bluuebunny/crossref_metadata_2025 huggingface dataset:
The regular free boundary in the thin obstacle problem for degenerate parabolic equations
Authors: Banerjee A. , Danielli D. , Garofalo N. , Petrosyan A.
Published: May 2021

This paper is devoted to the existence, the optimal regularity of solutions, and the regularity of the free boundary near the so-called regular points in a thin obstacle problem that arises as the local extension of the obstacle problem for the fractional heat operator

(

∂
t

−

Δ
x

)
s

(\partial _t - \Delta _x)^s

for

s
∈
(
0
,
1
)

s \in (0,1)

. The regularity estimates are completely local in nature. This aspect is of crucial importance in our forthcoming work on the blowup analysis of the free boundary, including the study of the singular set. The approach is based on first establishing the boundedness of the time-derivative of the solution. This allows reduction to an elliptic problem at every fixed time level. By using several results from the elliptic theory, including the epiperimetric inequality, the optimal regularity is established for solutions as well as the

H

1
+
γ
,

1
+
γ

2

H^{1+\gamma ,\frac {1+\gamma }{2}}

regularity of the free boundary near such regular points.
Floquet problem and center manifold reduction for ordinary differential operators with periodic coefficients in Hilbert spaces
Authors: Kozlov V. , Taskinen J.
Published: May 2021

A first order differential equation with a periodic operator coefficient acting in a pair of Hilbert spaces is considered. This setting models both elliptic equations with periodic coefficients in a cylinder and parabolic equations with time periodic coefficients. Our main results are a construction of a pointwise projector and a spectral splitting of the system into a finite-dimensional system of ordinary differential equations with constant coefficients and an infinite-dimensional part whose solutions have better properties in a certain sense. This complements the well-known asymptotic results for periodic hypoelliptic problems in cylinders and for elliptic problems in quasicylinders obtained by P. Kuchment and S. A. Nazarov, respectively.

As an application, a center manifold reduction is presented for a class of nonlinear ordinary differential equations in Hilbert spaces with periodic coefficients. This result generalizes the known case with constant coefficients explored by A. Mielke.
How do people living with dementia perceive eating and drinking difficulties? A qualitative study
Authors: Anantapong Kanthee , Barrado-Martín Yolanda , Nair Pushpa , Rait Greta , Smith Christina H , Moore Kirsten J , Manthorpe Jill , Sampson Elizabeth L , Davies Nathan
Published: May 2021

Background

Eating and drinking problems are common among people living with later-stage dementia, yet few studies have explored their perspectives.

Objective

This study aimed to explore how people living with mild dementia understand possible future eating and drinking problems and their perspectives on assistance.

Design

Qualitative study using semi-structured interviews.

Setting

Community.

Methods

We conducted semi-structured interviews with 19 people living with mild dementia. Interviews were transcribed verbatim and analysed thematically.

Results

Five themes were identified: (i) awareness of eating and drinking problems; (ii) food and drink representing an individual’s identity and agency; (iii) delegating later decisions about eating and drinking to family carers; (iv) acceptability of eating and drinking options; and (v) eating and drinking towards the end of life. For people living with mild dementia, possible later eating and drinking problems could feel irrelevant and action may be postponed until they occur. Fears of being a burden to family and of being treated like a child may explain reluctance to discuss such future problems. People living with mild dementia might wish to preserve their agency and maintain good quality of life, rather than be kept alive at later stages by artificial nutrition and hydration.

Conclusion

For people with mild dementia, eating and drinking problems may seem unrelated to them and so get left undiscussed. Negative connotations regarding eating and drinking problems may hinder the discussion. The optimal time to discuss possible future problems with eating and drinking with people with mild dementia may need an individual approach.
Development and Validation of a Large Synthetic Cohort for the Study of Cardiovascular Health Across the Life Span
Authors: Ning Hongyan , Krefman Amy , Zhao Lihui , Wilkins John T , Lloyd-Jones Donald M , Siddique Juned , Allen Norrina B
Published: May 2021

We developed and validated a synthetic cohort approach to examine numbers of cardiovascular risk factors (CRFs) and adverse clinical events, including incident cardiovascular disease and all-cause mortality, across the life span from ages 20 years to 90 years. The current analysis included 40,875 participants from 7 large, population-based longitudinal epidemiologic studies (1948–2016). On the basis of a joint multilevel imputation model, we multiply imputed each participant’s life-span numbers of CRFs and events using available records. To validate the imputed values, we partially removed the observed data and then compared the imputed and observed values. The complete life-span synthetic data set reflected the original observed data trends well. In our validation sample, the distributions of imputed CRFs and events were close to the observed distributions but with less variability. Bland-Altman plots indicated that there was a slightly negative trend in general, and the agreement bias was relatively small for the continuous CRFs. The hypothetical linear regression model suggested that the relationships between the CRFs and events were preserved in the imputed data set. This approach generated valid estimates of CRFs and events across the life span for African-American and White participants. The synthetic cohort may be sufficiently accurate to be useful in assessing the origins and timing of accumulating cardiovascular risk that can inform efforts to avoid cardiovascular disease development.
Outcome-Stratified Analysis of Biomarker Trajectories for Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Bowring Mary G , Wang Zitong , Xu Yizhen , Betz Joshua , Muschelli John , Garibaldi Brian T , Zeger Scott L
Published: May 2021

Longitudinal trajectories of vital signs and biomarkers during hospital admission of patients with COVID-19 remain poorly characterized despite their potential to provide critical insights about disease progression. We studied 1884 patients with severe acute respiratory syndrome coronavirus 2 infection from April 3, 2020, to June 25, 2020, within 1 Maryland hospital system and used a retrospective longitudinal framework with linear mixed-effects models to investigate relevant biomarker trajectories leading up to 3 critical outcomes: mechanical ventilation, discharge, and death. Trajectories of 4 vital signs (respiratory rate, ratio of oxygen saturation (Spo2) to fraction of inspired oxygen (Fio2), pulse, and temperature) and 4 laboratory values (C-reactive protein (CRP), absolute lymphocyte count (ALC), estimated glomerular filtration rate, and D-dimer) clearly distinguished the trajectories of patients with COVID-19. Before any ventilation, log(CRP), log(ALC), respiratory rate, and Spo2-to-Fio2 ratio trajectories diverge approximately 8–10 days before discharge or death. After ventilation, log(CRP), log(ALC), respiratory rate, Spo2-to-Fio2 ratio, and estimated glomerular filtration rate trajectories again diverge 10–20 days before death or discharge. Trajectories improved until discharge and remained unchanged or worsened until death. Our approach characterizes the distribution of biomarker trajectories leading up to competing outcomes of discharge versus death. Moving forward, this model can contribute to quantifying the joint probability of biomarkers and outcomes when provided clinical data up to a given moment.
Double Trouble for Logical Pluralists
Authors: Evershed J. W.
Published: May 2021

According to tradition, logic is normative for reasoning. According to many contemporary philosophers of logic, there is more than one correct logic. What is the relationship between these two strands of thought? This paper makes two claims. First, logic is doubly normative for reasoning because, in addition to constraining the combinations of beliefs that we may have, logic also constrains the methods by which we may form them. Second, given that logic is doubly normative for reasoning, a wide array of logical pluralisms are inconsistent with the normativity of logic as they entail contradictory claims about how agents ought to reason. Thus, if logic is normative for reasoning, these pluralisms are untenable.
Platelet-rich plasma protects human melanocytes from oxidative stress and ameliorates melanogenesis induced by UVB irradiation
Authors: Ma Yongshi , Xuan Min , Dong Yunqing , Wang Hong , Huang Jianfang , Cheng Biao , Cui Xiao
Published: May 2021

To investigate the role of platelet-rich plasma (PRP) from different sources in alleviating oxidative stress and ameliorating melanogenesis in UVB-irradiated PIG1 cells, PIG1 cells were irradiated with 80 mJ/cm2 UVB prior to 1% PRP application and the following experiments were taken: the viability of UVB-irradiated PIG1 cells, cellular malondialdehyde (MDA) and reactive oxygen species (ROS) content, and activities of antioxidant enzymes. Western blotting was utilized to detect the expression level of proteins associated with melanin synthesis, apoptosis, and DNA lesions. We found that PRP intervention promoted cell proliferation, reduced MDA and ROS content, increased the activities of series of antioxidant enzymes, and alleviated DNA damages in UVB-damaged PIG1 cells. It is important to note that PRP treatment inhibited UVB-induced melanogenesis via the PI3K/Akt/GSK3β signal pathway. Therefore, we suppose PRP treatment exerts a protective role through their antioxidation effect on UVB-damaged PIG1 cells and hinders melanogenesis induced by UVB irradiation.
Web repositories of natural agents promote pests and pathogenic microbes management
Authors: Jin Yin , Wang Zheng , Dong An-Yu , Huang Yuan-Qin , Hao Ge-Fei , Song Bao-An
Published: May 2021

The grand challenge to meet the increasing demands for food by a rapidly growing global population requires protecting crops from pests. Natural active substances play a significant role in the sustainable pests and pathogenic microbes management. In recent years, natural products- (NPs), antimicrobial peptides- (AMPs), medicinal plant- and plant essential oils (EOs)-related online resources have greatly facilitated the development of pests and pathogenic microbes control agents in an efficient and economical manner. However, a comprehensive comparison, analysis and summary of these existing web resources are still lacking. Here, we surveyed these databases of NPs, AMPs, medicinal plants and plant EOs with insecticidal, antibacterial, antiviral and antifungal activity, and we compared their functionality, data volume, data sources and applicability. We comprehensively discussed the limitation of these web resources. This study provides a toolbox for bench scientists working in the pesticide, botany, biomedical and pharmaceutical engineering fields. The aim of the review is to hope that these web resources will facilitate the discovery and development of potential active ingredients of pests and pathogenic microbes control agents.
Integration of the Disaster Component into Social Work Curriculum: Teaching Undergraduate Social Work Research Methods Course during COVID-19
Authors: Wu Haorui
Published: May 2021

This article aims to develop community-contextualised pedagogical innovations to embed disaster components into core social work curriculum through a research methods course. Professional social work education continues to lack a community-contextualised curriculum and professional training that reflects the complexities of extreme events associated with community and human service. This absence jeopardises the advancement of social work engagement in better providing humanitarian support for individuals, families and communities affected by extreme events. Through an undergraduate social work research methods course, this case study qualitatively analysed the instructor’s teaching experience, self-reflection and in-class observation. The study presents three major community-contextualised pedagogical innovations of integrating disaster components into the research methods course: public media critique, amidst-disaster community-based participation and observation and practice situation discussion. These pedagogical efforts support the students’ exploration and development of various research paradigms and strengthen their ability to connect research with practice, thus addressing the community-driven, short-term necessities and long-term development requirements. This contextualising process, which forms a community-based living laboratory, inspires instructors to integrate community-driven characteristics into their pedagogical instruments. The process illustrates a potential pedagogical framework for research methods courses, in particular, and for social work curriculum, in general.
Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study
Authors: Lv Kaiyang , Liu Huazhen , Xu Haiting , Wang Caixia , Zhu Shihui , Lou Xiaozhen , Luo Pengfei , Xiao Shichu , Xia Zhaofan
Published: May 2021

Background

Poor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.

Methods

In total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery.

Results

The CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total.

Conclusions

CO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.

Trial registration

The Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.
Moral Conflict in Economic Decision Making: The Role of the Anterior Cingulate Cortex—Striatum Pathway
Authors: Cui Fang , Huang Xiaoxuan , Li Xiaoyun , Liao Chong , Liu Jie , Luo Yue-jia
Published: May 2021

The present study combined a novel hypothetical investment game with functional magnetic resonance imaging to examine how moral conflict biases our real decision preference when it is not obvious or explicitly presented. Investment projects were chosen based on their prior subjective morality ratings to fit into 2 categories: a high level of moral conflict (HMC) or a low level of moral conflict (LMC). Participants were instructed to invest high or low amounts of capital into different projects. Behavioral and neural responses during decision making were recorded and compared. Behaviorally, we observed a significant decision bias such that investments were lower for HMC projects than for LMC projects. At the neural level, we found that moral conflict-related activity in the anterior cingulate cortex (ACC) was higher in the HMC condition than in the LMC condition and that reward-related activity in bilateral striatum was lower. Dynamic causal modeling further suggested that the moral conflict detected in the ACC influenced final decisions by modulating the representation of subjective value through the ACC’s connection to the reward system.
Perinatal Depressive Symptoms, Human Immunodeficiency Virus (HIV) Suppression, and the Underlying Role of Antiretroviral Therapy Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort
Authors: Momplaisir Florence , Hussein Mustafa , Kacanek Deborah , Brady Kathleen , Agwu Allison , Scott Gwendolyn , Tuomala Ruth , Bennett David
Published: May 2021

Background

Women with HIV have higher risk of depressive symptoms in the perinatal period. Evidence on how perinatal depressive symptoms affect viral suppression (VS) and adherence to antiretroviral therapy (ART) remains limited.

Methods

Perinatal depressive symptoms were assessed using 6 items from the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire. VS (viral load <400 copies/mL) was the outcome. Adherence was defined as no missed dose in the past 1–4 weeks using the ACTG Adherence Questionnaire. Generalized mixed-effects structural equation models estimated the association of depressive symptoms on VS and the mediating role of ART adherence among women enrolled in the IMPAACT P1025 Perinatal Core Protocol (2002–2013).

Results

Among 1869 participants, 47.6% were 21–29 years, 57.6% non-Hispanic Black. In the third trimester, the mean depressive symptoms score was 14.0 (±5.2), 68.0% had consistent adherence, and 77.3% achieved VS. At 6 months postpartum, depressive symptoms declined while adherence and VS fell to 59.8% and 53.0%, respectively. In the fully adjusted model, a 1-SD increase in depressive symptoms was associated with a 3.8-percentage-point (95% CI: −5.7, −1.9) decline in VS. This effect is the sum of the indirect effect of depressive symptoms on VS via ART adherence (−0.4; 95% CI: −.7, −.2) and the direct effect through other pathways (−3.4; −5.2, −1.5). The decline in adherence driven by depressive symptoms accounted for ≥11% of the total negative effect of depressive symptoms on VS.

Conclusions

Perinatal depressive symptoms were associated with decreased adherence and VS, highlighting the need to screen for, diagnose, and treat perinatal depression to optimize maternal outcomes.

Clinical Trials Registration

NCT00028145.
Prevalence of Genital Human Papillomavirus by Age and Race/Ethnicity Among Males
Authors: Berenson Abbey B , Hirth Jacqueline M , Chang Mihyun
Published: May 2021

Background

Genital and oral cancers are often caused by human papillomavirus (HPV) types that can be prevented through HPV vaccination. Since HPV is sexually transmitted, knowledge of penile prevalence of vaccine-type HPV among US males can help predict potential disparities in these cancers. This study examines penile HPV prevalence by age and race/ethnicity among males.

Methods

This study was a secondary analysis of publicly available data from the National Health and Nutrition Examination Survey (NHANES). Using data from penile swab samples collected from males between 2013 and 2016, the prevalence of 4vHPV and 9vHPV vaccine types was examined across age groups and by race/ethnicity. Logistic regression models adjusting for demographics, sexual behavior, and circumcision were examined to determine whether associations remained after accounting for confounders.

Results

Among 2548 males evaluated, HPV infection prevalence differed by race/ethnicity, with Black males exhibiting a higher prevalence of HPV. Examination of 4vHPV type prevalence by age group showed that 18–26-year-old males had a lower prevalence than older age groups. After controlling for confounders, 4vHPV prevalence was only significantly elevated among 27–34-year-old males, those who were single, and males with ≥3 lifetime sex partners. In adjusted models, 9vHPV type prevalence remained elevated among Black males compared with White males.

Conclusions

Variations in 9vHPV type prevalence between Black and White individuals indicate future disparities in HPV-related genital cancers may continue in the United States during the next decade. Revaccinating certain populations with the 9vHPV vaccine may be appropriate to help mitigate this.
Immediate Reactions After the First Dose of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Messenger RNA Vaccines Do Not Preclude Second-Dose Administration
Authors: Vanijcharoenkarn Kristine , Lee Frances Eun-Hyung , Martin Lindsay , Shih Jennifer , Sexton Mary Elizabeth , Kuruvilla Merin Elizabeth
Published: May 2021

Addressing coronavirus disease 2019 (COVID-19) vaccine hesitancy and minimizing potential vaccine contraindications are critical to combatting the pandemic. We describe a practical approach to immediate adverse events after the first dose of messenger RNA vaccines for severe acute respiratory syndrome coronavirus 2, focusing on diagnosis and management of allergic reactions.
Transparency and Transparency-related Litigation in Chinese Foreign Affairs
Authors: Cai Congyan , Wang Yifei
Published: May 2021

Chinese foreign affairs have become more transparent over the past decade. This trend, initially and largely, was induced by external pressures—especially China’s World Trade Organization accession negotiations—and China is expected to exhibit, in conducting foreign affairs, greater transparency as it exerts growing international influences. It is also enhanced by the improved rule of law and national governance in China, including the Open Government Information Regulation, China’s first freedom of information (FOI) law, adopted in 2007 and amended in 2019. The rising nationalism in China also has played a growing role in this regard. The records of FOI applications and FOI applications-related litigation indicate that, although the public has considerably increased their concerns over how China’s government conducts foreign affairs, especially those that rouse bitter historical memories among the Chinese people, they are not active in using legal means to push Chinese foreign affairs to be more transparent. Furthermore, they are frustrated by the courts in China, which tend to broadly interpret the meaning of ‘acts of state’ and therefore dismiss the relevant cases. In addition, the Chinese Community Party, an overarching political accountability mechanism in China, while having the potential to ensure that the Chinese government conducts itself in an accountable manner, often constitutes a major hindrance to the greater transparency of Chinese foreign affairs.
Viability, behavior, and color expression in the offspring of matings between common wall lizardPodarcis muraliscolor morphs
Authors: Abalos Javier , Pérez i de Lanuza Guillem , Bartolomé Alicia , Aubret Fabien , Uller Tobias , Font Enrique
Published: May 2021

Color polymorphisms are widely studied to identify the mechanisms responsible for the origin and maintenance of phenotypic variability in nature. Two of the mechanisms of balancing selection currently thought to explain the long-term persistence of polymorphisms are the evolution of alternative phenotypic optima through correlational selection on suites of traits including color and heterosis. Both of these mechanisms can generate differences in offspring viability and fitness arising from different morph combinations. Here, we examined the effect of parental morph combination on fertilization success, embryonic viability, newborn quality, antipredator, and foraging behavior, as well as inter-annual survival by conducting controlled matings in a polymorphic lacertid Podarcis muralis, where color morphs are frequently assumed to reflect alternative phenotypic optima (e.g., alternative reproductive strategies). Juveniles were kept in outdoor tubs for a year in order to study inter-annual growth, survival, and morph inheritance. In agreement with a previous genome-wide association analysis, morph frequencies in the year-old juveniles matched the frequencies expected if orange and yellow expressions depended on recessive homozygosity at 2 separate loci. Our findings also agree with previous literature reporting higher reproductive output of heavy females and the higher overall viability of heavy newborn lizards, but we found no evidence for the existence of alternative breeding investment strategies in female morphs, or morph-combination effects on offspring viability and behavior. We conclude that inter-morph breeding remains entirely viable and genetic incompatibilities are of little significance for the maintenance of discrete color morphs in P. muralis from the Pyrenees.
Biological and extrinsic correlates of extinction risk in Chinese lizards
Authors: Zhong (钟雨茜) Yuxi , Chen (陈传武) Chuanwu , Wang (王彦平) Yanping
Published: May 2021

China is a country with one of the most species-rich reptile faunas in the world. However, nearly a quarter of Chinese lizard species assessed by the China Biodiversity Red List are threatened. Nevertheless, to date, no study has explicitly examined the pattern and processes of extinction and threat in Chinese lizards. In this study, we conducted the first comparative phylogenetic analysis of extinction risk in Chinese lizards. We addressed the following 3 questions: (1) What is the pattern of extinction and threat in Chinese lizards? (2) Which species traits and extrinsic factors are related to their extinction risk? (3) How can we protect Chinese lizards based on our results? We collected data on 10 species traits (body size [BS], clutch size, geographic range size, activity time, reproductive mode, habitat specialization [HS], habitat use, leg development, maximum elevation, and elevation range) and 7 extrinsic factors (mean annual precipitation (MAP), mean annual temperature, mean annual solar insolation, normalized difference vegetation index (NDVI), human footprint, human population density, and human exploitation). After phylogenetic correction, these variables were used separately and in combination to assess their associations with extinction risk. We found that Chinese lizards with a small geographic range, large BS, high HS, and living in high MAP areas were vulnerable to extinction. Conservation priority should thus be given to species with the above extinction-prone traits so as to effectively protect Chinese lizards. Preventing future habitat destruction should also be a primary focus of management efforts because species with small range size and high HS are particularly vulnerable to habitat loss.
Association of waist circumstance with long-term all-cause mortality and cardiac death in patients with a pacemaker
Authors: Xue X , Li XY , Zhao S , Zhang S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

To explore the association of abdominal obesity with long-term prognosis in patients with a pacemaker.

Methods

Patients in the Summit study were enrolled and divided into groups according to baseline waist circumference: with obesity, normal, and lean. Regular follow-up was performed. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac death.

Results

In total, 492 patients were included in the analysis. The average baseline waist circumference was 84.2 ± 12.7 cm, and abdominal obesity was observed in 37.6% of patients. During a mean follow-up of 67.2 ± 17.5 months,71 all-cause mortality (14.40%) and 24 cardiac death (4.87%) events occurred. All-cause mortality was associated with higher waist circumference (87.6 versus 83.6 cm, P = 0.014), but not body mass index (23.6 versus 23.5, P= 0.930). Multivariate Cox analysis showed compared with patients with abdominal obesity, lean patients had a significant survival benefit in both all-cause mortality (HR 0.188, 95%CI 0.070-0.505, P = 0.001) and cardiac death (HR 0.097, 95% CI 0.012-0.792, P = 0.029).

Conclusions

Waist circumference was associated with long-term all-cause mortality and cardiac death. Baseline waist circumference less than 80 cm for men and less than 75 cm for women had a significant survival benefit.
The role of cardiopulmonary exercise testing in a contemporary heart failure population
Authors: Garcia Bras P , Valentim Goncalves A , Reis J , Pereira Da Silva T , Ilhao Moreira R , Viegas J , Ferreira V , Castelo A , Rio P , Silva S , Martins C , Coito S , Capile E , Soares R , Ferreira R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiopulmonary exercise testing (CPET) is used for risk stratification in patients with chronic heart failure (CHF). However, there is a lack of information regarding CPET prognostic power in patients under new HF therapies such as sacubitril/valsartan, Mitraclip, IV iron or SGLT2 inhibitors. The aim of this study was to evaluate the prognostic value of CPET parameters in a contemporary subset of patients with optimal medical and device therapy for CHF.

Methods

Retrospective evaluation of patients with CHF submitted to CPET in a tertiary center. Patients were followed up for 24 months for the composite endpoint of cardiac death, urgent heart transplantation or left ventricular assist device.

CPET parameters, including peak oxygen consumption (pVO2) and VE/VCO2 slope, were analysed and their predictive power was measured.

HF events were stratified according to cut-off values defined by the International Society for Heart and Lung Transplantation (ISHLT) guidelines: pVO2 of ≤12 mL/Kg/min and VE/VCO2 slope of >35.

Results

CPET was performed in 204 patients, from 2014 to 2018. Mean age was 59 ± 13 years, 83% male, with a mean left ventricular ejection fraction of 33 ± 8%, and a mean Heart Failure Survival Score of 8.6 ± 1.3.

The discriminative power of CPET parameters is displayed in the Table.

In patients with pVO2 ≤12 mL/Kg/min, the composite endpoint occurred in 18% of patients. A pVO2 value of ≤12 mL/Kg/min had a positive predictive power of 18% while pVO2 >12 had a negative predictive power of 93%.

Regarding VE/VCO2 slope >35, the composite endpoint occurred in 13% of patients.

A VE/VCO2 slope value of >35 had a positive predictive power of 13% while VE/VCO2 slope <35 had a negative predictive power or 94%.

Conclusion

Using ISHLT guideline cut-off values for advanced HF therapies patient selection, there was a reduced number of HF events (<20%) at 24 months in patients under optimal CHF therapy. While pVO2 and VE/VCO2 slope are still valuable parameters in risk stratification, redefining cut-off values may be necessary in a modern HF population.

Discriminative power of CPET parameters Parameters HR; 95% CI AUC p-value Peak VO2 0.824 (0.728-0.934) 0.781 0.001 Percent of predicted pVO2 0.942 (0.907-0.978) 0.774 0.002 VE/VCO2 slope 1.068 (1.031-1.106) 0.756 0.008 Cardiorespiratory optimal point 1.118 (1.053-1.188) 0.746 0.004 PETCO2 maximum exercise 0.854 (0.768-0.950) 0.775 0.003 Ventilatory Power 0.358 (0.176-0.728) 0.796 0.002 HR Hazard ratio, AUC: Area under the curve, PETCO2: end-tidal CO2 pressure
Prescription pattern of evidence-based pharmacotherapy in heart failure: An age perspective
Authors: Dakhil ZA , Farhan HASAN
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Elderly patients constitute substantial proportion of medical care beneficiaries, in same line; heart failure (HF); an extremely common comorbidity is predominately affecting older patients, yet, age disparity in managing this population still represents remarkable challenge in practice. However, little insight is available regarding adherence to evidence-based pharmacotherapy prescribed for this population in developing countries.

Purpose

this study sought to investigate age-based differences in clinical profile and pharmacotherapy prescription pattern in patients with HF.

Methods

This study recruited hospitalized patients with systolic HF, patientsꞌ demographic characteristics, investigational results as well as prescribed drugs in hospital and at discharge; all were recorded. Patients were grouped according to age into ≥65 years versus ˂65 years.

Results

The study recruited 201 patients, 89 (44.27%) of them at age ≥65 year vs 112 (55.72%) in younger group, mean age of older group was 72.4 ± 7.2 year vs 53.5 ± 8.9 year (p < 0.001), female gender constitutes 39.3% of older group vs 26.8% (p < 0.001), older patients were more to have hypertension (68.5% vs 63.4%, p < 0.001)  and AF (19.1% vs 17.9%, p < 0.001) and less to be diabetic than younger counterparts (48.3% vs 54.5%, p < 0.001).  IHD was most common cause of HF in both groups (92.1% in older group vs 82.1%), dilated cardiomyopathy caused more HF in younger group (12.5% vs 5.6%). No significant differences between both groups regarding heart rate, blood pressure at presentation nor blood urea, serum creatinine or ejection fraction. However, haemoglobin was lower in older group (12.3 ± 1.8 gm/dL vs 13.5 ± 2.2 gm/dL, p = 0.0001). Older patients were treated less with B-blockers 75.3% vs 79.5% while they were prescribed mineralocorticoid receptor antagonist (MRA) more than younger counterparts (46.1% vs 42.9%, p < 0.001), ACE/ARBs/ARNI were prescribed more in older population (62.9% vs 53.6%, p < 0.001). Among patients with heart failure in general: antiplatelet drugs were prescribed more in older patients 75.3% vs 71.4%, while statins used in 68.5% in elderly vs 69.6% in younger counterparts. However, in the context of HF and IHD, antiplatelet drugs were prescribed less in older patients (81.7% vs 86.95%, p < 0.001) same as statins (74.4% vs 84.8%, p < 0.001).

Conclusions

This study contradicted prior researches as ACEI/ARBs/ARNI and MRA were used more in older patients with HF compared to younger counterparts. However, there is still significant age disparity revealed in form of less use of B-blockers in elderly same as antiplatelet, statin and oral anticoagulant when indicated. Further studies are warranted to determine the predictors for age gap in practice in order to be bridged to achieve better cardiovascular outcomes.

Abstract Figure.
5 years follow-up of patients with heart failure and cardiac resynchronization: baseline variables associated to death
Authors: Oliveira S , Cunha PEDRO , Carmo MIGUEL , Valente BRUNO , Ricardo INÊS , Silva PEDRO , Yang HUA , Delgado ANA , Oliveira LUIS , Pinto FAUSTO , Oliveira MÁRIO , Abreu ANA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Chronic Heart Failure (HF) has proven to be an increasing challenge for the global health management. Prognosis is affected by pharmacological optimization, comorbidities and risk factors control, lifestyle changes and invasive treatments like resynchronization (CRT) and transplant. 

Purpose

 To evaluate the association of baseline variables in HF patients, before CRT, with death event at 5 years follow up (FU). 

Methods

 Single center, post-hoc analysis of a prospective cohort of consecutive HF patients referred to CRT (2013-2015). Demographic data, HF etiology and NYHA class were evaluated at baseline as well as plasmatic of natriuretic peptide (BNP), heart to mediastinum ratio (HMR), left ventricular ejection fraction (LVEF) and volumes. Mortality was evaluated at 5 years. Patients were divided in two groups: "non survivors" and "survivors". Data were analyzed using descriptive statistics. Spearman test was used to evaluate the correlation between baseline variables and death. 

Results

 102 patients were included (age 68.8 ± 10 years), 68.6% male, 29% ischemic cardiomyopathy, 74% NYHA III/IV, baseline LVEF 26 ± 7. 27% were CRT non-responders. At 5 years follow up 43% died, with 1.96% lost FU. Baseline variables in the two groups are displayed in table 1. Statistical analysis correlating baseline variables with death (Spearman test) showed weak correlation, with the strongest correlation obtained: late HMR with negative correlation 0.34; LV tele-diastolic volume with positive correlation 0.26. 

Conclusion

The mortality at 5 years of HF patients with CRT was high (43%). Baseline variables (late HMR, LV tele-diastolic volume) were associated to death. These results should call early attention for a possible worst prognosis in severe HF patients to CRT.

Table 1 "Non survivors" vs "Survivors" “Non Survivors”(n = 44) “Survivors”(n = 56) Age 67,11 ± 11,17 68,14 ± 10,51 Male 35 (80%) 35 (63%) NYHA III/IV 31 (70%) 43 (77%) Ischemic 15 (34%) 14 (25%) BNP 640,95 ± 606,23 370,41 ± 353,36 Late HMR 1,35 ± 0,16 1,47 ± 0,17 LVEF 27 ± 6,77 26 ± 7,47 Non responders 16 (36%) 12 (21%) LVTdV 225 ± 73,28 191 ± 58,5 PCR 10,33 ± 22,85 5,02 ± 9,27
Evolution of muscle strength and physical activity 1 year after heart transplantation: a prospective observational study
Authors: Hornikx M , Van Aelst L , Droogne W , Janssens S , Van Cleemput J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Heart transplantation (HTX) is a therapeutic option in a selected group of patients with end-stage heart failure. Although cardiac function normalizes after surgery, maximal exercise capacity of HTX-patients after 1 year is only half that of age- and gender matched healthy subjects. Data on the evolution of muscle strength and physical activity after HTX are scant. Having this knowledge might help to optimize rehabilitation programs.

Purpose

To describe changes in muscle strength and physical activity following HTX.

Methods

58 HTX-patients were addressed, of whom 52 (90%) patients participated in the study. Study visits were planned every 3 months from hospital discharge until 1 year of follow-up. 43 HTX-patients (67% male; age: 48 ± 14 years; BMI: 24 ± 4 kg/m²) fulfilled the study protocol. Outcome measures included functional exercise capacity (6MWD), peripheral strength (QF), respiratory muscle strength (MIP) and objectively measured physical activity (PAwalk, walking intensity (WI), PAsteps). All patients received physiotherapy at home during the first 6 weeks, as standard of care after thoracic surgery. After that, cardiac rehabilitation in a specialized center was started. Data were analyzed using repeated measures ANOVA, with Bonferroni test as post-hoc test.

Results

6MWD (+178 ± 17 meter), QF (+26 ± 4 Nm) and MIP (-32 ± 3 cmH2O) significantly improved over time (p < 0.0001). Despite improvements in QF, peripheral muscle weakness was still present in 32% of patients 1 year post-HTX. A significant time effect in PA (PAwalk (+33 ± 7 minutes/day), WI (+0.036 ± 0.007 g) and PAsteps (+3711 ± 640 steps/day)) could be noticed (p < 0.0001). Sedentary time did not significantly change during follow-up (p = 0.14). (Figure 1)

Conclusion

Functional exercise capacity and muscle strength gradually improve during 1 year after HTX. A considerable number of patients still present with peripheral muscle weakness. Despite improvements in PA, results remain below recommended health levels. Enrollment in a cardiac rehabilitation program, offering a combined exercise and PA intervention seems warranted to further enhance health outcomes in this patient population.

Abstract Figure 1
The relationship between clinical parameters and natriuretic peptides and quality of life in patients with heart failure with reduced ejection fraction
Authors: Sawczak F , Kukfisz A , Przytarska K , Szczechla M , Krysztofiak H , Kaluzna-Oleksy M , Migaj J , Straburzynska-Migaj E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure (HF) patients are exposed to severe symptoms of the disease, fatal prognosis, rehospitalizations and low quality of life status. Furthermore, it was observed that more patients with HF would rather live better than longer.

Purpose

The aim of the study was to determine the relationship between clinical parameters, natriuretic peptides level and quality of life (QoL) in patients with heart failure with reduced ejection fraction.

Methods

111 patients hospitalized due to heart failure with reduced ejection fraction (HFrEF) were examined using WHOQOL-BREF questionnaire and divided into three groups of similar quantity due to their transformed score of somatic domain of QoL: first group with score <45 - worst QoL (n = 33), second group with score between 45 and 55 (n = 42), and third with score >55 - best QoL (n = 36). Then the group with highest scores, with best somatic QoL, was compared with those with lowest scores in respect of chosen clinical and biochemical parameters.

Results

Patients with the highest somatic domain score, comparing with the lowest, had significantly higher BMI (mean 29.8 ± 5.5 vs. 26.8 ± 5.7 kg/m2, p = 0.016), lower BNP level (465 vs. 967 pg/ml, median 275 vs. 690, p =0.005), higher LVEF (30.7 ± 12.0 vs. 23.9 ± 10.8%, p = 0.006), higher triglycerides level (2.02 ± 1.22 vs. 1.43 ± 0.76 mmol/l, p = 0.027) and iron level (17.8 ± 6.6 vs. 13.6 ± 5.5 µmol/l, p = 0.019) as well as transferrin saturation (28.0 ± 11.0 vs. 21.3 ± 8.9 %, p = 0.015). The percentage of patients with NYHA class I and II was higher in the group with the highest somatic domain score in comparison with the lowest (66.6% vs. 33.3% respectively, p = 0.034).

Conclusions

The somatic domain of WHOQOL-BREF in patients with HFrEF correlates with patients’ clinical state assessed with the NYHA class and BNP level. QoL status was not associated with age and gender which are depicted in the literature as the important aspects influencing QoL of the community.
Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction
Authors: Santos M , Almeida I , Santos H , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Tavares J , Santos L , Almeida ML
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial.

Objective

To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data.

Methods

Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA).

Results

268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis <50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%.

KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p < 0.001), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p < 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yRA.

Conclusion

This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.
Acute Coronary Syndrome - reinfarction predictors and outcomes
Authors: Santos M , Santos H , Almeida I , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Tavares J , Santos L , Almeida ML
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS.

Objective

To evaluate predictors and prognosis of RI in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed.

Results

Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p < 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p < 0.001) non-invasive ventilation (5.4% vs 1.7%, p < 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p < 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399).

Conclusion

RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.