bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Dimensional Reconstruction Algorithm of Computed Tomography Imaging for Surgical Treatment and Rapid Rehabilitation Nursing of Renal Cell Carcinoma
Authors: Wang Lijun , Lin Haiyan , Zheng Hong , Jiang Yuying
Published: May 2021

This study was carried out to explore the promotion role of computed tomography (CT) imaging three-dimensional (3D) reconstruction technology and rapid rehabilitation nursing intervention (RRNI) in the treatment of patients with renal cell cancer (RCC) laparoscopic radical nephrectomy (LRN) in view of the patient’s condition. 98 RCC patients who were admitted to the hospital from July 2019 to July 2020 were selected as the research subjects, and all patients underwent the LRN and the RRIN. Of which, 46 RCC patients were scanned with CT images (regarded as the CT group), and 46 RCC patients were scanned with CT images based on 3D reconstruction algorithms (regarded as the 3D CT group). The clinical efficacy and the life quality, pain degree, and adverse mood changes before and after the RRN were analyzed and compared. The results showed that the surgery time in the 3D CT group and the CT group was 130.2 ± 42.8 minutes and 162.4 ± 38.5 minutes, respectively (

P
<
0.05

). The recurrence rate of RCC in both groups was 0%. The estimated blood loss in the 3D CT group and the CT group was 93.6 ± 35.5 mL and 90.3 ± 40.2 mL, respectively; the complication rate in the 3D CT and CT group was 5% and 12%, respectively; the hospital stay in the 3D CT and CT group was 12.5 ± 4.7 days and 12.1 ± 3.2 days, respectively, which had no statistical significance (

P
>
0.05

). The scores of visual analogue scale (VAS), 36-Item Short-Form Health Survey (SF-36), self-rating depression scale (SDS), and self-rating anxiety scale (SAS) of patients in the two groups were statistically significant (

P
<
0.05

). It indicated that CT images based on the 3D reconstruction algorithm could be applied in LRN of RCC patients to shorten the surgery time and improve the surgical effect, and implementation of the RRN could relieve the adverse mood of RCC patients and effectively improve their life quality.
Effects and Anti‐rotation Stabilization of the Non‐bridging External Fixation for Pronation‐Abduction Stage III Ankle Fracture: A Cadaveric Study
Authors: Chen Yili , Huang Xiaoyu , Cheng Yongzhong , Xu Jingjing , Chen Yang , Zhang Qi , Wen Jianmin
Published: May 2021

Objective. This study is aimed at providing a nonbridging external fixation technique with pinning fixation for the pronation‐abduction stage III ankle fracture. The secondary purpose was to evaluate its effect on anatomic reduction and fracture fragment stability against cadaveric models’ rotation. Method. A paired design study was conducted using 14 pairs of the cadaveric model which had been modeled for pronation‐abduction stage III ankle fracture. One fracture model from each pair was randomly allocated to receive an open reduction and internal fixation, while the other was reduced and stabilized with the external fixation technique. After the surgery, the antirotational stability tests were performed with external rotation torques of 10 nm, 15 nm, and 20 nm applied, respectively. The postoperation reduction rate and ankle parameters were recorded in anteroposterior and lateral radiographs before and after the antirotational stability experiment. Result. The outcomes were assessed according to Burwell‐Charnley’s radiographic criteria of reduction. It showed no statistically significant differences in reduction between the two groups (P < 0.05). The displacement of lateral fragment following a reduction in the external fixation group was significantly larger than that of the internal fixation group (3.14 ± 0.56 vs. 1.49 ± 0.39, P < 0.05). After applying rotational torques of 10 nm, 15 nm, and 20 nm, the results of other parameters showed no significant differences between the two groups. Conclusion. This nonbridging external fixation method with pin fixation of fracture fragments might have the same effect as that of internal fixation on the reduction rate of pronation‐abduction stage III ankle fracture.
Epstein–Barr Virus Mucocutaneous Ulcer: An Unexpected Diagnosis of a New Entity
Authors: Howden William , Kuo Tony
Published: May 2021

Epstein–Barr virus mucocutaneous ulcer (EBVMCU) is a new entity, only recently included in World Health Organisation classification of lymphoid neoplasms. Almost all cases described to date have been in patients with a predisposing risk factor of immunosuppression. This case presents a 21-year-old male admitted with tonsillitis and no overt immunosuppression, who is subsequently diagnosed with EBVMCU of likely iatrogenic origin.
Idiopathic Dural Optic Nerve Sheath Calcification Associated with Sclerochoroidal Calcification: Case Report and Review of Literatures
Authors: Sharifi Mohammad , Yousefi Bahar Tafaghodi
Published: May 2021

We present a patient with idiopathic intracranial calcifications with simultaneous involvement of sclera, choroid, optic nerve, and trochlear apparatus. A 70-year-old woman with bilateral decreased vision was referred to our hospital. Ocular examinations revealed sclerochoroidal mass beneath superotemporal vascular arcade in macular area. Orbital CT scan shows bilateral calcification of dural optic nerve sheath and posterior wall of the globe as well as calcification in the trochlear apparatus and brain. Ultrasound showed highly reflective echogenic lesion with shadowing. OCT revealed rolling topography with thinning of the overlying choroid and outer nuclear layer as well as absence of the external limiting membrane and inner segment-outer segment junction. Slight irregular thickening of the retinal pigment epithelium is present. It is the first case of simultaneous bilateral dural optic nerve sheath and sclerochoroidal calcification.
Bilateral Type 1 Idiopathic Macular Telangiectasia in a Female Patient: Multimodal Imaging of a Rare Presentation
Authors: Niyousha Mohamad Reza , Hassanpoor Narges , Jafari Sasan
Published: May 2021

We report a bilateral case of type 1 idiopathic macular telangiectasia (IMT) in a female patient. A 40-year-old otherwise healthy female with gradual vision loss since 2 years ago with best-corrected visual acuity of 20/400 in both eyes was referred. Her past medical history was negative for any systemic disease including diabetes and systemic hypertension. Color fundus photography showed bilateral loss of normal foveal reflex with macular edema. Fluorescein angiography demonstrated symmetric perifoveal telangiectasia mainly in the superior and nasal macula in both eyes with late staining and leakage. Spectral-domain optical coherence tomography revealed significant intraretinal fluid bilaterally and subretinal fluid in the left eye. Optical coherence tomography angiography (OCTA) revealed obvious saccular parafoveal capillary telangiectasia and capillary dropout as well as decreased vascular density in both superficial and deep capillary plexus. Deep capillary plexus involvement in OCTA was more evident than superficial plexus. Based on the patient’s medical history and multimodal imaging, the diagnosis of bilateral IMT type 1 was made. The patient underwent 5 intravitreal monthly injection of bevacizumab in both eyes, which resulted in macular edema resolution. However, after 3 months of discontinuation of intravitreal bevacizumab, macular edema relapsed. In conclusion, type 1 IMT can occur bilaterally in an otherwise healthy female patient as a very rare presentation. To the best of our knowledge, this case is the 4th case of bilateral type 1 IMT reported in a female.
Burden of Stroke in Myanmar
Authors: Venketasubramanian Narayanaswamy , Khine Yee Mon , Ohnmar Ohnmar , Khin Myat Po Po Kyaw , Win Min Thit
Published: May 2021

Myanmar is home to over 51 million people. The age- and sex-standardized mortality rate due to stroke is 165.4/100,000, while the rate of age- and sex-standardized disability-adjusted life years lost due to stroke is 2971.3/100,000. The prevalence of stroke among adults aged 40–99 years is 1.5%. Stroke is the leading cause of morbidity and mortality and comprises 20% of the neurological workload. There are only 10 stroke units in the whole country. Doctors are aware of the importance of hypertension in stroke prevention and the need for physiotherapy after stroke, but, until recently and in rural areas, they also tend to use steroids and neuroprotectants, and lower blood pressure aggressively acutely after stroke; antiplatelets are not widely used. Thrombolysis service is available at some tertiary centers but mechanical thrombectomy is not yet available.
Orbital Lymphatic-Venous Malformation Accompanied by an Intraocular Vascular Malformation: A Rare Case Study
Authors: Shouchane-Blum Karny , Yassur Iftach , Sternfeld Amir , Regev Miriam , Gal-Or Orly , Kornreich Liora , Ehrlich Rita , Ehrenberg Miriam
Published: May 2021

Lymphatic-venous malformations (LVMs) are development defects that result in abnormal connections between the lymphatic and venous systems. The authors describe a 7-weeks-old female infant who presented with a right orbital LVM extending to the ipsilateral cheek and subconjunctiva of the right eye, intracranial developmental venous anomalies in the right cerebellum, and a significant right eye intraocular retinal vascular malformation. Since orbital LVM is usually diagnosed in infancy or childhood, pediatric ophthalmologists should actively look for intraocular vascular malformations as such findings can poorly affect a patient’s vision.
Effects of Short- and Long-Term Aerobic-Strength Training and Determinants of Walking Speed in the Elderly
Authors: Slobodová Lucia , Oreská Ľudmila , Schön Martin , Krumpolec Patrik , Tirpáková Veronika , Jurina Peter , Laurovič Jakub , Vajda Matej , Nemec Michal , Hečková Eva , Šoóšová Ivana , Cvečka Ján , Hamar Dušan , Turčáni Peter , Tsai Chia-Liang , Bogner Wolfgang , Sedliak Milan , Krššák Martin , Ukropec Jozef , Ukropcová Barbara
Published: May 2021

Background/Aims: Walking speed (WS) is an objective measure of physical capacity and a modifiable risk factor of morbidity and mortality in the elderly. In this study, we (i) determined effects of 3-month supervised aerobic-strength training on WS, muscle strength, and habitual physical activity; (ii) evaluated capacity of long-term (21 months) training to sustain higher WS; and (iii) identified determinants of WS in the elderly. Methods: Volunteers (F 48/M 14, 68.4 ± 7.1 years) completed either 3-month aerobic-strength (3 × 1 h/week, n = 48) or stretching (active control, n = 14) intervention (study A). Thirty-one individuals (F 24/M 7) from study A continued in supervised aerobic-strength training (2 × 1 h/week, 21 months) and 6 (F 5/M 1) became nonexercising controls. Results: Three-month aerobic-strength training increased preferred and maximal WS (10-m walk test, p < 0.01), muscle strength (p < 0.01) and torque (p < 0.01) at knee extension, and 24-h habitual physical activity (p < 0.001), while stretching increased only preferred WS (p < 0.03). Effect of training on maximal WS was most prominent in individuals with baseline WS between 1.85 and 2.30 m·s−1. Maximal WS measured before intervention correlated negatively with age (r = −0.339, p = 0.007), but this correlation was weakened by the intervention (r = −0.238, p = 0.06). WS progressively increased within the first 9 months of aerobic-strength training (p < 0.001) and remained elevated during 21-month intervention (p < 0.01). Cerebellar gray matter volume (MRI) was positively associated with maximal (r = 0.54; p < 0.0001) but not preferred WS and explained >26% of its variability, while age had only minor effect. Conclusions: Supervised aerobic-strength training increased WS, strength, and dynamics of voluntary knee extension as well as habitual physical activity in older individuals. Favorable changes in WS were sustainable over the 21-month period by a lower dose of aerobic-strength training. Training effects on WS were not limited by age, and cerebellar cortex volume was the key determinant of WS.
The COVID-19 Impact in Hospital Healthcare Workers: Development of an Occupational Health Risk Management Program
Authors: Mendonça-Galaio Luís , Sacadura-Leite Ema , Raposo João , França Diana , Correia Ana , Lobo Rodrigo , Soares Jorge , Almeida Clara , Shapovalova Olena , Serranheira Florentino , Sousa-Uva António
Published: May 2021

As with the SARS-CoV-1 outbreak in 2003–2004 and the MERS outbreak in 2012, there were early reports of frequent transmission to healthcare workers (HCW) in the SARS-CoV-2 pandemic. Our hospital center identified its first COVID-19 confirmed case on March 9, 2020, in a 6-day hospitalized patient. The first confirmed COVID-19 case in a HCW happened 3 days later, in a nurse with a probable epidemiological link related to the first confirmed patient. Our study’s first objective is to describe and characterize the impact of the first 3 months of the SARS-CoV-2 pandemic on the Centro Hospitalar Universitário Lisboa Norte (CHULN). Our second objective is to report the performance of the CHULN Occupational Health Department (OHD) and the impact of the pandemic on CHULN HCW and its adaptation across national, regional, and institutional epidemiological evolution. Over the first 3 months, 2,152 HCW were screened (which represent 29.8% of the total HCW population), grouped in 100 separate identifiable clusters, each one ranging from 2 to 98 HCW. The most prevalent profession screened were nurses (n = 800; 37.2%) followed by doctors (n = 634; 29.5%). The main source of potential infection and cluster generating screening procedures was co-worker related (n = 1,216; 56.5%). A patient source or a combined patient co-worker source was only accountable for 559 (26%) and 43 (2%) of cases, respectively. Our preliminary results demonstrate a lower infection rate among HCW than the ones commonly found in the literature. The main source of infection seemed to be co-worker related rather than patient related. New preventive strategies would have to be implemented in order to control SARS-CoV-2 spread.
Personalized Approach to Tissue and Liquid Biopsy after Failure of First-Line EGFR-TKIs: Is There an Issue When Tissue Is Not the Issue? A Case Series
Authors: Bursac Daliborka , Zarić Bojan , Kovačević Tomi , Stojšić Vladimir , Vagionas Anastasios , Boukovinas Ioannis , Tsakiridis Kosmas , Kosmidis Christoforos , Sapalidis Konstantinos , Romanidis Konstantinos , Courcoutsakis Nikolaos , Matthaios Dimitris , Zarogoulidis Paul , Sardeli Chrysanthi , Sekerus Vanesa
Published: May 2021

Traditionally, tissue availability from rebiopsy is a prerequisite for adequate sequencing of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in therapy for advanced-stage lung cancer. Tissue biopsy truly is the gold standard for genetic analyses, but in some cases, such as with inadequate localization of the lesion or a patient’s inadequate performance status, comorbidities, or unwillingness to undergo an invasive procedure, liquid biopsy-based ctDNA analysis can be a noninvasive alternative approach. However, in some cases the gold standard might not shine that much. It is known that tumor heterogeneity or an inadequate amount of tissue might significantly interfere with the results of testing. In this paper, we present cases of patients with a negative tissue biopsy but a positive liquid biopsy which identified coexisting T790M mutation. These results enabled adequate sequencing and treatment with third-line EGFR-TKIs. Such possibilities stress the need to individualize testing for driver mutations in cases where it is clinically highly indicated.
Unilateral Familial Exudative Vitreoretinopathy: Clinical Profile and Pathology
Authors: Boal Nina S. , Distefano Alberto G. , Christiansen Stephen P. , Laver Nora V.
Published: May 2021

We report a case of a newborn with unilateral retinal detachment that could not be repaired. At examination under anesthesia, the retina was markedly abnormal and a presumptive diagnosis of retinal dysplasia was made. Several years later, the eye was enucleated because it was blind and painful. Final pathology was consistent with familial exudative vitreoretinopathy (FEVR). The literature describing unilateral retinal dysplasia is sparse. This case adds to the clinical spectrum of pathologic findings in FEVR.
Abnormal Liver Blood Tests: Hepatologist Approach
Authors: Krstić Miodrag N. , Mijač Dragana , Tomašević Ratko S. , Lukić Snežana , Stojković Lalošević Milica , Krstić Jovan M. , Milosavljević Tomica
Published: May 2021

Background: Available data suggest that the prevalence of chronic liver disease (CLD) and primary liver cancer is rising in Europe and represents a major public health problem. Predictions are showing that these trends will continue to rise in the upcoming years. Summary: Alcohol-related liver disease, nonalcohol fatty liver disease, and viral hepatitis B and hepatitis C are the leading causes of liver cirrhosis and primary liver cancer in Europe. Drug-induced liver injury represents a major cause of acute hepatitis, while liver transplantation is the second most common solid organ transplantation in the world. Patients with CLD have increasing rates of hospitalization, longer hospital stays, and more adverse outcomes compared to the other chronic conditions. Direct targeting of risk factors can prevent complications of advanced liver disease and improve outcome. Patients with CLD should be referred to a hepatologist for assessment of the stage of liver disease, for specific treatment and screening for hepatocellular carcinoma. Moreover, patients with unknown etiology of abnormal liver blood tests should be referred to a hepatologist for assessment of liver disease, as well as for prevention and treatment of complications of cirrhosis and/or portal hypertension. Key Messages: CLD is amenable to prevention and treatment, while disease management strategies need to improve in order to reduce the burden of liver disease and deaths due to end-stage liver diseases.
Abstract 12587: Clinical Outcomes of a Nurse-led Post-discharge Education Program for Heart-transplant Recipients
Authors: Lee Ji-hyeon , Kang Seok-min , Kim Young Ah , Chu Sang Hui
Published: May 2021

Introduction:
Heart transplantation is often more limited than other forms of organ transplants, as hearts can only be donated following brain death. Thus, effective discharge education and follow-up management should be provided to achieve successful clinical outcomes after heart transplantation. This study aimed to examine the effects of a nurse-led program with continuous education on outpatient visits with clinical problems and unplanned first rehospitalization, as compared to an existing discharge education.

Methods:
Participants’ electronic medical records from 2005 to 2018 were retrospectively analyzed. Participants were 136 recipients received heart transplantation operations and discharge education. Participant data were assigned to three groups: usual care (n = 25), nurse-led program without continuous education (n = 66), and nurse-led program with continuous education (n = 45). The usual care was conventional discharge education, provided to all recipients by ward nurses. In the nurse-led program, the transplant coordinator provided education at discharge and telephone response after discharge. The nurse-led program was divided, according to whether recipients received continuous education and counselling on post-heart transplantation care. Follow-up was provided for recipients regarding outpatient visits with clinical problems and unplanned first rehospitalization for 1 year post-transplantation.

Results:
The nurse-led program with continuous education was found to be associated with significantly reduced outpatient visits with clinical problems, compared to the usual care (
p
= 0.001) and nurse-led program without continuous education (
p
< 0.001). Compared to the usual care, the nurse-led program with continuous education was associated with a significant reduction in the risk of unplanned first rehospitalization (
p
= 0.011).

Conclusions:
Discharge education provided by a transplant coordinator using a brochure at discharge, and providing telephone responses for problems or questions and continuing education and counselling after discharge, improved post-transplant clinical outcomes. These finding suggest that nurse-led discharge education programs should be implemented after heart transplantation.
Abstract 12596: Manipulation of Gut Microbiota Influences Myocardial Mass in Mice
Authors: Kamo Takehiro
Published: May 2021

Introduction:
Gut microbiota have developed a close relationship with human host during the co-evolutionary process for millions of years, and they play an essential role in the maintenance of host homeostasis. There is accumulating evidence that an imbalance in the gut microbial communities, referred to as dysbiosis, is associated with human pathologies including cardiovascular diseases. We and others have recently demonstrated that heart failure is associated with gut microbiota dysbiosis using 16S ribosomal RNA gene sequencing of fecal samples from patients with heart failure. This finding suggests a potential significance of gut microbiota in the pathophysiology of heart failure. However, the link between the gut microbiota and the heart remains largely unclear.

Hypothesis:
We hypothesized that manipulation of gut microbiota influences the structure of the heart.

Methods:
To determine the effects of gut microbiota depletion, cardiac structure and gene expression were evaluated in mice following treatment with orally administered broad-spectrum antibiotic cocktail. We subsequently explored the effects of administration of a single antibiotic agent on myocardial structure.

Results:
Antibiotic cocktail-treated mice showed a remarkable decrease in myocardial mass and cardiomyocyte size as compared with untreated mice (mean [±SD] ratio of heart weight to body weight, 3.87±0.25 mg/g in 44 antibiotic-treated mice vs. 4.38±0.21 mg/g in 45 untreated mice). The decrease in myocardial mass was associated with substantial changes in gene expression profiles in the heart, including the expression of genes encoding sarcomere proteins and extracellular matrix proteins. In addition, oral treatment with ampicillin alone led to a significant decrease in myocardial mass (mean [±SD] ratio of heart weight to body weight, 3.52±0.24 mg/g in 11 ampicillin-treated mice vs. 4.10±0.24 mg/g in 12 untreated mice).

Conclusions:
These results suggest that gut microbiota may modulate myocardial mass through the remote regulation of gene expression in the heart. Our study indicates an intimate relationship between the gut microbiota and the heart, and suggests the potential efficacy of manipulating gut microbiota in the prevention and treatment of heart failure.
Abstract 12630: Association Between Z-score for Birth Weight and Postoperative Outcomes in Neonates and Infants With Congenital Heart Disease
Authors: Steurer Martina A , Peyvandi Shabnam , Costello John M , Moon-Grady Anita J , Habib Robert , Hill Kevin D , Jacobs Marshall L , Jelliffe-Pawlowski Laura , Keller Roberta , Pasquali Sara K , Reddy Vadiyala M , Tabbutt Sarah , rajagopal satish
Published: May 2021

Background:
Neonates with congenital heart disease are more likely to be small for gestational age. Few studies have investigated the effect of birth weight Z-score on outcomes after congenital heart surgery.

Methods:
Patients from the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2016) undergoing cardiac surgery at a corrected gestational age ≤ 44 weeks were included, and classified as severely (birth weight Z-score -4 to -2), moderately (Z-score between -2 and -1) and mildly growth restricted (Z-score -1.0 to -0.5) and compared to a reference (Z-score 0 to 0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality, postoperative complications and length of stay, adjusting for other patient characteristics. Interaction between Z-score for birth weight and gestational age was assessed.

Results:
In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared to the reference group with no growth restriction, the adjusted odds (AOR) of mortality was increased in infants with severe (AOR 2.4, CI 2.0-3.0), moderate (AOR 1.7, CI 1.4-2.0) and mild growth restriction (AOR 1.4, CI 1.2-1.6). The AOR for major postoperative complications was increased for infants with severe (AOR 1.4, CI 1.2-1.7) and moderate growth restriction (AOR 1.2, CI 1.1-1.4), but not in mildly growth restricted infants (AOR 1.0, CI 0.9-1.2). Length of stay was prolonged for all growth restricted cohorts (adjusted Hazard Ratio<1, p<0.05 for all). There was significant interaction between birth weight Z-score and gestational age (p=0.007) with the strongest association between birth weight Z-score and operative mortality in early-term (gestational age 37-38 weeks), followed by full-term (>38 weeks) and then preterm infants (<37 weeks).

Conclusions:
Even birth weight Z-scores that are slightly below average are independent risk factors for mortality and morbidity in neonates undergoing cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term neonates. These novel findings may account for some of the previously unexplained variation in cardiac surgical outcomes.
Abstract 12651: Fine-Tuning of Lung Thrombosis is a Therapeutic Strategy Against Inflammatory Lung Injury
Authors: Evans Colin E , Zhang Xianming , Machireddy Narsa , Zhao You-yang
Published: May 2021

Introduction:
Lung thrombosis (LT) and endothelial cell (EC) death are positively associated with mortality in sepsis-induced acute lung injury (ALI) patients, but anti-coagulants have failed in clinical trials of sepsis.

Hypothesis:
We hypothesized that different levels of LT mediate ALI by regulating lung EC viability.

Methods:
To assess the impact of different levels of LT on ALI, we used murine models of LT and ALI. To explore how LT level might alter lung EC viability and ALI, we assessed survival gene expression by RNA sequencing. To identify the mechanism(s) responsible for changes in ALI after varying levels of LT, we assessed lung EC viability and ALI in mice with cell-specific knockout of different survival genes.

Results:
In platelet-depleted mice, LT was reduced while ALI was increased. Intra-venous microbeads were then administered to induce LT in a dose-dependent manner, showing that restoration of LT to the level found in platelet-replete mice protected against thrombocytopenia-induced ALI. We next showed in wild type mice, that while excessive increases in LT worsened ALI, induction of a mild level of LT conversely protected against ALI. The opposing impact of diminished or excessive versus mild LT on ALI was associated with changes in lung EC apoptosis. Subsequent studies showed a panel of candidate survival factors were differentially expressed in the lungs of ALI mice with or without mild or excessive LT. Mechanistically, we found that the protective impact of mild LT on ALI is dependent upon hypoxia-inducible factor (HIF) 1α in Tie2-expressing cells. Remarkably, the same mild level of LT retained its protective impact in platelet-depleted and platelet-replete mice even when induced up to 8 hours after sepsis.

Conclusions:
ALI is enhanced by diminished or excessive LT but suppressed by mild LT through HIF1α. The control of LT represents a therapeutic strategy for the induction of a pro-survival response that protects against inflammatory lung injury.
Abstract 12672: Post-Implantation Hematoma Increases Risk of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-analysis
Authors: Kewcharoen Jakrin , Kanitsoraphan Chanavuth , Thangjui Sittinun , Leesutipornchai Thiratest , Navaravong Leenhapong
Published: May 2021

Introduction:
Several studies have shown inconsistent relationship between post-implantation hematoma (PH) and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of PH and the risk of CIED infection.

Hypothesis:
PH increases the risk of CIED infection.

Methods:
We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies and randomized controlled trials that reported incidence of PH and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results:
Fourteen studies from 2006 to 2018 were included, involving a total of 28,319 participants. There were 6 cohort studies, 7 case-control studies and 1 randomized controlled trial. In random-effect model, we found that PH significantly increases the risk of overall CIED infection (OR = 6.30, 95%CI: 3.87-10.24, I2=49.3%) (Figure 1). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger’s test.

Conclusions:
Our meta-analysis demonstrated that PH significantly increases the risk of CIED infection. Precaution should be taken to during device implantation to reduce PH and subsequent CIED infection.
Abstract 12679: Impact of Mental Health Disorders on Ventricular Assist Device Supported Patients Emergency Resource Use and Outcomes
Authors: Edwards Jonathan J , Edelson Jonathan , Katcoff Hannah , Mondal Antara , Lefkowitz Debra , Reza Nosheen , Hanff Thomas , Griffis Heather M , Mazurek Jeremy , Owens Anjali T , Wittlieb-Weber Carol , Burstein Danielle , Atluri Pavan , O’Connor Matthew , Goldberg Lee R , Zamani Payman , Groeneveld Peter W , Rossano Joseph , Lin Kimberly Y , Birati Edo
Published: May 2021

Introduction:
There are minimal data describing the prevalence of mental health disorders (MHDO) in VAD-supported patients, or the association between MHDO and resource use or outcomes.

Methods:
This retrospective analysis utilizes all emergency department (ED) encounter-level data from the 2010-2017 Nationwide Emergency Department Sample (NEDS). Patients with VADs were identified using ICD-9/10 codes, as were associated MHDO diagnoses, which were categorized as depression/anxiety, suicide/self harm, bipolar/psychoses, and substance abuse. Outcomes and characteristics were compared for patients with and without a MHDO via descriptive statistics. Hospital admission and mortality occurring in ED or inpatient was investigated with logistic multivariable regression models adjusted for demographic and clinical characteristics.

Results:
Of the 47,543 encounters with VADs during the study period, 23% (n=11,103) had at least one MHDO. Depression/anxiety (82%) and substance abuse (22%) were the most prevalent MHDOs. Suicide attempt or self harm was the primary diagnosis for 20 (0.2%) encounters. Patients with MHDOs were more likely to be female (31% vs. 26%), younger (median age 59 vs. 61 years), and to have a non-MHDO chronic condition (77% vs 70%, P<0.0001 for all). Inpatient admission rates (79% vs. 59%) and charges ($33,421 (95% CI 15,074-73,517) vs. $21,346 (95% CI 5,290-56,910) were higher for those with MHDOs (both p<0.0001, Figure). However, mortality (2.0% vs. 3.3%, p=0.003) was lower. After adjusting for age, gender, and non-MHDO diagnoses, patients with MHDOs had higher admission rates (OR 2.3 (95% CI 1.8-2.9), p<0.001) and lower mortality (OR 0.63 (95% CI 0.42-0.94), p=0.03).

Discussion:
1 in 5 VAD-supported ED patient encounters also have a MHDO diagnosis. VAD-supported patients with a MHDO had higher resource use but lower mortality. These data underscore the need for greater attention to how MHDO may impact outcomes in VAD-supported patients.
Abstract 12806: Anatomic Correlates of Systolic Anterior Motion in D-looped Transposition of the Great Arteries Post Atrial Switch
Authors: Aiad Norman , Sherrid Mark , Feinberg Jodi , AXEL Leon , Mosca Ralph S , Kumar TK , Argilla Michael , Halpern Dan
Published: May 2021

Introduction:
A paucity of data exists of the anatomic-physiological mechanisms for sub-pulmonic systolic anterior motion (SAM) of the mitral valve (MV) in d-looped transposition of the great arteries post atrial switch (d-TGA/AtS).

Hypothesis:
The development of SAM may be inherent to the anatomy of the MV or affected by external factors such as a dilated systemic right ventricle (RV) or pectus deformity.

Methods:
Clinical and cardio-imaging analysis of 18 adult patients with d-TGA/AtS (Age 42±6 years old, 56% Male) between 2015-2019 was performed. Echocardiography data included mitral apparatus anatomy (Figure) and CT/MRI data included biventricular dimensions, function, and Haller index (HI).

Results:
Patients with leaflet SAM (n=5) compared to patients without SAM (n=13) had significantly higher MV protrusion height (2.1 ± 0.4 vs 1.5 ± 0.4 cm p ≤0.01, respectively, Table) and longer anterior MV leaflet length (3.0 ± 0.24 vs 2.6 ± 0.34 cm p ≤0.05, respectively, Table) when compared to those without. CT/MRI showed higher sub-pulmonic left ventricular ejection fraction (LVEF) in the SAM group relative to No SAM (68 ± 5 vs 54 ± 7 % p ≤0.005, respectively, Table). RV size and function, chest deformity (HI>3.5), presence of a ventricular lead pacemaker, and septal thickness did not play a role in development of SAM (Table).

Conclusions:
An elongated mitral apparatus is associated with the development of SAM in d-TGA/AtS and the development of LVOT obstruction. Increased sub-pulmonic LVEF contributes to SAM, whereas the systemic RV dimensions, septal thickness, and degree of chest deformity do not correlate with SAM.
Abstract 12914: Multicenter Study of Diagnostic Performance of Noninvasive Coronary Angiography and Dynamic Myocardial Perfusion Imaging Using Dual Source Computed Tomography: The AMPLIFiED Study
Authors: Kitagawa Kakuya , Nakamura Satoshi , Ota Hideki , Ogawa Ryo , Shizuka Takehito , Kubo Tadahiro , Yi Yan , Ito Tatsuro , Nagasawa Naoki , Omori Taku , Nakamori Shiro , Kurita Tairo , Sugisawa Jun , Hatori Naoki , Nakashima Hitoshi , Wang Yining , Kido Teruhito , Watanabe Kouki , Matsumoto Yasuharu , Dohi Kaoru , Sakuma Hajime
Published: May 2021

Introduction:
Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of hemodynamically significant coronary artery disease (CAD). However, no prospective multicenter study has assessed the performance of combined coronary computed tomography angiography (CTA) and dynamic CTP.

Hypothesis:
In this prospective multicenter study, we assessed the hypothesis that dynamic CTP can provide an incremental diagnostic value over CTA detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR).

Methods:
Seven centers enrolled 165 patients with suspected or known CAD, who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT prior to ICA. FFR was done as part of ICA in case of 26-90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as of FFR<0.8 or ≥90% stenosis on ICA. Three blinded independent core laboratories analyzed CTA, CTP and ICA.

Results:
The study protocol was completed in 157 participants and hemodynamically significant stenosis was detected in 112 of 442 vessels (25%) and 123 of 157 patients (78%). According to receiver operating characteristic curve analysis, CTA showed an area under the curve (AUC) of 0.81 (95% confidence interval [CI], 0.73-0.86) on the patient level and 0.80 (95% CI, 0.76-0.84) on the vessel level. Adding dynamic CTP to CTA significantly increased the AUC to 0.85 (95% CI, 0.78-0.90; p=0.027) on the patient level and to 0.84 (95% CI, 0.80-0.87; p=0.002) on the vessel level. In the subgroups of patients with 1-, 2- and 3-vessel disease by CTA, the addition of dynamic CTP to CTA significantly increased AUC from 0.80 to 0.84 (p=0.041) in 2-vessel disease and from 0.65 to 0.73 (p=0.022) in 3-vessel disease, but not in 1-vessel disease (from 0.84 to 0.87, p=0.265).

Conclusion:
In this first prospective multicenter study on dynamic CTP, the combination of anatomical assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate detection of hemodynamically significant coronary artery stenosis. Improved diagnostic performance with dynamic CTP was mainly obtained when multivessel disease was suspected by CTA.
Abstract 12916: Outcomes of Magnetic Resonance Imaging in Patients With Pacemakers/ICDs and Fractured or Abandoned Leads
Authors: Greenhill Mark , Kang Paul , Su Wilber , Zawaneh Michael , Weiss Peter , Unzek Sameul , Morris Michael
Published: May 2021

Introduction:
Current guidelines exclude patients with fractured or abandoned leads from MRI scanning due to possible safety concerns. In vitro, the configuration of fractured or abandoned leads impacts lead tip heating during MRI. This study examined the clinical impact of lead length, lead location, and lead shape on patient outcomes in patients with pacemakers/ICDs and fractured or abandoned leads undergoing MRI.

Methods:
Single center retrospective review of patients with pacemakers/ICDs and fractured or abandoned leads undergoing clinically indicated MRI from 7/2016 through 3/2020.

Results:
58 patients with 68 abandoned/fractured leads underwent 112 MRI scans at 1.5T. The average age was 71.8 +/- 13.7 years with 22 (37%) female. Average MRI duration was 32.6 +/- 17 min. There were no significant changes in function of the intact leads or generator battery life after MRI. 58 leads were abandoned and 10 leads were fractured, including 52 pacemaker leads, 12 ICD leads, and 4 epicardial leads. Patients with abandoned leads had significantly longer lead length compared to those with fractured leads (58cm vs 6.8cm, p<0.01), more often had a "c" shape lead configuration on chest xray (p<0.01), and were more likely to terminate in the right ventricle (p<0.01). Patients with fractured leads more often had a vertical (p<0.01), horizontal (p<0.01), or "r" shaped (p=0.05) configuration on chest xray, and lead fragments more often terminated in the left chest wall (p<0.01). There were no adverse clinical events during MRI in any patient.

Conclusions:
In this study of patients with 68 abandoned/fractured leads undergoing 112 MRIs, neither lead length, lead location, nor lead shape was associated with adverse outcomes. In vitro studies suggesting that the configuration of abandoned/fractured leads can cause patient harm during MRI does not translate to clinical events. Future studies should further assess the safety of MRI scanning in patients with abandoned/fractured leads.
Abstract 12918: The Association Between Central Obesity and Myocardial Ageing: Traditional Body Mass Index (bmi) Falls Short of Expectation
Authors: Tan Yen How , Lim Jun Pei , Lim Wee Shiong , Gao Fei , Teo Loon Yee , EWE SEE HOOI , Keng Bryan , Tan Ru San , Koh Woon-Puay , Koh Angela S
Published: May 2021

Background:
The Asian phenotype of central obesity is intriguing. Current data suggest links between central obesity and cardiovascular (CV) risks. However, age-related sarcopenia (resulting in loss of skeletal muscle) may falsely reduce body mass index (BMI), leading to inaccurate measures of obesity. We aim to determine how waist circumference (WC), would compare against BMI, in differentiating obesity, among older adults. Further, we explore the differential association between each obesity definition and myocardial ageing.

Methods:
We performed anthropometric and CV examinations on a cohort of asymptomatic aged adults. Myocardial ageing was defined by ratio of peak velocity flow in early diastole E (m/s) to peak velocity flow in late diastole by atrial contraction A (m/s). For BMI, a cut-off of 27.5kg/m
2
was used, and WC cut-offs of >90cm for males and >80cm for females.

Results:
Among n=970 adults (mean age 73±4 years, 432 (44%) males), 124 (12.8%) were obese by BMI definition while 347 (35.7%) were obese by WC definition. Inter-definitional agreement was fair between BMI and WC (cohen’s κ=0.345). More women (66% vs 50%, p<0.001) and older participants (63±14 vs 65±11 years, p=0.007) were defined as obese by WC definition, while age and gender did not differentiate obese versus non-obese as defined by BMI. There were more hypertension (p<0.001) and diabetes mellitus (p<0.001) among the obese as defined by both definitions, compared to non-obese. Based on either definition, obese participants had significantly lower E/A ratio [(1.13 ± 0.46 vs 0.98 ± 0.35; P < 0.001 using BMI), (1.17 ± 0.49 vs 1.00 ± 0.37; P < 0.001 using WC)] compared to non-obese. Left atrial volume index was larger in obese in both the BMI group (20.5 ± 7.43 vs 22.3 ± 7.90; P = 0.020) and WC group (20.0 ± 6.9 vs 22.1 ± 8.3; P < 0.001). By multivariate regression, WC, but not BMI, was independently associated with E/A (β=-0.114, SE -0.114±0.024, p<0.001).

Conclusion:
Obesity prevalence varies depending on the definition used. Among Asians, waist circumference identifies higher prevalence of obesity, possibly related to central adiposity. While impact of age-related sarcopenia and BMI in older adults require deeper study, WC may better characterize the impact of obesity on myocardial ageing.
Abstract 12929: Pacemaker Lead-induced Tricuspid Regurgitation in Patients With or Without RV Dilatation
Authors: Riesenhuber Martin , Spannbauer Andreas , Pezawas Thomas , Schukro Christoph , Gwechenberger Marianne , Stix Guenter , Schneider Matthias , Anvari Anahit , Wrba Thomas , Khazen Cesar , Andreas Martin , Laufer Guenther , Hengstenberg Christian , Gyongyosi Mariann
Published: May 2021

Introduction:
Right ventricular (RV) leads of permanent pacemakers (PM) contribute or cause tricuspid regurgitation (TR) in up to 45% of implantations, which is associated with poor outcome. While primary lead-induced TR has its origin in direct interaction of the lead and the valve, secondary lead-induced TR has its origin in RV dilatation (RVD).

Hypothesis:
We hypothesize differences in lead-induced TR and its associated mortality comparing patients with vs. without RVD.

Methods:
Patients with first implantation of a cardiac PM with at least one transtricuspid RV-lead between May 2000 and April 2015 were retrospectively included. Echo was performed before and after PM implantation.

Results:
In total, 990 patients were enrolled (Table 1). Patients with RVD had progression of TR of at least one grade in 50.2%, compared to 35.9% in patients without RVD (p<0.001). In a multivariate regression model, independent predictors for lead-induced progression of TR were RVD (OR 1.46, 95% CI 1.01-2.12, p=0.045), and moderate/severe mitral regurgitation (OR 1.51, 95%CI 1.12-2.02, p=0.006). Independent predictors for 10-year-mortality were lead-induced progression of TR (HR 1.36, 95%CI 1.04-1.78, p=0.023), age > 80 years (HR 2.78, 95%CI 2.14-3.61, p<0.001), PM with single RV-lead (HR 1.35, 95%CI 1.03-1.77, p=0.032), heart failure (HR 1.75, 95%CI 1.32-2.32, p<0.001), chronic kidney disease (HR 1.61, 95%CI 1.24-2.09, p<0.001), moderate/severe mitral regurgitation (HR 1.31, 95%CI 1.03-1.74, p=0.031), and LVEDD > 25mm/m2 (HR 1.37, 95%CI 1.06-1.77, p=0.015).

Conclusions:
RVD is associated with lead-induced progression of TR, which is associated with decreased survival. Patients with RVD and indication for a PM, leadless pacing could be an alternative. If lead-induced TR occurs, transcatheter tricuspid valve intervention is a possibility, especially in patients with RVD.
Abstract 12937: Single-cell Transcriptomic Analysis Reveals Developmentally Impaired Endocardial Population in Hypoplastic Left Heart Syndrome
Authors: Miao Yifei , Tian Lei , Martin Marcy , Paige Sharon , Galdos Francisco X , Lee Soah , Grossfeld Paul D , Mital Seema , Wu Joseph C , RABINOVITCH Marlene , Nelson Timothy J , Nie Shuyi , Wu Sean M , Gu Mingxia
Published: May 2021

Hypoplastic left heart syndrome (HLHS) is one of the most challenging forms of congenital heart diseases. Previous studies were mainly focused on intrinsic defects in myocardium. However, this does not sufficiently explain the abnormal development of the cardiac valve, septum, and vasculature, known to originate from the endocardium. Here, using single-cell transcriptomic profiling, induced pluripotent stem cells (iPSC) derived endocardial cells (iEECs), human fetal heart tissue with underdeveloped left ventricle, as well as a
Xenopus
model, we identified a developmentally impaired endocardial population in HLHS. The intrinsic endocardial deficits contributed to abnormal endothelial to mesenchymal transition, NOTCH signaling, and extracellular matrix organization, all of which are key factors in valve formation. Consequently, in an endocardium-myocardium co-culture system, we found that endocardial abnormalities conferred reduced proliferation and maturation of iPSC derived cardiomyocyte (iPSC-CMs) judged by Ki67 staining, contractility, sarcomere organization, and related gene expressions through a disrupted fibronectin (FN1)-integrin interaction. Several recently described HLHS
de novo
mutations such as
ETS1
and
CHD7
showed reduced binding to
FN1
promoter and enhancer in HLHS vs. control iEECs based on ChIP-qPCR analysis. Additionally, we found that suppression of the ETS1 in
Xenopus
caused reduced endocardial FN1 expression and impaired heart development. Supplementation of FN1 or ETS1 over-expression in HLHS iEECs could rescue dysfunctions in both endocardium and myocardium in HLHS. Our studies reveal a critical role of endocardial abnormality in causing HLHS, and provide a rationale for improving endocardial function in future regenerative strategies.

Schematic illustration of the endocardial and myocardial defects in HLHS.
Abstract 12947: Development of Molecular Targeted Therapy Against Right Ventricular Failure: Involvement in A Network of Immunocompetent Cells
Authors: Ito Shogo , Yuasa Shinsuke , Komuro Jin , Kimura Mai , Kusumoto Dai , Hashimoto Hisayuki , Fukuda Keiichi , Fukumoto Yoshihiro
Published: May 2021

Backgrounds:
Right ventricular (RV) failure plays a critical role in right heart failure and left heart failure. However, there is no specific therapy developed for RV failure. To elucidate a novel therapeutic target against RV failure, we focus on differentially expressed genes in RV to develop novel therapeutics for RV failure.

Methods:
Microarray analysis using several parts of adult murine heart was conducted and differentially expressed genes (DEGs) were applied to pathway analysis by Ingenuity Pathway Analysis
R
. Molecular mechanism was examined by using neonatal rat ventricular cardiomyocyte (NRVM)
in vitro
. To understand the function of target molecule
in vivo
, we induced RV failure by pulmonary artery constriction (PAC) in mice and inhibition experiments were performed using these RV failure model mice.

Results:
In microarray analysis for RV, left ventricle and ventricular septum, 995 genes were extracted as DEGs in RV. Pathway analysis revealed that alternative complement pathway-related genes were significantly up-regulated in RV. Moreover, complement factor D (Cfd) and C3a was a potential upstream factor attributable to unique feature of RV. Administration of C3a recombinant protein to NRVM phosphorylated several MAP kinases. Moreover, in C3KO PAC mice, RV dysfunction was significantly suppressed, and histological study suggested that RV fibrosis was significantly suppressed by comparing to wild type PAC mice. Furthermore, administration of C3a receptor antagonist to wild type PAC mice dramatically improved RV dysfunction and reduced RV fibrosis. Additionally,
in vivo
electrophysiological study revealed that the inducibility of ventricular arrhythmia was increased in wild type PAC mice, but ventricular arrhythmia was significantly attenuated in C3KO PAC mice.

Conclusion:
We revealed that complement C3a was highly produced in RV, and genetic or chemical blockade of C3a ameliorates RV dysfunction and RV fibrosis in RV failure model mice. C3a was to be a potent bioactive protein for immunocompetent cells that played an important role in modulating RV function. Accordingly, we demonstrated that the blockade of C3a had a potential role for novel therapeutic target of RV failure.