bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma-Informed Practice in Early Childhood Education
Authors: Stephenson Elspeth
Published: June 2023

Early traumatic experiences can have a profound impact on the developing brain causing a catastrophic effect on a child’s growth and development, the result of which can be lifelong. Early childhood educators have a critical role to play in the lives of children who have trauma histories. These educators are well positioned to undertake this work because early childhood philosophy and pedagogy align with the needs of a child who has experienced early adversity. Beliefs about the role of relationships, attachment, and felt safety are central to this work. To be effective, however, educators need to be trauma informed in their practice. Understanding how adverse experiences cause adaptation to the developing brain and impede development is a good starting place to becoming trauma informed, but translating this understanding into practice is key to success.

While there are strategies that can support educators to work effectively with children with trauma histories, strategies alone will not suffice. They cannot simply be applied to any situation. If educators apply strategies without due thought and consideration in relation to the child’s needs and context, at best they may be ineffective and at worst, there is potential to retraumatize the child. All educators and children are unique individuals and therefore bring different attributes to each situation. Educators who understand themselves and their attributes can use this knowledge, along with their understanding of context and the impact of trauma, to make informed decisions about their practice. While this reflective process can sound arduous, educators can quickly become skilled as they hone their craft and see changes to their practice bring successful outcomes for children. In this way, early childhood educators have the capacity to change developmental trajectories for children and make a difference that will be lifelong.
International Relations in West Africa
Authors: Olaniyan Azeez O.
Published: June 2023

Relations among the states making up West Africa have endured over the years. It has passed through the phases of precolonial, colonial, and postcolonial. Each phase has its own dynamics. Shortly after the attainment of independence, political leaders in West Africa felt the need for more integration and unity to confront the major problems of underdevelopment and conflict bedeviling the region. This led to the formation of the Economic Community of West African States (ECOWAS) as a regional platform to address the problems. However, the contemporary time has brought more challenges, which include terrorism, climate change, migration, the trafficking of humans and drugs, corruption, violent conflicts, money laundering, and health issues. These new problems demand decisive, collective, and robust interventions. ECOWAS, as a regional organization, was found adapting to these new challenges, and re-engineering itself, thereby making it an important institution to focus on when interrogating relations in West Africa. Some of the interventions and responses to the challenges operate in the form of protocols and the establishment of agencies within ECOWAS. In addition, there is a noticeable incursion of China into the region, mostly as a development partner and a provider of soft loans. This has tended to influence the foreign policies of several states in the region. Despite the various intervening efforts, several of the problems facing the region remain largely unsolved. The issues of language barriers, violent conflict, vestiges of colonial rule, vested external interests, and a lack of strong institutions are some of the obstacles undermining the pace of bilateral and multilateral relations among the states and the drives toward development in the subregion.
The New Commons
Authors: Bodirsky Katharina
Published: June 2023

Traditionally, the notion of the commons refers to long-standing common-pool resources such as forests, meadows, or fisheries that are managed communally. By now, the term is used for the communal production and management of almost any material or immaterial resource. “New commons” can include—for example—co-produced knowledge, shared urban space such as housing or community gardens, or communities of care. They are defined less by the particular resource they use than by specific social relations of “commoning”: relatively open, egalitarian, and democratic relations of co-production and co-use by a community of “commoners.”

The (new) commons are a central hope for many activists and activist scholars that seek to work toward a postcapitalist future beyond the market and the state and related modes of sexist and racist domination. They are often associated with autonomist, anarchist, and neo-Marxist political practice and thought. Commons imaginaries are moreover central to critiques of neoliberalism and to initiatives that seek to carve out alternative spaces for social and cultural reproduction in an increasingly commodified world. Of particular importance in the literature are urban commons, with cities being key sites both of neoliberal enclosure and of contemporary social movements that practice commoning.

Ethnographers are increasingly exploring the complexity of actually existing commons, which often do not easily conform to commoning ideals. Such commons can be prone to co-optation into capitalist processes or have difficulties in maintaining egalitarian relations in communities open to difference. They often stand in ambivalent relation rather than clear opposition to the state. At the same time, anthropologists emphasize how commoning enables new experiences of personhood, sociality, and commonality.

While approaches to traditional and to new commons generally differ in central questions and conceptual tools, a possible point of connection is in a shared concern with planetary futures. While much of the literature on the traditional commons is concerned with the sustainable management of natural resources, many “new” commoning initiatives seek to enact postcapitalist relations to nature that are nonexploitative and recognizant of multispecies connections.
Food Consumption and Power: Nourishment and Identity
Authors: Guerrón Montero Carla , Gross Joan
Published: June 2023

All humans need food to stay alive, but food is also a complex social fact. As such, it is central to how people’s individual and collective identities are constructed and how others see us. Food is also associated in multiple ways with production and consumption processes; consumers influence these processes, whether they are motivated primarily by nourishment or by identity. Anthropology has been concerned with the study of food through different angles in connection with nourishment and identity, including the “classic” approaches (food taboos, gifts, and commodities, recurring commensality, food as material culture, hunger, food insecurity), while also taking new directions (the senses, culinary and food tourism, the nutrition transition, food sovereignty, food activism). Food consumption is embedded in webs of power that constrain food’s physical and social meanings. Food is nestled in systems of racism, sexism, and colonialism, resulting in embodied trauma. Yet, food also lies at the heart of reciprocity. Sharing food brings people together in their struggle for connection and agency. Whether we focus on physical nourishment or identity construction, food consumption is never separate from power.

Anthropology provides an effective way to study these complexities. The broad range of anthropological approaches allows for a deep understanding of food consumption’s complexities and power inequalities. Whether the question is approached from a physical nourishment angle or that of social identities, anthropological research has shown how the two cannot be divided. Similarly, anthropologists have taken a broad view of consumption, noting how recurrent commensality constructs the deep relationships that form the basis of human society. They have also shown the critical role that consumption plays in food production, distribution, and preparation. Robust critiques of the global food system have emerged from this work. They have led many anthropologists to work side by side with people attempting to improve their food systems to be more localized, nutritious, and fair.
Indigenous Religions in Brazil
Authors: Münzel Mark
Published: June 2023

In the past, Indigenous religions often served as a black box for various scholarly disciplines. For example, they have been seen as an example of psychopathic complexes or for the original primacy of the collective over the individual. With the emergence of the New Age movement, shamanism in particular has become an object of unscientific projection. In the process, on the one hand Indigenous religions were hold in higher esteem, but on the other hand the character of their reflections on time and the nature of the world and, more often than not, very abstract concepts are reduced to happiness.

Approaching the issue from the perspective of mythical indigenous narratives has the advantage that Indigenous people, the tellers of these myths, speak for themselves. Of course, when they come into contact with Western scholars (who record their myths) or missionaries (who are also interested in indigenous systems of beliefs), they too naturally absorb outside influences: A clinically pure Indigenous religion, so to speak, is an illusion.

Fortunately, myths, whether recorded by Indigenous scholars, or told to researchers who come from outside, are usually not dry factual reports, but literary works, today often aimed at Indigenous children and adolescents, but often enough also as literature for adults—Indigenous religions appear to us in literary guise.

Brazil’s Indigenous nations represent a large number of very different cultures and traditions. Since no central authority existed prior to European colonization, and since the state institutions in Brazil that have since been established are not responsible for Indigenous systems of beliefs, these various Indigenous religions have never been unified, even if they have been subject since the early days of colonialism to uniform external influences (above all the Christian mission and the Western school system).

To put it bluntly, one could say that the only thing they have in common is that they are different from one another. Still, some broad similarities can be found, and common traits that apply to a larger number, though never all, Indigenous systems of belief, myths, and rituals can be identified.

One of these widespread similarities is the idea that humans are an unreal illusion reflecting another world and another time. Another trait is a belief in culture heroes who long ago laid the groundwork for the situation in the 21st century and then left the people to their own devices. The world they built will not last forever, but will one day collapse in on itself in a catastrophe, just as other worlds have collapsed before ours. Ultimately, all relations are unstable, enduring merely for more or less long or short periods of time. The only thing permanent is the change.
robots and cyborgs in antiquity
Authors: Wentzel Rocki
Published: June 2023

Centuries before the popularization of robots in the fiction of the mid-20th century, the ancient Greeks were already dreaming up similar technological creatures and forms of artificial life. Ancient and modern views of technological beings offer a lens to consider what it means to be human by questioning the boundaries between natural and artificial, human and non-human, enslaved and free, mortal and immortal. Accounts of real-life automata, such as those of Philo and Heron of Alexandria demonstrate that such creations were noth, merely products of the imagination. Long before science fiction depicted dystopian worlds brought about by technological humanoids, the ancient Greeks and Romans already exhibited anxiety about such creations. In literary accounts, robots range from the useful, such as Hephaestus’ golden maiden assistants, to the destructive, such as Pandora and Talos. Pygmalion’s statue (Galatea), who is closely aligned with Pandora, has also inspired much reception in films such as Ex Machina and Her. Themes from the stories of Pandora and Galatea emerge frequently in the fiction of the 20th and 21st centuries, such as in the writings of Isaac Asimov and Philip K. Dick and the numerous films based on their work.
Sluicing and Predicate Ellipsis in Chinese
Authors: Li Audrey Yen-hui , Wei Ting-chi
Published: June 2023

This article focuses on sluicing-like constructions and those that have been subsumed under predicate ellipsis—the Aux(iliary)-construction (VP-ellipsis) and the shi-construction. Important facts and main analyses are evaluated in regard to their strengths and weaknesses, leaving some issues for further research. Regarding the sluicing-like construction, this article shows that neither the approach of base-generating a clause [pro (+ copula) + wh] nor the movement + deletion approach fully accommodates all the relevant facts. Nor is it adequate to adopt both derivations simultaneously, as it would wrongly allow sentences that are unacceptable in a number of cases. The second part of this article briefly compares the Aux-construction and the shi-construction. The two differ in the size of the part that is missing—in the former, a Verb Phrase (VP) licensed by an auxiliary, and in the latter, a Tense Phrase (TP) licensed by the verb shi. Neither one allows extraction from within the missing VP/TP, pointing to the advantage of a Logical Form (LF)–copying approach over a Phonological Form–deletion approach.
Brain-derived neurotrophic factor Val66Met polymorphism moderates the relationship between impulsivity, negative emotions, and binge drinking intensity in university students
Authors: Benzerouk Farid , Gierski Fabien , Lannoy Séverine , Barrière Sarah , Schmid Franca , Papillon Charles-Antoine , Houchi Hakim , DeWever Elodie , Quaglino Véronique , Naassila Mickael , Kaladjian Arthur
Published: June 2023

Studies on the genetic factors involved in binge drinking (BD) and its associated traits are very rare. The aim of this cross-sectional study was to investigate differences in the association between impulsivity, emotion regulation and BD in a sample of young adults according to the rs6265/Val66Met variant in the brain-derived neurotrophic factor (BDNF) gene, a well-known candidate gene in alcohol use disorders. We recruited 226 university students (112 women), aged between 18 and 25 years old, from two centers in France. The participants completed measures related to alcohol consumption, depression severity, state anxiety levels, impulsivity (UPPS-P), and difficulties in emotion regulation [Difficulty in Emotion Regulation Scale (DERS)]. The relationship between the BD score and the clinical characteristics in the BDNF genotype groups was assessed by partial correlation analyses and moderation analyses. The partial correlation analyses showed that, in the Val/Val genotype group, the BD score was positively related to UPPS-P Lack of Premeditation and Sensation Seeking scores. In the Met carriers group, the BD score was positively related to UPPS-P Positive Urgency, lack of Premeditation, lack of Perseverance and Sensation Seeking scores and to Clarity score of the DERS. Moreover, the BD score was positively associated with depression severity and state anxiety scores. The moderation analyses revealed that BDNF Val/Met genotype moderated the relationship between several clinical variables and BD. The results of the present study support the hypothesis of common and specific vulnerability factors regarding impulsivity and emotion regulation difficulties associated with BD according to this BDNF rs6265 polymorphism.
Pan-cancer analysis of G6PD carcinogenesis in human tumors
Authors: Liu Bin , Fu Xiaoli , Du Yuhui , Feng Zichen , Chen Ruiqin , Liu Xiaoxue , Yu Fangfang , Zhou Guoyu , Ba Yue
Published: June 2023

Glucose-6-phosphate dehydrogenase (G6PD) is involved in the catalytic pentose phosphate pathway (PPP), which is closely related to energy metabolism. G6PD plays a crucial role in many types of cancer, but the specific molecular mechanisms of G6PD in cancer remain unclear. Therefore, we investigated the potential oncogenic role of G6PD in various tumors based on The Cancer Genome Atlas (TCGA), the cBioPortal datasets, the University of California Santa Cruz (UCSC) Xena browser, and the UALCAN-based online tool. G6PD was highly expressed in several cancer tissues (hepatocellular carcinoma, glioma, and breast cancer) compared with normal tissues and was significantly associated with poor prognosis of hepatocellular carcinoma, clear cell renal cell carcinoma, and breast cancer. Promoter methylation levels of G6PD were lower in Bladder Urothelial Carcinoma (BLCA) (P = 2.77e−02), breast invasive carcinoma (BRCA) (P = 1.62e−12), kidney renal clear cell carcinoma (KIRC) (P = 4.23e−02), kidney renal papillary cell carcinoma (KIRP) (P = 2.64e−03), liver hepatocellular carcinoma (LIHC) (P = 1.76e−02), stomach adenocarcinoma (STAD) (P = 3.50e−02), testicular germ cell tumors (TGCT) (P = 1.62e−12), higher in prostate adenocarcinoma (PRAD) (P = 1.81e−09), and uterine corpus endometrial carcinoma (UCEC) (P = 2.96e−04) compared with corresponding normal tissue samples. G6PD expression was positively correlated with the infiltration level of immune cells in most tumors, suggesting that G6PD may be involved in tumor immune infiltration. In addition, the functional mechanism of G6PD also involves ‘Carbon metabolism’, ‘Glycolysis/Gluconeogenesis’, ‘Pentose phosphate pathway’, and ‘Central carbon pathway metabolism in cancer signaling pathway’. This pan-cancer study provides a relatively broad understanding of the oncogenic role of G6PD in various tumors and presents a theoretical basis for the development of G6PD inhibitors as therapeutic drugs for multiple cancers.
Responding to People in Pain with Jane Austen’s Mansfield Park
Authors: Konerman-Sease Jaime
Published: June 2023

Eliminating pain is problematic when it comes to caring for people with disabilities or chronic pain. This paper locates the drive to completely eliminate pain as a project of the Enlightenment and contrasts it with the tradition of interpreting suffering throughout the Christian tradition. I introduce Jane Austen’s novel Mansfield Park as a way to continue the tradition of interpretative suffering after the Enlightenment. Using textual analysis of Jane Austen’s Mansfield Park, I demonstrate how the novel’s heroine, Fanny Price, is able to resist the drive to eliminate pain through her contemplative reflection on suffering which allows her to participate in right relationships with others and God. Finally, I offer twenty-first century applications of Mansfield Park by addressing changes we can make in the church and the clinic to understand better the role pain plays in Christian life and community.
The significance of high sensitive troponin i and left atrial mechanical dispersion in middle-aged patients with atrial fibrillation
Authors: Borizanova-Petkova A , Georgieva N , Spasova N , Kinova E , Koleva V , Goudev A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is a progressive disease and can initiates and maintains in the absence of left atrial (LA) enlargement¹´². Echocardiographic parameters of LA mechanics had been proposed for best dealing with patients in AF³ . Combining different laboratory biomarkers with echocardiographic parameters can improve prediction, detection and treatment of AF in clinical practice. However, there is limited data about the significance of combination of novel echocardiographic and laboratory biomarkers in prediction of AF in middle-aged patients without LA enlargement.

Purpose

To investigate middle- aged AF patients with normal standart 2D echocardiography (2DE) to establish novel echocardiographic and laboratory biomarkers as predictors of reccurent AF.

Methods

Prospective consecutive patients with symptomatic AF (n= 936), were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm for more than 3 weeks, age between 40–60 years, without over heart disease and normal 2DE. They were separated in two groups: with new-onset AF (n=33) and recurrent episode of AF (n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE with speckle- tracking analyses and biomarker assays were collected, including baseline high sensitive troponin I (hsTnI), galectin-3, uric acid and hsCRP.

Results

There were significant differences between all groups in echocardiographic parameters of LA mechanics: LA reservoir, conduit and contractile strain and strain rate respectively, LA stiffness index- table 1. There were significant differences in laboratory markers- hsTnI and uric acid between groups. Moreover, pro-fibrotic biomarker Galectin-3 was higher only in patients with reccurent AF as was LA mechanical dispersion from speckle-tracking analysis. There were no differences in hsCRP between groups. Binary regression analysis demonstrated that hsTnI (OR 1,880; p< 0,025; 1,084- 3,260 95,0% CI) and LA mechanical dispersion (OR 1,012; p< 0,034; 1,001- 1,024 95,0% CI) are predictors of reccurent AF- ROC curve image .

Conclusion

As a progressive disease AF facilitates its own persistence through LA structural and functional remodeling. Left atrial dispersion along with baseline hsTnI may have additive value for prediction of reccurent AF episodes, reflecting this process in middle-aged patients without LA enlargement.
Exercise positively impacts global longitudinal strain (GLS) in women at risk of developing cardiovascular disease
Authors: Murray J , Bennett H , Bezak E , Perry R
Published: June 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Australian Government Research Training Scholarship.

Background/Introduction

Cardiovascular (CV) disease accounts for one in three deaths in women globally each year, with hypertension (HTN) and type 2 diabetes (T2DM) recognised as primary modifiable risk factors for its development. Global longitudinal strain (GLS) is a highly sensitive CV imaging measure that detects early signs of myocardial dysfunction prior to clinical abnormalities arising, and is a strong prognostic indicator for future CV dysfunction and mortality. However, the effect of exercise on GLS in women with HTN or T2DM is unclear.

Purpose

This study aimed to determine if exercise positively impacts GLS in women with HTN or T2DM. Changes in peak aerobic fitness (VO2peak) were also explored.

Methods

A randomised crossover trial was performed at our university between August 2021-December 2022. Fifteen women (aged 64.1 ± 4.7) diagnosed with HTN (n=12) and T2DM (n=3) participated. Participants completed an 8-week exercise and 8-week control period, separated by a washout period of 21.6 ± 14.2 weeks. Comprehensive 2D and 3D resting echocardiography and exercising testing were performed pre-and-post each arm to measure GLS (%) and VO2peak (ml/kg/min). The exercise intervention consisted of three supervised aerobic exercise sessions per week for eight consecutive weeks, performed at a moderate intensity. Nine participants were required to provide 80% power to detect an absolute mean difference in GLS of 1.7 between groups (10% relative change in GLS from a baseline GLS of −17%), with an alpha of 0.05. A linear mixed effect model was used to compare outcomes between (exercise vs control) and within (pre- vs. post-intervention) groups for GLS and VO2peak. All participants who completed at least one arm of the trial were included in analyses.

Results

Nine participants completed the crossover, with four completing the control arm only, and two completing the exercise arm only. Exercise adherence was high (86.6%). GLS (%) increased significantly following exercise (−16.8 ± 1.5 to −18.4 ± 1.8; p = <0.001), but not control (−17.2 ± 2.0 to −16.9 ± 1.4; p = 0.585). Similarly, a significantly improvement in VO2peak (ml/kg/min) was observed following exercise (18.0 ± 2.1 to 19.2 ± 2.6; p = <0.001), but not control (17.5 ± 2.7 to 17.2 ± 2.7; p = 0.269). There was a significant between-group difference for both GLS (p = <0.001) and VO2peak (p = 0.011) (figure 1).

Conclusion(s)

Aerobic exercise positively impacts GLS in women at risk of developing CV disease. Due to its high sensitivity, GLS could be used to measure the effectiveness of aerobic exercise programs in populations at risk of developing CV disease, before changes in traditional clinical measures are expected to occur.
Associated factors and clinical implications of dynamic changes in late gadolinium enhancement after acute myocarditis
Authors: Bohbot Y , Sanguineti F , Renard C , Hovasse T , Limouzineau I , Unterseeh T , Di Lena C , Boukefoussa W , Tawa C , Duhamel S , Garot P , Tribouilloy C , Garot J
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although follow-up cardiac magnetic resonance (CMR) is often performed after acute myocarditis (AM), the prognostic implications of dynamic changes in late gadolinium enhancement (LGE) are unknown.

Purposes

To determine the prognostic implications of dynamic LGE changes after acute AM.

Methods

In a two-centre study, 204 consecutive hemodynamically stable patients (mean age 35±16 years, 78.9% males) with a CMR-based diagnosis of AM were included and underwent repeat CMR 3–12 months after diagnosis. Quantitative LGE was expressed as percent of left ventricular (LV) myocardium. The primary endpoint was the occurrence of major adverse cardiac events (MACE) at median 7.3[IQR:5.7–8.7] years.

Results

Compared to index CMR, there was an increase in LV ejection fraction (EF) (59% vs. 55%,p<0.001) and a decrease in LGE extent (7.6% vs. 12.0%,p<0.001) at follow-up (mean 5.7±2.6 months after index CMR). LGE persisted in 175 patients at follow-up (85.8%). LGE decreased by ≥50% from baseline in 94 patients (46%), by <50% in 86(42%) and increased in 24(12%). Female gender (OR[95%CI]=3.27[1.17–9.12],p = 0.023), low baseline LVEF (OR[95%CI]=0.93[0.88–0.98] per %,p = 0.010) and LGE involving both septal and lateral walls (OR[95%CI]=4.64[1.77–12.17],p = 0.002) were independently associated with increased LGE. By multivariate Cox analysis, only acute heart failure at inclusion (HR[95%CI]=3.11[1.02–9.20],p = 0.044), baseline LVEF (HR[95%CI]=0.95[0.89–0.99] per %,p = 0.028), a <50% LGE decrease (HR[95%CI]=2.17[1.23–3.88],p = 0.021) and an increase in LGE (HR[95%CI]=4.12[1.47–11.52],p = 0.004) were significantly associated with MACE.

Conclusion

After AM, LGE persists at 6 months in the vast majority of patients but tends to decrease. A <50% decrease or an increase in LGE are associated with MACE, indicating that follow-up CMR is relevant for risk stratification.
CTLA-4 and PD-1 blocking agents affects longitudinal and radial strain in preclinical models, increases systemic SDF-1, cardiac fibronectin, S-100 calgranulin, galectine-3 and NLRP-3/MyD-88 pathways
Authors: Maurea N , De Lorenzo C , Passariello M , Di Mauro A , Cipullo C , Bisceglia I , Paccone A , Iovine M , Bruzzese F , Palma G , Luciano A , Canale M L , Quagliariello V
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ricerca Corrente, Ministero della Salute.

Background

Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases. In this study, pro-inflammatory and pro-fibrotic effects of short-term ICIs therapy in preclinical models were analyzed.

Methods

Firstly, in a human in vitro model, human cardiomyocytes co-cultured with hPBMC were exposed to ICIs (with CTLA-4 or PD-1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through colorimetric and enzymatic assays. C57/Bl6 mice were treated with CTLA-4 or PD-1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF-kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs (S100- Calgranulin, Fibronectin and Galectine-3), MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF-1, IL-1β and IL-6 were analyzed before, during and after ICIs therapy.

Results

Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF-kB expression shows that short-term anti-CTLA-4 or anti-PD-1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin-3, pro-collagen 1-α and MMP-9 were increased after treatment with all ICIs. Both anti-CTLA-4 or anti-PD-1 treatments increased the expression of DAMPs, NLRP3 inflammasome and MyD88 and induced both in vitro and in vivo the secretion of IL-1β, TNF-α and IL-6. Systemic levels of SDF-1, IL-1β and IL-6 were increased during and after treatment with ICIs.

Conclusions

Short therapy with PD-1 and CTLA-4 blocking agents increases vascular expression of NF-kB, systemic SDF-1, IL-1β, IL-6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro-inflammatory cytokine storm was induced in myocardial tissues and in cultured cardiac cells after ICIs therapy. The overall picture of the study suggests new putative biomarkers of ICIs-mediated systemic and myocardial damages potentially useful in clinical cardioncology.
Sex-specific impairment of cardiac functional reserve in HFpEF: insights from the HFpEF-Stress trial
Authors: Schulz A , Lange T , Evertz R , Kowallick J T , Hasenfuss G , Backhaus S J , Schuster A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): DZHK

Background

Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men.(1,2) While predisposing risk factors are quite similar between the sexes(2,3), this study aimed to identify sex-specific pathophysiological features in HFpEF using state-of-the-art diagnostic approaches.

Methods

75 Patients with exertional dyspnea, preserved ejection fraction (EF ≥ 50%) and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF-Stress Trial. Patients underwent right heart catheterization (RHC), echocardiographic and cardiovascular magnetic resonance (CMR) imaging at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure in RHC (rest ≥ 15mmHg, stress ≥ 25mmHg), below these thresholds patients were classified as non-cardiac dyspnea (NCD).

Results

Main results are displayed in Figure 1. Compared to men, women with HFpEF revealed lower right ventricular (RV)-stroke volumes during exercise stress (f 38.1 vs. m 50.4 ml/m2 BSA; p = 0.011) but not with NCD. This was accompanied by a decreasing left atrial (LA) EF in women but not men comparing resting to exercise conditions (f −2.7 vs. m 2.5%, p = 0.020) and an impaired left ventricular (LV) filling (f 35.5 vs. m 44.2 ml/m2 BSA, p = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in NCD. The exercise-induced decrease in LA EF emerged as a predictor for HFpEF in women (OR 13.67 95% CIs: 3.03 – 62.14, p<0.001) with high diagnostic accuracy (AUC 0.83 95% CIs: 0.7–0.95).

Conclusion

Women with HFpEF demonstrate sex-specific functional alterations of RV, LA, and LV function during exercise-stress. The biventricular impairment suggests a complex interplay of both sides of the heart during the progression of HFpEF in women. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
Segmental longitudinal strain and regional myocardial work index could help identify mitral valve prolapse patients with increased risk of ventricular arrhythmia
Authors: Danilowicz-Szymanowicz L , Zienciuk-Krajka A , Wabich E , Fijalkowski M , Raczak G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias. Mitral annular disjunction (MAD), which leads to excessive mobility, mechanical stretch, and myocardial damage, has been studied as a putative mechanism for an arrhythmic substrate. However, it is unclear whether that is the only sufficient arrhythmic risk factor in that patients. The aim of our study was to check whether two–dimensional speckle tracking echocardiography (STE) with segmental longitudinal strain and STE-derived myocardial work (MW) analysis may allow for a more accurate assessment of the arrhythmic risk in MVP patients.

Methods and results

Seventy-two MVP patients and twenty healthy volunteers enrolled in the study had performed echocardiography with STE assessment. Non-sustained ventricular tachycardia (NSVT) was the arrhythmic outcome for further calculations. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental myocardial work index (MWI) for basal lateral (−25% and 2200 mmHg%), mid-lateral (−25% and 2500 mmHg%), mid posterior (−25% and 2400 mmHg%), and mid inferior (−23% and 2400 mmHg%) segments were accurate predictors of NSVT. A combination of PSS and MWI increased the probability of NSVT occurrence, reaching the highest predictive value for the basal lateral segment (Figure): odds ratio 32.15 (3.78–273.8), p < 0.001 for PSS ≥ (−25%) and MWI ≥ 2200 mmHg%.

Conclusions

2D STE may be a valuable tool for assessing arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with augmented regional myocardial work index identifies patients with the highest risk of NSVT.
Assessment of incidental cardiac uptake in bone scintigraphy across Spain. ECCINGO study
Authors: Primiano D , De Haro Del Moral F J , Aguade Bruix S , Tabuenca Mateo M J , Tamayo Alonso M P , Mohamed Salem L , Tarilonte P
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Pfizer SLU

Introduction

Myocardial uptake on bone scintigraphy with diphosphonates has become a useful tool for the early detection of transthyretin cardiac amyloidosis (ATTR-CM), the prevalence of which remains unknown.

Purpose

To assess the prevalence of myocardial uptake in bone scintigraphy in patients without previous clinical suspicion of cardiac amyloidosis (CA).

Methods

Observational, retrospective, multicentre study in 21 hospitals across Spain, their reference population represented 24.38% of the total national population. All scans performed for non-cardiac reasons during the months of September, October and November 2019 were reviewed. Scans with positive cardiac uptake (Perugini scores 1-3) were evaluated by a central laboratory. Medical histories of the patients with positive uptake were reviewed.

Results

9864 scans were reviewed. Cardiac uptake was observed in 71 patients (0.72%) over 18 years of age (85.90% male). According to the central laboratory assessment the distribution in the Perugini grading scale was, grade 1 (23.90%), grade 2 (29.60%) and grade 3 (46.50%). No relationship between sex and Perugini grade was observed. Heart/Contralateral ratio (H/CL) was available for 24 patients with a mean of 2.1 ± 1.1 (95% CI 1.7–2.6). A third of the patients (33.80%) also presented extracardiac uptake, being the most common: bone metastasis (7.04%) abdominal wall (5.60%) and lower limbs muscular mass (4.20%). A previous heart failure (HF) diagnosis was found in the 16.90% of the patients with positive uptake, being most of them 57.10% in NYHA class II. Patients ≤ 80 y.o. were diagnosed with heart failure earlier than patients > 80 y.o. (p = 0.02) and with atrial fibrillation earlier than patients > 80 y.o. (p = 0.05). Ten patients with cardiac uptake were subsequently diagnosed with ATTR amyloidosis (ATTR-Y) with a mean delay of 10.8 months (95% CI: 6.0–16.8). All ATTR-Y patients were > 70 y.o., 90.00% were male, had left ventricular hypertrophy (LVH) compared to 25.49% of patients in whom a diagnosis of ATTR (ATTR-N) was not confirmed (p = 0.00003). Patients in the ATTR-Y group presented some episode of orthostatic hypotension and involuntary weight loss in the clinical history (30.00% in both) compared to 3.77% (p = 0.025) and 5.88% (p = 0.05) of the ATTR-N group respectively.

Conclusions

This national study found a prevalence of 0.72% of incidental cardiac uptake in bone scintigraphies performed for non-cardiac reasons in adult patients. The results of this study bring light on the profile of the elderly patients with incidental cardiac uptake. The referral of these patients can facilitate the early diagnosis of CA with the consequent impact on the management and prognosis of patients.
Myocardial work by speckle-tracking echocardiography in pacemaker patients according to pacing site: a prospective study
Authors: Oliveira Campinas A , Cabral S , Dias De Frias A , Alexandre A A , Sa Couto D , Aranda E , Silva V , Gomes C , Sousa M J , Roque C , Vieira P , Reis H , Torres S
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The optimal lead position for right ventricle (RV) pacing is still a matter of debate. Several studies compared 2D-echocardiography left ventricle ejection fraction (LVEF) and LV global longitudinal strain (LVGLS) by speckle-tracking imaging (STI). However, these parameters present limitations, such as load dependency. Recently, myocardial work (MW) has emerged as an alternative tool for myocardial systolic function assessment.

Purpose

To compare LV MW and LVGLS between patients with RV outflow tract/septum pacing (Group1) and RV apical pacing (Group2).

Methods

Prospective single-center study of patients with permanent pacemaker (PMK) followed at our cardiac device’s outpatient clinic between july and november of 2022. Patients were divided into two groups according to RV pacing site. Moderate/severe valvular disease, LVEF<50%, segmental wall-motion abnormalities, pulmonary hypertension, cardiomyopathies, or RV dysfunction were exclusion criteria. STI-based LVGLS analysis and MW parameters were obtained (GWI:Global Work Index; GCW:Global Constructive Work; GWW:Global Wasted Work; GWE:Global Work Efficiency). RV pacing was required at the moment of imaging. A 12-lead ECG was also performed. Blood pressure (BP) was simultaneously measured.

Results

Our cohort comprised 30 patients in group 1 and 25 patients in group 2. The 2 groups were well-matched, except for the median time since PMK implantation, which was significantly higher in Group2 (5.3years vs 0.9years, p<0.001). The QRS was significantly narrower in Group1 (Group1:129ms±9 vs Group2:165ms±15, p<0.001). LVEF was similar in both groups (Group1:58%±7.5 vs Group2:60%±7.5, p = NS). Likewise, both systolic and diastolic BP were comparable (p = NS), but LVGLS was significantly higher in Group1 (15±3.3 vs 13±3.7, p = 0.043). Except for GWI which was also significantly higher in Group1 (1553mmHg%±581 vs 1238mmHg%±516, p = 0.040), no significant differences were found in the other parameters of MW among the groups (all p = NS).

Conclusion

Our results point to LVGLS being significantly lower in the group of RV apical pacing. Despite most parameters of MW didn’t differ between groups, GWI also showed significant impairment. These findings should be regarded as preliminary and further larger studies are needed to ascertain the value of this new tool in understanding the impact of pacing depolarization site on LV mechanics.
Is myocardial fibrosis in patients with non-ischemic dilated cardiomyopathy associated with the whole-heart myocardial mechanics?
Authors: Melinyte-Ankudavice K , Butnoriute E , Bucius P , Mizariene V , Lapinskas T , Sakalyte G , Plisiene J , Jurkevicius R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Non-ischemic dilated cardiomyopathy (NIDCM) is a severe form of primary myocardial disease related with progressive heart failure (HF) and a poor prognosis. In patients with NIDCM, myocardial fibrosis (MF) is associated to adverse cardiovascular outcomes and should be evaluated quickly in each case of NIDCM [1,2].

Purpose

To evaluate the relationships between the whole-heart myocardial strain parameters and presence of late gadolinium enhancement (LGE) in a prospective cohort of NIDCM patients.

Methods

The study group consisted of 101 patients with NIDCM who were referred for a cardiovascular magnetic resonance (CMR) and speckle tracking echocardiography examination. We analyzed MF by LGE, and the whole-heart (both ventricles and atria) myocardial mechanics were evaluated by speckle tracking. All patients underwent a comprehensive clinical evaluation, laboratory test assessment, electrocardiogram, Holter monitoring. The exclusion criteria were ischemic coronary disease, primary valvular heart disease, chronic kidney disease (eGFR <30 ml/min/1.73 m2), under the age of 18, a poor echocardiographic or CMR image quality, inflammatory myocardial disease, previous pulmonary embolism, peripartum cardiomyopathy and toxic damage.

Results

The study group was divided into two groups according to the presence of MF fibrosis. The presence of MF was associated to worse of the whole-heart myocardial strain parameters. Both ventricles or atria were more dilated in the group with MF. The strongest relationships were detected between presence of MF and mechanical strain parameters of the left side of the heart (left ventricle ejection fraction (LVEF) (r=0.662, 25 p<0.001), left ventricle global circumferential strain (LV GCS) (r=-0.609, p<0.001), left ventricle global longitudinal strain (LV GLS) (r=-0.586, p<0.001), left atrial reservoir strain (LASr) (r=0.588, p<0.001). Logistic regression analysis revealed that the last three mentioned strain parameters were independently associated with presence of MF.

Conclusions

In patients with NIDCM, the whole-heart myocardial mechanics are worse in patients‘ presence of MF. LV GLS, LV GCS, and LARs are the best 2D echocardiographic mechanical strain parameters to prognosticate the presence of MF.
Left atrial stiffness in predicting poor exercise oxygen consumption and ventilatory inefficiency
Authors: Ahn H , Cho G Y , Yoon Y E , Hwang I C , Choi H M , Choi H J , Park J S , Kang S E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Introduction

Cardiopulmonary exercise test (CPET) provides integrative information of cardiovascular, pulmonary, muscular, and cellular oxidative systems. Peak exercise O2 consumption (VO2) and ventilatory efficiency (VE/VCO2) are potent predictors of poor outcome in heart failure (HF).

Purpose

We studied to find echocardiographic parameters to predict peak VO2 and VE/VCO2.

Methods

We analyzed 680 patients who underwent CPET and supine bicycle stress echocardiography simultaneously. CPET was performed using semi-supine ramp bicycle exercise with encouraging R > 1.0.

Results

Both poor exercise tolerance (peak VO2 < 14 mL/kg/min) and ventilatory inefficiency (VE/VCO2 > 36) were associated with age, LV mass index, LV ejection fraction, baseline or exercise E/e’, TR velocity, LA strain, peak apical rotation, and LA stiffness ((E/e’)/LA strain). In multivariate analysis, only LA stiffness was highly associated in both poor exercise tolerance(p < 0.001, odds ratio 0.96, 95% CI [0.94 0.98]) and ventilatory inefficiency(p<0.001, odds ratio 1.05, 95% CI [1.02 1.08]).

Conclusion

LA stiffness is independently associated with poor exercise tolerance and ventilatory inefficiency.
The effect of hyperbaric oxygen therapy on myocardial function in post- covid syndrome patients: a randomized controlled trial
Authors: Leitman M , Fuchs S , Tyomkin V , Hadanny A , Zilberman-Itskovich S , Efrati S
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Post-COVID-19 condition refers to a range of persisting physical and neurocognitive symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection.

Methods

Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session.

Results

Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (−17.8±1.1 to −20.2±1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041).

Conclusion

Post-COVID syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.
Is it real that no idiopathic tricuspid regurgitation anymore after atrial tricuspid regurgitation regarded as a distinct entity?
Authors: Tsai W C , Lee J Y , Wu C I , Lee W H
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

We have recently found that idiopathic tricuspid regurgitation (TR) had unique characteristics after a systemic approach to strictly define it. Atrial TR has been proposed that TR caused by right atrial dilatation related to the atrial fibrillation and without other causes of TR. Some researchers suggested idiopathic TR was no longer existed.

Methods

We retrospectively recruit 978 subjects with significant (moderate and severe) TR during a period of 9 months. We carefully evaluated their echocardiography images and divided these subjects into different type of TR according to a step-by-step systemic approach which we have developed. The characteristics of these TR were compared.

Results

After a step-by-step diagnostic approach, we found that there were 105 subjects with primary TR (10.7%), 76 (7.8%) pacemaker or other intracardiac instrumentation related, 388 (39.7%) left heart disease related, 32 (3.3%) congenital heart disease related, 160 (16.3%) pulmonary hypertension related, 7 (0.7%) right ventricular myopathy, and 210 (21.5%) idiopathic TR. Among idiopathic TR, 81 (38.6%) men, mean age 74.4 ± 14.0 years, 35 (16.7%) severe TR, and 82 (39%) atrial fibrillation. Compared to the idiopathic TR in sinus rhythm, subjects with atrial fibrillation had older age (78.1 ± 10.4 vs. 72.0 ± 13.9 years, p = 0.001), more severe TR (32 vs. 7 %, p <0.001), higher pulmonary artery pressure (43.5 ± 9.8 vs. 38.9 ± 7.9 mmHg, p = 0.001), less fractional area fraction of right ventricle (44.9 ± 13.3 vs. 51.1 ± 10.8 %, p = 0.001), larger tricuspid annulus (3.4 ± 0.7 vs. 2.8 ± 0.6 cm, p <0.001), and large right atrial area (23.2 ± 7.6 vs. 13.6 ± 4.5 cm2, p <0.001).

Conclusion

There were only 39% atrial TR among idiopathic TR in our study. Many significant TR subjects without other causes were still in sinus rhythm with smaller annulus and right atrial size. Even atrial TR do a distinct entity, there are still have TR subjects without any obvious causes (idiopathic TR).