bluuebunny/crossref_metadata_2025 huggingface dataset:
NTproBNP values for diagnosis of congestive heart failure in old patients regarding kidney failure
Authors: Berthelot E , Lehova X , Bailly M T , Hamdadou R , El Hatimi S , Hrynshynshyn N , Jourdain P
Published: November 2023

Background

The diagnosis of heart failure (HF) in old patients is often difficult, due to overlap of typical symptoms and comorbidities. Plasma N-Terminal Pro-Brain Natriuretic Peptide(NTproBNP) is known to increase with age and according to comorbidities particularly in chronic kidney failure. However, the diagnostic performance of this biomarker is unclear in those patients with kidney failure.

Aims

This study sought to define the diagnostic accuracy of plasma NTproBNP in patients over 75 yo in a large population referred for acute dyspnea in the Assistance Publique-Hôpitaux de Paris.

Methods and Results

In this retrospective, longitudinal multicenter cohort study, we collected data from 12,974 patients aged 75 years or older who were hospitalized for acute dyspnea with NTproBNP measurement in the 48 hours after admission between 2011 and 2021 in geriatrics, cardiology and pulmonology departments. The final diagnosis was classified with the International Classification of Diseases, 10th Revision (ICD 10) as either "AHF" or "other acute respiratory failure" (OARF), represented by pulmonary embolism, COPD and pneumonia. The Mean (SD) age of our population was 84.4 (6.1) years old, and 52.7% of patients were women. 8,385 (64.6%) patients had an AHF diagnosis at discharge. Regarding creatinine clearance (CrCl) of patients, NT-proBNP threshold values was lower in patients with CrCl ≥40 ml/min compared to that of patients CrCl <40 ml/min, 1681 and 2238 ng/L respectively. The NTproBNP threshold for ‘ruling-out’ AHF had 81% sensitivity in patient with CrCl ≥40 ml/min and 87% sensitivity in patient with CrCl <40 ml/min. In patients with CrCl ≥40 ml/min compared with patient with CrCl <40 ml/min, predictive positive value was 82 and 89 %, specificity was 70% and 45% and AUC was 0.81 and 0.69. The other comorbidities that statistically change NTproBNP cutpoint diagnostic value were atrial fibrillation, age and sex.

Conclusion

In old patients referred for acute dyspnea with NTproBNP dosage at admission with kidney failure, cutpoint values of 1681 and 2238 ng/L according to CrCl allow for an accurate diagnosis of AHF.
The effect of iron deficiency on RV function in acute decompensated heart failure patients
Authors: Engin K , Sinan U Y , Arslan S , Kucukoglu M S
Published: November 2023

Background

Iron deficiency is a major problem in heart failure (HF) patients. Although the negative impact of iron deficiency on left ventricular (LV) function is known, the effect on right ventricle function (RV) is unclear. In this study we aimed to investigate the effect of iron deficiency on RV function.

Material and Methods

A hundred patients hospitalized with acute decompensated HF (ADHF) regardless of LV ejection fraction (LVEF) were included in our study. The primary outcome was association between iron deficiency and TAPSE, RVEF, RV FAC, and RV TDI S’. The secondary outcome was impact of iron deficiency on RV free wall global longitudinal strain (GLS).

Results

The mean age of study population was 70±10 years-old and 64% were male. The prevalence of hypertension (HT), diabetes mellitus (DM), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) was 80%, 52%, 71%, and 18%, respectively. While the median LVEF was 35%, the proportion of patients with reduced EF (HFrEF), mildly-reduced EF (HFmrEF), and preserved EF (HFpEF) was 66%, 6% and 28%, respectively. On transthoracic echocardiography the median TAPSE was 16.4 mm, the mean FAC %37,2±7.8, the mean RV GLS %-16.4±5.1, and the mean RV TDI S’ was 10.6±2,9 cm per second. More than half of the patients (58%) had iron deficiency. There was no difference between patients with or without iron deficiency on neither demographics nor LVEF, RV FAC, RV TDI S’ and systolic pulmonary artery pressure (sPAP). The TAPSE (15.6 vs 17.2 mm, p = 0.05) and RV free wall GLS (-14.7% vs -18.2%, p = 0.005) was lower in HF patient with iron deficiency. Anemia was present in 56% of the patients and both TAPSE (15.3 vs 17.3 mm, p = 0.01) and RV GLS (-14.7% vs -18.6%, p = 0.01) were lower in patients with anemia.

Conclusion

RV dysfunction accompanying LV dysfunction adversely affects the prognosis. In patients with ADHF, iron deficiency causes subclinical RV dysfunction namely decreased RV free wall GLS before the right ventricle systolic functions parameters commonly used on echocardiography (RVEF, TAPSE, RV FAC, RV TDI S’) in daily practice deteriorate. In conclusion, screening for iron deficiency in HF patients facilitates early detection and treatment of iron deficiency which prevents RV dysfunction with iron replacement.Table 1Table 2
Peak VO2 and VE/VCO2 exhibit differential prognostic capacity for predicting cardiac events
Authors: Choi J , Park J S , Choi H J , Choi H M , Hwang I C , Yoon Y E , Cho G Y
Published: November 2023

Background

Cardiopulmonary exercise testing (CPET) are commonly used to assess the functional capacity of patients with heart failure. While both peak oxygen uptake (VO2) and ventilatory efficiency (VE/CO2) are significant prognostic factors in heart failure, their values may not always be concordant.

Methods

This retrospective study included 688 patients who underwent both CPET and supine bicycle echocardiography (SBE) simultaneously. The primary endpoint of the study was defined as heart failure hospitalization or cardiac death. The patients were categorized into subgroups based on their VO2 and VE/VCO2 slope values.

Results

After median follow-up of 89 months, 111 (16.4%) patients developed cardiac events. The mean age and ejection fraction were 58 years and 59%. In multivariate analysis, both VO2 and VE/VCO2 remained powerful predictors of cardiac events after adjusting for age, ejection fraction, baseline or exercise E/e’, and peak TR velocity. Subgroup analysis revealed that Group III (VO2 >20 and VE/VCO2 >30) and IV (VO2 <20 and VE/VCO2 >30) had a significantly higher risk of cardiac events, with hazard ratios of 3.38 (CI 1.36-8.40) and 8.40 (CI 3.86-18.34), respectively, compared to Group I (VO2 >20 and VE/VCO2 <30). Group II (VO2 <20 and VE/VCO2 <30) had a non-significantly increased risk of cardiac events with a hazard ratio of 2.04 (CI 0.80-5.21) compared to Group I (Fig).

Conclusion

Both VO2 and VE/VCO2 slope were found to be excellent predictors of cardiac events in patients who underwent CPET and SBE. However, there is a slight difference between the two parameters, and poorer ventilatory inefficiency was found to be more associated with a worsened prognosis. The study suggests that the risk stratification using the VE/VCO2 slope and peak VO2 values can provide valuable information for clinicians in managing patients with heart failure.
Transcatheter endomyocardial alginate-hydrogel injection for treatment of heart failure
Authors: Wang B , Lee R , Zhu C J , Gao C H A O , Wang R T , Meng X I N , Serruys P W , Tao L I N G
Published: November 2023

Background and Aim

Intramyocardial injection of alginate-hydrogel, an emerging and promising strategy for patients with advanced heart failure (HF), is limited by the paucity of commercially available intramyocardial delivery methods. This study investigates the feasibility and safety of a novel X-DROP catheter injection system (Figure 1) for delivery of the alginate-hydrogel to pre-defined target areas in the treatment of HF with reduced ejection fraction.

Methods and results

Prior to the First-in-man, we demonstrated that transcatheter endo-myocardial alginate-hydrogel implantation (TEAi) was successfully and precisely performed with the X-DROP catheter system under TEE and fluoroscopy guidance in a healthy porcine model (Figure 2). Acute animal results (n = 15) showed no mortality, perforation, and sustained ventricular arrhythmias. Gross examination revealed the retention of the alginate-hydrogel in the pre-defined endocardial area at six months post-procedure (n = 4, Figure 2). The histological assessment showed that alginate-hydrogel was encapsulated by multiple layers of fibrosis without causing damage to the nearby myocardium. Expanding from the animal result, we conducted a first-in-human trial to evaluate the TEAi in patients with heart failure. Ten patients with NYHA class III-IV were enrolled, and all patients were successfully treated with TEAi without the device or procedure-related complications. At the 30-day follow-up, there were no serious adverse device events. One death occurred at a 3-month follow-up. The mean LVEF evaluated by MRI improved from 17.7±3.82 % at baseline to 24.94±11.15 % at 6 months post-procedure (p = 0.046). Also, ESV (297.50±67.85 vs 264.79±101.41, p = 0.029), EDV (359.5±71.92 vs 341.56±67.85, p = 0.105), six minutes walking test (339.7±37.6 m vs 370.4±64.8 m, p = 0.184), NYHA functional class (30% Class III and 70% Class IV vs 100% Class II), and KCCQ score (49.7±3.91 vs 79.0±8.1) were improved at 6-month follow-up. Holter monitor data showed no sustained ventricular arrhythmia during the TEAi or follow-up.

Conclusions

Our results established the safety and feasibility of TEAi using a novel platform, the X-DROP system and paved the way for the clinical application of intramyocardial injection of alginate-hydrogel in patients with HF.Figure 1Figure 2
Uptake of SGLT2i therapy among patients hospitalized with heart failure: Insights from the veterans affairs healthcare system
Authors: Calma J , Varshney A S , Funes Hernandez M , Hsiao S , Sallam K , Heidenreich P A , Sandhu A T
Published: November 2023

Introduction

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes among heart failure (HF) patients. However, the uptake of SGLT2i over time remains unknown.

Purpose

This study describes SGLT2i use in Veteran Affairs (VA) patients hospitalized with HF.

Methods

We identified a patient cohort of VA patients who were hospitalized with HF (primary HF diagnosis or secondary HF diagnosis with intravenous loop diuretics) from January 2019 to December 2022. Patients without VA medication prescriptions, prior allergy to SGLT2i, advanced chronic kidney disease (CKD), end-stage kidney disease (ESKD), and advanced heart failure therapies were excluded. We identified predictors of SGLT2i use in 2022 and compared the SGLT2i prescription rate to the ARNI prescription rate. The hospital-level variation in SGLT2i prescription was assessed via the median odds ratio.

Results

From 2019-2022, 70,344 VA patients were hospitalized with HF and eligible for SGLT2i therapy (Table 1). The average age was 72.6 years (SD 10.2); 45.5% had EF ≤40%, 12.3% EF 41%-49%, and 42.3% ≥50%. Among this cohort, 11.6% were prescribed SGLT2is at discharge. SGLT2i prescription rates increased over time (Figure 1) and were higher among patients with HFrEF and those with a primary hospital diagnosis of HF.

Among 16,426 patients hospitalized in 2022, SGLT2i prescription was more likely among patients with diabetes mellitus (OR 2.27; 95% CI: 2.09-2.46) and ischemic heart disease (OR 1.13; 95% CI: 1.03-1.25) in multivariable models. Patients with CKD were not more likely to receive SGLT2i therapy (OR 1.07; 95% CI: 0.98-1.16). Patients with increased age (OR 0.77 per 10 years; 95% CI: 0.73-0.80) and lower systolic blood pressure (OR 0.94 per 10mmHg; 95% CI: 0.92-0.96) were less likely to be prescribed SGLT2i. There was substantial facility-level variation of SGLT2i prescription with a median odds ratio (MOR) of 1.81 (1.64-2.03), suggesting a 1.8-fold variation in the likelihood that similar patients at 2 random VA sites were prescribed SGLT2i. Among patients with HFrEF, 30.7% (2,231/7,263) were prescribed an SGLT2i compared with 26.7% (1,937/7,263) patients prescribed ARNI.

Conclusion

Although utilization of SGLT2i at the time of discharge is overall low in hospitalized VA patients with HF, SGLT2i prescription rates have increased rapidly compared with ARNI. Opportunities exist to reduce variation in SGLT2i prescription rates in eligible patients across hospitals and to emphasize use in patients with CKD and advanced age.
Torsemide versus furosemide in patients with heart failure: a systematic review and updated meta-analysis of randomised controlled trials
Authors: Teixeira L M F , Felix N S , Navalha D D P , Madeira T M , Farias C F , Clemente M R C , Scabello I F , Ferreira R O M , Nogueira A K S , Tramujas L
Published: November 2023

Background

Furosemide is the most widely used diuretic for the management of heart failure (HF). However, the results of recent randomised controlled trials (RCTs) suggest that torsemide may be superior to furosemide in this setting.

Purpose

We aimed to compare the efficacy of torsemide versus furosemide in patients with HF.

Methods

We systematically searched PubMed, Scopus, and Cochrane Library for randomised controlled trials (RCTs) comparing torsemide with furosemide in patients with HF until February 2023 in accordance with PRISMA guidelines. Our outcomes of interest were all-cause mortality, hospitalisations for HF, and improvement in NYHA class. Review Manager software version 5.4.1 was used for statistical analyses. Between-study heterogeneity was assessed using I2 statistics.

Results

We included nine RCTs comprising 8270 patients with HF, of whom 2529 (30%) were randomised to torsemide. Mean follow-up ranged from 32 weeks to 17.4 years. In the pooled analysis, there was no significant difference between groups in terms of all-cause mortality (OR 0.98; 95% CI 0.85–1.13; p = 0.77; I2 = 0; Fig. 1A), hospitalizations for HF (OR 0.78; 95% CI 0.48–1.27; p = 0.32; I2 = 48; Fig. 1B), or improvement in NYHA class (OR 1.39; 95% CI 0.91–2.12; p = 0.13; I2 = 0; Fig. 1C).

Conclusion

In this meta-analysis, no significant difference was observed between torsemide and furosemide in managing HF with regards to all-cause mortality, hospitalisations for HF, or NYHA class improvement.Figure 1
Mediterranean diet and epicardial adipose tissue in patients with atrial fibrillation treated with ablation: a substudy of the ‘PREDIMAR’ trial
Authors: Barrio-Lopez María Teresa , Ruiz-Canela Miguel , Goni Leticia , Valiente Almudena Martinez , Garcia Silvia Romero , de la O Víctor , Anton Belen Diaz , Fernandez-Friera Leticia , Castellanos Eduardo , Martínez-González Miguel Angel , Almendral Jesus
Published: November 2023

Aims

To analyse the relationship between Mediterranean diet (MedDiet) adherence and epicardial adipose tissue (EAT) in patients with atrial fibrillation (AF) and the association between EAT or MedDiet adherence at baseline with AF recurrence after ablation.

Methods and results

We included 199 patients from the PREDIMAR trial (PREvención con DIeta Mediterránea de Arritmias Recurrentes), in a single centre in this substudy. All of them had a computed tomography with EAT measurement. Lifestyle and clinical characteristics were obtained at baseline. The traditional MedDiet pattern was defined according to the MedDiet Adherence Screener (MEDAS). Any documented AF > 30 s after ablation was considered a recurrence. Multivariable-adjusted linear and logistic regression models were run to assess the cross-sectional association of MedDiet with EAT, and of EAT with the AF type at baseline. Also, Cox regression models were used to prospectively assess the associations of MedDiet adherence and EAT with AF recurrences after ablation. Median EAT was 135 g (interquartile range: 112–177), and the mean MedDiet score was 7.75 ± 2 points. A higher MEDAS ≥ 7 that was associated with lower odds of an EAT ≥ 135 g [multivariable odds ratio (mOR) = 0.45; 95% CI = 0.22–0.91; P = 0.025] was significantly associated with persistent AF after adjusting for traditional risk factors (mOR: 2.22; 95% CI: 1.03–4.79; P = 0.042). No significant associations were observed between EAT ≥ 135 g and the risk of atrial tachyarrhythmia recurrences after ablation [multivariable-adjusted hazard ratio (mHR) = 1.18; 95% CI: 0.72–1.94; P = 0.512], or between MEDAS ≥ 7 and AF recurrence (mHR = 0.78; 95% CI: 0.47–1.31; P = 0.344).

Conclusion

In patients with AF, higher adherence to MedDiet is associated with a significantly lower amount of EAT. Epicardial adipose tissue ≥ 135 g was significantly associated with persistent AF.
Automatic measurement of short-term variability of repolarization to indicate ventricular arrhythmias in a porcine model of cardiac ischaemia
Authors: Loen Vera , Smoczynska Agnieszka , Aranda Hernandez Alfonso , Scheerder Coert O S , van der Linde Britt H R , Beekman Henriëtte D M , Cervera-Barea Aina , Boink Gerard J J , Sluijter Joost P G , van der Heyden Marcel A G , Meine Mathias , Vos Marc A
Published: November 2023

Aims

An automated method for determination of short-term variability (STV) of repolarization on intracardiac electrograms (STV-ARIauto) has previously been developed for arrhythmic risk monitoring by cardiac implantable devices, and has proved effective in predicting ventricular arrhythmias (VA) and guiding preventive high-rate pacing (HRP) in a canine model. Current study aimed to assess (i) STV-ARIauto in relation to VA occurrence and secondarily (ii-a) to confirm the predictive capacity of STV from the QT interval and (ii-b) explore the effect of HRP on arrhythmic outcomes in a porcine model of acute myocardial infarction (MI).

Methods and results

Myocardial infarction was induced in 15 pigs. In 7/15 pigs, STV-QT was assessed at baseline, occlusion, 1 min before VA, and just before VA. Eight of the 15 pigs were additionally monitored with an electrogram catheter in the right ventricle, underwent echocardiography at baseline and reperfusion, and were randomized to paced or control group. Paced group received atrial pacing at 20 beats per min faster than sinus rhythm 1 min after occlusion. Short-term variability increased prior to VA in both STV modalities. The percentage change in STV from baseline to successive timepoints correlated well between STV-QT and STV-ARIauto. High-rate pacing did not improve arrhythmic outcomes and was accompanied by a stronger decrease in ejection fraction.

Conclusion

STV-ARIauto values increase before VA onset, alike STV-QT in a porcine model of MI, indicating imminent arrhythmias. This highlights the potential of automatic monitoring of arrhythmic risk by cardiac devices through STV-ARIauto and subsequently initiates preventive strategies. Continuous HRP during onset of acute MI did not improve arrhythmic outcomes.
Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data
Authors: Silva Cássia S S , Bensenor Isabela M , Goulart Alessandra C , Lotufo Paulo A , Santos Itamar S
Published: November 2023

Background

Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults.

Methods

The primary analyses included 15,051 participants aged 35–74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia.

Results

Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6–3.4%) of men and 7.4% (95%CI: 6.9–8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65–74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races.

Conclusions

Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.
Understanding barriers and facilitators of appropriate antibiotic use: a qualitative analysis of an online parenting forum
Authors: Reblin Maija , Ward Carter , Hammond Alice , Peloquin Jack , Rabinowitz Morgan , Fung Mark , Threlkeld Kirsten , Nowak Sarah
Published: November 2023

Purpose

Antibiotic use and misuse are common in pregnant women and young children. Few studies have assessed real-world discussions of antibiotics in these populations. Using social media posts of pregnant women and parents, our goal was to identify key themes about facilitators and barriers to appropriate antibiotic usage.

Methods

A purposive sample of public posts and comments relevant to antibiotic use was collected from the BabyCenter United States social media site. Using a directed content analysis, themes related to facilitators and barriers to appropriate antibiotic use were identified.

Results

Seven hundred and twenty-six posts and 5227 comments were analysed. Themes centred around individual factors, interpersonal factors, and structural factors. Individual factors included knowledge and beliefs. Though misinformation was present, most parents were aware of appropriate antibiotic usage and perceived antibiotics as safe and effective. Some hesitance around using antibiotics led to recommendations for home remedies or over-the-counter treatments. Interpersonal factors focused on a lack of available offline peer support, the expertise of providers, as well as a potential lack of attention from those providers. Structural factors, including access to care, also impacted parents’ antibiotic use and misuse.

Conclusion

Though most parents demonstrated appropriate knowledge about antibiotics and a willingness to follow guidelines, negative experiences with their providers, a lack of support from peers, and structural factors presented as potential barriers to appropriate antibiotic use. Implementing avenues for peer support for parents, allowing more time for providers to address parents’ concerns, and improving access to providers could improve appropriate antibiotic use in parents.
A Simulation Framework for Modeling the Within-Patient Evolutionary Dynamics of SARS-CoV-2
Authors: Terbot John W , Cooper Brandon S , Good Jeffrey M , Jensen Jeffrey D
Published: November 2023

The global impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable interest in detecting novel beneficial mutations and other genomic changes that may signal the development of variants of concern (VOCs). The ability to accurately detect these changes within individual patient samples is important in enabling early detection of VOCs. Such genomic scans for rarely acting positive selection are best performed via comparison of empirical data with simulated data wherein commonly acting evolutionary factors, including mutation and recombination, reproductive and infection dynamics, and purifying and background selection, can be carefully accounted for and parameterized. Although there has been work to quantify these factors in SARS-CoV-2, they have yet to be integrated into a baseline model describing intrahost evolutionary dynamics. To construct such a baseline model, we develop a simulation framework that enables one to establish expectations for underlying levels and patterns of patient-level variation. By varying eight key parameters, we evaluated 12,096 different model–parameter combinations and compared them with existing empirical data. Of these, 592 models (∼5%) were plausible based on the resulting mean expected number of segregating variants. These plausible models shared several commonalities shedding light on intrahost SARS-CoV-2 evolutionary dynamics: severe infection bottlenecks, low levels of reproductive skew, and a distribution of fitness effects skewed toward strongly deleterious mutations. We also describe important areas of model uncertainty and highlight additional sequence data that may help to further refine a baseline model. This study lays the groundwork for the improved analysis of existing and future SARS-CoV-2 within-patient data.
A role for β-1,6- and β-1,3-glucans in kinetochore function in Saccharomyces cerevisiae
Authors: Kshirsagar Rucha , Munhoven Arno , Tran Nguyen Tra My , Ehrenhofer-Murray Ann E
Published: November 2023

Chromosome segregation is crucial for the faithful inheritance of DNA to the daughter cells after DNA replication. For this, the kinetochore, a megadalton protein complex, assembles on centromeric chromatin containing the histone H3 variant CENP-A, and provides a physical connection to the microtubules. Here, we report an unanticipated role for enzymes required for β-1,6- and β-1,3-glucan biosynthesis in regulating kinetochore function in Saccharomyces cerevisiae. These carbohydrates are the major constituents of the yeast cell wall. We found that the deletion of KRE6, which encodes a glycosylhydrolase/ transglycosidase required for β-1,6-glucan synthesis, suppressed the centromeric defect of mutations in components of the kinetochore, foremost the NDC80 components Spc24, Spc25, the MIND component Nsl1, and Okp1, a constitutive centromere-associated network protein. Similarly, the absence of Fks1, a β-1,3-glucan synthase, and Kre11/Trs65, a TRAPPII component, suppressed a mutation in SPC25. Genetic analysis indicates that the reduction of intracellular β-1,6- and β-1,3-glucans, rather than the cell wall glucan content, regulates kinetochore function. Furthermore, we found a physical interaction between Kre6 and CENP-A/Cse4 in yeast, suggesting a potential function for Kre6 in glycosylating CENP-A/Cse4 or another kinetochore protein. This work shows a moonlighting function for selected cell wall synthesis proteins in regulating kinetochore assembly, which may provide a mechanism to connect the nutritional status of the cell to cell-cycle progression and chromosome segregation.
Palaeomagnetic field intensity measurements from the 2.6 Ga Yandinilling dyke swarm (Western Australia)
Authors: Hawkins Louise M , Biggin Andrew J , Liu Yebo , Grappone J Michael , Li Zheng-Xiang
Published: November 2023

Precambrian palaeointensity measurements provide fundamental constraints on the evolution of the deep Earth. Core evolution models predict trends in dipole moment on billion-year timescales that can be tested by palaeomagnetic records. Here, we report new palaeointensity results from the recently identified ∼2.62 Ga Yandinilling dyke swarm of the Yilgarn Craton, Western Australia, and consider them alongside published measurements spanning 500 Myr across the late Archaean to earliest Proterozoic. Rock magnetic and scanning electron microscopy analysis confirm that the magnetic mineralogy is fine-grained magnetite, appearing mostly as exsolved lamellae with ilmenite. Six sites produced acceptable palaeointensity estimates from thermal and microwave IZZI protocol Thellier experiments and from double-heating technique Shaw experiments. These site mean values of 9–26 µT translate to virtual dipole moments of 11–44 ZAm2 that are considerably lower than today's dipole moment of ∼80 ZAm2 and the value predicted for this time period by some thermal evolution models. Their average (median = 41 ZAm2) is, however, similar to the long-term average during both of the intervals 2300–2800 Ma (median = 44 ZAm2; N = 103) and 10–500 Ma (median 41 ZAm2; N = 997). While there is little evidence for a substantial net change in average dipole moment between the late Archaean and Phanerozoic, there is preliminary evidence that its variance has increased between the two intervals. This lower variance more than two billion years ago supports the idea that the geodynamo, even while not producing a stronger magnetic field, was more stable on average at the Archaean–Proterozoic transition than it is today.
Proposal for targeted, neo-evolutionary-oriented secondary prevention of early-onset endometriosis and adenomyosis. Part II: medical interventions
Authors: Vercellini Paolo , Bandini Veronica , Viganò Paola , Ambruoso Deborah , Cetera Giulia Emily , Somigliana Edgardo
Published: November 2023

According to consistent epidemiological data, the slope of the incidence curve of endometriosis rises rapidly and sharply around the age of 25 years. The delay in diagnosis is generally reported to be between 5 and 8 years in adult women, but it appears to be over 10 years in adolescents. If this is true, the actual onset of endometriosis in many young women would be chronologically placed in the early postmenarchal years. Ovulation and menstruation are inflammatory events that, when occurring repeatedly for years, may theoretically favour the early development of endometriosis and adenomyosis. Moreover, repeated acute dysmenorrhoea episodes after menarche may not only be an indicator of ensuing endometriosis or adenomyosis, but may also promote the transition from acute to chronic pelvic pain through central sensitization mechanisms, as well as the onset of chronic overlapping pain conditions. Therefore, secondary prevention aimed at reducing suffering, limiting lesion progression, and preserving future reproductive potential should be focused on the age group that could benefit most from the intervention, i.e. severely symptomatic adolescents. Early-onset endometriosis and adenomyosis should be promptly suspected even when physical and ultrasound findings are negative, and long-term ovulatory suppression may be established until conception seeking. As nowadays this could mean using hormonal therapies for several years, drug safety evaluation is crucial. In adolescents without recognized major contraindications to oestrogens, the use of very low-dose combined oral contraceptives is associated with a marginal increase in the individual absolute risk of thromboembolic events. Oral contraceptives containing oestradiol instead of ethinyl oestradiol may further limit such risk. Oral, subcutaneous, and intramuscular progestogens do not increase the thromboembolic risk, but may interfere with attainment of peak bone mass in young women. Levonorgestrel-releasing intra-uterine devices may be a safe alternative for adolescents, as amenorrhoea is frequently induced without suppression of the ovarian activity. With regard to oncological risk, the net effect of long-term oestrogen–progestogen combinations use is a small reduction in overall cancer risk. Whether surgery should be considered the first-line approach in young women with chronic pelvic pain symptoms seems questionable. Especially when large endometriomas or infiltrating lesions are not detected at pelvic imaging, laparoscopy should be reserved to adolescents who refuse hormonal treatments or in whom first-line medications are not effective, not tolerated, or contraindicated. Diagnostic and therapeutic algorithms, including self-reported outcome measures, for young individuals with a clinical suspicion of early-onset endometriosis or adenomyosis are proposed.
Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects
Authors: Vercellini Paolo , Bandini Veronica , Viganò Paola , Di Stefano Giorgia , Merli Camilla Erminia Maria , Somigliana Edgardo
Published: November 2023

The potential for repeated ovulation and menstruation is thought to have provided a Darwinian advantage during the Palaeolithic. Reproductive conditions remained relatively stable until the pre-industrial era, characterized by late menarche, very young age at first birth, multiple pregnancies, and prolonged periods of lactational amenorrhoea. For hundreds of thousands of years, menstruators experienced few ovulatory cycles, even though they were genetically adapted to ovulate and menstruate every month. In the post-industrial era, the age at menarche gradually declined, the age at first birth progressively increased, and breastfeeding became optional and often of short duration. This created a mismatch between genetic adaptation and socio-environmental evolution, so that what was initially a probable reproductive advantage subsequently contributed to increased susceptibility to diseases associated with lifetime oestrogen exposure, such as ovarian, endometrial and breast cancer and, hypothetically, also those associated with the number of ovulatory menstruations, such as endometriosis and adenomyosis. The incidence of endometriosis shows a steep and progressive increase around the age of 25 years, but given the consistently reported delay in diagnosis, the actual incidence curve should be shifted to the left, supporting the possibility that the disease has its roots in adolescence. This raises the question of whether, from an evolutionary point of view, anovulation and amenorrhoea should not still be considered the physiological state, especially in the postmenarchal period. However, an increase in the frequency of endometriosis in recent decades has not been demonstrated, although this deserves further epidemiological investigation. In addition, as endometriosis occurs in a minority of individuals exposed to retrograde menstruation, other important pathogenic factors should be scrutinised. Research should be resumed to explore in more detail the transtubal reflux of not only blood, but also endometrial cells, and whether they are systematically present in the peritoneal fluid after menstruation. If repetitive ovulatory menstruation during the early reproductive years is shown to increase the risk of endometriosis and adenomyosis development and progression in susceptible individuals, hormonal interventions could be used as secondary prevention in symptomatic adolescents.
20-Year follow-up and comparison of valved conduits used for right ventricular outflow tract reconstruction: single-centre, propensity score match analysis
Authors: Sabateen Fadi , Soják Vladimír , Nagi Aref Saif , Valentík Pavel , Šagát Michal , Nosál' Matej
Published: November 2023

OBJECTIVES

Surgical repair of complex congenital heart defects with hypoplasia or atresia of the right ventricular outflow tract (RVOT) may require pulmonary valve implantation or replacement during the primary repair or reoperation. The purpose of this study is to evaluate the outcomes of cryopreserved homografts, bovine jugular vein conduits and decellularized Matrix P Plus N conduits in patients undergoing RVOT reconstruction at a single centre.

METHODS

Retrospective, single-centre review of 173 patients with 199 conduits undergoing right ventricle-to-pulmonary artery reconstruction with valved conduit from 2002 to 2022.

RESULTS

A total of 199 conduits were implanted in 173 patients (62.8% male), with a mean age of 8.97 ± 8.5 years. The following 3 types of conduits were used: homografts 129 (64.8%), bovine jugular vein conduits 45 (22.7%) and Matrix P Plus N 25 (12.5%). During the mean follow-up duration of 8.6 ± 5.8 years, there were 20 deaths, 35 conduit reoperations and 44 catheter reinterventions. Overall survival, reoperation-free and catheter reintervention-free survival at 20 years were 83%, 67.8% and 65.6%, respectively. Multivariable Cox analysis identified younger patient age, smaller conduit size, low patient weight and primary diagnosis of common arterial trunk as risk factors for reoperation and catheter reintervention.

CONCLUSIONS

Long-term outcomes of reconstruction of the RVOT using homografts, bovine jugular vein and Matrix P Plus N conduits were acceptable. The reoperation rate for conduit dysfunction did not differ significantly among groups. Over time, the need for conduit replacement was higher in smaller conduits and in patients with common arterial trunk diagnosis.
Equality of the Wobbly and Shaky Loci
Authors: Peón-Nieto Ana
Published: November 2023

Let $X$ be a smooth complex projective curve of genus $g\geq 2$, and let $D\subset X$ be a reduced divisor. We prove that a parabolic vector bundle ${\mathcal{E}}$ on $X$ is (strongly) wobbly, that is, ${\mathcal{E}}$ has a non-zero (strongly) parabolic nilpotent Higgs field, if and only if it is (strongly) shaky, that is, it is in the image of the exceptional divisor of a suitable resolution of the rational map from the (strongly) parabolic Higgs moduli to the vector bundle moduli space, both assumed to be smooth. This solves a conjecture by Donagi–Pantev [ 14] in the parabolic and the vector bundle context. To this end, we prove the stability of strongly very stable parabolic bundles, and criteria for very stability of parabolic bundles.
Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals
Authors: Havranek Michael M , Rüter Florian , Bilger Selina , Dahlem Yuliya , Oliveira Leonel , Ehbrecht Daniela , Moos Rudolf M , Westerhoff Christian , Beck Thomas , Le Pogam Marie-Annick
Published: November 2023

The validity of the Agency for Healthcare Research and Quality’s Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014–18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90–99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18–49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.
Top Rated or Best Seller? Cultural Differences in Responses to Attitudinal versus Behavioral Consensus Cues
Authors: Barnes Aaron J , Shavitt Sharon
Published: November 2023

Marketers commonly use consensus cues about others’ behavioral choices (“best seller”) or their attitudes (“top rated”) when labeling products. This article suggests that the effectiveness of these types of cues may differ across cultures in ways that carry implications for marketing practice. Prior research shows that in contexts that give rise to an interdependent cultural self-construal, choices are often responsive to social expectations rather than personal preferences. We propose that, because interdependents expect such behavioral conformity, cues that convey consensus about others’ choices may be less diagnostic and, thus, less persuasive than cues that convey consensus about others’ attitudes. Five studies examining cultural self-construal in multiple ways, along with two cross-national industry datasets, offer evidence consistent with this reasoning, suggesting that, among interdependents, behavioral consensus cues can actually be less effective than attitudinal ones, reducing persuasion and willingness to pay. However, among independents, because attitudes are assumed to influence behavioral choices, whether the consensus cue is attitudinal or behavioral makes little difference.
Role of immune cells in the pathogenesis of myocarditis
Authors: Liu Keyu , Han Bo
Published: November 2023

Myocarditis is an inflammatory heart disease that mostly affects young people. Myocarditis involves a complex immune network; however, its detailed pathogenesis is currently unclear. The diversity and plasticity of immune cells, either in the peripheral blood or in the heart, have been partially revealed in a number of previous studies involving patients and several kinds of animal models with myocarditis. It is the complexity of immune cells, rather than one cell type that is the culprit. Thus, recognizing the individual intricacies within immune cells in the context of myocarditis pathogenesis and finding the key intersection of the immune network may help in the diagnosis and treatment of this condition. With the vast amount of cell data gained on myocarditis and the recent application of single-cell sequencing, we summarize the multiple functions of currently recognized key immune cells in the pathogenesis of myocarditis to provide an immune background for subsequent investigations.
Adoptive cell immunotherapy for breast cancer: harnessing the power of immune cells
Authors: Li Xue , Zhu Yunan , Yi Jinfeng , Deng Yuhan , Lei Bo , Ren He
Published: November 2023

Breast cancer is the most prevalent malignant neoplasm worldwide, necessitating the development of novel therapeutic strategies owing to the limitations posed by conventional treatment modalities. Immunotherapy is an innovative approach that has demonstrated significant efficacy in modulating a patient's innate immune system to combat tumor cells. In the era of precision medicine, adoptive immunotherapy for breast cancer has garnered widespread attention as an emerging treatment strategy, primarily encompassing cellular therapies such as tumor-infiltrating lymphocyte therapy, chimeric antigen receptor T/natural killer/M cell therapy, T cell receptor gene–engineered T cell therapy, lymphokine-activated killer cell therapy, cytokine-induced killer cell therapy, natural killer cell therapy, and γδ T cell therapy, among others. This treatment paradigm is based on the principles of immune memory and antigen specificity, involving the collection, processing, and expansion of the patient's immune cells, followed by their reintroduction into the patient's body to activate the immune system and prevent tumor recurrence and metastasis. Currently, multiple clinical trials are assessing the feasibility, effectiveness, and safety of adoptive immunotherapy in breast cancer. However, this therapeutic approach faces challenges associated with tumor heterogeneity, immune evasion, and treatment safety. This review comprehensively summarizes the latest advancements in adoptive immunotherapy for breast cancer and discusses future research directions and prospects, offering valuable guidance and insights into breast cancer immunotherapy.
Status of and Challenges to the Establishment and Retention of Young, Beginning, and Minority-Owned Logging Businesses in Florida and Georgia
Authors: Ellis Anna M , Conrad Joseph L , Dwivedi Puneet , Green Gary T
Published: November 2023

Most logging businesses in the US South are owned by White males, many of whom are approaching retirement. The purpose of this study was to evaluate the characteristics of logging businesses with a young owner, beginning (new) business owner, and businesses owned by members of a minority group (YBM). In-person interviews were conducted with twelve YBM logging business owners in Florida and Georgia to gather information on business characteristics and perceived barriers to the formation of these businesses. The YBM business owners were more educated, employed more workers, and had similar capital investments relative to other logging business owners. These owners stated that difficulty recruiting quality employees, high startup costs, lack of industry connections, and high insurance premiums were unique obstacles to establishing YBM businesses. Purposeful actions by the forest industry, policymakers, and other stakeholders may encourage the formation and retention of YBM logging businesses.

Study Implications: As the current generation of logging business owners leaves the industry, it is important to develop new businesses. New businesses will likely be owned by young owners, mid-career professionals starting new logging businesses (beginning businesses), and businesses owned by members of a minority group (YBM). Targeted efforts by loggers’ associations, the forest industry, and other stakeholders that provide business management training, develop a skilled workforce of equipment operators and log truck drivers, and promote policies that result in affordable insurance may encourage the establishment and retention of YBM businesses.
Analytical solutions of free vibration for rectangular thin plate and right-angle triangle plate on the Winkler elastic foundation based on the symplectic superposition method
Authors: Jiang Hao-Jie , Chen Tong-Bo , Ren Yu-Xiang , Gao Ning-Hua
Published: November 2023

Based on the symplectic superposition method, the free vibration models of rectangular and right-angle triangle plates on the Winkler elastic foundation are established in the present paper, and the modes and frequencies are studied. In addition, the theoretical calculation model and finite element analysis model of rectangular thin plate and right-angle triangle plate on elastic foundation are established by using Mathematica software and ABAQUS software. It proves that the symplectic superposition method converges very fast and has a good consistency with the finite element simulation results. Analytical results show that foundation stiffness, aspect ratio, and boundary condition have great influences on vibration frequency and mode shape for structures. This paper solved the free vibration problem of rectangular plate and right-angle triangle plate on elastic foundation by using symplectic superposition method. Compared with the inverse or semi-inverse method, this method avoids the process of assuming the form about the solution, hence the result of this method is completely rational.