bluuebunny/crossref_metadata_2025 huggingface dataset:
A STRANGE CASE OF CARDIOTOXICITY FROM ANTIBLASTIC TREATMENT: A HIGH PRICE TO PAY
Authors: Samperi S , Laura C , Trambaiolo P , D‘Ambrosi A , Mustilli M , Romano S , Granatelli A
Published: May 2024

Introduction

Cardiovascular diseases and cancer represent the two main public health problems in the west. Targeted oncological therapies extend the average life expectancy of patients, but also cause acute or chronic cardiovascular toxicity.

Case Report

A 58–year–old woman without cardiovascular risk factors comes to the Emergency Department for oppressive chest pain, associated with vomiting and tachycardia. Two days before admission, adjuvant chemotherapy treatment with 5–fluorouracil (5–FU) and oxaliplatin had been administered to the patient for a rectal cancer detected the previous year. At blood tests D–Dimer was negative, the troponin was 0.44 ng/ml [<0.034 ng/ml], NTproBNP 8820 pg/ml [<125 pg/ml]. The electrocardiogram showed a mild but widespread elevation in the anterior lead and the transthoracic echocardiography (TTE) revealed a reduction in ejection fraction (EF 20%) with global hypokinesia and akinesia of the apex extending to the middle segments. At the angiography the coronary arteries were free from significant stenoses. Hospitalization in cardiac intensive care unit was complicated by episodes of torsades de pointes degenerating into ventricular fibrillation (VF), treated with 3 DC–shocks; the patient was intubated and mechanically ventilated for two days. During the hospitalizzation, heart failure and antiarrhythmic therapy was started, with improvement in the patient‘s ventricular systolic function and symptoms. The patient rejected cardiac magnetic resonance imaging (cardiac MRI). On discharge, after ten days, TTE revealed an EF of 40%, filling pressures reduced, NTproBNP and troponins values normalised.

Discussion

5–FU is the second most cardiotoxic oncology drug, after anthracyclines. Patients who start therapy with fluoropyrimidines may present chest pain associated with findings suggestive of coronary occlusion, as well as biochemical evidence of myocardial injury in the absence of disease on coronary angiography. The pathogenetic mechanism is probably related both to coronary vasospasm and a direct myocardial toxicity of the drug. However severe left ventricular dysfunction remains a behavior not described in the literature with this type of antiblastics. Cardiac MRI would have been helpful in clarifying the etiology of the toxicity.
PATIENT WITH CHRONIC CORONARY SYNDROME: USE OF MULTIMODAL IMAGING FOR CORRECT DIAGNOSIS AND TREATMENT
Authors: Formigli D , Luongo A , Franco V , Moscato F , Cocozza S , Parente A , Coppola G , Di Donato M , Tozzi N , De Vizia M , Scherillo M
Published: May 2024

In the context of CCS, CCTA allows us to discriminate with almost certainty between patients with the absence of disease. In case of a positive test, the characteristics of the plaque allow to stratified risk of developing future events. In doubtful cases it is necessary to resort to a multimodal imaging strategy for the correct diagnosis. We present the case of a 63-year-old hypertensive and dyslipidemic man who started presenting two months ago episodes of asthenia associated with tachycardia and jugular constriction after taking the usual CCB therapy. With a pre-test probability of 26%, a CCTA scan was requested which highlighted a non-calcific fibrous plaque (Image 1) at the level of the middle circumflex inducing a moderate stenosis (Cad-Rads 3). The patient underwent coronary angiography which confirmed this lesion and also highlighted a similar one downstream of the first. (Image 2) The OCT evaluation showed: 7 mm eccentric fibrous proximal plaque with evidence of multiple intimal layers (Healed plaque) in its distal third and with evidence of a medial-intimal flap involving three quadrants in the proximal two thirds (270°), with current intact endothelium and presence of neo-angiogenesis; MLA 2.33 mm² and AS 70%. Picture compatible with healed spontaneous dissection of the vessel. (Image 3) The subsequent 12 mm concentric plaque (360° involvement of the vessel) had a predominantly lipid component with macrophages and fibrous cap of 60 µm, MLA of 2.3mm² and AS 72%. Panel compatible with high risk plaque. (Image 4) It was decided to implant a 3.5x26mm drug-eluting stent through OCT-guided PCI with final MSA of 7.62 mm², stent expansion of 81%, absence of dissections at the edges and residual distal edge plaque with MLA of 7.6 mm². (Image 5).

Conclusions

Healed plaques are more frequent in patients with CCS and represent a plaque complicated by medial-intimal ulceration subsequently healed by neo-endothelialization. On CCTA they appear as non-calcific fibrous plaques with an intermediate density expressed in Hounsfield Units but the definitive diagnosis can only be obtained using an Intravascular Imaging method (OCT in the case presented). The patient appears asymptomatic after resuming his usual antihypertensive therapy at 30-day FU.
A RARE CASE OF INTERVENTRICULAR SEPTUM DUPLICATION
Authors: Massara M
Published: May 2024

Case Report

A 62–year–old man, history of hypertension. In 2015, there was suspicion of non–compaction cardiomyopathy, and he underwent cardiac MRI at another facility (report not available). The patient reported palpitations and dyspnea with exertion, leading to a follow–up visit. EKG showed sinus rhythm 90/min, nonspecific intraventricular conduction delay and isolated monomorphic ventricular ectopic beats. Echo revealed a mildly dilated left ventricle (end–diastolic volume 88 ml/m), systolic function at the lower limits of normal (EF 53%), and prominent muscular structures near the posterior interventricular septum (SIV), likely related to anomalies of the papillary muscles (prominent and possibly duplicated posterior–medial papillary muscle). There was apical trabecular protrusion, which did not meet the criteria for non–compaction (NC/C ratio in systole approximately 1), with no other significant findings. The cardiac MRI, performed to assess dilated cardiomyopathy, revealed a conspicuous structural abnormality in the septo–papillary region, located medio–apically and paraseptal–endocardial in the left ventricle. This anomaly lacked evident chordae tendineae with the mitral valve leaflets and exhibited synchronous systo–diastolic motion with the left ventricular wall, suggesting septal duplication. The septal thickness was slightly reduced, particularly in the medio–apical region. Additionally, there was hypertrabeculation of the posterior and lateral walls of the left ventricle, exceeding the threshold for non–compaction (NC/C ratio in end–diastole: 2.6 – normal range: <2.3). Left ventricular mass was normal (mass: 173.52 g; mass/body surface area (BSA): 86.58 g/m). Basal septum, medio–apical septum and medio–apical lateral wallshowed hypokinetic contractility. The left ventricle was dilated (end–diastolic diameter: 55.0 mm; end–systolic diameter: 45.3 mm – end–diastolic volume: 230 ml; stroke volume/BSA: 57.6 ml/m² – EF: 51%). Areas of late gadolinium enhancement (LGE) were observed in the anterior medio–basal septum and at the site of the described structural muscular anomaly, both displaying an intramural non–ischemic pattern.

Conclusions

The described findings suggest a picture of dilated cardiomyopathy and an associated structural septo–papillary anomaly of uncertain diagnostic interpretation (septum duplication with associated non–compacted myocardium? duplicated posterior–medial papillary muscle with associated non–compacted myocardium?).
SUBACUTE LEFT VENTRICULAR FREE WALL RUPTURE
Authors: Astuti G , Mingoia G , D’Amico L , Gargano M , Marotta A , D’Angelo F , Leggio G , Ciaramitaro G , De Michele G , Coppola G , Evola S , Argano V , Puccio D , Corrado E
Published: May 2024

Left ventricular free wall rupture is a rare and catastrophic mechanical complication after myocardial infarction. Surgical exploration and rupture repair is the definitive diagnostic and therapeutic procedure. We report the case of a 69–year–old male with no significant cardiac history, admitted to our department for an inferior–lateral ST–segment elevation myocardial infarction, manifesting as chest pain and subsequent loss of consciousness. On admission, the patient was hemodynamically stable (BP: 100/60 mmHg; HR: 127 bpm). Urgent coronary angiography indicated acute thrombotic occlusion of the circumflex artery’s OM branch, necessitating percutaneous coronary intervention on the affected vessel. Echocardiography identified akinesia in the inferior septal, inferior and inferior–lateral walls, along with pericardial effusion with hemorrhagic density (3.7 cm at the atrioventricular junction in subcostal projection), causing marked biatrial compression and significant dilation of the suprahepatic venous system. Urgent angio–CT ruled out aortic dissection or ventricular wall rupture. However, due to deteriorating hemodynamic conditions, emergency median sternotomy with pericardial toilet was performed, revealing no evident breaches in the cardiac walls and targeted echocardiography revealed a mild circumferential pericardial effusion (1.1 cm). Following amino and inotropic support, the patient’s clinical conditions stabilized. On the fifteenth day post–acute event, a new syncopal episode occurred (BP: 110/70 mmHg, HR 90 bpm). Echocardiography showed an organized clot compressing right atrium and right ventricular inflow tract during the systo–diastolic phase. Angio–CT revealed a voluminous blood collection at the left ventricular apex, supplied by iodinated contrast, suggesting a probable rupture of the postero–inferior cardiac wall. Consequently, a second emergency median sternotomy exposed profuse bleeding from a left ventricular wall pseudoaneurysm. After initiating extracorporeal circulation, the clot was evacuated and a 1 cm breach in the left ventricular inferior wall was sutured. Considering recent STEMI and the need for high doses of inotropic support, an intra–aortic balloon pump was positioned.Post–procedural echocardiography confirmed successful repair with no subvalvular mitral apparatus alterations. Unfortunately, after approximately 12 hours of intensive monitoring, the patient succumbed to refractory cardiogenic shock despite therapy.
ROLE OF ST–SEGMENT ELEVATION AT POST–ROSC ECG IN PATIENTS RESUSCITATED FROM OUT–OF–HOSPITAL CARDIAC ARREST
Authors: Pontremoli S , Bendotti S , Primi R , Currao A , Sechi G , Marconi G , Ronchi V , Contri E , Panni G , Sgotti D , Zorzi E , Cazzaniga M , Piccolo U , Bussi D , Ruggieri S , Facchin F , Soffiato E , Centineo P , Reali F , Gentile F , Baldi E , Compagnoni S , Quilico F , Vicini Scajola L , Fasolino A , Lopiano C , Savastano S
Published: May 2024

Background

A 12–lead electrocardiogram (ECG), performed after return of spontaneous circulation (ROSC) in out–of–hospital cardiac arrest (OHCA), is essential for the identification of ST–segment elevation). The aim of the study is to investigate whether the presence of ST elevation may be a prognostic determinant in post–OHCA patients.

Materials and Methods

A total of 878 post–ROSC ECGs were collected from patients enrolled from 01/01/2015 to 12/31/2022 from the Lombardy Region Cardiac Arrest Registry (LombardiaCARe). Univariable and multivariable Cox regression models were applied to test the association between the presence of and morphology of supraST and mortality at 30 days after the event.

Results

Among the 878 post–ROSC ECGs, 406 (46.2%) had ST elevation [49 with tombstone morphology; 26 with lambda morphology; 45 with triangular morphology; and 8 with wave morphology]. Patients with ST elevation were more frequently males (73% vs 59%, p<0.001), younger [66 years old (57–75) vs 71 (61–80), p<0.01], and with a more frequently non–defibrillating rhythm of presentation (25%vs59%, p<0.01) and an event more frequently witnessed by 118 (30% vs 21%, p=0.008). Thirty–day survival was higher in patients with ST elevation (56% vs 41%, p<0.001). Correcting for variables associated with 30–day survival (age, sex, QRS amplitude, ECG acquisition time, first rhythm of presentation), the presence of ST elevation was not significantly associated with 30–day mortality [HR: 0.67 (95% CI: 0.27–1.64); p=0.05], while the number of segments was [1.1 (95%CI 0.85–0.15), p=0.004]. No morphology was independently associated with mortality when compared with standard morphology.

Conclusions

The presence of ST elevation on ECG post ROSC possesses, in addition to a known diagnostic role, a prognostic role in predicting 30–day survival especially if present in more than one segment.
AN UNUSUAL LEFT VENTRICULAR APICAL MASS COMPLICATING ACUTE MYOCARDIAL INFARCTION
Authors: Nunziata L , Ambrosino S , Carbone L , Laezza A , Nardiello V , Prisco A , Miele R , Sena L , America R , Buonauro A , Munciguerra O , Pirozzi C , Di Mauro P , Terracciano F , Maresca G , Granata F , Falato S , Volpicelli M , Muto C , Capasso M , Caliendo L
Published: May 2024

An 34–year–old man presented to the emergency department of our hospital with palpitations and presyncope. He was a smoker but had no others known cardiovascular risk factors. At admission, his electrocardiogram (ECG) showed sustained monomorphic ventricular tachycardia (VT) at a rate of 187 beats per minute. The VT was successfully treated with synchronized direct current cardioversion. The ECG in sinus rhythm showed Qs from V1 to V6 with ventricular repolarization anomalies in the same site suspicious for previous anterior necrosis. A transthoracic echocardiogram revealed akinetic apex, akinesia of middle segments of the interventricular septum, anterior and lateral walls, Left Ventricular (LV) ejection fraction of 30% and a large apical mass suspicious for LV thrombus. The patient was admitted to the coronary care unit and taken to the Cath lab that showed total left anterior descending mid–segment occlusion. Due to the chronicity of the condition, the patient was recommended to optimal medical therapy. Suspecting LV thrombus, the patient began treatment with unfractionated heparin i.v. and subsequently imbricate therapy with enoxaparin s.c. and warfarin. Additionally, the patient underwent subcutaneous implantable cardioverter defibrillator (S–ICD) implantation for secondary prevention of sudden cardiac death. At echocardiographic follow–up one week after discharge, the apical mass remained unchanged despite warfarin therapy with INR at target. For this reason, the patient was recommended to perform a Cardiovascular magnetic resonance (CMR). Three months after S–ICD implantation, a CMR was performed which showed transmural areas of late gadolinium enhancement involving all apical segments and middle segments of the interventricular septum which allowed the diagnosis of a large intramyocardial dissecting hematoma (IDH) of left ventricle. IDH is a rare complication of ST–elevation myocardial infarction (STEMI), it is an unusual form of subacute cardiac rupture and could be fatal. It usually consists of a cavity or channels within the myocardium. Its prognosis varies according to its location, but generally apical IDH have more favorable outcome with a higher likelihood of spontaneous retraction. We report this case because the IDH is a diagnostic challenge and it represents an extremely rare and poorly described event in the literature.
SEVERE SYMPTOMATIC MITRAL REGURGITATION AFTER ANNULOPLASTY FAILURE: SUCCESSFUL TRANSCATHETER EDGE TO EDGE REPAIR
Authors: Coradello E , Zilio F , D‘Onghia G , Saraò E , Bonmassari R , Dallago M
Published: May 2024

Surgical mitral valve repair is the most common, feasible and preferred procedure to treat primary and secondary mitral regurgitation (MR). However, 30% of patients suffer from residue severe regurgitation 10 years after surgical intervention, resulting in a considerable number of Redo procedures. In elderly and high–risk patients with major comorbidities medical treatment is the only and often insufficient option for symptoms’ relief. Percutaneous Transcatheter Edge to Edge repair technique (TEER) with MitraClip system is emerging as an off–label valid alternative to successfully treat severe mitral regurgitation after surgical valvuloplasty failure. Transesophageal echocardiography (TEE) is essential in diagnosis, planning, intraprocedural device placement, and follow up. In the peculiar setting of failed annuloplasty, with small residual valve area, the main risk is the creation of a gradient across the mitral valve. We present two cases of severe mitral regurgitation after surgical annuloplasty with ring placement, carefully evaluated for TEER and successfully treated with this procedure: 1) a 79–year–old man presented with exertional dyspnea and orthopnea in the setting of previous surgical mitral Annuloplasty (2003) with a 32–mm Carpentier Ring. Transesophageal echocardiography demonstrated severe mitral regurgitation due to P2 prolapse and central V–shaped cut of the valve, mean diastolic gradient 1.8 mmHg. 2) a 83 year–old woman presented with dyspnea (NYHA functional class III) and severe mitral regurgitation after previous Annuloplasty with a 34–mm Edwards Ring and placement of Goretex artificial Chordae (2016). TEE showed prolapse of P2 and P3 leaflets, mean diastolic gradient 2.17 mmHg, valvular area 3.5 cmq. Both patients underwent transfemoral and transseptal implantation of one MitraClip device (XTw and XT, respectively) under Transesophageal echocardiography guidance with successful reduction of mitral regurgitation to mild level and symptoms relief. In the first case post procedural mean diastolic gradient was 3.7 mmHg, in the second case it was 3.16 mmHg.
GUIDEWIRE SHAPE MODIFICATION: A SIMPLE TECHNIQUE TO PREVENT CONDUCTION SYSTEM INJURIES DURING TRANSCATHETER VALVE IMPLANTATION
Authors: Azzola Guicciardi N , Buzzatti N , Longoni M , Denti P , Faggi A , Ascione G , Gatto P , Godino C , Saccocci M , Maisano F
Published: May 2024

Background

Atrioventricular (AV) conduction abnormalities remain one of the important unsolved issues with transcatheter aortic valve implantation (TAVI). To minimize trauma on the conduction fibers, we introduced a simple technique involving the bending of the stiff guidewire wire at the level of the arch to prevent and minimize contact with the interventricular septum.

Aim

To report the technique for shape manipulation of the stiff guidewire during TAVI and to evaluate its safety and effectiveness in reducing the need for permanent pace–make implantation after TAVI.

Methods and Results

Before insertion into the left ventricle the TAVI stiff wire was bended by hand to obtain a ³180° degree curve 15–20cm from its tip. Distance between stiff wire and septum was assessed in cranial–lao cusp overlap projection. Among 26 consecutive patients who underwent TAVI with a bended stiff wire, 13(50%) presented preoperative factors of increased risk for need of PM implantation after TAVI due to LVOT calcification (10, 38.5%), bicuspid aortic valve with raphe opposite to the septum (2, 7.7%) and baseline RBBB (2, 7.7%). Wire was observed to be distant from the septum >5mm in 22/26 (85%) cases. Median distance from septum was 9.0 [6.0, 12.0] mm. Pre–dilatation was required in 20 patients (77%). Balloon was observed to inflate distant from septum in 18 (90%) of them. Self–expandable valves were most frequently employed (n = 21, 81%).No patient required new PM implantation after TAVI. The two patients with baseline RBBB developed transient complete AVB, which recovered before discharge.No major complication (vascular, ventricular perforation, annular rupture, device embolization) was observed.

Conclusions

In this early preliminary experience stiff wire bending was able not only to keep far from the septum the wire in the majority of patients, without any complication, but also to provide wire stability and prevented inadvertent pressure of the wire over the left ventricular apex. No patient required PM implantation after TAVI. While wire bending seems promising in minimizing trauma on the conduction system, this study is to be considered hypothesis generating and more data are needed to confirm its findings.
3D CT Radiomic Analysis Improves Detection of Axillary Lymph Node Metastases Compared to Conventional Features in Patients With Locally Advanced Breast Cancer
Authors: Barszczyk Mark , Singh Navneet , Alikhassi Afsaneh , Van Oirschot Matthew , Kuling Grey , Kiss Alex , Gandhi Sonal , Nofech-Mozes Sharon , Look Hong Nicole , Bilbily Alexander , Martel Anne , Matsuura Naomi , Curpen Belinda
Published: May 2024

Objective

Preoperative detection of axillary lymph node metastases (ALNMs) from breast cancer is suboptimal; however, recent work suggests radiomics may improve detection of ALNMs. This study aims to develop a 3D CT radiomics model to improve detection of ALNMs compared to conventional imaging features in patients with locally advanced breast cancer.

Methods

Retrospective chart review was performed on patients referred to a specialty breast cancer center between 2015 and 2020 with US-guided biopsy-proven ALNMs and pretreatment chest CT. One hundred and twelve patients (224 lymph nodes) met inclusion and exclusion criteria and were assigned to discovery (n = 150 nodes) and testing (n = 74 nodes) cohorts. US-biopsy images were referenced in identifying ALNMs on CT, with contralateral nodes taken as negative controls. Positive and negative nodes were assessed for conventional features of lymphadenopathy as well as for 107 radiomic features extracted following 3D segmentation. Diagnostic performance of individual and combined radiomic features was evaluated.

Results

The strongest conventional imaging feature of ALNMs was short axis diameter ≥ 10 mm with a sensitivity of 64%, specificity of 95%, and area under the curve (AUC) of 0.89 (95% CI, 0.84-0.94). Several radiomic features outperformed conventional features, most notably energy, a measure of voxel density magnitude. This feature demonstrated a sensitivity, specificity, and AUC of 91%, 79%, and 0.94 (95% CI, 0.91-0.98) for the discovery cohort. On the testing cohort, energy scored 92%, 81%, and 0.94 (95% CI, 0.89-0.99) for sensitivity, specificity, and AUC, respectively. Combining radiomic features did not improve AUC compared to energy alone (P = .08).

Conclusion

3D radiomic analysis represents a promising approach for noninvasive and accurate detection of ALNMs.
Reconstructing Nasal Defects With Acellular Dermal Matrix After Mohs Micrographic Surgery: A 12-year Experience
Authors: Bascone Corey M. , Lin Stephanie K. , Deitermann Annika , Raj Leela K. , Nugent Shannon T. , Wang Leo , McGraw J. Reed , Broach Robyn B. , Miller Christopher J. , Kovach Stephen J.
Published: May 2024

BACKGROUND AND OBJECTIVE

Large defects of the nose after Mohs surgery pose a significant reconstructive challenge to both dermatologic and reconstructive surgeons. The authors present their 12-year experience utilizing acellular dermal matrices for nasal reconstruction.

METHODS

A retrospective review of patients undergoing Mohs surgery and alloplastic nasal reconstruction with acellular dermal matrices between 2010 and 2022 was performed. Patients who underwent single-stage reconstruction and dual-stage reconstruction with skin graft with at least 90 days of follow-up were included.

RESULTS

Fifty-one patients met criteria with a median age of 77 years. Fifty-three lesions were reconstructed with acellular dermal matrices. The most common lesion location was nasal sidewall (50%) with a mean defect size of 10.8 cm2. 30.8% underwent same-day acellular dermal matrix reconstruction, with 69.2% undergoing two-stage reconstruction. Acellular dermal matrices successfully reconstructed acquired defects in 94.2% of lesions. Average time to re-epithelialization was 27.6 + 6.2 days. Average time to repigmentation was 145.35 + 86 days. No recurrences were recorded. Total complication rate was 9.62%. Average size for successful healing was 10.8 cm2. Average defect size for complication or failure was 14.7 cm2. Seven sites (13.46%) underwent aesthetic improvement procedures.

CONCLUSION

Acellular bilayer wound matrix is an adequate reconstructive option for single or dual-stage reconstruction of the nose with low complication and revision rates.
Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity
Authors: Schmitt Jessicia S. , Knight Laura D.
Published: May 2024

The incidence of suicide by intentional nitrite ingestion has increased since 2017. Limited options exist for commercial laboratory analysis for nitrite/nitrate. This study investigates the use of urine dipsticks for screening at autopsy for potential toxicity with sodium nitrite and, less commonly, alkyl nitrite. Archived samples of blood, urine, vitreous fluid, and gastric contents from 4 sodium nitrite/nitrate cases, 3 alkyl nitrite cases, and 4 control cases were tested using dipsticks. A rapid, strong positive result for nitrite was in the vitreous fluid of all 4-sodium nitrite/nitrate cases, along with 2 positive urine and 1 positive gastric. The 2 alkyl nitrite inhalation toxicity cases had no positive results. One alkyl nitrite ingestion case had a positive urine. The 4 controls had negative urine: equivocal results in 2 vitreous, and 1 positive gastric. Urine dipsticks are a useful adjunct to laboratory testing for nitrite toxicity and provide a rapid, cost-effective tableside result that may guide the need for further testing. Vitreous fluid and urine appear to be the most reliable specimens, although testing of gastric liquid may be useful to corroborate oral ingestion. Dipsticks may not be a reliable adjunct for testing for alkyl nitrite toxicity via inhalation route, likely due to the much lower nitrite concentration compared to nitrite ingestion cases.
Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease
Authors: Harris Julia G. , Jones Jordan T. , Favier Leslie , Fox Emily , Holland Michael J. , Ivy Amy , Hoffart Cara M. , Ibarra Maria , Cooper Ashley M.
Published: May 2024

Background:

Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year.

Methods:

Two process measures were up-to-date vaccination status on (1) 13-valent pneumococcal conjugated vaccine (PCV13) and (2) 23-valent pneumococcal polysaccharide vaccine (PPSV23). Our outcome measure was being fully up to date on both pneumococcal vaccinations. Interventions included an immunization algorithm, reporting of eligible patients, education, reminders, and pre-visit planning.

Results:

There were shifts in the centerline for all quality measures in both phases of this project. The combined pneumococcal vaccination rate for Phase 1 increased from 9.6% to 91.1%, and this centerline was sustained. Pneumococcal vaccination rates also significantly increased for Phase 2: 68.8% to 93.4% for PCV13, 65.2% to 88.5% for PPSV23, and 62.6% to 86.5% for the combined pneumococcal vaccination rate.

Conclusions:

Quality improvement methodology significantly increased and sustained pneumococcal vaccination rates in our high-risk, immunosuppressed patients. We continue to prioritize this important initiative to mitigate the risk of invasive pneumococcal disease.
Classifying Genetic Interactions Using an HIV Experimental Study
Authors: Huckleberry Sean C. , Silva Mary S. , Drocco Jeffrey A.
Published: May 2024

Current methods of addressing novel viruses remain predominantly reactive and reliant on empirical strategies. To develop more proactive methodologies for the early identification and treatment of diseases caused by viruses like HIV and Sars-CoV-2, we focus on host targeting, which requires identifying and altering human genetic host factors that are crucial to the life cycle of these viruses. To this end, we present three classification models to pinpoint host genes of interest. For each one, we thoroughly analyze the current predictive accuracy, susceptibility to modifications of the input space, and potential for further optimization. Our methods rely on the exploration of different gene representations, including graph-based embeddings and large foundation transformer models, to establish a set of baseline classification models. Subsequently, we introduce an order-invariant Siamese neural network that exhibits more robust pattern recognition with sparse datasets while ensuring that the representation does not capture unwanted patterns, such as the directional relationship of genetic interactions. Through these models, we generate biological features that predict pairwise gene interactions, with the intention of extrapolating this proactive therapeutic approach to other virus families.
Phenotype correlations with pathogenic DNA variants in theMUTYHgene
Authors: Thet Monica , Plazzer John Paul , Capella Gabriel , Latchford Andrew , Nadeau Emily AW , Greenblatt Marc S , Macrae Finlay
Published: May 2024

MUTYH-associated polyposis (MAP) is an autosomal recessive disorder where the inheritance of constitutional biallelic pathogenicMUTYHvariants predisposes a person to the development of adenomas and colorectal cancer (CRC). It is also associated with extracolonic and extraintestinal manifestations that may overlap with the phenotype of familial adenomatous polyposis (FAP). Currently, there are discrepancies in the literature regarding whether certain phenotypes are truly associated with MAP. This narrative review aims to explore the phenotypic spectrum of MAP to better characterise the MAP phenotype. A literature search was conducted to identify articles reporting on MAP-specific phenotypes. Clinical data from 2109 MAP patients identified from the literature showed that 1123 patients (53.2%) had CRC. Some patients with CRC had no associated adenomas, suggesting that adenomas are not an obligatory component of MAP. Carriers of the two missense founder variants, and possibly truncating variants, had an increased cancer risk when compared to those who carry other pathogenic variants. It has been suggested that somatic G:C>T:A transversions are a mutational signature of MAP, and could be used as a biomarker in screening and identifying patients with atypical MAP, or in associating certain phenotypes with MAP. The extracolonic and extraintestinal manifestations that have been associated with MAP include duodenal adenomas, duodenal cancer, fundic gland polyps, gastric cancer, ovarian cancer, bladder cancer and skin cancer. The association of breast cancer and endometrial cancer with MAP remains disputed. Desmoids and Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPEs) are rarely reported in MAP, but have long been seen in FAP patients, and thus could act as a distinguishing feature between the two. This collection of MAP phenotypes will assist in the assessment of pathogenicMUTYHvariants using the American College of Medical Genetics and the Association for Molecular Pathology (ACMG/AMP) Variant Interpretation Guidelines, and ultimately improve patient care.
Activation of the 20S proteasome core particle prevents cell death induced by oxygen- and glucose deprivation in cultured cortical neurons
Authors: Salazar Ivan L. , Curcio Michele , Mele Miranda , Vetrone Rossela , Frisari Simone , Costa Rui O. , Caldeira Margarida V. , Trader Darci J , Duarte Carlos B.
Published: May 2024

Abstract

Neuronal damage in brain ischemia is characterized by a disassembly of the proteasome and a decrease in its proteolytic activity. However, to what extent these alterations are coupled to neuronal death is controversial since proteasome inhibitors were shown to provide protection in different models of stroke in rodents. This question was addressed in the present work using cultured rat cerebrocortical neurons subjected to transient oxygen- and glucose-deprivation (OGD) as a model for in vitro ischemia. Under the latter conditions there was a time-dependent loss in the proteasome activity, determined by cleavage of the Suc-LLVY-AMC fluorogenic substrate, and the disassembly of the proteasome, as assessed by native-polyacrylamide gel electrophoresis followed by western blot against Psma2 and Rpt6, which are components of the catalytic core and regulatory particle, respectively. Immunocytochemistry experiments against the two proteins also showed differential effects on their dendritic distribution. OGD also downregulated the protein levels of Rpt3 and Rpt10, two components of the regulatory particle, by a mechanism dependent on the activity of NMDA receptors and mediated by calpains. Activation of the proteasome activity, using an inhibitor of USP14, a deubiquitinase enzyme, inhibited OGD-induced cell death, and decreased calpain activity as determined by analysis of spectrin cleavage. Similar results were obtained in the presence of two oleic amide derivatives (B12 and D3) which directly activate the 20S proteasome. Together, these results show that proteasome activation prevents neuronal death in cortical neurons subjected to in vitro ischemia, indicating that inhibition of the proteasome is a mediator of neuronal death in brain ischemia.
Learning difficulties among students when applying Ampére-Maxwell’s law and its implications for teaching
Authors: Suárez Álvaro , Marti Arturo C. , Zuza Kristina , Guisasola Jenaro
Published: May 2024

We investigate learning difficulties among second-year students in electromagnetism courses when they apply Ampère-Maxwell’s law. Using phenomenography, we analyzed written answers from 65 undergraduate physics students to four questions on Ampère’s and Ampère-Maxwell’s laws. We complemented our research by interviewing 12 students. To design the questionnaire, we ran an epistemological analysis of classical electromagnetism which helped us to identify a set of key essential concepts to understand this theory, guided the definition of learning objectives, and drew up the questions. The results revealed that the students found it hard to recognize the validity framework from Ampère’s law and to apply Ampère-Maxwell’s law. They face particular difficulties to recognize the appearance of the displacement current and the relationship between the circulation of the magnetic field and an electric field that is variable over time.

Published by the American Physical Society
2024
Understand resist use online customer service chatbot: an integrated innovation resist theory and negative emotion perspective
Authors: Chang Tsung-Sheng , Hsiao Wei-Hung
Published: May 2024

Purpose

The rise of artificial intelligence (AI) applications has driven enterprises to provide many intelligent services to consumers. For instance, customers can use chatbots to make relevant inquiries and seek solutions to their problems. Despite the development of customer service chatbots years ago, they require significant improvements for market recognition. Many customers have reported negative experiences with customer service chatbots, contributing to resistance toward their use. Therefore, this study adopts the innovation resistance theory (IRT) perspective to understand customers’ resistance to using chatbots. It aims to integrate customers’ negative emotions into a predictive behavior model and examine users’ functional and psychological barriers.

Design/methodology/approach

In this study, we collected data from 419 valid individuals and used structural equation modeling to analyze the relationships between resistance factors and negative emotions.

Findings

The results confirmed that barrier factors affect negative emotions and amplify chatbot resistance influence. We discovered that value and risk barriers directly influence consumer use. Moreover, both functional and psychological barriers positively impact negative emotions.

Originality/value

This study adopts the innovation resistance theory perspective to understand customer resistance to using chatbots, integrates customer negative emotions to construct a predictive behavior model and explores users’ functional and psychological barriers. It can help in developing online customer service chatbots for e-commerce.
A bibliometric analysis of literature published on ChatGPT and GPT
Authors: Safdar Muhammad , Siddique Nadeem , Gulzar Ayesha , Adil Syed Adnan , Yasin Haisim , Khan Muhammad Ajmal
Published: May 2024

Purpose

This study aims to analyse the literature published on ChatGPT and generative pre-trained transformer (GPT) available through Scopus to identify the top countries, institutions, authors, journals and titles in terms of publishing and citations in the area.The research also intends to determine the collaborative trends among countries and authors as well as top-used keywords on the topic identified from the analysed literature.

Design/methodology/approach

The researchers searched the Scopus database to collect and assess the literature on the topic. The paper used six applications such as Biblioshiny, VosViewer, Python, MS Access and Excel and Endnote to collect and analyse the literature.

Findings

It is found that European countries such as the USA, the UK and Germany took the lead in terms of publishing and impact in the area but the USA stood first with 90 publications and 1,720 citations in this connection. Likewise, the organization “Rheinisch-Westfälische Technische Hochschule Aachen” scored the top position regarding publishing, but Open AI remained on top for getting the highest citations (1,384). Apropos, the author “Choi, Y” produced the highest number of publications. The research also shares the collaborative patterns, top journals and publications in the area, as well as the top-used keywords on the topic.

Originality/value

To the best of the authors’ knowledge, this is the first study that shares a bibliometric analysis of literature published on GPT and ChatGPT. The research not only fills the research gap on the topic but also shares implications for relevant stakeholders and future research directions for future researchers.
Brand avatar present or absent? Investigate brand avatar and consumer forgiveness in public apology
Authors: Wang Xueying , Zhang Yuexian
Published: May 2024

Purpose

The rising occurrence of digitally driven public consumer complaints has made it necessary for enterprises to obtain consumer forgiveness. However, existing research has provided little understanding regarding how to obtain consumer forgiveness effectively. Thus, the present study examined how brand avatars can improve consumer forgiveness in the context of public apology.

Design/methodology/approach

This study tested the mechanism of a brand avatar on consumer forgiveness using three studies. Specifically, we explored the direct and mediating effect of empathy toward a brand (Study 1); we identified the moderating mediating effect of humorous responses (Study 2) and product type (Study 3). Data for these studies were collected on Credamo. We analyzed the data using SPSS (26.0) for the primary analysis and PROCESS (3.5) for the mediating and moderating mediating analysis.

Findings

The results indicate that brand avatars enhance consumer forgiveness. Moreover, empathy toward a brand plays a mediating role in the effect of brand avatars on consumer forgiveness. Additionally, when a humorous response is present, a brand avatar can enhance customer forgiveness through empathy toward that brand. Compared to utilitarian products, hedonic products can also increase the impact of a brand avatar on empathy toward the brand, thus enhancing consumers' forgiveness.

Originality/value

From the perspective of emotion, this study explored the impact of brand avatars on consumer forgiveness via empathy toward a brand. It augments the research on brand avatars and consumer forgiveness. The study also verified the moderating mediating effect of humor response and product type while expanding the brand avatar research boundary.
Does Medicare Support Multidisciplinary Teams Working to the Top of Their Ticket?
Authors: Spinks Jean , Nancarrow Susan , McAvoy Sue , Nissen Lisa
Published: May 2024

The health landscape has changed enormously since the introduction of Medicare 40 years ago. Not only have population health needs changed, the provision of health care has also evolved. A wider range of health practitioners with enhanced skills and competencies are ready and able to provide high‐quality primary health care. However, expecting the funding model introduced 40 years ago to be fit for purpose to support this expanded workforce may be unrealistic. Whilst optimising person‐centred team care might be the vision, currently missing is the systems thinking approach required to realise the synergistic benefits of health care teams.
PREFIGURING PRAGMATICALLY? Prefigurative Politics and the Constellation of People Power Strategies for Winning Affordable Housing in Cape Town
Authors: Tattersall Amanda , Iveson Kurt
Published: May 2024

This article contributes to ongoing discussions about the practice of prefigurative politics by urban social movements, and the relationship between prefiguration and other political practices. We argue that urban social movements can deploy prefigurative power in combination with other political strategies with which it is often contrasted and opposed. To demonstrate, we explore Cape Town's Reclaim the City movement that occupied several inner‐city buildings to create affordable housing for low‐wage Black communities—prefiguring the kind of affordable housing that they were demanding. They developed this strategy iteratively after having tried to play by the rules through litigation and mobilize through protest. When those approaches failed to shift decision makers, they tried to prefigure their goal for housing through occupation. Prefiguration offered distinctive strategic advantages: it helped demonstrate that affordable housing was possible and provided direct relief for people facing housing stress. These advantages not only engaged new participants but contributed to new affordable housing commitments from the City of Cape Town and the courts. We show how movement participants understood their prefigurative occupation as part of a constellation of people power strategies and suggest that this points towards the potential for prefiguration to be deployed pragmatically as well as ideologically by urban social movements.
What is the impact of legal strategy?
Authors: Bird Robert C. , Evans Justin W.
Published: May 2024

Law and strategy (LAS)—the study of the law's role in competitive advantage—has developed rapidly and with substantial promise for over 20 years. However, at this critical juncture in its development, the LAS literature lacks both a systematic review of its impact and an organized call for future research. To fill this scholarly gap, this article reports two citation analysis studies that identify the overall impact of the literature as well as the specific influence of seminal articles in the field. We find that LAS is widely cited, has a substantial and diverse disciplinary reach, and, crucially, that the influence of its seminal works has not faded over time. Building on these findings, we recommend pathways for future LAS research, including more cross‐disciplinary scholarship, a closer engagement with the related stream of proactive law, a deeper inquiry into ethics, more systematic theory‐building and empirical work, and a global perspective that tests the boundaries of LAS beyond fully developed markets. We conclude that LAS has a promising future with the potential for a wide range of applications that address significant challenges facing law and business.
Austerity, economic vulnerability, and populism
Authors: Baccini Leonardo , Sattler Thomas
Published: May 2024

Governments have repeatedly adjusted fiscal policy in recent decades. We examine the political effects of these adjustments in Europe since the 1990s using both district‐level election outcomes and individual‐level voting data. We expect austerity to increase populist votes, but only among economically vulnerable voters, who are hit the hardest by austerity. We identify economically vulnerable regions as those with a high share of low‐skilled workers, workers in manufacturing and in jobs with a high routine‐task intensity. The analysis of district‐level elections demonstrates that austerity increases support for populist parties in economically vulnerable regions, but has little effect in less vulnerable regions. The individual‐level analysis confirms these findings. Our results suggest that the success of populist parties hinges on the government's failure to protect the losers of structural economic change. The economic origins of populism are thus not purely external; the populist backlash is triggered by internal factors, notably public policies.
Resistance exercise upregulates Irisin expression and suppresses myocardial fibrosis following myocardial infarction via activating AMPK‐Sirt1 and inactivating TGFβ1‐Smad2/3
Authors: Li Hangzhuo , Qin Shuguang , Tang Jie , Wang Tao , Ren Wujing , Di Lingyun , Bo Wenyan , Ma Yixuan , Wu Fangnan , Xu Zujie , Song Wei , Cai Mengxin , Xi Yue , Tian Zhenjun
Published: May 2024

Aim

To reveal the contribution of Irisin in the beneficial effects of resistance exercise on myocardial fibrosis (MF) and cardiac function in the mice with myocardial infarction (MI).

Methods

The MI model was built by ligating the left anterior descending coronary artery in Fndc5 knockout mice (Fndc5−/−). Resistance exercise was started one week after surgery and continued for four weeks. In addition, H2O2, AICAR, recombinant human Irisin protein (rhIRISIN), and Sirt1 shRNA lentivirus (LV‐Sirt1 shRNA) were used to intervene primary isolated cardiac fibroblasts (CFs). MF was observed through Masson staining, and apoptosis was assessed using TUNEL staining. MDA and T‐SOD contents were detected by biochemical kits. The expression of proteins and genes was detected by Western blotting and RT‐qPCR.

Results

Resistance exercise increased Fndc5 mRNA level, inhibited the activation of TGFβ1‐TGFβR2‐Smad2/3 pathway, activated AMPK‐Sirt1 pathway, reduced the levels of oxidative stress, apoptosis, and MF in the infarcted heart, and promoted cardiac function. However, Fndc5 knockout attenuated the protective effects of resistance exercise on the MI heart. Results of the in vitro experiments showed that AICAR and rhIRISIN intervention activated the AMPK‐Sirt1 pathway and inactivated the TGFβ1‐Smad2/3 pathway, and promoted apoptosis in H2O2‐treated CFs. Notably, these effects of rhIRISIN intervention, except for the TGFβR2 expression, were attenuated by LV‐Sirt1 shRNA.

Conclusion

Resistance exercise upregulates Fndc5 expression, activates AMPK‐Sirt1 pathway, inhibits the activation of TGFβ1‐Smad2/3 pathway, attenuates MF, and promotes cardiac function after MI.