bluuebunny/crossref_metadata_2025 huggingface dataset:
SPECIFIC FEATURES OF THEORY AND PRACTICE OF TEACHING FOREIGN LANGUAGES TO STUDENTS IN GERMAN-SPEAKING COUNTRIES
Authors: Yelahina N. I.
Published: December 2023

This research article delves into the intricacies of teaching foreign languages to students in German-speaking countries (based on a German model), uncovering the distinctive features that shape both theoretical frameworks and practical implementations. The globalized world necessitates effective language education, and within German-speaking nations, language learning holds a pivotal role due to their commitment to multilingualism and intercultural communication. This study examines the multifaceted approach to language education, which considers linguistic, cultural, and cognitive aspects. It explores the integration of diverse theoretical foundations, such as communicative language teaching and intercultural competence, to tailor teaching methodologies. Cultural context and technological advancements, including digital tools and experiential learning, contribute to fostering language skills and intercultural understanding. Furthermore, this article highlights future research prospects, including the exploration of pedagogical strategies, assessment methods, technology integration, teacher training, and the socio-cultural dynamics influencing language education. Ultimately, this investigation provides insights into how language education in German-speaking countries adapts to the demands of a globally connected society.
СИСТЕМА ВПРАВ ДЛЯ ФОРМУВАННЯ ГРАМАТИЧНОЇ КОМПЕТЕНЦІЇ МАЙБУТНІХ МЕДИКІВ НА ЗАНЯТТЯХ ЛАТИНСЬКОЇ МОВИ
Authors: Ворона І. І.
Published: December 2023

У cтaттi зазначено, що вивчення латинської мови є важливою передумовою професійного спілкування медиків; розглянуто проблему формування граматичної компетенції студентів на заняттях латинської мови, адже одним із важливих елементів при вивченні мови є правильне використання граматики для утворення медичних термінів. Встановлено, що для побудови граматично правильного професійного мовлення необхідно володіти граматичними поняттями та системно вивчати всі аспекти граматики: фонетичний, орфографічний, морфологічний, синтаксичний. Володіння граматичною компетенцією допомагає застосовувати знання граматики у професійній мовленнєвій діяльності медиків. Зазначено, що формування граматичних умінь відбувається у три етапи: аналіз граматичних правил; застосування цих правил при виконанні вправ; використання граматики для правильного вживання медичних термінів. Для формування граматичної компетенції важливу роль відіграє система вправ для закріплення, визначено особливості класифікації вправ та подано систему вправ для підвищення граматичної компетенції на заняттях латинської мови при вивченні теми «Прикметник, граматичні категорії прикметника, поділ на групи, словникова форма. Узгоджене означення».
COMMUNICATION ORIENTED APPROACH TO THE FORMATION OF GRAMMAR COMPETENCE IN THE STUDENTS OF HIGHER MEDICAL EDUCATIONAL INSTITUTIONS
Authors: Kitura H. Ya. , Prokop I. A.
Published: December 2023

The article deals with grounding of the use of English grammar tasks as a component of forming communicative competence in the students of higher medical educational institutions. The essence of grammar competence as an important component of the future medic's communicative competence is found out, and the need for learning grammar in order to be able to express one’s thoughts properly is emphasized. English communicative approach to medical students’ professional competence is an integral aspect of professionally oriented study at the higher medical educational institution, and is formed through mastering the specifics of language competence at its phonetic, lexical, and grammar levels, particular attention being focused on the analysis of scientifically grounded classification of the exercise system aimed at the formation of grammar competence as a fundamental basis for professionally targeted English course. The issues of semantic content for professionally targeted English, selection of training grammatical material, and development of communicative component in the process of students' mastering English language skills are under consideration. Main components of medical students' grammar competence are characterized; science-based classification of grammar tasks for the formation of English language communication is considered, the emphasis being put on the role of grammar for the proper formulation of thoughts. Both theoretical and methodological aspects of communicative approach to learning English grammar, which is studied through combining grammar, lexical, and phonetic phenomena, are covered. In particular, when teaching correct sentence construction, their semantic and thematic content are considered, grammar skills being formed both at the level of separate structures and fluent dialogue-monologue speech. The use of communicative type grammar tasks at professionally targeted classes of English has been found to develop speech skills and abilities that make possible to estimate and express one's thoughts along with training attention, memory, developing thinking and having high motivation characteristics.
Economia circular
Authors:   Universidade de São Paulo. Escola de Engenharia de São Carlos, Castro Ana Maria Rodrigues Costa de , Andrade Julia Fonseca Colombo ,   Universidade de São Paulo. Escola de Engenharia de São Carlos, Nunes Cleyse Kelly Barbosa ,   Universidade de São Paulo. Escola de Engenharia de São Carlos, Benites Igor Matheus ,   Universidade de São Paulo. Escola de Engenharia de São Carlos, Schalch Valdir ,   Universidade de São Paulo. Escola de Engenharia de São Carlos
Published: December 2023

Com o objetivo de celebrar o vigésimo aniversário do Núcleo de Estudo e Pesquisa em Resíduos Sólidos (NEPER) vinculado ao Programa de Pós-Graduação em Engenharia Hidráulica e Saneamento, da Escola de Engenharia de São Carlos, Universidade de São Paulo, em 2023 e promover a disseminação do conhecimento científico na área de resíduos sólidos, foi elaborada esta compilação de obras abrangendo todos os estudos realizados pelo grupo até 2022. O volume 2, intitulado "Economia circular" reune estudos sobre logística reversa; coleta seletiva; triagem; reciclagem; reutilização; redução; prevenção; avaliação de ciclo de vida; educação ambiental; catadores de materiais recicláveis, integrando as Contribuições cientificas em resíduos sólidos: compilação de estudos do NEPER.
Conceitos de astronomia. 2.ed
Authors:   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Boczko Roberto
Published: December 2023

A obra, publicada originalmente em 1984, tem a finalidade de apresentar de forma clara, e sem a utilização de conhecimentos profundos de matemática, conceitos básicos da Astronomia que estuda a posição dos astros. A obra aborda os seguintes itens: noções de calendário; sistemas de referência e suas interrelações; sistemas de medidas de tempo; deslocamentos dos planos fundamentais de referência; efeitos físicos que deslocam a imagem de um astro; estrutura do sistema solar; movimento orbital de um astro; coordenadas de um corpo orbital; noções de perturbações gravitacionais. Esta edição digital reproduz totalmente o livro original sem modificações.
Astrobiologia: uma ciência emergente
Authors:   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Galante Douglas , Silva Evandro P. ,   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Rodrigues Fabio ,   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Horvath Jorge E. ,   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Avellar Marcio G. B. ,   Universidade de São Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas
Published: December 2023

O livro é uma introdução ao tema da astrobiologia e reúne textos de pesquisadores de diversas áreas científicas, que abordam desde a origem da vida, passando pelas luas de nosso Sistema Solar com possíveis condições de abrigar vida, até as viagens interestelares e os exoplanetas que foram descobertos nos últimos anos.
Pensamento fervente
Authors: Buitoni Dulcilia Helena Schroeder , Bagolin Luiz Armando , Marras Stelio
Published: December 2023

Editorial da Revista do IEB n.86
Lula na primeira página da Folha: a linguagem da vidraça trincada, a imagem do tiro no coração
Authors: Martins Ana Taís , Lacerda Rayane
Published: December 2023

Este trabalho investiga as variações epistemológicas nas abordagens da fotografia como imagem e como linguagem. A partir do retrato de Lula destacado na capa da Folha de S. Paulo em 19 de janeiro de 2023, refletimos sobre as bases conceituais da fotografia jornalística e compreendemos seus apelos ao imaginário. A abordagem é de natureza filosófica, analisando as contradições entre diferentes perspectivas teóricas. Concluímos que a fotografia é uma forma de compreender o mundo, na qual ela não é tomada como sua representação e sim percebida como sua parte intrínseca.
Violência obstétrica: urgência de regulação legislativa no Brasil
Authors: Andrighetto Aline , Reinheimer Caroline Salim
Published: December 2023

O presente estudo teve como objetivo identificar os meios existentes de proteção à mulher e investigar a real necessidade de regulamentação do combate à violência obstétrica no Brasil. Além disso, buscou identificar as formas de violência contra a mulher e as medidas protetivas, nacionais e internacionais, existentes. Para tal, foram realizadas pesquisas bibliográfica, doutrinária e jurisprudencial. O estudo demonstrou a importância de uma legislação específica que trate da violência obstétrica, que defina um conceito nítido sobre a questão e da qual as mulheres tenham ciência, para que possam se defender. Tal legislação também é fundamental para a elaboração e implementação de medidas a serem tomadas em caso de cometimento de violência obstétrica por parte de agentes públicos ou privados. Concluiu-se que é urgente a necessidade de promulgação dessa legislação para a proteção de mulheres a fim de assegurar seus direitos reprodutivos.
Abstract 100: Blood Pressure Targets and Hemodynamics According to Initial Blood Lactate Levels in Patients With Comatose Out-of-Hospital Cardiac Arrest - A Substudy of the BOX Trial
Authors: Beske Rasmus Paulin , Schmidt Henrik , Obling Laust , Hoejgaard Henrik , Grand Johannes , Moeller Jacob , Kjaergaard Jesper , Hassager Christian
Published: December 2023

Out-of-hospital cardiac arrest (OHCA) patients are often circulatory unstable and have high mortality in the first days following resuscitation. An increase in lactate will reflect the severity and duration of hypoperfusion in out-of-hospital cardiac arrest (OHCA). Further, the severity of hypoperfusion could modify the effect on survival and neurological injury of different mean arterial blood pressure (MAP) targets. In this sub-study of the BOX trial, adults successfully resuscitated comatose OHCA patients (n=789) with a presumed cardiac cause were randomized to a MAP 63 mmHg vs. 77 mmHg. Patients were arbitrarily grouped in low-lactate: <25%, medium-lactate: 25%-75%, and high >75 % according to blood lactate levels at hospital arrival as a surrogate of severity of hypoperfusion. Invasive evaluations were performed using an arterial line and pulmonary artery catheter (PAC). Logistic regression analysis evaluated whether lactate levels (as continuous and categorical) modify the effect of MAP targets on 1-year mortality. The three lactate groups were: low-lactate: <2.9 mmol/L, medium-lactate: 2.9-7.9 mmol/L, and high-lactate >7.9 mmol/L. The vasoactive inotropic score was higher with increasing initial lactate level with the largest difference at 6 hours (low-lactate: 7.8 (95%CI: 5.7 - 10.1) vs. high-lactate: 16.4 (95%CI: 13.4 - 19.6). No difference in the cardiac index or systemic vascular resistance was observed between lactate groups. The initial lactate level modified the effect of the two MAP targets (p=0.044), with a tendency to higher mortality for high-lactate patients if the MAP target were 77 mmHg (odds ratio: 1.7 (95%CI: 0.9-3.0, p=0.08). Comatose OHCA patients with high initial lactate levels required more vasoactive drugs on the first two days of ICU admission to meet the blood pressure target and have a poorer prognosis. The results do not support a higher MAP target benefit for patients with an initial high lactate level in the first 48 hours.
Abstract 11389: Circulating Aldosterone is an Independent Risk Marker for Left Main Coronary Artery Disease
Authors: Wan Jindong , Liu Sen , Wang Xinquan , Yang Yi , Wang Dan , Zhou Peng , Wang Peijian
Published: December 2023

Background:
Elevated plasma aldosterone concentrations reflect remodeling of the vascular wall and increased cardiovascular risk, whereas data from the left main coronary artery (LMCA) are lacking. Patients with stenosis of the LMCA present difficult challenges. Therefore, the aim of this study was to investigate the relationship between plasma aldosterone concentrations and LMCA in patients with hypertension.

Methods:
We recruited hypertensive patients with LMCA with assessed plasma aldosterone concentrations before disease onset from the hospital between 2018 and 2022 and set them as the case group. Simultaneously, an age- and gender-matched cohort with plasma aldosterone concentration measurements but without LMCA was selected as the control group using a ratio of 1:3. Multivariable logistic regression analysis was used to assess the relationship of plasma aldosterone concentrations with LMCA. Angiographically significant LMCA stenosis is defined as luminal diameter stenosis ≥ 50%.

Results:
A total of 608 hypertensive patients were identified in this study, including 152 cases and 456 controls. The mean age of the patients was 60.8 ± 17.5 years, and 389 (64.0%) were men. Compared with the control group, the case group exhibited significantly higher plasma aldosterone concentrations (15.38 versus 9.68 ng/dL,
P
=0.009). In logistic regression analysis, higher plasma aldosterone concentrations showed 2.73-fold higher odds (95% confidence interval [CI], 1.35-3.68,
P
=0.003) for the presence of LMCA, which was significant in the adjusted model (odds ratio, 2.02 [95% CI, 1.18-2.97],
P
=0.008). In a stratified analysis, males with coronary artery disease and women of all ages showed a relationship between the two. The link between the two was unaffected by sensitivity analysis that excluded those who were exposed to interfering substances during the measurement of plasma aldosterone concentration and those who had primary aldosteronism.

Conclusions:
This study indicated that higher plasma aldosterone levels were associated with an increased risk of LMCA in patients with hypertension, even in the absence of primary aldosteronism. Interventional studies are needed to elucidate the health effect of treatments to lower aldosterone levels.
Abstract 11513: Impact of Pulmonary Hypertension on Patients With Heart Failure With Preserved Ejection Fraction: A 5-year Analysis
Authors: Alitter Qusai , Al Wahadneh Omar
Published: December 2023

Introduction:
The purpose of this retrospective study is to determine the impact of pulmonary hypertension on the outcome of patients with heart failure with preserved ejection fraction (HFpEF). The study investigated various outcomes associated with pulmonary hypertension in HFpEF patients.

Methods:
We analyzed data from the National Inpatient Sample between 2016 and 2020 to identify patients admitted to the hospital with an acute exacerbation of HFpEF and pulmonary hypertension as a secondary diagnosis. This retrospective study used multivariable logistic and linear regression analysis to identify factors associated with mortality, hospital length of stay, total charges, and other secondary outcomes. Outcomes were adjusted to multiple factors including age, race, gender, and other comorbidities.

Results:
343,490 patients were admitted with an acute exacerbation of HFpEF from 2016 to 2020, of whom 127,655 also carried the diagnosis of pulmonary hypertension. Patients with pulmonary hypertension were at higher risk for mortality, longer hospital stay, and incurred greater healthcare costs. Additionally, patients with pulmonary hypertension were at increased risk of atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. Despite no difference in the rate of developing acute respiratory failure between both groups, patients with pulmonary hypertension were more likely to need non-invasive ventilation or mechanical ventilation.

Conclusions:
The study concludes that the presence of pulmonary hypertension in HFpEF patients is linked to poorer outcomes, including increased mortality risk, longer hospital stay, higher healthcare costs, and greater risk for complications such as arrhythmias and ventilation requirements. Early identification and management of pulmonary hypertension are important to improve patient outcomes, Nevertheless, more research is needed to determine the most effective treatment approaches.
Abstract 11565: Clinical Implications of Left Atrial Size and Its Changes After Cardiac Resynchronization Therapy in Patients With Heart Failure
Authors: Yu Yu
Published: December 2023

Background:
Little evidence is available regarding the impact of left atrial (LA) diameter, especially its changes after cardiac resynchronization therapy (CRT), on the prognosis of patients with heart failure (HF).

Objective:
To investigate the association of LA diameter and its changes with all-cause mortality and HF hospitalization in HF patients with CRT.

Methods:
This cohort study retrospectively included 488 HF patients with CRT, who were assessed with echocardiography at baseline and 6 months after CRT. The multivariate Cox proportional hazards regression models were used to examine the specific association of LA diameter and its changes with all-cause mortality and HF hospitalization.

Results:
Non-linear associations were found for LA diameter with all-cause mortality (
P
= 0.006 for nonlinearity) and HF hospitalization (
P
= 0.02 for nonlinearity). The positive association of LA diameter with all-cause mortality (HR, 1.88; 95% CI, 1.42-2.49) and HF hospitalization (HR, 1.72; 95% CI, 1.32-2.22) only in the range of LA diameter <45 mm. There was a positive association of LA diameter changes with all-cause mortality (HR, 1.29; 95% CI, 1.12-1.48) and HF hospitalization (HR, 1.28; 95% CI, 1.13-1.45). LA adverse remodeling (LAAR) was associated with an increased risk of all-cause mortality (HR, 2.35; 95% CI, 1.46-3.79) and HF hospitalization (HR, 2.18; 95% CI, 1.40-3.41).

Conclusions:
LA enlargement and LAAR were associated with an unfavorable outcome in HF patients with CRT. These findings suggest that monitoring LA diameter and its changes has potential clinical implications for HF treatment.
Abstract 11582: The Fingertip Artery is Better Than the Brachial Artery in Evaluating Vascular Endothelial Function for Coronary Artery Disease in Diabetic Patients
Authors: Tomohiro Ueda
Published: December 2023

Introduction:
Several studies demonstrated that endothelial function is impaired in diabetic patients, but no study evaluated vascular parameters in diabetic patients trough a combined analysis of macro and micro-endothelial function. In addition, the difference in vascular parameters between diabetes patients with coronary artery disease (CAD) and without CAD remains unknown. We assessed whether CAD is related to macro or micro vascular endothelial function in diabetic patients.

Hypothesis:
We measured vascular function in 219 diabetic patients (age 68±10 years), including 147 patients with CAD (CAD group) and 72 patients without CAD (control group). Flow mediated vasodilatation (FMD)indicating macro-endothelial function in the brachial artery was measured by ultrasound using a semi-automatic device: UNEXEF18G (UNEX Co. Nagoya, Japan). Reactive hyperemia index (RHI) indicating micro-endothelial function in the fingertip artery was measured by peripheral arterial tonometry (EndoPAT 2000). Vascular function tests were measured on the same day.

Results:
RHI was significantly impaired in CAD group (RHI: 2.0±0.7 vs.1.7±0.5 P=0.012), however FMD had no deference in the two groups. Logistic regression analysis revealed that RHI (odds ratio: 0.44, 95% confidence interval: 0.21-0.94) was an independent predictor for CAD in diabetic patients.

Conclusions:
RHI, an acknowledged marker of micro-endothelial function was a more sensitive method than FMD in evaluating the risk assessment of CAD in diabetic patients. more peripheral vascular endothelial function was associated with CAD in diabetic patients.
Abstract 11638: Physician Attitudes Toward Beta Blocker and Antiplatelet Therapy in Spontaneous Coronary Artery Dissection Patients
Authors: Liu Olivia , Jaspan Vita , Hausvater Anais , Saw Jacqueline , Reynolds Harmony
Published: December 2023

Background:
Spontaneous Coronary Artery Dissection (SCAD) primarily affects younger women and is a cause of acute coronary syndrome for which medical management guidelines and clinical trial data are lacking. Our study assessed physician attitudes toward beta blocker (BB) and antiplatelet therapy (APT) in SCAD.

Methods:
We conducted an online survey among 165 physicians who treat SCAD. Data were collected about their demographics, BB and APT prescribing practices in hypothetical SCAD patients each with one key difference from the base case, and willingness to randomize patients to BB or no BB and to dual APT [DAPT] (12 months of aspirin and P2Y12 inhibitor, then only aspirin) or single APT [SAPT] (3 months of aspirin, then no APT). Results were analyzed with descriptive statistics and chi-squared test.

Results (Table):
Of the respondents, 163 (99%) were cardiologists, and 64 (39%) were women. When considering BB at discharge, 88% of physicians would prescribe BB in the base case of an otherwise healthy 49-year-old woman with SCAD, with higher likelihood of prescribing BB in a patient with hypertension or ejection fraction (EF) < 50%. Most physicians (95%) were willing to randomize the base case to BB or no BB. Respondents expressed uncertainty about the benefit of BB use, particularly in patients with normal blood pressure or with EF > 50%. When considering APT at discharge, 38% of physicians would prescribe DAPT, 46% would prescribe SAPT, and 16% would prescribe no APT in the base case. Most physicians (92%) were willing to randomize the base case to the DAPT or SAPT strategies. Physicians expressed concern about inadequate and excessive APT, indicating a range of opinions.

Conclusion:
Most physicians would prescribe BB and APT at discharge after SCAD, with the type of APT varying widely. Nearly all were willing to randomize patients to BB or no BB and to DAPT or SAPT. Our results suggest clinical equipoise exists for BB and APT use in SCAD and point to the need for clinical trial data.
Abstract 11684: Comparison of Two Implantable Loop Monitors Implanted in the Same Patient and at the Same Site
Authors: Prakash Atul , gupta eisha , Hadaya Tarick , srivastava kartikeya
Published: December 2023

Introduction:
Implantable loop recorders (ILR) are utilized for diagnosis of AF and evaluation of syncope. The diagnosis of AF is based mainly on RR variability. Under sensing and Oversensing with these ILRs is being reported in a separate retrospective analysis. In this study we compared the real time & recorded Electrogram characteristics obtained with two ILRs in the same patient at the same site Hypothesis: The amplitude of the R wave & clarity of P wave would enable the correct diagnosis of a recorded event & minimize under sensing and oversensing. This would thereby increase the specificity and sensitivity of the diagnosis of AF & asystole.

Methods:
The two ILRs were the Medtronic REVEAL LINQ I and the BioMonitor III device. The Biomonitor is 77.5mm x8.6 mm x4.4 vs the LINQ I is 44.8x7.2x4 mm. When the Medtronic ILRs reached EOS they were replaced with a BioMonitor III at the same site using the existing pocket. We compared the amplitude of the R wave, presence of a clear P wave at the time of implant, undersensing and oversensing of recorded events.

Results:
30 consecutive patients were included in the study. 17 Male and 13 Female Mean age was 70.3
+
8 yrs. Mean BMI was 28.4
+
5.05. Indication for implantation was AF management in 23 and syncope in 7. The mean R wave was 0.35
+
0.2 mv with the Reveal as compared to 0.98
+
0.4 with the BioMonitor III, ( p=0.001 ).P wave in sinus rhythm was present in 19/30 with the Reveal vs 28/30 of the BioMonitor III implants (P=0.004).Undersensing of events was seen in 5/ 30 patients with the Reveal vs 5/30 with the BioMonitor III (p>0.1), Oversensing was seen in 4/30 with the reveals vs 0/30 with the BioMonitor III P>0.1(p=0.12). The amplitude of the R wave and the presence of a clear P wave had a negative correlation with the BMI R =(-0.2) ). A clear P wave when present confirmed an AF episode as labelled by the device /mechanism of tachycardia and type of block in both loop monitor’s

Conclusions:
1.R wave was significantly greater with the BioMonitor III (greater surface area) than a Reveal LINQ. 2. A clear P wave was more often present in sinus rhythm with a BioMonitor III 3. BMI had a negative correlation with both the amplitude of R wave and the presence of a clear P wave with both ILRs. 4. A clear P wave in the recordings significantly impacts the confirmation of an AF episode
Abstract 11687: Percutaneous Coronary Intervention for Chronic Total Occlusions is Associated With Higher Inpatient Mortality and Complications
Authors: Movahed Mohammad Reza , Nathan Allistair , Hashemzadeh Mehrtash
Published: December 2023

Background:
Percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is commonly performed despite unclear long-term benefits.

Hypothesis:
The goal of this study was to evaluate the post-procedural outcome of patients with CTO intervention.

Methods:
The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients with CTO intervention were compared to patients without CTO. We evaluated post-procedural mortality and complications.

Results:
PCI in patients with CTO was associated with higher mortality and all post-procedural complications. A total of 2,011,854 patients underwent PCI with 259,574 having CTO. The CTO group had a 3.17% mortality rate vs 2.57% of non-CTO PCI. (OR, 1.24; CI:1.18-1.31; p<0.001). Using multivariate analysis adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, CTO PCI remained significantly associated with higher mortality (OR, 1.37; 95% CI, 1.3 - 1.45; p<0.001). Patients with CTO compared to non-CTO PCI patients had higher rates of myocardial infarction (OR, 2.85; 95% CI, 2.54 - 3.21; p<0.001), coronary perforation (OR, 6.01; 95% CI, 5.25-6.89; p<0.001), tamponade (OR, 3.36; 95% CI, 2.91-3.88, p<0.001), contrast-induced nephropathy (OR, 2.05; 95% CI, 1.45-2.90), p<0.001), procedural bleeding (OR, 3.57; 95% CI, 3.27-3.89, p<0.001), and acute post-procedural respiratory failure (OR, 2.07; 95% CI, 1.81-2.36, p<0.001). All post-procedural complications were more than 3 times the non-CTO patients (OR, 3.45; 95% CI, 3.24-3.67; p<0.001).

Conclusion:
Using a large national inpatient database, PCI performed in patients with CTO was associated with significantly much higher mortality and post-procedural complications compared to PCI in non-CTO patients.
Abstract 11700: Left Ventricular Global Longitudinal Strain After Transcatheter Aortic Valve Implantation in Patients With Preserved Ejection Fraction
Authors: matsubara yuki , Yamano Michiyo , Yamano Tetsuhiro , Zen Kan , Matoba Satoaki
Published: December 2023

Background:
Left ventricular (LV) global longitudinal strain (GLS), which could assess subtle LV dysfunction, is already deteriorated in a certain number of aortic stenosis (AS) patients with preserved ejection fraction (EF). Although GLS improves after valve replacement, detailed outcome is not well understood.

Research Question:
In AS patients with preserved EF undergoing transcatheter aortic valve implantation (TAVI), is there a difference in post-procedural GLS between patients with and without reduced pre-procedural GLS?
Aim:
To elucidate the post-procedural course of GLS after TAVI.

Methods:
The present study was a single-center retrospective cohort study that included 119 out of 347 consecutive patients undergoing TAVI by excluding EF <50%, atrial fibrillation, inadequate echo image for analysis, and loss to follow-up echocardiography. Subjects were divided into two groups according to pre-procedural GLS: reduced GLS (r-GLS) (> -15%) and preserved GLS (p-GLS) (≤ -15%), and echocardiographic parameters at baseline and changes from baseline to mid-term follow-up (6 months to 1 year) were compared.

Results:
There was no significant difference in baseline characteristics (
Table
). Before the procedure, higher severity of AS, higher LV mass index and E/e’, and lower EF and peak left atrial longitudinal strain were observed in r-GLS. Both EF and LV mass index improved after TAVI in r-GLS and became comparable in p-GLS (
Figure
). After TAVI, GLS improved in r-GLS, but remained significantly inferior to p-GLS (-14.7 ± 2.3% vs. -16.5 ± 2.8%, P < 0.001;
Figure
).

Conclusions:
In AS patients with preserved EF, GLS improved after TAVI in patients with r-GLS but remained inferior to those with p-GLS, suggesting underlying refractory myocardial damage presumably caused by more severe AS and consequently more severe LV hypertrophy in patients with r-GLS. It might indicate the possibility of GLS for determining optimal timing of TAVI in AS patients with preserved EF.
Abstract 11703: Proteomic Analysis for the Formation of the Plexiform Lesions of a Rat Pulmonary Arterial Hypertension Model
Authors: Morimoto Yoshihito , Yamamoto Hidenori , Go Kiyotaka , Fukasawa Yoshie , Ohashi Naoki , Takahashi Yoshiyuki , Kato Taichi
Published: December 2023

Introduction:
Although plexiform lesions (PLs) are the hallmark of the severe pulmonary arterial hypertension, the mechanism of this lesion formation has not been fully elucidated. In this study, to explore the pathways associated PLs formation, we examined the proteome analysis using vascular tissue before and after the formation of PLs obtained by laser capture microdissection (LCM).

Methods:
7 weeks old rats were injected Sugen 5416 subcutaneously, followed by exposed to hypoxia for 3 weeks. In addition, the rats were kept in room air for 5 weeks (8-week model) or 10 weeks (13-week model) thereafter. We obtained the tissue of vessels with medial hypertrophy from 8-week models (n=5) and PLs from 13-week models (n=5) by LCM. Those micro-dissected samples were then subject to a qualitative and then quantitative proteomics approach. Differentially expressed proteins (DEPs) were defined by abundance in mass spectrometry (MS) (P-value < 0.05 and |log2 (fold change)| > 0.5 or proteins deteced only in lesions extracted from one model). In addition, we investigated enhanced pathway by gene ontology (GO) analysis of the identified DEPs in each of the 8-week and 13-week models.

Results:
We identified 718 uniquely expressed proteins including 57 DEPs (31 in 8-week model versus 26 in 13-week model) by using LCM-MS. GO analysis revealed that the actin cytoskeleton organization, actin filament-based process, and actomyosin structure organization processes were enhanced in 8-week model. On the other hand, the innate immune system, G2/M check points, and cellular response to reactive oxygen species were enhanced in 13-week model.

Conclusion:
Pulmonary vascular lesions of 8-week and PLs of 13-week Sugen hypoxia model evaluated by proteomics using samples obtained by LCM methods showed differential protein expression. Analysis of these DEPs may contribute to elucidate the mechanisms of PLs formation.
Abstract 11708: Examining the Impact of Social Determinants of Health in Cardiovascular Disease Risk Factors: Insights From an Implementation Study in a Rural Primary Care Clinic
Authors: Acharya Sameer , Yadav Yogesh , Rana Dibyata , Elzinga Eric , Riaz Amna , Du Kaili , Griffin Judy
Published: December 2023

Introduction:
The social determinants of health (SDoH) are associated with uncontrolled cardiovascular disease (CVD) risk factors and warrant attention.

Methods:
We describe methods and cross-sectional results of the SDoH screening and referral system at a resident-run primary care clinic at Cayuga Medical Center (total 30 residents ~539 patients seen/month with 12% no shows) starting from Nov 2019. Eight domains of SDoH including food security, utility, housing, childcare, finances, transportation, literacy, and social support were selected based on local county data and focus group discussions. We developed an annual screening tool and referral system integrated into the electronic medical record for any SDoH positive patients to the community health and social workers (CHW/SW), who facilitated access to community resources. Patient education about available community resources, regular follow-up visits with the physician and CHW/SW, and periodic SDoH screening were other key components.

Results:
Among 741 patients (Hypertension and Diabetes), 607 (82%) patients underwent SDoH screening (Table). 200 (33%) patients had at least one domain of SDoH (SDoH +) and received SDoH interventions whereas, 407 (67%) did not have any SDoH. The three most common SDoH were lack of social support (61%), transportation (35%) and finance issues (25%). Patients in the SDoH+ group were younger, with higher percentage of non-White race/ethnicity, unemployment, disability, living alone, current smokers, illicit substance use, anxiety, depression, obesity, and opioid use with statistical significance. However, there were no significant differences in CVD risk factors like SBP (138.3 vs 138.4 mmHg), DBP (84 vs 83 mmHg), HbA1c (6.4 vs 6.2) and LDL-c (103.7 vs 101.5 mg/dL).

Conclusions:
In addition to controlling standard CVD risk factors, implementation of SDoH routine screening and referral system in a primary care clinic may help in mitigating CVD burden as seen in our study.
Abstract 11758: Right Atrial Dysfunction is Associated With Atrial Arrhythmias in Adults With Repaired Tetralogy of Fallot
Authors: Abozied Omar , Younis Ahmed , Kandlakunta Sriharsha , Ahmed Marwan , Karnakoti Snigdha , Egbe Alexander C
Published: December 2023

Introduction:
Adults with repaired tetralogy of Fallot (TOF) have right atrial (RA) remodeling and dysfunction, and RA function can be measured using speckle-tracking echocardiography. There is limited data about the role of RA strain imaging in risk stratification in this population.

Hypothesis:
We hypothesized that RA reservoir strain could identify TOF patients at risk of developing atrial arrhythmia. We assessed the relationship between RA reservoir strain and atrial arrhythmias in adults with repaired TOF to test this hypothesis.

Methods:
Retrospective cohort study of adults with repaired TOF, and no prior history of atrial arrhythmias. Atrial arrhythmia was defined as atrial fibrillation, atrial flutter/atrial tachycardia, and categorized as new onset versus recurrent atrial arrhythmias.

Results:
We identified 426 patients (age 33±12 years; males 208 (49%)) that met the inclusion criteria. The mean RA reservoir, conduit, and booster strains were 34±11%, 20±9%, and 15±12%, respectively. Of 426 patients, 73 (17%) developed new-onset atrial arrhythmias (atrial flutter/tachycardia n=42; atrial fibrillation n=31); annual incidence 1.9%. RA reservoir strain was associated with new-onset atrial arrhythmias (adjusted HR 0.95, 95% CI 0.93-0.97) after multivariable adjustment. Of 73 patients with new-onset atrial arrhythmia, 41 (56%) had recurrent atrial arrhythmia (atrial flutter/tachycardia n=18; atrial fibrillation n=23); annual incidence 11.2%. Similarly, RA reservoir strain was associated with recurrent atrial arrhythmias (adjusted HR 0.92, 95% CI 0.88-0.96) after multivariable adjustment.

Conclusions:
RA strain indices can identify patients at risk for atrial arrhythmias, and this can, in turn, be used to guide the type/intensity of therapy in such patients.
Abstract 11763: A Unique Presentation of Heart Failure With Severe Pulmonary Hypertension and Pericardial Effusion in a Young Patient With a Ruptured Sinus of Valsalva Aneurysm
Authors: Ahmed Asad , Tumkur Panduranga Varshitha , Goel Ridhima , Casillas Joseph A , Burkhanova Umida , Bukharovich Inna , John Sabu
Published: December 2023

Case:
26 y/o female immigrant from a developing nation presented with shortness of breath at rest. On physical exam, she desaturated to 75% with minimal movement, had an audible pansystolic murmur, and 2+ pitting edema. Initial presentation was indicative of decompensated Heart Failure (HF). 2D Echocardiogram (Echo) showed a right sinus of Valsalva aneurysm (SOV) with a left to right shunt to the pulmonary artery, as well as, severe pulmonary hypertension (PHTN) and moderate pericardial effusion. CT Scan of the chest showed a right Ruptured SOV (RSOV) with a dissection flap extending into the aorta. Transesophageal Echocardiogram confirmed the diagnosis; noted a right RSOV extending into the pulmonary artery causing severe pulmonary HTN leading to HF and pericardial effusion. The patient underwent surgical correction with full recovery and resolution of symptoms.

Conclusions:
SOV is a rare cardiac complication with variable etiology. Congenital causes are often found early in age and resolved surgically. Cases regarding the management of adults, especially in the critical care setting, are not well described. Here we report a 26-year-old female who rapidly developed HF with PHTN and pericardial effusion secondary to an RSOV. This case shows the importance of Echo in managing HF and determining its etiology. Using Echo we saw a dilated Inferior Vena Cava of 2.7 cm characteristic of HF. Next, we were able to visualize a dilated RSOV with a shunt to the right, subsequent turbulent flow through the Aortic valve, and severe tricuspid regurgitation. Lastly, we were able to see elevated pulmonary artery systolic pressure secondary to the shunt, and subsequent pericardial effusion (fig 1). The patient's symptoms were initially managed with IV diuretics and resolved with surgery. This is a rare case of right-sided RSOV extending into the pulmonary artery, its successful treatment, and the important role of Echo in treating HF and PHTN.
Abstract 11787: The Association Between Preoperative Sarcopenia and Outcomes After Cardiac Transplantation
Authors: Driggin Elissa , Chung Alice , Harris Erin , Bordon Abraham , Rahman Salwa , Sayer Gabriel T , Uriel Nir , Takeda Koji , Maurer mathew S , Leb Jay , Clerkin Kevin
Published: December 2023

Introduction:
Sarcopenia, or reduced muscle mass and function, is underdiagnosed in advanced heart failure and is not routinely assessed. In patients receiving a left ventricular assist device (LVAD), preoperative sarcopenia, defined using CT-derived pectoralis muscle area index (muscle area indexed to height), was an independent predictor of post-operative mortality. The association between preoperative sarcopenia and outcomes after cardiac transplantation is unknown.

Aims/Hypotheses:
The primary aim was to determine if preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of days alive & out of the hospital at 1-year post-cardiac transplant. We hypothesize that patients with preoperative sarcopenia will have fewer days alive & out of the hospital compared to those without.

Methods:
Patients who underwent cardiac transplantation from January 2018 to June 2022 with available preoperative chest CT scans (68% of total cohort) were included. Sarcopenia was diagnosed as pectoralis muscle area index in the lowest sex-specific tertile (male < 5.7 cm
2
/m
2
; female < 4.4 cm
2
/m
2
). The primary endpoint was days alive & out of the hospital at 1-year post-transplant.

Results:
172 patients were included of whom 32.7% met criteria for sarcopenia. Patients with sarcopenia were more likely white with lower body mass index (BMI) (23.5 vs 27.7 kg/m
2
). Patients with sarcopenia had fewer days alive & out of the hospital compared to those without, with a median difference of 16.5 days (320.5 vs. 337 days, p=0.004). Patients with sarcopenia had a longer index hospitalization (28.5 vs. 22 days) and were more likely to be discharged to a facility other than home (40.4% vs. 12.3%). In a linear regression model, sarcopenia was a significant univariable and the strongest multivariable predictor of days alive & out of the hospital at 1-year when controlling for diabetes status (β = -14.4, 95% CI -28, -1.2, p = 0.032).

Conclusions:
Preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of poor outcomes after cardiac transplant. This parameter is easily measurable from commonly obtained preoperative CT scans and may be considered in the transplant evaluation as a marker of risk.
Abstract 11795: CXCL5 Inhibition Recovers Neovascularization in Diabetes Mellitus
Authors: Chang Ting-Ting , Chen Ching , Lin Liang-Yu , Chen Jaw-Wen
Published: December 2023

Introduction:
Diabetes mellitus (DM) is a chronic inflammatory disease accompanied by dysfunction of vascular endothelial cells. Vascular complications are the main causes of death in patients with DM. CXCL5 is an inflammatory chemokine that upregulated in patients with type 2 DM. However, its role in diabetic vasculopathy was not clarified. This study aimed to explore the impacts and mechanistic insights of CXCL5 in neovasculogenesis in DM.

Methods:
Endothelial progenitor cells (EPCs) and human aortic endothelial cells (HAECs) were used in vitro. Streptozotocin-induced diabetic mice and dbdb mice were used as type 1 and type 2 DM models. CXCL5 knockout mice were also used to generate the diabetic animal model. The hindlimb ischemia surgery, matrigel plug assay, and aortic ring assay were conducted. Flow cytometry were used to evaluate the circulating number of EPCs.

Results:
CXCL5 concentrations were increased in plasma and EPCs culture medium from type 2 DM patients. CXCL5 inhibition by neutralizing antibody upregulated VEGF/SDF-1 expression and improved migration and tube formation abilities in EPCs from type 2 DM patients and high glucose-treated EPCs from non-diabetic subjects as well as HAECs. Intraperitoneal injection of CXCL5 neutralizing antibody increased circulating EPC number, enhanced capillary density, and recovered the blood flow after hindlimb ischemia surgery in both type 1 and type 2 diabetic animals. Protein levels of VEGF and SDF-1 in ischemic muscle were upregulated in the CXCL5 inhibition group. Additionally, diabetic mice injected with CXCL5 neutralizing antibody showed higher hemoglobin contents and neovascular branches in the matrigel plug assay and aortic ring assay, respectively. Importantly, CXCL5 knockout diabetic mice showed improved ischemia-induced angiogenesis and higher expression of angiogenic proteins in ischemic muscle compared with wild-type diabetic mice.

Conclusion:
CXCL5 inhibition can improve neovasculogenesis via protecting vascular endothelial function and upregulating angiogenic protein expressions in both type 1 and type 2 DM. Further clinical studies are needed to verify that CXCL5 may be a potential therapeutic target for DM vascular complications.
Abstract 11798: Comparison of Echocardiographic Measurements and Cardiac Biomarkers Between Neonates With Neonatal Encephalopathy Who Developed Brain Injury or Not During Therapeutic Hypothermia
Authors: Lapointe Anie , Wintermark PIa , Rampakakis Emmanouil , Simoneau Jessica , Altit Gabriel
Published: December 2023

Background:
Despite therapeutic hypothermia (TH), many newborns with neonatal encephalopathy (NE) develop brain injury (BI). We hypothesis that newborns with NE have with brain injury have different echocardiographic (ECHO) parameters to those with no brain injury.

Aims:
To compare the ECHO parameters on day of life (DOL) 2 between neonates with NE undergoing TH developing or not brain injury.

Methods:
Prospective cohort study in a single tertiary unit enrolling neonate (born ≥36weeks and ≥1800 grams) undergoing TH for NE, between 2016 and 2020. All neonates presented on admission with moderate to severe NE by amplitude-integrated electroencephalogram (aEEG) profile and underwent a brain magnetic resonance (MRI) on DOL 2. ECHO was performed on the MRI day and data were extracted offline. Multiple logistic regression analyses were constructed to determine which parameters best predicted brain injury or not.

Results:
A total of 34 neonates were recruited, of which 19 (56%) had brain injury. Those with BI had a higher gestational age (GA) at birth (39.6±1.6 vs 38.2±1.5, p=0.01) and more severe pattern on aEEG (p=0.007) (Table 1). Mortality was also more frequent. Left and right ventricular performance were similar between groups by standard ECHO measures, strain and tissue Doppler imaging (Table 2). Although TAPSE was increased in those with brain injury (p=0.04), the Z-Score accounting for GA was similar. Initial aEEG pattern was the best predictor of brain injury, when accounting for GA and ECHO parameters/biomarkers.

Conclusion:
Initial aEEG pattern and not hemodynamic profile was most predictive of brain injury on MRI.
Abstract 11801: Timing of Critical Congenital Heart Defect (CCHD) Detection at 7 U.S. Sites, the Birth Defects Study to Evaluate Pregnancy Exposures (BD-STEPS), 2014-2018
Authors: Moss Shannon E , Ailes Elizabeth , Downing Karrie F , Fundora Michael P , Bolin Elijah H , Carmichael Suzan L , Glidewell Jill , Liberman Rebecca F , Oster Matthew E , Shaw Gary M , Farr Sherry L
Published: December 2023

Background:
CCHD detection prenatally or at birth hospitalization may reduce infant mortality and morbidity, yet little is known about prevalence and characteristics associated with timing of detection.

Objective:
To examine prevalence and characteristics associated with prenatal and late (>3 days after birth) detection of CCHD among infants in BD-STEPS, a multi-site population-based case-control study of risk factors for birth defects.

Methods:
Liveborn infants with non-syndromic CCHD without genetic causes born 2014-2018 with interviewed mothers were included. Timing of detection was based on date of earliest fetal or postnatal echocardiogram. Multivariable log-binomial models calculated adjusted prevalence ratios (aPR) for prenatal (vs postnatal) and late (vs not late) CCHD detection, by clinical and demographic characteristics. Log-linear models evaluated trends over time.

Results:
Among the 588/672 infants with CCHD and complete data, most infants’ mothers were Non-Hispanic White (53.4%), had some prenatal insurance (94.4%), and were multiparous (74.5%). Prenatal detection increased from 2014 to 2018 (24.7% to 40.1%) while late detection decreased (22.4% to 8.7%, Fig 1). Hypoplastic left heart syndrome had the highest prenatal detection (58.6%); late detection was highest for coarctation of the aorta (41.7%). Prenatal detection was more likely in infants of mothers 30-34 vs. 25-29 years at delivery (aPR=1.4, 95% confidence interval 1.0-1.9), and with additional non-cardiac defects (1.2, 1.1-1.4), and less likely among infants of mothers with <11 years of education vs. > bachelor’s degree (0.6, 0.3-1.0). Late detection was more likely among infants of mothers without prenatal insurance (1.8, 1.1-3.1), and less likely among those with non-cardiac defects (0.4, 0.2-0.8).

Conclusion:
From 2014 to 2018, prenatal detection increased and late detection decreased. Yet, disparities in detection by maternal insurance and education were observed.