bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental investigations of liquid bridge rupture between a sphere and a spherical concave
Authors: Huang Congcong , Fan Zenghua , Wang Han , Li Jiyong , Wang Lefeng , Rong Weibin
Published: May 2023

The formation and rupture of liquid bridges between solid surfaces have widespread applications in micro gripping, self-alignment, and particles wetting. The axisymmetric liquid bridge rupture between a sphere and a spherical concave is systematically investigated in this study. Detailed analysis was conducted to examine the effects of the radius ratio, liquid bridge volume, and contact angles on the rupture distance and transfer ratio. When the radius ratio is smaller than 2, it exerts a substantial impact on the rupture distance and transfer ratio. The experimental studies support the effectiveness of the simulation modeling based on a minimal energy approach. Theoretical findings of the shooting method and simulated results exhibit great agreement. The maximum absolute errors for rupture distance and transfer ratio were 0.001 and 0.0175, respectively. The simulated and theoretical results are helpful to predict the rupture distance and transfer ratio.
The study of phase transition of MoS2 regulated by H+
Authors: Wang Zhenyu , Gu Chaoqun , Jiang Sisi , Sun Tong , Wang Zonghua
Published: May 2023

The mixed-phase MoS2 (1T/2H MoS2) with heterostructure exhibited high catalytic activity. The specific ratios of 1T/2H could exhibit optimal performance in various applications. Therefore, more methods need be developed for synthesizing 1T/2H mixed-phase MoS2. Herein, a viable route was studied for the phase transition of 1T/2H MoS2 regulated by H+. Briefly, the commercially available bulk MoS2 was used to obtain 1T/2H MoS2 via chemical intercalation of Li+. Then the residual Li+ around 1T/2H MoS2 was replaced by H+ in acidic electrolytes, owing to the extremely higher charge-to-volume ratio of H+. Thus, the thermodynamically unstable 1T phase lost the protection of residual Li+ and could be re-transforming into the relatively stable 2H phase. The change of the 2H/(2H+1T) ratio was measured using novel extinction spectroscopy, which provides a rapid identification method in comparison with x-ray photoelectron spectroscopy (XPS). The experimental results revealed that the concentration of H+ influenced the phase transition velocity of MoS2. In particular, the phase transition from 1T to 2H phase in the H+ solution was faster at the beginning, and the higher the H+ concentration in an acidic solution, the faster the increase in 2H content. For an instant, the ratio of the 2H phase was increased by 7.08% in an acidic solution (CH
+ = 2.00 M) after 1 h, which was several times greater than the case in the distilled water. This finding provides a promising method to easily obtain different ratios of 1T/2H MoS2, which is beneficial for further development of catalytic performance especially in energy generation and storage.
Unbiased zero-count correction method in low-dose high-resolution photon counting detector CT
Authors: Bushe Daniel , Zhang Ran , Chen Guang-Hong , Li Ke
Published: May 2023

Objective. To address the zero-count problem in low-dose, high-spatial-resolution photon counting detector CT (PCD-CT) without introducing statistical biases or degrading spatial resolution. Approach. The classical approach to generate the sinogram projection data for estimating the line integrals of the linear attenuation coefficients of the image object is to take a log transform of detector counts, which requires zero counts to be replaced by positive numbers. Both the log transform and the zero-count replacement introduce biases. After analyzing the statistical properties of the zero-count replaced pre-log and post-log data, a formula for the statistical sinogram bias was derived, based on which a new sinogram estimator was empirically constructed to cancel the statistical biases. Dose- and object-independent free parameters in the proposed estimator were learned from simulated data, and then the estimator was applied to experimental low-dose PCD-CT data of physical phantoms for validation and generalizability testing. Both bias and noise performances of the proposed method were evaluated and compared with those of previous zero-count correction methods, including zero-weighting, zero-replacement, and adaptive filtration-based methods. The impact of these correction methods on spatial resolution was also quantified using line-pair patterns. Main Results. For all objects and reduced-dose levels, the proposed method reduces the statistical CT number biases to be within ± 10 HU, which is significantly lower than the biases given by the classical zero-count correction methods. The Bland-Altman analysis demonstrated that the proposed correction led to negligible sinogram biases at all attenuation levels, whereas the other correction methods did not. Additionally, the proposed method was found to have no discernible impact on image noise and spatial resolution. Significance. The proposed zero-count correction scheme allows the CT numbers of low-dose, high-spatial-resolution PCD-CT images to match those of standard-dose and standard-resolution PCD-CT images.
Effect of zirconium and niobium on the microstructure and mechanical properties of high-strength low-alloy cast steels
Authors: Makeshkumar M , Anburaj J , Kumar M Sasi , Santhosh A Johnson
Published: May 2023

The aim of this work is to study the effect of zirconium and niobium on the refinement of grain size and mechanical properties of micro-alloyed cast steels in heat treated conditions. Five micro-alloyed cast steels with different compositions, as steel without microalloying elements and micro-alloyed steel with (i) 0.05% Zirconium (Zr), (ii) 0.05% Zirconium (Zr) and 0.05% Niobium (Nb), (iii) 0.10% Zirconium (Zr), and (iv) 0.10% Zirconium (Zr) and 0.10% Niobium (Nb) were investigated. The heat treated samples are normalized at 1000 °C followed by air cooling and were characterized to study the characteristics of carbide precipitates by SEM and TEM and mechanical properties were evaluated by tensile test as per ASTM A370. Among these five cast steels, steel containing 0.10% Zr and 0.10% Nb showed a higher tensile strength of 1184 MPa and yield strength of 740 MPa with reasonable impact energy of 42 J compared to other steels under the same heat treated conditions. Due to the combined addition of Zr and Nb elements in the micro-alloyed steel, a remarkable improvement of mechanical properties particularly strength and impact energy was observed. As evident from microstructure investigation, these improved mechanical properties in the present steel could be attributed due to the effective refinement of ferritic grain size in the normalized condition.
Recyclable luminescent carbon dots nanopaper for flexible electronics
Authors: Abulikemu Mutalifu , Tabrizi Bita E A , Mofarah Hamed M , Shad Kimia Rezaei , Jabbour Ghassan E
Published: May 2023

The use of sustainable materials in high-tech devices is one way to decrease the carbon footprint and tackle global climate change. We first synthesized blue-emissive carbon dots (CDs) from biocompatible onion inner epidermal cells using solvothermal method. Then, cellulose nanofiber was prepared by TEMPO oxidization, followed by homogenization from soft wood source. Finally, the blue emissive CDs-cellulose nanofibers-based nanopaper was fabricated by simple roller-coating approach, and its optical and morphological properties were investigated by transmittance, photoluminescence, fourier-transform infrared (FTIR) and scanning electron microscopy techniques. The results indicate that nanopapers have a high light emission, and that their transparency may be easily adjusted by varying the proportion of CDs content. These nanopapers can be incorporated into flexible and stretchable electronics and optical sensor platforms.
Equilibrium steps for adsorption of nitrogen compounds : examining the potential of silica application as adsorbent
Authors: de Souza Wallace Carvalho , Baia Luana , Costa André Luiz Hemerly , de Oliveira Veloso Cláudia , de Figueiredo Marco Antonio Gaya , Chiaro Sandra Ximeno , Corrêa Harrison Lourenço
Published: May 2023

The hydrotreating (HDT) process currently used to reduce the sulphur content in fuels requires high energy consumption and hydrogen. Furthermore, the presence of nitrogen compounds makes them more severe. This work studies the removal of nitrogen compounds present in a sample of heavy diesel using a commercial silica sample. Adsorption tests were performed in a stirring bath to generate the equilibrium data. Three test conditions were used at temperatures of 40, 80 and 100 °C. In adsorption studies in a fixed bed, the influence of temperature and liquid hourly space velocity (LHSV) was observed . In the regeneration test of the adsorbent, adsorption was achieved at 80 °C and desorption at 60 °C. Ethanol was used as the solvent and fourteen adsorption tests and thirteen desorption tests were performed. The removal of sulphur compounds in the stirring bath tests were checked. From a comparative perspective, the silica adsorbent used showed a higher affinity to the removal of nitrogen compounds than those related to sulphur in the stirring bath tests. The recovery test showed a reduction of approximately 20% in adsorption capacity of the adsorbent treated after the adsorption cycle in relation to the fresh adsorbent. This result indicates that the silica sample can be reused.
Demographic noise in complex ecological communities
Authors: Larroya Ferran , Galla Tobias
Published: May 2023

We introduce an individual-based model of a complex ecological community with random interactions. The model contains a large number of species, each with a finite population of individuals, subject to discrete reproduction and death events. The interaction coefficients determining the rates of these events is chosen from an ensemble of random matrices, and is kept fixed in time. The set-up is such that the model reduces to the known generalised Lotka–Volterra equations with random interaction coefficients in the limit of an infinite population for each species. Demographic noise in the individual-based model means that species which would survive in the Lotka–Volterra model can become extinct. These noise-driven extinctions are the focus of the paper. We find that, for increasing complexity of interactions, ecological communities generally become less prone to extinctions induced by demographic noise. An exception are systems composed entirely of predator-prey pairs. These systems are known to be stable in deterministic Lotka–Volterra models with random interactions, but, as we show, they are nevertheless particularly vulnerable to fluctuations.
Stable categories of spherical modules and torsionfree modules
Authors: Otake Yuya
Published: May 2023

Auslander and Bridger [Stable module theory, Memoirs of the American Mathematical Society, No. 94, American Mathematical Society, Providence, R.I., 1969] introduced the notions of

n
n

-spherical modules and

n
n

-torsionfree modules. In this paper, we construct an equivalence between the stable category of

n
n

-spherical modules and the category of modules of grade at least

n
n

, and provide its Gorenstein analogue. As an application, we prove that if

R
R

is a Gorenstein local ring of Krull dimension

d
>
0

d>0

, then there exists a stable equivalence between the category of

(
d
−
1
)

(d-1)

-torsionfree

R
R

-modules and the category of

d
d

-spherical modules relative to the local cohomology functor.
Symplectic rational blow-ups on rational 4-manifolds
Authors: Park Heesang , Shin Dongsoo
Published: May 2023

We prove that if a symplectic 4-manifold

X
X

becomes a rational 4-manifold after applying rational blow-down surgery, then the symplectic 4-manifold

X
X

is originally rational. That is, a symplectic rational blow-up of a rational symplectic

4
4

-manifold is again rational. As an application we show that a degeneration of a family of smooth rational complex surfaces is a rational surface if the degeneration has at most quotient surface singularities, which generalizes slightly a classical result of Bădescu [J. Reine Angew. Math. 367 (1986), pp. 76–89] in algebraic geometry under a mild additional condition.
Signed Distance Correlation (SiDCo): an online implementation of distance correlation and partial distance correlation for data-driven network analysis
Authors: Monti Francesco , Stewart David , Surendra Anuradha , Alecu Irina , Nguyen-Tran Thao , Bennett Steffany A L , Čuperlović-Culf Miroslava
Published: May 2023

Motivation

There is a need for easily accessible implementations that measure the strength of both linear and non-linear relationships between metabolites in biological systems as an approach for data-driven network development. While multiple tools implement linear Pearson and Spearman methods, there are no such tools that assess distance correlation.

Results

We present here SIgned Distance COrrelation (SiDCo). SiDCo is a GUI platform for calculation of distance correlation in omics data, measuring linear and non-linear dependencies between variables, as well as correlation between vectors of different lengths, e.g. different sample sizes. By combining the sign of the overall trend from Pearson’s correlation with distance correlation values, we further provide a novel “signed distance correlation” of particular use in metabolomic and lipidomic analyses. Distance correlations can be selected as one-to-one or one-to-all correlations, showing relationships between each feature and all other features one at a time or in combination. Additionally, we implement “partial distance correlation,” calculated using the Gaussian Graphical model approach adapted to distance covariance. Our platform provides an easy-to-use software implementation that can be applied to the investigation of any dataset.

Availability and implementation

The SiDCo software application is freely available at https://complimet.ca/sidco. Supplementary help pages are provided at https://complimet.ca/sidco. Supplementary Material shows an example of an application of SiDCo in metabolomics.
Reflections on the Brain Conference 2023
Authors: Simzer Elizabeth
Published: May 2023

Our acting Scientific Editor, Elizabeth Simzer, highlights a session from the third annual Brain Conference held on 16 March 2023.
Ginseng mediates its anticancer activity by inhibiting the expression of DNMTs and reactivating methylation-silenced genes in colorectal cancer
Authors: Okuno Keisuke , Pratama Muhammad Yogi , Li Jiang , Tokunaga Masanori , Wang Xin , Kinugasa Yusuke , Goel Ajay
Published: May 2023

Developing safe and effective therapeutic modalities remains a critical challenge for improving the prognosis of patients with colorectal cancer (CRC). In this regard, targeting epigenetic regulation in cancers has recently emerged as a promising therapeutic approach. Since several natural compounds have recently been shown to be important epigenetic modulators, we hypothesized that Ginseng might exert its anticancer activity by regulating DNA methylation alterations in CRC. In this study, a series of cell culture studies were conducted, followed by their interrogation in patient-derived 3D organoid models to evaluate Ginseng’s anticancer activity in CRC. Genome-wide methylation alterations were interrogated by undertaking MethylationEpic BeadChip microarrays. First, 50% inhibitory concentrations (IC50) were determined by cell viability assays, and subsequent Ginseng treatment demonstrated a significant anticancer effect on clonogenicity and cellular migration in CRC cells. Treatment with Ginseng potentiated cellular apoptosis through regulation of apoptosis-related genes in CRC cells. Furthermore, Ginseng treatment downregulated the expression of DNA methyltransferases (DNMTs) and decreased the global DNA methylation levels in CRC cells. The genome-wide methylation profiling identified Ginseng-induced hypomethylation of transcriptionally silenced tumor suppressor genes. Finally, cell culture-based findings were successfully validated in patient-derived 3D organoids. In conclusion, we demonstrate that Ginseng exerts its antitumorigenic potential by regulating cellular apoptosis via the downregulation of DNMTs and reversing the methylation status of transcriptionally silenced genes in CRC.
Accelerated Infliximab Infusion Safety and Tolerability Is Non-inferior to Standard Infusion Protocol in Inflammatory Bowel Disease Patients: A Randomized Controlled Study
Authors: Abushamma Suha , Walker Ted , Garza Kevin , Chen Ling , Nix Darren , Chen Chien-Huan
Published: May 2023

Background and Aim

Infliximab is typically given over an infusion time of 2 hours, leading to a significant burden in inflammatory bowel disease (IBD) patients. We aimed to determine the safety and cost-effectiveness of an accelerated infliximab infusion of 1 hour, compared with the standard 2-hour infusion.

Methods

Open-label randomized trial where IBD patients receiving maintenance infliximab infusions were randomly assigned to 1- and 2-hour infusion groups, corresponding to study and control groups, respectively. The primary outcome was the rate of infusion reactions. Secondary outcomes were assessment of the effect of premedications and immunomodulators on the rate of infusion reactions, and cost-effectiveness analysis. The cost-effectiveness analysis was based on direct nursing costs for the infusion time, indirect infusion center costs, and cost of productivity loss for patients. This trial is registered with ClinicalTrials.gov, NCT05340764.

Results

From November 2020 to November 2021, 96 patients were randomly assigned: 51 (53%) to the 1-hour infusion group and 45 (47%) to the 2-hour infusion group. Over a median time of 1 year, 309 infusions were administered in the control group, and 376 in the study group. Fifty-seven (18%) infusions in the control group and 45 (12%) infusions in the study group experienced an infusion reaction. The only infusion reaction was asymptomatic hypotension not requiring infusion discontinuation. No other infusion reactions (mild or moderate/severe) were seen. Diphenhydramine was associated with an increased rate of infusion reactions (OR 2.04 [95% CI 1.18–3.52], P = .01). The average costs were estimated to reduce by 37% in the accelerated infusion group.

Conclusions

Accelerated 1-hour infusions are non-inferior in safety and superior in cost-effectiveness compared with standard 2-hour infusions in IBD patients receiving maintenance infliximab infusions.

Trial Identification Number

Registered with ClinicalTrials.gov, NCT05340764.
Left atrial area as a simple predictor of paroxysmal AF in patient with acute ischemic stroke
Authors: Wilk A , Krol W , Zarek-Starzewska A , Guzik W , Ziemska-Gorczyca M , Franczuk-Gwiazda M , Braksator W
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The most important cardiogenic reason of acute Ischemic stroke (AIS) is atrial fibrillation (AF). Left atrial (LA) enlargement (atriopathy) is one of the risk factors of atrial fibrillation. Basic bio-metric measurements (height , weight and BSA) in patients with AIS can be challenging due to immobilization, therefor estimation of LA size using recommended parameter (left atrial volume index) is often not possible in every day practice.

Aim

To assess the discriminant value of different LA size parameters for detection of known paroxysmal AF in patients with acute ischemic stroke. To estimate best cut-off value of LA size parameters which predict presence of paroxysmal AF in patients with AIS.

Materials and methods

A database of 663 consecutive patients admitted to a neurology department with the diagnosis of acute ischemic stroke (AIS) who underwent transthoracic echocardiography (TTE) were analysed. After exclusion of 117 patient with persistent or permanent AF (present during TTE) the examined group comprised of 546 patients. Average age was 70,1years (20-97yrs), 53% were women. From the examined group 56 (10,3%) had known (from past medical history or diagnosed during the hospitalization in ecg, telemetry or holter monitoring) paroxysmal AF. 35,6% of examined patients required bedside echocardiography due to immobilization. The predictive values for the presence of paroxysmal AF were assessed for: LA antero-posterior diameter (LAd) in parasternal long axis , LA area in four chamber diameter (LAA), as well as LAd and LAA indexed to aorta diameter(Ao) (innere-to-inner method on the level of sinus of Valsalvy). Receiver Operating Characteristic (ROC) curves, area under the curve (AUC), specificity and sensitivity were analysed, Younden index was used for the estimation of cut-off values.

Results

ROC – curves of all examined parameters are presented in fig. 1. The AUC of LAd, LAA, LAd/Ao and LAA/Ao were: 0,60; 0,73 0,72; 0,81 respectively. Differences in AUC were statistically significant (p<0,05). The best cut of value for LAA/Ao was 7,2cm2/cm , with sensitivity of 0,90 and specificity of 0,59. 112 of 490 (23%) patient without known paroxysmal AF exceeded the estimated cut-off point.

Conclusions

1. In 1/3 of patients with AIS the assessment of recommended parameter of LA size (LAVI) can be difficult in clinical practice.

2. A simple, widely available parameter of left atrial size (LAA/Ao) has the best predictive value for the detection of patients with known paroxysmal AF.

3. Nearly ¼ of patients without known AF presenting with AIS have atriopathy which can be connected to not recognized arrhythmia.

4. LAA/Ao can be used as a simple, widely available parameter for the selection of patient for more profound prospective screening for AF in patients with AIS.
Performance of APACHE, SOFA and SAPS-2 score in predicting good neurological outcome at discharge from ICU in patient admitted after an out-of-hospital cardiac arrest
Authors: Bagliani A , Fasolino A , Quilico F , Gentile F R , Ambrosini E , Baldi E , Compagnoni S , Primi R , Bendotti S , Currao A , Vecchione A , Lamastra R , Colombo C N J , Savastano S , Tavazzi G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Acute Physiologic and Chronic Health Evaluation (APACHE), Sequential (sepsis-related) Organ Failure Assessment (SOFA) and Simplified Acute Physiologic Score-2 (SAPS-2) are common predictive scoring systems in the intensive care unit (ICU) used all around the world to predict outcomes in general or specific population (eg. sepsis and septic shock). However, these scores were found to have mixed performance in several subgroups of critically ill patients.

Purpose

Few and conflicting data are available on patients admitted in the ICU after an out-of-hospital cardiac arrest (OHCA) regarding these prognostic scores. We sought to evaluate the performance of these scores obtained on admission in predicting good neurological outcome at ICU discharge.

Methods

We enrolled 171 consecutive patients admitted to ICU at our center after being resuscitated from an OHCA from September 2017 to April 2021. APACHE, SOFA and SAPS-2 were available for 133 patients [77% male, mean age 60 (18-90) years, 54% with first shockable rhythm, median number of shocks delivered 1 (0-14), median value of adrenaline administered 3 mg (0-12), 26% received amiodarone, median cardiac arrest duration 38 min (IQR 22-74)]. Worst values collected during the first 24 hours were considered for APACHE and SAPS-2 calculations, whereas SOFA was assessed at 24 hours from admission.

The median values of each one of the three scores of patients with and without good neurological outcome (cognitive performance category 1-2) at ICU discharge were compared with Mann-Whitney U-test. For each one of the scores the Receiver Operating Characteristic (ROC) curve was analysed and the corresponding area under the curve AUC with its 95%CI was calculated, with the endpoint of survival with good neurological outcome at ICU discharge.

Results

patients with good neurological outcome had lower values of APACHE [22 (IQR 19-25) vs 24 (IQR 21-28)(p=0.01], SOFA [9 (IQR 7-10) vs 10 (IQR 8-12)(p<0.01] and SAPS-2 [56 (IQR 44-64) vs 72 (IQR 61-83)(p<0.01] . APACHE and SOFA scores showed similar AUC [0.616 (95% CI 0.528-0.699) vs 0.652 (95%CI 0,564-0,732), p=0.54]. SAPS-2 score performed significantly better than the other two [AUC 0.784 (95% CI 0.705-0.851, p<0.0001)].

Conclusion

SAPS-2 score discriminates survival with good neurological outcome at ICU discharge significantly better than APACHE and SOFA in patients resuscitated from an OHCA and admitted to the ICU. These results could help clinicians in identifying which patients yield a better prognosis after 24 hours of clinical observation in the ICU and could therefore be safely and rapidly discharged to the ward.
An alternative to transvenous lead extraction in selected patients with CIED infections: a retrospective outcome study
Authors: Meda G , Llewellyn J , Rao A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac implantable electronic devices (CIED) implants are rising in an older, more co-morbid population [1]. The prevalence of CIED infection ranges from 1-4% [2, 3]. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded or pre-eroding CIEDs [4], this approach is not without risk [5] and may be unacceptable to some patients [6]. Long term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients.

Method

A retrospective review of all CIED revision procedures at a large tertiary centre, over a 7-year period was undertaken with a mean follow up of 39 months.

Results

86 patients underwent 96 revision procedures. 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of follow up. There was no in hospital mortality and all patients were alive at 30 days. Overall mortality at 12 months was 8.1% (7 deaths), increasing to 24.4% (21 deaths) at end of follow up.

Conclusion

Our data provides important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication free at 12 months.
Impact of pre-existing history of heart failure on patient profile, therapeutic management and prognosis in cardiogenic shock: Insights from the FRENSHOCK registry
Authors: Schurtz G , Delmas C , Fenouillet M , Roubille F , Puymirat E , Leurent G , Ternacle J , Harbaoui B , Combaret N , Lattuca B , Bruel C , Bourenne J , Henry P , Lamblin N , Lemesle G
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Emergency and Acute Cardiovascular Care Working Group from the French Society of Cardiology

Aims

There is a large heterogeneity in patients presenting with cardiogenic shock (CS). To better apprehend this heterogeneity is crucial to adapt treatment and improve prognosis in these severe patients. Of note the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be entire part of this heterogeneity and data focusing on this aspect are lacking.

Methods

We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/- 13.4 vs. 62.7 +/- 16.2, p<0.001) and had a greater burden of extra-cardiac co-morbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p<0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p=0.029).

Conclusions

Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profile and this translated in a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.
Long-term outcomes following percutaneous coronary intervention (PCI)
Authors: Pottle A , Bellchambers J , Harrison N , Harrison S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Outcomes measures following PCI usually focus on in-hospital and 30-day mortality and readmission rates following discharge. There are numerous cardiac registries worldwide but there is a lack of data on longer-term patient-centred outcomes. ESC guidance recommends that patients are re-evaluated at least annually following myocardial revascularisation to reassess symptoms and adherence to secondary prevention measures and reinforce medical therapy and lifestyle changes when appropriate (1C recommendation). The International Consortium for Health Outcome Measures have produced a dataset of recommended outcome measures including long-term follow-up to 5 years and beyond, focusing on aspects of health experience that are important to patients. Real life data on long-term outcomes following PCI is needed in addition to short-term outcome measures to establish patient experience of PCI.

Purpose

The study was carried out to evaluate the long-term outcomes of patients undergoing PCI in this tertiary centre.

Method

Nurse-led follow-up for all patients post PCI has been carried out since 2001. Outcome data were initially collected prospectively during clinic appointments; short-term at 1-month, and medium-term at 6-months and 1-year. Long-term outcome data at 3 and 5-years were collected from 2012 via telephone appointment or purpose-made questionnaire.

Results

Data are available from 3-year follow-up for patients who underwent PCI between 2009 and 2014 and 5-year follow-up from patients between 2007 and 2012. The results only relate to patients followed-up in the nurse-led service. There were 3568 patients followed-up at 3-years and 2088 followed-up at 5-years (total 5656). 59.4% of patients had undergone primary PCI at 3-years and 64.1% at 5-years. 76% of the respondents were male at both time periods. The average age was 75.4 years. The data showed that at 3-years, 45.2% of patients reported they had no chest pain, or no angina on normal activity. At 5-years this number was 48.6%. 80.7% were free of MACE events at 3-years and 78.4% at 5-years. Approximately 50.0% of MACE events were non-cardiac hospitalisations. The number of patients requiring further intervention at both time periods was small.

Conclusion

Procedural outcome from PCI is good in the long, as well as short-term. Patient reported outcomes indicate that symptom control is potentially not as good as would be expected. Patients need long-term follow-up with a healthcare professional to establish if reported symptoms are truly cardiac and therefore warrant further investigation, however, healthcare resources may limit the ability to do this.
Results from healthy donors for novel point-of-care high-sensitivity troponin test
Authors: Christenson R , Briseno T , Wilson E , Fonville J , De Theije F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

This study evaluates healthy donor values of a novel high-sensitivity troponin test, an 8-minute whole blood assay performed with fingerstick or Lithium-heparin samples using a handheld sized platform designed for Point-of-Care or in-lab measurements. In accordance with the Fourth Universal Definition of Myocardial Infarction, whole blood 99th percentile upper reference limits (URLs) and 50th percentile (median) values for healthy individuals were characterised per gender; values were established for fingerstick, venous whole blood, and plasma.

Purpose

To determine 99th percentile URLs for hs-cTnI in healthy donors as myocardial injury cut-off for use in clinical trials and clinical practice. The median values were determined to confirm high-sensitivity performance in all matrices.

Methods

Whole blood from consented healthy subjects, 22 to 85 years (n=810), were collected across 5 clinical sites. Subjects taking cardiac history/medications or having abnormal hemoglobin A1c, NT-proBNP, and eGFR values were excluded. hs-cTnI values were determined in capillary (fingerstick), Li-Heparin venous whole blood, and venous Li-Heparin plasma matrices. Sex-specific and overall 99th percentile URLs using the recommended non-parametric approach and median values for each sample matrix were determined.

Results

Statistical outliers were eliminated by the Dixon-Reed test, prior to calculating the 99th percentile and median values. There was no significant difference between the three sample types. The median results are tabulated below: as expected, the female values are lower than the male values (p <0.01). These data additionally show that >50% of results exceed the assays limit of detection [ref .1] for all matrices, confirming this assay is a high-sensitive assay for troponin-I.

Conclusion

The novel hs-cTnI system is the first that demonstrates high-sensitivity cTnI performance in fingerstick, whole blood and plasma matrices. Quality measurements in all three matrices translates to use with confidence in emergency department and other diagnosis and triage settings. Hence, the data presented here are of relevance to current and future studies and clinical implementation of this device.

Table 1: median hs-cTnI values in healthy subject, % of subjects above LoD (limit of detection) and %CV at 99th URL.
Predictive value of cerebral natriuretic peptide in acute myocardial infarction without obstructive coronary disease
Authors: Rocha Carvalho P , Goncalves F , Carvalho C , Bernardo M , Fontes P , Moreira J I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The brain natriuretic peptide (BNP) has a protective role on the coronary vasculature. On the other hand, vascular dysfunction is one of the main factors associated with acute myocardial infarction without obstructive coronary disease (MINOCA). Therefore, one can theorize that BNP might be involved in the pathophysiological mechanism of this disease.

Purpose

This study sought to determine whether a low BNP value is a significant predictor of MINOCA.

Methods

This was a national multicenter retrospective study of patients hospitalized for an acute myocardial infarction (AMI) between October 2010 and September 2019. Patients with previous history of heart failure, severe valvular disease, chronic kidney disease, atrial fibrillation and who didn’t have a coronary angiography during hospitalization were excluded.

Results

Of a total of 4954 patients with an AMI, 306 (6,2%) were diagnosed as MINOCA. The MINOCA group had a higher percentage of women (42,5% vs 24,6%, p<0,001) and was more frequently hospitalized for a non-ST-segment elevation myocardial infarction (70,9% vs 39,3%, p<0,001). Left ventricular ejection fraction was significantly higher in these patients (58±13% vs 54±13%, p=0,002). MINOCA was associated with a better in-hospital prognosis: less cardiogenic shock (1,0% vs 4,0%, p=0,008), less cardiac arrests (1,0% vs 4,8%, p=0,002), less major bleeding events (0% vs 1,8%, p=0,019) and lower mortality (0% vs 2,2%, p=0,010).

The BNP median was lower in patients with MINOCA (91 (38;269) pg/mL vs 141 (56;328) pg/mL, p<0,001). The BNP cut-off, determined by ROC curve analysis, was 85,5pg/mL. Therefore, 49,3% of the patients with MINOCA had BNP values considered low, in contrast to 35,3% of the patients with obstructive coronary disease (p<0,001). In a multivariate regression analysis, we found that a low BNP value was a significant predictor of MINOCA (adjusted OR 2,46, 95% CI 1,87-3,23).

Conclusions

As expected, MINOCA was an entity associated with a better in-hospital prognosis when compared to AMI with obstructive coronary disease. In this study, a low BNP value was able to independently and significantly predict MINOCA.
Prognostic importance of neuron-specific enolase measured in plasma or serum in patients resuscitated after out-of-hospital cardiac arrest
Authors: Abdi Isse Y , Frikke-Schmidt R , Kjaergaard J , E Moeller J , Schmidt H , A S Meyer M , Hassager C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Patients who are successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to the hospital in a comatose stage are in high risk for anoxic brain injury. Multimodal approach for neuroprognostication include measurement of neuron-specific enolase (NSE) as a biomarker for neurological injury. NSE has been intensively studied over the past years and has shown a valid predictive value for neurological outcome. However, there has been no clinical studies comparing NSE analyzed on plasma and serum samples.

Purpose

To compare NSE at 48 hours obtained from both in serum and plasma samples, and to investigate the performance of both these measuring techniques in predicting all-cause mortality at 365-days among patients resuscitated from out-of-hospital cardiac arrest.

Methods

This is a post-hoc sub study of the BOX trial in which resuscitated OHCA patients admitted to the hospital in comatose stage were included. NSE was measured 48 hours after admission, both in serum samples used for clinical analysis with no freeze-thaw cycle (NSE-Serum), and plasma samples from biobank (NSE-Plasma). The comparison of NSE-Serum and NSE-Plasma was performed by Spearmans correlation. The area under the receiver operating characteristics curve (AUROC) for predicting all-cause mortality at 365-days for both NSE-Serum and NSE-Plasma were determined.

Results

369 patients had NSE values from both serum and plasma at 48 hours available for comparison. In these patients the NSE-Serum was median 21.2 µg/L (IQR 15.7 - 45.5), NSE-Plasma was median 19.3 µg (IQR 11.3 - 40.9), and mortality at 365-days was 32.5%. The correlation between NSE-Serum and NSE-Plasma was r=0.63 P<0.001. AUROC for NSE-Serum and NSE-Plasma were 0.94 and 0.83 respectively (FIGURE), and the differences in AUROC was -0.10 (95% confidence limits: -0.14 to -0.06), p<0.001.

Conclusion

In this sub study, we found moderate correlation between serum NSE values and plasma NSE values. Moreover, both measuring techniques had good predictive value against 1 year mortality, with clinically measured NSE from serum being slightly superior to NSE from plasma in predicting mortality.
Incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction: Results from the Korea Acute Myocardial Infraction Registry
Authors: Cho K , Shin M H , Kim M C , Sim D S , Hong Y J , Kim J H , Ahn Y , Kim H S , Hur S H , Lee S R , Hwang J Y , Oh S K , Cha K S , Jeong M H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea Centre for Disease Control and Prevention.

Background/Introduction

Data regarding the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction (STEMI) in the modern era of percutaneous coronary intervention are limited.

Purpose

We investigated the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of STEMI from a nationwide, prospective Korean registry of acute myocardial infarction.

Methods

Out of 28,470 patients with acute myocardial infarction between November 2011 and June 2020, 11,796 were eventually diagnosed with STEMI following a coronary angiogram. They were classified into two groups: patients with an initial working diagnosis of STEMI before starting the initial treatment and patients with an initial working diagnosis of non-STEMI (misdiagnosed group).

Results

Out of 11,796 patients with a final diagnosis of STEMI, 165 (1.4%) were misdiagnosed. The door-to-angiography time in the misdiagnosed group was five times longer than that in the timely diagnosed group (median 220 [interquartile range 66–1177] vs. 43 [31–58] minutes, P <0.001). In a multivariable adjustments model, patients with a history of heart failure, atypical chest pain, anaemia, or symptom-to-door time ≥4 hours had significantly higher odds, whereas those with systolic blood pressure <100 mmHg or anterior ST-elevation or left bundle branch block on electrocardiogram had lower odds of STEMI misdiagnosis (Figure 1). For patients with culprit lesions in the left anterior descending artery (n = 5838), the adjusted one-year mortality risk for STEMI misdiagnosis was 1.84 (95% confidence interval 1.01–3.38; Figure 2).

Conclusion

Misdiagnosis of STEMI is not uncommon and is associated with a significant delay in coronary angiography, resulting in an increased one-year mortality for patients with culprit lesions in the left anterior descending artery.
Atrial fibrillation is associated with mortality and increased admission biomarkers reflecting neurohormonal activation and inflammation in patients with ST-elevation myocardial infarction
Authors: Frydland M , Moeller J E , Holmvang L , Helgestad O K L , Jensen L O , Goetze J P , Hassager C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Righospitalets Forskningsfond (07IO) Lundbeck Foundation (R186-2015-2132).

Background

Neurohormonal activation and inflammation is associated with mortality in STEMI patients. We sought to assess, whether AFIB – a known risk factor in MI – also was associated with increased 1-year mortality as well as neurohormonal activation and inflammation in STEMI patients.

Methods

In 1892 consecutive STEMI patients from two danish tertiary heart centers biomarkers reflecting neurohormonal activation (copeptin, pro-atrial natriuretic peptide (proANP), and mid-regional pro-adrenomedullin (MRproADM)) and inflammation (ST2) was measured. Patients were stratified according to known AFIB or new onset AFIB on admission vs no AFIB.

Results

In total, 198 (10%, 100 known/98 new onset) patients had AFIB, which was associated with increased 1-year mortality (19% vs. 8.4%, p<0.0001). Patients with AFIB were older (mean (SD) age 70 (13) vs 63 (13) years, p<0.0001), had more comorbidity (e.g. hypertension 61% vs. 43%, p<0.0001; stroke 13% vs 6.4%, p=0.002; heart failure 11% vs 2.3%, p<0.0001), lower left ventricular ejection fraction (LVEF) (mean (SD) 41 (13) vs 45 (13), p<0.0001), were more often comatose after cardiac arrest (12% vs 6%, p=0.001), and in cardiogenic shock (CS) (20% vs 9.1%, p<0.0001). Plasma concentration (median (IQR)) of all four biomarkers were higher in AFIB patients (copeptin 124 (39; 298) vs 66 (21; 170) pmol/L; proANP 1678 (1018; 2439) pmol/L; MRproADM 0.96 (0.76; 1.41) vs 0.70 (0.58; 0.90) nmol/L; ST2 48 (34; 74) vs 39 (29; 55) ng/ml, p<0.0001 for all). When adjusting for age, sex, hypertension, previous stroke, LVEF, CS, and being comatose after cardiac arrest, AFIB remained associated with increased plasma concentration of all four biomarkers (two-fold increase – OR (95% CI): Copeptin 1.21 (1.02-1.23); proANP 2.22 (1.82-2.72); MRproADM 2.01 (1.56-2.60); ST2 1.21 (1.03-1.43)).

Conclusion

AFIB in STEMI patients is associated with increased admission biomarkers reflecting neurohormonal activation and inflammation and 1-year mortality.
Periodic repolarization dynamics in patients undergoing primary PCI for acute myocardial infarction
Authors: Theurl F , Schreinlechner M , Sappler N , Massmann C , Dolejsi T , Reinstadler S J , Bauer A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Innsbruck.

Background and aims

Periodic Repolarization Dynamics (PRD) is a novel ECG-based risk marker which quantifies sympathetic-activity associated oscillation of repolarization in the low frequency range. [1] Previous studies demonstrated that increased PRD is a strong and independent predictor of mortality in ischemic and non-ischemic cardiomyopathy being closely linked to malignant arrhythmias and sudden death. [2] [3] PRD could also be a useful marker in the setting of acute myocardial ischemia. We therefore aimed to investigate PRD in acute myocardial infarction (MI) and the effects of primary PCI on PRD.

Methods

Consecutive patients aged ≥ 18 years presenting with acute ST-elevation MI were included. In all patients, a high-resolution (1000Hz) 24-hour ECG recording in Frank leads configuration was started at hospital admission. PRD was assessed for the period before primary PCI and for 24 successive 1-hour periods thereafter according to previously established procedures. [1] Time of PCI was defined as wire crossing.

Results

Between January and April 2022, a total of 23 patients were enrolled. Median age was 63 (IQR 56 - 70) years, 6 (26 %) patients were female. Average length of the pre PCI segment was 60 (IQR 40 – 78) minutes. Coronary blood flow prior to PCI was TIMI 0 in 10 patients and TIMI 1 in 13 patients. Primary PCI was successful with an achieved TIMI 3 flow in all patients. PRD before primary PCI was increased at 7.8 (IQR 6.4 - 10.5) deg². Within the first six hours after recanalization PRD decreased to 4.1 (IQR 2.8 - 6.2) deg² (p = 0.004 for difference). No significant change of PRD was observed between 6 h and 24 h after PCI (p = 0.652 for difference).

Conclusion

In patients with acute STEMI, PRD is significantly increased. Revascularization by primary PCI results in a decrease in PRD within the first 6 hours. Our results suggest that arrhythmic risk is increased within the first 6 hours after primary PCI.
A prediction model for ventricular arrythmias in the acute phase of infarction
Authors: Rivadeneira Ruiz M , Marin Andreu P , Garcia Gonzalez N , Izquierdo Bajo A , Hidalgo Urbano R J , Garcia Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in the acute phase of infarction (first 24-48 hours) has declined over recent decades, probably due to the uptake of reperfusion strategies and the early use of beta-blockers. However, according to some series, 6–8% of patients still develop hemodynamically significant VT or VF during this phase.

Purpose

The objective of our study was to evaluate the baseline characteristics of patients who suffered VT or VF in the acute phase of the infarction and to create a predictive model of ventricular arrhythmias in this setting which allow us to anticipate arrhythmic events.

Methods

We performed an observational, retrospective, and single-centre study carried out through the review of clinical records of patients who suffered an acute myocardial infarction with ST-segment elevation (STEMI) and were admitted in our Coronary Care Unit between July 2011 and August 2022.

Results

In our cohort we observed 179 episodes of VT/VF (10,7%) in a population of 1668 patients underwent STEMI. The mean age in this subgroup was 61,69±12,61 years old, 78% were males and 56% smokers. Approximately a quarter of the patients were diabetic or obese. There was a very low percentage of previous myocardial infarction (12%) and heart failure (3%) (Table 1). We estimated the best prediction model (Mallows’ Cp=5.12) for VT/VF. The variables included in our model (LL=-435,43) were: male sex, absence of diabetes, smoking habit, use of fibrinolysis, worst Killip at admission and hypotension at admission (Table 2).

Conclusion

The presence of VT or VF in the acute phase of infarction is still considered a controversial factor in the prognosis of these patients. In our cohort we identified that males, smokers, non-diabetics, and the use of fibrinolysis and the worst haemodynamical situation at admission were independent predictors of developing VT/VF in this context.