Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents

BACKGROUND

Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood.

METHODS

A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status.

RESULTS

The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings.

CONCLUSIONS

Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood.

Assessing automated CMR contouring algorithms using systematic contour quality scoring analysis

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): SmartHeart EPSRC programme grant (www.nihr.ac.uk), London Medical Imaging and AI Centre for Value-Based Healthcare

Background

Quality measures for machine learning algorithms include clinical measures such as end-diastolic (ED) and end-systolic (ES) volume, volumetric overlaps such as Dice similarity coefficient and surface distances such as Hausdorff distance. These measures capture differences between manually drawn and automated contours but fail to capture the trust of a clinician to an automatically generated contour.

Purpose

We propose to directly capture clinicians’ trust in a systematic way. We display manual and automated contours sequentially in random order and ask the clinicians to score the contour quality. We then perform statistical analysis for both sources of contours and stratify results based on contour type.

Data

The data selected for this experiment came from the National Health Center Singapore. It constitutes CMR scans from 313 patients with diverse pathologies including: healthy, dilated cardiomyopathy (DCM), hypertension (HTN), hypertrophic cardiomyopathy (HCM), ischemic heart disease (IHD), left ventricular non-compaction (LVNC), and myocarditis. Each study contains a short axis (SAX) stack, with ED and ES phases manually annotated. Automated contours are generated for each SAX image for which manual annotation is available. For this, a machine learning algorithm trained at Circle Cardiovascular Imaging Inc. is applied and the resulting predictions are saved to be displayed in the contour quality scoring (CQS) application.

Methods: The CQS application displays manual and automated contours in a random order and presents the user an option to assign a contour quality score

1: Unacceptable, 2: Bad, 3: Fair, 4: Good. The UK Biobank standard operating procedure is used for assessing the quality of the contoured images. Quality scores are assigned based on how the contour affects clinical outcomes. However, as images are presented independent of spatiotemporal context, contour quality is assessed based on how well the area of the delineated structure is approximated. Consequently, small contours and small deviations are rarely assigned a quality score of less than 2, as they are not clinically relevant. Special attention is given to the RV-endo contours as often, mostly in basal images, two separate contours appear. In such cases, a score of 3 is given if the two disjoint contours sufficiently encompass the underlying anatomy; otherwise they are scored as 2 or 1.

Results

A total of 50991 quality scores (24208 manual and 26783 automated) are generated by five expert raters. The mean score for all manual and automated contours are 3.77 ± 0.48 and 3.77 ± 0.52, respectively. The breakdown of mean quality scores by contour type is included in Fig. 1a while the distribution of quality scores for various raters are shown in Fig. 1b.

Conclusion

We proposed a method of comparing the quality of manual versus automated contouring methods. Results suggest similar statistics in quality scores for both sources of contours.

Abstract Figure 1

Anti-HMGB1 antibody reduces weight gain in mice fed a high-fat diet

Insulin resistance in obesity is believed to be propagated by adipose tissue and liver inflammation. HMGB1 is a multifunctional protein that is pro-inflammatory when released from cells. It has been previously demonstrated that anti-HMGB1 antibody reduces atherosclerotic lesion pro-inflammatory cells and progression of atherosclerosis in a mouse model. To test the potential beneficial role of blocking HMGB1 in adipose tissue and liver inflammation in mice fed an obesogenic diet, we administered anti-HMGB1 antibody to C57Bl/6 mice fed a high (60%)-fat diet. The mice were treated with weekly injections of an anti-HMGB1 antibody or anti-KLH antibody (isotype control) for 16 weeks. Mice that received the anti-HMGB1 antibody gained less weight than the control-treated animals. Anti-HMGB1 treatment also reduced hepatic expression of TNF-alpha and MCP-1, molecules that promote inflammation. However, adipose tissue inflammation, as measured by gene expression analyses and immunohistochemistry, did not differ between the two groups. There also were no differences in glucose or insulin tolerance between the two groups. When feeding mice a high-fat diet, these data suggest that HMGB1 may have a crucial role in weight gain and liver inflammation.

Late presentation of a deep sternal wound infection and left breast abscess

In this paper, we present a case review of a 58-year-old female who presented to our emergency department with pyrexia, dyspnoea, dehydration and pain in her left breast six months following coronary artery bypass grafting (CABG). Although her sternotomy wound had healed well, examination revealed fluctuance of the whole precordium and left breast. She underwent antibiotic treatment and subsequent surgical debridement, followed by the application of vacuum-assisted dressings. Surgical reconstruction was deemed unsuitable and therefore the patient continued to be managed with vacuum dressings followed by routine dressings to allow the wound to heal by secondary intention. The patient was discharged three months after initial presentation in a good condition. The wound had completely healed four months later.

Molecular Characterization of Vegetative Compatibility Group 4A and 4B Isolates of Verticillium dahliae Associated with Potato Early Dying

Forty isolates of Verticillium dahliae, collected from potato seed tubers and potato plants from various regions in North America and previously assigned to vegetative compatibility groups (VCGs) 4A or 4B, were characterized using molecular markers. The VCG 4A isolates were previously shown to be a highly virulent pathotype of potato and to interact synergistically with the root-lesion nematode Pratylenchus penetrans to cause potato early dying. All but one of the VCG 4A isolates characterized in this study lacked the subspecies-specific repetitive DNA sequence E18 and could be differentiated from the remaining isolates by restriction fragment length polymorphisms (RFLPs) in the nuclear rDNA and Trp1 loci. The E18 RFLP patterns of several VCG 4B isolates from Maine and New York were highly similar to those of VCG 4B isolates previously collected from potato and tomato fields in Ontario. The data presented here suggest that the molecular markers will be useful for the detection and classification of isolates of V. dahliae associated with potato early dying.