bluuebunny/crossref_metadata_2025 huggingface dataset:
Progress of Induced Pluripotent Stem Cell-Derived Renal Organoids in Clinical Application
Authors: Ning Na , Liu Zhiting , Li Xinyu , Liu Yi , Song Wei
Published: November 2024

Background: Kidney disease has become a growing public health problem worldwide, and there is an urgent need to develop reliable models for investigating novel and effective treatment strategies. In recent years, kidney organoids, as novel models different from traditional two-dimensional cells and model animals, have attracted more and more attention. Current advances have allowed the generation of kidney organoids from the directed differentiation of induced pluripotent stem cells (iPSCs), which possess similar characteristics to embryonic stem cells, but bypass ethical constraints and have a wide range of sources. Summary: Herein, the methods of generating renal organoids from iPSCs, the applications of iPSC-derived renal organoids in disease modeling, drug effectiveness detection, and regenerative medicine as well as the challenges were reviewed. Key Messages: iPSC-derived renal organoids can be used to model kidney diseases and are great models for studying kidney injury and toxicity. Many efforts are needed to finally apply organoids into clinical application.
Cerebrotendinous Xanthomatosis Disease Prevalence in Patients with Autism Spectrum Disorder: A Prospective Observational Study
Authors: Karadag Mehmet , Turan Mehmet Ibrahim , Celebi Canan , Caglar Tahir
Published: November 2024

Background: Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive congenital metabolic disorder, which is characterized by the impairment of the enzymatic activity of sterol 27-hydroxylase. CTX, a rare neurodegenerative disease of sterol metabolism, can affect multiple systems, including the nervous system. It has been demonstrated that many congenital metabolic diseases like CTX are associated with autism spectrum disorder (ASD). The aim of this study was to identify the prevalence of CTX disease in patients with ASD. Method: The clinical conditions of all patients were evaluated using the Mignarri Scoring Index. A sociodemographic form and Gilliam Autism Rating Scale-2 were applied to all participants. Results: In total, 101 children and adolescents with ASD were analyzed for genes. Following genetic analyses, 4 patients with mutations in the CYP27A1 gene, two homozygous variants, and two different heterozygous mutations were identified. Most common symptom was diarrhea. Overall, 67.3% of all patients and 3 in 4 cases with CYP27A1 gene mutation had gone through psychiatric evaluation. A family history of a psychiatric disorder was present in 19.8% of all cases and in 75% of cases with mutations. Moreover, all mutant cases had comorbid oppositional defiant disorder. A total of 81.2% of all patients and all mutant patients were diagnosed with a behavioral disorder. Conclusion: Psychiatric manifestations ranging from personality changes to behavioral disorders might accompany CTX. Better understanding and knowledge of the CTX disease by distinguishing specific psychiatric and systemic symptoms might help prevent missed diagnoses, progressive neurological deterioration, and permanent disability through early initiation of chenodeoxycholic acid treatment.
Concentration and Stability of Fluoride Chemically Available in Charcoal-Containing Toothpastes
Authors: Fernández Constanza E. , García-Manriquez Natalia L. , Zero Domenick , Cury Jaime A.
Published: November 2024

Introduction: Among the wide variety of commercially oral hygiene products, activated charcoal-based toothpastes have irrupted the market, claiming multiple benefits. Although most are fluoride free, others incorporate fluoride into their formulations, yet the chemical availability and stability of fluoride in these products remain unclear. Our study aimed to assess the chemical availability and stability of fluoride in commercially fluoridated toothpastes formulated with activated charcoal. Methods: We purchased duplicate samples with different lot numbers of different brands containing fluoride (F) and activated charcoal (n = 20) in the USA and Chile. Three toothpastes, one non-fluoridated, one containing sodium fluoride (NaF), and another with sodium monofluorophosphate (Na2FPO3), were used as controls. All toothpastes were evaluated at the time of purchase (fresh) and after their expiration date (aged). We determined total F and available total soluble F (TSF), using a F-specific ion electrode. Values were expressed in mg F/kg (ppm F, w/w). Results: Most evaluated toothpaste contained NaF (70%) or Na2FPO3 (30%) as the F salt, and all declared to contain silica. The TSF concentration ranged from 952.6 to 1,438.1 and from 925.7 to 1,493.7 ppm F for fresh and aged toothpaste, respectively. TSF remained close to total F and in agreement with the F concentration reported by the manufacturer. After expiring, the commercial toothpastes did not form insoluble F, except the Na2FPO3-/CaCO3-based control. Conclusion: The silica-based toothpastes formulated with activated charcoal present fluoride potentially bioavailable and chemically stable to control caries. However, concerns regarding abrasiveness, as raised by other researchers, cast doubt on the suitability of these toothpastes for widespread use.
Sex-Disaggregated Analysis of Central Venous Catheter-Related Bloodstream Infections in Patients with Cancer
Authors: Schalk Enrico , Seltmann Alva , Böll Boris , Giesen Nicola , Grans-Siebel Judit , Kriege Oliver , Lanznaster Julia , Minti Antrea , Naendrup Jan-Hendrik , Neitz Julia , Panse Jens , Schmidt-Hieber Martin , Seggewiss-Bernhardt Ruth , Teschner Daniel , Weber Philipp , Wille Kai , von Lilienfeld-Toal Marie , Hentrich Marcus
Published: November 2024

Introduction: Men are generally more susceptible to bacterial infections than women. Central venous catheters (CVCs), often used to administer systemic treatment in patients with cancer, are an important source of infection. However, little is known about sex-specific differences of CVC-related bloodstream infections (CRBSIs) in patients with cancer. This study aimed to compare CRBSIs in men versus women in a large cohort of patients with cancer. Methods: Data were derived from the SECRECY registry including nonselected patients with centrally inserted non-tunneled internal jugular or subclavian vein CVCs in 10 hematology and oncology sites in Germany. Only CRBSIs classified as definite CRBSI (dCRBSI) or probable CRBSI were included, and the combination of both was summarized as dpCRBSI. CVCs were matched 1:1 for underlying disease, anatomic site of CVC insertion, type of CVC dressing, antimicrobial coated CVC, complicated CVC insertion, and CVC in situ time by propensity score matching (PSM). Endpoints were CRBSI rates and incidences in CVCs inserted in men versus women. Results: A total of 5,075 CVCs registered from March 2013 to March 2024 were included in the analysis, of which 3,024 comprise the PSM cohort. A total of 1,512 (50.0%) CVCs were inserted in men. Underlying diseases mainly were hematological malignancies (96.4%). While there was no statistically significant difference between men and women in the dCRBSI rate (5.4% vs. 4.1%; p = 0.12) and the dCRBSI incidence (3.8 vs. 2.9/1,000 CVC days; p = 0.11), the rate of dpCRBSI (9.9% vs. 6.7%; p = 0.002) and the dpCRBSI incidence (7.0 vs. 4.7/1,000 CVC days; p = 0.002) were significantly higher in men versus women. The proportion of coagulase-negative staphylococci as causative agent of both dCRBSI and dpCRBSI was higher in men than in women (58.8% vs. 41.2%; p = 0.07 and 61.5% vs. 38.5%; p = 0.002, respectively). A multivariable regression revealed neutropenia as an independent risk factor for dCRBSI and male sex as risk factor for dCRBSI and dpCRBSI. Conclusion: In patients with hematological malignancies, men have a higher risk of CRBSI than women. This finding may be attributed to the high number of jugular vein-inserted CVCs, which in men may be associated with higher rates of skin colonization than in women. Special preventive measures such as earlier removal of CVCs in men may be studied in future.
КОНЦЕПЦІЯ ПРОЕКТУ АНАЛІТИЧНОЇ СТАТТІ У РОБОТІ ЗІ СТУДЕНТАМИ НАУКОВОГО ГУРТКА ЯК МЕТОДОЛОГІЧНИЙ ПІДХІД ПРОБЛЕМНО-ОРІЄНТОВАНОГО НАВЧАННЯ ТА ОСОБИСТІСНОГО РОЗВИТКУ
Authors: Савосько С. І. , Шамало С. М.
Published: November 2024

У статті описано шлях реалізації проекту з написання аналітичної статті студентами наукового гуртка, ресурс для якої був одержаний шляхом бібліометричного аналізу публікацій із дослідження патофізіології інсульту. Членами СНГ кафедри гістології та ембріології є студенти з прагненням поглибленого вивчення дисципліни та бажанням брати участь в експериментальних дослідженнях. Студенти перших курсів навчання мають обмежені знання у морфологічних дисциплінах та біохімії для написання наукової статті медико-біологічного профілю, предметом якої можуть бути патофізіологічні процеси, порушення, патологічні стани при захворюваннях. Водночас немає жодних обмежень для аналізу тенденцій у вивченні предмета дослідження та стилю написання статті у наукових журналах. Концепція проекту з написання статті полягає у підборі публікацій із відкритої бібліотеки NCBI, аналізі предмета дослідження, створенні класифікатора або електронного каталога для внесення даних зі статей, аналітики, формування висновків. Принцип отримання кількісних параметрів полягає у розробці класифікатора або таблиці параметрів, за якими здійснюється аналітика опублікованих праць – види методів дослідження, кількість методів, основні завдання тощо. Кінцевим завданням проекту роботи студентів у СНГ є підготовка аналітичної розробки, презентація у формі доповіді та рукопису статті. Розроблений типовий міні-проект щодо написання статті є зручним інструментом у дослідженні сучасних трендів з обраного предмета дослідження. Запропонований проект дає можливість підготуватися до написання наукової статті за типом мета-аналізу, і це значний крок у розвитку критичного мислення студентів, аналітичних здібностей та розкритті особистісного потенціалу.
Implicações da datificação no trabalho dos comunicadores: embates discursivos no contexto da plataformização do trabalho
Authors: Figaro Roseli , Rebechi Claudia Nociolini , Dias Cristiane , Nonato Claudia
Published: November 2024

This study aims to discuss the possible implications of the phenomenon of datafication in the work of communication professionals by considering the restructuring of production processes inherent to the context of platformization. It problematizes this matter based mainly on the following question: how does the rise of datafication change the social conditions of the production process in the work of communicators and the speeches these professionals produce? These initial reflections arose from collective research, carried out by the Center for Research in Communication and Work with support from Fapesp.
Descolonizar pelo afeto é um caminho possível no ambiente digital
Authors: Damasceno Marcelo
Published: November 2024

Pollyana Ferrai, una experta en comunicación social, aborda la influencia de las Tecnologías de la Información y la Comunicación (TIC) en la vida diaria, destacando la importancia del afecto, la educación mediática y la descolonización digital. A través de sus trabajos y libros, explora cómo las redes sociales y el internet afectan nuestras relaciones y percepciones sociales. Critica la infodemia y la falta de reconocimiento de derechos socioculturales en un mundo digitalmente conectado. Su enfoque busca crear conciencia sobre la necesidad de reflexionar sobre nuestras interacciones en línea y offline para construir una sociedad más justa y empática.
Cultura, comunicação pública e cidadania: práticas de deliberação cidadã no campo das artes/cultura (Brasil-Canadá)
Authors: Sampaio Adriano de Oliveira
Published: November 2024

This study describes a stage of research linked to the international cooperation plan that investigates practices of citizen deliberation and public communication in municipal management planning documents and citizen mobilization practices — such as the culture and tourism plans in Brazil (Salvador and Belo Horizonte) and Canada (Montreal) — and online public consultations. It presupposes conflicting public administrations interests as sometimes they aim to implement public policies with a view to citizens, such as those to promote Arts/Culture and, on the other hand, strictly mercantile practices toward tourists and the construction of cities merchandise by place branding.
Experiência francesa impulsiona o debate sobre comunicação pública no Brasil
Authors: Zémor Pierre , Duarte Jorge
Published: November 2024

Este artigo contextualiza e transcreve a palestra de Pierre Zémor, realizada em Brasília em 2009, na qual ele discute as práticas e os desafios da comunicação pública com base na experiência francesa. Zémor destaca a importância da transparência, do diálogo e do engajamento cidadão como pilares fundamentais para a comunicação pública em democracias. A palestra ilustra como os conceitos desenvolvidos na França e na Europa podem oferecer insights valiosos e servir de inspiração para o aprimoramento da comunicação pública no Brasil, ressaltando a necessidade de adaptação e inovação nesse campo.
O discurso sobre a “crise da história” nos séculos XIX e XX: os diagnósticos de Ernst Troeltsch e Hayden White
Authors: Gonçalves Murilo
Published: November 2024

Este artigo procura abordar e problematizar a evolução de um discurso sobre a “crise da história” que se desenvolveu no final do século XIX e ao longo do século XX. A análise concentra-se em dois textos fundamentais escritos por Ernst Troeltsch e Hayden White, a saber, “A crise do historicismo” (1922) e “O fardo da história” (1966), respectivamente. A discussão em torno da “crise da história” revela preocupações profundas sobre a natureza da disciplina histórica e as mudanças significativas que ocorreram em relação à sua concepção, prática e propósito. No presente artigo, os textos acima citados são analisados como manifestos e diagnósticos de suas respectivas épocas. No entanto, argumenta-se, eles estão fundamentalmente ligados como testemunhos da crise do historicismo.
A trajetória intelectual de Mário Neme em São Paulo (1930-1960)
Authors: Silva Tathianni Cristini da
Published: November 2024

Este artigo apresenta e discute a trajetória intelectual de Mário Neme em sua construção enquanto intelectual polígrafo no decorrer de sua fixação e estabelecimento na cidade de São Paulo, durante as décadas de 1930 até 1960. Neste período, o intelectual tornou-se funcionário público, escreveu para jornais, produziu contos, realizou pesquisas históricas e compôs a rede de intelectuais que discutia a formação histórica do estado e do país. Esta investigação, objetiva compreender a formação empírica e a rede de sociabilidade vivenciadas por Neme, e o impacto nos trabalhos executados por ele. Para a escrita deste texto, realizei pesquisa em periódicos, fontes literárias e documentos de instituições como Arquivo Histórico Municipal de São Paulo, Centro de Documentação do Museu Paulista, entre outros. São discutidos conceitos e contextos a partir de alguns autores como Sirinelli (2003), Lahuerta (1999), Darnton (2001), Miceli (2008), entre outros pesquisadores que discutem temas aqui tratados. Pretende-se assim, analisar uma fração da vida do autor em que sua formação e inquietações são latentes e demonstram a riqueza da vida cultural daquele momento histórico.
Abstract 4113405: The Role of Cardiac Power Output and Stroke Work Index in Balloon Pulmonary Angioplasty Therapy for Chronic Thromboembolic Pulmonary Hypertension
Authors: Nashed Nicole , Ang Lawrence , Fregoso Alma , Omens Jonathan , Buchalla Taylor , Chavez Paul , Poch David , YANG JENNY , Kim Hyong , Mahmud Ehtisham
Published: November 2024

Background:
Right ventricular (RV) and left ventricular (LV) measures of cardiac power output (CPO) and stroke work index (SWI) are existing markers of cardiac function and clinical outcomes. These metrics have not been used to evaluate the effects of balloon pulmonary angioplasty (BPA) therapy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods:
CTEPH patients who underwent at least six BPA sessions and were included in the UC San Diego BPA registry were included for analysis. Left and right ventricular CPO and SWI during each session were recorded. Cardiac output was measured using the thermodilution technique. Differences in continuous variable measurements before versus after BPA therapy were evaluated using the Student T-test. P-value <0.05 was significant.

Results:
A total of 66 subjects underwent six consecutive BPA sessions (55.5% female, BMI 28.3±6.10kg/m
2
,16.7% prior pulmonary thromboendarterectomy surgery) and were included for analysis. Measurements of RV function, including RVCPO (Pre-BPA 0.38±0.14 vs Post-BPA 0.30±0.13 W, p=0.001)(Figure 1) and RVSWI (Pre-BPA 16.52±5.09 vs Post-BPA 14.14±4.00 g*m/beat/m
2
, p=0.004) significantly decreased after BPA therapy. Measurements of LV function, including LVCPO (Pre-BPA 1.00±0.32 vs Post-BPA 1.04±0.31 W, p=0.523) (Figure 2) and LVSWI (Pre-BPA 37.13±10.14 vs Post-BPA 39.73±9.37 g*m/beat/m
2
, p=0.152) did not change significantly after BPA therapy. The ratio of LVCPO/RVCPO increased in stepwise fashion from baseline to the last BPA session (2.82± 0.95 vs. 3.54±1.31 W, p<0.001)(Figure 3).

Conclusions:
Hemodynamic work expended by the RV decreased after BPA therapy, while work expended by the LV remained unchanged during BPA therapy. The ratio of LV-to-RV work increased in a stepwise manner during consecutive BPA sessions. These measurements may be useful parameters to monitor clinical response to BPA therapy.
Abstract 4119517: Association of Systemic Inflammatory Response Syndrome with Cardiovascular Events after Mitral Transcatheter Edge-to-edge Repair
Authors: Mannina Carlo , Sharma Akarsh , Carbone Andreina , Bossone Eduardo , Tuttolomondo Antonino , Argulian Edgar , Neibart Eric , Halperin Jonathan , Dangas George , Sharma Samin , Kini Annapoorna , lerakis stamatios
Published: November 2024

Background:
Systemic inflammatory response syndrome (SIRS) following cardiovascular interventions is associated with adverse events during hospitalization and follow-up. Mitral transcatheter edge-to-edge repair (M-TEER) is increasingly utilized for treatment of mitral regurgitation (MR).

Hypothesis:
It is unknown whether SIRS following M-TEER may occur and be associated with adverse clinical outcomes.

Goals:
to investigate the frequency and impact of SIRS following M-TEER on major cardiovascular events (MACE) and MR recurrence.

Methods:
A total of 158 consecutive patients with severe MR undergoing M-TEER were studied. SIRS was defined by leukocytosis (≥12×10
9
/L) and fever (T≥38 °C) within 48 hours after intervention. Baseline inflammation was measured by absolute neutrophil and lymphocyte counts and neutrophil: lymphocyte ratio (NLR). The primary endpoint of MACE was the composite of non-fatal myocardial infarction (MI), non-fatal stroke, and all-cause death. Recurrent MR at follow-up was also recorded.

Results:
The mean patient age was 80.8±8.8 years. 44 (27.9%) developed SIRS. NLR correlated with onset of leukocytosis and fever (p=0.04). During a median follow-up of 12.5±8.2 months, the primary endpoint occurred in 27 (17.1%) patients (6 MI, 5 strokes and 16 deaths). Patients with SIRS more often had severe MR (79.5% vs. 62.7%, p=0.02) and adverse left ventricular (LV) remodeling indicated by lack of reduction in end-diastolic diameter (LVEDD) at follow-up (p=0.12 for SIRS-patients vs. p=0.0012 for non-SIRS patients). After adjustment for pertinent variables, SIRS (HR 3.24, CI 1.13-9.31, p=0.03) was independently associated with MACE.

Conclusion:
SIRS after M-TEER is a strong independent predictor of MACE. Closer follow-up is warranted as patients with SIRS have more severe MR and unfavorable LV remodeling at follow-up.
Abstract 4122350: Most Diabetes Mellitus Patients Had Right Lower Pulmonary Vein Thrombi; Additionally, Many Patients Had Extended Large Rod-Like Thrombi in the Left Atrium
Authors: Takeuchi Hidekazu
Published: November 2024

Background:
Retrieved thrombus studies have shown that retrieved thrombi have calcifications, indicating that the thrombi are old. Left atrium diverticula (LADs) are common; however, the mechanisms of LAD formation are poorly understood. Pulmonary vein thrombi (PVTs) are common and are underestimated. In 2022, we reported that 98.6% of senior patients with age-related diseases such as hypertension, dyslipidemia and atrial fibrillation had PVTs, as estimated by cardiac computed tomography (CT) and transesophageal echocardiography (TEE). Additionally, we reported a case in which a malignant lymphoma patient had ATs in the right lower pulmonary vein, in which extended large rod-like thrombi in the left atrium (LA) were found, as determined by TEE. Patients with type 2 diabetes mellitus (T2DM) must have PVTs. The characteristics of extended LA thrombi in patients with T2DM are unclear.

Methods:
Thirty-one patients with T2DM (73.5 +/- 8.9 y.o., from 50 y.o. to 88 y.o.; male, 24) were examined for PVTs, as estimated via TEE and cardiac CT.

Results:
Thirty (97%) patients with T2DM had PVTs in the right lower pulmonary vein (RLPV) and connected LA thrombi, as estimated using TEE. Among them, 27 (87%) patients had large white rod-like LA thrombi extending from RLPV thrombi, and the diameter of the thin part of the rod-like LA thrombi was approximately 5 mm. The end of the LA thrombi was mainly attached to the left side of the anterior wall or the posterior side of left side wall of the LA. Additionally, there were left atrium diverticula (LADs) around the attachment regions. Three patients had RLPV thrombi and connected shorter LA thrombi. A 79-year-old male patient did not have detectable PVTs. The patient had taken apixaban (2.5 mg, twice daily) for six years due to atrial fibrillation and stroke.

Conclusions:
Most (97%) elderly T2DM patients had RLPV thrombi. Additionally, many (87%) patients had extended large rod-like thrombi in the LA. The diameter of the thin part of the large rod-like LA thrombi was approximately 5 mm. There were LADs around the attachment regions where the ends of the LA thrombi from the RLPV thrombi were attached.
Abstract 4124931: Usefulness of the AHEAD Score for Prediction of All-cause Death in Patients With Acute and Chronic Coronary Syndromes
Authors: Tamaki Shunsuke , Higaki Akinori , Kawakami Hiroshi , Nishimura Kazuhisa , Inoue Katsuji , Ikeda Shuntaro , Yamaguchi Osamu , Akashi Naoyuki , Matoba Tetsuya , Kohro Takahide , Kabutoya Tomoyuki , Kario Kazuomi , Kiyosue Arihiro , Nakayama Masaharu , Miyamoto Yoshihiro , Tsujita Kenichi , Fujita Hideo , Nagai Ryozo
Published: November 2024

Background:
The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been introduced to predict all-cause death (ACD) in patients with heart failure. There is no information available on the utility of this score for the prediction of ACD in patients with coronary artery disease (CAD).

Hypothesis:
The AHEAD score may provide superior predictive value for ACD compared to the CHADS
2
score, which has been reported to be useful for predicting poor clinical outcomes in patients with acute (ACS) and chronic coronary syndromes (CCS).

Methods:
This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for ACS or CCS between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, hemoglobin <13 mg/dL for men and <12 mg/dL for women, age >70 years, elevated creatinine levels (>130 μmol/L), and diabetes mellitus. The CHADS
2
score was calculated as previously reported. The study endpoint was ACD.

Results:
In total, 9,033 patients were enrolled (median age, 72 years; 77% male; 3,920 with ACS and 5,113 with CCS). Higher AHEAD or CHADS
2
scores were significantly associated with a higher rate of left main disease or three-vessel disease in both patients with ACS and CCS. In addition, after accounting for multiple variables using Cox multivariate analysis, both the AHEAD (hazard ratio [HR], 1.83 [95% confidence interval, 1.63–2.06] for ACS and 1.66 [1.49–1.85] for CCS) and CHADS
2
scores (HR 1.27 [1.15–1.40] for ACS and 1.23 [1.12–1.35] for CCS) remained significantly associated with ACD. However, receiver operating characteristic curve analysis for predicting ACD revealed that the predictive value of the AHEAD score was significantly higher than that of the CHADS
2
score in both ACS and CCS (Figure). A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups (both
P
<0.001).

Conclusions:
The AHEAD score had superior predictive value for ACD compared to the CHADS
2
score in patients with CAD, irrespective of ACS or CCS.
Abstract 4133830: Uncovering the Gaps: Analyzing Prescribing Patterns of Combination Therapy with SGLT2-inhibitors and GLP-1 Receptor Agonists in Established Atherosclerotic Cardiovascular Disease (ASCVD) and Type 2 Diabetes (T2DM)
Authors: Khetrapal Sanchaya , Gadani Mrudula , Manalo Kathryn , Oehler Andrew , Yin Yue , Pratapneni Siddarth , Pulipati Yochitha , Shah Aaisha
Published: November 2024

Introduction:
Combination therapy with SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA) reduces major cardiovascular events (MACE) and improves HbA1c, blood pressure, weight, and renal disease progression. The European Society of Cardiology recommends this therapy for ASCVD and T2DM, independent of HbA1c. This study evaluates prescribing patterns in the Internal Medicine Residency Clinics for patients with ASCVD and T2DM.

Aims:
To investigate demographic and social determinants of health (SDOH) influencing the prescription of combination therapy versus no therapy in an outpatient population and identify factors affecting prescribing patterns and guideline adherence.

Methods:
We reviewed 828 electronic records of T2DM and ASCVD patients from March 2024. Patients were grouped into combination therapy (SGLT2i and GLP1RA) and no therapy groups. Data on demographics (Table 1) and SDOH (Table 2) were analyzed. Patients on monotherapy or those who did not complete the SDOH questionnaire were excluded. Descriptive statistics were used to summarize demographics. Welch’s t-test compared continuous variables, and chi-square or Fisher’s exact tests compared categorical variables. Analyses were done with SAS 9.4 with significance at 0.05.

Results:
Age significantly differed between groups (t = 4.56, p < .05), with older patients less likely to receive therapy. Sex was also significant (p < .05); more females were in the no therapy group. No significant association was found between SDOH and combination therapy (p > .05).

Conclusion:
Over 90% of patients with T2DM and ASCVD were not on optimal medical therapy to reduce MACE, with nearly half on no medications. This highlights the need for increased awareness and targeted interventions to improve outcomes. Future research will explore insurance status and physician awareness to address prescription discrepancies.

Limitations:
Patients with a GFR <30 are precluded from SGLT2i usage but were not excluded from this study.
Abstract 4135624: A Hypertrophic Cardiomyopathy Polygenic Score Modifies Penetrance of Pathogenic Hypertrophic and Dilated Cardiomyopathy Variants in Opposite Directions
Authors: Abramowitz Sarah , Hoffman-Andrews Lily , Depaolo John , Judy Renae , Owens Anjali , Damrauer Scott , Levin Michael
Published: November 2024

Background:
Hypertrophic (HCM) and dilated (DCM) cardiomyopathy have been postulated to represent morphologically opposing cardiac disease traits, with genetic pathways implicated in HCM demonstrating inverse relationships with DCM. The degree to which polygenic risk for HCM protects from DCM in individuals at genetic risk of DCM remains unexplored.

Research Question:
Is polygenic risk for HCM protective against developing DCM in carriers of titin truncating variants?

Methods:
Associations between polygenic risk for HCM, monogenic variants, and cardiomyopathy outcomes were modeled among Penn Medicine BioBank (PMBB) participants genetically similar to European reference populations using logistic regression. Polygenic risk for HCM was determined using a previously published HCM polygenic score (PGS; PGS Catalog PGS000739; Harper et al. 2021); scores were PCA adjusted, and the mean and variance were normalized using pgsc_calc. Pathogenic variants in definitive HCM genes were identified using ACMG criteria. Titin truncating variants in high percentage spliced in exons (TTNtv) were considered pathogenic. HCM and DCM outcomes were assigned based on diagnosis codes +/- clinical notes in the electronic health record.

Results:
Of 26,728 PMBB participants, 205 (0.77%) had HCM and 589 (2.2%) had DCM. 289 had a TTNtv, and 144 had a pathogenic HCM variant. Pathogenic HCM variant status (n=144) conferred a 76-fold increase in HCM risk (p=1.8 e-87). A one standard deviation change in HCM PGS had a significant positive association with HCM (OR 1.6; p=1.5e-9) and negative association with DCM (OR 0.72; p=1.e-12). TTNtv status (n=289) was associated with an increased risk of DCM (OR 5.0; p=1.4e-12). An interaction term between TTNtv status and HCM PGS had a negative association with DCM (OR 0.61; p=4.5e-2). Among the top HCM PGS quintile, there was no statistically significant difference in DCM risk between those with and without TTNtv (Figure 1).

Conclusions:
These results provide additional evidence that HCM and DCM are influenced by polygenic background. We observe that polygenic risk of HCM additively increases risk of HCM among pathogenic HCM variant carriers and may synergistically protect from DCM among TTNtv carriers.
Abstract 4136085: The Prognostic Impact of Thrombocytopenia at 6 months after Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Study
Authors: Takahara Motoyoshi , Zen Kan , Iwaya Takuma , Fujimoto Tomotaka , Yashige Masaki , Yamano Michiyo , Yamano Tetsuhiro , Nakamura Takeshi , Matoba Satoaki
Published: November 2024

Background:
Transient thrombocytopenia after transcatheter aortic valve replacement (TAVR) is a common phenomenon. Thrombocytopenia after TAVR during the perioperative period has been reported to impact prognosis. However, the impact of thrombocytopenia in the mid-term post-TAVR period is currently unknown.

Methods:
A retrospective observational study was conducted on 1405 patients who underwent TAVR from May 2016 to February 2023 at four institutions. Of these, 850 patients were analyzed. Patients who underwent dialysis (67), converted to an open chest surgery (8), had a Valve-in-Valve procedure (30), underwent a direct aortic approach (16), had a malignant tumor (66), and patients whose platelet levels could not be measured at 6 months after TAVR due to death or dropout were excluded from the analysis. The clinical follow-up occurred at 1, 6, and 12 months after the procedure. Laboratory testing was conducted before TAVR, during the perioperative period, 1 month post-procedure, and 6 months later. The decrease in platelet count (DPC) 6 months after TAVR was calculated by the following formula: [(Baseline platelet – 6 months platelet)/baseline platelet *100]. A receiver operating characteristics curve was plotted for all-cause mortality at 1 year and DPC at 6 months. The calculated cutoff value for the DPC at 6 months (28.68%) was utilized to classify and compare the two groups. Multivariate logistic regression models were also used to examine the association between the DPC at 6 months and all-cause mortality at 1 year. Adjusted for propensity score matching, the DPC was compared at 6 months in self-expandable and balloon-expandable prosthetic valves.

Result:
Of the 850 eligible patients (age: 85.5 ± 4.9 years), 31 (3.4%) died between 6 months and 1 year after TAVR. The DPC at 6 months after TAVR was 11.9 ± 22.5%. Multivariate logistic regression analysis including the DPC at 6 months, age, gender, and STS score showed that the DPC at 6 months was independently associated with all-cause mortality at 1 year (odds ratio: 1.03, 95% confidence interval: 1.005-1.046, p=0.01). After adjustment for propensity score matching, the balloon-expandable prosthetic valve had a higher rate of thrombocytopenia at 6 months (15.0% vs. 9.6%, p=0.04).

Conclusion:
The DPC at 6 months after TAVR may predict all-cause mortality at 1 year.
Abstract 4136926: Premature Ventricular Complexes and Nonsustained Ventricular Tachycardia in Cardiac Sarcoidosis
Authors: de Melo Jose , Debertin Julia , Castrichini Matteo , Rosenbaum Andrew , Bois John , Abou-Ezzeddine Omar , Kapa Suraj , Deshmukh Abhishek , Asirvatham Samuel , Siontis Konstantinos
Published: November 2024

Introduction:
The prevalence and prognostic significance of PVC and NSVT in cardiac sarcoidosis (CS), especially in patients with normal or mildly decreased LV function, are not well known and were investigated in the current study.

Methods:
We included 192 patients with definite and probable CS with LVEF>35%, no prior history of VT/VF or sudden cardiac death, who underwent up to 48 hours of Holter monitoring. They were followed retrospectively for the composite endpoint of sustained VT/VF, advanced heart failure therapy, and all-cause mortality. We performed multivariable analysis for the association of PVC burden and NSVT with the composite endpoint. Covariates were considered if they were present in at least 95% of the study sample and were significantly associated with the composite endpoint in univariable analysis.

Results:
The median PVC burden in the overall population was 0.3% (IQR 0.02-2.5%) and 36 (18.8%) patients had a PVC burden ≥5%. Sixty-two (32.3%) patients had NSVT detected during monitoring. The PVC burden and prevalence of NSVT in patient subgroups are shown in Figures 1 and 2. A total of 33 (17.2%) patients experienced one of the composite endpoints at a median follow-up of 3 years. In the multivariable analysis (Figure 3), PVC burden ≥5% versus <5% (HR 3.96 [1.19, 5.97], p-value <0.01) and presence of NSVT (HR 4.55 [2.09, 9.94], p-value <0.01) were associated with the composite outcome.

Conclusion:
Our results suggest that a high PVC burden and the presence of NSVT carry isolated prognostic value in CS. In addition, ventricular ectopy does not appear to be an indicator of disease activity based on abnormal uptake on PET scan.
Abstract 4136967: Congestive Heart Failure Impedes Effective Fluid Resuscitation in Sepsis
Authors: Ma Zhiyuan , Krishnamurthy Mahesh , Puleo Peter , Allen David , Shirani Jamshid
Published: November 2024

Background:
Fluid resuscitation is recommended in patients with sepsis. Sepsis, however, may be associated with myocardial dysfunction. Additionally, myocardial dysfunction and insufficient cardiac reserves in patients with congestive heart failure (CHF) may complicate fluid resuscitation in the setting of sepsis. We aimed to determine whether CHF would affect fluid resuscitation in septic patients admitted to intensive care unit. Outcome of patients with and without CHF were compared.

Methods:
Unmatched and propensity score matched septic patients with or without CHF were examined in a retrospective cohort of critically ill adults from the MIMIC-IV database by multivariable logistic regression. Mortality and length of stay were compared. Generalized additive models were used for assessing association between fluid resuscitation and in-hospital mortality.

Results:
Of 24,376 critically ill patients with sepsis, 6838 (28.1%) were also diagnosed with CHF. CHF in septic patients was associated with higher in-hospital mortality with an adjusted odds ratios of 1.25 (95% confidence interval (CI)=1.14-1.37; p<0.001) in unmatched analysis. Compared with patients without CHF, those with CHF had higher in-hospital mortality (14.3% vs. 9.8%, p < 0.001) and received less IV fluid in the first 24 hours of ICU stay (median=1936 ml, IQR=808-3654 vs. 3037, IQR=1810-4585 ml, p<0.001). Similar results were obtained in propensity score matched septic patients with or without CHF. We also found that fluid resuscitation had a U-shaped association with in-hospital mortality with a lowest mortality at roughly 60 ml/kg in the first 24 hours of ICU stay in septic patients without CHF. In septic patients with CHF, liberal fluid resuscitation did not reduce mortality, while restrictive fluid resuscitation was associated with an increased mortality rate.

Conclusions:
CHF was significantly associated with higher in-hospital mortality among septic patients. Adequate fluid resuscitation improved in-hospital mortality in septic patients without but not with CHF.
Abstract 4136977: Childhood Food Security and Cardiometabolic Health in Young Adulthood
Authors: Lam Emily , Gauen Abigail , Kandula Namratha , Notterman Daniel , Goldman Noreen , Lloyd-Jones Donald , Allen Norrina , Shah Nilay
Published: November 2024

Background:
Food insecurity is associated with adverse cardiometabolic health in adults. To understand the early, long-term impact of food insecurity, we examined the associations of food insecurity in childhood with young adult cardiovascular-kidney-metabolic (CKM) syndrome stage and suboptimal cardiovascular health (CVH), and the modifying effects of participation during childhood in the Supplemental Nutrition Assistance Program (SNAP).

Methods:
In the Future of Families and Child Wellbeing Study of individuals enrolled at birth (1998-2000) and followed through age 22 years (2020-24) across 20 US cities, the associations of household food insecurity during childhood (age 3-5 years; score ≥1 on the US Household Food Security Survey) with CKM stage (0 [reference], 1, 2, or 3/4) and Life’s Essential 8 CVH score (high 80-100 [reference], intermediate 50-79, low 0-49) at age 22 years were evaluated with adjusted multinomial logistic regression. The interactions of food insecurity and SNAP participation, and food insecurity and race, were evaluated.

Results:
Among 1,071 participants, 53% were female; 53% non-Hispanic Black, 25% non-Hispanic White, 18% Hispanic; 39% lived in households with food insecurity, and 44% participated in SNAP. Food insecurity was associated with higher odds of being in CKM Stage 1 (aOR 1.41 [95% CI: 1.02-1.93]) and Stage 3/4 (aOR 1.78 [95% CI 1.11-2.83]) compared with Stage 0 at year 22 (Table). Food insecurity was also associated with having intermediate vs. high CVH in young adulthood (aOR 1.46 [95% CI 1.04-2.06]). SNAP participation modified the association of food insecurity and CVH; ffood insecurity was more strongly associated with intermediate vs. high CVH among those who did not participate in SNAP (aOR 2.37 [95% CI 1.39-4.04]) compared to those who were SNAP participants (aOR 0.79 [95% CI 0.46-1.35]) in childhood. There was no significant interaction of food insecurity and race for either outcome.

Conclusions:
Childhood food insecurity is associated with worse cardiometabolic health in young adulthood, especially among children whose families did not participate in SNAP. Policies to promote food security in children may promote cardiometabolic health across the life course.
Abstract 4136989: Association of alternating PR intervals with paroxysmal atrioventricular block in patients with right bundle branch block following cardiac surgery
Authors: Olleik Farah , Istvanic Filip , Pacifici Stefano , Ceron Carlos , Liu Tong , Gao Chuanyu , Yan Gan-Xin
Published: November 2024

Background:
We previously observed a positive correlation between QRS duration and the preceding RP interval in sinus rhythm in certain patients experiencing new onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). This unique phenomenon, termed inverse decremental conduction (
IDC
) or Yan conduction, prompted us to investigate whether
IDC
in the left bundle could manifest as AV conduction in an
IDC
pattern in patients with preexisting right bundle branch block (RBBB) and its association with atrioventricular block (AVB).

Methods:
12 lead ECGs, available in-patient telemetry and mobile cardiac outpatient telemetry were reviewed in patients with sinus rhythm and preexisting RBBB who developed paroxysmal AVB requiring temporary or permanent pacemaker within 7 days following any types of cardiac surgery from 2014 to 2023 in Lankenau Medical Center.

Results:
A total of 9 patients (5 males) with a mean age of 71±15 years were identified to exhibit PR interval changes consistent with
IDC
prior to paroxysmal AVB. Among these patients, 6 had undergone TAVR, while the remaining 3 had undergone surgical aortic valve replacement, mitral valve repair, and ventricular septal defect repair, respectively. Specifically, PR interval alternation in the setting of RBBB occurred during sinus rhythm in a pattern that the longer RP interval is followed by a longer PR interval (Figure 1). This pattern exhibits the following features: 1) 8 of 9 patients had RBBB plus left anterior fascicular block (LAFB); 2) PR alternation occurred at sinus rates from 68 to 91 bpm within 5 days following surgical procedures; 3) proximal AVB occurred within 1 to 12 hours after PR interval alternation began. A positive correlation was established between PR and preceding RP interval in 2 of 9 patients whose telemetry data were available for analysis (
Figure 2A
). In a patient with RBBB who developed paroxysmal AVB without
IDC
changes in the PR interval post TAVR, intracardiac recording showed a decrease in AH interval but an increase in HV interval with slowing heart rates (
Figure 2B
), indicating that decremental conduction in AV node can mask
IDC
in Purkinje system.

Conclusion:
1) PR alternation with longer PR following longer preceding RP interval in presence of RBBB, likely due to
IDC
in left bundle, heralds paroxysmal AVB; 2) PR interval changes resulting from
IDC
in left bundle in the setting of RBBB may be masked by decremental conduction in AV node.
Abstract 4139144: "Comparative Analysis of Inpatient Outcomes: Decompensated Systolic Heart Failure (HFrEF) with and without Iron Deficiency Anemia, Propensity-Matched Nationwide Study (2017-2021)."
Authors: Dilli Babu Aravind , Baig Mirza , Bhutani Ram , Patel Krunalkumar , Kharkongor Chengappa Nivedita , Tang Clinton , Raghavakurup Lekshmi Narayan , Snipelisky David
Published: November 2024

Background:
Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF).

Methods:
Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts.

Results:
Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000).

Conclusion:
HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.
Abstract 4139169: Treatment with methotrexate associated with LDL-like nanoparticles prevents the development of left ventricular fibrosis in a spontaneously hypertensive rat model
Authors: de Oliveira Silva Aline , Guido Maria Carolina , Costa Mauricio , da Silva Priscila , Freitas Fatima , Silva Amanda , Irigoyen Maria , Maranhao Raul
Published: November 2024

Introduction:
Systemic arterial hypertension (SAH) can lead to left ventricle (LV) fibrosis and ventricular dysfunction. Methotrexate (MTX) associated with lipid nanoparticles (LDE) increases the cellular uptake of MTX by ninety-fold, which leads to therapeutic efficacy and reduces drug toxicity. Previously, treatment of rats with myocardial infarction with LDE-MTX decreased LV fibrosis and prevented ventricular dysfunction. The aim was to test LDE-MTX to preclude the development of cardiac damages caused by hypertension in spontaneously hypertensive rats (SHR).

Methods:
Twenty-four male rats with six-week-old were allocated in 3 groups: Control (CT): Wistar-Kyoto rats injected with saline; SHR: treated with LDE only and SHR-LDE-MTX: treated with LDE-MTX (1mg/Kg/week, I.P.). After 20 weeks of treatment, echocardiography, morphometry and protein expression were performed in the LV. The data were analyzed by ANOVA with Turkey’s post-test or Kruskal-Wallis test with Dunn's post-test. Linear regression was used to evaluate potential relationships.

Results:
Compared to CT, the two SHR groups showed dilation (increase in systolic and diastolic diameter); hypertrophy (increased thickness of the posterior wall) and systolic dysfunction (decreased ejection and shortening fractions). Furthermore, the SHR group showed increased LV fibrosis in both the interstitial region and the papillary muscle, possibly resulting from increased of type I collagen content. Treatment of SHR with LDE-MTX had no effect on LV dilation, hypertrophy or systolic dysfunction. However, LDE-MTX decreased LV fibrosis of the interstitial region and the papillary muscle. In addition, LDE-MTX increased the expression of MMP-2, and increased the bioavailability of intracellular adenosine, via increased expression of the adenosine A3 receptor. There was a negative correlation between the expression of the adenosine A3 receptor with interstitial fibrosis (r2=-0.31, p=0.03) and papillary muscle (r2=-0.47, p=0.03), indicating that the increased bioavailability of intracellular adenosine also contributed to the decrease in LV fibrosis in SHR.

Conclusion:
In SHR, treatment with LDE-MTX reduced LV fibrosis, possibly by modulating MMP-2 expression and increasing the bioavailability of intracellular adenosine, via the adenosine A3 receptor. These results suggest a therapeutic role for LDE-MTX in patients with LV fibrosis and heart failure caused by SAH, to be explored in future clinical studies.