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1
Murai, Tadashi, Tetsumin Lee, Yoshihisa Kanaji, Junji Matsuda, Eisuke Usui, Makoto Araki, Takayuki Niida, et al. "The influence of elective percutaneous coronary intervention on microvascular resistance: a serial assessment using the index of microcirculatory resistance." American Journal of Physiology-Heart and Circulatory Physiology 311, no. 3 (September 1, 2016): H520—H531. http://dx.doi.org/10.1152/ajpheart.00837.2015.
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This study investigates whether hyperemic microvascular resistance (MR) is influenced by elective percutaneous coronary intervention (PCI) by using the index of microcirculatory resistance (IMR). Seventy-one consecutive patients with stable angina pectoris undergoing elective PCI were prospectively studied. The IMR was measured before and after PCI and at the 10-mo follow-up. The IMR significantly decreased until follow-up; the pre-PCI, post-PCI, and follow-up IMRs had a median of 19.8 (interquartile range, 14.6–28.9), 16.2 (11.8–22.1), and 14.8 (11.8–18.7), respectively ( P < 0.001). The pre-PCI IMR was significantly correlated with the change in IMR between pre- and post-PCI ( r = 0.84, P < 0.001) and between pre-PCI and follow-up ( r = 0.93, P < 0.001). Pre-PCI IMR values were significantly higher in territories with decreases in IMR than in those with increases in IMR [pre-PCI IMR: 25.4 (18.4–35.5) vs. 12.5 (9.4–16.8), P < 0.001]. At follow-up, IMR values in territories showing decreases in IMR were significantly lower than those with increases in IMR [IMR at follow-up: 13.9 (10.9–17.6) vs. 16.6 (14.0–21.4), P = 0.013]. The IMR decrease was significantly associated with a greater shortening of mean transit time, indicating increases in coronary flow ( P < 0.001). The optimal cut-off values of pre-PCI IMR to predict a decrease in IMR after PCI and at follow-up were 16.8 and 17.0, respectively. In conclusion, elective PCI affected hyperemic MR and its change was associated with pre-PCI MR, resulting in showing a wide distribution. Overall hyperemic MR significantly decreased until follow-up. The modified hyperemic MR introduced by PCI may affect post-PCI coronary flow.
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Jang, Ji-Hun, Man-Jong Lee, Kyu-Yong Ko, Jin-Hee Park, Yong-Soo Baek, Kwon Sung-Woo, Sung-Hee Shin, et al. "Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data." Journal of Interventional Cardiology 2020 (July 9, 2020): 1–12. http://dx.doi.org/10.1155/2020/5036396.
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Objectives. We aimed to identify mechanical and pharmacological revascularization strategies correlated with the index of microcirculatory resistance (IMR) in ST-elevation myocardial infarction (STEMI) patients. Background. Microvascular dysfunction (MVD) after STEMI is correlated with infarct size and poor long-term prognosis, and the IMR is a useful analytical method for the quantitative assessment of MVD. However, therapeutic strategies that can reliably reduce MVD remain uncertain. Methods. Patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled. The IMR was measured with a pressure sensor/thermistor-tipped guidewire immediately after primary PCI. High IMR was defined as values ≥66th percentile of IMR in enrolled patients (IMR > 30.9 IU). Results. A total of 160 STEMI patients were analyzed (high IMR = 54 patients). Clinical factors for Killip class P=0.006, delayed hospitalization from symptom onset P=0.004, peak troponin-I level P=0.042, and multivessel disease P=0.003 were associated with high IMR. Achieving final thrombolysis in myocardial infarction myocardial perfusion grade 3 tended to be associated with low IMR P=0.119, whereas the presence of distal embolization was significantly associated with high IMR P=0.034. In terms of therapeutic strategies that involved adjusting clinical and angiographic factors associated with IMR, preloading of third-generation P2Y12 inhibitors correlated with reducing IMR value (β = −10.30, P<0.001). Mechanical therapeutic strategies including stent diameter/length, preballoon dilatation, direct stenting, and thrombectomy were not associated with low IMR value (all P>0.05), and postballoon dilatation was associated with high IMR (β = 8.30, P=0.020). Conclusions. In our study, mechanical strategies were suboptimal in achieving myocardial salvage. Preloading of third-generation P2Y12 inhibitors revealed decreased IMR value, indicative of MVD prevention.
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Owens-Young, Jessica, and Caryn N. Bell. "Structural Racial Inequities in Socioeconomic Status, Urban-Rural Classification, and Infant Mortality in US Counties." Ethnicity & Disease 30, no. 3 (July 8, 2020): 389–98. http://dx.doi.org/10.18865/ed.30.3.389.
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Objectives: Despite improvements in infant mortality rates (IMR) in the United States, racial gaps in IMR remain and may be driven by both structural racism and place. This study assesses the relationship between structural racism and race-specific IMR and the role of urban-rural classification on race-specific IMR and Black/White racial gaps in IMR.Methods: We conducted an analysis of variance tests using 2019 County Health Rankings Data to determine differences in structural racism indicators, IMR and other co-variates by urban-rural classification. We used linear regressions to determine the associations between measures of structural racism and county-level health outcomes.Results: Study results suggest that racial inequities in education, work, and homeownership negatively impact Black IMR, especially in large fringe, medium, and small metro counties, and positively impact White IMR. Structural racism is also associated with Black-White gaps in IMR.Conclusions: Factors related to structural racism may not be homogenous or have the same impacts on overall IMR, race-specific IMR, and racial differences in IMR across places. Understanding these differential impacts can help public health professionals and policymakers improve Black infant health and eliminate racial inequities in IMR. Ethn Dis. 2020;30(3):389-398; doi:10.18865/ed.30.3.389
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Berry, Stephanie E. "Democracy and the Preservation of Minority Identity: Fragmentation within the European Human Rights Framework." International Journal on Minority and Group Rights 24, no. 3 (August 8, 2017): 205–28. http://dx.doi.org/10.1163/15718115-02403005.
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The international human rights (ihr) and international minority rights (imr) regimes have very different origins. However, the two regimes converged in the 20th century, and imr are now understood to be a sub-regime of ihr. This article argues that the different historical origins of the two regimes impact how actors within each regime interpret their mission, and have resulted in institutional fragmentation within the Council of Europe. The mission of the European Court of Human Rights is the promotion and protection of democracy, whereas the Advisory Committee to the Framework Convention for the Protection of National Minority’s mission is the preservation of minority identity. In practice, this has led to conflicting interpretations of multi-sourced equivalent norms. It is suggested that inter-institutional dialogue provides an avenue through which these conflicting interpretations can be mediated.
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Castillero, Estibaliz, Daniel P. Howsmon, Bruno V. Rego, Samuel J. Keeney, Kathryn H. Driesbaugh, Takayuki Kawashima, Yingfei Xue, et al. "Altered Responsiveness to TGFβ and BMP and Increased CD45+ Cell Presence in Mitral Valves Are Unique Features of Ischemic Mitral Regurgitation." Arteriosclerosis, Thrombosis, and Vascular Biology 41, no. 6 (June 2021): 2049–62. http://dx.doi.org/10.1161/atvbaha.121.316111.
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Objective: Ischemic mitral regurgitation (IMR) often develops after an ischemic event, which results in distortion of the valvulo-ventricular complex and incomplete mitral valve (MV) leaflet coaptation. After left ventricular ischemic events, only some patients develop IMR. The susceptibility of the MV to remodel may influence whether IMR develops. We hypothesized that impaired signaling response in MV cells may contribute to IMR development by inducing maladaptive tissue remodeling. Approach and Results: Sheep (n=14) were subjected to ligation of the circumflex coronary artery to induce myocardial infarction. IMR was reported by echocardiography. MV leaflets and MV interstitial cells (MVICs) were collected at baseline (control, n=10), 4 and 8 weeks post-myocardial infarction. RNA sequencing highlighted differences in TGFβ (transforming growth factor beta) signaling between MV with/without IMR. SMAD6/7 and ID2 (inhibitor of DNA binding 2) were the highest increased TGFβ-signaling genes associated with IMR. MVICs from myocardial infarction sheep were less responsive to BMP (bone morphogenic protein) 4 pro-osteogenic stimulation (ID2, OPN [osteopontin], and OC [osteocalcin] mRNA) than control. MVICs from IMR sheep had a diminished COL (collagen) 1A1 mRNA response to TGFβ1 and enhanced prochondrogenic RUNX2 (runt-related transcription factor 2) and SOX9 mRNA response to BMP4 versus non-IMR MVICs. Baseline CD45 (cluster of differentiation) expression was detectable only in IMR MVICs. Upon TGFβ1 stimulation, CD45 expression was detected in all groups. Immunostaining confirmed increased presence of CD45+ cells in IMR MV interstitium. Conclusions: MVs from sheep with IMR had an altered TGFβ/BMP response, associated with increased CD45+ cell presence within the tissue interstitium. Pharmacological strategies aimed to modulate TGFβ/BMP signaling after myocardial infarction may protect from pathological MV remodeling leading to IMR.
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Hickethier, Tilman, Bettina Baeßler, Jan Robert Kroeger, Dirk Müller, David Maintz, Guido Michels, and Alexander C. Bunck. "Knowledge-based iterative reconstructions for imaging of coronary artery stents: first in-vitro experience and comparison of different radiation dose levels and kernel settings." Acta Radiologica 60, no. 2 (May 28, 2018): 160–67. http://dx.doi.org/10.1177/0284185118778875.
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Background Advanced knowledge-based iterative model reconstructions (IMR) became recently available for routine computed tomography (CT). Using more realistic physical models it promises improved image quality and potential radiation dose reductions, both possibly beneficial for non-invasive assessment of coronary stents. Purpose To evaluate the influence of different IMR settings at different radiation doses on stent lumen visualization in comparison to filtered back projection (FBP) and first-generation (hybrid) iterative reconstruction (HIR). Material and Methods Ten coronary stents in a coronary phantom were examined at four different dose settings (120 kV/125 mAs, 120 kV/75 mAs, 100 kV/125 mAs, 100 kV/75 mAs). Images were reconstructed with stent-specific FBP and HIR kernels and with IMR using CardiacRoutine (CR) and CardiacSharp (CS) settings at three different iteration levels. Image quality was evaluated using established parameters: image noise; in-stent attenuation difference; and visible lumen diameter. Results Image noise was significantly lower in IMR than in corresponding HIR and FBP images. At lower radiation doses, image noise increased significantly except with IMR CR3 and IMR CS3. Visible lumen diameters were significantly larger with IMR CS than with FBP, HIR, and IMR CR. IMR CR showed the smallest attenuation difference, while attenuation was artificially decreased extensively with IMR CS. FBP and HIR showed moderately increased in-stent attenuations. No relevant influence of used radiation doses on visible lumen diameters or attenuation differences was found. Conclusion IMR CR reduces image noise significantly while offering comparable stent-specific image quality in comparison to FBP and HIR and therefore potentially facilitates stent lumen delineation. Utilization of IMR CS for stent evaluation seems unfavorable due to artificial image alterations.
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Kodeboina, Monika, Sakura Nagumo, Daniel Munhoz, Jeroen Sonck, Niya Mileva, Emanuele Gallinoro, Alessandro Candreva, et al. "Simplified Assessment of the Index of Microvascular Resistance." Journal of Interventional Cardiology 2021 (June 2, 2021): 1–7. http://dx.doi.org/10.1155/2021/9971874.
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Background. To validate a simplified invasive method for the calculation of the index of microvascular resistance (IMR). Methods. This is a prospective, single-center study of patients with chronic coronary syndromes presenting with nonobstructive coronary artery disease. IMR was obtained using both intravenous (IV) adenosine and intracoronary (IC) papaverine. Each IMR measurement was obtained in duplicate. The primary objective was the agreement between IMR acquired using adenosine and papaverine. Secondary objectives include reproducibility of IMR and time required for the IMR measurement. Results. One hundred and sixteen IMR measurements were performed in 29 patients. The mean age was 68.8 ± 7.24 years, and 27.6% was diabetics. IMR values were similar between papaverine and adenosine (17.7 ± 7.26 and 20.1 ± 8.6, p = 0.25 ; Passing-Bablok coefficient A 0.58, 95% CI −2.42 to 3.53; coefficient B 0.90, 95% CI −0.74 to 1.07). The reproducibility of IMR was excellent with both adenosine and papaverine (ICC 0.78, 95% CI 0.63 to 0.88 and ICC 0.93, 95% CI 0.87 to 0.97). The time needed for microvascular assessment was significantly shortened by the use of IC papaverine (3.23 (2.84, 3.78) mins vs. 5.48 (4.94, 7.09) mins, p < 0.0001 ). Conclusion. IMR can be reliably measured using IC papaverine with similar results compared to intravenous infusion of adenosine with increased reproducibility and reduced procedural time. This approach simplifies the invasive assessment of the coronary microcirculation in the catheterization laboratory.
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Pineda, Víctor, Jaume Figueras, Sergio Moral, Jordi Bañeras, José Rodríguez-Palomares, Artur Evangelista, and David García-Dorado. "Comparison of distinctive clinical and cardiac magnetic resonance features between ST elevation myocardial infarction patients with incomplete myocardial rupture and those with moderate to severe pericardial effusion." European Heart Journal: Acute Cardiovascular Care 8, no. 5 (July 21, 2017): 457–66. http://dx.doi.org/10.1177/2048872617719650.
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Background: Whether patients with incomplete myocardial rupture (IMR) present distinctive clinical and cardiac magnetic resonance features from those with moderate–severe pericardial effusion (⩾10 mm (PE)) remains unknown Methods: We compared the clinical, angiographic and cardiac magnetic resonance characteristics of nine patients with IMR (diagnosed angiographically and/or by cardiac magnetic resonance) with 29 with PE, and also with 38 without IMR or PE with evidence of transmural necrosis (reference group) matched for age, gender and year of admission. Results: Patients with IMR were younger than those with PE ( p<0.001) but the two groups shared a higher rate of admission delay (78% and 41%) than those without IMR/PE (5%, p<0.001) and lower frequency of reperfusion therapy (44%, 55% and 100%, respectively, p<0.001). Thirteen patients with PE (45%) but only one IMR (11%) presented recurrent chest pain. IMR patients tended to present smaller infarct size at cardiac magnetic resonance ( p=0.153 and 0.036) and number of segments with ⩾75% necrosis than PE patients and those without IMR/PE ( p=0.098 and 0.029, respectively). Ten PE patients presented cardiac tamponade (35%). A control 2D-echocardiogram performed within two years in 71 patients (93%) documented a pseudoaneurysm in one PE and in one IMR patient. Conclusions: IMR is generally silent and occurs in younger patients with smaller infarct size than those with PE although both present late and are often untreated with reperfusion therapy. These findings may warrant imaging assessment in ST elevation myocardial infarction patients with delayed admission, particularly in absence of reperfusion, to rule out an IMR.
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Adamyan, K. G., A. L. Chilingaryan, N. G. Mkrtchyan, and L. G. Tunyan. "Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction." Russian Journal of Cardiology 25, no. 2 (March 11, 2020): 52–59. http://dx.doi.org/10.15829/1560-4071-2020-2-3098.
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Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease.
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Khan, Kamran, Naveedullah Khan, Faisal Qadir, Muhammad Tariq Farman, Khalid Iqbal Bhatti, and Parveen Akhtar. "FREQUENCY OF ISCHEMIC MITRAL REGURGITATION AFTER ACUTE ST- ELEVATION MYOCARDIAL INFARCTION AT A TERTIARY CARE CARDIAC CENTER." Pakistan Heart Journal 55, no. 4 (December 31, 2022): 375–79. http://dx.doi.org/10.47144/phj.v55i4.2367.
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Objectives: Among the common complications of coronary artery disease (CAD) is the ischemic mitral regurgitation (IMR). Identifying IMR and assessing its severity is pertinent owing to its significance in post- myocardial infarction (MI) risk stratification. It is associated with a higher risk of heart failure and mortality. This study aimed to determine the frequency of IMR after the first acute ST-elevation MI (STEMI) in the Pakistani population. Methodology: A cross-sectional observational study was conducted at NICVD, Karachi between January and July 2021. One hundred and ninety-five consecutive participants of first acute ST elevation MI who fulfilled the diagnostic criteria of IMR were included in the study. Demographic and clinical profile was recorded. All patients underwent echocardiography to grade the severity of IMR. Data was entered and analyzed using SPSS version 20. Results: Of 195 patients, 141 (72.3%) were males. 77 (39.5%) were diabetic, 92 (47.2%) were hypertensive, 18 (9.2%) had dyslipidemia and 58 (29.7%) used tobacco. IMR was observed in 74 (37.9%) with mild in 50 (67.6%), moderate in 18 (24.3%), and severe in 6 (8.1%) patients. IMR was statistically significantly associated with duration of symptoms, type of MI, diabetes mellitus, hypertension, and tobacco use. Conclusion: IMR was prevalent in more than one-third of patients presenting with acute ST elevation MI. Severity of IMR was moderate to severe in about one-third of the patients. IMR was found to be associated with duration of symptoms, type of MI, diabetes mellitus, hypertension, and tobacco use. Considering its prognostic role, assessment of IMR and its severity is necessary for appropriate management of patients.
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Maciel, Thiago Trovati, Caroline Carvalho, Rachel Rignault, Biree Andemariam, Betty S. Pace, Jennifer Isler OCain, and Rahul Ballal. "IMR-261, a Novel Oral Nrf2 Activator, Induces Fetal Hemoglobin in Human Erythroblasts, Reduces VOCs, and Ameliorates Ineffective Erythropoiesis in Experimental Mouse Models of Sickle Cell Disease and Beta-Thalassemia." Blood 138, Supplement 1 (November 5, 2021): 853. http://dx.doi.org/10.1182/blood-2021-149528.
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Abstract Background Sickle cell disease (SCD) is an autosomal recessive disorder where mutated hemoglobin (HbS) polymerizes and can lead to irreversible red blood cell (RBC) sickling and painful vaso-occlusive crisis (VOC). The RBC sickling is amplified by inflammation, resulting in tissue and organ damage. The transcription factor Nuclear factor erythroid 2-related factor 2 (Nrf2) coordinates the expression of antioxidant genes in response to oxidative stress, regulates inflammation, inhibits the NFkB pathway, and induces fetal hemoglobin (HbF), making it an attractive target in SCD and beta-thalassemia. IMR-261 is a novel oral activator of Nrf2 and has been tested in Phase 2 clinical trials (previously as CXA-10). Methods & Results CD14+ human monocytes were exposed to IMR-261 at 3µM and 10µM for 3 hours, to determine via quantitative PCR (qPCR) its ability to induce expression of antioxidant genes. IMR-261 at 10 µM significantly increased (p<0.05) the expression of Nrf2-dependent genes (p<0.05), including HMOX1, HSPA1A, HSP90, GCLM, SOD1 and TXNRD1. Human monocytes were treated with lipopolysaccharide (LPS) to test the ability of IMR-261 to block inflammatory genes with a NFkB target dataset. IMR-261 significantly inhibited (p<0.05) LPS-induced expression of IL-1-beta, TNF-alpha and IL-6 in human monocytes. To test the effects of IMR-261 on HbF induction, human erythroblasts were derived from CD34+ blood marrow progenitor cells sourced from healthy or SCD subjects. IMR-261 induced expression of the gamma-globin gene (4.0-fold change at 3µM and 7.18-fold change at 6 µM). This was accompanied by increased %F-cells (2.8-fold change at 3µM and 3.0-fold change at 6 µM). IMR-261 was also tested in the Townes HbSS mouse model of SCD to assess the potential for HbF induction. Mice were dosed with IMR-261 at 12.5 mg/kg or 37.5 mg/kg BID for 4 weeks (N=4-8/group). After 4 weeks of treatment, IMR-261 at 12.5 mg/kg and 37.5 mg/kg resulted in a significant increase in HbF relative to control, and 37.5 mg/kg resulted in a significant increase in %F-cells relative to control (Table 1, p<0.05). In addition, both doses of IMR-261 led to significant increases in RBC counts and total hemoglobin (Hb) (Table 1, p<0.05). IMR-261 at 37.5 mg/kg also significantly decreased (p<0.05) both reticulocyte counts and spleen cellularity. The ability of IMR-261 to reduce VOCs was assessed in separate Townes HbSS mice after the administration of TNF-alpha (0.5 µg/mice i.p.). IMR-261 was dosed at 37.5 mg/kg BID for 5 days before triggering VOCs. RBCs were stained with Ter-119 antibodies on spleen and liver of mice. Compared to controls, IMR-261 significantly reduced the presence of RBC on occluded vessels. This was coupled with a reduction of P-selectin (3109±97 Mean Fluorescence Units [MFI] in vehicle-treated vs. 1974±379 MFI in IMR-261 group, p<0.05) and L-selectin (375±20 MFI in vehicle-treated vs. 242±60 MFI in IMR-261 group, p<0.05). IMR-261 also reduced select hemolysis biomarkers: bilirubin (11.2±0.3 mg/dL in vehicle-treated vs. 8.4±0.7 mg/dL in IMR-261 group, (p<0.05) and free-heme (325±52 µM in vehicle-treated vs. 203±51 µM in IMR-261 group, p<0.05). A beta-thalassemia experimental model Hbb th1/th1 was tested to evaluate whether IMR-261 could improve ineffective erythropoiesis seen in beta-thalassemia. IMR-261 treatment at 37.5 mg/kg BID significantly increased hemoglobin levels, RBC counts and hematocrit (p<0.05), with significant reductions observed in reticulocytes (p<0.05). flow cytometry analysis (CD71/Ter119) showed that IMR-261 significantly decreased late basophilic and polychromatic erythroblasts (Ery.B) and increased orthochromatic erythroblasts and reticulocytes (Ery.C) cell numbers in the spleen (p<0.05). Conclusions IMR-261 activates Nrf2-dependent antioxidant genes and inhibits NFkB-induced pro-inflammatory genes in human monocytes. In human erythroblasts, IMR-261 significantly increased HbF and %F-cells. In vivo SCD models show that IMR-261 significantly induced HbF and %F-cells, improved hemolytic markers, and decreased VOCs. IMR-261 also increased Hb and improved ineffective erythropoiesis in a beta-thalassemia in-vivo model. Together these data suggest that IMR-261 is a promising, novel, oral therapy that warrants clinical testing in SCD and beta-thalassemia. Figure 1 Figure 1. Disclosures Maciel: Imara Inc.: Research Funding. Carvalho: Imara Inc.: Research Funding. Rignault: Imara Inc.: Research Funding. Pace: Imara Inc.: Consultancy. OCain: Imara Inc.: Current Employment, Current equity holder in publicly-traded company. Ballal: Imara Inc.: Current Employment, Current equity holder in publicly-traded company.
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Yoon, Gwang-Seok, Sung Gyun Ahn, Seong-Ill Woo, Myeong Ho Yoon, Man-Jong Lee, Seong Huan Choi, Ji-Yeon Seo, Sung Woo Kwon, Sang-Don Park, and Kyoung-Woo Seo. "The Index of Microcirculatory Resistance after Primary Percutaneous Coronary Intervention Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction." Journal of Clinical Medicine 10, no. 20 (October 16, 2021): 4752. http://dx.doi.org/10.3390/jcm10204752.
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The index of microcirculatory resistance (IMR) is a simple method that can measure microvascular function after primary percutaneous coronary intervention (PCI) in patients with ST-segment Elevation Myocardial Infarction (STEMI). This study is to find out whether IMR predicts clinical long-term outcomes in STEMI patients. A total of 316 patients with STEMI who underwent primary PCI from 2005 to 2015 were enrolled. The IMR was measured using pressure sensor/thermistor-tipped guidewire after primary PCI. The primary endpoint was the rate of death or hospitalization for heart failure (HF) over a mean follow-up period of 65 months. The mean corrected IMR was 29.4 ± 20.0. Patients with an IMR > 29 had a higher rate of the primary endpoint compared to patients with an IMR ≤ 29 (10.3% vs. 2.1%, p = 0.001). During the follow-up period, 13 patients (4.1%) died and 6 patients (1.9%) were hospitalized for HF. An IMR > 29 was associated with an increased risk of death or hospitalization for HF (OR 5.378, p = 0.004). On multivariable analysis, IMR > 29 (OR 3.962, p = 0.022) remained an independent predictor of death or hospitalization for HF with age (OR 1.048, p = 0.049) and symptom-to-balloon time (OR 1.002, p = 0.049). High IMR was an independent predictor for poor long-term clinical outcomes in STEMI patients after primary PCI.
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Pandey, Ashutosh, and Arvind Mohan. "The role of national rural health mission in reducing infant mortality rate in India." International Journal of Health Governance 24, no. 1 (February 22, 2019): 56–65. http://dx.doi.org/10.1108/ijhg-09-2018-0044.
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Purpose The purpose of this paper is to assess the role of National Rural Health Mission (NRHM) in reducing Infant Mortality in India. The study will help the government in deciding its future course of action regarding the infant mortality rate (IMR) reduction in India. Design/methodology/approach This paper adopts the interrupted time series analysis (ITSA) approach with a control group to study the role of NRHM in reducing the IMR in India. The authors examined infant mortality in rural areas of India for the level and trend change before and after the implementation of NRHM. The authors then applied a suitable ARMA model to estimate the coefficients of the regression model. From the estimated results, the study predicts the counterfactuals for both the rural IMR and urban IMR and plots the results. Findings The study found the evidence supporting the hypotheses that the NRHM has led to a reduction in the difference between urban IMR and rural IMR. The research shows that the rural IMR declined at steeper rates in the post-NRHM period (2005–2015). Originality/value None of the existing studies analyses the impact of a social scheme like NRHM on the reduction of IMR in India by applying the ITSA. The study is unique as it estimates the counterfactuals and plots the results which show the impact of NRHM on reducing IMR.
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Imaizumi, Yoko, and Kazuo Hayakawa. "Infant Mortality Among Singletons and Twins in Japan During 1999–2008 on the Basis of Risk Factors." Twin Research and Human Genetics 16, no. 2 (January 29, 2013): 639–44. http://dx.doi.org/10.1017/thg.2012.156.
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The infant mortality rate (IMR) among single and twin births from 1999 to 2008 was analyzed using Japanese Vital Statistics. The IMR was 5.3-fold higher in twins than in singletons in 1999 and decreased to 3.9-fold in 2008. The reduced risk of infant mortality in twins relative to singletons may be related, partially, to survival rates, which improved after fetoscopic laser photocoagulation for twin — twin transfusion syndrome. The proportion of neonatal deaths among total infant deaths was 54% for singletons and 74% for twins. Thus, intensive care of single and twin births may be very important during the first month of life to reduce the IMR. The IMR decreased as gestational age (GA) rose in singletons, whereas the IMR in twins decreased as GA rose until 37 weeks and increased thereafter. The IMR was significantly higher in twins than in singletons from the shortest GA (<24 weeks) to 28 weeks as well as ≥38 weeks, whereas the IMR was significantly higher in singletons than in twins from 30 to 36 weeks. As for maternal age, the early neonatal and neonatal mortality rates as well as the IMR in singletons were significantly higher in the youngest maternal age group than in the oldest one, whereas the opposite result was obtained in twins. The lowest IMR in singletons was 1.1 per 1,000 live births for ≥38 weeks of gestation and heaviest birth weight (≥2,000 g), while the lowest IMR in twins was 1.8 at 37 weeks and ≥2,000 g.
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Anikmah, Siti, Yeti Kartikasari, and Ary Kurniawati. "VARIASI PENGGUNAAN REKONTRUSI ALGORITMA FBP, iDose4 DAN ITERATIVE MODEL RECONTRUCTION (IMR) TERHADAP KUALITAS CITRA MCST THORAK LOW DOSE UNTUK MENDETEKSI NODUL PARU." JRI (Jurnal Radiografer Indonesia) 3, no. 2 (November 9, 2020): 76–79. http://dx.doi.org/10.55451/jri.v3i2.72.
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Background: Pulmonary nodules are often found accidentally when thorax imaging is done. The size and rate of nodule growth are the most important predictors of imaging for malignancy. When the low dose protocol applied to the thorax MSCT will affect image quality, such as increased noise and decreased spatial resolution, so that the detection of nodules becomes less accurate. For noise limitation the reconstruction of the FBP, iDose4 and IMR algorithm is used. The purpose of this literature study is to evaluate variations in the FBP, iDose4 and IMR algorithm in improving image quality.
Methods: This method is a qualitative research with a descriptive approach using comprehensive literatures studies
Results: The result show that noise reduction is highest at IMR and lowest at FBP. The highest number of detected nodules on IMR especially for solid nodules < 4 mm and the lowest on FBP. Pathological findings with the best quality on IMR and quality are limited to FBP. Visibility of normal and abnormal findings, iDose4 is better than IMR and FBP especially for reticular patterns. Effective doses are reduced by 44 % to 59 % based on this literature study. In clinical practice, IMR shows the potential for pathological recovery at low dose level and IMR can improved measured image quality based on noise, high contrast spatial resolution and low contrast detectability.
Conclusion: So IMR is the most effective algorithm applied for scanning low dose MSCT thorax for detection of pulmonary nodules.
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Palupi, Weike Retno, and Lailatul Khusnul Rizki. "ANALYSIS OF FACTOR AFFECTING INFANT MORTALITY RATE (IMR) IN EAST JAVA USING MULTIPLE LINEAR REGRESSION." Jurnal Biometrika dan Kependudukan 9, no. 1 (June 15, 2020): 69. http://dx.doi.org/10.20473/jbk.v9i1.2020.69-76.
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Infant Mortality Rate (IMR) is one of the important indicators in public health. Indonesia still has a relatively high IMR compared to the neighboring countries. Based on the Indonesian Demographic Health Survey (IDHS) in 2012, IMR in East Java reached 25.50 deaths per 1000 births. IMR decline occurred during 2012 to 2015. Achievement depends on the factors that influence it. This study aims to create a model of IMR based on maternal and external factors in East Java. The method used was a non-reactive study using 38 districts/cities as sample units in East Java, which came from Central Bureau of Statistics secondary data in 2015. Statistical analysis used multiple linear regression. The results showed the independent variables together affected the IMR (p-value = 0,000 <0.05), but partially influenced by the age of the first married mother (p-value = 0,000 <0.05) and the helper delivery of non-medical personnel (p-value = 0.014 <0.05). The conclusion of this study is the regression equation model for IMR in East Java in 2015, which is IMR = 1,064 + 1,319 * (age of first marriage) + 0.439 * (helper of non-medical births). Suggestions for the Government of East Java Province to implement strategies so that infant mortality cases can be reduced.
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Toropoc, Iulia. "The case for life expectancy at age 60 as a prominent health indicator. A comparative analysis." National Accounting Review 4, no. 4 (2022): 390–411. http://dx.doi.org/10.3934/nar.2022022.
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<abstract> <p>The aim of this paper is to argue the case of using life expectancy at age 60 (LE60) as a significant health indicator closely related to sustainable economic development. To this purpose, we investigate the impact of GDP on LE60 in parallel with the impact of GDP on Infant Mortality Rate (IMR). The rationale for selecting IMR as a comparison indicator is twofold. First, the relationship between IMR and GDP has been widely studied. Second, the two indicators display opposite trajectories, making the comparison more striking. For our comparison, we conduct several statistical analyses on LE60, IMR and GDP using global country data grouped by income level and region. Our results endorse the effect of GDP on LE60 and IMR and suggest a differentiation of the effect based on region and ultimately on income. We observe that as countries develop, their IMR values lower and their LE60 values increase. We conclude that, once countries reach the upper stages of development, LE60 becomes a better health indicator than IMR.</p> </abstract>
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Romero-Sandoval, Natalia, Diego Del Alcázar, Jacob Pastor, and Miguel Martín. "Ecuadorian infant mortality linked to socioeconomic factors during the last 30 years." Revista Brasileira de Saúde Materno Infantil 19, no. 2 (June 2019): 295–301. http://dx.doi.org/10.1590/1806-93042019000200003.
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Abstract Objectives: to analyze the difference among geographical units and the evolution of infant mortality rate (IMR) based on Ecuadorian censuses (1990-2001-2010). Methods: artificial Neural Network analyzed the impact of sociodemographic factors over the variability of IMR. Poisson regression analyzed the variation of the standardized IMR (sIMR). Results: the decrease in the national IMR was 63.8%; however, 42.8% provinces showed an increase in 2001-2010. The variability was explained mainly by illiteracy decrease. The adjusted RR between provincial sIMR with illiteracy and poverty revealed a trend towards the unit. Conclusions: the variation of IMR reflects a complex interaction of the sociodemographic factors.
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Egeland, Karina Myhren, Kristin Sverdvik Heiervang, Matthew Landers, Torleif Ruud, Robert E. Drake, and Gary R. Bond. "Psychometric Properties of a Fidelity Scale for Illness Management and Recovery." Administration and Policy in Mental Health and Mental Health Services Research 47, no. 6 (November 7, 2019): 885–93. http://dx.doi.org/10.1007/s10488-019-00992-5.
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Abstract This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91–.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR. Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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Tohari, Achmad Ilham, and Agus Supriono. "Program Penurunan Angka Kematian Bayi Melalui KKN Back To Village Di Desa Jelbuk Kabupaten Jember." JURNAL KREATIVITAS PENGABDIAN KEPADA MASYARAKAT (PKM) 5, no. 3 (March 4, 2022): 841–48. http://dx.doi.org/10.33024/jkpm.v5i3.5173.
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ABSTRAK Angka Kematian Bayi (AKB) adalah salah satu faktor penentu kualitas kesehatan dalam suatu negara. Tingginya AKB pada suatu negara mengindikasikan kurangnya kualitas kesehatan yang ada. Jember termasuk dalam daerah dengan kematian bayi yang tinggi yaitu 50,19 per 1000 kelahiran hidup. Pada kawasan Kecamatan Jelbuk telah ada lima kejadian kematian bayi selama Juli – Agustus 2021 dengan dua diantaranya berada pada wilayah kerja Posyandu Mawar 2A di Desa Jelbuk. Penurunan AKB di Desa Jelbuk membutuhkan bantuan dari berbagai pihak. Kegiatan pengabdian ini bertujuan untuk menurunkan angka AKB di Desa Jelbuk. Metode pengabdian berbentuk program penurunan AKB (berbasis kader kesehatan masyarakat) yang terdiri atas kegiatan penyuluhan AKB, BPJS kesehatan, dan pendampingan “Jemput Bola” imunisasi di kawasan Posyandu Mawar 2A. Lokasi pengabdian dipilih berdasarkan urgensi yang ada, yaitu dua AKB yang terjadi dalam lingkup Desa Jelbuk berada dalam kawasan kerja Posyandu Mawar 2A. Hasil dari kegiatan pengabdian berupa kader kesehatan posyandu mawar 2A dan masyarakat berhasil memahami materi AKB dan BPJS kesehatan. Anak yang diimunisasi dalam program kerja pendampingan “Jemput Bola” imunisasi berjumlah enam bayi. Kesimpulan program ini dapat meningkatkan pengetahuan kader kesehatan dan warga di Desa Jelbuk, khususnya mengenai penurunan AKB. Kata kunci: Angka Kematian Bayi, , anak, AKB, pencegahan AKB. ABSTRACT Infant Mortality Rate (IMR) is one of health quality defining factor in a country. Increased IMR indicate that the country had a poor health quality. Jember is a region that has a highest IMR about 50.19 per 1000 live birth. There were five IMR in Jelbuk district during July – August 2021 with two of them located in Posyandu Mawar 2A working area. In order to decrease the IMR, various help is needed from the stage holder. The aim of this community service is to decrease IMR in Jelbuk. The methods of this community service were arranged in several programs to decrease IMR (health cadres based) including IMR counselling, BPJS kesehatan, and “Jemput Bola” immunization in Posyandu Mawar 2A area. The community service location is based on the urgency that two of five IMR in Jelbuk is in Posyandu Mawar 2A working area. The results of this community service showed that the health cadres understand the topic about IMR and BPJS kesehatan. Total of six babies get immunization during “Jemput Bola” immunization program. The conclusion of this community service is this program may increase the knowledge of Jelbuk’s inhabitant and health cadres, specially in the scope of decreasing IMR. Keywords: Infant Mortality Rate, Infant, IMR, IMR prevention
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Schmidt-Holtz, Jakob, Azien Laqmani, Sebastian Butscheidt, Max Kurfürst, Maxim Avanesov, Cyrus Behzadi, Clemens Spink, et al. "Iterative Model Reconstruction (IMR) in MDCT Below 2 mSv for the Detection of Urinary Calculi: Diagnostic Accuracy and Image Quality in Comparison to Filtered Back-Projection and 4th Generation Iterative Reconstruction (iDose4)." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 190, no. 07 (July 2018): 630–36. http://dx.doi.org/10.1055/s-0044-100724.
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Purpose The purpose of the study was to assess the impact of iterative model reconstruction (IMR) on reader confidence with respect to stone detection and image quality in comparison to filtered back-projection (FBP) and iDose level 4 (iDose4) in abdominal MDCT with radiation doses below 2 mSv. Materials and Methods For 32 consecutive patients with suspected ureteral stone disease, the raw data of unenhanced 256 slice MDCT (120 kV, 40 reference mAs, mean CTDIvol: 2.7 ± 0.8 mGy, mean DLP: 126 ± 38 mGy × cm) were reconstructed using a prototype version of IMR (levels 1 – 3), iDose4 (level 4) and FBP at a 3 mm slice thickness. Image analysis was independently performed by two radiologists in a blinded fashion. The reader confidence level with respect to stone detection was recorded based on a 5-point scale (1 – certain exclusion; 5 – concrement definitely present) as well as for the evaluation of image quality regarding the depiction of anatomical details (1 – poor; 5 – excellent). A clinical reference standard for stone detection was not established. Statistical evaluation included weighted kappa analysis and Wilcoxon test. Results 17 pelvic and ureteral stones were found. 11 further concrements were located within the ostium of the urinary bladder or the bladder itself. Applying IMR, a distinct improvement in image quality was observed at every level (mean value for FBP, 2.0; iDose4, 2.9; IMR L1, 4.2; IMR L2, 4.0; IMR L3, 3.9; all p < 0.001). Applying the higher IMR levels L2 and L3, a certain level of so-called “blotchiness” of anatomical contours was observed. Reader confidence was significantly improved and was independent of IMR level (certain stone detection FBP, 69 %; iDose4, 81 %; IMR L1 to L3, 95 %; all p > 0.001). With increasing IMR levels, the reduction in streak artifacts was quantified by a decrease in image noise. A loss of anatomical information was not observed. The sensitivity rates for stone detection were equivalent for all MDCTs reconstructed with FBP, iDose4 and IMR. A mean effective dose of 1.9 ± 0.6 mSv was calculated. Conclusion In comparison to FBP and iDose4, a significant increase in mean image quality, reduction in image noise and improvement in subjective reader confidence can be achieved by applying IMR even at significantly reduced dose settings below 2 mSv. Results indicate that a further dose reduction might be possible with IMR. Key Points Citation Format
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Komarova, I. S., L. B. Karova, N. V. Andreeva, N. A. Cherkasova, and V. V. Zhelnov. "Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction." Kardiologiia 59, no. 5 (May 25, 2019): 18–25. http://dx.doi.org/10.18087/cardio.2019.5.2607.
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Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.
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Wolf, Mattie F., Allison T. Rose, Ruchika Goel, Jennifer Canvasser, Barbara J. Stoll, and Ravi M. Patel. "Trends and Racial and Geographic Differences in Infant Mortality in the United States Due to Necrotizing Enterocolitis, 1999 to 2020." JAMA Network Open 6, no. 3 (March 3, 2023): e231511. http://dx.doi.org/10.1001/jamanetworkopen.2023.1511.
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This cohort study analyzes yearly trends in necrotizing enterocolitis–related infant mortality rates (NEC-IMR) from 1999 to 2020, overall and by Black and White race, and described Black-to-White NEC-IMR ratios and NEC-IMR for US states.
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Kanno, Yoshinori, Masahiro Hoshino, Rikuta Hamaya, Tomoyo Sugiyama, Yoshihisa Kanaji, Eisuke Usui, Masao Yamaguchi, et al. "Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio." Open Heart 7, no. 1 (January 2020): e001179. http://dx.doi.org/10.1136/openhrt-2019-001179.
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BackgroundMeasurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised.MethodsWe performed a post-hoc analysis of 504 vessels with angiographically intermediate stenosis in 504 patients who underwent measurement of FFR, coronary flow reserve (CFR), the index of microcirculatory resistance (IMR) and Duke jeopardy score.ResultsIn total, 396 (78.6%) and 108 (21.4%) lesions showed concordant and discordant FFR and cQFR functional classifications, respectively. Among lesions with a reduced FFR (FFR+), those with a preserved cQFR (cQFR−) showed significantly lower IMR, shorter mean transit time (Tmn), shorter lesion length (all, p<0.01) and similar CFR and Duke jeopardy scores compared with lesions showing a reduced cQFR (cQFR+). Furthermore, lesions with FFR+ and cQFR− had significantly lower IMR and shorter Tmn compared with lesions showing a preserved FFR (FFR−) and cQFR+. Of note, in cQFR+ lesions, higher IMR lesions were associated with decreased diagnostic accuracy (high-IMR; 63.0% and low-IMR; 75.8%, p<0.01). In contrast, in cQFR− lesions, lower IMR lesions was associated with decreased diagnostic accuracy (high-IMR group; 96.8% and low-IMR group; 80.0%, p<0.01). Notably, in total, 31 territories (6.2%; ‘jump out’ group) had an FFR above the upper limit of the grey zone (>0.80) and a cQFR below the lower limit (≤0.75). In contrast, five territories (1.0%; ‘jump in’ group) exhibited opposite results (FFR of ≤0.75 and cQFR of >0.80). The ‘jump out’ territories showed significantly higher IMR values than ‘jump in’ territories (p<0.01).ConclusionsFFR− with cQFR+ is associated with increased microvascular resistance, and FFR+ with cQFR− showed preservation of microvascular function with high coronary flow. Microvascular function affected diagnostic performance of cQFR in relation to functional stenosis significance.
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Mahfouz, Ragab A., Marwa M. Gad, Mohamed Arab, and Moei-E. deen Abulfotouh. "Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention." Pulse 9, no. 3-4 (2021): 125–32. http://dx.doi.org/10.1159/000520074.
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Objective: We aimed to investigate the relation between CHA2DS2-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). Subjects and Methods: The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA2DS2-VASc score. Results: Subjects were stratified into 2 groups based on IMR </≥ 40 U; 72 patients (62.6) with IMR <40 U and 43 patients (37.4) with IMR ≥40 U. Patients with IMR ≥40 U had higher CHA2DS2-VASc score (p < 0.001). CHA2DS2-VASc score was significantly correlated with increased left atrial volume index, diastolic dysfunction, wall motion score index, and inversely correlated left ventricular ejection. Moreover, CHA2DS2-VASc score was strongly correlated with IMR (p < 0.001). At multivariate analysis, low systolic blood pressure, stent diameter, and CHA2DS2-VASc score were associated with MVD. Besides, CHA2DS2-VASc score ≥4 was the optimal value in predicting MVD (IMR ≥40) in STEMI patients. Conclusions: The data of the current study point out that increased CHA2DS2-VASc score, lower systolic blood pressure <90 mm Hg, and stent diameter are associated with increased incidence of MVD (increased IMR) after PPCI of STEMI. We suggest that the CHA2DS2-VASc score may be a simple, inexpensive useful risk score for the prediction of MVD risk after PPCI for STEMI patients.
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Xu, Xinye, Jinbao Zhou, Yongzhen Zhang, Qian Li, Lijun Guo, Yanyang Mao, and Liyun He. "Evaluate the Correlation between the TIMI Frame Count, IMR, and CFR in Coronary Microvascular Disease." Journal of Interventional Cardiology 2022 (February 2, 2022): 1–7. http://dx.doi.org/10.1155/2022/6361398.
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Objective. To evaluate the correlation between the TIMI frame count, IMR, and CFR in coronary microvascular disease (slow flow phenomenon). Methods. TFC and IMR were recorded in the nitroglycerin and ATP administration states, and the relationship between TFC, IMR, and CFR in specific states was analyzed. Results. A total of 41 patients with baseline TFC >25 frames on coronary angiography were enrolled, and nitroglycerin reduced TFC by 50% from baseline in 24 (58.54%) patients; 16 of the remaining 17 patients were able to achieve a 50% reduction in TFC by further intracoronary ATP injection. 10 patients were further tested for IMR, and the results showed significant correlations between baseline TFC and IMR (r = 0.775, P = 0.008 ), TFC and IMR after nitroglycerin (r = 0.875, P = 0.001 ), and the minimal TFC and IMR that could be obtained with nitroglycerin or ATP administration (r = 0.890, P = 0.001 ). There was also a significant correlation between the proportional improvement in TFC and CFR before and after nitroglycerin injection (r = 0.685, P = 0.029 ). In addition, we observed a lower IMR measured after nitroglycerin than after ATP in three patients, suggesting that CMD may be dominated by NO-sensitive vascular such as prearterioles and that an extensive analysis of the target site of CMD may be achieved by stepwise drug administration. Conclusion. Induction of TFC in different states by a stepwise drug approach may serve as a potential primary screening method for coronary microcirculatory dysfunction, thereby reducing the need for further IMR or CFR testing.
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Lu, Zhuangzhuang, Guangmin Song, and Xiao Bai. "Predictive Efficacy of the Index of Microcirculatory Resistance for Acute Allograft Rejection and Cardiac Events After Heart Transplantation: A Systematic Review and Meta-Analysis." Heart Surgery Forum 25, no. 5 (November 30, 2022): E784—E792. http://dx.doi.org/10.1532/hsf.4899.
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Background: In patients treated by heart transplantation, the index of microcirculatory resistance (IMR) has been found to have predictive potential for subsequent acute allograft rejection (AAR) and long-time cardiac events. When consulting related literature, the studies mostly were single-center with small sample sizes. The question of whether IMR can be utilized as a predictive biomarker is becoming increasingly contentious. To confirm the predictive efficacy of IMR, researchers did a systematic review and meta-analysis. Method: From inception to April 2022, PubMed, EMBASE, Cochrane Library, Web of Science, Ovid, ProQuest, and Scopus systematically were searched. The results were presented as pooled ratio rate (RR) with 95% confidence intervals (CI). Assessment of the quality, heterogeneity analyses, and publication bias analysis also were performed. Results: A total of 616 patients were studied in five trials. There were significant differences in subsequent AAR (RR = 4.08; 95% CI: 2.69~6.17; P = 0.000) or long-time cardiac events (RR=2.14; 95% CI: 1.44~3.19; P = 0.000) between IMR-high and IMR-low patients in the forest plots. Patients treated with heart transplantation in the high IMR group had better predictive efficacy than the low IMR group. Conclusions: High IMR could predict the events of subsequent AAR and cardiac events after heart transplantation. This will help reduce the occurrence of adverse events and personalize treatment for patients.
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Banerjee, Subhanil. "Major Determinants of Infant Mortality." Journal of Health Management 20, no. 3 (July 6, 2018): 345–62. http://dx.doi.org/10.1177/0972063418779912.
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Infant mortality rate (IMR) is one of the most important development indicators. In India, there is a severe interstate disparity regarding IMR. Kerala registers a very low IMR; whereas in Odisha it is pretty high. It is somewhat paradoxical as Odisha fares substantially better than many other states with lower IMR regarding total fertility rate, antenatal care and in many other aspects. The present article attempts to investigate the applicability of usually perceived major determinants of IMR as evidenced in the existing literature for Odisha. The panel data multiple regression carried out with data of 30 districts of Odisha over three years indicates that physiological and behavioural factors together with maternal and demographic factors are perhaps more important than the health programmes for reduction of IMR in Odisha. Moreover, many of the usually perceived major determinants of IMR including economic betterment are statistically insignificant for Odisha. The policymakers should take into account these facts and instead of a series of health programmes, they might resort to awareness building regarding breastfeeding and birth spacing. Mother’s nutritional status should also be strengthened so that they can sustain exhaustive breastfeeding for first six months after the birth of the child.
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Banerjee, Subhanil, Ashok Kumar Sar, and Shilpa Pandey. "Improved yet Unsafe: An Aquatic Perspective of Indian Infant Mortality." Journal of Health Management 22, no. 1 (March 2020): 57–66. http://dx.doi.org/10.1177/0972063420908379.
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Infant mortality rate (IMR) is an important development indicator and a vital component of millennium development goals (MDGs) set by United Nations Development Programme (UNDP). According to UNDP, so far India has only fared moderately in reducing IMR (Goal 4 of MDGs). India (32) ranks 144th among 196 countries regarding IMR as per the 2017 data availed from World Development Indicators. Its adjacent countries such as Bhutan (25.6), Bangladesh (26.9) and Nepal (27.8) have fared much better regarding infant survival. Numbers within the parentheses indicate the IMR of the respective country. The United Nations Children’s Fund (UNICEF) has identified that IMR among families with better access to improved drinking water sources and toilet is much lower than those bereft of the same. This inference has been drawn from National Family Health Survey 3 data (NFHS III). The present study investigates into the aforementioned relation analysing NFHS IV data. The result depicts that contrary to UNICEF’s findings, IMR increases with better accessibility to improved water sources. Further to this, the article shows that an additional aqua-related practice together with improved drinking water sources might lead to the betterment of IMR for India.
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Shen, Zhongping, Jun Shi, and Yadong Lei. "Comparison of the Long-Range Climate Memory in Outgoing Longwave Radiation over the Tibetan Plateau and the Indian Monsoon Region." Advances in Meteorology 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/7637351.
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Based on the detrended fluctuation analysis (DFA) method, scaling behaviors of the daily outgoing longwave radiation (OLR) from 1979 to 2015 over the Tibetan Plateau (TP) and the Indian Monsoon Region (IMR) are analyzed. The results show that there is long-term memory for the OLR time series over the TP and IMR. The long-range memory behaviors of OLR over TP are stronger than those over IMR. The averaged values of the scaling exponents over TP and IMR are 0.71 and 0.64; the maximum values in the two regions are 0.81 and 0.75; the minimum values are 0.59 and 0.58. The maximum frequency counts for scaling exponents occur in the range of 0.625 and 0.675 both in TP and in IMR. The spatial distribution of the scaling exponents of the OLR sequence is closely related to the conditions of climatic high cloud cover in the two areas. The high cloud cover over TP is obviously less than that of IMR. In addition, the scaling behaviors of OLR over TP and IMR are caused by the fractal characteristics of time series, which is further proved by randomly disrupting the time series to remove trends and correlation.
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Rosenberg, Dina Y. "Political Economy of Infant Mortality Rate: Role of Democracy Versus Good Governance." International Journal of Health Services 48, no. 3 (May 7, 2018): 435–60. http://dx.doi.org/10.1177/0020731418774226.
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Despite numerous studies on whether democracy reduces the infant mortality rate (IMR), the empirical results remain mixed at best. In this article, I perform several theoretical and empirical exercises that help explain why and under what conditions we should expect politics to matter most for a decrease in IMR. First, I capitalize on the epidemiological view that IMR – the most commonly used indicator of health in social sciences – is better suited to reflect public health micromanagement than overall social development. Second, I theorize that autocrats have incentives to invest in health up to a certain point, which could lead to a reduction in IMR. Third, I introduce an omitted variable – good governance – that trumps the importance of a political regime for IMR: (1) it directly affects public health micromanagement, and (2) many autocrats made inroads in achieving good governance. Finally, for the first time in such research, I use a disaggregated IMR approach to corroborate my hypotheses.
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Fan, Yuewei, Shibo Wang, Hua Wang, Jianxin Xu, Qingtai Xiao, and Yonggang Wei. "Formation mechanism and chaotic reinforcement elimination of the mechanical stirring isolated mixed region." International Journal of Chemical Reactor Engineering 19, no. 3 (February 18, 2021): 239–50. http://dx.doi.org/10.1515/ijcre-2020-0213.
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Abstract The isolated mixed region (IMR) is gradually formed during stirring and reduces the mixing efficiency. The unsteady-state formation process of the IMR was modeled and its formation mechanism was analyzed. The rotating frequency of the impeller was optimized using the chaos mathematical theory to improve the stirring efficiency without increasing the power consumption. The calculated results demonstrate that the IMR is a coherent structure, and its formation process is based on the free shear effect of the mixed layer. The chaotic stirring method can accelerate the momentum dissipation process by 37% by eliminating the IMR, and increase the speed by up to 31%. Therefore, chaotic mixing can eliminate the IMR in a shorter time and lower the power consumption.
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Hono, K., T. Hashizume, and T. Sakurai. "The IMR atom probe." Surface Science 266, no. 1-3 (April 1992): 506–12. http://dx.doi.org/10.1016/0039-6028(92)91067-l.
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Akoh, Craig C., Amanda N. Fletcher, Rishin J. Kadakia, Jie Chen, Young-uk Park, Hyong Nyun Kim, Juntao Wang, Mark E. Easley, and James A. Nunley. "Was Mark Reiley Right? A Outcome Analysis of Intramedullary Versus Extramedullaryalignment Referencing for Total Ankle Replacement." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0009. http://dx.doi.org/10.1177/2473011420s00096.
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Category: Ankle Arthritis; Ankle Introduction/Purpose: The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) versus intramedullary-referenced (IMr) total ankle replacement (TAR). Methods: From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR for primary arthritis, post-traumatic arthritis, and inflammatory arthritis was enrolled in this study. Analyses were performed comparing IMr versus EMr components for patient-reported outcomes data, pre and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. Data was prospectively collected and retrospectively analyzed. A p-value of < 0.05 was considered significant for all statistical analyses. Results: A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years ( +- 2.5, range 2-12). The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; p < 0.0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; p=0.6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; p-value <0.0001). There were similar improvements in patient-reported outcome scores at one year and final follow up (all p > 0.05). The 5-year implant survivorship was 98.6.% for IMr versus 97.5% for EMr at final follow-up. Conclusion: Despite the IMr TAR group having more severe preoperative coronal and sagittal malalignment, both IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. Among the patients with preoperative varus, valgus, or anterior distal tibial slope, the IMr patients achieved greater correction than the EMr patients. Although the 5-year implant survivorship was similar between the two cohorts with 98.6% survival for IMr TAR and 97.5% for EMr TAR, impending failures were greater for the mobile-bearing EMr TAR.
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Derso, Endeshaw Assefa, Maria Gabriella Campolo, and Angela Alibrandi. "The Causes and Factors Associated with Infant Mortality Rate in Ethiopia: The Application of Structural Equation Modelling." Children 10, no. 2 (February 17, 2023): 397. http://dx.doi.org/10.3390/children10020397.
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Infant mortality rate is a proxy measure of population health. Previous studies on the infant mortality rate in Ethiopia did not consider measurement errors in the measured variables and had a one-directional effect; little emphasis was placed on testing multiple causal paths at the same time. We used structural equation modelling for a better understanding of the direct, indirect, and total effects among causal variables in a single model. A path analysis was part of an algorithm providing equations that were relating the variances and covariances of the indicators. From the results, the maternal mortality ratio (MMR) was significantly mediating the influence of out-of-pocket expenditure (OOP) on infant mortality rate (IMR), and the fertility rate (FR) was significantly mediating the influence of GDP to IMR (β = 1.168, p < 0.001). The GDP affects the IMR directly and indirectly while the OOP affects IMR indirectly. This study showed that there was a causal linkage between the World Bank Health and Population Variables for causing IMR in Ethiopia. The MMR and FR were found to be the intermediate indicators in this study. Through the indicators, FR had the highest standardised coefficients for increasing the IMR. We recommended that the existing interventions to reduce IMR be strengthened.
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Kimura, Toshiyuki, Véronique L. Roger, Nozomi Watanabe, Sergio Barros-Gomes, Yan Topilsky, Shun Nishino, Yoshisato Shibata, and Maurice Enriquez-Sarano. "The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study." European Heart Journal - Cardiovascular Imaging 20, no. 4 (December 4, 2018): 396–406. http://dx.doi.org/10.1093/ehjci/jey177.
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Abstract Aims Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. Methods and results We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01). Conclusions 3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.
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Chaurasia, Aalok Ranjan. "Long-Term Trend in Infant Mortality in India: A Joinpoint Regression Analysis for 1971–2018." Indian Journal of Human Development 14, no. 3 (December 2020): 394–406. http://dx.doi.org/10.1177/0973703020975044.
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Infant mortality rate (IMR) in India remains high by international standards. India accounts for the largest number of global infant deaths. This study analyses the trend in IMR in India over almost four decades beginning 1971 through 2018. The analysis is based on annual estimates of IMR available through India’s official sample registration system and follows the joinpoint regression analysis approach. The analysis reveals that the trend in IMR in India changed three times during 1971–2018 and the pace of decrease has been different in different sub-periods with a considerable deceleration in the decrease during 1992–2006. It is only after the launch of National Rural Health Mission in 2005 that the decrease in IMR in India and selected states accelerated to more than 4 per cent per year.
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Romero Prieto, Julio, Andrea Verhulst, and Michel Guillot. "Estimating the infant mortality rate from DHS birth histories in the presence of age heaping." PLOS ONE 16, no. 11 (November 3, 2021): e0259304. http://dx.doi.org/10.1371/journal.pone.0259304.
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Background The infant mortality rate (IMR) is a critical indicator of population health, but its measurement is subject to response bias in countries without complete vital registration systems who rely instead on birth histories collected via sample surveys. One of the most salient bias is the fact that child deaths in these birth histories tend to be reported with a large amount of heaping at age 12 months. Because of this issue, analysts and international agencies do not directly use IMR estimates based on surveys such as Demographic and Health Surveys (DHS); they rely instead on mortality models such as model life tables. The use of model life tables in this context, however, is arbitrary, and the extent to which this approach appropriately addresses bias in DHS-based IMR estimates remains unclear. This hinders our ability to monitor IMR levels and trends in low-and middle-income countries. The objective of this study is to evaluate age heaping bias in DHS-based IMR estimates and propose an improved method for adjusting this bias. Methods and findings Our method relies on a recently-developed log-quadratic model that can predict age-specific mortality by detailed age between 0 and 5. The model’s coefficients were derived from a newly constituted database, the Under-5 Mortality Database (U5MD), that represents the mortality experience of countries with high-quality vital registration data. We applied this model to 204 DHS surveys, and compared unadjusted IMR values to IMR values adjusted with the log-quadratic model as well as with the classic model life table approach. Results show that contrary to existing knowledge, age heaping at age 12 months rarely generates a large amount of bias in IMR estimates. In most cases, the unadjusted IMR values were not deviating by more than +/- 5% from the adjusted values. The model life table approach, by contrast, introduced an unwarranted, downward bias in adjusted IMR values. We also found that two regions, Sub-Saharan Africa and South Asia, present age patterns of under-5 mortality that strongly depart from the experience represented in the U5MD. For these countries, neither the existing model life tables nor the log-quadratic model can produce empirically-supported IMR adjustments. Conclusions Age heaping at age 12 months produces a smaller amount of bias in DHS-based IMR estimates than previously thought. If a large amount of age heaping is present in a survey, the log-quadratic model allows users to evaluate, and whenever necessary, adjust IMR estimates in a way that is more informed by the local mortality pattern than existing approaches. Future research should be devoted to understanding why Sub-Saharan African and South Asian countries have such distinct age patterns of under-five mortality.
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Akoh, Craig C., Rishin Kadakia, Amanda Fletcher, Young Uk Park, Hyongnyun Kim, James A. Nunley, and Mark E. Easley. "Intermediate-term Patient-Reported Outcomes and Radiographic Evaluation Following Intramedullary- vs Extramedullary-Referenced Total Ankle Replacement." Foot & Ankle International 42, no. 5 (January 27, 2021): 633–45. http://dx.doi.org/10.1177/1071100720980024.
Full textAbstract:
Background: The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) vs intramedullary-referenced (IMr) total ankle replacement (TAR). Methods: From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR was enrolled in this study. Analyses were performed comparing IMr vs EMr components for patient-reported outcomes data, pre- and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years (±2.5, range 2-12). Results: The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; P < .0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; P = .6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; P < .0001). There were similar improvements in patient-reported outcome scores at 1 year and final follow-up (all P > .05). The 5-year implant survivorship was 98.6% for IMr vs 97.5% for EMr at final follow-up. Conclusion: The IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. The 5-year implant survivorship was similar between the IMr and EMr groups. Level of Evidence: Level III, retrospective comparative study.
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Jha, Ajay Kumar, and Vishwas Malik. "Diagnosis and Management of Ischemic Mitral Regurgitation: Evidence-Based Clinical Decision Making at the Point of Care." Seminars in Cardiothoracic and Vascular Anesthesia 23, no. 3 (December 31, 2017): 268–81. http://dx.doi.org/10.1177/1089253217745363.
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Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction. Unlike primary MR, IMR is usually associated with reduced ejection fraction. Therefore, it appears unrealistic to keep the similar cutoff for primary MR and IMR. The cutoff of severity can be modified according to projected values of Rvol normalized to ejection fraction and EROA normalized to Rvol. In addition, the treatment outcome in these patients is determined by factors (left ventricular dyssynchrony, annular dilatation, tenting area, tenting height, tenting volume, and myocardial viability) other than the simple grading. In this review article, a series of graph have been constructed from the numerical data derived from the literatures on IMR to depict the relationship between EROA, Rvol, left ventricular end diastolic volume, and ejection fraction in order to obtain a reasonable projection formula for EROA and Rvol. Furthermore, a management algorithm has been proposed for patients with IMR undergoing coronary artery bypass grafting based on echocardiographic predictors that influence the postoperative outcome.
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Bronte-Hall, Lanetta, Biree Andemariam, Blyden Gershwin, Sanne Lugthart, Timothy Mant, Jo Howard, Henry Fok, et al. "Benefits and Safety of Long-Term Use of IMR-687 As Monotherapy or in Combination with a Stable Dose of Hydroxyurea (HU) in 2 Adult Sickle Cell Patients." Blood 136, Supplement 1 (November 5, 2020): 29–30. http://dx.doi.org/10.1182/blood-2020-140540.
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Study Background IMR-687 is an inhibitor of phosphodiesterase 9 intended to treat sickle cell disease (SCD) by stimulating the production of fetal hemoglobin (HbF). IMR-SCD-102-EXT is an open-label extension (OLE) study of an ongoing Ph 2a, randomized, double-blind, placebo-controlled study (IMR-SCD-102) of IMR-687 in patients with SCD (homozygous sickle hemoglobin [HbSS] or sickle-β0 thalassemia). The Ph 2a study consists of a monotherapy sub-study (IMR-687 vs. placebo) of 6 months and a combination sub-study (IMR-687 + HU vs. HU + placebo) of 4 months. The OLE study examines the long-term benefit and safety of IMR-687 administered for up to 4 years. Patient Background Patient 1, a 28-year-old female diagnosed with HbSS, received IMR-687 100 mg once daily (qd) for 3 months, then escalated to 200 mg qd in the monotherapy Ph 2a sub-study. After a 1-month safety follow-up period, the patient enrolled in the OLE, received IMR-687 100 mg qd for an additional 12 months; and subsequently escalated to 200 mg qd per protocol amendment. Patient 2, a 33-year-old female diagnosed with HbSS, received placebo for 4 months in the combination Ph 2a sub-study. After a 14-month hiatus, the patient enrolled in the OLE, received IMR-687 for ~6 months: 100 mg qd for 4 months, then escalated to 200 mg qd for ~2 months. The patient was on a stable dose of HU for >18 months prior to OLE study and has remained on that same dose during the OLE. Analysis Methods Retrospective review of patient medical records allows for comparison of equal time periods prior to and after the start of IMR-687 treatment, with durations of 18 months for Patient 1 and 6 months for Patient 2. For patient-reported outcomes (PROs) and biomarkers, values were compared for the patient's most recent OLE visit and their baseline visit before the first dose of IMR-687, i.e., the start of the Ph 2a study for Patient 1 and the start of the OLE for Patient 2. Clinical Outcomes: VOCs, Healthcare Use, and PROs Patient 1 had a 55% reduction in reported vaso-occlusive crises (VOCs) when comparing the 18 months prior to IMR-687 initiation to the 18 months while on IMR-687 (38 to 17 VOCs). Specifically, VOCs that resulted in emergency department (ED) and outpatient visits decreased by 55% (22 to 10 visits) and 50% (14 to 7 visits), respectively, in the periods before versus after IMR-687 initiation. VOCs that resulted in hospitalization decreased from 2 to 0 while on IMR-687. Analysis of the 18-month period on IMR-687 showed a decrease in reported VOCs with increased time on therapy. In the first 6-month interval, the patient had 9 VOCs, of which 5 were ED visits and 4 were outpatient visits. In the second interval, the patient had 6 VOCs, with 5 ED visits and 1 outpatient visit. In the third and most recent 6-month interval, the patient had 2 VOCs, with 0 ED visits and 2 outpatient visits. Patient 1 also showed improvement in 5 of the 7 domains (including pain episode frequency and severity) of the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me®) after 18 months of IMR-687 treatment compared with pre-treatment baseline. Patient 2 has had no reported VOCs since starting IMR-687, compared with 15 VOCs (all outpatient visits) in the 6 months prior to first dose of IMR-687. The patient also showed a substantial improvement in an average pain score while on IMR-687, from a pre-treatment score of 8/10 to 2/10 after ~6 months of IMR-687 treatment and had a decrease in breakthrough opioid use (morphine sulfate, immediate release) from 63 to 5 tablets weekly. Safety and Biomarker Results IMR-687 was well-tolerated in both patients. Improvement across key SCD biomarkers was observed for both patients (Figure 1). Parameters included cells positive for fetal hemoglobin (F-cells), HbF, mean corpuscular volume (MCV), hemoglobin (Hb), and markers of hemolysis: percent reticulocytes, absolute reticulocyte count (ARC), indirect bilirubin, and lactate dehydrogenase (LDH). Conclusion A case series of 2 patients enrolled on the IMR-SCD-102 EXT study and treated with IMR-687, showed sustained increases in F-cells/HbF, better clinical outcomes, and improved SCD biomarkers, including Hb and measures of hemolysis. These preliminary results potentially show that extended duration of treatment with IMR-687 could be beneficial to SCD patients as a monotherapy or in combination with HU. Disclosures Andemariam: Guidepoint: Honoraria; Sanofi Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees; Cyclerion: Consultancy, Membership on an entity's Board of Directors or advisory committees; CRISPR/Vertex: Consultancy, Membership on an entity's Board of Directors or advisory committees; CHNCT: Consultancy; Accordant: Membership on an entity's Board of Directors or advisory committees; Imara: Research Funding; Hemanext: Membership on an entity's Board of Directors or advisory committees; Terumo BCT: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Emmaus: Membership on an entity's Board of Directors or advisory committees; Vertex: Honoraria; bluebird bio: Consultancy, Membership on an entity's Board of Directors or advisory committees; NovoNordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Mant:Imara, Inc: Consultancy. Howard:Agios, Forma Therapeutics, Inc., Global Blood Therapeutics, Imara, Inc., Novo Nordisk, Novartis: Membership on an entity's Board of Directors or advisory committees; Imara, Inc., Novartis, Resonance Health: Honoraria. Fok:Imara, Inc: Consultancy. Hagar:Imara, Inc: Other: Data Monitoring Committee. Ballal:Imara, Inc: Current equity holder in publicly-traded company. Lufkin:Imara, Inc: Current equity holder in publicly-traded company. Lisbon:Imara, Inc: Current equity holder in publicly-traded company.
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Rudenko, S. A., S. V. Potashev, and N. M. Verich. "Preoperative Left Ventricular Remodeling Based on Echocardiographic Findings in Patients with Ischemic Mitral Regurgitation." Ukrainian journal of cardiovascular surgery, no. 1 (42) (March 16, 2021): 16–19. http://dx.doi.org/10.30702/ujcvs/21.4203/r012016-019/036.
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Ischemic mitral regurgitation (IMR) is a dynamic phenomenon depending on myocardial function and he- modynamics. Grade, hemodynamic significance and anatomic reasons of IMR are always key features for defining indica- tions for surgical treatment. In chronic IMR diagnosis, the emphasis is upon mitral regurgitation (MR) mechanisms and its hemodynamic consequences.
The aim. To study preoperative echocardiographic features of left ventricular (LV) remodeling and IMR, and retro- spectively define their influence upon the choice of IMR surgical correction method.
Materials and methods. We performed surgical correction of IMR in 292 patients over the period from January 2012 to December 2019 at the National Amosov Institute of Cardiovascular Surgery. All the patients were divided into 2 groups depending on MR surgical correction method. Group 1 included 141 patients who underwent valve-sparing sur- gery. Group 2 included 151 patients after prosthetic mitral valve replacement. All the patients underwent comprehensive echocardiography prior to surgery.
Results and discussion. The patients of Group 2, who underwent prosthetic mitral valve replacement showed sig- nificantly more marked eccentric LV remodeling, namely significantly higher LV EDI (p=0.02) and ESI (p=0.0027) with significantly worse LV global contractility: compared to Group 1, almost twice bigger proportion of patients in Group 2 had severely decreased LVEF ≤30% (p=0.047), while mean LVEF corresponded with moderate LV systolic dysfunc- tion (LVEF≤45%), and in Group 1 the majority of patients had mild-to-moderate LV systolic dysfunction (LVEF ≥45% and ≥35%, respectively, p=0.016) with significantly higher proportion of patients with preserved LVEF (p=0.039). This caused marked remodeling in Group 2 patients, lead to impossibility of valve-sparing MV plastics and brought up neces- sity of prosthetic MV replacement, which is aligned with available evidence on poor prognosis markers and reverse left chambers remodeling in functional secondary MR, including IMR.
Conclusions. Significantly more marked LV remodeling and more severe systolic dysfunction lead to more severe IMR with more marked MV valvular morphology alterations and more frequent MV replacement. Our data witness in favor of earlier surgical intervention in coronary artery disease (CAD) patients with IMR aiming at successful valve-sparing IMR correction.
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Saidova, M. A., and A. M. Andrianova. "Ischemic Mitral Regurgitation: Echocardiographic Algorithm, the Place of Three-Dimensional Transesophageal Echocardiography." Kardiologiia 60, no. 2 (March 5, 2020): 54–60. http://dx.doi.org/10.18087/cardio.2020.2.n839.
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Objective Identify the diagnostic markers of the severe MV changes in patients with ischemic mitral regurgitation (IMR) and suggest a modification of the echocardiography (EchoCG) algorithm.Materials and Methods A two-stage examination of 65 patients with mild (n=22), moderate (n=22), and severe (n=21) IMR was performed using two-dimensional (2D) transthoracic EchoCG with dopplerography, 2D and three-dimensional (3D) transesophageal EchoCG (TEE). 4D MV-Assessment in off-line mode was made in TomTec Imaging Systems GmbH, Germany. Statistical analysis (SAS 9.4) included Student’s t-test, Kruskal-Wallis method, Pearson correlation, multivariate regression analysis, and ROC-analysis.Results According to 3D TEE the significant changes in MV annulus, leaflets and tenting are detected. 3D parameters of MV geometry are related to IMR severity, left ventricle (LV) remodeling (global and regional), and they are different in symmetric and asymmetric variants. In symmetric variant MV reconstruction is correlated with LV dilatation and contractility decrease, in asymmetric variant it’s correlated with regional remodeling parameters. Severe IMR is characterized by a decrease in MV annulus displacement (27,0±6,6 mm/s versus 32,4±10,8 mm/s in mild IMR; р<0,05), tenting volume fraction (32,5±14,8% versus 56,2±16,8% in mild IMR; p<0,05), and annulus area fraction (4,7±2,7% versus 6,6±4,5% in mild IMR; р<0,05). Vena contracta width (VCW), Proximal Isovelocity Surface Area (PISA) radius, Effective Regurgitant Orifice Area (EROA), Regurgitant Volume (Rvol), LV end systolic dimension (LV ESD), and central large jet >50% of left atrium (LA) area have a predictive value in the diagnosis of MV geometry severe changes. If thresholds are reached these 2D TTE parameters can be used as indications for the 3D TEE.Conclusion 3D TEE allows for detailed assessment of MV geometry and function depended on IMR severity and variant. To make decision of MV surgery 3D TEE is recommended if the following indicators are presented: (1) VCW ≥0,7 cm; PISA radius ≥1,0 cm; central large jet >50% of LA area; LV ESD ≥4,0 cm; (2) VCW ≥0,6 cm; PISA radius = 0,6-0,99 cm; EROA ≥0,3 cm2; RVol≥45 cm; IMR eccentric jet + IMR elliptical orifice.
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Siahanidou, Tania, Nick Dessypris, Antonis Analitis, Constantinos Mihas, Evangelos Evangelou, George Chrousos, and Eleni Petridou. "Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study." BMJ Open 9, no. 8 (August 2019): e025287. http://dx.doi.org/10.1136/bmjopen-2018-025287.
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ObjectiveTo study trends of infant mortality rate (IMR) and neonatal mortality rate in Greece during the period 2004–2016 and explore the role of sociodemographic factors in the years of crisis.DesignNationwide individual data for live births and infant (0–11 months) deaths provided by the Hellenic Statistical Authority were examined using Poisson, joinpoint regression and interrupted time series (ITS) analyses.SettingGreece.ParticipantsAll infant deaths (n=4862) over the 13-year period, of which 87.2% were born to Greek mothers, and respective live births.Main outcome measuresEvolution of IMR (0–364 days), early (<7 days) neonatal mortality rate (ENMR), late (7–27 days) neonatal mortality rate (LNMR) and post neonatal (28–364 days) mortality rate (PNMR) trends, by maternal nationality, place of residence and Human Development Index (HDI).ResultsBy Poisson regression, overall, during the study period, among infants of Greek mothers, IMR and PNMR declined significantly (−0.9%; 95% CI −1.7% to −0.1% and −1.6%; −3.0% to −0.2% annually, respectively), although differentially by place of residence (IMRurban: −2.1%; −2.9% to −1.3%, IMRrural: +10.6%; 7.6% to 13.6%). By contrast, among infants of non-Greek mothers, the low starting IMR/ENMR/LNMR/PNMR increased significantly (max ENMR:+12.5%; 8.6% to 16.5%) leading to a non-significant time–trend pattern overall in Greece. The inverse associations of HDI with IMR, ENMR and PNMR were restricted to Greek mothers’ infants. Joinpoint regression analyses among Greek mothers’ infants indicated non-significant increasing trends of IMR and ENMR following the crisis (+9.3%, 2012–2016, p=0.07 and +10.2%, 2011–2016, p=0.06, respectively). By contrast, the high (+17.1%; 8.1% to 26.9%, p=0.002) IMR increases among non-Greek infants were restricted to 2004–2011 and equalised to those of Greek mothers’ infants thereafter. ITS analyses in preset years (2008, 2010, 2012) identified significantly increasing trends in IMR, LNMR and PNMR after 2012, and in ENMR after 2010, among Greek mothers’ infants.ConclusionsHDI and rural residence were significantly associated with IMR. The strongly decreasing IMR trends among Greek-mothers’ infants were stagnated after a lag time of ~4 years of crisis approximating the previously sharply increasing trends among non-Greeks.
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Alvaro, Rendy, Ratna Christianingrum, and Tio Riyono. "DAK FISIK KESEHATAN TO REDUCE MATERNAL AND INFANT MORTALITY RATE." Jurnal Ekonomi Kesehatan Indonesia 7, no. 1 (July 30, 2022): 36. http://dx.doi.org/10.7454/eki.v7i1.5412.
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Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) are essential indicators of health development that are written on the national development plan documents. Nevertheless, Indonesia has not yet achieved the national target of MDG’s and SDG’s. In prediction, without extraordinary policies, the target of SDGs will not be reached by 2030. The government has allocated DAK Fisik Penugasan as one of the efforts to reduce MMR and IMR. So this study aims to capture the effect of DAK Fisik in decreasing MMR and IMR. Panel data from 34 provinces level in 2019 and 2020 are analyzed using mean difference test and quadrant analysis. Results show that there is no significant difference of MMR in 34 provinces with or without DAK Fisik Penugasan. Then there are still many provinces with the lower MMR and IMR which get budget priorities and vice versa. The government should 1) provide a local government stimulus to enhance acceleration of reducing MMR and IMR; 2) allocate budget priority to provinces that have higher score of MMR and IMR; 3) Encourage local governments to improve the quality of DAK Fisik proposals along with better quality of budget absorption.
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Jain, Pragati, and Prerna Jain. "Analysis of Infant Mortality Rate in Indian States." Journal of Health Management 19, no. 2 (May 10, 2017): 334–39. http://dx.doi.org/10.1177/0972063417699695.
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The aim of this research is to explore the status of infant mortality at the state level, rate of change over the study period (1981–2011) and regional variation in infant mortality rate (IMR) and present a case as to how health status can be improved through targeting goals as in the case of IMR by the health planners and policymakers. The achievement of each of the 15 states on the basis of IMR is examined on the basis of divergence reduction. Sigma and beta absolute convergence measures used to determine the nature of change in the degree of regional inequality in IMR show positive results in achieving regional convergence. This confirms that the government policy and programmes to control and reduce IMR have been successful. IMR is frequently questioned as a measure of health status as infant mortality turns out to be the main focus of health policy; however, the entire population’s health possibly will be ignored in achieving the policy targets. However, the brighter side to it is that the entire gamut of health indicators can be targeted in a phased manner to achieve the overall improvement in the health status.
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Weingarten, David M., Ashok R. Asthagiri, John A. Butman, Susumu Sato, Edythe A. Wiggs, Bonita Damaska, and John D. Heiss. "Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite." Journal of Neurosurgery 111, no. 6 (December 2009): 1185–90. http://dx.doi.org/10.3171/2009.5.jns09164.
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Frameless stereotactic neuronavigation provides tracking of surgical instruments on radiographic images and orients the surgeon to tumor margins at surgery. Bipolar electrical stimulation mapping (ESM) delineates safe limits for resection of brain tumors adjacent to eloquent cortex. These standard techniques could complement the capability of intraoperative MR (iMR) imaging to evaluate for occult residual disease during surgery and promote more complete tumor removal. The use of frameless neuronavigation in the high-field iMR imaging suite requires that a few pieces of standard equipment be replaced by nonferromagnetic instruments. Specific use of ESM in a high-field iMR imaging suite has not been reported in the literature. To study whether frameless neuronavigation and electrical stimulation mapping could be successfully integrated in the high-field iMR imaging suite, the authors employed these modalities in 10 consecutive cases involving patients undergoing conscious craniotomy for primary brain tumors located in or adjacent to eloquent cortices. Equipment included a custom high-field MR imaging–compatible head holder and dynamic reference frame attachment, a standard MR imaging–compatible dynamic reference frame, a standard MR imaging machine with a table top that could be translated to a pedestal outside the 5-gauss line for the operative intervention, and standard neuronavigational and cortical stimulation equipment. Both ESM and frameless stereotactic guidance were performed outside the 5-gauss line. The presence of residual neoplasm was evaluated using iMR imaging; resection was continued until eloquent areas were encountered or iMR imaging confirmed complete removal of any residual tumor. Mapping identified essential language (5 patients), sensory (6), and motor (7) areas. The combined use of frameless stereotactic navigation, ESM, and iMR imaging resulted in complete radiographic resection in 7 cases and resection to an eloquent margin in 3 cases. Postoperative MR imaging confirmed final iMR imaging findings. No patient experienced a permanent new neurological deficit. Familiar techniques such as frameless navigation and ESM can be rapidly, inexpensively, safely, and effectively integrated into the high-field iMR imaging suite.
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Bellut, David, Martin Hlavica, Christoph Schmid, and René L. Bernays. "Intraoperative magnetic resonance imaging–assisted transsphenoidal pituitary surgery in patients with acromegaly." Neurosurgical Focus 29, no. 4 (October 2010): E9. http://dx.doi.org/10.3171/2010.7.focus10164.
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Object Acromegaly is a rare disease, usually caused by a growth hormone (GH)–producing pituitary adenoma. If untreated, severe cardiovascular, metabolic, cosmetic, and orthopedic disturbances will result. Surgery is generally recommended as the first-line treatment. Transsphenoidal surgical techniques were recently extended by the introduction of intraoperative MR (iMR) imaging. In the present study, the contribution of ultra-low-field (0.15-T) iMR imaging to tumor resection, complication avoidance, and endocrinological and neurological outcome was analyzed. Methods A series of 39 consecutive transsphenoidal iMR imaging–guided (using the PoleStar N20 device) surgical procedures performed between September 2005 and August 2009 for GH-producing pituitary adenomas was retrospectively analyzed. In addition to the patients' clinical data, the following criteria were evaluated independently: duration of surgery; length of hospital stay; endocrinological parameters; results of neurological examinations; and pre-, post-, and intraoperative MR imaging results. Results Thirty-seven patients with acromegaly underwent 39 transsphenoidal surgeries for pituitary adenomas. During a median follow-up period of 30 months (range 9–56 months), the remission rate was 73.5% in 34 patients with primary surgery and 20% in 5 cases with previous surgery; overall the remission rate was 66.7%. There were no serious postoperative complications. Detection of tumor remnant on iMR imaging led to a 5.1% increase in remission rate. Conclusions In this largest study to date of GH-producing pituitary adenomas in which iMR imaging–guided transsphenoidal surgery was analyzed, the results suggest that this method is a highly effective and safe treatment modality, even compared with previously published surgical series in which high-field iMR imaging was used. Limitations of iMR imaging are the detection of small residual tumor in the cavernous sinus and persisting disease that could not be observed, even on diagnostic high-field follow-up MR images. This points to a general limitation regarding remission rates that can be achieved using iMR imaging. Nevertheless, iMR imaging led to an increase of the remission rate in this study.
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Wardhana, Faishal Azhar, and Rachmah Indawati. "PANEL DATA REGRESSION ANALYSIS FOR FACTORS AFFECTING INFANT MORTALITY RATE IN EAST JAVA 2013-2017." Indonesian Journal of Public Health 16, no. 3 (November 30, 2021): 437. http://dx.doi.org/10.20473/ijph.v16i3.2021.437-448.
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ABSTRACTThe escalating infant mortality rate (IMR) in Indonesia has not been able to fulfill the target of Sustainable Development Goals (SDGs) that restrict the limit of IMR to just 12 of 1,000 live births. According to such fact, this research was designed as the application of panel data regression in an IMR case study of East Java from 2013–2017. Regression panel data enable research in describing cross-sectional and time series information. The variety of data availability in this method were capable of producing a high degree of freedom, allowing it to meet the prerequisites and statistical properties. This method was considered the most suitable one for analyzing the rising IMR. This research was classified as non-reactive research. All regencies/cities in East Java served as this study’s population. Data collection included K4 coverage, childbirth assistance, and KN complete coverage. The result of panel data regression showed a significant connection between K4 coverage (0.0230), childbirth assistance (p = 0.0105), and KN complete coverage (0.0205). Adjusted R-Square value was obtained with an amount of 80%, which means that all independent variables were able to explain the dependent one of that value, while the remaining were explained by other factors. This study can provide some suggestions to support IMR in East Java, including handling from the government or related pregnant families to support IMR on an ongoing basis. Keywords: panel data regression, IMR, K4, childbirth assistance, KN complete
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"IMR Reviewers." International Migration Review 34, no. 4 (December 2000): 1371–73. http://dx.doi.org/10.1177/019791830003400435.
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