bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Potentials of Medicinal Leech in Chinese Medicine
Authors: Wu Shaohua , Zhou Yaya , Wang Yang , Zhang Zuping
Published: June 2024

The use of medicinal leeches in clinical therapy has been employed for a long time, as it was originally recognized for exerting antithrombin effects. These effects were due to the ability of the leech to continuously suck blood while attached to human skin. According to Chinese Pharmacopoei, leeches used in traditional Chinese medicine mainly consist of Whitmania pigra Whitman, Hirudo nipponia Whitman, and Whitmania acranulata, but the latter two species are relatively scarce. The main constituents of leeches are protein and peptide macromolecules. They can be categorized into two categories based on their pharmacological effects. One group consists of active ingredients that directly target the coagulation system, such as hirudin, heparin, and histamine, which are widely known. The other group comprises protease inhibitor components like Decorsin and Hementin. Among these, hirudin secreted by the salivary glands of the leech is the most potent thrombin inhibitor and served as the sole remedy for preventing blood clotting until the discovery of heparin. Additionally, leeches play a significant role in various traditional Chinese medicine formulations. In recent decades, medicinal leeches have been applied in fields including anti-inflammatory treatment, cardiovascular disease management, antitumor treatment, and many other medical conditions. In this review, we present a comprehensive overview of the historical journey and medicinal applications of leeches in various medical conditions, emphasizing their pharmaceutical significance within traditional Chinese medicine. This review offers valuable insights for exploring additional therapeutic opportunities involving the use of leeches in various diseases and elucidating their underlying mechanisms for future research.
Using Quercetin to Construct Molecularly Imprinting Polymer in the Preparation and Enrichment of Flavonol and Flavonoid Compounds
Authors: Yang Dan-Dan , Li Shu-Yi , Xu Xiao-Wei , Li Qing-Yao , He Jia-Yuan , Zhou Lian-Di , Zhang Qi-Hui
Published: June 2024

Flavonol and flavonoid compounds are important natural compounds with various biomedical activities. Therefore, it is of great significance to develop a strategy for the specific extraction of flavonol and flavonoid compounds. Quercetin is a well-studied flavonoid possessing many health benefits. This compound is a versatile antioxidant known to possess protective abilities against body tissue injury induced by pathological situations and various drug toxicities. Although quercetin is widely distributed in many plants, its content generally is not very high. Therefore, the specific extraction of quercetin as well as other flavonol and flavonoid compounds has profound significance. In this work, the quercetin molecularly imprinting polymer (QMIP) was successfully prepared, in which a typical flavonol quercetin was selected as the template molecule. QMIP was synthesized by performing the surface molecular imprinting technology on the surface of NH2-MIL-101(Fe). Our study results showed that QMIP exhibited quick binding kinetic behavior, a high adsorption capacity (57.04[Formula: see text]mg/g), and the specific recognition ability toward quercetin compared with structurally distinct compounds (selective [Formula: see text]). The specific adsorption ability of quercetin by QMIP was further explained using computation simulation that molecules with non-planar 3D conformations hardly entered the molecularly imprinted cavities on QMIP. Finally, QMIP was successfully used for the specific extraction of quercetin and five other flavonol and flavonoid compounds in the crude extracts from Sapium sebiferum. This study proposes a new strategy to synthesize the molecularly imprinted polymer based on a single template for enriching and loading a certain class of active ingredients with similar core structures from variable botanicals.
Rare top quark decays in the minimal R-symmetric supersymmetric standard model
Authors: Sun Ke-Sheng , Wang Zhi-Chuan , Yang Xiu-Yi , Gao Tie-Jun , Zhang Hai-Bin
Published: June 2024

The one-loop contributions to the flavor-changing neutral current decays of the top quark into a light quark and a gauge boson or Higgs boson, namely, [Formula: see text], with q being u or c, and V being [Formula: see text], g, or Z, are analyzed in this study within the framework of the minimal R-symmetric supersymmetric standard model. The charginos in this model have been separated into two sets, i.e. [Formula: see text]-chargino and [Formula: see text]-chargino. The numerical results reveal that gluino or [Formula: see text]-chargino predominantly dictate the predictions for BR ([Formula: see text]), while the impact of neutralino or [Formula: see text]-chargino contributions is insignificant. By incorporating the constraints imposed by the squark mixing parameters from [Formula: see text] and [Formula: see text], the theoretical predictions for BR([Formula: see text]) can be significantly augmented to approximately [Formula: see text]. On the other hand, the values of BR([Formula: see text]) are predicted to be at least four orders of magnitude below the current experimental limits.
Exploring the dynamics of shallow water waves and nonlinear wave propagation in hyperelastic rods: Analytical insights into the Camassa–Holm equation
Authors: Khater Mostafa M. A.
Published: June 2024

The objective of this paper is to examine the analytical properties of the nonlinear [Formula: see text]-dimensional Camassa–Holm equation ([Formula: see text]), a fundamental model within the domain of nonlinear evolution equations. The aforementioned equation serves as a valuable tool in elucidating the unidirectional propagation of shallow water waves over a level terrain, as well as in representing certain nonlinear wave phenomena seen in cylindrical hyperelastic rods. We use the Khater III ([Formula: see text]hat.III) and improved Kudryashov ([Formula: see text]ud) technique to provide accurate solutions, drawing inspiration from the intricate mathematical framework of the [Formula: see text] issue. He’s variational iteration ([Formula: see text]) technique is used as a numerical methodology to assess the correctness of the generated answers. This strategy reveals a notable concurrence between the analytical and numerical outcomes. This alignment guarantees the suitability of the acquired solutions within the framework of the studied model.

The importance of this investigation lies in its ability to improve our comprehension of the intricate dynamics regulated by the [Formula: see text] equation and its connections with other nonlinear evolution equations that describe shallow water wave behaviors and nonlinear wave propagation in cylindrical hyperelastic rods. The results of the study demonstrate novel analytical approaches, expanding the range of potential solutions and offering valuable insights into the physical characteristics of the interconnected wave phenomena. This research offers valuable insights and methodologies for addressing intricate mathematical models in shallow water wave theory and studying nonlinear waves in hyperelastic materials, therefore making substantial advances to the subject of nonlinear partial differential equations.
Breather-type and N-breather solutions for the positive Gardner-KP equation
Authors: Zeng Hang , Tang Lu
Published: June 2024

Starting from the bilinear form of the positive Gardner–Kadomtsev–Petviashvili equation, breather-type and N-breather solutions are obtained with the help of the extended homoclinic test approach. Breather-type, one-breather, two-breather and three-breather solutions are illustrated through 3D plots, density plots and contour plots and some appropriate parameter values have been chosen to better demonstrate their time evolution.
Numerical solutions of steady radiative Maxwell-nanofluid flow toward a stretching sheet in the presence of magnetic field and porous medium
Authors: Babu P. Ramesh , Kumar M. Anil , Raju R. Srinivasa , Reddy Y. Dharmendar
Published: June 2024

The study investigates the behavior of a Maxwellian nanofluid flowing steadily over an extending sheet in a permeable medium with a magnetic field. The energy equation includes the radiation, and the conservation of momentum equation considers the magnetic field and porous medium. The novelty of this study is in its examination of complex phenomena involving magnetic fields, radiation, Maxwell fluids, and nanoparticle suspensions in a porous medium via an exponential stretching sheet. The study of Maxwell fluids has been enriched by the substantial contributions made by researchers, delving into their rheological behavior, modelling, and applications. Their work has provided valuable insights into the complexities of these materials and has advanced the knowledge in this specialized area of fluid mechanics. The governing partial differential equations (PDEs) are converted into ordinary differential equations (ODEs) utilizing an appropriate similarity transformation. These resultant ODEs are then resolved by employing a numerical approach, specifically the finite element method. The numerical simulations provide valuable information regarding the distributions of velocity, temperature, and nanoparticle concentration. Furthermore, the presented tabulated outcomes display alterations in skin friction, mass transfer rate, heat transmission coefficients, and their reliance on different emerging parameters. The velocity diminishes as the magnetic field, suction, Maxwell fluid, and medium factors increase, while it enhances with the stretching sheet limitation. The temperature diminishes with the Prandtl number but upsurges with higher radiation, thermophoresis, and Brownian motion. As the thermophoresis limit increases, concentration rises, but it decreases with an upsurge in the Lewis and Brownian motion. The heat transfer rate rises with radiation, thermophoresis, and Brownian motion, but the mass transfer rate decreases with Lewes and Brownian motion. The outcomes of the study could have implications for various engineering and industrial applications that control and manipulate fluid flows and heat transfer.
A numerical investigation of the chemically reactive Maxwell nanofluid flow over a convectively heated rotating disk using Darcy–Forchheimer porous medium
Authors: Lone Showkat Ahmad , AL-Essa Laila A. , Alrabaiah Hussam , Ali Farhan , Yasmin Humaira , Saeed Anwar
Published: June 2024

This study investigates the convective heat transfer characteristics in the vicinity of a stagnation point for the flow of Maxwell nanofluid over a porous rotating disk. The analysis takes into account the complex inert-active effects arising from nonlinear thermal radiation, activation energy, and the presence of a Darcy–Forchheimer medium. Through numerical simulations, the enhancement of heat transfer due to the addition of nanoparticles is explored, considering their impact on heat transport. The rotational and porous characteristics of the disk, coupled with nonlinear thermal radiation and activation energy effects, are crucial factors in shaping the overall heat transfer behavior. The study aims to provide valuable insights into the complicated interactions of these phenomena, contributing to the understanding of advanced heat transfer processes and their potential applications in various engineering systems. Using suitable variables to convert the system of leading equations to dimensionless form has then been evaluated by employing the bvp4c approach. It has been revealed that Radial flow has retarded with an upsurge in Deborah number, inertial factor, and porous factor while has upsurge with growth in rotational factor. Angular velocity has declined with higher values of Deborah number, and porous factor and has upsurged with escalation in inertial and rotational factors. Azimuthal flow has weakened with an upsurge in porous factor and has augmented with growth in Deborah number, inertial factor, and rotational factor. Thermal profiles have augmented with an upsurge in rotational, porous, inertial, thermophoresis, Brownian, and radiation factors, and Deborah number has declined with growth in the Prandtl number. Concentration distribution has declined with an upsurge in Schmidt number, Brownian motion factor, rotation factor, and porous factor, while has grown with the escalation in chemically reactive, thermophoresis, inertial factors, and Deborah number.
New optical hydrodynamic representation of dispersive two-phase
Authors: Şevgin Fatih , Körpinar Zeliha
Published: June 2024

In this paper, we construct the photonic dam-break flow problem for [Formula: see text] magnetic fluid in a spherical model. Then, we obtain an optical magnetic transform for the NLSE in hydrodynamical form. By dispersive photonic hydrodynamic representation, normal of surface [Formula: see text] flow is obtained. Thus, we design two-phase [Formula: see text] flow dispersion density in a spherical model. Finally, we have new modeling of dispersive dam break two-phase [Formula: see text] flux.
A note on generalized Robertson–Walker spacetimes and f(ℛ∗)-gravity
Authors: De Uday Chand , Mofarreh Fatemah
Published: June 2024

First, we prove that a Ricci symmetric spacetime is a perfect fluid spacetime if and only if it is a generalized Robertson–Walker spacetime. Consequently, we establish that under certain constraints on the associated scalar, such a spacetime turns into a static spacetime and is classified under Petrov classification [Formula: see text], [Formula: see text], or [Formula: see text]. Also, we notice that a semi-symmetric as well as pseudo-Ricci symmetric generalized Robertson–Walker spacetime is a perfect fluid spacetime. We examine conformally flat generalized Robertson–Walker spacetime as a solution of [Formula: see text]-gravity theory and describe the physical relevance. For the model [Formula: see text], numerous energy conditions in terms of associated scalars are investigated. This model agrees with the current investigations which states that the Cosmos is in an accelerating phase.
Investigation of Bardeen stellar structures in modified f(R,ϕ,X) theory of gravity
Authors: Malik Adnan , Moneer Eman M. , Sanaullah Ayesha , Zotos Euaggelos E. , Shamir M Farasat
Published: June 2024

This paper is devoted to investigating the behavior of charged compact stars in the [Formula: see text] theory of gravity, where [Formula: see text] denotes the Ricci Scalar, [Formula: see text] is a scalar potential, and [Formula: see text] is a kinetic term. For this purpose, we consider spherically symmetric spacetime with Bardeen geometry as exterior spacetime to investigate various properties of compact stars, including energy density and pressure components. Matching conditions are used to find model parameters. We present a detailed analysis, including a discussion of equations of state parameters, and stability criteria. In this analysis, we discuss the energy conditions to check the viability of our model. Furthermore, an equilibrium condition can be visualized through the modified Tolman–Oppenheimer–Volkov equation. It is concluded that Bardeen’s geometry supports the existence of compact stars in the background of the [Formula: see text] theory of gravity.
Filling with separating curves
Authors: Saha Bhola Nath , Sanki Bidyut
Published: June 2024

A pair [Formula: see text] of simple closed curves on a closed and orientable surface [Formula: see text] of genus [Formula: see text] is called a filling pair if the complement is a disjoint union of topological disks. If [Formula: see text] is separating, then we call it as separating filling pair. In this paper, we find a necessary and sufficient condition for the existence of a separating filling pair on [Formula: see text] with exactly two complementary disks. We study the combinatorics of the action of the mapping class group [Formula: see text] on the set of such filling pairs. Furthermore, we construct a Morse function [Formula: see text] on the moduli space [Formula: see text] which, for a given hyperbolic surface [Formula: see text], outputs the length of the shortest such filling pair with respect to the metric in [Formula: see text]. We show that the cardinality of the set of global minima of the function [Formula: see text] is the same as the number of [Formula: see text]-orbits of such filling pairs.
Digital literacy and financial inclusion in virtual economies: Analyzing the role of education in shaping attitudes toward cryptocurrencies
Authors: Sharma Pooja , Vashishtha Sangeet
Published: June 2024

The development of cryptocurrencies has altered traditional economic institutions and financial inclusion. This study investigates the complicated relationships between education, digital literacy, cryptocurrency views, and financial inclusion in virtual economies, addressing a key gap in comprehending the disruptive dynamics of emerging financial technologies. Undergraduate, postgraduate, and PhD students from private universities in Delhi NCR were polled using a standardized questionnaire with a 5-point Likert scale. According to the study, higher education boosts digital literacy, cryptocurrency opinions and financial inclusion. Although education is critical for financial inclusion, the link between positive attitudes about cryptocurrencies and financial inclusion remains uncertain. As virtual currencies expand, these results urge policymakers and educators to concentrate on digital literacy and positive attitudes in order to promote inclusive financial ecosystems.
Radar Signal Recognition Based on CWD Spectrogram and Inception Module
Authors: Zou Borong , Wang Yueyue , Wang Hong , Lou Ao , Cheng Yuanyang
Published: June 2024

A convolutional neural network (CNN) based on the Choi–Williams Distribution (CWD) spectrogram and inception module is proposed for radar signal recognition. It is used in a complex electromagnetic environment where the traditional methods have a low recognition rate. The method can automatically identify the modulation type of the received signals while ensuring the multiplicity of extracted features and the precision of signal classification. First, the eight radar signals generated in this research are converted into time–frequency images (TFIs) by CWD. Then the time–frequency information of the signals is extracted by the CNN; two asymmetric four-channel structures are then constructed by Inception structure, and the extracted features are fused separately to achieve the purpose of extracting features in both depth and width of the network. Finally, the classification and recognition of radar signals are realized according to the fused feature map. The experimental results prove that the method has excellent performance in terms of recognition rate and noise immunity compared with the traditional recognition methods.
Performance Changes of Lithium-Ion-Batteries due to Electrolyte-Introduced Metal Oxalate Contaminants
Authors: Rollin Anna , Wang Ziang , Novák Petr , Kurrat Michael
Published: June 2024

This work highlights how different metal oxalates (lithium, nickel, cobalt, manganese, aluminum, and copper) as possible contaminants from certain recycling technologies impact calendar and cyclic aging of NMC811 based LIBs. It also outlines the differences between their two aging modes. By comparing calendar and cyclic aging, differences become apparent: E.g., the presence of copper oxalate resulted in reduced calendar aging effects, while aluminum oxalate negatively affected calendar aging performance but cyclic aging less. Our method is also suitable for screening other materials, especially if one of the aging modes appears more important. By adding lithium oxalate to LIBs, overcharges strongly affected the SoH during cyclic aging. To optimize recycling performance by evaluating the impact of potential impurities, special attention should be given to particularly aluminum and, if economically viable, eliminated.
Numerical Modeling and Topology Optimization for Designing the Anode Catalyst Layer in Proton Exchange Membrane Water Electrolyzers Considering Mass Transport Limitation
Authors: Passakornjaras Phonlakrit , Orncompa Peerapat , Alizadeh Mehrzad , Charoen-amornkitt Patcharawat , Suzuki Takahiro , Tsushima Shohji
Published: June 2024

With the escalation of global warming primarily attributed to fossil fuel and other non-renewable energy consumption, the production of green hydrogen emerges as a mitigation strategy to reduce fossil fuel usage and effectively harness renewable energy sources for energy storage. The proton exchange membrane water electrolyzer (PEMWE) stands out as a promising technology, boasting high efficiency and a rapid response to variations in current density. Despite its stellar performance, the reliance on precious materials presents a cost challenge. To address this concern, we developed a numerical model considering mass transport limitations and temperature variation. The topology optimization (TO) method is employed to generate the optimal structure of the electrode by organizing the two primary constituent materials. Additionally, the impact of optimization points representing low (1.73 V) and high (2.03 V) operating voltage characteristics is analyzed. The optimal structure demonstrates a maximum performance improvement of up to 2.7 times at an operating voltage of 2.03 V compared to the homogeneous electrode structure. The gas coverage model influences the rearrangement of constituent materials, particularly the void fraction, creating channels to facilitate the reaction. Optimization at high voltage points yields a more significant improvement compared to the low voltage scenario.
Numerical Voltammetry of Phase Separating Materials Using Phase Field Modeling
Authors: Hussain Umair , Swaminathan Narasimhan , Phanikumar Gandham
Published: June 2024

Higher capacity materials, such as Si and Sn are known to have phase separating behavior during the (de)lithiation. While initial models for lithiation in graphite electrode were based on single phase diffusion, with the introduction of Si and Sn, disposition of the models has shifted to the two-phase diffusion. It is important to understand the interaction of various phenomenon in materials which show phase change during (dis)charging cycles. In this work, we present a phase field model to simulate two-phase lithiation. This model is used to study the electrochemical response of the system by conducting numerical voltammetry. The main goal of this effort is to highlight the difference in electrochemical response occurring during single-phase diffusion and two-phase diffusion and explain the ensuing physics. Furthermore, effect of elasticity which governs the phase-change process and also alters corresponding voltammograms is also studied in detail. The voltammograms show clear shift in current peaks’ size and position for the changing diffusion behavior. Also as elasticity affects the two-phase diffusion, change in nucleation timing and diffusion rate are visible in voltammograms. Additionally, it is also observed how elasticity can cease the phase separation behavior and voltammogram for two-phase diffusion can become identical to single-phase diffusion.
Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing
Authors: Malcolmson James W. , Hughes Rebecca K. , Husselbury Tim , Khan Kamran , Learoyd Annastazia E. , Lees Martin , Wicks Eleanor C. , Smith Jamie , Simms Alexander D. , Moon James C. , Lopes Luis R. , O’Mahony Constantinos , Sekhri Neha , Elliott Perry M. , Petersen Steffen E. , Dhinoja Mehul B. , Mohiddin Saidi A.
Published: June 2024

BACKGROUND:

Patients with refractory, symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy have few therapeutic options. Right ventricular pacing is associated with modest hemodynamic and symptomatic improvement, and LV pacing pilot data suggest therapeutic potential. We hypothesized that site-specific pacing would reduce LVMCO gradients and improve symptoms.

METHODS:

Patients with symptomatic-drug-refractory LVMCO were recruited for a randomized, blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical right ventricular pacing sites were assessed during an invasive hemodynamic study of multisite pacing. Patient-specific pacing-site and atrioventricular delays, defining PPoP, were selected on the basis of LVMCO gradient reduction and acceptable pacing parameters. Patients were randomized to 6 months of active PPoP or backup pacing in a crossover design. The primary outcome examined invasive gradient change with best-site pacing. Secondary outcomes assessed quality of life and exercise following randomization to PPoP.

RESULTS:

A total of 17 patients were recruited; 16 of whom met primary end points. Baseline New York Heart Association was 3±0.6, despite optimal medical therapy. Hemodynamic effects were assessed during pacing at the right ventricular apex and at a mean of 8 LV sites. The gradients in all 16 patients fell with pacing, with maximum gradient reduction achieved via LV pacing in 14 (88%) patients and right ventricular apex in 2. The mean baseline gradient of 80±29 mm Hg fell to 31±21 mm Hg with best-site pacing, a 60% reduction (
P
<0.0001). One cardiac vein perforation occurred in 1 case, and 15 subjects entered crossover; 2 withdrawals occurred during crossover. Of the 13 completing crossover, 9 (69%) chose active pacing in PPoP configuration as preferred setting. PPoP was associated with improved 6-minute walking test performance (328.5±99.9 versus 285.8±105.5 m;
P
=0.018); other outcome measures also indicated benefit with PPoP.

CONCLUSIONS:

In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic patients with LVMCO.

REGISTRATION:

URL:
https://clinicaltrials.gov/study
; Unique Identifier: NCT03450252.
Impact of Neighborhood Social Deprivation on Delays to Access for Transcatheter Aortic Valve Replacement: Wait‐Times and Clinical Consequences
Authors: Zaheer Aida , Qiu Feng , Manoragavan Ragavie , Madan Mina , Sud Maneesh , Mamas Mamas A. , Wijeysundera Harindra C.
Published: June 2024

Background

Transcatheter aortic valve replacement (TAVR) has become the standard of care for severe aortic stenosis treatment. Exponential growth in demand has led to prolonged wait times and adverse patient outcomes. Social marginalization may contribute to adverse outcomes. Our objective was to examine the association between different measures of neighborhood‐level marginalization and patient outcomes while on the TAVR waiting list. A secondary objective was to understand if sex modifies this relationship.

Methods and Results

We conducted a population‐based retrospective cohort study of 11 077 patients in Ontario, Canada, referred to TAVR from April 1, 2018, to March 31, 2022. Primary outcomes were death or hospitalization while on the TAVR wait‐list. Using cause‐specific Cox proportional hazards models, we evaluated the relationship between neighborhood‐level measures of dependency, residential instability, material deprivation, and ethnic and racial concentration with primary outcomes as well as the interaction with sex. After multivariable adjustment, we found a significant relationship between individuals living in the most ethnically and racially concentrated areas (quintile 4 and 5) and mortality (hazard ratio [HR], 0.64 [95% CI, 0.47–0.88] and HR, 0.73 [95% CI, 0.53–1.00], respectively). There was no significant association between material deprivation, dependency, or residential instability with mortality. Women in the highest ethnic or racial concentration quintiles (4 and 5) had significantly lower risks for mortality (HR values of 0.52 and 0.56, respectively) compared with quintile 1.

Conclusions

Higher neighborhood ethnic or racial concentration was associated with decreased risk for mortality, particular for women on the TAVR waiting list. Further research is needed to understand the drivers of this relationship.
Genetics and Pathophysiological Mechanisms of Lipoprotein(a)‐Associated Cardiovascular Risk
Authors: Volgman Annabelle Santos , Koschinsky Marlys L. , Mehta Anurag , Rosenson Robert S.
Published: June 2024

Elevated lipoprotein(a) is a genetically transmitted codominant trait that is an independent risk driver for cardiovascular disease. Lipoprotein(a) concentration is heavily influenced by genetic factors, including
LPA
kringle IV‐2 domain size, single‐nucleotide polymorphisms, and interleukin‐1 genotypes. Apolipoprotein(a) is encoded by the
LPA
gene and contains 10 subtypes with a variable number of copies of kringle ‐2, resulting in >40 different apolipoprotein(a) isoform sizes. Genetic loci beyond
LPA
, such as
APOE
and
APOH
, have been shown to impact lipoprotein(a) levels. Lipoprotein(a) concentrations are generally 5% to 10% higher in women than men, and there is up to a 3‐fold difference in median lipoprotein(a) concentrations between racial and ethnic populations. Nongenetic factors, including menopause, diet, and renal function, may also impact lipoprotein(a) concentration. Lipoprotein(a) levels are also influenced by inflammation since the
LPA
promoter contains an interleukin‐6 response element; interleukin‐6 released during the inflammatory response results in transient increases in plasma lipoprotein(a) levels. Screening can identify elevated lipoprotein(a) levels and facilitate intensive risk factor management. Several investigational, RNA‐targeted agents have shown promising lipoprotein(a)‐lowering effects in clinical studies, and large‐scale lipoprotein(a) testing will be fundamental to identifying eligible patients should these agents become available. Lipoprotein(a) testing requires routine, nonfasting blood draws, making it convenient for patients. Herein, we discuss the genetic determinants of lipoprotein(a) levels, explore the pathophysiological mechanisms underlying the association between lipoprotein(a) and cardiovascular disease, and provide practical guidance for lipoprotein(a) testing.
Machine Learning–Based Critical Congenital Heart Disease Screening Using Dual‐Site Pulse Oximetry Measurements
Authors: Siefkes Heather , Oliveira Luca Cerny , Koppel Robert , Hogan Whitnee , Garg Meena , Manalo Erlinda , Cresalia Nicole , Lai Zhengfeng , Tancredi Daniel , Lakshminrusimha Satyan , Chuah Chen‐Nee
Published: June 2024

Background

Oxygen saturation (Sp
o
2
) screening has not led to earlier detection of critical congenital heart disease (CCHD). Adding pulse oximetry features (ie, perfusion data and radiofemoral pulse delay) may improve CCHD detection, especially coarctation of the aorta (CoA). We developed and tested a machine learning (ML) pulse oximetry algorithm to enhance CCHD detection.

Methods and Results

Six sites prospectively enrolled newborns with and without CCHD and recorded simultaneous pre‐ and postductal pulse oximetry. We focused on models at 1 versus 2 time points and with/without pulse delay for our ML algorithms. The sensitivity, specificity, and area under the receiver operating characteristic curve were compared between the Sp
o
2
‐alone and ML algorithms. A total of 523 newborns were enrolled (no CHD, 317; CHD, 74; CCHD, 132, of whom 21 had isolated CoA). When applying the Sp
o
2
‐alone algorithm to all patients, 26.2% of CCHD would be missed. We narrowed the sample to patients with both 2 time point measurements and pulse‐delay data (no CHD, 65; CCHD, 14) to compare ML performance. Among these patients, sensitivity for CCHD detection increased with both the addition of pulse delay and a second time point. All ML models had 100% specificity. With a 2‐time‐points+pulse‐delay model, CCHD sensitivity increased to 92.86% (
P
=0.25) compared with Sp
o
2
alone (71.43%), and CoA increased to 66.67% (
P
=0.5) from 0. The area under the receiver operating characteristic curve for CCHD and CoA detection significantly improved (0.96 versus 0.83 for CCHD, 0.83 versus 0.48 for CoA; both
P
=0.03) using the 2‐time‐points+pulse‐delay model compared with Sp
o
2
alone.

Conclusions

ML pulse oximetry that combines oxygenation, perfusion data, and pulse delay at 2 time points may improve detection of CCHD and CoA within 48 hours after birth.

Registration

URL:
https://www.clinicaltrials.gov/study/NCT04056104?term=NCT04056104&rank=1
; Unique identifier: NCT04056104.
Exploring Health‐Related Quality of Life in Children With Hypertrophic Cardiomyopathy and Relationship to Physical Activity
Authors: Wagner Mitchell J. , Jeewa Aamir , Pidborochynski Tara , Lemaire‐Paquette Samuel , Khoury Michael , Cunningham Chentel , Dhillon Santokh , Laroussi Nassiba Alami , Vaujois Laurence , Dallaire Frederic , Schantz Daryl , Armstrong Kathryn , Mawad Wadi , Bradley Timothy J. , Conway Jennifer
Published: June 2024

Background

Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health‐related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy.

Methods and Results

A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist‐worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self‐reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8–16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed.

Conclusions

These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.
Eicosapentaenoic Acid and the Outcomes in Older Patients Undergoing Atrial Fibrillation Ablation
Authors: Sudo Yuya , Morimoto Takeshi , Tsushima Ryu , Oka Akihiro , Sogo Masahiro , Ozaki Masatomo , Takahashi Masahiko , Okawa Keisuke
Published: June 2024

Background

A lower serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio (EPA/AA) level correlates with cardiovascular events. Nevertheless, elevated serum EPA levels increase the risk of new‐onset atrial fibrillation (AF) in older patients. The relationship between the EPA/AA and outcomes post‐AF ablation remains unclear. This study investigated the impact of the EPA/AA on AF recurrence and cardiovascular events after AF ablation in older patients.

Methods and Results

This retrospective cohort study examined consecutive patients with AF aged ≥65 years who underwent a first‐time AF ablation. We compared the 3‐year AF recurrence and 5‐year major adverse cardiovascular event (MACE) rates between patients divided into high and low EPA/AA levels defined as above and below the median EPA/AA value before ablation. MACE was defined as heart failure hospitalizations, strokes, coronary artery disease, major bleeding, and cardiovascular death. Among the 673 included patients, the median EPA/AA value was 0.35. Compared with the low EPA/AA group, the high EPA/AA group had a significantly higher cumulative incidence of AF recurrence (39.3% versus 27.6%; log‐rank
P
=0.004) and lower cumulative incidence of MACE (13.8% versus 25.5%, log‐rank
P
=0.021). A high EPA/AA level was determined as an independent predictor of AF recurrence (hazard ratio [HR], 1.75 95% CI, 1.24–2.49;
P
=0.002) and MACE (HR, 0.60 [95% CI, 0.36–0.99];
P
=0.046).

Conclusions

The EPA/AA was associated with AF recurrence and MACE after ablation in patients with AF aged ≥65 years.
New Perspectives in Management of Cardiovascular Risk Among People With Diabetes
Authors: Gami Abhishek , Blumenthal Roger S. , McGuire Darren K. , Sarkar Sudipa , Kohli Payal
Published: June 2024

Following the publication of results from multiple landmark cardiovascular outcome trials of antihyperglycemic medications over the past 8 years, there has been a major shift in the focus of care for people with type 2 diabetes, from control of hyperglycemia to managing cardiovascular risk. Multiple international cardiology and diabetes society guidelines and recommendations now endorse sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like protein‐1 receptor agonists as first‐line therapies to mitigate cardiovascular risk. The most recent publication is the 2023 European Society of Cardiology guideline on the management of cardiovascular disease in those with type 2 diabetes that, for the first time, recommends use of both classes of medications for the mitigation of cardiovascular risk for those with or at high risk for atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. Here, we review the evidence behind contemporary society guidelines and recommendations for the management of type 2 diabetes and cardiovascular risk.
Improving the Detection of Potential Cases of Familial Hypercholesterolemia: Could Machine Learning Be Part of the Solution?
Authors: Stevens Christophe A. T. , Vallejo‐Vaz Antonio J. , Chora Joana R. , Barkas Fotis , Brandts Julia , Mahani Alireza , Abar Leila , Sharabiani Mansour T. A. , Ray Kausik K.
Published: June 2024

Background

Familial hypercholesterolemia (FH), while highly prevalent, is a significantly underdiagnosed monogenic disorder. Improved detection could reduce the large number of cardiovascular events attributable to poor case finding. We aimed to assess whether machine learning algorithms outperform clinical diagnostic criteria (signs, history, and biomarkers) and the recommended screening criteria in the United Kingdom in identifying individuals with FH‐causing variants, presenting a scalable screening criteria for general populations.

Methods and Results

Analysis included UK Biobank participants with whole exome sequencing, classifying them as having FH when (likely) pathogenic variants were detected in theirLDLR,APOB, orPCSK9genes. Data were stratified into 3 data sets for (1) feature importance analysis; (2) deriving state‐of‐the‐art statistical and machine learning models; (3) evaluating models' predictive performance against clinical diagnostic and screening criteria: Dutch Lipid Clinic Network, Simon Broome, Make Early Diagnosis to Prevent Early Death, and Familial Case Ascertainment Tool. One thousand and three of 454 710 participants were classified as having FH. A Stacking Ensemble model yielded the best predictive performance (sensitivity, 74.93%; precision, 0.61%; accuracy, 72.80%, area under the receiver operating characteristic curve, 79.12%) and outperformed clinical diagnostic criteria and the recommended screening criteria in identifying FH variant carriers within the validation data set (figures for Familial Case Ascertainment Tool, the best baseline model, were 69.55%, 0.44%, 65.43%, and 71.12%, respectively). Our model decreased the number needed to screen compared with the Familial Case Ascertainment Tool (164 versus 227).

Conclusions

Our machine learning–derived model provides a higher pretest probability of identifying individuals with a molecular diagnosis of FH compared with current approaches. This provides a promising, cost‐effective scalable tool for implementation into electronic health records to prioritize potential FH cases for genetic confirmation.
Advanced Atrioventricular Block in Athletes: Prevalence and Role of Anti‐Ro/Sjögren Syndrome–Related Antigen A Antibodies
Authors: Lazzerini Pietro Enea , Bertolozzi Iacopo , Cartocci Alessandra , Ginjupalli Vamsi Krishna Murthy , Teneggi Pietro Alberto , Pica Davide , Merico Giovanni , Bogazzi Irene , Salvini Viola , Accioli Riccardo , Salvadori Fabio , Marzotti Tommaso , Cevenini Gabriele , Capecchi Matteo , Cantara Silvia , Cantore Anna , Infantino Maria , Bisogno Stefania , Finizola Francesco , D'ascenzi Flavio , Laghi‐Pasini Franco , Acampa Maurizio , Capecchi Pier Leopoldo , Boutjdir Mohamed
Published: June 2024

Background

Advanced atrioventricular block (AVB), that is, higher than second‐degree Mobitz‐1, is an abnormal finding in athletes. Despite intensive investigation, in several cases the pathogenesis remains unknown, but frequently pacemaker implantation is still indicated. Increasing evidence points to circulating anti‐Ro/Sjögren syndrome–related antigen A (SSA) antibodies cross‐reacting with L‐type calcium channel and inhibiting the related current as an epidemiologically relevant and potentially reversible cause of isolated AVB in adults.

The aim of the study was to determine the prevalence of anti‐Ro/SSA‐associated advanced AVBs in a large sample of young athletes.

Methods and Results

A total of 2536 consecutive athletes aged <40 years without a history of cardiac diseases/interventions were enrolled in a cross‐sectional study. Resting and exercise electrocardiography was performed, and those presenting any AVB were further evaluated by 24‐hour Holter ECG. Athletes with second‐degree AVBs and their mothers underwent anti‐Ro/SSA testing. Moreover, purified immunoglobulin G from subjects with anti‐Ro/SSA‐positive and anti‐Ro/SSA‐negative advanced AVB were tested on L‐type calcium current and L‐type‐calcium channel expression using tSA201 cells. The global prevalence of advanced AVB in the overall sample was ≈0.1%, but the risk considerably increased (2%) when intensely trained postpubertal male subjects were selectively considered. While none of the athletes with advanced AVB showed heart abnormalities, in 100% of cases anti‐Ro/SSA antibodies were detected. Ex vivo experiments showed that immunoglobulin G from anti‐Ro/SSA‐positive but not ‐negative subjects with advanced AVB acutely inhibit L‐type calcium current and chronically downregulate L‐type‐calcium channel expression.

Conclusions

Our study provides evidence that advanced AVB occurs in young athletes, in most cases associated with anti‐Ro/SSA antibodies blocking L‐type calcium channels. These findings may open new avenues for immunomodulating therapies to reduce the risk of life‐threatening events in athletes, avoiding or delaying pacemaker implantation.
Comparison of Endovascular Therapy and Open Surgical Revascularization in Patients With Acute Superior Mesenteric Artery Occlusion: A Large‐Scale Analysis Based on the JROAD‐DPC Database
Authors: Goto Daiki , Yanishi Kenji , Ozawa Takaaki , Yoshimura Jun , Kawamata Hirofumi , Fujioka Ayumu , Seki Tomotsugu , Zen Kan , Matoba Satoaki
Published: June 2024

Background

Acute mesenteric ischemia is rare, and few large‐scale trials have evaluated endovascular therapy (EVT) and open surgical revascularization (OS). This study aimed to assess clinical outcomes after EVT or OS for acute superior mesenteric artery occlusion and identify predictors of mortality and bowel resection.

Methods and Results

Data from the Japanese Registry of All Cardiac and Vascular Diseases‐Diagnosis Procedure Combination (JROAD‐DPC) database from April 2012 to March 2020 were retrospectively analyzed. Overall, 746 patients with acute superior mesenteric artery occlusion who underwent revascularization were classified into 2 groups: EVT (n=475) or OS (n=271). The primary clinical outcome was in‐hospital mortality. The secondary outcomes were bowel resection, bleeding complications (transfusion or endoscopic hemostasis), major adverse cardiovascular events, hospitalization duration, and cost. The in‐hospital death or bowel resection rate was ≈30%. In‐hospital mortality (22.5% versus 21.4%,
P
=0.72), bowel resection (8.2% versus 8.5%,
P
=0.90), and major adverse cardiovascular events (11.6% versus 9.2%,
P
=0.32) were comparable between the EVT and OS groups. Hospitalization duration in the EVT group was 6 days shorter than that in the OS group, and total hospitalization cost was 0.88 million yen lower. Interaction analyses revealed that EVT and OS had no significant difference in terms of in‐hospital death in patients with thromboembolic and atherothrombotic characteristics. Advanced age, decreased activities of daily living, chronic kidney disease, and old myocardial infarction were significant predictive factors for in‐hospital mortality. Diabetes was a predictor of bowel resection after revascularization.

Conclusions

EVT was comparable to OS in terms of clinical outcomes in patients with acute superior mesenteric artery occlusion. Some predictive factors for mortality or bowel resection were obtained.

Registration

URL:
www.umin.ac.jp/ctr/
; Unique Identifier: UMIN000045240.
Framing Nonviolent Islamism: Hizb ut-Tahrir al-Islami, the Ukrainian State and the 2014 Annexation of Crimea
Authors: Shestopalets Denys
Published: June 2024

The article offers an analysis of the paradoxes and dilemmas in the relations between Hizb ut-Tahrir al-Islami (hti) and the Ukrainian state prior to and after the 2014 annexation of Crimea. In the first place, it traces the representations of hti by Ukrainian officials in the 2000s and early 2010s, as well as various measures adopted by the government for dealing with the group’s proliferation among Crimean Muslims. On the basis of this, the article reviews the responses of various Ukrainian government bodies and law enforcement agencies to the criminal prosecution of hti as a terrorist organisation by the Russian authorities in Crimea in the post-annexation period. In this respect, it demonstrates how hti cases were used as an important element in Ukraine’s strategy of returning control over the peninsula by rallying extensive international support against Russia’s violations of human rights. At the same time, it is an argument of this paper that, despite vocal protests against arrests and long prison sentences for the Crimean hizbis, the Ukrainian state and law enforcement remained deeply ambivalent vis-à-vis hti as a transnational Islamist organisation – a state of affairs which became particularly evident in the treatment of Russian and Central Asian hti members who sought political asylum in Ukraine.
U.S. Commercial Diplomacy Toward Turkey: Ambassador George C. McGhee’s Role in the Privatization of the Oil Business in the 1950s
Authors: Iplikci Murat
Published: June 2024

American diplomats occupied an important place in Turkish politics in the 1950s. They were not only highly valued by Turkish governments; they also participated in decision-making processes as advisers, especially in matters of commerce and privatization. This article focuses on one of these influential actors, George C. McGhee, who played a significant role in the denationalization of Turkey’s oil operations in March 1954. With a degree and business background in the oil sector and experience in the Turkish mission, McGhee was an effective commercial diplomat. Throughout his short tenure as ambassador, McGhee influenced Turkish leaders to privatize the oil sector. He mediated between the Turkish government and American lawyers specializing in oil bills, alongside American companies as possible investors. Shortly after he left the Turkish post, Turkey passed a law that privatized the oil sector.