bluuebunny/crossref_metadata_2025 huggingface dataset:
Bayesian inference of Lévy walks via hidden Markov models
Authors: Park Seongyu , Thapa Samudrajit , Kim Yeongjin , Lomholt Michael A , Jeon Jae-Hyung
Published: October 2021

The Lévy walk (LW) is a non-Brownian random walk model that has been found to describe anomalous dynamic phenomena in diverse fields ranging from biology over quantum physics to ecology. Recurrently occurring problems are to examine whether observed data are successfully quantified by a model classified as LWs or not and extract the best model parameters in accordance with the data. Motivated by such needs, we propose a hidden Markov model for LWs and computationally realize and test the corresponding Bayesian inference method. We introduce a Markovian decomposition scheme to approximate a renewal process governed by a power-law waiting time distribution. Using this, we construct the likelihood function of LWs based on a hidden Markov model and the forward algorithm. With the LW trajectories simulated at various conditions, we perform the Bayesian inference for parameter estimation and model classification. We show that the power-law exponent of the flight-time distribution can be successfully extracted even at the condition that the mean-squared displacement does not display the expected scaling exponent due to the noise or insufficient trajectory length. It is also demonstrated that the Bayesian method performs remarkably inferring the LW trajectories from given unclassified trajectory data set if the noise level is moderate.
Selective catalytic reduction of NO
x
with NH3 assisted by non-thermal plasma over CeMnZrO
x
@TiO2 core–shell catalyst
Authors: ZHU Tao , ZHANG Xing , LI Zhenguo , REN Xiaoning , WANG Baodong , CHONG Xuyang , MA Hongli
Published: October 2021

The presented work reports the selective catalytic reduction (SCR) of NO
x
assisted by dielectric barrier discharge plasma via simulating marine diesel engine exhaust, and the experimental results demonstrate that the low-temperature activity of NH3-SCR assisted by non-thermal plasma is enhanced significantly, particularly in the presence of a C3H6 additive. Simultaneously, CeMnZrO
x
@TiO2 exhibits strong tolerance to SO2 poisoning and superior catalytic stability. It is worthwhile to explore a new approach to remove NO
x
from marine diesel engine exhaust, which is of vital significance for both academic research and practical applications.
Integral binary Hamiltonian forms and their waterworlds
Authors: Parkkonen Jouni , Paulin Frédéric
Published: October 2021

We give a graphical theory of integral indefinite binary Hamiltonian forms

f
f

analogous to the one of Conway for binary quadratic forms and the one of Bestvina-Savin for binary Hermitian forms. Given a maximal order

O

\mathscr {O}

in a definite quaternion algebra over

Q

\mathbb {Q}

, we define the waterworld of

f
f

, analogous to Conway’s river and Bestvina-Savin’s ocean, and use it to give a combinatorial description of the values of

f
f

on

O

×

O

\mathscr {O}\times \mathscr {O}

. We use an appropriate normalisation of Busemann distances to the cusps (with an algebraic description given in an independent appendix), the

SL

2

⁡
(

O

)

\operatorname {SL}_{2}(\mathscr {O})

-equivariant Ford-Voronoi cellulation of the real hyperbolic

5
5

-space, and the conformal action of

SL

2

⁡
(

O

)

\operatorname {SL}_{2}(\mathscr {O})

on the Hamilton quaternions.
Making cobordisms symplectic
Authors: Eliashberg Yakov , Murphy Emmy
Published: October 2021

We establish an existence

h
h

-principle for symplectic cobordisms of dimension

2
n
>
4

2n>4

with concave overtwisted contact boundary.
On dimensions of visible parts of self-similar sets with finite rotation groups
Authors: Järvenpää Esa , Järvenpää Maarit , Suomala Ville , Wu Meng
Published: October 2021

We derive an upper bound for the Assouad dimension of visible parts of self-similar sets generated by iterated function systems with finite rotation groups and satisfying the weak separation condition. The bound is valid for all visible parts and it depends on the direction and the penetrable part of the set, which is a concept defined in this paper. As a corollary, we obtain in the planar case that if the projection is a finite or countable union of intervals then the visible part is 1-dimensional. We also prove that the Assouad dimension of a visible part is strictly smaller than the Hausdorff dimension of the set provided the projection contains interior points. Our proof relies on Furstenberg’s dimension conservation principle for self-similar sets.
Uniform estimates for almost primes over finite fields
Authors: Elboim Dor , Gorodetsky Ofir
Published: October 2021

We establish a new asymptotic formula for the number of polynomials of degree

n
n

with

k
k

prime factors over a finite field

F

q

\mathbb {F}_q

. The error term tends to

0
0

uniformly in

n
n

and in

q
q

. Previously, asymptotic formulas were known either for fixed

q
q

, through the works of Warlimont [Arch. Math. (Basel) 60 (1993), pp. 58–72] and Hwang [Random Structures Algorithms 13 (1998), pp. 17–47], or for small

k
k

, through the work of Arratia, Barbour and Tavaré [Math. Proc. Cambridge Philos. Soc. 114 (1993), pp. 347–368].

As an application, we estimate the total variation distance between the number of cycles in a random permutation on

n
n

elements and the number of prime factors of a random polynomial of degree

n
n

over

F

q

\mathbb {F}_q

. The distance tends to

0
0

at rate

1

/

(
q

log
⁡
n

)

1/(q\sqrt {\log n})

. Previously this was only understood when either

q
q

is fixed and

n
n

tends to

∞
\infty

, or

n
n

is fixed and

q
q

tends to

∞
\infty

, by results of Arratia, Barbour and Tavaré.
Discrete analytic Schur functions
Authors: Alpay Daniel , Volok Dan
Published: October 2021

We introduce the Schur class of functions, discrete analytic on the integer lattice in the complex plane. As a special case, we derive the explicit form of discrete analytic Blaschke factors and solve the related basic interpolation problem.
A generalized Powers averaging property for commutative crossed products
Authors: Amrutam Tattwamasi , Ursu Dan
Published: October 2021

We prove a generalized version of Powers’ averaging property that characterizes simplicity of reduced crossed products

C
(
X
)

⋊
λ

G

C(X) \rtimes _\lambda G

, where

G
G

is a countable discrete group, and

X
X

is a compact Hausdorff space which

G
G

acts on minimally by homeomorphisms. As a consequence, we generalize results of Hartman and Kalantar on unique stationarity to the state space of

C
(
X
)

⋊
λ

G

C(X) \rtimes _\lambda G

and to Kawabe’s generalized space of amenable subgroups

Sub
a

⁡
(
X
,
G
)

\operatorname {Sub}_a(X,G)

. This further lets us generalize a result of the first named author and Kalantar on simplicity of intermediate C*-algebras. We prove that if

C
(
Y
)
⊆
C
(
X
)

C(Y) \subseteq C(X)

is an inclusion of unital commutative

G
G

-C*-algebras with

X
X

minimal and

C
(
Y
)

⋊
λ

G

C(Y) \rtimes _\lambda G

simple, then any intermediate C*-algebra

A
A

satisfying
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="upper C left-parenthesis upper Y right-parenthesis right-normal-factor-semidirect-product Subscript lamda Baseline upper G subset-of-or-equal-to upper A subset-of-or-equal-to upper C left-parenthesis upper X right-parenthesis right-normal-factor-semidirect-product Subscript lamda Baseline upper G">

C
(
Y
)

⋊
λ

G
⊆
A
⊆
C
(
X
)

⋊
λ

G

C(Y) \rtimes _\lambda G \subseteq A \subseteq C(X) \rtimes _\lambda G

is simple.
Fatigue Symptoms Associated With COVID-19 in Convalescent or Recovered COVID-19 Patients; a Systematic Review and Meta-Analysis
Authors: Rao Sanjay , Benzouak Tarek , Gunpat Sasha , Burns Rachel J , Tahir Tayyeb A , Jolles Stephen , Kisely Steve
Published: October 2021

Background

The prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown.

Aims

We performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection.

Method

Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on fatigue in samples that recovered from polymerase chain reaction (PCR) diagnosed COVID-19. English, French, and Spanish studies were included. Meta-analyses were conducted separately for each recruitment setting.

Results

We identified 41 studies with 9,362 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (risk ratio (RR) = 3.688, 95%CI [2.502, 5.436], p < .001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (event rate [ER] = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). Ten percent of the community patients reported fatigue in the first-month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.11, p < .001). Female patients recovering from COVID-19 had a greater self-report of fatigue (odds ratio [OR] = 1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe.

Conclusion

Fatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond the acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes. Further studies should examine the impact of sociodemographic, pandemic-related restrictions and pre-existing conditions on fatigue.
The American Society for Clinical Pathology 2020 Vacancy Survey of Medical Laboratories in the United States
Authors: Garcia Edna , Kundu Iman , Kelly Melissa , Soles Ryan
Published: October 2021

Objectives

To determine the extent and distribution of workforce shortages within the nation’s medical laboratories.

Methods

The survey was conducted through collaboration between the American Society for Clinical Pathology Institute for Science, Technology, and Public Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and Board of Certification in Chicago, IL. Data were collected via an internet survey distributed to individuals who were able to report on staffing and certifications for their laboratories.

Results

The coronavirus disease 2019 (COVID-19) pandemic disrupted the staffing of clinical laboratories and the stream of incoming graduates entering the workforce. Results show decreased vacancy rates for the majority of laboratory positions across all departments surveyed. The overall anticipated retirement rates continue to decline, which suggests that the field has already lost personnel with vast amounts of experience.

Conclusions

Addressing the current and future needs of the laboratory workforce requires a collective effort by numerous groups of stakeholders at all levels, including the laboratory employers, laboratory training programs, health care executives/hospital administrators, and professional organizations. The time is now to address the future shortage of laboratory professionals and to create a resilient clinical laboratory professional workforce.
Identification of Enzymes from Pseudogluconobacter saccharoketogenes Producing d-Glucaric Acid from d-Glucose
Authors: Ito Tetsuya , Masaki Hisaharu , Fujita Koki , Murakami Hiromi , Shizuma Motohiro , Kiso Taro , Kiryu Takaaki
Published: October 2021

In 2004, the US Department of Energy listed d-glucaric acid as one of the top 12 bio-based chemicals and a potential biopolymer building block. In this study, we show that Pseudogluconobacter saccharoketogenes strains can produce d-glucaric acid from d-glucose, although in low yield because of the generation of the byproduct 2-keto-d-gluconic acid in large quantities. To improve d-glucaric acid yield, we generated Rh47-3, a P. saccharoketogenes IFO14464 mutant, which produced d-glucaric acid from d-gluconic acid and d-glucose with 81 and 53 mol% yields, respectively. Furthermore, the key enzymes involved in d-glucaric acid production, alcohol dehydrogenase (Ps-ADH), aldehyde dehydrogenase (Ps-ALDH), and gluconate 2-dehydrogenase (Ps-GADH), were purified and their roles in d-glucaric acid synthesis were evaluated. Ps-ADH and Ps-ALDH catalyzed d-glucaric acid production, which was mediated by d-gluconic acid and d-glucuronic acid pathways. In contrast, Ps-GADH inhibited d-glucaric acid production by promoting the formation of 2-keto-d-gluconic acid from d-glucose.
Different expressions of aquaporin water channels and macrophages infiltration in human cervix remodeling during pregnancy
Authors: Yang Jinying , Yu Shengjun , Zhang Guanglan , Zheng Zheng , Li Ping , Mei Shanshan , Han Xinjia
Published: October 2021

Despite aquaporin water channels (AQPs) play a critical role in maintaining water homeostasis in female reproductive tract and prompt a gradual increase in water content in cervical edema as pregnancy progressed, their relationship with macrophage infiltration and collagen content in human cervical remodeling need to be further investigated. This is the first study to examine the expression and localization of AQP3, AQP4, AQP5, AQP8, and macrophages simultaneously in human cervical ripening. The immunoreactivity of these AQPs was 2.6 to 6-fold higher on gestational weeks 26 (GD26W) than that on GD6W and GD15W, but AQP4 expression on GD39W dropped a similar extent on GD15W, other AQPs continued to rise on GD39W. The AQP3, AQP4, and AQP5 intensity seemed more abundant in cervical stroma than in the perivascular area on GD26W; the distribution of AQP3, AQP5, and AQP8 in cervical stroma was equivalent to that in the perivascular area on GD39W. Macrophage numbers were 1.7-fold higher in subepithelium region and 3.0-fold higher in center area on GD26W than that on GD15W; such numbers remained elevated on GD39W. The electron micrographs showed that cervical extensibility increased significantly on GD26W and GD39W accompanied with increased macrophage infiltration, cervical water content, and much more space among collagen fibers. These findings suggest that the upregulation of AQPs expression in human cervix is closely related to enhanced macrophage infiltration during pregnancy; there may be a positive feedback mechanism between them to lead the increase of water content and the degradation of collagen.
Metabolic changes in female rats exposed to intrauterine hyperglycemia and postweaning consumption of high-fat diet
Authors: Paula Verônyca Gonçalves , Sinzato Yuri Karen , de Moraes-Souza Rafaianne Queiroz , Soares Thaigra Sousa , Souza Franciane Quintanilha Gallego , Karki Barshana , de Andrade Paes Antonio Marcus , Corrente José Eduardo , Damasceno Débora Cristina , Volpato Gustavo Tadeu
Published: October 2021

We evaluated the influence of the hyperglycemic intrauterine environment and postweaning consumption of a high-fat diet (HFD) on the glycemia, insulin, lipid, and immunological profile of rat offspring in adulthood. Female rats received citrate buffer (Control—C) or Streptozotocin (a beta cell-cytotoxic drug to induce diabetes—D) on postnatal day 5. In adulthood, these rats were mated to obtain female offspring, who were fed a standard diet (SD) or HFD from weaning to adulthood (n = 10 rats/group). OC/SD and OC/HFD represent female offspring of control mothers and received SD or HFD, respectively; OD/SD and OD/HFD represent female offspring of diabetic mothers and received SD or HFD, respectively. At adulthood, the oral glucose tolerance test (OGTT) was performed and, next, the rats were anesthetized and euthanized. Pancreas was collected and analyzed, and adipose tissue was weighted. Blood samples were collected to determine biochemical and immunological profiles. The food intake was lower in HFD-fed rats and visceral fat weight was increased in the OD/HFD group. OC/HFD, OD/SD, and OD/HFD groups presented glucose intolerance and lower insulin secretion during OGTT. An impaired pancreatic beta-cell function was shown in the adult offspring of diabetic rats, regardless of diet. Interleukin (IL)-6 and IL-10 concentrations were lower in the OD/HFD group and associated to a low-grade inflammatory condition. The fetal programming was responsible for impaired beta cell function in experimental animals. The association of maternal diabetes and postweaning HFD are responsible for greater glucose intolerance, impaired insulin secretion and immunological change.
Still the Exception? Challenging Ideas of Gender in Norwegian Policing
Authors: Jon Nina
Published: October 2021

This article is an empirical exploration of the role of gender in today’s Norwegian police force. For this study, 21 emergency response officers were interviewed as part of an investigation into the role played by gender in operational police work. This study indicates that changes towards a more gender-equal Norwegian society, combined with general developments within the police at a time when the number of women in the police force has increased considerably, have led to female operational police officers finding that their gender is not a problem. The findings challenge earlier models of theorising and conceptualisation, and point to the need to avoid perpetuating notions that may needlessly limit policewomen’s individual freedom and agency on account of their gender.
How social profiles influence community entrepreneurs’ capacity to develop networks. A Bourdieuan perspective on Italian community co-operatives
Authors: Michele Bianchi
Published: October 2021

During the last decade, Italian community co-operatives have emerged as a new form of community-development organization. The literature on community-based enterprises (CBEs) explains this phenomenon as a community that becomes entrepreneurial and develops locally based businesses for its socio-economic development. Nevertheless, a more critical view of CBEs reveals the partiality of a community’s participation in these organizations. Therefore, it is necessary to investigate the extent to which the mainstream theoretical framework for analysing these organizations has influenced the general understanding of this phenomenon. This research brings into discussion social–capital theories, particularly Putnam’s neo-communitarian approach. It also proposes a diverse perspective on CBEs and community development by offering a critical analysis based on Pierre Bourdieu’s works. The present study considers a specific form of CBEs—the community co-operative—with particular reference to the Italian context. Results from an online questionnaire (twenty-nine participants) and a cross-case study analysis (five co-operatives) show that community entrepreneurs have common determined social profiles and these help them to aggregate certain local agents instead of others.
Two-stage instrumental variable estimation of linear panel data models with interactive effects
Authors: Cui Guowei , Norkutė Milda , Sarafidis Vasilis , Yamagata Takashi
Published: October 2021

This paper analyses the instrumental variables (IV) approach put forward by Norkute et al. (2021), in the context of static linear panel data models with interactive effects present in the error term and the regressors. Instruments are obtained from transformed regressors, thereby it is not necessary to search for external instruments. We consider a two-stage IV (2SIV) and a mean-group IV (MGIV) estimator for homogeneous and heterogeneous slope models, respectively. The asymptotic analysis reveals that: (i) the $\sqrt{\textit {NT}}$-consistent 2SIV estimator is free from asymptotic bias that may arise due to the estimation error of the interactive effects, while (ii) existing estimators can suffer from asymptotic bias; (iii) the proposed 2SIV estimator is asymptotically as efficient as existing estimators that eliminate interactive effects jointly in the regressors and the error, while (iv) the relative efficiency of the estimators that eliminate interactive effects only in the error term is indeterminate. A Monte Carlo study confirms good approximation quality of our asymptotic results.
Commodity risk in European dairy firms
Authors: Bagnarosa Guillaume , Cummins Mark , Dowling Michael , Kearney Fearghal
Published: October 2021

We apply a multivariate mixed-data sampling (MIDAS) conditional quantile regression technique to understand the dairy commodity exposure of European dairy firms. Leveraging a theoretically sound hedonic dairy pricing framework, we show that our approach is able to identify both market and operational risk. Profit margins for butter and milk price are particularly important for operational performance. Additional tests are provided, including an application of MIDAS quantile on a period of amplified dairy market risk. Our approach thus allows dairy firms to gain new perspectives on the significant risks posed by the current structure of dairy production in Europe.
Prediction of early left ventricular recovery and adverse remodelling in patients with acute myocardial infarction: the role of non-invasive myocardial work evaluation
Authors: Caminiti R , Vetta G , Parlavecchio A , Marano G , Ruggieri C , Citro R , Radano I , Pucci M , Di Bella G , Micari A , Carerj S , Zito C
Published: October 2021

Background

Left ventricular recovery (LVR) and adverse left ventricular remodelling (aLVR) after acute myocardial infarction (AMI) play an important prognostic role.

Purpose

Our aim was to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and aLVR.

Methods

Fifty patients with AMI (mean age, 63,8±13,4 years), treated by percutaneous coronary intervention (PCI), were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 48 hours after PCI and a median of 31 days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. Segmental LVR was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥5% from LVEF at the baseline. The aLVR was defined as an increase of ≥20% of the LV end diastolic volume (LVEDV) at 1 month follow up.

Results

We found significant differences between the baseline and the follow-up value of LVEF (49,28 vs 52,80 p=0.001), Global Longitudinal Strain (GLS) (−13,41 vs −18,72, p=0.016), Global Work Index (GWI) (1368,68 vs 1788,08, p<0.0001), Global Work Efficiency (GWE) (86,96 vs 91,36, p=0.001), and Global Constructive Work (GCW) (1619,16 vs 2008,68, p<0.0001). The LVR at 1 month of follow-up was observed in 36% of the population enrolled, whereas aLVR was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 137 mmHg/% for baseline Global Wasted Work (Sensitivity 100%, Specificity 57,14%, AUC 0.6667, CI 95%: 0,51618- 0,81715, p<0.0001) to identify patients with aLVR at 1 month. With regards to conventional echo parameters, patients with LVR showed lower baseline Wall Motion Score Index (WMSI) than those with LVR (1,73 vs 1,38, p=0.007).

Conclusions

Baseline global wasted work can predict early adverse left ventricular remodelling at 1 months after AMI. These parameters could be used at baseline in order to predict worse outcome in AMI patients. Further larger scale studies are needed to validate these findings.

Funding Acknowledgement

Type of funding sources: None.
Chronic kidney disease and risk of atrial fibrillation and heart failure in general population-based cohorts – the BiomarCaRE project
Authors: Rehm M , Rothenbacher D , Iacoviello L , Costanzo S , Tunstall-Pedoe H , Fitton C.A , Soederberg S , Hultdin J , Salomaa V , Palosaari T , Waldeyer C , Schnabel R.B , Zeller T , Blankenberg S , Koenig W ,   the BiomarCaRE Consortium
Published: October 2021

Background

Chronic kidney disease (CKD) has a complicated relationship with the heart, leading to many adverse outcomes.

Purpose

The aim of the study was to evaluate the relationship between CKD and the incidence of atrial fibrillation (AF) and heart failure (HF) along with mortality as a competing risk in general population cohorts.

Methods

This study was conducted as part of the BiomarCaRE project using harmonised data from 12 population-based cohorts (n=40,212) from Europe. Cox proportional hazards models were used to determine hazard ratios (HRs) for the incidence of AF and HF in CKD and with competing mortality risk after adjusting for covariates.

Results

Mean age at baseline was 51.1 (standard deviation 11.9) years, and 49.3% were men. Overall, 3.5% had CKD at baseline. The rate for incident AF was 3.9 per 1000 person-years during follow-up. The HR for AF for those with CKD compared with those without was 1.23 (95% CI 1.00–1.52, p=0.0465) after adjustment for covariates. The rate for incident HF was 3.9 per 1000 person-years and the associated risk in the presence of CKD was HR 1.67 (95% CI 1.39–2.01). In subjects with CKD, N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed an association with AF, while NT-proBNP and C-reactive protein (CRP) showed an association with HF.

Conclusion

CKD is an independent risk factor for subsequent AF and even more so for HF. In patients with CKD, NT-proBNP was clearly associated with subsequent risk of AF. In addition to this marker, hs-CRP was also associated with risk of subsequent HF.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011_278913. Atrial Fibrillation and HF in CKD
Antidiabetic drugs use and new-onset atrial fibrillation in patients with diabetes mellitus
Authors: Fauchier L , Fauchier G , Bisson A , Bodin A , Herbert J , Angoulvant D , Ducluzeau P.H , Lip G.Y.H
Published: October 2021

Background

Diabetes is one of the most common chronic disorders worldwide and is an important cause of cardiovascular disease. Large studies investigating the risk of atrial fibrillation (AF) in diabetic patients taking different diabetes medications are still missing.

Methods

The analysis was based on the EGB (“Echantillon Généraliste des Bénéficiaires”) database, a 1/97 representative sample of the French nationwide claims and hospitalisation database. A cohort comprising 25,117 adult patients with diabetes and no previous AF seen between 2010 and 2018 was created and followed until December 2018 for incidence of new-onset AF. Among these diabetic patients, 36.0% were treated with metformin, 32.0% were treated with Sulfonylureas, 7.0% were treated with DPP4-inhibitors, 1.6% were treated with GLP1- analogues and 19.6% were treated with insulin. A Cox proportional hazards model was used to determine factors and different oral diabetes medications independently associated with the risk of AF during follow-up.

Results

During a follow-up of 4.8±3.5 years, there were 3,300 patients with new onset AF (yearly rate 2.7%). In multivariable analysis, among baseline characteristics, we found that older age, male sex, hypertension, heart failure, aortic stenosis, chronic kidney disease, anemia and diuretic use were independently associated with a higher risk of new AF. Among diabetes medications included in the multivariable model, use of sulfonylureas was independently associated with a lower risk of AF (HR 0.86, 95% CI 0.80–0.92, p<0.0001 vs no use). By contrast, use of GLP1-analogues (HR 2.27, 95% CI 1.49–3.46, p=0.0001 vs no use), DPP4-inhibitors (HR 1.88, 95% CI 1.59–2.22, p<0.0001 vs no use), metformin (HR 1.09, 95% CI 1.01–1.18, p=0.03 vs no use) and of insulin (HR 1.15, 95% CI 1.05–1.26, p=0.004 vs no use) were independently associated with a higher risk of AF.

Conclusions

Patients with different diabetes medications have significantly different long-term risk of AF. Specifically, sulfonylureas use was associated with a lower risk of incident AF whilst other antidiabetic drugs were associated with a higher risk of AF during follow-up.

Funding Acknowledgement

Type of funding sources: None.
Immunothrombosis and new-onset atrial fibrillation in the general population
Authors: Tilly M.J , Geurts S , Donkel S.J , Ikram M.A , De Groot N.M.S , De Maat M.P.M , Kavousi M
Published: October 2021

Background

Atrial fibrillation (AF) is the most common, age-related cardiac arrhythmia. However, the etiology underlying atrial fibrillation is still largely unknown. At the intersection of the innate immune system and hemostasis, immunothrombosis may be a possible cause of atrial remodeling, and therefore be an underlying cause of AF.

Purpose

We aim to evaluate the association between markers of immunothrombosis and new-onset AF in the general population

Methods

From 1990 to 2014, we followed 6,174 participants aged 55 and over, free from AF at inclusion. Immunothrombosis factors fibrinogen, von Willebrand factor, ADAMTS13, and neutrophil extracellular traps (NETs) levels were measured at baseline. Participants were followed until either onset of AF, death, loss-to-follow-up, or reaching the end-date of 01–01–2014. Cox proportional hazard modelling was used to calculated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for cardiovascular risk factors.

Results

We followed 6,174 participants (mean age 69.1 years, 57% women) for a median follow-up time of 12.8 years. 364 men (13.7%, incidence rate 13.0/100 person-years) and 365 women (10.4%, incidence rate 8.9/1000 person-years) developed AF. We found no significant associations between markers of immunothrombosis and new-onset AF after adjusting for cardiovascular risk factors [HR 1.00 (95% CI 0.93–1.08) for fibrinogen, 1.04 (0.97–1.12) for von Willebrand factor, 1.00 (1.00–1.01) for ADAMTS13, and 1.01 (0.94–1.09) for NETs]. Additionally, we found no significant differences in associations between men and women.

Conclusion

We found no association between markers of immunothrombosis and new-onset AF in the general population. Our findings imply that inflammation and immunothrombosis may be associated with AF by other cardiovascular risk factors or predisposing conditions of AF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw) Erasmus MC Mrace grant
Less dementia in patients with newly diagnosed atrial fibrillation adhering with a clustering of healthy lifestyle behaviours: a nationwide population-based cohort study
Authors: Park S.H , Lee S.R , Choi E.K , Lee S.W , Han K.D , Oh S , Lip G.Y.H
Published: October 2021

Background

Atrial fibrillation (AF) increases the risk of dementia. A new paradigm for AF management should include a new pillar targeting lifestyle modification. There are limited data on the clinical impact of healthy lifestyle behaviours on the risk of dementia in patients with newly diagnosed AF.

Purpose

To evaluate the association between the combination(s) of healthy lifestyle behaviours and the risk of incident dementia in patients with AF

Methods

Using the Korean National Health Insurance database between 2009 and 2016, we identified adult patients who were newly diagnosed as AF without dementia and underwent national health screening examination within 2-year after their AF diagnosis. Patients were categorized into 4 groups according to a healthy lifestyle-behavior score (HLS) 0, 1, 2, and 3 by assigning 1 point each for no current smoking, abstaining alcohol, and performing regular exercise. For the comparison, each group was balanced using the inverse probability of treatment weighting (IPTW). The primary outcome was incident dementia during follow-up.

Results

Among a total of 199,952 patients (mean age 63.2; 60.2% male) were included, the number of patients within the HLS 0, 1, 2, and 3 groups were 8709 (4.4%), 34839 (17.4%), 106796 (53.4%) and 49608 (24.8%), respectively. After IPTW, weighted incidence rates of dementia were 21.8, 16.8, 16.8, and 13.6 per 1000 person-years for HLS 0, 1, 2, and 3 groups, respectively. After multivariable adjustment of subjects edited by IPTW, HLS 1,2, and 3 groups were associated with a lower risk of dementia compared to HLS 0 group: Hazard Ratio [HR] 0.769, 95% confidence interval [CI] 0.704–0.842 for score 1; HR 0.770, 95% CI 0.709–0.836 for score 2; HR 0.622, 95% CI 0.569–0.679 for score 3. The effect of healthy lifestyle was similar for Alzheimer's dementia (HR 0.823, 95% CI 0.739–0.917 for score 1; HR 0.839, 95% CI 0.760–0.927 for score 2; HR 0.660, 95% CI 0.594–0.734 for score 3) and vascular dementia (HR 0.532, 95% CI 0.437–0.648 for score 1; HR 0.503 95% CI 0.422–0.600 for score 2; HR 0.458, 95% CI 0.378–0.554 for score 3). There was consistency in subgroup analyses stratified by age, sex, CHA2DS2-VASc score, oral anticoagulation use and prior stroke history.

Conclusion

A combination of a healthy lifestyle, including quitting smoking, abstaining from alcohol consumption, and performing regular physical activity, was associated with a significantly lower risk of dementia in both Alzheimer's dementia and vascular dementia in patients with new-onset AF. These findings support the promotion of a healthy lifestyle within an integrated care approach to AF patient management, which could reduce the risk of dementia.

Funding Acknowledgement

Type of funding sources: None.
Atrial chamber colocalization for multiple 3D imaging techniques in atrial fibrillation
Authors: Rios-Munoz G , Perez-Hernandez C , Fernandez-Aviles F , Arenal A
Published: October 2021

Introduction

There exist many imaging techniques and systems to reproduce atrial chambers in 3D. These technologies include electroanatomical (EA) mapping systems, noninvasive electrocardiographic imaging (ECGI), magnetic resonance imaging (MRI), or computed tomography (CT) scans. In the case of atrial fibrillation (AF), the most employed non-pharmacological treatment is catheter ablation to electrically isolate the pulmonary veins from the rest of the left atrium. Driver mechanisms such as focal or rotational activity have been proposed as possible initiating and maintaining mechanisms of AF. However, correspondence and validation of these sites when several systems are employed in the same patient remains a challenge, as they are mostly manually aligned based on visual inspection.

Purpose

To develop an automatic 3D alignment algorithm for cardiac 3D meshes to colocalize points between atrial maps generated with multiple EA mapping systems, ECGI, MRI, or CT scans.

Methods

A total of 25 left atrial meshes from persistent AF patients were exported from an EA mapping system. The total number of vertices for all the meshes was 2545444 points (101817.8±13593.3 points per map). A reference mesh was employed with minor modifications [1]. All meshes were manually segmented into 12 different left atrial regions, see Table for the region names. The method implements a non-rigid variant of the iterative closest point algorithm to transform the atrial mesh onto the reference one, see Figure. The geographical distance between the mean position of the 12 different segmented reference areas and the 12 transformed points was employed as the performance metric.

Results

The global error for all the fiducial points in all left atrial meshes was 11.57±2.55 mm. The average local errors for the 12 atrial areas are summarized in the Table. The best three aligned areas were the RSPV, atrial septum, and lateral wall. The areas with less alignment accuracy were the LAA, LSPV, and atrial roof.

Conclusions

The algorithm provides a promising solution to evaluate and validate site-related results from different systems, e.g., rotational activity presence between EA mapping and ECGI systems. The method works automatically for any given chamber anatomy or any number of points. No prior segmentation is needed since the transformation and co-localization are applied to the raw chamber mesh. Further analysis with a larger mesh database is needed.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Ministerio de Ciencia, Innovaciόn y Universidades
Should we keep performing electrical cardioversion in atrial fibrillation/flutter?
Authors: Menezes Fernandes R , Mota T.F , Costa H.A , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I
Published: October 2021

Introduction

Atrial fibrillation (AF) and atrial flutter (AFL) are frequently diagnosed arrhythmias in the outpatient setting or in the Emergency Department. Electrical cardioversion (EC) is a therapeutic option when a rhythm control strategy is pursued.

Purpose

To evaluate the clinical outcomes of patients with AF/AFL referred to EC and to analyse the procedures' complications.

Methods

We conducted a retrospective study enrolling patients with AF/AFL referred to EC in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. Primary endpoint was the incidence of ischemic stroke during follow-up.

Results

A total of 719 patients were referred to EC during the 9-year period, with a median age of 67 years-old and 70,4% male predominance. Most patients were cardioverted in an outpatient setting (60,6%) and 21% had AFL. 62,1% had persistent AF/AFL, 19,6% presented with first diagnosed AF/AFL and 17,2% had paroxysmal episodes. EC was successfully performed in 93,2% and 0,3% had major non-fatal immediate complications. Arterial hypertension was present in 57,3% of patients, 20,4% had diabetes, 34,6% were obese, 13,3% mentioned alcohol consumption and 6,3% had sleep apnea. Previous stroke was diagnosed in 6,8% and 19% had ischemic heart disease. Left ventricular (LV) ejection fraction (LVEF) was preserved in 66,7%. Median CHA2DS2-VASc score was 2,0 and 89,8% were anticoagulated (75,7% with non-vitamin K antagonist oral anticoagulants). Antiarrhythmic therapy was prescribed in 85% and 64,5% maintained sinus rhythm one-year after EC. After EC, it was documented complete reversal of LV systolic dysfunction in 46,3% of patients with previously reduced LVEF, confirming the diagnosis of arrhythmia-induced cardiomyopathy (AIC). During a median follow-up of 1355 days, ischemic stroke occurred in 4,8%, but only 5 patients had an embolic event in the first week after EC (0,7% stroke rate at one week, the same at one month). AIC was associated to a lower rate of cardiovascular death (3,8% vs 25,5%; p=0,002), comparing to patients who did not recover LV function.

Conclusion

EC is a safe procedure, with a very low rate of immediate and embolic complications. AIC was diagnosed in 46,3% of patients with previously reduced LVEF and it was associated with a significantly lower rate of CV death. EC should be considered to relieve patients' symptoms and when there is suspicion of AIC.

Funding Acknowledgement

Type of funding sources: None.
Pulmonary congestion during exercise stress echocardiography in hypertrophic cardiomyopathy
Authors: Palinkas E.D , Re F , Torres M.A.R , Peteiro J , Cotrim C , Van De Heyning C , Agoston G , D'Alfonso M.G , Mori F , De Castro E Silva Pretto J.L , Sepp R , Palinkas A , Simova I , Ciampi Q , Picano E ,   Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Published: October 2021

Background

B-lines detected by lung ultrasound (LUS) indicate pulmonary congestion during exercise stress echo (ESE).

Aim

To assess B-lines during ESE in hypertrophic cardiomyopathy (HCM).

Methods

We enrolled 110 HCM patients (age 52±16 years, 74 males) referred for ESE (treadmill in 39, semi-supine bicycle in 71 patients) in 10 quality-controlled centers from 8 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Portugal, Serbia, Spain). ESE assessment included: left ventricular outflow tract gradient (LVOTG); mitral regurgitation (MR, score from 0 to 3); E/e'; systolic pulmonary arterial pressure (SPAP, from tricuspid regurgitant jet velocity); end-diastolic volume (EDV); left atrial volume (LAV). B-lines were assessed by LUS with the 4-site simplified scan, each site scored from 0 (normal A-lines) to 10 (coalescing B-lines). The positivity criterion was a B-line score stress ≥2 points.

Results

LUS was feasible in all subjects, with additional scanning and analysis time <1 minute for each stage (rest and peak stress). B-lines were present in 13 patients at rest and in 33 during stress (12 vs 30%, p<0.001). When compared to patients without stress B-lines (Group 2, n=77), patients with B-lines (Group 1) showed higher values of change from rest to stress (Δ) in LVOTG (Group 1= 39±54 vs Group 2= 21±24 mm Hg, p=0.015) and ΔMR grade (Group 1= 0.7±0.8 vs Group 2= 0.1±0.5, p<0.001), more frequent peak stress E/e' ≥15 (Group 1=61% vs Group 2=27%, p=0.007), lower peak EDV (Group 1= 86±35 vs Group 2= 102±33 ml, p=0.039) and higher peak SPAP (Group 1= 60±21 vs Group 2= 39±12 mm Hg, p<0.001): see figure. At multivariable logistic regression analysis, presence of stress B-lines was predicted by ΔMR grade (odds ratio: 3.96, 95% CI 1.46–10.71) and stress E/e' ≥15 (odds ratio: 4.95, 95% CI 1.24–19.70).

Conclusion

B-lines are found in about 1 of 10 HCM patients at rest and in 1 of 3 during ESE. Acute backward heart failure during exercise can recognize multiple mechanisms in HCM, and ESE can help to capture this heterogeneity.

Funding Acknowledgement

Type of funding sources: None. Functional correlates of stress B-lines
Renal function and arrhythmia outcomes in persistent atrial fibrillation patients after catheter ablation: subanalysis of the EARNEST-PVI trial
Authors: Tanaka N , Inoue K , Masuda M , Furukawa Y , Hirata A , Egami Y , Watanabe T , Minamiguchi H , Miyoshi M , Okada M , Sunaga A , Sotomi Y , Dohi T , Hikoso S , Sakata Y ,   EARNEST-PVI trial
Published: October 2021

Background

Atrial fibrillation (AF) reduces the renal function. Renal dysfunction and AF often coexist. Catheter ablation (CA) of persistent AF can maintain a sinus rhythm and may improve the renal function.

Purpose

We sought to elucidate whether the estimated glomerular filtration rate (eGFR) in patients with persistent AF was increased after CA, especially with the presence of an AF recurrence.

Methods

We enrolled 487 persistent AF patients whose eGFR data were available both before and 1-year after the CA out of 512 patients in the EARNEST-PVI trial.

Results

The mean age was 65±9 year and 113 patients (24.8%) had long-standing persistent AF. We compared the eGFR at baseline with that 1-year after the CA. AF recurrences were recognized in 118 patients (25.8%). The eGFR was similar between the group without recurrence and that with recurrence at baseline (without AF recurrence vs. with AF recurrence; 63.8±14.3 vs. 62.7±13.6 mL/min/1.73m2, p=0.46). In patients without AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 13 (3.8%), 198 (58.4%), 98 (28.9%), 26 (7.7%), 3 (0.9%), and 1 (0.3%), respectively at baseline. In the patients with AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 3 (2.5%), 68 (57.8%), 38 (32.2%), 6 (5.1%), 3 (2.5%), and 0 (0%), respectively at baseline. The ΔeGFR was significantly higher in the patients without AF recurrence than in those with AF recurrence (without AF recurrence vs. with AF recurrence; 5.1 [−0.3, 10.8] vs. 3.0 [−3.0, 7.6], p=0.0033). In the patients without AF recurrence, a better eGFR class at 1-year after the CA than in those before the CA was recognized in 75 patients (22.1%), while it was recognized in 19 patients (16.1%) with AF recurrences.

Conclusion

Successful catheter ablation in patients with persistent AF led to a better renal outcome.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This study was funded by Medtronic, Johnson & Johnson, and Abbott.
Incidence of cardiovascular events in patients with atrial fibrillation anticoagulated with rivaroxaban after 2.5 years of follow-up: not all is stroke or bleeding
Authors: Anguita Sanchez M , Ruiz Ortiz M , Marin F , Sanmartin M , Rafols C , Masjuan J , Urena I , Baron Esquivias G , Lekuona I , Perez Cabeza A , Vazquez Rodriguez J.M ,   EMIR study group
Published: October 2021

Introduction

Atrial fibrillation (AF) is not a benign arrhythmia, but is associated with an increase in mortality, above all related to the risk of suffering thromboembolic events, mainly stroke. The use of oral anticoagulants (OAC) reduces this risk, but increases the risk of serious bleeding. The DOACs have been shown to be superior to the classic vitamin K antagonists (VKAs). It is not as well known whether AF is associated with an increase in other serious cardiac events.

Purpose

The objective of this analysis was to assess the incidence of stroke, major bleeding, total mortality and major adverse cardiac events [MACE, defined as cardiac mortality (including death for coronary events, progressive heart failure death and sudden cardiac death), coronary revascularization, myocardial infarction] in a contemporary series of patients with AF anticoagulated with rivaroxaban.

Methods

To do this, we have analyzed a series of 1,433 patients with AF, anticoagulated with rivaroxaban for at least the previous 6 months, consecutively included in the first half of year 2017 in 79 Spanish centers (EMIR study), and followed for 2.5 years.

Results

Mean age was 74.2±9.7 years, 44.5% being women. Prevalence of diabetes was 27.1%, chronic renal failure 16.1%, coronary heart disease 16.4% and heart failure 22.7%. 2MACE score was 1.8±1.4, CHA2DS2-VASc was 3.5±1.5 and HAS-BLED 1.6±1.0. 77.1% of patients received 20 mg/ day of rivaroxaban and 22.9% 15 mg/day. After a follow-up of 2.5 years, the annual rate (events/100 patients/year) of myocardial infarction was 0.16 (all non-STEMI), coronary revascularization 0.28, cardiac death 0.63 (sudden 0.16, heart failure 0.41, other 0.06), overall MACE 1.07 and overall mortality 2.73, while the incidence of stroke was 0.57 / 100 patients / year (ischemic 0.35, haemorrhagic 0.22) and major bleeding 1.04 (gastrointestinal 0.63, intracranial 0.28).

Conclusion

In a current series of patients with AF anticoagulated with rivaroxaban, the incidence of embolic and hemorrhagic complications and mortality are low, while the incidence of serious cardiac events is significant, being overall similar to that of stroke and major bleeding. Attention must be paid to the prevention and diagnosis of these problems.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania