bluuebunny/crossref_metadata_2025 huggingface dataset:
Suffusion of irregular concave gap-graded sand with resolved CFD-DEM
Authors: Liu Yajing , Yin Zhen-Yu
Published: November 2024

The complex morphologies of particles are a crucial factor influencing suffusion in gap-graded granular soils. However, the micro-mechanism of soil suffusion composed of irregular concave particles remains unclear. To this end, a systematic numerical simulation that considers particle concavity and aspect ratio is performed with the resolved discrete element method (DEM) and computational fluid dynamics (CFD) approach. The macro responses of suffusion of particles with varying morphologies, e.g., cumulative eroded particle mass and sample profile, are revealed and interpreted from a microscopic view, e.g., particle rotation, average number of contact points, and moment. It is found that the rotation of irregularly shaped particles during suffusion requires overcoming the moment applied by the surrounding particles. Particles with bigger contact force or irregularity require a higher moment to be overcome, thus significantly increasing their suffusion resistance. Irregularly shaped particles can adjust their orientation to reduce the moment and drag force applied to them. At the same aspect ratio, particles with larger concavity are more likely to interlock with each other, with increasing the average number of contact points of the soil packing and shrinking the pore channel for particle migration. A shape parameter considering both concavity and aspect ratio is finally proposed to characterise the influence on suffusion.
A Space-Efficient One-Pass Online SVM Algorithm
Authors: Liu Yangwei , Huang Ziyun , Xu Jinhui
Published: November 2024

In this paper we consider the problem of training a Support Vector Machine (SVM) online using a stream of data in random order. We provide a fast online training algorithm for general SVM on very large datasets. Based on the geometric interpretation of SVM known as the polytope distance, our algorithm uses a gradient descent procedure to solve the problem. With high probability our algorithm outputs an [Formula: see text]-approximation result in constant time and space, which is independent of the size of the dataset, where [Formula: see text]-approximation means that the separating margin of the classifier is almost optimal (with error [Formula: see text]), and the number of misclassified training points is very small (with error [Formula: see text]). Experimental results show that our algorithm outperforms most of existing online algorithms, especially in the space requirement aspect, while maintaining high accuracy.
Microbial mats writing the fossil record of true substrates in clastic rock successions
Authors: Noffke Nora , Buntin Rogers C. C.
Published: November 2024

True substrates are bedding surfaces that represent the original environmental surfaces that existed at the time of burial. In the clastic depositional regime, there are abiotic and biotic causes that may contribute to the formation of such true substrates. This paper focuses on how sediment-stabilizing microbial mats may increase the preservation potential of true substrates. Baffling and trapping enrich fine-grained particles and heavy minerals in mat textures inducing a layer of heterogeneity in the otherwise homogenous deposits. Together with
in situ
mineral precipitation during the life time of the microbial mat and post-depositional diagenesis, baffling and trapping contributes to processes leading to bedding plane preservation. Microbial mats interact with the hydrological system of a coastal environment causing typical microbially induced sedimentary structures (MISS). The morphologies of MISS can indicate climate seasonality and zone of the respective true substrate. The interaction of animals and plants with microbial mats allow reconstructing events that took place during the exposure of the original environmental surface. Finally, true substrates displaying MISS are well-defined indicators for life exploration of Earth's oldest sedimentary rock successions and equivalent lithologies on other planets.
A Machine Learning Approach for Automated Filling of Categorical Fields in Data Entry Forms—RCR Report
Authors: Belgacem Hichem , Li Xiaochen , Bianculli Domenico , Briand Lionel
Published: November 2024

This article represents the Replicated Computational Results (RCR) related to our TOSEM paper “A Machine Learning Approach for Automated Filling of Categorical Fields in Data Entry Forms,” where we proposed LAFF, an approach to automatically suggest possible values of categorical fields in data entry forms, which is a common user interface feature in many software systems. In this RCR report, we provide details about our replication package. We make available the different scripts needed to fully replicate the results obtained in our paper.
Membership Inference Attacks and Defenses in Federated Learning: A Survey
Authors: Bai Li , Hu Haibo , Ye Qingqing , Li Haoyang , Wang Leixia , Xu Jianliang
Published: November 2024

Federated learning is a decentralized machine learning approach where clients train models locally and share model updates to develop a global model. This enables low-resource devices to collaboratively build a high-quality model without requiring direct access to the raw training data. However, despite only sharing model updates, federated learning still faces several privacy vulnerabilities. One of the key threats is membership inference attacks, which target clients’ privacy by determining whether a specific example is part of the training set. These attacks can compromise sensitive information in real-world applications, such as medical diagnoses within a healthcare system. Although there has been extensive research on membership inference attacks, a comprehensive and up-to-date survey specifically focused on it within federated learning is still absent. To fill this gap, we categorize and summarize membership inference attacks and their corresponding defense strategies based on their characteristics in this setting. We introduce a unique taxonomy of existing attack research and provide a systematic overview of various countermeasures. For these studies, we thoroughly analyze the strengths and weaknesses of different approaches. Finally, we identify and discuss key future research directions for readers interested in advancing the field.
Improving Diagnosis of Acute Cholecystitis with US: New Paradigms
Authors: Patel Richa , Tse Justin R. , Shen Luyao , Bingham David B. , Kamaya Aya
Published: November 2024

Although acute cholecystitis is a common clinical problem, accurate sonographic diagnosis may be compromised by overreliance on the sonographic Murphy sign, but using more nuanced and predictive findings can improve diagnostic accuracy for acute cholecystitis.
Lithium-Ion Battery Degradation in Grid Applications: Analysis through Frequency- and Time-Domain Parameterization
Authors: Ohrelius Mathilda , Lindström Rakel Wreland , Lindbergh Göran
Published: November 2024

Lithium-ion batteries have a great potential in stationary energy storage, both for first- and second life, but the understanding and tools to evaluate cell degradation needs to be improved. In this study, the degradation of batteries subjected to three types of stationary services, as well as the repurposing of cells from more demanding to a milder application is investigated. The milder cycle is frequency regulation with a maximum C-rate of 1.5 C (FR1.5C) and the more demanding cycles peak shaving with a C-rate of 1 C (PS1C) and FR and PS combined (FRPS2C). The main driver for accelerated capacity loss was identified as the state-of-charge (SOC) change during operation, increasing the rate of degradation for PS and FRPS. The cell impedance was measured and fitted to a physics-based model to deconvolute the sources of polarization increase. A tortuosity increase in the negative electrode was seen for all cells, as well as a resistance increase. FRPS2C and PS1C further showed a decrease in the electrolyte mass transport properties. When repurposed to the milder FR1.5C application, PS1C showed a clear decrease in capacity loss rate while more heterogeneous degradation might be the reason for a higher rate of degradation for the repurposed FRPS2C cell.
Anticancer Activities of Peanut (Arachis hypogaea L.) Testa Extract in Combination With Cisplatin and 5‐Fluorouracil Against Cholangiocarcinoma Cells In Vitro and in Mouse Xenograft Models
Authors: Jeeunngoi Jarckrit , Senawong Gulsiri , Jogloy Sanun , Saenglee Somprasong , Sripa Banchob , Senawong Thanaset
Published: November 2024

Cholangiocarcinoma (CCA) is a very aggressive cancer and CCA treatments with cisplatin and 5‐fluorouracil (5‐FU) often cause side effects and drug resistance. This study aimed to investigate the combined effects of Valencia KK4‐type peanut’s (Arachis hypogaea L.) skin ethanolic extract (KK4‐PSE) and cisplatin or 5‐FU on CCA cells in vitro and in nude mouse xenografts. Antiproliferative activity was evaluated using MTT assay. The in vitro drug interaction was studied by the Chou–Talalay method. Apoptosis induction and cell cycle arrest were analyzed by flow cytometry. The levels of proteins involved in apoptosis were evaluated by western blot analysis. Mouse xenograft models were used to evaluate the anticancer activity of KK4‐PSE in animals (in vivo). KK4‐PSE inhibited the proliferation of CCA cell line (IC50 = 37.22 ± 4.31, 26.27 ± 0.78, and 17.72 ± 0.50 μg/mL at 24 h, 48 h, and 72 h exposures, respectively) more effectively than that of the noncancer H69 cholangiocyte cell line (IC50 = 193.35 ± 6.55, 75.35 ± 1.00, and 57.41 ± 0.96 μg/mL at 24 h, 48 h, and 72 h exposures, respectively). In KKU‐M213B cells, KK4‐PSE treatments in combination with cisplatin caused cell cycle arrest at G2/M, whereas combined KK4‐PSE and 5‐FU caused a significant increase of Sub G1 population for 24 h exposure. Furthermore, a significant increase in the percentage of apoptotic cells was also observed in combination treatments. The combination treatments of KK4‐PSE with cisplatin and 5‐FU caused downregulation of pERK1/2 and Bcl2 and caused a decrease in the Bcl2/Bax ratio, resulting in enhanced apoptosis. In addition, KK4‐PSE treatments in combination with 5‐FU suppressed tumor growth in BALB/cAJcl‐Nu/Nu xenograft models more effectively than the combinations with cisplatin. Taken together, KK4‐PSE may be an effective synergistic agent with 5‐FU and cisplatin for CCA chemotherapy, warranting further clinical examination.
Timeliness of Lung Cancer Care and Area-Level Determinants in Victoria: A Bayesian Spatiotemporal Analysis
Authors: Tesema Getayeneh Antehunegn , Tessema Zemenu Tadesse , Heritier Stephane , Stirling Rob G. , Earnest Arul
Published: November 2024

Background:

The reports have stated that the timeliness of lung cancer care varies significantly across different regions. According to the Victorian Lung Cancer Registry report, the timeliness of lung cancer care in Victoria has changed over time. Therefore, we aimed to quantify the extent of these spatial inequalities over time and to identify area-level determinants contributing to these changes.

Methods:

The study analyzed lung cancer cases reported to the Victorian Lung Cancer Registry between 2011 and 2022. Bayesian spatiotemporal conditional autoregressive models were fitted, incorporating spatial random effects, temporal random effects, and spatiotemporal interactions. The best performing model was selected using the deviance information criterion. For the final best fit model, the adjusted RRs and their 95% credible intervals were reported.

Results:

More than half (51.24%) of patients with lung cancer experienced treatment delays, whereas approximately one third (30.98%) encountered diagnostic delays. Moderate spatiotemporal variations were observed in both delayed diagnosis and treatment. In the final best fit model for treatment delay, an increase in the percentage of smokers was significantly associated with a higher risk of treatment delay (RR = 2.13; 95% credible interval, 1.13–4.20).

Conclusions:

Identifying high-risk areas provides useful information for policymakers, helping in the reduction of delays in lung cancer diagnosis and treatment.

Impact:

This study has revealed spatiotemporal inequalities in diagnostic and treatment delays, providing valuable insights for identifying areas that should be prioritized to ensure timely care for lung cancer.
Metabolic Phenotype and Risk of Obesity-Related Cancers in the Women’s Health Initiative
Authors: Karra Prasoona , Hardikar Sheetal , Winn Maci , Anderson Garnet L. , Haaland Benjamin , Shadyab Aladdin H. , Neuhouser Marian L. , Seguin-Fowler Rebecca A. , Thomson Cynthia A. , Coday Mace , Wactawski-Wende Jean , Stefanick Marcia L. , Zhang Xiaochen , Cheng Ting-Yuan David , Karanth Shama , Sun Yangbo , Saquib Nazmus , Pichardo Margaret S. , Jung Su Yon , Tabung Fred K. , Summers Scott A. , Holland William L. , Jalili Thunder , Gunter Marc J. , Playdon Mary C.
Published: November 2024

Body mass index (BMI) may misclassify obesity-related cancer (ORC) risk, as metabolic dysfunction can occur across BMI levels. We hypothesized that metabolic dysfunction at any BMI increases ORC risk compared with normal BMI without metabolic dysfunction. Postmenopausal women (n = 20,593) in the Women’s Health Initiative with baseline metabolic dysfunction biomarkers [blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, fasting glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and high-sensitive C-reactive protein (hs-CRP)] were included. Metabolic phenotype (metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese) was classified using four definitions of metabolic dysfunction: (i) Wildman criteria, (ii) National Cholesterol Education Program Adult Treatment Panel III, (iii) HOMA-IR, and (iv) hs-CRP. Multivariable Cox proportional hazards regression, with death as a competing risk, was used to assess the association between metabolic phenotype and ORC risk. After a median (IQR) follow-up duration of 21 (IQR, 15–22) years, 2,367 women developed an ORC. The risk of any ORC was elevated among metabolically unhealthy normal weight (HR = 1.12, 95% CI, 0.90–1.39), metabolically healthy overweight/obese (HR = 1.15, 95% CI, 1.00–1.32), and metabolically unhealthy overweight/obese (HR = 1.35, 95% CI, 1.18–1.54) individuals compared with metabolically healthy normal weight individuals using Wildman criteria. The results were similar using Adult Treatment Panel III criteria, hs-CRP alone, or HOMA-IR alone to define metabolic phenotype. Individuals with overweight or obesity with or without metabolic dysfunction were at higher risk of ORCs compared with metabolically healthy normal weight individuals. The magnitude of risk was greater among those with metabolic dysfunction, although the CIs of each category overlapped.

Prevention Relevance: Recognizing metabolic dysfunction as a significant risk factor for ORCs underscores the importance of preventive measures targeting metabolic health improvement across all BMI categories.
Supplementary Material from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Additional mathematical reasoning and simulation results.
Supplementary Figure S.7 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.7
Supplementary Figure S.6 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.6
Supplementary Figure S.26 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.26
Supplementary Figure S.2 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.2
Supplementary Figure S.19 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.19
Supplementary Figure S.18 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.18
Supplementary Figure S.12 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.12
Figure 2 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Model simulations of treatment by pure radioconjugates (coefficient of drug impurity η = 0) for the basic set of parameters with the dose Acur leading to minimal number of viable cancer cells Nm = 0.01, which is considered as the curative threshold. A, Dynamics of active antibodies and their fragments in plasma. B, Dynamics of cancer cells. C, Dependence of minimal single curative dose, Acur, on relative significance of self-damage, ks. Star marks the case with basic value of ks = 0.3. See Supplementary Section S.2.1.6 for analytical estimation of Acur. D, Dynamics of occupied receptors on viable cancer cells. The density of radionuclides on them decreases due to the decay of nuclides, rate of which is λ, and due the to the redistribution of nuclides among the newborn cells, characterized by cell proliferation rate ρ. E, Dynamics of occupied receptors on damaged cancer cells. After a transient period, the density of radionuclides on them decreases only due to the decay of nuclides.
Figure 1 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

A, Schematic view of the main processes considered in the mathematical model of TRT of blood cancer. Note that antibody–receptor binding is considered irreversible. B, Illustration of three types of radiation damage, considered in the model. (B, Created with BioRender.com.)
Computational codes from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Designed in Wolfram Mathematica, version 13.3.1.0.
Data from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Abstract
Targeted radionuclide therapy (TRT) is based on injections of cancer-specific molecules conjugated with radioactive nuclides. Despite the specificity of this treatment, it is not devoid of side effects limiting its use and is especially harmful for rapidly proliferating organs well perfused by blood, like bone marrow. Optimization of radioconjugate administration accounting for toxicity constraints can increase treatment efficacy. Based on our experiments on a disseminated multiple myeloma mouse model treated by 225Ac-DOTA-daratumumab, we developed a mathematical model, investigation of which highlighted the following principles for optimization of TRT: (i) Nuclide-to-antibody ratio importance. The density of radioconjugates on cancer cells determines the density of radiation energy deposited in them. A low labeling ratio as well as accumulation of unlabeled antibodies and antibodies attached to decay products in the bloodstream can mitigate cancer radiation damage due to excessive occupation of specific receptors by antibodies devoid of radioactive nuclides. (ii) Cancer-binding capacity–based dosing. The total number of specific receptors on cancer cells is a critical factor for treatment optimization, and its estimation may allow increasing treatment efficacy close to its theoretical limit. Injection of doses significantly exceeding cancer-binding capacity should be avoided because radioconjugates remaining in the bloodstream have a negligible efficacy-to-toxicity ratio. (iii) Particle range–guided multi-dosing. The use of short-range particle emitters and high-affinity antibodies can allow for robust treatment optimization via initial saturation of cancer-binding capacity, enabling redistribution of further injected radioconjugates and deposited doses toward still viable cells that continue expressing specific receptors.
Significance:
Mathematical modeling yields general principles for optimization of TRT in mouse models of multiple myeloma that can be extrapolated to other cancer models and clinical settings.
Depigmented, Polymerized Cat Epithelium Extract Is Safe and Improves Rhinitis and Asthma Symptoms in Cat-Allergic Patients: A Real-World Retrospective Study
Authors: Vázquez de la Torre María , López-González Paula , Haroun-Díaz Elisa , Somoza María Luisa , Cervera María Desamparados , Ruiz-García Mónica , Ruano Francisco Javier
Published: November 2024

Introduction: Exposure to cat allergens is often difficult to avoid. Here, we evaluated the safety and effectiveness of a depigmented, polymerized cat epithelium extract (Dpg-pol-cat) for the treatment of allergic rhinoconjunctivitis and asthma. Methods: Real-world, retrospective study of patients ≥12 years of age with cat allergy and moderate to severe allergic rhinitis/rhinoconjunctivitis, with or without asthma, who started allergen immunotherapy (AIT) with Dpg-pol-cat extract during routine visits to the Allergy Department. Safety and effectiveness (improvement in FEV1) of AIT were evaluated. The use of rescue medication and patient perceptions were also assessed. Results: A total of 62 patients were included, of whom 34 (54.8%) received AIT for at least 12 months. There were 15 adverse events, 8 local and 7 systemic, of which 3 led to discontinuation of AIT. Patients with moderate to severe rhinitis decreased from 88.2% at baseline to 29.4% at 12 months (p < 0.0001) and patients with moderate asthma decreased from 76.5% to 38.2% (p = 0.0004). FEV1 improved from a mean (standard deviation) of 3,188.9 (771.4) mL to 3,419.6 (878.4) mL (p = 0.0023). The use of rescue medication for rhinitis decreased from 94.1% to 23.5% (p < 0.0001). All patients requiring rescue medication for conjunctivitis (20.6%) were off medication at 12 months, and 97.1% and 92.6% of patients reported improvement in rhinitis and asthma symptoms, respectively. Conclusion: AIT with Dpg-pol-cat extract shows a favorable safety and effectiveness profile in patients with allergic rhinitis/rhinoconjunctivitis due to cat allergy, with or without allergic asthma, representing a valuable treatment option for these patients.
Correspondência entre Guerra-Peixe e Lopes-Graça
Authors: Tacuchian Ricardo
Published: November 2024

Femando Lopes-Graça, embora perseguido pelo regime salazarista, assumiu importante posição no cenário musical português após a Revolução dos Cravos, de 1974, e a instalação de um regime constitucional, a partir de 1976. Inúmeros músicos brasileiros mantiveram intercâmbio com o músico português em ocasiões em que ele dirigia entidades culturais em Lisboa. Neste trabalho faremos referência apenas ao intercâmbio de correspondência entre Lopes-Graça e Guerra-Peixe. A correspondência de Guerra-Peixe tem um caráter de depoimento. Nela o ilustre compositor expõe seu credo estético e comenta o meio artístico brasileiro com mais espontaneidade do que o faria se o texto se destinasse a ser lido em território nacional. Além desta correspondência, fizemos um levantamento da Coleção C. Guerra-Peixe, encontrada na Divisão de Música da Biblioteca Nacional, no Rio de Janeiro, onde localizamos algumas cartas de Lopes-Graça enviadas ao seu colega brasileiro. Este intercâmbio é rico em informações históricas e posicionamentos estéticos dos dois artistas.
Abstract 4138074: Sex differences in safety and efficacy of dual antiplatelet therapy strategies for patients with acute coronary syndromes: A systematic review and meta-analysis
Authors: Saito Tetsuya , Miyamoto Yoshihisa , Fujisaki Tomohiro , Hosseini Kaveh , Kazemian Sina , Briasoulis Alexandros , Slipczuk Leandro , Akkawi Abdul Rahman , Takagi Hisato , Kolte Dhaval , Kuno Toshiki
Published: November 2024

Background:
Various durations and de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for patients presenting with acute coronary syndromes (ACS) have been reported in randomized controlled trials (RCTs). However, it remains uncertain whether the effect of these DAPT strategies is influenced by sex.

Methods:
PubMed and EMBASE were searched in May 2024. We included RCTs which investigated DAPT strategies for ACS patients comparing any de-escalation strategies such as short-term DAPT (≤6 months) followed by P2Y
12
inhibitor or aspirin monotherapy, unguided de-escalation from potent P2Y
12
inhibitors to low-dose potent P2Y
12
inhibitors or clopidogrel at one month, and guided de-escalation with platelet function tests, compared with standard duration DAPT (6-12 months). We conducted a systematic review and meta-analysis. The efficacy and safety of each DAPT strategy was compared between sexes, and relative hazard ratios (RHR) were calculated. The primary outcome was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and major bleeding (BARC 3 or 5).

Results:
Eleven RCTs that enrolled 27,033 patients with ACS were included. De-escalation of antiplatelet therapy had a lower risk of NACE than standard duration DAPT for both female (HR, 0.73; 95% CI, 0.55-0.96;

I
2

=32%) and male (HR, 0.85; 95% CI, 0.74-0.97;

I
2

=23%). There were no significant differences in NACE between female and male patients randomized to de-escalation vs. standard duration DAPT (RHR, 0.84; 95% CI, 0.65-1.09 ;

I
2

=0%) (Figure). Similarly, no significant differences were observed between female and male patients with respect to major adverse cardiovascular events (RHR, 0.75; 95% CI, 0.52-1.08;

I
2

=0%) or major bleeding (RHR, 1.37; 95% CI, 0.85-2.21 ;

I
2

=0%).

Conclusion:
In patients with ACS, de-escalation of antiplatelet therapy is safe and effective irrespective of sex.
Abstract 4138090: Time-in-range, Diabetes Eating Problems and Diabetes Distress among Individuals with Type 2 Diabetes
Authors: Nam Soohyun , Lee Minjung
Published: November 2024

Background:
Time-in-range (TIR), the percentage of time that glucose values are in the range of 70 to 180mg per dL as measured with continuous glucose monitoring (CGM), has become an important metric for assessing glycemic control for clinical care and as an endpoint in cardiometabolic research. For people with diabetes, a TIR >70 % is recommended, which is about 17 hours of a 24-hour day. Diabetes eating and distress are modifiable factors associated with long-term glucose control, such as HbA1c. However, little is known about the relationship between diabetes eating, diabetes distress, and TIR.

Research Hypothesis:
A group with the recommended TIR (>70%) will have fewer eating problems or diabetes distress than a group with TIR ≤70%.

Methods:
Participants with type 2 diabetes completed sociodemographic surveys, the Diabetes Eating Problem Survey (DEPS), and the Diabetes Distress Scale (DDS). The DDS has 4 subscales—Emotional Burden, Physician distress, Regimen Distress, and Interpersonal Distress. TIR was calculated by a 14-day blinded CGM.

Results:
Among 53 participants, 66% were female with a mean (M) age of 62.08±10.26 years. The majority were White (67.9%), followed by Black (17%). About 70% had a TIR over 70%. The mean DEPS score was 31.65 ±10.05, which indicates clinically significant disordered eating behaviors (cut off>20). The mean overall DDS score was 2.0±1.0, indicating a moderate level of diabetes distress: regimen distress was the highest (M:2.3±1.1), followed by emotional burden (M:2.2±1.3). The DEPS score in the TIR>70% group were significantly lower than in the TIR of ≤ 70% group (28.45 vs. 40.36; P=0.004). All DDS scores except physician-related distress were significantly higher in the TIR ≤ 70% group than in the TIR >70% group (p<0.05). Similarly, better TIR was significantly associated with fewer diabetes eating problems (r=-0.48, p<0.05) and lower overall DDS score (r=-0.44, p<0.05).

Conclusions:
In our cross-sectional study, diabetes eating problem was significantly associated with TIR—the group with recommended level of TIR showed fewer eating problems. Also, less diabetes distress was significantly associated with better TIR. These findings suggest that interventions targeting eating problems and diabetes distress may help to achieve the recommended TIR. Future research with a prospective study design and large sample size is needed to examine factors associated with TIR and its relationship in type 2 diabetes.
Abstract 4138113: C-X-C Motif Chemokine Receptor 4-directed Molecular Imaging of Mediastinal Lymph Nodes after Acute Myocardial Infarction in Patients
Authors: Reiter Theresa , Kosmala Aleksander , Doerrler Anna Lena , Hasenauer Natalie , Kraus Nils , Serfling Sebastian , Hartrampf Philipp E. , Bauer Wolfgang R. , Hofmann Ulrich , Buck Andreas , Higuchi Takahiro , Werner Rudolf A.
Published: November 2024

Purpose:
After acute myocardial infarction (MI), lymphocytes play a pivotal role in the scar formation and remodeling of the remote myocardium. Activation of lymphocytes takes places in mediastinal lymph nodes (MLN). Therefore, imaging of MLN as a read-out of the adaptive immune response to MI may identify subjects at increased risk for cardiac functional decline.

Methods:
The on-going prospective study (NCT05519735) enrolls patients with acute ST-elevation MI followed by complete reperfusion and multimodal imaging with C-X-C motif chemokine receptor 4 (CXCR4)-directed PET/CT and cardiac MRI (CMR) as baseline imaging. Follow-up (FU) CMR scans are repeated after 6 and 12 months. The CMR scans are analyzed regarding LV function, myocardial and LGE mass. Tracer uptake (SUVpeak) in the myocardium and MLN (defined as LN with most intense uptake) are determined. Infarct/remote myocardial (IRR), MLN/Remote LN (LNR) ratios and the overall LNR (including uptake from all LN) are calculated. Association of uptake with the function CMR parameters is tested.

Results:
Currently, 41 patients (29 males, median age 59 yo) were enrolled in the study (6 months FU 27/41, 12 months FU 17/41). At baseline, the median CMR EF was 49% and improved with the FUs (6mo: 52.8%, 12 mo 53.2%). LGE mass was 30.3 g and declined to 13.8 g after 12 months (LGE/Myocardial 15.8%). SUV
peak
from infarcted myocardium and mediastinal LN were consistently >1, indicating increased uptake relative to background.

Changes of LVEF correlated with LNR (6 mo FU: %LVEF, r= - 0.48; P = 0.01, 12 mo FU: %LVEF, r= - 0.55; P = 0.02) and overall LNR (6 mo FU: %LVEF, r= - 0.52; P< 0.01; 12 mo FU: %LVEF; r= - 0.61; P = 0.01), but not with IRR (P= 0.498).

LNR was increased in subjects with decreased LVEF. In logistic regression analysis, increasing LNR and overall LNR were significantly associated with decreased LVEF at the 12 months FU (LNR OR 1.32 (95% CL: 1.06-1.81, p = 0.03), Overall LNR OR 1.36 (95 % CL: 1.09-1.92, p = 0.03)).

Conclusion:
CXCR4-directed imaging of MLN provides information on the extent of local and systemic tissue inflammation in patients after acute MI. Especially MLN CXCR4 uptake holds predictive potential for cardiac adverse remodelling during follow up (LVEF decline) and may be used to identify patients who benefit from a selective immune modulation after acute MI.

Funding:
German Research Foundation (453989101).
Abstract 4138150: Modern Breast Radiation and Comprehensive Echocardiography-Derived Measures of Cardiac Function
Authors: Berlin Eva , Wilcox Nicholas , Ko Kyunga , Ma Lin , Messing Ian , Hollawell Casey , Smith Amanda , Upshaw Jenica , Koropeckyj-Cox Daniel , Wang Jessica , Knollman Hayley , Clark Amy , Shah Payal , Bhattacharya Saveri , Taunk Neil , Narayan Vivek , Yegya-Raman Nikhil , Sula Megi , Lefebvre Benedicte , Freedman Gary , Ky Bonnie
Published: November 2024

Background:
Radiation therapy (RT) has resulted in significant improvements in breast cancer outcomes, but cardiac morbidity remains an important concern. We evaluated the changes in cardiac function after breast RT and the relationship between cardiac dose metrics and echocardiography-derived measures of cardiac function.

Methods:
We performed detailed quantitation of radiation cardiac dose metrics and echocardiographic measures of cardiac function in a prospective longitudinal cohort study of racially diverse women with breast cancer treated at a quaternary healthcare system. Radiation cardiac dose metrics included whole heart, left ventricle (LV), right ventricle (RV) and left anterior descending artery (LAD). Echocardiographic measures included LV ejection fraction (LVEF), longitudinal strain, circumferential strain, E/e’, ventricular-arterial coupling, and RV fractional area change. The mean change in echocardiogram measures from pre-RT, and 6, 12, 24, 36 months post-RT, and the association between cardiac dose metrics and echocardiogram measures, were estimated by repeated measures multivariable linear regression via generalized estimating equations. Analyses were stratified by treatment site (right versus bilateral/left).

Results:
303 participants (33% African American) received adjuvant RT between 2010-2019, and had an echocardiogram performed within three months prior to the start of and after RT. The median mean heart dose (MHD) was 1.19 Gy (Q1-Q3, 0.75-2.61). LVEF increased over time (pre-RT 52.1% to 53.6% at 3 years; p = 0.004), and consistent with this, ventricular-arterial coupling decreased (pre-RT 1.02 to 0.93 at 3 years; p = 0.03). MHD was significantly associated with systolic and diastolic function measures, but the effect sizes were small. For each IQR increase in MHD, there was a 0.31% (95% CI 0.04, 0.57) worsening in longitudinal strain. The maximum LAD dose was associated with multiple echocardiographic parameters, including LVEF (-0.85, 95% CI: -1.58, -0.13), longitudinal strain (0.62, 95% CI: 0.17, 1.08), and circumferential strain (0.64, 95% CI: 0.00, 1.28) for bilateral/left-sided RT.

Conclusion:
Modern breast RT was not associated with a clinically important effect on echocardiographic measures of cardiac systolic and diastolic function over a median follow-up of two years. Our findings provide clinically actionable guidance and reassurance regarding the cardiac safety of RT for breast cancer patients in the modern era.
Abstract 4138159: Dual antiplatelet therapy duration and stent type in patients with high bleeding risk: A Systematic Review and Network Meta-Analysis
Authors: Saito Tetsuya , Kuno Toshiki , Fujisaki Tomohiro , Gupta Rahul , Hosseini Kaveh , Takagi Hisato , Wiley Jose , Bangalore Sripal
Published: November 2024

Background:
It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (e.g., durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)).

Objectives:
We aimed to study the stent type and DAPT duration appropriate for patients with HBR.

Methods:
PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified (Figure). The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model.

Results:
Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES versus standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES versus short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]).

Conclusions:
In patients with HBR who underwent PCI, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.
Abstract 4138212: Efficacy of Left Atrial Appendage Occlusion in Reducing Mortality and Major Bleeding Events in Cancer Patients with Atrial Fibrillation
Authors: Issa Rochell , Majeed Zoha , Issa Ryan , Prasad Rohan , Collier Patrick , Agdamag Arianne , Kaelber David , Sadler Diego , Khorana Alok , Kanj Mohamed , Moudgil Rohit
Published: November 2024

Introduction:
Atrial fibrillation (AF) is a common comorbidity in cancer patients, increasing their risk of stroke and mortality. Cancer patients are often excluded from anticoagulation and AF intervention trials due to the nature of their disease, and risk scores such as HAS-BLED, CHADS2/CHADS2-VASc often underpredict the high risk of AF and related complications for these patients.

Research Question:
Does left atrial appendage occlusion (LAAO) reduce mortality, major bleeding events (MBE), and stroke in cancer patients with AF?

Methods:
Using TriNetX, an international health research network with data from over 100 million patients, cancer patients with AF, with and without LAAO were identified between 2015 and 2022. Equal cohorts of 147 patients were created after propensity score matching for demographics, diabetes, hypertension, and heart failure. Measures of Association and Survival Analysis were conducted between 3-months and 5-years. The primary outcome was mortality. The secondary outcomes were MBE and stroke.

Results:
The study included 294 cancer patients with AF, with 147 having received LAAO. The risk of mortality at 3 months was 6.8% in the LAAO+ group compared to 15% in the LAAO- group (p-value= 0.025). At 6 months, the mortality risk was 8.8% in the LAAO+ group and 18.4% in the LAAO- group (p-value= 0.017). At 1 year, the mortality risk was 12.2% in the LAAO+ group and 23.8% in the LAAO- group (p-value=0.010). At 5 years, the mortality risk was 28.6% in the LAAO+ group and 49.7% in the LAAO- group (p-value<0.0001).

The MBE risk was 20.4% for the LAAO+ group and 32% for the LAAO- group at 3 months (p-value= 0.024). At 6 months, the MBE risk was 25.9% in the LAAO+ group and 40.1% in the LAAO- group (p-value=0.009). Although there was no significant difference in risk of MBE at 1 year and 5 years, survival was higher among the LAAO+ group than the LAAO- group (64.92% vs 52.76%; p-value= 0.038 at 1 year and 52.67% vs 39.23%; p-value=0.029 at 5 years). However, there was no difference between stroke risk or survival probability across all measured time points.

Conclusion:
LAAO in cancer patients with AF was associated with significantly reduced mortality and major bleeding events over a 5-year period compared to those without LAAO. These findings suggest that LAAO may be a beneficial intervention for improving survival and reducing bleeding complications in cancer patients with AF.
Abstract 4138230: Incidence of Worsening Tricuspid Regurgitation Following Implantation of Leadless versus Dual-Chamber Pacemakers
Authors: Aldaas Omar , Gil Jesus , Ho Gordon , Birgersdotter-Green Ulrika
Published: November 2024

Introduction:
Cardiac implantable electronic devices (CIED) may result in or worsen tricuspid regurgitation (TR), which is associated with a higher risk of morbidity and mortality (
Figure 1
). However, the incidence of TR following implantation of leadless pacemakers versus dual-chamber pacemakers (DC-PPM) is not well described.

Hypothesis:
Micra leadless pacemakers will have a lower incidence of worsening TR relative to standard DC-PPMs.

Aims:
To evaluate the incidence of worsening TR after implantation of leadless and DC-PPMs.

Methods:
We performed a retrospective study of all patients who underwent Micra leadless pacemaker or DC-PPM implantation at the University of California, San Diego from 2/2019-2/2024. The primary outcome was incidence of worsening TR.

Results:
A total of 476 patients underwent CIED implantation with both pre- and post-echocardiograms completed, of which 26.9% (n=128) had a Micra leadless pacemaker implanted and 73.1% (n=348) had a DC-PPM implanted. The average time to first post-implantation echocardiogram was 359 days in the Micra group and 510 days in the DC-PPM group (p=0.004). Worsening TR post-CIED implantation occurred in 21.9% (n=28) of patients who had a Micra and 25.9% (n=90) of patients who had a DC-PPM (p=0.192). The TR worsened by an average of 0.88 ± 0.32 grades in the Micra group versus 0.98 ± 0.33 grades in the DC-PPM group (p=0.08).

Conclusion:
In this analysis, leadless pacemaker implantation was associated with a statistically insignificant trend towards less TR. However, the degree of worsening TR following leadless pacemaker or DC-PPM implantation is relatively mild and of unclear clinical significance.
Abstract 4138238: A Tense Race: Correlation of Liver Stiffness with Ultrasound Elastography and Hemodynamics in Fontan Patients.
Authors: Lo Yau Yuen , Purlee Matthew , Brinkle Lindsey , Gupta Dipankar , Lopez-Colon Dalia , Saulino David , Coppola John Anthony , Vyas Himesh
Published: November 2024

Background:
Ultrasound elastography (USE) is a non-invasive tool to diagnose and monitor liver fibrosis. Patients with Fontan physiology are predisposed to congestive hepatopathy, progressive liver fibrosis, and end-stage liver disease. We sought to determine whether hemodynamics pre- and post-Fontan are associated with increased liver stiffness on USE.

Methods:
A single-center retrospective study included Fontan patients who had one or more USE between 06/2008-03/2024. Liver stiffness was reported as shear wave elastography (SWE) in m/s. Hemodynamic data pre- and post-Fontan and recent echocardiographic data were collected. Data was analyzed as continuous (linear regression model) and as a dichotomous variable (t-test).

Results:
A total of 78 post-Fontan USE results in 56 patients were analyzed. Table 1 describes the demographics of our patient population. The spectrum of fibrosis based on USE was normal (3.8%), mild (10.3%), moderate (55.1%) and severe (30.8%). In patients with more than one USE, the average increase in SWE was 0.04m/s per month. Pre-Fontan median Glenn pressure was 12mmHg [IQR 13, 15] (p=0.83). On post-Fontan catheterization, median Fontan pressure was 18mmHg [16, 21] (p=0.86). We did not find a significant correlation between hemodynamics and severity of liver stiffness on USE (Tables 2&3). No correlation was seen between USE and severity of ventricular function or atrioventricular valve regurgitation. SWE as a function of time from Fontan operation (<5 yr, 5-10 yrs, >10 yrs) did not vary significantly.

Conclusions:
USE as a marker of liver congestion does not correlate with hemodynamics pre- or post-Fontan. Further studies are necessary to determine the clinical utility of USE in Fontan patients.
Abstract 4138277: Protamine Administration and Bleeding Risk Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis
Authors: Kara Arwi Omar , S. Beshr Mohammed , Alzubi Alhasan Saleh , Alansari Arowa hassan abdulrahman , Arhaym Esraa , Mukhtar Aburawi Dania , EL AWAMI MOSTAFA , Shahin Hatim , Abdelwahed Abdelrahman Farag , Abdulsalam Anas Atiyah , ALMEZGHWI HEYAM , Elhadi Muhammed
Published: November 2024

Background:
Bleeding risk is a major concern for patients receiving transcatheter aortic valve implantation (TAVI) due to heparin use. In recent studies, Heparin antagonists, such as protamine, have shown potential in mitigating this complication. We aim to evaluate its potential role in reducing the risk of bleeding in patients post-TAVI.

Methods

On March 18, 2024, related articles were searched in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion criteria consisted of studies that reported the use of protamine in patients who underwent TAVI, with the aim of reducing bleeding risk compared to administering a placebo or no treatment. Our primary outcomes included major bleeding, life-threatening bleeding, the need for blood transfusion, the 30-day mortality rate, and any events of stroke or transient ischemic attack (TIA). The effect size was calculated using the odds ratio with a 95% confidence interval. Meta-analysis was conducted based on random-effect model using Revman.

Results

Out of the 14,705 articles we obtained, only 5 papers were included. One was a randomized controlled trial; the remaining 4 were observational cohorts with control groups. These studies comprised a total of 3,502 patients. Protamine significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p = 0.0003, I
2
= 37%), especially with full-dose administration (1 mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH) (OR 0.38, 95% CI 0.25-0.58, p < 0.00001, I
2
= 0%). Similarly, protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI 0.20-0.67, p = 0.001, I
2
= 4%), particularly with full-dose usage compared to partial-dose (OR 0.37, 95% CI 0.18-0.73, p = 0.004, I
2
= 0%). However, no significant difference was observed in the need for blood transfusion (OR 0.75, 95% CI 0.46-1.24, p = 0.27, I
2
= 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p = 0.56, I
2
= 49%), or 30-day mortality (OR 0.93, 95% CI 0.62-1.39, p = 0.73, I
2
= 0%).

Conclusions

The use of protamine appears to significantly reduce major and life-threatening bleeding. The need for blood transfusion, risk of stroke or TIA, and 30-day mortality did not show significant differences. These findings suggest that protamine may be an effective intervention for reducing bleeding complications post-TAVI. However, large randomized controlled trials are needed to validate these findings.