bluuebunny/crossref_metadata_2025 huggingface dataset:
The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community
Authors: Kim Katherine K. , McGrath Scott P. , Solorza Juan L. , Lindeman David
Published: May 2023

Background Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic.

Objectives The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community.

Methods ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension.

Results Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0–8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80).

Conclusion The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
Evaluación de tratamiento con mini-open para pinzamiento femoroacetabular tipo CAM
Authors: Salgado Martín , Avilés Carolina , Fernández Felipe , Letelier María Loreto
Published: May 2023

Objetivo Describir y evaluar los resultados del tratamiento del pinzamiento femoroacetabular (PFA) con mini-open no asistido en una población definida.

Materiales y Métodos Se realiza una descripción prospectiva de cincuenta pacientes jóvenes con diagnóstico de PFA tipo CAM, con baja demanda deportiva, tratados con mini-open no asistido. Se incluyeron pacientes mayores de 18 años con PFA sintomático, con estudio radiológico completo y con test de lidocaína positivo. Se excluyeron pacientes con patología previa o subyacente de cadera comprometida. Se comparó la Escala de Cadera Harris modificada (Modified Harris Hip Score, MHHS, en inglés) en los periodos pre y posoperatorio (por el test de Wilcoxon) y los puntajes pre y posoperatorio en la escala visual análoga (EVA) (por el test análisis de la varianza [analysis of variance, ANOVA, en inglés] de Friedman). Se consideró significativo un valor de p < 0,05. En total, 50 pacientes cumplían los criterios de inclusión: 33 hombres y 17 mujeres.

Resultados La edad promedio fue de 36,8 ±  6,5 años. El ángulo alfa promedio fue de 62,6° ±  5,6°. Todos presentaron artrosis de grado 1 de Tonnis. Un total de 39 pacientes tenían nivel de actividad 3 (en la escala de Tegner). El seguimiento promedio fue de 27,3 ±  6,2 (mínimo de 12) meses. El MHHS mejoró desde una mediana preoperatoria de 60,5 (rango: 30,8–84,7) puntos a una mediana posoperatoria de 96,8 (rango: 91,3–100) puntos (p < 0,001). Todos los pacientes presentaron disminución significativa del dolor, con mediana de 0 en la EVA al año de seguimiento.

Conclusión Esta técnica presenta buenos resultados clínicos y funcionales en pacientes de baja demanda deportiva. Faltan estudios que demuestren sus ventajas respecto de la resección de bump de mayor tamaño o en otras localizaciones.

Nivel de Evidencia: 4.
Avulsión proximal de los isquiotibiales, del diagnóstico al tratamiento: una revisión del tema en relación con un caso clínico
Authors: Carrasco Miguel , Edwards Diego , Carrasco Consuelo , Zelaya Gerardo , Schmidt-Hebbel Andrés , Bianchi Sebastián
Published: May 2023

La avulsión proximal de los isquiotibiales (ITs) es una lesión poco frecuente, la que puede producir alteraciones funcionales permanentes, además de tener un riesgo de rerrotura elevado (en hasta un 30% de los casos).

Ocurre habitualmente en deportistas que realizan aceleraciones rápidas o requieren “movimiento balístico” durante su entrenamiento, aunque también se presentan en la población más sedentaria con caídas a nivel en mecanismos de baja energía. El mecanismo más frecuente de lesión es una contracción excéntrica de los ITs al intentar resistir una caída, con la cadera en flexión y la rodilla en extensión.

Existen numerosos signos descritos al examen físico y dentro del estudio, si bien la radiografía convencional y la ecografía son de gran utilidad, se reconoce a la resonancia magnética como el estándar de oro para su correcto diagnóstico.

El tratamiento dependerá del tipo de paciente y sus expectativas, aunque en los últimos años se ha considerado cada vez con más relevancia la opción quirúrgica en los casos en los que se presenta una avulsión completa de los ITs asociada a una retracción de estos.

Se presenta una revisión del tema en relación con un caso clínico resuelto de forma quirúrgica, y se discuten las generalidades, la presentación clínica, el estudio y las opciones de tratamiento con las que se cuenta en la actualidad.
Antithrombin Deficiency Is Associated with Prothrombotic Plasma Fibrin Clot Phenotype
Authors: Natorska Joanna , Corral Javier , de la Morena-Barrio Maria Eugenia , Bravo-Pérez Carlos , Bagoly Zsuzsa , Bereczky Zsuzsanna , Treliński Jacek , Witkowski Michał , Klajmon Adrianna , Undas Anetta , Ząbczyk Michał
Published: May 2023

Background Deficiency of antithrombin increases risk of venous thromboembolism. We hypothesized that antithrombin deficiency affects fibrin clot structure and function.

Methods We evaluated 148 patients (age: 38 [32–50] years; 70% women) with genetically confirmed antithrombin deficiency and 50 healthy controls. Fibrin clot permeability (Ks) and clot lysis time (CLT) along with thrombin generation capacity were assessed before and after antithrombin activity normalization in vitro.

Results Antithrombin-deficient patients had lower antithrombin activity (−39%) and antigen levels (−23%) compared with controls (both p < 0.01). Prothrombin fragment 1 + 2 levels were 26.5% higher in patients with antithrombin deficiency than in controls along with 94% increased endogenous thrombin potential (ETP) and 108% higher peak thrombin (all p < 0.01). Antithrombin deficiency was associated with 18% reduced Ks and 35% prolonged CLT (both p < 0.001). Patients with type I (n = 65; 43.9%) compared with type II antithrombin deficiency (n = 83; 56.1%) had 22.5% lower antithrombin activity (p < 0.001) and despite similar fibrinogen levels, 8.4% reduced Ks, 18% prolonged CLT, and 30% higher ETP (all p < 0.01). Reduced Ks was associated with lower antithrombin antigen level (β = − 6.1, 95% confidence interval [CI]: −1.7 to −10.5), while prolonged CLT was associated with lower antithrombin antigen (β = − 69.6, 95% CI: −9.6 to −129.7), activity (β = − 2.4, 95% CI: −0.3 to −4.5), higher PAI-1 (β = 12.1, 95% CI: 7.7–16.5), and thrombin-activatable fibrinolysis inhibitor levels (β = 3.8, 95% CI: 1.9–5.7). Addition of exogenous antithrombin reduced ETP (−42%) and peak thrombin (−21%), and improved Ks (+8%) and CLT (−12%; all p < 0.01).

Conclusion Our study suggests that enhanced thrombin generation and prothrombotic plasma fibrin clot phenotype can contribute to increased risk of thrombosis in patients with antithrombin deficiency.
Framing of female medical personnel during the COVID-19 pandemic: a case study of the Chinese official media
Authors: Gao Cunling , Yi Hongfa , Wang Jinfu , Han Shanshan
Published: May 2023

This paper analyzes the media frames adopted by the official WeChat and Sina Weibo accounts of the People’s Daily between January 1 and December 31, 2020, for reports about female medical personnel involved in pandemic prevention and control. Although the number of female medical personnel involved in pandemic prevention and control far exceeded that of their male counterparts, the extent of media reports on the former was far less than that of the latter. The human interest frame about female medical personnel was mainly applied, while the use of the action frame was less frequent, which highlighted the gender identity and family role of these women but weakened their professional identity. This was not conducive to praising the contributions of female medical personnel in fighting the pandemic. The media frames of reporting medical personnel in WeChat and Sina Weibo accounts of the People’s Daily are not always the same. After Wuhan’s lockdown ended on April 8, the proportion of the human interest frame of the report text of female medical personnel decreased, and the proportion of the action frame increased, while the proportion of the human interest frame of the report text of male medical personnel increased and the proportion of the action frame decreased. Previous studies mainly analyzed the use of the media frames of female news personalities, but few studies focused on whether women had the possibility of breaking away from the gender media frames. This study shows that some female medical personnel with exceptional professional competence are likely to transcend the gender media frames and receive similar coverage to that of male medical professionals, like Li Lanjuan and Chen Wei.
Strategies to minimise the impact of climate change and weather variability on the welfare of dairy cattle in New Zealand and Australia
Authors: Jago Jenny , Beukes Pierre , Cuttance Emma , Dalley Dawn , Edwards J. Paul , Griffiths Wendy , Saunders Katie , Shackleton Liz , Schütz Karin
Published: May 2023

This perspective paper provides industry leaders, researchers and policy developers strategic approaches to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to climate change. Farm systems and practices will evolve in response to the direct impacts of climate change and/or from responses to climate change, such as mitigation strategies to reduce dairy’s greenhouse-gas (GHG) emissions. The five domains framework (nutrition, physical environment, health, behaviour, mental state) was used to assess the potential impacts on animal welfare and strategies to minimise these impacts are outlined. Given that the future climate cannot be certain these approaches can be applied under a range of emissions pathways to (1) ensure that the effects of GHG mitigations on animal welfare are considered during their development, (2) engage with end users and the public to ensure solutions to the effects of climate change and weather variability are accepted by consumers and communities, (3) identify and measure the areas where improved animal health can contribute to reducing GHG emissions from dairy production, (4) ensure those supporting farmers to develop and manage their farm systems understand what constitutes a good quality of life for dairy cattle, (5) ensure effective surveillance of animal disease and monitoring of welfare outcomes and farm-system performance in response to climate change and GHG mitigations. Overall, these strategies require a multi-disciplinary co-development approach to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to the wider impacts of a changing climate.
Flux-periodic oscillations in proximitized core–shell nanowires
Authors: Klausen Kristjan Ottar , Sitek Anna , Erlingsson Sigurdur I. , Manolescu Andrei
Published: May 2023

Flux-periodic oscillations of the superconducting gap in proximitized core–shell nanowires are explored. Periodicity of oscillations in the energy spectrum of a cylindrical nanowire is compared with nanowires having hexagonal and square cross-section geometry, along with the effects of Zeeman and Rashba spin–orbit interaction. A transition between h/e and h/2e periodicity is found and shown to be dependent on the chemical potential, with correspondence to degeneracy points of the angular momentum quantum number. For a thin shell of a square nanowire, solely h/e periodicity is found in the infinite wire spectrum and shown to result from energy separation between the lowest groups of excited states.
Characterization of the INFN proton CT scanner for cross-calibration of x-ray CT
Authors: Fogazzi Elena , Trevisan Diego , Farace Paolo , Righetto Roberto , Rit Simon , Scaringella Monica , Bruzzi Mara , Tommasino Francesco , Civinini Carlo
Published: May 2023

Objective. The goal of this study was to assess the imaging performances of the pCT system developed in the framework of INFN-funded (Italian National Institute of Nuclear Physics) research projects. The spatial resolution, noise power spectrum (NPS) and RSP accuracy has been investigated, as a preliminary step to implement a new cross-calibration method for x-ray CT (xCT). Approach. The INFN pCT apparatus, made of four planes of silicon micro-strip detectors and a YAG:Ce scintillating calorimeter, reconstructs 3D RSP maps by a filtered-back projection algorithm. The imaging performances (i.e. spatial resolution, NPS and RSP accuracy) of the pCT system were assessed on a custom-made phantom, made of plastic materials with different densities ((0.66, 2.18) g cm−3). For comparison, the same phantom was acquired with a clinical xCT system. Main results. The spatial resolution analysis revealed the nonlinearity of the imaging system, showing different imaging responses in air or water phantom background. Applying the Hann filter in the pCT reconstruction, it was possible to investigate the imaging potential of the system. Matching the spatial resolution value of the xCT (0.54 lp mm−1) and acquiring both with the same dose level (11.6 mGy), the pCT appeared to be less noisy than xCT, with an RSP standard deviation of 0.0063. Concerning the RSP accuracy, the measured mean absolute percentage errors were (0.23+−0.09)% in air and (0.21+−0.07)% in water. Significance. The obtained performances confirm that the INFN pCT system provides a very accurate RSP estimation, appearing to be a feasible clinical tool for verification and correction of xCT calibration in proton treatment planning.
How different are shadows of compact objects with and without horizons?
Authors: Wang Xiangyu , Hou Yehui , Guo Minyong
Published: May 2023

In this work, we theoretically assume that a compact object (CO) has a dark surface such
that this simplified CO has no emissions and no reflections. Considering that the radius of the
surface can be located inside or outside the photon region, which is closely related to the shadow
curve, we investigate whether a CO without an event horizon can produce shadow structures similar
to those of black holes and compare the shadows of COs with and without horizons. In particular,
by introducing the (possible) observational photon region, we analytically construct an exact
correspondence between the shadow curves and the impact parameters of photons; we find that there
are indeed several differences between the shadows of COs without horizons and those of black
holes. More precisely, we find that the shadow curve is still determined by the photon region
when the radius of the surface is small enough to retain a whole photon region outside the
shell. When only part of the photon region remains, the shadow curve is partially determined by
the photon region, and the remaining portion of the shadow curve is partly controlled by the
impact parameters of photons that have a turning point on the surface. When there is no photon
region outside the surface, the shadow curve is totally controlled by the impact parameters of
photons, which have a turning point on the surface.
Exploring unbinding mechanism of drugs from SERT via molecular dynamics simulation and its implication in antidepressants
Authors: Tan Xin-Guan , Liu Xue-Feng , Pang Ming-Hui , Wang Yu-Qing , Zhao Yun-Jie
Published: May 2023

The human serotonin transporter (SERT) terminates neurotransmission by removing serotonin from the synaptic cleft, which is an essential process that plays an important role in depression. In addition to natural substrate serotonin, SERT is also the target of the abused drug cocaine and, clinically used antidepressants, escitalopram, and paroxetine. To date, few studies have attempted to investigate the unbinding mechanism underlying the orthosteric and allosteric modulation of SERT. In this article, the conserved property of the orthosteric and allosteric sites (S1 and S2) of SERT was revealed by combining the high resolutions of x-ray crystal structures and molecular dynamics (MD) simulations. The residues Tyr95 and Ser438 located within the S1 site, and Arg104 located within the S2 site in SERT illustrate conserved interactions (hydrogen bonds and hydrophobic interactions), as responses to selective serotonin reuptake inhibitors. Van der Waals interactions were keys to designing effective drugs inhibiting SERT and further, electrostatic interactions highlighted escitalopram as a potent antidepressant. We found that cocaine, escitalopram, and paroxetine, whether the S1 site or the S2 site, were more competitive. According to this potential of mean force (PMF) simulations, the new insights reveal the principles of competitive inhibitors that lengths of trails from central SERT to an opening were ∼18 Å for serotonin and ∼22 Å for the above-mentioned three drugs. Furthermore, the distance between the natural substrate serotonin and cocaine (or escitalopram) at the allosteric site was ∼3 Å. Thus, it can be inferred that the potent antidepressants tended to bind at deeper positions of the S1 or the S2 site of SERT in comparison to the substrate. Continuing exploring the processes of unbinding four ligands against the two target pockets of SERT, this study observed a broad pathway in which serotonin, cocaine, escitalopram (at the S1 site), and paroxetine all were pulled out to an opening between MT1b and MT6a, which may be helpful to understand the dissociation mechanism of antidepressants.
Toward a better understanding of the environmental impacts of expanding farmer-led irrigation in Sub-Saharan Africa: an exploratory assessment of irrigation-induced risk of nutrient water pollution in Ethiopia
Authors: Xie Hua , Dile Yihun Taddele , Ringler Claudia , Srinivasan Raghavan , Worqlul Abeyou Wale
Published: May 2023

Irrigation, and especially farmer-led irrigation, is considered to be a promising option for enhancing agricultural productivity in Sub-Saharan Africa. However, there is a lack of thorough understanding of the impacts of irrigation development on environment. Past discussions are mainly limited to the water depletion and hydrological regime change effect of irrigation. This paper presents a study to narrow the knowledge gap by assessing nutrient water pollution risk induced by the expansion of farmer-led irrigation in Ethiopia. Using household survey data collected from four woredas in Ethiopia where irrigated crop production currently concentrates, we first evaluate the impact of irrigation on cropping intensity and annual consumption level of fertilizers and then use the findings of the household survey data analysis to support conceptualization of a modeling framework for assessing agricultural nutrient water pollution risk from farmer-led irrigation development in Ethiopia at national scale. We project that overall farmer-led irrigation development in Ethiopia will lead to a gentle increase in national total of agricultural nutrient loadings. This result helps justify the endeavor of promoting farmer-led irrigation in Ethiopia. On the other hand, the projected nutrient flow and nutrient loading growth rate related to the farmer-led irrigation expansion are highly heterogeneous spatially, and risk of local water quality deterioration exists. There is still need to make investment to ensure the environmental sustainability of farmer-led irrigation development.
A-200 BILATERAL ADRENALECTOMY: EXPERIENCE FROM AN ENDOCRINE SURGERY REFERENCE CENTER
Authors: Butz F , Dobrindt E , Dukaczewska A , Skachko T , Pratschke J , Goretzki P , Mogl M
Published: May 2023

Background

Synchronous bilateral adrenalectomy (BA) remains one of the least frequently performed surgeries worldwide, as only selected patients are eligible. Consequently, experience in this regard remains limited.

Methods

Retrospective data analysis of all patients who underwent synchronous bilateral adrenalectomy from 2011 to 2022 was performed.

Results

Single-stage bilateral adrenalectomy was performed in n=17 patients (n=10 female, n=7 male, age: 48 ± 17 years) with Cushing's syndrome (n=11; including 7 ectopic ACTH production (EA) and 4 therapy-refractory Cushing's syndrome (CD)), pheochromocytoma (n=3), adrenal carcinoma (n=1), metastases (n=1), and adenomas (n=1). Minimally invasive (MI) surgery was performed in n=15 cases; open surgery in n=2. Mean operative time was 200 ± 68 mins. and median hospital stay was 22 d (IQR 6-35 d). In n=3 cases, surgery was an emergency-procedure; in all 3 cases, indication was Cushing's crisis in EA. These 3 patients died within the first 4 months after surgery due to septic complications of derailed Cushing's or underlying malignancy. While duration of surgery and hospital stay did not differ, emergency patients were significantly older (69 ± 9 vs. 43 ± 14 years; p=0.01) and ICU stay was significantly longer (29 ± 17 vs. 3 ± 7 days; p=0.001).

Conclusion

Single-stage bilateral adrenalectomy remains a rarely performed procedure. The MI procedure represents the standard. Patients who need emergency surgery due to a Cushing's crisis have a very high mortality. Thus, timing of surgery is of highest priority and requires a critical interdisciplinary discussion.
A-123 S-GRAS SCORE CORRELATES WITH SURVIVAL AFTER RESECTION OF ADRENOCORTICAL CARCINOMAS
Authors: Mihai R
Published: May 2023

Background

Prognosis after resection of adrenocortical cancers (ACC) based on ENSAT staging and nomograms is not sufficiently accurate. A new combined score (S-GRAS) has been recently proposed based on age, hormone- or tumour-related symptoms at presentation, ENSAT stage, R stage and Ki67 index but this score is yet to be validated.

Methods

Retrospective analysis of consecutive unselected patients who underwent surgery for ACC in a regional referral centre.

Results

Between 2000–2022, 71 patients underwent surgery for ACC of whom 31 patients (14M:17F, median age 54 years), the limiting factor being the lack of assessment of Ki67 marker on historical histological specimens.

Survival rates decreased with a rise in S-GRAS from 8/9 (score 0 and 1) to 4/6 (score 2 and 3), 4/10 (score 4 and 5) and 0/6 (score 6 and 7) and overall survival decreased from median 93 months (score 2 and 3) to 19 months (score 4 and 5) and 4 months (score 6 and 7).

Mitotane treatment did not follow the S-GRAS-based protocol proposed recently: for low S-GRAS (score 0–3) Mitotane is not indicated (yet 8/15 received it), those with high SGRAS (score 4-5) should receive mitotane (9/10 did so), and those with S-GRAS 6 and over should receive combination of mitotane&EDP chemotherapy yet none did so.

Conclusion

S-GRAS score correlates well with overall survival after resection of ACC and this score could inform the decision of using adjuvant therapy after surgery for ACC.
Quantum Bit Commitment Without Quantum Memory
Authors: Xu Lidong , Wang Mingqiang , Qin Jing
Published: May 2023

Commitment scheme is a fundamental cryptographic primitive that serve as building blocks for many other two-party protocols. In this paper, we propose a novel quantum bit commitment scheme, which is secure and does not require quantum memory. Our scheme processes the quantum information using coherent states and unambiguous state discrimination (USD) measurements, which can be experimentally realized by linear optics and photon detectors. We ensure the unconditionally hiding and binding property by preventing both Alice and Bob from obtaining complete information about the commitment in committing stage, and eliminate the requirement for quantum memory by performing USD measurements and phase shifts immediately after receiving the coherent states.
Cardiac rupture in acute myocardial infarction: a cardiac magnetic resonance study
Authors: De Lazzari Manuel , Cipriani Alberto , Cecere Annagrazia , Niero Alice , De Gaspari Monica , Giorgi Benedetta , De Conti Giorgio , Motta Raffaella , Rizzo Stefania , Tona Francesco , Cacciavillani Luisa , Tarantini Giuseppe , Gerosa Gino , Basso Cristina , Iliceto Sabino , Perazzolo Marra Martina
Published: May 2023

Aims

We assessed the feasibility of cardiac magnetic resonance (CMR) and the role of myocardial strain in the diagnostic work-up of patients with acute myocardial infarction (AMI) and a clinical suspicion of cardiac rupture (CR).

Methods and results

Consecutive patients with AMI complicated by CR who underwent CMR were enrolled. Traditional and strain CMR findings were evaluated; new parameters indicating the relative wall stress between AMI and adjacent segments, named wall stress index (WSI) and WSI ratio, were analysed. A group of patients admitted for AMI without CR served as control. 19 patients (63% male, median age 73 years) met the inclusion criteria. Microvascular obstruction (MVO, P = 0.001) and pericardial enhancement (P < 0.001) were strongly associated with CR. Patients with clinical CR confirmed by CMR exhibited more frequently an intramyocardial haemorrhage than controls (P = 0.003). Patients with CR had lower 2D and 3D global radial strain (GRS) and global circumferential strain (in 2D mode P < 0.001; in 3D mode P = 0.001), as well as 3D global longitudinal strain (P < 0.001), than controls. The 2D circumferential WSI (P = 0.010), as well as the 2D and 3D circumferential (respectively, P < 0.001 and P = 0.042) and radial WSI ratio (respectively, P < 0.001 and P: 0.007), were higher in CR patients than controls.

Conclusion

CMR is a safe and useful imaging tool to achieve the definite diagnosis of CR and an accurate visualization of tissue abnormalities associated with CR. Strain analysis parameters can give insights into the pathophysiology of CR and may help to identify those patients with sub-acute CR.
ANMCO position paper on vericiguat use in heart failure: from evidence to place in therapy
Authors: Di Fusco Stefania Angela , Alonzo Alessandro , Aimo Alberto , Matteucci Andrea , Intravaia Rita Cristina Myriam , Aquilani Stefano , Cipriani Manlio , De Luca Leonardo , Navazio Alessandro , Valente Serafina , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio
Published: May 2023

In the growing therapeutic armamentarium for heart failure (HF) management, vericiguat represents an innovative therapeutic option. The biological target of this drug is different from that of other drugs for HF. Indeed, vericiguat does not inhibit neuro-hormonal systems overactivated in HF or sodium–glucose co-transporter 2 but stimulates the biological pathway of nitric oxide and cyclic guanosine monophosphate, which is impaired in patients with HF. Vericiguat has recently been approved by international and national regulatory authorities for the treatment of patients with HF and reduced ejection fraction who are symptomatic despite optimal medical therapy and have worsening HF. This ANMCO position paper summarises key aspects of vericiguat mechanism of action and provides a review of available clinical evidence. Furthermore, this document reports use indications based on international guideline recommendations and local regulatory authority approval at the time of writing.
ANMCO-SIMEU consensus document: appropriate management of atrial fibrillation in the emergency department
Authors: Caldarola Pasquale , De Iaco Fabio , Pugliese Francesco Rocco , De Luca Leonardo , Fabbri Andrea , Riccio Carmine , Scicchitano Pietro , Vanni Simone , Di Pasquale Giuseppe , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio
Published: May 2023

Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable impact on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, in order to make it homogeneous across the national territory.
C2 DIFFERENT CLINICAL PREDICTORS OF EARLY AND LATE PRIMARY VENTRICULAR FIBRILLATION: RESULTS OF THE PREDESTINATION STUDY
Authors: Dusi V , Baldi E , Ruffinazzi M , Camporotondo R , Angelini F , Peano V , Picollo C , Cipriani A , Cerea P , Cacciavillani L , Noussan P , Dossi F , Sanna T , D'Acunto G , Caputo M , Auricchio A , Kotta M , Gnecchi M , Crotti L , Schwartz P , De Ferrari G
Published: May 2023

Introduction

Few studies evaluated risk factors for primary ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). Important parameters such as kalemia, blood pressure (BP) and heart rate (HR) at presentation were rarely considered. Furthermore, potential differences according to the time elapsed between symptoms onset and VF onset have never been investigated.

Objectives

to evaluate predictors of primary VF in the PREDESTINATION (PRImary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) study cohort also differentiating between early (<60 min from symptoms onset) and late (>60 min) VF. Early VF is more likely to cause sudden death (SD) before medical services arrival.

Patients and Methods

PREDESTINATION is a prospective, multicenter, case–control (1:2 age– and sex–matched) study enrolling patients aged 18–80 years with a first AMI, either complicated (cases) or not (controls) by primary VF before reperfusion.

Results

1478 patients were analysed: mean age was 59 years, 83% were male, 36% cases. The multivariate analysis (logistic regression) on the whole population (c–statistic= 0.74) identified 8 independent predictors of primary VF: atrial fibrillation as presenting rhythm (OR 4.61), kalemia ≤3.5 mEq/L (OR 2.8), HR at presentation ≥90 bpm (OR 2.25), first–degree family history of SD (OR 2.08), anterior infarct site (OR 1.54), physical inactivity (OR 1.59), systolic BP at presentation (OR 0.98 for each mmHg), and first–degree family history of coronary artery disease/myocardial infarction (OR 0.71). The time elapsed between symptoms onset and VF was known for 405 cases (184 early and 221 late VF). There were 6 predictors of early VF, with loss of significance of physical inactivity and of family history of coronary artery disease/infarction, and an increase in the OR of family history of SD to 2.85 (95% CI: 1.6–5.08), and in the c–statistic of the model to 0.80. Among the 6 predictors of late VF, on the other hand, anterior site of AMI and family history of SD were not confirmed (c–statistic of the model 0.7).

Conclusions

The present study identified 8 independent predictors of primary VF. First–degree family history of SD is a powerful independent predictor of early VF, but not of late VF, suggesting that genetic predisposition plays a determining role only in early–onset VF cases and therefore the advisability of a specific genetic investigation in these patients.
C6 VENTRICULAR FIBRILLATION SPECTRAL AREA (AMSA) AND LOW–ENERGY SHOCK SUCCESS PREDICTION IN PATIENTS WITH OUT–OF–HOSPITAL CARDIAC ARREST
Authors: Lopiano C , Romana Gentile F , Quilico F , Aramendi E , Isasi I , Baldi E , Fasolino A , Contri E , Palo A , Currao A , Bendotti S , Primi R , Savastano S
Published: May 2023

Introduction

In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy level for defibrillation is that which achieves defibrillation and minimize the current–induced myocardial damage. Therefore, it would be reasonable to reduce the energy level as well as the number of shocks. ECG–based VF waveform analysis features such as amplitude spectral area (AMSA) have been recently introduced as predictors of shock success but their predictivity for shock success with low energy level is not known. We aimed to assess whether AMSA of VF is able to predict the efficacy of low energy level for defibrillation in out–of–hospital cardiac arrest (OHCA) patients.

Methods

All the OHCAs with at least one shockable rhythm occurred from January 2015 to December 2020 in the province of Pavia, Italy, were considered. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators and by using a 2–second–pre–shock ECG interval.

Results

Among 4619 OHCA, AMSA values and energy for defibrillation were documented in 791 shocks, of which 45% received a shock at low energy (<= 150J) and 55% at high energy (>150J). The rate of efficacy between the two groups did not differ significantly (44% vs 38%, p=0.102), however in patients efficaciously treated with low energy, AMSA was higher compared to those efficaciously treated with high energy [13.2 mV·Hz (12.5–14.2) vs 10.8 (10.1–11.5), p<0.001]. Moreover, AMSA was found to be different even when comparing ineffective shock at low energy with effective shock at high energy [(6.6 (4.6–10) vs 10.8 (8.1–13.8), p<0.001] and similar when comparing ineffective shock at low and at high energy [6.6 (4.6–10) vs 6.3 (4.5–8.7), p=0.21]. By dividing AMSA values into three tertiles the rate of shock success at low energy was found to be different: [T1 (0.7–6.2) 4.2%; T2 (6.2–10.8) 13%; T3 (10.8–63.2) 42%, Chi squared p<0.001 and p for trend <0.001]. After correction for age, sex, amiodarone use, call to shock time, AMSA values corresponding to the third and second tertile were associated with higher probability of shock success compared with the values in the lowest tertile [T3 OR 15 (95%CI 7–30), p< 0.001; T2 OR 3 (95%CI 1–7), p= 0.002].

Conclusion

Amplitude spectral area of VF is a predictor of shock success at low energy. This could be useful to optimize the choice of energy limiting the current related myocardial injury.
C10 HEART FAILURE DURING ACUTE CORONARY SYNDROME AND THE LONG–TERM RISK OF CANCER DEATH. THE ABC–9* STUDY ON HEART DISEASE
Authors: Mahmoud H , Berton G , Cordiano R , Palmieri R , Merotto D , Menegon F , Petucco S , Dal Bo A , Mahmoud M , Cavuto F
Published: May 2023

Introduction

Emerging evidence suggests that patients with coronary artery disease carry an increased risk of cancer death.

Methods

To assess the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long–term cancer death risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were followed prospectively for 24 years or until death.

Results

All except for three patients completed the follow–up, representing 6913 person–years. Patients‘ mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow–up, 107 patients (19%) died due to cancer; of them, 81 with no HF [79% of patients without HF] and 26 had baseline HF [14% of patients with HF]. The incidence rates for cancer death were 17 and 14 per 1000 person–years for patients with and without baseline HF, respectively (p = 0.48). The risks for cancer death associated with HF were (HR: 1.37; 95% CI: 0.88–2.15; p=0.16). Similar associations were observed among men and women and in patients younger and older than 75 years of age. The unadjusted HRs for incident cancer were (HR: 1.25; 95% CI: 0.61–2.53; p=0.53) and (HR: 1.26; 95% CI: 0.66–2.39; p=0.49) for patients with HFrEF and HFpEF respectively. We observed a positive interaction between age and LVEF for the risk of cancer death (HR: 1.002; 95% CI: 1.001 –1.004; p=0.01) in the unadjusted model.

Results

were the same in the fully adjusted model.

Conclusions

A lack of association between clinical HF at admission for ACS and the long–term cancer death risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.
C11 LARGE PLEURAL AND PERICARDIAL EFFUSION: WHICH DRAIN FIRST?
Authors: De Carlini C , Balestri G , Saltafossi D , Spinelli M , Centola M , Corticelli A , Achilli F
Published: May 2023

Introduction

Large pleural and pericardial effusion is a common finding in lung cancer patients. However, a chronic large pleural effusion and the “lung entrapment” fenomenon, due to the neoplastic lung infiltration, could precipitate the re–expansion pulmonary edema (REPO) after the thoracentesis procedure. REPO is a rare and potentially life–threatening complication after large volume thoracentesis. It is characterized by alveolar infiltration in the reexpanded lung.Indeed, in the presence of “lung entrapment”, REPO development could be due not only to and excessive fluid removal, but also to the development of an excessively negative intrapleural pressure (< – 20 mmHg). As the REPO is often associated to an hemodynamic impairment, in patients with concomitant severe pericardial effusion, this condition could cause cardiac tamponade and the optimal therapeutic approach could be challenging.In this perspective, the decision on the effusion to be drained first, in this population, is not always straightforward.Case report In a 62 years –old woman with severe respiratory failure, a chest CT scan showed a massive left –sided pleural effusion with a complete collapse of the left lung, a severe pericardial effusion (35 mm) and the presence of malignant mediastinal nodes. (Figure 1).In the ICU a left thoracentesis was performed, with an early drainage of 1400 ml, the drain was then clamped. 30 minutes later, the patient developed a severe acute respiratory failure. An urgent chest x ray revealed an ipsilateral pulmonary oedema (Figure2). The patient was then treated with respiratory support with cPAP and intravenous diuretic therapy. Afterward, a rapid hemodynamic derangement occurred, with cardiac tamponade. An emergency echoguided pericardiocentesis was then performed followed by an immediate recovery. A repeated thorax CT scan revealed an advanced pulmonary tumor (Figure 3).

Discussion

In this case all the risk factors for REPO were coexistent: chronic pleural effusion and lung cancer. In addition, the large pericardial effusion represented a complicating factor in this situation as both the cPAP and the REPO’s hypovolemia may have brought to a clinical tamponade. In this context, where a neoplastic severe pleural and pericardial effusions are coexistent, it is essential to know which possible complications may occur after a large volume thoracentesis in order to prevent a high risk urgent pericardial drainage in patient with severe respiratory distress.
C13 AT THE ROOT OF HYPOXIA: NEVER UNDERESTIMATE THE CLINICAL
Authors: Pasero G , Guareschi A , Valli F , Vicenzi M , Mangini A , Carugo S
Published: May 2023

A 74–year–old woman arrived to the ER for syncope, reporting episodes of atypical chest pain for a few months. The initial ECG showed negative T waves in the lateral leads; an echocardiogram documented lower–limit systolic function due to akinesia of the antero–lateral segments and the presence of an ascending aorta aneurysm (AAA). The woman, with multiple cardiovascular risk factors, had previous transmural myocardial ischemia documented by MRI and never investigated with coronary angiography (ICA). Admitted to ICCU for suspected ischemic heart disease, she experienced a sudden clinical deterioration with onset of acute respiratory failure, initially stabilized with noninvasive ventilation. A chest angioCT excluded acute events (pulmonary embolism, aortic dissection) and confirmed the presence of AAA with bovine arch. Given the persistent need for oxygen therapy, closer clinical observation allowed objectification of platypnea–orthodeoxia syndrome (POS) that presented with desaturation, dyspnea, and mental confusion in the orthostatic position that improved with supine position. A bubble test in the two positions documented worsening intracardiac shunt in the sitting position, and a transesophageal echocardiogram showed the presence of a tunnel–like patent foramen ovale (PFO). The patient then underwent ICA that found a stenosis–free vascular tree, but a marked fusiform common trunk aneurysm (CTA) was appreciated. After exclusion of altered cardiopulmonary hemodynamic balance, percutaneous closure of the PFO was performed, which allowed progressive improvement of respiratory exchanges and subsequent complete weaning from oxygen. Typically, PFO occurs in the case of a pulmonary ventilo–perfusory mismatch or right–left shunt (rlS), associating mainly with atrial congenital defects and, to a lesser extent, pulmonary arteriovenous malformations. Sometimes, for POS to occur, the presence of a functional component facilitating rlS is necessary. In our case, it is conceivable that such a contribution was both ab–extrinsic compression of the right atrium by the AAA and compression of the pulmonary trunk at the level of the pulmonary valve by the CTA. This diagnostic hypothesis is compatible with the late presentation.
C14 CASE REPORT: MULTIMODALITY IMAGE–CHALLENGE IN PRIMARY CARDIAC DIFFUSE LARGE B–CELL LYMPHOMA
Authors: Colopi M , Civera S , Mabritto B , Annibali G , Quadri G , Bongioanni S , Aranzulla T , Musumeci G
Published: May 2023

A 76–year–old Caucasian woman presented to our hospital with progressive exertional fatigue and weight–loss over 2 months.Her past medical history revealed a recent local–hospital admission because of atrioventricular third–degree block, requiring permanent pacemaker implan­tation. At presentation her cardiovascular exam was normal.Laboratory studies revealed elevated LDH and PCR; electrolytes, cardiac biomarkers and complete blood count were normal. ECG demonstrated AF and ventricular stimulation.Transtoracich echocardiography showed LV hypertrophy in the basal segments, with normal ejection fraction and a reduced LV–GLS with a relative apical sparing pattern.There was a large, well–circumscribed mass arising from the right atrium, with a contextual moderate pericardial effusion (Fig1).Vasculitic, thrombophilic and infectious work–up were negative.The patient was immunocompetent. CMR was proposed but could not be performed due to patient claustrophobia. ECG gated cardiac CT was carried out for a better differential diagnosis of the mass, as well as to look for possible embolization or primary tumours, in the hypothesis of cardiac metastases. A CT total body showed a large ill–defined mass invading the interatrial and interventricular septum with projections into the left ventricle. Not enlarged lymph nodes were detected with neither hepatosplenomegaly nor abdominal lymphadenopathy. A total body 18FDG PET revealed significant tracer uptake in the heart and pericardium without extracardiac uptake, consistent with a malignant cardiac mass (Fig2).LV endomyocardial biopsy was attempted: pathology revealed large B–cell lymphoma expressing CD20, Bcl–2, Bcl–6, Mum–1, C–myc and with a high Ki67 proliferation rate. The patient underwent six cycles of chemotherapy(R–POCH).Echocardiography imaging after the second cycle showed significant reduction in myocardial wall thickness and concomitant improvement in LV–GLS. Repeated PET–CT scans 6 months post–chemotherapy showed complete remission with no evidence of FDG–avid lymphoma (Fig3). Primary cardiac lymphoma (PCL) is an extranodal non–Hodgkin’s B–cell lymphoma exclusively located in the heart or pericardium, accounting for 1–2% of primary cardiac tumours. PCL often presents with non–specific clinical symptoms making the diagnosis challenging. Multimodality approach and myocardial biopsy are essential in the diagnostic work–up. Early diagnosis and treatment are crucial since a good response to chemotherapy is expected.