bluuebunny/crossref_metadata_2025 huggingface dataset:
Decomposition strategy for surface EMG with few channels: a simulation study
Authors: Wu Wenhao , Jiang Li , Yang Bangchu
Published: May 2024

Objective. In the specific use of electromyogram (EMG) driven prosthetics, the user’s disability reduces the space available for the electrode array. We propose a framework for EMG decomposition adapted to the condition of a few channels (less than 30 observations), which can elevate the potential of prosthetics in terms of cost and applicability. Approach. The new framework contains a peel-off approach, a refining strategy for motor unit (MU) spike train and MU action potential and a re-subtracting strategy to adapt the framework to few channels environments. Simulated EMG signals were generated to test the framework. In addition, we quantify and analyze the effect of strategies used in the framework. Main results. The results show that the new algorithm has an average improvement of 19.97% in the number of MUs identified compared to the control algorithm. Quantitative analysis of the usage strategies shows that the re-subtracting and refining strategies can effectively improve the performance of the framework under the condition of few channels. Significance. These prove that the new framework can be applied to few channel conditions, providing a optimization space for neural interface design in cost and user adaptation.
PyHFO: lightweight deep learning-powered end-to-end high-frequency oscillations analysis application
Authors: Zhang Yipeng , Liu Lawrence , Ding Yuanyi , Chen Xin , Monsoor Tonmoy , Daida Atsuro , Oana Shingo , Hussain Shaun , Sankar Raman , Fallah Aria , Santana-Gomez Cesar , Engel Jerome , Staba Richard J , Speier William , Zhang Jianguo , Nariai Hiroki , Roychowdhury Vwani
Published: May 2024

Objective. This study aims to develop and validate an end-to-end software platform, PyHFO, that streamlines the application of deep learning (DL) methodologies in detecting neurophysiological biomarkers for epileptogenic zones from EEG recordings. Approach. We introduced PyHFO, which enables time-efficient high-frequency oscillation (HFO) detection algorithms like short-term energy and Montreal Neurological Institute and Hospital detectors. It incorporates DL models for artifact and HFO with spike classification, designed to operate efficiently on standard computer hardware. Main results. The validation of PyHFO was conducted on three separate datasets: the first comprised solely of grid/strip electrodes, the second a combination of grid/strip and depth electrodes, and the third derived from rodent studies, which sampled the neocortex and hippocampus using depth electrodes. PyHFO demonstrated an ability to handle datasets efficiently, with optimization techniques enabling it to achieve speeds up to 50 times faster than traditional HFO detection applications. Users have the flexibility to employ our pre-trained DL model or use their EEG data for custom model training. Significance. PyHFO successfully bridges the computational challenge faced in applying DL techniques to EEG data analysis in epilepsy studies, presenting a feasible solution for both clinical and research settings. By offering a user-friendly and computationally efficient platform, PyHFO paves the way for broader adoption of advanced EEG data analysis tools in clinical practice and fosters potential for large-scale research collaborations.
Simulation study on hydraulic characteristics of Changzhou fishway based on FLUENT
Authors: Zhang Jian , Ruan Tianpeng , Xu Tingxin
Published: May 2024

Guangxi Changzhou Fishway is the first significant water conservancy project above the mouth of the Pearl River and also the first large fishway independently designed in China. It is the primary migration channel for six kinds of state-level protected fish, such as Chinese sturgeon and a typical vertical slit fishway. This paper takes the Changzhou fishway as the research object, based on the theory of fluid mechanics, and adopts the method of combining theoretical analysis, experimental research, and numerical simulation to study the flow field of different water depths in the pond. The analysis results show that the upper water flow has a larger resting area than the lower water flow, and the fishway has a rich flow field distribution and can produce “S” shaped meandering flow characteristics. The research results provide some reference for the design of vertical fishways.
Simulation on stirling reverse osmosis desalination power system
Authors: Yang Ying , Li Longfei , Qu Xingchuang
Published: May 2024

In this article, a new power system based on the Stirling engine and hydraulic free piston engine is proposed to provide power for reverse osmosis (RO) desalination. First, the design of the Stirling free piston RO desalination power system was carried out, and the size parameters of the main structures such as the regenerator, heater, cooler, power piston, and valve distribution piston were obtained. A physical model was established to simulate the process of the Stirling engine driving the RO desalination power system based on finite element CFD. The flow field distribution cloud map and output power of the Stirling engine were analyzed. The results indicate that the gas motion of the Stirling engine is stable, and the entire power system can operate normally.
Impact radius of light oil pipeline leakage under different operating conditions
Authors: Zhang Weipeng , Zhang Shuxin , Gong Yanshuang , Xie Shuyi , Wu Chao , Tan Chuanjiang
Published: May 2024

This study investigated the impact range of pipeline leaks for light oil pipelines under different operating conditions. Three different calculation methods were employed to study the influence of various factors, including obstacle height, wind speed, leak hole diameter, and slope, on the leak impact range of flowing fires, pool fires, and overpressure waves. The results indicate that the impact range decreases as the height of obstacles increases. The most significant decrease occurs when obstacles are 2 meters high, and further increasing the obstacle height leads to a less pronounced decrease. Wind speed has a complex influence on the impact range. For flowing fires, the impact range initially increases and then decreases with higher wind speeds. For pool fires, a higher wind speed leads to a larger impact range, while for overpressure waves, higher wind speeds result in a smaller impact range. Larger leak hole diameters lead to larger impact ranges for both fire radiation and overpressure waves. Increasing the environmental slope has a slight effect on the impact range. Sensitivity analysis indicates that wind speed has the most significant impact, followed by leak hole diameter, while the environmental slope has the least influence on the impact range.
Analysis of enhanced thermal transmission mechanism with microstructures by field synergy theory
Authors: Yuan Ding , Li Zhujun , Liu Yifei
Published: May 2024

This study numerically examines the impact of oblique ribs and staggered herringbone microstructures on the heat transfer performance of microchannels. The results indicate that the Nux
values of the oblique rib (Type A) and staggered herringbone (Type B) microchannels exhibit significantly higher performance compared to smooth rectangular (Type C) microchannels. The oblique ribs and staggered herringbone microstructures improve heat transfer efficiency along the flowing direction, leading to an evident increase followed by horizontal fluctuations in Nux
. In contrast, the Nux
of Type C without microstructures decreases significantly at the inlet and subsequently remains relatively constant. The bottom temperature Tw
of Type A and B are lower than the temperature of Type C. The results of field cooperation analysis indicate that the synergistic fields of the oblique ribs microchannels primarily exist along both sidewalls, while they are present at the fluid center for the staggered herringbone microchannels. Type A exhibits a slightly stronger heat transfer effect despite having a smaller synergistic area compared to Type B.
Free motion characteristics of the ventilated supercavitating vehicles
Authors: Zou Wang , Gan Hanyu
Published: May 2024

Supercavitation theory and technology are important methods for reducing the drag of underwater vehicles to achieve motion with high speed. A ventilated supercavitating vehicle can break the limitation of natural supercavitation on speed and ambient pressure and has broad application prospects. The presence of hydrodynamic forces only at the head and tail restricts the significant improvement of the motion performance of the vehicle. Therefore, this study improves the dynamic model of a supercavitating vehicle using a self-developed shear-layer gas loss model and simulates the vehicle’s level-free motions to reveal the motion characteristics and hydrodynamic distribution characteristics. Further, the effects of the cavitator as an important control surface on motion characteristics are analyzed by changing the cavitator diameter in numerical simulations. The results lay a theoretical foundation for designing control surfaces and motion control systems for the vehicle.
Integrated heat dissipation mechanism design of electronic equipment cabinet based on flow and sound analysis
Authors: Jiang Shuai , Chen Kui , Cai Yongqing , Tian Xingyu
Published: May 2024

The electronic equipment cabinet is the main bearing platform of radar back equipment, normally using a forced convection cooling form. With the continuous increase of radar function and processing capacity, the total heat consumption of electronic equipment is getting higher and higher, and the fan speed is constantly increasing. Besides the noise of electronic equipment cabinet shows a trend of gradually increasing. To reduce cabinet noise from the source, this paper presents three structural forms of integrated heat dissipation mechanism, and uses FloEFD fluid heat transfer analysis software and COMSOL acoustic module to analyze the cabinet flow field and the cabinet sound field respectively. By comparing the cabinet noise characteristics under different structural forms, the analysis results show that the noise reduction effect of bilateral air duct structure is best.
Simulation of regular wave impact on beam-plate structure on a slope
Authors: Jin Feng , Xu Dabao , Lin Wenshun , Zhang Chenjuan
Published: May 2024

In order to study the peculiarities of wave slamming on beam-plate structures on a slope, two-dimensional numerical models of regular waves have been developed on the basis of the FLUENT software. Firstly, the validity of the numerical wave flume was verified. Then, with plentiful simulations, the parametric studies were performed for different wave steepness, structure geometry, and the distance between the underside of the horizontal plate and the still water level. The effects of the three parameters on the impact pressure and vertical velocities were investigated. Lastly, the statistical relationship between the waves’ impact pressures and the corresponding flow velocities was investigated. The results had a certain significance to the further understanding of the mechanism of the impact of the waves.
Numerical simulation of two-dimensional plain flap ground effect based on NACA4412 airfoil
Authors: Xiao Yanping , Wang Furui , Sun Peiyan
Published: May 2024

Based on the NACA4412 airfoil, by solving a two-dimensional unsteady Reynolds-averaged N-S equation and using the k-ωSST model, this paper analyzes the influence of near-ground altitude change on different configuration flow fields under moving ground conditions and explores the variation law of wing pressure coefficient at different near-ground altitudes. The results show that the attraction of the upper airfoil is weakened by the GE (ground effect), the pressure of the lower airfoil is increased, and the upper and lower airfoils influence the lift change of the airfoil. With the decrease of near-ground altitude, at a certain AOA (angle of attack), the greater the flap angle is, the faster the suction loss on the upper wing surface is and the slower the pressure increases on the lower wing surface, and the lower the near-ground altitude corresponding to the minimum lift coefficient is. With the decrease of near-ground altitude, at a certain flap angle, the greater the AOA is, the faster the suction loss on the upper wing surface is and the slower the pressure increases on the lower wing surface, and the lower the near-earth altitude corresponding to the minimum lift coefficient is.
Optimization method for renewable energy investment planning in the electricity carbon coupling market environment considering economy
Authors: Jiang Xue , Zhang Ou , Shi Jing , Gu Zheng , Li Dongxue
Published: May 2024

China is developing rapidly in renewable energy development, electricity market reform, and carbon market construction, using market mechanisms for efficient planning and investment. The electricity and carbon markets are interrelated for market entities. This context has led to a dual-level optimization model for renewable energy investment planning, considering cost recovery and new power system goals. The model includes deriving electricity carbon coupling quotations for conventional units based on dynamic carbon emission characteristics and proposing an electricity spot market mechanism influenced by carbon quota trading. The model’s upper level maximizes renewable energy investment capacity, determining its size and location, while the lower level simulates electricity spot and voluntary emission reduction market trading to guide investment decisions. The model transformed into a mixed integer linear programming problem for optimal solutions was validated numerically, examining various factors affecting optimal renewable energy investment capacity.
Flexible Load Optimization Operation Method for Integrated Energy Systems in Parks Considering Demand Response
Authors: Yang Lin , Zhao Deren , Yu Changle , Li Wenwen , Zhang Su , Kong Deping
Published: May 2024

The ongoing advancements in energy technology are progressively unveiling the high energy utilization benefits of comprehensive energy systems (CIES) in parks. Based on the concept of an energy hub, a CIES model including distributed power supply, gas turbine, and flexible loads is constructed by combining the characteristics of flexible loads in the park that can be leveled, shifted, and curtailed. In light of the demand response mechanism, a method for the low-carbon economic optimization operation of CIES has been developed, focusing on minimizing the total cost. This method utilizes the CPLEX solver to process the algorithm. The approach involves a comparative analysis of load distribution before and after engaging in demand response activities. Such analysis is crucial in understanding the influence of the demand fluctuations mechanism and in determining the most efficient method for adjusting flexible loads. This adjustment aims to further reduce the system costs of CIES. The findings indicate that, under the demand response mechanism, the involvement of flexible loads in CIES operations can significantly enhance the system’s economic efficiency.
Optimization Scheme for Energy Storage Capacity of Large Grid Connected with Wind Farm in New Power System
Authors: Han Xingning , Wan Lu , Peng Zhuyi , Xu Sixuan , Qi Wanchun
Published: May 2024

In this study, our foremost focus was on mitigating the significant impacts on system frequency due to power output variations from large-scale wind farms integrated into the grid. We conducted in-depth simulations using Matlab to meticulously analyze the relationship between the output power of wind turbines and wind speed. Taking into account the power features of wind turbines and the probability distribution of wind velocities, we proposed an innovative calculation method to determine the energy storage requirements to maintain consistent and stable output from wind energy systems over long durations. By rigorously testing with real wind farm data, the feasibility of this method was validated, highlighting its pivotal role as a reference in future wind power project designs.
Human Rights
Authors: Williams Abiodun
Published: May 2024

Chapter 4 focuses on Kofi Annan’s promotion and elevation of human rights in the work of the UN. It examines his vision for human rights; the use of the moral authority of the Secretary-Generalship in support of human rights; and mainstreaming human rights within the organization. He believed that democracy provides an environment for the protection and realization of human rights, and that the UN should nurture the conditions of democracy rather than fixate on its forms. He persuaded member states to create the Human Rights Council, alongside the Security Council and the Economic and Social Council, in order to establish human rights at their proper level within the system. The chapter includes a case study of his response to a human rights crisis in the Democratic Republic of the Congo in his first year as Secretary-General, and his efforts to ensure respect for human rights during the campaign against terrorism after the 9/11 attacks in the US.
9/11, Afghanistan, and Iraq
Authors: Williams Abiodun
Published: May 2024

Chapter 6 explains how Kofi Annan dealt with three major crises during his tenure: the 9/11 terrorist attacks, Afghanistan, and the US invasion of Iraq. In the wake of 9/11 he tried to preserve the moral authority of the Secretary-Generalship while negotiating a treacherous political terrain. After 9/11, the salience of terrorism as an international issue spiked dramatically. He played a critical role in developing the UN’s first Global Counter-Terrorism Strategy. He tried to dissuade the US from unilateral military action against Iraq and to preserve unity on the Security Council. During the Iraq crisis, Annan was caught between the conflicting interests of the permanent members of the Security Council, as well as two superpowers: the US and world public opinion. The invasion of Iraq led to deep and bitter division of the international community. The UN is the creature of a political world, and, if the UN is found wanting, that is symptomatic of wider fault lines in global politics.
The Translation of Recovery-Oriented Social Work Practice in Child and Youth Mental Health: A Scoping Review
Authors: Reid Katherine , Olsen Alexandra , Farwa Aniqa , Dalziel Matt , Wyder Marianne
Published: May 2024

Recovery-oriented practice has become taken for granted and seen as the most ideal way of working for social workers alongside other allied health practitioners in the mental health field. Recovery-oriented practice is defined as a person-centred and strengths-based approach, providing interventions, as well as facilitating environmental and multidisciplinary resources to support the individual’s independence. The applicability of recovery in a child and youth mental health (CYMH) context, however, continues to be questioned. Although some research has explored what recovery means for young people, there is scant literature that examines how recovery-oriented practice is enacted when working with children and their families. This scoping review, guided by the Arksey and O’Malley’s framework explores how recovery is conceptualised and translated into practice with children aged two to twelve years who have identified ‘mental health concerns’ and their families. Qualitative and grey literature from the last twenty years was thematically analysed. The findings highlight the primacy placed on global recovery-oriented principles and expose the superficial articulation of the application of recovery-oriented practice with children. Findings underscore the need to critically investigate how social workers enact recovery approaches when working in a clinical CYMH setting, dominated by the medical model which prioritises evidence-based intervention and marginalises children’s knowledge.
Clinical and laboratory findings characterizing the need for systemic corticosteroids and nonsteroidal systemic therapies and the predicted outcomes in cutaneous polyarteritis nodosa: a single-centre retrospective analysis
Authors: Tanaka Ryo , Tanese Keiji , Ito Yoshihiro , Takeuchi Sakiko , Morimoto Ari , Sujino Kazuyo , Amagai Masayuki , Tanikawa Akiko
Published: May 2024

Background

Cutaneous polyarteritis nodosa (cPN) is a necrotizing arteritis of medium-sized vessels limited to the skin. Because of its rarity and the diversity of its clinical manifestations, there is no consensus treatment. Moreover, there are no established indicators that predict disease severity or its outcome.

Objectives

To investigate clinicolaboratory features that predict patients requiring systemic therapy, including corticosteroids, to control disease activity.

Methods

Thirty-six patients with cPN who had not received systemic corticosteroids at their initial visit were retrospectively analysed by correlating the treatment and its response with clinicolaboratory findings.

Results

The major medications administered were antiplatelet agents [64% (23/36)], vasodilators [39% (14/36)] and prednisolone (PSL) [36% (13/36)]. In total, 23 patients achieved remission without PSL, 5 were managed with compression therapy alone or even observation and 18 received antiplatelet monotherapy or combined with vasodilator/dapsone whereas 13 required PSL. Of the 13 who required PSL, 10 achieved remission with PSL monotherapy or PSL and single/multiple medications and 3 with PSL and multiple drugs then failed to achieve remission and underwent limb amputation. There were more skin ulcers and an elevated peripheral white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) before corticosteroid induction in patients requiring PSL. Three patients with treatment failure had a markedly elevated ESR (> 50 mm h–1).

Conclusions

More than half of patients with cPN can achieve remission without corticosteroids. An elevated WBC, an elevated ESR and the presence of skin ulcers predict the need for PSL. A high ESR before corticosteroid induction predicts treatment resistance, even with PSL.
Prevalence of omalizumab-resistant chronic urticaria and real-world effectiveness of dupilumab in patients with omalizumab-refractory chronic urticaria: a single-centre experience
Authors: Zhu Catherine , BinJadeed Hessah , Gabrielli Sofianne , Prosty Connor , Rahme Elham , Shand Greg , Fein Michael , Ben-Shoshan Moshe , Netchiporouk Elena
Published: May 2024

Chronic urticaria (CU) is characterized by weals (hives) angio-oedema (or both) that last for ≥ 6 weeks, with chronic spontaneous urticaria (CSU) being the most common subtype. Patients with omalizumab-refractory CSU represent an unmet clinical need. In this study, we aimed to assess the prevalence and predictors of omalizumab failure in a large cohort of patients with CU and assess the effectiveness of dupilumab for omalizumab-refractory CU. Of 338 patients with CU, 33 received omalizumab; 69.7% (n = 23) were responders and 30.3% (n = 10) were nonresponders. Bivariate regression demonstrated that female sex [adjusted odds ratio (aOR) 1.53, 95% confidence interval (CI) 1.14–2.06], higher baseline weekly urticaria activity score (aOR 1.05, 95% CI 1.01–1.09) and older age (controlling for sex) (aOR 1.00, 95% CI 1.00–1.01) were associated with omalizumab failure. Of 10 patients with omalizumab-refractory CU, 3 were well controlled with ciclosporin (all children), whereas the 7 adults failed a mean [standard deviation (SD)] of 5.6 (2.6) treatments, including ciclosporin. All seven achieved a complete response with dupilumab, with time to response varying between 1 and 6 months. While our results suggest a favourable efficacy of dupilumab in patients with omalizumab-refractory CU, future confirmatory studies are required.
Evaluating the efficacy of ChatGPT in addressing patient queries about acne and atopic dermatitis
Authors: Lau Charles B , Lilly Evelyn , Yu JiaDe , Smith Gideon P
Published: May 2024

In this study, we evaluated ChatGPT 3.5 responses to common patient questions about acne and atopic dermatitis. While ChatGPT generally provided accurate and comprehensive answers, its readability was at the college level, which is above the recommended grade for patient materials. Significant information gaps were also noted, including omissions of newer treatments, probably because of the model’s training limitations up to mid-2021. Despite these limitations, ChatGPT can be a valuable resource, especially in regions where dermatological expertise is scarce.
Pneumococcal vaccination effectiveness (PCV13 and PPSV23) in individuals with and without reduced kidney function: a test-negative design study
Authors: Le Dustin , Chang Alexander , Grams Morgan E , Coresh Josef , Ishigami Junichi
Published: May 2024

Background

Streptococcus pneumoniae vaccination effectiveness (VE) in individuals with reduced kidney function is unknown. We estimated pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and combined PCV13 and PPSV23 effectiveness against pneumococcal disease in individuals with and without reduced estimated glomerular filtration rate (eGFR).

Methods

All eligible individuals (case and controls) were adults (aged ≥18 years) hospitalized within the Geisinger Health System and required to have S. pneumoniae urinary antigen testing (i.e. test-negative design). Vaccination records were obtained from the electronic health record and statewide vaccination registry. After controlling for the probability of receiving a pneumococcal vaccine, we used multivariable logistic regression models to estimate the odds ratios (ORs) of vaccination between those who did and did not meet the S. pneumoniae case definition. VE was calculated as (1 – OR) × 100%.

Results

There were 180 cases and 3889 controls (mean age 69 years, female 48%, white 97%, mean eGFR 71 mL/min/1.73 m2). The adjusted population PCV13 VE was 39% (95% CI 13%–58%), and combination PCV13 and PPSV23 was 39% (95% CI 12%–58%). PPSV23 VE was –3.7% (95% CI –57% to 32%). Stratified by eGFR, adjusted PCV13 VE was consistent in eGFR ≥60 [VE 38% (95% CI 2.9%–61%)] and 30–59 [VE 61% (95% CI 24%–80%)] without significant interaction. VE was not calculable for eGFR <30 due to small sample size.

Conclusion

PCV13 vaccination was associated with reduced risk of S. pneumoniae hospitalization in individuals with a reduced eGFR (30–59 mL/min/1.73 m2).
Role of endothelial Raptor in abnormal arteriogenesis after lower limb ischaemia in type 2 diabetes
Authors: Liu Ting , Zhang Jiachen , Chang Fangyuan , Sun Mengyu , He Jinlong , Ai Ding
Published: May 2024

Aims

Proper arteriogenesis after tissue ischaemia is necessary to rebuild stable blood circulation; nevertheless, this process is impaired in type 2 diabetes mellitus (T2DM). Raptor is a scaffold protein and a component of mammalian target of rapamycin complex 1 (mTORC1). However, the role of the endothelial Raptor in arteriogenesis under the conditions of T2DM remains unknown. This study investigated the role of endothelial Raptor in ischaemia-induced arteriogenesis during T2DM.

Methods and results

Although endothelial mTORC1 is hyperactive in T2DM, we observed a marked reduction in the expression of endothelial Raptor in two mouse models and in human vessels. Inducible endothelial-specific Raptor knockout severely exacerbated impaired hindlimb perfusion and arteriogenesis after hindlimb ischaemic injury in 12-week high-fat diet fed mice. Additionally, we found that Raptor deficiency dampened vascular endothelial growth factor receptor 2 (VEGFR2) signalling in endothelial cells (ECs) and inhibited VEGF-induced cell migration and tube formation in a PTP1B-dependent manner. Furthermore, mass spectrometry analysis indicated that Raptor interacts with neuropilin 1 (NRP1), the co-receptor of VEGFR2, and mediates VEGFR2 trafficking by facilitating the interaction between NRP1 and Synectin. Finally, we found that EC-specific overexpression of the Raptor mutant (loss of mTOR binding) reversed impaired hindlimb perfusion and arteriogenesis induced by endothelial Raptor knockout in high-fat diet fed mice.

Conclusion

Collectively, our study demonstrated the crucial role of endothelial Raptor in promoting ischaemia-induced arteriogenesis in T2DM by mediating VEGFR2 signalling. Thus, endothelial Raptor is a novel therapeutic target for promoting arteriogenesis and ameliorating perfusion in T2DM.
Reclassification of CADILLAC risk score with lung ultrasound at admission in patients with STEMI in a one-year follow-up
Authors: Carreras J , Vidal-Burdeus M , Rodriguez-Gonzalez C , Simon-Ramon C , Rodriguez-Sotelo L , Sionis A , Giralt-Borrell T , Izquierdo-Marquisa A , Cainzos-Achirica M , Tizon-Marcos H , Rivas-Lasarte M , Ribas-Barquet N
Published: May 2024

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): JC-M received Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology.

Introduction

Lung ultrasound (LUS) has emerged as a valuable diagnostic and prognostic tool in heart failure (HF) and shows promise in risk stratification for ST-segment elevation myocardial infarction (STEMI) during the acute phase. Current risk stratification scales for STEMI primarily rely on the Killip scale to assess the severity of heart failure (HF) upon admission. However, these scales were developed before the widespread use of LUS, and as a result, LUS findings have not been incorporated into any existing risk stratification scales for STEMI.

Purpose

To assess the potential improvement in prognostic predictive value achieved by incorporating LUS findings into a current risk score for STEMI.

Methods

In a prospective multicenter cohort study, an independent operator conducted LUS, and offline B-line counting was performed upon admission. Patients were categorized as having wet lung (at least one site with ≥3 B-lines) or dry lung based on LUS results. The CADILLAC score was calculated, and patients were classified as either low risk (≤2 points) or medium/high risk (>2 points). We evaluated the Net Reclassification Index (NRI) and conducted a Receiver Operating Characteristics (ROC) comparison based on the prediction of a composite endpoint which included death, hospitalization for HF, acute coronary syndrome, or stroke within one year following revascularization.

Results

The CADILLAC score was computed for 353 patients after excluding those admitted with Killip IV. Among these, 216 (61.2%) had a low-risk score (≤2), and 137 (38.8%) had a medium-high score. LUS significantly reclassified CADILLAC results, resulting in an absolute NRI of 12.4%. ROC comparison of models comprising CADILLAC and CADILLAC + LUS demonstrated that the addition of LUS significantly improved the accuracy of predicted risk (0.722 vs. 0.770, p=0.05).

Conclusion

The inclusion of LUS findings in the CADILLAC score enhances its prognostic capacity.Figure 1
SCAI SHOCK stage classification: valid for all indications and devices in patients with short-term mechanical circulatory support?
Authors: Hernandez Martos A , Alonso Fernandez De Gatta M , Diego Nieto A , Gonzalez Cebrian M , Toranzo Nieto I , Barrio Rodriguez A , Martin Herrero F , Merchan Gomez S , Gonzalez Calle D , Hernandez Hidalgo M , Barreira De Sousa G J , De Avila Neila A , Sanchez Fernandez P L
Published: May 2024

Funding Acknowledgements

None.

Background

The Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stage has demonstrated prognostic value in patients with cardiogenic shock (CS), including patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. It has also been validated in different scenarios as acute coronary syndrome -ACS- or out-of-hospital cardiac arrest.

Purpose

Our objective was to study the prognostic value of SCAI SHOCK stage in different indications and etiologies requiring different types of short-term mechanical circulatory support (MCS).

Methods

Retrospective analysis of consecutive patients supported with VA-ECMO or Impella CP® in a referral center. We studied the SCAI SHOCK stage at MCS implantation according different devices, indication and etiology, and its relationship with in-hospital and follow-up survival.

Results

263 patients were included between 2014-March 2023 (Table). The SCAI SHOCK stage was less advanced in complex high risk percutaneous coronary intervention (CHIP-PCI) indication and more advanced in postcardiotomy shock, myocarditis, pulmonary embolism (PE), refractory cardiac arrest or electric storm (Figure A).

In-hospital survival was 41.1% and it was significantly lower as SCAI SHOCK stage increased (A 83.9%, B 100%, C 66.7%, D 39.2%, E 24.5%; p=0.000), as well as in follow-up for a median time of 24.5 [47] months (figure B). This association was maintained with both types of devices separately: VA-ECMO (A 80%, B 100%, C 33.3%, D 38.9%, E 24.5%, p=0.001) and Impella (A 84%, B 100%, C 75%, D 42.9%, E 25%, p=0.005).

Regarding the indication and etiology for MCS, SCAI SHOCK classification was significantly related with survival in CS indication, as well as in ACS and heart failure (HF) etiology (Figure B).

However, no relationship between SCAI and survival was observed in indications as CHIP-PCI (A 83.9%, B 100%, C 50%; p=0.386), electrical storm (C 0%, D 100%, E 70%; p=0.075) and postcardiotomy shock (D 35.6%, E 20%; p=0.470), neither in etiologies as PE (D 0%, E 28.6%; p=1), infective endocarditis (D 28.6%, E 0%; p=1), myocarditis (D 100%, E 0%; p=0.250),and other causes of cardiac arrest (D 0%, E 25%; p=1), nor in patients admitted for elective cardiac surgery.

Conclusions

SCAI SHOCK stage classification showed prognostic value in patients with short-term MCS indicated by diverse etiologies, including both VA-ECMO and Impella CP devices. The prognostic value was maintained for the indication of CS, and in ACS and HF etiologies, but not in electrical storm, CHIP-PCI, PE, myocarditis or postcardiotomy shock. Studies are needed to validate this classification in other settings.TableFigure
Using continuous electronic urine output monitoring for the management of acute cardio-renal syndrome in patients with acute decompensated heart failure
Authors: Shacham Y , Stern T , Stern T , Banai S , Banai S , Rozenfeld A , Rozenfeld A
Published: May 2024

Funding Acknowledgements

None.

Background

Patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome (CRS) related to venous congestion and diuretic resistance.

Positive fluid balance has been associated with adverse outcomes including acute kidney injury (AKI) and mortality. In critically ill patients urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance .We investigated the possible effect of real-time UO monitoring, fluid balance, renal outcomes and 30-day mortality of patients admitted to the cardiac intensive care unit (ICU) with ADHF.

Methods

We performed a case series of 50 patients admitted to the cardiac ICU from July 2021 and June 2023 with ADHF. Their standard foley catheter was connected to an electronic monitoring system that continuously monitors UO in real-time. Its technology is described elsewhere (1). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included change in fluid balance, incidence of AKI and 30-day mortality. The case series group was than compared to a historical group of 50 matched controlled patients admitted between 2019-2020. Patients were matched according to cause of admission, age and glomerular filtration rate.

Results

In the study cohort the median age was 71±12 years, and 36 (72%) were men. In the historical cohort the median age was 71±13 years, and 36 (72%) were men.

Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P<0.001 for all, Figure 1). Incidence of AKI and the combined endpoint of AKI and 30-day mortality was significantly lower in the electronic UO monitoring cohort (24% vs. 46%, p=0.0197 and 40% vs 78%, P<0.0001 respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (Figure 2).

Conclusion

We demonstrated that real time monitoring of UO was associated with better prevention of fluid overload and the management of type I CRS in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.Fluid balance renal senseAKI and 30-day mortality
Temporal trends in acute coronary syndrome by subtype
Authors: Crljenko K , Jerkic H , Babic Z
Published: May 2024

Funding Acknowledgements

None.

Introduction

Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU).

Methods

We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data.

Results

Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p<0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p<0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= <0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= <0.001).

Conclusion

We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.
The prognostic value of remnant cholesterol in patients with ST segment elevation myocardial infarction
Authors: Zhou Y , Melissa Madsen J , Tas Oezbek B , Koeber L , Thomsen Loenborg J , Engstroem T
Published: May 2024

Funding Acknowledgements

None.

Background

Remnant cholesterol (RC) is the cholesterol content within triglyceride rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond low density lipoprotein cholesterol (LDL-C).

Purpose

The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We aimed to estimate RC-related risk beyond LDL-C in patients with STEMI.

Methods

A total of 6602 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) from 1999 to 2016 were included. RC was calculated as total cholesterol minus LDL-C minus high-density lipoprotein cholesterol. Adjusted Cox models were used to estimate the association between continuous RC levels and all-cause mortality, cardiovascular death, ischemic stroke, and recurrent myocardial infarction (MI) at long-term (median follow-up of 6.0 years). Besides, discordance analyses were applied to examine the risk of the discordantly high RC (RC percentile rank minus LDL-C percentile rank> 10 units) compared to the discordantly low RC (LDL-C percentile rank minus RC percentile rank> 10 units). The concordance was defined as the percentile rank difference between RC and LDL-C ≤ 10 units.

Results

The median age of patients was 63 years old [interquartile range (IQR) 54–72] and 74.8% of them were men. There were 2441, 1651 and 2510 people in the discordantly low RC group, concordant group and discordantly high RC group. All outcomes in the discordantly high RC group were higher than the other groups and its event rate of all-cause mortality was 31.87 (event number/patient number in the group*100). In the unadjusted analysis, the discordantly high RC was associated with increased all-cause mortality [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.63–2.04] and increased cardiovascular death (HR 1.79, 95% CI 1.55–2.06) compared to the discordantly low RC. In an adjusted model RC was associated with higher all-cause mortality (HR 1.14, 95% CI 1.07–1.22). The discordantly high RC was associated with increased all-cause mortality (HR 1.55, 95% CI 1.37–1.75) and increased cardiovascular death (HR 1.47, 95% CI 1.25–1.72) compared to the discordantly low RC. There were no associations between RC and ischemic stroke or recurrent MI.

Conclusions

In patients with STEMI treated with primary PCI, elevated RC levels beyond LDL-C were independently associated with increased all-cause mortality.Graphical summaryLong-term survival probability
Long-term prognostic ability of the GRACE 3.0 risk score in patients hospitalized for acute coronary syndromes
Authors: Kofos C , Douki E , Rousopoulou S , Takas A , Karagiannidis E , Samaras A , Tzikas A , Fragakis N , Kassimis G
Published: May 2024

Funding Acknowledgements

None.

Background

The GRACE 3.0 (GRS 3.0) is a risk assessment tool for in hospital mortality for patients admitted with acute coronary syndrome (ACS). This study sought to validate the accuracy of GRS 3.0 in predicting long-term mortality following a hospitalization for ACS.

Methods

We measured retrospectively all various factors included in GRS 3.0 such as age, heart rate, systolic blood pressure, creatinine, sex, cardiac arrest, ST-segment deviation on ECG, troponin elevation, and Killip Class. Multivariable Cox regression analysis was used. The discriminative ability of the GRACE 3.0 risk score was calculated by the c-index, which corresponds to the area under the ROC curve.

Results

223 patients with ACS were included. During a median follow-up of 3 years, 57 (25.6%) patients died. Among the variables of GRS 3.0, age, heart rate, and troponin elevation at admission were the only independent predictors of mortality. The score had good discrimination for all-cause mortality (c-index=0.82, 95% CI 0.75–0.89) [Figure]. It performed equally well in both sexes.

Conclusions

The newly developed GRS 3.0 is well-performing for predicting long-term mortality in patients hospitalized for ACS. Thus, it may assist in tailored risk stratification and management of these patients following hospital discharge.
Assessing PERT integration: a European survey on pulmonary embolism response teams
Authors: Hobohm L , Keller K , Farmakis I T , Tichelbaecker T , Sagoschen I , Gori T , Lurz P , Konstantinides S , Ahrens I
Published: May 2024

Funding Acknowledgements

None.

Background

In recent years, the establishment of multidisciplinary pulmonary embolism response teams (PERTs) has become more prevalent in response to the growing challenges in managing acute pulmonary embolism (PE). A survey was conducted to assess the availability and structure of PERTs in selected European PE reference centers.

Methods

A survey was circulated among leading European PE centers to obtain data on their current PE treatments, the existence and features of PERTs, their activation methods, and their structural organization. Additionally, data regarding PE treatment priority relative to acute coronary syndrome and the availability of outpatient PE follow-up programs was collected.

Results

Overall, 26 selected reference centers for PE from 13 European countries participated at this survey and in more than four fifth (80.8%) of the centers PERT is already implemented. Although 76.9% of the centers handle over 40 PE cases annually, less than half (42.8%) of their PE cases are discussed in a PERT meeting. Figure 1A illustrates the risk classifications for which PERTs are typically consulted. The most common method of activating PERTs is through phone calls (47.6%), followed by mobile apps (38.1%) and pagers (4.8%). In almost 60% PERT is leading from the Department of Cardiology followed by Pulmonology (18.2%), Critical Care Medicine (9.1%), General Internal Medicine (4.6%), Angiology (4.6%) and Radiology (4.6%) (Figure 1B and 1C). Regarding advanced treatment the majority of European expert centers for PE offers catheter-directed thrombolysis (78.3%) and catheter-based thrombectomy (78.3%) and the opportunity of surgical embolectomy (65.2%). Notably, over 46% of centers prioritize ST-elevation infarction over high-risk PE (Figure 1D). The follow-up of patients with PE is organized in 34.6% in a dedicated PE clinic, in 23.1%in the clinic of the physician leading PERT and in 7.7% no PE follow-up is available.

Conclusion

The findings confirm the widespread adoption of PERTs in European PE reference centers. However, there is a discernible trend of prioritizing myocardial infarction over PE with hemodynamic instability, even when mortality rates are comparable for high-risk PE cases. This emphasizes the pressing need for awareness campaigns to enlighten physicians about the significant mortality rates linked with unstable PE, aiming for enhanced management and intervention for this thrombotic disease.
Albuminuria in patients with type 2 diabetes mellitus and newly diagnosed heart failure with preserved ejection fraction
Authors: Khutsishvili N , Nazarov I S , Misan I A , Tolkacheva V V , Safarova A F , Galochkin S A , Galochkina M A , Cabello Monotya F E , Smirnov I P , Kontareva N I , Kobalava Z H D
Published: May 2024

Funding Acknowledgements

None.

Aim

To evaluate the frequency of albuminuria in patients with type 2 diabetes and newly diagnosed heart failure with preserved ejection fraction

Methods

100 patients with T2DM were included (female, 62%; mean age, 64±10 years). Patients were divided into 2 groups with albuminuria (>30 mg albumin/g creatinine) and without albuminuria (<30 mg albumin/g creatinine). HFA-PEFF score was considered as a diagnostic parameter of heart failure with preserved ejection fraction (HFpEF): low probability/excluded HFpEF (<2 points), high probability/confirmed HFpEF (≥5 points), intermediate probability HFpEF (2 -4 points). The detailed echocardiographic criteria for LV diastolic dysfunction (structural parameters), the natriuretic peptide NT-proBNP, urine albumin to creatinine ratio (UACR) were detected in all patients.

Results

Albuminuria was detected in 55% (n=55) patients with DM, no albuminuria 45% (n=45). Newly diagnosed HFpEF were identified in 46% (n=46) patients, intermediate probability HFpEF in 37% (n=37), low probability/excluded HFpEF in 11% (n=11). Albuminuria was detected in 71% (n=39) of patients with newly diagnosed HFpEF, 22% (n=12) with intermediate probability HF, in 7% (n=4) with excluded HFpEF. In patients with HFpEF albuminuria was associated with the following echo parameters with: E/e’>9(r=0,51; p < 0,001) and Left ventricular mass index (LVMI) ≥115 g/m² (male) or ≥95 g/m² (female) (r=0,68; p < 0,001).

Conclusions

In patients with type 2 diabetes and newly diagnosed HFpEF the frequency of albuminuria was significantly high and was associated with echo parameters E/e’ ratio and LVMI.