bluuebunny/crossref_metadata_2025 huggingface dataset:
Glass Beads in West Africa
Authors: Babalola Abidemi Babatunde
Published: October 2022

The earliest glass beads in the archaeological record in West Africa dates to the 7th through 5th centuries bce, predating the Islamic trade in the region. By early 2nd millennium ce, the occurrence of glass beads had increased exponentially following the influx of goods and people. Thus, glass beads on the subcontinent are traced to outside sources. Compositional analysis has revealed that most glass beads in West Africa were made from soda-lime-silica glass fluxed with either mineral soda or plant ash. A group with soda-lime-alumina and another with high concentration of lead have also been identified. The origins of the glass beads of these compositional groups have been traced to the Middle East, Mesopotamia, the Levant, the Eastern Mediterranean, South Asia, and medieval Europe connecting West African to the global interactive system. Archaeological investigations since 2010 at Ile-Ife, Southwest Nigeria have revealed the existence of the first-known West African primary glassmaking workshop dated to early 2nd millennium ce. The workshop at Ile-Ife mass-produced glass beads and became a regional center supplying glass beads to the trade network. Three techniques of glass bead manufacture are common in West Africa: drawn, wound, and molded/powdered. While drawn and wound beads have early occurrence in West Africa, molded/powdered beads appeared later, popular from the 16th century. Morphologically, glass beads of all colors, shapes, size, and diaphaneity have been recovered from archaeological context. Glass beads are ubiquitous materials in West Africa. They are materiality of globalized world, insignias of power and status, indicators of West African ingenuity and creativity, and emblems of social, political, and religious complexity.
Water and Economy-Wide Modeling: An Overview
Authors: Bryant William D. A.
Published: October 2022

General equilibrium theory thinks of the economy as a collection of interconnected markets, each of which, in isolation and in combination, is driven toward some sort of equilibrium. Computable general equilibrium (CGE) models add to this abstract point of view by calibrating models of the economy using actual economic data. The aim is to empirically solve for equilibrium demand, supply, and price levels across the markets in the economy. Many areas of economic analysis, reform, and policymaking have benefitted from scrutiny in a CGE context. This is particularly true of issues to do with tax and tariff reform, where CGE models first gained prominence. More recently, the areas of environmental economics and regulation has attracted the attention of CGE modelers. Considerations of environment and environmental regulation, inevitably involve a consideration of issues to do with water. Such issues range from aquaculture through pricing of water to virtual water—and many points in between. In the analysis of each of these issues—and the role water plays in the overall economy, CGE models have made an important contribution to understanding and informed policymaking.
Managed Aquifer Recharge as a Tool to Improve Water Security and Resilience
Authors: Cruz-Ayala Mary-Belle , Megdal Sharon B.
Published: October 2022

Groundwater overdraft is an issue faced by urban and rural water users worldwide. With climate change making efforts to meet global water demands even more challenging, improving water security and resilience is of paramount importance. Managed aquifer recharge efforts are being deployed globally to further achieve water management goals, such as helping to reduce groundwater overdraft at a local level. Artificial recharge or managed aquifer recharge (MAR) is a concept that has been applied to describe diverse methods with the aim of both augmenting groundwater resources during times when water is available and recovering the water from the same aquifer in the future when it is needed.

MAR projects are distributed in almost every continent. An extensive study published in 2018 identified that 15 countries and regions account for 76% of the installed MAR capacity (Australia, China, France, Finland, India, Israel, Italy, Jordan, Netherlands, Qatar, Southern Africa, Spain, United States, and United Kingdom). MAR is considered a viable tool to face the negative impacts of climate change and to increase public water supply at a local level. In arid and semiarid regions, MAR plays an important role because it allows the storage of large volumes of water without the risk of evaporation. MAR is used to provide water for agricultural activities in groundwater-dependent countries and regions. Increasingly, at least in India, many MAR projects are designed to protect domestic water supply. MAR is also used as a water source for maintaining environmental services, although this use is still incipient.
The Predictive Validity of the Danish Psychosocial Work Environment Questionnaire With Regard to Onset of Depressive Disorders and Long-Term Sickness Absence
Authors: Clausen Thomas , Christensen Karl Bang , Sørensen Jeppe Karl , Bjorner Jakob B , Madsen Ida E H , Borg Vilhelm , Rugulies Reiner
Published: October 2022

Objectives

To investigate the predictive validity of 32 measures of the Danish Psychosocial Work Environment Questionnaire (DPQ) against two criteria variables: onset of depressive disorders and long-term sickness absence (LTSA).

Methods

The DPQ was sent to 8958 employed individuals in 14 job groups of which 4340 responded (response rate: 48.4%). Depressive disorders were measured by self-report with a 6-month follow-up. LTSA was measured with a 1-year follow-up in a national register. We analyzed onset of depressive disorders at follow-up using logistic regression models, adjusted for age, sex, and job group, while excluding respondents with depressive disorders at baseline. We analyzed onset of LTSA with Cox regression models, adjusted for age, sex, and job group, while excluding respondents with previous LTSA.

Results

The general pattern of the results followed our hypotheses as high job demands, poorly organized working conditions, poor relations to colleagues and superiors, and negative reactions to the work situation predicted onset of depressive disorders at follow-up and onset of LTSA during follow-up. Analyzing onset of depressive disorders and onset of LTSA, we found risk estimates that deviated from unity in most of the investigated associations. Overall, we found higher risk estimates when analyzing onset of depressive disorders compared with onset of LTSA.

Conclusions

The analyses provide support for the predictive validity of most DPQ-measures. Results suggest that the DPQ constitutes a useful tool for identifying risk factors for depression and LTSA in the psychosocial work environment.
Preventing Soft Tissue Complications in Secondary Aesthetic Breast Surgery Using Indocyanin Green Angiography
Authors: Salgarello Marzia , Pino Valentina , Pagliara Domenico Maria , Visconti Giuseppe
Published: October 2022

Background

Secondary cosmetic breast surgery after primary augmentation with implant can be associated with an increased risk of adverse events. Partial/complete nipple-areola complex necrosis is particularly feared. In this preliminary study, the authors propose the utilization of indocyanine green (ICG) angiography to assess the blood supply of breast tissue after implant removal.

Objectives

The main objective was to prevent skin and gland necrosis in revision breast surgery.

Methods

The authors performed a retrospective comparative analysis of 33 patients who underwent secondary breast surgery between 2018 and 2021 by a single surgeon (M.S.). Breast tissue perfusion was assessed in 16 patients by intraoperative ICG angiography at the end of implant removal and possible capsulectomy. Non-stained/non-fluorescent areas were judged to be low perfusion areas and were excised with short scar mastopexy.

Results

In the ICG angiography group, 7 patients (44%) showed an area of poor perfusion along the inferior pole; all of these patients underwent subglandular breast augmentation. Resection of the poor perfusion areas allowed an uneventful postoperative course. In the non­­- ICG angiography group (17 patients), 5 patients experienced vertical-scar dehiscence/necrosis. We found a statistically significant association between the non-ICG angiography group and vertical scar dehiscence/necrosis, and also between vertical scar dehiscence/necrosis and subglandular implant placement (P = 0.04).

Conclusions

Safer secondary surgery can be offered to patients undergoing secondary aesthetic breast procedures, especially when the first augmentation surgery is unknown—for example, implant plane, type of pedicle employed, if the implant is large and subglandular, and if capsulectomy is performed.

Level of Evidence: 4
Prospective Study of Clinical Outcomes From a Breast Implant Assessment Service
Authors: Masoumi Elnaz , Seow Christina , Deva Anika Preeti , Cuss Amanda , Chow Oliver , Davies Matthew , Lajevardi Sepehr , Connell Tony , Magnusson Mark , Beath Kenneth , Isacson Daniel , Deva Anand K
Published: October 2022

Background

Breast augmentation remains the commonest cosmetic surgical procedure worldwide, in spite of recent regulatory action.

Objectives

The aim of this study was to evaluate women with breast implants attending a breast implant assessment clinic and to capture clinical and implant data in women presenting to the service.

Methods

Patients were enrolled prospectively between January 2018 and December 2021. Clinical, implant, and practitioner data were recorded. Patients reported satisfaction on size, shape, and overall outcome as well as the presence or pain. Radiological evaluation, where indicated, was performed and data were included on these findings.

Results

A total of 603 patients were assessed. Their mean age was 42.7 years and mean age at implantation was 29.1 years. The most common complications were capsular contracture followed by pain, waterfall deformity, and double bubble, with rupture/contracture rates increasing after the 10-year mark. The risk of double bubble was significantly lower if patients were operated on by certified practitioners (odds ratio = 0.49, P = 0.011). There was almost universally poor awareness of the risks of breast implants in patients presenting for evaluation.

Conclusions

This study has shown benefit in a breast implant assessment clinic to gather information on adverse events and patient-reported outcomes following breast implant surgery. Having appropriately trained and certified practitioners perform cosmetic augmentation significantly lowers the risk of implant malposition and deformity. Any adverse event occurring within 5 years of initial surgery should be flagged as a mandatory reportable clinical indicator and trigger further investigation.

Level of Evidence: 2
MHADTI: predicting drug–target interactions via multiview heterogeneous information network embedding with hierarchical attention mechanisms
Authors: Tian Zhen , Peng Xiangyu , Fang Haichuan , Zhang Wenjie , Dai Qiguo , Ye Yangdong
Published: October 2022

Motivation

Discovering the drug–target interactions (DTIs) is a crucial step in drug development such as the identification of drug side effects and drug repositioning. Since identifying DTIs by web-biological experiments is time-consuming and costly, many computational-based approaches have been proposed and have become an efficient manner to infer the potential interactions. Although extensive effort is invested to solve this task, the prediction accuracy still needs to be improved. More especially, heterogeneous network-based approaches do not fully consider the complex structure and rich semantic information in these heterogeneous networks. Therefore, it is still a challenge to predict DTIs efficiently.

Results

In this study, we develop a novel method via Multiview heterogeneous information network embedding with Hierarchical Attention mechanisms to discover potential Drug–Target Interactions (MHADTI). Firstly, MHADTI constructs different similarity networks for drugs and targets by utilizing their multisource information. Combined with the known DTI network, three drug–target heterogeneous information networks (HINs) with different views are established. Secondly, MHADTI learns embeddings of drugs and targets from multiview HINs with hierarchical attention mechanisms, which include the node-level, semantic-level and graph-level attentions. Lastly, MHADTI employs the multilayer perceptron to predict DTIs with the learned deep feature representations. The hierarchical attention mechanisms could fully consider the importance of nodes, meta-paths and graphs in learning the feature representations of drugs and targets, which makes their embeddings more comprehensively. Extensive experimental results demonstrate that MHADTI performs better than other SOTA prediction models. Moreover, analysis of prediction results for some interested drugs and targets further indicates that MHADTI has advantages in discovering DTIs.

Availability and implementation

https://github.com/pxystudy/MHADTI
AIscEA: unsupervised integration of single-cell gene expression and chromatin accessibility via their biological consistency
Authors: Jafari Elham , Johnson Travis , Wang Yue , Liu Yunlong , Huang Kun , Wang Yijie
Published: October 2022

Motivation

The integrative analysis of single-cell gene expression and chromatin accessibility measurements is essential for revealing gene regulation, but it is one of the key challenges in computational biology. Gene expression and chromatin accessibility are measurements from different modalities, and no common features can be directly used to guide integration. Current state-of-the-art methods lack practical solutions for finding heterogeneous clusters. However, previous methods might not generate reliable results when cluster heterogeneity exists. More importantly, current methods lack an effective way to select hyper-parameters under an unsupervised setting. Therefore, applying computational methods to integrate single-cell gene expression and chromatin accessibility measurements remains difficult.

Results

We introduce AIscEA—Alignment-based Integration of single-cell gene Expression and chromatin Accessibility—a computational method that integrates single-cell gene expression and chromatin accessibility measurements using their biological consistency. AIscEA first defines a ranked similarity score to quantify the biological consistency between cell clusters across measurements. AIscEA then uses the ranked similarity score and a novel permutation test to identify cluster alignment across measurements. AIscEA further utilizes graph alignment for the aligned cell clusters to align the cells across measurements. We compared AIscEA with the competing methods on several benchmark datasets and demonstrated that AIscEA is highly robust to the choice of hyper-parameters and can better handle the cluster heterogeneity problem. Furthermore, AIscEA significantly outperforms the state-of-the-art methods when integrating real-world SNARE-seq and scMultiome-seq datasets in terms of integration accuracy.

Availability and implementation

AIscEA is available at https://figshare.com/articles/software/AIscEA_zip/21291135 on FigShare as well as {https://github.com/elhaam/AIscEA} onGitHub.

Supplementary information

Supplementary data are available at Bioinformatics online.
The Inflammation Biomarker GlycA Reflects Plasma N-Glycan Branching
Authors: Noel Maxence , Chasman Daniel I , Mora Samia , Otvos James D , Palmer Christopher D , Parsons Patrick J , Smoller Jordan W , Cummings Richard D , Mealer Robert G
Published: October 2022

Background

GlycA is a nuclear magnetic resonance (NMR) signal in plasma that correlates with inflammation and cardiovascular outcomes in large data sets. The signal is thought to originate from N-acetylglucosamine (GlcNAc) residues of branched plasma N-glycans, though direct experimental evidence is limited. Trace element concentrations affect plasma glycosylation patterns and may thereby also influence GlycA.

Methods

NMR GlycA signal was measured in plasma samples from 87 individuals and correlated with MALDI-MS N-glycomics and trace element analysis. We further evaluated the genetic association with GlycA at rs13107325, a single nucleotide polymorphism resulting in a missense variant within SLC39A8, a manganese transporter that influences N-glycan branching, both in our samples and existing genome-wide association studies data from 22 835 participants in the Women’s Health Study (WHS).

Results

GlycA signal was correlated with both N-glycan branching (r2 ranging from 0.125–0.265; all P < 0.001) and copper concentration (r2 = 0.348, P < 0.0001). In addition, GlycA levels were associated with rs13107325 genotype in the WHS (β [standard error of the mean] = −4.66 [1.2674], P = 0.0002).

Conclusions

These results provide the first direct experimental evidence linking the GlycA NMR signal to N-glycan branching commonly associated with acute phase reactive proteins involved in inflammation.
Pygmalion and Medusa as Cixous’ writing women inInSEXts: ‘I Write Woman’
Authors: Swain Natalie J
Published: October 2022

Set in nineteenth century Europe, InSEXts tells the story of Lady Bertram and Mariah, two women in a romantic relationship who can transform into insects in order to defend their nascent family. In the second arc of the series, The Necropolis, Lady Bertram, and Mariah are joined by Phoebe (a Black, transgender artist) whose friends are being transformed into art by members of the patriarchal art community, who value women only as silent and beautiful Muses. Allying with ‘Medusa’, a misidentified Javanese goddess who has been forcibly brought to Europe, Lady Bertram and Mariah thus enter a narrative replete with Greek and Roman mythology. In this paper, the author sets out to demonstrate that, through the receptions of Pygmalion and Medusa, InSEXts: The Necropolis effectively reflects Cixous’ ‘Laugh of the Medusa’, replicating the empowerment of female creativity which Cixous suggests. By mirroring these Ovidian intertexts and becoming ‘writing women’ themselves, comics creators Bennett and Kristantina allow their own characters to re-write and subvert traditional narratives, to tell their own stories that represent elements of Ovidian narrative to respond to and embody the kind of female creativity advocated by Cixous.
The Humed Serpent: Lucian, miracles, enlightenment, and empire
Authors: Devecka Martin
Published: October 2022

In his essay ‘Of Miracles’, published separately and as the final chapter of his Enquiry Concerning Human Understanding, David Hume enlists Lucian’s Alexander, or the False Prophet as evidence for his claim that miracle narratives first take root among gullible rural populations before spreading to cultured city-dwelling elites. This essay reads Lucian’s Alexander and On the Death of Peregrinus against the Humean grain to suggest that miracle stories emerge as a consequence of the forms of commerce and circulation enabled by empires. In light of this, I recharacterize Hume’s geography of gullibility as an aspirational but unsustainable ideal engendered by the emergence of an eighteenth-century ‘Republic of Letters’.
Catch Effectiveness Revealed by Site-Related Differences in Capture–Mark–Recapture Methods: A Butterfly Metapopulation Study
Authors: Adamski Paweł
Published: October 2022

Understanding metapopulation structures is very important in the context of ecological studies and conservation. Crucial in this respect are the abundances of both the whole metapopulation and its constituent subpopulations. In recent decades, capture–mark–recapture studies have been considered the most reliable means of calculating such abundances. In butterfly studies, individual insects are usually caught with an entomological net. But the effectiveness of this method can vary for a number of reasons: differences between fieldworkers, in time, between sites etc. This article analyses catch effectiveness data with respect to two subpopulations of the Apollo butterfly (Parnassius apollo) metapopulation in the Pieniny National Park (Polish Carpathians). The results show that this parameter varied significantly between sites, probably because of differences in microrelief and plant cover. In addition, a method is proposed that will include information on catch effectiveness for estimating the sizes of particular subpopulations and will help to elucidate the structure of the entire metapopulation.
A case of covered stent failure in sealing up a coronary perforation potentially related to intravascular lithotripsy treatment: insights from optical coherence tomography
Authors: Doost Ata , Mabote Thato , Clugston Richard , Ihdayhid Abdul Rahman
Published: October 2022

Background

Intravascular lithotripsy (IVL) is a new modality in treatment of calcified coronary lesions which improves procedural outcomes. Coronary perforation is an extremely uncommon but potentially catastrophic complication of percutaneous coronary intervention (PCI) and IVL therapy.

Case summary

We report a case of an elective PCI to a calcified left anterior descending (LAD) and diagonal bifurcation lesion in a 65-year-old man. LAD was treated with two stents. Despite high pressure non-compliant balloon inflation, a focal area of under-expansion remained. IVL successfully treated the under-expansion but was complicated with a large coronary perforation. The perforation was successfully sealed with a PK-PAPYRUS covered stent sacrificing the diagonal branch. Patient remained stable until 3 hours later when he developed tamponade requiring urgent pericardial drainage. Repeat angiography demonstrated recanalization of the diagonal branch and ongoing contrast extravasation along its course. Optical coherence tomography intracoronary imaging was used to delineate the mechanism of ongoing bleeding. This demonstrated an interrupted elastic membrane of the covered stent, potentially caused by underlying fractured calcium. Therefore, a second overlying PAPYRUS stent was deployed which satisfactorily sealed the perforation.

Discussion

IVL is an emerging less invasive treatment for calcified coronary stenosis but could be associated with drastic complications. This case highlights the importance of awareness of IVL-related coronary perforation and the potential limitation of new generation thinner-wall covered stents. Intracoronary imaging plays an important role in identifying mechanisms of stent failure, tailoring treatment, and optimizing outcomes.
Total anomalous pulmonary venous return with mixed drainage and double connection: a rare case report not previously described
Authors: Rocamora Salort Sandra , Ruiz González Eladio , Cano Sánchez Ana , Fernández Tudela Belén
Published: October 2022

Background

Total anomalous pulmonary venous return is a rare cyanotic congenital heart disease in which pulmonary veins connect to the systemic veins, right atrium, or coronary sinus. Given its variability, it is essential to define the pathway and drainage site.

Case summary

We describe a 3-day-old patient with total anomalous pulmonary venous return, in which the four pulmonary veins drained into a common vertical vein that had a double connection at the cardiac (coronary sinus) and infracardiac (portal vein) levels. The echocardiographic diagnosis was confirmed by computed tomography scan. At 1.5 months, she underwent surgery by anastomosis of the venous collector with the left atrium, unroof of the coronary sinus, and clousure of its communication with right atrium. The vertical vein was ligated. There were no complications after 1 year of follow-up.

Discussion

This is an unusual anatomy that has not been described in the literature. In this article, we discuss the embryological origin. Furthermore, we highlight the importance of an accurate diagnosis of the venous pathway and its impact on surgical planning and patient prognosis.
Management of patients with left main stem stenosis in Iceland 2010–2020: PCI or CABG?
Authors: Reynisdottir H O , Kristjansdottir M K , Mogensen B A , Gudbjartsson T , Andersen K A , Sigurdsson M I , Gudmundsdottir I J
Published: October 2022

Introduction

Coronary artery bypass surgery (CABG) has been standard treatment for patients with left main coronary artery disease (LMCAD) but percutaneous coronary intervention (PCI) is a good alternative in selected patients.

Our purpose was to evaluate the prevalence of LMCAD in Iceland, the impact of background factors on treatment choices, and treatment changes in recent years with respect to current guidelines.

Methods

This retrospective, population-based study analyzed data from the SCAAR-SWEDEHEART database. Patients with significant LMCAD on coronary angiography in Iceland 2010–2020, without previous history of CABG or contraindication for surgery were enrolled. Survival analysis was estimated with Kaplan-Meier and COX regression analysis for investigating the association between survival time and predictor variables.

Findings

Of 702 patients with LMCAD, 195 were treated with PCI, 460 with CABG and 47 with medical treatment only. The widest age range was in the PCI group and the mean age was highest in the medical therapy only group (p<0.001). Patients with LMCAD and either three vessel disease or heart valve disease were most often treated with CABG (76.1% and 84.4%, p<0.001).The majority of patients with LMCAD only were treated with PCI, as were patients with STEMI or cardiogenic shock (67.1% and 70.0%, p<0.001). The proportion of patients treated with PCI increased from 19.8% in 2010–2015 to 42.7% in 2016–2020. There was no significant difference in survival between PCI and CABG (p=0.41).

Conclusions

In patients with LMCAD the main factors that affect treatment choice are age, anatomical complexity and acuteness. Treatment choice appears to be in keeping with current guidelines. There is no significant difference in long term survival between PCI and CABG groups but the groups are different. There has been a significant increase in patients treated with PCI in recent years.

Funding Acknowledgement

Type of funding sources: None.
Outcomes of COVID-19 patients with STEMI undergoing primary PCI
Authors: Kleczynski P , Niewiara L , Kulbat A , Kaczynski M , Pawlowski T , Socha` S , Rakowski T , Gil R , Bartus S , Legutko J
Published: October 2022

Introduction and aim

Coronavirus disease (COVID-19) has substantial impact on acute myocardial infarction (AMI) clinical course and outcome.

In Poland during early phase of COVID-19 pandemic a network of dedicated hospitals was set to treat SARS-Cov2 positive patients. There is scarce data on STEMI patients outcome treated in this setting.

Our aim was to compare outcomes of STEMI patients treated with primary PCI in hospitals dedicated to treat COVID-19 and referral high volume haemodynamic centres.

Methods

Study was a retrospective analysis of 115 consecutive COVID-19 patients with STEMI, treated with primary PCI, admitted to 4 high volume centres (2 referral hospitals and 2 COVID dedicated sites) in southern Poland between May 2020 and November 2021. Data was obtained from patients' electronic medical records.

Results

Detailed characteristics are presented in Table 1 and 2. In general in all hospitals, patients were similar in terms of age (median 69 y.o., IQR: 60–73), with similar profile of comorbidities. All patients used acetylsalicylic acid and unfractioned heparin.

In referral centres, as compared with COVID-19 dedicated sites, there was a higher use of mechanical thrombectomy (p<0.001) and adenosine (p<0.001). Overall mortality rate was higher in COVID-19 centres (50% vs 25%, p=0.008). Detailed results are presented in Table 3.

Conclusions

There is a significantly higher mortality in COVID patients who develop STEMI than in patients with STEMI who were tested positive on admission.

Patients in COVID-19 hospitals had higher levels of CRP and NT-proBNP at baseline.

There are substantial differences in treatment of patients in referral centres and COVID dedicated hospitals.

Funding Acknowledgement

Type of funding sources: None.
Changes in cardiovascular risk factors in patients undergoing first time coronary revascularization from 2003–2020, A nationwide population study
Authors: Pham M , Christensen D M , Kristensen A T , Clausen C S , Gislason G H , Olsen N T
Published: October 2022

Introduction

Current knowledge of cardiovascular risk factors is primarily based on older studies that may not reflect current populations. Monitoring risk factors may influence decisions about prevention and treatment of ischemic heart disease. We hypothesize that the prevalence of traditional risk factors in patients undergoing first-time coronary revascularization has changed over time.

Purpose

We examined the proportion of patients with traditional cardiovascular risk factors from year 2003–2020 in patients undergoing first-time coronary revascularization.

Methods

We identified all adults undergoing first-time coronary revascularization (percutaneous intervention and bypass grafting) from 2003–2020 using Danish nationwide registries. Risk factors were defined as either medical prescriptions or diagnosis prior to first-time revascularization. We calculated the proportion of individual risk factors per year with associated 95% CI, and calculated the trend using chi-squared test for trend in proportion.

Results

We identified 152,692 patients who underwent first-time coronary revascularization. 78.5% of the patients underwent percutaneous coronary intervention and 21.5% underwent coronary artery bypass grafting, 73.8% were male, mean age 65 (SD 11.5), and 67.9% had at least 1 risk factor at first-time revascularization.

Figure 1 shows the trends in risk factors from 2003 to 2020.

From 2003–2005 to 2018–2020, the proportion of patients with at least 1 risk factors changed from 70.9 to 64.0%, hypertension changed from 41.4 to 36.0%, hypercholesterolemia decreased from 47.6 to 43.6%, aspirin use decreased from 52.4 to 32.06%, diabetes increased from 11.7 to 15.8%, chronic kidney disease increased from 2.4 to 4.4%, and chronic obstructive pulmonary disease increased from 4.95 to 4.96% (p-value for trend <0.001 for all risk factors, except chronic obstructive pulmonary disease (p-value 0.96)).

Conclusion

We assessed the temporal trends in coronary risk factors over a 17-year period in patients undergoing first-time coronary revascularization. We found a large decrease in the proportion of patients with any risk factor, hypertension, hypercholesterolemia, and aspirin use, and an increase in diabetes and chronic kidney disease. The proportion of patients with chronic obstructive pulmonary disease was unchanged.

Funding Acknowledgement

Type of funding sources: None.
Clinical outcomes of percutaneous coronary intervention and rotational atherectomy using second generation drug eluting stents: a Korean multicentre analysis
Authors: Kim K , Lee K , Jung J , Choi I , Lee J , Lee J , Lee S , Lee P , Lee S , Yoo K , Yun K , Lee H , Her S
Published: October 2022

Background

The aim of this study was to compare the clinical outcomes of different second generation drug-eluting stents (DES) in patients with calcified coronary lesions who underwent percutaneous coronary intervention using rotational atherectomy.

Methods

This study was based on a multicentre registry which enrolled patients with calcified coronary artery disease who received RA during between January 2010 and October 2019 from 9 tertiary centres in Korea. The primary outcome was target-vessel failure (TVF), defined as the compositae of cardiac death, target-vessel myocardial infarction (MI), and target-vessel revascularisation (TVR). The secondary outcomes were all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.

Results

540 patients who underwent PCI after RA were enrolled and followed up for a median period of 16.1 months. From this registry, 439 patients who were treated using second generation DES were selected for further analysis. They were divided into four groups based on the characteristics of the stents used during the procedure. [Group I cobalt-chromium sirolimus eluting stent (CoCr-SES): Ultimaster 48 & Orsiro 30, Group II platinum-chromium everolimus eluting stent (PtCr-EES): Synergy 93 & Promus 70, Group III cobalt-chromium everolimus eluting stent (CoCr-EES): Xience 105, Group IV zotarolimus eluting stent (ZES): Resolute 93] There was no inter-group difference in procedural success rates, and the primary outcome of TVF showed no difference across the four groups (I: 10.3%, II: 13.5%, III: 13.3%, IV: 15.1%, log-rank p=0.922). Even after multivariate Cox regression analysis, there was no significant difference in TVF, or the secondary outcomes of all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.

Conclusions

There was no difference in procedural success rates and clinical outcomes between four different types of second-generation DES (CoCr-SES, PtCr-EES, CoCr-EES, ZES) in patients who underwent PCI using RA.

Funding Acknowledgement

Type of funding sources: None.
Results of percutaneous treatment of the left main coronary artery in elderly patients
Authors: Gallo Fernandez I , Pastor Wulf D , Lopez Baizan J , Serrano Criado M , Gonzalez Manzanares R , Flores Vergara G , Duenas Perez G , Ojeda Pineda S , Romero Moreno M , Pan Alvarez-Ossorio M , Hildago Lesmes F J
Published: October 2022

Introduction and objectives

Surgical revascularization of the left main (LM) coronary lesions has been the most accepted strategy. However, elderly and frailty patients are not represented in the specific trials that compared surgical versus percutaneous revascularization. Conservative treatment does not seem to be a feasible option due to high major cardiac adverse event rate at short term follow-up. The objective of the study was to analyze the results of percutaneous treatment of the LM in elderly patients who were not candidates for surgical revascularization due to high surgical risk or medical decision.

Methods

We performed an unicentric, retrospective and descriptive study. We included patients aged 75 years or older who presented with an LM lesion (isolated or associated with other coronary lesions) between between 2017 and 2021 underwent percutaneous treatment.

Results

During this time period, a total of 140 patients who met the inclusion criteria were treated in our center. The mean age was 81±4 years and 64% (89 patients) were male. Acute coronary syndrome was the clinical presentation in 59% of patients. Seventy-five patients (54%) met criteria of frailty or high comorbidity. The use of nonsteroidal anti-inflammatory drugs were predominated risk factor associated (94 patients, 67%). Immediate success of the procedure was obtained in 97%, with an in-hospital mortality of 7%. The remaining variables are described in Figure 1. With a median follow-up of 19 months, 29 adverse cardiac events (20%) were recorded: 3 (2%) patients suffered a nonfatal myocardial infarction, 7 (5%) patients required a new revascularization, and 19 (14%) patients died of cardiac causes. However, up to 11% (15 patients) died of non-cardiac causes at follow-up (Figure 1 and 2a). A non-significant trend was found for a worse prognosis in terms of survival in frail patients (HR: 1.6 (0.76–3.3), p: 0.212) (Figure 2b).

Conclusions

Percutaneous treatment of left main coronary artery in elderly patients with multiple associated comorbidities could be considered a feasible option in this special population. The rate of cardiac events at follow-up seems acceptable.

Funding Acknowledgement

Type of funding sources: None.
Impact of the ISCHEMIA randomized clinical trial on the management of patients with chronic coronary syndrome
Authors: Spagnolo M , Laudani C , Occhipinti G , Agnello F , Legnazzi M , Scalia L , Mauro M S , Rochira C , Finocchiaro S , Greco A , Capodanno D
Published: October 2022

Background

In the ISCHEMIA trial, patients with chronic coronary syndromes (CCS) and moderate or severe ischemia had no significant difference in combined ischemic events with an initial invasive compared with a conservative strategy [1]. Coronary computed tomography angiography (CCTA) was part of the pre-randomization workup of ISCHEMIA and is gaining popularity over ischemia testing or initial invasive coronary angiography (ICA) as the initial diagnostic strategy for CCS [2].

Purpose

To analyse whether the results of the ISCHEMIA trial had a sizeable impact on the diagnostic algorithm for CCS by analysing trends in referral to ICA and/or revascularization.

Methods

ICAs performed in CCS patients between November 2019 and February 2022 at a high-volume centre were analysed. Two groups were defined based on procedure date: i) pre-ISCHEMIA, including ICAs performed before March 2020 (date of trial publication); ii) post-ISCHEMIA, including ICAs performed ≥3 months (i.e., blanking period) after trial publication. The primary outcome was the incidence of referral to ICA by CCTA. Secondary objectives included referral to ICA or revascularization by ischemia testing, referral to revascularization by CCTA, and referral by CCTA to ICA that did not require further intervention.

Results

A total of 2,365 patients qualified for the analysis, of which 487 (20.6%) and 1878 (79.4%) in the pre-ISCHEMIA and post-ISCHEMIA groups, respectively. There were no notable differences in baseline characteristics between groups. The primary outcome occurred more frequently in the post-ISCHEMIA group (73.5% vs 32.5%, p<0.01). Referral to ICA by ischemia testing was lower in the post-ISCHEMIA group (31.6%, vs 52.5% p<0.01), while referral for revascularization by CCTA was more frequent (8.3% vs 12.0% p<0.01). There were no significant differences in referral to revascularization by ischemia testing (3.4% vs 3.0%, p=0.73) and referral by CCTA to ICA that did not require further intervention (60.3% vs 60.8%, p=0.90).

Conclusions

At two years from publication, the ISCHEMIA trial seems to have impacted significantly on the decision-making algorithm for patients with CCS. The frequency of referral to ICA and revascularization by CCTA considerably increased, paralleled by decreased referral to ICA by ischemia testing.

Funding Acknowledgement

Type of funding sources: None.
Clinical features and lipid profiles of plaque erosion over lipid rich plaque versus fibrous plaque
Authors: Sekimoto T , Mori H , Koba S , Suzuki H , Shinke T
Published: October 2022

Backgrounds and aims

Plaque erosion (PE) which is one of the most common causes of acute coronary syndrome (ACS) can occur over fibrous plaque or lipid-rich plaque (LRP) according to pathological reports. Whereas in plaque rupture (PR) the main cause of ACS, underlying plaque is basically LRP with thin fibrous cap. We aimed to investigate the clinical features and lipid profiles of PE with or without LRP in comparison to PR.

Methods

A total of 165 statin-naïve patients with ACS who underwent percutaneous coronary intervention using optical coherence tomography and met the criteria for PR or PE were included. LRP was defined as a plaque with lipid having the maximal lipid arc (>180°). Culprit lesions were categorized into the PR, PE with/without LRP [PE(LRP), PE(Fibrous), respectively).

Results

The prevalence of PR, PE(LRP), and PE(Fibrous) was 104 (63.0%), 42 (25.5%), and 19 (11.5%), respectively. Patients with PR and PE(LRP) had significantly higher peak creatine kinase (1338, 1733, 214 U/L, respectively, P<0.01) and more prevalence of ST-elevation myocardial infarction (71.2, 78.6, 21.1%, respectively, P<0.01) than PE(Fibrous).

Overall, the levels of the various lipid profiles were mostly comparable between PE(Lipid) and PR but different in PE(Fibrous). The levels of small-dense low-density lipoprotein cholesterol was significantly greater in PR and PE(LRP) than in PE(Fibrous) (39.0, 36.6, 25.7 mg/dL, respectively, P=0.02).

Conclusion

PE(LRP) had substantially different clinical features and lipid profiles compared to PE(Fibrous) showing some similarity to those of PR.

Funding Acknowledgement

Type of funding sources: None.
Fractional flow reserve versus angiography guided revascularization for patients with multivessel coronary artery disease: a systematic review and meta-analysis of randomized controlled trials
Authors: Goel S , Slomovich S , Edris S , Park W J , Agarwal C , Hooda A , Krishnamoorthy P M , Gidwani U , Sharma S , Kini A
Published: October 2022

Background

Recently published randomized controlled trials (RCT) have questioned the utility of Fraction Flow Reserve (FFR) to guide revascularization in patients with multivessel coronary artery disease (CAD) as compared to Angiography

Purpose

This current analysis aimed to compare the clinical outcomes associated with FFR guided versus standard angiography-guided revascularization for patients with multivessel CAD using a large number of randomized patients with stable CAD and acute coronary syndrome (ACS)

Methods

We conducted an electronic database search of all published data for RCT that compared FFR versus Angiography for patients with multivessel CAD and reported on subsequent mortality, cardiac death, myocardial infarction, revascularization, and other outcomes of interest. Event rates were compared using a forest plot of odds ratios using a fixed-effects model assuming interstudy heterogeneity.

Results

Eleven RCT (n=6052; FFR = 3043, Angiography = 3027) were included in the final analysis. Mean follow-up period was 1.7 years. In our analysis, FFR guided revascularization as compared to angiography guided revascularization alone was not associated with any significant reduction in overall mortality (OR = 1.10, 95% CI = 0.83–1.47, P=0.47, I2=0), cardiac mortality (OR = 0.95, 95% CI = 0.63–1.45, P=0.42, I2=0), all revascularization (OR = 0.96, 95% CI = 0.80–1.14, P=0.17, I2=31%) or myocardial infarction (OR = 0.99, 95% CI = 0.79–1.23, P=0.33, I2=12%). There was also no difference between two groups in terms of major adverse cardiac or cerebrovascular event [MACCE] (OR = 1.13, 95% CI = 0.90–1.42, P=0.39, I2=5%), major adverse cardiac event [MACE] (OR = 0.86, 95% CI = 0.70–1.07, P=0.55, I2=0), stroke/TIA (OR = 1.61, 95% CI = 0.92–2.82, P=0.36, I2=8%) or target lesion revascularization [TLR] (OR = 0.86, 95% CI = 0.44–1.67, P=0.71, I2=0). Furthermore, sensitivity analysis was conducted to include only studies with ACS patients and studies which used CABG only for revascularization. However, there was no difference between the two groups for any of the above outcomes

Conclusion

There is no difference in clinical outcomes in patients undergoing FFR-guided versus angiography guided revascularization for multivessel CAD

Funding Acknowledgement

Type of funding sources: None.
Comparison of quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) during daily routine in the catheterization laboratory
Authors: Antoniadis M , Stader J , Ussat M , Wachter R , Jurisch D , Lavall D , Metze M , Neef M , Baum P , Spies C , Laufs U , Lenk K
Published: October 2022

Background

The prognosis of patients with coronary artery disease (CAD) depends strongly on the hemodynamic relevance of the stenosis. The gold standard is the invasive evaluation of the stenosis using Fractional Flow Reserve (FFR), instantaneous wave-free ratio (iFR) or Resting Full-Cycle Ratio (RFR). The use of invasive procedures remains low due to procedural factors and costs. Quantitative Flow Ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions during cardiac catheterization. Computing a three-dimensional model of the vessel based on two angiographic recordings and analyzing the fluid dynamics of the contrast medium flow, the software computes the FFR. In the setting of clinical studies, it has been demonstrated that QFR is feasible and correlates well with FFR. The aim of this study is to compare feasibility and reliability of QFR with established measurements of the iFR or RFR in daily routine.

Methods

Patients with an indication for an invasive coronary angiography and a stenosis of 30 to 90% were simultaneously assessed using QFR and iFR/RFR in a routine setting. The QFR-computation was performed online by a certified expert with QAngio XA 3D 3.2. The following outcome parameters were analyzed: time to result, volume of applicated contrast medium, applicated dose area product, result of the evaluation. The results have been registered for both methods, respectively.

Results

102 coronary arteries were analyzed using QFR and iFR or RFR. QFR shows a good correlation (r=0.753, AUC=0.922) and accuracy (agreement 89.22%, sensitivity 95.83%, specificity 83.33%, PPV 83.64%, NPV 95.74%). The data show that QFR delivers significantly faster results and reduces the procedure related applicated radiation dose from in median 598.8 cGy cm2 to 306.75 cG ycm2 (p<0.001). The study shows no significant difference regarding the amount of contrast medium used.

Conclusion

QFR has a good diagnostic agreement and can reduce procedure length and applicated radiation dose. Thereby QFR could increase the use of physiologically guided coronary interventions in daily routine.

Funding Acknowledgement

Type of funding sources: None.
Cardioprotective effect of empagliflozin in acute myocardial infarction: the role of ketone bodies availability
Authors: Badimon J J , Santos-Gallego C G , Requena-Ibanez J A , Picatoste B , Fardman B , Ishikawa K , Mazurek R , Pieper M , Fuster V
Published: October 2022

Background

The cardio-renal benefits of SGLT2i have been clearly established by clinical trials. Of interest, despite not having any effect on the incidence of classic atherothrombotic events (MI and strokes), patients receiving SGLT2i treatment had a higher chance of surviving myocardial infarction (MI).

Purpose

We aim to evaluate the cardioprotective potential of empagliflozin on acute myocardial infarction.

We postulate that the benefits of SGLT2-I are mediated via an increase in circulating ketone bodies (KBs) induced by SGLT2i, and its preferential myocardial utilization energetically benefits the heart to better withstand an ischemic event.

Methods

The study was undertaken in our non-diabetic porcine model of ischemia/reperfusion. Animals were allocated to either one-week pre-treatment with empagliflozin or placebo before MI-induction. A third group received IV infusion of KBs at the time of the MI- induction to serve as positive-control. The acute effects of the treatments were studied 24 hours after MI-induction by Cardiac Magnetic Resonance (CMR). Immediately post-CMR, animals were sacrificed and heart samples collected for molecular analysis.

Results

(see Table and Figure): Despite similar initial ischemic injury (area at risk) in all groups, empagliflozin was associated with a significantly higher myocardial salvage (MSI 23.7±9.7 vs 4.5±3.6%, p<0.001) and better preserved cardiac function (LVEF 41.3±3.1 vs 33±5.5%, p<0.009) compared with placebo. The infusion of KBs replicated in part the beneficial profile of the empagliflozin group (MSI 16.7±8.8 and LVEF 39.1±3.6%). Histological analysis showed less cardiomyocyte apoptosis and less oxidative stress

Conclusions

To the best of our knowledge, this is the first study evaluating in vivo the cardioprotective potential of a SGLT2 inhibitor in a well-stablished porcine translational model. Furthermore, effects are evaluated using the gold standard for visualization and quantification of MI, Cardiac Magnetic Resonance (CMR). Three are the main conclusions:

1. One-week treatment with empagliflozin raises circulating KBs levels and confers significant cardio-protection during a myocardial infarction. Acute post-MI benefits (greater myocardial salvage and better preserved cardiac function) are already seen within 24 hours as compared with placebo.

2. Periprocedural IV infusion of KBs induces similar benefits than the SGLT2-I group.

3. These observations strongly support our hypothesis that SGLT2 inhibition is associated with increased circulating KBs and its selective use as preferential myocardial source of energy as a potential mechanism of action involved in the cardio-renal benefits observed with SGLT2i.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology. Research Fellowship Grant.