bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15798: Prevalence and Effects of Pulmonary Embolism on Hospital Outcomes Among COVID-19 Patients
Authors: Appunni Sandeep , Ramamoorthy Venkataraghavan , Zhang Zhenwei , Ahmed Md Ashfaq , McGranaghan Peter , Salami Joseph , Morcos Ramez , Rubens Muni , Saxena Anshul , Veledar Emir , Jimenez Javier , Chaparro Sandra
Published: June 2023

Introduction:
Approximately 531 million cases of coronavirus disease 2019 (COVID-19) has been reported globally, leading to 6.3 million deaths. Many studies have previous studies have reported that PE is a significantly dangerous complication of COVID-19. Therefore, we explored the prevalence of PE among COVID-19 hospitalizations. We also looked for the adverse effects of the coexistence of these two conditions using a large administrative database.

Hypothesis:
PE among COVID-19 hospitalizations could significantly increased the risk for adverse in-hospital outcomes.

Methods:
Using a retrospective analysis of the 2020 California State Inpatient Database we identified all COVID-19 hospitalizations and PE using ICD-10-CM codes among patients aged 18 years and above. Several outcomes such as in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were explored for differences between those with and without PE. Prolonged length of stay was defined as hospital length of stay ≥75th percentile. We used multivariate logistic regression analyses to understand the relationship between PE and adverse hospital outcomes after accounting for cofactors.

Results:
A total of 94,114 COVID-19 hospitalizations were included for the analysis, of which 1798 (1.9%) had PE. COVID-19 hospitalizations with PE had significantly greater rates of adverse hospital outcomes such as mortality (19.5% versus 11.2%, P<0.001), prolonged length of stay (40.0% versus 28.2%, P<0.001), vasopressor use (4.6% versus 2.1%, P<0.001), mechanical ventilation (20.4% versus 9.9%, P<0.001), and ICU admission (19.6% versus 9.6%, P<0.001). PE significantly increased the odds of for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84).

Conclusions:
Though very few COVID-19 hospitalizations in our cohort had PE, they had greater risk for adverse hospital outcomes and death. Given these adverse associations, PE among COVID-19 patients should be aggressively treated in order to decrease the disease burden of COVID-19.
Abstract 15806: The Unique Cellular Ecosystem of the Human Basilic Vein: A Single-Cell Transcriptomic Analysis
Authors: Rojas Miguel G , Martinez Laisel , Pereira-Simon Simone , Zigmond Zachary , Santos Falcon Nieves , Salama Alghidak , Vazquez-Padron Roberto I
Published: June 2023

Introduction:
The cells in veins that contribute to vascular disease have not been fully characterized. This study generated a cellular atlas of the human basilic vein that will help understand vein physiology and pathologies.

Methods:
Single-cell sequencing of four basilic veins from healthy organ donors.

Results:
The integrated single-cell profile of 15,747 vein cells revealed 13 populations containing canonical and non-canonical vascular markers. The SMC population represented 16% of cells, of which 8% were purely contractile and the remaining 8% had a modulated phenotype. One cluster of modulated SMCs expressed ECM genes (collagen type IV, FN1, and TNC) while retaining high expression of contractile markers (DES, MYH11, ﻿ACTG2). The other SMC cluster had unique expression of CD36, APOE, LPL, and STEAP4, characteristic of lipid-processing cells. Surprisingly, these non-diseased veins contained a high number of resident immune cells, including pro-inflammatory macrophages (9%), CD163- and HMOX1-expressing Mhem-like macrophages (18%), lymphocytes (5%), and small counts of neutrophils (0.3%) and mast cells (0.7%). The adventitial cell populations highlighted the fundamental role of this layer in vascular maintenance, remodeling, and angiogenesis. We found a significant number of vasa vasorum ECs (6.5%) which differentiated from the luminal subpopulation (3.5%) by CD34, KDR, NOTCH4, and ICAM2 expression. There were also two types of fibroblasts. Classical fibroblasts (19%) had high expression of collagen genes, while adipogenic fibroblasts (21%) were characterized by high levels of ECM-interacting fibulins, adipocyte-associated genes (ADH1B, APOD, CXCL14, IGF1), and modulators of angiogenesis (ADM and EFEMP1). CellCall analyses identified 46 overrepresented ligand-receptor communication pathways in all clusters, including CXCL, FGF, IL-6, and complement signaling. Communication between pro-inflammatory macrophages and luminal ECs was the most overrepresented signaling connection.

Conclusions:
This comprehensive atlas of the human vein will help identify cell subpopulations relevant to venous pathologies, without relying on extrapolations from arterial biology and focusing instead on the uniqueness of vein tissues.
Abstract 15810: Cerebral Thrombus Transcriptome in Acute Ischemic Stroke
Authors: Federico Emma M , Dupont Christopher , Gonzalez Alexandra , Levitt Michael , Walker Melanie
Published: June 2023

Establishment of mechanical thrombectomy as the standard of care provides a unique opportunity to refine stroke subtype mechanism by studying thrombus retrieved from stroke patients. Using traditional pathologic methods, researchers have described the form and structure of cerebral thrombi. These methods do not spatially resolve tissues and cell populations with functional segmentation. We applied next generation genomic tools to determine the spatially resolved transcriptome within cerebral thrombus.

Methods:
Cerebral thrombus was retrieved under sterile conditions. Tissue was formalin-fixed and paraffin embedded in standard fashion. Using the GeoMx Digital Spatial Profiling platform, morphology marker antibodies and WTA RNA probes coupled to photocleavable oligonucleotide tags were applied to the slide. After hybridization of the probes to tissue sections, 24 regions of interest (ROIs) were selected, and oligonucleotide tags were released from the discrete regions of the tissue via UV exposure. Released tags were quantitated using next generation sequencing and counts were mapped back to tissue location, yielding a spatially-resolved digital profile of analyte abundance.

Results:
Sequencing quality was inspected for sufficient saturation and data normalized to the third quartile to account for differences in cellularity. 18,676 genes were assayed across the 24 ROI. Of these, 4,590 genes were expressed in 10% of ROI and 1,127 genes were expressed in 50% of ROI.

Conclusion:
Significant transcriptional activity is seen within cerebral thrombus and preliminary analysis shows feasibility for a novel application of spatial transcriptomics. Further evaluation of expressed genes provides information about the microenvironment of thrombus origin and mechanistic insight to stroke subtype etiology.

Figure.

Number of genes detected across increasing % of ROIs.
Abstract 15827: A Case of Ventricular Arrhythmia as Presentation for Cardiac Involvement of Polymyositis
Authors: Gomez Jorge , Requeña Carlos , Mehrotra Amit , Bhardwaj Chetan
Published: June 2023

Introduction:
Polymyositis is an autoimmune systemic disease which is characterized by chronic weakness and inflammation in skeletal muscle predominantly. Cardiac involvement has been reported and is a poor prognostic factor. Clinical course 61-year-old male with biopsy proven polymyositis with history of cardiac arrest secondary to ventricular fibrillation and dual chamber automatic implantable cardioverter defibrillator (AICD) implanted for secondary prevention. He had recurrent PVC-induced ventricular fibrillation causing AICD shocks. Eventually, he underwent electrophysiology study and successful ablation of PVC targeted to the basal lateral left ventricle.Transthoracic echocardiogram showed unremarkable systolic and akinetic basal inferolateral wall segment.He underwent PET-CT of myocardium which showed focal FDG uptake of the lateral basal left ventricular could indicate focal myocarditis.Endomyocardial biopsy did not show any evidence of myocarditis.Eventually he had recurrent rapid monomorphic ventricular tachycardia and was briefly placed on amiodarone. He was placed on immunosuppressive therapy managed by Rheumatology with etanercept, rituximab and IVIG. No recurrence of ventricular arrythmia has occurred since. Amiodarone has been discontinued.

Discussion:
Myocardial involvement of polymyositis is not uncommon and has been noted to increase morbidity and mortality.The most common reported manifestations include congestive heart failure, conduction abnormalities which can range from ventricular arrhythmia to complete heart block and coronary artery disease. ConclusionIt is very important to recognize polymyositis as a cause for ventricular arrhythmias in the right clinical setting as management with immunosuppressive therapy can decrease the burden in ventricular arrhythmias.
Abstract 15830: Pharmacological Inhibition of Lysophosphatidic Acid Reduces Inflammation and Enhances Myocardial Recovery After Acute Infarction in Diet-Induced Obese Mice
Authors: Tripathi Himi , Donahue Renee R , Gao Erhe , Levitan Bryana , Abdel-Latif Ahmed
Published: June 2023

Introduction:
Obesity is approaching epidemic status in the United States and is strongly associated with a higher risk of heart failure after myocardial infarction (MI), a major cause of morbidity and mortality in obese individuals. However, the mechanisms underlying obesity-associated heart failure are poorly understood. Lysophosphatidic acid (LPA), produced by autotaxin (ATX), is highly expressed in adipose tissue with increased levels in obesity and has been shown to mediate post-MI inflammation.

Methods:
3-week aged male C57BL/6J mice were randomly assigned to low-fat (LFD-10%) or high-fat (HFD-60%) diet based on the percentage of calories from fat. HFD-fed mice were randomly assigned to receive the specific ATX inhibitor, PF-8380 at 10 mg/kg twice daily. 2 months after initiating the diet, mice were randomized to undergo MI surgery (permanent ligation of the left anterior descending artery) or sham surgery.

Results:
MI was associated with an increased number of circulating inflammatory monocytes (CD45
+
/Ly6C
+
/CD115
+
), as well as cardiac total and pro-inflammatory macrophages (CD45
+
/F4-80
+
/CD11b
+
/CD86
+
), as assessed by flow cytometry (Fig. 1A). This effect was exacerbated in HFD-fed mice but significantly attenuated in HFD+PF8380 treated mice with effective ATX inhibition. Changes in circulating and cardiac immune cells were reflective of increased proliferation of bone marrow progenitors, a phenomenon that was blunted by ATX inhibition (Fig. 1B). Moreover, HFD was associated with larger scar size (Fig. 1C) and worse cardiac functional recovery (Fig. 1D) 30 days after MI. The obesity-asscoiated heart failure could be rescued by ATX inhibition.

Conclusion:
ATX/LPA plays an important role in modulating inflammation and could be a therapeutic target for obesity-related coronary heart diseases.
Abstract 15848: Prognostic Value of Left Ventricular Diastolic Function in Patients With Hypertrophic Cardiomyopathy
Authors: Gizem Cifci , Wen Songnan , Abdelrazek Ahmad , Ali Khaled , Pislaru Sorin V , Pellikka Patricia A , Kane Garvan C , Geske Jeffrey B , Pislaru Cristina
Published: June 2023

Background:
Diastolic dysfunction (DD) is frequently present in patients with hypertrophic cardiomyopathy (HCM) due to abnormal left ventricular (LV) relaxation, wall hypertrophy, increased LV filling pressures and myocardial disarray and fibrosis, even though ejection fraction (EF) remains preserved until late stages. Our aim was to investigate in a large cohort whether contemporary markers of DD and increased filling pressures are associated with outcomes in these patients.

Methods:
We screened consecutive patients with HCM who had transthoracic echocardiography and no significant valvular heart disease. The associations of septal/lateral e’ velocity, E/e’, left atrial volume index (LAVi), and tricuspid regurgitant velocity (TR) with all-cause mortality were tested. A diastolic score (DS) was also calculated (1 point for each abnormality in e’, E/e’, TR, LAVi).

Results:
1,496 patients with HCM were studied (mean age 52±15 yrs; 61% men; LV EF 69±7%;
Table).
Diastolic abnormalities were highly prevalent in these patients (
Table
). In the subset without septal reduction therapy (SRT; n=900), at a median followup of 9 years (IQR 7-11 yrs; n=78 deaths), increased E/e’ and DS were strongly associated with mortality (log-rank
P
<.0001 for both;
Figure
). However, E/e’ did not remain significant in multivariable models after adjustment for known cardiac risk factors or other significant confounders (
Table
). In contrast, DS >2 remained independently associated with ~2-fold higher mortality risk (adjusted HR 1.91 [1.14-3.20,
P
=.01]; n=693;
Table).
In patients who underwent SRT (n=596), these associations showed the same trend but attenuated.

Conclusion:
In HCM patients who did not require SRT, the severity of DD was associated with mortality, independent of cardiac pump function or known cardiac risk factors. The composite score was more powerful than E/e’. Further studies are needed to fully understand the impact of DD in these patients with and without SRT.
Abstract 15875: Poorer Arterial Compliance is Associated With Decreased Cognitive Function: The Bogalusa Heart Study
Authors: De Anda-Duran Ileana , Duran Antonio , Alonso Camilo F , Libon David , Bazzano Lydia
Published: June 2023

Introduction:
Pathological arterial stiffness has been linked to lower cognitive function (CF) in the elderly. However, information is scarce on the association between poorer arterial compliance and decreased cognitive function among middle-aged adults and whether sex and/or race modify this association. We explored this observation among noninstitutionalized individuals living in a rural community.

Methods:
This cross-sectional analysis considered 1,228 adult participants of the Bogalusa Heart Study (mean age 48.2 ± 5.3 years, 57.6% female, 33.1% Black) that completed standardized neuropsychological (NP) assessments to evaluate CF and non-invasive pulse-wave velocity (PWV) measurements to explore arterial compliance. CF was expressed as a global cognitive score (GCS). GCS and PVW were divided into quartiles, and multivariable-adjusted binary logistic regression models were employed to determine the association between the upper quartile (Q4) of PVW (poorer compliance) and the lower quartile (Q1) of GCS (decreased cognitive function), controlling for traditional CMRF, education and depression status. Race, sex, and PWV interactions were tested to explore effect modification.

Results:
In contrast to their counterparts, Blacks and males had lower GCS (p<0.001); whereas PVW was higher among Blacks and males (p<0.01). Following a significant sex*PVW interaction term, sex-specific models yielded a significant independent association between Q4 PVW and Q1 GCS (OR: 1.9, 95%CI: 1.2-3.1, p<0.01) in males only. Race did not modify this association.

Conclusion:
Poorer arterial compliance is associated with decreased cognitive function during midlife in males but not females. These findings underscore the need to introduce patient-centered, early management strategies to control arterial compliance, potentially considering a sex-specific approach, even in the absence of overt hypertension, to lower the risk of cognitive impairment typically associated with aging.
Abstract 15878: Relationship Between Cardiac Biomarkers and Echocardiographic Parameters of Cardiac Structure in Patients With Diabetes
Authors: Raygor Viraj , Segar Matthew , Chunawala Zainali , Shah Sonia , Pandey Ambarish , Chandra Alvin
Published: June 2023

Introduction:
Current guidelines recommend N-terminal pro-brain natriuretic peptide (NT-proBNP) screening to identify subclinical structural cardiac abnormalities in patients at risk for developing clinical heart failure (HF) such as those with diabetes (DM). High-sensitivity cardiac troponin (hs-cTn) is another cardiac biomarker that can predict incident HF in patients with DM. It is unclear how the addition of hs-cTn to NT-proBNP screening impacts the detection of subclinical abnormalities of cardiac structure in patients with DM.

Methods:
Participants with DM but without known CVD at visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) study who had available cardiac biomarker data and detailed echocardiographic assessment were included. The associations of abnormal hs-cTn and/or NT-proBNP (defined as hs-cTn ≥ 6 ng/L and NT-proBNP ≥ 125 pg/mL) with abnormal echocardiographic measures of cardiac structure were assessed using multivariable adjusted linear regression analysis.

Results:
Participants (N=797, mean age 75±5y, 43% male, 77% White) had mean BMI 31±6 kg/m
2
, systolic blood pressure 129±17 mmHg, and serum creatinine 1.0±0.3 mg/dL. As shown in the table, abnormal NT-proBNP was associated with higher left ventricular (LV) mass, LV end-diastolic volume (EDV), left atrial (LA) volume, and E/A ratio. Abnormal hs-cTn was associated with lower global longitudinal strain (GLS), but no other measures of cardiac structure. The combination of abnormal hs-cTn and NT-proBNP was associated with higher LV EDV and LA volume and lower GLS.

Conclusion:
Among participants with DM free of CVD, abnormal NT-proBNP was associated with several echocardiographic parameters of abnormal cardiac structure. The addition of hs-cTn to NT-proBNP did not significantly improve detection of structural cardiac abnormalities other than low GLS.
Abstract 205: Vadilation Of Neuron-specific Enolase In Cardiac Arrest Patients And Association Factors For Neurological Outcomes In The Subgroup Of Negative Neuron-specific Enolase
Authors: Lee Byungkook , Lee Dong H
Published: June 2023

Aim:
Neuron-specific enolase (NSE) alone has limitations in prognostication in cardiac arrest survivors, like other tools. To avoid early withdrawal of life-sustaining therapy, we verified the prognostic performance according to the reference value of NSE and investigated the variables related to the neurological outcomes in the patients with negative NSE.

Methods:
We performed a retrospective analysis of data from adult cardiac arrest survivors who underwent targeted temperature management at a university-affiliated hospital between January 2014 and December 2020. We measured the NSE level 48 hr after the return of spontaneous circulation. We performed receiver operating characteristics (ROC) and used the reference value of NSE (< 17 μg/L), the Youden index indicated NSE, and European Resuscitation Council (ERC) suggested NSE value (< 60 μg/L) as a threshold. We performed a multivariable logistic regression analysis to investigate the independent factors associated with true negative versus false negative for NSE cutoff. The primary outcome was 6-month neurological outcomes with Cerebral Performance Category (CPC), dichotomized into good (CPC 1 or 2) or poor (CPC 3-5) neurologic outcomes.

Results:
Of the 522 included patients, 355 (68.0%) patients had poor neurological outcomes. The area under ROC of NSE was 0.887 (95% confidence intervals [CIs], 0.856-0.913; p < 0.001) with Youden index value of 35.6 μg/L. Analyses with specific cutoff values of 17 μg/L, 35.6 μg/L, and 60 μg/L showed a sensitivity of 86.8%, 72.4%, and 58.0% with a specificity of 66.5%, 93.4%, and 98.8%, respectively. In the patients with NSE < 60 μg/L, younger age (odd ratio [OR], 0.954 [95% CIs, 0.934-0.976]), witness of collapse (OR, 3.520 [95% CIs, 1.625-7.626]) shockable rhythm (OR, 5.953 [95% CIs, 2.879-12.308]), cardiac etiology (OR, 2.796 [95% CIs, 1.444-5.416]), and lower sequential organ failure assessment (SOFA) (OR, 0.823 [95% CIs, 0.744-0.912]) were independently associated with true negative group rather than false negative group.

Conclusions:
NSE < 60 μg/L had less than 2% false-positive rate. Younger age, a witness of collapse, shockable rhythm, cardiac etiology, and lower SOFA were associated with good neurological outcomes in the negative NSE group.
Abstract 213: Remote Ischemic Conditioning To Enhance Resuscitation After Cardiac Arrest
Authors: Bartlett Emily S , Morse Sophie , Goodson Lucy , Morse Dana , Nichol Graham
Published: June 2023

Introduction:
Restoration of blood flow after out-of-hospital cardiac arrest (OHCA) induces inflammation that causes cellular injury and death. Remote ischemic conditioning (RIC) consists of brief episodes of ischemia then reperfusion to a limb. Trials in animal models in cardiac arrest and in humans with acute infarction show RIC reduces RI.

Objective:
We sought to demonstrate the feasibility and safety of RIC in patients resuscitated from OHCA and transported to hospital.

Methods:
Single site 2-arm, single blind randomized feasibility trial comparing a treatment group receiving RIC versus usual care following OHCA. For patients allocated to the intervention group, RIC was performed via 3 cycles of 5-minutes inflation then 5-minutes deflation of a blood pressure cuff applied to an upper extremity. Included were adults resuscitated from OHCA with non-traumatic etiology of arrest, spontaneous circulation present upon emergency department arrival, no response to verbal commands and ongoing or planned induced hypothermia. Excluded were those with: ST-elevation on first 12-lead ECG obtained after return of spontaneous circulation, do not attempt resuscitation (DNAR) status, drowning or hypothermia as cause of arrest, dialysis fistula in either upper extremity or pre-existing amputation of upper extremity, pregnancy or incarcerated status. The primary outcome was attrition, i.e., the proportion of patients enrolled and not on allocated therapy for the study duration.

Results:
N=30 patients were enrolled (n=14 control, n=16 intervention). Mean age was 52.5 ± 16.2 years. Twenty-seven percent had female gender and 27% had a shockable first recorded rhythm. There was 0% attrition amongst enrolled patients. Other outcomes are summarized (Table).

Conclusions:
Application of RIC after OHCA is feasible and safe. An adequately powered trial is required to assess whether RIC is effective at decreasing morbidity and mortality after CA.

TABLE: OUTCOMES
Abstract 236: Clinician-reported Physiologic Monitoring Of Cardiopulmonary Resuscitation Quality During Pediatric In-hospital Cardiac Arrest: A Propensity-weighted Cohort Study
Authors: Kienzle Martha , Morgan Ryan W , Alvey Jessica , Reeder Ron , Berg Robert A , Nadkarni Vinay M , Topjian Alexis A , Lasa Javier J , Sutton Robert M
Published: June 2023

Objectives:
The primary objective was to investigate the association between clinician-reported use of end-tidal CO2 (ETCO2) or diastolic blood pressure (DBP) to monitor cardiopulmonary resuscitation (CPR) quality during pediatric in-hospital cardiac arrest (IHCA) and survival outcomes. The secondary objective was to investigate the change in use of ETCO2 or DBP monitoring over time.

Design:
A retrospective cohort study was performed in two cohorts: 1) Patients with an invasive airway in place at the time of arrest to evaluate ETCO2 use, and 2) patients with an arterial line in place at the time of arrest to evaluate DBP use. The primary exposure was clinician-reported use of ETCO2 and DBP in each respective cohort. The primary outcome was return of spontaneous circulation (ROSC). Propensity-weighted logistic regression evaluated the association between monitoring and outcomes. The proportions of patients with clinician-reported ETCO2 or DBP monitoring were examined per calendar year.

Setting:
Hospitals reporting to the American Heart Association’s Get With The Guidelines

®

- Resuscitation registry.

Patients:
Children <18 years of age with an index IHCA arrest lasting at least one minute who had an invasive airway or arterial line in place at the time of arrest.

Interventions:
None.

Measurements and Main Results:
Between 2007 and 2021, 9710 arrests met all inclusion and exclusion criteria: 6824 in the invasive airway cohort and 2886 in the arterial line cohort. Clinicians reported using ETCO2 to monitor CPR quality in 1333 (20%) arrests and DBP in 1042 (36%). Neither ETCO2 nor DBP monitoring was associated with ROSC. Among secondary outcomes, ETCO2 monitoring was associated with higher odds of return of circulation (ROC; ROSC plus extracorporeal CPR [ECPR] (aOR 1.21 [1.03, 1.42], p = 0.02) and 24-hour survival (aOR 1.16 [1.00, 1.34], p = 0.04). Clinician-reported use of both ETCO2 and DBP monitoring increased over time (p < 0.001).

Conclusions:
Despite increasing clinician-reported use of physiologic monitoring during IHCA, neither ETCO2 nor DBP monitoring was associated with ROSC. Monitoring of ETCO2 was associated with ROC and 24-hour survival.
Abstract 240: High First Shock Success With Reduction In Refractory Ventricular Fibrillation In A Real-world Public Access Defibrillator Registry Of Out-of-hospital Cardiac Arrests
Authors: Kernaghan Amy , Harvey Adam , McAlister Olibhear , Torney Hannah , McEneaney David , Adgey Jennifer
Published: June 2023

Introduction:
Refractory VF, which is defined as fibrillation that persists after three or more shocks, has been reported to occur in 20% of VF presenting cardiac arrest patients. This analysis was conducted to assess the frequency of shock resistant VF, during OHCA treated with a public access defibrillator (PAD).

Methods:
Heartsine Samaritan PAD post-market data collected between October 2012 to January 2021 were analyzed; electrocardiography (ECG) is recorded by the PAD and is assessed for shockability immediately after detecting patient impedance and then following each 2-minute period of CPR. Shock success (SS) was determined for each shock. SS was defined as one in which the initial shockable arrhythmia was terminated for at least five seconds. A consecutive shock was defined as a shock delivered after the first analysis mode following a previous shock.

Results:
Data was analyzed for 1082 patients who received at least one shock during OHCA. First shock success (FSS) was 88.2% (862/977 assessable shocks). At least three consecutive shocks were delivered in 207/1082 (19.1%) patients. Three patients (3/207, 1.4%) had two unsuccessful shocks followed by termination of VF on the third shock. A further thirteen (13/204, 6.4%) patients had VF which was resistant to defibrillation (i.e., three or more consecutive failed shocks with no observed successful shock). In the remaining 191 patients at least one of the three consecutive shocks was successful, or shock success could not be determined.

Conclusion:
The prevalence of shock resistant VF for OHCA treated with a PAD is much lower (6.4%) than published data. This low prevalence is in part due to the high FSS observed resulting in reduction in the number of possible shock resistant cases.
Abstract 267: Differences Of Temporal Trends In Outcomes After Out-of-hospital Cardiac Arrest Between Urban And Rural Regions In Japan: A 4-year Observational Study From 2016 To 2019
Authors: Funada Akira , Goto Yoshikazu
Published: June 2023

Introduction:
Recently, multiple studies have demonstrated improvement in survival after out-of-hospital cardiac arrest (OHCA). However, outcomes after OHCA vary with region and city worldwide.

Hypothesis:
Differences of temporal trends in outcomes after OHCA between rural and urban regions in Japan were postulated.

Methods:
We included 98,496 patients (aged ≥18 years) using an All-Japan Utstein-style Registry who were witnessed by bystanders after OHCA of presumed cardiac origin between January 1, 2016 and December 31, 2019. Based on population density, patients were classified into urban (n=76,411, 28 prefectures with a population of ≥200 inhabitants/km
2
) and rural (n=22,085, 19 prefectures with a population of <200 inhabitants/km
2
) groups. The study endpoints were 1-month survival and neurologically intact survival, defined with a cerebral performance category (CPC) score of 1 or 2.

Results:
The mean age in rural regions significantly increased from 77.1 years to 77.8 years (
P
<0.01) despite unchanged patients’ age in urban regions for 4 years (
P
=0.45). The bystander cardiopulmonary resuscitation (B-CPR) rate in urban regions significantly increased from 54.0% to 55.7% (
P
<0.01) unlike in rural regions (
P
=0.45). The overall crude 1-month survival and CPC 1-2 rates during the study periods were 10.9% and 6.8%, respectively. The overall 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.04 [95% confidence interval (CI), 1.02-1.07,
P
<0.01] and 1.03 [1.01-1.06,
P
<0.05]. In the urban group, 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.05 [95% CI, 1.03-1.08,
P
<0.01] and 1.04 [1.01-1.07,
P
<0.01]. However, in the rural group, 1-month outcomes did not significantly improve from 2016 to 2019; the corresponding risk-adjusted ratios per year were 0.99 [95% CI, 0.95-1.04,
P
=0.68] and 1.01 [0.95-1.07,
P
=0.74].

Conclusions:
One-month outcomes after OHCA significantly improved over the recent 4 years in urban regions, unlike in rural regions in Japan. No change in B-CPR rate in rural regions was noted, and an increase in the B-CPR rate in urban regions may be associated with these results.
Abstract 9334: Risk Prediction With the Anatomic Syntax Score in Patients With Left Main Coronary Artery Disease Undergoing PCI Or CABG
Authors: Bergmark Brian A , Ninomiya Kai , Murphy Sabina A , van Klaveren David , Smith Peter K , Ogara Patrick T , Kappetein A. Pieter , Park Seung-jung , Park Dukwoo , Christiansen Evald , Holm Niels R , Nielsen Per , Stone Gregg , Sabik Joseph F , Sabatine Marc S , Serruys Patrick W
Published: June 2023

Background:
Individualized risk prediction is central to personalized decision-making in patients with left main coronary artery disease being considered for revascularization.

Purpose:
To examine the prognostic performance and treatment interactions with the anatomic SYNTAX score in patients with left main disease undergoing PCI vs CABG.

Methods:
Individual patient data from the four major trials comparing PCI with DES to CABG in patients with left main disease (SYNTAX, PRECOMBAT, NOBLE, EXCEL) were combined. Patients were categorized by core lab-determined SYNTAX score categories (low: ≤22; intermediate: 23-32; high: ≥33). KM event rates were calculated in each treatment arm through 5 years. Hazard ratios were generated using a Cox model with trial as a random effect; absolute risk differences were calculated. Heterogeneity between randomized treatment effect and baseline score was tested.

Results:
4,394 patients were randomized to PCI or CABG. The SYNTAX score identified a gradient of risk for death (~2-fold) and for major coronary events (spontaneous MI or revasc; MCE) (
Fig
). The risk gradient for MCE was only apparent after PCI and not after CABG, leading to differential absolute risk reductions with CABG from 5.5% (95%CI 2.3-8.7%) to 16.2% (11.1-21.3%) in those with low vs high SYNTAX scores (P
int
=0.002). There was no significant heterogeneity across SYNTAX score categories for risk of stroke, protocol-defined procedural MI, or UDMI-defined procedural MI after PCI vs CABG.

Conclusion:
The anatomic SYNTAX score identified risk for death and coronary events following PCI and CABG for left main disease. Mortality was similar after PCI and CABG across SYNTAX score categories. In contrast, MCE risk increased with higher SYNTAX scores after PCI but not after CABG, and the anatomic SYNTAX score thus identified high-risk patients with greater relative and absolute MCE reductions with CABG.
Abstract 9390: Cardiac Geometry, Function, and Mechanics in Biventricular Takotsubo Syndrome
Authors: de la Villa Ricardo , Porudominsky Ruben , Lozier Matthew , Urina Daniela , Ujueta Francisco , Mihos Christos
Published: June 2023

Introduction:
Approximately 30% of patients with Takotsubo syndrome have biventricular involvement (BiV-TTS), which confers an increased morbidity. This study aimed to detail cardiac geometry, function and mechanics in BiV-TTS.

Methods:
Twenty-five patients diagnosed with BiV-TTS according to the InterTAK diagnostic criteria between 2006 to 2020 were retrospectively identified and analyzed with 2-dimensional and speckle-tracking strain echocardiography. An independent t-test, Mann-Whitney U-test, or Kruskal-Wallis test were used for the statistical analyses.

Results:
Mean age was 71.1 ± 17.9 years, and 56% were female. The LV ejection fraction was decreased (31.4 ± 12.2%), chamber size was increased (end-systolic volume index: 41.3 ± 10.2 ml/m2), and 48% had concentric remodeling. The right ventricular (RV) size was upper normal (40.6 ± 4.1 mm), and tricuspid annular plane systolic excursion was decreased (12.0 ± 2.6 mm). Sixteen patients had suitable images for speckle-tracking analysis. Global LV longitudinal strain was impaired (-7%, IQR -9.6 to -4.5), with significant differences between basal (-7.1%), mid (-4.3%), and apical (-0.2%) territories (P=0.001). Segmental strain within the LV base statistically varied, with the anteroseptum most impaired (-3.1%) and the inferolateral segments most preserved (-11%) (p=0.01). RV free wall strain was impaired (-9.9% ± 4.7), and differed between basal (-14.6%), mid (-11.9%), and apical (-5.4%) territories (P<0.001). Females had worse global LV (-4.6 vs. -9.5%, p=0.02) and similar RV free wall strain (-9.6 vs. -10.2%, p=0.78) impairment compared with males.

Conclusions:
Chamber remodeling, dysfunction, and mechanical impairment characterize BiV-TTS. Important differences exist in territorial and segmental strain values, and between genders.
Abstract 9957: Utility of Cardiac MRI Assessment of Right Ventricle Function Before LVAD Implantation
Authors: Lee Dae H , Zaidi Syed Imran , Madu Chinedu , scoma christopher , Chhaya Ronak , Feliberti Jason , Mackie Benjamin , Patel Aarti , PATEL NIDHI
Published: June 2023

Introduction:
Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a feared complication. Right ventricle (RV) dysfunction by echocardiogram prior to LVAD implant is a significant risk factor for post-LVAD RVF. However, RV’s unique crescent shape makes it difficult for accurate assessment through echocardiogram. Cardiac MRI can image RV in its entirety and is the gold standard for evaluating RV size and function.

Hypothesis:
Our study aimed to assess RV comprehensively through cardiac MRI before LVAD implantation to predict severe RVF post-LVAD.

Methods:
This retrospective cohort study included 231 consecutive patients who underwent LVAD from January 2015 to July 2021. We utilized the commercially available QStrain Application (Medis Suite, the Netherlands) for feature-tracking myocardial strain using gated cine SSFP images. We also assessed for quantitative measurements of RV (systolic/ diastolic volume, stroke volume, and systolic function).

Results:
There were 12 patients with cardiac MRI before LVAD, of which 4 patients developed severe RVF after LVAD. There were 9 cardiac MRIs available for strain analysis (image quality and old studies before 2012). The RV end-systolic volume (ESV) was higher in severe RVF post-LVAD, but not RV ejection fraction. Endocardial and myocardial global longitudinal strain and global radial strain of RV were not different in severe RVF.

Conclusions:
In this small series investigating RV function before LVAD implant, we have shown that ESV was higher with severe RVF. Although feature tracking strain of RV was not different in patients with severe RVF, a larger cohort study is warranted to investigate this.
Abstract 9970: Characteristics Associated With Risk-Standardized Acute Admission Rates Among Patients With Heart Failure Enrolled in Accountable Care Organizations
Authors: Chuzi Sarah , Lindenauer Peter , Faridi Kamal , Priya Aruna , Pekow Penelope S , D'Aunno Thomas , Mazor Kathleen M , stefan mihaela , Spatz Erica S , Gilstrap Lauren , Werner Rachel , Lagu Tara
Published: June 2023

Introduction:
Accountable Care Organizations (ACOs) aim to improve quality and reduce costs of care, but few studies have described variation across ACOs in hospitalization rates for patients with heart failure (HF) or factors associated with hospitalization rates.

Methods:
We identified a sample of Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program (MSSP) ACO in 2017 and survived at least 30 days into 2018. Using a hierarchical, negative binomial model that accounted for clustering of patients within ACOs, we calculated 2018 risk-standardized, unplanned ACO admission rates (RSAARs) as the ratio of predicted to expected admissions per 100 persons, multiplied by the overall rate of admissions. We then used multiple linear regression to identify ACO characteristics associated with RSAAR variation.

Results:
Among 1,232,222 beneficiaries with HF, 283,795 were assigned to one of 467 MSSP ACOs (mean age 81 years, 54% female, 86% white, 78% urban). Median RSAAR [IQR] was 87 [82-92] admissions per 100 persons (Figure 1). A 5% increase in the percentage of Black beneficiaries in the ACO corresponded to an increase of 0.65 admissions per 100 HF patients (95% CI 0.31, 0.99, p<0.001). ACOs in the Northeast had higher RSAAR (B=5.16, 95% CI 3.25, 7.07, p<0.001), while ACOs in the West had lower RSAAR (B=-4.36, 95% CI -6.64, -2.09, p<0.001) (Table 1).

Conclusions:
Among Medicare beneficiaries with HF, there is variation in admission rates across ACOs. Region was strongly associated with RSAAR. Further studies should examine whether regional variation in admission rates is related to ACO quality or regional variation in admission more generally.
Abstract 9971: Distribution of Coronary Artery Calcium and Risk for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Allen Tara S , Criqui Michael H , Allison Matthew A , Reyes Mikaila P , Denenberg Julie O , Bhatia Harpreet S
Published: June 2023

Introduction:
We tested the hypothesis that specific arteries with coronary artery calcium (CAC) would be associated with higher risk for incident cardiovascular disease (CVD) outcomes, even after accounting for traditional risk factors, and that adding this metric to current risk scores would improve event prediction.

Methods:
We analyzed data from 3,255 MESA participants with baseline CAC and event follow-up. Cox proportional hazards models assessed the independent associations between CAC presence in each of the main coronary arteries and incident myocardial infarction (MI), hard coronary artery disease (CHD), and hard CVD, adjusting for the ASCVD risk score and CAC volume and density. Area under the receiver operating characteristic curve (AUC) analyses assessed for risk discrimination by adding CAC distribution to existing risk models.

Results:
At baseline [mean age 66 years (SD 9.6); 1,893 female (58%)], 2,909 (89%) participants had CAC in the left anterior descending (LAD), 1,871 (58%) in the left circumflex (LCx), 1,691 (52%) in the right coronary artery (RCA), and 693 (21%) in the left main (LM). Over a median of 15.5 years, 275 developed MI, 408 CHD, and 598 CVD. After adjustment for the ASCVD risk score and CAC volume and density, only the RCA remained significant for MI and CHD, and was borderline for CVD (Table). AUC increased after adding RCA CAC presence to the ASCVD risk score for MI (0.5992 to 0.6660; 95% CI 0.031-0.102) and CHD (0.6483 to 0.6818; 95% CI, 0.003-0.064), but not for CVD, and there was no significant increase for any endpoints when added to models accounting for CAC volume and density.

Conclusion:
Prevalent CAC was most common in the LAD, followed by the LCx and RCA. Accounting for risk factors and CAC measures, the RCA was the only artery independently associated with additional MI and CHD risk. Moreover, MI and CHD risk prediction were improved with the addition of CAC distribution to the ASCVD score but not when also accounting for CAC volume and density.
Anomalocolax nemipteri gen. et sp. nov. (Copepoda, Cyclopoida, Bomolochidae) recovered from Nemipterus japonicus (Bloch, 1791) (Actinopterygii) in Japan
Authors: Izawa Kunihiko
Published: June 2023

Anomalocolax nemipteri gen. et sp. nov. is described based on a single specimen of the female recovered from the bucco-branchial cavity of the Japanese threadfin bream, Nemipterus japonicus (Bloch, 1792) (Nemipteridae) in Japan. This species is unique in the family in having one process on the first free segment of the antennule in addition to five plumose setae in the adult female.
On Pseudocypretta franki n. sp. (Ostracoda, Cyprididae) from Lake Sibaya, South Africa
Authors: Ferreira Vitor Góis , Higuti Janet , Martens Koen
Published: June 2023

Pseudocypretta franki n. sp. is described from Lake Sibaya in South Africa. This is the first African species of the genus, which has two further Asian and one South American species. Clearly, the genus has a much wider distribution than originally thought and it is postulated that further species could be found in zoogeographical regions from where it is presently unknown. Pseudocypretta franki n. sp. differs from its congeners in the much larger overlap of the right valve by the left valve along anterior, ventral and posterior sides, and by the shape of the valves both in dorsal and in lateral views. The new species lacks the caudal rami, just as in the South American P. amor, whereas both Asian species do have Cypridopsinae-type reduced caudal rami.
The Historical School and German International Legal Thought in the 19th Century
Authors: von Bernstorff Jochen , Mayer Max
Published: June 2023

This article traces the influence of the German Historical School of Law around Friedrich Carl von Savigny has had on various fundamental concepts of international law during the 19th and into the beginning of the 20th century in a detailed manner. During this time, the Historical School’s radical reformulation of the notion of law as a peoples’ spiritual essence unfolding through its habitual social action allowed 19th century scholars to redefine international law as customary law and, together with notably Hegelian teleological thought, laid conceptual groundwork for the integration of themes of European cultural superiority into the doctrines and philosophy of international law. Its conceptual legacy can further be traced in the later German positivism à la Jellinek or Oppenheim with its theories on ‘common civilised consent’ as foundation of international law.
The Strategy of Strengthening the Country Through Higher Education in China: a Historical Policy Perspective
Authors: Li Kun , Li Jian
Published: June 2023

The strategy of strengthening the country through higher education in China concentrates on building a stronger higher education country is the necessary requirement for implementing the strategy of strengthening the country with talents and enhancing our overall national strength and international competitiveness. Building a strong country in higher education is an inevitable requirement for strengthening the ability of independent innovation and building an innovative country. Building a strong country in higher education is an inevitable requirement for building an advanced socialist culture and promoting the great development and prosperity of culture. In addition, this study also put forward the ideological route and strategic focus of the construction of higher education power.
Modernization of Higher Education Governance in China: Contexts and Ideas
Authors: Li Jian , Wei Yukai
Published: June 2023

The governance of higher education in China is a systematic project. Only by coordinating various systems can we build a scientific and reasonable national higher education governance system and comprehensively improve the governance capacity and performance of the country. To achieve this general goal, we need to promote overall progress and key breakthroughs, strengthen the combination of top-level design and correctly handle the relationship between the state and society, government, and market, central and local, government administration and public participation, economic efficiency, and social equity on the basis of the rule of law.
Use of mobile applications and health technologies among dementia caregivers with chronic conditions: A cross-sectional study
Authors: Mendez Kyra Jennifer Waligora , Labrique Alain Bernard , Budhathoki Chakra , Sadak Tatiana , Tanner Elizabeth K. , Cotter Valerie T. , Han Hae-Ra
Published: June 2023

Objective

Almost 80% of people, who are caring for someone with dementia, have one or more chronic conditions and require self-management support. New technologies offer promising solutions; however, little is known about what technologies caregivers use for their health or in general. This study aimed to describe the prevalence of mobile application (app) and health-related technology use among caregivers who have chronic conditions and care for someone with dementia.

Methods

A cross-sectional study was conducted with 122 caregivers recruited online and from communities in the Baltimore-metropolitan area. Data were collected with online surveys and computer-assisted telephone interviews. Descriptive and inferential statistics were used to analyze survey data.

Results

Study participants were primarily female (95 of 122, 77.9%), middle-aged (average 53 years, standard deviation (SD) 17), well educated (average 16 years, SD 3.3), an adult child of the person with dementia (53 of 122, 43.4%), and had 4 chronic conditions on average (SD 2.6). Over 90% of caregivers used mobile apps (116 of 122), spending a range of 9 to 82 min on each app. Most caregivers reported using social media apps (96 of 116, 82.8%), weather apps (96 of 116, 82.8%), and/or music or entertainment apps (89 of 116, 76.7%). Among caregivers using each app type, more than half of caregivers used social media (66 of 96, 69%), games (49 of 74, 66%), weather (62 of 96, 65%), and/or music or entertainment apps (51 of 89, 57%) daily. Caregivers also used several technologies to support their own health—the most common being websites, mobile devices, and health-related mobile apps.

Conclusion

This study supports the feasibility of using technologies to promote health behavior change and support self-management among caregivers.
Allelic variation of KIR and HLA tunes the cytolytic payload and determines functional hierarchy of NK cell repertoires
Authors: Philippon Camille , Tao Sudan , Clement Dennis , Haroun-Izquierdo Alvaro , Kichula Katherine M. , Netskar Herman , Brandt Ludwig , Oei Vincent Sheng , Kanaya Minoru , Lanuza Pilar Maria , Schaffer Marie , Goodridge Jodie P. , Horowitz Amir , Zhu Faming , Hammer Quirin , Sohlberg Ebba , Majhi Rakesh Kumar , Kveberg Lise , Önfelt Björn , Norman Paul J. , Malmberg Karl-Johan
Published: June 2023

The functionality of natural killer (NK) cells is tuned during education and is associated with remodeling of the lysosomal compartment. We hypothesized that genetic variation in killer cell immunoglobulin-like receptor (KIR) and HLA, which is known to influence the functional strength of NK cells, fine-tunes the payload of effector molecules stored in secretory lysosomes. To address this possibility, we performed a high-resolution analysis of KIR and HLA class I genes in 365 blood donors and linked genotypes to granzyme B loading and functional phenotypes. We found that granzyme B levels varied across individuals but were stable over time in each individual and genetically determined by allelic variation in HLA class I genes. A broad mapping of surface receptors and lysosomal effector molecules revealed that DNAM-1 and granzyme B levels served as robust metric of the functional state in NK cells. Variation in granzyme B levels at rest was tightly linked to the lytic hit and downstream killing of major histocompatibility complex–deficient target cells. Together, these data provide insights into how variation in genetically hardwired receptor pairs tunes the releasable granzyme B pool in NK cells, resulting in predictable hierarchies in global NK cell function.