bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Scoparia dulcis Extract on Lipid Oxidation in Fish Feed, Growth Performance, and Hypoxia Tolerance in Juvenile Jian Carp (Cyprinus carpio var. Jian)
Authors: Chen Gangfu , Xu Jing , Li Fengyi , He Mingquan , Yu Xiaolu , Du Wenhao , Ye Yuxue , Liao Ling , Wu Min , Li Huatao
Published: May 2024

Lipid oxidation and hypoxia can lead to oxidative damage in aquatic animals. This study explored the effects of Scoparia dulcis extracts (SDE) on lipid oxidation, fish growth performance, digestive ability, antioxidant capacity, and hypoxia tolerance ability. The results showed that SDE decreased malonaldehyde (MDA), conjugated diene (CD), and peroxide value (PO) in the linoleic acid and linolenic acid as well as in fish feed. Broken‐line analysis revealed that the optimal acetone extract of S. dulcis (AE) supplements was 4.02, 4.01, and 4.01 g kg−1 determined from PO, CD, and MDA, respectively. Dietary AE supplementation increased feed intake and specific growth rate and activities of amylase, trypsin, and lipase as well as alkaline phosphatase in fish hepatopancreas and gut. Polynomial regression analysis showed that optimal dietary AE supplement was 3.61 g kg−1 diet determined from weight gain. Furthermore, dietary AE supplementation decreased MDA content and increased glutathione content and the activities of glutathione peroxidase, catalase, superoxide dismutase, and glutathione reductase in fish digestive organs, gills, erythrocytes, and muscle. Dietary AE supplementation increased durative time (DT) and oxygen consumption rate (OCR) under hypoxia condition. Based on polynomial regression analysis, optimal dietary AE supplements were 4.73 and 4.60 g kg−1 diet determined from DT and OCR for hypoxia tolerance in fish, respectively. According to our current research, SDE’s antioxidant capacity may be attribute to their phenolic chemicals.
Simulation Analysis of Arc-Quenching Performance of Eco-Friendly Insulating Gas Mixture of CF3I and CO2 under Impulse Arc
Authors: Wu Dong , Chen Wengui , Ji Zelin
Published: May 2024

Due to its superior insulating qualities, SF6 gas is extensively used in the power sector. However, because of its poor environmental protection properties, finding ecologically acceptable insulating gas has become a critical challenge in the power sector in the context of pursuing green electricity. This work simulates the arc-quenching performance of a gas mixture of CF3I and CO2, which is thought to be a workable substitute for SF6 gas. The COMSOL software is used to build a two-dimensional model of a single-pipe arc-quenching chamber based on the concepts of magnetohydrodynamics (MHD) theory. The lightning impulse current is made by applying electrical stimulation to pure CO2 gas, gas mixtures with 10% CF3I and 90% CO2, and gas mixtures with 30% CF3I and 70% CO2 in the single-pipe arc-quenching chamber. During the first stage of arc formation, the results show that CF3I/CO2 gas mixtures with 10% and 30% CF3I have lower electrical conductivity than pure CO2 gas. An 8/20 μs lightning impulse current waveform with a magnitude of 4 kA is used for this observation. The highest airflow velocity for pure CO2 is 1744 m/s, but the mixture of 10%/90% CF3I/CO2 has a maximum airflow velocity of 1593 m/s. The 30%/70% CF3I/CO2 mixture has the highest maximum airflow velocity at 1840 m/s. Airflow velocity increases and the overpressure in the arc-quenching chamber is prolonged when there is a greater concentration of CF3I gas in the gas mixture. Consequently, these factors greatly reduce the duration of the arc-extinguishing time. The arc-quenching chamber’s overpressure is extended when the amount of CF3I gas in the gas mixture is increased, which increases the velocity of the airflow. As a result, these factors significantly decrease the duration of the arc-extinguishing time.
Knowledge, Attitude, and Practice of Physiotherapists about Cardiac Rehabilitation Program Adherence among Patients Discharged from the Hospital after Cardiac Surgery in India
Authors: Gondekar Ayman , Singh Vijay Pratap , Rajan Samuel Stephen , Raghavan Harish , Khandelwal Bidita , Kumar K. Vijaya
Published: May 2024

Background. In most settings, patients receive phase 1 cardiac rehabilitation in CTVS ICU at the hospital, but there are several barriers to follow-up after patients are discharged from the hospital. Physiotherapists play an important role in the enrolment and continuation of cardiac rehabilitation. Thus, we aim to study the knowledge, attitude, and practice of physiotherapists about CR program adherence among patients discharged from the hospital after cardiac surgery. Objectives. (i) To study the knowledge of physiotherapists about the importance of cardiac rehabilitation after discharge; (ii) to know the attitude of physiotherapists towards cardiac surgery patients after discharge; and (iii) to know what approach various centres are applying for patients after discharge to ensure adherence to cardiac rehabilitation. Methods. A questionnaire was developed with reference to the objectives of the study, which was answered by a total of 127 physiotherapists. Results. The overall response rate was 42.3%; nearly 35.4% of the participants indicated that they knew a lot about CR, while 5.5% said they knew very little. Regarding the program’s content, 36.2% of participants reported having a medium degree of awareness of the diverse CR components, while 8.6% reported having very little knowledge of them. Only about one-third, 35.7% stated that CR in India is effective and 95% believed that CR will have an added value for the country. Approximately 80% of respondents thought that it would be challenging for a physiotherapist to recommend patients to a CR in the nation. Nearly 35% of respondents believed that they, “themselves as physios,” needed to commence CR, and slightly less than 70% thought that doctors were required to choose and refer the patients when asked who should take the initiative to start this kind of programme in the country. A little over 40% of respondents said that insurance firms are also involved in starting a CR programme. Conclusion. Physiotherapists have good knowledge of cardiac rehabilitation. However, their attitude and practice towards adherence to exercise protocols are confounded by various clinician- and patient-level factors.
Improved Deep Extreme Learning Machine for State of Health Estimation of Lithium‐Ion Battery
Authors: Chen Yan , Meng Junli , Ming Shunyang , Tong Gengxin , Qi Ziyi
Published: May 2024

Prediction of state of health (SOH), a crucial aspect of battery management systems, necessitates accurate and reliable estimations for lithium‐ion batteries. However, achieving high‐precision SOH estimation using the deep extreme learning machine (DELM) in complex environments is challenging due to the instability caused by its random key parameters. To address this, we propose a novel approach that combines the improved bald eagle search (IBES) algorithm with DELM. By utilizing the IBES algorithm, we can extract highly relevant health indicators from the battery’s parameter curve during charging and discharging, as well as the incremental capacity curve. These indicators serve as inputs to the constructed estimation model, which predicts SOH under different working conditions. The proposed method has been validated using publicly available experimental data, with an overall error in SOH estimation of less than 1%. In comparison to the existing model, the proposed method achieves RMSE, MAE, and MAPE values lower than 0.35%, 0.26%, and 0.21%, respectively. These findings demonstrate that the proposed method excels in terms of both the speed and accuracy of SOH estimation, showcasing its enhanced robustness and reliability.
Investigation of Early Maladaptive Schemas and Coping Strategies in Turkish Adults under Probation
Authors: Gulder Altuner Ozlem , Yararbas Gorkem
Published: May 2024

Purpose. The aim of the study was to examine the relationships of early maladaptive schemas, overcompensation, and avoidant behaviors with sociodemographic, psychological, legal, and substance use status of individuals under probation due to illicit substance use. Methods. The data of this cross‐sectional study were collected from adults under probation through self‐report. The dependent variables were early maladaptive schemas, overcompensation, and avoidant behaviors. Sociodemographic, legal, and psychological characteristics and characteristics related to illicit substance use were the independent variables of the study. Student‐t test and ANOVA or Mann–Whitney‐U and Kruskal–Wallis tests were used in bivariate analyses. Multiple linear regression analysis was used in multivariate analyses. Results. A total of 300 adult individuals under probation participated in the study, and the inclusion rate was 93.5%. The mean age of the study group was 27.96 ± 6.40 years. The amount of smoking (B = 0.65 (95% CI: 0.04–1.27), p = 0.038), frequency of illicit substance use (B = 12.15 (95% CI: 2.04–22.25), p = 0.019), and childhood violence (B = 29.24 (95% CI: 16.92–41.56), p < 0.001) were explanatory for schema scores (R2: 0.240). Frequency of illicit substance use (B = 7.06 (95% CI: 0.58–13.54), p = 0.033) and childhood violence (B = 9.18 (95% CI: 1.36–17.00), p = 0.022) were explanatory for compensation scores (R2: 0.083). The amount of smoking (B = 0.49 (95% CI: 0.22–0.76), p = 0.001), frequency of illicit substance use (B = 5.16 (95% CI: 0.67–9.65), p = 0.025), being treated for substance use disorder (B = 6.74 (95% CI: 0.30–13.17), p = 0.040), and experiencing violence in childhood (B = 6.02 (95% CI: 0.59–11.45), p = 0.030) were explanatory for avoidant scores (R2:0.169). Conclusion. Childhood violence and frequency of illicit substance use were associated with early maladaptive schemas, overcompensation, and avoidance. Smoking appears to be a behavioral way of coping with both early maladaptive schemas and schemas through avoidance.
Relationship between the Significant Solutions of Static Traffic Assignment Problems for Mixed Traffic Flow of Connected and Automated Vehicles and Human‐Driven Vehicles
Authors: Yun Jaewoong
Published: May 2024

Connected and automated vehicles can reduce the traffic congestion level of the entire network through platoon‐driving technologies compared to human‐driven vehicles. One promising approach to enhancing platoon‐driving technology’s efficiency is deploying dedicated lanes or roads for connected and automated vehicles. Since asymmetric interactions between different vehicle types increase road congestion, it is necessary to distinguish routes for efficient traffic management. However, the traditional traffic assignment problem, which uses only user equilibrium as a constraint with no difference in travel time between users, could not be proposed as a globally optimal solution because it generates an infinite number of locally optimal solutions. Recent studies have attempted to overcome the limitations by considering the sum of system‐wide travel times as an additional constraint. Their research sought to help propose optimal deployment strategies through the lowest total travel time solution (best‐case) or design robust transport planning strategies through the highest total travel time solution (worst‐case). However, past studies have not focused on the possibility of the best/worst case appearing in reality. This study focused on the relationship between the two solutions pointed out in past studies and traffic patterns likely to appear in reality. This study interprets the Karush–Kun–Tucker condition of the static traffic assignment problem, considering the asymmetric interaction, and proposes a solution algorithm using discrete dynamics. The proposed algorithm extends the most widely used method in transportation planning research, which can overcome the limitations of asymmetric interaction problems through simple variations. The proposed algorithm can reliably derive two solutions, and entropy theory shows that both solutions are unlikely to appear in reality without additional policies such as dedicated lanes or roads.
Mass‐Based Hybrid Nanofluid Model for Thermal Radiation Analysis of MHD Flow over a Wedge Embedded in Porous Medium
Authors: Choudhary Sushila , Kumar Jarwal Vijendra , Choudhary Prasun , Loganathan K. , Pattanaik Balachandra
Published: May 2024

This study addresses the intricate interplay of magnetohydrodynamics (MHD), thermal radiation, and porous media effects, which are crucial in numerous engineering applications, including aerospace, energy systems, and environmental processes. The development of a mass‐based hybrid nanofluid model signifies a novel approach, potentially yielding more accurate predictions and insights into the thermal behavior of fluids in diverse scenarios. Thus, the current research explores the heat transfer characteristics of a unique nanofluid known as TiO2 (titania)‐CuO (copper oxide)/H2O (water) hybrid nanofluid. This nanofluid flows past a static or moving wedge considering the impact of thermal radiation and magnetic field in the appearance of porous medium. To calculate the effective thermophysical attributions of the hybrid (TiO2‐CuO) nanofluid, a mass‐based strategy is employed. This approach involves analyzing the masses of both the first and second nanoparticles, along with the mass of the base fluid, as essential input parameters. The proposed mathematical model is modified to a dimensionless form by applying similarity transformations. The numerical solution is obtained by utilizing the bvp4c built‐in function within the MATLAB environment. Graphs illustrate the influence of various parameters on temperature and velocity trends, including the magnetic field parameter and heat absorption/generation parameter as well as the thermal radiation parameter. It is noted that along with the enhancement in the values of parameters related to porous medium or magnetic field, the velocity of the hybrid nanofluid improves. This occurs when the moving wedge parameter’s value is below 1. Conversely, when the moving wedge parameter’s value exceeds 1, the velocity of the hybrid nanofluid decreases. The shape factor is more effective in the temperature profile for developed inputs of heat absorption/generation parameter. A juxtaposition of enhancement in heat transfer rate due to nanofluid (TiO2/H2O) and hybrid nanofluid (TiO2‐CuO/H2O) is likewise presented. The main outcome indicates that the hybrid nanofluid exhibits superior thermal conductivity relative to the conventional nanofluid.
Changes in the Biomechanical Properties of Corneal Stromal Lens after Collagen Crosslinking Induced by EDC-NHS
Authors: Shi Rong , Wang Lijing , Liang Chengpeng , Cheng Yu , Xiang Liu Tai , Luo Xin
Published: May 2024

Introduction. To evaluate the changes of lens antidilatation, antiedema, and antienzymolysis ability after different concentrations of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and N-hydroxysuccinimide (EDC-NHS)-induced collagen cross-linking. Methods. Corneal stromal lenticules (n = 100) obtained from small incision lenticule extraction (SMILE) procedures were divided into 5 groups: no treatment (control); EDC/NHS (5%/2.5%); EDC/NHS(5%/5%); EDC/NHS (10%/5%); riboflavin and ultraviolet-A light (UVA). Collagen crosslinking was induced using EDC-NHS and UVA. Biomechanical assessments including inflation test, enzymatic degradation resistance, and light transmittance were evaluated posttreatment. Results. (1) Lenticule apex displacement ranked: control Group > UVA Group > Group (5%/5%) > Group (5%/2.5%) > Group (10%/5%) (Friedman test, p<0.0001). (2) Light transmittance was significantly higher in the crosslinked groups versus control, with EDC/NHS superior to UVA riboflavin. After 15 minutes in PBS, light transmittance decreased due to swelling; however, crosslinked groups maintained significantly higher transmittance versus control. (3) Following crosslinking, enzymatic resistance improved significantly, with the EDC-NHS crosslinking group was significantly better than the UVA cross-linking group. Conclusions. EDC/NHS crosslinking enhanced lenticule stiffness, antiedema, and enzymatic resistance and without compromising the transparency of the lens. Moreover, EDC/NHS crosslinking efficacy exceeded UVA riboflavin crosslinking in improving lenticule biomechanical properties.
Cardiovascular Risk Estimation Is Suboptimal in People With HIV
Authors: Triant Virginia A. , Lyass Asya , Hurley Leo B. , Borowsky Leila H. , Ehrbar Rachel Q. , He Wei , Cheng David , Lo Janet , Klein Daniel B. , Meigs James B. , Grinspoon Steven K. , Plutzky Jorge , Silverberg Michael J. , LaValley Michael , Massaro Joseph M. , D'Agostino Ralph B.
Published: May 2024

Background

Established cardiovascular disease (CVD) risk prediction functions may not accurately predict CVD risk in people with HIV. We assessed the performance of 3 CVD risk prediction functions in 2 HIV cohorts.

Methods and Results

CVD risk scores were calculated in the Mass General Brigham and Kaiser Permanente Northern California HIV cohorts, using the American College of Cardiology/American Heart Association atherosclerotic CVD function, the FHS (Framingham Heart Study) hard coronary heart disease function and the Framingham Heart Study hard CVD function. Outcomes were myocardial infarction or coronary death for FHS hard coronary heart disease function; and myocardial infarction, stroke, or coronary death for American College of Cardiology/American Heart Association and FHS hard CVD function. We calculated regression coefficients and assessed discrimination and calibration by sex; predicted to observed risk of outcome was also compared. In the combined cohort of 9412, 158 (1.7%) had a coronary heart disease event, and 309 (3.3%) had a CVD event. Among women, CVD risk was generally underestimated by all 3 risk functions. Among men, CVD risk was underestimated by the American College of Cardiology/American Heart Association and FHS hard CVD function, but overestimated by the FHS hard coronary heart disease function. Calibration was poor for women using the FHS hard CVD function and for men using all functions. Discrimination in all functions was good for women (c‐statistics ranging from 0.78 to 0.90) and moderate for men (c‐statistics ranging from 0.71 to 0.72).

Conclusions

Established CVD risk prediction functions generally underestimate risk in people with HIV. Differences in model performance by sex underscore the need for both HIV‐specific and sex‐specific functions. Development of CVD risk prediction models tailored to HIV will enhance care for aging people with HIV.
Reduction of Filamin C Results in Altered Proteostasis, Cardiomyopathy, and Arrhythmias
Authors: Ohiri Joyce C. , Dellefave‐Castillo Lisa , Tomar Garima , Wilsbacher Lisa , Choudhury Lubna , Barefield David Y. , Fullenkamp Dominic , Gacita Anthony M. , Monroe Tanner O. , Pesce Lorenzo , Blancard Malorie , Vaught Lauren , George Alfred L. , Demonbreun Alexis R. , Puckelwartz Megan J. , McNally Elizabeth M.
Published: May 2024

Background

Many cardiomyopathy‐associated
FLNC
pathogenic variants are heterozygous truncations, and
FLNC
pathogenic variants are associated with arrhythmias. Arrhythmia triggers in filaminopathy are incompletely understood.

Methods and Results

We describe an individual with biallelic
FLNC
pathogenic variants, p.Arg650X and c.970‐4A>G, with peripartum cardiomyopathy and ventricular arrhythmias. We also describe clinical findings in probands with
FLNC
variants including Val2715fs87X, Glu2458Serfs71X, Phe106Leu, and c.970‐4A>G with hypertrophic and dilated cardiomyopathy, atrial fibrillation, and ventricular tachycardia. Induced pluripotent stem cell‐derived cardiomyocytes (iPSC‐CMs) were generated. The
FLNC
truncation, Arg650X/c.970‐4A>G, showed a marked reduction in filamin C protein consistent with biallelic loss of function mutations. To assess loss of filamin C, gene editing of a healthy control iPSC line was used to generate a homozygous
FLNC
disruption in the actin binding domain. Because filamin C has been linked to protein quality control, we assessed the necessity of filamin C in iPSC‐CMs for response to the proteasome inhibitor bortezomib. After exposure to low‐dose bortezomib,
FLNC‐
null iPSC‐CMs showed an increase in the chaperone proteins BAG3, HSP70 (heat shock protein 70), and HSPB8 (small heat shock protein B8) and in the autophagy marker LC3I/II.
FLNC
null iPSC‐CMs had prolonged electric field potential, which was further prolonged in the presence of low‐dose bortezomib.
FLNC
null engineered heart tissues had impaired function after low‐dose bortezomib.

Conclusions

FLNC
pathogenic variants associate with a predisposition to arrhythmias, which can be modeled in iPSC‐CMs. Reduction of filamin C prolonged field potential, a surrogate for action potential, and with bortezomib‐induced proteasome inhibition, reduced filamin C led to greater arrhythmia potential and impaired function.
Optimal Timing for Resumption of Anticoagulation After Intracranial Hemorrhage in Patients With Mechanical Heart Valves
Authors: Barra Megan E. , Forman Rachel , Long‐Fazio Bianca , Merkler Alexander E. , Gurol M. E. , Izzy Saef , Sharma Richa
Published: May 2024

Background

Anticoagulation in patients with intracranial hemorrhage (ICH) and mechanical heart valves is often held for risk of ICH expansion; however, there exists a competing risk of acute ischemic stroke (AIS). Optimal timing to resume anticoagulation remains uncertain.

Methods and Results

We retrospectively studied patients with ICH and mechanical heart valves from 2000 to 2018. The primary outcome was a composite end point of symptomatic hematoma expansion or new ICH, AIS, and intracardiac thrombus up to 30 days post‐ICH. The exposure was timing of reinitiation of anticoagulation classified as early (resumed up to 7 days after ICH), late (≥7 and up to 30 days after ICH), and never if not resumed or resumed after 30 days post‐ICH. We included 184 patients with ICH and mechanical heart valves (65 anticoagulated early, 100 late, 19 not resumed by day 30 post‐ICH). Twelve patients had AIS, 16 new ICH, and 6 intracardiac thromboses. The mean time from ICH to anticoagulation was 12.7 days. Composite outcomes occurred in 12 patients resumed early (18.5%), 14 resumed late (14.0%), and 4 never resumed (21.1%). There was no increased hazard of the composite outcome (hazard ratio [HR], 1.1 [95% CI, 0.2–6.0]), AIS, or worsening or new ICH among patients resumed early versus late. There was no difference in the composite among patients never resumed versus resumed. Patients who never resumed anticoagulation had significantly more severe ICH (median Glasgow Coma Scale: 10.6, 13.9, and 13.9 among those who resumed never, early, and late, respectively;
P
=0.0001), higher in‐hospital mortality (56.5%, 0%, and 0%, respectively;
P
<0.0001), and an elevated 30‐day AIS risk (HR, 15.9 [95% CI, 1.9–129.7],
P
=0.0098).

Conclusions

In this study of patients with ICH and mechanical heart valves, there was no difference in 30‐day thrombotic and hemorrhagic brain‐related outcomes when anticoagulation was resumed within 7 versus 7 to 30 days after ICH. Withholding anticoagulation >30 days was associated with severe baseline ICH, higher in‐hospital case fatality, and elevated AIS risk.
Associations of Long‐Term Exposure to Fine Particulate Constituents With Cardiovascular Diseases and Underlying Metabolic Mediations: A Prospective Population‐Based Cohort in Southwest China
Authors: Zhou Hanwen , Liang Xian , Zhang Xueli , Wu Jialong , Jiang Ye , Guo Bing , Wang Junhua , Meng Qiong , Ding Xianbin , Baima Yangji , Li Jingzhong , Wei Jing , Zhang Juying , Zhao Xing
Published: May 2024

Background

The health effects of particulate matter with an aerodynamic diameter ≤2.5 μm (PM
2.5
) might differ depending on compositional variations. Little is known about the joint effect of PM
2.5
constituents on metabolic syndrome and cardiovascular disease (CVD). This study aims to evaluate the combined associations of PM
2.5
components with CVD, identify the most detrimental constituent, and further quantify the mediation effect of metabolic syndrome.

Methods and Results

A total of 14 427 adults were included in a cohort study in Sichuan, China, and were followed to obtain the diagnosis of CVD until 2021. Metabolic syndrome was defined by the simultaneous occurrence of multiple metabolic disorders measured at baseline. The concentrations of PM
2.5
chemical constituents within a 1‐km
2
grid were derived based on satellite‐ and ground‐based detection methods. Cox proportional hazard models showed that black carbon, organic matter (OM), nitrate, ammonium, chloride, and sulfate were positively associated with CVD risks, with hazard ratios (HRs) ranging from 1.24 to 2.11 (all
P
<0.05). Quantile g‐computation showed positive associations with 4 types of CVD risks (HRs ranging from 1.48 to 2.25, all
P
<0.05). OM and chloride had maximum weights for CVD risks. Causal mediation analysis showed that the positive association of OM with total CVD was mediated by metabolic syndrome, with a mediation proportion of 1.3% (all
P
<0.05).

Conclusions

Long‐term exposure to PM
2.5
chemical constituents is positively associated with CVD risks. OM and chloride appear to play the most responsible role in the positive associations between PM
2.5
and CVD. OM is probably associated with CVD through metabolic‐related pathways.
Assessing Glycosylated Hemoglobin Thresholds for Development of Cardiovascular Disease by Racial and Ethnic Groups
Authors: Low Christopher G. , Merchant Maqdooda , Hung Yun‐Yi , Liu Yu Hsin , Vu Joseph , Pursnani Seema
Published: May 2024

Background

Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic–specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups.

Methods and Results

This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456–1.843];
P
<0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022–1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal.

Conclusions

Findings suggest that the use of race and ethnic– and sex‐specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.
Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study
Authors: Rouleau Codie R. , Chirico Daniele , Wilton Stephen B. , MacDonald Matthew K. , Tao Tianqi , Arena Ross , Campbell Tavis , Aggarwal Sandeep
Published: May 2024

Background

Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality.

Methods and Results

A retrospective mediation analysis was conducted among 11 196 patients referred to a 12‐week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All‐cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2‐year follow‐up (SD, 2.81 years). CR completion was associated with reduced all‐cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54–0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40–0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (
P
<0.001). CR attendance had an indirect effect on all‐cause mortality via improved cardiorespiratory fitness (
ab
=−0.006 [95% CI, −0.008 to −0.003]) and via low‐density lipoprotein cholesterol (
ab
=−0.002 [95% CI, −0.003 to −0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (
ab
=−0.007 [95% CI, −0.012 to −0.003]).

Conclusions

Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.
Comparison of Contemporary Treatment Strategies in Patients With Cardiogenic Shock Due to Severe Aortic Stenosis
Authors: Nair Raunak M. , Chawla Sanchit , Abdelghaffar Bahaa , Alkhalaieh Feras , Bansal Agam , Puri Rishi , Yun James , Krishnaswamy Amar , Kapadia Samir , Menon Venu , Reed Grant W.
Published: May 2024

Background

The aims of this study were to understand the incidence and outcomes of patients with cardiogenic shock (CS) due to severe aortic stenosis (AS), and the impact of conventional treatment strategies in this population.

Methods and Results

All patients admitted to the Cleveland Clinic cardiac intensive care unit between January 1, 2010 and December 31, 2021 with CS were retrospectively identified and categorized into those with CS in the setting of severe AS versus CS without AS. The impact of various treatment strategies on mortality was further assessed. We identified 2754 patients with CS during the study period, of whom 216 patients (8%) had CS in the setting of severe AS. Medical management was associated with the highest 30‐day mortality when compared with either balloon aortic valve replacement or aortic valve replacement (surgical or transcatheter aortic valve replacement) (hazard ratio, 3.69 [95% CI, 2.04–6.66];
P
<0.0001). Among patients who received transcatheter therapy, 30‐day mortality was significantly higher in patients who received balloon aortic valvuloplasty versus transcatheter aortic valve replacement (26% versus 4%,
P
=0.02). Both surgical and transcatheter aortic valve replacement had considerably lower mortality than medical management and balloon aortic valvuloplasty at 30 days and 1 year (
P
<0.05 for both comparisons).

Conclusions

CS due to severe AS is associated with high in‐hospital and 30‐day mortality, worse compared with those with CS without AS. In suitable patients, urgent surgical aortic valvuloplasty or transcatheter aortic valve replacement is associated with favorable short‐ and long‐term outcomes. Although balloon aortic valvuloplasty may be used to temporize patients with CS in the setting of severe AS, mortality is ≈50% if not followed by definitive aortic valve replacement within 90 days.
Trends in Dual Antiplatelet Therapy of Aspirin and Clopidogrel and Outcomes in Ischemic Stroke Patients Noneligible for POINT/CHANCE Trial Treatment
Authors: Kim Joon‐Tae , Lee Ji Sung , Kim Hyunsoo , Kim Beom Joon , Lee Keon‐Joo , Park Jong‐Moo , Kang Kyusik , Lee Soo Joo , Kim Jae Guk , Cha Jae‐Kwan , Kim Dae‐Hyun , Park Tai Hwan , Lee Kyungbok , Lee Jun , Hong Keun‐Sik , Cho Yong‐Jin , Park Hong‐Kyun , Lee Byung‐Chul , Yu Kyung‐Ho , Oh Mi Sun , Kim Dong‐Eog , Choi Jay Chol , Kwon Jee‐Hyun , Kim Wook‐Joo , Shin Dong‐Ick , Yum Kyu Sun , Sohn Sung Il , Hong Jeong‐Ho , Lee Sang‐Hwa , Park Man‐Seok , Ryu Wi‐Sun , Park Kwang‐Yeol , Lee Juneyoung , Saver Jeffrey L. , Bae Hee‐Joon
Published: May 2024

Background

Recent clinical trials established the benefit of dual antiplatelet therapy with aspirin and clopidogrel (DAPT‐AC) in early‐presenting patients with minor ischemic stroke. However, the impact of these trials over time on the use and outcomes of DAPT‐AC among the patients with nonminor or late‐presenting stroke who do not meet the eligibility criteria of these trials has not been delineated.

Methods and Results

In a multicenter stroke registry, this study examined yearly changes from April 2008 to August 2022 in DAPT‐AC use for stroke patients ineligible for CHANCE/POINT (Clopidogrel in High‐Risk Patients with Acute Nondisabling Cerebrovascular Events/Platelet‐Oriented Inhibition in New TIA and Minor Ischemic Stroke) clinical trials due to National Institutes of Health Stroke Scale >4 or late arrival beyond 24 hours of onset. A total of 32 118 patients (age, 68.1±13.1 years; male, 58.5%) with National Institutes of Health Stroke Scale of 4 (interquartile range, 1–7) were analyzed. In 2008, DAPT‐AC was used in 33.0%, other antiplatelets in 62.7%, and no antiplatelet in 4.3%. The frequency of DAPT‐AC was relatively unchanged through 2013, when the CHANCE trial was published, and then increased steadily, reaching 78% in 2022, while other antiplatelets decreased to 17.8% in 2022 (
P
trend
<0.001). From 2011 to 2022, clinical outcomes nonsignificantly improved, with an average relative risk reduction of 2%/y for the composite of stroke, myocardial infarction, and all‐cause mortality, both among patients treated with DAPT‐AC and patients treated with other antiplatelets.

Conclusions

Use of DAPT‐AC in stroke patients with stroke ineligible for recent DAPT clinical trials increased markedly and steadily after CHANCE publication in 2013, reaching deployment in nearly 4 of every 5 patients by 2022. The secondary prevention in patients with ischemic stroke seems to be gradually improving, possibly due to the enhancement of risk factor control.
Association of Lipoprotein (a) and Standard Modifiable Cardiovascular Risk Factors With Incident Myocardial Infarction: The Mass General Brigham Lp(a) Registry
Authors: Shiyovich Arthur , Berman Adam N. , Besser Stephanie A. , Biery David W. , Kaur Gurleen , Divakaran Sanjay , Singh Avinainder , Huck Daniel M. , Weber Brittany , Plutzky Jorge , Di Carli Marcelo F. , Nasir Khurram , Cannon Christopher , Januzzi James L. , Bhatt Deepak L. , Blankstein Ron
Published: May 2024

Background

Lipoprotein (a) [Lp(a)] is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. We aimed to evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI).

Methods and Results

This retrospective study used the Mass General Brigham Lp(a) Registry, which included patients aged ≥18 years with an Lp(a) measurement between 2000 and 2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease. Diabetes, dyslipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90th percentile, and low Lp(a) was defined as <50th percentile. The primary outcome was fatal or nonfatal AMI. A combination of natural language processing algorithms,
International Classification of Diseases
(
ICD
) codes, and laboratory data was used to identify the outcome and covariates. A total of 6238 patients met the eligibility criteria. The median age was 54 (interquartile range, 43–65) years, and 45% were women. Overall, 23.7% had no SMuRFs, and 17.8% had ≥3 SMuRFs. Over a median follow‐up of 8.8 (interquartile range, 4.2–12.8) years, the incidence of AMI increased gradually, with higher number of SMuRFs among patients with high (log‐rank
P
=0.031) and low Lp(a) (log‐rank
P
<0.001). Across all SMuRF subgroups, the incidence of AMI was significantly higher for patients with high Lp(a) versus low Lp(a). The risk of high Lp(a) was similar to having 2 SMuRFs. Following adjustment for confounders and number of SMuRFs, high Lp(a) remained significantly associated with the primary outcome (hazard ratio, 2.9 [95% CI, 2.0–4.3];
P
<0.001).

Conclusions

Among patients with no prior atherosclerotic cardiovascular disease, high Lp(a) is associated with significantly higher risk for first AMI regardless of the number of SMuRFs.
Trends in Survival After First Myocardial Infarction in People With Diabetes
Authors: Glynn Linn , Lind Marcus , Andersson Tomas , Eliasson Björn , Hofmann Robin , Nyström Thomas
Published: May 2024

Background

The aim of this study was to investigate temporal trends in survival and subsequent cardiovascular events in a nationwide myocardial infarction population with and without diabetes.

Methods and Results

Between 2006 and 2020, we identified 2527 individuals with type 1 diabetes, 48 321 individuals with type 2 diabetes and 243 170 individuals without diabetes with first myocardial infarction in national health care registries. Outcomes were trends in all‐cause death after 30 and 365 days, cardiovascular death and major adverse cardiovascular events (ie, nonfatal stroke, nonfatal myocardial infarction, cardiovascular death, and heart failure hospitalization). Pseudo‐observations were used to estimate the mortality risk, with 95% CIs, using linear regression, adjusted for age and sex. Individuals with type 1 diabetes were younger (62±12.2 years) and more often women (43.6%) compared with individuals with type 2 diabetes (75±10.8 years; women, 38.1%), and individuals without diabetes (73±13.2 years; women, 38.4%). Early death decreased in people without diabetes from 23.1% to 17.5%, (annual change −0.48% [95% CI, −0.52% to −0.44%]) and in people with type 2 diabetes from 22.6% to 19.3% (annual change, −0.33% [95% CI, −0.43% to −0.24%]), with no such significant trend in people with type 1 diabetes from 23.8% to 21.7% (annual change, −0.18% [95% CI, −0.53% to 0.17%]). Similar trends were observed with regard to 1‐year death, cardiovascular death, and major adverse cardiovascular events.

Conclusions

During the past 15 years, the trend in survival and major adverse cardiovascular events in people with first myocardial infarction without diabetes and with type 2 diabetes have improved significantly. In contrast, a similar improvement was not seen in people with type 1 diabetes.
Differential Effect of Aortic Valve Replacement for Severe Aortic Stenosis on Hyperemic and Resting Epicardial Coronary Pressure Indices
Authors: Minten Lennert , Bennett Johan , Otsuki Hisao , Takahashi Kuniaki , Fearon William F. , Dubois Christophe
Published: May 2024

Background

Coronary pressure indices to assess coronary artery disease are currently underused in patients with aortic stenosis due to many potential physiological effects that might hinder their interpretation. Studies with varying sample sizes have provided us with conflicting results on the effect of transcatheter aortic valve replacement (TAVR) on these indices. The aim of this meta‐analysis was to study immediate and long‐term effects of TAVR on fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs).

Methods and Results

Lesion‐specific coronary pressure data were extracted from 6 studies, resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long‐term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found. Lesion data were pooled and compared with paired
t
tests. Immediately after TAVR, FFR decreased significantly (−0.0130±0.0406 SD,
P
: 0.0002) while NHPR remained stable (0.0003±0.0675,
P
: 0.9675). Long‐term after TAVR, FFR decreased significantly (−0.0230±0.0747,
P
: 0.0038) while NHPR increased nonsignificantly (0.0166±0.0699,
P
: 0.0543). When only borderline NHPR lesions were considered, this increase became significant (0.0249±0.0441,
P
: 0.0015). Sensitivity analysis confirmed our results in borderline lesions.

Conclusions

TAVR resulted in small significant, but opposite, changes in FFR and NHPR. Using the standard cut‐offs in patients with severe aortic stenosis, FFR might underestimate the physiological significance of a coronary lesion while NHPRs might overestimate its significance. The described changes only play a clinically relevant role in borderline lesions. Therefore, even in patients with aortic stenosis, an overtly positive or negative physiological assessment can be trusted.
Long‐Term Mortality Predictors Using a Machine‐Learning Approach in Patients With Chronic Limb‐Threatening Ischemia After Peripheral Vascular Intervention
Authors: Callegari Santiago , Romain Gaëlle , Cleman Jacob , Scierka Lindsey , Jacque Francky , Smolderen Kim G. , Mena‐Hurtado Carlos
Published: May 2024

Background

Patients with chronic limb‐threatening ischemia (CLTI) face a high long‐term mortality risk. Identifying novel mortality predictors and risk profiles would enable individual health care plan design and improved survival. We aimed to leverage a random survival forest machine‐learning algorithm to identify long‐term all‐cause mortality predictors in patients with CLTI undergoing peripheral vascular intervention.

Methods and Results

Patients with CLTI undergoing peripheral vascular intervention from 2017 to 2018 were derived from the Medicare‐linked VQI (Vascular Quality Initiative) registry. We constructed a random survival forest to rank 66 preprocedural variables according to their relative importance and mean minimal depth for 3‐year all‐cause mortality. A random survival forest of 2000 trees was built using a training sample (80% of the cohort). Accuracy was assessed in a testing sample (20%) using continuous ranked probability score, Harrell C‐index, and out‐of‐bag error rate. A total of 10 114 patients were included (mean±SD age, 72.0±11.0 years; 59% men). The 3‐year mortality rate was 39.1%, with a median survival of 1.4 years (interquartile range, 0.7–2.0 years). The most predictive variables were chronic kidney disease, age, congestive heart failure, dementia, arrhythmias, requiring assisted care, living at home, and body mass index. A total of 41 variables spanning all domains of the biopsychosocial model were ranked as mortality predictors. The accuracy of the model was excellent (continuous ranked probability score, 0.172; Harrell C‐index, 0.70; out‐of‐bag error rate, 29.7%).

Conclusions

Our random survival forest accurately predicts long‐term CLTI mortality, which is driven by demographic, functional, behavioral, and medical comorbidities. Broadening frameworks of risk and refining health care plans to include multidimensional risk factors could improve individualized care for CLTI.
Cardiac Biomarker Change at 1 Year After Tafamidis Treatment and Clinical Outcomes in Patients With Transthyretin Amyloid Cardiomyopathy
Authors: Kuyama Naoto , Takashio Seiji , Oguni Tetsuya , Yamamoto Masahiro , Hirakawa Kyoko , Ishii Masanobu , Hanatani Shinsuke , Oda Seitaro , Matsuzawa Yasushi , Usuku Hiroki , Yamamoto Eiichiro , Hirai Toshinori , Ueda Mitsuharu , Tsujita Kenichi
Published: May 2024

Background

Although tafamidis treatment improves prognosis in patients with wild‐type transthyretin amyloid cardiomyopathy, an optimal surrogate marker monitoring its therapeutic effect remains unclear. This study investigated the association between changes in cardiac biomarkers, high‐sensitivity cardiac troponin T (hs‐cTnT) and B‐type natriuretic peptide (BNP) during the first year after tafamidis treatment and clinical outcomes.

Methods and Results

In 101 patients with wild‐type transthyretin amyloid cardiomyopathy receiving tafamidis at our institution, change in cardiac biomarkers from baseline to 1 year after tafamidis administration and its association with composite outcomes (composite of all‐cause death and hospitalization attributable to heart failure) was assessed. During the follow‐up period (median, 17 months), 16 (16%) patients experienced composite outcomes. The hs‐cTnT level significantly decreased at 1 year after tafamidis treatment, unlike the BNP level. The frequencies of increased hs‐cTnT and BNP levels were significantly higher in those with composite outcomes than in those without (44% versus 15%;
P
=0.01). Kaplan‐Meier survival analysis showed that patients in whom both hs‐cTnT and BNP levels increased at 1 year after tafamidis had a higher probability of composite outcomes compared with those with decreased hs‐cTnT and BNP levels (log‐rank
P
<0.01). Cox regression analysis identified increased hs‐cTnT and BNP levels at 1 year after tafamidis administration as an independent predictor of higher cumulative risk of composite outcomes.

Conclusions

Deterioration in cardiac biomarkers during the first year after tafamidis treatment predicted a worse prognosis, suggesting the utility of serial assessment of cardiac biomarkers for monitoring the therapeutic response to tafamidis in patients with wild‐type transthyretin amyloid cardiomyopathy.
Optimized Design of Shell and Tube Heat Exchanger with Segmental Baffles
Authors: Vasekar Sukhadeo S. , Kore Sandeep S. , Pawar Avinash M.
Published: May 2024

Heat exchangers are the apparatus which is widely used in various industries. They transmit heat among two or more fluid streams. Theoretical analysis done by Kern’s method has been done on Shell and tube heat exchanger with segmental baffle and then experimented in CFD to check
Heat Transfer rate and pressure drop with varying number of baffles which is 6, 8 and 10, and by keeping all the rest of parameters constant. It is found that as the number of baffles increase heat transfer rate increases also pressure drop is increases significantly. To optimize model in
next step, CFD analysis is has been done by varying baffle cut to 25%, 35% and 45% by keeping same number of baffles which found best in heat transfer rate in earlier Kern’s method. Other parameters like velocity, temperature, pressure and baffle numbers are kept constant. Results obtained
from numerical solution are analysed extensively to get the effect of baffle cut on heat transfer rate and pressure drop on shell side. The pressing need of the heat exchanger industry, the tradeoff optimization between the pressure drop and the heat transfer coefficient has been studied to
provide an idea to get effects of the change in two parameters, namely, baffle spacing and baffle cut simultaneously and observe how these two will affect the performance of an STHX. An attempt to find the optimum geometric configuration has been carried out with number of baffles. Increasing
baffles for same length of shell and baffle cut increases from 25% to 35%, heat transfer rate increases. It is beneficial in elucidating that a higher heat transfer coefficient can be obtained for fewer baffles when coupled with the appropriate baffle cut. So selection of correct optimized
shell and tube heat exchanger. The work is carried out for copper tube bundles and steel shell. So optimization of baffle cut with correct number of baffles and reduction in pressure drop studied with CFD tool.
Reflux Deposited ZnO Nanoparticles for Supercapacitor Application
Authors: Babar Umesh , Chavan Priyanka , Chougale Ashok , Patil Rahul , Mahajan Smita , Kamble Pradip
Published: May 2024

In the current study, zinc oxide (ZnO) nanocrystals have been created by the reflux method. Investigations have been made into their structural, morphological, optical, and capacitive properties. This polycrystalline nature is shown by X-ray diffraction structural analysis. ZnO integration
was verified using elemental analysis with EDX. SEM technology demonstrated that the coating of the nanostructures’ surfaces was successful. The binder-free ZnO nanoparticle electrode as it was optimized displayed a reversible electrochemical property and offered a high specific capacitance
of 335 Fg−1 at 5 mV s−1. These ZnO nanoparticle achievements were attributed to their open mesoporous structure and significant accessible area of hierarchical nanocrystals.