bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized Controlled Trial of Remimazolam Compared with Placebo in Japanese Patients Undergoing Colonoscopy: A Phase III, Investigator-Initiated Trial
Authors: Ichijima Ryoji , Ikehara Hisatomo , Ono Hiroyuki , Hotta Kinichi , Yamaguchi Daisuke , Esaki Mitsuru , Minoda Yosuke , Nagata Yasuhiko , Ogura Kanako , Kiriyama Shinsuke , Sumiyoshi Tetsuya , Kanmura Yuichi
Published: July 2024

Introduction: We conducted an investigator-initiated clinical trial in which remimazolam was used to achieve sedation in patients undergoing colonoscopies. Methods: This multicenter, double-blind, placebo-controlled, phase III investigator-initiated trial included patients who underwent colonoscopy under sedation with remimazolam (initial dose: 3 mg; additional dose: 1 mg) or normal saline (placebo). The primary endpoint of the study was the successful sedation rate during colonoscopy, defined as achieving a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score of ≤4 before the procedure, maintaining this score throughout colonoscopy, and requiring no more than five additional drug doses per 15 min. Results: The sedation success rate was 95.0% (38/40 patients) in the remimazolam group and 0.0% (0/11 patients) in the placebo group (p < 0.01). The time from the end of procedure to regaining consciousness was 0.0 (interquartile range: 0.0–0.0) min in both groups. The time from the end of the procedure to ambulation was 5.0 (interquartile range: 0.0–10.0) min in the remimazolam group and 0.0 (interquartile range: 0.0–0.0) min in the placebo group (p = 0.02). Serious adverse events were not observed. Conclusion: The use of remimazolam to achieve sedation in Japanese patients undergoing colonoscopy was more effective than placebo.
Unisex and Sex-Specific Prescriptive Fetal Growth Charts for Improved Detection of Small-for-Gestational-Age Babies in a Low-Risk Population: A post hoc Analysis of a Cluster-Randomized Study
Authors: van Roekel Mariëlle , Verhoeven Corine J. , Kamphof Hester D. , Gordijn Sanne J. , Ganzevoort Wessel , Franx Arie , van Wieringen Wessel , de Jonge Ank , Henrichs Jens
Published: July 2024

Introduction: Our aim was to develop and evaluate the performance of population-based sex-specific and unisex prescriptive fetal abdominal circumference growth charts in predicting small-for-gestational-age (SGA) birthweight, severe SGA (sSGA) birthweight, and severe adverse perinatal outcomes (SAPO) in a low-risk population. Methods: This is a post hoc analysis of the Dutch nationwide cluster-randomized IRIS study, encompassing ultrasound data of 7,704 low-risk women. IRIS prescriptive unisex and IRIS sex-specific abdominal circumference (AC) fetal growth charts were derived using quantile regression. As a comparison, we used the descriptive unisex Verburg chart, which is commonly applied in the Netherlands. Diagnostic parameters were calculated based on the 34–36 weeks’ ultrasound. Results: Sensitivity rates for predicting SGA and sSGA birthweights were more than twofold higher based on the IRIS prescriptive sex-specific (respectively SGA 43%; sSGA 59%) and unisex (SGA 39%; sSGA 55%) charts, compared to the Verburg chart (SGA 16%; sSGA 23% both p < 0.01). Specificity rates were highest for Verburg (SGA 99%; sSGA 98%) and lowest for IRIS sex-specific (SGA 94%; sSGA 92%). Results for predicting SGA with SAPO were similar for the prescriptive charts (44%), and again higher than the Verburg chart (20%). The IRIS sex-specific chart identified significantly more males as SGA and sSGA (respectively, 42%; 60%, p < 0.001) than the IRIS unisex chart (respectively, 35%; 53% p < 0.01). Conclusion: Our study demonstrates improved performance of both the IRIS sex-specific and unisex prescriptive fetal growth compared to the Verburg descriptive chart, doubling detection rates of SGA, sSGA, and SGA with SAPO. Additionally, the sex-specific chart outperformed the unisex chart in detecting SGA and sSGA. Our findings suggest the potential benefits of using prescriptive AC fetal growth charts in low-risk populations and emphasize the importance of considering customizing fetal growth charts for sex. Nevertheless, the increased sensitivity of these charts should be weighed against the decrease in specificity.
Multiple Aneuploidy: First Report of a Patient Presenting with a Karyotype 45,X/48,XXX,+21
Authors: Costa Gabriela Roldão Correia , Jorente Josep , Pontes Larissa Bretanha , Viguetti Campos Nilma Lúcia , Marques-de-Faria Antonia Paula , Vieira Társis Paiva , Steiner Carlos Eduardo
Published: July 2024

Introduction: The dual diagnosis of Down syndrome and Turner syndrome in the same patient was clinically identified in the early 1950s before the development of karyotyping techniques. After that, several authors reported anecdotal patients and/or reviewed series of Down-Turner double aneuploidies due to a regular 46,X,+21 constitution or different combinations of abnormal cell lines. In such cases, the most typical presentation encompasses the female sex, Down syndrome phenotype, and chromosomal mosaicism. Case Presentation: Here we report a female patient presenting with short stature, dysmorphic features, developmental delay, and learning disabilities, whose karyotype revealed a previously undescribed 45,X[47]/48,XXX,+21[3] constitution. Conclusion: This is the first case encompassing these three aneuploidies together and, contrary to most previous reports, exhibiting a predominantly Turner syndrome phenotype associated with developmental delay.
Enhancing radar signal processing through LVQ-Kalman fusion: a tsunami prediction perspective
Authors: Shobha Shobha , Narasimhaiah Nalini
Published: July 2024

In radar signal processing, the pursuit of precise prediction algorithms motivates the exploration of innovative methodologies. This study introduces a pioneering fusion of learning vector quantization (LVQ)- Kalman, merging LVQ with the advanced Kalman filter. The primary aim is to enhance adaptability and robustness, vital in weather monitoring and military surveillance. LVQ, known for its efficacy in pattern recognition and prediction, adjusts prototype vectors iteratively based on input data, ideal for radar signal intricacies. Various LVQ types are incorporated, tailored meticulously for specific radar applications. The Kalman filter, originally for aerospace, excels in tracking and predicting dynamic systems, seamlessly integrated to address uncertainties in radar data. By combining LVQ’s pattern recognition with the Kalman filter’s adaptability, the fusion aims to create a versatile system navigating radar data intricacies. Applications range from airborne target tracking to weather analysis and military surveillance. The integrated approach offers adaptability and robustness, vital for real-world implementations, particularly in tsunami detection. Future research may explore deep learning to further enhance adaptability. This fusion technique presents significant potential for advancing radar signal processing, promising accurate and adaptive systems, especially in critical applications like tsunami detection.
Spiking neural network with blockchain for tampered image detection using forensic steganography images
Authors: Basavanyappa Gurumurthy Shikaripura , Danti Ajit
Published: July 2024

Accurate tools are required to acknowledge misleading images in order to maintain image legitimacy, and these tools must allow for legal operations on images. Additionally, after posting their images to the Internet, image owners lose rights over the images because there are no measures in place to safeguard them from misuse. One of the most well-liked techniques for addressing copyright disputes is the use of steganography technologies. The embedded steganography images can, sadly, be easily altered or deleted. To address this problem, this work presents the spiking neural network (SNN) with blockchain for tampered image detection utilizing forensic steganography images. Forensic steganography images that have been altered can be found with this SNN. Using steganography images from the database, SNN is trained in this model. The blockchain stores the owners’ access policies. The Python platform is used to implement the proposed strategy. F-measure, specificity, accuracy, precision, recall false positive rate (FPR), and false negative rate (FNR) are used to gauge how well the proposed approach performs. When compared to state-of-the-art approaches, the proposed approach obtained an impressive rise of 98.65%, in classification accuracy.
Hybrid optimized multi-objective honey badger algorithm and NSGA-II for feature selection problems
Authors: Papasani Anusha , Devarakonda Nagaraju
Published: July 2024

One of the most important aspects of classification is choosing features in such a way as to get rid of redundant or irrelevant elements in the dataset. For the most part, multi-objective feature selection strategies have been offered by a number of scholars as a strategy for this aim. On the other hand, these techniques frequently fail to simultaneously improve classification accuracy while removing redundant feature combinations. This article presents a wrapper-based feature selection strategy that strikes a compromise between classification accuracy and redundancy reduction by combining features of the multi objective (MO) based honey badger algorithm (MO-HBA) and non-dominated sorting genetic algorithm-II (NSGA-II). The technique was developed as part of this investigation. Increasing the accuracy of the classification while simultaneously reducing the number of redundant characteristics is one of the optimizations aims of this approach. The MO-HBA shows excellent performance in exploration and exploitation. A Kernel version of the extreme learning machine (KELM) is used for the process of selecting the features to use. In order to evaluate how well this method of feature selection performs, eighteen benchmark datasets are utilized, and the results are compared to four established methods of multi-objective feature selection based on different metrics.
Improving magnetic fields in overhead transmission lines using the insulated cross-arm method
Authors: Ahsan Matiullah , Baharom Md Nor Ramdon , Zainal Zainab , Sahari Norain , Hanim Faridah , Kamarudin Saufi , Abd Rahman Rashisham , Mohd Yousof Mohd Fairouz , Jamail Nor Akmal , Othman Nordiana Azlin
Published: July 2024

This research study evaluates the effectiveness of the insulated cross-arm (ICA) method in reducing magnetic field (MF) levels in transmission lines. Using Ansys Maxwell finite element method (FEM) software, the study models and analyses the MF distribution in 132 kV and 275 kV overhead transmission lines (OTLs) in Malaysia. The findings reveal that implementing the ICA method can substantially reduce MF levels, improving MF performance by 36% (at 132 kV) and 48% (at 275 kV). These findings have important implications for mitigating potential health risks associated with high MF exposure near transmission lines. Furthermore, the study highlights the potential for future enhancements in ampacity and emphasizes the importance of promoting a health-conscious environment. Field studies, assessments, and investigations into economic feasibility and practical implementation are recommended for further validation and application of the ICA method. Overall, this research study contributes to the knowledge and understanding of reducing MF exposure and improving the efficiency of power transmission systems.
Digital transformation technologies for conveyor belts predictive maintenance: a review
Authors: Santoshi Anusha Pediredla Veni , Peravali Swapna , Koti Reddy Dodda Venkata Rama
Published: July 2024

The availability of condition-monitoring data has increased due to internet of things (IoT) technologies, providing information on various parameters like vibration, temperature, current, and voltage. Cloud computing and big data facilitate the prevention of failures and estimation of remaining useful life through advanced mathematical models and artificial intelligence (AI) techniques. These enable prompt and suitable maintenance actions. This article conducts a systematic review of digital transformation technologies, including cloud computing, edge computing, AI, machine learning (ML), and TinyML, in predictive maintenance for conveyor belt systems. This article reviews how these digital transformation technologies improve predictive maintenance strategies for conveyor belts. The systematic review summarizes the results and challenges of various methodologies used in conveyor belt systems and suggests areas for further research. This paper aimed to serve as a useful resource for researchers, practitioners, and industry professionals seeking insights into current predictive maintenance technologies for conveyor belt systems. The takeaways of the review are expected to ignite discussion on efficient and proactive maintenance strategies and promote the development of innovative solutions for ensuring the reliability and longevity of conveyor belt systems in the digital era.
Solar irradiation intensity forecasting for solar panel power output analyze
Authors: Sucita Tasma , Hakim Dadang Lukman , Hidayahtulloh Rizky Heryanto , Fahrizal Diki
Published: July 2024

Accurate forecasting of global horizontal irradiance (GHI) is critical for optimizing solar power plant (SPP) output, particularly in tropical locales where solar potential is high yet underutilized due to forecasting challenges. This research aims to enhance GHI prediction in one of the major cities of Indonesia, where existing models struggle with the area’s natural climate unpredictability. Our analysis harnesses a decade of data 2011-2020, including GHI, temperature, and the Sky Insolation Clearness Index, to calibrate and compare these methodologies. We evaluate and contrast the exponential smoothing method versus the more complicated artificial neural network (ANN). Our findings reveal that the ANN method, notably its fourth iteration model with 12 input and hidden layers, substantially outperforms exponential smoothing with a low error rate of 1.12%. The use of these methodologies forecasts an average energy output of 252,405 Watt for a solar panel with specification 15.3% efficiency and 1.31 m2 surface area throughout the 2021 to 2025 timeframe. The work offers the ANN method as a strong prediction tool for SPP development and urges a further exploration into more advanced forecasting methodologies to better harness solar energy.
Modos de cuidar e se movimentar: experiências etnográficas entre indígenas, quilombolas e agricultoras familiares
Authors: Weitzman Rodica , Godoi Emília Pietrafesa de , Lovo Arianne Rayis
Published: July 2024

Com base em etnografias realizadas em diferentes contextos – povo Pankararu em Pernambuco e São Paulo, quilombolas de Alcântara/MA e agricultoras agroecológicas do leste de Minas Gerais –, propomos, neste artigo, que os “modos de cuidar” fazem parte de uma ética de relacionamentos que envolve seres tangíveis – homens, mulheres, plantas e a terra – e seres intangíveis, como os encantados. E, ainda, que há práticas de cuidado relacionadas a “movimentos” que se realizam com intensidades e ritmos variados. Nos contextos trabalhados, os modos de cuidar, enquanto eixo organizador de relações sociais, são protagonizados pelas mulheres, embora não sejam restritos ao universo feminino, e são compreendidos em suas dimensões afetivas e disruptivas. Ao trazer a relação entre “movimento e cuidado”, nosso propósito é contribuir com uma nova perspectiva para os debates que têm sido realizados sobre estes temas.
Transversalidades, descentramentos e inquietações
Authors: Marques Ana Claudia Duarte Rocha
Published: July 2024

Derivado del informe elaborado em la reunión, sin pretensiones de exhaustividad, el articulo destaca énfasis y aportes de las comunicaciones, así como de los debates
A Retomada dos Guaiamuns: pesca artesanal, infraestrutura neoextrativista e renascimento ecológico quilombola na Baía de Todos os Santos
Authors: Buti Rafael Palermo
Published: July 2024

TThe article is an ethnographic exercise of fishing for blue land crab (Cardisoma ganhumi) in the mangroves of Baía de Todos os Santos. Taking as a reference the ways of living and inhabiting this crustacean and the gaiamunzeiros that capture them as a fishing activity, it aims to describe the effects of neoextractivism in the fishing landscapes of the region. The intention is, on the one hand, to show practices, habitability and landscapes associated with blue land crab fishing and, on the other hand, to offer a description of conflicts and impacts arising from agropastoral and oil infrastructures in their territories and ways of life. Thus, the article also aims to contribute to the public debate on the regulatory framework for blue land crab fisheries, reinforcing the importance of the participation of gaiamunzeiros and quilombola artisanal fishermen in decision-making on the preservation of the species and protection of their living environments.
Nacionalismo, musealização e (de)colonialidade em Barbados: algumas considerações preliminares sobre a diversidade sexual e de gênero entre legados indigestos e falsos paradoxos
Authors: Gontijo Fabiano Souza
Published: July 2024

Desde 2019, o Museu Nacional de Barbados vem apresentando algumas exposições temporárias que abordam a importância dos movimentos sociais para a promoção do respeito à diversidade sexual e de gênero. Trata-se de esboçar uma reflexão sobre as relações entre a formação dos Estados nacionais, os efeitos do colonialismo, a instituição da heteronormatividade e, enfim, a recente visibilização da diversidade sexual e de gênero, a partir de Barbados e seu Museu Nacional.
Redescobrindo um autor (quase) esquecido e sua obra
Authors: Schröder Peter
Published: July 2024

Resenha de:
MERE, Gleice; SNETHLAGE, Rotger M. e SNETHLAGE, Alhard-Mauritz (org.). 2021. A expedição do Guaporé (1933-1935). Vol. I: Cadernos de campo. Vol. II: publicações e acervo. Belém: Museu Paraense Emilio Goeldi, 776 + 855 pp.
Um tetinho armado no deserto ou a crítica literária de Tamara Kamenszain
Authors: Azevedo Marcela Maria de Paiva , Pinto Tainá
Published: July 2024

This article proposes how the construction of a space for women writers in literary criticism takes place. To this end, we will follow Tamara Kamenszain, an Argentine poet and essayist, who questions in her book Chicas en tiempos suspendidos (2022) – which we will read as a hybrid of poetry and feminist criticism – the difference that guarantees bards a secure and comfortable place in the canon. Based on what Tamara shares in her writings about the paths of her first publication as a critic, with the book El texto silencioso (1983), as well as her relationship with this textual genre that comes to her under the weight of laws and judgment, we will develop the foundation of a new place, the precarious little roof set up in the desert that she will propose in the book Solos y solas (2005). This roof has the particularity of being unstable, as it is located not only in the desert, but also inside an outside, producing a radical exteriority in the field of literary thought. But this exteriority has the ethic of bringing together the difference, the dissidents, a gesture that Tamara is committed to as she opens up her writing to the field of the other, ensuring they have the possibility of saying something.
Da sensibilidade à criação: a Albertine de Proust e o aprendizado da arte
Authors: Starling Betysa
Published: July 2024

The guiding objective of this article is the analysis of the character Albertine based on the hypothesis that she is the most emblematic figure in the novel In search of lost time, above all because she promotes the convergence of the great themes developed by Marcel Proust – love, art, time, memory, sexuality, and the sub-themes that are linked to such themes. By trancending the condition of a simple character, becoming the point at which almost all of Proust´s themes intersect, Albertine proves to be a great mediator of the narrator Marcel's learning, which makes her fundamental to the journey of the proustian hero, helping him to recognize new meanings for his experiences and to resignify his own life, from childhood to regained time. In this sense, we envision, with the study of the character Albertine, understanding the artistic creation that follows the search of lost time and the process of sublimation in Marcel Proust´s novel.
A Educação Feminina: diálogo entre Christine de Pizan, Mary Wollstonecraft e Jane Austen
Authors: Galeno Maria do Carmo Balbino
Published: July 2024

Christine de Pizan foi uma mulher intelectual na Idade Média, uma exceção, se considerarmos que a educação era um campo dos homens para os homens. Sua obra A Cidade das Damas (1405) traz a utopia da construção de uma cidade na qual as mulheres estariam livres da misoginia dos homens. Observamos que para construir a cidade, a autora é auxiliada por três damas alegóricas, sendo a Razão a primeira delas. No final do século XVIII, Mary Wollstonecraft publica A Reivindicação dos Direitos da Mulher (1792), demonstrando que a mulher, assim como o homem, é dotada de razão e por isso tem o direito a ter educação de qualidade. No início do século XIX Jane Austen publica Orgulho e preconceito (1813), romance cuja protagonista é um ícone de razão e inteligência. Isso posto, o presente artigo busca identificar a razão nos escritos das três autoras que reivindicam para seu sexo a nobreza de pensar e decidir por si mesmas, como sujeito racional, em um mundo patriarcal que as consideravam objeto do desejo masculino. Nos auxiliam nesse diálogo as teóricas Virginia Woolf, Simone de Beauvoir, Gerda Lerner, Silvia Federici, Sandra Vasconcelos, Luciana Calado Deplagne, Lucimara Leite, dentre outras.
Demandas, emergências e antropologias
Authors: Macedo Victor Miguel Castillo de , Varjão João Victtor Gomes
Published: July 2024

Este ensaio editorial analisa o volume 33.1 da revista Cadernos de Campo, destacando a preocupação fundamental na formação da antropologia, agora delineada por novos contornos e questões, com "novos sujeitos", a partir de demandas e emergências antropológicas. Este contexto aproxima e distingue as reflexões, ensaios, resenhas, artigos, tradução e entrevista que compõem a edição, oferecendo uma perspectiva sobre as produções antropológicas atuais.
Contribuição ao estudo da tensão superficial do leite
Authors: Cordoso Francisco Antonio
Published: July 2024

É inútil encarecer a importância da determinação das constantes físicas do leite como meio auxiliar valioso para o seu contrôle higiênico no laboratório. Essa determinação se presta sobretudo para verificar a adulteração mais comumente observada que é a adição de água ao leite.
Eficácia da aplicação do método estatístico aos fenômenos de vida referentes ao homem
Authors: Carvalho Egydio de , Vieira F. Borges
Published: July 2024

O presente trabalho representa mais uma tentativa por parte dos autores em demonstrar, em nosso meio, o valor que pode assumir o método estatístico, quando aplicado aos fenômenos de vida referentes ao homem. Embora a parte material tenha sido principalmente elaborada por um de nós, (Pedro Egydio), as idéias que vão ser expendidas vêm sendo propugnadas pelos autores há já longo tempo e sistematicamente postas em prática em suas publicações.
Estudo de uma Salmonella Derby (isolada em S. Paulo), pelo esquema de classificação sorológica de Kauffmann-White
Authors: Assumpção Lucas de
Published: July 2024

The first part presents general considerations on the antigert'ic structure of the salmonellas, carrying these studies up to the agreement of which resu-lted the Kauffmann-White scheme. The second part describes the technique used in certain studies on the serological classification of the Salmonellas. This shows that each author uses its own process but that practically, the results are more or less satisfactory. There follows a study on a salmonella isolated from an adult's stools (V. F.) ; the patient had some vomiting, bloodless diarrhoea, headache, abdominal pain and slight fever. After a short review of the morfologic ánd biochemical characteristics considered sufficient to place the germ observed in the genus Salmonella, its sorological study revealed the presence of somatic factors "IV" and "XII" and the ciliary "fg" factor in the specific phase. No factors were observed in the non specific phase. After severa! agglutination, absorbtion and mutual absorbtion tests it became evident that the organism was a monophasic salmonella with an antigenic formula equal to IV .XII: fg: - which expresses the antigenic constitution of Salmonella derby in accordance to the Kauffmann-White scheme, thus identifying race V. F .. The final section covers a brief discussion on the practical application of the Kauffmann determination and some comments on the identification done in this st~dy.
Contribuição ao estudo do conforto térmico
Authors: Ribeiro Benjamim Alves
Published: July 2024

Estudaram-se, neste trabalho, as variações da sensação de confôrto térmico contra as de alguns índices conhecidos. As observações, em número de vinte, realizaram-se na estação fria do ano (agosto e setembro), entre nove e dez horas da manhã, no interior duma sala de aulas, aproveitando-se as condições térmicas naturais reinantes no local. A sensação de confôrto térmico foi avaliada pelo método da votação, e o grupo de votantes constou, em média, de 43 indivíduos, todos do sexo feminino, de idade variando entre 18 e 29 anos, normalmente vestidos e em condições de sedentariedade A sensacão média de confôrto apresentou os seguintes graus de correlação (coeficiente de Pearson): com o cata sêco, -0,94; com o cata úmido, -0,71 ; com a temperatura efetiva (escala normal), 0.85; com o bulbo sêco, +0,92; com o bulbo úmido, -0,39. Os valores ótimos de confôrto foram de 5, 2 5 para o çata sêco; 15,0 para o cata úmido; 19,5ºC para a temperatura efetiva (escala normal) ; e 21,O ºC para o bulbo sêco.
Questões de saude e Assistência na cidade e no Campo
Authors: Vieira Francisco Borges
Published: July 2024

Vastíssimo é o terna que me cabe a honra de relatar. Na realidade ele e toda a higiene. Penso, entretanto, que a ilustre Comissão que o programou, teve em mira, de acordo aliás com as justas finalidades do Certame. apenas a focalização dos principais problemas médico-sociais que afligem as nossas populações, na cidade e no campo, a serem ainda mais agravados pelas condições de após guerra, a-fim-de que, aquí discutidos, dêm margem à proposição de medidas mais racionais para procurar solvê-los
First record of Proszynskia diatreta (Simon, 1902) (Araneae: Salticidae) from Gujarat, India
Authors: Manisha P. Patel  , Prajapati Dhruv A.
Published: July 2024

In this study, we report the first record of Proszynskia diatreta Kanesharatnam & Benjamin, 2019 in Gujarat, marking the first instance of this species being found outside of its type locality in Tamil Nadu, India.
Lysozyme 1 Inflamed CCR2
+
Macrophages Promote Obesity-Induced Cardiac Dysfunction
Authors: Zhang Lai , Han Huian , Xu Andi , Sathe Adwait , Fu Siying , Zhao Jiaqi , Cai Wenhan , Yang Yaqing , Liu Jinting , Bai Hui , Ben Jingjing , Zhu Xudong , Li Xiaoyu , Yang Qing , Wang Zidun , Gu Yayun , Xing Chao , Schiattarella Gabriele G. , Cheng Steven Yan , Zhang Hanwen , Chen Qi
Published: July 2024

BACKGROUND:

Macrophages are key players in obesity-associated cardiovascular diseases, which are marked by inflammatory and immune alterations. However, the pathophysiological mechanisms underlying macrophage’s role in obesity-induced cardiac inflammation are incompletely understood. Our study aimed to identify the key macrophage population involved in obesity-induced cardiac dysfunction and investigate the molecular mechanism that contributes to the inflammatory response.

METHODS:

In this study, we used single-cell RNA-sequencing analysis of Cd45
+
CD11b
+
F4/80
+
cardiac macrophages to explore the heterogeneity of cardiac macrophages. The CCR2
+
(C-C chemokine receptor 2) macrophages were specifically removed by a dual recombinase approach, and the macrophage CCR2 was deleted to investigate their functions. We also performed cleavage under target and tagmentation analysis, chromatin immunoprecipitation-polymerase chain reaction, luciferase assay, and macrophage-specific lentivirus transfection to define the impact of lysozyme C in macrophages on obesity-induced inflammation.

RESULTS:

We find that the
Ccr2
cluster undergoes a functional transition from homeostatic maintenance to proinflammation. Our data highlight specific changes in macrophage behavior during cardiac dysfunction under metabolic challenge. Consistently, inducible ablation of CCR2
+
CX3CR1
+
macrophages or selective deletion of macrophage CCR2 prevents obesity-induced cardiac dysfunction. At the mechanistic level, we demonstrate that the obesity-induced functional shift of CCR2-expressing macrophages is mediated by the CCR2/activating transcription factor 3/lysozyme 1/NF-κB (nuclear factor kappa B) signaling. Finally, we uncover a noncanonical role for lysozyme 1 as a transcription activator, binding to the
RelA
promoter, driving NF-κB signaling, and strongly promoting inflammation and cardiac dysfunction in obesity.

CONCLUSIONS:

Our findings suggest that lysozyme 1 may represent a potential target for the diagnosis of obesity-induced inflammation and the treatment of obesity-induced heart disease.
Frailty and Cardiovascular Health
Authors: James Kirstyn , Jamil Yasser , Kumar Manish , Kwak Min J. , Nanna Michael G. , Qazi Saadia , Troy Aaron L. , Butt Jawad H. , Damluji Abdulla A. , Forman Daniel E. , Orkaby Ariela R.
Published: July 2024

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.
Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS‐CARES Study
Authors: Blake Jason A. , Long D. Leann , Knight Amy J. , Goodin Burel R. , Crowe Michael , Judd Suzanne E. , Rhodes J. David , Roth David L. , Clay Olivio J.
Published: July 2024

Background

Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke severity ratings and a caregiver‐report of poststroke functioning with longitudinal cognitive outcomes.

Methods and Results

One hundred fifty‐seven caregivers and stroke survivor dyads participated in the CARES (Caring for Adults Recovering From the Effects of Stroke) project, an ancillary study of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) national cohort study. The Glasgow Outcome Scale and modified Rankin Scale scores collected at hospitalization discharge were included as 2 primary predictors of cognitive impairment. The number of caregiver‐reported problems and impairments at 9 months following stroke were included as a third predictor. Cognition was measured using a biennial telephone battery and included the domains of learning, memory, and executive functioning. Multiple cognitive assessments were analyzed up to 5 years poststroke, controlling for prestroke cognition and demographic variables of the stroke survivor. Separate mixed models showed significant main effects of the Glasgow Outcome Scale (b=0.3380 [95% CI, 0.14–0.5];
P
=0.0009), modified Rankin Scale (b=−0.2119 [95% CI, −0.32 to −0.10];
P
=0.0002), and caregiver‐reported problems (b=−0.0671 [95% CI, −0.09 to −0.04];
P
<0.0001) on longitudinal cognitive scores. In a combined model including all 3 predictors, only caregiver‐reported problems significantly predicted cognition (b=−0.0480 [95% CI, −0.08 to −0.03];
P
<0.0001).

Conclusions

These findings emphasize the importance of caregiver feedback in predicting cognitive consequences of stroke.
Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk
Authors: Kovbasyuk Zanetta , Ramos‐Cejudo Jaime , Parekh Ankit , Bubu Omonigho M. , Ayappa Indu A. , Varga Andrew W. , Chen Ming‐Huei , Johnson Andrew D. , Gutierrez‐Jimenez Eugenio , Rapoport David M. , Osorio Ricardo S.
Published: July 2024

Background

Although related, the precise mechanisms linking obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are unclear. Platelets are mediators of CVD risk and thrombosis and prior studies suggested associations of OSA and platelet activity. The aim of this study is to assess the link between OSA, platelet activity, and CVD‐related risk factors.

Methods and Results

We studied the association of OSA‐measures and platelet aggregation in participants dually enrolled in the SHHS (Sleep Heart and Health Study) and FHS (Framingham Heart Study). We applied linear regression models with adjustment for demographic and clinical covariates and explored interactions with OSA and CVD‐related factors, including age, sex, body mass index, hypertension, OSA diagnosis (apnea‐hypopnea index 4%≥5), and aspirin use. Our final sample was of 482 participants (60 years [14.00], 50.4% female). No associations were observed between apnea‐hypopnea index 4% and platelet aggregation in the main sample. Stratified analysis revealed an association in aspirin users (n=65) for our primary exposure (apnea‐hypopnea index 4%, β=0.523;
P
<0.001; n=65), and secondary exposures: hypoxic burden (β=0.358;
P
<0.001), minimum saturation (β=−0.519;
P
=0.026), and oxygen desaturation index 3% (β=74.672;
P
=0.002). No associations were detected in nonaspirin users (n=417).

Conclusions

No associations were detected between OSA and platelet aggregation in a community sample. Our finding that OSA associates with increased platelet aggregation in the aspirin group, most of whom use it for primary prevention of CVD, suggests that platelet aggregation may mediate the adverse impact of OSA on vascular health in individuals with existing CVD risk, supporting further investigation.
Aspirin‐Free Strategy for Percutaneous Coronary Intervention in Patients With Oral Anticoagulation: Prespecified Subgroup Analysis From the STOPDAPT‐3 Trial
Authors: Natsuaki Masahiro , Watanabe Hirotoshi , Morimoto Takeshi , Yamamoto Ko , Obayashi Yuki , Nishikawa Ryusuke , Ando Kenji , Suwa Satoru , Isawa Tsuyoshi , Takenaka Hiroyuki , Ishikawa Tetsuya , Yamada Minoru , Wakatsuki Tetsuzo , Nozaki Yoichi , Kitahara Hideki , Kato Ryuichi , Kawai Ryoma , Kobayashi Yohei , Ishii Mitsuru , Goto Yoshitaka , Ono Koh , Kimura Takeshi
Published: July 2024

Background

The effects of aspirin‐free strategy on bleeding and cardiovascular events in patients undergoing percutaneous coronary intervention with oral anticoagulation (OAC) have not been fully elucidated.

Methods and Results

We conducted the prespecified subgroup analysis based on the use of OAC, including vitamin K antagonist and direct oral anticoagulants, within 7 days before percutaneous coronary intervention in the STOPDAPT‐3 (Short and Optimal Duration of Dual Antiplatelet Therapy‐3) trial, which randomly compared prasugrel monotherapy (2984 patients) to dual antiplatelet therapy (DAPT) with prasugrel and aspirin (2982 patients) in patients with acute coronary syndrome or high bleeding risk. The coprimary end points were major bleeding events (Bleeding Academic Research Consortium types 3 or 5) and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) at 1 month. Among 5966 study patients, there were 530 patients (8.9%) with OAC (no aspirin: N=248, and DAPT: N=282) and 5436 patients (91.1%) without OAC (no aspirin: N=2736, and DAPT: N=2700). Regardless of the use of OAC, the effects of no aspirin compared with DAPT were not significant for the bleeding end point (OAC: 4.45% and 4.27%, hazard ratio [HR], 1.04 [95% CI, 0.46–2.35]; no‐OAC: 4.47% and 4.75%, HR, 0.94 [95% CI, 0.73–1.20];
P
for interaction=0.82), and for the cardiovascular end point (OAC: 4.84% and 3.20%, HR, 1.53 [95% CI, 0.64–3.62]; no‐OAC: 4.06% and 3.74%, HR, 1.09 [95% CI 0.83–1.42];
P
for interaction =0.46).

Conclusions

The no‐aspirin strategy compared with the DAPT strategy failed to reduce major bleeding events irrespective of the use of OAC. There was a numerical excess risk of the no‐aspirin strategy relative to the DAPT strategy for cardiovascular events in patients with OAC.
Frailty and Clinical Outcomes of Ticagrelor Versus Clopidogrel in Older Adults With Acute Myocardial Infarction
Authors: Ko Darae , Evans Peter T. , Lin Kueiyu Joshua , Pande Ashvin N. , Cervone Alexander , Lee Su Been , Cheng Susan , Tsacogianis Theodore , Glynn Robert J. , Kim Dae Hyun
Published: July 2024

Background

Ticagrelor is recommended over clopidogrel in acute coronary syndrome based on the results of the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial. We aimed to emulate PLATO in older adults with and without frailty and with acute coronary syndrome treated with percutaneous coronary intervention.

Methods and Results

We created a new‐user cohort of Medicare fee‐for‐service beneficiaries aged ≥65 years hospitalized for acute coronary syndrome from 2014 to 2018 and initiated ticagrelor or clopidogrel following percutaneous coronary intervention. Frailty was defined using a validated claims‐based frailty index ≥0.25. Coprimary outcomes were major adverse cardiovascular events and major bleeding. Follow‐up began on the date of first outpatient prescription for ticagrelor or clopidogrel and ended on the earliest date for an outcome event, death, discontinuation of the index drug, or disenrollment from Medicare. The study included 42 843 older adults; 23% were frail. After propensity score matching, the rates of major adverse cardiovascular events per 100 person‐years comparing ticagrelor versus clopidogrel groups were 7.8 and 7.3 in the frail cohort (hazard ratio [HR], 1.07 [95% CI, 0.84–1.36]) and 3.7 and 4.2 in the nonfrail cohort (HR, 0.87 [95% CI, 0.75–1.02]). The corresponding rates of major bleeding were 4.3 and 3.8 in the frail cohort (HR, 1.12 95% CI, [0.80–1.56]) and 2.2 and 1.8 in the nonfrail cohort (HR, 1.22 [95% CI, 0.98–1.51]).

Conclusions

There was a trend toward a modest reduction in risk of major adverse cardiovascular events and a trend toward a modest increase in risk of major bleeding with ticagrelor compared with clopidogrel in the nonfrail cohort. There was insufficient evidence for the benefit of ticagrelor in frail older adults.
Acute Declines in Estimated Glomerular Filtration Rate in Patients Treated With Benazepril and Hydrochlorothiazide Versus Amlodipine and Risk of Cardiovascular Outcomes
Authors: Ku Elaine , Jamerson Kenneth , Copeland Timothy P. , McCulloch Charles E. , Tighiouart Hocine , Sarnak Mark J.
Published: July 2024

Background

Acute declines in estimated glomerular filtration rate (eGFR) occur commonly after starting angiotensin‐converting enzyme inhibitors. Whether declines in eGFR that occur after simultaneously starting angiotensin‐converting enzyme inhibitors with other antihypertensive agents modifies the benefits of these agents on cardiovascular outcomes is unclear.

Methods and Results

We identified predictors of acute declines in eGFR (>15% over 3 months) during randomization to benazepril plus amlodipine versus benazepril plus hydrochlorothiazide in the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial. We then determined the relation between declines in eGFR (treated as a binary variable, ≤15% versus >15% and separately, as a restricted spline variable) and the composite risk of fatal and nonfatal cardiovascular events using Cox proportional hazards models. We included 10 714 participants (median age 68 years [Q1 63, Q3 73]), of whom 1024 reached the trial end point over median follow‐up of 2.8 years. Predictors of acute declines in eGFR>15% over 3 months included assignment to hydrochlorothiazide (versus amlodipine) and higher baseline albuminuria. Overall, declines in eGFR ≥15% (versus <15%) were associated with a 26% higher hazard of cardiovascular outcomes (95% CI, 1.07–1.48). In spline‐based analysis, risk for cardiovascular outcomes was higher in the hydrochlorothiazide arm at every level of decline in eGFR compared with the same magnitude of eGFR decline in the amlodipine arm.

Conclusion

Combined use of benazepril and amlodipine remains superior to benazepril and hydrochlorothiazide for cardiovascular outcomes, regardless of the magnitude of the decline in eGFR that occurred with initiation of therapy.
Secondary Stroke Prevention in People With Schizophrenia
Authors: Kapral Moira K. , Porter Joan , Kurdyak Paul , Yu Amy Y. X. , Matheson Emilie , Fang Jiming , Casaubon Leanne K. , Kapoor Eshita , Sheehan Kathleen A.
Published: July 2024

Background

People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke.

Methods and Results

In this retrospective cohort study, we used linked population‐based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017. Outcomes were screening, treatment, and control of risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each outcome among people with and without schizophrenia, adjusting for age and other factors. Among 81 163 people with ischemic stroke, 844 (1.04%) had schizophrenia. Schizophrenia was associated with lower rates of screening for hyperlipidemia (60.5% versus 66.0%, adjusted relative risk [aRR] 0.88 [95% CI, 0.84–0.93]) and diabetes (69.4% versus 73.9%, aRR 0.93 [95% CI, 0.89–0.97]), prescription of antihypertensive medications (91.2% versus 94.7%, aRR 0.96 [95% CI, 0.93–0.99]), achievement of target lipid levels (low‐density lipoprotein <2 mmol/L) (30.6% versus 34.6%, aRR 0.86 [95% CI, 0.78–0.96]), and outpatient specialist visits (55.3% versus 67.8%, aRR 0.78 [95% CI, 0.74–0.83]) or primary care physician visits (94.5% versus 98.5%; aRR 0.96 [95% CI, 0.95–0.98]) within 1 year. There were no differences in prescription of antilipemic, antiglycemic, or anticoagulant medications, or in achievement of target hemoglobin A1c ≤7%.

Conclusions

People with stroke and schizophrenia are less likely than those without to receive secondary preventive care. This may inform interventions to improve poststroke care and outcomes in those with schizophrenia.
Endothelial Cell‐Specific Prolyl Hydroxylase‐2 Deficiency Augments Angiotensin II–Induced Arterial Stiffness and Cardiac Pericyte Recruitment in Mice
Authors: Liu Bo , Zeng Heng , Su Han , Williams Quinesha A. , Besanson Jessie , Chen Yingjie , Chen Jian‐Xiong
Published: July 2024

Background

Endothelial prolyl hydroxylase‐2 (PHD2) is essential for pulmonary remodeling and hypertension. In the present study, we investigated the role of endothelial PHD2 in angiotensin II–mediated arterial stiffness, pericyte recruitment, and cardiac fibrosis.

Methods and Results

Chondroitin sulfate proteoglycan 4 tracing reporter chondroitin sulfate proteoglycan 4– red fluorescent protein (DsRed) transgenic mice were crossed with PHD2
flox/flox
(PHD2
f/f
) mice and endothelial‐specific knockout of PHD2 (PHD2
EC
KO) mice. Transgenic PHD2
f/f
(TgPHD2
f/f
) mice and TgPHD2
EC
KO mice were infused with angiotensin II for 4 weeks. Arterial thickness, stiffness, and histological and immunofluorescence of pericytes and fibrosis were measured. Infusion of TgPHD2
f/f
mice with angiotensin II resulted in a time‐dependent increase in pulse‐wave velocity. Angiotensin II–induced pulse‐wave velocity was further elevated in the TgPHD2
EC
KO mice. TgPHD2
EC
KO also reduced coronary flow reserve compared with TgPHD2
f/f
mice infused with angiotensin II. Mechanistically, knockout of endothelial PHD2 promoted aortic arginase activity and angiotensin II–induced aortic thickness together with increased transforming growth factor‐β1 and ICAM‐1/VCAM‐1 expression in coronary arteries. TgPHD2
f/f
mice infused with angiotensin II for 4 weeks exhibited a significant increase in cardiac fibrosis and hypertrophy, which was further developed in the TgPHD2
EC
KO mice. Chondroitin sulfate proteoglycan 4 pericyte was traced by DsRed
+
staining and angiotensin II infusion displayed a significant increase of DsRed
+
pericytes in the heart, as well as a deficiency of endothelial PHD2, which further promoted angiotensin II–induced pericyte increase. DsRed
+
pericytes were costained with fibroblast‐specific protein 1 and α‐smooth muscle actin for measuring pericyte–myofibroblast cell transition. The knockout of endothelial PHD2 increased the amount of DsRed
+
/fibroblast‐specific protein 1
+
and DsRed
+
/α‐smooth muscle actin
+
cells induced by angiotensin II infusion.

Conclusions

Knockout of endothelial PHD2 enhanced angiotensin II–induced cardiac fibrosis by mechanisms involving increasing arterial stiffness and pericyte–myofibroblast cell transitions.