bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication model of musyawarah and role of traditional leaders in building public acceptance to support nuclear powerplant development plan at Bengkayang Regency
Authors: Herawati N , Sunyata L , Sudagung A D
Published: April 2021

The paper aims to explain communication strategy to increase the public acceptance of nuclear power plant in Bengkayang Regency. West Kalimantan will be the first area to have a nuclear power plant in Indonesia. In order to get the permit to build it, the government need public acceptance. Nevertheless, society divided into pro and cons on the nuclear issue. Government need a new communication strategy to bridge the divided opinion. This study aims to elaborate on the concept of deliberation communication and social perception. The qualitative method used in doing this research. Data analysis conducted by interview and literature studies. Results of the research found that the society of Bengkayang tends to trust their traditional leaders. The best communication strategy to help people understand the message is by having deliberation communication. Within the deliberation, the communicator should be accompanied by the traditional leader. Before that, the expert has to convince those traditional leaders to support the message they wanted to deliver to the people. Others finding of this research was the people only need a simple explanation on the benefit and risk with a nuclear power plant in there area.
The effect of various varieties of cassava stems waste and tapioca adhesive concentrations on the quality of bio-coal briquette
Authors: Asmara S , Lanya B , Tamrin  , Putri A N , Rahmat A , Mutolib A
Published: April 2021

This study aims to utilize the combination of cassava and coal waste as raw materials for making briquettes using several different concentrations of tapioca adhesives. This study uses a completely randomized design (RDC) with 2 factorials. The first factor is material composition, assigned by the letter P, which has 3 different varieties of different cassava, which are (P1) Kasetsart cassava and coal waste, (P2) Thai cassava and coal waste, and (P3) butter cassava and coal waste. The second factor is tapioca adhesive concentration, which consists of two different treatments: (M1) 15% and (M2) 20%. The combination of these different treatments then repeated 4 times resulted in 24 experimental units. The briquettes produced then underwent several characteristics tests, including water content, calorific value, combustion rate, density, compressive strength, shatter resistance index, and changes in the temperature of the pan base when the briquettes were burned. The acquired data then processed using Microsoft Excel 2010 and SAS v9 software. The data obtained will then be compared to SNI (Indonesia National Standard) to find out whether the briquette is fulfilling the requirement for application. The results are as follows: treatment P1M1 and P1M2 have a water content ranging from 5.36-7.09% and a calorific value between 4.427 – 5.541 cal/g, and it also fulfills the SNI Standard. Another characteristic is shown by P1M1 and P1M2 such as combustion rate around 0.37-0.4 g/min, density between 0.37-0.39 g/cm3, compressive strength between 48.67 N/cm2, and shatter resistance index numbering around 99.90-99.92%, able to fulfill 95% of the SNI requirement for bio coal briquette, as well as changes in the bottom temperature of the pan which has reached the highest temperature of 303°C in the 26th minute of the P1M1 treatment combination and the lowest is 311°C at the 28th minute of the P1M2 treatment combination.
Spatial model of control of fire prone peatlands based on rainfall data (case study: Kepulauaan Meranti Regency, Riau Province)
Authors: Turmudi  , Suryanta J , Nahib I
Published: April 2021

Peatland fires in Indonesia occur every year, and the impacts are also known to cause many costs. Fires in Indonesia are 99% caused by humans. Fires can occur when the components of the fire are available, namely fuel, oxygen and heat sources. Triangel fire components are in optimal conditions when the land is dry. Dry conditions are mainly caused by weather, and are reinforced by human activities. The main influence of weather is in the form of rainfall, while the human influence is in the form of canalization. Low rainfall causes dry land and plants. Canalization has the potential to cause the surrounding land to become dry. The canalization is made so that the plant roots are in the aerobic zone, so that the plants can grow well. The purpose of this study is to find out how much rainfall there are still fires and their distribution. By knowing this information, it is hoped that efforts to control forest and land fires can be carried out more effectively. The method used is spatial analysis. Materials used: 2005-2016 rainfall data, 2005-2016 hotspots data, 1: 50,000 scale RBI map. The results of this study indicate that thde chance of occurrence of fires on the low rainfall class (0 - 100 mm) has 70,5 % higher than chance of occurrence of fires than medium raifall class (100 - 300 mm) of 24,5 %.
Dynamic Urban Modelling for Urban Growth Varieties and Transport : Building A Complex Dynamic Model
Authors: Abdul Hussein Bedewy Baydaa , Hassan Alwan Kareem , Kamel Fleeh Moheeb
Published: April 2021

The need for urban simulation is to improve understanding of urban development and to predict urban changes. The dynamics of urban systems seek to represent the evolutionary patterns of a city over time and space, and it is possible to reduce uncertainty and increase understanding of the urban system as it is a very complex system. An integrated and proactive approach has been developed to plan for growth and transportation for the city of Al-Diwaniyah. Which is based on the CA (Cellular Automata) and shows that the pathway of simulation results reveals the difference in the expansion of urban areas in all directions of the city. This study extended to future stages to (2049) through a dynamic model. It is complicated by using the certification authority (CA cell model) and the results show that the complex interaction between growth and transmission has been well handled by the model. The model has shown during the simulation period of reality and the future (2019-2049) with cellular modelling CA and the future scenario for prediction indicates that commercial and entertainment in Al-Diwaniyah city increased in (2049) and therefore cellular modelling was found to be the most suitable for use in simulating urban growth in areas with evidence of simulation of reality and its comparison with the averages of uses in the city’s basic plan, which determined a percentage of 2035 that was exceeded by reality in 2029. The simulation results show that Al-Diwaniyah will face enormous challenges in the field of transport and urban development in (2049) within the framework of the current trends scenario. The accelerated growth of the population that excelled the estimates of the basic plan by a large percentage, especially among the model, reached 2034 with a city area of 10805 hectares. While in the basic plan it was explained by 2035 the city reaches 10643 hectares, and from the observation of the stages of changing uses according to the basic plan for the city of Al-Diwaniyah. In fact, the reality excelled the proportions from 2009 until Now 2019, especially the city of Al-Diwaniyah, which is directed towards commercial activity and religious and recreational tourism investments. The study ended with the most important recommendations and proposals to improve the city’s reality and drew the researchers’ attention to the importance of the subject of the study.
The natural and environmental resources in the marshes and the means of their investments (Chebaish as a model)
Authors: Abdul-Kaream Alabbas Aalaa , Oudah Alumery Abbas
Published: April 2021

The marshes are possessing natural economic capabilities and environmental resources and unique biological diversity. It inhabited by thousands of citizens for thousands of years, as these residents relied heavily on the natural environmental and economic resources which they depend on them as a basis for their livelihood, and given the increasing continuous demand for these resources as well as the frequent government neglect for this environment, for these reasons the research problem resulted from the weak investment of natural and economic environmental resources and their excessive and unsustainable exploitation, which led to an imbalance in the environmental and economic balance of the region. The main goals of the research were to maintain the natural resources in sustainable and sustainable economic activities for the residents and to achieve the goals of sustainable development, and the research adopted the hypothesis that natural and economic resources can be sustained through sustainable spatial development by activating institutional aspects as well as environmental awareness, which will enhance their sustainability in the present and the future. To achieve this, a complete survey of villages and human settlements in the study area was conducted, as well as a determination of the proportions of the economic activities and their geographical distribution. The research concluded that there is unsustainable use and un-environmentally sound methods for some natural resources through some economic activities such as fishing for fish and birds, as well as a lack of interest and governmental neglect for some of the economic activities, such as buffalo breeding and milk production. The research reached the most important recommendations of the necessity of activating sustainable spatial development and the existence of great opportunities to invest better and sustainable natural and economic resources as well as developing the eco-tourism aspect, to achieve the well-being and prosperity of the inhabitants as well as to preserve the marshes, their integrity and their sobriety within the list of world heritage and their international environmental agreements.
Contemporary trends in sustainable urban planning Analytical Vision in Contemporary Global Experiences
Authors: Kamel Al-Rawe Moheb , Rezaq Ali Al-Timimy Sophia , Yassir Hussain Kamil
Published: April 2021

In recent years, planning science has evolved from a rational approach to an experimental one, from (as a product forms to a process of policy formulation and planning decision-making). Then, planning had transformed from the era of modernity to post-modernity, Which was accompanied by a lot of a number of trends, refer to planning is no longer measured by matching its outputs, results and formulated in shapes to the plan, but rather on the extent to which the planner contributes to improving the decision-makers’ understanding of immediate problems now and in future. Among the most prominent of these trends: Multi Ethic planning or Multicultural City planning to(Leonie Sandercock), collaborative planning to (Innes, Healy), Just city to (Fainstein), New Urbanism, and Phronetic planning to (Flyvbjerg), Which will be summarized by the research, and sheds light on Phronetic planning is the main of research axis.Wherefore, the research deals with the definition of this schematic, the philosophical foundations and the intellectual dimensions by introducing a theoretical framework that deals in detail with the concepts, details and rationality in the ideas of Aristotle and Foucault. The Planning and Design Study Project (OECD) as a model for international accreditation, winning the European Union Prize as Urban Policy in Democracy and Planning Terms. Finally, The research concludes that Phronetic planning is the most appropriate to deal with democratic practices to influence the solution of local problems that require practice and application to solve the conflict between the reconciliation and societal need, To deals with each urban situation as a special urban phenomenon and a unique humanitarian problem, that cannot be generalized or resorted to rational theories to find unilateral solutions.
Microstructural and Mechanical Properties of Laser Deposited Ti-6Al-4V Alloy: A Review
Authors: Omoniyi P.O. , Akinlabi E.T. , Mahamood R. M.
Published: April 2021

Laser Metal Deposition (LMD) is known to be an Additive Manufacturing (AM) technique which produces parts by depositing materials layer by layer. Its quality is reliant on the process parameters, which need to be optimised to attain improved mechanical properties. This article reviewed the mechanical properties (microstructure and tensile strength) of LMD Ti6Al4V alloy published by different authors and relates these mechanical properties with the effects of some of the processing parameters required for additive manufacturing of titanium alloys. Furthermore, the article summaries important findings and proffer suggestions for future research in the area of machine part repair using LMD technique.
Haplotype-based membership inference from summary genomic data
Authors: Bu Diyue , Wang Xiaofeng , Tang Haixu
Published: April 2021

Motivation

The availability of human genomic data, together with the enhanced capacity to process them, is leading to transformative technological advances in biomedical science and engineering. However, the public dissemination of such data has been difficult due to privacy concerns. Specifically, it has been shown that the presence of a human subject in a case group can be inferred from the shared summary statistics of the group, e.g. the allele frequencies, or even the presence/absence of genetic variants (e.g. shared by the Beacon project) in the group. These methods rely on the availability of the target’s genome, i.e. the DNA profile of a target human subject, and thus are often referred to as the membership inference method.

Results

In this article, we demonstrate the haplotypes, i.e. the sequence of single nucleotide variations (SNVs) showing strong genetic linkages in human genome databases, may be inferred from the summary of genomic data without using a target’s genome. Furthermore, novel haplotypes that did not appear in the database may be reconstructed solely from the allele frequencies from genomic datasets. These reconstructed haplotypes can be used for a haplotype-based membership inference algorithm to identify target subjects in a case group with greater power than existing methods based on SNVs.

Availability and implementation

The implementation of the membership inference algorithms is available at https://github.com/diybu/Haplotype-based-membership-inferences.
GEInter: an R package for robust gene–environment interaction analysis
Authors: Wu Mengyun , Qin Xing , Ma Shuangge
Published: April 2021

For understanding complex diseases, gene–environment (G–E) interactions have important implications beyond main G and E effects. Most of the existing analysis approaches and software packages cannot accommodate data contamination/long-tailed distribution. We develop GEInter, a comprehensive R package tailored to robust G–E interaction analysis. For both marginal and joint analysis, for data without and with missingness, for continuous and censored survival responses, it comprehensively conducts identification, estimation, visualization and prediction. It can fill an important gap in the existing literature and enjoy broad applicability.

Availability and implementation

TCGA data is analyzed as demonstrating examples. It is well known that such data is publicly available https://cran.r-project.org/web/packages/GEInter/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Splenial white matter integrity is associated with memory impairments in posterior cortical atrophy
Authors: Overman Margot Juliëtte , Zamboni Giovanna , Butler Christopher , Ahmed Samrah
Published: April 2021

Posterior cortical atrophy is an atypical form of Alzheimer’s disease characterized by visuospatial impairments and predominant tissue loss in the posterior parieto-occipital and temporo-occipital cortex. Whilst episodic memory is traditionally thought to be relatively preserved in posterior cortical atrophy, recent work indicates that memory impairments form a common clinical symptom in the early stages of the disease. Neuroimaging studies suggest that memory dysfunction in posterior cortical atrophy may originate from atrophy and functional hypoconnectivity of parietal cortex. The structural connectivity patterns underpinning these memory impairments, however, have not been investigated. This line of inquiry is of particular interest, as changes in white matter tracts of posterior cortical atrophy patients have been shown to be more extensive than expected based on posterior atrophy of grey matter. In this cross-sectional diffusion tensor imaging MRI study, we examine the relationship between white matter microstructure and verbal episodic memory in posterior cortical atrophy. We assessed episodic memory performance in a group of posterior cortical atrophy patients (n = 14) and a group of matched healthy control participants (n = 19) using the Free and Cued Selective Reminding Test with Immediate Recall. Diffusion tensor imaging measures were obtained for 13 of the posterior cortical atrophy patients and a second control group of 18 healthy adults. Patients and healthy controls demonstrated similar memory encoding performance, indicating that learning of verbal information was preserved in posterior cortical atrophy. However, retrieval of verbal items was significantly impaired in the patient group compared with control participants. As expected, tract-based spatial statistics analyses showed widespread reductions of white matter integrity in posterior cortical regions of patients compared with healthy adults. Correlation analyses indicated that poor verbal retrieval in the patient group was specifically associated with microstructural damage of the splenium of the corpus callosum. Post-hoc tractography analyses in healthy controls demonstrated that this splenial region was connected to thalamic radiations and the retrolenticular part of the internal capsule. These results provide insight into the brain circuits that underlie memory impairments in posterior cortical atrophy. From a cognitive perspective, we propose that the association between splenial integrity and memory dysfunction could arise indirectly via disruption of attentional processes. We discuss implications for the clinical phenotype and development of therapeutic aids for cognitive impairment in posterior cortical atrophy.
Endothelial Zeb2 preserves the hepatic angioarchitecture and protects against liver fibrosis
Authors: de Haan Willeke , Dheedene Wouter , Apelt Katerina , Décombas-Deschamps Sofiane , Vinckier Stefan , Verhulst Stefaan , Conidi Andrea , Deffieux Thomas , Staring Michael W , Vandervoort Petra , Caluwé Ellen , Lox Marleen , Mannaerts Inge , Takagi Tsuyoshi , Jaekers Joris , Berx Geert , Haigh Jody , Topal Baki , Zwijsen An , Higashi Yujiro , van Grunsven Leo A , van IJcken Wilfred F J , Mulugeta Eskeatnaf , Tanter Mickael , Lebrin Franck P G , Huylebroeck Danny , Luttun Aernout
Published: April 2021

Aims

Hepatic capillaries are lined with specialized liver sinusoidal endothelial cells (LSECs) which support macromolecule passage to hepatocytes and prevent fibrosis by keeping hepatic stellate cells (HSCs) quiescent. LSEC specialization is co-determined by transcription factors. The zinc-finger E-box-binding homeobox (Zeb)2 transcription factor is enriched in LSECs. Here, we aimed to elucidate the endothelium-specific role of Zeb2 during maintenance of the liver and in liver fibrosis.

Methods and results

To study the role of Zeb2 in liver endothelium we generated EC-specific Zeb2 knock-out (ECKO) mice. Sequencing of liver EC RNA revealed that deficiency of Zeb2 results in prominent expression changes in angiogenesis-related genes. Accordingly, the vascular area was expanded and the presence of pillars inside ECKO liver vessels indicated that this was likely due to increased intussusceptive angiogenesis. LSEC marker expression was not profoundly affected and fenestrations were preserved upon Zeb2 deficiency. However, an increase in continuous EC markers suggested that Zeb2-deficient LSECs are more prone to dedifferentiation, a process called ‘capillarization’. Changes in the endothelial expression of ligands that may be involved in HSC quiescence together with significant changes in the expression profile of HSCs showed that Zeb2 regulates LSEC–HSC communication and HSC activation. Accordingly, upon exposure to the hepatotoxin carbon tetrachloride (CCl4), livers of ECKO mice showed increased capillarization, HSC activation, and fibrosis compared to livers from wild-type littermates. The vascular maintenance and anti-fibrotic role of endothelial Zeb2 was confirmed in mice with EC-specific overexpression of Zeb2, as the latter resulted in reduced vascularity and attenuated CCl4-induced liver fibrosis.

Conclusion

Endothelial Zeb2 preserves liver angioarchitecture and protects against liver fibrosis. Zeb2 and Zeb2-dependent genes in liver ECs may be exploited to design novel therapeutic strategies to attenuate hepatic fibrosis.
A comparative analysis of the diagnostic performances of four clinical probability models to rule out pulmonary embolism
Authors: Silva BV , Mendonca C , Silverio Antonio P , Ferreira A , Cunha N , Rodrigues T , Morais P , Alves Da Silva P , Pacheco R , Jorge C , Pinto FJ
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Ruling out pulmonary embolism (PE) through a combination of clinical assessment and Ddimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA), and different algorithms should be considered as an alternative to the fixed cutoff to achieve that goal.

Purpose

 To compare diagnostic performance of 4 algorithms to rule out PE: fixed Ddimer cutoff, age-adjusted, YEARS and PEGeD.

Methods

 Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to May 2020.

In fixed and age-adjusted cut-off, high probability patients are directly selected for CTPA. Low to moderate probability patients perform CTPA if Ddimer ≥500µg/L in fixed cutoff, and in age-adjusted cutoff if Ddimer ≥500µg/L in patients who are ≤ 50 years of age, and if Ddimer level was more than 10 times the patient’s age in patients older than 50 years. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimers >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA.

Results

We enrolled 571 patients and PE was confirmed by CTPA in 172. Compared with a fixed Ddimer cutoff, age-adjusted was associated with a significant increase of specificity (p < 0.001), correctly avoiding 38 CTPAs, without losing sensitivity. YEARS and PEGED resulted in a increase in specificity, compared to the fixed cutoff, but with an impairment of sensitivity (p < 0.001). PEGeD had the worst sensitivity (13 more false negatives (FN) than the fixed cutoff). Despite the lack of difference between PEGed and YEARS strategies regarding sensitivity, PEGED had a significantly higher specificity (p < 0.001) and allowed to correctly avoid a higher number of CTPA (95 vs 85), compared to the fixed cutoff.

Conclusion

 Compared to fixed d-dimer cutoff, all algorithms were associated with an increased specificity. Age-adjusted cutoff was the only that is not associated with a significant decrease in sensitivity when compared to fixed cutoff, allowing to safely reduce the need to perform CTPA. Sen(%)Spec(%)Correctly avoid CTPAs(n)FN(n)Fixed cutoff251017Age-adjusted933513912YEARS894718619PEGED884919620
Association of CTLA4 gene polymorphism with dilated cardiomyopathy
Authors: Chernova A , Nikulina SY , Kuznecova OO
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Aim

To evaluate the Association of rs231775 polymorphism of the CTLA4  gene with dilated idiopathic cardiomyopathy (DCMP) and myocardial dilation of ischemic origin (DMI).

Subjects and methods

The study included patients with ICMP and DMI in the number of 221 people. The average age of the subjects was in the range of 55.30 ± 9.69 years.

We divided the patients into 2 groups: the first – patients diagnosed with idiopathic dilatation cardiomyopathy and the second-patients with myocardial dilatation of ichemic origin. The number of patients in the first group was 111, including 99 men (89.2%) and 12 women (10.8%). The average age of patients in this group is 51.73 ± 9.74 years, in men 51.00 ± 8.96 years, in women 57.75 ± 3.71 years.

The second group included patients with myocardial dilatation of ischemic origin. Their number is 110 people, including 100 men (91.5%) and 10 women (8.5%). The average age of respondents is 58.68 ± 8.38 years, for men 58.29 ± 8.46 years, for women 62.90 ± 6.29 years.

The control group included patients who had no manifestations of cardiovascular diseases. Their number is 121 people (average age 53.6 ± 4.8 years).

The patients underwent laboratory and instrumental studies, as well as molecular and genetic studies of the 49A/G polymorphism of the CTLA4  gene (rs231775). All patients underwent coronary angiography. Based on the anamnesis data and instrumental studies, those patients who could be said to have no risk factors for the development of dilatation of the heart cavities were identified in the first group. And those patients who were reliably diagnosed with CHD were in the second group, that is, dilatation of the heart cavities is due to a previous myocardial infarction, existing angina pectoris.

Results

In the group with DCMP 34.2% of patients were carriers of the common homozygous 49AA genotype, the heterozygous 49AG genotype-48.6%, and the rare homozygous 49GG genotype-17.1%. In the control group 33.5% of patients were identified as carriers of a homozygous genotype by a common allele, and 49.3% were carriers heterozygous genotype, and homozygous genotype for a rare allele – 17.2%. The analysis revealed a statistically non significant increase in the frequency of carrying the homozygous AA genotype in patients with DCMP compared to the control group of the rs231775 polymorphism of the CTLA4  gene. In the group with DMI, there was no association with the rs231775 polymorphism of the CTLA4  gene.

Conclusion

A statistically significant association of rs231775 of the CTLA4 gene with DCMP was not  found. The association of DMI c rs231775 could not be confirmed.
S-reflex score: a predictor score of vaso-vagal reflex syncope
Authors: Costa H , Fernandes R , Mota T , Bispo J , Azevedo P , Santo M , Carvalho D , Marques N , Candeias R , Jesus I
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Reflex syncope is one of the most common causes of syncope, usually associated with unspecified triggers and prodromes. The probability of occurrence is higher when  concomitant factors coexist whether inherent to individual or related to environment, and changes in conventional tests may prove useful in their diagnosis.

Objective

Identify predictive factors in the initial investigation in order to establish a predictor score of vasovagal reflex syncope (VVS).

Methods

Observational and retrospective study, with descriptive analysis and correlation of patients followed in syncope appointment at a Cardiology Center from 1 January 2015 to 31 Novembe 2019. Descriptive analysis on patient characteristics and complementary exams were carried out. The correlation test used between categorical variables was Chi-square and among continuous variables the T-Student test with a significance level of 95%. Independent predictors of VVS were identified through binary logistic regression considering a p = 0.05, with subsequent application of a discriminatory function using the lambda Wilks test to determine the discriminant score of variables under analysis. SPSS 24.0 was used for statistical analysis.

Results

Identified N694 patients, 52% male, mean age of 63 years. 15.7% of patients with suspected VVS in a first impression. At the end, 22.9% diagnosed with VVS and of these 66% had syncope recurrence. 42% had long prodromes (p = 0.013), 17% with heat prodromes (p = 0.012), in 11.3% the trigger was the meal (p = 0.031), 12.2% suffered trauma (p = 0.07) and 59.7% had ECG with pathological q wave (p = 0.00), thus showing to be independet predictors of  VVS. A predictor score of VVS was determined using the formula = -0.761 + (0.529.Long_Prodromes) + (0.721.Heat_Prodromes) + (0.313.Trigger_Meal) + (2,431.ECG_q) - (0.542.Trauma), with a cutoff value of 0.258, specificity of 90.5% with discriminative power of 87%.

Conclusion

The final diagnosis of VVS was higher than suspicions during initial clinical investigation and 66% of these patients had recurrence. The independent predictors factors of VVS are long prodromes, heat prodromes, meal as a trigger, ECG with q waves and trauma. The S-Reflex score was determined with a good discriminative power with high specificity. Considering clinical variables and conventional exams, this score could be useful to guide the strategy for syncope patients after the first evaluation to a more cost-effective strategy.
Leadless pacemaker vs conventional single chamber pacemaker for urgent permanent implantation in elderly and very elderly patients
Authors: Marschall A , Del Castillo Carnevali H , Torres Lopez M , Goncalves Sanchez F , Marti Sanchez D , Delgado Calva F , Biscotti Rodil B , Alvarez Anton S , Rubio Alonso M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Data on feasibility of leadless pacemaker (LPM) in the elderly and very elderly is scarce. We aimed to investigate the security and feasibility of urgent LPM implantation in elderly patients.  

Methods

Observational study of a prospective register of consecutive patients that underwent LPM insertion in a single centre. Elderly (≥75 years) and very elderly patients (≥85 years) that underwent LPM implantation in a non-elective setting between June 2016 and January 2020 were eligible. We compared pacing thresholds, R wave and impedance at baseline, short- and long term follow-up. Furthermore, we compared complication rate and all-cause mortality of LPM patients to patients that underwent conventional SCP insertion. 

Results

78 elderly patients (25 LPM, 53 SCP) with a mean age of 82.4 and 83.8 years, respectively (p = 0.82), were included in the study. The mean follow-up time was 11.2 months. 35 patients (11 LPM, 24 SCP) had an age of ≥ 85 years. There were no significant differences with respect to demographic and baseline clinical data between LPM patients and SCP patients. (Table) Furthermore, we did not find significant changes in pacing thresholds, R wave and impedance on short- and long-term follow-up. Complication rates at 12 months of elderly and very elderly LPM patients were similar to those that underwent conventional SCP implantation (0% vs 5.7%, p = 0.35; 0% vs 4.2%, p = 0.41, respectively). Likewise, we did not find significant differences regarding all-cause mortality (12% vs 13%, p = 0.92; 9% vs 25%, p = 0.18). Comparing Kaplan-Meier curves, no significant differences were found regarding 12 month complication rate and all-cause mortality between LPM patients and conventional SCP patients, as assessed by Log Rank test (p = 0.98 and p = 0.91, respectively). (Figure)

Conclusion

LPM implantation is a feasible and secure alternative to conventional SCP insertion in elderly and very elderly patients, even in a non-elective setting. Basline characteristicsBaseline characteristicsConventional SCP, n = 53Leadless pacemaker, n = 25p-valueAge - years83.8 (±6.4)82.4 (±6.4)N/SSex, male - n (%)28 (52)16 (64)N/SChronic kidney disease - n (%)16 (30)6 (24)N/SAtrial fibrillation - n (%)45 (85)19 (76)N/SCharlson index, (IQR)4 (3-7)5 (4-7)N/SR wave amplitude, mV (IQR)10.5 (7.4-13.3)12.2 (9.3-15.2)N/SPacing threshold, mV (IQR)0.6 (0.5-0.9)0.4 (0.3-0.7)N/SImpedance, Ohm (IQR)669 (±185)713 (±191)N/SIQR, interquartile range; N/S: Not significant; SCP: Single chamber pacemaker​Abstract Figure. Kaplan Meier curves, Mortality
Arrhythmic storm in the acute coronary care unit
Authors: Garcia-Arribas D , Rosillo S , Caro J , Armada E , Carrion I , Ferrera C , Noriega FJ , Viana A , Lopez De Sa E
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Beca para la Formación e Investigación en Cuidados Críticos Cardiológicos concedida por la Asociación de Cardiopatía Isquémica y Cuidados Críticos Cardiológicos de la SEC

Introduction

Available data on arrhythmic storm (AS) is usually obtained from retrospective observational studies based on series of patients (pts) with ICD or who undergo ablation. Therefore, selection bias limits the evidence regarding mortality and prognosis of this entity.

Purpose/ Methods

Describe epidemiological and clinical characteristics, as well as therapeutic strategies and in-hospital mortality as main outcome of pts admitted between 2006 and 2020 for AS in the Acute Cardiac Care Unit (ACCU) of 2 tertiary hospitals in Madrid, Spain.

Results

A total of 190 episodes of AS in 169 pts were analysed. Baseline characteristics are depicted in Figure 1. Cardiovascular targeted treatments of pts included: betablockers (68.7%), ACEi or ARB (53.2%), ARNI (6.5%), AA (38.5%), group III antiarrhythmic drugs (27.1%) and digoxin (5.9%).

Aetiology of the AS was determined in 68.6% of the episodes: myocardial ischemia 25.1%, STEMI 22.5%, acute myocarditis 0.5%, heart failure or cardiogenic shock 28.8%, infection 11%, Bradycardia and long QT interval 10%, ionic disturbances 6.3%, others 11.5%.

Antiarrhythmic drugs used for the acute episode were: amiodarone (73.3%), procainamide (27.2%), sotalol (5.7%), other beta blockers (75.9%), calcium channel blockers (3.1%), quinidine (2.1%). Other therapies were performed as follows: sedative drugs 50.3%, endotracheal intubation 39,9%, correction of electrolyte disturbances 51.8%, therapeutic hypothermia 13.6%, intravenous temporary pacemaker insertion or ICD reprogramming (9.9%). In 45% of pts coronary angiography was performed, but only 25.7% required revascularization. Vasopressors and inotropic drugs were used in 51% of pts. Regarding mechanical support intra-aortic balloon pump was implanted in 16.2% of episodes, ECMO in 3.7% and other left ventricular assist devices in 3.1%. One patient was transplanted.

Ventricular tachycardia (VT) ablation was performed in 38.7% of episodes and its efficiency was 69.4%. Three pts underwent stellate ganglion ablation and surgical sympathectomy, and in one pt sympathectomy alone was performed. ICD was implanted in 23 pts after the AS episode.

Survival at discharge was 81.1%. Mortality in STEMI related AS was 44.2%, while in the rest of aetiologies was 6.1%. Mortality among patients with an ICD was 6.3%.

Conclusion

Patients with AS requiring admission to an ACCU have predominantly ischemic background (both acute and chronic). Most common therapeutics are beta-blockers, amiodarone, sedation and VT-ablation. In-hospital mortality differs depending on the aetiology being worst in STEMI related AS. Abstract Figure 1
Complications and outcome of the long-term use of the intra-aortic balloon pump in patients with end-stage heart failure
Authors: Stratinaki M , Bousoula E , Malakos I , Zymatoura M , Fountas E , Tsiampalis A , Aravanis N , Kadda O , Chatzi S , Athinaiou A , Karagiannis A , Sbarouni E
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Intra-aortic balloon pump (IABP) can be used as circulatory support in order to stabilize haemodynamically compromised patients as either a bridge to therapy or to further mechanical support. Based on the current literature its use should be limited to up to two weeks and there are not enough data regarding its long term use’s efficacy and possible complications.

Purpose

To review the possible complications of the long-term use of IABP

Methods

We restrospectively analysed the data from 24 consecutive patients with end-stage heart failure (ESHF) who received long-term IABP support and recorded the complications during their hospitalization as well as their outcome.

Results

24 patients (14 male and 10 female) were included. In 5 of them ESHF was attributed to ischemic cardiomyopathy and the in 19 to dilated cardiomyopathy. Their mean age was 45.6+/-14 years. The mean duration of IABP support was 70.2 days (minimum 30days maximum 192 days). The mean ejection fraction (EF) was 20%. Regarding the pharmacological therapy, 12/24 patients were on dobutamine, 4/24 on dobutamine and milrinone and 8/24 on dobutamine and noradrenaline. Regarding the clinical course of these patients, 7/24 underwent heart transplantation, 2/24 managed to wean from IABP, 5/24 received left lentrivular assist device (LVAD), 6/24 received biventricular assist veice (BiVAD) and 4/24 died. In terms of complications they were recorded as following : infection 7/24, bleeding 3/24, thrombosis 4/24, heparin-induced thrombocytopenia(HIT) 5/24, hematoma 4/24, ischemia 0/24 and rupture 1/24.

Conclusions

  Although not indicated by the current guidelines, long term IABP can be used as a relatively safe  circulatory support method.
Pulmonary hypertension with or without right ventricular failure as short-term prognostic predictors in patients with AHF
Authors: Quintana Da Silva M , Gimenez JE , Martinez J , Ojeda J , Gomes D
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Different registries have reported Right Ventricular Failure (RVF) as a predictor of IH mortality in patients with AHF. However, the association of different degrees of Pulmonary Hypertension (PH) associated with or without RVF as prognostic predictors of IH mortality and Rehospitalization (RH) at 60 days is not well stablished.

Methods

We included 394 consecutive patients from January 2012 to August 2020 with the primary diagnosis of AHF and different degrees of PH with or without RVF. IH mortality and RH after 60 days of patients with AHF and the presence of RVF with or without PH were evaluated and stratified by severity into mild, moderate and severe PH and forms of presentation of AHF. Univariate, bivariate and multivariate analysis was performed by logistic regression of the independent variables. The qualitative variables were analyzed by the chi square test and the quantitative variables by T Test. P was considered significant at values <0.05.

Results

 The mean age was 74 years, 40% female, HBP 49%, dyslipidemia 52%, obesity 52%, type 2 DM 42%, smoking 28% and COPD 26%. 16% were de novo AHF and 84% with exacerbated CHF. Global RVF 6%. PH was present in 60%, being 24% mild, 25% moderate, 10% severe. The Left ventricular Ejection fraction (LVEF) mean was 52% (SD ± 15.1); Preserved 60%, Intermediate Range 18% and Reduced 22%. The IH mortality was 6.6% and the RH rate at 60 days was 21%. In the bivariate analysis for IH mortality, RVF was identified as an independent predictor of mortality (p = 0.001) nor for RH (p = 0.857). The different levels of PH were not identified as predictors of IH Mortality as well as RH. LVEF ranges did not show significant differences, nor in the forms of AHF presentation. The combined analysis of RVF or Left with different degrees of PHT did not show significant differences in IH mortality and RH.In the multivariate analysis by logistic regression for IH mortality, the presence of RVF maintained independence as a predictor variable (p = 0.004).

Conclusion

 In our population of patients with AHF, the presence of RVF is a predictor of IH mortality regardless of the presence of PH, the PH and LVEF ranges. The presence of RVF was not associated with a higher rate of RH at 60 days.
Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors
Authors: Marcusohn E , Kobo O , Postnikov M , Epstein D , Agmon Y , Gepstein L , Hellman Y , Zukermann R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR).

Aim

 The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL).

Methods

 This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF.

All patients had documented preserved LVEF at baseline (EF >50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded.

Results

From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction.

Conclusion

In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.
Indirect autonomic nervous system activity assessment in patients with myocardial infarction
Authors: Aleksandrenko VA , Kuzheleva EA , Garganeeva AA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Abnormalities in the cardiac sympathetic nervous system have been documented in myocardial infarction (MI) and have been directly implicated in pathogenesis and progression of MI. Assessment of the autonomic nervous system activity in acute stage of MI allowed us to identify groups of high-risk patients.

Purpose

To investigate the sympathetic nervous system activity in patients with MI by assessing the condition of beta-adrenergic reactivity of erythrocytes. To analyze ADRB1 Arg389Gly associations with the state of beta-adrenergic reactivity of erythrocytes in patients with MI.

Methods

During the study period, 62 patients were enrolled. The patients were divided into 2 groups. The first group consisted of 11 patients (nine women and two men, median age of 54.0 [49.0;61.0] years) with normal beta-adrenergic reactivity of erythrocytes, the second group consisted of 51 patients (40 women and 11 man, median age of 61.0 [48.0;72.0] years) with abnormal beta-adrenergic reactivity of  erythrocytes. The research of beta-adrenergic reactivity of erythrocytes was conducted by analysis of changing erythrocyte osmoresistance under the influence of beta blocker in the first 6 hours from the onset of the heart attack. The genetic research was conducted by PСR method in real time.

Results

Groups of patients were comparable in main clinical indicators (anamnesis of ischemic heart disease and chronic heart failure, frequency of beta blockers administration before and during of MI, electrocardiography features: elevation of ST-segment, Q-wave and etc.).

The second group presented with a higher occurrence of acute left ventricular failure (33.3% vs 0%, p = 0.026) and arterial hypertension (90.2% vs 63.6%, p = 0.044). Parameters of myocardial damage were significantly higher in the second group than the first group. Primarily, this manifested in the presence of a greater number of hypokinesis zones on echocardiography (p = 0.015). In addition, patients of the second group had a lower ejection fraction according to echocardiography (51.0 [46.5;59.0]% vs 58.0 [52.0;63.0]%, p = 0.042). Levels of blood necrosis biomarkers were significantly higher in the second group, e.g. Troponin I (24.1 [9.9;68.0] ng/ml vs 1.3 [0.2;1.8] ng/ml, p = 0.001). At the same time statistically significant distinctions of the severity of coronary atherosclerosis in groups were not revealed.

The analysis of ADRB1 Arg389Gly demonstrated association of CC-genotype with abnormal beta-adrenergic reactivity of erythrocytes [OR 5.9, 95% СI 1.16-30.25, p = 0.043].

Conclusion

Patients with an abnormal beta-adrenergic reactivity were characterized by a greater volume of damage to the heart muscle. Moreover, association of CC-genotype of gene ADRB1 Arg389Gly with abnormal beta-adrenergic reactivity of erythrocytes was identified.
Association of biomarkers of fibrinolysis and inflammation with mortality in acute coronary syndrome
Authors: Matsudo M , Aladio JM , Costa D , Scazziota A , Swieszkowski SP , Perez De La Hoz RA
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Universidad de Buenos Aires.

Introduction

in acute coronary syndromes (ACS), plaque rupture elicits a prothrombotic response that is counter balanced by a fibrinolytic response. D-dimer (DD) serves as a marker of both processes, reflecting thrombin activity and through cross-linked fibrin degradation. Inflammatory mediators are also involved, evidenced with the rise of C-reactive protein (CPR) levels, enhancing the prothrombotic and proatherogenic endothelial vascular response. Current evidence with these biomarkers has shown conflicting results with no conclusive impact on cardiovascular outcomes, risk stratification nor potential treatments.

Purpose

our aim was to determine an association between DD and CRP with in-hospital and 1-year mortality in patients with ACS.

Methods

observational study of patients admitted to a coronary care unit with ACS and elevated troponin. Clinical characteristics, in-hospital and 1-year outcomes and serum levels at admission of DD and CRP were assessed.

Results

we included 127 patients with ACS. Mean age was 68.4 ± 12.8 years and 61% were male, 57.7% had hypertension, 17.1% had dyslipidemia, 25.2% had diabetes and 17.9% had previous myocardial infarction. Most patients received DAPT and 67.5% underwent PCI or CABG during the index hospitalization. In-hospital mortality was 5.7% and 1-year all-cause and cardiovascular mortality were 14.6% and 9.7% respectively. The median of admission DD for patients who died during hospital stay was higher than those who survived (4.59 [IQR 1.94-6.05 ug/ml FEU] vs 0.56 [IQR 0.31-1.12 ug/ml FEU], p = 0.001). At 1-year follow-up, the median of admission DD for patients who died was significantly higher than those who survived: 1.55 (IQR 0.91-5.08 ug/ml FEU) vs. 0.53 (IQR 0.29-0.90 ug/ml FEU), p < 0.001 (figure A). We analyzed positive DD vs. negative DD at admission, with 0.5 ug/ml FEU cut-off value, almost a quarter of the positive patients were dead at 1-year follow up (22.4% vs. 2.4% negative DD, p= 0.011). We found a positive significative correlation between DD and CRP levels (R = 0.56, p < 0.001) (figure B).

Conclusion

high levels of DD at admission were strongly associated with in-hospital and 1-year mortality. Significant correlations with CRP could explain the inflammatory nature that lead to poorer outcomes. DD could be useful in risk-stratification in ACS; however, a specific threshold should be defined for this type of patients. Abstract Figure A. Figure B.