article
ISSN	2561-1011
ISSN (online)	2561-1011
DOI	10.2196/47262
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Article ; Online: Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study.

Bourdillon, Maximillian T / Gaye, Bamba / Song, Rebecca J / Vasan, Ramachandran S / Xanthakis, Vanessa

PloS one

2022 Volume 17, Issue 5, Page(s) e0267267

Abstract: Importance: Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with ... ...

Abstract	Importance: Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with poor CVH profiles escape CVD development. Objective: To describe the prevalence of paradoxical relations among CVH, SubDz, and CVD. Design: Cohort study, Framingham Study data collected prospectively (1995-2016). Setting: Population-based. Participants: 7,627 participants (mean age 49 years, 53% women) attending Offspring examinations 6/7 and Third Generation examinations 1/2. Exposures: CVH score (range 0-14) constructed from poor, intermediate, or ideal status for each metric (smoking, diet, physical activity, blood pressure, body mass index, fasting glucose, total cholesterol); and prevalent SubDz (≥1 of: increased carotid intimal media thickness, CIMT; left ventricular hypertrophy, LVH; microalbuminuria, MA; elevated ankle brachial index, ABI; coronary artery calcium score ≥100,CAC). Main outcome(s) and measure(s): Ideal CVH (scores 12-14), intermediate CVH (scores 8-11), and poor CVH (0-7). We described three distinct paradoxical phenomena, involving combinations of CVH, SubDz, and CVD, and generated CVD incidence rates and predicted CVD probabilities for all combinations. Results: We observed 842 CVD events (median follow-up 13.7 years); 1,663 participants had SubDz. Most individuals with poor CVH (78%) or SubDz (57% for CIMT to 77% for LVH) did not develop CVD on follow-up. Among participants with incident CVD, the majority had intermediate or ideal CVH (68%) or absent SubDz (46% for CAC to 96% for ABI) at baseline. We observed similar paradoxical results in relations between CVH and prevalent SubDz. Poor CVH and prevalent SubDz were each associated with higher CVD incidence rates compared to intermediate or ideal CVH and absent SubDz, respectively. The predicted CVD probability was nearly three-times greater among participants with poor (22%) versus intermediate or ideal CVH (8%). Mean CVD predicted probabilities were nearly three (26% vs. 10% for MA) to six-times (29% vs. 5% for CAC) greater among participants with SubDz versus without SubDz. Findings were consistent within age and sex strata. Conclusions and relevance: Although poor CVH and SubDz presence are associated with CVD incidence, paradoxical phenomena involving CVH, SubDz, and CVD are frequently prevalent in the community. Further studies to elucidate biological mechanisms underlying these phenomena are warranted.
MeSH term(s)	Cardiovascular Diseases ; Cohort Studies ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Hypertrophy, Left Ventricular/epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Risk Factors
Language	English
Publishing date	2022-05-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0267267
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