bluuebunny/crossref_metadata_2025 huggingface dataset:
Polarization conversion in soft glass fluoride and chalcogenide fibers for mid-infrared applications
Authors: Khan Md Moinul Islam , Shamim Md Hosne Mobarok , Delarosbil Jean-Luc , Messaddeq Younes , Smektala Frederic , Rochette Martin
Published: January 2025

Mid-infrared (MIR) technologies are crucial for applications from chemical sensing to precision medical surgery. Effective polarization control is essential to enhance the functionality of fiber systems. Current solutions for polarization control in the MIR primarily involve free-space devices and components. In this work, we take a step forward and experimentally demonstrate polarization conversion within soft glass fluoride and chalcogenide fibers using a commercially available in-line polarization controller (PC). Our experiments using a single PC show a polarization extinction ratio (PER) of 20.7 dB in a ZBLAN fiber (FiberLabs) with a coating of urethane acrylic resin. Cascading two PCs enhances the PER to 39.1 dB while reducing the required compressive force and, thus, increasing the fiber lifetime. Chalcogenide fibers (As2Se3, As2S3, Ge20Se60Te20) are coated with polymethyl methacrylate and tested using a single PC. Thanks to the higher strain-optic coefficients of chalcogenide glass, these fibers exhibited exceptional PER values, reaching 39.3 dB for As2Se3, 41.4 dB for As2S3, and 38.3 dB for Ge20Se60Te20. The polymer coatings of the ZBLAN and chalcogenide fibers effectively protect them from compressive force and twisting, enabling them to endure more than 30 cycles of compression and decompression without breakage. Stability test conducted over 12 h with ZBLAN fiber demonstrated that the achieved polarization state remains stable, with maximum deviations due to environmental factors estimated to be less than 2%. This work is the first proof that in-line polarization control using soft glass fibers is achievable, paving the way toward the development of all-fiber MIR systems.
YOLO-VDS: accurate detection of strawberry developmental stages for embedded agricultural robots
Authors: Zhu Changshuang , Li Zelun , Liu Wei , Wu Pengcheng , Zhang Xin , Wang Shuai
Published: January 2025

Detecting the various developmental stages of strawberries in their natural environment is crucial for modern agricultural robots. Existing methods focus on fruit detection but ignore stage classification. Moreover, they usually requiring substantial computational resources and are not suitable for small and low-power embedded platforms. To address this problem, we propose YOLO-VDS, a lightweight model based on YOLOv5s and optimized for embedded platforms. We introduce the Inverse Residual Bottleneck with 3 Convolutions (IRBC3) module to enhance the feature extraction capability and reduce the model computation. Then, we enhance the feature extraction and representation capabilities by introducing Efficient Channel Attention (ECA) in the backbone. Experiments on the Strawberry-DS dataset show that YOLO-VDS performs significantly better than YOLOv5s and other similar algorithms. Compared to YOLOv5s, the accuracy is improved by 5.8%, mAP@ 0.5 by 7.7%, and the number of model parameters is reduced by 24.29%. Deployed on a Jetson TX2 NX, YOLO-VDS reaches 19.2 FPS after TensorRT acceleration, demonstrating its suitability for vision-guided harvesting robots and edge computing applications.
Subcutaneous Lower Pole Release as Double Bubble Prevention in Constricted Base Breasts: The “Plus One” Augmentation Technique
Authors: Fertsch Sonia , Wolter Andreas , Rancati Alberto , Angrigiani Claudio , Voigt Matthias , Andree Christoph
Published: January 2025

Background

Breasts with a broad base, constricted inframammary fold (IMF) and a short distance between the nipple and the IMF are predisposed to form a double bubble (DB) deformity. Most publications have focused on the correction of a DB rather than on its prevention and thorough analysis of the IMF.

Objectives

Introduction of a third dissection plane in breast augmentation for preventing or correcting DB deformities.

Methods

This study is a retrospective analysis conducted by a single surgeon, involving 46 patients with a well-defined constricted IMF who underwent breast augmentation with the ‘Plus One’ technique between 2019 and 2021. Women who required mastopexy were excluded. All procedures were analyzed for lower pole curvature using visual and graphical photographic analysis. The lower pole breast contour was plotted as a graph for better comparison of outcomes. Breast-Q surveys were conducted before and 3 months after surgery. Follow-ups were done at 2 weeks, 6 months, and 12 months after surgery.

Results

The curve of the postoperative lower pole was convex in 96% of the cases. In 4%, the curve tends to straighten out in the lower pole. In one case, the curve became concave at one point indicating a DB deformity, making a DB complication rate of 2%. The mean preoperative satisfaction score was 43±2, and the postoperative satisfaction score was 94±3 on the BREAST-Q scale.

Conclusions

The “plus one” method showed stable and satisfying results and is easily reproducible with a low complication rate. This can also be used as either a prophylactic or corrective measure.
Multidimensional scaling improves distance-based clustering for microbiome data
Authors: Chen Guanhua , Wang Xinyue , Sun Qiang , Tang Zheng-Zheng
Published: January 2025

Motivation

Clustering patients into subgroups based on their microbial compositions can greatly enhance our understanding of the role of microbes in human health and disease etiology. Distance-based clustering methods, such as partitioning around medoids (PAM), are popular due to their computational efficiency and absence of distributional assumptions. However, the performance of these methods can be suboptimal when true cluster memberships are driven by differences in the abundance of only a few microbes, a situation known as the sparse signal scenario.

Results

We demonstrate that classical multidimensional scaling (MDS), a widely used dimensionality reduction technique, effectively denoises microbiome data and enhances the clustering performance of distance-based methods. We propose a two-step procedure that first applies MDS to project high-dimensional microbiome data into a low-dimensional space, followed by distance-based clustering using the low-dimensional data. Our extensive simulations demonstrate that our procedure offers superior performance compared to directly conducting distance-based clustering under the sparse signal scenario. The advantage of our procedure is further showcased in several real data applications.

Availability and implementation

The R package MDSMClust is available at https://github.com/wxy929/MDS-project.
Efficacy of dupilumab for treatment-resistant Grover disease: a retrospective study
Authors: Amara Shivkar , Hawkins Kelly , Skaggs Elena , Kodali Nilesh , George Elisabeth , Lau Megan , Largen Joseph , Navrazhina Kristina , Lebwohl Mark , Guttman-Yassky Emma
Published: January 2025

Grover disease, while rare, significantly impacts quality of life due to its symptomatic pruritic papules and lack of definitive treatment strategy. Our study provides evidence of the effectiveness of dupilumab in the treatment of Grover disease, especially in patients with a history of atopic disease.
Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: scoping review
Authors: Fisch Charlotte , Gelderblom Malou E , Hermens Rosella P M G , de Reuver Philip R , Nienhuijs Simon W , Somford Diederik M , de Hullu Joanne A , Piek Jurgen M J
Published: January 2025

Background

Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries.

Methods

A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively.

Results

Eighteen studies were identified reporting on the implementation, surgical feasibility, patients’ perspectives, physicians’ knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective.

Conclusions

Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.
Non-ischemic etiology is a better prognostic factor of reverse left ventricular remodeling in patients with heart failure reduced ejection fraction
Authors: Yoon H J , Kim K H , Cho J Y , Park H J , Lee N L , Choi G H , Cho Y E
Published: January 2025

Background and Purpose

Even though the similar guideline directed standard care of heart failure (HF) is applied, clinical outcomes may differ in case by case. Since progressive left ventricular (LV) dilation makes the worse outcome, we investigate the prognostic factor of LV reverse remodeling and functional recovery in patients with heart failure reduced ejection fraction (HFrEF).

Methods

More than 1000 HFrEF who were followed from 2018 to 2023, 438 patients (61.1±15.2 years, 284 male) with consecutive echocardiography at 1-year intervals and treated by the guideline directed medical therapy including angiotensin receptor neprilysin inhibitor were enrolled. We compared clinical, laboratory, echocardiographic parameters according to LV reverse remodeling. LV reverse remodeling was defined as the normalized LV end-systolic volume index and LV functional recovery was defined as LV EF ≥ 50% on 1-year follow up echocardiography.

Results

Baseline clinical and echocardiographic characteristics including LV EF were not different between the groups. Non-ischemic etiology was significantly frequent in LV reverse remodeling group compared with non-reverse group (96.4% vs.88.6, p=0.005). During 5 years of clinical follow up, death was developed in 25 patients (5.7%), most of death was in non-reverse group (1.5% vs. 9.0%). Non-ischemic etiology was an independent predictor for LV reverse remodeling (OR 3.329, CI 1.253-8.846, p=0.012) and LV functional recovery (OR 4.210, CI 1.459-12.151, p=0.008) in patients with HFrEF. In Kaplan Meier analysis, non-ischemic etiology showed better outcome than ischemic etiology (Log Rank p=0.001). Ischemic etiology was an independent predictor of mortality in patients with HFrEF (OR 5.569, CI 2.127-14.582, p<0.001).

Conclusions

LV reverse remodeling was more common and clinical outcomes were better in non-ischemic etiology as compared to those of ischemic etiology, even after standard medication in patients with HFrEF. This etiologic difference of clinical outcomes should be considered in the management of HF.
Impact of unique hemodynamic characteristics and paradoxical ventricular function on clinical outcome of portopulmonary hypertension
Authors: Kim Y , Kwak S , Choi K , Yang J , Kang J , Hwang D , Chang S , Kim H
Published: January 2025

Background

Limited data are available on hemodynamic characteristics, outcomes, and liver transplantation candidacy for portopulmonary hypertension (PoPH). This study aimed to evaluate the hemodynamic characteristics, natural course, and outcomes following liver transplantation in PoPH patients.

Methods

Patients diagnosed with PoPH by right heart catheterization at two referral centers were retrospectively analyzed. PoPH was defined as Group 1 pulmonary arterial hypertension with clinical evidence of portal hypertension.

Results

We included 43 patients with PoPH (median age: 52 years; 19 men). Advanced liver cirrhosis was associated with higher cardiac index and tricuspid annular plane systolic excursion (TAPSE). Mean pulmonary arterial pressure (PAP) and right atrial pressure increased with increasing pulmonary vascular resistance (PVR), while the cardiac index declined but was mostly preserved within normal limits. Of the 34 patients without liver transplantation, 13 (38%) died during a median follow-up of 2.2 years. Severity of liver cirrhosis and an increased TAPSE were significant predictors of mortality (per 1 mm increase, adjusted hazard ratio 1.17, 95% confidence interval 1.01-1.35, p=0.042). Among the nine patients who underwent liver transplantation, six had a mean PAP of 35–45 mmHg and PVR >3 Wood units; of these, one died after liver transplantation, from reasons unrelated to pulmonary hypertension.

Conclusion

In PoPH patients, a higher cardiac index with right ventricular hypercontraction was prominent in advanced stages of liver cirrhosis. Higher TAPSE was identified as a risk factor for mortality in patients without liver transplantation. Establishing optimal PoPH candidates for liver transplantation is essential for improving patient survival.
Important role of longitudinal strain evaluated by speckle tracking echocardiography in Japanese Fabry disease patients
Authors: Nojiri A , Morimoto S , Fukoro E , Okuyama T , Anan I , Kawai M , Yoshimura M , Hongo K
Published: January 2025

Introduction

Fabry disease is an important infiltrative secondary cardiomyopathy caused by a decrease or deficiency in the lysosomal enzyme alpha-galactosidase A activity. The resultant accumulation of glycosphingolipids causes left ventricular hypertrophy (LVH), myocardial fibrosis, and arrhythmias. Recent advances in speckle tracking echocardiography have enabled the detection of early contractile dysfunction in various heart diseases.

Purpose

We examined whether or not longitudinal strain (LS) evaluated using speckle tracking echocardiography could detect early contractile dysfunction in Japanese patients with Fabry disease.

Methods

We recruited 56 patients with Fabry disease (22 men and 34 women) who were followed up at our University Hospital and 28 control subjects who showed normal standard echocardiographic findings in the present study. The diagnosis of Fabry disease was based on a mutation analysis of the GLA gene. Comprehensive echocardiography was performed using an ultrasound scanner. Cardiac mechanics were analyzed using the two-dimensional speckle tracking technique via automated function imaging and a Q-analysis software program according to consensus statements on cardiac mechanics quantitation. Using 3 apical views, the LS values of the 17 segments of the left ventricle were calculated for each patient. The global longitudinal strain (GLS) of each patient was also calculated.

Results

We divided the Fabry disease patients into two groups: patients without LVH (Fabry LVH [-]) and patients with LVH (Fabry LVH [+]). Figure 1 shows the results of the averaged LS values among the control, Fabry LVH (-), and Fabry LVH (+) groups. An analysis of variance detected significant differences in GLS and LS in the anterolateral region of the left ventricle (anterolateral LS) among the 3 groups. A post-hoc analysis revealed a significant decrease in GLS and anterolateral LS in Fabry LVH (-) compared to the control (Figure 2A-B). A receiver operating characteristic (ROC) analysis revealed that both GLS and anterolateral LS could discriminate Fabry LVH (-) from controls (Figure 2C). Using GLS, a cutoff value of -20.0 discriminated Fabry LVH (-) from controls with a sensitivity of 66.7% and specificity of 67.9%. Using anterolateral LS, a cutoff value of -18.8 discriminated Fabry LVH (-) from controls with a sensitivity of 69.7% and specificity of 60.7%.

Conclusions

These results suggest that early contractile dysfunction can be detected using GLS and anterolateral LS in Japanese patients with Fabry disease, even without LVH. The early detection of contractile dysfunction may be used to identify candidate patients for enzyme replacement therapy or pharmacological chaperone therapy.
Right ventricular and right atrial strain are associated with kidney dysfunction in acute heart failure
Authors: Anastasiou V , Peteinidou E P , Tountas C T , Daios S D , Moysidis D V M , Fardoulis E F , Gogos C G , Theodorakopoulou M T , Iatridi F I , Sarafidis P S , Giannakoulas G G , Karamitsos T K , Delgado V D , Ziakas A Z , Kamperidis V K
Published: January 2025

Background

In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. The present study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF.

Methods

A total of 377 patients hospitalized for acute HF were prospectively evaluated. The first blood sample on admission was used to measure estimated glomerular filtration rate (eGFR) using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed in all patients within 24 hours from admission.

Results

Patients with eGFR <45mL/min/1.73m2 were older and more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥45mL/min/1.73m2. In addition, patients in the lower eGFR group had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV function assessed by RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequently severe tricuspid regurgitation (Figure 1). RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not.

Conclusion

Impaired RV and RA longitudinal strain were independently associated with eGFR <45mL/min/1.73m2 in acute HF, while reduced cardiac output and reduced renal preload were not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output (Figure 2).

Figure 1

Figure 2
Prognostic role of right atrial strain in patients with secondary tricuspid regurgitation: insights from the CARE-TR registry
Authors: Lupi L , Saccani N , Alghisi F , Pezzola E , Pancaldi E , Pagliaro B , Villaschi A , Soranzo E , Pagnesi M , Tomasoni D , Mangieri A , Stolfo D , Sinagra G , Metra M , Adamo M
Published: January 2025

Background

Recently, right atrial (RA) deformation evaluated with speckle tracking echocardiography has emerged as prognostic parameter in patients with pulmonary hypertension and tricuspid regurgitation (TR).

Purpose

To explore the prognostic role of right atrial reservoir strain (RASr) in patients atrial and ventricular secondary TR (ASTR; VSTR).

Methods

The Consecutive pAtients with seveRE Tricuspid Regurgitation evaluated in heart failure (HF) and Valve Clinics (CARE-TR) registry collected data from patients with at least severe TR enrolled at 3 Italian Centres between January 2020 and December 2022. The present analysis includes 402 patients with STR and complete data on right atrial function. Patients were classified as ASTR in presence of all the following echocardiographic parameters: left ventricular ejection fraction ≥ 50%, pulmonary artery systolic pressure ≤ 50 mmHg, right ventricular (RV) mid end-diastolic diameter (RVEDD) ≤ 38 mm and/or RV end-diastolic area ≤ 13 cm2/m2, RV fractional area change ≥ 35% and/or RV free wall longitudinal strain (RVFWLS) ≥ 17%. Right atrial indexed volume (RAVI) and RASr were collected. The lack of at least one of these parameters identified the VSTR aetiology. The study endpoint was a composite of all-cause mortality and heart failure hospitalization at 18-months follow-up.

Results

Patients’ median age was 79 years (IQR 72-83) and 45% were male. At 18-months follow-up, 139 patients (46%) reached the primary endpoint. After adjustment for age, male sex, glomerular filtration rate (GFR), New York Heart Association (NYHA) class, RAVi and loop diuretic dose, RASr was the only independent predictor of events in patients with ASTR (HR 0.91, 95% CI 0.86-0.96, p = 0.001); in patients with V-FTR after adjustment for age, male sex, coronary artery disease, GFR, NYHA class, loop diuretic dose and RAVi, RVEDD (HR 1.04, 95% CI 1.01-1.07, p = 0.029) and RVFWLS (HR 1.07, 95% CI 1.01-1.12, p = 0.049) were the only echocardiographic parameters associated with poor prognosis, while RASr was not. At receiver operating characteristic analysis, the best cut-off of RASr to predict the composite outcome in the whole population was 12% (sensitivity 74%, specificity 70%, area under the curve [AUC] 0.75, p < 0.001). Cumulative survival free from events was lower in patients with RASr ≤ 12% as compared to those with RASr > 12% in the whole population (52% vs 84%; Log rank p < 0.001) and in both ASTR and VSTR (Figure 1 and Figure 2).

Conclusions

Right atrial reservoir strain is an useful and reliable tool to identify patients with STR at high risk of death and hospitalization for heart failure and it offers the best prognostic performance in patients with ASTR.

ASTR patients survival according to RASr

VSTR patients survival according to RASr
Utility of left atrial strain in differentiating between cardiac amyloidosis and reablated atrial fibrillation
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Llano Cardenal M F , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Zarauza Navarro J , Coroas Pascual C A , Zubiaur Zamacola J , Perez Barquin R , Alarcos Blasco H , Carreiro Da Cunha E , Olalla Antolin J J , Ruisanchez Villar C
Published: January 2025

Introduction and Objectives

Cardiac amyloidosis (AL) is a disease characterized by the abnormal accumulation of anomalous proteins in cardiac tissue, while atrial fibrillation (AF) is an exceedingly prevalent arrhythmia in the current population, often related to the amount of atrial fibrosis. The echocardiogram has emerged as a fundamental tool in the diagnosis and follow-up of these patients, and strain analysis techniques can provide highly useful additional information on cardiac function in these patients, especially in the early stages of the disease. We questioned whether it might be useful in differentiating between these two pathologies.

Methods

This retrospective analysis included adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 52 patients with a confirmed diagnosis of AL by transthyretin, confirmed by scintigraphy and/or biopsy, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups.

Results

Patients with AL showed significantly lower absolute strain values compared to patients with reablated AF in all three analyzed varieties (Reservoir, Conduit, and Pump) with p<0.01 for all comparisons. The mean strain in the reablated AF group was 17.42 for reservoir strain, -11.72 for conduit strain, and -6.33 for pump strain; while the mean in the AL group was 9.28, -6.93, and -3.10, respectively.

Conclusions

Our study found significant differences in left atrial strain values between patients with reablated AF and patients with transthyretin AL. These findings suggest that left atrial strain analysis could be useful in evaluating cardiac function, follow-up, and differential diagnosis between patients with AL and reablated AF, especially in the earlier stages of the disease, where it is more challenging to establish a reliable diagnosis.

Atrial fibrillation Vs amyloidosis
Transcatheter edge-to-edge repair of severe tricuspid regurgitation with the pascal system. one-year results of a pioneering series in spain, with the use of the pascal system.
Authors: Barreiro Mesa L , Ruiz Ortiz M , Urbano Sanchez C , Aguayo Cano N , Roldan Guerra A , Rodriguez Almodovar A , Esteban Martinez F , Delgado Ortega M , Pan Alvarez Osorio M , Ojeda Pineda S , Perea Armijo J , Suarez De Lezo J , Mesa Rubio D
Published: January 2025

Background and objectives

Transcatheter edge-to-edge repair (TEER) of severe tricuspid regurgitation (TR) is emerging as a lower-risk alternative to surgery.

Our aim was to evaluate the safety and efficacy of treatment of severe TR with the Edwards Pascal system as well as the results at 1 year, in the longest Spanish series performed to date with this device.

Methods

observational study in a prospective cohort of patients from a third level referral university hospital, which included all cases of severe or major TR and persistent symptoms treated by TEER with Pascal device from December 2021 to February 2024. Baseline clinical and echocardiographic characteristics and immediate and 3-month safety and efficacy outcomes were evaluated. All-cause mortality and hospitalization for heart failure at 1 year were analyzed.

Results

35 patients were included: mean age 72.5±11.5 years; 54% female, 100% with severe to torrential TR and a median Tri-score of 5(p25-75.3-6). Primary success was achieved in 97 % and 34 of 35 (97%) patients achieved moderate or lower TR, with a significant reduction in TR (p<0.0005 ). The echocardiogram at discharge showed 1 case of partial device loosening and there was a reduction in right ventricular (RV) diastolic diameter (48±10 vs 41±7mm,p<0.0005) and a reduction in the tricuspid septolateral septal annulus (44±7 vs 37±6mm,p<0.0005). At 3 months there were no deaths, strokes, device embolization or reinterventions. Mild or moderate TR persisted in 20 of 22 patients (91%, p<0.0005) and NYHA I-II in 91% (p=0.019). At one year the probability of overall and hospitalization-free survival due to heart failure according to Kaplan-Meier analysis was 100% and 84%, respectively (Figure).

Conclusions

The Pascal system in the treatment of severe TR demonstrated high success rate with few complications, with favorable remodeling of the tricuspid annulus and the RV and also with significant and sustained improvements in TR and functional status. At 1 year, the heart failure readmission-free survival rate was very high
Evaluation of the presence and extension valvular-related cardiac damage in patients with moderate aortic stenosis and its impact on outcomes
Authors: Rivadeneira Ruiz M , Islas F , Mahia P , Gil-Abizanda S , Jimenez P , Nombela L , De Agustin A , Olmos C
Published: January 2025

Introduction and objective

Echocardiographic measurements form the basis for diagnosing and determining the indication for therapy in aortic stenosis (AS). These measurements may vary depending on different patient-related and operator-related conditions. Recently, staging cardiac damage has emerged as a prognostic tool in asymptomatic and moderate to severe AS.

We aim to evaluate the presence and severity of cardiac damage (1,2), and its impact on outcomes, in patients with a first diagnosis of moderate and severe AS.

Methods

A total of 119 patients undergoing transcatheter aortic valve replacement (TAVR) from November 2019 to January 2021 were included in a single-center retrospective registry. In each patient, the first echocardiogram establishing the diagnosis of moderate and severe AS was analysed.

Results

119 patients with a mean age of 82.8±5.33 years (51% men) were included. At the first echo study with the diagnosis of moderate AS, mean pressure gradient was 23±9 mmHg, maximum pressure gradient was 42±15 mmHg, and mean aortic valve area was 1.13±0.41 cm2 (0.64±0.23 cm2/m2).

Regarding cardiac damage, mean left ventricular ejection fraction was 65.4±10.4%, mean longitudinal global strain was -18.5±5.4%, and mean left atrial volume index was 41.6±31.2 mL/m2. 16% of patients have significant mitral regurgitation, and 10% right ventricular dysfunction. The mean progression time between moderate and severe diagnoses was 36 (2.4-175.2) months.

Figure 1 shows the distribution of patients in different staging classification systems (1,2) at the time of diagnosis of moderate and severe AS.

According to one of these staging classifications (1), 75.7% of patients had left-sided cardiac damage (Stages 1 and 2) and 16.8% had right-sided damage (Stages 3 and 4), without differences compared to the same patients when the stenosis became severe (p=0.194).

On the contrary, following the most recent second classification (2), 63% had no significant cardiac damage (Stage 0), 31.1% of patients had left-sided cardiac damage (Stages 1 and 2) and 5.9% had right-sided damage (Stage 3), and this system showed better ability to discriminate between moderate and severe AS related-damage (p=0.002).

The area under the ROC curve for one-year mortality after TAVR for the 2 staging systems applied at the moment of diagnosis of moderate and severe AS is presented in Figure 2. When used in moderate AS, it showed fair discrimination. However, the best model for predicting one-year mortality among those used, is the one used in the second classification (2) when the stenosis became severe.

Conclusions

AS-related cardiac damage may be present in early stages of AS and may help to guide the timing of intervention in selected patients.

Staging classification of cardiac damage

AUROC curve for one-year mortality
Explainable machine learning for estimation of elevated left ventricular filling pressure: development and validation using multicenter data
Authors: Nakamura Y , Kagiyama N , Shrestha S , Akama Y , Kito S , Takamatsu S , Toki M , Kitai T , Okada T , Kurita A , Kaneko T , Miyazaki S , Okazaki S , Minamino T
Published: January 2025

Background

Guideline-recommended algorithms (GL-algorithm) (1) often results in indeterminate left ventricular filling pressure (LVFP) (2). Despite high accuracy, machine learning (ML) methods lack interpretability, limiting their clinical use.

Objective

To develop an explainable ML model for LVFP estimation, which provides patient-level interpretation.

Methods

We retrospectively enrolled patients who underwent echocardiography and right heart catheterization at three hospitals within a median of 3 days. Two extreme gradient boosting (XGBoost) models were trained using data from two hospitals to estimate elevated pulmonary artery wedge pressure (PAWP >18 mmHg) as a surrogate for elevated LVFP. Model 1 used variables from GL-algorithm, while model 2 used variables selected by Shapley additive explanations (SHAP) values. Model performances were compared using external test data from the other hospital.

Results

In a cohort of 956 patients (mean age 68±14 years; 43.2% female; 44.6% with left ventricular ejection fraction ≤50%), 296 (31.0%) had elevated PAWP. The GL-algorithm classified 42.5% as indeterminate LVFP, with 34.1% of these having elevated PAWP. The algorithm's area under the receiver-operating-characteristics curve (AUROC) was 0.72 (95% CI 0.60–0.83) for elevated LVFP. ML models classified all patients, with Model 1 achieving an AUROC of 0.81 (95% CI 0.75–0.87, p=0.020 vs. GL-algorithm) and Model 2 achieving an AUROC of 0.84 (95% CI 0.79–0.89, p=0.016). Notably, the ML models performed equally well regardless of GL-algorithm classification. SHAP force plots enabled patient-level interpretation. The model is available online.

Conclusions

Explainable ML outperformed the GL-algorithm in estimating LVFP, providing patient-level interpretability and potentially more user-friendly tools for clinicians.
Coronary sinus unroofing associated with congenitally corrected transposition of the great arteries: a case report
Authors: García-Rodeja Arias Federico , López Abel Bernardo , Álvarez Barredo María , García Campos Ana , González Juanatey José Ramón
Published: January 2025

Background

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart defect that is frequently associated with ventricular septal defects (VSDs) and valvular abnormalities. Advanced cardiac imaging techniques are often needed for early detection and detailed study of potential complications during long-term follow-up in these patients.

Case summary

A 20-year-old male, asymptomatic during regular follow-ups, with ccTGA, restrictive subpulmonary VSD, and mild pulmonary stenosis. Latest outpatient evaluations showed progressive biventricular dilation, particularly in the subpulmonary left ventricle. Advanced cardiac imaging, including magnetic resonance imaging (MRI), identified an imbalance in flow between pulmonary and systemic circulations, indicated by a Qp/Qs ratio of 2.6, which could not be attributed to the known restrictive VSD. Additionally, 4D-flow MRI sequences detected low-velocity interatrial flow in the lower atrial segment. Subsequent targeted cardiac computed tomography (CT) confirmed extensive unroofing of the coronary sinus, revealing an unrecognized shunt contributing to the patient’s haemodynamic imbalance.

Discussion

Coronary sinus unroofing is exceedingly rare and often clinically silent, complicating diagnosis. Advanced cardiac imaging (MRI, CT) plays a pivotal role in detecting such anomalies. This case underscores the challenges of diagnosing subtle shunts in complex congenital heart disease and highlights the importance of comprehensive imaging for timely intervention and management.
The Triglycerides, total Cholesterol, and Body weight Index associating with frailty and predicting poor outcome after transcatheter aortic valve implantation: insights from LAPLACE-TAVI registry
Authors: Doi Shinichiro , Funamizu Takehiro , Iwata Hiroshi , Naito Ryo , Moriya Soshi , Koike Takuma , Nishio Ryota , Takahashi Norihito , Chikata Yuichi , Koga Seiji , Okazaki Shinya , Higuchi Ryosuke , Takamisawa Itaru , Saji Mike , Sato Kei , Tamura Harutoshi , Yokoyama Hiroaki , Onishi Takayuki , Tobaru Tetsuya , Takanashi Shuichiro , Tabata Minoru , Minamino Tohru
Published: January 2025

Aims

The nutritional status and frailty are crucial in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), as they significantly impact outcomes. We have previously developed an easily calculable nutritional index, TCBI (Triglycerides, total Cholesterol, and Body weight Index), which has been validated as a prognostic indicator in various cardiovascular disease contexts. This study aimed to evaluate the impact of a low TCBI on the frailty and outcomes of patients undergoing TAVI.

Methods and results

This study is a part of a Japanese multi-centre prospective registry database of TAVI cases (n = 824). Participants were categorized into three groups based on TCBI tertiles before TAVI. The primary endpoint was all-cause mortality with a follow-up duration of up to 3 years. In the lowest TCBI tertile group, motor functions reflecting frailty were substantially impaired, and cumulative incidences of primary endpoint was significantly higher compared to other groups. Multivariate Cox proportional hazard analyses adjusted by risk factors for poor outcomes following TAVI identified low TCBI significantly associated with an increased risk of the primary endpoint [hazard ratio (HR) and 95% confidence interval (95% CI) of 1 SD lower TCBI for all-cause mortality: 1.52, 1.08–2.13, P = 0.015]. Moreover, in individuals who experienced serious preprocedural complications, the negative prognostic impact of low TCBI was significantly amplified (HR and 95% CI: 4.9, 1.9–12.5, P < 0.001).

Conclusion

The present findings underscore the importance of nutritional assessment in patients undergoing TAVI. TCBI proved useful for accurate risk stratification and determining TAVI procedural strategies.
Optimal duration of ex vivo lung perfusion for heat stress-mediated therapeutic reconditioning of damaged rat donor lungs
Authors: Parapanov Roumen , Debonneville Anne , Allouche Manon , Lugrin Jérôme , Lugon-Moulin Tanguy , Abdelnour-Berchtold Etienne , Liaudet Lucas , Krueger Thorsten
Published: January 2025

OBJECTIVES

Transient heat stress (HS) application during experimental ex vivo lung perfusion (EVLP) of warm ischaemic (WI) rat lungs produces a range of therapeutic benefits. Here, we explored whether different EVLP durations after HS application would influence its therapeutic effects.

METHODS

In protocol 1, WI rat lungs were exposed to HS (41.5°C, 60–90 min EVLP), and EVLP was maintained for 3, 4.5 or 6 h (n = 5/group), followed by physiological measurements (compliance, oedema, oxygenation capacity). In protocol 2, WI rat lungs treated with (HS groups) or without HS (control groups) were maintained for 3 or 4.5 h EVLP (n = 5/group), followed by physiological evaluation and measurements (lung tissue) of heat shock proteins (HSP70, HSP27, HS90, GRP78), endogenous proteins (surfactant protein-D, CC16, platelet endothelial cell adhesion molecule-1), anti-apoptotic (Bcl2, Bcl-xL) and pro-apoptotic proteins (Bcl2-associated X protein, CCAAT/enhancer binding-protein homologous protein), antioxidant enzymes (heme-oxygenase-1, nicotinamide di-phospho-nucleotide dehydrogenase quinone-1) and nitrotyrosine (oxidative stress biomarker).

RESULTS

In protocol 1, physiological variables were stable after 3 and 4.5 h but deteriorated after 6 h. In protocol 2, at 3 h EVLP, HS-treated lungs differed from controls by higher expression of HSP70 and heme-oxygenase-1, and lower CC16 expression. In contrast, at 4.5 h EVLP, HS-treated lungs displayed improved physiology, higher levels of all HSPs, preserved or increased expression of surfactant protein-D, CC-16 and platelet endothelial cell adhesion molecule-1, increased antioxidant and anti-apoptotic proteins, and reduced pro-apoptotic proteins and nitrotyrosine.

CONCLUSIONS

The protective effects of HS application during EVLP of WI-damaged rat lungs strictly depend on the duration of post-HS recovery. An EVLP duration of 4.5 h appears to optimize the therapeutic potential of HS, while maintaining lungs in a stable physiological state.
Developing Adverse Outcome Pathways to support radioecological risk assessment: Challenges and insights
Authors: Dufourcq-Sekatcheff E , Quevarec L , Delignette-Muller M -L , Car C , Bonzom J -M , Gilbin R , Tollefsen K -E , Armant O , Frelon S
Published: January 2025

Environmental pollution associated with long term effects, especially in the case of ionizing radiation, poses significant risks to wildlife, necessitating a more nuanced approach to Ecological Risk Assessment (ERA). In radioecology, current methods, as outlined by the International Commission on Radiological Protection (ICRP), focus primarily on exposure and individual/population-level effects, often both suffering a lack of ecological realism due to the nature of data used, and, sidelining a big amount of critical non-individual effects such as sub-individual one like genotoxicity. This review aims to address these gaps by suggesting the integration of New Approach Methods (NAMs) and the Adverse Outcome Pathway (AOP) framework in the field of radioecology. NAMs encompass innovative techniques, such as in silico and in vitro methodologies, that can provide predictive insights without relying solely on traditional animal testing. The AOP framework, developed by the Organization for Economic Cooperation and Development (OECD), structures effects data into a sequence of causally linked events, enabling a clearer understanding of how molecular changes lead to adverse ecological outcomes. In the first section of the review, we explore the challenges of applying AOPs within radioecology, including the complexities of modelling realistic exposure scenarios, the temporal dynamics of effects, and the impacts of multiple stressors. The second section highlights the potential and the application of some NAMs within an AOP framework to contribute improving risk assessment methodologies (in species realism issue and the use of sub-individual data). This part also offers other potential solutions to increase the number of data to be used in ERA as well as their ecological realism, through the use of AOP framework with relevant biological scales and ecological endpoints still uninvestigated in such way. In conclusion, leveraging NAMs and AOPs is much valuable for bridging molecular data and ecological implications, thereby advancing regulatory practices in radioecology and ensuring more comprehensive protection of ecosystems from radiological hazards.
Incident heart failure and recurrent coronary events following acute myocardial infarction
Authors: Butler Javed , Hammonds Kendall , Talha Khawaja M , Alhamdow Ayman , Bennett Monica M , Bomar J Vee Anne , Ettlinger Jason A , Traba Monica Martinez , Priest Elisa L , Schmedt Niklas , Zeballos Cecilia , Shaver Courtney N , Afzal Aasim , Widmer Robert J , Gottlieb Robert L , Mack Michael J , Packer Milton
Published: January 2025

Background and Aims

Recurrent myocardial infarction (MI) and incident heart failure (HF) are major post-MI complications. Herein, contemporary post-MI risks for recurrent MI and HF are described.

Methods

A total of 6804 patients with a primary discharge diagnosis of MI at 28 Baylor Scott & White Health hospitals (January 2015 to December 2021) were studied. Patient characteristics, treatment, and outcomes, including incident HF, recurrent MI, all-cause death, and all-cause and cardiovascular rehospitalizations, were assessed. Landmark approach anchored at 3 months post-discharge was used to assess 1-year outcomes.

Results

Median age was 69 years, 59.7% were male, and 76.7% had non-ST-elevation MI. Comorbidities included hypertension (89%), dyslipidaemia (87%), Type 2 diabetes (48%), and chronic kidney disease (34%); 17% had a history of MI and 23% of HF; 63% underwent percutaneous/surgical revascularization. In landmark-anchored 1-year outcomes (N = 6210), 413 (6.7%) patients died, 1730 (27.9%) had all-cause and 735 (11.8%) cardiovascular hospitalizations, 234 (3.8%) had recurrent MI. Of patients without history of HF, 1160 (23.8%) developed incident HF [42.2%, 26.7%, and 31.1% with ejection fraction (EF) < 40%, 41–49%, and >50%, respectively) within 3 months of discharge. Patients who developed HF had higher risk of death and hospitalizations (all P < .001), irrespective of EF. Of 2179 patients with EF > 50% without prevalent HF or HF during index hospitalization, 257 (11.8%) developed HF and 77 (3.5%) recurrent MI within 1 year.

Conclusions

In a contemporary post-MI cohort, the risk for incident HF was greater than recurrent MI, even among those with normal EF and no HF at discharge.
Body mass index, regional adipose deposition, and clinical outcomes in non-ischaemic dilated cardiomyopathy: a prospective cohort study
Authors: Huang Chuan , Li Yangjie , Xu Yuanwei , Zhou Yaqiong , Li Weihao , Guo Jiajun , Wan Ke , Wang Jie , Xu Ziqian , Zhang Qing , Han Yuchi , Sun Jiayu , Chen Yucheng
Published: January 2025

Aims

This study aims to assess the relationship between body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), epicardial adipose tissue (EAT), pericardial adipose tissue (PAT), and clinical outcomes in dilated cardiomyopathy (DCM) patients.

Methods and results

Non-ischaemic DCM patients were prospectively enrolled. Regional adipose tissue, cardiac function, and myocardial tissue characteristics were measured by cardiac magnetic resonance. The primary endpoint included all-cause mortality and heart transplantation (HTX). This study enrolled 1042 DCM patients (68% men, mean age 48 ± 15 years, mean BMI 23.9 ± 4.0 kg/m2). Underweight patients were more frequently women and had lower blood pressure, worse New York Heart Association class, reduced biventricular ejection fraction, and higher native T1 and extracellular volume fraction value. Similarly, reduced regional adipose tissue was associated with adverse heart remodelling, worse cardiac function, and higher diffuse myocardial fibrosis. After a median follow-up of 41 months, primary endpoint occurred in 237 patients. Body mass index [hazard ratio (HR): 0.94, 95% confidence interval (CI): 0.90–0.98, P = 0.006], VAT thickness (per 1 mm: HR 0.94, 95% CI: 0.91–0.97, P < 0.001), and EAT volume (per 1 mL: HR 0.96, 95% CI: 0.95–0.97, P < 0.001) were independent predictors of primary endpoint. Epicardial adipose tissue volume showed the highest predictive value for heart failure death/HTX (C-index: 0.70). Body mass index was the best predictor of arrhythmia endpoint (C-index: 0.64).

Conclusion

Lower BMI and thinner regional adipose tissue represented the worse clinical phenotype and adverse remodelling and were associated with worse clinical outcomes in patients with DCM.
8. Postcolonialism
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines postcolonialism, which adopts a critical attitude in order to understand the situation in areas that were conquered by European colonial powers, in Africa, Asia, and Latin America. The chapter first describes these colonization processes and the decolonization that followed. It identifies early voices of postcolonialism, including W.E.B. Du Bois, Aimé Césare and Frantz Fanon. Special attention is devoted to Edward Said’s work on orientalism. Postcolonialism aims to shed light on lived experiences and insights from the Global South in order to gain a more nuanced and hence more complete understanding of world politics. It is critical of the Eurocentric (and therefore biased) analyses undertaken by established theories, including realism and liberalism. The chapter reflects on recent calls for ‘Global IR’, where voices from outside of Western research environments are heard. It concludes with an overview of the postcolonial research programme and the criticisms against it.
10. Green Theory, the Environment, and Climate Change
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines the international politics of climate change. Its point of departure is that the environment now makes up a major issue of world politics, especially due to the consequences of human-made global warming. The chapter summarizes what natural science tells us about this issue. It then describes international efforts to deal with the problem of climate change and the challenges that have times and again undermined and delayed these efforts. It discusses what IR and GP theories have to say about the possibility of addressing these challenges, and it introduces green theory, a GP perspective which fundamentally challenges all other theories of world politics by calling for an abandonment of the human-centred premises of existing theories.