bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized Controlled Trial of Intravenous Dexmedetomidine for Control of Hemodynamics, Surgical Bleeding, and Recovery Profile during Transsphenoidal Pituitary Surgery
Authors: Mathew Preethy J. , Jain Aparna , Wig Jyotsna , Mukherjee Kanchan K. , Gupta Aakriti
Published: October 2019

Background Microscopic transsphenoidal excision of pituitary gland, though considered safe from neurosurgical point of view, produces marked cardiovascular and stress responses despite adequate depth of anesthesia. The aim of this study was to evaluate the effect of dexmedetomidine bolus and infusion in microscopic transsphenoidal pituitary surgery on hemodynamics, bleeding in surgical field, and recovery parameters.

Materials and Methods A prospective randomized double-blind study was conducted in 40 American Society of Anesthesiologists (ASA) I-II patients between 18 and 65 years, who underwent elective transsphenoidal excision of pituitary tumor. Two groups were constituted: one group received dexmedetomidine 1 μg/kg loading dose followed by 0.5 μg/kg/h infusion, the other received placebo bolus and infusion. A standard anesthesia protocol including isoflurane and fentanyl was used in both groups. The hemodynamic profile, intraoperative bleeding, and recovery profile were studied.

Results The heart rate (HR) did not vary significantly from the baseline during surgery and recovery in the dexmedetomidine group. The systolic, diastolic, and mean blood pressures decreased significantly with dexmedetomidine in statistical terms, though they were within the clinically acceptable range and did not require intervention. On comparing the groups, dexmedetomidine group had better perioperative blood pressure profile and decreased isoflurane requirement. Bleeding scores during surgery and recovery were similar in both groups.

Conclusions Intraoperative use of dexmedetomidine in transsphenoidal pituitary surgery provided stable perioperative hemodynamics comprising reduced cardiovascular response to intubation and surgical noxious stimuli along with a similar recovery compared with the control group. Therefore, dexmedetomidine appears as a useful adjunct to control hemodynamics in neurosurgical patients undergoing transsphenoidal surgery.
Pyridoxine Responsive Seizures: Beyond Aldehyde Dehydrogenase 7A1
Authors: Koul Roshan , Alfutaisi Amna , Abdelrahim Rana , Altihilli Khalid
Published: October 2019

Objective Pyridoxine responsive seizures (PDRs) are characterized by early-onset seizures and epileptic encephalopathy (neonates and infants) which respond to pyridoxine. Any type of seizures can be the first presentation of PDRs in these children. The aim of this 20-year retrospective study was to report the profile of 35 children with PDRs.

Materials and Methods Neonatal and infantile seizures responding to pyridoxine were analyzed retrospectively from 1998 to 2018. Depending on the clinical features, laboratory results, and genetic study, they were divided into following four groups: (A) responders with α-aminoadipic semialdehyde dehydrogenase 7A1 (ALDH7A1) mutation, (B) responders with pyridoxal phosphate homeostasis protein (PLPHP) mutation, (C) responders with none of these two known mutations, (D) and responders in combination with antiepileptic medications.

Results Sixteen of 35 children had genetic mutation, 4 with ALDH7A1 mutation, and 12 with PLPHP mutation recently described. Nineteen of 35 children had no genetic positivity.

Conclusion A large number of children with pyridoxine response do not have known genetic confirmation. Over time, new genes, responsible for pyridoxine dependency, may be identified or an unknown metabolic disorder may be seen in these children.
A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap
Authors: Pereira Nicolás , Parada Leonardo , Kufeke Matías , Troncoso Ekaterina , Roa Ricardo
Published: October 2019

Background The superficial circumflex iliac artery perforator flap (SCIP) is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. Different planning methods have been described, but these are not yet standardized like in other flaps. The aim of this study is to present a fast, effective, and reliable method for SCIP flap planning using computed tomography angiography (CTA).

Patients and Methods Between October 2017 and September 2018, CTA was performed on 40 patients. Preoperative planning of SCIP flaps based on the medial branch was performed analyzing CTA images. The perforating sites of the medial branch on the deep (point D) and superficial fascia (point S) were identified. Distances to those points, from the center of the umbilicus in the “y-axis” and the midline perpendicularly in the “x-axis,” were measured. These measurements were transferred to the patient's skin as a guide for dissection.

Results Eighty areas were studied identifying points D and S in CTA. Forty-three SCIP flaps were performed using this planning method. In 100% of the flaps, points D and S matched perfectly with handheld Doppler and surgical findings.

Conclusion Points D and S method for medial branch based SCIP planning with CTA is an easy to learn, efficient, fast, and reliable technique for preoperative planning, allowing a safe and predictable elevation of the flap.
Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction
Authors: Heijboer Willem M.P. , Suijkerbuijk Mathijs A.M. , van Meer Belle L. , Bakker Eric W.P. , Meuffels Duncan E.
Published: October 2019

Multiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R
2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.
Light extraction enhancement of BGO scintillator by monolayers of SiO2 periodic array
Authors: Liu Yingdu , Liu Fangyuan , Tang Wen , Yang Yanli , Zhu Jieqiong , Zhao Nie , Qi Fugang , Ouyang Xiaoping
Published: October 2019

Utilizing the self-assembly method, we have successfully prepared a two-dimensional photonic crystal (PhC) of monolayer SiO2 spheres onto the Bismuth Germinate (Bi4Ge3O12, BGO) crystal and therefore supply another photonic crystal structure with the advantages of low-cost and large-area preparation to improve the light extraction efficiency of scintillator. A light extraction enhancement ratio up to 145.3% as compared the BGO coated by the PhC with the plain reference sample is observed and the underlying mechanism of scintillator light extraction is discussed in detail via a rigorous coupled-wave analysis calculation. The calculated transmission spectra and electric-field distribution exhibit the electric-field eigenmodes confined in SiO2 spheres resonating by the way of whispering gallery modes (WGMs) and becoming leaky modes due to the diffraction effect. Since almost no SiO2 nanospheres over the polystyrene spheres are immersed in preparation, we have demonstrated that the introduction of PhC structures using the SiO2 nanospheres onto the scintillator surface is an effective way to solve the light-trapping problem and therefore the design is very useful to be applied to the particle detection of radiation field.
Effects of texture geometry on the tribological performance of brass with a TiN coating under lubricated rotation
Authors: Chen Juan , Zeng Liangcai , Wan Qiang , Chen Keying , Lu Yan
Published: October 2019

Pin-on-disc experiments are conducted to investigate the tribological performance of untextured and textured brass surfaces with TiN coatings under oil lubrication. The surface texture is designed as a dimple pattern with different diameters and depths for the transverse surfaces of brass pins. After texturing, a TiN coating is deposited through pulsed-bias arc ion plating in a pure N2 atmosphere using a Ti target. Three dimple diameters are used, namely 130 μm, 150 μm, and 170 μm, along with three dimple depths, namely 15 μm, 40 μm, and 60 μm. The TiN coating is around 5 μm thick. Friction tests are conducted under different rotation speeds and loads, and the interfacial adhesion is assessed via a scratch test. Compared to the untextured surface, the textured one offers improved tribological behavior in mixed lubrication because the dimples generate hydrodynamic lift. To reduce friction in the case of higher speed and lower load, the optimum texture parameters are a diameter of 150 μm and a depth of 40 μm.
Relationship between seed morphological traits and wind dispersal trajectory
Authors: Zhou Quanlai , Liu Zhimin , Xin Zhiming , Daryanto Stefani , Wang Lixin , Qian Jianqiang , Wang Yongcui , Liang Wei , Qin Xuanping , Zhao Yingming , Li Xinle , Cui Xue , Liu Minghu
Published: October 2019

The structure and dynamics of plant populations and communities are largely influenced by seed dispersal. How the wind dispersal trajectory of seeds shifts with differences in seed morphology remains unknown. We used a wind tunnel and video camera to track the dispersal trajectory of seven species of Calligonum whose seeds have different kinds of appendages and other morphological traits, using variable wind speeds and release heights to determine the relationship between seed morphological traits and wind dispersal trajectory. Concave-, straight-line-, horizontal-projectile- and projectile-shaped trajectories were found. Dispersal trajectories such as the horizontal projectile (HP) and projectile (P) tended to have a long dispersal distance. Straight line (SL) and concave curve (CC) trajectories tended to have a short dispersal distance. Seeds with bristles and large mass tended to have SL and CC trajectories, those with wings or balloon and small mass tended to have HP and P trajectories. Wind speed tended to have a stronger influence on the dispersal trajectory of light and low-wing-loading seeds, and release height tended to have a stronger influence on the dispersal trajectory of heavy and high-wing-loading seeds. Thus, seed wind dispersal trajectory is not only determined by seed morphological characteristics but also by environmental factors such as wind speed and release height.
Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care
Authors: Manifold Andreana , Atkinson David , Marley Julia V. , Scott Lydia , Cleland Gavin , Edgill Paula , Singleton Sally
Published: October 2019

The aim of this study is to ascertain whether a simplified screening algorithm incorporating glycated haemoglobin (HbA1c) tests increases type 2 diabetes (T2D) screening in 10- to 14-year-old Aboriginal Australians presenting to primary healthcare (PHC) services. The study involved a 6-month pilot of a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town. A retrospective audit of electronic health records for the pilot period (27 June–26 December 2016) and a 6-month period before the screening algorithm was introduced (1 October 2015–31 March 2016) was conducted. Interviews were held with 30 PHC staff at participating PHC services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service. During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (28/130 (22%) v. 50/139 (36%), P = 0.011), but there was no change at the hospital (0.02% v. 0.02%, P = 0.615). Staff feedback suggested measures to improve screening; these include simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
Equine non-invasive time-lapse imaging and blastocyst development
Authors: Meyers S. , Burruel V. , Kato M. , de la Fuente A. , Orellana D. , Renaudin C. , Dujovne G.
Published: October 2019

In this study we examined the timeline of mitotic events of invitro-produced equine embryos that progressed to blastocyst stage using non-invasive time-lapse microscopy (TLM). Intracytoplasmic sperm injection (ICSI) embryos were cultured using a self-contained imaging incubator system (Miri®TL; Esco Technologies) that captured brightfield images at 5-min intervals that were then generated into video for retrospective analysis. For all embryos that progressed to the blastocyst stage, the initial event of extrusion of acellular debris preceded all first cleavages and occurred at mean (±s.e.m.) time of 20.0±1.1h after ICSI, whereas 19 of 24 embryos that did not reach the blastocyst stage demonstrated debris extrusion that occurred at 23.8±1.1h, on average 4h longer for this initial premitotic event (P<0.05). Embryos that failed to reach the blastocyst stage demonstrated a 4-h delay compared with those that reached the blastocyst stage to reach the 2-cell stage (P<0.05). All embryos that reached the blastocyst stage expressed pulsation of the blastocyst with visible expansion and contraction at approximate 10-min intervals, or five to six times per hour. Using a logit probability method, we determined that 2- and 8-cell stage embryos could reasonably predict which embryos progressed to the blastocyst stage. Together, the results indicate that TLM for equine embryo development is a dynamic tool with promise for predicting successful embryo development.
The influence of wildfire on water quality and watershed processes: new insights and remaining challenges
Authors: Rhoades Charles C. , Nunes João P. , Silins Uldis , Doerr Stefan H.
Published: October 2019

This short paper provides the framework and introduction to this special issue of International Journal of Wildland Fire. Its eight papers were selected from those presented at two consecutive conferences held in 2018 in Europe and the USA that focussed on the impacts of wildfire on factors that regulate streamflow, water quality, sediment transport, and aquatic habitats. Despite decades of watershed research, our understanding of the effects of wildfires on the processes that regulate clean water supply remains limited. Here, we summarise the key challenges and research needs in this interdisciplinary field and evaluate the contributions the eight special issue papers make to improved understanding of wildfire impacts on watershed processes. We also outline research priorities aimed at improving our ability to predict and, where necessary, mitigate wildfire impacts on watersheds. Achieving these advances is all the more pressing given the increasing extent and severity of wildfires in many areas that are the source of clean water for major population centres.
Agency and impoliteness in Korean online interactions
Authors: Kim Ariel , Brown Lucien
Published: October 2019

(Im)politeness research has often focused either on the importance of social norms or on the intentions of the speaker, with the active role of the listener in assigning social meanings overlooked. This limitation particularly applies to so-called “discernment languages” such as Korean and Japanese. The current paper addresses this gap by offering a small-scale qualitative study of recipient agency in Korean naturally occurring computer-mediated communication (CMC). The data analyzed includes 14 text messages between the recipient (the proprietor of an online food business) and his customer, which were posted on a blog that he owned and operated. We focus on how the recipient agentively evaluates the language usage of the customer, including inconsistent evaluations of her use of non-honorific language, orpanmal. The results suggest that the instability of (im)politeness interpretations cannot be explained solely by social norms or intentions but should also include the socially-mediated agency of the recipient.
Vieni anche te?
Authors: Fiorentino Giuliana
Published: October 2019

In this paper we return to the question of the use of te, the Italian personal pronoun, as
subject instead of complement. According to scientific literature, the diffusion of te in substitution of
tu as the subject of the clause is attributed to the spoken variety of language.

We aim at verifying this hypothesis and to further document the use of te as subject using
existing corpora of both written and spoken language.

The research considers old and new issues (for example the diffusion of the coordinative phrase io e
te instead of io e tu, on which see Blasco Ferrer, 1992)
and intends to represent the phenomenon in quantitative and qualitative terms.

In the conclusions it is stated that the phenomenon, even better represented in the spoken versus the written,
seems diachronically stable, and sensitive to diatopic factors. The most significant results of the current research consist in
having evaluated the presence of the phenomenon separately in the different constructs in which it occurs, and in having
identified other contexts of attestation.
How to learn to stop worrying and love environmental DNA monitoring
Authors: Darling John A.
Published: October 2019

Environmental DNA is one of the most promising new tools in the aquatic biodiversity monitoring toolkit, with particular appeal for applications requiring assessment of target taxa at very low population densities. And yet there persists considerable anxiety within the management community regarding the appropriateness of environmental DNA monitoring for certain tasks and the degree to which environmental DNA methods can deliver information relevant to management needs. This brief perspective piece is an attempt to address that anxiety by offering some advice on how end-users might best approach these new technologies. I do not here review recent developments in environmental DNA science, but rather I explore ways in which managers and decision-makers might become more comfortable adopting environmental DNA tools—or choosing not to adopt them, should circumstances so dictate. I attempt to contextualize the central challenges associated with acceptance of environmental DNA detection by contrasting them with traditional “catch-and-look” approaches to biodiversity monitoring. These considerations lead me to recommend the cultivation of four “virtues,” attitudes that can be brought into engagement with environmental DNA surveillance technologies that I hope will increase the likelihood that those engagements will be positive and that the future development and application of environmental DNA tools will further the cause of wise management.
Pd@MC-PVA composite electrocatalyst for ethanol electrochemical oxidation
Authors: Zhang Guoqing , Jin Binbin , Zhao Yongqing
Published: October 2019

By a simple and effective intermittent microwave heating (IMH) method, Pd anchored on mesoporous carbon (MC) and Poly (vinyl alcohol), (PVA) (Pd@MC-PVA) composite was successful synthesized for ethanol electrochemical oxidation. Both cyclic voltammetric and chronoamperametric measurements indicate that the performance of Pd@MC-PVA was significant improved for ethanol oxidation. The activity of Pd@MC-PVA for ethanol oxidation is four times higher than that of Pd@MC with the same Pd loading in alkaline media. The activity enhancement could attribute to a good Pd dispersion and utilization on MC because of strong hydrophilic and excellent conductivity.
The Ottoman Empire: The Mandate That Never Was
Authors: Akın Yiğit
Published: October 2019

A century after the victorious Allied powers distributed their spoils of victory in 1919, the world still lives with the geopolitical consequences of the mandates system established by the League of Nations. The Covenant article authorizing the new imperial dispensation came cloaked in the old civilizationist discourse, entrusting sovereignty over “peoples not yet able to stand by themselves under the strenuous conditions of the modern world” to the “advanced nations” of Belgium, England, France, Japan, and South Africa. In this series of “reflections” on the mandates, ten scholars of Europe, Africa, the Middle East, Asia, and the international order consider the consequences of the new geopolitical order birthed by World War I. How did the reshuffling of imperial power in the immediate postwar period configure long-term struggles over minority rights, decolonization, and the shape of nation-states when the colonial era finally came to a close? How did the alleged beneficiaries—more often the victims—of this “sacred trust” grasp their own fates in a world that simultaneously promised and denied them the possibility of self-determination? From Palestine, to Namibia, to Kurdistan, and beyond, the legacies of the mandatory moment remain pressing questions today.
Fat Graft Enhanced With Adipose-Derived Stem Cells in Aesthetic Breast Augmentation: Clinical, Histological, and Instrumental Evaluation
Authors: Gentile Pietro , Kothari Ashutosh , Casella Donato , Calabrese Claudio
Published: October 2019

Background

Fat graft enhanced with adipose-derived stem cells (FG-e-ASCs) has been utilized in outcomes of radiotherapy after mastectomy, breast soft tissue defects, ulcers, and loss of substance. The authors present their experience utilizing FG-e-ASCs in breast augmentation.

Objectives

The aim of this study was to evaluate the safety and efficacy of a study group (SG) regarding utilization of FG-e-ASCs in breast augmentation for aesthetic improvement, comparing the results with a control group (CG).

Methods

A total of 46 patients affected by breast hypoplasia were treated with FG-e-ASCs, comparing results with those of a CG (n = 30) treated with fat graft not enhanced with adipose-derived stem cells (FG-ne-ASCs). The preoperative evaluation included a complete clinical evaluation, a photographic assessment, magnetic resonance imaging of the soft tissue, ultrasound, and mammography. Postoperative follow-up took place at 1, 3, 7, 12, 24, and 48 weeks and then annually.

Results

The patients treated with FG-e-ASCs showed 58% maintenance of the contour restoring and of 3-dimensional (3D) volume after 3 years compared with the patients of the CG treated with FG-ne-ASCs, who showed 29% maintenance. In 67.4% (n = 31) of breast augmentations treated with FG-e-ASCs, we observed a restoration of the breast contour and an increase of 10.3 mm in the 3D volume after 36 months, which was observed in only 20.0% (n = 6) of patients in the CG treated with FG-ne-ASCs. Volumetric persistence in the SG was higher than that in the CG (P < 0.0001 SG vs CG).

Conclusions

Utilization of FG-e-ASCs was safe and effective in this series of cases performed.

Level of Evidence: 4
Surgical correction of postpneumonectomy syndrome with adjustable saline implants and transoesophageal echocardiography
Authors: Encarnacion Carlos O , Deshpande Seema P , Mondal Samhati , Carr Shamus R
Published: October 2019

Postpneumonectomy syndrome can have a significant clinical impact on a patient. It presents as progressive dyspnoea due to compression of the contralateral bronchus and/or pulmonary veins. Herein, we present a patient who over a 2-year period developed progressive dyspnoea on exertion and eventually also at rest, due to compression of her left mainstem bronchus and her left inferior pulmonary vein. Surgical correction with implantable adjustable saline implants was undertaken to ameliorate her symptoms. Concurrent use of intraoperative transoesophageal echocardiography permitted real-time adjustment of the implants. This allowed objective measurement and demonstration of normalization of pulmonary vein velocity, which resulted in complete symptom resolution.
2979The effect of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors on endothelial progenitor cells
Authors: Itzhaki Ben Zadok O , Mager A , Leshem-Lev D , Lev E , Kornowski R , Eisen A
Published: October 2019

Background

Endothelial progenitor cells (EPCs) have an important role in the process of vascular repair by promoting re-endothelialization following endothelial injury. We hypothesized that proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors, which reduce cardiovascular events, will increase the level of EPCs and thus affect the process of vascular repair. Therefore, we sought to investigate the effect of PCSK9 inhibitors on circulating EPCs.

Methods

Study population included patients with known stable CAD who were initiated PCSK9 inhibitors. Blood samples were drawn and evaluated for EPCs at baseline and after treatment (1 month). Circulating EPCs were then assessed quantitatively by the expression of VEGFR-2, CD34 and CD133 using flow cytometry, and functionally by the formation of colony forming units (CFUs).

Results

Our preliminary cohort included 12 patients (median age of 69 years), 31% of whom were female. At baseline, total cholesterol and low density lipoprotein levels were 190 (IQR 180, 227) mg/dL and 123 (IQR 107, 154) mg/dL, respectively. Following 1-month of therapy with a PCSK9 inhibitor and along with a decrease in LDL to a median of 58 (IQR 50, 67) mg/dL, we observed an increase in the expression of CD34(+)/VEGFR-2(+) (1.2% (IQR 0.6, 1.6) to 3.0% (IQR 1.2, 4.5), P=0.07) and CD133(+)/VEGFR-2(+) (0.8% (IQR 0.7, 1.4) to 1.7% (IQR 0.6, 4.0), P=0.5). Proliferation of EPCs was confirmed microscopically (1 CFUs (IQR 1, 1.5) to 1.5 CFUs (IQR 1.5, 2.5), P=0.016) (Figure 1) and by an MTT assay (0.16 (IQR 0.12, 0.19) to 0.19 (IQR 0.17, 0.21), p=0.016).

Conclusions

These preliminary results in patients with CAD demonstrate that treatment with PCSK9 inhibitors is associated with higher levels of EPCs, thus promote endothelial repair. This finding may represent a novel mechanism of action of PCSK9 inhibitors, which might have important future clinical implications.
3035Synergy of artificial intelligence and single lead EKG to detect and localize STEMI
Authors: Vieira D , Mehta S , Fernandez F , Villagran C , Frauenfelder A , Ceschim M , Matheus C , Torres M A , Mazzini J , Quintero S , Pisana L , Safie R , Nola F , Krisciunas S , Cecilio S
Published: October 2019

Background

The cumbersome, standard 12-lead electrocardiogram (EKG) challenges an efficient detection of ST-Elevation Myocardial Infarction (STEMI) in pre-hospital (ambulances) and hospital (portable devices) settings. We believe that our machine-learning algorithm embedded into a single lead EKG will be successful in acute care settings.

Purpose

To incorporate Artificial Intelligence-guided, single lead EKG interpretation, to facilitate easy and accurate STEMI detection in urgent situations.

Methods

This is an observational, retrospective, case-control study. A subset sample was generated from the International Telemedical Systems (ITMS) database that contains cardiologist annotated EKG records. Subset: A total of 2,542 exclusively confirmed STEMI diagnosis EKG records from enrolled healthcare centers in Mexico, Colombia, and Brazil; including specific ischemic heart wall (anterior, inferior, and lateral). Following discharge of treated patients, confirmation of STEMI diagnosis was obtained as feedback from healthcare centers. Records were anonymized EKG that excluded all medical information. Sample: A Standard 12 lead, 10-seconds length, 500Hz sampling frequency EKG was fed to the LUMENGT-AI STEMI detecting algorithm. Preprocessing: Detection of QRS complexes by wavelet system, segmentation of each EKG record into individual heartbeats (total dataset 27,152 beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, three classes were considered for individual heartbeats: “Anterior”, “Inferior” and “Lateral”, each corresponding to the heart wall affected. These individual probabilities were aggregated to generate the final label for each of the 12 leads. Training & Testing: 90% and 10% of the dataset was used respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with a NVidia GTX 1070 GPU, 8GB RAM.

Results

Accuracy – Lead V2 (91.7%); Sensitivity Anterior wall – Lead V2 (97.4%); Sensitivity for Lateral wall – Lead I (10.0%); and Sensitivity for Inferior wall – Lead V2 (93.6%).

Conclusions

AI algorithms merged with a Single lead approach detect and localize STEMI within any setting. The V2 lead yields superior results for mapping of ischemic areas of the heart among the anterior and inferior walls. In contrast, diagnosis remains suboptimal for identifying the lateral wall. The usage of synergistic technologies facilitates easy, fast and early STEMI triage and management.
3041Wall shear stress measurement by ultrafast vector flow imaging for atherosclerotic carotid stenosis
Authors: Goudot G , Khider L , Pedreira O , Poree J M , Julia P , Alsac J M , Mirault T , Pernot M , Messas E
Published: October 2019

Background

Carotid plaque vulnerability assessment is an important factor in guiding the decision to treat significant carotid stenosis. Ultrafast Ultrasound Imaging (UF) offers the possibility of evaluating local flow velocities over an entire 2D image, allowing access to velocity measurements in contact with the arterial wall and to measure the wall shear stress (WSS).

Purpose

To evaluate the feasibility of WSS measurement in a prospective series of patients with carotid stenosis.

Methods

A 7.5 MHz linear probe of an Aixplorer scanner was used. UF acquisitions had 3 tilted plane waves transmits (−10; 0; 10°) and an effective frame rate of 5000Hz. We evaluated the flow velocity in 5 areas of the carotid wall: common carotid artery (1), plaque ascent (2), plaque peak (3), plaque descent (4), internal carotid artery (5) (Figure). WSS was computed with the vector field speed using the following formula, WSS=μ·δn·v with v the blood velocity, n the normal vector to the vessel wall and μ, the blood viscosity, calculated from the hematocrit value for each patient. WSS measurement method was first validated using a laminar flow phantom and known viscosity. And then, 33 patients were then prospectively evaluated, with a median carotid stenosis degree of 80% [75–85].

Results

Significant correlation was found between in vitro measurement and the theoretical WSS values (R2=0.95; p<0.001).In patients,the maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascend, reaching its maximum value of 3.57 Pa [2.47–4.45] at the peak of the plaque, and a fall after passing the peak (0.99 Pa [0.8–1.32]) lower than the WSS values in the non-stenotic areas (1.55 Pa [1.13–1.90] for the common carotid artery) (Table).

Table 1 Wall's area Wall shear stress (Pa) Min Max Delta 1. Common carotid artery 0.14 [0.05–0.27] 1.55 [1.13–1.90] 0.73 [0.55–0.96] 2. Plaque's ascent 0.39 [0.24–0.59] 2.63 [1.89–3.28] 1.20 [0.89–1.79] 3. Plaque's peak 0.60 [0.32–0.89] 3.57 [2.47–4.45] 1.78 [1.44–2.46] 4. Plaque's descent 0.16 [0.13–0.22] 0.99 [0.80–1.32] 0.52 [0.34–0.73] 5. Internal carotid artery 0.17 [0.13–0.35] 1.37 [1.04–1.75] 0.72 [0.50–0.87] Results are median [25th–75th percentile].

Figure 1

Conclusion

UF provide reliable WSS values. High WSS was present at the peak of the plaque, whereas lowest WSS values were found at the post-stenotic zone. WSS evaluation may help to better characterize the carotid plaque vulnerability.
3045Role of osteogenic circulating endothelial progenitor cells in dissemination of large arterial calcification in rheumatoid arthritis
Authors: Chan Y.-H , Ngai M C , Chen Y , Wu M Z , Yu Y J , Zhen Z , Lai K , Cheung T T , Ho L M , Chung H Y , Lau C S , Tse H F , Yiu K H
Published: October 2019

Background

Rheumatoid arthritis is associated with both abnormal bone metabolism and atherogenesis but mechanistic links were missing.

Aim

This study aimed to investigate the role of osteocalcin (OCN)-expressing circulating endothelial progenitor cells (EPC)s in the severity and dissemination of systemic arterial calcifications in rheumatoid arthritis.

Methods

We performed flow cytometry studies in 145 consecutive patients with rheumatoid arthritis to determine osteogenic circulating levels of OCN-positive (OCN+) CD34+KDR+ and OCN+CD34+, versus conventional early EPC CD34+CD133+KDR+. Total calcium load of the thoracic aorta (ascending plus descending) and the carotid arteries were assessed by non-contrast computed tomography (CT) and contrast CT angiography.

Results

Osteogenic EPCs OCN+CD34+KDR+ (P=0.002) and OCN+CD34+ were strikingly associated with the clustered presence of aortic and carotid calcification (P=0.002 and 0.001 respectively, Figure). Multivariable analyses revealed that circulating OCN+CD34+KDR+ (B=14.4 [95% CI 4.0 to 24.8], P=0.007) and OCN+CD34+ (B=9.6 [95% CI 4.9 to 14.3], P<0.001) remained independently associated with increased aortic calcium load. OCN+CD34+ EPC (B=0.8 [95% CI 0.1 to 1.5], P=0.023), but not OCN+CD34+KDR+ EPC (B=1.2 [95% CI −0.2 to 2.6], P=0.09) was further independently associated with carotid calcium load. In comparison, conventional early EPC CD34+CD133+KDR+ had no significant association with aortic or carotid calcium load (P=0.46 and 0.88, respectively).

Conclusions

Circulating level of osteogenic EPC is associated with promulgated aortic and carotid calcification in patients with rheumatoid arthritis, suggesting a potential mechanistic role of the bone-vascular axis in pro-atherogenicity of rheumatic diseases.

Acknowledgement/Funding

General Research Fund, Hong Kong Research Grants Council
3047Long-term changes after carotid stenting assessed by intravascular ultrasound and near-infrared spectroscopy
Authors: Stechovsky C , Hajek P , Horvath M , Veselka J
Published: October 2019

Background/Introduction

Long-term effect of carotid stenting (CAS) on the stabilization of the plaque is not well described. The interaction among the late stent expansion, neointimal hyperplasia, and lipid core might explain stabilization of the plaque and low long-term incidence of stroke after CAS.

Purpose

To assess long-term change in the lipid signal, stent, and luminal dimensions and restenosis after CAS with the multimodality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.

Methods

We performed follow-up NIRS-IVUS imaging in patients who underwent CAS at our institution. Of the 112 patients (120 carotid arteries) who had NIRS-IVUS during CAS, 96 were alive at the time of the study, and 52 (58 carotid arteries) agreed to participate on the study. The lipid signal of the stented segment was calculated from the NIRS-derived chemogram (a spectroscopic map) as the lipid core burden index (LCBI, a dimensionless number from 0 to 1000). Volumetric calculations were performed using dedicated software with the automated lumen and stent detection and manual corrections. Median time from CAS to the follow-up examination was 31 months (range 5–56).

Results

The mean (± SD) LCBI significantly decreased from 32±56 to 17±27 (p=0,002). The mean stent volume significantly increased from 717±302 mm3 to 1019±429 mm3 (p<0,001) with mean stent expansion 43±24%. The mean luminal volume increased from 717±302 mm3 to 760±359 mm3 (p=0,025) due to the mean in-stent restenosis (ISR) 26±15% of the stent volume. Significant increase in the mean minimal stent area (MSA) (from 11,1±3,0 mm2 to 15,0±3,5 mm2, p<0,001) was not observed in the minimal luminal area (MLA) (from 11,1±3,0 mm2 to 11,4±4,4 mm2, p=0,098) due to the ISR. Significant restenosis (reduction of MLA ≥50% from baseline) was present in 7 stents.

Conclusions

During nearly three years of the follow-up after CAS the lipid signal decreased suggesting stabilization of the plaque. Significant late stent expansion was balanced with substantial neointimal hyperplasia therefore the late luminal gain was only modest in volume and nonsignificant at the site of MLA. There was a major variability in the rate of the late stent expansion and restenosis.
3051Effectiveness and safety of apixaban, dabigatran and warfarin compared to rivaroxaban in non-valvular atrial fibrillation; a Norwegian nationwide cohort study
Authors: Rutherford O.-C.W , Jonasson C J , Ghanima W G , Halvorsen S H
Published: October 2019

Introduction

Non-vitamin K oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Although proven effective and safe, there is limited knowledge of the comparative effectiveness and safety of the different NOACs in real life. Norway has nationwide registries of good quality, being suitable for doing such a comparison.

Purpose

The aim of this nationwide cohort study was to compare the risk of stroke/systemic embolism (SE) and major bleeding in patients with NVAF treated with dabigatran, apixaban and warfarin compared with patients treated with rivaroxaban.

Methods

By merging nationwide registries (the Norwegian Patient Registry and the Norwegian Prescription Database), a cohort was created including all oral anticoagulant (OAC)-naïve adult NVAF patients initiating OAC in the study period 1 Jan 2013 to 31 Dec 2017. The patients were followed until switching of OAC type, discontinuation, death, or end of study-period. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (HRs) for the risk of stroke/SE or bleeding in patients using dabigatran, apixaban and warfarin compared to rivaroxaban.

Results

A total of 65 563 new users of OAC were included; 10,413 initiated dabigatran, 28,363 apixaban, 13,087 warfarin and 13,700 rivaroxaban. The median age was 71 yrs for dabigatran, 74 yrs for apixaban, 75 yrs for warfarin, and 73 yrs for rivaroxaban; 58.3% were men. Dabigatran-users were younger and had less comorbidities than all other OAC-users; the greatest difference was in the proportion with chronic kidney disease (2.4% in the dabigatran-group versus 7.0%, 12.5%, and 4.6% in the apixaban, warfarin and rivaroxaban groups, respectively). During a median follow-up time of 14.7 months (IQR 4.9–30.6), 2 361 (3.6%) patients suffered a stroke/SE, 2,051 (3.1%) had a major bleeding, and 4 250 (6.5%) died. Adjusted HRs for stroke/SE and major bleeding are presented in the figure. When the risk of stroke/SE and major bleeding was assessed solely in patients that received the standard dose of OAC (73% of NOAC users), the results were similar to the results for the entire population.

OACs compared to rivaroxaban

Conclusion

In this nationwide cohort study of patients with NVAF being new users of OAC, we found no significant differences in risk of stroke/SE between different OACs and rivaroxaban, whereas dabigatran and apixaban were associated with significantly lower risk of major bleeding.

Acknowledgement/Funding

The study was funded by the South-Eastern Norway Regional Health Authority, and by BMS/Pfizer through the ERISTA program.
3055Interactions between metabolism regulator adiponectin and intrinsic cardiac autonomic nervous system: a potential treatment target for atrial fibrillation
Authors: Yu L , Zhou Z , Jiang H
Published: October 2019

Background

Previous studies indicated that inhibiting the cardiac autonomic nervous system (CANS) suppressed atrial fibrillation (AF). Clinical research revealed that high levels of serum adiponectin (APN) could exert a beneficial influence on sympathetic and vagal tone in patients with type 2 diabetes. The aim of this study was to elucidate whether APN could regulate CANS and subsequently suppress rapid atrial pacing (RAP)-induced AF.

Methods

Eighteen anesthetized male beagles were randomly divided into three groups: the control group (saline plus sham RAP, N=6), the RAP group (saline plus 3 h RAP, N=6) and the APN + RAP group (APN plus 3 h RAP, N=6). Multielectrode catheters were attached to all atria and pulmonary veins. After bilateral thoracotomy, APN (10 μg, 0.1 μg/μL) or saline was microinjected into 4 fat pads, each containing one of the major atrial ganglionated plexi (GP), prior to RAP. Electrophysiological parameters including atrial effective refractory period (ERP), cumulative window of vulnerability (ΣWOV), anterior right GP (ARGP) function and neural activity were measured at baseline and 3 h after pacing. The fat pads containing the GP were excised for molecular biological testing and pathological staining at the end of the protocol.

Results

Compared with the control treatment, RAP markedly shortened ERP values at all tested sites and increased ΣWOV, ARGP function and neural activity, whereas APN injection into the GP reversed these changes. Mechanistically, APN treatment ameliorated the increased inflammatory response induced by RAP. In addition, the APN receptors AdipoR1 and AdipoR2 were detected both in neurons and in non-neuronal cells. Downstream of the AdipoRs, AMPK signaling was significantly activated and NF-κB signaling was significantly inhibited. More importantly, binding between APN and AdipoRs promoted macrophage phenotype switching from proinflammatory to anti-inflammatory.

Figures

Conclusion

This study demonstrates that local administration of APN into atrial GP suppress RAP-induced AF by regulating the activity of the CANS. AMPK activation and macrophage phenotype switching may contribute to the attenuation of GP inflammation after APN injection. Therefore, APN signaling may provide a potential therapeutic target to AF.
3077Load dependency of left ventricular longitudinal strain by 2D-speckle tracking echocardiography: myth or reality?
Authors: Nobre De Matos Pereira Vieira M J , Ribeiro D , Craveiro N , Teixeira R , Pitta L , Alves M , Martins V
Published: October 2019

Background

2D-speckle tracking echocardiography (2D-STE) derived strain measurements has been proposed as a non-invasive measure of myocardial deformation and function. However, the effects of left ventricular (LV) loading conditions on 2D-STE derived LV longitudinal strain (GLS) have not been totally elucidated and the results of some studies regarding the load dependency of GLS are controversial.

Purpose

To characterize the effects of acute load change (preload increase) on LV GLS.

Methods and results

We evaluated the variation of LV GLS by 2D-STE, in response to a preload increasing maneuver (leg lifting maneuver – LLM), in a population of 30 healthy individuals. Clinical, demographic and echocardiographic parameters (including LV longitudinal mechanics obtained with 2D-STE before and after LLM) were described. The population had a mean age of 27±4 years and 73% were women. Increased preload to the heart with LLM was confirmed by an increase in the maximal diameter of the inferior vena cava (16±3.5 vs 22±3.3 mm, p<0.01). No significant changes in left atrial volume, LV ejection volume and LV ejection fraction were observed in response to the LLM. There was a significant variation of global LV GLS (−21.9±2.3 vs −23.2±1.6%, p<0.001, Δ 1.25%, 95% CI 0.5–1.91) – figure. An increase in right ventricular longitudinal function with LLM (TAPSE 22.5±5.4 vs 25.5±0.5 mm, p=0.005, Δ 2.9, 95% CI 0.9–4.8) was also observed.

Conclusion

To our knowledge this is the first study performed to assess the effect of preload increase in GLS using the LLM in healthy individuals. In this study, the absolute LV GLS value increased significantly in response to preload increase (LLM). The dependence of GLS on preload is in accordance with the Frank-Starling Law, in which an increase in preload in a healthy individual lead to an increase in myocardial contractility. These findings suggest that LV GLS is a sensitive parameter for detecting subtle changes in LV longitudinal function.
3079Subclinical progression of biventricular cardiomyopathy in patients with systemic sclerosis
Authors: Stronati G , Guerra F , Zuliani L , Manfredi L , Ferrarini A , Fischetti C , Danieli M G , Gabrielli A , Capucci A
Published: October 2019

Background

Systemic sclerosis (SSc) is a progressive autoimmune disease which has been proven to affect the heart. While it is widely known that the disease can cause pulmonary artery hypertension and therefore secondary right heart impairment, new studies have detected a subclinical heart involvement of both the left and right ventricles. The similar changes in myocardial deformation of both chambers assessed by speckle tracking imaging are consistent with the definition of SSc-related cardiomyopathy as a standalone entity with peculiar characteristics.

Purpose

The aim of the present study is to describe the progression of myocardial deformation as assessed through speckle tracking in patients with SSc and no pulmonary hypertension.

Methods

Prospective, longitudinal study on 48 patients affected by SSc. Patients with a history of heart failure, known structural heart disease, atrial fibrillation, and pulmonary hypertension were excluded. For every patient, standard echocardiographical and speckle-tracking derived variables for the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) were acquired at baseline and after 15±6 months.

Results

While common parameters of systolic function (Simpons's left ventricular ejection fraction, right ventricular fractional area change, TAPSE, tricuspidal S') did not change during follow-up, mean global longitudinal strain (GLS) significantly worsened for both left (from −19.1%±4.2% to −17.2%±5.0%) and right ventricle (from −17.9%±5.2% to −15.9%±4.8%) over 15 months. The increased impairment seen in SSc patients was homogeneous across endocardial layers (LV: from −21.8%±4.8% to −18.8%±5.2%; RV: from −20.6%±4.5% to −19.4%±4.9%), midventricular layers (LV: from −19.2%±4.5% to −17.7%±4.9%; RV: from −17.7%±4.7% to −16.7%±4.6%) and epicardial layers (LV: from −16.3%±4.7% to −16.0%±4.3%; RV: from −15.4%±5.0% to −14.6%±4.1%), as well as across myocardial segments (Figure 1). No difference in progression rate was seen between the diffuse and limited version of SSc, nor between different serotypes.

Figure 1

Conclusions

While traditional echocardiographical parameters are useless in order to follow the natural history of SSc-related cardiomyopathy during its early stages, GLS impairment progresses during a 15-month follow-up and involves similarly both the left and right ventricle. Whether, how, and how much the altered myocardial deformation contributes to the incidence of pulmonary arterial hypertension in these patients is still to be assessed.

Acknowledgement/Funding

Marche Polytechnic University