bluuebunny/crossref_metadata_2025 huggingface dataset:
Freezing Damage Control of Railway Subgrade Miniature Shields in Cold Climatic Regions: Construction Technology Optimization via Numerical Simulation
Authors: Qing Caolin , Jie Shaolong , Yue Zurun , Wang Liwei , Wang Bingcheng
Published: November 2023

Microshield structure replacement technology is commonly used to control the freezing damage of railway roadbeds, featuring high efficiency and easy operation. However, improper disposal of measures in the construction process will still cause excessive deformation of the line and endanger the safety of train operations. On the background of a subgrade freezing damage improvement and speed improvement project of the Xige section of Quinghai–Tibet railway, this study performed numerical simulation of the microshield based on the measured data of the field automatic monitoring system to improve the operation safety of the existing lines and optimize the construction technology of the microshield. The effect of the changes in the microshield segment material, construction process, and formation loss on the settlement of the operating railway subgrade was analyzed to control the construction disturbance settlement of the existing operating line. The results obtained show that the overall settlement deformation of the line is small when the steel pipe is used as the shield segment, which meets the safety management requirements of the existing operating line. When PE tube segments are used for construction, construction measures should be strictly controlled to reduce the effect of settlement deformation on the operational lines. When steel pipe segments are used, the settlement generated by the construction process from both sides to the middle is minimal. When PE tube segments are adopted in the construction, the settlement generated by the construction process with unilateral advancement and an interval of two pipe diameters is the least, producing unimodal settlement curve of the line. The latter features a double peak when the shield pipe interval is three pipe diameters or more. When using PE tube pieces for the microshield construction, it is necessary to strictly control the formation loss rate within 10% by optimizing the construction control measures.
Introspection of the Etiopathological Mechanisms Underlying Noncarious Cervical Lesions: Analysis of the Different Theories and Their Impact on the Mineralized Structures of the Tooth
Authors: Dioguardi Mario , Polverari Davide , Spirito Francesca , Iacovelli Giovanna , Sovereto Diego , Laneve Enrica , Caloro Giorgia Apollonia , Ballini Andrea , Lo Muzio Lorenzo
Published: November 2023

The noncarious cervical lesions (NCCLs) recognize an etiological framework of onset very different from the carious processes with etiology whose bacteria aggregated in a biofilm play a predominant role, leading in this way to the loss of the mineralized structure of the tooth. The pathological picture of the NCCLs, which manifests itself with a clinical picture of dental wear, differs from caries because it mainly recognizes a series of pathological processes, such as erosion, through the action of generally acidic chemical agents and abrasion, which is basically expressed through repeated mechanical trauma characteristic of tooth brushing. However, in the literature, there is no unanimous agreement in identifying only these two mechanisms, but there are some who propose a more marked role of anomalous occlusal loads, which would be unloaded on some teeth which, in addition to both erosive and abrasive mechanisms, would give rise to abfraction. Therefore, the aim of this review was to collect literature etio-pathological information and discuss the mechanisms underlying NCCLs.
Postintravitreal Injection Endophthalmitis: Incidence, Characteristics, Management, and Outcome
Authors: Davidov Bar , Ohayon Avi , Trivizki Omer , Schwartz Shulamit , Shulman Shiri
Published: November 2023

Purpose. Postintravitreal injection (IVI) endophthalmitis is a rare but devastating complication. Herein, we report the incidence ,and clinical and microbiological characteristics, as well as the visual outcome, in IVIs endophthalmitis in two medical centers. Methods. All patients undergoing intravitreal injections between 1/2018 and 12/2019 in two large medical centers were analyzed for post‐IVI endophthalmitis. Results. Of the total of 51,356 IVIs performed, 23 cases of post‐IVI endophthalmitis were diagnosed, yielding an overall incidence of 0.045%. The median interval from IVI to symptoms onset was 2 days (IQR: 1–5). Cultures were positive in 56% of the cases (100% Gram‐positive bacteria and 76% coagulase‐negative staphylococcus). Parameters associated with higher culture‐positive rates included samples taken during vitrectomy, WBC on vitreous smear, the number of IVIs in the 12 months prior to presentation, and the time interval from last IVI to diagnostic sampling. At 6‐ and 12‐month follow‐up, the median change in VA (logMAR) was −1.10 (IQR: (−1.32)–(−0.40)) and −1.02 (IQR: (−1.10)–(−0.30)), respectively. Younger age and better BCVA at presentation were associated with better VA outcome, while positive culture result and systemic steroids treatment were each associated with the worse visual outcome. We found no difference in visual outcomes between PPV and TAI as a primary procedure. Conclusion. Post‐IVI endophthalmitis is a rare complication, and most patients do not regain their initial VA. Certain parameters (clinical, microbiological, and therapeutic) may help anticipate the outcome and guide decision making regarding diagnosis and treatment.
Educación Chilena: Topten de la desigualdad en el mundo
Authors: Cerda Morales Arturo
Published: November 2023

Recurriendo a la historia de la educación del siglo XX y, confrontando la vieja tesis de controversia del siglo XIX, estado docente versus libertad de enseñanza, se concluye en la necesidad ineludible del rol preponderante del estado en la educación. Ante los acontecimientos recientes, se insiste en que las universidades públicas, especialmente, deben ser financiadas por el estado. Se concluye que sin una educación pública potente, Chile seguirá siendo el top ten de la desigualdad social.
Notch Signaling Regulates Immunosuppressive Tumor-Associated Macrophage Function in Pancreatic Cancer
Authors: Yan Wei , Menjivar Rosa E. , Bonilla Monica E. , Steele Nina G. , Kemp Samantha B. , Du Wenting , Donahue Katelyn L. , Brown Kristee L. , Carpenter Eileen S. , Avritt Faith R. , Irizarry-Negron Valerie M. , Yang Sion , Burns William R. , Zhang Yaqing , Pasca di Magliano Marina , Bednar Filip
Published: November 2023

Pancreatic ductal adenocarcinoma (PDA) continues to have a dismal prognosis. The poor survival of patients with PDA has been attributed to a high rate of early metastasis and low efficacy of current therapies, which partly result from its complex immunosuppressive tumor microenvironment. Previous studies from our group and others have shown that tumor-associated macrophages (TAM) are instrumental in maintaining immunosuppression in PDA. Here, we explored the role of Notch signaling, a key regulator of immune response, within the PDA microenvironment. We identified Notch pathway components in multiple immune cell types within human and mouse pancreatic cancer. TAMs, the most abundant immune cell population in the tumor microenvironment, expressed high levels of Notch receptors, with cognate ligands such as JAG1 expressed on tumor epithelial cells, endothelial cells, and fibroblasts. TAMs with activated Notch signaling expressed higher levels of immunosuppressive mediators, suggesting that Notch signaling plays a role in macrophage polarization within the PDA microenvironment. Genetic inhibition of Notch in myeloid cells led to reduced tumor size and decreased macrophage infiltration in an orthotopic PDA model. Combination of pharmacologic Notch inhibition with PD-1 blockade resulted in increased cytotoxic T-cell infiltration, tumor cell apoptosis, and smaller tumor size. Our work implicates macrophage Notch signaling in the establishment of immunosuppression and indicates that targeting the Notch pathway may improve the efficacy of immune-based therapies in patients with PDA.
Figure S5 from PRMT5 Inhibitors Regulate DNA Damage Repair Pathways in Cancer Cells and Improve Response to PARP Inhibition and Chemotherapies
Authors: Carter Jack , Hulse Michael , Sivakumar Monisha , Burtell Jessica , Thodima Venkat , Wang Min , Agarwal Anjana , Vykuntam Komali , Spruance Jacob , Bhagwat Neha , Rager Joseph , Ruggeri Bruce , Scherle Peggy , Ito Koichi
Published: November 2023

PRT543 inhibits growth of PARP inhibitor resistant ovarian and breast cancer models in vitro and in vivo.
Open and Percutaneous Trigeminal Nucleotractotomy: A Case Series and Literature Review
Authors: Anisimov Egor Dmitrievich , Rzaev Jamil A. , Moysak Galina I. , Dmitriev Alexander B. , Duff Irina E. , Slavin Konstantin V.
Published: November 2023

Introduction: Nucleotractotomy is an efficient surgical technique that provides a high pain relief rate for specific clinical indications. There are two main approaches for performing this operation: an open and percutaneous technique. Methods: In the Federal Center of Neurosurgery (Novosibirsk, Russia) from 2016 to 2022, 13 trigeminal nucleotractotomies (7 open and 6 percutaneous) were performed in 12 patients (5 women and 7 men). The indications for surgery were deafferentation pain and chronic drug-resistant pain syndrome caused by malignancy in the facial region. A neurological examination was done on each patient 1 day before the surgery, right after the surgery, and at the follow-up (examinations were done after 1, 6, and 12 months, or when the patient independently applied to our hospital). In the early postoperative period, patients underwent brain MRI. Results: The average pain intensity score before nucleotractotomy on the 11-point (0–10) visual analog scale (VAS) was 9.3. The effectiveness of open interventions was somewhat higher; the average VAS score in the early postoperative period for the open technique was 1.57, in the group of patients who underwent percutaneous nucleotractotomy were 2.66. Complete regression of the pain syndrome was achieved in 6 patients; in 5 patients, the pain in the face decreased by more than 50%. One case had an unsatisfactory outcome. In the open-surgery group in the early postoperative period, according to MRI, the average length of the visualized area of signal change was longer (21.5 mm, the average diameter was 3.75 mm) than in a percutaneous nucleotractotomy group (16 mm, the average diameter was 3.75 mm). During the postoperative period (average follow-up 40 months), the pain recurred in 3 patients (30%): 2 patients after percutaneous nucleotractotomy (3 and 18 months after surgery) and in 1 patient 4 months after the open surgery. The mean VAS score at the last follow-up was 2.6. Conclusion: Trigeminal nucleotractotomy is an effective approach to the treatment of intractable facial pain. Our experience suggests this technique is highly effective in patients with drug-resistant pain caused by craniofacial tumors and deafferentation conditions after treating trigeminal neuralgia.
A Rare Case of Lambert-Eaton Myasthenia Syndrome Associated with Non-Hodgkin’s Lymphoma: A Case Report and Review of the Literature
Authors: Abu-Tineh Mohammad , Alamin Mohammed A. , Aljaloudi Esra’a , Alshurafa Awni , Garcia-Cañibano Beatriz , Taha Ruba Y. , Elkourashy Sarah A.
Published: November 2023

Introduction: Lambert-Eaton myasthenia syndrome (LEMS) is a rare autoimmune disorder characterized by autoantibodies targeting presynaptic neuromuscular junctions. It results in muscle weakness and autonomic dysfunction. LEMS can be idiopathic or associated with neoplastic diseases, often small-cell lung cancer. This case report describes a rare instance of paraneoplastic LEMS in a man with non-Hodgkin lymphoma. Case Presentation: A 57-year-old male with non-Hodgkin lymphoma presented with progressive muscle weakness, diminished reflexes, and autonomic symptoms. Diagnosis revealed LEMS with autoantibodies against voltage-gated calcium channels. Immunosuppressive therapy and lymphoma treatment led to significant improvement in his condition. Conclusion: This case highlights the rare occurrence of paraneoplastic LEMS in a patient with non-Hodgkin lymphoma. Recognition and timely management of LEMS alongside lymphoma treatment can lead to significant clinical improvement, emphasizing the need for increased awareness of such complex associations.
Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke
Authors: Gorsel Bart Van , Remmers Michel J.M. , Vos Louwerens D. , Scholzel Bas E. , Haans Dirk A.W. , Aarts Ruud A.H.M. , Versteylen Rob J. , Van Norden Anouk G.W. , Van Oers Casper A.M.M. , Vos Jeroen , IJsselmuiden Sander J.J. , Van Den Branden Ben J.L. , De Boer Onno J. , Imani Farshad , Alings Marco , Pertiwi Kartika R. , De Winter Robbert J. , Miah Ishita , Van Der Wal Allard C. , Van De Hoef Tim P. , Meuwissen Martijn
Published: November 2023

Introduction: Acute mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion-related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the aetiology and pathology of the lesion to predict prognosis and propose possible future acute ischaemic stroke therapy. Methods: A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria, they were considered fresh (<1 day old) or old (>1 day old). Patients were followed for 2 years for documentation of all-cause mortality. Results: Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission, and patient age were associated with long-term mortality (p < 0.1). Multivariable Cox hazards and Kaplan-Meier analysis demonstrated that after extensive adjustment for clinical and procedural variables, thrombus age persisted in being independently associated with higher long-term mortality (hazard ratio: 3.34; p = 0.038, log-rank p = 0.013). Conclusion: In this study, older thromboemboli are responsible for almost half of acute large ischaemic strokes. Moreover, the presence of an old thrombus is an independent predictor of mortality in acute large vessel occlusion-related stroke. More research is warranted regarding future therapies based on thrombus composition.
Abstract 13836: Percentage of Patients Achieving Blood Pressure Goals With Aprocitentan, a Dual Endothelin Receptor Antagonist: Results From a Randomized, Controlled Phase 3 Study (PRECISION)
Authors: Weber Michael A , Wang Jiguang , Flack John M , Schlaich Markus , Bakris George , Lu Wentao , Haskell Lloyd , Narkiewicz Krzysztof ,   on behalf of the PRECISION investigators.
Published: November 2023

Background:
In the phase 3 PRECISION trial, aprocitentan (APRO) lowered BP in patients with resistant hypertension.

Research Question:
How effective is APRO for achieving the following BP goals over 4 weeks: mean 24-hour ambulatory BP monitoring (ABPM) measurements <130/80 mmHg, daytime ABPM <135/85 mmHg, nighttime ABPM <120/70 mmHg, reduction in 24-hour ABPM ≥5 mmHg, mean trough unattended automated office BP <130/80 mmHg, and reduction in office systolic BP (SBP) ≥10 mmHg?

Aim:
To evaluate percentages of patients achieving BP goals with APRO or placebo (PBO) after 4 weeks of treatment.

Methods:
Patients had sitting unattended automated office SBP ≥140 mmHg despite prescription of ≥3 antihypertensives of different classes in the year prior to enrollment. After 4 weeks of standardized triple therapy (amlodipine, valsartan, hydrochlorothiazide), those still hypertensive could enter a 4-week single-blind placebo (PBO) run-in period, followed by a 4-week double-blind period wherein patients were randomized 1:1:1 to APRO 12.5 mg, 25 mg, or PBO added to background therapy. We evaluated percentages of patients achieving BP goals during the double-blind period.

Results:
The APRO 12.5 mg, APRO 25 mg, and PBO groups comprised 243, 243, and 244 patients, respectively. Among 633 patients with ABPM data, 41.1%, 51.6%, and 29.6% in the APRO 12.5 mg, APRO 25 mg, and PBO groups had 24-hour mean ABPM <130/80 mmHg. Similarly, 47.4%, 52.7%, and 35.8% in the APRO 12.5 mg, APRO 25 mg, and PBO groups had daytime ABPM <135/85 mmHg; 37.9%, 44.0%, and 22.9%, respectively, had nighttime ABPM <120/70 mmHg. In the APRO 12.5 mg, APRO 25 mg, and PBO groups, 61.7%, 64.8%, and 39.7% had reductions in ABPM of ≥5 mmHg. Overall, 25.1%, 24.2%, and 16.5% in the APRO 12.5 mg, APRO 25 mg, and PBO groups achieved mean office BP <130/80 mmHg; 65.0%, 65.8%, and 55.8%, respectively, had reductions in office SBP of ≥10 mmHg. APRO was generally well tolerated. Edema or fluid retention occurred in 9%, 18%, and 2% of patients in the APRO 12.5 mg, 25 mg, and PBO groups, respectively, during the 4-week double-blind period.

Conclusion:
Greater proportions of patients receiving APRO versus PBO achieved BP goals at 4 weeks. Based on ABPM, treatment benefits with APRO showed dose-dependency, with a larger effect for APRO 25 mg.
Abstract 13839: Value of 2D Speckle Tracking Echocardiography in Predicting Short-Term Cardiovascular Outcomes in Multisystem Inflammatory Syndrome in Children: Analysis of the MUSIC Data
Authors: Sperotto Francesca , Kazlova Valiantsina , Trachtenberg Felicia , Truong Dongngan , AGGARWAL Sanjeev , Bradford Tamara T , Block Joseph R , Buddhe Sujatha , Dionne Audrey , Dragulescu Andreea , Farooqi Kanwal M , Forsha Daniel E , Giglia Therese , Golding Ian F , Hasbani Keren , Jone Pei-Ni , Krishnan Anita , Lang Sean , McFarland Carol , Mitchell Elizabeth , Moussi Elias , Nowlen Todd , Pignatelli Ricardo H , Pletzer Scott , Serrano Ryan , Shakti Divya , Srivastava Shubhika , Thorsson Thor , Votava-Smith Jodie , Friedman Kevin G ,   the Pediatric Heart Network Investigators
Published: November 2023

Introduction:
Cardiovascular (CV) involvement in multisystem inflammatory syndrome in children (MISC) is frequent (80-85%). Data on 2D speckle tracking echocardiography and its value in predicting CV outcomes are limited.

Hypothesis:
We hypothesized that an association exists between 2D speckle tracking strain/strain rate parameters at admission and adverse CV outcomes during hospitalization (inotropic support, major arrhythmias, cardiac arrest, ECMO, death, or transplant).

Methods:
We performed a multicenter (33 centers) cohort study on MISC patients hospitalized from 03/2020 to 11/2021 with at least one echocardiogram read by the Core Lab. The association between each 2D speckle tracking strain parameter and adverse CV outcomes was assessed by logistic regression.

Results:
Of 349 patients (median age 8.7 years [IQR 5.3,12.9]), 122 (35%) had decreased left ventricle (LV) ejection fraction (EF) and 156 (45%) had depressed LV 4-chamber longitudinal strain (LS) or basal circumferential strain (CS) during hospitalization. Worst EF and strain occurred around 5 days of illness. Of those with abnormal LS or CS strain, 50% normalized in ≤1 week, 95% within 50 days. Adverse CV outcomes occurred in 121 (35%) patients. Patients with adverse outcomes were older (p=0.003), more likely to have an underlying metabolic/genetic disorder (p=0.015), abnormal troponin (p<0.001), and higher C-reactive protein (CPR) at admission (p<0.001). They also had higher indexed LV end-diastolic volume (p<0.001) and mass (p=0.015), worse EF (p<0.001), worse LS (p=0.002), and worse CS (p=0.001). When adjusting for days of illness, age, gender, race, obesity, comorbidities, SARS-CoV-2 positivity, CRP, and abnormal troponin at admission, LS Z-score (adjusted OR 1.24 [95% CI 1.03,1.49], AUC 0.754 and longitudinal early diastolic strain rate (LEDSR; adjusted OR 1.98 [IQR 1.18, 3.33], AUC 0.760) at admission were independently associated with adverse CV outcomes.

Conclusion:
Almost half of the MISC patients had abnormal LS or CS at admission, but the majority recovered quickly. LS and LEDSR at admission were independently associated with adverse CV outcomes. These data may help in early characterization, risk stratification, and prognostication in patients with MISC.
Abstract 16092: Oncology Meets Cardiology: Sustained Ventricular Tachycardia With a Pulse
Authors: Sodhi Palwinder , Ewer Steven
Published: November 2023

Introduction:
Palpitations are one of the most common presenting symptoms. While usually benign, they can be life-threatening. We present a case of a sustained VT in the setting of a rare transformation of Follicular Lymphoma (FL).

Case Description:
An 86-year-old female with a history of FL with cardiac involvement, hypothyroidism, and hypertension presented with three episodes of palpitations. The first lasted about 20 minutes and spontaneously resolved. The second occurred a few hours later and was resolved within 15 minutes. Her third did not resolve. On presentation, she was complaining of palpitations and lightheadedness. BP 136/97, HR 193. Physical exam revealed no respiratory distress, rapid rate, clear lung fields, and unremarkable neurological exam with clear mentation. ECG (below) demonstrated sustained VT with rates of ~260 bpm. Amiodarone bolus was started. Cardioversion was attempted, but her VT degenerated into Ventricular Fibrillation. She achieved ROSC and was admitted with sinus rhythm. It was suspected that her FL had transformed into a more aggressive lymphoma, i.e. Diffuse Large B cell Lymphoma (DLBCL). On Cardiac MRI, she had metastasis to the right AV groove consistent with cardiac lymphoma, which was the etiology of her arrhythmia. She elected to enroll in hospice and was discharged in sinus rhythm.

Impact/Discussion:
Histological transformation (HT) of indolent non-Hodgkin lymphoma subtypes (FL) to clinically aggressive subtypes (DLBCL) is estimated to occur 1-2 %/year. Although there have been studies examining risk factors suggestive of HT, much still needs to be studied to effectively manage patients with cardiac metastasis. In this case, metastasis involved the right AV groove, which was the cause of her arrhythmia. Patients with sustained VT usually present with severe symptoms including cardiac arrest, but can present with mild symptoms, as was the case of this patient. Prompt evaluation and management of palpitations is paramount.
Angiographic Severity of the Nonculprit Lesion and the Efficacy of Fractional Flow Reserve–Guided Complete Revascularization in Patients With AMI: FRAME-AMI Substudy
Authors: Seung Jaeho , Choo Eun Ho , Kim Chan Joon , Kim Hyun Kuk , Park Keun Ho , Lee Seung Hun , Kim Min Chul , Hong Young Joon , Ahn Sung Gyun , Doh Joon-Hyung , Lee Sang Yeub , Park Sang Don , Lee Hyun-Jong , Kang Min Gyu , Koh Jin-Sin , Cho Yun-Kyeong , Nam Chang-Wook , Koo Bon-Kwon , Lee Bong-Ki , Yun Kyeong Ho , Hong David , Joh Hyun Sung , Choi Ki Hong , Park Taek Kyu , Lee Joo Myung , Yang Jeong Hoon , Song Young Bin , Choi Seung-Hyuk , Gwon Hyeon-Cheol , Hahn Joo-Yong ,   the FRAME-AMI Investigators
Published: November 2023

BACKGROUND:

The benefit of fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for noninfarct-related artery (IRA) lesions with angiographically severe stenosis in patients with acute myocardial infarction is unclear.

METHODS:

Among 562 patients from the FRAME-AMI trial (Fractional Flow Reserve Versus Angiography-Guided Strategy for Management of Non-Infraction Related Artery Stenosis in Patients With Acute Myocardial Infarction) who were randomly allocated into either FFR-guided or angiography-guided PCI for non-IRA lesions, the current study evaluated the relationship between non-IRA stenosis measured by quantitative coronary angiography (QCA) and the efficacy of FFR-guided PCI. The incidence of the primary end point (death, myocardial infarction, or repeat revascularization) was compared between FFR- and angiography-guided PCI according to non-IRA stenosis severity (QCA stenosis ≥70% or <70%).

RESULTS:

A total of 562 patients were assigned to FFR-guided (n=284) versus angiography-guided PCI (n=278). At a median follow-up of 3.5 years, the primary end point occurred in 14 of 181 patients with FFR-guided PCI and 31 of 197 patients with angiography-guided PCI among patients with QCA stenosis ≥70% (8.5% versus 19.2%; hazard ratio, 0.41 [95% CI, 0.22–0.80];
P
=0.008), while occurred in 4 of 103 patients with FFR-guided PCI and 9 of 81 patients with angiography-guided PCI among those with QCA stenosis <70% (3.9% versus 11.1%;
P
=0.315). There was no significant interaction between treatment strategy and non-IRA stenosis severity (
P
for interaction=0.636). FFR-guided PCI was associated with the reduction of death and myocardial infarction in both patients with QCA stenosis ≥70% (6.7% versus 15.1%;
P
=0.008) and those with QCA stenosis <70% (1.0% versus 9.6%;
P
=0.042) compared with angiography-guided PCI.

CONCLUSIONS:

In patients with acute myocardial infarction and multivessel disease, FFR-guided PCI tended to have a lower risk of primary end point than angiography-guided PCI regardless of non-IRA stenosis severity without significant interaction.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02715518.
Effects of Long‐Term Home Exercise in Participants With Peripheral Artery Disease
Authors: Gardner Andrew W. , Montgomery Polly S. , Wang Ming , Liang Menglu
Published: November 2023

Background

This randomized controlled trial compared long‐term changes in peak walking time (PWT) and exercise time‐to‐minimum calf muscle oxygen saturation (StO
2
) in symptomatic participants with peripheral artery disease following a long‐term home exercise program (HEP), a short‐term supervised exercise therapy (SET) program that transitioned to a long‐term HEP (SET/HEP), and a control intervention.

Methods and Results

For the first 3 months, HEP and SET/HEP groups performed intermittent walking to mild‐to‐moderate claudication pain, whereas the control group performed light resistance training. For the subsequent 15 months, the HEP group continued their exercise program, the SET/HEP group transitioned from SET to the HEP program, and the control group transitioned to only receive walking advice. PWT increased significantly from baseline to month 18 in the HEP group (408
±
279 meters to 814
±
393 meters,
P
<0.001) and in the SET/HEP group (457
±
288 meters to 818
±
313 meters,
P
<0.001). Exercise time‐to‐minimum calf muscle StO
2
increased significantly from baseline to month 18 in the HEP group (238
±
241 seconds to 497
±
485 seconds,
P
<0.05) and in the SET/HEP group (296
±
289 seconds to 620
±
450 seconds,
P
<0.001). These changes in PWT and exercise time‐to‐minimum calf muscle StO
2
were greater than in the control group (
P
<0.001 and
P
<0.01, respectively). Additionally, the change in exercise time‐to‐minimum calf muscle StO
2
was correlated with the change in PWT in both exercise groups combined (
r
=0.601,
P
=0.0015).

Conclusions

Long‐term HEP and SET/HEP were efficacious in improving PWT and exercise time‐to‐minimum calf muscle StO
2
in symptomatic participants with peripheral artery disease, and these changes were correlated with each other.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00618670.
Association Between Symptoms of Chronic Psychological Distress and Myocardial Ischemia Induced by Mental Stress in Patients With Coronary Artery Disease
Authors: Moazzami Kasra , Garcia Mariana , Sullivan Samaah , Lewis Tené T. , Bremner J. Douglas , Razavi Alexander C. , Shallenberger Lucy , Sun Yan V. , Raggi Paolo , Shah Amit J. , Quyyumi Arshed A. , Vaccarino Viola
Published: November 2023

Background

Mental stress–induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease and is associated with a greater risk of future cardiovascular events. The association between chronic symptoms of psychological distress and mental stress–induced ischemia is not clear.

Methods and Results

We used a composite score of psychological distress derived from symptoms of depression, posttraumatic stress disorder, anxiety, anger, and perceived general stress. Participants underwent myocardial perfusion imaging with both mental (public speaking task) and conventional (exercise or pharmacological) stress testing. Overall, 142 (15.9%) patients experienced mental stress–induced myocardial ischemia. After adjusting for demographic factors, medical history, and medication use, patients in the highest tertile of psychological distress score had 35% higher odds of having mental stress–induced ischemia compared to those in the lowest tertile (odds ratio [OR], 1.35 [95% CI, 1.06–2.22]). Stratified analyses showed that the association between psychological distress score and mental stress–induced myocardial ischemia was significantly associated only within the subgroup of patients with a prior myocardial infraction, with patients with a prior myocardial infarction in the highest tertile having a 93% higher odds of developing myocardial ischemia with mental stress (95% CI, 1.07–3.60). There was no significant association between psychological distress and conventional stress–induced ischemia (OR, 1.19 [95% CI, 0.87–1.63]).

Conclusions

Among patients with a history of myocardial infarction, a higher level of psychosocial distress is associated with mental stress–induced myocardial ischemia but not with ischemia induced by a conventional stress test.
Association Between the Liver Fibrosis Markers and Scores, and Hemodynamic Congestion Assessed by Peripheral Venous Pressure in Patients With Acute Heart Failure
Authors: Nagao Kazuya , Maruichi‐Kawakami Shiori , Aida Kenji , Matsuto Kenichi , Imamoto Kazumasa , Yukawa Hiroshi , Kanazawa Takenori , Kobayashi Yohei , Takahashi Naoki , Ito Haruyasu , Hayashi Fujio , Inada Tsukasa
Published: November 2023

Background

Peripheral venous pressure (PVP) has been shown to be a reliable surrogate for right atrial pressure in assessing congestion in patients with heart failure (HF). Liver fibrosis markers and scores can be useful in assessing organ injury in patients with acute HF. This study aimed to investigate the association of liver fibrosis markers and scores with PVP in patients with acute HF.

Methods and Results

The 7S domain of the collagen type IV N‐terminal propeptide (P4NP 7S), aspartate aminotransferase‐to‐platelet ratio index, fibrosis‐4, and nonalcoholic fatty liver disease fibrosis score were determined along with PVP measurements before discharge in 229 patients with acute HF. The strongest correlation with PVP was found for P4NP 7S (Pearson
r
=0.40). Patients with high P4NP 7S levels (≥median [6.2 ng/mL]) had an increased risk of cardiovascular death or HF hospitalization (adjusted hazard ratio [HR], 1.80 [95% CI, 1.09–3.04],
P
=0.02). The concomitant high PVP (≥mean [8 mm Hg])/high P4NP 7S group, in contrast to the high PVP/low P4NP 7S or low PVP/high P4NP 7S group, had a significant risk relative to the low PVP/low P4NP 7S group for cardiovascular death or HF hospitalization (adjusted HR, 2.63 [95% CI, 1.43–5.05],
P
=0.002). A sustained elevation in PVP for 1 month postdischarge was associated with a persistent increase in P4NP 7S.

Conclusions

The study demonstrated the relationship between the liver fibrosis marker P4NP 7S and congestion. PVP and P4NP 7S could be useful for assessing congestion‐related organ injury and predicting prognosis in patients with acute HF.
Right Heart Remodeling After Pulmonary Valve Replacement in Patients With Pulmonary Atresia or Critical Stenosis With Intact Ventricular Septum
Authors: Irwin Margaret , Reynolds Lindsey , Binney Geoffrey , Lipsitz Stuart , Ghelani Sunil J. , Harrild David M. , Baird Christopher W. , Geva Tal , Brown David W.
Published: November 2023

Background

Patients with pulmonary atresia or critical pulmonary stenosis with intact ventricular septum (PA/IVS) and biventricular circulation may require pulmonary valve replacement (PVR). Right ventricular (RV) remodeling after PVR is well described in tetralogy of Fallot (TOF); we sought to investigate RV changes in PA/IVS using cardiac magnetic resonance imaging.

Methods and Results

A retrospective cohort of patients with PA/IVS who underwent PVR at Boston Children's Hospital from 1995 to 2021 with cardiac magnetic resonance imaging before and after PVR was matched 1:3 with patients with TOF by age at PVR. Median regression modeling was performed with post‐PVR indexed RV end‐diastolic volume as the primary outcome. A total of 20 patients with PA/IVS (cases) were matched with 60 patients with TOF (controls), with median age at PVR of 14 years. Pre‐PVR indexed RV end‐diastolic volume was similar between groups; cases had higher RV ejection fraction (51.4% versus 48.6%;
P
=0.03). Pre‐PVR RV free wall and left ventricular (LV) longitudinal strain were similar, although LV midcavity circumferential strain was decreased in cases (−15.6 versus −17.1;
P
=0.001). At a median of 2 years after PVR, indexed RV end‐diastolic volume was similarly reduced; cases continued to have higher RV ejection fraction (52.3% versus 46.9%;
P
=0.007) with less reduction in RV mass (Δ4.5 versus 9.6 g/m
2
;
P
=0.004). Post‐PVR, RV and LV longitudinal strain remained unchanged, and LV circumferential strain was similar, although lower in cases.

Conclusions

Compared with patients with TOF, patients with PA/IVS demonstrate similar RV remodeling after PVR, with lower reduction in RV mass and comparatively higher RV ejection fraction. Although no differences were detected in peak systolic RV or LV strain values, further investigation of diastolic parameters is needed.
Genome‐Wide Association Study of Cardiovascular Resilience Identifies Protective Variation in the
CETP
Gene
Authors: Yu Chenglong , Bakshi Andrew , Watts Gerald F. , Renton Alan E. , Fulton‐Howard Brian , Goate Alison M. , Natarajan Pradeep , Chasman Daniel I. , Robman Liubov , Woods Robyn L. , Guymer Robyn , Wolfe Rory , Thao Le Thi Phuong , McNeil John J. , Tonkin Andrew M. , Nicholls Stephen J. , Lacaze Paul
Published: November 2023

Background

The risk of atherosclerotic cardiovascular disease (ASCVD) increases sharply with age. Some older individuals, however, remain unaffected despite high predicted risk. These individuals may carry cardioprotective genetic variants that contribute to resilience. Our aim was to assess whether asymptomatic older individuals without prevalent ASCVD carry cardioprotective genetic variants that contribute to ASCVD resilience.

Methods and Results

We performed a genome‐wide association study using a 10‐year predicted ASCVD risk score as a quantitative trait, calculated only in asymptomatic older individuals aged ≥70 years without prevalent ASCVD. Our discovery genome‐wide association study of N=12 031 ASCVD event‐free individuals from the ASPREE (Aspirin in Reducing Events in the Elderly) trial identified 2 independent variants, rs9939224 (
P
<5×10
−8
) and rs56156922 (
P
<10
−6
), in the
CETP
(cholesteryl ester transfer protein) gene. The
CETP
gene is a regulator of plasma high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and lipoprotein(a) levels, and it is a therapeutic drug target. The associations were replicated in the UK Biobank (subpopulation of N=13 888 individuals aged ≥69 years without prevalent ASCVD). Carriers of the identified
CETP
variants (versus noncarriers) had higher plasma high‐density lipoprotein cholesterol levels, lower plasma low‐density lipoprotein cholesterol levels, and reduced risk of incident ASCVD events during follow‐up. Expression quantitative trait loci analysis predicted the identified
CETP
variants reduce
CETP
gene expression across various tissues. Previously reported associations between genetic
CETP
inhibition and increased risk of age‐related macular degeneration were not observed among the 3917 ASPREE trial participants with retinal imaging and genetic data available.

Conclusions

Common genetic variants in the
CETP
gene region are associated with cardiovascular resilience during aging.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01038583.
Longitudinal Changes in Health‐Related Quality of Life in Patients With Atrial Fibrillation
Authors: Foster‐Witassek Fabienne , Aebersold Helena , Aeschbacher Stefanie , Ammann Peter , Beer Jürg H. , Blozik Eva , Bonati Leo H. , Cattaneo Mattia , Coslovsky Michael , Felder Stefan , Moschovitis Giorgio , Müller Andreas , Netzer Seraina , Paladini Rebecca E. , Reichlin Tobias , Rodondi Nicolas , Stauber Annina , Sticherling Christian , Szucs Thomas , Conen David , Kühne Michael , Osswald Stefan , Serra‐Burriel Miquel , Schwenkglenks Matthias ,   the Swiss‐AF Investigators
Published: November 2023

Background

Optimizing health‐related quality of life (HRQoL) is an important aim of atrial fibrillation (AF) treatment. Little is known about patients' long‐term HRQoL trajectories and the impact of patient and disease characteristics. The aim of this study was to describe HRQoL trajectories in an observational AF study population and in clusters of patients with similar patient and disease characteristics.

Methods and Results

We used 5‐year follow‐up data from the Swiss–Atrial Fibrillation prospective cohort, which enrolled 2415 patients with prevalent AF from 2014 to 2017. HRQoL data, collected yearly, comprised EuroQoL‐5 dimension utilities and EuroQoL visual analog scale scores. Patient clusters with similar characteristics at enrollment were identified using hierarchical clustering. HRQoL trajectories were analyzed descriptively and with inverse probability‐weighted regressions. Effects of postbaseline clinical events were additionally assessed using time‐shifted event variables. Among 2412 (99.9%) patients with available baseline HRQoL, 3 clusters of patients with AF were identified, which we characterized as follows: “cardiovascular dominated,” “isolated symptomatic,” and “severely morbid without cardiovascular disease.” Utilities and EuroQoL visual analog scale scores remained stable over time for the full population and the clusters; isolated symptomatic patients showed higher levels of HRQoL. Utilities were reduced after occurrences of stroke, hospitalization for heart failure, and bleeding, by −0.12 (95% CI, −0.18 to −0.06), −0.10 (95% CI, −0.13 to −0.08), and −0.06 (95% CI, −0.08 to −0.04), respectively, on a 0 to 1 utility scale. Utility of surviving patients returned to preevent levels 4 years after heart failure hospitalization; 3 years after bleeding; and 1 year after stroke.

Conclusions

In patients with prevalent AF, HRQoL was stable over time, irrespective of baseline patient characteristics. Clinical events of hospitalization for heart failure, stroke, and bleeding had only a temporary effect on HRQoL.
Use of Atrial Fibrillation Electrograms and T1/T2 Magnetic Resonance Imaging to Define the Progressive Nature of Molecular and Structural Remodeling: A New Paradigm Underlying the Emergence of Persistent Atrial Fibrillation
Authors: Rottmann Markus , Yoo Shin , Pfenniger Anna , Mikhailov Aleksei , Benefield Brandon , Johnson David A. , Zhang Wenwei , Ghosh Asish K. , Kim Daniel , Passman Rod , Knight Bradley P. , Lee Daniel C. , Arora Rishi
Published: November 2023

Background

The temporal progression states of the molecular and structural substrate in atrial fibrillation (AF) are not well understood. We hypothesized that these can be detected by AF electrograms and magnetic resonance imaging parametric mapping.

Methods and Results

AF was induced in 43 dogs (25–35 kg, ≥1 year) by rapid atrial pacing (RAP) (3–33 weeks, 600 beats/min), and 4 controls were used. We performed high‐resolution epicardial mapping (UnEmap, 6 atrial regions, both atria, 130 electrodes, distance 2.5 mm) and analyzed electrogram cycle length, dominant frequency, organization index, and peak‐to‐peak bipolar voltage. Implantable telemetry recordings were used to quantify parasympathetic nerve activity over RAP time. Magnetic resonance imaging native T1, postcontrast T1, T2 mapping, and extracellular volume fraction were assessed (1.5T, Siemens) at baseline and AF. In explanted atrial tissue, DNA oxidative damage (8‐hydroxy‐2′‐deoxyguanosine staining) and percentage of fibrofatty tissue were quantified. Cycle length and organization index decreased (
R
=0.5,
P
<0.05; and
R
=0.5,
P
<0.05; respectively), and dominant frequency increased (
R
=0.3,
P
n.s.) until 80 days of RAP but not thereafter. In contrast, voltage continued to decrease throughout the duration of RAP (
R
=0.6,
P
<0.05). Parasympathetic nerve activity increased following RAP and plateaued at 80 days. Magnetic resonance imaging native T1 and T2 times increased with RAP days (
R
=0.5,
P
<0.05;
R
=0.6,
P
<0.05) in the posterior left atrium throughout RAP. Increased RAP days correlated with increasing 8‐hydroxy‐2′‐deoxyguanosine levels and with fibrosis percentage (
R
=0.5,
P
<0.05 for both).

Conclusions

A combination of AF electrogram characteristics and T1/T2 magnetic resonance imaging can detect early‐stage AF remodeling (autonomic remodeling, oxidative stress) and advanced AF remodeling due to oxidative stress and fibrosis.
Addition to Pseudoplagiostomataceae: Pseudoplagiostoma inthanonense sp. nov. from Doi Inthanon National Park, Northern Thailand
Authors: SILVA VEENAVEE S. HITTANADURAGE , PERERA REKHANI H. , FARIAS ANTONIO R. GOMES DE
Published: November 2023

Fungi are dominant microorganisms in plant litter, especially in pristine environments. This study collected leaf litter of broadleaf species within Doi Inthanon National Park, Chiang Mai, Thailand. Phylogenetic analyses utilizing DNA sequence data from ITS, LSU, tef1-α, rpb2, and tub2 regions and morphological characteristics revealed a new species, Pseudoplagiostoma inthanonense (Pseudoplagiostomataceae). The phylogeny and morphology of this novel species are thoroughly described and supported with detailed illustrations. Pseudoplagiostoma inthanonense is characterized by the shape and size of the conidiogenous cell and spore size. The discovery of P. inthanonense confirms that Pseudoplagiostoma consists of pathogenic, endophytic, and saprobic life forms while creating new research opportunities on potential lifestyle changes of Pseudoplagiostoma species.
Re-establishment of the Nearctic oak cynipid gall wasp genus Feron Kinsey, 1937 (Hymenoptera: Cynipidae: Cynipini), including the description of six new species
Authors: CUESTA-PORTA VICTOR , MELIKA GEORGE , NICHOLLS JAMES A. , STONE GRAHAM N. , PUJADE-VILLAR JULI
Published: November 2023

The Nearctic cynipid oak gall wasp genus Feron Kinsey, comb. rev., is re-established with 34 species: F. albicomus (Weld, 1952), comb. nov., F. amphorus (Weld, 1926), comb. nov., F. apiarium (Weld, 1944), comb. nov., F. atrimentum (Kinsey, 1922), comb. nov., F. bakkeri (Lyon, 1984), comb. nov., F. caepula (Weld, 1926), comb. nov., F. californicum (Beutenmueller, 1911), comb. nov., F. clarkei (Bassett, 1890), comb. nov., F. comatum (Weld, 1952), comb. nov., F. crystallinum (Bassett, 1900), comb. nov., F. cylindratum (Kinsey, 1937), comb. nov., F. discale (Weld, 1926), comb. nov., F. discularis (Weld, 1926), comb. nov., F. dumosae (Weld, 1957), comb. nov., F. gigas (Kinsey, 1922), comb. nov., F. izabellae Melika, Nicholls & Stone, sp. nov., F. kingi (Bassett, 1900), comb. nov., F. parmula (Bassett, 1900), comb. nov., F. pattersonae (Fullaway, 1911), comb. nov., F. roberti Melika, Nicholls & Stone, sp. nov., F. rucklei Melika, Nicholls & Stone, sp. nov., F. scutellum (Weld, 1930), comb. nov., F. serranoae Pujade-Villar & Cuesta-Porta, sp. nov., F. splendens (Weld, 1919), comb. nov., F. stellare (Weld, 1926), comb. nov., F. stellulum (Burnett, 1974), comb. nov., F. sulfureum (Weld, 1926), comb. nov., F. syndicorum Pujade-Villar & Cuesta-Porta, sp. nov., F. tecturnarum (Kinsey, 1920), comb. nov., F. tetyanae Melika, sp. nov., F. tibiale Kinsey, 1937, comb. rev., F. tubifaciens (Weld, 1926), comb. nov., F. verutum Kinsey, 1937, comb. rev., and F. vitreum Kinsey, 1937, comb. rev. Most species are known only from the asexual generation; F. clarkei, F. comatum, and F. dumosae are known only from the sexual generation, while both generations are recognised for F. atrimentum, F. crystallinum, F. gigas, F. kingi, and F. pattersonae. Matching of alternate sexual and asexual generations is established for the first time for F. kingi and F. pattersonae (= Andricus pedicellatus (Kinsey, 1922), syn. nov.) based on molecular data (both cytb and ITS2 sequences). Morphological descriptions, re-descriptions, diagnoses, and a key to species are given, as well as data on DNA sequences, biology, phenology, and distribution.
Vapor-Phase Contribution to Laser-Induced Plasma Emission of Magnesium in Liquid Aluminum
Authors: Thorarinsdottir Kristbjorg Anna , Maghsoudi Mehdi , Leosson Kristjan
Published: November 2023

Liquid aluminum containing the important alloying element magnesium in varying concentrations was analyzed using in-situ laser-induced breakdown spectroscopy (LIBS). Magnesium emission shows an exponential dependence on melt temperature that correlates well with the expected partial pressure of magnesium above the aluminum melt. Furthermore, comparison with LIBS measurements on corresponding solid samples supports the conclusion that a significant part of Mg emission from liquid metal samples originates from the vapor phase above the metal surface. Simultaneously, curves of growth measured over four orders of magnitude in Mg concentration reveal a level of self-absorption for liquid aluminum samples that is stronger than for solid aluminum samples having a corresponding Mg concentration, and beyond what is expected from conventional plasma models. The implications for measurements of volatile species in liquid metals in general are discussed.
Depictions of Firearm Violence Perpetrators and Support for Firearm Policies: An Experimental Survey Analysis of Mental Illness and Criminal Background
Authors: Semenza Daniel C. , Berryessa Colleen M. , Sierra-Arévalo Michael
Published: November 2023

We used an experimental study design with newspaper vignettes to examine how characteristics of gun violence perpetrators including mental illness and previous incarceration influence three categories of firearm policy support in a national sample of U.S. adults ( N = 3,387). Depictions of mass shootings elicit greater support for firearm policies than other types such as suicides, accidents, or street-level homicides. Further, depictions of mental illness and previous incarceration increase support for policies regulating who may legally own, purchase, and possess firearms. Demographic characteristics of perpetrators such as gender and race largely do not affect public policy support, although personal characteristics of respondents themselves are predictive of support.
Thyroid collision tumour with pulmonary metastases treated effectively with nedaplatin and paclitaxel chemotherapy: A case report
Authors: Liu Feng , Han Fei , Lu Lifang , Chang Jiang , Bian Zeyu , Yao Jingchun
Published: November 2023

Collision tumour of the thyroid is a rare entity for which surgical resection is the primary treatment. We present here a case of a collision thyroid tumour of oncocytic and papillary carcinoma with lung metastases occurring in a 62-year-old woman who initially presented with a rapidly enlarging cervical mass and dyspnoea. The patient had extensive venous tumour thrombosis in the internal jugular and subclavian veins. The patient received six cycles of combined chemotherapy with nedaplatin and paclitaxel which significantly reduced the size of the metastases in the lungs. Following discharge from the hospital, the patient was treated with oral anlotinib and at 14 months follow up she had not experienced any serious side effects and the metastases in her lung and thyroid surgery areas were well controlled.