bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of plasma parameters of coaxial plasma source using triple Langmuir probe and Faraday cup diagnostics
Authors: KANCHI Sunil , SHUKLA Rohit , SHARMA Archana
Published: November 2023

Coaxial plasma guns are a type of plasma source that produces plasma which propagates radially and axially controlled by the shape of the ground electrode, which has attracted much interest in several applications. In this work, a 120° opening angle of CPG nozzle is used as a plasma gun configuration that operates at the energy of 150 J. The ionization of polyethylene insulator between the electrodes of the gun produces a cloud of hydrogen and carbon plasma. The triple Langmuir probe and Faraday cup are used to measure plasma density and plasma temperature. These methods are used to measure the on-axis and off-axis plasma divergence of the coaxial plasma gun. The peak values of ion densities measured at a distance of 25 mm on-axis from the plasma gun are (1.6

0.5)

10

m

and (2.8

0.6)

10

m

for hydrogen and carbon plasma respectively and the peak temperature is 3.02

0.5 eV. The mean propagation velocity of plasma is calculated using the transit times of plasma at different distances from the plasma gun and is found to be 4.54

0.25 cm/

s and 1.81

0.18 cm/

s for hydrogen and carbon plasma respectively. The Debye radius is obtained from the measured experimental data that satisfies the thin sheath approximation. The shot-to-shot stability of plasma parameters facilitates the use of plasma guns in laboratory experiments. These types of plasma sources can be used in many applications like plasma opening switches, plasma devices, and as plasma sources.
Optimization of visible photoluminescence emission from Ni-Zn ferrite thin films
Authors: Faramawy A M , El-Sayed H M
Published: November 2023

Ni-Zn ferrite films with different thicknesses were prepared by the spray method, aiming to study the relationship between the annealing effect in an oxygen rich environment and the structural, optical properties and photoluminescence emission. X-ray diffraction (XRD) analysis used with Rietveld refinement showed that all prepared samples had a single spinel phase structure. Likewise, the Fourier transform infrared (FTIR) spectra confirmed the phase formation of Ni-Zn ferrites by appearing in both of the two characteristic absorption bands which are related to the tetrahedral and octahedral sites. For annealed thin film samples of Ni-Zn ferrite, the atomic force microscope (AFM) surface morphology exhibits pinning structure on the surface in nanoscale height, whereas for un-annealed samples, there are hills and valleys cover a broad region. The different electronic transitions were estimated from the UV-visible transmission spectrum. Strong photoluminescence (PL) intensity in the visible range was observed under the excitation of UV radiation. The intensity of the PL signal was strongest at a film thickness of 750 nm then decreased for higher thicknesses. This could be interpreted by using proposed energy level structures based on the transmission spectrum of the investigated samples. The strong PL intensity introduces the samples as a direct optical detector for UV radiation.
LGN loss randomizes spindle orientation and accelerates tumorigenesis in PTEN-deficient epidermis
Authors: Viala Sophie , Hadjadj Charlotte , Nathan Vandana , Guiot Marie-Christine , McCaffrey Luke , Cockburn Katie , Bouchard Maxime
Published: November 2023

Loss of cell polarity and disruption of tissue organization are key features of tumorigenesis that are intrinsically linked to spindle orientation. Epithelial tumors are often characterized by spindle orientation defects, but how these defects impact tumor formation driven by common oncogenic mutations is not fully understood. Here, we examine the role of spindle orientation in adult epidermis by deleting a key spindle regulator, LGN, in normal tissue and in a PTEN-deficient mouse model. We report that LGN deficiency in PTEN mutant epidermis leads to a threefold increase in the likelihood of developing tumors on the snout, and an over 10-fold increase in tumor burden. In this tissue, loss of LGN alone increases perpendicular and oblique divisions of epidermal basal cells, at the expense of a planar orientation of division. PTEN loss alone does not significantly affect spindle orientation in these cells, but the combined loss of PTEN and LGN fully randomizes basal spindle orientation. A subset of LGN- and PTEN-deficient animals have increased amounts of proliferative spinous cells, which may be associated with tumorigenesis. These results indicate that loss of LGN impacts spindle orientation and accelerates epidermal tumorigenesis in a PTEN-deficient mouse model.
Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure
Authors: Hiura Grant T , Markossian Talar W , Probst Beatrice D , Tootooni Mohammad Samie , Wozniak Gregory , Rakotz Michael , Kramer Holly J
Published: November 2023

BACKGROUND

Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities.

METHODS

We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65–74 and ≥75 years) after covariate adjustment.

RESULTS

Baseline mean age was 75.0 years (SD 7.8); 41.4% were male. TI occurred in 79.0% and 83.7% of clinic visits in age groups 65–74 and ≥75 years, respectively. In age group 65–74 years, prevalence ratio of TI with 2, 3–4, and ≥5 comorbidities compared with zero comorbidities was 1.07 (95% confidence interval [CI]: 1.04, 1.12), 1.08 (95% CI: 1.05, 1.12), and 1.15 (95% CI: 1.10, 1.20), respectively. The number of comorbidities was not associated with TI prevalence in age group ≥75 years. After implementation of the improvement program, TI declined from 80.3% to 77.2% in age group 65–74 years and from 85.0% to 82.0% in age group ≥75 years (P < 0.001 for both groups).

CONCLUSIONS

TI was common among older adults but not associated with comorbidities after age ≥75 years. A hypertension improvement program had limited impact on TI in older patients.
Seed coat colour and structure are related to the seed dormancy and overwintering ability of crop-to-wild hybrid soybean
Authors: Zhang Li , Jia Ruizong , Liu Laipan , Shen Wenjing , Fang Zhixiang , Zhou Bin , Liu Biao
Published: November 2023

The possible persistence of genetically modified (GM) crop-to-wild hybrid seeds in the soil seed bank is a major concern in risk assessment and is closely related to seed characteristics such as dormancy. In the present study, we generated F3 hybrids via crosses between GM soybean accessions and wild soybean and evaluated the dormancy, overwintering ability and inheritance of foreign genes in different-coloured hybrid seeds (yellow, green, brown and black). The results revealed that the 5-enolpyruvylshikimate-3-phosphate synthase transgene may have no influence on crop wild hybrid seed dormancy and overwintering ability, and the dormancy of the hybrid seeds was closely related to seed coat colour. F3 hybrid seeds with light colours (yellow and green) were relatively nondormant, while seeds that were dark (brown and black) in colour were relatively dormant. Moreover, the hybrid seeds that were dark in colour had a much stronger overwintering ability than the lighter-coloured seeds, with 21.33 % of the black seeds and 33.33 % of the brown seeds remaining viable after 240 days of soil burial. In contrast, almost all the F3 yellow and green seeds were no longer viable during winter. Scanning electron microscopy revealed that the lighter-coloured seeds had a thin palisade layer and very few surface deposits, while the darker-coloured seeds had a thicker palisade layer and a large area of honeycomb-like surface deposits similar to those of wild soybean seeds. Thus, the physical dormancy and overwintering ability of the darker-coloured seeds may be related to the seed coat. Our results suggest that transgenes of GM soybean might disperse into wild populations and persist in seed banks.
pyPESTO: a modular and scalable tool for parameter estimation for dynamic models
Authors: Schälte Yannik , Fröhlich Fabian , Jost Paul J , Vanhoefer Jakob , Pathirana Dilan , Stapor Paul , Lakrisenko Polina , Wang Dantong , Raimúndez Elba , Merkt Simon , Schmiester Leonard , Städter Philipp , Grein Stephan , Dudkin Erika , Doresic Domagoj , Weindl Daniel , Hasenauer Jan
Published: November 2023

Mechanistic models are important tools to describe and understand biological processes. However, they typically rely on unknown parameters, the estimation of which can be challenging for large and complex systems. pyPESTO is a modular framework for systematic parameter estimation, with scalable algorithms for optimization and uncertainty quantification. While tailored to ordinary differential equation problems, pyPESTO is broadly applicable to black-box parameter estimation problems. Besides own implementations, it provides a unified interface to various popular simulation and inference methods.

Availability and implementation

pyPESTO is implemented in Python, open-source under a 3-Clause BSD license. Code and documentation are available on GitHub (https://github.com/icb-dcm/pypesto).
Dermatopathology
Authors: Lim Puo Nen , Muttoni Elisabetta , Morris Hayley T , Tilston Simon
Published: November 2023

This is a Specialty Certificate Examination case highlighting the typical histological features of pemphigus foliaceus.
Reimagining Approaches to Out-of-School Time Spaces That Center Youth
Authors: Greer Carl Donovan , Fosl Lyrah Grace , Mitchell Brandon D
Published: November 2023

The beginning of 2020 marked the onset of the COVID-19 pandemic and a new reality. Mainstream learning loss discourse emerged as young people faced new social challenges and rising inequities. However, how we define some of these challenges may pose new barriers to equity promotion. Deficit-based narratives often negatively construct youth identities and intertwine with neoliberal forces and systemic inequities. Out-of-school time (OST) spaces offer hope and opportunity for a re-envisioned environment to centralize youth voice and provide critical time for leisure and reconnection. In this article, authors explore the strategies that can exist between youth workers and social workers in cultivating OST spaces for young people to engage with complex social justice development in humane, nurturing, and respectful environments. Authors center the argument for shifting away from extractive neoliberal models that commodify youth, the importance of becoming cognizant of OST’s impact on young people’s development, and raising awareness of the possibilities within OST spaces through youth-focused frameworks.
Artificial intelligence–enabled assessment of right ventricular to pulmonary artery coupling in patients undergoing transcatheter tricuspid valve intervention
Authors: Fortmeier Vera , Lachmann Mark , Stolz Lukas , von Stein Jennifer , Unterhuber Matthias , Kassar Mohammad , Gerçek Muhammed , Schöber Anne R , Stocker Thomas J , Omran Hazem , Körber Maria I , Hesse Amelie , Harmsen Gerhard , Friedrichs Kai Peter , Yuasa Shinsuke , Rudolph Tanja K , Joner Michael , Pfister Roman , Baldus Stephan , Laugwitz Karl-Ludwig , Windecker Stephan , Praz Fabien , Lurz Philipp , Hausleiter Jörg , Rudolph Volker
Published: November 2023

Aims

Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters.

Methods and results

This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R: 0.68; P value: 1.3 × 10−8). Moreover, predicted mPAP (mPAPpredicted) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography) levels in predicting 2-year mortality after TTVI [area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10−6]. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10−4).

Conclusion

Artificial intelligence–enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling.
Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports
Authors: Dal Piaz Matheus Ramos , Pires Lucas Tachotti , Herrera Jonathan Cayo Urdiales , Labat André Luis Bezerra , Cividanes Felipe Reale , Spina Guilherme Sobreira , Palma José Honório , Tarasoutchi Flávio
Published: November 2023

Background

Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear.

Cases summary

A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed.

Discussion

Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.
Development and internal validation of machine learning–based models and external validation of existing risk scores for outcome prediction in patients with ischaemic stroke
Authors: Axford Daniel , Sohel Ferdous , Abedi Vida , Zhu Ye , Zand Ramin , Barkoudah Ebrahim , Krupica Troy , Iheasirim Kingsley , Sharma Umesh M , Dugani Sagar B , Takahashi Paul Y , Bhagra Sumit , Murad Mohammad H , Saposnik Gustavo , Yousufuddin Mohammed
Published: November 2023

Aims

We developed new machine learning (ML) models and externally validated existing statistical models [ischaemic stroke predictive risk score (iScore) and totalled health risks in vascular events (THRIVE) scores] for predicting the composite of recurrent stroke or all-cause mortality at 90 days and at 3 years after hospitalization for first acute ischaemic stroke (AIS).

Methods and results

In adults hospitalized with AIS from January 2005 to November 2016, with follow-up until November 2019, we developed three ML models [random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBOOST)] and externally validated the iScore and THRIVE scores for predicting the composite outcomes after AIS hospitalization, using data from 721 patients and 90 potential predictor variables. At 90 days and 3 years, 11 and 34% of patients, respectively, reached the composite outcome. For the 90-day prediction, the area under the receiver operating characteristic curve (AUC) was 0.779 for RF, 0.771 for SVM, 0.772 for XGBOOST, 0.720 for iScore, and 0.664 for THRIVE. For 3-year prediction, the AUC was 0.743 for RF, 0.777 for SVM, 0.773 for XGBOOST, 0.710 for iScore, and 0.675 for THRIVE.

Conclusion

The study provided three ML-based predictive models that achieved good discrimination and clinical usefulness in outcome prediction after AIS and broadened the application of the iScore and THRIVE scoring system for long-term outcome prediction. Our findings warrant comparative analyses of ML and existing statistical method–based risk prediction tools for outcome prediction after AIS in new data sets.
The one-minute sit-to-stand test (1-min STST) and its relationship to quality of life (QoL) in patients with pulmonary hypertension (PH)
Authors: Kronberger C , Willixhofer R , Dachs T , Rettl R , Camuz Ligios L , Badr Eslam R
Published: November 2023

Introduction

Patients with pulmonary hypertension (PH) have a decreased functional capacity and poor quality of life (QoL). The one-minute sit-to-stand test (1-min STST) can be potentially used for functional capacity assessment, but there is no data to date on its relationship to QoL in PH patients.

Aims

Our aim was to find out if 1-min STST performance correlates to patient-reported QoL.

Methods

106 PH patients (mean age 66 ± 15 years, 57% female) were prospectively assessed for cardiorespiratory fitness using the 1-min STST. The patients had to stand-up and sit-down from a chair as many times as possible within one minute. Patients QoL was evaluated with the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire.

Results

Mean number of 1-min STST repetitions was 16 ± 6.5 and mean CAMPHOR score was 26 ± 19. Patients with worse 1-min STST performance reported significantly worse QoL concerning the total score and all the sub-scores of the CAMPHOR questionnaire: They had a higher total score (r = -0.533, p < 0.001) and regarding sub-scores more symptoms: (r = -0.457, p < 0.001), worse functioning (r = -0.524, p < 0.001) and decreased QoL (r = -0.505, p < 0.001). Also, in multivariable linear regression analysis, adjusted for age, sex and BMI, lower 1-min STST performance was an independent predictor for worse QoL (β⁠ = -1.5, p < 0.001).

Conclusion

Our results indicate that regardless of age, sex and BMI the 1-min STST performance is associated with QoL in patients with PH.
Short- and long-term results of total arch replacement for acute type I aortic dissection in comparison to hemiarch replacement: a 10-year follow-up analysis
Authors: Fischer J , Siemeni T , Doenst T , Caldonazo T , Kirov H , Malouhi A , Zanow J , Ludewig S , Faeber G , Diab M
Published: November 2023

Background

Optimal management of the arch in cases of acute type-A aortic dissection (ATAAD) involving the aortic arch (DeBakey type I) is still controversial. Extended total arch replacement (TAR) to address re-entries increases the complexity of surgery and may be associated with worse short-term outcome. We aimed in this study to compare short- and long-term outcomes of TAR compared to hemiarch replacement.

Methods

We retrospectively analyzed data of patients operated for ATAAD in our center. The study was approved by the ethics committee. We used Student’s t-test or Mann-Whitney U test to compare continuous variables. We performed univariate Chi-square and multivariate logistic regression analysis. Log-rank test was used to compare long-term mortality between the two groups. In addition, hazard ratio (HR) with 95% confidence interval (CI) was reported.

Results

Between July 2007 and November 2021, 396 patients underwent surgery for ATAAD in our center. Among them, 326 (82%) presented with DeBakey type I dissection and were included in further analyses. TAR was performed in 103 (32%) patients, while hemiarch in 221 (68%) patients. Patients who received TAR were significantly younger (59.2±12.3 vs 64.0±13.5 years), had more frequently peripheral arterial disease (24% vs 15%, p=0.065), and presented more frequently preoperatively with neurological deficits (32% vs 18%, p=0.046). Patients in the TAR group received more aortic repair/replacement (29% vs 17%, p=0.018). New permanent postoperative neurological deficits (stroke or paraplegia) occurred in 10% of the TAR group and in 15% of the hemiarch group (p=0.463). Mortality at 30 days was higher in the TAR group but the difference was not statistically significant (27% vs 20%, p=0.198). In the multivariate analyses TAR was not an independent predictor for 30-day mortality (OR: 1.71, 0.91-3.19, p=0.092) or post operative neurological complications (OR: 0.66, 0.28-1.55, p=0.337). The estimated 10-year survival for patients with TAR was 56% compared to 63% for the hemiarch group (Logrank=0.450). In the multivariate Cox regression analysis, TAR was not an independent predictor for long-term survival (adjusted HR: 1.24, 0.79-1.94, p=0.348).

Conclusions

Total arch replacement was not an independent predictor for postoperative neurological complications, short-, or long-term mortality. Putting a potential surgeon bias aside, our results suggest that the fear of TAR may be overestimated.
The importance of active rhythm monitoring in patients with renal infarction: Korean national health insurance registry
Authors: Park S , Kim D E , Moon I K , Kong M G , Park H W , Choi H O , Seo H S , Cho Y H , Lee N H , Suh J
Published: November 2023

Background/Introduction

Several studies reported that approximately 50% of renal infraction (RI) is caused by cardioembolic disease, particularly associated with atrial fibrillation (AF). However, in the Korean national health insurance database (NHIS), from 2013 to 2019, the prevalence of AF in patients with RI was only 15%. So, we aimed to analyze the incidence of newly developed AF in RI patients.

Method

This nationwide population-based retrospective cohort study included 5,200 patients with RI using the NHIS database from 2002 to 2012. We analyzed the incidence rate of AF during 12 months among the patients without previous history of AF. We selected clinical events after three months of RI diagnosis to exclude cases diagnosed by initial screening or with previously missed diagnosis of AF. The definition of RI, AF, and comorbidities use the ICD-10-CM codes.

Result

During the total follow-up period (median 2.5 years, interquartile range 1.04-4.25), AF occurred in 19.1% of RI patients (n=993). Most cases (n=837, 16.1%) occurred within a year, and the incidence of AF was 3.965 per 10,000 person-year. Patients with newly developed AF had a higher proportion of older age than those without AF (64.1 vs. 57.3 years, P<0.001). The prevalence of comorbidities, including hypertension (HTN), ischemic heart disease (IHD), and heart failure (HF), was higher in those with AF. The independent predictors of AF were age (adjusted hazard ratio [aHR] 1.05, 95% CI 1.04-1.05, P<0.001), male (aHR 1.26, 95% CI 1.09-1.45, P=0.002), body mass index (BMI) (aHR 1.04, 95% CI 1.02-1.06, P <0.001), current smoker (aHR 1.20, 95% CI 1.03-1.40, P =0.023), IHD (aHR 1.20, 95% CI 1.00-1.45, P =0.050) and HF (aHR 1.70, 95% CI 1.25-2.33, P =0.001). Additionally, the incidence of all-cause death was 14.264 per 10,000 person-year during the follow-up period.

Conclusion

Even if AF is not diagnosed in the initial screening after diagnosis of RI, the physician should consider active rhythm monitoring to detect subclinical AF for optimal management in these patients. Especially it might be helpful to reduce the burden of recurrent embolic events in those with risk factors, such as older age, male, higher BMI, current smoker, IHD, or HF.Cox regression analysisAtrial fibrillation cumulative incidence
Adjudicated thrombotic events in a cotemporary multicenter cohort of patients with COVID-19: findings from the CORONA-VTE Registry
Authors: Bikdeli B , Bejjani A , Khairani C D , Krishnathasan D , Armero A , Davies J , Assi A , Campia U , Almarzooq Z , Welker J , Sharma A , Carroll B , Lan Z , Goldhaber S , Piazza G
Published: November 2023

Background

Venous thromboembolism (VTE) and arterial thrombosis emerged among the main serious complications of coronavirus disease 2019 (COVID-19) in the early post-infection period and during convalescence. Data are less consistent about how the event rates may have changed over time considering the change in viral variants and COVID-19 therapies, and vaccination status.

Purpose

To report VTE and arterial thrombotic events in patients with COVID-19, and assess results by vaccination status and over time from a large multicenter patient-level US registry.

Methods

Adult patients with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at Mass-General Brigham (MGB) Health system, the largest health system in the Massachusetts that serves 1.5 million patients, were eligible. Data elements were entered into a centralized database by trained research staff. Thrombotic events were adjudicated by two independent physicians. Outcomes were assessed at 30- and 90-day follow-up. Findings were pre-specified to be assessed separately for patients who were hospitalized with COVID-19 vs outpatients. Vaccination status was ascertained for subgroup analysis.

Results

The study included 4,123 patients from the MGB Health System from 3/13/2020 through 06/03/2022 (age: 53.5 ± 18 years; 55.9% female, Table). Among hospitalized patients, the cumulative incidence of VTE was 7.7% at day 90 (95% CI: 6.2-9.2%). Respective 30-day event rates for arterial thrombosis among hospitalized patients were 4.4% (95% CI: 3.2%-5.5%). Event rates were lower for outpatients (Figure, Panel A). Thirty-day cumulative incidence of VTE and arterial thrombosis/thromboembolism based on history of vaccination (restricted to cohort from 12/14/2020 onward) are presented in Panel B.

Conclusions

In this multicenter study 30-day adjudicated thrombotic events were frequent in patients with COVID-19, albeit lower among vaccinated patients. Follow-up for 90-day outcomes are being finalized and will be presented at ESC 2023.
Long-term prognostic risk score for CLTI including nutritional state
Authors: Okina Y , Ueki Y , Kato T , Miura T , Oyama Y , Hashizume N , Yokota D , Taki M , Senda K , Okina Y , Wakabyashi T , Fujimori K , Karube K , Sakai T , Kuwahara K
Published: November 2023

Background

Chronic limb-threatening ischemia (CLTI) is well known for its poor prognosis. Although nutritional state is reportedly related to outcome, few studies have considered a long-term prognostic score for CLTI that includes nutritional status.

Methods

The I-PAD registry was a prospective, multicenter, observational patient registry designed to provide up to 5 years of clinical follow-up data. A total of 366 patients having undergone 463 endovascular treatments for symptomatic lower extremity artery disease were enrolled, from which 125 patients with CLTI were analyzed. We searched for prognostic predictors including nutritional status for amputation-free survival (AFS) to develop a scoring system for long-term CLTI prognosis.

Results

Median patient age was 77 [68, 86] years and follow-up period was 1729 [797, 1954] days. Cox multivariate analysis revealed Geriatric Nutritional Risk Index score <92 points, >71 years of age, female, heart failure, and anemia (<13.0 g/dL in men and <12.0 g/dL in women) to be significant prognostic predictors for AFS (all p<0.05). We calculated the weighted risk score for each prognostic factor (0 to 11 points) and divided the cohort into the high score group (≥4 points) and low score group (≤3 points). The incidence of AFS at 5 years was significantly lower in the high score group (35.4% vs. 89.5%, p<0.001). The area under the receiver operating characteristic curve was 0.81 for 5-year AFS.

Conclusion

A higher prognostic score incorporating nutritional state may indicate a worse long-term prognosis in CLTI patients.
Prevalence and associated factors of chronic venous disease among a modern non-western population
Authors: Babaei M , Afrooghe A , Rafati A , Mohebbi B , Moosavi J , Ghadri N , Mohajer Koohestani B , Baay M , Alemzadeh-Ansari M J , Hosseini Z , Khalilipur E , Ghaemmaghami Z , Pouraliakbar H , Bakhshandeh H , Sadeghipour P
Published: November 2023

Background

Chronic venous disease (CVD) of the lower extremities is a commonly occurring vascular disease with varied clinical manifestations and an uncertain prevalence due to differences in population characteristics and measurement techniques.

Purpose

The aim of this study was to assess chronic venous disease prevalence and identify associated risk factors in a modern non-western urban population.

Methods

2227 adults aged 30–75 years with no overt cardiovascular diseases were randomly selected from different city districts to participate in a cardiovascular cohort. After they were informed about the examination methods, including total lower extremities exposure, 1176 (52%) of them agreed to participate. Two trained interventional cardiologists evaluated CVD using the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification ensuring that all participants were evaluated by the same criteria in order to obtain reliable results. CVD was classified as C1–C6, and chronic venous insufficiency (CVI) as C3–C6. In this study, CVD associations were investigated using a multivariable regression model that accounted for pre-specified variables such as age, sex, body mass index (≥30 kg/m2), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery.

Results

The prevalence of CVD and CVI among the participants was 36.5% (95% CI, 33.8 to 39.3) and 0.7% (95% CI, 0.3 to 1.3), respectively, and CVD prevalence was more frequent in women (44.2% vs. 23.5%). Based on multivariable analysis advanced age (OR, 1.06; 95% CI, 1.04 to 1.08), female sex (OR, 2.98; 95% CI, 2.14 to 4.14), and a body mass index of ≥30 (OR, 1.36; 95% CI, 1.03 to 1.81) were independently associated CVD. Physical activity (OR, 0.77; 95% CI, 0.58 to 1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, did not appear to have any meaningful association with CVD.

Conclusions

Our results showed that CVD was prevalent in a modern non-western urban population. Due to the low prevalence of advanced stages of the disease, mass screening is debatable, and better risk discriminators are needed.Figure 1Table 1
The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis - A nationwide cohort study
Authors: Chao T , Lip G Y H , Chen S A
Published: November 2023

Background

In post-stroke AF patients with indications for both oral anticoagulants (OACs) and antiplatelet agents (AP), eg. those with carotid artery stenosis, there is debate over the best management strategy.

Objectives

We aimed to examine outcomes in post-stroke AF patients with extracranial artery stenosis (ECAS). Second, to explore stroke and bleeding outcomes as well as the net clinical benefit (NCB), with OACs (non-vitamin K antagonist OACs [NOACs] or warfarin) and with AP-OAC combination therapy, when compared to AP alone.

Methods

We performed a nationwide cohort study in post-stroke AF patients with and without ECAS (n=6390 and 28093, respectively). The risks of clinical events and NCB with different antithrombotic strategies were compared to AP alone.

Results

The risk of recurrent ischemic stroke was higher for patients with ECAS than those without (12.72%/yr versus 10.60/yr; adjusted hazard ratio [aHR] 1.104, p<1.001). For patients with ECAS, when compared to AP only, NOAC monotherapy was associated with lower risks for ischaemic stroke (aHR 0.551 [95%CI 0.454-0.669], the composite of ischaemic stroke/major bleeding (aHR 0.577 [95%CI 0.478-0.697]) and the composite of ischaemic stroke/ICH (aHR 0.577 [95%CI 0.478-0.697]), with nonsignificant difference for major bleeding and ICH (Figure). NOAC monotherapy was the only approach associated with a positive NCB, while all other options (warfarin, combination AP-OACs) were associated with negative NCB.

Conclusions

For post-stroke AF patients with ECAS, NOAC monotherapy was associated with lower risks of adverse outcomes and a positive NCB. Combination of AP with NOAC or warfarin did not offer any benefit, but more bleeding especially with AP-warfarin combination therapy.
Incidence of fatal stroke 24 years after acute coronary syndrome: the value of baseline albuminuria and hypertension. The ABC study on acute coronary syndrome
Authors: Berton G , Cordiano R , Palmieri R , Pasquinucci M , Bagato F , Merotto D , Menegon F , Nardi T , Ahmed M M , Mahmoud H T
Published: November 2023

Background

Albuminuria and hypertension are known independent predictors of stroke risk.

Purpose

To investigate the additive effect of baseline albuminuria and hypertension on the very long-term risk prediction of fatal stroke (FS) in patients with acute coronary syndrome (ACS).

Methods

The present analysis includes 589 patients admitted with ACS to 3 Italian hospitals and discharged alive. Patients were followed prospectively for 24 years or until death. Baseline clinical and laboratory data were recorded within the first 7 days of hospitalization.

Results

All but three patients completed the follow-up representing 7065 person-years and 44 patients (7%) developed FS. They shared most of the baseline clinical characteristics with the patients who did not have FS, except for being significantly older (mean age was 72±8 vs. 66±12 years, p=0.0008). Patients with FS also had albuminuria more frequently (66% vs. 49%, p=0.03) with significantly higher values of 3rd-day albumin–creatinine ratio (ACR), (p=0.009). At Cox regression analysis; patients who had hypertension or albuminuria had a higher risk of developing FS, hazard ratios were (HR=1.8; 95%CI=1.0–3.2; p=0.05 and HR=2.9; 95%CI=1.5–5.3; p=0.001 respectively. Patients with both hypertension and albuminuria showed an independent risk association for developing FS than patients with neither HR=4.2; 95%CI=1.8–9.7; p=0.001. Results kept true with a model adjusted for age, gender and presence of atrial fibrillation. The same results were obtained with the competing risk analysis (HR=2.6; 95%CI=1.1–6.0, p=0.02).

Conclusions

the results showed that the combination of hypertension and albuminuria is associated with an independent greater risk of developing a fatal stroke long after ACS.
Clinical impact of valvular strands or Lambl's excrescences in the real-world practice
Authors: Hasegawa Y , Toyota T , Okada T , Ohara N , Murai R , Sasaki Y , Taniguchi T , Kim K , Kobori A , Ehara N , Kinoshita M , Furukawa Y
Published: November 2023

Background

Due to recent advancements in high-resolution echo systems, valvular strands or Lambl’s excrescences are frequently observed in daily clinical practice. However, it can be challenging to differentiate these valvular structures as fibroelastomas or infective endocarditis. Although those redundant cardiac tissues are reported to cause embolic events, the incidence or outcomes of valvular strands and Lambl’s excrescences have not been well investigated.

Purpose

To investigate the clinical impact of valvular strands or Lambl’s excrescences (VS/LEs) on clinical outcomes.

Methods

We searched our hospital’s institutional echocardiography database for transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) reports with VS/LEs between 2018 and 2022. Patients diagnosed with infectious endocarditis or overt papillary fibroelastoma were excluded. Clinical outcomes of all-cause death, ischemic stroke, systemic embolism, or surgical resection were evaluated from the electronic medical chart. We analyzed the cumulative incidences of each clinical outcome for the entire cohort, and we compared cases assessed by TEE (With TEE) and cases confirmed by TTE only (TTE only).

Results

From the 53799 TTE and 3186 TEE tests, we found 340 reports from 174 cases with VS/LEs (With TEE, 67 cases, and TTE only, 107 cases). Only one stroke case was suspected of aortic valve strand origin for stroke at the index TEE or TTE. Surgical resection was performed in two cases (one each in With TEE and TTE only groups) within 30 days from the first detection of the VS/LEs. The median follow-up period was 355 days. We observed all-cause death in 8 cases (6.1%: With TEE, 1 case [1.6%] and TTE only, 7 cases [8.6%], P=0.09). Ischemic stroke occurred in 6 cases (5.0%: With TEE, 3 cases [6.5%], TTE only, 3 cases [4.1%], P=0.27). None of the deaths were associated with embolic events. We performed landmark analysis at 30 days for surgical resection, and five cases underwent surgical treatment at one year (With TEE, 5 cases, and TTE only, no case). All surgical resections for the VS/LEs were performed concurrently with other cardiac operations.

Conclusions

In this study, we observed that most VS/LEs were managed non-invasively and rarely associated with embolic events, especially TTE-only detected VS/LEs.
Effects of guiding catheter on franctional flow reserve and non-hyperemic pressure ratios for the assessment of coronary artery stenoses
Authors: Di Serafino L , Scalamogna M , Carbone C , De Rosa M L , Mitrano L , Cirillo P , Franzone A , Piccolo R , Spaccarotella C , Esposito G
Published: November 2023

Aims

Non-hyperemic pressure-derived Indexes (NHPI) provide diagnostic efficacy equivalent to fractional flow reserve (FFR) to guide percutaneous coronary interventions. In the Disengage (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, selective decannulation of the guiding catheter (GC) within the coronary ostium during FFR assessment was associated with a significant overall decrease in FFR, particularly when the stenosis was located in the proximal and middle coronary segments. So far it is unclear what influence the selective cannulation of the catheter in the coronary artery ostium has on the NHPI. This prospective registry aimed to evaluate the influence of GC engagement within the coronary ostium on FFR and NHPI values.

Methods and results

In the DISENGAGE@Rest (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) 133 patients with 164 intermediate coronary artery stenoses (40-90%) were enrolled. We evaluated: 1) the impact of GC engagement within the coronary ostium on FFR and NHPI values; 2) implications for clinical decision making; 3) the relationship between coronary physiology indices and study site (proximal, middle and distal coronary segments). Disengagement of GC was associated with a significant decrease in FFR (FFReng, 0.85±0.07 vs. FFRdis, 0.83±0.07; p< .001), Pd/Pa (Pd/Paeng, 0.94±0.05 vs. Pd/Padis, 0.93±0.05; p< .001) and RFR values (RFReng, 0.91±0.07 vs. RFRdis, 0.90±0.07; p= .018). This significant decrease in invasive physiologic indexes was driven by a significant increase in mean Pa value (Pa eng, 93±15 mm Hg vs. Pa dis, 97±15 for FFR; P < .001; Pa eng, 94±15 mm Hg vs Pa dis, 96±15 for Pd/Pa; P < .001 Pa eng, 95±15 mm Hg vs Pa dis, 97±15 for RFR; P < .001), without changes in mean Pd value. In 24 (15%), 12 (7%) and 17 (10%) lesions, FFR, RFR and Pd/Pa values, respectively, shifted below the cut-off point after GC disengagement with changes in clinical decision-making. There was a significant FFR change, but no NHPI, across different segments (ΔFFReng–FFRdis proximal 0.04±0.03 vs. ΔFFReng–FFRdis middle 0.02±0.02 vs. ΔFFReng–FFRdis distal 0.03±0.04; p= .018).

Conclusions

The results confirm a significant overall decrease in FFR after GC disengagement and extend this to Pd/Pa and RFR. In case of proximal coronary artery disease, GC disengagement should be performed in order not to underestimate the hemodynamic significance of the lesion under examination.
Side branch closure in patients undergoing coronary bifurcation stenting with or without side branch predilatation
Authors: Vassilev D , Mileva N , Panayotov P , Rigatelli G , Gil R
Published: November 2023

Background

Considerable progress in the treatment of coronary bifurcation lesions has been achieved. Side branch pre-dilatation (SPPD) is a technique that is generally not recommended by the latest guidelines and consensus statements. The main reason is the risk of side branch (SB) dissection or vessel closure.

Aim

The aim of the current study is to explore the rates of SB closure in patients undergoing bifurcation PCI with or without SB pre-dilatation.

Methods

All patients with coronary bifurcation lesions treated between 2012 and 2022 were included in the prospective registry. For the current analysis, only patients with stable or unstable angina were included, with follow-up of at least two years. Patients with STEMI and left main stenosis were excluded. Propensity Score Matching (PSM) was performed to equalize the effects of the following characteristics: age, sex, diabetes, smoking, hypertension, dyslipidemia, renal failure, cancer, COPD, atrial fibrillation, left ventricular ejection fraction, and SYNTAX score. SB closure was defined as SB ostial stenosis ≥99% with TIMI 0-1 flow.

Results

832 patients from the registry covered the criteria for the current analysis. After PSM, 324 matched couples remained, and 648 patients were analyzed. The demographic characteristics of SBP(+) and SBP (-) were well balanced, with no differences between groups – age 68±10 years, 71% males, 40% smokers, 47% with diabetes, 26% with previous MI, 53% with previous PCI, 4% after CABG, 12% with peripheral arterial disease, 13% with COPD, 32% with renal failure, 23% AFib, LVEF 55±10%. Patient with SBP(+) wad more CTOs (17% vs. 9%, p=0.003), longer lesions (42±21mm vs. 36±20mm, p<0.001) and more severe SB stenoses (68%±25% vs. 41%±31%, p<0.001). Among true bifurcation stenoses (Medina xx1 – 63%, 410/648), 88% were predilated.

SB closure was non-significantly different in groups with SBPD and SBnPD (3.6% vs. 2.2%, p=0.272). Acute SB closure after stenting occurred at similar rates in SBPD and SBnPD groups (3.6% vs. 2.7%, p=0.505), without difference in rates of MI if SB was closed or not (n=10/17, 59% vs. n=227/631, 36%, p=0.058). The rate of periprocedural MI was not significantly different between groups with and without SB closure – 52% vs. 34%, p=0.066. At the end of the procedure, only 7 SBs were closed, 2 in the SBPD group and 5 in the SBnPD group (p=0.461).

Conclusions

The rates of final SB closure were numerically lower (but not significantly different) when SBPD was performed. SB closure did not translate into worse clinical outcomes.
Trends and outcomes of intravascular imaging in patients undergoing percutaneous coronary intervention for coronary chronic total occlusion: a 5-year retrospective analysis
Authors: Moras E , Gandhi K , Isath A , Wu L , Casso Dominguez A
Published: November 2023

Background

Elderly patients with coronary chronic total occlusions (CTO) represent a vulnerable population with comorbid conditions and complex coronary anatomy. Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). There is limited data on its impact in patients undergoing percutaneous coronary intervention (PCI) for coronary CTO.

Purpose

We aimed to identify the trends in utilization of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in patients undergoing single vessel (SV) - CTO PCI and its impact on clinical outcomes.

Methods

We queried the Nationwide Inpatient Sample database to identify hospitalizations for SV PCI between 2016 – 2020. Patients with CTO were identified using the ICD-10 diagnosis code. The use of IVUS and OCT was identified using the ICD-10 codes. We compared utilization of IVUS-OCT for SV-CTO PCI to those without and studied the impact of their utilization on clinical outcomes. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes included in-hospital mortality, re-infarction, stroke and post-procedural AKI. Outcomes were compared using univariate and multivariate logistic regression analysis.

Results

A total of 135,745 weighted hospitalizations for SV CTO-PCI were identified of which 13,610 (10%) utilized IVUS/OCT (mean age 66+/-12, 26.5 % females). Hospitalizations were stratified by patient age into a younger cohort <75 years (mean age 61 ± 9 years) and an older cohort ≥75 years (mean age 81 + 4). Male sex, Caucasians, and admissions to a large urban hospital were associated with higher IVUS/OCT use in both cohorts (p < 0.001). The use of IVUS/OCT was associated with significantly lower MACCE (aOR 0.73, 95% CI 0.6 - 0.8, p < 0.001) and lower incidence of re-infarction in both cohorts (OR 0.6, 95% CI 0.5-0.6, p<0.001 for both cohorts). In-hospital mortality was significantly lower in both cohorts utilizing intravascular imaging (OR 0.8, 95% CI 0.7-1.0, p<0.05 for age ≥75 years and OR 0.6, 95% CI 0.5-0.7, p <0.001) for age < 75). Overall, the rates of stroke and length of stay (4 + 5 days) were comparable but associated with higher hospitalization costs (153k-170k vs 110k-120k, p < 0.001). In patients undergoing CTO-PCI, there was an increasing trend towards the utilization of IVUS and OCT over the study period.

Conclusion

The use of IVUS/OCT guidance for CTO-PCI was associated with a significant reduction in MACCE, re-infarction and in hospital mortality regardless of age. There was a significant increase in the utilization of IVUS and OCT for the study period in all groups.