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Mild MDD was clinically diagnosed in 23%, moderate MDD in 12%, and severe MDD in 14% of the participants. The IRT method identified the following HADS depression score thresholds for mild, moderate, and severe MDD 10.7, 13.2, and 15.1, respectively. Conclusion The new IRT method identifies clinical thresholds that are unbiased by disease prevalence.Emerging evidence suggests that the gut microbiome plays an important role in the pathophysiology of both obesity and type 2 diabetes mellitus. We previously reported that dietary annatto-extracted tocotrienol exerts beneficial effects by modulating inflammatory responses in mice fed a high-fat diet (HFD). The purpose of this study was to test the hypothesis that tocotrienol supplementation when combined with an HFD would result in an altered gut microbiota composition. For 14 weeks, forty-eight male C57BL/6J mice were assigned to 4 groups-low-fat diet, HFD, HFD supplemented with annatto-extracted tocotrienol at 800 mg/kg diet (AT), and HFD supplemented with metformin at 200 mg/kg diet. Glucose homeostasis was assessed by glucose and insulin tolerance tests, serum and pancreas insulin levels, and histological assessments of insulin and glucagon in pancreatic tissue. The concentrations of adipokines were measured in white adipose tissues. For the gut microbiome analysis, cecal content was collected, DNA was extracted, and 16S rRNA gene sequencing was performed. AT supplementation improved glucose homeostasis and lowered resistin, leptin, and interleukin-6 levels in white adipose tissue. Relative to the HFD group, AT-supplemented mice showed a decrease in the Firmicutes to Bacteroidetes ratio and had a lower abundance of Ruminococcus lactaris, Dorea longicatena, and Lachnospiraceae family. The relative abundance of Akkermansia muciniphila was increased in the AT group compared to the low-fat diet group. The association between the metabolic improvements and the identified bacterial taxa suggests a potential metabolic modulation caused by AT supplementation through the gut microbiota composition in mice fed an HFD.Background Though at lower risk, patients with prior extracardiac conduit (EC) Fontan still may require catheter ablation for supraventricular arrhythmia. Objective To determine the optimal approach to pulmonary venous access (PVA) after EC Fontan operation. Methods All electrophysiologic procedures requiring PVA over a 10-year period at the UCLA Medical Center were reviewed. PVA was grouped by transcaval (TCP) or direct conduit puncture. Procedural characteristics and outcomes were compared. Results Between June 2009 and November 2019, 23 electrophysiology procedures requiring PVA access were performed in 17 EC Fontan patients (53% male, median age 25 years [11 - 34]). Cavo-atrial overlap was identified in 14 patients by pre-procedure imaging (10 cardiac CT, 4 cardiac MR). PVA access was obtained via TCP in 11, direct conduit puncture in 6, pre-existing fenestration in 5, and pulmonary artery puncture in 1. Time to PVA was significantly shorter for TCP vs direct conduit puncture (0.2 vs 1.1 hours, respectively; p=0.03). The only predictor of successful TCP was length of cavo-atrial overlap by pre-procedure imaging (14 mm vs 3 mm; p=0.02). There were no procedural complications. [https://www.selleckchem.com/products/solcitinib.html find more] No change in oxygen saturation was noted and no evidence of residual shunting was detected by follow up echocardiography. Conclusions TCP is feasible in most patients after EC Fontan surgery and can be predicted by pre-procedural advanced imaging. TCP is associated with shorter time to PVA and was uncomplicated in this single center study. Pre-operative assessment of cavo-atrial overlap should be considered prior to catheter ablation for EC Fontan.Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage. This search resulted in 390 unique records, of which 14 were ultimately selected for qualitative synthesis and which included data on 1515 COVID-19 patients. Approximately 10% of COVID-19 patients treated with these drugs developed QT prolongation. We found evidence of ventricular arrhythmia in 2 COVID-19 patients from a group of 28 treated with high-dose chloroquine. Limitation of these results are unclear follow-up and possible publication/reporting bias, but there is compelling evidence that chloroquine and hydroxychloroquine induce significant QT-interval prolongation and potentially increase the risk of arrhythmia. Daily electrocardiographic monitoring and other risk mitigation strategies should be considered in order to prevent possible harms from what is currently an unproven therapy.Background Antitachycardia pacing (ATP) success rates as low as 50% for fast ventricular tachycardias (VTs) have been reported, providing an opportunity for improved ATP to decrease shocks. Objective The purpose of this study was to determine how a new automated antitachycardia pacing (AATP) therapy would perform compared with traditional burst ATP using computer modeling to conduct a virtual study. Methods Virtual patient scenarios were constructed from magnetic resonance imaging and electrophysiological (EP) data. Cardiac EP simulation software (CARPEntry) was used to generate reentrant VT. Simulated VT exit sites were physician adjudicated against corresponding clinical 12-lead electrocardiograms. Burst ATP comprised 3 sequences of 8 pulses at 88% of VT cycle length, with each sequence decremented by 10 ms. AATP was limited to 3 sequences, with each sequence learning from the previous sequences. Results Two hundred fifty-nine unique ATP scenarios were generated from 7 unique scared hearts. Burst ATP terminated 145 of 259 VTs (56%) and accelerated 2.