bluuebunny/crossref_metadata_2025 huggingface dataset:
The shortcomings of quality evaluation of postgraduate training under the orientation of “five only” and its countermeasures
Authors: Liu Quanhong , Nie Yu
Published: May 2023

This paper analyzes the causes and the current situation of the traditional education evaluation in China based on the goal of breaking the “five only”, and discusses its drawbacks in terms of distorting the real level of scholars, hindering the diversified innovation of schools, driving the academic style and merit, and harming the national education development. Finally, the paper proposes countermeasures to break the “five only” reform in terms of establishing a new style of education, improving result evaluation, strengthening process evaluation, exploring value-added evaluation, and improving comprehensive evaluation. The paper may be useful to promote the reform of postgraduate training quality evaluation and improve the institutional mechanism of moral education.
Duplicate Left-Sided Vagus Nerve: Intraoperative Imaging, Management, and Placement
Authors: Zacharewski Nicholas , Killory Brendan D.
Published: May 2023

Introduction Duplicate cranial nerves are fundamentally rare anatomical variants. Few case reports have documented cranial nerve duplication. One previous case report has reported a vagus nerve with a smaller secondary accessory nerve component. We present the first reported case of duplicate vagus nerves identical in size and thickness with otolaryngological diagnostic confirmation.

Case Description A 25-year-old woman with seizures refractory to medical management decided to undergo placement of a vagus nerve stimulator. During carotid sheath microdissection, two parallel nerve tracts were identified. The two nerves were identical in size and width. Proximal dissection confirmed that the two nerves were independent of one another and neither was a branching segment. To confirm duplicate vagus nerves, otolaryngology was consulted intraoperatively and the duplicate nerves were verified. The vagus nerve stimulator was placed in typical fashion around the medial nerve.

Conclusion This is the first reported case of duplicate vagus nerves identical in size and with confirmation by otolaryngology. The authors would like to highlight the operative management of the vagus nerve stimulator placement as well as integrity of the diagnostic conclusions based on size, further dissection, and specialist consultation.
Patent Ductus Arteriosus Response to Treatment by Course and Associations with Perinatal and Clinical Factors
Authors: Rutledge Austin D. , Wahlquist Amy E. , Patel Ekta U. , Hlavacek Anthony M. , Ryan Rita M. , Steflik Heidi J.
Published: May 2023

Objective The objective of this study is to examine patent ductus arteriosus (PDA) response by treatment course and investigate associations with postmenstrual age (PMA), chronological age (CA), gestational age (GA), antenatal steroid exposure (ANS), birthweight (BW), weight at treatment initiation (WT), and PDA/left pulmonary artery (LPA) ratio.

Study Design This is a single-center retrospective cohort study of preterm infants less than 37 weeks' GA born January 1, 2016 to December 31, 2018 who received acetaminophen and/or indomethacin for PDA treatment. Cox proportional hazards regression models were used to determine whether factors of interest were associated with PDA response to medical treatment.

Results In total, 289 treatment courses were administered to 132 infants. Thirty-one (23%) infants experienced treatment-associated PDA closure. Ninety-four (71%) infants had evidence of PDA constriction following any treatment course. Ultimately, 84 (64%) infants experienced definitive PDA closure. For each 7-day increase in CA at the time of treatment initiation, the PDA was 59% less likely to close (p = 0.04) and 42% less likely to respond (i.e., constrict or close) to treatment (p < 0.01). PDA/LPA ratio was associated with treatment-associated PDA closure (p = 0.01). For every 0.1 increase in the PDA/LPA ratio, the PDA was 19% less likely to close in response to treatment.

Conclusion In this cohort, PDA closure is independent of PMA, GA, ANS, BW, and WT; however, CA at treatment initiation predicted both treatment-associated PDA closure and PDA response (i.e., constriction or closure), and PDA/LPA ratio was associated with treatment-associated closure. Most infants experienced PDA constriction rather than closure, despite receiving up to four treatment courses.

Key Points
A selectivity filter in the ER membrane protein complex limits protein misinsertion at the ER
Authors: Pleiner Tino , Hazu Masami , Pinton Tomaleri Giovani , Nguyen Vy N. , Januszyk Kurt , Voorhees Rebecca M.
Published: May 2023

Tail-anchored (TA) proteins play essential roles in mammalian cells, and their accurate localization is critical for proteostasis. Biophysical similarities lead to mistargeting of mitochondrial TA proteins to the ER, where they are delivered to the insertase, the ER membrane protein complex (EMC). Leveraging an improved structural model of the human EMC, we used mutagenesis and site-specific crosslinking to map the path of a TA protein from its cytosolic capture by methionine-rich loops to its membrane insertion through a hydrophilic vestibule. Positively charged residues at the entrance to the vestibule function as a selectivity filter that uses charge-repulsion to reject mitochondrial TA proteins. Similarly, this selectivity filter retains the positively charged soluble domains of multipass substrates in the cytosol, thereby ensuring they adopt the correct topology and enforcing the “positive-inside” rule. Substrate discrimination by the EMC provides a biochemical explanation for one role of charge in TA protein sorting and protects compartment integrity by limiting protein misinsertion.
A full-time deep learning-based alert approach for bridge–ship collision using visible spectrum and thermal infrared cameras
Authors: Gu Siyang , Zhang Xin , Zhang Jian
Published: May 2023

With the rapid development of transportation infrastructure and the growing water transportation industry, many bridges have been constructed across navigable rivers. However, collisions between ships and bridges remain a frequent occurrence, particularly under low illumination conditions. To address this issue, this paper proposes a full-time bridge–ship collision alert approach based on the combination of visible spectrum and infrared cameras. This approach includes the following steps: (1) capturing and identifying ships in the channel using a single visible spectrum camera is challenging in low illumination environments such as nighttime. To overcome this limitation, we propose the use of infrared thermal imaging technology, which can monitor ships at night due to their inherent emissivity of ship thermal radiation. By comprehensively analyzing factors such as the real-time lighting environment and comparing the advantages of visible spectrum cameras and thermal infrared cameras in object recognition under various illuminance levels, we determine the effectiveness of the decision-making method of the dual-channel camera for ships under different illumination conditions. (2) To detect and track ships in the channel, a deep learning-based automatic detection and tracking method is designed using visible spectrum and infrared thermal imaging cameras, providing early warning of dangerous trajectories of ships that threaten the piers. To address the real-time identification and positioning of ships by dual-channel cameras in different light environments, we adopt a target detection network and a displacement calculation algorithm for multi-target tracking. Analysis results demonstrate that this method can automatically assign visible spectrum and thermal imaging cameras as effective input sources in different illumination environments to detect and warn ships with dangerous trajectories, contributing to the safety of navigable ships and bridges in low illumination conditions.
A latch-based sense amplifier with improved performance for single ended SRAM application
Authors: Rawat Bhawna , Mittal Poornima
Published: May 2023

The growing processing load and decreasing technology node has augmented the need for single ended memory. Consequently, generating requirement for a single ended sense amplifier for ease of integration with single ended memory. Therefore, this paper presents a single bitline based latch type sense amplifier. It is designed at feature size of 32 nm and its performance is evaluated at 1 V supply, with the environment temperature at 27 °C. It is analyzed for its output waveform, delay, variability tolerance, and area occupancy. The ON current for the proposed sense amplifier is 1.2 uA, while the OFF current is 10 nA. The ON current for proposed sense amplifier is 0.18, 0.43, and 0.88 times higher than SA-2, SA-5, and SA-6 respectively. While, its OFF current is lowest with the exception of SA-3 at 9 nA. Also, the delay for the proposed sense amplifier is minimal at 0.77 ns in comparison to other topologies. The SA-1, SA-2, SA-5, and SA-6 are 3.9, 2.8, 3.7, and 0.3 times slower than SA-P, thereby deeming its operation faster than others. The reliability for the proposed circuit is evaluated using process corner analysis for all performance parameters.
Parametric study for modified couple stress theory on postbuckling of size-dependent FG saturated porous mindlin microplates
Authors: Rezaei Masoud , Khorshidvand Ahmad Reza , Khorsandijou S Mahdi , Jabbari Mohsen
Published: May 2023

Using modified couple stress and Mindlin plate theory, the present study is a parametric study for revealing the effect of length scale parameter on postbuckling of saturated poroelastic rectangular microplates with pore distribution being functionally graded across thickness. The microplate postbuckling is a nonlinear eigenvalue problem with coupled partial differential equations of equilibrium. In order to find the mode shapes, the eigenfunctions have been approximated by some complete polynomial series expansions in accordance with the conventional Ritz approximation technique. After discretizing the governing equations throughout the microplate grid points, the assembled difference equations construct a nonlinear eigenvalue problem with coupled algebraic equations. The nontrivial coefficients of the expansions were calculated such that the eigenfunctions extremize the microplate potential energy for satisfying the equilibrium homogeneous equations. Variation of the potential energy have been derived with respect to the expansions coefficients from the vantage of using Maple software. By gradual reduction in the initial end shortening of the movable supports and solving the assembled difference equations via Newton-Raphson iterations, the critical postbuckling displacement imposed to the movable supports are found along with the nontrivial coefficients regarding eigenfunctions. The results of the parametric study have revealed how geometric parameters, pore distribution, the Skempton’s coefficient, porosity, and different Supports modify the influence of length scale parameter on the microplate postbuckling.
Transformation protocols of pure-coherent states under incoherent operation
Authors: Li Ping , Li Yongming
Published: May 2023

It is well known that the majorization condition is the necessary and sufficient for the deterministic transformations of pure-coherent states under incoherent operation (IO). In this paper, we present the protocol 1 (product-form) which provides a method for the pure-coherent transformation under IO and overcomes the restriction of the number of Kraus operators of Protocol I (Torun and Yildiz 2018 Phys. Rev. A 97 052331). Then, we show that the corresponding uncorrelated-catalytic protocol (discarding the catalytic state) is not incoherent-preserving. We construct the protocol 2 such that the uncorrelated-catalytic transformation with four-dimensional catalyst state can be implemented probabilistically under dephasing-covariant IO. Especially, the protocol 2 provides the target state from the catalyst-assisted transformation and its equivalent states with respect to Pauli operators

X
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Z

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Using analytically-corrected semiclassical rescattering model to study Coulomb impact in spiderlike photoelectron momentum distributions
Authors: Fu Guoyue , Zhang Guizhong , Zhang Shenghua , Shi Wei , Yao Jianquan
Published: May 2023

We present a numerical investigation on the impact of the Coulomb interaction in the spiderlike photoelectron momentum distributions (PMDs) of a hydrogen atom ionized by an intense laser pulse. We have shown, by integrating analytical correction terms into the standard semiclassical rescattering model (SRM) to formulate the Coulomb analytically-corrected SRM (AC-SRM), that the interference fringes manifest a systematic shift along the transverse momentum direction upon considering the Coulomb action. A Coulomb correction to the SRM model has rarely been reported before. Analyses are made by varying physical quantities such as the carrier frequency and initial transverse velocity of the ionized electron. In particular, we decipher the impact of the Coulomb interaction with the classical-action phase map scheme, and demonstrate that this effect is more pronounced for smaller momenta in the spiderlike PMDs. It is proven that the presented AC-SRM is simple and effective in accounting for the Coulomb effect, as an alternative correction due to the Coulomb interaction to the standard SRM theory. Also, our phase map scheme is shown to be more powerful than the plain interference fringes in interrogating the Coulomb effect, especially for the first interference minimum. We anticipate that the present AC-SRM can be useful in investigating other strong field processes where the Coulomb interaction is considered.
Effect of laser pulse energy on atomic lines and molecular bands in femtosecond LIBS of aluminum
Authors: Zhang Yong , Wang Qiuyun , Chen Anmin , Gao Xun
Published: May 2023

This study explored the characteristics of atomic and molecular emissions in Al plasmas generated by femtosecond lasers. The influence of laser pulse energy on Al atoms and AlO molecules time-integrated spectra was examined. As laser pulse energy increased, the intensity of Al atoms increased, while the emission of AlO molecules first increased and then remained unchanged. Secondly, the vibration temperature of AlO was determined and found to result in strong emission at a low temperature. Finally, the influence of laser pulse energy on the time-resolved spectra of Al atom and AlO molecule was explored, finding consistency with the time-integrated emission. These results indicate that the Al atom and AlO molecule have different sensitivities to femtosecond laser pulse energy. This research enriches our knowledge of femtosecond laser-plasma interactions and has potential applications in material processing and spectroscopic analysis.
Efficient method to calculate the eigenvalues of the Zakharov–Shabat system
Authors: Cui 崔 Shikun 世坤 , Wang 王 Zhen 振
Published: May 2023

A numerical method is proposed to calculate the eigenvalues of the Zakharov–Shabat system based on Chebyshev polynomials. A mapping in the form of tanh(ax) is constructed according to the asymptotic of the potential function for the Zakharov–Shabat eigenvalue problem. The mapping can distribute Chebyshev nodes very well considering the gradient for the potential function. Using Chebyshev polynomials, tanh(ax) mapping, and Chebyshev nodes, the Zakharov–Shabat eigenvalue problem is transformed into a matrix eigenvalue problem. This method has good convergence for the Satsuma–Yajima potential and the convergence rate is faster than the Fourier collocation method. This method is not only suitable for simple potential functions but also converges quickly for a complex Y-shape potential. It can also be further extended to other linear eigenvalue problems.
Performance of the wavelength-shifting fiber upgrade for the Mu2e cosmic-ray veto detector
Authors: Coveyou D. , Dukes E.C. , Group R.C. , Oksuzian Y. , Roberts S. , Solt M.
Published: May 2023

The Cosmic-Ray Veto detector for the muon-to-electron conversion experiment at Fermilab consists of four plastic scintillating counter layers read out by silicon photo-multipliers through embedded wavelength-shifting fibers. In order to increase the light yield in the most critical regions of the Cosmic-Ray Veto detector for improved background rejection, a 1.8 mm diameter fiber is being used in many of the detector's critical modules instead of the previously planned 1.4 mm diameter fiber. This paper reports the testing procedure and light properties of thirty-four 1.8 mm fiber spools, with measurements performed using a custom-built scanner. We compare these new results with previously published data from the 1.4 mm diameter fiber used for regions of the cosmic-ray veto where the increased light yield is not required. In addition, measurements of fiber aging were performed.
The top 10 research priorities for the treatment of bullous pemphigoid, mucous membrane pemphigoid and pemphigus vulgaris in the UK: results of a James Lind Alliance Priority Setting Partnership
Authors: Harman Karen E , Barha Jag , Chalmers Jo R , Dart John K G , Davies Isobel , Ellis Patricia  , Grindlay Douglas , Hampton Philip J , Hill Sharleen , Hockey Sharon , Lloyd-Lavery Antonia , McPhee Maggie , Murphy Ruth , Rauz Saaeha , Setterfield Jane F , Thompson Ingrid , Westmoreland Melanie , Waistell Christina
Published: May 2023

To identify priorities for future research into the treatment of bullous pemphigoid, mucous membrane pemphigoid and pemphigus vulgaris, we conducted a Priority Setting Partnership (PSP) using James Lind Alliance methodology. The top 10 priorities identified in this PSP represent the key questions that patients, carers and healthcare professionals have about the treatment of these diseases and which future research will hopefully address.
Research priorities in the management of hidradenitis suppurativa
Authors: Leighton Paul , Howells Laura , Bates Janine , Gibbons Angela , Cannings-John Rebecca , Collier Fiona , Evans Judith , Harris Ceri , Hood Kerry , Howes Rachel , Riaz Muhammad , Rodrigues Jeremy , Stanton Helen , Thomas-Jones Emma , Thomas Kim , Ingram John R
Published: May 2023

There is a need for high-quality research to support the management of hidradenitis suppurativa. This letter offers suggestions for priority research topics derived from a stakeholder consensus meeting. Investigation of laser hair removal treatment, potentially in combination with medical treatment, was recognized as an important focus for future hidradenitis suppurativa research.
A-296 IMPACT OF EN BLOC EXTENDED R0 RESECTION ON ONCOLOGIC OUTCOME OF STAGE III ADRENOCORTICAL CARCINOMA
Authors: Procopio P , Pennestrì F , Voloudakis N , Palmieri L , Gallucci P , Bellantone R D A , De Crea C , Raffaelli M
Published: May 2023

Background

In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III – S-III) R0 surgery, involving en bloc extended resection, is the only potential curative treatment. We evaluated oncologic outcome and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II).

Methods

Among 931 adrenalectomies over 25 years (1997–2022) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV patients.

Results

Forty-one patients were identified: 6 S-I patients (14.6%), 30 S-II (73.2%) and 5 S-III (12.2%). The latter underwent extended en bloc resection (1 partial and 2 radical nephrectomies, 1 right hepatectomy and 1 renal vein thrombectomy). Minor complications (Clavien-Dindo ≤ 2) were observed in 11.5% of S-I/II patients and 20% of S-III (p=NS). Adjuvant treatments included: mitotane (all but 1 S-I patients), chemotherapy (2 S-II and 1 S-III) and radiotherapy (3 S-II). Four S-II patients (13.3%) developed locoregional recurrence (2 lodge, 1 paracaval nodes and 1 peritoneal) (median 21 months). Metastatic disease occurred in 13 (43.3%) S-II and 1 (20%) S-III patients. At a median follow-up of 108 months, all but 8 S-II patients were alive, with recurrent disease in 9 S-II (2 regional, 7 distant) and 1 S-III (lung). No difference was observed between S-I/II and S-III in terms of DFS and OS (p=NS).

Conclusion

OS and DFS of S-III ACC patients undergoing extended en bloc R0 resection were comparable to those of SII/III, without increasing postoperative morbidity. Multi-Institutional studies are necessary to validate these results.
A-240 PHEOCHROMOCYTOMATOSIS – A RARE DISEASE WITH OMINOUS PROGNOSIS
Authors: Knyazeva P , Brinkmann S , Walz M K
Published: May 2023

Background

Pheochromocytomatosis is a rare but dramatic complication of pheochromocytoma surgery. In this study, we collected and analysed our experience with the surgical treatment of cases of this rare condition.

Methods

In total 9 patients were operated on between December 2001 and August 2022 at the Kliniken Essen-Mitte due to pheochromocytomatosis. There were 5 female and 4 male patients, mean age of 58 ± 18 (range: 22 to 86). The data was prospectively collected and retrospectively analysed.

Results

All patients were initially operated on due to pheochromocytoma (2 with SDHB-Syndrome and 1 with MEN-IIa-Syndrome). In 4 cases an intraoperative tumour capsule injury during the initial surgery was described. The operation due to pheochromocytomatosis was performed minimally invasive in 8 cases, 1 patient was operated on by open approach. The mean time between the primary surgery and the pheochromocytomatosis operation was 107 ± 60 months. Operation time was 246 + 119 minutes. Follow-up data were available for 8 patients (mean follow-up time 12 years). 2 patients were cured at the time of the last follow-up. 7 patients developed recurrent disease: loco-regional recurrence in 6 cases and distant metastasis in 3 cases. 4 patients with loco-regional recurrence were reoperated within 54 ± 50 months (range 10–137 months). By the follow-up, 3 patients died.

Conclusion

Pheochromocytomatosis is a potentially lethal complication of pheochromocytoma surgery. Even if the initial pheochomocytomatosis could be managed minimally invasive, the recurrence rate is extremely high.
A-213 PROLONGED AND TAILORED FOLLOW-UP BY ENDOCRINE SURGEONS IS A PROTECTIVE FACTOR AGAINST PERSISTENT POSTOPERATIVE HYPOPARATHYROIDISM. ANALYSIS OF A SERIES OF 1965 CONSECUTIVE PATIENTS
Authors: Dughiero S , Torresan F , Armellin C , Carrillo J L , Iacobone M
Published: May 2023

Background

Postoperative hypoparathyroidism (HypoPTH) is the most common complication after total thyroidectomy (TT). Risk factors have been identified, but no data about the specialists performing follow-up have been previously reported.

Methods

The study focused on 1965 patients undergoing TT at a tertiary level academic centre. Anamnestic, surgical, pathological, biochemical and follow-up data were evaluated. HypoPTH was defined by serum concentration of PTH <10 pg/mL in the 1st and/or the 2nd post-operative day. Persistent hypoPTH was defined by hypoPTH at the end of the trial, lasting >6 months.

Results

Postoperative HypoPTH occurred in 541 patients (28%). At multivariate analysis, reduced preoperative PTH levels, association of lymph-nodal dissection, higher rate of incidentally removed parathyroids and longer duration of the surgery were independent risk factors. With a drop-out of 9% at final follow-up, hypoPTH regressed in 494 (in 6% >6 months after surgery) and persisted in 53 patients (2.7%). Patients having higher product Calcium×PTH levels at 1st post-operative day (OR 0.821; p=<0.001), or undergoing prolonged and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent hypoPTH (2.5% compared to 33% for other specialists) (OR 0.09; p=<0.001).

Conclusion

Various patients, disease and surgeon-related risk factors may predict increased postoperative HypoPTH. Prolonged and tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.
A-252 A SINGLE CENTER SERIES OF TRACHEA RESECTIONS FOR LOCALLY ADVANCED TUMOR INFILTRATION
Authors: Staubitz J , Lozan O , Fuhrmann S , Musholt T J
Published: May 2023

Background

Infiltration of the cervical-visceral axis in advanced thyroid carcinoma determines the prognosis of the patients. Complete locoregional tumour resection therefore prolongs the survival even in presence of distant metastases. Results of trachea resections performed at the University Medical Center (UMC) Mainz are presented and discussed with regard to the literature.

Methods

Patients who underwent neck surgery along with trachea resection in a time period from January 2007 to December 2022 were retrospectively included in the study. Surgical resection strategy and operation-associated complications were documented. Overall survival and post resection survival were analysed.

Results

From 2007 to 2022, at the single-center UMC Mainz 36 patients (16 female, 20 male) were treated with neck surgery with trachea resections for locally advanced carcinomas. Of these, 18 underwent trachea shaving, 15 partial trachea resection and 3 circular trachea resections. Underlying histology was papillary (16/36), follicular (8/36) and poorly differentiated (4/36) thyroid carcinoma, and 8 other diagnoses. 10 patients suffered from postoperative complications (of these, 5 patients ≥ Dindo Clavien grade 4). Tumor recurrence was registered in 5 cases, whereas 19 patients remained tumour free after the operation (tumour persistence in 12 individuals). Mean overall survival from diagnosis was 75 months, mean postoperative survival was 31 months (mean postoperative follow-up period: 31 months).

Conclusion

Trachea resections for locally advanced tumour infiltration are feasible within highly individualised treatment concepts.
A-146 TRACHEAL RECONSTRUCTION IN ADVANCED THYROID CANCER USING STENTED AORTIC MATRICES
Authors: Kuczma P , Radu D , Onorati I , Martinod E , Trésallet C
Published: May 2023

Background

Extensive airway involvement in thyroid cancer is associated with poor prognosis and constitutes one of the main causes of mortality. Airway replacement based on the implantation of stented aortic matrices emerges as a novel tool in the treatment of primary tracheobronchial malignancies and tracheal involvement in advanced thyroid cancer.

Methods

We conducted a retrospective cohort study including patients who had tracheal replacement with a stented aortic matrix for advanced thyroid cancer with (crico)-tracheal invasion at our centre. Cryopreserved aortic allografts were used for tracheal reconstruction. To prevent airway collapse, silicone stents were placed inside the grafts. The bioprostheses were covered with local muscle flaps. No immunosuppressive therapy was required.

Results

Over 5 years, 10 patients underwent tracheal replacement with stented aortic matrices. 2 patients underwent a concomitant thyroidectomy with neck dissection and 8 had thyroidectomy prior to airway replacement and presented with recurrence. A R0 resection was achieved in all patients. There were no cases of perioperative mortality. At a median follow-up of 19 months, 8 patients were alive and breathing and speaking normally. 2 patients died of causes unrelated to the graft. De novo generation of pseudocartilage was observed within the grafts.

Conclusion

Tracheal resection using stented aortic allografts is a simple and efficient technique of tracheal replacement that is becoming part of standard care at our institution. This approach allows for a R0 resection in advanced thyroid malignancies considered thus far as non-resectable.
A-207 IMPACT OF THE USE OF AUTOFLUORESCENCE FOR DETECTION OF PARATHYROID GLANDS DURING THYROIDECTOMY: A RANDOMISED CONTROLLED TRIAL
Authors: Bergenfelz A , Hermann M , Passler C , Schneider M , Muth A , Dahlberg J , Elf A-K , Heie A , Brauckhoff K , Wierzbicka P , Konturek A , Barczynski M
Published: May 2023

Background

Hypoparathyroidism is the most frequent complication to thyroid surgery. Recently techniques for auto fluorescence have been introduced in order to visualise and protect the parathyroid glands during surgery. Only a few randomised controlled trials have been reported.

Methods

A multi-center randomised controlled trial to investigate the use of FluobeamÒLX to visualise the parathyroid glands during first time surgery with total thyroidectomy compared to no use. There was no restriction in the indication for thyroid surgery. The primary endpoint was the rate parathyroid hormone (PTH) levels below the lower reference limit the day after surgery.

Results

Some 486 patients were randomised to the use of FluobeamÒLX (n=246) or controls (n=240). Mean age was 51 (s.d. 15) years and 389 (80.0 per cent) were women.

The rate of low levels of PTH on the first postoperative day was 64 (26.0 per cent) in the FluobeamÒgroup and 77 (32.1 per cent) in the control group (p=0.141). Sub-analysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18.3 per cent) patients in the FluobeamÒgroup and 31 of 92 (33.7 per cent) in the control group (p=0.021) had low levels of PTH the day after surgery.

Conclusion

The use of auto-fluorescence to detect parathyroid glands during thyroidectomy did not reduce the rate of low PTH levels at postoperative day one significantly. However, it was beneficial in sub-groups of patients.
Convergent and distinct neural structural and functional patterns of mild cognitive impairment: a multimodal meta-analysis
Authors: Yang Chengmin , Gao Xin , Liu Naici , Sun Hui , Gong Qiyong , Yao Li , Lui Su
Published: May 2023

Mild cognitive impairment (MCI) is regarded as a transitional stage between normal aging and Alzheimer’s disease. Numerous voxel-based morphometry (VBM) and resting-state fMRI (rs-fMRI) studies have provided strong evidence of abnormalities in the structure and intrinsic function of brain regions in MCI. Studies have recently begun to explore their association but have not employed systematic information in this pursuit. Herein, a multimodal meta-analysis was performed, which included 43 VBM datasets (1,247 patients and 1,352 controls) of gray matter volume (GMV) and 42 rs-fMRI datasets (1,468 patients and 1,605 controls) that combined 3 metrics: amplitude of low-frequency fluctuation, the fractional amplitude of low-frequency fluctuation, and regional homogeneity. Compared to controls, patients with MCI displayed convergent reduced regional GMV and altered intrinsic activity, mainly in the default mode network and salience network. Decreased GMV alone in ventral medial prefrontal cortex and altered intrinsic function alone in bilateral dorsal anterior cingulate/paracingulate gyri, right lingual gyrus, and cerebellum were identified, respectively. This meta-analysis investigated complex patterns of convergent and distinct brain alterations impacting different neural networks in MCI patients, which contributes to a further understanding of the pathophysiology of MCI.
Italian Association of Hospital Cardiologists practical guidance for sodium–glucose cotransporter 2 inhibitors use in patients with heart failure
Authors: Di Fusco Stefania Angela , Spinelli Antonella , Aquilani Stefano , Borrelli Nunzia , Iannopollo Gianmarco , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio
Published: May 2023

Sodium–glucose cotransporter 2 inhibitors (SGLT2-is) have recently been included among the first-line drugs for the treatment of heart failure with reduced ejection fraction. International guidelines recommend SGLT2-i use in association with neuro-hormonal modulators (renin–angiotensin blockers, beta blockers, and aldosterone antagonists). Although SGLT2-is are well tolerated, it is important to know potential side effects and conditions that may lead to an increased risk of adverse events in order to maximize clinical benefits. The aim of this Italian Association of Hospital Cardiologists document is to briefly report clinical evidence that supports SGLT2-i use in patients with heart failure and provide practical indications for clinical implementation.
C3 OUTCOME OF CARDIAC SYMPATHETIC DENERVATION IN CARDIOMYOPATHIES AND PREDICTORS OF RECURRENCES
Authors: Dusi V , Ruffinazzi M , Pugliese L , Guerrera F , Baldi E , Sanzo A , Vicentini A , Savastano S , Greco A , Camporotondo R , Vairo A , Frea S , Proclemer A , Driussi M , Massimo I , Tritto M , Trompeo A , Belliato M , Ghio S , Raineri C , Rordorf R , De Ferrari G
Published: May 2023

Background

Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). Long–term outcome and predictors of recurrences after the procedure are still poorly defined. Aim: To describe our multicenter Italian experience with CSD in CMP patients with refractory VAs.

Methods

32 patients with CMP and refractory VAs underwent either left CSD (n=4) or BCSD (n=28). All patients had a Video Assisted Thoracoscopic Surgery, in 8 cases with the robotic technique. The main reason (3/4 cases, 75%) to perform LCSD instead of BCSD was sinus bradycardia in single ICD lead recipients.

Results

84% of patients were male, mean age was 55 ± 16 yrs and mean LVEF was 32± 12%; most (n=26, 81%) had non–ischemic CMP (including 3 with hypertrophic CMP and 2 with cardiolaminopathy) and 34% were in NYHA class ≥3. Main indications for CSD were refractory polymorphic/fast VAs (>200 bpm) in 56% of pts and refractory monomorphic VAs in the rest. Except for 5 patients (15%) with previous thyrotoxicosis, the majority were either on amiodarone (n=20, 63%) or on sotalol (n=3, 9%) and 53% had previously undergone ≥1 catheter ablation for VAs. The median follow–up (FU) after CSD was 16 months (IQR 5–45 months). No major complications occurred. Eleven patients (34%) either died during FU (n=8, 25%), mostly due to end–stage heart failure, or underwent heart transplant (n=3, 9%). After CSD, the percentage of patients with ES decreased from 78% to 40% (p<0.01), while patients with appropriate ICD shocks decreased from 100% to 62%. The mean number of ICD shocks was reduced from 6 (IQR 3–16) in the 6 months before CSD to 0 (IQR 0–2) in the 6 months after (p=0.001). Overall, 69% of patients experienced a 6–months reduction in ICD shocks ≥ 75%, 81% a reduction ≥ 50%. At the univariate Kaplan Meier survival analysis, NYHA class ≥ 3 (p<0.001), VT heart rate < 180 bpm (p=0.02) and left ventricular ejection fraction (LVEF) ≤ 25% (p=0.02) were associated with ICD shock recurrences.

Conclusions

Our case series of CSD in CMP represents the largest reported in Europe and the one with the longest follow–up. The occurrence of electrical storms was almost halved by CSD, and most patients had a reduction in ICD shocks at 6 months larger than 75%. Patients with better functional class, better LVEF and faster VAs benefited more from CSD, suggesting the opportunity of an earlier referral of these patients.
C5 FUNCTIONAL MAPPING: A NEW APPROACH FOR SUBSTRATE CHARACTERIZATION IN PATIENTS AFFECTED BY ATRIAL FIBRILLATION
Authors: Gabriele P , Grossi B , Ceriotti C , Poggio L , Galimberti P , Taormina A , Battaglia V , Pagani S , Del Monaco G , Valcher S , Latini A , Gregusova N , Condorelli G , Frontera A
Published: May 2023

Background

The ongoing challenge is to generate meaningful data during electrophysiological (EP) studies, integrating the knowledge on atrial fibrillation (AF) progression gained by the EP community in the latest years. At the present time there is a lack of EP protocols and none of the most used approaches take in consideration neither the wavefront propagation nor the analysis of functional phenomena. Purpose. To investigate whether zones of delayed conduction (slow conduction, SC) or functional propagation (pivot sites, PS) may play a role in terms of maintenance of paroxysmal (PAF) and persistent (PsAF) AF.

Methods

Twenty–seven consecutive patients with PAF (14 patients) and PsAF (13 patients) have been enrolled in this study. For each patient, a sinus rhythm activation map and a paced map have been created. Abnormal conduction was defined as a delimited zone in which the propagation became suddenly slower (slow conduction zones) or changed its direction (pivot sites). At each of these sites, EGMs were collected and characterized in terms of amplitude (mV), location and fractionation.

Results

In sinus rhythm maps, a total number of 65 pivot sites and slow conduction corridors was identified. In the PAF group 22 PS and SC were found (1,6/pt), whereas those included in the PsAF one showed a significantly higher number: 43 (3,3/pt). The bipolar voltage value reported at abnormal conduction areas amounted to 1,95 ± 0,93 mV and 1,78 ± 0,54 mV for PAF and PsAF patients, respectively, showing a lower value with respect to healthy tissue areas (2,94 ± 4,81 mV). More than four deflections per signal were identified in 57/65 zones. In PsAF cases, these areas were mainly found on the posterior wall. A concordance with esophagus location occurred in the 89%. In paced maps, instead, we documented an average value of 38 PS and SC zones (1,5/pt), of which 27 in persistent patients. As for bipolar values, a lower voltage value was reported in PS and SC zones. Fractionation of EGMs was confirmed in almost all cases.

Conclusion

The main findings of this analysis are: (i) in PsAF patients the number of pivot sites is higher with respect to PAF cases; (ii) In PsAF patients, abnormal conduction phenomena are predominantly localized on the posterior wall, with a strong correlation with esophagus location; (iii) slow conduction zones and pivot sites are characterized by lower voltage amplitude and higher fractionation with respect to normal conduction areas.
C8 INSTITUTIONAL VALIDATION OF THE JOINT ANMCO AND AIOM TUSCANY CLINICAL CARDIO–ONCOLOGY PATHWAY FOR THE CARDIOLOGY MANAGEMENT OF CANCER OUTPATIENTS
Authors: Canale M , Camerini A , Bisceglia I , Orso F , Misuraca L , Carluccio M , Talini E , Sorini Dini C , Magnaghi G , Grippo G , Simonetti F , Amoroso D , Allegrini G , Bengala C , Casolo G
Published: May 2023

Background

Given the relevance and the growing complexity of the management of cardio–oncology (CO) outpatients, a common care pathway has been recently proposed by ANMCO and AIOM Tuscany. Materials and methods: The proposal: 1) defined 3 categories of patients to be entered into the pathway (A: known cardiac disease needing active oncology treatment; B: undergoing cancer treatments with potential cardiac toxicity; C: experiencing cardiac toxicity and/or worsening of cardiovascular risk profile); 2) proposed two standard request forms for oncology (ONCO) and hematology (HEM); 3) set the minimum requirements for a cardio–oncology path; 4) indicated follow–up strategies during and after oncological treatments. Given the short observation interval we focused on points 1 and 2. Medical records of all cancer patients for whom a CO examination was required were analized to check if proposed forms have been used and if cases fulfilled into appropriate categories. Observation period was retrospectively set to 1 year starting from October 2022. Minimum appropriateness threshold for each process index was set to 80%.

Results

A total of 480 requests for a CO visit were retrospectively identified, 322 out of 480 (67%) from medical oncology and 158 out of 480 (33%) from hematology units. Appropriate request form was used in 95% of cases (456 out of 480) with no difference between ONCO and HEM units. All patients but 20 (460 out of 480, 95.8%) fulfilled (at least) one of the 3 pre–defined categories with no difference between ONCO and HEM units. Categories distribution was: A group 25%, B group 60%, and C group 15%. Patients from medical oncology were more likely to belong to A and B groups while cases from hematology to B and C groups.

Conclusions

Our data indicate that minimum thresholds were met for both index 1 and 2 (with values that are approaching to 100%) so supporting the use of the proposed clinical CO pathway.
C23 ELECTROCARDIOGRAPHIC PREDICTORS OF PRIMARY VENTRICULAR FIBRILLATION DURING A FIRST ACUTE MYOCARDIAL INFARCTION
Authors: Ruffinazzi M , Baldi E , Camporotondo R , Angelini F , Peano V , Picollo C , Cerea P , Kotta M , Cipriani A , Cacciavillani L , Dossi F , Noussan P , Caputo M , Auricchio A , Crotti L , Gnecchi M , Schwartz P , De Ferrari G , Dusi V
Published: May 2023

Introduction

Few small studies evaluated electrocardiographic (ECG) predictors of ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). None accounted for the time between symptom onset and ECG.

Objectives

To evaluate the ECG predictors of primary VF in the PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) population. Patients and methods: PREDESTINATION is an ongoing, prospective, multicenter, case–control study (1:2 match for sex and age) enrolling patients aged 18–80 with a first AMI, whether complicated (cases) or not (controls) by primary VF before reperfusion. For the present analysis, we matched 1:1 for age, sex, infarct site, and symptom–ECG time, the ECGs of cases before VF and those of controls revascularized at least 60 minutes after symptom onset. ECG traces were digitized in pdf and enlarged by 400%. Three blind analyzes were performed: on the entire population, on only anterior and only non–anterior AMI.

Results

PREDESTINATION currently includes 1478 patients (mean 59 years, 83% male), 533 of whom are cases. Among the cases, only 59 (58 ± 11 years, 10% females, 64% with anterior AMI, mean symptoms–ECG time 78±60 minutes, mean ECG–VF time 23±15 minutes) had a pre–VF ECG of adequate quality. Both in the general population (118 ECGs) and in anterior AMIs subgroup (76 ECGs), the presence of ventricular (VEB) or supraventricular ectopic beats (SVEB) was associated with an increased risk of developing VF (maximum OR 8.35 for VEBs in anterior AMIs). In the subgroup of anterior AMIs, the Tpeak–Tend interval in non–infarction leads, both corrected for the RR interval (Bazett) and for the QT interval (TpTe/QT) was significantly longer in cases compared to controls. A TpTe/QT ≥0.33 in non–infarction leads was associated with an OR of 4.6 (p=0.02) of developing VF.

Conclusions

the present analysis, aimed at identifying ECG predictors of primary VF, is the first to perform a rigorous case–control matching including symptom–ECG time. In addition to ectopic beats, a well–known marker and promoter of electrical instability, we identified, only for anterior AMIs, a single additional predictor (TpTe/QT), which correlates with an increased dispersion of repolarization and consequently of ventricular refractoriness.
C24 MICROALBUMINURIA DURING ACUTE CORONARY AS LONG–TERM PROGNOSTIC FACTOR. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC–9 STUDY ON HEART DISEASE
Authors: Berton G , Cordiano R , Palmieri R , Cavuto F , Mohammed Ahmed M , Bagato F , Merotto D , Menegon F , Palatini P , Mahmoud H
Published: May 2023

Background

Microalbuminuria is one of the earliest biomarkers of kidney injury that reflects an endothelial dysfunction with increased glomerular permeability and it is independently associated with adverse outcomes in several clinical situations.

Methods

To evaluate the very long–term prognostic yield of baseline microalbuminuria in patients with acute coronary syndrome (ACS), we prospectively studied 589 ACS patients admitted to three Italian hospitals. The baseline albumin/creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24–h urine samples. Patients were followed for 24 years or until death.

Results

Virtually all patients completed the follow–up, representing 7066 person–years. During follow–up, 482(82%) had died: 38% due to non–sudden cardiac death (non–SCD), 19% sudden cardiac death (SCD), and 43% due to non–cardiac (non–CD) death. Throughout the 1st admission week, ACR was consistently higher in the patients who died during follow–up than in those who survived. Similar higher values were found for deaths from non–SCD causes. The unadjusted Cox regression analysis revealed that ACR is a significant predictor of all–cause mortality (HR:1.24; 95%CI 1.20–1.28; p<0.0001) and the 3 causes of death (HR:1.38; 95%CI 1.31–1.45; p<0.0001), (HR:1.16; 95%CI 1.07–1.25; p=0.0001) and (HR:1.17; 95%CI 1.10–1.23; p<0.0001) for non–SCD, SCD and non–CD respectively. Yet the fully adjusted model showed that ACR is a significant independent predictor of all–cause mortality (HR:1.10; 95%CI 1.08–1.14; p<0.0001) and only non–SCD (HR:1.18; 95%CI 1.12–1.25; p<0.0001). A positive interaction between ACR and the presence of heart failure during admission (HR:1.12; 95%CI 1.02–1.24; p=0.02) and a negative interaction with LVEF (HR:0.86; 95%CI 0.78–0.95; p=0.004) for all–cause death was also observed at the multivariable level.

Conclusion

This prospective study shows that baseline ACR during ACS seems to be a strong independent long–term risk predictor, chiefly associated with non–sudden cardiac death. Positive independent interaction with indicators of heart failure has been also observed.
C25 TEMPORAL TREND MORTALITY AND IN–HOSPITAL MORTALITY PREDICTORS IN AN ISCHEMIC CARDIOGENIC SHOCK POPULATION: A 10 YEARS SINGLE–CENTRE RETROSPECTIVE STUDY
Authors: Belfioretti L , Marini M , Francioni M , Battistoni I , Angelini L , Matassini M , Pongetti G , Shkoza M , Piva T , Compagnucci P , Munch C , Dello Russo A , Di Eusanio M , Perna G
Published: May 2023

Background

Cardiogenic shock (CS) after acute myocardial infarction (AMI) represents the most severe form of acute heart failure (AHF) syndromes with an high rate of in–hospital mortality. Purpose describe predictors of in–hospital mortality; evaluate ten years mortality temporal trend in our CICU; assess the feasibility of CARDSHOCK risk score; elaborate a simpler version of CARDSHOCK risk score.

Methods

All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study.

Results

We included 167 patients [males 67%; age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 mmol/L. All patients required inotropes: 71% required dopamine, 65% noradrenaline, 32% dobutamine; 32% adrenalina,17,4% received levosimendan alone. Mechanical cardiac support (MCS) was pursued in 91,1% [65% IABP, 23% Impella CP, 4% VA–ECMO]. From March 2012 to July 2021 we observed a significative temporal trend mortality reduction (p=0.0015) from 57% of first time–quartile to 29% of the fourth quartile (fig1). In addition we noted a significant increase in Impella catheter use (p=0,0005) with a consequent reduction of IABP (p=0,01), a reduction in dopamine administration (p=0,007) and a greater use of inotropic drugs with vasodilatory action (p=0,015 and p=0,001). In our population of AMI–CS patients CARDSHOCK risk score was a reliable in–hospital mortality predictor tool (p=0.00011). After the multivariate analysis only EF at baseline (p=0,009), lactate level at presentation (p=0,015) and presence of three–vessels CAD (p=0,0038) resulted to be in–hospital mortality predictors. A new prediction model composed by those three variables was created and it exhibited better predictive performance for in–hospital mortality than Cardshock risk score (AUC 0,94 vs 0,72 respectively, p=0,015) (fig2).

Conclusions

In our retrospective single–centre study a significant reduction of mortality through the years is observed, probably due to more extensive use of micro axial pumps and a greater use of inodilators drug therapies. Cardshock risk score represents a feasible tool to predict in–hospital mortality also in our sample composed only of ischemic CS patients. A new prediction model composed by three clinical variables demonstrates at least the same predictive performance but future validation in a larger population could be advisable to validate the simplified score.