bluuebunny/crossref_metadata_2025 huggingface dataset:
Plant and fungal gene expression coupled with stable isotope labeling provide novel information on sulfur uptake and metabolism in orchid mycorrhizal protocorms
Authors: De Rose Silvia , Kuga Yukari , Sillo Fabiano , Fochi Valeria , Sakamoto Naoya , Calevo Jacopo , Perotto Silvia , Balestrini Raffaella
Published: July 2023

Orchid mycorrhiza (OM) represents an unusual symbiosis between plants and fungi because in all orchid species carbon is provided to the host plant by the mycorrhizal fungus at least during the early stages of orchid development, named a protocorm. In addition to carbon, orchid mycorrhizal fungi provide the host plant with essential nutrients such as phosphorus and nitrogen. In mycorrhizal protocorms, nutrients transfer occurs in plant cells colonized by the intracellular fungal coils, or pelotons. Whereas the transfer of these vital nutrients to the orchid protocorm in the OM symbiosis has been already investigated, there is currently no information on the transfer of sulfur (S). Here, we used ultra‐high spatial resolution secondary ion mass spectrometry (SIMS) as well as targeted gene expression studies and laser microdissection to decipher S metabolism and transfer in the model system formed by the Mediterranean orchid Serapias vomeracea and the mycorrhizal fungus Tulasnella calospora. We revealed that the fungal partner is actively involved in S supply to the host plant, and expression of plant and fungal genes involved in S uptake and metabolism, both in the symbiotic and asymbiotic partners, suggest that S transfer most likely occurs as reduced organic forms. Thus, this study provides original information about the regulation of S metabolism in OM protocorms, adding a piece of the puzzle on the nutritional framework in OM symbiosis.
Mutation to a cytochrome P450‐like gene alters the leaf color by affecting the heme and chlorophyll biosynthesis pathways in Brassica napus
Authors: Yang Mao , Wan Shubei , Chen Jun , Chen Wenjing , Wang Yangming , Li Weiyan , Wang Meihong , Guan Rongzhan
Published: July 2023

The regulated biosynthesis of chlorophyll is important because of its effects on plant photosynthesis and dry biomass production. In this study, a map‐based cloning approach was used to isolate the cytochrome P450‐like gene BnaC08g34840D (BnCDE1) from a chlorophyll‐deficient mutant (cde1) of Brassica napus obtained by ethyl methanesulfonate (EMS) mutagenization. Sequence analyses revealed that BnaC08g34840D in the cde1 mutant (BnCDE1I320T) encodes a substitution at amino acid 320 (Ile320Thr) in the conserved region. The over‐expression of BnCDE1I320T in ZS11 (i.e., gene‐mapping parent with green leaves) recapitulated a yellow‐green leaf phenotype. The CRISPR/Cas9 genome‐editing system was used to design two single‐guide RNAs (sgRNAs) targeting BnCDE1I320T in the cde1 mutant. The knockout of BnCDE1I320T in the cde1 mutant via a gene‐editing method restored normal leaf coloration (i.e., green leaves). These results indicate that the substitution in BnaC08g34840D alters the leaf color. Physiological analyses showed that the over‐expression of BnCDE1I320T leads to decreases in the number of chloroplasts per mesophyll cell and in the contents of the intermediates of the chlorophyll biosynthesis pathway in leaves, while it increases heme biosynthesis, thereby lowering the photosynthetic efficiency of the cde1 mutant. The Ile320Thr mutation in the highly conserved region of BnaC08g34840D inhibited chlorophyll biosynthesis and disrupted the balance between heme and chlorophyll biosynthesis. Our findings may further reveal how the proper balance between the chlorophyll and heme biosynthesis pathways is maintained.
Increase in the Efficiency of the Isotope-Selective Infrared Laser Multiphoton Dissociation of 11BCl3 Molecules in a Mixture with SF6 Serving As a Sensitizer and an Acceptor of Radicals
Authors: Makarov G. N. , Petin A. N.
Published: July 2023

A strong increase in the efficiency of the isotope-selective infrared laser multiphoton dissociation of 11BCl3 molecules in the natural mixture with 10BCl3 by radiation of a pulsed CO2 laser in the case of admixture of SF6 molecules, which serve as a sensitizer and simultaneously acceptors of radicals, Cl atoms formed in the dissociation of BCl3 molecules, has been detected. The yield and selectivity of dissociation of 11BCl3 molecules increase by several times and the threshold energy density for the dissociation of molecules decreases significantly in the case of their irradiation in the mixture with SF6 compared to irradiation without SF6. This property allows the single-frequency isotope-selective dissociation of 11BCl3 molecules by unfocused laser radiation at a moderate energy density (≈3–5 J/cm2), which is important and relevant for the practical implementation of the laser separation of boron isotopes.
Tilt and Anisotropy of the Dirac Spectrum Caused by the Overlapping of Bloch Functions
Authors: Alisultanov Z. Z. , Demirov N. A.
Published: July 2023

It has been shown that the overlapping of bands belonging to equivalent representation of the symmetry group is possible in systems with Dirac points appearing at the crossing of these bands. This overlapping results in the tilt and additional anisotropy of the Dirac spectrum, as well as in the renormalization of the velocity. At the same time, overlapping does not violate the general conditions of existence of the stable band crossing point. The effective Dirac Hamiltonian in the presence of band overlapping is pseudo-Hermitian and corresponds to the effective action of a massless spinor field in the curved spacetime.
Quasicrystalline Structures with Narrow-Band Frequency–Angular Selectivity
Authors: Chistyakov V. A. , Sidorenko M. S. , Sayanskiy A. D. , Rybin M. V.
Published: July 2023

Design methods in the reciprocal space allow one to obtain structures with desired properties. Quasicrystalline photonic structures, which ensure the selective scattering of an electromagnetic wave incident on the sample, have been designed. The maxima of the Fourier transform of the desired distribution of the permittivity in the reciprocal space are located along two arcs on the Ewald sphere, which corresponds to the scattering of the wave with the required wavelength and angle of incidence. The material distribution has been determined by the transition to the real space. A structure with a low dielectric contrast has been formed after the binarization of the refractive index. The theoretical analysis of the properties of the structure has confirmed the frequency–angular selectivity of scattering. The numerical calculations show the possibility of achieving the effective scattering and absorption of the electromagnetic energy up to 94% in a narrow frequency range and in a narrow interval of angles of incidence at a dielectric contrast of two materials of 1.07.
An Efficient RFID Tag Search Protocol Based on Historical Information Reasoning for Intelligent Farm Management
Authors: Liu Xuan , Huang Yuanmu , Xi Zhong , Luo Juan , Zhang Shigeng
Published: July 2023

Due to the ability to simultaneously interrogate multiple tags with a far operating distance, radio frequency identification (RFID) has been widely used in modern farms to improve management efficiency. In smart farm applications, how to quickly locate and search some specified items (e.g., animals) is a critical problem, for which tag searching can be used to solve the problem. While there are some works on tag searching, they are designed for static objects and cannot meet the time efficiency requirements where the searched animals’ movement brings challenges. In this paper, we propose SHIR, an efficient tag-searching protocol based on historical information reasoning, which can be applied in scenarios containing mobile tags that cannot be well handles in existing tag search protocols. By continuously counting the difference between the predicted reply signal and the actual signal received from tags for multiple rounds, SHIR avoids the waste of time slots and achieves high time efficiency. Furthermore, it can infer unverified tag status through historical information to speed up the search process. We further propose the Enhanced SHIR (ESHIR) protocol by filtering out the interference tags in the query area to avoid wasting time verifying interference tags. Compared with previous probabilistic approaches, SHIR gets accurate search results with no false positives. Extensive experimental results show that our best protocol can improve the time efficiency by up to 42% compared with the the-state-of-art solution.
Advances in Computational Intelligence Techniques‐Based Multi‐Intersection Querying Theory for Efficient QoS in the Next Generation Internet of Things
Authors: Kumar Ashish , K Kannan , Dahiya Mamta , Kushwah Virendra Singh , Siddiqa Ayesha , Kaur Kiranjeet , Rahin Saima Ahmed
Published: July 2023

An environment of physically linked, technologically networked things that can be found online is known as the “Internet of Things.” With the use of various devices connected to a network that allows data transfer between these devices, this includes the creation of intelligent communications and computational environments, such as intelligent homes, smart transportation systems, and intelligent FinTech. A variety of learning and optimization methods form the foundation of computational intelligence. Therefore, including new learning techniques such as opposition‐based learning, optimization strategies, and reinforcement learning is the key growing trend for the next generation of IoT applications. In this study, a collaborative control system based on multiagent reinforcement learning with intelligent sensors for variable‐guidance sections at various junctions is proposed. In the future generation of Internet of Things (IoT) applications, this study provides a multi‐intersection variable steering lane‐appropriate control approach that uses intelligent sensors to reduce traffic congestion at many junctions. Since the multi‐intersection scene’s complicated traffic flow cannot be accommodated by the conventional variable steering lane management approach. The priority experience replay algorithm is also included to improve the efficiency of the transition sequence’s use in the experience replay pool and speed up the algorithm’s convergence for effective quality of service in the upcoming IoT applications. The experimental investigation demonstrates that the multi‐intersection variable steering lane with intelligent sensors is an appropriate control mechanism, successfully reducing queue length and delay time. The effectiveness of waiting times and other indicators is superior to that of other control methods, which efficiently coordinate the strategy switching of variable steerable lanes and enhance the traffic capacity of the road network under multiple intersections for effective quality of service in the upcoming IoT applications.
Factors Associated with Acute Kidney Injury among Children with Severe Malaria at Kiryandongo General Hospital, Uganda
Authors: Kwambele Lokengama , Ndeezi Grace , Ortiz Yamile Arias , Twesigemuka Sabinah , Nduwimana Martin , Egesa Walufu Ivan , Kumbakulu Patrick Kumbowi , Bafwa Yves Tibamwenda
Published: July 2023

Background. Malaria remains one of the leading health problems of the developing world, and acute kidney injury (AKI) is a well-recognized complication of severe malaria in adults; but the clinical importance of AKI in paediatric severe malaria is not well documented. Knowledge of the prevalence and factors associated with AKI among children with severe malaria is among the key strategies, which can help to reduce the burden of AKI among this vulnerable group. Methodology. A hospital-based prospective cross-sectional descriptive and analytic study of children with severe malaria was carried out at Kiryandongo General Hospital. The study involved 350 children with severe malaria attending the study site from August to October 2021. Questionnaires were administered to caretakers to obtain sociodemographic characteristics. Medical data were obtained through physical examination followed by laboratory tests. Blood samples were tested for creatinine and blood smear for malaria. Data were analyzed using binary logistic regression (bivariate and multivariate) to assess for the factors associated with AKI. A

p

value < 0.05 was considered statistically significant. Results. The mean age of children with severe malaria was

7.0
±
3.8

years, and 54.3% of them were male. Of the 350 children enrolled, 167 had AKI, giving an overall AKI prevalence of 47.7% (95% CI: 42.5-53.0). The factors that were significantly associated with AKI among children with severe malaria included caretaker with no formal education (

aOR
=
21.0

, 95% CI: 1.68–261.18,

p
=
0.018

), caretaker with primary education level (

aOR
=
4.5

, 95% CI: 1.41–14.12,

p
=
0.011

), age of

child
<
5

years (

aOR
=
1.8

, 95% CI: 1.07–2.88,

p
=
0.025

), history of receiving NSAIDs (

aOR
=
5.6

, 95% CI: 2.34–13.22,

p
<
0.001

), moderate anemia (

aOR
=
3.1

, 95% CI: 1.39–6.94,

p
=
0.006

), and severe anemia (

aOR
=
3.8

, 95% CI: 1.66–8.55,

p
=
0.002

). Conclusion. The prevalence of AKI was high among children with severe malaria in Kiryandongo General Hospital. Acute kidney injury among children with severe malaria was associated with low level of education of caretakers, age of children less than 5 years, history of receiving NSAIDs, and anemia. The management of severe malaria should include screening for AKI especially in children under five years of age, anemic, and those who have received NSAIDs.
Modeling and Optimization of Electrodeposition Process for Copper Nanoparticle Synthesis Using ANN and Nature-Inspired Algorithms
Authors: Tamilvanan A. , Balamurugan K. , Mohanraj T. , Admassu Yesgat
Published: July 2023

Due to its outstanding physical, chemical, and thermal properties, an increasing consideration has been paid to produce copper (Cu) nanoparticles (NPs). Various methods are accessible for producing Cu NPs by conceiving the top–down and bottom–up approaches. Electrodeposition is a bottom–up method to synthesize high-quality Cu NPs at a low cost. The attributes of Cu NPs rely on their way of deduction and electrochemical process parameters. This work aims to deduce the mean size of Cu NPs. Artificial neural networks (ANN) and nature-inspired algorithms, namely genetic algorithm (GA), firefly algorithm (FA), and cuckoo search (CS) algorithm were used to predict and optimize the electrochemical parameters. The results obtained from ANN prediction agreed with data from the electrodeposition process. All nature-inspired algorithms reveal similar operating conditions as optimal parameters. The minimum NP size of 20 nm was obtained for the process parameters of 4 g·l−1 of CuSO4 concentration, electrode distance of 3 cm, and a potential difference of 27 V. The synthesized NP size was in line with the anticipated NP size. The scanning electron microscope and X-ray diffractometer (XRD) were performed to analyze the nanoparticle size and morphology.
Automated Cognitive Health Assessment Based on Daily Life Functional Activities
Authors: Alsubai Shtwai , Alqahtani Abdullah , Sha Mohemmed , Abbas Sidra , Gregus Michal , Furda Robert
Published: July 2023

Dementia is increasing day‐by‐day in older adults. Many of them are spending their life joyfully due to smart home technologies. Smart homes contain several smart devices which can support living at home. Automated assessment of smart home residents is a significant aspect of smart home technology. Detecting dementia in older adults in the early stage is the basic need of this time. Existing technologies can detect dementia timely but lacks performance. In this paper, we proposed an automated cognitive health assessment approach using machines and deep learning based on daily life activities. To validate our approach, we use CASAS publicly available daily life activities dataset for experiments where residents perform their routine activities in a smart home. We use four machine learning algorithms: decision tree (DT), Naive Bayes (NB), support vector machine (SVM), and multilayer perceptron (MLP). Furthermore, we use deep neural network (DNN) for healthy and dementia classification. Experiments reveal the 96% accuracy using the MLP classifier. This study suggests using machine learning classifiers for better dementia detection, specifically for the dataset which contains real‐world data.
Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study
Authors: Elifranji Zuhdi O. , Al-Ajlouni Jihad M. , Al-Saber Munther G. , Hammad Yazan S. , Baniatta Basel A. , Alshoubaki Sara N. , Jabaiti Mohammad S. , Alkhatib Ahmad M. , Abu awad Abdelrahman M. , Altarazi Abdelrahman E. , Abdin Aseel N. , Al-Ani Abdallah , Alshrouf Mohammad Ali
Published: July 2023

Background. The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. Methods. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. Results. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Conclusion. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.
Design of a Nanosecond Voltage Comparator with PECL Logic for a Photon-Counting Radiation Imaging System Application
Authors: Zhang Huaxia , Sun Yuewen , Chen Zijia , Wu Zhifang
Published: July 2023

In this paper, a nanosecond voltage comparator with PECL logic for a photon-counting radiation imaging system is presented. To realize a high-speed comparison of four gamma detector channels in a limited board space, quad comparators MAX9602 with PECL logic are chosen. Each of the four channels is coupled with a PECL to CMOS converter ICS508, which exports CMOS logic data for later use in an FPGA. Simulated findings for cobalt-60 with intensities ranging from 30 Ci to 300 Ci show little count loss caused by using a comparator and indicate ideal propagation delays at all source intensities. While in the laboratory test using a PCB-level system, signals with pulse width less than 3 ns might be dropped, and dispersion of propagation delay occurs. Despite these, the performance is still satisfactory and can meet the requirements of practical applications, as demonstrated by an improved result of 0.9% in the contrast indicator model. Further studies to optimize the circuit design can be conducted to gain improvement.
Hybrid Recommender System for Mental Illness Detection in Social Media Using Deep Learning Techniques
Authors: Ahmad Sayed Sayeed , Rani Rashmi , Wattar Ihab , Sharma Meghna , Sharma Sanjiv , Nair Rajit , Tiwari Basant
Published: July 2023

Recommender systems are chiefly renowned for their applicability in e‐commerce sites and social media. For system optimization, this work introduces a method of behaviour pattern mining to analyze the person’s mental stability. With the utilization of the sequential pattern mining algorithm, efficient extraction of frequent patterns from the database is achieved. A candidate sub‐sequence generation‐and‐test method is adopted in conventional sequential mining algorithms like the Generalized Sequential Pattern Algorithm (GSP). However, since this approach will yield a huge candidate set, it is not ideal when a large amount of data is involved from the social media analysis. Since the data is composed of numerous features, all of which may not have any relation with one another, the utilization of feature selection helps remove unrelated features from the data with minimal information loss. In this work, Frequent Pattern (FP) mining operations will employ the Systolic tree. The systolic tree‐based reconfigurable architecture will offer various benefits such as high throughput as well as cost‐effective performance. The database’s frequently occurring item sets can be found by using the FP mining algorithms. Numerous research areas related to machine learning and data mining are fascinated by feature selection since it will enable the classifiers to be swift, more accurate, and cost‐effective. Over the last ten years or so, there have been significant technological advancements in heuristic techniques. These techniques are beneficial because they improve the search procedure’s efficiency, albeit at the potential sacrifice of completeness claims. A new recommender system for mental illness detection was based on features selected using River Formation Dynamics (RFD), Particle Swarm Optimization (PSO), and hybrid RFD‐PSO algorithm is proposed in this paper. The experiments use the depressive patient datasets for evaluation, and the results demonstrate the improved performance of the proposed technique.
Privacy Preserved Cervical Cancer Detection Using Convolutional Neural Networks Applied to Pap Smear Images
Authors: Alsubai Shtwai , Alqahtani Abdullah , Sha Mohemmed , Almadhor Ahmad , Abbas Sidra , Mughal Huma , Gregus Michal
Published: July 2023

Image processing has enabled faster and more accurate image classification. It has been of great benefit to the health industry. Manually examining medical images like MRI and X‐rays can be very time‐consuming, more prone to human error, and way more costly. One such examination is the Pap smear exam, where the cervical cells are examined in laboratory settings to distinguish healthy cervical cells from abnormal cells, thus indicating early signs of cervical cancer. In this paper, we propose a convolutional neural network‐ (CNN‐) based cervical cell classification using the publicly available SIPaKMeD dataset having five cell categories: superficial‐intermediate, parabasal, koilocytotic, metaplastic, and dyskeratotic. CNN distinguishes between healthy cervical cells, cells with precancerous abnormalities, and benign cells. Pap smear images were segmented, and a deep CNN using four convolutional layers was applied to the augmented images of cervical cells obtained from Pap smear slides. A simple yet efficient CNN is proposed that yields an accuracy of 0.9113% and can be successfully used to classify cervical cells. A simple architecture that yields a reasonably good accuracy can increase the speed of diagnosis and decrease the response time, reducing the computation cost. Future researchers can build upon this model to improve the model’s accuracy to get a faster and more accurate prediction.
T Cell–intrinsic Immunomodulatory Effects of TAK-981 (Subasumstat), a SUMO-activating Enzyme Inhibitor, in Chronic Lymphocytic Leukemia
Authors: Lam Vi , Roleder Carly , Liu Tingting , Bruss Nur , Best Scott , Wang Xiaoguang , Phillips Tycel , Shouse Geoffrey , Berger Allison J. , Alinari Lapo , Wang Lili , Siddiqi Tanya , Pennock Nathan D. , Danilov Alexey V.
Published: July 2023

Novel targeted agents used in therapy of lymphoid malignancies are recognized to have complex immune-mediated effects. Sumoylation, a posttranslational modification of target proteins by small ubiquitin-like modifiers (SUMO), regulates a variety of cellular processes indispensable in immune cell activation. Despite this, the role of sumoylation in T-cell biology in context of cancer is not known. TAK-981 (subasumstat) is a small-molecule inhibitor of the SUMO-activating enzyme (SAE) that forms a covalent adduct with an activated SUMO protein. Using T cells derived from patients with chronic lymphocytic leukemia (CLL), we demonstrate that targeting SAE activates type I IFN response. This is accompanied by largely intact T-cell activation in response to T-cell receptor engagement, with increased expression of CD69 and CD38. Furthermore, TAK-981 decreases regulatory T cell (Treg) differentiation and enhances secretion of IFNγ by CD4+ and CD8+ T cells. These findings were recapitulated in mouse models, suggesting an evolutionarily conserved mechanism of T-cell activation regulated by SUMO modification. Relevant to the consideration of TAK-981 as an effective agent for immunotherapy in hematologic malignancies, we demonstrate that the downstream impact of TAK-981 administration is enhancement of the cytotoxic function of CD8+ T cells, thus uncovering immune implications of targeting sumoylation in lymphoid neoplasia.
Diagnostic Accuracy of the Standing Test in Adults Suspected for Congenital Long‐QT Syndrome
Authors: Vink Arja S. , Hermans Ben J. M. , Hooglugt Jean‐Luc Q. , Peltenburg Puck J. , Meijborg Veronique M. F. , Hofman Nynke , Clur Sally‐Ann B. , Blom Nico A. , Delhaas Tammo , Wilde Arthur A. M. , Postema Pieter G.
Published: July 2023

Background

An elegant bedside provocation test has been shown to aid the diagnosis of long‐QT syndrome (LQTS) in a retrospective cohort by evaluation of QT intervals and T‐wave morphology changes resulting from the brief tachycardia provoked by standing. We aimed to prospectively determine the potential diagnostic value of the standing test for LQTS.

Methods and Results

In adults suspected for LQTS who had a standing test, the QT interval was assessed manually and automated. In addition, T‐wave morphology changes were determined. A total of 167 controls and 131 genetically confirmed patients with LQTS were included. A prolonged heart rate–corrected QT interval (QTc) (men ≥430 ms, women ≥450 ms) at baseline before standing yielded a sensitivity of 61% (95% CI, 47–74) in men and 54% (95% CI, 42–66) in women, with a specificity of 90% (95% CI, 80–96) and 89% (95% CI, 81–95), respectively. In both men and women, QTc≥460 ms after standing increased sensitivity (89% [95% CI, 83–94]) but decreased specificity (49% [95% CI, 41–57]). Sensitivity further increased (
P
<0.01) when a prolonged baseline QTc was accompanied by a QTc≥460 ms after standing in both men (93% [95% CI, 84–98]) and women (90% [95% CI, 81–96]). However, the area under the curve did not improve. T‐wave abnormalities after standing did not further increase the sensitivity or the area under the curve significantly.

Conclusions

Despite earlier retrospective studies, a baseline ECG and the standing test in a prospective evaluation displayed a different diagnostic profile for congenital LQTS but no unequivocal synergism or advantage. This suggests that there is markedly reduced penetrance and incomplete expression in genetically confirmed LQTS with retention of repolarization reserve in response to the brief tachycardia provoked by standing.
Trigger‐Associated Clinical Implications and Outcomes in Takotsubo Syndrome: Results From the Multicenter GEIST Registry
Authors: Pätz Toni , Santoro Francesco , Cetera Rosa , Ragnatela Ilaria , El‐Battrawy Ibrahim , Mezger Matthias , Rawish Elias , Andrés‐Villarreal Mireia , Almendro‐Delia Manuel , Martinez‐Sellés Manuel , Uribarri Aitor , Pérez‐Castellanos Alberto , Guerra Federico , Novo Giuseppina , Mariano Enrica , Musumeci Maria Beatrice , Arcari Luca , Cacciotti Luca , Montisci Roberta , Akin Ibrahim , Thiele Holger , Brunetti Natale Daniele , Vedia Oscar , Núñez‐Gil Ivan J. , Eitel Ingo , Stiermaier Thomas
Published: July 2023

Background

Takotsubo syndrome is usually triggered by a stressful event. The type of trigger seems to influence the outcome and should therefore be considered separately.

Methods and Results

Patients included in the GEIST (German‐Italian‐Spanish Takotsubo) registry were categorized according to physical trigger (PT), emotional trigger (ET), and no trigger (NT) of Takotsubo syndrome. Clinical characteristics as well as outcome predictors were analyzed. Overall, 2482 patients were included. ET was detected in 910 patients (36.7%), PT in 885 patients (34.4%), and NT was observed in 717 patients (28.9%). Compared with patients with PT or NT, patients with ET were younger, less frequently men, and had a lower prevalence of comorbidities. Adverse in‐hospital events (NT: 18.8% versus PT: 27.1% versus ET: 12.1%,
P
<0.001) and long‐term mortality rates (NT: 14.4% versus PT: 21.6% versus ET: 8.5%,
P
<0.001) were significantly lower in patients with ET. Increasing age (
P
<0.001), male sex (
P
=0.007), diabetes (
P
<0.001), malignancy (
P
=0.002), and a neurological disorder (
P
<0.001) were associated with a higher risk of long‐term mortality, while chest pain (
P
=0.035) and treatment with angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (
P
=0.027) were confirmed as independent predictors for a lower risk of long‐term mortality.

Conclusions

Patients with ET have better clinical conditions and a lower mortality rate. Increasing age, male sex, malignancy, a neurological disorder, chest pain, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, and diabetes were confirmed as predictors of long‐term mortality.
Vitamin D Metabolites and Risk of Cardiovascular Disease in Chronic Kidney Disease: The CRIC Study
Authors: Hsu Simon , Zelnick Leila R. , Bansal Nisha , Brown Julia , Denburg Michelle , Feldman Harold I. , Ginsberg Charles , Hoofnagle Andrew N. , Isakova Tamara , Leonard Mary B. , Lidgard Benjamin , Robinson‐Cohen Cassianne , Wolf Myles , Xie Dawei , Kestenbaum Bryan R. , de Boer Ian H. , Appel Lawrence J. , Chen Jing , Cohen Debbie L. , Go Alan S. , Lash James P. , Nelson Robert G. , Rahman Mahboob , Rao Panduranga S. , Shah Vallabh O. , Unruh Mark L.
Published: July 2023

Background

The ratio of 24,25‐dihydroxyvitamin D
3
/25‐hydroxyvitamin D
3
(vitamin D metabolite ratio [VDMR]) may reflect functional vitamin D activity. We examined associations of the VDMR, 25‐hydroxyvitamin D (25[OH]D), and 1,25‐dihydroxyvitamin D (1,25[OH]
2
D) with cardiovascular disease (CVD) in patients with chronic kidney disease.

Methods and Results

This study included longitudinal and cross‐sectional analyses of 1786 participants from the CRIC (Chronic Renal Insufficiency Cohort) Study. Serum 24,25‐dihydroxyvitamin D
3
, 25(OH)D, and 1,25(OH)
2
D were measured by liquid chromatography–tandem mass spectrometry 1 year after enrollment. The primary outcome was composite CVD (heart failure, myocardial infarction, stroke, and peripheral arterial disease). We used Cox regression with regression‐calibrated weights to test associations of the VDMR, 25(OH)D, and 1,25(OH)
2
D with incident CVD. We examined cross‐sectional associations of these metabolites with left ventricular mass index using linear regression. Analytic models adjusted for demographics, comorbidity, medications, estimated glomerular filtration rate, and proteinuria. The cohort was 42% non‐Hispanic White race and ethnicity, 42% non‐Hispanic Black race and ethnicity, and 12% Hispanic ethnicity. Mean age was 59 years, and 43% were women. Among 1066 participants without prevalent CVD, there were 298 composite first CVD events over a mean follow‐up of 8.6 years. Lower VDMR and 1,25(OH)
2
D were associated with incident CVD before, but not after, adjustment for estimated glomerular filtration rate and proteinuria (hazard ratio, 1.11 per 1 SD lower VDMR [95% CI, 0.95–1.31]). Only 25(OH)D was associated with left ventricular mass index after full covariate adjustment (0.6 g/m
2.7
per 10 ng/mL lower [95% CI, 0.0–1.3]).

Conclusions

Despite modest associations of 25(OH)D with left ventricular mass index, 25(OH)D, the VDMR, and 1,25(OH)
2
D were not associated with incident CVD in chronic kidney disease.
Individual Assessment of Perioperative Brain Growth Trajectories in Infants With Congenital Heart Disease: Correlation With Clinical and Surgical Risk Factors
Authors: Cromb Daniel , Bonthrone Alexandra F. , Maggioni Alessandra , Cawley Paul , Dimitrova Ralica , Kelly Christopher J. , Cordero‐Grande Lucilio , Carney Olivia , Egloff Alexia , Hughes Emer , Hajnal Joseph V. , Simpson John , Pushparajah Kuberan , Rutherford Mary A. , Edwards A. David , O'Muircheartaigh Jonathan , Counsell Serena J.
Published: July 2023

Background

Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors.

Methods and Results

A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants.
Z‐
scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of
Z
‐score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate
P
<0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate
P
=0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate
P
=0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate
P
<0.027).

Conclusions

Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short‐ and long‐term hypoxic injury.
Individual Trajectories of Health Status During the First Year of Discharge From Hospitalization for Heart Failure and Their Associations With Death in the Following Years
Authors: Zhang Lihua , Ji Runqing , He Guangda , Tian Aoxi , Huo Xiqian , Zheng Yang , Qi Liwei , Mi Yafei , Yan Xiaofang , Wang Bin , Lei Lubi , Li Jingkuo , Liu Jiamin , Li Jing
Published: July 2023

Background

Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long‐term individual trajectories of health status in patients with acute HF after discharge.

Methods and Results

We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire–12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire–12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (
P
<0.05). Compared with the pattern of persistently good, slowly improving (hazard ratio [HR], 1.50 [95% CI, 1.06–2.12]), moderately regressing (HR, 1.92 [1.43–2.58]), severely regressing (HR, 2.26 [1.54–3.31]), and persistently poor (HR, 2.34 [1.55–3.53]) were associated with increased risks of all‐cause death.

Conclusions

One‐fifth of 1‐year survivors after hospitalization for HF experienced unfavorable health status trajectories and had a substantially increased risk of death during the following years. Our findings help inform the understanding of disease progression from a patient perception perspective and its relationship with long‐term survival.

Registration

URL:
https://www.clinicaltrials.gov
; unique identifier: NCT02878811.
Sex Differences in the Effectiveness of Angiotensin‐Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers, and Sacubitril–Valsartan for the Treatment of Heart Failure
Authors: Sohani Zahra N. , Behlouli Hassan , de Moura Cristiano Soares , Abrahamowicz Michal , Pilote Louise
Published: July 2023

Background

PARAGON‐HF (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction) suggested a potential benefit of sacubitril–valsartan in women with preserved ejection fraction. Among patients with heart failure previously treated with angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), we studied whether effectiveness of treatment with sacubitril–valsartan compared with ACEI/ARB monotherapy differed between men and women for both preserved and reduced ejection fraction.

Methods and Results

Data were derived from the Truven Health MarketScan Databases between January 1, 2011, and December 31, 2018. We included patients with a primary diagnosis of heart failure on treatment with ACEIs, ARBs, or sacubitril–valsartan on the basis of the first prescription after diagnosis. A total of 7181 patients treated with sacubitril–valsartan, 25 408 patients using an ACEI, and 16 177 patients treated with ARBs were included. A total of 790 readmissions or deaths occurred among 7181 patients in the sacubitril–valsartan group and 11 901 events in 41 585 patients treated with an ACEI/ARB. Adjusted for covariates, the hazard ratio (HR) for treatment with sacubitril–valsartan compared with an ACEI or ARB was 0.74 (95% CI, 0.68–0.80). The protective effect of sacubitril–valsartan was evident for men and women (women: HR, 0.75 [95% CI, 0.66–0.86];
P
<0.01; men: HR, 0.71 [95% CI, 0.64–0.79];
P
<0.01;
P interaction
0.03). A protective effect for both sexes was seen only among those with systolic dysfunction.

Conclusions

Treatment with sacubitril–valsartan is more effective at reducing death and admission to the hospital for heart failure compared with ACEIs/ARBs similarly among men and women with systolic dysfunction; sex differences in the effectiveness of sacubitril–valsartan in diastolic dysfunction requires further investigation.
Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation
Authors: Gartenberg Ari J. , Okunowo Oluwatimilehin , Dori Yoav , Smith Christopher L. , Gaynor J. William , Mascio Christopher E. , Rome Jonathan J. , Gillespie Matthew J. , Glatz Andrew C. , O'Byrne Michael L.
Published: July 2023

Background

Intensive monitoring has been associated with a lower death rate between the Norwood operation and superior cavopulmonary connection, possibly due to early identification and effective treatment of residual anatomic lesions like recoarctation before lasting harm occurs.

Methods and Results

Neonates undergoing a Norwood operation and receiving interstage care at a single center between January 1, 2005, and September 18, 2020, were studied. In those with recoarctation, we evaluated association of era ([1] preinterstage monitoring, [2] a transitional phase, [3] current era) and likelihood of hemodynamic compromise (progression to moderate or greater ventricular dysfunction/atrioventricular valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding catheterization, or interstage death with recoarctation on autopsy). We also analyzed whether era was associated with technical success of transcatheter recoarctation interventions, major adverse events, and transplant‐free survival. A total of 483 subjects were studied, with 22% (n=106) treated for recoarctation during the interstage period. Number of catheterizations per Norwood increased (
P
=0.005) over the interstage eras, with no significant change in the proportion of subjects with recoarctation (
P
=0.36). In parallel, there was a lower likelihood of hemodynamic compromise in subjects with recoarctation that was not statistically significant (
P
=0.06), with a significant difference in the proportion with ventricular dysfunction at intervention (
P
=0.002). Rates of technical success, procedural major adverse events, and transplant‐free survival did not differ (
P
>0.05).

Conclusions

Periods with interstage monitoring were associated with increased referral for catheterization but also reduced likelihood of ventricular dysfunction (and a suggestion of lower likelihood of hemodynamic compromise) in subjects with recoarctation. Further study is needed to guide optimal interstage care of this vulnerable population.
Clinical Outcomes in Hypertensive Emergency: A Systematic Review and Meta‐Analysis
Authors: Siddiqi Tariq Jamal , Usman Muhammad Shariq , Rashid Ahmed Mustafa , Javaid Syed Sarmad , Ahmed Aymen , Clark Donald , Flack John M. , Shimbo Daichi , Choi Eunhee , Jones Daniel W. , Hall Michael E.
Published: July 2023

Background

To study the prevalence and types of hypertension‐mediated organ damage and the prognosis of patients presenting to the emergency department (ED) with hypertensive emergencies.

Methods and Results

PubMed was queried from inception through November 30, 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Studies reporting data on hypertensive emergencies in other departments were excluded. The extracted data were arcsine transformed and pooled using a random‐effects model. Fifteen studies (n=4370 patients) were included. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI, 0.40%–0.70%) in all patients presenting to ED and 35.9% (95% CI, 26.7%–45.5%) among patients presenting in ED with hypertensive crisis. Ischemic stroke (28.1% [95% CI, 18.7%–38.6%]) was the most prevalent hypertension‐mediated organ damage, followed by pulmonary edema/acute heart failure (24.1% [95% CI, 19.0%–29.7%]), hemorrhagic stroke (14.6% [95% CI, 9.9%–20.0%]), acute coronary syndrome (10.8% [95% CI, 7.3%–14.8%]), renal failure (8.0% [95% CI, 2.9%–15.5%]), subarachnoid hemorrhage (6.9% [95% CI, 3.9%–10.7%]), encephalopathy (6.1% [95% CI, 1.9%–12.4%]), and the least prevalent was aortic dissection (1.8% [95% CI, 1.1%–2.8%]). Prevalence of in‐hospital mortality among patients with hypertensive emergency was 9.9% (95% CI, 1.4%–24.6%).

Conclusions

Our findings demonstrate a pattern of hypertension‐mediated organ damage primarily affecting the brain and heart, substantial cardiovascular renal morbidity and mortality, as well as subsequent hospitalization in patients with hypertensive emergencies presenting to the ED.
Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population‐Based Cohort Study
Authors: Jung Mi‐Hyang , Lee So‐Young , Youn Jong‐Chan , Chung Woo‐Baek , Ihm Sang‐Hyun , Kang Dongwoo , Kyoung Dae‐Sung , Jung Hae Ok , Chang Kiyuk , Youn Ho‐Joong , Lee Hokyou , Kang Danbee , Cho Juhee , Kaneko Hidehiro , Kim Hyeon Chang
Published: July 2023

Background

Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer.

Methods and Results

Using the 2002 to 2013 Korean National Health Insurance Service–National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio <0.8), and poor (medication possession ratio <0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow‐up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85‐fold and 2.19‐fold increased risk for overall mortality, and 1.72‐fold and 1.71‐fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33‐fold and 1.34‐fold elevated risk of new‐onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes.

Conclusions

Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.