bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperature-assisted microstructure development for TiB2 reinforced Cu matrix composite
Authors: Murmu Uttam Kumar , Ghosh Abhishek , Ghosh Manojit
Published: January 2023

The current research demonstrates the fabrication and characterization of TiB2-reinforced (10%) Cu matrix composite through a powder metallurgy route. The composites have been prepared by hot compaction (200 °C and 500 °C) of Cu and TiB2 powders subsequent to mechanical milling in a high-energy planetary mill. The influence of temperature on the microstructure, hardness, and mechanical properties of the composites was investigated. The development of clean and well-connected interfaces between matrix and reinforcement is revealed by scanning electron microscopy (SEM). X-ray diffraction (XRD) revealed the absence of intermetallic compounds during the entire tenure of the ball milling and consolidation process. Differential scanning calorimetry (DSC) analysis displayed the possibility of oxide formation with the gases trapped inside the pores of the compacts that could not be ignored. The kinetics of the formation of Cu2O phases with associated activation energies at various temperatures were calculated using Johnson-Mehl-Avramani (JMA) equation. The values of activation energy (Q) were 405.14, 573.74, and 705.69 (KJ mol−1) for sintering at 500 °C, 200 °C, and RT, respectively. This indicates the formation of endothermic peaks at a lower temperature for samples with higher consolidation temperatures. A uniform distribution of hardness on the cross-section ensured proper load spread and an accurate selection of the H (height)/D (diameter) ratio during compaction. Increasing hardness with higher consolidation temperature might sound aberrated from the traditional understanding of softening with temperature through grain growth. A hardness value of 158.5 Hv at a higher consolidation temperature (500 °C) achieved through a reduction of porosity by removing entrapped gases with temperature outweighs the softening effect.
The stochastic nature of power-grid frequency in South Africa
Authors: Rydin Gorjão Leonardo , Maritz Jacques
Published: January 2023

In this work, we explore two mechanisms that explain non-Gaussian behaviour of power-grid frequency recordings in the South African grid. We make use of a Fokker–Planck approach to power-grid frequency that yields a direct relation between common model parameters such as inertia, damping, and noise amplitude and non-parametric estimations of the same directly from power-grid frequency recordings. We propose two explanations for the non-Gaussian leptokurtic distributions in South Africa: the first based on multiplicative noise in power-grid frequency recordings, which we observe in South Africa; the second based on the well-known scheduled and unscheduled load shedding and rolling blackouts that beset South Africa. For the first we derive an analytic expression of the effects of multiplicative noise that permits the estimation of all statistical moments—and discuss drawbacks in comparison with the data; for the second we employ a simple numerical analysis with a modular power grid of South Africa. Both options help understand the statistics of power-grid frequency in South Africa—particularly the presence of heavy tails.
Loss of ATF6α in a human carcinoma cell line is compensated not by its paralogue ATF6β but by sustained activation of the IRE1 and PERK arms for tumor growth in nude mice
Authors: Jin Shengyu , Jin Byungseok , Ishikawa Tokiro , Ninagawa Satoshi , Okada Tetsuya , Koyasu Sho , Harada Hiroshi , Mori Kazutoshi
Published: January 2023

Tumor cells activate the unfolded protein response for growth. We investigated the requirement for the ATF6 arm, consisting of ubiquitously expressed ATF6α and ATF6β, and found that the loss of ATF6α in tumor cells resulted in sustained activation of the IRE1 and PERK arms, contrary to the expectation from our analysis of mouse embryonic fibroblasts.
Spatio-temporal regulation of endocytic protein assembly by SH3 domains in yeast
Authors: Hummel Daniel R. , Kaksonen Marko
Published: January 2023

SH3 domains are abundant protein–protein interaction domains in clathrin-mediated endocytosis. We used mutagenesis and live-cell imaging in yeast to dissect SH3-mediated regulation of endocytosis. Our results show that SH3 domains cooperatively regulate the assembly, localization, and disassembly of the actin nucleation–promoting Las17/Vrp1 complex.
Mechanically primed cells transfer memory to fibrous matrices for invasion across environments of distinct stiffness and dimensionality
Authors: Almeida José A. , Mathur Jairaj , Lee Ye Lim , Sarker Bapi , Pathak Amit
Published: January 2023

Cell invasion across mechanically dissimilar environments is mediated by cell-to-matrix transfer of mechanical memory. Past mechanical priming of cells in stiff environments increases cellular forces that enhance collagen remodeling and subsequent cell invasion. Computational model explains that a positive feedback between cell and matrix memories reduces energy barrier for sustained cell invasion from stiff substrates to 3D collagen matrices.
Sad Historian
Authors: Steedman Carolyn
Published: January 2023

William Godwin’s history writing and Oliver Goldsmith’s poetry are used to explore the visual turn in history writing and the historian’s project of “rescuing” the poor and dispossessed of the past.
Plasmid-free CRISPR/Cas9 genome editing inSaccharomyces cerevisiae
Authors: Nishimura Akira , Tanahashi Ryoya , Oi Tomoki , Kan Kyoyuki , Takagi Hiroshi
Published: January 2023

The current CRISPR/Cas9 systems in the yeast Saccharomyces cerevisiae cannot be considered a non-genetic modification technology because it requires the introduction of Cas9 and sgRNA into yeast cells using plasmid expression systems. Our present study showed that the yeast genome can be edited without plasmid expression systems by using a commercially available protein transfection reagent and chemically modified sgRNAs.
Confirm Not Command: Examining Fraudsters’ Use of Language to Compel Victim Compliance in Their Own Exploitation
Authors: Carter Elisabeth
Published: January 2023

Using discourse analysis to examine exchanges between fraudsters and victims in telephone-mediated frauds, this research examines the interactional techniques used by perpetrators of fraud to gain and maintain compliance from their victims, without causing them alarm. It reveals how compliance is secured and maintained in a process of establishing the relationship, grooming the victim and setting expectations of follow-through. Reimagining traditional understandings of fraud victimization and vulnerability, this work exposes how social and interactional norms are replicated and manipulated by fraudsters in order to compel individuals to be drawn into participating in an alternate, exploitative reality that is indistinguishable from safety; quashing a victim’s ability to recognize the situation as harmful and rendering any motivation to escape as nonsensical. In doing so, this paper questions the efficacy of public fraud protection guidance strategies and delivers evidence for the need to change the present approach to understanding and tackling fraud victimization and complicity.
314 Injection site reactions from an integrated analysis of phase 2 and phase 3 clinical trials of lebrikizumab treatment in moderate-to-severe atopic dermatitis
Authors: Gooderham Melinda , Shi Vivian Y , Wollenberg Andreas , Thyssen Jacob P , Torres Tiago , Gil Esther Garcia , Bardolet Laia , Natalie Chitra R , Atwater Amber R , Zhao Fangyi , Blauvelt Andrew
Published: January 2023

Lebrikizumab is an injectable, IgG4 monoclonal antibody that selectively binds to interleukin-13 with high affinity. Injection-site reactions (ISRs) are localized adverse events in the immediate site of administration of a drug and are common with injectable therapies. This analysis reports ISRs in patients from eight lebrikizumab (LEB) clinical trials in atopic dermatitis. To report ISRs in patients with moderate-to-severe atopic dermatitis treated with LEB, from an integrated safety analysis of phase 2 and 3 LEB clinical trials. These data sets include adolescents and adult patients who received at least one dose of LEB from a total of eight atopic dermatitis clinical trials, including four 16-week placebo-controlled clinical trials. Eight trials consist of: ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE and Phase 2b study. Treatment duration ranged from a single dose to 100 weeks. ISRs were defined using the preferred terms from the Medical Dictionary for Regulatory Activities high-level term, injection site reactions, excluding terms related to joints. This analysis includes ISRs frequencies in patients treated with LEB compared to placebo (ALL PC week 0–16), and all patients who received any dose of LEB (ALL LEB), and reports ISRs type, exposure adjusted incidence rates (EAIR) per 100 patient-years, the timing of ISRs occurrence, and ISRs leading to discontinuation. In the ALL PC week 0–16 analysis, 2.6% (n = 20/783, EAIR 9.0) of patients in the LEB group reported ISRs vs. 1.5% (n = 6/404 EAIR 5.4) in the placebo group. Injection site pain (n = 7, 0.9%) and injection site erythema (n = 7, 0.9%) were the most frequent reactions reported in the LEB group. Most ISRs were mild or moderate, with only 1 (0.1%) severe event. In the ALL LEB analysis, 3.1% of patients reported ISRs (n = 53/1720, EAIR 3.3). Injection site pain (n = 16, 0.9%) and injection site erythema (n = 12, 0.7%) were the most frequent reactions. Almost all reports were mild or moderate, with 3 (0.2%) severe. The incidence of ISRs did not increase with a longer duration of LEB exposure. The majority of ISRs were reported between weeks 0 and 16 (n = 38, 2.2%). The frequency of ISRs from week 16 to 32 was 1.0% (n = 15), from week 32 to 48 was 0.4% (n = 4) and from week 48 to 64 was 0.2% (n = 2). Treatment discontinuation due to ISRs occurred in a few patients (n = 5, 0.3%). Overall, a low proportion of patients reported ISRs (<3%) with a numerically higher frequency of LEB-treated patients who reported ISRs compared to placebo (1.5%). Most events were mild or moderate in severity, did not lead to treatment discontinuation, occurred within the first 16 weeks of treatment, and ISRs incidence did not increase with a longer duration of exposure.
334 Baseline demographics and family disease history in patients with atopic dermatitis: an update from the GLOBOSTAD registry
Authors: Calzavara-Pinton Piergiacomo , Čelakovská Jarmila , Lapeere Hilde , Holzer Gregor , Al-Ahmad Mona , Chu Chia-Yu , Wu Jiangming , Ardeleanu Marius , Bosman Kwinten
Published: January 2023

The efficacy and safety of dupilumab have been reported previously based on data from controlled clinical trials. The GLOBOSTAD study extends the scope of these trials by providing real-world data. This analysis reports baseline demographics and family disease history in patients with atopic dermatitis (AD) who received treatment with dupilumab in a real-world setting. This 5-year, international, multicentre, non-interventional study (GLOBOSTAD; NCT03992417) included patients ≥12 years old with moderate-to-severe AD (Investigator’s Global Assessment score ≥3) who received dupilumab treatment based on country-specific prescribing criteria. Data reported are for the population at baseline (N = 952; data cut-off: March 2022) in 22 countries. In the 952 patients included at baseline, mean (standard deviation) age at AD onset was 11.1 (16.0) years. Male patients represented 57.8% of patients and White patients 65.2%. The majority of patients were enrolled from Italy (17.2%), Japan (12.4%) and Spain (11.3%). Family history of type 2 inflammatory conditions (number of patients [%]) was prevalent, including AD (364 [38.2%]), asthma (238 [25%]), allergic rhinitis (219 [23%]), food allergies (74 [7.8%]), recurrent or chronic urticaria (31 [3.3%]), nasal polyposis (21 [2.2%]), eosinophilic esophagitis (11 [1.2%]) and other atopic/allergic conditions (39 [4.1%]). Most cases of type 2 inflammatory conditions were reported in first-degree relatives. Most patients enrolled in the GLOBOSTAD study developed AD during pre-adolescence. Family history of select type 2 inflammatory conditions, including AD, asthma and allergic rhinitis, was present in a moderate proportion of patients.
347 The real-world burden of atopic dermatitis: MEASURE-AD multicountry study results from Brazil, Mexico and Argentina
Authors: Jardim Criado Roberta Fachini , Rodrigues Tatiane , de Campos Lucila , Cestari Tania , Maspero Jorge , Luna Paula Carolina , Angles María Valeria , Antila Martti
Published: January 2023

The burden of atopic dermatitis (AD), a chronic, relapsing inflammatory skin disease, increases with disease severity and is associated with multiple flares per year over many years. We characterized the real-world burden of disease, including flares, in patients with AD enrolled in MEASURE-AD from Latin America. Patients (aged ≥12 years) with physician-confirmed AD receiving or eligible for systemic therapy were enrolled in MEASURE-AD between December 2019 and June 2020. Patient characteristics, treatments and outcomes were recorded during a single office visit. Primary outcome measures included worst itch within the past 24 h (Worst Pruritus Numerical Rating Scale [WP-NRS]) and quality of life (QoL; Dermatology Life Quality Index [DLQI] and cDLQI). Among secondary outcomes, the frequency and duration of disease flares within the last 6 months were assessed. Herein result from the Latin American (Brazil, Mexico and Argentina) population (N = 180; adults (≥18 years), n = 157; adolescents, n = 23). Analyses were based on observed data; only descriptive statistics were presented. The mean (SD) age was 33.8 (17.0) years, 52.2% were males and all patients were receiving AD treatment, including 65.6% receiving systemic therapy alone or in combination. Severe pruritus (WP-NRS ≥7) was reported by 54.4% of patients (adults, 57.3%; adolescents, 34.8%). A very or extremely large effect on QoL (DLQI or cDLQI ≥11) was reported among 50.0% of patients ≥16 years and 42.9% of patients 12–15 years. Over the previous 6 months, 0, 1–2, 3–4, 5–6 and >6 flares were reported by 8.3%, 27.2%, 31.1%, 11.7% and 15.6% of patients, respectively. On average, flares lasted 15.2 days (adults, 15.9 days; adolescents, 11.1 days). Although all patients received treatment and two-thirds received systemic therapies, severity scores and impact on QoL and itch were extremely high, suggesting that AD is not adequately controlled in all patients.
Incorrectly Generated RSA Keys: How I Learned To Stop Worrying And Recover Lost Plaintexts
Authors: Shumow Daniel
Published: January 2023

When generating primes $p$ and $q$ for an RSA key, the algorithm specifies that if $p-1$ and $q-1$ must be relatively prime to the public exponent $e$. If this is not done, then the decryption exponent is not well defined. However, what if a software bug allows the generation of public parameters $N$ and $e$ of an RSA key with this property and then it is subsequently used for encryption? Though this may seem like a purely academic question, a software bug in a preview release of the Windows 10 operating system makes this question of more than purely theoretical. Without a well defined decryption exponent, plaintexts encrypted to such keys will be undecryptable thus potentially losing user data, a serious software defect. Though the decryption exponent is no longer well defined, it is in fact possible to recover the a small number of potential plaintexts, if the prime factors $p$ and $q$ of the public modulus $N$ are known. This paper presents an analysis of what steps fail in the RSA algorithm and derives a plaintext recovery algorithm. The runtime of this algorithm is $O(e)$ making it practical to use, and it has been implemented in python.
Transcatheter repair of massive primary mitral regurgitation: beyond the reach of the guidelines
Authors: Eerdekens Rob , Bouwmeester Sjoerd , Zimmermann Frederik M , Brueren Guus R G , Tonino Pim A L
Published: January 2023

A 58-year-old male with prior history of mechanical aortic valve replacement (AVR) in 2009 for severe symptomatic aortic regurgitation in a bicuspid aortic valve, and since 2013 a new-onset severe asymptomatic primary mitral regurgitation (MR) due to prolapse of the anterior mitral valve leaflet (AMVL) presented himself with acute heart failure. Based on current guidelines recommendations, this patient was not eligible for transcutaneous mitral valve edge-to-edge repair (TEER), as well he was found as too high risk for conventional mitral valve repair. However, as a last resort TEER was undertaken with an unconventional strategy, which resulted in resolution of the MR and improvement of clinical, biochemical findings.
The diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia
Authors: Samman A S , Alsaeed N A , Hanfi Y H
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Coronavirus disease (COVID-19) continues to cause considerable morbidity and mortality worldwide. The complication in patients with severe COVID-19 disease include arrhythmias, peri-myocarditis (PM), and heart failure (HF).

Purpose

The important role of echocardiogram (ECHO) and cardiac MRI (CMRI) in the diagnosis of myocarditis in COVID-19 patients in Saudi Arabia has not been assessed. The objective is to assess the diagnostic value of ECHO and CMRI and define phenotypes patterns in the COVID-19 subgroup.

Methods

In this retrospective study, adults with suspected COVID-19 presented with dyspnea and cardiovascular comorbidities were studied between January 2021 and December 2021. We collected 329 patients, (LVEF by ECHO was 44±11%). Fifty-two percent (173/329), had HF (HFrEF or HFpEF), thirty-six percent presented with acute coronary syndrome ACS (120/329), and four percent had adult congenital heart disease (ACHD). CMRI was performed in 160 patients (LVEF is 40±11%), and fifty-two were COVID-19 positive. CMRI Phenotypes patterns were described as normal, ischemic, or nonischemic (peri-myocarditis). LVEF was divided by CMRI as (EF≥50 or EF <50%). The average time interval from diagnosis to CMRI was 4-8weeks.

Results

Sixty percent of patients (221/329) were confirmed COVID-19 infection, the mean age is 54±13 years. Ten patients were diagnosed with pulmonary embolism (2/10 were ACHD). peri-myocarditis patterns were found in sixty percent of COVID-19 patients (31/52), five percent (3/52) had an ischemic pattern, and thirty- five percent (18/52) had normal LGE. However, in COVID-19 negative patients, Eighty percent (85/108) had an ischemic pattern, and twenty percent (23/108) had normal LGE.

Conclusion

In this observational study, CMRI confirms its high diagnostic tool in evaluating myocarditis activity. In COVID-19 patients, two third of the population were found to have peri-myocarditis, with half of them reporting LVEF was ≥50 %.
The efficacy and safety of pulsed-field ablation in para-Hisian paroxysmal supraventricular tachycardia: first-in-human pilot trial
Authors: Li F H , Zeng R , Zhang Q , Ma C S
Published: January 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Key Research and Development Program of China

Background

Para-Hisian paroxysmal supraventricular tachycardia (PSVT) is associated with a higher risk of atrioventricular block due to proximity of the His bundle during catheter ablation. Pulsed-field ablation (PFA) with high tissue selectivity may be a promising technique for catheter ablation in patients with para-Hisian PSVT.

Purpose

This study aimed to evaluate the efficacy and safety of PFA for para-Hisian PSVT.

Methods

This investigator-initiated, single-center, single-arm, prospective study was the first in-human pilot phase to evaluate the efficacy and safety of a novel PFA system in patients with PSVT. Patients diagnosed with para-Hisian PSVT via electrophysiological examination were included and treated with PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcome was ablation success and safety after 3 months.

Results

A total of seven patients with a mean age of 49.4±13.1 years were included and underwent PFA. Acute ablation success was achieved in all seven patients. The skin-to-skin procedure time was 135.0±17.7 minutes, fluoroscopy time was 4.3±1.6 minutes, and the number of PFA applications was 7±1.6. No adverse events occurred in any patient during the ablation or during the 3-month follow-up.

Conclusion

PFA had favorable efficacy and safety in para-Hisian PSVT patients and can help minimize the risk of inadvertent atrioventricular block during ablation. PFA may be a favorable treatment choice for patients with para-Hisian PSVT.
SGLT2 inhibitors among patients with heart failure with preserved ejection fraction: a meta analysis of randomised controlled trials
Authors: Jaiswal V I K A S H , Ang S O N G P , Hameed M A H A , Chia J I A E E , Kalra K R I T I , Attia A A , Kanakannavar S S , Roy S , Naz S I D R A , Hugo Alvarez-Aguilera V I C T O R , Sharma P R A C H I , Jaiswal A K A S H
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Sodium glucose co-transporter 2 (SGLT2) inhibitors have been recommended in the practice guidelines for the treatment of patients with heart failure with reduced ejection fraction, however their effects among patients with preserved ejection fraction has been debatable.

Objective

We aim to evaluate the SGLT2 inhibitor effect among patients with

HFpEF including DELIVER and EMPEROR-Preserved trials.

Methods

We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 30th, 2022. Statistical analysis was performed by calculating hazard ratio (HR) using the random effect model with 95% confidence interval (CI) and probability value (P). Statistical significance was met if 95% CI doesn’t cross numeric "1" and p <0.05.

Results

A total of 4 studies with 30418 patients (15390 SGLT2 inhibitor vs 15028 placebo) were included in our analysis. The average age and percentage of females were comparable between groups, with a mean age of 68.3 years and 39.7% of females in the SGLT2 inhibitor group, whereas 67.7 years and 40.5% of females in the placebo group. Most common comorbidities among the SGLT2 inhibitor group included diabetes mellitus (78.8% vs 78.4%). Mean follow-up duration was 2.92 years. SGLT2 inhibitors reduced composite cardiovascular death or first hospitalisation for heart failure (HR, 0.82(95%CI: 0.75-0.89), P<0.001, heart failure hospitalisation (HR, 0.74(95%CI: 0.67-0.82), P<0.001) compared with placebo. However, all-cause mortality (HR, 0.97(95%CI: 0.89-1.06), P=0.54), and cardiovascular mortality (HR, 0.96(95%CI: 0.82-1.13), P=0.66) were comparable between the both groups on SGLT2 inhibitor and placebo.

Conclusion

SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalisation for heart failure. The results suggest patients with HFpEF have almost similar outcomes compared with previous studies on HFrEF. Hence SGLT2 inhibitors can be used among patients with reduced and preserved ejection fraction.
Antithrombotic monotherapy for stable coronary artery disease and atrial fibrillation patients with and without prior coronary artery revascularization: Insights from the AFIRE trial
Authors: Noda T , Nochioka K , Kaikita K , Akao M , Ako J , Matoba T , Nakamura M , Miyauchi K , Hagiwara N , Kimura K , Hirayama A , Matsui K , Ogawa H , Yasuda S
Published: January 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Japan Cardiovascular Research Foundation under a contract with Bayer Yakuhin

Background

The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial demonstrated that rivaroxaban monotherapy was noninferior to combination therapy with rivaroxaban plus a single antiplatelet therapy regarding efﬁcacy and superior for safety endpoints in patients with atrial fibrillation and stable coronary artery disease including patients not requiring revascularization [prior percutaneous coronary intervention (PCI) or bypass grafting (CABG)].

Purpose

The aim of this post-hoc subgroup analysis was to investigate the efficacy and safety of rivaroxaban monotherapy compared to combination therapy in patients with and without prior revascularization.

Methods

Among 2,215 patients included in the modified intention-to-treat analysis in the AFIRE trial, 1445 patients (65.2%) had undergone previous PCI alone, and 252 (11.4%) had undergone previous CABG. The remaining 518 patients (23.4%) was categorized as a group without prior revascularization and then compared with a group with prior revascularization (PCI or CABG). The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis.

Results

In 1697 patients with prior revascularization, efficacy and safety endpoints of rivaroxaban monotherapy were superior to combination therapy (efficacy: HR 0.62, 95%CI 0.45-0.85, p=0.003; safety: HR 0.62, 95%CI 0.39-0.98, p=0.040), whereas there were no significant differences in efficacy and safety endpoints among 518 patients without prior revascularization (efficacy: HR 1.19, 95%CI 0.67-2.11, p=0.553; safety: HR 0.47, 95%CI 0.18-1.26, p=0.125). There was a borderline interaction of efficacy endpoint (P for interaction=0.055) by randomized treatment assignment (Figure 1 and Figure 2). Compared with combination therapy, the safety benefit of rivaroxaban monotherapy on any bleeding was significant in patients without prior revascularization (HR 0.59, 95%CI 0.38-0.93, p=0.022).

Conclusions

In patients with prior PCI or CABG, rivaroxaban monotherapy resulted in more favorable safety and efficacy outcomes than combination therapy. There was a borderline interaction for primary efficacy outcome between prior revascularization and anti-thrombotic therapy.
Gender distribution in STEMI patients and how does it affect primary PCI performances
Authors: Putranto A Y , Haykal Putra T M , Soedarsono W A
Published: January 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Jakarta Heart Center

Background

Managing ST-Segment Elevation Myocardial Infarction (STEMI) patients was always challenging for Healthcare Professionals (HCP) to pursue time-sensitive treatment.1 Gender distribution among STEMI patients is always an interesting issue because it represents the disparity between men and women from multiple aspects. There is a higher proportion of interhospital transfers among men, but women with STEMI had a more severe clinical profile and longer Door-to-Balloon (DTB) times than men.2 In this study, we sought to evaluate gender-related differences in STEMI patients and how does it affect the performance of DTB in the hospital.

Methods

This is a single-centered retrospective observational study among STEMI patients which was treated by PPCI. Secondary data from the medical record were collected consecutively from April 2018 to January 2022 (46 months). We compared both gender in regards of their clinical profile and the performance of their PPCI (DTB). (Figure 1)

Results

During 46 months period, the total population of this research was 880 patients. There were total 742 men (84.3%) and 138 women (15.7%). The mean age of the populations was 55 (49 – 61) years old and 62 (55 – 69) years old in men and women respectively (p<0.001). Women were most likely to present with late onset (>12 hours) STEMI than men (p=0.002). No significant different clinical condition between men and women based on the distribution of Killip class (p=0.991). There is no significant difference of PPCI performance (DTB being achieved) between genders. Male patients achieved DTB in 90 (75 – 130) minutes while female patients achieved DTB in 91 (74 – 136) minutes (p=0.946). (Figure 2)

Conclusion

Our study shows that the majority of STEMI patients underwent PPCI in our hospital were men. The incidence of STEMI differed significantly in the mean age of the two groups, with the mean age of the men being younger than the women. Although it does not affect the performance of DTB between genders, in the future it is necessary to evaluate the outcomes for both groups.
Contemporary review of the management of left ventricular thrombus
Authors: Jiang H , Cuenza L R , Cader A , Al-Omary M S , Ho K H , Sung J G , Tan J , Yap J
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI) and other cardiomyopathies. LVT increases the risk of stroke and systemic embolism, hence treatment with oral anticoagulation is indicated. While the initial treatment options for LVT is clear, the management of patients after the initial duration of anticoagulation is more complex and varied.

Purpose

We aimed to undertake a comprehensive literature review to study the currently available evidence regarding not only the initial type and duration of anticoagulation for LVT, but also potential treatment options after the initial period of anticoagulation in the setting of both LVT persistence and resolution.

Methods

MEDLINE, EMBASE, Scopus, and Google Scholar were searched from inception to August 2022. Data from randomized controlled trials (RCTs), observational studies and case series discussing management of LVT were included in this summarized synthesis.

Results

Of 2050 studies screened, 30 studies (24 observational studies, 3 case series, 2 RCTs, 1 non-randomized, open-label trial) were included. A total of 17 studies compared warfarin with direct oral anticoagulants (DOACs) for the initial anticoagulation strategy, with the vast majority showing similar outcomes (Table 1). Half (n = 9/18) of the studies repeated imaging between 3-6 months. All studies (n=30) used transthoracic echo with or without contrast as the imaging modality of choice, with selected patients undergoing computed tomography (CT) or cardiac magnetic resonance (CMR). If the LVT persisted, most studies recommended continuing anticoagulation (n = 11/16, 69%) or switching to a different class of anticoagulants (n = 6/16, 38%). In the event of LVT non-resolution, high-risk features of embolization (protruding, mobile vs layered clot) may aid in the discussion of risk and benefit of long-term anticoagulation. Even upon resolution of the LVT, some studies (n=5) recommend continuing anticoagulation in the presence of high-risk features of recurrence (eg. persistently depressed left ventricle ejection fraction (LVEF) and/or apical wall dyskinesis). Regardless, medical management should be optimized together with the appropriate revascularization strategy as clinically indicated.

Conclusions

Current evidence on the management of LVT is limited. This updated review summarizes the available evidence for the management for LVT. Evidence-based recommendations on the management of these patients is warranted to appropriately guide clinicians.
Cardiac tamponade in a multiracial population- epidemiology, clinical characteristics and survival outcomes - a single centre experience
Authors: Selavraju N , Mahadevan G , Liu K Y
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac tamponade is a medical emergency which requires prompt medical intervention via pericardiocentesis. Diverse etiologies has been attributed, with malignancy and Tuberculous effusions being the leading causes. The aim of this study is to compare clinical characteristics and survival outcome in a multiethnic Asian centre.

Methods

We performed a single centre retrospective analysis in a hospital in Malaysia. All patients who are acutely presenting with echocardiographic cardiac tamponade between January 2013 to July 2022 were included in this study. Demographic details, clinical presentations, echographic findings, fluid analysis procedural details, and complications were obtained via electronic medical records. Data were analysed using Statistical Package for the Social Sciences version 26 Software.

Results

Of the 6015 patients admitted to our CCU over 9 years, we identified 46 patients fulfilling criteria of tamponade, representing about 0.8% of total admission. Mean age of our cases are 44.59 (±16.48).Males represent 60.9%( n=28) of our cases with Malay race forming nearly 54.3% ( n=25), followed by Chinese, 28.3% ( n= 13). Orthopnea was the commonest clinical manifestation representing 89.1%,followed by tachypnoea ( 69.6% ),fever (69.6%, cough ( 63%,) , and pleuritic chest pain (26.1%.) Malignancy forms the bulk of our cases (60.9%, n= 28), with lung malignancy being the commonest ( 42%, n= 12), followed by breast ( 25%, n= 7), and lymphoma (17.9%, n= 5). Other aetiologies includes infective cause (15.2% , n= 7), with Tuberculosis being the predominant cause, Uremic effusion (10.86 %, n= 5) and rheumatological effusion ( 6.5%, n= 3). Complications occurred in 34.8 % ( n=16) of our cases, with mortality reaching up to 43.8% ( n=7). No significant association seen between Race, tamponade size, amount drained and drainage duration among the oncology vs non oncologic groups ( P value >0.005). The median survival time is 28 days (SE=1.23) for oncology patients and 52 days (0.0) for non-oncology patients at 1 year. Log-rank test indicated that survival experience is significantly different (p< 0.048) between groups in one year outcome. Lymphoma patients have better median survival rate than breast cancer patients (P=0.014)

Conclusion

Malignancy is the commonest cause of Cardiac Tamponade at our centre. Lymphoma patients with tamponade fare better compared to other forms of malignancy, with breast cancer patient faring the worst.
Real-world outcomes of Selexipag for treatment of pulmonary hypertension in an Asian population
Authors: Loo G , Yap J , Hon J S , Ismail A , Lim C L , Sumanthy P , Ruan W , Sewa D W , Phua G C , Ng S A , Hong C , Low A , Lim S T , Tan J L
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Selexipag is an oral selective prostacyclin IP receptor agonist indicated for treatment of pulmonary arterial hypertension (PAH). Data on its real-world safety and efficacy in Asians is lacking.

Purpose

We sought to evaluate the clinical characteristics, treatment regimens and outcomes of patients initiated on selexipag in a tertiary cardiac centre in Asia.

Methods

This was a retrospective study on all patients initiated on selexipag from January 2017 to December 2020. Baseline and follow up characteristics including demographics, functional status and clinical data were collected. Clinical outcomes evaluated included hospitalisation for PH related complications and all-cause mortality. Patients were risk stratified using the COMPERA 2.0 risk scores.

Results

A total of 36 PAH patients were treated with selexipag. At baseline, most patients were WHO functional class II or III (36.4% and 51.5% respectively), with a NT-proBNP of 1335 pg/ml (557 – 2918) and 6 minute walk test (6MWT) duration of 327.5 ±126.4 meters. Selexipag was initiated at 200mcg twice daily dosage for all except one patient (started at 200mcg once daily) and the maximum tolerated dose ranged from 200mcg twice daily to 1400mcg twice daily, with majority tolerating up to a dose of 600mcg twice daily (58.3%). Side effects were reported in 23 patients (63.9%), of which headache (27.8%), diarrhea (30.6%) or musculoskeletal symptoms (27.8%) were predominant. After a median follow up duration of 25.9 ± 23.1 months, selexipag was stopped in 20 patients (55.6%), of which eight patients were due to PAH progression requiring alternative therapy, and 12 patients due to side effects from selexipag. At baseline, patients were classified into low (8.3%), intermediate-low (30.6%), intermediate-high (33.3%) and high risk (27.8%) respectively. Patients who continued on selexipag at follow up showed no change (46.2%), improvement (15.4%) and deterioration (38.5%) in risk score. In the overall cohort of 36 patients, majority (75%) had at least one hospitalisation for PAH related complications and 15 patients (41.7%) demised.

Conclusion

In this real-world study, while selexipag was associated with a stable or improved PAH risk scores in majority of patients, there was a subset of patients with disease progression or intolerance to the medication. Further studies are warranted to identify patients who will benefit most from this therapy.
Preliminary findings from a risk stratification, quality of life and burden of illness in pulmonary arterial hypertension pilot study
Authors: Reeves G , Shepherd J
Published: January 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Australia and New Zealand (Janssen-Cilag Pty Ltd)

Pulmonary Arterial Hypertension (PAH) management strategies focus on lowering mortality risk, extending the patient’s life span through the control and alleviation of disease symptoms, improving Quality of Life (QoL) and decreasing the burden of illness.

This paper describes preliminary results of an Investigator Initiated pilot study exploring the relationship between PRO measures (PAH-SYMPACT, EQ5D5L); Burden of Illness assessment; and the ESC/ERS Risk Stratification.

Findings

Measures of PAH risk and QoL were assessed in 42 patients presenting to the IPAH clinic for management; mean age 69.2 [range 39, 84]; females 35 (83.3%), males 7 (16.7%). Tools analysed and compared included: PAH-SYMPACT and EQ-5D-5L as PRO and QoL measures; and ESC-ERS PAH risk stratification criteria to assess mortality risk. Health utility scores were derived from existing value sets: there was a 20% median reduction in QALYs for our patient population, with detrimental effects being more marked in those patients with greater impairment of EQ-5D-5L physical and cognitive-emotional domains (respectively: r = -0.92, p<0.001; and r = -0.85, p<0.001), PAH-SYMPACT physical domain reduction (r = -0.59, p<0.01), and PAH-SYMPACT cardiovascular symptoms (r = 0.64), p<0.01) and cardiorespiratory (r = 0.64, p<0.01) involvement. Physical domain scores were highly correlated for the two PROs studied (r = 0.74, p<0.001), but an unexpected poor correlation was seen in the cognitive/emotional domain (non-significant negative correlation) which requires further exploration. Unsurprisingly, EQ-5D-5L Visual Analogue Score for well-being was inversely correlated with physical domain impairment (r = -0.59, p<0.01), although it was noted that this did not apply for the cognitive/emotional domain. The agreement between tools was variable, with highest concordance seen for assessment of the physical domain (r = 0.74, p<0.001), and this raises the need to further define the merits of disease-specific (PAH-SYMPACT) vs generic (EQ-5D-5L) PRO analytic approaches. Tools examined in this study were well-correlated with symptomatic impairment, but neither PRO tool correlated with established risk markers as characterized in compound prognostic guides such as ESC-ERS criteria.

Conclusions

The fact that PRO indices showed little correlation with established risk stratification markers implies that the information provided by PROs is not redundant, and it is yet be assessed whether the incorporation of PRO’s may add further to the precision of risk assessment, a little-studied area which this group is further exploring. There should be more widespread and uniform use of PRO measures as part of standard PAH management.
Improving cardiovascular health behaviors through a comprehensive lifestyle intervention program during the pandemic in India
Authors: Chockalingam P , Rajeswari S , Shobika J , Anantharaman R , Yusuf M M , Sengottuvelu G , Chockalingam V
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

We have witnessed a dramatic dip in adherence to cardiovascular health behaviors during the COVID-19 pandemic. Data from across the globe has shown that risk factors for cardiovascular disease (CVD) such as decreased physical activity, poor diet, and increased depression, loneliness, and stress have peaked during the pandemic. Having been badly affected by the pandemic and having had prolonged periods of countrywide lockdown, the at-risk and established CVD population has faced a major challenge in adhering to a healthy lifestyle in India.

Purpose

This study aimed to analyze the change in cardiovascular health behaviors brought about by a comprehensive lifestyle intervention program (CLIP) during the pandemic in India.

Methods

All at-risk and CVD patients who had participated in the CLIP from mid 2020 to mid 2022 and had completed the internally validated health behavior assessment questionnaire, pre and post-program, were included in this retrospective study. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the sessions online and/or in-person for the home-based and hybrid programs respectively. When a combination of online and in-person sessions were provided for a subject, it was called a hybrid program. The core components of the CLIP were exercise training, education on relevant health topics, nutritional guidance and psychosocial counseling.

Results

Age of the subjects (n=50) at enrolment was 54±13 years and 40 (80%) were male. The time between pre-program and post-program assessments was 110 (IQR 47) days. Number of at-risk and CVD patients attending home-based and hybrid programs are shown in the Figure. There were 4 couples in the study cohort; 21 (50%) of the remaining 42 subjects had at least 1 other family member attend the majority of sessions. There was a significant improvement in all the cardiovascular health behaviors, namely adequate daily intake of fruits, vegetables and whole grains, choice of heart-healthy foods between meals, sufficient weekly exercise and a reduction in self-reported chronic stress, upon completion of the CLIP (Table).

Conclusions

A comprehensive lifestyle intervention program that incorporates a multipronged approach to behavior modification is effective in improving cardiovascular health behaviors in individuals at-risk as well as with established cardiovascular disease in India. The ripple effect of behavior modification in the accompanying family members needs to be studied systematically.
Perceptions, insights, and attitudes (P.I.A.) of selected filipino female physicians on cardiovascular risks and diseases
Authors: Estepa L , De Lara A C
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

In 2012, coronary heart disease and stroke are the leading causes of death worldwide, accounting for more than 31% of deaths from all causes. In 2020, PH statistics showed that ischemic heart diseases were the leading causes of death in the Philippines (PH), responsible for 17.3% of the total deaths.

Objective

To determine the knowledge, perceptions, insights and attitudes on cardiovascular disease (CVD) prevention, personal health-related lifestyle practices, and lifestyle counseling practices of selected female physicians who are practicing or training in the PH through an online survey.

Methods

A descriptive ambispective cross-sectional study where the survey questionnaire of Ameh, et al. (2019) was modified with the authors' permission, was conducted online and answered by consenting female physicians. 484 participants’ data were collated and analyzed.

Results

Majority had accurate responses for the CVD prevention knowledge items (Figures 1 and 2). Among the participants, 36.98% had hypertension, 32% were obese, 28.5% had dyslipidemia, and 17.2% had diabetes mellitus. Sleep of 6-8 hours is practiced by 60.33%, 53.51% eat vegetables and fruits daily, 55.79% prefer fish and seafood, 89.05% do not smoke, 61.2% take coffee or black tea daily, 84.51% have no regular exercise, and 30.79% of those who do only exercise for 10-20 minutes. Moreover, 67.98% add salt, soy or fish sauce to their meals, and 72.73% do not drink enough water daily. In addition, 44.42% do not undergo annual general check-up and 58.06% do not have a personal physician. Limitations due to COVID-19 pandemic, lack of education, and expensive screening tests are perceived to be major barriers to CVD screening. More than 90% of our participants practice health teachings on diabetes mellitus prevention, high blood pressure screening, cholesterol screening and management, nutrition, and weight management. Counseling on regular exercise, smoking, and alcohol abuse are being practiced by 88.02%, 85.74%, and 83.88% of our respondents, respectively.

Conclusion

There are female physicians who are not aware of the World Health Organization’s recommendations on the prevention of CVD, who do not do health teaching and counseling, and who practice unhealthy lifestyle. Changing physicians’ knowledge and behavior towards CVD prevention is a great challenge to improve standards of CVD prevention. Improvement and enhancement in education of both physicians and patients, together with more consultation time, financing for CVD prevention, and comprehensive, multidisciplinary preventive cardiology programs supported by government and societies in favor of prevention are some of the best ways to improve management of CVD risk factors and prevention.