Symptoms such as dull chest pain or a feeling of tightness in the chest may be indicative of coronary artery disease (CAD), a condition which develops when a narrowing of the coronary arteries limits the blood supply to the heart muscle. In the worst-case scenario, CAD can lead to a life-threatening heart attack or sudden cardiac death. Prompt diagnosis is therefore essential.

Until now, patients with suspected CAD have often been examined using cardiac catheterization for coronary angiography, a procedure that involves a tube (catheter) being inserted into a blood vessel via a small incision in the groin or arm and then advanced to the heart. The advantage of this method is that it combines diagnosis with treatment: if a narrowed segment is detected, the intervention to open up the affected artery can be performed immediately. However, the procedure is not without its risks, and out of a total of 880,000 patients who undergo the procedure in Germany every year, 58% do not require such an intervention. Led by Charité, an international research consortium has now been able to show that, in certain patients, an equally accurate diagnosis can be achieved using cardiac CT angiography — a non-invasive imaging method.

Research groups from 22 countries worked together to analyze the data of more than 5,300 patients from a total of 65 completed studies. Their analysis revealed that coronary CT angiography is a suitable diagnostic technique in patients with a low to intermediate probability of CAD. “Physicians can determine a patient’s probability of having CAD using individual factors such as age, sex and type of chest pain,” says study lead Prof. Dr. Marc Dewey, Deputy Head of the Department of Radiology on Campus Charité Mitte. “If this probability is between 7 and 67 percent, coronary CT angiography will provide a reliable diagnosis as to whether or not the patient has narrowed arteries. Cardiac catheterization is indicated in patients with higher probabilities, as these patients are likely to need an intervention.”

“Cardiac CT is a gentle technique, which only lasts a few minutes,” emphasizes the study’s first author, Robert Haase, a doctoral student and member of Prof. Dewey’s research group. The technique involves a circular X-ray machine taking 1,000 images per second from various angles. These images are then combined to produce a 3D reconstruction of the heart. Contrast agents are used to make the coronary arteries clearly visible. “Our work shows that, in both men and women, this method is capable of clearly visualizing narrowed segments,” adds Robert Haase.

“Our findings will make it easier for physicians to determine which patients may benefit from having a coronary CT angiogram rather than a catheter-based procedure to diagnose coronary artery disease,” says Prof. Dewey. The radiologist also hopes that the study will contribute to the harmonization of clinical practice guidelines. Country-specific guidelines continue to vary in terms of courses of action recommended when dealing with suspected CAD.

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Materials provided by Charité – Universitätsmedizin Berlin. Note: Content may be edited for style and length.

Results from the Ovarian Reserve and Exposure to Environmental Pollutants (ORExPo study), a ‘real-world data’ study using hormone measurements taken from more than 1300 Italian women, are presented today at the Annual Meeting of ESHRE by first investigator Professor Antonio La Marca from the University of Modena and Reggio Emilia, Italy.

Behind the study lay emerging evidence that many environmental chemicals, as well as natural and artificial components of everyday diet, have the potential to disturb the physiological role of hormones, interfering with their biosynthesis, signaling or metabolism. The hormone in this case, anti- Müllerian hormone or AMH, is secreted by cells in the ovary and is now widely recognised as a reliable circulating marker of ovarian reserve.(1)

‘The influence of age and smoking on AMH serum levels is now largely accepted,’ explains Professor La Marca, ‘but a clear effect of environmental factors has not been demonstrated so far.’

The ORExPo study was in effect an analysis of all AMH measurements taken from women living in the Modena area between 2007 and 2017 and assembled in a large database. These measurements were extended to a computing data warehouse in which AMH levels were linked to patients’ age and residential address. The analysis was completed with environmental data and a ‘geo-localisation’ estimate based on each patient’s residence. The assessment of environmental exposure considered daily particulate matter (PM) and values of nitrogen dioxide (NO₂), a polluting gas which gets into the air from burning fuel.

Results from the 1463 AMH measurements collected from 1318 women firstly showed — as expected — that serum AMH levels after the age of 25 were inversely and significantly related to the women’s age. However, it was also found that AMH levels were inversely and significantly related to environmental pollutants defined as PM10, PM2.5 and NO₂. This association was age-independent.

These results were determined by dividing the full dataset into quartiles reflecting PM10, PM2.5 and NO₂ concentrations. The analysis found significantly lower levels of AMH in the fourth quartile than in the lowest quartiles, which, said Professor La Marca, ‘again confirms that independently of age the higher the level of particulate matter and NO₂, the lower the serum concentration of AMH’. The lowest concentration of AMH — reflecting ‘severe ovarian reserve reduction’ — was measured in subjects who were exposed to levels of PM10, PM2.5 and NO₂ above 29.5, 22 and 26 mcg/m3 respectively. Nevertheless, these were values well below the upper limits recommended by the EU and local authorities (ie, 40, 25 and 40 mcg /m3 respectively).

Severe ovarian reserve reduction, as reflected in a serum AMH concentration below 1 ng/ml, was significantly more frequent in the fourth quartile than in the first three quartiles for PM10 (62% vs 38%), for PM2.5, and for NO₂. ‘This means by our calculations,’ said Professor La Marca, ‘exposure to high levels of PM10, PM2.5 and NO₂ increases the risk of having a severely reduced ovarian reserve by a factor between 2 and 3.’

While noting that this study again confirms that age is the most important determinant of AMH concentration in women, Professor La Marca emphasised that other factors such as smoking, body weight and long-term hormonal contraception are already recognised as having an impact on AMH. Similarly, he said, environmental pollutants may also have a significant effect in determining circulating levels of AMH. ‘Living in an area associated with high levels of air pollutants in our study increased the risk of severely reduced ovarian reserve by a factor of 2 or 3,’ he said.

Their work, published in the journal Behavior Research Methods, recently found that, when it comes to puppy love, the heart doesn’t always know what it wants.

The results are based upon data from a working animal shelter and could help improve the pet adoption process.

“What we show in this study is that what people say they want in a dog isn’t always in line with what they choose,” said Samantha Cohen, who led the study as a Ph.D. student in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences. “By focusing on a subset of desired traits, rather than everything a visitor says, I believe we can make animal adoption more efficient and successful.”

As a member of the lab of IU Provost Professor Peter Todd, Cohen conducted the study while also volunteering as an adoption counselor at an animal shelter. Todd is co-author on the study.

“It was my responsibility to match dogs to people based on their preferences, but I often noticed that visitors would ultimately adopt some other dog than my original suggestion,” Cohen said. “This study provides a reason: Only some desired traits tend to be fulfilled above chance, which means they may have a larger impact on dog selection.”

The researchers categorized dogs based upon 13 traits: age, sex, color, size, purebred status, previous training, nervousness, protectiveness, intelligence, excitability, energy level, playfulness and friendliness. They surveyed the preferences of 1,229 people who visited dogs at an animal shelter, including 145 who decided to make an adoption.

A similar disconnect has been found in research on speed dating led by Todd, who has shown that people’s stated romantic preferences tend not to match the partners they choose.

Although most participants in the dog adoption study listed many traits they preferred — with “friendliness” as the most popular — they ultimately selected dogs most consistent with just a few preferences, like age and playfulness, suggesting that others, like color or purebred status, exerted less influence on decision-making.

There was also another parallel to the world of dating. In short: Looks matter.

“As multiple psychologists have shown in speed-dating experiments, physical attractiveness is very important,” Cohen said. “Most people think they’ve got a handsome or good-looking dog.”

In the article, Cohen outlines some challenges facing aspiring dog-owners:

• Focusing on “the one”: Although adopters often came to the shelter with a vision of the perfect pet, Cohen said many risked missing a good match due to overemphasis on specific physical and personality traits. For example, an adopter who wants an Irish wolfhound because they’re large, loyal and light shedders might fail to consider a non-purebred with the same qualities.
• Mismatched perceptions: Surprisingly, adopters and shelters often used different traits to describe the same dog. These included subjective traits, such as obedience and playfulness, as well as seemingly objective traits, such as color.
• Missed signals: People who have never had a dog may not grasp the implications of certain behaviors. A dog seen as “playful” at the shelter may come across as “destructive” in a small home, for example.
• Performance anxiety: Shelters are high-stress environments for dogs, whose personalities may shift when they’re more relaxed at home. Picking a dog based upon personality at the shelter is akin to choosing a date based on how well they perform while public speaking, Cohen said.

To improve pet adoptions, Cohen said animal shelters need to know that people tend to rely on certain traits more strongly when choosing a dog, which might make it easier to match adopters to dogs. She also suggested shelters consider interventions, such as temporary placement in a calmer environment, to help stressed or under-socialized dogs put their best paw forward, showing their typical level of desirable traits, such as friendliness.

Finally, Cohen advises caution about online adoption, since adopters are dependent upon someone else’s description of the dogs. She suggests users limit their search criteria to their most desired traits to avoid filtering out a good match based upon less important preferences.

The study was supported in part by an IU Graduate and Professional Student Government Research Award.