bluuebunny/crossref_metadata_2025 huggingface dataset:
Biosynthesis and Chemopreventive Potential of Jute (Corchorus
capsularis and C. olitorius) Flavonoids and Phylogeny of
Flavonoid Biosynthesis Pathways
Authors: Satya Pratik , Sarkar Debabrata , Chatterjee Amitava , Pal Srikumar , Ray Soham , Sharma Laxmi , Roy Suman , Bera Amit , Ghosh Srinjoy , Mitra Jiban , Kar Gouranga , Singh Nagendra Kumar
Published: February 2022

Flavonoids are valuable phytochemicals for human health and nutrition. Jute
(Corchorus capsularis and C. olitorius), a vegetable rich in
phenolics and flavonoids, is globally consumed for its health benefit, but the
biosynthesis pathways and metabolic profiles of its flavonoids are poorly
characterized. Elucidating the flavonoid biosynthesis pathways would augment the
broader use of jute, including targeted synthesis of its specific flavonoids. We
reconstructed the core flavonoid biosynthesis pathways in jute by integrating
transcriptome mining, HPLC and flavonoid histochemistry. In C. capsularis
(white jute), the flavonoid biosynthesis pathways’ metabolic flux was
driven toward the biosynthesis of proanthocyanidins that mediate the acquisition
of abiotic stress tolerance. However, higher levels of flavonols in C.
olitorius (tossa jute) render it more suitable for nutritional and
medicinal use. Jute flavonoid extract exhibited in vitro inhibition of
matrix metalloproteinase-2, suggesting its potential chemopreventive and
immunity-boosting roles. Using the flavonoid biosynthesis pathways profiles of
93 plant species, we reconstructed the flavonoid biosynthesis pathways phylogeny
based on distance-based clustering of reaction paths. This reaction-path
flavonoid biosynthesis pathways phylogeny was quite distinct from that
reconstructed using individual gene sequences. Our flavonoid biosynthesis
pathways-based classification of flavonoid groups corroborates well with their
chemical evolution, suggesting complex, adaptive evolution of flavonoid
biosynthesis pathways, particularly in higher plants.
Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension
Authors: Pasha Hamdan Ahmed , Wasif Muhammad , Ikram Mubasher , Hammad Muhammad , Ghaloo Shayan Khalid , Rashid Zafar
Published: February 2022

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.

Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.

Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.

Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.

Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.
Gastroesophageal Stents for the Management of Post Sleeve Gastrectomy Leakage: Interventional Radiology Experience
Authors: Bin Dahmash Abdulmajeed , Arabi Mohammad , Alfutais Aljabriyah , Alswayah Mohammed A. , Alshehri Shaker , Salman Refaat , Zahrani Yousof Al , Almoaiqel Mohammed
Published: February 2022

Objective The aim of this study was to assess the efficacy and safety of retrievable, self-expandable gastroesophageal stents to manage gastric leaks post sleeve gastrectomy by interventional radiology (IR).

Methods This is a retrospective study of patients with gastric leaks post sleeve gastrectomy who were managed with gastroesophageal stent placement. The diameters of the stents ranged from 23 to 30 mm and the lengths 12.5 to 24 cm.

Results Thirty-one patients (mean age, 32.4 ± 7.97 years) were included in the study, and 46 stents were placed. The total average stenting time was 59.1 ± 35.5 days. Leakage resolved in 93.5% of the patients. Thirty-eight (82.6%) of the stents were retrieved by IR, and the remaining stents were retrieved under endoscopic visualization. Stricture occurred as a complication in four patients: three of which were treated with stenting (one by IR and two by endoscopy) and one required esophagoplasty. Six patients experienced stent migration, three of which underwent stent adjustment, while the remaining three underwent stent reinsertion

Conclusion Gastroesophageal stent placement by IR for gastric leaks post sleeve gastrectomy is safe and effective in our study.
Utility of Administrative Databases and Big Data on Understanding Glioma Treatment—A Systematic Review
Authors: Owens Monica-Rae , Nguyen Sarah , Karsy Michael
Published: February 2022

Background Gliomas are a heterogeneous group of tumors where large multicenter clinical and genetic studies have become increasingly popular in their understanding. We reviewed and analyzed the findings from large databases in gliomas, seeking to understand clinically relevant information.

Methods A systematic review was performed for gliomas studied using large administrative databases up to January 2020 (e.g., National Inpatient Sample [NIS], National Surgical Quality Improvement Program [NSQIP], and Surveillance, Epidemiology, and End Results Program [SEER], National Cancer Database [NCDB], and others).

Results Out of 390 screened studies, 122 were analyzed. Studies included a wide range of gliomas including low- and high-grade gliomas. The SEER database (n = 83) was the most used database followed by NCDB (n = 28). The most common pathologies included glioblastoma multiforme (GBM) (n = 67), with the next category including mixes of grades II to IV glioma (n = 31). Common study themes involved evaluation of descriptive epidemiological trends, prognostic factors, comparison of different pathologies, and evaluation of outcome trends over time. Persistent health care disparities in patient outcomes were frequently seen depending on race, marital status, insurance status, hospital volume, and location, which did not change over time. Most studies showed improvement in survival because of advances in surgical and adjuvant treatments.

Conclusions This study helps summarize the use of clinical administrative databases in gliomas research, informing on socioeconomic issues, surgical outcomes, and adjuvant treatments over time on a national level. Large databases allow for some study questions that would not be possible with single institution data; however, limitations remain in data curation, analysis, and reporting methods.
Dual-Energy Computed Tomography in Diffuse Liver Diseases
Authors: Marri Uday Kumar , Madhusudhan Kumble Seetharama
Published: February 2022

Dual-energy computed tomography (DECT) is an advancement in the field of CT, where images are acquired at two energies. Materials are identified and quantified based on their attenuation pattern at two different energy beams using various material decomposition algorithms. With its ability to identify and quantify materials such as fat, calcium, iron, and iodine, DECT adds great value to conventional CT and has innumerable applications in body imaging. Continuous technological advances in CT scanner hardware, material decomposition algorithms, and image reconstruction software have led to considerable growth of these applications. Among all organs, the liver is the most widely investigated by DECT, and DECT has shown promising results in most liver applications. In this article, we aim to provide an overview of the role of DECT in the assessment of diffuse liver diseases, mainly the deposition of fat, fibrosis, and iron and review the most relevant literature.
The pattern of breeding and management within the New Zealand Thoroughbred breeding industry 2005–2015. 1. The stallion population
Authors: Chin Y. Y. , Rogers C. W. , Gee E. K. , Stafford K. J. , Cameron E. Z.
Published: February 2022

Context There has been a contraction within the New Zealand Thoroughbred racing industry and there are limited data demonstrating how this has affected, or been reflected, within the breeding industry that supplies horses for the racing industry. A reduction in the breeding industry, to a greater extent in the sector servicing domestic rather than export market has been speculated. Aim To describe the demographics, breeding pattern, reproductive career and workload of New Zealand Thoroughbred stallions between 2005 and 2015. Methods The breeding records of all Thoroughbred stallions covering >10 mares during 2005/2006–2015/2016 breeding seasons and the lifetime breeding records of all the mares covered by these stallions were extracted from the New Zealand Thoroughbred Racing website. The demographics, population numbers, career pattern, and 10-year trend in market share of stallions in different stud fee categories were examined using descriptive analysis. The stallion’s reproductive workload was modelled deterministically. Results The breeding population reduced over the 10 years examined (mares by 20%, sires by 32%). This industry consolidation was almost entirely due to the 50% reduction in the number of mares mated to the low-priced stallions, which generated horses for the domestic market. The relative proportion of mares sent to medium- and high-priced stallions (breed to sell and export sector) doubled. The commercial breeding career of low- and medium-priced stallions and shuttle stallions was short (4–5 years). The number of mares covered by a stallion increased with stud fee category. Stallions covered a greater number of mares in October and November than in September and December because of the restricted opportunity to cover foaled mares early in the season, caused by the long gestation length of mares and the need to cover mares before December. Conclusions Findings in this study support that the contraction in the New Zealand Thoroughbred breeding industry was due to a reduction in the industry sector that focuses primarily on supplying horses for domestic racing. Commercial pressure and biological constraints heavily influenced the reproductive management of the breeding industry. The breeding management of stallions during the season is heavily influenced by stallion service fee category, which reflects his book size and the commercial appeal of the resultant progeny. Implications The contraction within the domestic sector of the breeding industry was reflected in the concurrent contraction within New Zealands domestic racing population and fewer colts and geldings entering racing. Industry breeding trends demonstrate that economic viability and optimisation of revenue depend on the breeding industry focusing on the export rather than domestic market.
Finding alternative uses for Australian rosella (
Authors: Batley Ryan J. , Johnson Joel B. , Mani Janice S. , Broszczak Daniel A. , Naiker Mani
Published: February 2022

Context Rosella (Hibiscus sabdariffa L.) is a relatively new crop in Australia, with only a few commercial producers. The calyces are harvested for human consumption, with the seed pods often discarded as a waste byproduct. However, this material may have potential as a livestock feed supplement or as a value-added product in the food processing industry. Aims This study aimed to investigate the nutritional potential of rosella pods for use as a feed supplement, including an in vitro assessment of their digestibility in beef cattle. Methods Samples of rosella plants were separated into leaves, pods and calyces, then freeze-dried and ground. These products were measured in duplicate for their antioxidant capacity, as well as protein, metal, phenolic and anthocyanin content. Samples of the dried rosella pods (n = 3) underwent in vitro digestibility analysis using rumen/pepsin digestions and were compared with samples of commercial feedstock (n = 3). The resulting simulated gastrointestinal fluids from these digestions were tested for antioxidant capacity and phenolic content. Key results The highest antioxidant and phenolic contents of plant parts were observed in the pods (14 300 mg Trolox equivalents and 2960 mg gallic acid equivalents 100 g−1, respectively), highlighting their potential for human or animal nutrition. The pods also contained moderate to high levels of minerals including calcium, potassium, sodium, magnesium, copper, iron, manganese and zinc. Although the in vitro dry matter digestibility was lower (P < 0.001) than that of a conventional grain feedstock, the rosella pod substrate released significantly higher (P = 0.02) levels of antioxidants upon digestion than the commercial feedstock. Conclusion Although rosella pod digestibility was lower than that of a conventional grain feedstock, it was comparable to mean values for Australian hays and silages. Given the higher levels of antioxidants released during digestion, rosella waste product has potential to be used in small amounts as a feed supplement, with the added benefit of enhancing free radical quenching ability. Implications This study provides evidence for further investigation of the use of rosella waste as an animal feed, which would improve sustainability in agriculture as well as potentially improve animal health.
Habanero pepper (
Authors: Nieto-Garibay Alejandra , Barraza Aarón , Caamal-Chan Goretty , Murillo-Amador Bernardo , Troyo-Diéguez Enrique , Burgoa-Cruz Carlos Alexis , Jaramillo-Limón Jhesy Nury , Loera-Muro Abraham
Published: February 2022

Drought is one of the major factors limiting global crop yield. In Mexico, agriculture is expected to be severely affected by drought. The Capsicum genus has several crop species of agricultural importance. In this work, we analysed the Capsicum chinense plant physiological responses and differentially expressed genes under water stress mainly focused on the responses elicited following recovery through repetitive stress. Plants were cultivated in an experimental block. Each block consisted of plants under water deficit and a control group without deficit. Morphometric and functional parameters, and the expression of genes related to resistance to abiotic stresses were measured. Morphological differences were observed. Plants subjected to water deficit showed impaired growth. Nonetheless, in the physiological parameters, no differences were observed between treatments. We selected abiotic stress-related genes that include heat-shock proteins (HSPs), heat-shock factors (HSFs), transcription factors related to abiotic stress (MYB, ETR1, and WRKY), and those associated with biotic and abiotic stress responses (Jar1 and Lox2). HSF, HSP, MYB72, ETR1, Jar1, WRKYa, and Lox2 genes were involved in the response to water-deficit stress in C. chinense plants. In conclusion, our work may improve our understanding of the morphological, physiological, and molecular mechanisms underlying hydric stress response in C. chinense.
Endophytic fungi and drought tolerance: ecophysiological adjustment in shoot and root of an annual mesophytic host grass
Authors: Manzur Milena E. , Garello Fabián A. , Omacini Marina , Schnyder Hans , Sutka Moira R. , García-Parisi Pablo A.
Published: February 2022

Epichloid endophytic fungi, vertically transmitted symbionts of grasses, can increase plant tolerance to biotic and abiotic stress. Our aim was to identify ecophysiological mechanisms by which the endophyte Epichloë occultans confers drought tolerance to the annual grass Lolium multiflorum Lam. Endophyte-associated or endophyte-free plants were either well-watered or subjected to water deficit. We evaluated plant biomass, root length and nitrogen concentration, and we assessed intrinsic water use efficiency (iWUE) and its components net photosynthesis and stomatal conductance, by carbon and oxygen isotope analysis of shoot tissues. Endophyte-free plants produced more biomass than endophyte-associated ones at field capacity, while water deficit strongly reduced endophyte-free plants biomass. As a result, both types of plants produced similar biomass under water restriction. Based on oxygen isotope composition of plant cellulose, stomatal conductance decreased with water deficit in both endophyte-associated and endophyte-free plants. Meanwhile, carbon isotope composition indicated that iWUE increased with water deficit only in endophyte-associated plants. Thus, the isotope data indicated that net photosynthesis decreased more strongly in endophyte-free plants under water deficit. Additionally, endophyte presence reduced root length but increased its hydraulic conductivity. In conclusion, endophytic fungi confer drought tolerance to the host grass by adjusting shoot and root physiology.
The death of political possibility? Reading State and society in Nigeria 40 years on
Authors: Roelofs Portia
Published: February 2022

In this 2019 reboot of his collection of essays from the 1970s, Gavin Williams traces the lingering the impact of colonialism and international capital on Nigeria’s political economy, the shaky development of an indigenous industrial class and the changing role of the state in national development. However, reading the book, it is not clear what such an analysis is for. Is it intended as a diagnosis? An indictment? Williams leftist commitments are clear, but amid the painstaking analysis one can ask: what is the point of studying politics? In this review article the author unpicks Williams’ at times contradictory answers to this question and argues that the book demonstrates the relevance of mid twentieth-century Nigerian politics to readers today. She poses the question of how we can navigate the possibility and risks of newly volatile twenty-first-century politics, unchained as it is from the liberal orthodoxy of the past 40 years.
Nonlinear refractive index of the gold nanoparticle/silicon quantum dot hybrid structure
Authors: Biranvand Neda , Bahari Ali , Yazdanfar Hanieh , Kodeary Ahmed Kadem , Hamidi Seyedeh Mehri
Published: February 2022

The nonlinear refractive index n2 of hybrid structure composed of metal nanoparticle, Au, and a silicon quantum dot is measured and calculated by means of experimental and theoretical methods, respectively. Experimentally, gold nanoparticles are prepared by laser ablation in liquid method and Si quantum dot by liquid jet method. By using Z-scan technique, the mixture of them is exposed by 532 nm pump light, in close aperture configuration, to obtain the nonlinear refractive index. Moreover, hybrid structure is modeled, and the third-order nonlinear susceptibility

χ

3

is calculated by the local field theory. Our results show enhanced third-order nonlinear susceptibility

χ

3

and as a result nonlinear refractive index of the sample in the presence of the gold nanoparticles theoretically by the extracted nonlinearity experimentally.
Improved sustainability assessment of the G20’s supply chains of materials, fuels, and food
Authors: Cabernard Livia , Pfister Stephan , Hellweg Stefanie
Published: February 2022

Transparency in global value chains of materials, fuels, and food is critical for the implementation of sustainability policies. Such policies should be led by the G20, who represent more than 80% of global material, fuel, and food consumption. Multi-regional input–output analysis plays an important role for consumption-based assessment, including supply chains and their environmental impacts. However, previous accounting schemes were unable to fully assess the impacts of materials, fuels, and food. To close this gap, we provide an improved method to map key aspects of sustainability along value chains of materials, fuels, and food. The results show that the rise in global coal-related greenhouse gas (GHG) emissions between 1995 and 2015 was driven by the G20’s metals and construction materials industry. In 2015, the G20 accounted for 96% of global coal-related GHG emissions, of which almost half was from the extraction and processing of metals and construction materials in China and India. Major drivers include China’s rising infrastructure and exports of metals embodied in machinery, transport, and electronics consumed by other G20 members. In 2015, the vast majority (70%–95%) of the GHG emissions of metals consumed by the EU, USA, Canada, Australia, and other G20 members were emitted abroad, mostly in China. In contrast, hotspots in the impact displacement of water stress, land-use related biodiversity loss, and low-paid workforce involve the G20’s food imports from non-G20 members. Particularly high-income members have contributed to the G20’s rising environmental footprints by their increasing demand for materials, food, and fuels extracted and processed in lower-income regions with less strict environmental policies, higher water stress, and more biodiversity loss. Our results underline the G20’s importance of switching to renewable energy, substituting high-impact materials, improving supply chains, and using site-specific competitive advantages to reduce impacts on water and ecosystems.
General truncated linear statistics for the top eigenvalues of random matrices
Authors: Grabsch Aurélien
Published: February 2022

Invariant ensembles, which are characterised by the joint distribution of eigenvalues P(λ
1, …, λ

N
), play a central role in random matrix theory. We consider the truncated linear statistics

L

K

=

∑

n
=
1

K

f

(

λ

n

)

with 1 ⩽ K ⩽ N, λ
1 > λ
2 > ⋯ > λ

N
and f a given function. This quantity has been studied recently in the case where the function f is monotonous. Here, we consider the general case, where this function can be non-monotonous. Motivated by the physics of cold atoms, we study the example f(λ) = λ
2 in the Gaussian ensembles of random matrix theory. Using the Coulomb gas method, we obtain the distribution of the truncated linear statistics, in the limit N → ∞ and K → ∞, with κ = K/N fixed. We show that the distribution presents two essential singularities, which arise from two infinite order phase transitions for the underlying Coulomb gas. We further argue that this mechanism is universal, as it depends neither on the choice of the ensemble, nor on the function f.
On the green aurora emission of Ar atmospheric pressure plasma
Authors: LIU Fengwu , NIE Lanlan , LU Xinpei
Published: February 2022

The Ar atmospheric pressure plasma was found to be an excellent laboratorial source for green aurora emission. However, the characteristic and production mechanism of the green aurora emission of the Ar atmospheric pressure plasma are still not clear. In this work, an Ar plasma in a long glass tube which emits intense green aurora light is investigated. With the long glass tube, it can be concluded that the green aurora emission in the Ar plasma is not owing to the mixture of Ar plasma plume with the surrounding air. It is also found that the green aurora emission often appeared beyond the active electrode when the active electrode is placed at the downstream of the gas flow. The green emission disappears when the traces amount of O2 or N2 (about 0.05%–0.07%) is added to Ar. This is because the O2 molecules deactivate the upper state O(1S), which results in the decrease of the green emission. On the other hand, when N2 is added, Ar metastable atoms are quenched by N2, which results in the decrease of O atoms and eventually leads to the decrease of the green emission intensity. The intensity of the green aurora emission increases when the driving voltage frequency increases from 1 to 10 kHz. More importantly, it is found that the green aurora emission is not affected when a grounded stainless steel needle is in contact with the plasma plume. Thus, the green emission is not driven electrically. All these findings are helpful for the understanding of the physics and its applications of atmospheric pressure plasma jet in space physics, laser physics and other application areas.
Kidney health for all: bridging the gap in kidney health education and literacy
Authors: Langham Robyn G , Kalantar-Zadeh Kamyar , Bonner Ann , Balducci Alessandro , Hsiao Li-Li , Kumaraswami Latha A , Laffin Paul , Liakopoulos Vassilios , Saadi Gamal , Tantisattamo Ekamol , Ulasi Ifeoma , Lui Siu-Fai ,   The World Kidney Day Joint Steering Committee, Langham Robyn G , Kalantar-Zadeh Kamyar , Balducci Alessandro , Hsiao Li-Li , Kumaraswami Latha A , Laffin Paul , Liakopoulos Vassilios , Saadi Gamal , Ulasi Ifeoma , Lui Siu-Fai
Published: February 2022

The high burden of kidney disease, global disparities in kidney care and poor outcomes of kidney failure bring a concomitant growing burden to persons affected, their families and caregivers and the community at large. Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find, understand and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient deficit, improving health literacy largely rests with healthcare providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policymakers, health literacy provides the imperative to shift organizations to a culture that places the person at the center of healthcare. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons’ and providers’ education. The World Kidney Day declares 2022 as the year of ‘Kidney Health for All’ to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of healthcare providers and health policymakers. By engaging in and supporting kidney health–centered policymaking, community health planning and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.
Global burden of heart failure: a comprehensive and updated review of epidemiology
Authors: Savarese Gianluigi , Becher Peter Moritz , Lund Lars H , Seferovic Petar , Rosano Giuseppe M C , Coats Andrew J S
Published: February 2022

Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
Additive prognostic and diagnostic value of diastolic exercise parameters in patients referred for exercise echocardiography
Authors: Peteiro Jesús , Bouzas-Mosquera Alberto , Barbeito-Caamaño Cayetana , Martin-Alvarez Esteban , Souto-Cainzos Borja , Vazquez-Rodriguez Jose M
Published: February 2022

Aims

Exercise echocardiography (ExE) may evaluate left ventricular (LV) systolic and diastolic function. We aimed to assess the value of diastolic parameters at exercise [early LV inflow velocity to early tissue Doppler annulus velocity (E/e′)] in patients with normal or abnormal resting diastolic function (DF) referred for a clinically indicated ExE.

Methods and results

LV systolic and DF according to ASE/EACVI guidelines and mitral regurgitation (MR) were evaluated at rest in 772 patients (age 67 ± 12 years) with preserved LV ejection fraction (LVEF ≥ 50%). We assessed regional/global LV systolic function at peak exercise, while MR and E/e′ where evaluated in the immediate post-exercise period. Abnormal ExE was defined as ischaemia or fixed wall motion abnormalities, and raised E/e′ values as >15 at rest and at exercise (e′ at the septal level). Patients were grouped as complaining or not of dyspnoea. Events were overall mortality, myocardial infarction, admission for unstable angina or cardiac failure, and coronary revascularization. DF was abnormal at rest in 221 patients (29%) and indeterminate in 77 (10%), with similar percentages in patients with and without dyspnoea. Exercise E/e′ >15 was found in 37% of patients with abnormal DF, 21% with indeterminate DF, and 6% with normal DF (P < 0.001). Patients with abnormal ExE had more often abnormal resting DF (39% vs. 25%, P = 0.001) and exercise E/e′ >15 (25% vs. 13%, P < 0.001) than those with normal ExE. During a median follow-up of 1.68 years, there were 132 events. Independent predictors included peak exercise LVEF [hazard ratio (HR) = 0.93, 95% confidence interval (CI) = 0.91–0.94, P < 0.001], and exercise E/e′ (HR= 1.04, 95% CI = 1.01–1.07, P = 0.01). Neither resting E/e′ values nor resting abnormal DF by ASE/EACVI guidelines, were independent predictors. Annualized event-rates were 43.2% in patients with (+) ExE plus (+) exercise E/e′, 23.8% in those with (+) ExE and (−) exercise E/e′, 7.9% in (−) ExE and (+) exercise E/e′, and 3.6% with both variables normal.

Conclusions

The results of diastolic dysfunction at rest and at exercise were similar between patients with or without dyspnoea referred for ExE, but they were associated with abnormal ExE. Exercise E/e′ reclassified 21% of patients with indeterminate DF and further predicted outcome on top of ExE results.
Wearable cardioverter defibrillator multicentre experience in a large cardiac surgery cohort at transient risk of sudden cardiac death
Authors: Kuehn Christian , Ruemke Stefan , Rellecke Philipp , Lichtenberg Artur , Joskowiak Dominik , Hagl Christian , Hassan Mohamed , Leyh Rainer G , Erler Stefan , Garbade Jens , Eifert Sandra , Grieshaber Philippe , Boening Andreas , Doenst Torsten , Velichkov Ilia , Madej Tomas , Knaut Michael , Hain Andreas , Burger Heiko
Published: February 2022

OBJECTIVES

The wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare.

METHODS

Retrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data.

RESULTS

A total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57–73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7–23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22–32%) before WCD prescription to 35% (IQR 28–42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD.

CONCLUSIONS

The risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF.
Performance of anticoagulation risk scores for predicting ischaemic stroke in dialysis patients with atrial fibrillation
Authors: Liao Y W L , Wang TKMW
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Risk models such as the CHADS₂ and revised CHA₂DS₂-VASc scores are recommended for anticoagulation decision-making in atrial fibrillation (AF) patients. Despite this, their prognostic utilities in dialysis patients with AF are not well established. We evaluated the performance of conventional anticoagulation risk scores at predicting adverse outcomes in dialysis patients with AF.

Methods

Pubmed database was searched until 3/20/2021 for studies reporting the area under receiver-operative characteristics curve (AUC) and/or hazards ratios (HR) of anticoagulation scores for adverse outcomes in dialysis patients with AF. Data was pooled using the random-effects DerSimonian-Laird method and OpenMetaAnalyst software.

Results

Amongst 260 studies screened, 34 full-text articles were reviewed and 7 eligible studies totalling 13,693 patients were analysed. Pooled AUCs (95% confidence intervals) for discriminating ischemic stroke were 0.705 (0.574-0.836) in 4 studies for the CHADS₂ score, and 0.719 (0.606-0.832) in 3 studies for the CHA₂DS₂-VASc score. Pooled HRs (95% confidence intervals) for stroke were 1.66 (1.26-2.18) in 4 studies for the CHADS₂ score, and 1.40 (1.17-1.67) in 3 studies for the CHA₂DS₂-VASc score. There were significant heterogeneity in all analyses (I2 inconsistency statistic 80.5-93.1%, P < 0.001-0.006). Only one study reported either AUC or HR for predicting other outcomes such as bleeding and deaths in these patients, insufficient for pooled analyses.

Conclusion

The CHADS₂ and CHA₂DS₂-VASc scores had moderate discriminative ability for ischemic stroke during follow-up, comparing similarly to general AF populations. Further studies are required to assess if these scores can also guide selection for anticoagulation in this challenging to manage high-risk cohort.
J waves reaching to equal or more than 2 of 3 LV inferior wall leads may predict the presence of organized myocardial fibrotic or fat change in survivors of ventricular fibrillation
Authors: Funabashi N , Kobayashi Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The distribution of J waves and the presence of organized left ventricular (LV) myocardial damage may be related in survivors of ventricular fibrillation (VF).

Purpose

To predict the presence of organized myocardial damage such as fibrotic or fat change on cardiac computed tomography (CT) using the distribution of J waves in survivors of VF.

Methods

We conducted a retrospective analysis of 21 survivors of VF (17 males; mean age, 61 ± 14 years) that were implanted with a cardioverter defibrillator and underwent cardiac CT.

Results

On ECG, 4 patients had atrial fibrillation and 15 had J waves. On CT, 13 patients had organized LV myocardial fibrotic and/or fat change in myocardium. The mean corrected QT interval was 453 ± 30 and 429 ± 48 msec in patients with and without myocardial fibrotic and/or fat change, respectively (P = 0.182). The distribution of J waves was as follows: 5 had J waves in II, III and aVF leads (one had myocardial fibrotic and/or fat change) and 2 had J waves in III lead (one had myocardial fibrotic and/or fat change). One patient each had J waves in V1 lead; V1,2 leads; II, III, aVF and V1-3 leads; I, III, aVF and V1 leads; II, III, aVF, aVL and V1-6 leads; II, III, aVF and V4,5 leads; II, III, aVF and V2-5 leads; and III and aVF leads. The first one did not have myocardial fibrotic and/or fat change and the remaining 6 had myocardial fibrotic and/or fat change. If the J waves reached to ≥1 of 3 LV inferior wall leads (II, III, aVF leads) (N = 13), 10 (77%) had LV myocardial fibrotic and/or fat change. If not (N = 8), 3(38%) had LV myocardial fibrotic and/or fat change (P = 0.071). If the J waves reached ≥2 of 3 LV inferior wall leads (N = 11), 9 (82%) had LV myocardial fibrotic and/or fat change. If not (N = 10), 4 (40%) had LV myocardial fibrotic and/or fat change (P = 0.049). If the J waves reached all three LV inferior wall leads (N = 10), 8 (80%) had LV myocardial fibrotic and/or fat change. If not (N = 11), 5 (46%) had LV myocardial fibrotic and/or fat change (P = 0.104).

Conclusions

In survivors of VF, if the J waves reached ≥2 of 3LV inferior wall leads, the frequency of organized LV myocardial fibrotic and/or fat change was significantly higher than those without. Furthermore, the distribution of J waves and the presence of myocardial fibrotic and/or fat change on CT may predict VF. Abstract Figure. CT fibrosis in VF survivors with HCM
Echinacoside inhibited cardiomyocyte apoptosis and improved heart function in heart failure rats induced by isoproterenol via suppressing nadph/ros/atf6/chop associated endoplasmic reticulum stress
Authors: Ni Y J , Gao L , Zhu W J
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Shaanxi Provincial Key Research and Development Projects (2019SF-218)

Background

Endoplasmic reticulum (ER) stress played an essential role in the development and progression of HF due to it could induce cardiomyocyte apoptosis, ATF6/CHOP was regulated by NADPH and ROS and was the crucial pathway to link ER stress and apoptosis in HF. Our previous study indicated that ECH reversed cardiac remodeling and improves heart function, but the underlying mechanisms are still unclear.

Objectives

To investigate the effect of ECH on cardiomyocyte apoptosis and endoplasmic reticulum stress and the underlying mechanisms.

Methods

In vitro, we cultured AC-16 cells and induced cell damage and ER stress by ISO, treated by ECH, the cell apoptosis and biomarkers of ER stress (GRP78, ATF6α, IRE1α, PERK) were detected. In vivo, we induced HF rat model by ISO and treated by ECH, indexes of heart function, cardiomyocyte apoptosis, biomarkers of ER stress and NADPH/ROS/ATF6/CHOP pathway were measured.

Results

In vitro, we confirmed that ECH inhibited ER stress and apoptosis. In vivo, we demonstrated that ECH inhibited cardiomyocyte apoptosis and improved heart function, it significantly decreased GRP78, ATF6α, IRE1α, PERK, and down-regulated NADPH/ROS/ATF6/CHOP pathway.

Conclusions

ECH inhibited cardiomyocyte apoptosis and improved heart function via suppressing NADPH/ROS/ATF6/CHOP pathway associated ER stress.
Cardiac resynchronization therapy in patients with true left bundle branch block : a systematic review and meta-analysis
Authors: Cheng C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background  Cardiac resynchronization therapy has been shown to improve clinical outcomes of heart failure. Still, about 30% of the patients had no response to CRT. A stricter LBBB criteria emphasizing notched or slurred R waves was newly proposed by Strauss to select patients for CRT.

Purpose  To evaluate whether true left bundle branch block defined by Strauss criteria predicts a better clinical and instrumental response to CRT.

Methods  A systematic review and meta-analysis was performed. Cohort studies including CRT patients with true left bundle branch block (LBBB) and non-true LBBB patients were identified. Non-true LBBB patients were defined as the patients who have conventional LBBB QRS morphology but not fulfilling Strauss criteria according to the ECG characteristic. Outcomes included death, heart failure(HF) hospitalization, CRT nonresponse, changes in QRS duration and left ventricular ejection fraction(LVEF).

Results  Eight studies characterizing 1697 patients were identified. Pooled analysis of random effrct model demonstrated that true LBBB patients, as compared to non-true LBBB patients, had noticeable reduction in HF hospitalization or mortality (HR 0.49 , 95%CI 0.40,0.59; p < 0.001), mortality alone (HR 0.55 , 95%CI 0.46, 0.66; p < 0.001) , and HF hospitalization alone (HR 0.45 , 95%CI 0.22,0.93; p = 0.031). For other CRT response parameters, true LBBB patients had a significantly greater improvement of LVEF (SMD 7.30, 95%CI 0.57,14.03; p < 0.001) .And the pooled value of the reduction in QRS duration was higher in the true LBBB patients (WMD -11.56, 95% CI -25.58, 2.45, P < 0.001). Overall, there were more responders in the true LBBB patients than non-true LBBB patients (OR 8.16, 95% CI 1.64, 40.46, P < 0.001).

Conclusions  True left bundle branch block patients benefits more than non-true LBBB patients. Therefore, Strauss criteria of true LBBB is strong predictor of lower mortality, HF hospitalization and better response to CRT. (PROSPERO number : CRD42021242318)
Impact of angiotensin-receptor neprilysin inhibitor on reverse cardiac remodeling in patients with heart failure with reduced ejection fraction (hfref)
Authors: Atan N , Loch ALEX , Hadi FIRDAU
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Cardiac remodeling is a detrimental consequence of heart failure. The angiotensin-receptor neprilysin inhibitor (ARNI) sacubitril/valsartan has been shown to reverse cardiac remodeling and to improve systolic function in observational studies. There is a lack of local data regarding the effects of ARNI on cardiac remodeling in Asian populations. To determine the impact of ARNI on reverse cardiac remodeling. 

The study was conducted at our University Medical Centre as a retrospective cohort study. Data was collected for the period from January 2017 until December 2020. Patients were included if they fulfilled the following criteria: i) age >18 years, ii) recent diagnosis of HFrEF (EF < 40%), iii) baseline Echocardiography was performed not more than 18 months prior to initiation of ARNI or Perindopril, iv)  Echocardiography reassessment was performed not earlier than 6 months and not later than 18 months post initiation of ARNI or Perindopril, v) the HFrEF must have been diagnosed not more than 1 year prior to  initiation of therapy. Echocardiographic parameters analyzed included Left Ventricular Ejection Fraction (LVEF), Left Ventricular End Diastolic Volume (LVEDV), and Left Ventricular End Systolic Volume (LVESV). 40 patients with complete echocardiographic sets treated with ARNI were identified. Another 40 patients treated with Perindopril and matching clinical characteristics were identified accordingly. Patients receiving ARNI recorded an increase in the LVEF from 24.9% ± 8.0% (mean ± standard deviation) to 36.4% ±12.3% (p <0.001) and improvement in LVESV by 17% from the baseline (p = 0.003). Patients treated with Perindopril demonstrated a similar improvement in the LVEF from 28.7% ± 7.4% to 40.5%±15.9% (p <0.001) with improvement in LVESV by 12.7% from the baseline (p = 0.093). The changes in LVEDV were less significant in both group (5.8% volume reduction in ARNI group and 2.6% in Perindopril group; p value 0.224 and 0.584 respectively). Treatment of recently diagnosed HFrEF patients with both ARNI and Perindopril resulted in significant improvement in the LVEF within 18 months after initiation of therapy. 

The results of the study must be interpreted with caution as for the small sample size, the retrospective character of the study, and the relatively short follow-up period.
Association of Body mass index and clinical outcomes in patient with coronary artery disease undergoing percutaneous coronary intervention
Authors: Lin T Y , Leu H B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Most of the world"s population lives in countries in which overweight status and obesity issues cause more morbidity and mortality than underweight status. Mortality increased as BMI increased above 25 kg/m², and the lowest mortality existed in a population with ideal body weight. Recently, the BMI or obesity paradox was widely discussed. The lower future risk was observed in these overweight subjects, not normal weight or lower BMI population, in patients with cardiovascular disease.

Purpose 

The association of body weight and adverse outcomes in patients with coronary artery disease, undergoing percutaneous coronary intervention (PCI), has not yet been clearly established. The purpose of our study was to investigate the outcome of patients undergoing PCI, stratified by body mass index (BMI). 

Methods

Moreover, 5,427 patients with established coronary artery disease (CAD) were enrolled while undergoing successful PCI from 2005 to 2015. The primary outcome, or total cardiovascular (CV) events, was the composite of cardiac death, nonfatal myocardial infarction, stroke, and hospitalization for congestive heart failure (CHF). 

Results

During an average 65.06 ± 32.1 month follow-up, there were 573 total cardiovascular (CV) events (18.95%), 315 major adverse cardiovascular events (MACEs) (10.42%), 105 cardiac deaths (3.47%), 169 acute myocardial infarction (MI) (5.59%), 69 ischemic strokes (CVAs) (2.28%), 314 heart failure hospitalizations (10.39%) recorded. There was a "J-shape" curve association between BMI and future adverse events. Being overweight (BMI = 25-29.9 kg/m²) was associated with significantly lower risk of future total CV events (HR: 084, 95% CI:0.72-0.98), MACEs (0.76, 95% CI:0.63-0.93), acute MIs (0.76, 95%CI:0.58-1.00), and CVAs (HR:0.61, 95%CI:0.39-0.95). 

Conclusion

A J-shape relationship exists between baseline BMI and future adverse events in CAD patients undergoing PCI, with the overweight (BMI = 25-29.9 kg/m²) group associated with the lowest risk of total CV events.