bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of solar pp neutrino flux using electron recoil data from PandaX-4T commissioning run*
Authors: Lu 芦 Xiaoying 晓盈 , Abdukerim 阿布都沙拉木· Abdusalam 阿布都克力木 , Bo 薄 Zihao 子豪 , Chen 陈 Wei 葳 , Chen 谌 Xun 勋 , Chen 陈 Yunhua 云华 , Cheng 程 Chen 晨 , Cheng 成 Zhaokan 兆侃 , Cui 崔 Xiangyi 祥仪 , Fan 樊 Yingjie 英杰 , Fang 方 Deqing 德清 , Geng 耿 Lisheng 立升 , Giboni Karl , Guo 郭 Xuyuan 绪元 , Han 韩 Chencheng 晨成 , Han 韩 Ke 柯 , He 何 Changda 昶达 , He 何 Jinrong 金荣 , Huang 黄 Di 迪 , Huang 黄 Junting 俊挺 , Huang 黄 Zhou 周 , Hou 侯 Ruquan 汝全 , Hou 侯 Yu 钰 , Ji 季 Xiangdong 向东 , Ju 巨 Yonglin 永林 , Li 李 Chenxiang 晨翔 , Li 李 Jiafu 家富 , Li 李 Mingchuan 名川 , Li 李 Shuaijie 帅杰 , Li 李 Tao 涛 , Lin 林 Qing 箐 , Liu 刘 Jianglai 江来 , Lu 陆 Congcong 聪聪 , Luo 罗 Lingyin 棱尹 , Luo 罗 Yunyang 云阳 , Ma 马 Wenbo 文博 , Ma 马 Yugang 余刚 , Mao 冒 Yajun 亚军 , Meng 孟 Yue 月 , Ning 宁 Xuyang 旭阳 , Pang 庞 Binyu 彬宇 , Qi 祁 Ningchun 宁春 , Qian 钱 Zhicheng 志成 , Ren 任 Xiangxiang 祥祥 , Shaheed Nasir , Shang 尚 Xiaofeng 晓凤 , Shao 邵 Xiyuan 熙元 , Shen 申 Guofang 国防 , Shen 申 Manbin 满斌 , Si 司 Lin 琳 , Sun 孙 Wenliang 文良 , Tao 陶 Yi 奕 , Wang 王 Anqing 安庆 , Wang 王 Meng 萌 , Wang 王 Qiuhong 秋红 , Wang 王 Shaobo 少博 , Wang 王 Siguang 思广 , Wang 王 Wei 为 , Wang 王 Xiuli 秀丽 , Wang 王 Xu 旭 , Wang 王 Zhou 舟 , Wei 魏 Yuehuan 月环 , Wu 武 Mengmeng 蒙蒙 , Wu 邬 Weihao 维浩 , Wu 吴 Yuan 渊 , Xiao 肖 Mengjiao 梦姣 , Xiao 肖 Xiang 翔 , Xiong 熊 Kaizhi 开智 , Yan 燕 Binbin 斌斌 , Yan 颜 Xiyu 玺雨 , Yang 杨 Yong 勇 , Yu 喻 Chunxu 纯旭 , Yuan 袁 Ying 影 , Yuan 苑 Zhe 哲 , Yun 运 Youhui 有辉 , Zeng 曾 Xinning 鑫宁 , Zhang 张 Minzhen 敏桢 , Zhang 张 Peng 鹏 , Zhang 张 Shibo 世博 , Zhang 张 Shu 澍 , Zhang 张 Tao 涛 , Zhang 张 Wei 威 , Zhang 张 Yang 洋 , Zhang 张 Yingxin 瀛心 , Zhang 张 Yuanyuan 园园 , Zhao 赵 Li 力 , Zhou 周 Jifang 济芳 , Zhou 周 Ning 宁 , Zhou 周 Xiaopeng 小朋 , Zhou 周 Yubo 钰博 , Zhou 周 Zhizhen 知震 , (PandaX Collaboration)
Published: June 2024

The proton-proton (

) fusion chain dominates the neutrino production in the Sun. The uncertainty of the predicted

neutrino flux is at the sub-percent level, whereas that of the best measurement is

(10%). In this study, for the first time, we measure solar

neutrinos in the electron recoil energy range from 24 to 144 keV using the PandaX-4T commissioning data with 0.63 tonne

year exposure. The

neutrino flux is determined as

, which is consistent with the Standard Solar Model and existing measurements, corresponding to an upper flux limit of

at 90% C.L..
Neuromorphic circuits based on memristors: endowing robots with a human-like brain
Authors: Wang Xuemei , Yang Fan , Liu Qing , Zhang Zien , Wen Zhixing , Chen Jiangang , Zhang Qirui , Wang Cheng , Wang Ge , Liu Fucai
Published: June 2024

Robots are widely used, providing significant convenience in daily life and production. With the rapid development of artificial intelligence and neuromorphic computing in recent years, the realization of more intelligent robots through a profound intersection of neuroscience and robotics has received much attention. Neuromorphic circuits based on memristors used to construct hardware neural networks have proved to be a promising solution of shattering traditional control limitations in the field of robot control, showcasing characteristics that enhance robot intelligence, speed, and energy efficiency. Starting with introducing the working mechanism of memristors and peripheral circuit design, this review gives a comprehensive analysis on the biomimetic information processing and biomimetic driving operations achieved through the utilization of neuromorphic circuits in brain-like control. Four hardware neural network approaches, including digital-analog hybrid circuit design, novel device structure design, multi-regulation mechanism, and crossbar array, are summarized, which can well simulate the motor decision-making mechanism, multi-information integration and parallel control of brain at the hardware level. It will be definitely conductive to promote the application of memristor-based neuromorphic circuits in areas such as intelligent robotics, artificial intelligence, and neural computing. Finally, a conclusion and future prospects are discussed.
Electronic nose based analysis of exhaled volatile organic compounds spectrum reveals asthmatic shifts and consistency in controls post-exercise and spirometry
Authors: Dragonieri Silvano , Marco Marcin Di , Ahroud Madiha , Quaranta Vitaliano Nicola , Portacci Andrea , Iorillo Ilaria , Montagnolo Francesca , Carpagnano Giovanna Elisiana
Published: June 2024

Analyzing exhaled volatile organic compounds (VOCs) with an electronic nose (e-nose) is emerging in medical diagnostics as a non-invasive, quick, and sensitive method for disease detection and monitoring. This study investigates if activities like spirometry or physical exercise affect exhaled VOCs measurements in asthmatics and healthy individuals, a crucial step for e-nose technology’s validation for clinical use. The study analyzed exhaled VOCs using an e-nose in 27 healthy individuals and 27 patients with stable asthma, before and after performing spirometry and climbing five flights of stairs. Breath samples were collected using a validated technique and analyzed with a Cyranose 320 e-nose. In healthy controls, the exhaled VOCs spectrum remained unchanged after both lung function test and exercise. In asthmatics, principal component analysis and subsequent discriminant analysis revealed significant differences post-spirometry (vs. baseline 66.7% cross validated accuracy [CVA], p < 0.05) and exercise (vs. baseline 70.4% CVA, p < 0.05). E-nose measurements in healthy individuals are consistent, unaffected by spirometry or physical exercise. However, in asthma patients, significant changes in exhaled VOCs were detected post-activities, indicating airway responses likely due to constriction or inflammation, underscoring the e-nose’s potential for respiratory condition diagnosis and monitoring.
Sparse Cholesky factorization for solving nonlinear PDEs via Gaussian processes
Authors: Chen Yifan , Owhadi Houman , Schäfer Florian
Published: June 2024

In recent years, there has been widespread adoption of machine learning-based approaches to automate the solving of partial differential equations (PDEs). Among these approaches, Gaussian processes (GPs) and kernel methods have garnered considerable interest due to their flexibility, robust theoretical guarantees, and close ties to traditional methods. They can transform the solving of general nonlinear PDEs into solving quadratic optimization problems with nonlinear, PDE-induced constraints. However, the complexity bottleneck lies in computing with dense kernel matrices obtained from pointwise evaluations of the covariance kernel, and itspartial derivatives, a result of the PDE constraint and for which fast algorithms are scarce.

The primary goal of this paper is to provide a near-linear complexity algorithm for working with such kernel matrices. We present a sparse Cholesky factorization algorithm for these matrices based on the near-sparsity of the Cholesky factor under a novel ordering of pointwise and derivative measurements. The near-sparsity is rigorously justified by directly connecting the factor to GP regression and exponential decay of basis functions in numerical homogenization. We then employ the Vecchia approximation of GPs, which is optimal in the Kullback-Leibler divergence, to compute the approximate factor. This enables us to computeϵ\epsilon-approximate inverse Cholesky factors of the kernel matrices with complexityO(Nlogd⁡(N/ϵ))O(N\log ^d(N/\epsilon ))in space andO(Nlog2d⁡(N/ϵ))O(N\log ^{2d}(N/\epsilon ))in time. We integrate sparse Cholesky factorizations into optimization algorithms to obtain fast solvers of the nonlinear PDE. We numerically illustrate our algorithm’s near-linear space/time complexity for a broad class of nonlinear PDEs such as the nonlinear elliptic, Burgers, and Monge-Ampère equations. In summary, we provide a fast, scalable, and accurate method for solving general PDEs with GPs and kernel methods.
Adaptations of masculinity: mapping the affective power of Achilles and Patroclus
Authors: Svelstad Per Esben
Published: June 2024

The Greek myth of Achilles and Patroclus, two of the heroes of the Trojan War, has served various ideological purposes in adaptive revisions. The central question of this article is how the story lends itself to different interpretations and ideological projects across time. Building on concepts of affect, power, and cartographical reading, as described by Gilles Deleuze, the analyses highlight the potential of the myth to do different things. The examples analysed are Christa Wolf’s novel Kassandra, Madeline Miller’s novel The Song of Achilles, and a figure skating routine by French elite skater Kevin Aymoz. A comparison of these adaptations shows how the myth can be used to celebrate alternative notions of masculinity and challenge homophobic discourses. Furthermore, the comparison highlights figure skating as a mode of adaptation where a performer becomes a character, thus underlining the affirmative potential of the sport.
Urban-rural disparities in the short-term effects of cold and heat on myocardial infarction mortality in Anhui Province, China
Authors: Yang Min , He Qin , Wu Keyu , Wu Qiyue , Bai Zhongliang , Cheng Qianyao , Hu Jingyao , Wang Huadong , Su Hong , Xing Xiuya , Cheng Jian
Published: June 2024

Non-optimal ambient temperatures are risk factors for myocardial infarction (MI) and urban-rural temperature differences in the context of climate change may have caused and will lead to differential association between temperature and MI. We collected daily mean temperature and daily MI deaths from 1 January 2016 to 31 December 2020 in Anhui Province, China. A distributed lag nonlinear model was performed to estimate the area-specific association of heat and cold (defined as the 2.5th and 97.5th percentile of the daily mean temperature) with MI mortality; the random-effects meta-analysis was then used to pool the effects of cold and heat. We found the risk of MI death due to cold was higher in rural areas [relative risk (RR): 1.13, 95% confidence interval (CI): 1.02-1.26, lag0) than in urban areas (RR: 0.99, 95% CI: 0.80-1.21, lag0), whereas the risk of MI death associated with heat was higher in urban areas (RR: 1.14, 95% CI: 1.03-1.27, lag0) than in rural areas (RR: 1.04, 95% CI: 0.99-1.10, lag0). Our findings may help to develop targeted protective strategies to reduce the adverse effects of cold and heat on cardiovascular disease.
Key considerations for the future of mental health epidemiology
Authors: Abdalla Salma M , Galea Sandro
Published: June 2024

Psychiatric epidemiology has led to substantial progress in our understanding of the causes of mental health disorders. The increasing sophistication of etiologic psychiatric research has been accompanied by a greater focus on the biological and genetic causes of psychiatric disorders, to some extent diverging from field’s early focus on the burden of poor mental health due to a breadth of social and economic conditions. We argue that the moment is ripe for advancing a mental health epidemiology that can reconnect the field to these earlier—and still central—concerns while retaining the strengths of psychiatric epidemiology. Embracing 5 considerations can help advance the evolving field of mental health epidemiology. First, conceptually, an ambitious vision for the future of the field necessitates investment in refining our definitions and methodologies. Second, there is a need for a renewed focus on the macrosocial determinants of mental health. Third, a deeper engagement with mental health inequities should be central to our scholarship. Fourth, the field would benefit from a more deliberate assessment of the mechanisms leading to adverse mental health outcomes, which can then be used to inform novel interventions. Finally, realizing this future is contingent upon a wholesale commitment to studying population mental health globally.

This article is part of a Special Collection on Mental Health.
Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: a design-weighted intersectional MAIHDA
Authors: McGuire F Hunter , Beccia Ariel L , Peoples JaNiene E , Williams Matthew R , Schuler Megan S , Duncan Alexis E
Published: June 2024

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect under interlocking systems of oppression to socially pattern depression among US adults. With cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (n = 234 722), we conducted a design-weighted, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) under an intersectional framework to predict past-year and lifetime major depressive episodes (MDEs). With 42 intersectional groups constructed from 7 race/ethnicity, 2 sex/gender, and 3 sexual orientation categories, we estimated age-standardized prevalence and excess or reduced prevalence attributable to 2-way or higher interaction effects. Models revealed heterogeneity across groups, with prevalence ranging from 1.9% to 19.7% (past-year) and 4.5% to 36.5% (lifetime). Approximately 12.7% (past year) and 12.5% (lifetime) of total individual variance was attributable to between-group differences, indicating key relevance of intersectional groups in describing the population distribution of depression. Main effects indicated, on average, that people who were White, women, gay/lesbian, or bisexual had greater odds of MDE. Main effects explained most between-group variance. Interaction effects (past year: 10.1%; lifetime: 16.5%) indicated another source of heterogeneity around main effects average values, with some groups experiencing excess or reduced prevalence compared with main effects expectations. We extend the MAIHDA framework to calculate nationally representative estimates from complex sample survey data using design-weighted, Bayesian methods.

This article is part of a Special Collection on Mental Health.
Predictive value of early lactate (<6 h) during normothermic machine perfusion and outcome after liver transplantation: results from a multicentre study
Authors: Hofmann Julia , Meszaros Andras T , Butler Andrew , Hann Angus , Hartog Hermien , Kneifel Felicia , Iype Satheesh , Crick Keziah , Cardini Benno , Fiore Barbara , Attia Magdy , Pollok Joerg-Matthias , Pascher Andreas , Vogel Thomas , Perera Thamara , Watson Christopher J E , Schneeberger Stefan
Published: June 2024

Background

Biomarkers with strong predictive capacity towards transplantation outcome for livers undergoing normothermic machine perfusion (NMP) are needed. We investigated lactate clearing capacity as a basic function of liver viability during the first 6 h of NMP.

Methods

A trial conducted in 6 high-volume transplant centres in Europe. All centres applied a back-to-base NMP approach with the OrganOx metra system. Perfusate lactate levels at start, 1, 2, 4 and 6 h of NMP were assessed individually and as area under the curve (AUC) and correlated with EAD (early allograft dysfunction), MEAF (model for early allograft function) and modified L-GrAFT (liver graft assessment following transplantation) scores.

Results

A total of 509 livers underwent ≥6 h of NMP before transplantation in 6 centres in the UK, Germany and Austria. The donor age was 53 (40–63) years (median, i.q.r.).

The total NMP time was 10.8 (7.9–15.7) h. EAD occurred in 26%, MEAF was 4.72 (3.54–6.05) and L-GrAFT10 −0.96 (−1.52–−0.32). Lactate at 1, 2 and 6 h correlated with increasing robustness with MEAF. Rather than a binary assessment with a cut-off value at 2 h, the actual 2 h lactate level correlated with the MEAF (P = 0.0306 versus P = 0.0002, Pearson r = 0.01087 versus r = 0.1734). The absolute lactate concentration at 6 h, the AUC of 0–6 h and 1–6 h (P < 0.0001, r = 0.3176) were the strongest predictors of MEAF.

Conclusion

Lactate measured 1–6 h and lactate levels at 6 h correlate strongly with risk of liver allograft dysfunction upon transplantation. The robustness of predicting MEAF by lactate increases with perfusion duration. Monitoring lactate levels should be extended to at least 6 h of NMP routinely to improve clinical outcome.
The interictal suppression hypothesis is the dominant differentiator of seizure onset zones in focal epilepsy
Authors: Doss Derek J , Shless Jared S , Bick Sarah K , Makhoul Ghassan S , Negi Aarushi S , Bibro Camden E , Rashingkar Rohan , Gummadavelli Abhijeet , Chang Catie , Gallagher Martin J , Naftel Robert P , Reddy Shilpa B , Williams Roberson Shawniqua , Morgan Victoria L , Johnson Graham W , Englot Dario J
Published: June 2024

Successful surgical treatment of drug-resistant epilepsy traditionally relies on the identification of seizure onset zones (SOZs). Connectome-based analyses of electrographic data from stereo electroencephalography (SEEG) may empower improved detection of SOZs. Specifically, connectome-based analyses based on the interictal suppression hypothesis posit that when the patient is not having a seizure, SOZs are inhibited by non-SOZs through high inward connectivity and low outward connectivity. However, it is not clear whether there are other motifs that can better identify potential SOZs. Thus, we sought to use unsupervised machine learning to identify network motifs that elucidate SOZs and investigate if there is another motif that outperforms the ISH.

Resting-state SEEG data from 81 patients with drug-resistant epilepsy undergoing a pre-surgical evaluation at Vanderbilt University Medical Center were collected. Directed connectivity matrices were computed using the alpha band (8–13 Hz). Principal component analysis (PCA) was performed on each patient’s connectivity matrix. Each patient’s components were analysed qualitatively to identify common patterns across patients. A quantitative definition was then used to identify the component that most closely matched the observed pattern in each patient.

A motif characteristic of the interictal suppression hypothesis (high-inward and low-outward connectivity) was present in all individuals and found to be the most robust motif for identification of SOZs in 64/81 (79%) patients. This principal component demonstrated significant differences in SOZs compared to non-SOZs. While other motifs for identifying SOZs were present in other patients, they differed for each patient, suggesting that seizure networks are patient specific, but the ISH is present in nearly all networks.

We discovered that a potentially suppressive motif based on the interictal suppression hypothesis was present in all patients, and it was the most robust motif for SOZs in 79% of patients. Each patient had additional motifs that further characterized SOZs, but these motifs were not common across all patients. This work has the potential to augment clinical identification of SOZs to improve epilepsy treatment.
Economics Imperialism then and now: Ben Fine on the Changing Relationship between Economics and the Other Social Sciences
Authors: Morgan Jamie
Published: June 2024

In this review essay, I explore the first two of a planned 10 volumes of Ben Fine’s selected journal publications. The two are broadly concerned with economics imperialism before and after a ‘watershed’ (before which it is recognised for what it is and after which it is less so). I first set out what Fine means by economics imperialism. I then discuss a few examples of what heterodox economists have been talking about insofar as they were not (quite) talking about economics imperialism. This provides a useful segue into the specifics of Fine’s writings across the two volumes, and in two subsections, I separately survey the volumes. Finally, I conclude with some comment on the sense of unfinished business that hangs over constructive change.
Lipid lowering for prevention of venous thromboembolism: a network meta-analysis
Authors: Farmakis Ioannis T , Christodoulou Konstantinos C , Hobohm Lukas , Konstantinides Stavros V , Valerio Luca
Published: June 2024

Background and Aims

Studies have suggested that statins may be associated with reduced risk of venous thromboembolism (VTE). The aim of the current study was to assess the evidence regarding the comparative effect of all lipid-lowering therapies (LLT) in primary VTE prevention.

Methods

After a systematic search of PubMed, CENTRAL, and Web of Science up until 2 November 2022, randomized controlled trials (RCT) of statins (high- or low-/moderate-intensity), ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were selected. An additive component network meta-analysis to compare VTE risk during long-term follow-up across different combinations of LLT was performed.

Results

Forty-five RCTs (n = 254 933 patients) were identified, reporting a total of 2084 VTE events. Compared with placebo, the combination of PCSK9i with high-intensity statin was associated with the largest reduction in VTE risk (risk ratio [RR] 0.59; 95% confidence interval [CI] 0.43–0.80), while there was a trend towards reduction for high-intensity (0.84; 0.70–1.02) and low-/moderate-intensity (0.89; 0.79–1.00) statin monotherapy. Ezetimibe monotherapy did not affect the VTE risk (1.04; 0.83–1.30). There was a gradual increase in the summary effect of VTE reduction with increasing intensity of the LLT. When compared with low-/moderate-intensity statin monotherapy, the combination of PCSK9i and high-intensity statin was significantly more likely to reduce VTE risk (0.66; 0.49–0.89).

Conclusions

The present meta-analysis of RCTs suggests that LLT may have a potential for VTE prevention, particularly in high-intensity dosing and in combination therapy.
Timing of administration of beta-blockers: effects on early de novo postoperative atrial fibrillation
Authors: De Kruijf N L M , Zwijnenburg R D , Van Schie M S , Kavousi M , Taverne Y J H J , De Groot N M S
Published: June 2024

Background

Early postoperative atrial fibrillation (ePoAF) is the most common complication after cardiac surgery. Guidelines recommend use of perioperative beta-blockers for ePoAF prevention. Despite these recommendations and improvements of surgical skills and postoperative care, the occurrence of ePoAF did not alter over time.

Purpose

We examined the effect of pre- and post-operative beta-blocker’ usage on development of early (≤ 5 days after surgery) de novo PoAF.

Methods

Adult patients (N=415) with coronary artery bypass grafting (N=225), valve surgery (N=135) or a combination of both (N=55) were retrieved from an existing database to investigate the relation between beta-blocker’ usage and de novo ePoAF. Early de novo PoAF was defined as AF occurring ≤ 5 days after surgery. Sub analysis was performed in a subpopulation on patients who received pre- and post-operative beta-blockers and had undergone epicardial mapping of the right atrium in sinus rhythm (SR) (N=125) (Table 1). Unipolar potentials were classified as single, short or long double and fractionated potentials. Unipolar potential voltage, conduction velocity and conduction block (CB) prevalence were measured.

Results

De novo ePoAF occurred in 135 (33%) patients and mainly (46%) on the second post-operative day. Post-operative beta-blockers were administered in 13 (4%) patients in day 0, 163 (46%) patients in day 1, 103 (29%) patients in day 2, 42 (12%) patients in day 3, 23 (7%) patients in day 4, and 8 (3%) patients in day 5. Preoperative beta-blockers’ usage was not significantly associated with lower prevalence of de novo ePoAF (usage versus no usage 35% versus 27%; odds ratio 1.45 [95% CI, 0.93 – 2.25]). However, postoperative beta-blockers’ usage was significantly associated with lower prevalence of de novo ePoAF (usage versus no usage 20% versus 61%; odds ratio 0.16 [95% CI, 0.10- 0.26]). De novo ePoAF occurred in 22% of the patients using both pre- and post-operative beta-blockers. In the sub analyses of the epicardial mapping data patients without (N=91) and with ePoAF (N=34) were compared. ePoAF was associated with more low voltage areas and CB. Furthermore, patients with ePoAF had more long doubles, and fractionated potentials and subsequently less single potentials. (Figure 1).

Conclusion

Our results suggest that administration of beta-blockers after, but not prior to cardiac surgery, could be effective in preventing de novo ePoAF. However, this therapy is only moderately effective in preventing ePoAF. Among patients using both pre- and postoperative beta-blockers, patients with ePoAF had more extensive arrhythmogenic substrates prior to cardiac surgery compared to patients who remained in SR.
Supraventricular tachycardia (SVT) and high troponin levels: patient characteristics and evaluation of coexisting coronary artery disease
Authors: Aletras G , Stratinaki M , Bachlitzanaki E , Georgopoulou T , Korela D , Rogdakis E , Pitarokoilis M , Bachlitzanaki M , Foukarakis E
Published: June 2024

Background

High-sensitive troponin (hs-cTnI/hs-cTnT) assays are preferred for detecting myocardial injury and can be elevated in various clinical conditions other than acute myocardial infarction including supraventricular tachycardias (SVTs). Patients with SVT and troponinemia often need further evaluation for coronary artery disease (CAD), guiding the clinical management.

Purpose

The purpose of this study is to characterize patients with supraventricular tachycardia (atrioventricular nodal reentrant tachycardia-AVNRT, atrioventricular reentrant tachycardia-AVRT and atrial tachycardia-AT) and elevated troponin values as well as to evaluate the association between troponin increase and coexisting coronary artery disease.

Methods

We recorded demographic characteristics, main complaints, underlying comorbidities, presence or absence of a previous history of SVT, duration of tachycardia, systolic blood pressure (SBP), heart rate (HR), creatinine and peak hs-cTnI values on admission. Further details on the type of cardioversion and the total number of patients who visited the Emergency Department (ED) or were admitted to the Cardiology department due to SVT in the last 3 years were recorded. Subsequently, we examined all hospitalized patients, distinguishing those who underwent an invasive or non-invasive test to rule out CAD and noting the presence or absence of coexisting CAD. The patients were divided into two groups based on the presence of troponinemia. Data analysis using IBM-SPSS 27 and results presentation with mean and standard deviation for values with normal distribution and median and interquartile range (25th-75th) for values with non-normal distribution.

Results

Out of 106 patients who presented to the ED due to SVT 47 had abnormal hs-cTnI values. A statistically significant difference was observed in patients with troponinemia, particularly those with retrosternal pain, no previous history of SVT, and a longer duration of tachycardia. Factors such as gender, admission Cr, sodium, potassium, and SBP values, the presence of known CAD, diabetes mellitus (DM), thyroid disease, hypertension, or the type of cardioversion had no significant effect on the occurrence of troponinemia. Among the 47 patients with troponinemia, 39 were admitted to the Cardiology Department, and 21 of them underwent further evaluation for CAD, with only one patient showing significant disease.

Conclusions

Patients without a previous episode of SVT, presenting with retrosternal pain and longer duration of tachycardia on admission seem to be the ones to present abnormal troponin values after an episode of SVT. The occurrence of troponinemia in these patients is more likely to be related to myocardial oxygen-demand needs mismatch than to the presence of CAD. Comorbidities and other characteristics  Admission values
Impact of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in cancer patients: a systematic review and meta-analysis of heart failure hospitalisation and mortality
Authors: Veerni R , Bhalraam U , Paddock S , Meng J , Vassiliou V , Tsampasian V
Published: June 2024

Introduction

The use of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) has demonstrated cardiovascular benefits in a variety of patient populations [1]. This systematic review and meta-analysis aims to determine the impact of SGLT2i on cardiovascular outcomes, specifically heart failure (HF) hospitalisation and mortality in patients with cancer.

Methods

A systematic literature search of PubMed and Ovid databases was conducted from inception until the 18th of November 2023. The search criteria used were : ["((SGLT2) OR (Sodium glucose cotransporter 2 inhibitors) OR (canagliflozin) OR (dapagliflozin) OR (empagliflozin) OR (ertugliflozin)) AND (cancer)"]. The primary inclusion criteria for studies were: Randomised Controlled Trials (RCTs) or observational studies, involving patients administered SGLT2 inhibitors, with a comparison group. The outcomes of interest were all-cause mortality and heart failure hospitalisation. Exclusion criteria included studies not specifically examining patients on SGLT2 inhibitors, and studies not reporting on cardiac dysfunction outcomes. The statistical analysis was conducted using R 4.3.1 on RStudio.

Results

Our search yielded 1304 studies, out of which, 8 studies with 2402 patients receiving SGLT2i and 30,494 controls were included in the analysis. The pooled analysis of 6 studies and 32,197 patients revealed that SGLT2i use was associated with a significant reduction in the risk of All-Cause Mortality (Risk Ratio [RR] 0.49, 95% Confidence Interval [CI] [0.35, 0.67], I² = 93%, p < 0.01) [figure 1]. In addition, meta-analysis of 5 studies and 4,116 patients showed that the use of SGLT2i was associated with 62% reduction of HF Hospitalisation (Risk Ratio [RR] 0.49, 95% Confidence Interval [CI] [0.35, 0.67], I² = 93%, p < 0.01) [figure 2].

Conclusions

SGLT2i is associated with a significant decrease in both HF hospitalisation and all-cause mortality rates in patients with cancer. These findings suggest that SGLT2i could be beneficial in managing cardiovascular outcomes in this patient population. Further research is warranted to elucidate the mechanisms and potential clinical applications of SGLT2i in oncological settings. Figure 1  Figure 2
Frailty evaluation a key to tailored cardiovascular rehabilitation in elderly patients
Authors: German-Sallo M , Preg Z , Balint Szentendrey D , Pal T , Nagy Z , Tatar M C
Published: June 2024

Introduction

Aging most frequently is associated with increasing number of comorbidities and disability leading to frailty, which decreases functional independence. Cardiovascular rehabilitation can be challenging in these situations.

Purpose

Our aim was to assess frailty syndrome in elderly patients, as part of a comprehensive cardiovascular rehabilitation program and to identify the main components contributing to loss of self –care.

Methods

A total number of 92 patients (53,3% female) , aged 60 years or older (mean age 72,4 ±7,44 ) admitted to a cardiovascular rehabilitation clinic were included in a cross- sectional study. History, physical examination and guideline recommended investigations were performed. 2 different instruments were used to evaluate frailty: Clinical Frailty Scale (CFS) and Frail Scale (FS). Based on the obtained points, patients with a mean CFS score of 5 or higher or a mean FS score 3 or higher were classified into the frail group. We compared the clinical and laboratory parameters of the frail patients with data of the non-frail group. In addition we looked for occurence of frailty in individuals below 70 years compared to those above 70 years. Data were processed using Microsoft Excel 2019 , t- test and chi-square test, p<0.05 was considered statistically significant.

Results

30 patients (32,6%) were identified with frailty according to CFS and also based on FS. Mean age of frailty patients was higher (76,89 ±6,7 years vs. 70,37 ±6,7 years , p < 0,001). Prevalence was significantly higher in subjects older than 70 years (28% vs 11%, p<0,001) according to CFS, but not to FS. In the frailty group the following parameters were significantly lower : serum albumin (3.92 g/dl vs. 4.15 g/dl, p=0.02), hemoglobin (12.01 g/dl vs. 13.13 g/dl; p =0.01) and eGFR (66.65 ml/min/1.73 m2 vs. 82.86 ml/min/1.73 m2, p=0.02). Based on CFS the following comorbidities were more prevalent in the affected group: atrial fibrillation (57,1% vs 30,6%, p=0,01), chronic kidney disease (42,85% vs 18%, p < 0,001) and osteoarticular diseases (39% vs 19%, p=0,04). FS score based evaluation showed that previous stroke (26% vs 8%, p=0,01) , CKD (50%vs 15%, p=0,01) and osteoarticular diseases (39% vs 19%, p=0,04) were more frequent in frail patients.

Conclusions

Assessment of frailty can be integrated in older cardiovascular patient's evaluation. Revealing and addressing specific frailty related aspects could overcome the barrier to restoration of their functional independence.
Lipid-lowering treatment pattern in chronic coronary syndrome - lower proportion of treatment observed among women during 3 years of follow-up
Authors: Johnston N , Schubert J , Svensson M K , Taufer Cederlof E , Cars T , Gustafsson S , Schalin L , Hagstrom E
Published: June 2024

Background

Lipid-lowering treatment (LLT) is one of the cornerstones in secondary prevention in patients with chronic coronary syndrome (CCS). Despite having the same recommendations for target levels of low-density lipoprotein cholesterol (LDL-C), studies have shown that women have worse control of LDL-C than men. Older age has been suggested as a significant explanatory factor.

Purpose

To describe and compare the treatment pattern and target achievement of LDL-C levels in men and women managed for CCS in a primary care setting. Furthermore, to elucidate factors contributing to sex differences by examining the frequency of LDL-C assessment and LLT intensity by age.

Methods

A retrospective observational study of patients with CCS was performed in a region of Sweden comprising 390 000 inhabitants. The study population included men and women with a CCS first-time diagnosed between 2012 and 2020 and without previous myocardial infarction. The CCS diagnosis was based on the combination of an international classification diagnosis code (ICD-10) of angina and coronary artery disease confirmed by either a non-invasive or an invasive investigation. Data on clinical measurements after inclusion were collected from the electronic health records. Target levels were LDL-C <1.8 mmol/L (2012-2015) and LDL-C <1.4 mmol/L (2015-2020) and systolic blood pressure (SBP) <140 mmHg. Data were stratified by sex and age categories (<60, 60-<70, 70-<80, ≥80 years). Measurement of blood pressure (BP) was used as a proxy for a healthcare visit.

Results

Median age was 68 (interquartile range [IQR], 62-74) and 70 (IQR, 63-76) years in men (N=1037) and women (N=415), respectively. Compared with men, women were less often treated with LLT and less likely to receive combination with a statin and ezetimibe (Figure 1). A larger proportion of women was not treated with any LLT. In all age subgroups, a decline in LLT use in women compared to men was observed over time. Assessment of LDL-C decreased markedly after the first year of follow-up irrespective of sex (assessment of LDL-C was 67.7% and 50.9% at year one and three, respectively). In both men and women, target achievement of LDL-C was low and decreased during follow-up (Figure 2). Regardless of sex, measurements and target achievement of BP were monitored more frequently than those of LDL-C levels.

Conclusion

Women were less often and less aggressively treated with LLT than men, on average. Although most patients with CCS are in contact with healthcare professionals for BP monitoring, little or no actions seem to be taken to improve lipid management.
Incidence and short term outcome of patients manifesting delirium in a university hospital cardiac intensive care unit
Authors: Pavli E , Sulku E , Dado E , Gjana A , Kristo E , Dibra L , Katana E , Seiti J , Xhafaj M , Tafaj E , Kastrati A , Dibra A
Published: June 2024

Introduction

Among patients admitted in Intensive Care Unit, delirium is increasingly a common manifestation, especially on those who need mechanical ventilation. Due to its potential unfavorable effect on outcomes, early detection and adequate treatment may have an important preventive value.

Purpose

To evaluate in-hospital and 30 days’ outcome of patients experiencing delirium in a Tertiary Center Cardiac Intensive Care Unit.

Methods

We prospectively collected in hospital and 30-day follow-up data of 113 consecutive patients admitted at our cardiac intensive care unit from May to December 2022, who manifested delirium. Primary endpoint was in-hospital and 30-day all-cause death. Secondary endpoints included major in-hospital adverse events (composite of new onset or decompensated heart failure, bleeding, malignant ventricular arrhythmia, and acute renal failure), and composite of re-hospitalization and reappearance of cognitive dysfunction at 30-day follow-up.

Results

Out of 1952 patients admitted at our intensive care unit, 133 (5.79%) manifested delirium, with a rate of in-hospital all-cause mortality of 14.78% compared to 4.6% of total cohort. 30 days’ all-cause mortality for the studied population was 30.97%. New onset or worsening of heart failure occurred in 27.4% of patients, acute kidney injury in 27.4% of patients, malignant ventricular arrhythmias in 12.4% and major bleeding (BARC3, 5) in 5.3% of patients. During 30 days’ follow-up, the rate of re-hospitalization for cardiac causes was 9.4% and 33.3% of patients re-manifested cognitive dysfunction. Independent predictive factor for an in-hospital adverse event resulted the use of inotropic and vasopressor drugs and for occurrence of an adverse event at 30 days’ follow-up was history of atrial fibrillation and use of inotropic and vasopressor drugs.

Conclusions

Delirium among patients hospitalized in cardiac ICU is related with worse short term outcomes including higher rates of death from any cause. Early detection and appropriate treatment has a crucial importance in preventing major adverse events.
Prevalence of modifiable risk factors among patients hospitalized for acute coronary syndrome in Brazil: a call to action for Brazilian healthcare
Authors: Mota D , Almeida K M N D , Ferreira I M , Sobreira V , Baccaro B M , Bicalho V , Ramadan H R , Sequetin P A U , Franchini K
Published: June 2024

Background

Acute Coronary Syndrome (ACS) represents a substantial public health challenge in Brazil. Modifiable risk factors are pivotal in its incidence, yet large-scale data is sparse for crafting effective interventions to mitigate the leading cause of mortality.

Purpose

To elucidate the prevalence of classic modifiable risk factors in ACS hospitalizations at a premier Brazilian public cardiology institution.

Methods

This investigation harnessed the ACS registry data from a prominent high-complexity cardiology reference center in Brazil. The study spanned from July 2018 to October 2022, encompassing patient demographics, clinical characteristics, and outcomes. The focus was on the prevalence of modifiable risk factors (hypertension, diabetes, dyslipidemia, overweight/obesity) in patients with verified ACS diagnoses, ascertained via self-reporting or at admission.

Results

Of 143,352 patients evaluated in the emergency department, 19,752 required admission, with 5,580 confirmed ACS cases (28.2%). ACS presentations were unstable angina (56.0%), NSTEMI (34.8%), and STEMI (9.2%). The mean age was 63 years, with females constituting 35.9%. A staggering 99.3% displayed sedentary lifestyles, 80.4% had hypertension, 72.5% were overweight/obese, 56.6% had diabetes, 53.5% had dyslipidemia, and 20.6% were smokers.

Conclusion

The study underscores a critical prevalence of modifiable risk factors in ACS admissions. These findings underscore the critical need for aggressive public health strategies and lifestyle interventions to tackle the modifiable risks associated with ACS in Brazil.
Prognostic significance of non-ischemic computational pressure-flow dynamics derived fractional flow reserve in stable coronary artery disease patients in LAD versus non-LAD artery lesions
Authors: Sze H , Leung K L C , Yiu K H
Published: June 2024

Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is an angiographic-derived index to determine the fractional flow reserve (FFR) without the need of invasive pressure wire and hyperaemic stimulus. Although the safety of FFR-guided deferral of revascularization in non-ischemic lesions is well-established, physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because the LAD often supplies a large territory of myocardium. It has been suggested that because of the relatively large area of myocardium at risk, only hyperaemia-based indexes can be trusted for decision-making in the LAD. However, whether caFFR guided deferral of LAD lesions is safe compared to non-LAD lesions is unclear. The aim of the study is to investigate the prognostic implications of caFFR for non-ischemic deferred LAD compared to non-LAD lesions in stable coronary artery disease (CAD) patients.

Among the 1552 stable CAD patients who were recruited from 2014-2017, 650 of the stable CAD patients (mean age=63.3±12.2, 65.2% male) had non-ischemic lesions defined by caFFR≥0.80 and did not undergo PCI for said lesions. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular mortality, vessel-related myocardial infarction (MI) and any unplanned revascularisation at median follow-up time of 4.4 years. Survival curves were constructed using Kaplan-Meier estimates and differences between groups were tested using the log-rank test. Cox proportional hazards model was also used to evaluate the association between an LAD artery and the risk of VOCE, with parameters with P<0.1 upon univariate analysis entered into multivariable Cox model.

A total of 430 (23.1%) LAD and 1434 non-LAD (76.9%) non-ischemic lesions that had not undergone PCI were studied. Mean caFFR was 0.90±0.04 amongst LAD lesions and 0.92±0.04 for non-LAD lesions (P<0.001). LAD lesions had significantly higher incidence rates than non-LAD lesions in terms of VOCE (6.0% vs 3.0%; P=0.003), MI (2.1% vs 0.6%; P=0.007), and unplanned revascularisation (4.9% vs 2.4%; P=0.009). After multivariate adjustment, LAD lesions had a significantly higher risk than non-LAD lesions in terms of VOCE (HR 1.80; 95%CI 1.10-2.95; P=0.019), vessel-related MI (HR 3.54; 95%CI 1.36-9.20; P=0.010), and unplanned revascularisation (HR 1.82; 95%CI 1.06-3.14; P=0.031).

In stable CAD patients, caFFR-based deferral has superior prognostic durability in non-LAD lesions compared to LAD lesions during long-term follow up. This novel index could enhance risk stratification of non-ischemic vessels in stable CAD patients for LAD and non-LAD lesions. Kaplan-Meier curves for VOCE
Feasibility and preliminary effectiveness of a population health management approach to improve cardiovascular risk management in primary care: a mixed-method implementation study
Authors: Rakers M , Van Hattem N E , Hiddink E , Van Peet P G , Vos R C , Chavannes N H , Atsma D E , Bonten T N , Van Os H J A
Published: June 2024

Background

Cardiovascular disease (CVD) is a leading cause of death and results in a significant burden on the healthcare system. Population-level prevention strategies in primary care, especially combined with technology such as remote patient management (RPM), are promising for managing risk factors effectively. To overcome implementation barriers in cardiovascular risk management using RPM, population health management has been proposed as a systematic approach for proactively assigning appropriate interventions tailored to specific subgroups of patients.

Purpose

This study evaluated the feasibility, acceptability and preliminary effectiveness of Connect@Heart, a proactive population health management RPM program which includes a blood pressure monitor, scale, or activity tracker. These devices were connected to a data exchange platform, enabling real-time cardiovascular risk management.

Methods

We conducted a mixed methods feasibility study to assess the improvement of blood pressure control through a six-month pre-post intervention in four general practices in the Leiden region in the Netherlands. Patients with a moderate to high risk of CVD or established CVD were proactively identified by an algorithm embedded in the electronic health record. Assessments were performed between baseline and six-month follow-up using paired-sample t-tests and linear mixed effects models. Feasibility criteria included >80% enrollment and completion rates. Acceptability was measured using the System Usability Scale (score > 68), Client Satisfaction Questionnaire-8 (score > 20), and interviews with healthcare professionals. Preliminary effectiveness was determined by changes in blood pressure and weight.

Results

94% (189/200) of eligible patients were enrolled, of which 81% (153/189) completed the assessments after 6 months. In total, 121 technical queries sent to the technical portal of which 71% could be solved immediately. Patients rated the program as acceptable (SUS = 65.86 and CSQ-8 = 24.58). Interviews with healthcare professionals confirmed this. At 6-month follow-up, patients showed significant reductions in systolic blood pressure (baseline mean 140 mmHg, SD 18 mmHg; follow-up mean 131 mmHg, SD 14 mmHg; p < 0.001) and diastolic blood pressure (baseline mean 86 mmHg, SD 10 mmHg; follow-up mean 81 mmHg, SD 9 mmHg; p < 0.001). A 49% relative risk reduction in uncontrolled systolic blood pressure (>135 mmHg) was found at 6-months.

Conclusion

The Connect@Heart program is an acceptable and feasible approach for healthcare professionals and patients, tailored for individuals at risk of cardiovascular disease or with established CVD, and may substantially reduce blood pressure levels. The Connect@Heart program