bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Intelligent Recommendation of Maintenance Scheme based on Multi-modal Data Learning
Authors: Li Jiaqi , Tan Chengle , Zhou Qunhao , Cheng Qing
Published: November 2023

In view of the unavoidable degradation and damage to the performance and stability of military, medical, transportation and industrial equipment in the process of daily use, especially after long-term operation or shutdown, and the maintenance personnel cannot be timely in place, an intelligent recommendation technology or program for remote maintenance of equipment based on multi-modal data learning is studied. Multi-modal data such as text, pictures and videos are integrated. Based on image recognition and learning of multi-modal data, intelligent recommendation of remote maintenance solutions can be realized when maintenance personnel cannot arrive in time.
Efficient and Lightweight Spatial Attention-Based Shallow CNNs with Superior Performance for Concrete Surface Crack Detection
Authors: Dai Dikang , Xia Peiwen
Published: November 2023

To solve the problems of high training cost and low time efficiency when detecting concrete surface crack defects, this paper proposes a concrete surface crack detection method based on shallow CNNs. First, an image dataset of concrete surface cracks is constructed and preprocessing operations are performed on the dataset. Then, a shallow CNNs model for concrete surface crack detection is constructed, hyperparameters of the network model are set, spatial attention mechanism is introduced, and the dataset is input to the model for training. Finally, the results are analyzed and evaluated, and compared with the mainstream deep learning models InceptionV3 and Resnet50. Experimental results demonstrate that our proposed method achieves a 99.56% accuracy rate for detecting cracks on concrete surfaces, while also offering higher time efficiency and lower training costs. Given the significantly higher training costs associated with mainstream deep learning models such as InceptionV3 and ResNet50, our proposed method holds promise for future applications in industrial production processes and the intelligent field of construction quality inspection. By effectively, automatically, and accurately identifying cracks on concrete surfaces, it can reduce the risk of catastrophic failures.
Overcoming Catastrophic Forgetting with Detail-Degradation Decoupling Networks for Super-Resolution
Authors: Jiang Yichun , Liu Yunqing , Zhan Weida
Published: November 2023

Super-resolution reconstruction is a crucial technology that can significantly enhance image resolution and reconstruct high-frequency details. Existing methods are fine-tuned based on the application target during their usage, which enables them to be applied to new data domains. Nevertheless, the extent to which the fine-tuned model can generalize to the original data domain remains unclear, and therefore, additional research is warranted in this particular aspect. To solve the above problems, we analyzed the forgetting phenomenon of super-resolution methods under different degradation kernels, scenarios, and modalities. Then, we introduced Detail-Degradation Decoupling Networks, which separate the inverse process of degradation and the process of recovering high-frequency details in super-resolution. During the incremental learning process, the network parameters can be adjusted based on the task’s characteristics. Our experimental results demonstrate that our approach can significantly reduce catastrophic forgetting in super-resolution reconstruction and enhance the network’s ability to generalize and remain robust.
Crop Water Requirement Prediction Method Based on EEMD-Attention-LSTM Model
Authors: Ma Yuanzheng , Lv Bing , Wang Yuanfa , Shi Changyu
Published: November 2023

Crop water demand prediction is an important part of Precision agriculture. Due to the nonlinear relationship between input variables (weather data, soil moisture, and crop type) and output variables (crop water demand), it is difficult to accurately predict crop water demand. This article proposes a method for predicting crop water demand based on the EEMD Attention LSTM model. The model combines the ensemble empirical mode decomposition (EEMD), attention mechanism (Attention), and Long short-term memory (LSTM) neural networks to capture the changes in different scales of input variables. It selectively focuses on the relevant parts of the input sequence when making predictions. The performance of the EEMD attention LSTM model was evaluated on the historical crop water demand data set and compared with other prediction models such as RNN, LSTM, and EMD-LSTM. It shows that the model is superior to other methods in terms of Mean squared error and mean absolute error. When the relationship between input variables and output variables is nonlinear, the EEMD-attention-LSTM model is a powerful tool for crop water demand prediction.
Gear Transmission System Based on Cloud Platform
Authors: Lu Daixing , He Jintao , Shen Ye
Published: November 2023

Based on the Amazon cloud platform, the development and application scenarios of industrial software for gear transmission systems are introduced. Taking the geometric dimension calculation transmission with involute cylindrical gear as an example, the design idea, development process and system architecture design of the transmission design software based on the cloud platform are expounded. Results show that the developed software of transmission system design based on the cloud platform can meet the requirements of accurate calculation, fast response and operation.
Small Target Detection Algorithm Based on Wavelet Domain Features and Weighted Sample Allocation Strategy
Authors: Tian Chunxin , Chen Xujun , Li Huxiao
Published: November 2023

Small target detection using UAV aerial photography has emerged as a popular research topic. The resolution of small target images is low and the background is complex. In this paper, utilizing a single-stage target detection algorithm ATSS as its foundation, we propose a small target network detection model SDW-Net that combines deformation convolution with wavelet domain feature enhancement by weighting the samples from both classification and regression tasks, and combining the strong local feature representation ability of discrete wavelet transform. Firstly, the original features are obtained by using discrete wavelet transform, and the weighted wavelet features are obtained through the deformable convolution block and the spatial channel attention unit; secondly, the weighted features of the regular domain are obtained through the inverse wavelet trans-form; finally, the original feature and the wavelet features are fused to enrich the details of the small target image and sent to the detection head for output. According to the experimental findings, when compared to the ATSS algorithm, the proposed detection model achieved an average increase in prediction accuracy of 7.2%, and a recall rate increase of 3.7%, and the problem of missing detection and false detection can be alleviated, which can provide a new technical solution for small-sized target detection scenarios.
Multi-modal Physiological Signal Fusion for Emotion Classification: A Multi-Head Attention Approach
Authors: Bai Xuemei , Tan Jiaqi , Hu Hanping , Zhang Chenjie , Gu Dongbing
Published: November 2023

In this essay, a model-level fusion technique of multi-modal physiological signals using Multi-Head Attention is studied. A framework that utilizes multi-model physiological signals for the task of emotion classification is proposed. First, the GCRNN model, which combines the Graph Convolutional Network (GCN) and the Long and Short Term Memory (LSTM), captures the unique features of electroencephalogram (EEG) signals. The spatial and temporal information that makes up impulses from the EEG can be captured precisely by such a technique. The CCRNN model, which combines the Convolutional Neural Network (CNN) integrated with the Channel-wise Attention and the LSTM, is used for peripheral physiological signals. The model can extract useful features from peripheral physiological signals and automatically learn to weigh the importance of various channels. Finally, Multi-head Attention is employed to fuse the output of the GCRNN and CCRNN methods. The Multi-head Attention can automatically learn the relevance and importance of different modal signals and weigh them accordingly. Emotion classification is implemented by adding a component of Softmax to map what the model produced to discrete emotion categories. The DEAP dataset was utilized in this study for experimental verification, and the results indicate that the method using multi-modal physiological signal fusion is substantially greater in precision than the technique using simply EEG signals. Additionally, the Multi-head Attention fusion method performs better than previous fusion techniques.
Multi target tracking algorithm based on anchor free detection
Authors: Zhu Xinli , Kou Tingting , Si Mingzhi , Wang Shuai
Published: November 2023

In order to alleviate the problems of frequent identity label switching caused by mutual occlusion between targets and missed detection caused by small target sizes in multi-target tracking, this paper proposes a multi-target tracking algorithm based on anchor-free detection. This algorithm first uses YOLOX for detection and embeds the ReID algorithm to enhance pedestrian recognition. Then, it uses the DeepSORT algorithm for tracking and correcting abnormal trajectory algorithms for occluded targets. Finally, experiments are conducted on both the MOT16 dataset and the self-made dataset. This algorithm has higher tracking accuracy than other algorithms, and its tracking performance for small targets has also been effectively improved.
Inter-satellite Routing Study for LEO Constellations Based on Orbit Prediction
Authors: Lei Chaowen , Wang Tao , Wang Junrui , Cheng Shiqi , Wang Zhijun
Published: November 2023

Due to the periodic motion of the LEO constellation network, finding the shortest delay path between two satellites in a dynamic network is a challenge for LEO constellations to perform inter-satellite communication. In this paper, we first use the two-body model for orbit prediction to fit the trajectories of satellites in the future period and construct the network topology of the LEO constellation in the future period. Finally, the shortest delay path algorithm based on a time aggregation graph is designed. Simulation results show that the shortest delay path algorithm designed in this paper has good performance in terms of both end-to-end delay and packet loss rate of satellite networks.
Branched microtubule nucleation and dynein transport organize RanGTP asters in Xenopus laevis egg extract
Authors: Scrofani Jacopo , Ruhnow Felix , Chew Wei-Xiang , Normanno Davide , Nedelec Francois , Surrey Thomas , Vernos Isabelle
Published: November 2023

Chromosome segregation relies on the correct assembly of a bipolar spindle. Spindle pole self-organization requires dynein-dependent microtubule (MT) transport along other MTs. However, during M-phase RanGTP triggers MT nucleation and branching generating polarized arrays with nonastral organization in which MT minus ends are linked to the sides of other MTs. This raises the question of how branched-MT nucleation and dynein-mediated transport cooperate to organize the spindle poles. Here, we used RanGTP-dependent MT aster formation in Xenopus laevis ( X. laevis) egg extract to study the interplay between these two seemingly conflicting organizing principles. Using temporally controlled perturbations of MT nucleation and dynein activity, we found that branched MTs are not static but instead dynamically redistribute over time as poles self-organize. Our experimental data together with computer simulations suggest a model where dynein together with dynactin and NuMA directly pulls and move branched MT minus ends toward other MT minus ends.
Lower Socioeconomic Status, Psychological Distress, and Self-reported Hypertension: A Longitudinal Moderated Mediation Analysis
Authors: Zhang Liying , Dailey Rhonda , Brook Robert D , Opara Ijeoma Nnodim , Liu Xianchen , Carbone Jason T , Levy Phillip D
Published: November 2023

BACKGROUND

Lower socioeconomic status (SES) has been associated with hypertension; however, the mediators and moderators of this association remain understudied. We examined the mediation effect of psychological distress on the link between lower SES and self-reported hypertension and the racial and sex moderation effects.

METHODS

We analyzed the data collected from 2009 to 2019 among adults from the Panel Study of Income Dynamics (PSID). Lower SES was defined as one of 3 indicators: education ≤12 years, unemployed, or individual annual income <$27,800. Psychological distress was assessed using the Kessler K6 scale. Cox proportional hazard regression was conducted. Mediation analyses were performed using the PROCESS macro.

RESULTS

In the sample of heads of family who did not have self-reported hypertension in 2009 (N = 6,214), the mean age was 41 years, 30.6% were female, 32.9% were African American. The cumulative incidence of self-reported hypertension was 29.8% between 2009 and 2019. Cox proportional hazard regression analysis showed that after controlling for covariates, lower SES (score > 0 vs. score = 0) was associated with self-reported hypertension (hazard ratio = 1.27, 95% confidence interval = 1.14–1.42). SES had indirect effect on self-reported hypertension through psychological distress and the indirect effect (0.02 in females, 0.01 in males, P < 0.05) was moderated by sex but not by race.

CONCLUSIONS

The association of SES and self-reported hypertension was mediated by psychological distress and sex moderated the mediation effect. Interventions focused on reducing contributors to SES and psychological stress should be considered to reduce hypertension risk.
Examining DNA breathing with pyDNA-EPBD
Authors: Kabir Anowarul , Bhattarai Manish , Rasmussen Kim Ø , Shehu Amarda , Usheva Anny , Bishop Alan R , Alexandrov Boian
Published: November 2023

Motivation

The two strands of the DNA double helix locally and spontaneously separate and recombine in living cells due to the inherent thermal DNA motion. This dynamics results in transient openings in the double helix and is referred to as “DNA breathing” or “DNA bubbles.” The propensity to form local transient openings is important in a wide range of biological processes, such as transcription, replication, and transcription factors binding. However, the modeling and computer simulation of these phenomena, have remained a challenge due to the complex interplay of numerous factors, such as, temperature, salt content, DNA sequence, hydrogen bonding, base stacking, and others.

Results

We present pyDNA-EPBD, a parallel software implementation of the Extended Peyrard-Bishop-Dauxois (EPBD) nonlinear DNA model that allows us to describe some features of DNA dynamics in detail. The pyDNA-EPBD generates genomic scale profiles of average base-pair openings, base flipping probability, DNA bubble probability, and calculations of the characteristically dynamic length indicating the number of base pairs statistically significantly affected by a single point mutation using the Markov Chain Monte Carlo algorithm.

Availability and implementation

pyDNA-EPBD is supported across most operating systems and is freely available at https://github.com/lanl/pyDNA_EPBD. Extensive documentation can be found at https://lanl.github.io/pyDNA_EPBD/.
Multilayer analysis of dynamic network reconfiguration in pediatric posttraumatic stress disorder
Authors: Suo Xueling , Lan Huan , Zuo Chao , Chen Li , Qin Kun , Li Lingjiang , Kemp Graham J , Wang Song , Gong Qiyong
Published: November 2023

Neuroimage studies have reported functional connectome abnormalities in posttraumatic stress disorder (PTSD), especially in adults. However, these studies often treated the brain as a static network, and time-variance of connectome topology in pediatric posttraumatic stress disorder remain unclear. To explore case-control differences in dynamic connectome topology, resting-state functional magnetic resonance imaging data were acquired from 24 treatment-naïve non-comorbid pediatric posttraumatic stress disorder patients and 24 demographically matched trauma-exposed non-posttraumatic stress disorder controls. A graph-theoretic analysis was applied to construct time-varying modular structure of whole-brain networks by maximizing the multilayer modularity. Network switching rate at the global, subnetwork, and nodal levels were calculated and compared between posttraumatic stress disorder and trauma-exposed non-posttraumatic stress disorder groups, and their associations with posttraumatic stress disorder symptom severity and sex interactions were explored. At the global level, individuals with posttraumatic stress disorder exhibited significantly lower network switching rates compared to trauma-exposed non-posttraumatic stress disorder controls. This difference was mainly involved in default-mode and dorsal attention subnetworks, as well as in inferior temporal and parietal brain nodes. Posttraumatic stress disorder symptom severity was negatively correlated with switching rate in the global network and default mode network. No significant differences were observed in the interaction between diagnosis and sex/age. Pediatric posttraumatic stress disorder is associated with dynamic reconfiguration of brain networks, which may provide insights into the biological basis of this disorder.
Characteristics in patients with adult-onset idiopathic peripheral pulmonary artery stenosis
Authors: Tamura Y , Tamura Y , Takemura R , Shigeta A , Hosokawa K , Taniguchi Y , Inami T , Adachi S , Tsujita I , Nakanishi N , Sato K , Sakamoto J , Tanabe N , Sugimura K
Published: November 2023

Background

Peripheral pulmonary artery stenosis (PPS) refers to the obstruction of the pulmonary artery from the pulmonary artery trunk to the peripheral arteries. Although pediatric PPS is well described, the clinical characteristics of adult-onset idiopathic PPS have not been established.

Purpose

To establish the disease profile of adult-onset PPS, we characterized the clinical background, laboratory and imaging findings, treatment, and prognosis.

Methods

The nationwide survey in Japan, supported by the government, retrospectively collected clinical data on patients with idiopathic PPS from multiple centers. This cohort comprised individuals aged 15 years and above who had pulmonary arterial stenosis confirmed through pulmonary angiography, indeed patients with chronic thromboembolic pulmonary hypertension or Takayasu arteritis were excluded. Patient backgrounds, imaging findings, treatment profiles, right heart catheterization findings, and long-term prognosis were collected. A comparison was made between the data obtained from prior-treatment and post-treatment right heart catheterization.

Results

Forty-five patients (median age at diagnosis: 38 years [Q1–Q3:28–56]; 29 males [64.4%]) with idiopathic PPS were enrolled from 21 centers. The median period between diagnosis of PPS and the final follow-up was 60 months [Q1–Q3: 24–114 months]. Eight patients (17.8%) were associated with moyamoya disease. Pulmonary angiography was performed in all patients for a definite diagnosis, and stenosis of segmental and peripheral pulmonary arteries was observed in 41 (91.1%) and 36 patients (80.0%), respectively. Thirty-six patients (80.0%) received treatment with pulmonary arterial hypertension (PAH)-specific drugs, 23 patients (51.1%) received combination therapy, and 25 patients (55.6%) received transcatheter pulmonary angioplasty. Right heart catheterization data showed improvements in both the mean pulmonary artery pressure (46 vs. 41 mmHg; p<0.001) and pulmonary vascular resistance (738 vs. 506 dyn.s.cm-5; p<0.001) from baseline to the final follow-up. The 3-, 5-, and 10-year survival rates of patients with idiopathic PPS were 97.6% (95% confidence interval [CI]:83.9–99.7), 89.7% [95% CI:69.9–96.6), and 68.6% (95% CI:43.9–84.2), respectively.

Conclusion

In this study, the patients with adult-onset idiopathic PPS presented with segmental and peripheral pulmonary artery stenosis. Although patients had severe pulmonary hypertension at baseline, they showed a favorable treatment response to the PAH-specific drugs combined with transcatheter pulmonary angioplasty.
Circulating biomarkers associated with aortic diameter in male and female thoracic aortic disease patients: a cross-sectional study
Authors: Meccanici F , Thijssen C G E , Dekker S , Bons L R , Gokalp A L , De Rijke Y B , Takkenberg J J M , Mokhles M M , Bekkers J A , Boersma E , Bouwens E , Van Den Bosch A E , Van Kimmenade R R J , Roos-Hesselink J W
Published: November 2023

Background

As thoracic aortic disease (TAD) is generally asymptomatic, biomarkers are needed to provide insight into early progression.

Purpose

We aimed to examine the association between circulating blood biomarkers and the maximal thoracic aortic diameter (TADmax).

Methods

In this cross-sectional study, consecutive adult patients with a thoracic aortic diameter ≥ 40 mm and/or genetically proven hereditary TAD (HTAD) visiting our specialized outpatient clinic between 2017-2020, were prospectively included. Venous blood sampling and computed tomography angiography and/or transthoracic echocardiography of the aorta were performed. Linear regression analyses were performed and estimates were presented as mean difference in TADmax in mm per doubling of standardized biomarker level.

Results

In total 158 patients were included (median age 61 [50.3-68.8] years, 37.3% female). HTAD diagnosis was confirmed in 36/158 (22.7%) patients. TADmax was 43.9 ± 5.2 mm in males versus 41.9 ± 5.1 in females, p=0.030. In unadjusted analysis, significant associations with TADmax were found for interleukin-6 (IL-6) (1.15 (95%CI 0.33-1.96), p=0.006), growth-differentiation factor-15 (GDF-15) (1.01 (95%CI 0.18-1.84), p=0.018), microfibrillar-associated protein 4 (MFAP4) (-0.88 (95%CI -1.71—0.05), p=0.039) and triiodothyronine (T3) (-2.00 (95%CI -3.01—0.99), p<0.001). The association fherer MFAP4 was stronger in females (p=0.020) and for homocysteine an inverse association was observed when compared to males (p=0.008). When adjusted for age, sex, hyperlipidaemia and HTAD, total cholesterol (1.10 (95%CI 0.27-1.93), p=0.010) and T3 (-1.20 (95%CI -2.14—0.25), p=0.014) were significantly associated with TADmax.

Conclusions

Circulating biomarkers indicative of inflammation, lipid metabolism and thyroid function, might be associated with thoracic aortic disease severity. Possible distinct biomarker patterns for males and females warrant further investigation.Figure 1Table 1
Worse glycemic control is associated with an impaired arterial energy transfer pattern in elderly with diabetes
Authors: Tas A , Broyd C J , Kara I , Umman S , Sezer M
Published: November 2023

Background

Worse glycaemic control is known to exacerbate endothelial insult, increasing macro- and microvascular complication risks in diabetes. Impaired intracranial haemodynamics have been frequently reported in patients with diabetes alongside with malperfusion causing structural abnormalities, and poor cognitive and cortical functionality (1-2).Assessment of the alterations in energy transfer characteristics derived from hemodynamic signals may provide novel mechanistic information about how worse glycaemic control may affect cerebrovascular perfusion. Wave reflection index(WRI) is a previously proposed measure of arterial energy transfer efficiency which reflects distal impedance mismatch(3-4).

Purpose

We aim to interrogate potential relationship between a worse glycaemic control and a less efficient arterial energy transfer, which could enhance our understanding of the cerebrovascular-cortical functional coupling on a mechanistic basis in elderly with diabetes.

Methods

Left middle cerebral artery wave intensity (WI) was computed with arterial blood pressure and flow velocity (transcranial Doppler) signal as previously described (WI = (dP/dt)*(dU/dt)) (Figure 1). Standard statistical tests were used to interrogate the relationship between glycated haemoglobin levels (HbA1c) and WI parameters.

Results

In 36 patients with diabetes mellitus type-2 (DM2) (mean age = 65.7 ± 8.8 years), backward compression wave intensity (BCWI) and wave reflection ratio (WRI= BCWI/FCWI) were significantly correlated with HbA1c levels before (rBCWI: 0.409 pBCWI:0.013; rWRI:0.345 pWRI:0.040) and after (rBCWI: 0.410 pBCWI:0.018, rWRI:0.351 pWRI:0.045) adjusting for age, sex and mean arterial pressure (Figure 2).

Conclusion(s)

In elderly patient with DM2, higher HbA1c values indicating worse glycaemic control are significantly correlated with altered cerebrovascular energy transfer characteristics as assessed by MCA wave intensity analysis. Continuous relationship between worse glycaemic control and higher wave reflection index (a measure of less efficient energy transfer in arterial system and distal impedance mismatch) may imply that the use of energy transfer related indices alongside with conventional hemodynamic indices may help providing a more comprehensive pathophysiological understanding about how cardiovascular risk factors interfere with perfusion.Computation of Wave IntensityMain Results
Comorbidity burden assessed by the charlson comorbidity index and its influence on prognosis of patients with pulmonary embolism
Authors: Keller K , Schmitt V , Espinola-Klein C , Munzel T , Konstantinides S , Hobohm L
Published: November 2023

Background

Pulmonary embolism (PE) is an acute cardiovascular syndrome and can be associated with high morbidity and mortality. Short-term outcomes of PE are closely related to right ventricular dysfunction (RVD) and the patient’s haemodynamic status as well as age and comorbidity profile. According to the current ESC guidelines for management of acute PE patients, initial risk stratification is based on clinical symptoms and signs, whereby haemodynamic instability indicates a high-risk status with substantial increase of the risk for early death. However, the vast majority of PE patients are haemodynamically stable at presentation; they require further risk stratification with clinical, imaging, and laboratory indicators of PE severity as well as the patient’s comorbidity profile and other aggravating conditions. The pulmonary embolism severity index (PESI) and the simplified pulmonary embolism severity index (sPESI) are implemented for risk stratification in the ESC guidelines. However, other tools may be more suitable for characterizing the comorbidity profile of PE patients. One established approach to evaluate the comorbidity profile is the Charlson Comorbidity Index.

Purpose

The objective of the present study is to investigate the impact of the comorbid profile on prognosis of patients with acute PE in a large nationwide inpatient sample.

Methods

We used the German nationwide inpatient sample to analyse the Charlson Comorbidity Index score of all hospitalised patients with PE in Germany 2005-2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, own calculations). The patients were categorized in the very-low severity (Charlson Comorbidity Index 0 points, mild severity (Charlson Comorbidity Index 1-2 points), moderate severity (Charlson Comorbidity Index 3-4 points) and severe severity (Charlson Comorbidity Index >4 points) and severity classes were compared.

Results

Overall, 1,373,145 hospitalizations of patients with acute PE (53.0% females, 55.9% aged ≥70years) were recorded in Germany between 2005 and 2020; they were stratified by the Charlson Comorbidity Index class. Among these, 100,156 (7.3%) were categorized as very-low, 221,545; (16.1%) as mild, 394,965 (28.8%) as moderate, and 656,479 (47.8%) as patients with a severe comorbidity burden. In-hospital case-fatality increased with the current Charlson Comorbidity Index class: 3.6% in very-low, 6.5% in mild, 12.1% in moderate and 22.1% in the severe Charlson Comorbidity Index class (P<0.001). The Charlson Comorbidity Index class was associated with increased in-hospital case-fatality (OR 2.014 [95%CI 2.000-2.027], P<0.001).

Conclusion

The results of our study may help to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case-fatality in patients with acute PE.
Dual pathway inhibitor therapy switched from dual antiplatelet therapy reduces risk of recurrent in-stent occlusion after endovascular therapy for femoropopliteal in-stent occlusion
Authors: Nakao S , Iida O , Asai M , Masuda M , Okamoto S , Ishihara T , Nanto K , Tsujimura T , Matsuda Y , Hata Y , Uematsu H , Toyoshima T , Higashino N , Kusuda M , Mano T
Published: November 2023

Background

Femoropopliteal (FP) in-stent occlusion (ISO), which increases the risk of repetition of reintervention and worsens the limb prognosis, is substantially encountered in clinical setting.1,2 Although previous study demonstrated that dual pathway inhibitor therapy (DPIT) reduced major adverse cardiovascular and limb events, whether this would be effective as anti-thrombotic therapy after endovascular therapy (EVT) for FP-ISO.3

Purpose

To investigate whether DPIT reduces a risk of recurrent ISO after EVT for FP-ISO.

Methods

We retrospectively studied 117 limbs (chronic limb-threatening ischemia: 52%, chronic total occlusion: 74%) in 110 symptomatic patients with lower extremity arterial disease (male: 55%, diabetes mellitus: 49%) due to FP-ISO between August 2012 and October 2021. We compared the clinical outcomes of patients who were switched from dual antiplatelet therapy (DAPT) to DPIT with those who continued DAPT (DPIT group: 25 limbs in 25 patients, DAPT group: 92 limbs in 85 patients) after FP-ISO revascularization. The outcome measures were recurrent ISO and bleeding complications defined as the bleeding academic research criteria (BARC) and the International Society on Thrombosis and Haemostasis (ISTH). Cox proportional hazards regression models were used to identify prognostic factor of recurrent ISO.

Results

The 1-year cumulative incidence of recurrent ISO was significantly lower in DPIT group. (24.0±9.4% vs. 54.1±5.8%, p=0.037, Figure 1). The 1-year cumulative incidence of bleeding complications were similar between two groups (BRAC 3 or 5 bleeding: 4.2% vs. 2.4%, p=0.63), ISTH major bleeding: 12.6% vs. 11.4%, p=0.86) (Figure 2). Multivariate analysis revealed that DPIT group (hazard ratio [HR]: 0.34, 95% confidential interval [CI] 0.13-0.86, P=0.004) significantly associated with a reduced risk of recurrent ISO, whereas higher age (HR: 1.05, 95%CI 1.01-1.09, P=0.006) and poor BTK run-off (HR: 4.77, 95%CI 1.76-12.91, P=0.002) were significantly associated with an increased risk.

Conclusion

Switching from DAPT to DPIT after EVT for FP-ISO reduced the risk of recurrent ISO without increasing the risk of bleeding, while higher age and poor BTK run-off increased the risk of recurrent ISO.Figure 1Figure 2
Trimethyllysine, trimethylamine N-oxide, and long-term risk of stroke: the western norway coronary angiography cohort
Authors: Bjornestad E O , Nygaard O , Svingen G F T , Pedersen E R , Sulo G , Ueland P M , Orn S , Svenningsson M M , Laaksonen R , Dhar I
Published: November 2023

Background

Trimethyllysine (TML) is a precursor of the gut-microbiota derived metabolite trimethylamine N-oxide (TMAO), and both biomarkers are associated with adverse cardiovascular outcomes. Whether circulating levels of TML or TMAO predict long-term risk of stroke is uncertain.

Purpose

To examine prospective associations of plasma TML and TMAO with long-term risk of total and ischemic stroke.

Methods

By Cox regression analyses, risk-associations were examined among 4132 patients undergoing elective coronary angiography for suspected stable coronary heart disease. Endpoints were obtained from the Cardiovascular Disease in Norway project.

Results

Median levels of TML and TMAO were 0.67 and 5.7 µmol/L, respectively. Median age was 62 years and 28.1% of the participants were female. During a median follow up of 7.4 years, 240 (5.8%) patients experienced a stroke, of which 193 were ischemic strokes. After multivariable adjustments for cardiovascular risk factors, the hazard ratios (95% confidence intervals) per 1 standard deviation increase in log-transformed plasma TML were 1.05 (0.92-1.19, p=0.49) for total stroke and 0.99 (0.86-1.15, p=0.92) for ischemic stroke. Corresponding risk estimates were 0.99 (0.86-1.13, p=0.83) and 0.95 (0.82-1.12, p=0.55) per 1 standard deviation increase in log-transformed plasma TMAO.

Conclusion

In this large prospective cohort of patients with suspected coronary heart disease, neither plasma TML nor plasma TMAO predicted long-term (∼7 years) risk of stroke.
A cluster of blood-based protein biomarkers associated with decreased cerebral blood flow relates to future cardiovascular events in patients with cardiovascular disease
Authors: Overmars M , Kuipers S , Van Es B , De Bresser J H J M , Hoefer I E , Bron E , Van Solinge W W , Kappelle L J , Van Osch M J P , Teunissen C , Biessels G J , Haitjema S
Published: November 2023

Introduction

Biological processes underlying decreased cerebral blood flow (CBF) in patients with cardiovascular disease (CVD) are largely unknown. We hypothesized that identification of protein clusters associated with lower CBF in patients with CVD may explain underlying processes.

Methods

In 428 participants (74% cardiovascular diseases; 26% reference participants) from the Heart-Brain Connection Study, CBF was measured with MRI in normal-appearing grey matter with pseudo-continuous arterial spin labeling. We assessed the relation between 92 plasma proteins from the Olink® cardiovascular III panel and CBF using cluster-based analyses and generated a Biomarker Compound Score (BCS). The BCS was related to cardiovascular risk and observed cardiovascular events within 2-year follow-up.

Results

Thirteen proteins were associated with CBF (ρSpearman range: -0.10 to -0.19, pFDR-corrected <0.05), and formed one cluster. The cluster primarily reflected extracellular matrix organization processes. The BCS was higher in patients with CVD compared to reference participants (pFDR-corrected <0.05) and was associated with cardiovascular risk (p <0.001) and cardiovascular events (OR 2.05, p <0.01).

Conclusions

We identified a cluster of plasma biomarkers related to CBF, which is related to future cardiovascular events in patients with CVD. The cluster primarily reflected extracellular matrix organization processes, which represent potential targets to preserve CBF in patients with CVD.
Discordance between quantitative coronary angiography and fractional flow reserve or intravascular ultrasound: a substudy of the FLAVOUR trial
Authors: Lee J H , Jeon H S , Lee J W , Youn Y J , Ahn S G , Kang J H , Koo B K
Published: November 2023

Background

Discrepancies between quantitative coronary angiography (QCA) and fractional flow reserve (FFR) or intravascular ultrasound (IVUS) are often observed in coronary lesions with intermediate stenosis.

Objectives

We investigated the impact of physiology- or intracoronary imaging-directed revascularization strategies on clinical outcomes in patients with discordant coronary lesions between QCA and FFR or IVUS.

Methods

This study was a post hoc analysis of the FLAVOUR study, an investigator-initiated, prospective, randomized, open-label, multinational trial performed at 18 sites in Korea and China. In the FLAVOUR study, 200 patients with ≥60% diameter stenosis (DS) deferred percutaneous coronary intervention (PCI) according to FFR > 0.8 (n=141) or a minimal lumen area > 3 mm2 or 3-4 mm2 with a plaque burden <70% on IVUS whereas 351 patients with <60% DS performed PCI according to positive FFR (n=118) or positive IVUS (n=233) results. The primary outcome was a patient-oriented composite outcome (POCO), a composite of death, myocardial infarction, or revascularization.

Results

The incidence of discordance was 28.1% in the FFR group and 32.4% in the IVUS group. At 24 months, among patients with ≥60% DS, the incidence of POCO was similar between FFR-guided and IVUS-guided deferral strategies (4.4% vs. 3.4%, p=0.757). Among patients with <60% DS, FFR-directed or IVUS-directed PCI did not differ in the POCO incidence (5.2% vs. 2.6%, p=0.207). However, FFR-guided PCI showed a higher incidence of periprocedural myocardial infarction than IVUS-guided PCI in <60% DS lesions (2.6% vs. 0.0%, p=0.014).

Conclusions

In patients with discordant intermediate stenosis between QCA and FFR or IVUS, physiology- and imaging-directed revascularization strategies are comparable concerning POCO at 24 months.
Predictors of optical coherence tomography-defined calcified nodules in patients with acute coronary syndrome: a substudy from TACTICS registry
Authors: Sugiyama T , Kakuta T , Hada M , Hoshino M , Yonetsu T , Kimura S , Mizukami T , Yamamoto M H , Kondo S , Wakabayashi K , Suwa S , Kobayashi N , Higuma T , Mori H , Shinke T
Published: November 2023

Background

We investigated the clinical predictors of optical coherence tomography (OCT)-defined calcified nodules (CN) in patients with acute coronary syndrome in a prospective multicenter registry.

Methods

We investigated 695 patients enrolled in TACTICS registry who underwent OCT assessment of the culprit lesion during primary percutaneous coronary intervention. OCT-CN was defined as eruptive calcific nodules into the lumen with disruption of the fibrous cap and an underlying calcified plate. Patient characteristics were compared between patients with and without OCT-CN.

Results

OCT-CN was detected in 28 patients (4.0%). Patients with OCT-CN were older (75.0 ± 11.3 vs. 65.7 ± 12.7 years, p < 0.001) and had a higher prevalence of diabetes mellitus (50.0% vs. 29.4%, p = 0.034), hemodialysis (21.4% vs. 1.6%, p < 0.001) and heart failure (Killip 3/4, 21.4% vs. 5.7%, p = 0.003) than patients without OCT-CN. The angiographic SYNTAX score was higher in patients with OCT-CN than those without (median, 15 [interquartile range, 11, 25] vs. 11 [7, 19], p = 0.003). Multivariable analysis demonstrated that age (odds ratio [OR], 1.072; 95% confidence interval [CI], 1.033–1.116; p < 0.001), Killip class 3/4 (OR, 4.466; 95% CI, 1.472–11.943; p = 0.004) and hemodialysis (OR, 16.571; 95% CI, 4.946–52.863; p < 0.001) were significantly associated with the presence of OCT-CN. In non-dialysis patients (n=678), age (OR, 1.081; 95% CI, 1.035–1.135; p < 0.001), Killip class 3/4 (OR, 4.414; 95% CI, 1.327–12.709; p = 0.009) and diabetes mellitus (OR, 3.046; 95% CI, 1.251–7.594; p = 0.014) were significantly associated with the presence of OCT-CN.

Conclusions

TACTICS registry demonstrated the clinical predictors of OCT-CN, which may be associated with worse prognosis.
The effect of ventricular microvascular dysfunction on cardiomyocyte excitation-contraction coupling and mitochondria
Authors: Boegner M , Huettemeister J , Weiss J , Schallopp L , Falk V , Schoenrath F , Just I A , Stawowy P , Hohendanner F
Published: November 2023

Introduction

Microvascular dysfunction is a hallmark feature of cardiac allograft vasculopathy in HTx patients and associated with heart failure and coronary artery disease. On a cellular level, impaired mitochondrial respiration has been associated with the disease, however the exact mechanisms remain elusive.

Objective

The aim of this study was to determine the effect of microvascular dysfunction on functional and structural properties of cardiomyocytes isolated from ventricular biopsies of HTx patients.

Methods

We functionally assessed coronary artery microvasculature using guidewire based coronary flow reserve(CFR)/microvasculatory resistance (IMR) measurements (Abbott) in 13 post-HTx patients with angiographically normal coronary arteries or normal FFR. Ventricular (RV septum) myocardial biopsies were obtained for in-vitro measurements and single ventricular cardiomyocytes were isolated using enzymatic digestion. Cells were electrically stimulated (1 Hz) and subcellular Ca2+ signalling during excitation-contraction coupling was measured using confocal imaging (Fluo-4 AM). In a subset of cardiomyocytes mitochondrial density was quantified upon staining with Mitotracker Red FM (otsu thresholding).

Results

Microvascular dysfunction (MVD) measured by IMR was present in 6 of 13 patients with a mean IMR of 56±11 and 13±3 in MVD and CTRL, respectively. CFR did not differ between MVD and CTRL. Ca2+ transients during excitation-contraction coupling in isolated ventricular cardiomyocytes from a subset of patients showed unaltered amplitudes (1.2±0.01 vs. 1.3±0.05; a.u. F/F0). In addition, Ca2+ release (i.e. time to peak Ca2+) and Ca2+ removal (i.e. tau) were not significantly different between MVD and CTRL. However, mitochondrial density was significantly increased in MVD vs. CTRL, indicating subcellular changes associated with MVD.

Conclusion

In-vivo ventricular microvascular dysfunction is associated with preserved excitation-contraction coupling in-vitro, potentially owing to compensatory changes on the mitochondrial level.
Microvascular Resistance Reserve assessed by bolus and continuous thermodilution
Authors: Gallinoro E , Bertolone D T , Belmonte M , Paolisso P , Mizukami T , Bermpeis K , Storozhenko T , Esposito G , Sakai K , Munhoz D , Seki R , Ohashi H , Sonck J , Collet C , De Bruyne B
Published: November 2023

Aim

The main limitation of Coronary flow reserve (CFR) as an index to assess coronary microvascular function, is that it is influenced by epicardial resistance. Microvascular Resistance Reserve (MRR) has been recently introduced as a metric that is truly specific for the coronary microcirculation. MRR can, in principle, be derived from any tool that measure flow and pressure. The aim of the present study was to compare CFR and MRR as derived by bolus (CFRbolus and MRRbolus, respectively) and continuous thermodilution (CFRcont and MRRcont, respectively).

Methods and Results

A total of 175 patients were studied. Bolus and continuous thermodilution measurements were performed in the LAD in all patients. The MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressures. Coefficient of variation was calculated to assess the precision of both methods. Mean CFRbolus was higher than the corresponding value of CFRcont (3.47±1.42 and 2.67±0.81, respectively, p<0.001, mean bias 0.80). Also mean MRRbolus was higher than the corresponding value of MRRcont (4.40±1.99 vs 3.22±1.02, respectively p<0.001, mean bias 1.2) The correlation between CFR and MRR values obtained by both approaches was weak (R= 0.28 (0.14 to 0.41) for CFR; R=0.26 (0.16 to 0.39) for MRR; p<0.001 for both). Continuous thermodilution had a smaller dispersion of data for both CFR (CoV= 30.2% vs 46.6% respectively, p<0.001) and MRR (CoV= 31.7 % vs 45.2% vs, respectively, p<0.001).

Conclusion

Bolus thermodilution significantly overestimates continuous thermodilution-derived CFR and MRR and shows a larger scatter of the data. Therefore, bolus thermodilution seems a less appropriate method to assess microvascular function than is continuous thermodilution.
Two-year outcomes of drug-coated balloon only strategy for de novo lesions in large coronary vessels
Authors: Bando R , Wakatsuki T , Yamaguchi K , Kawabata Y , Takahashi T , Saijo Y , Kadota M , Matsuura T , Ise T , Kusunose K , Yagi S , Yamada H , Soeki T , Akaike M , Sata M
Published: November 2023

Background

Drug-coated balloons (DCB) are effective for the treatment of in-stent restenosis and de novo lesions in small coronary vessels (reference vessel diameter: RVD < 3.0 mm). Recently, several studies have reported acceptable results of DCB for de novo lesions in large coronary vessels (RVD ≧ 3.0 mm). However, previous studies were limited, we investigated the clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels.

Methods

We retrospectively analyzed 97 patients with 107 de novo lesions (RVD ≧ 3.0 mm) who underwent DCB only angioplasty from January 2016 to December 2021. We scheduled angiographic follow-up at 6 months after procedure and analyzed quantitative coronary angiography (QCA) data.

Results

The mean duration of follow-up was 737.8 ± 512.6 days. Patients who met the high bleeding risk (HBR) criteria was 56 (57.7%). Procedure success rate was 97.2% (3 lesions needed bailout drug eluting stent implantation) and acute coronary occlusion was not observed. The 2-year cumulative incidences of all-cause death was 7.1%, cardiac death was 1.6%. Target vessel revascularization was 9.2%, target lesion revascularization was 4.2%, respectively. Two patients had major bleeding events (BARC type 3 or 5) within 3 months after treatment and during the DAPT period. No major bleeding events were observed during the SAPT period.

Conclusion

The clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels were safe and acceptable. Especially in HBR patients, DCB only strategy could be an alternative treatment option.
Drug coated balloon treatment with or without long inflation time in patients undergoing percutaneous coronary intervention: a propensity score matching analysis
Authors: Fujiwara Y , Ueda H , Nishida Y , Maenaka M , Yoshimura K , Oshida Y , Natsuyama K , Matsuhisa S , Yoshida N , Yoshitani H , Yamaguti K , Kuga Y , Ueda K , Nishida Y
Published: November 2023

Aim

Although drug coated balloon (DCB) treatment for coronary de novo or in-stent restenosis lesions is a widespread strategy, consensus is lacking regarding appropriate DCB inflation time during percutaneous coronary intervention (PCI). We sought to evaluate the effect of long inflation time of DCB on procedural results and clinical outcomes after PCI.

Methods

Between January 2019 and August 2020, 314 consecutive patients with 445 lesions underwent intravascular imaging-guided PCI with paclitaxel DCB using different inflation time. In the entire cohort, the median follow-up duration was 966 days. We classified patients into DCB inflation time of ≥180 sec (prolonged group, n = 101) or <180 sec (standard group, n = 212). The primary clinical endpoint was a composite of death, myocardial infarction (MI), stroke, and target lesion revascularization. One-to-one propensity score matching was performed for potential bias. A total of 92 pairs were matched.

Results

In the matched population, the median age was 73 years, 82.1% was male, and 35.8% was treated for in-stent restenosis. The median duration of DCB inflation was 300 sec in the prolonged group and 60 sec in the standard group during PCI. After PCI, angiographic acute lumen gain was similar between the groups, but diameter stenosis was smaller in the prolonged group than in the standard group (30.0% vs. 33.5%, p = 0.042). Intravascular ultrasound (IVUS) analysis revealed that the prolonged group resulted in smaller plaque burden at the MLA (61.9% vs. 66.7%, p = 0.002), smaller area stenosis (66.6% vs. 69.4%, p = 0.044), and less mean increase in percent atheroma volume (-11.2 ± 7.1% vs. -7.4 ± 5.9%, p = 0.004). The rate of the primary clinical endpoint was lower in the prolonged group compared with the standard group (log-rank p = 0.025). The rate of IVUS dissection and hematoma and the incidence of periprocedural MI were not different among the 2 groups.

Conclusions

Despite comparable acute lumen gain, long DCB inflation time was associated with favorable angiographic and IVUS results and reduced adverse events compared with standard DCB treatment in patients with coronary artery disease.