bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Faster R-CNN Traffic Sign Detection Algorithm Based on Transformer
Authors: Tian Chengjun , Liu Zhe , Liu Haobo , Yan Yu , Zhang Jintong
Published: November 2023

In view of the fact that traffic sign detection is becoming more and more important in assisted driving, but there are situations where the target is small, occluded and the background is complex, this paper proposes a Transformer-based improved Faster R-CNN algorithm for traffic sign detection. The algorithm in this paper uses the Transformer network based on the shift window as the backbone. The multi-level feature map is fused across layers through the cascade fusion module to obtain the fusion feature map. Moreover, the model’s feature extraction ability is improved. The detection head module eliminates rounding through RoI Align quantization error. Based on experiments in the TT100K dataset, it can be known that the mAP and detection speed of the algorithm in this paper has been improved. The effectiveness of the improved model in this paper is proven and it is applicable to real scenarios.
Application and evaluation of CNN-LSTM classification regression based multi-source precipitation data fusion model in water resources research in Qinghai Province
Authors: You Shaojie , Zhang Xiaodan , Quan Chen , Wang Hongyu , Zhao Tong , Liu Chang , Du Huali
Published: November 2023

Qinghai Province is located in the Qinghai-Tibet Plateau region, with complex and diverse topography and sparse precipitation stations, which makes it difficult to obtain reliable precipitation data. This study proposes a classification and regression model based on a deep learning algorithm, which combines a convolutional neural network (CNN) and a long short-term memory neural network (LSTM), with the CNN extracting the spatial features of multi-source data, the LSTM capturing their temporal dependencies. The regression results are used to determine whether rainfall is occurring and to further calibrate the non-rainfall component of the precipitation forecast results. ERA5, IMERG, CHIRPS and DEM were selected as feature data and rain gauge data as label data. The findings indicate that the proposed CNN-LSTM classification regression model (CLCR) is superior to other models (CNN, CNN-LSTM, LSTM). The Kling-Gupta efficiency (KGE) of the data fused using CLCR was 0.66, which was significantly better than that of the raw rainfall data (0.53, -0.36, 0.34) and other models (0.58, 0.65, 0.63). CLCR also showed more performance in daily precipitation detection than other models and raw precipitation data, with Critical Success Index (CSI), Probability of Detection (POD), and False Alarm Ratio (FAR) 0.61, 0.25 and 0.76 respectively. This study generated a high-precision daily rainfall dataset with a precision of 0.01° resolution for 2013-2017 in Qinghai Province, which provides reliable data support for hydrological studies in Qinghai Province.
Differential evolutionary algorithm based on principal component analysis for the satellite bandwidth resource scheduling problem
Authors: Wang Zihan , Wang Dan , Zhang Anqi , Yang Liping
Published: November 2023

This paper focuses on the research of the communication satellite bandwidth resource scheduling problem. Satellite resource scheduling refers to adjusting the order of task execution within a certain scheduling time to complete as many satellite tasks as possible while satisfying bandwidth and time constraints. Traditional algorithms cannot meet the time requirements in the process of satellite communication resource scheduling. Therefore, this paper proposes a differential evolution algorithm based on principal component analysis (PCA) and combines it with the Lowest Horizontal Line Algorithm (LHLA) to solve this problem. The method was validated on two datasets at 20 dimensions and 40 dimensions, and compared with other traditional DE algorithms. The experimental results showed that the method obtained better solutions.
Capsule Endoscopy Image Deblurring Method Based on Multi-scale Recurrent Network
Authors: Yang Shiyu , Guo Tai , Zhan Ruoya
Published: November 2023

During the process of acquiring capsule endoscope images, image motion blur may result from errors made by the operating physician. A multi-scale recurrent attention network is proposed to address the issue of motion blur in collected images. Considering the issue of over-exposure during image acquisition in capsule endoscopy, which can adversely affect network generation results, an image preprocessing module has been incorporated into the network to eliminate highlights caused by over-exposure in input images. To enhance network sampling efficiency, the encoder is equipped with a Convolutional Block Attention Module (CBAM) to extract fuzzy features more effectively. Additionally, depthwise separable convolution is employed to reduce parameter count. Since the structure of images obtained through capsule endoscopy is relatively simple and stable, we have opted for the mean square error as our loss function due to its heightened sensitivity to data errors. The experimental results demonstrate that the proposed network achieves a Peak Signal-to-Noise Ratio (PSNR) of 31.096 and a Structural Similarity Index Measure (SSIM) of 0.925, indicating a significant improvement over DeblurGAN-v2 and Pix2pix.
A Y-Shaped Tilting Wing UAV for Vertical Take-off and Landing Cargo
Authors: Shen Xinmin , Zhu Xiaoqing
Published: November 2023

To address the growing demand for express cargo transportation within and between cities, this study presents a conceptual design of a Y-shaped tilting wing unmanned aerial vehicle (UAV) capable of vertical take-off and landing (VTOL). The design aims to overcome the limitations of existing UAV designs and combine the advantages of multi-rotor and fixed-wing aircraft. By incorporating fixed-wing features, the UAV offers an extended battery life and range, making it an ideal choice for urban express cargo transportation. Firstly, a master geometry model of the UAV is established. Subsequently, dynamic simulations are conducted to evaluate the UAV’s performance under different trajectories. The analysis of the research results verifies that the UAV can successfully complete its flight missions along predetermined paths.
Lightweight Transformer with Transposed-attention for Hyperspectral Unmixing
Authors: Mo Ye , Sun Haixin , Meng Fanlei
Published: November 2023

Hyperspectral unmixing primarily involves accurately estimating the end members and abundances from mixed pixels in hyperspectral images. In our task, we design a transposed-attention mechanism in the lightweight Transformer to capture the effective information between channels to provide better performance and faster computing speed. We compare the proposed model with those of the CyCU, FCLS, and DHTN methods. The quantitative and qualitative results indicate that our method outperforms the quality of endmember spectral and abundance maps and has a competitive advantage in calculation speed.
Dynamic Object Tracking Based on Triplet Relationship Guided Sampling Consensus Algorithm
Authors: Zhou Jiaxing , Yao Youxin , Chen Xiang , Guo Hanlin , Huang Qixuan
Published: November 2023

Compared with the traditional methods based on the prediction of moving object trajectory, the method based on image registration has the advantage of not relying on the object motion equation to track the object. However, in the case of a large number of outliers, the image matching method has the defects of inadequate filtering of outliers or erroneous filtering of incomers due to the limitations of spatial constraints of feature matching pairs, which will make the tracking of flying objects inaccurate or impossible. During the flight, the object may be in a similar background and the image shooting angle is different, which makes the object imaging angle change, resulting in a large number of outlier interference. Because of the above situation, this paper adopted an improved TRESAC algorithm based on RANSAC, which used a feature matching method based on a triplet relationship to effectively filter outliers and then adopted an initial data subset selection strategy to increase its robustness. Experimental results show that the TRESAC algorithm can filter outliers quickly and accurately, and the object is still tracked effectively under the condition of similar background and pose change.
The spatial and temporal evolution of surface temperature in the main urban area of Hangzhou from 1990 to 2020 based on GEE
Authors: Liu Han
Published: November 2023

In this study, remote sensing (RS), geographic information system (GIS), Google Earth Engine (GEE), and mathematical analysis methods are applied to study the evolution and development trend of land surface temperature in Hangzhou. The GEE platform used in this study, which can fit remote sensing images of multiple regions under different spatial and temporal conditions, has the advantages of wide range and timeliness, and enables the study area to cover the entire Hangzhou city. The purpose of this study is to study the evolution of surface temperature in Hangzhou from 1990 to 2020 using a combination of remote sensing inversion and GIS spatial analysis, and to combine a variety of geostatistical analysis methods to specifically study the trend of surface temperature change and urban heat island development in Hangzhou in order to improve the local people’s life and local environment.
Study on Remote Sensing Image Coverage Frequency Based on Spatial Grid
Authors: Huang Shusong , Zeng Yong , Chen Weirong , Qi Wenping , Zhang Wenhui
Published: November 2023

The coverage frequency analysis of remote sensing images is helpful to analyse the data acquisition capability of satellites or the vigorous users’ demand. In the current research, thermal values are mostly calculated using an individual point or surface target. In this paper, an index RSICF is proposed, which is calculated based on two shapes, image vectors, and spatial grid, to measure the frequency of remote sensing image coverage. The study uses GF-1 satellite image vectors to calculate RSICF around China to verify its availability. The result shows RSICF can reflect the distribution of historical image frequency respectively and can be introduced by creating a heatmap of remote sensing image coverage.
CDMnet: Cloud Detection in Remote Sensing Images Based on CNN
Authors: Shi Jia , Wang Chunyu
Published: November 2023

The main objective of cloud detection is to accurately distinguish between clouds and areas that are not clouds to extract accurate surface information. To achieve an accurate distinction between cloud and non-cloud regions, we propose a novel method called Cloud Detection Method Net (CDMnet). The method employs a lightweight network backbone, compared to traditional classical algorithms like SVM, to effectively reduce computational costs while maintaining accuracy. Additionally, we utilize hole convolutions with varying dilation rates to extract cloud features in parallel. We also employ SAM spatial attention multiple times to fine-tune cloud position positioning and obtain more accurate cloud masks. From the experimental results, it can be concluded that our method is more efficient than other traditional methods.
Electric field in the RF cavity with large beam duct for high current beam acceleration
Authors: Sako T. , Ishi Y. , Uesugi T. , Kuriyama Y. , Mori Y. , Tsumori K. , Ando A. , Yonemura Y.
Published: November 2023

A acceleration scheme using a bunch of single-cell cavities
as the first-stage acceleration of ion beams. The single-cell cavity
has been shown the possibility of accelerating high-current beams of
1 A or more. As an elemental test before we started a cavity
fabrication, we compared simulations of the electric field
distribution with experiments utilizing the existing cavity.
Effects of a spherical slip cavity filled with micropolar fluid on a spherical micropolar droplet
Authors: Salem Ahmed G
Published: November 2023

In this work, a two-fluid phase flow problem involving an axisymmetrical quasi-steady motion of a spherical micropolar droplet translating at a concentric point in a second non-mixable micropolar fluid within a spherical impermeable cavity with a slip surface is analysed under low Reynolds numbers. The two fluid phases that have a microstructure (micropolar fluid) are the case that is being focused on. The Stokes equations are solved inside and outside the droplet for the velocity fields. In addition, based on the concentric position, general solutions in terms of spherical coordinates are obtained. In this case, tangential couple stress and continuity of microrotation are used. For different cases, the normalised drag forces acting on the droplet are represented via graphs for different values of relative viscosity, droplet-to-cavity radii ratio, and the parameter that connects the tangential couple stress with microrotation. The normalised drag force is found to be a monotonically increasing function of the drop-to-cavity radii ratio. It is found that when the droplet-to-cavity radii ratio approaches zero, there is a very strong interaction between the droplet and the cavity. When comparing a solid sphere to a gas bubble, the normalised drag force is larger. Additionally, the results showed that permitting spin and slip at the cavity’s interior surface improved the wall correction factor influencing the droplet. The present study is important in the fields of natural, industrial, and biomedical processes such as raindrop formation, liquid–liquid extraction, suspension rheology, sedimentation, coagulation, and the motion of blood cells in an artery or vein.
Validated frailty measures using electronic primary care records: a review of diagnostic test accuracy
Authors: Brack Carmen , Kynn Mary , Murchie Peter , Makin Stephen
Published: November 2023

Introduction

Identification of people who have or are at risk of frailty enables targeted interventions, and the use of tools that screen for frailty using electronic records (which we term as validated electronic frailty measures (VEFMs)) within primary care is incentivised by NHS England. We carried out a systematic review to establish the sensitivity and specificity of available primary care VEFMs when compared to a reference standard in-person assessment.

Methods

Medline, Pubmed, CENTRAL, CINHAL and Embase searches identified studies comparing a primary care VEFM with in-person assessment. Studies were quality assessed using Quality Assessment of Diagnostic Accuracy Studies revised tool. Sensitivity and specificity values were extracted or were calculated and pooled using StatsDirect.

Results

There were 2,245 titles screened, with 10 studies included. These described three different index tests: electronic frailty index (eFI), claims-based frailty index (cFI) and polypharmacy. Frailty Phenotype was the reference standard in each study. One study of 60 patients examined the eFI, reporting a sensitivity of 0.84 (95% CI = 0.55, 0.98) and a specificity of 0.78 (0.64, 0.89). Two studies of 7,679 patients examined cFI, with a pooled sensitivity of 0.48 (95% CI = 0.23, 0.74) and a specificity of 0.80 (0.53, 0.98). Seven studies of 34,328 patients examined a polypharmacy as a screening tool (defined as more than or equal to five medications) with a pooled sensitivity of 0.61 (95% CI = 0.50, 0.72) and a specificity of 0.66 (0.58, 0.73).

Conclusions

eFI is the best-performing VEFM; however, based on our analysis of an average UK GP practice, it would return a high number of false-positive results. In conclusion, existing electronic frailty tools may not be appropriate for primary care-based population screening.
Contemporary Trends in Antiseptic Pocket Rinse in Primary Breast Implant Surgery
Authors: Leow Sean Kwang Howe , Knight Robert John William
Published: November 2023

Background

Broad evidence supports the use of antiseptic pocket rinse in breast implant surgery to minimize the risk of capsular contracture or other complications. However, there is limited consensus or standardization of antiseptic rinse in practice.

Objectives

In this preliminary study, we sought to determine contemporary trends in antiseptic rinse use in primary breast implant surgery based on Australian Breast Device Registry (ABDR) data, and whether these trends align with the suggestions of the 14-point plan. This further served as a feasibility study for subsequent comparison of antiseptic rinse effects on clinical outcomes.

Methods

Institutional ethics approval was obtained and national ABDR data for primary breast implant surgery from 2015 to 2020 were analyzed for the use and type of antiseptic rinse. The surgeon-reported data were homogenized with regard to terminology and categorized by major trends, and the literature was reviewed.

Results

We analyzed data for 37,143 patients, totaling 73,935 primary implants. Antiseptic rinse included povidone-iodine (PVP-I) in 35,859 (48.5%), no antiseptic use in 24,216 (32.8%), other concentrations of PVP-I in 4200 (5.7%), and Betadine triple antibiotic in 1831 implants (2.5%). Multiple other antiseptic permutations were noted in 7004 implants (9.5%).

Conclusions

The majority (56.7%) of Australian practitioners utilize previously described antiseptic pocket irrigation solutions that align with the 14-point plan. A third (32.8%), however, do not record any antiseptic pocket irrigation. These findings will permit a subsequent (ongoing) study of outcomes comparing PVP-I pocket rinse to no antiseptic pocket rinse, which will likely constitute the largest study of its kind.
ChromaX: a fast and scalable breeding program simulator
Authors: Younis Omar G , Turchetta Matteo , Ariza Suarez Daniel , Yates Steven , Studer Bruno , Athanasiadis Ioannis N , Krause Andreas , Buhmann Joachim M , Corinzia Luca
Published: November 2023

ChromaX is a Python library that enables the simulation of genetic recombination, genomic estimated breeding value calculations, and selection processes. By utilizing GPU processing, it can perform these simulations up to two orders of magnitude faster than existing tools with standard hardware. This offers breeders and scientists new opportunities to simulate genetic gain and optimize breeding schemes.

Availability and implementation

The documentation is available at https://chromax.readthedocs.io. The code is available at https://github.com/kora-labs/chromax.
Fine-scale phylogeography of the Japanese Genji firefly
Authors: Suzuki Tomoya , Hiraishi Naoki , Ohba Shin-ya
Published: November 2023

The Japanese Archipelago consists of four major islands and numerous small islands. The Goto Islands are located near Kyushu, a major island in the Japanese Archipelago. We have previously reported that the population of the Japanese Genji firefly, Nipponoluciola cruciata, inhabiting the Goto Islands displays a unique flashing pattern that is used for pre-mating communication between males and females, indicating the possibility of genetic isolation of the Goto Islands population from neighbouring N. cruciata populations. In this study, we aimed to elucidate the gene flow between the Goto Islands N. cruciata population and its neighbouring island populations by molecular phylogenetic analyses based on the mitochondrial DNA regions of cytochrome c oxidase subunit II and ND5, also coupled to genome-wide analysis of nuclear DNA single nucleotide polymorphisms. Our results suggested that the Goto Islands N. cruciata population is genetically isolated from other populations of this species. Nuclear DNA-based population analyses indicated gene flow between the populations inhabiting the Kyushu and Iki Islands, situated at a distance approximately equal to that between the Goto and Kyushu Islands. Therefore, the genetic isolation of the Goto Islands N. cruciata population is largely affected by flashing pattern behaviour, underlining an ongoing speciation process.
Reducing re-excision rates in breast conserving surgery with Margin Probe: systematic review
Authors: Rossou Chara , Alampritis Georgios , Patel Bijendra
Published: November 2023

Introduction

Different intraoperative techniques with varying levels of evidence are available to decrease positive surgical margins during breast conserving surgery. The aim of this review is to assess the effectiveness of the MarginProbe® device as an intraoperative adjunct tool in reducing positive surgical margins, and subsequently exploring the effect on patient re-excision rates.

Methodology

A systematic review of the available medical literature was conducted from 2007 to March 2022. A literature search of Cochrane, PubMed and Embase by two independent reviewers reviwers was performed to identify eligible articles looking at the primary outcome of percentage reduction in patient re-excision rates using MarginProbe®. Secondary outcomes analysed were comparison of tissue volume removed, absolute and relative reduction in re-excision rate, cosmetic outcome, as well as MarginProbe® sensitivity and specificity.

Results

A total of 12 full text articles were identified. An independent samples t-test using a total of 2680 patients found a 54.68 per cent reduction in re-excision rate with the use of MarginProbe®, which was statistically significant with a large effect size (P < 0.001; d = 1.826). Secondary outcomes showed a relatively higher sensitivity of the MarginProbe® device, at the expense of decreased specificity, and no significant impact on cosmesis and volume of breast tissue excised.

Conclusion

MarginProbe® is an effective intraoperative adjunct in breast-conservation surgery that reduces patient re-excision rates, with no adverse effects relating to breast cosmesis or increase in volume of excised tissue.
Motor cortex activation during visuomotor transformations: evoked potentials during overt and imagined movements
Authors: Syrov Nikolay , Yakovlev Lev , Kaplan Alexander , Lebedev Mikhail
Published: November 2023

Despite the prevalence of visuomotor transformations in our motor skills, their mechanisms remain incompletely understood, especially when imagery actions are considered such as mentally picking up a cup or pressing a button. Here, we used a stimulus–response task to directly compare the visuomotor transformation underlying overt and imagined button presses. Electroencephalographic activity was recorded while participants responded to highlights of the target button while ignoring the second, non-target button. Movement-related potentials (MRPs) and event-related desynchronization occurred for both overt movements and motor imagery (MI), with responses present even for non-target stimuli. Consistent with the activity accumulation model where visual stimuli are evaluated and transformed into the eventual motor response, the timing of MRPs matched the response time on individual trials. Activity-accumulation patterns were observed for MI, as well. Yet, unlike overt movements, MI-related MRPs were not lateralized, which appears to be a neural marker for the distinction between generating a mental image and transforming it into an overt action. Top-down response strategies governing this hemispheric specificity should be accounted for in future research on MI, including basic studies and medical practice.
Bone mineral density after exercise training in patients with chronic kidney disease stages 3 to 5: a sub-study of RENEXC—a randomized controlled trial
Authors: Petrauskiene Vaida , Hellberg Matthias , Svensson Philippa , Zhou Yunan , Clyne Naomi
Published: November 2023

Background

We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3–5 not on kidney replacement therapy (KRT).

Methods

A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry.

Results

Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD (P < .001), the balance group (BG) increased total body T score (P < .05) and total body Z score (P < .005). Total body ΔT score was negative in the SG and unchanged in the BG (P < .005). Total body ΔZ score was negative in the SG and positive in the BG (P < .001). The proportion of progressors measured by ΔT (P < .05) and ΔZ scores (P < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores.

Conclusions

Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT.
TWAIL and Alternative Visions: ‘Talking About a Revolution’: Afterword to the Foreword by Antony Anghie
Authors: Kapur Ratna
Published: November 2023

This Afterward is in response to an invitation by EJIL to engage with Tony Anghie’s Foreword in the same journal entitled ‘Rethinking International Law: A TWAIL Retrospective’. I join in conversation with Anghie to further expand and amplify the redemptive potential of TWAIL, through a focus on human rights. I tease out and amplify a robust account of what constitutes an ‘alternative vision’ found in TWAIL as an epistemological inquiry that reflects a yearning to break free of the Eurocentric discourses that continue to structure human rights and the human subject. It also draws attention to the transformative and revolutionary vision of the project available in the aftermath of the critiques of traditional international law.
Overlapping methodologies? Rhetoric, English Studies, and the social world
Authors: Finlayson Alan
Published: November 2023

This article reflects on the overlaps of English studies with studies of Political Rhetoric. It outlines current UK-based research agendas in ‘Rhetorical Political Analysis’. It proposes a shared agenda focused on speech and argument as social action, and informed by the idea of ‘Rhetorical Citizenship’, the right to participate fully in disputation.
The impact of Covid-19 on mortality and clinical characteristics in hospitalized patients with peripheral artery disease in the year 2020
Authors: Piepenburg S , Maslarska M , Kaier K , Von Zur Muehlen C , Westermann D , Hehrlein C
Published: November 2023

Background

The Covid-19 pandemic developed its full destructive capacity and caused over 6.6 million confirmed deaths worldwide in the year 2020. This retrospective study aimed to examine the effects of Covid-19 on the mortality and clinical characteristics of peripheral artery disease (PAD) patients because these chronically ill patients are at risk for arterial embolic vascular complications and a fatal outcome.

Methods and results

From a German nationwide registry of 2020 all patients hospitalized with PAD (n=173.075) were compared in four different groups. The first group had no additional diabetes mellitus type 2 or Covid-19 (n=110.531), the second diabetes mellitus but no Covid-19 (n=59.991), the third diabetes mellitus and Covid-19 (n=1497) and the fourth no diabetes mellitus but Covid-19 (n=1056). Mortality rates in all PAD patients without Covid-19 were low and ranging between 1.1-3.6%, depending on PAD classification. However, PAD patients with Covid-19 had significantly higher mortality rates of 11.1-12.6%. Clinical characteristics and the Charlson- comorbidity index surprisingly revealed that PAD patients with Covid-19 but without diabetes mellitus presented more complications such as higher rates of stroke (1.4%), cardiogenic shock (3.3%), chronic kidney failure with GFR < 15 ml/min (10.5%) and prolonged ventilation time >48 hours (4.4%).

Conclusion

Covid-19 massively increased death rates in PAD patients in the year 2020. Neither disease severity of different stages of PAD nor additional diabetes mellitus had an effect on in-hospital mortality. One explanation of this finding might be that the risk for arterial embolism increases after a Covid-19 infection and thus leads to higher mortality rates in PAD patients, who are in danger for vascular/embolic complications. Our study reveals the importance of preventing the spread of Covid-19 disease, especially in the case of patients with atherosclerotic diseases.
Haptoglobin 1 gene polymorphism protects against postoperative cardiovascular events
Authors: Mohsen Y , Shami A , Edsfeldt A , Sun J , Goncalves I
Published: November 2023

Background

Haptoglobin (Hp) is a plasma glycoprotein with antioxidant properties that plays a role in maintaining the integrity of the bloodstream and in clearing plasma lipids. The human haptoglobin gene is polymorphic, with two prevalent alleles (Hp1 and Hp2) resulting in three distinct phenotypes. The Hp subtypes have been linked to the risk of symptomatic carotid stenosis and major ischemic cardiovascular events, with some studies suggesting a protective role of the Hp1 allele. However, observed discrepancies in the relationship between Hp genotype and cardiovascular events suggest the presence of additional underlying mechanisms or differences among Hp1 allele subtypes. This study aims to examine the role of Hp1 alleles (Hp1F and Hp1S) in atherosclerosis and determine their association with cardiovascular events in our cohort of carotid endarterectomy patients.

Methods

The study included a total of 691 patients who underwent a carotid endarterectomy. All patients underwent genotyping for Haptoglobin. A total of 668 carotid plaques were collected, and 45 of these plaques were randomly selected for histopathological analysis and underwent staining for lipids using (Oil Red O), hemorrhage (glycophorin A), macrophages (CD68 [cluster of differentiation 68]), smooth muscle cells (alpha-actin) and collagen (Movat pentachrome).

Participants were subsequently followed-up for postoperative cardiovascular events using data from clinical registers. The median follow-up for cardiovascular events was 48 months. All included patients gave written informed consent. The study was approved by the local ethical review board and followed the declaration of Helsinki.

Results

There were no significant differences in the baseline clinical characteristics between Hp1S carriers (36.6%) and non-carriers (63.4%). Postoperative cardiovascular and mortality events were found to be significantly associated with Hp1S subtype, with carriers exhibiting a decreased risk (HR=0.372, 95%CI 0.180-0.769, p=0.008). The histological examination of the plaques revealed that Hp1S carriers had a significantly greater percentage of plaque area stained positive alpha-actin (p=0.033). However, there were no significant differences observed in other histological markers.

Conclusions

Hp1S was associated with lower risk of postoperative cardiovascular events in our cohort of carotid endarterectomy patients. Patients with this genotype had plaques with more smooth muscle cells, so possibly more stable. This suggests that Hp1 subtypes could be of interest in risk stratification of this patient population, deserving further studies.
Impact of atrial fibrillation on mortality of patients undergoing bifurcation PCI
Authors: Mileva N , Vassilev D , Panayotov P , Rigatelli G , Gil R
Published: November 2023

Background

Patients with coronary bifurcation lesions represent a group with a greater risk of mortality when referred for e percutaneous coronary intervention (PCI).

Aim

We aimed to compare the clinical outcomes in patients with or without present atrial fibrillation (AF) undergoing bifurcation PCI.

Methods

Investigator-initiated prospective study of patients with stable coronary artery disease, with a significant angiographic bifurcation lesion defined as diameter stenosis ≥50% who were referred for a PCI. All patients were followed up by telephone contact and/or clinical visit at 30 days and then monthly for vital status. Cardiovascular (CV) death was defined as death with clearly determined cardiac origin or death from an unknown reason. Log-rank test was used to assess the difference in mortality between the two groups. Propensity-matching was performed to account for differences in age, sex, hypertension, dyslipidemia, diabetes, smoking, cancer, renal failure, LV ejection fraction, and SYNTAX score between the two groups. The primary endpoint was the incidence of all-cause and cardiovascular death.

Results

A total of 358 patients were included – 179 in each group. The mean age was 71.1 ± 9.6, 31% (112) were females, 32% (119) were smokers, 98% (353) -hypertensive, 92% (329) with dyslipidemia, 44% (156) -diabetics, 28% (99) had previous MI, mean EF was 51.9 ±10.8 %. After 1:1 propensity-score matching, baseline characteristics between the two groups were similar. Intervention vessel was LAD in 69% (n=247), LCx – 17% (62), RCA – 10% (37) of the patients. For a median follow-up time of 56.5 [39-110] months, total mortality was 40%, whereas CV death occurred in 30.5% (n=109) of the patients. Both all-cause and CV death were significantly higher in patients with AF - 64 (35.8%) versus 79 (44.1%); p=0.040, and - 47 (26.3%) versus 62 (34.6%); p=0.031, respectively. Furthermore, atrial fibrillation was revealed as an independent predictor of cardiovascular death in Cox-regression analysis, together with the following factors: AF – HR 1.704, 95%CI [1.156-2.510], p=0.007, age – HR 1.057, 95%CI [1.032-1.082], p<0.01; diabetes HR 1.556, 95%CI [1.059-2.2287], p=0.024; COPD HR 2.037 95%CI [1.328-3.123], p=0.001; EF –HR 0.968, 95% CI [0.950-0.987], p=0.001.

Conclusion

The presence of atrial fibrillation in patients with coronary bifurcation lesions referred for PCI is associated with higher all-cause and cardiovascular mortality.
Impact of intracoronary imaging-guided percutaneous coronary intervention on procedural outcomes among complex patient groups
Authors: Mohamed M , Kinnaird T , Wijeysundera H C , Johnson T W , Zaman S , Moledina S , Mamas M
Published: November 2023

Background

Intracoronary imaging (ICI) has been previously shown to improve survival and clinical outcomes after percutaneous coronary intervention (PCI). However, whether this prognostic benefit is sustained across different indications/patient groups remains unclear.

Methods

All PCI procedures performed in England and Wales between 1st April 2014 and 31st March 2020 were retrospectively analysed. The association between ICI use and in-hospital MACCE (major adverse cardiovascular and cerebrovascular outcomes; composite of all-cause mortality, stroke and reinfarction) and mortality was examined using multivariable logistic regression analysis for each imaging-recommended indication (stent thrombosis (ST), in-stent restenosis, stent length>60mm, acute coronary syndrome (ACS) indications, chronic total occlusion, left main stem (LMS) intervention, renal failure and bioresorbable vascular scaffolds (BVS)).

Results

Of 555,398 PCI procedures, 10.8% (n=59,752) were performed under ICI guidance. ICI use doubled between 2014 (7.8%) and 2020 (17.5%). ICI use was highest for BVS (44.7%) and LMS PCI (41.2%) cases and lowest in ACS (9%). Overall, the odds ratios (OR) of in-hospital MACCE and mortality were only reduced with ICI-guided PCI in cases with an imaging-recommended indication (OR 0.75 95% confidence interval (CI) 0.69-0.81 and OR 0.69 95%CI 0.63-0.76, respectively). Only specific imaging-recommended indications were associated with reduced MACCE and mortality, including LMS PCI (OR 0.45 95%CI 0.39-0.52 and 0.41 95%CI 0.35-0.48, respectively), ACS (OR 0.76 95%CI 0.70-0.82 and 0.70 95%CI 0.63-0.77), stent length>60mm (OR 0.75 95%CI 0.59-0.94 and 0.72 95%CI 0.54-0.95). ST was only associated with lower mortality (OR: 0.69 95%CI 0.52-0.91) while renal failure was associated with reduced MACCE (OR 0.77 95%CI 0.60-0.99) but not mortality. (Figure 1)

Conclusion

The utilisation of ICI has more than doubled over a seven-year period at a national level but remains low, with less than 1-in-5 procedures performed under ICI guidance. In-hospital survival was better with ICI-guided than angiography-guided PCI, albeit only for specific indications.Figure 1
The integration of angio-IMR, QFR and FFR for the detection of ischemia
Authors: Jukema R , Raijmakers P , Driessen R , Van Diemen P , Knuuti J , Maaniitty T , Twisk J , Kooistra R , Timmer J , Reiber J , Van Der Hoef T , Knaapen P , Danad I
Published: November 2023

Background

Fractional flow reserve (FFR) and quantitative flow ratio (QFR) are important tools to assess coronary-specific ischemia, but ischemia may be obscured in the presence of coronary microvascular dysfunction (CMD). Wire free angiography based index of microcirculatory resistance (angio-IMR) might aid in identifying ischemic territories with normal FFR or QFR.

Purpose

First we sought to validate angio-IMR against invasive resistance indices and [15O]H2O positron emission tomography (PET) derived resistance. Secondly, we investigated whether angio-IMR can help identifying ischemic vessels with normal FFR/QFR.

Methods

In this PACIFIC 1 and 2 sub study symptomatic patients underwent [15O]H2O PET and invasive coronary angiography with routine three vessel FFR. Invasive hyperemic microvascular resistance (HMR) and IMR were measured in a sub set of patients. A FFR/QFR ≤0.80 and hyperemic myocardial blood flow (hMBF) ≤2.3 ml/min/g were considered ischemic. Microvascular resistance on PET was defined as the ratio of mean distal coronary pressure to MBF. Angio-IMR, QFR and PET analyses were performed by core labs blinded to invasive angiography results.

Results

Among 259 patients (mean age 61 ± 9 years, 188 (73%) male) 494 vessels were included. Invasive IMR and or HMR were measured in 95 vessels. Angio-IMR did not correlate with invasive HMR/IMR for the right coronary artery (RCA) but correlated weakly with invasive HMR (r=0.39, p=0.03) and moderately (r=0.48, p<0.01) with invasive IMR for the left coronary artery (LCA). The RCA was excluded for further analysis. A very weak correlation between angio-IMR and PET resistance was observed (r=0.17, p<0.01). Territories with ischemia and a normal FFR showed a higher angio-IMR than ischemic territories with reduced FFR (31.3 ± 13.8 vs 22.2 ± 10.3, p<0.01). The same was observed after stratification by QFR/PET results (34.3 ± 15.5 vs 23.9 ± 9.9, p<0.01). Results remained consistent after stratification for diameter stenosis percentage.

Conclusions

A weak to moderate correlation was found between angio-IMR and invasive resistance indices for the LCA. In territories with an ischemic perfusion angio-IMR was higher in those with a normal FFR/QFR compared to patients with a reduced FFR/QFR. Integration of FFR/QFR and angio-IMR might lead to superior vessel-specific ischemia detection.
Treatment of coronary artery disease with sirolimus- versus paclitaxel-coated balloons
Authors: Cuculi F , Madanchi M , Cioffi G M , Majcen I , Gnan E , Gjergjizi V , Zhi Y , Seiler T , Attinger-Toller A , Bossard M
Published: November 2023

Background

Percutaneous coronary interventions (PCI) with paclitaxel-coated balloons (PCB) represent an established treatment for in-stent restenosis (ISR) and small coronary arteries. Lately sirolimus-coated balloons (SCB) have been introduced. Yet, studies comparing SCBs to PCBs are lacking.

Purpose

We sought to assess clinical outcomes at 12 months of an all-comer population presenting with acute or chronic coronary artery disease (CAD) treated with either a novel SCB or an established PCB.

Methods

We analyzed consecutive patients from the ongoing prospective SIROOP registry (NCT:04988685). Outcomes of interest included, target lesion failure (TLF), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiac-death (cv-death). All angiograms and outcomes were independently adjudicated.

Results

A total of 359 patients were included in this analysis, 220 (61%) and 139 (39%) patients were treated with SCBs and PCBs, respectively. Diabetes was present in 108 (30%) of patients and 145 (40%) patients presented with an acute coronary syndrome. The mean Syntax score of the overall population was 17.8±11, 95 (26%) of the lesions were ISR, 30 (8.4%) chronic total occlusions (CTOs) and 211 (59%) had moderate to severe calcifications. All lesions were treated with a DCB-only approach in both groups. Mean DCB diameter was 2.8±0.56 mm and the maximal mean dilatation pressure was 8.1±4.7 atm. We encountered no relevant coronary artery perforations or acute vessel closures. Further baseline and procedural characteristics can be found in Figure 1.

At 1-year follow-up, there was no statistically significant difference in the TLF rate between patients treated with SCBs versus PCBs (14 (7.4%) versus 12 (10%), respectively, (p=0.5)), with TLR being the leading cause for TLF (13 (6.8%) in the SCB and 10 (8.8%) in the PCB group, p=0.7). Figure 2 depicts the Kaplan-Meier curve of TLF over time. The leading TLF cause appeared to be lesion recoil/ collapse in both groups. Comparing ISR lesions treated with SCBs versus PCBs, there was also no significant difference with regards to the TLF rate (3 (9.1%) versus 4 (8.2%), respectively, p=1.00).

Conclusions

To our best knowledge, this is one of the first studies comparing SCBs to PCBs for treatment of CAD. At 1-year follow-up, there was no significant difference in outcomes between the two groups. Moreover, there was a numerically lower number of adverse events among patients treated with SCBs. These findings warrant further investigation in a dedicated randomized trial.Baseline and procedural characteristicsKaplan-Meier curve of TLF
Comparison of clinical outcomes with short-term and long-term DAPT after PCI using second-generation drug-eluting stents in high bleeding risk patient : a systematic review and meta-analysis
Authors: Intan R , Suryawan I G R , Ratri A K , Lusida T T E , Jonatan M , Nugraha R A
Published: November 2023

Background

Now that second-generation drug-eluting stents (DES) are available in almost every hospital in the world, it is unknown whether reducing the duration of double antiplatelet therapy (DAPT) following percutaneous coronary intervention in high-bleeding-risk (HBR) populations is beneficial and safe.

Purpose

This systematic review and meta-analysis aims to determine the safety, efficacy, and advantages of shortening the duration of DAPT (<6 months) in HBR patients with second-generation DES implantation.

Methods

We searched Ebsco, PubMed, Web of Science, Scopus, and Google scholar databases from inception to December 2022 for papers comparing short-term DAPT (6 months) followed by aspirin or P2Y 12 inhibitor monotherapy with long-term DAPT (6 months) in HBR patients after PCI with second generation DES. The primary objectives are major bleeding, definite or probable stent thrombosis (ST), and myocardial infarction (MI), while the secondary endpoint is mortality from any cause. Random-effect models were used to assess the relative risk and 95% confidence interval.

Results

This study included 9,789 HBR patients from three observational studies and one randomized controlled trial (Figure 1). Short DAPT for HBR patients undergoing PCI with second generation DES had a tendency of lower incidence of major bleeding in comparison with standard (6 months) DAPT, even though statistically non-significant (2.33% vs. 3.36%, RR 0.66 [95% CI 0.39 – 1.10], p = 0.11). Short-term DAPT was also found to be comparable and non-inferior to standard DAPT with in term of stent thrombosis (0.251% vs. 0.252%, RR 1.00 [95% CI 0.46-2.17], p = 0.99), Myocardial Infarction (2.08% vs. 1.85%, RR 1.09 [95% CI 0.82-1.44], p = 0.57), and All cause of death (3.01% vs. 2.56%, RR 1.17 [95% CI 0.93-1.49], p = 0.18) (Figure 2).

Conclusions

Among HBR patients implanted with second-generation DES, short DAPT was associated with slightly lower but comparable risk of major bleeding and non-inferior to reduce stent thrombosis, myocardial infarction, and all cause of death compared to standard DAPT.
In vivo evaluation of intravascular lithotripsy in a healthy porcine coronary model
Authors: Yin J , Wang R , Chen H , Shen L , Ge J
Published: November 2023

Objectives

In this study, we aimed to investigate the vascular response to an intravascular lithotripsy (IVL) shockwave balloon in a healthy porcine coronary artery model.

Background

IVL is a novel clinical technique for modifying heavily calcified atherosclerotic plaques.

Methods

A total of 24 porcine coronary arteries were treated with IVL or plain old balloon angioplasty (POBA). Histology, histomorphometry, quantitative coronary angiography analysis (QCA), and optical coherence tomography (OCT) were performed post-procedure and at 1-month follow-up (1M-FU).

Results

There was no significant difference in the late lumen loss and diameter stenosis (determined by QCA) and the minimal lumen area (evaluated by OCT) of the IVL and POBA groups at 1M-FU. Pathological analysis revealed that the lumen and neointima areas were similar between the two groups. However, the medial and adventitial layers were more prominent in the IVL than in the POBA group. The injury score and inflammation of the media and adventitia increased dramatically in the IVL group post-procedure and at 1M-FU. At 1M-FU, media fibrin deposition and adventitial fibrosis were also significantly increased in the IVL group. However, there was no significant difference in neointima fibrin deposition, endothelialization, and thrombosis between both groups. Layered separation of the media and adventitia was observed in the IVL group.

Conclusion

The findings indicate that the IVL balloon did not cause serious intimal hyperplasia and endothelial damage compared with the effects of POBA in the healthy coronary artery. However, shock waves may cause unique damage to the vascular media and adventitia in the coronary artery, which was not observed in the peripheral artery.Device introductionPathological image at 1M FU