bluuebunny/crossref_metadata_2025 huggingface dataset:
Literaturrecherche in der Handtherapie
Authors: van Kooij Yara , Fink Alexandra , Bonhof Elske ,   (übersetzt aus dem Niederländischen mit Hilfe von
                        Kerstin Fricke)
Published: October 2021

Ihre Patientin fragt Sie, welche Behandlungsmaßnahme für sie
die effektivste ist. Um eine evidenzbasierte Antwort geben zu
können, benötigen Sie neben Ihrem Fachwissen auch die
Kenntnis über den aktuellen Stand der Wissenschaft zu diesem Thema.
Dieser Artikel zeigt, wie und wo Sie wissenschaftliche Informationen finden
und wie Sie bei der Beantwortung einer klinischen Fragestellung konkret
vorgehen können.
Delivery of Ursolic Acid by Polyhydroxybutyrate Nanoparticles for
Cancer Therapy: in silico and in vitro Studies
Authors: Ram Kumar Pandian Sureshbabu , Kunjiappan Selvaraj , Pavadai Parasuraman , Sundarapandian Velmurugan , Chandramohan Vivek , Sundar Krishnan
Published: October 2021

Ursolic acid (UA), a pentacyclic triterpenoid and a phytochemical, is a potent
inhibitory agent against proliferation of various tumors. Polyhydroxybutyrate
nanoparticles (PHB NPs) are preferred in therapeutics due to their
drug-stabilizing property and enhanced biological activity. In this study, PHB
NPs were utilized to deliver and enhance the bioavailability of UA against
cancer cells (HeLa). Further, molecular docking and dynamic studies were
conducted to calculate the binding affinity and stability of UA at the active
site of target protein (epidermal growth factor receptor-EGFR). The PHB NPs
revealed the average size as 150–200 nm in TEM, which were used
in subsequent experiments. The cytoplasmic uptake of nanoparticles was confirmed
by florescent microscopy. The encapsulation potential of PHB NPs with UA was
assessed by UV–visible spectrophotometer as 54%. Besides, the
drug release behavior, cytotoxicity and the regulation of apoptosis were
investigated in vitro. The cytotoxicity results revealed that the maximum
efficiency of drug delivery was at 96th hour.
Comparison of Perinatal Outcomes between Patients with Suspected Complex and Simple Gastroschisis
Authors: Virginia Medina-Jiménez , Sandra Acevedo-Gallegos , Monica Aguinaga-Rios , Manuel Gallardo-Gaona Juan
Published: October 2021

Objective The aim of this study was to compare perinatal outcomes between patients with and without prenatal ultrasound markers predictive of complex gastroschisis.

Study Design A prospective cohort of 98 patients with isolated fetal gastroschisis underwent antenatal ultrasound and delivered in a tertiary referral center. Patients were classified according to eight ultrasonographic markers predictive of complexity, and perinatal outcomes were assessed accordingly. The primary outcome was the presence of fetal growth restriction and staged SILO reduction postnatally.

Results Of all fetuses, 54.1% (n = 53) displayed ultrasonographic markers predictive of complexity at 32.7 ± 4.3 weeks of gestation. Gastric dilatation was the most frequent marker followed by extra-abdominal bowel dilatation. The presence of ultrasound markers predictive of complexity, was not associated with fetal growth restriction but its absence was less associated with staged SILO reduction of the abdominal wall postnatally with a relative risk of 0.79 (CI 95% 0.17–0.53).

Conclusion Fetuses with ultrasound markers that predict complexity were not associated with fetal growth restriction, but its absence was less associated with staged SILO reduction of the abdominal wall postnatally. It is necessary to unify criteria, establish cut-off points, and the optimal moment to measure these markers.

Key Points
Performance of a Maternal Abdominal Surface Electrode System for Fetal Heart Rate and Uterine Contraction Monitoring from 34 to 37 Weeks
Authors: Gonzalez Maritza , Hill Meghan , Cohen Wayne R.
Published: October 2021

Objective The objective of this study was to compare performance of a maternal surface electrode patch with ultrasound- and tocodynamometer-based monitoring to detect fetal heart rate and uterine contractility in late preterm labors.

Study Design Thirty women between 340/7 and 366/7 weeks' gestation were monitored simultaneously with a Doppler/tocodynamometer system and a wireless fetal–maternal abdominal surface electrode system. Fetal and maternal heart rate and uterine contraction data from both systems were compared. Reliability was measured by the success rate and percent agreement. Deming regression and Bland–Altman analysis estimated the concordance between the systems. Uterine contractions were assessed by visual interpretation of monitor tracings.

Results The success rate for the surface electrode system was 89.5% (95% confidence interval [CI], 85.7–93.3), and for ultrasound it was 88.4% (95% CI, 84.9–91.9; p = 0.73), with a percent agreement of 88.1% (95% CI, 84.2–92.8). Results were uninfluenced by the patients' body mass. The mean Deming slope was 1 and the y-intercept was −3.0 beats per minute (bpm). Bland–Altman plots also showed a close relationship between the methods, with limits of agreement less than 10 bpm. The percent agreement for maternal heart rate was 98.2% (95% CI, 97.4–98.8), and for uterine contraction detection it was 89.5% (95% CI, 85.5–93.4).

Conclusion Fetal heart rate and uterine contraction monitoring at 340/7 to 366/7 weeks using abdominal surface electrodes was not inferior to Doppler ultrasound/tocodynamometry for fetal–maternal assessment.

Registration clinicaltrials.gov/February 20, 2017/identifier NCT03057275.

Key Points
Antenatal Corticosteroids Decrease the Risk of Composite Neonatal Respiratory Morbidity in Planned Early Term Cesarean Deliveries
Authors: DeBolt Chelsea A. , Johnson Shaelyn , Harishankar Krupa , Monro Johanna , Kaplowitz Elianna , Bianco Angela , Stone Joanne
Published: October 2021

Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity.

Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression.

Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks.

Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management.

Key Points
Temporal Evolution of Maternal Mortality: 1980-2019
Authors: Vettorazzi Janete , Valério Edimárlei Gonsales , Zanatta Maria Alexandrina , Scheffler Mariana Hollmann , Costa Sergio Hofmeister de Almeida Martins , Ramos José Geraldo Lopes
Published: October 2021

Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.

Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).

Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).

Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
A tale of two (and more) altruists
Authors: De Bruyne B , Randon-Furling J , Redner S
Published: October 2021

We introduce a minimalist dynamical model of wealth evolution and wealth sharing among N agents as a platform to compare the relative merits of altruism and individualism. In our model, the wealth of each agent independently evolves by diffusion. For a population of altruists, whenever any agent reaches zero wealth (that is, the agent goes bankrupt), the remaining wealth of the other N − 1 agents is equally shared among all. The population is collectively defined to be bankrupt when its total wealth falls below a specified small threshold value. For individualists, each time an agent goes bankrupt (s)he is considered to be ‘dead’ and no wealth redistribution occurs. We determine the evolution of wealth in these two societies. Altruism leads to more global median wealth at early times; eventually, however, the longest-lived individualists accumulate most of the wealth and are richer and more long lived than the altruists.
Urban expansion inferenced by ecosystem production on the Qinghai-Tibet plateau
Authors: Tian Li , Chen Jiquan
Published: October 2021

Assessments of changes in landscape patterns and functions during urban development need to factor urban fringes (UPs) as part of the overall social-environmental system, especially in regions with poor transportation systems where urban functions depend heavily on surrounding suburbs. In this study, we use net primary production (NPP) as an integrative measure to delineate UPs and to measure the expansion in 15 urban areas in the remote Qinghai-Tibet Plateau. Using a logistic curve fitting model based on NPP to delineate differences between the UF and rural landscapes, we explore how NPP-inferred UF expansions may have changed with increase in urban population and the secondary and tertiary industrial production. The UF width (area) was 17.4 km (950.67 km2) in 2000 but increased to 27.0 km (2289.06 km2) in 2019 for Lhasa. For Xining, this was from 28.0 km (2461.76 km2) to 36.0 km (4069.44 km2) during 2000–2019. For the prefecture-level cities, the rate increased from 2–16 km (12.56–803.84 km2) to 7–17 km (153.86–907.46 km2). More importantly, the ratio between UF width and population during the five study periods showed a linear decreasing trend, but an exponential decrease with economic measures. The urban expansion due to population increase changed from 26 m in 2000 to 21 m in 2019 for every increase of 1000 residents, while the expansion due to economic changes was significantly reduced from 732 m per billion RMB (Ren Min Bi) in 2000 to 52 m per billion RMB in 2019. We confirm a hypothesis that the ratio of expansion of UFs was more dependent on economic growth in early stages of urbanization than in later stages, whereas urban population promoted expansions over the entire study period.
Hydrologic controls on the accumulation of different sized microplastics in the streambed sediments downstream of a wastewater treatment plant (Catalonia, Spain)
Authors: Margenat Henar , Nel Holly A , Stonedahl Susa H , Krause Stefan , Sabater Francesc , Drummond Jennifer D
Published: October 2021

Wastewater treatment plants (WWTPs) act as a point source of microplastics (MPs) to freshwater ecosystems. Although MP abundance has been linked to high-density population areas, the mechanisms of how river hydrodynamics and particle size influence MP accumulation in streams are still largely unknown. This study investigated the spatial distribution of MPs within streambed sediments downstream of a WWTP effluent in Cànoves stream (Montseny, Catalonia) during baseflow conditions. MP concentrations from an upstream control site were compared to the WWTP bypass that added untreated wastewater at times when stream discharge exceeded capacity. The 450 m section investigated downstream of the WWTP consisted of three geomorphically altered sub-reaches interspersed between three unaltered buffer sub-reaches, each ∼75 m that provided a range in hydrologic conditions. Measurements of MP characteristics, hydrogeomorphic variables, and fine particles were simultaneously taken. MPs were quantified following the Nile red fluorescence method for large (>64 µm) and small (10–64 µm) particles. MPs in sediment samples downstream of the WWTP were mainly fragments with a higher abundance of small MPs (85 particles/g of sediment) vs large MPs (9 particles/g of sediment). While the abundance of large MPs in streambed sediments decreased with distance from the WWTP point source, the abundance of small MPs increased. Furthermore, the area of small MPs decreased with distance from the WWTP. MPs were most abundant at the WWTP bypass, suggesting these infrequent inputs during storm events represent an important source of MPs to the stream. Higher MP abundance coincided with increased organic matter content and smaller sediment grain sizes. Overall, our results present significant findings that could help explain differences in transport and accumulation patterns of MPs that influence their retention times in streambeds, suggesting a combination of preferential filtration in the streambed sediments, and fragmentation of larger particles.
Fabrication of magnetic cobalt-nickel ferrite nanoparticles for the adsorption of methyl blue in aqueous solutions
Authors: Ouyang Hezhong , Liu Shuyan , Liu Dandan , Wang Yan , Xu Shuping , Pan Shengying
Published: October 2021

An innovative method of combustion–calcination of a nitrate–ethanol solution to produce magnetic Co0.5Ni0.5Fe2O4 nanoparticles was developed. The calcination temperature and the volume of ethanol were two pivotal elements that determine the properties of the Co0.5Ni0.5Fe2O4 nanoparticles in this study. When the volume of ethanol used was increased from 20 ml to 40 ml, the crystallinity of the Co0.5Ni0.5Fe2O4 nanoparticles increased; further increase of the volume of ethanol decreased the crystallinity. The smallest nanoparticle was obtained using 20 ml ethanol. As the calcination temperature increased from 400 °C to 700 °C, the saturation magnetization of the Co0.5Ni0.5Fe2O4 nanoparticles increased from 12.8 emu g−1 to 30.8 emu g−1. Co0.5Ni0.5Fe2O4 nanoparticles fabricated using 20 ml ethanol at 400 °C were used to study the removal of methyl blue (MB) by adsorption. Experimental data revealed that the adsorption was best described by pseudo-second kinetics. The adsorption isotherm applied the Temkin model, which indicated the presence of a single and multilayer associative mechanism in the adsorption of MB on the Co0.5Ni0.5Fe2O4 nanoparticles. The effect of pH and recycling on the adsorption was measured. At pH values ≥5, the adsorption was high. After eight cycles of use and recycling, the relative removal rate of MB by the Co0.5Ni0.5Fe2O4 nanoparticles was 75% of the initial adsorption value.
Early fault-tolerant simulations of the Hubbard model
Authors: Campbell Earl T
Published: October 2021

Simulation of the Hubbard model is a leading candidate for the first useful applications of a fault-tolerant quantum computer. A recent study of quantum algorithms for early simulations of the Hubbard model [Kivlichan et al 2019 Quantum 4 296] found that the lowest resource costs were achieved by split-operator Trotterization combined with the fast-fermionic Fourier transform (FFFT) on an L × L lattice with length L = 2
k
. On lattices with length L ≠ 2
k
, Givens rotations can be used instead of the FFFT but lead to considerably higher resource costs. We present a new analytic approach to bounding the simulation error due to Trotterization that provides much tighter bounds for the split-operator FFFT method, leading to 16× improvement in error bounds. Furthermore, we introduce plaquette Trotterization that works on any size lattice and apply our improved error bound analysis to show competitive resource costs. We consider a phase estimation task and show plaquette Trotterization reduces the number of non-Clifford gates by a factor 5.5× to 9× (depending on the parameter regime) over the best previous estimates for 8 × 8 and 16 × 16 lattices and a much larger factor for other lattice sizes not of the form L = 2
k
. In conclusion, we find there is a potentially useful application for fault-tolerant quantum computers using around one million Toffoli gates.
Bi-Lipschitz invariance of planar 𝐵𝑉- and 𝑊^{1,1}-extension domains
Authors: García-Bravo Miguel , Rajala Tapio , Zhu Zheng
Published: October 2021

We prove that a bi-Lipschitz image of a planar

B
V

BV

-extension domain is also a

B
V

BV

-extension domain, and that a bi-Lipschitz image of a planar

W

1
,
1

W^{1,1}

-extension domain is again a

W

1
,
1

W^{1,1}

-extension domain.
Roles for L o microdomains and ESCRT in ER stress-induced lipid droplet microautophagy in budding yeast
Authors: Liao Pin-Chao , Garcia Enrique J. , Tan Gary , Tsang Catherine A. , Pon Liza A.
Published: October 2021

ER stressors induce Lo microdomain formation in the yeast vacuolar membrane. Lo microdomains and ESCRT mediate lipid droplet (LD) uptake into the vacuole during lipid imbalance-induced microlipophagy. ESCRT mediates LD uptake during microlipophagy in response to chemically induced ER stress.
Cell-Free Fat Extract Prevents Vaginal Atrophy in an Ovariectomized Model by Promoting Proliferation of Vaginal Keratinocytes and Neovascularization
Authors: Kang Bijun , Cai Yizuo , Jia Zhuoxuan , Chen Chingyu , Deng Mingwu , Zhang Wenjie , Li Wei
Published: October 2021

Background

Most perimenopausal and postmenopausal women experience estrogen deficiency–induced vaginal atrophy. However, estrogen replacement therapy has contraindications and side effects, which makes it unsuitable for most women. Cell-free fat extract (CEFFE) has pro-proliferative and proangiogenic tissue regeneration activities.

Objectives

The purpose of this study was to evaluate the effect of topical application of CEFFE in the vagina and the effect of CEFFE on vaginal keratinocytes.

Methods

Ovariectomized mice were treated with CEFFE via vaginal topical application for 2 weeks. The vaginal mucosal cell layer number, mucosal thickness, and vaginal collagen volume were determined by histologic analyses. Vaginal mucosa proliferation and lamina propria angiogenesis were evaluated with anti–proliferating cell nuclear antigen and anti-CD31 staining, respectively. For in vitro analysis, VK2/E6E7 cells were administered, increasing the CEFFE concentration. Cell proliferation and cell-cycle distribution were analyzed by Cell Counting Kit 8 assay and flow cytometry, respectively. Mucosal migration was evaluated with a wound-healing assay. The expression of Ki-67 and estrogen-related proteins was detected by western blotting.

Results

CEFFE-treated mice showed increased mucosal thickness and number of vaginal mucosal cell layers and reduced vaginal atrophy compared to ovariectomized mice. The number of proliferating cell nuclear antigen–positive cells and CD31-positive capillaries also increased. In addition, CEFFE promoted the proliferation and migration of VK2/E6E7 cells, upregulated the expression of Ki-67, and inhibited the expression of estrogen-related proteins and the PI3K/AKT pathway.

Conclusions

CEFFE prevents estrogen deficiency–induced vaginal atrophy by promoting vaginal mucosal proliferation and increasing neovascularization, but not through the estrogen/estrogen receptor pathway, in an ovariectomized mouse model.
Compensatory functional connectome changes in a rat model of traumatic brain injury
Authors: Yang Zhihui , Zhu Tian , Pompilus Marjory , Fu Yueqiang , Zhu Jiepei , Arjona Kefren , Arja Rawad Daniel , Grudny Matteo M , Plant H Daniel , Bose Prodip , Wang Kevin K , Febo Marcelo
Published: October 2021

Penetrating cortical impact injuries alter neuronal communication beyond the injury epicentre, across regions involved in affective, sensorimotor and cognitive processing. Understanding how traumatic brain injury reorganizes local and brain wide nodal interactions may provide valuable quantitative parameters for monitoring pathological progression and recovery. To this end, we investigated spontaneous fluctuations in the functional MRI signal obtained at 11.1 T in rats sustaining controlled cortical impact and imaged at 2- and 30-days post-injury. Graph theory-based calculations were applied to weighted undirected matrices constructed from 12 879 pairwise correlations between functional MRI signals from 162 regions. Our data indicate that on Days 2 and 30 post-controlled cortical impact there is a significant increase in connectivity strength in nodes located in contralesional cortical, thalamic and basal forebrain areas. Rats imaged on Day 2 post-injury had significantly greater network modularity than controls, with influential nodes (with high eigenvector centrality) contained within the contralesional module and participating less in cross-modular interactions. By Day 30, modularity and cross-modular interactions recover, although a cluster of nodes with low strength and low eigenvector centrality remain in the ipsilateral cortex. Our results suggest that changes in node strength, modularity, eigenvector centrality and participation coefficient track early and late traumatic brain injury effects on brain functional connectivity. We propose that the observed compensatory functional connectivity reorganization in response to controlled cortical impact may be unfavourable to brain wide communication in the early post-injury period.
A rare and reversible cause of third-degree atrioventricular block: a case report
Authors: Lee Gino , Badertscher Patrick , Sticherling Christian , Osswald Stefan
Published: October 2021

Background

Cardiac involvement of Lyme disease (LD) typically results in atrioventricular (AV) conduction disturbance, mainly third-degree AV block.

Case summary

A 54-year-old patient presented to our emergency department due to recurrent syncope. Third-degree AV block with a ventricular escape rhythm (33 b.p.m.) was identified as the underlying rhythm. Transthoracic echocardiography (TTE) was normal. To rule out common reversible causes of complete AV block, a screening test for Lyme borreliosis was carried out. Elevated levels for borrelia IgG/IgM were found and confirmed by western blot analysis. Lyme carditis (LC) was postulated as the most likely cause of the third-degree AV block given the young age of the patient. Initiation of antibiotic therapy with ceftriaxone resulted in a gradual normalization of the AV conduction with stable first-degree AV block on Day 6 of therapy. The patient was changed on oral antibiotics (doxycycline) and discharged without a pacemaker. After 3 months, the AV conduction recovered to normal.

Discussion

Lyme carditis should always be considered, particularly in younger patients with new-onset AV block and without evidence of structural heart disease. Atrioventricular block recovers in the majority of cases after appropriate antibiotic treatment.
The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study
Authors: Jaakkola Jussi , Teppo Konsta , Biancari Fausto , Halminen Olli , Putaala Jukka , Mustonen Pirjo , Haukka Jari , Linna Miika , Kinnunen Janne , Tiili Paula , Aro Aapo L , Hartikainen Juha , Airaksinen K E Juhani , Lehto Mika
Published: October 2021

Aims

Little is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs).

Methods and results

The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007–18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients’ mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P < 0.001). Any MHC was associated with lower incidence of OAC initiation [adjusted subdistribution hazard ratio (aSHR) 0.867; 95% confidence interval (CI) 0.856–0.880], as were depression (aSHR 0.868; 95% CI 0.856–0.880), bipolar disorder (aSHR 0.838; 95% CI 0.824–0.852), anxiety disorder (aSHR 0.840; 95% CI 0.827–0.854), and schizophrenia (aSHR 0.838; 95% CI 0.824–0.851), during the entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC era during 2015–18 (aSHR 0.821; 95% CI 0.805–0.837).

Conclusion

MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.
Application of local gentamicin in the treatment of deep sternal wound infection: a randomized controlled trial
Authors: Vos Roemer J , van Putte Bart P , de Mol Bas A J M , Hoogewerf Marieke , Mandigers Tim J , Kloppenburg Geoffrey T L
Published: October 2021

OBJECTIVES

In patients with deep sternal wound infection (DSWI), primary closure of the sternal bone over high negative pressure Redon drains has shown to be a safe and feasible treatment method. Addition of local gentamicin could accelerate healing and improve clinical outcomes.

METHODS

We conducted a randomized controlled trial to evaluate the effectiveness of local gentamicin in the treatment of DSWI. In the treatment group, collagenous carriers containing gentamicin were left between the sternal halves during sternal refixation. In the control group, no local antibiotics were used. Primary outcome was hospital stay. Secondary outcomes were mortality, reoperation, wound sterilization time, time till removal of all drains and duration of intravenous antibiotic treatment.

RESULTS

Forty-one patients were included in the trial of which 20 were allocated to the treatment group. Baseline characteristics were similar in both groups. Drains could be removed after a median of 8.5 days in the treatment group and 14.5 days in the control group (P-value: 0.343). Intravenous antibiotics were administered for a median of 23.5 days in the treatment group and 38.5 days in the control group (P-value: 0.343). The median hospital stay was 27 days in the treatment group and 28 days in the control group (P-value: 0.873). Mortality rate was 10% in the treatment group and 9.5% in the control group (P-value: 0,959). No side effects were observed.

CONCLUSIONS

This randomized controlled trial showed that addition of local gentamicin in the treatment of DSWI did not result in shorter length of stay.

Clinical trial registration number

2014-001170-33.
Outcomes of novel pacing technologies with right ventricular pacing as a primary strategy for patient undergoing transvenous permanent pacing regardless of pacing indication
Authors: Abdin A , Aktaa S , Vukadinovic D , Arbelo E , Boehm M , Burri H , Glikson M , Meyer C , Munyombwe T , Nielsen N C , Vernooy K , Ukena C , Gale C P
Published: October 2021

Background

Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permeant pacemaker (PPM) irrespective of baseline pacing indication.

Methods and results

Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 using MEDLINE and Embase. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random and fixed effects meta-analyses of the effect of pacing technology on study outcomes (all-cause mortality, heart failure hospitalization (HFH), left ventricular ejection fraction, QRS duration, lead revision, atrial fibrillation and procedure and pacing metrics) were performed. Overall, 7 studies were included. HBP compared with RVP was associated with decreased mortality (risk ratio [RR] 0.76, 95% CI 0.59 to 0.98), preservation of LVEF (mean difference [MD] 1.2, 95% CI −1.37 to 3.8 vs. −5.22, 95% CI: −6.94 to −3.51), increased procedure duration (MD 15.17 min, 95% CI: 11.27 to 19.07) and more lead revisions (RR 6.30, 95% CI: 2.31 to 17.19). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI −6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2 to 62.9) and increased procedure durations (MD 37.78 min, 95% CI: 20.04 to 55.51).

Conclusion

Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy. Well conducted comparative studies are required to understand the impact of such novel pacing strategies on clinical outcomes.

Funding Acknowledgement

Type of funding sources: None.
Prevalence and incidence rates of atrial fibrillation in Denmark 2004–2018
Authors: Hegelund E.R , Kjerpeseth L.J , Mortensen L.H , Igland J , Berge T , Anjum M , Tell G.S , Ariansen I
Published: October 2021

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with substantial morbidity and mortality. Its prevalence is currently rising partly due to population ageing. However, reported trends in incidence rates are conflicting, and the comparability of existing reports is limited due to methodological inconsistencies across studies.

Purpose

The main purpose of the current study was to investigate the prevalence of AF in the Danish adult population and time trends in incidence rates from 2004 through 2018. As a secondary purpose, the prevalence and incidence were compared to corresponding Norwegian estimates from 2004 through 2014 derived using the same methodology.

Methods

A register-based study was conducted including all individuals aged ≥18 years in Denmark from 2004–2018. AF cases were identified in the National Patient Register and the Cause of Death Register, which comprise information on all hospital contacts and deaths in Denmark, respectively. The prevalence of AF was calculated as the number of individuals alive at the end of the study period with at least one registered diagnosis from 1994 through 2018 divided by the number of Danish residents aged ≥18 years. Incidence rates were calculated as the number of annual AF cases with no previous diagnosis noted in the past 10 years divided by the person-time contributed by the population free of AF on 1 January in the same calendar year. All incidence rates were standardized according to a Nordic standard population. The comparison of the Danish and Norwegian incidence estimates focused solely on AF hospitalizations and deaths from 2004 through 2014.

Results

The cumulative prevalence of AF was 3.0% in the Danish adult population. The incidence increased from 391 per 100,000 person-years in 2004 to 481 per 100,000 person-years in 2015, after which it declined to 367 per 100,000 person-years in 2018 (Figure 1). On average, the incidence increased by 1.7% annually until 2015 (IRR: 1.017 (95% CI: 1.016–1.018); p<0.001) and then declined by 8.5% (IRR: 0.915 (95% CI: 0.909–0.921); p<0.001). Although the incidence rates generally were higher among men and older individuals, a similar time trend was observed in both men and women irrespective of age. Focusing solely on AF hospitalizations and deaths did not change the interpretation of the results. The comparable Norwegian estimates will be presented at the conference.

Conclusions

The prevalence of AF is currently around 3.0% in the Danish adult population, but the incidence rate has declined steeply since 2015. The observed decline in new cases is promising from a public health perspective and its underlying causes warrant further investigation.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Figure 1
High level of growth differentiation factor 15 and lower left ventricular ejection fraction as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation
Authors: Belokurova A.V , Gizatulina T.P , Khorkova N.Y.U , Martyanova L.U , Petelina T.I , Shirokov N.E
Published: October 2021

Background

The presence of left atrial/left atrial appendage (LA/LAA) thrombus is used as a surrogate marker of potential stroke in patients (pts) with atrial fibrillation (AF).

Purpose

To assess the role of growth differentiation factor 15 (GDF-15) level, clinical and echocardiographic (EchoCG) data as predictors of LA/LAA thrombus in pts with nonvalvular AF.

Methods

Out of 158 pts with nonvalvular AF admitted to Cardiology Center for radiofrequency ablation or elective cardioversion in 2019–2020 2 groups were formed according to transesophageal EchoCG results: group 1 included pts without LA/LAA thrombus (n=102, mean age 59.5±6.0 years) and group 2 (n=42, mean age 60.9±8.8 years) – pts with LA/LAA thrombus. Arterial hypertension was found in 93 pts of group 1 (91%) and in 40 pts of group 2 (95%, p=0.42), coronary artery disease - in 53 pts (52%) and 29 pts (69%), respectively (p=0.06). Both groups did not differ in frequency and spectrum of oral anticoagulants administration. General clinical assessment, EchoCG, and laboratory tests were performed, including GDF-15 (pg/ml) levels using Human GDF-15/MIC-1 ELISA kit and NT-proBNP (pg/ml) in blood.

Results

Pts with LA/LAA thrombus more often had persistent AF, while paroxysmal AF was more common in pts without thrombus. There was a tendency to more significant congestive heart failure in group 2. Mean CHA2DS2-VASc score was higher in pts with LA/LAA thrombus, also there was a tendency to a larger proportion of pts with scores ≥3. According to EchoCG data, sizes and volumes of both atria, right ventricle, end-systolic volume, left ventricular (LV) size, pulmonary artery systolic pressure and LV mass index were higher in group 2; LV ejection fraction (LVEF) was normal in both groups, but it was significantly lower in pts with LA/LAA thrombus: 59.1±5.1 and 64.0±7.3, respectively (p<0.001). GDF-15 and NT-proBNP levels were significantly higher in group 2 compared to group 1: p=0.00025 and p=0.ehab724.048801 respectively. According to ROC analysis cut-off were set at level >935.0 pg/ml for GDF-15 (AUC=0.705, 95% CI 0.609–0.800, p<0.001) and >143 pg/ml for NT-proBNP (AUC=0.759, 95% CI 0.670–0.849, p<0.001). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: GDF-15 >935.0 pg/ml (OR=4.132, 95% CI 1.305–13.084) and LVEF (OR=0.859, 95% CI 0.776–0.951). According to ROC analysis, the model had a good quality: AUC=0.776 (p<0.001), sensitivity was 78.3%., specificity - 78.3%.

Conclusion

High level of GDF-15 (>935.0 pg/ml) along with lower LVEF are independent predictors of LA/LAA thrombus in pts with nonvalvular AF.

Funding Acknowledgement

Type of funding sources: None.
Pulmonary congestion during exercise stress echocardiography in ischaemic, heart failure and valvular patients
Authors: Merli E , Zagatina A , Merlo P.M , Arbucci R , Borguezan Daros C , De Castro E Silva Pretto J.L , Amor M , Morrone D , D'Andrea A , Reisenhofer B , Rodriguez-Zanella H , Wierzbowska-Drabik K , Agoston G , Ciampi Q , Picano E ,   the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Published: October 2021

Background

Lung ultrasound (LUS) detects pulmonary congestion as B-lines at rest and exercise stress echocardiography (ESE).

Aim

To assess the prevalence of B-lines during ESE in different cardiovascular diseases.

Methods

We performed ESE plus LUS (4-site simplified scan) in 4419 subjects referred for semi-supine bike ESE in 28 certified centers. B-lines score ranged from 0 (normal) to 40 (severely abnormal). Stress B-lines abnormal result was ≥2 units. Six different populations were evaluated: healthy controls (n=103); chronic coronary syndromes (CCS, n=3701); heart failure with reduced ejection fraction (HFrEF, n=395); heart failure with preserved ejection fraction (HFpEF, n=70); valvular heart disease (VHD) for ischemic mitral regurgitation ≥moderate at rest (n=123); repaired tetralogy of Fallot (ToF, n=27).

Results

Feasibility of B-lines was 100% at rest and peak ESE in all subjects. Imaging and analysis time were <1 minute. B-lines (median) were not detectable in healthy subjects (rest=0.1 [0–1] vs 0.1 [0–1], p=ns) and TOF (rest=0.2 [0–2] vs 0.3 [0–4], p=ns), but were present in all other groups: see figure. During ESE, B-lines increased in CCS (rest=0.5 [0–24] vs ESE=1.3 [0–28], p<0.001); HFrEF (rest=1.4 [0–35] vs ESE=2.9 [0–40], p<0.001); HFpEF (rest=0.3 [0–2] vs ESE=3.4 [0–12], p<0.001), VHD (rest=1.7 [0–12] vs ESE=4.3 [0–23], p<0.001). Stress B-lines were correlated with stress-rest change in wall motion score index in CCS (r=0.325, p<0.001), contractile reserve in HFrEF (r=−0.266, p<0.001) and in VHD (r=−.0300, p=0.001), left atrial volume stress-rest change in HFpEF (r=0.287, p=0.043).

Conclusion

B-lines identify the pulmonary congestion phenotype at rest and more frequently during ESE in patients with different coronary, myocardial or valvular heart disease, all sharing the final common pathway of acute backward left heart failure through different disease-specific mechanisms. B-lines are absent in healthy subjects and in conditions inducing a mostly right-sided overload such as repaired ToF.

Funding Acknowledgement

Type of funding sources: None. Figure 1. B-lines at rest and during stress. Percentage (%) of rest (empty bar) and stress (full bar) B-lines abnormality (≥2 units) in six different study groups.
Pharmacological cardioversion of recent-onset atrial fibrillation in patients with chronic kidney disease: sub-analysis of the CANT study
Authors: Ceynowa-Sielawko B , Wybraniec M , Topp-Zielinska A , Maciag A , Miskowiec D , Krzowski B , Balsam P , Wojcik M , Wrobel W , Farkowski M , Kozinski M , Kasprzak J , Szwed H , Mizia-Stec K , Szolkiewicz M
Published: October 2021

Purpose

Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) at the emergency departments (ED), and there are reports proving that antazoline is a noteworthy agent to restore sinus rhythm. This is a sub-analysis of the CANT study evaluating the effectiveness and safety of antazoline in patients with AF at different stages of chronic kidney disease (CKD).

Methods

Total n=777 patients admitted to ED for the urgent termination of AF were included into this analysis. We analysed the results concerning effectiveness and safety of PCV with special consideration of antazoline, in patients at 3 stages of CKD defined on the basis of eGFR (CKD-EPI): Group I ≥60 mL/min (n=531), Group II 45–59 mL/min (n=149), and Group III <45 mL/min (n=97). Primary end-point was the termination of AF, a restoration of a sinus rhythm and its persistence until discharge.

Results

Patients of group III were older and with higher prevalence of comorbidities, however, we have not found statistically significant differences in overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs 35%; p<0.001), and it increased close to a significant manner in patients receiving propafenone (69.9 vs 100%; p=0.067; Figure). In patients of Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone, however in patients of Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p=0.002 and p=0.034, respectively). The rate of safety endpoint was highest in patients of Group III (eGFR<45 mL/min), and it was significantly higher than in patients of Group I and II (p=0.008 and p=0.036, respectively). We have not observed antazoline-related adverse events in any of studied groups of patients.

Conclusion

This real-world registry analysis revealed a different influence of CKD on individual drug effectiveness, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm. Its favourable safety profile has not changed.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The study received no external funding
Maintaining sinus rhythm after electrical cardioversion
Authors: Menezes Fernandes R , Mota T.F , Costa H.A , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I
Published: October 2021

Introduction

Atrial fibrillation (AF) and atrial flutter (AFL) are commonly terminated by electrical cardioversion (EC) when a rhythm control strategy is adopted. However, the long-term success following EC is variable.

Purpose

To determine the clinical characteristics and independent predictors of sinus rhythm (SR) maintenance after EC due to AF/AFL.

Methods

We conducted a retrospective study enrolling patients with AF/AFL referred to EC in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics and echocardiographic studies were analysed. Primary endpoints were the incidence of ischemic stroke, all-cause and cardiovascular (CV) mortality. Independent predictors of SR maintenance were identified through a binary logistic regression analysis, considering p=0,05.

Results

A total of 719 patients with a median age of 67 years-old were included, and EC was successfully performed in 93,2%. AFL was diagnosed in 21%, 57,3% had arterial hypertension and 34,6% were obese. 62,1% had persistent AF/AFL, 19,6% presented with first diagnosed AF/AFL and 17,2% had paroxysmal episodes. Left ventricular ejection fraction (LVEF) was preserved in 66,7%. Maintenance of SR after one-year was documented in 64,7% of patients with successful EC. They had lower prevalence of chronic kidney disease (CKD) (2,6% vs 10,7%; p<0,001) and received less electrical shocks during EC (1,20 vs 1,39; p=0,005). There were no differences regarding antiarrhythmic therapy between both groups. Complete LVEF recovery after EC was more frequent in patients who maintained SR (58,8% vs 31,9%; p=0,008), with a greater prevalence of preserved LVEF after EC (88,8% vs 73,6%; p<0,001). During a median follow-up of 1368 days, these patients performed less additional EC (0,26 vs 0,65; p<0,001) and were less referred to ablation procedures (7,1% vs 15,1%; p=0,011). No differences were found regarding stroke rate, but all-cause mortality (12,8% vs 25%; p=0,002) and CV death (3,8% vs 10,9%; p=0,005) were significantly lower in patients who maintained SR. Absence of CKD (p=0,013), applying fewer electric shocks during EC (p=0,013) and preserved LVEF after EC (p=0,004) were independent predictors of SR maintenance.

Conclusion

In our study, most patients maintained SR one year after EC, which was associated with a lower all-cause and CV mortality. Absence of CKD, applying fewer electric shocks during EC and preserved LVEF after EC were independent predictors of SR maintenance.

Funding Acknowledgement

Type of funding sources: None.
The impact of abnormal conduction zone on outcomes after catheter ablation for atrial fibrillation
Authors: Mine T , Kishima H , Fukuhara E , Kitagaki R , Ishihara M
Published: October 2021

Background

The abnormal conduction zone (ACZ) in the left atrium (LA) has attracted attention as an arrhythmia substrate in atrial fibrillation (AF).

Purpose

We investigated whether the ACZ affects outcomes after catheter ablation (CA) for AF.

Methods

We studied 78 patients (42 Non-paroxysmal AF, 49 males, and 68±10 years) who received CA for AF. High-density LA mapping during high right atrial pacing was constructed gaining than 2000 points (average 4377±846 points). Isochronal activation maps created at 5-ms interval setting. ACZ was identified by locating a site with isochronal crowding of ≥3 isochrones, and ≥8 isochrones were defined as the conduction block zone (CBZ) in a 4-mm diameter tag (conduction velocity were calculated as ≤27 cm/s and≤10 cm/s, respectively).

Result

Recurrent AF was detected in 25/78 patients (32%) during the follow-up period (9.2±3.0 month). ACZ and CBZ were distributed linearly, and ACZ was observed in 73 of 78 patients and 8 of these 73 patients had the CBZ. Univariate analysis revealed that elevated body mass index (26.2±3.8 vs. 24.3±3.3 kg/m2, P=0.0303), the higher prevalence of non-paroxysmal AF (72% vs. 45%, P=0.0272), larger LA diameter (47.6±6.6 vs. 42.1±6.9 mm, P=0.0014), and longer length of ACZ (79.7±45.1 vs. 52.9±35.7 mm, P=0.0058) were associated with recurrent AF after CA. On multivariate analysis, longer ACZ was independently associated with recurrent AF. Moreover, patients with longer ACZ (cutoff value: 84 mm) had a higher risk of recurrent AF than shorter ACZ (12/22; 55% vs 13/56; 23%, log-rank P=0.0024).

Conclusion

The length of ACZ was associated with recurrent AF after CA.

Funding Acknowledgement

Type of funding sources: None.