bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of seawater temperature and NaCl concentration on interlaminar shear behavior of CFRP laminates
Authors: Li Hailin , Chen Huijian , Zhang Wei , Suo Haoyuan
Published: February 2022

The aim of this paper is to study the interlaminar shear behavior of CFRP in critical service conditions. The specimens were immersed in the prepared artificial seawater for 7 months to investigate the ageing time, ambient temperature and salt concentration effects. Analytical balance was used to weight the samples for analyzing the dynamic moisture absorption behavior. Short beam shear tests were carried out to evaluate the interlaminar shear properties. Scanning electron microscopy (SEM) was used to observe the ageing damage and failure morphology. The results show that moisture absorption behavior of composites follows Fickian diffusion law. Moisture absorption rate and the maximum absorption content are mainly affected by ambient temperature but not by NaCl concentration. Compared with ageing time and NaCl concentration, the shear stiffness and shear strength are more sensitive to aging environmental temperature. After exposed in 3.5%–70 °C seawater environment for 7 months, the retention rate of shear strength is only 68.8% and the failure displacement decreases by 20.5%. The shear strength increases first and then decreases with the increase of the maximum moisture absorption, which is mainly related to the release of curing shrinking stress and the damage of interface properties. The shear properties degradation after aging is mainly related to the damage of materials induced by environment (delamination, fiber/matrix interface debonding and matrix cracking).
HAp/TiO2 heterojunction catalyst towards low-temperature thermal oxidation of VOC
Authors: Kato Kunihiko , Kobayashi Fumiaki , Xin Yunzi , Nakagawa Sohei , Nishikawa Harumitsu , Shirai Takashi
Published: February 2022

Ceramic catalyst without precious metals and rare-earth elements is a promising technology for removing volatile organic compounds (VOC) produced in the manufacturing process to feasibly solve worldwide health and environmental problems. We first investigate the influence of hydroxyapatite (HAp)/TiO2 heterojunction formation on the temperature dependence of VOC catalytic performance. The comprehensive evaluation by XRD, FT-IR, UV–vis, and in situ ESR clarifies that the anisotropic crystal distortion along the c-axis of HAp lattice is caused by hydrolysis and hetero-condensation of TiO2 precursor accompanying with the defective structure in HAp. The structural modified HAp (m-HAp) provides the notable alteration of optical bandgap with the visible-light coloration and the preferential generation of oxygen radicals. Furthermore, we propose a new model that the m-HAp/TiO2 heterojunction should be a possible main factor affecting the more than twice higher catalytic performance in thermal oxidation of ethyl acetate at a lower temperature, as typically shown in HAp-T1.
A discontinuous Galerkin pressure correction scheme for the incompressible Navier–Stokes equations: Stability and convergence
Authors: Masri Rami , Liu Chen , Riviere Beatrice
Published: February 2022

A discontinuous Galerkin pressure correction numerical method for solving the incompressible Navier–Stokes equations is formulated and analyzed. We prove unconditional stability of the proposed scheme. Convergence of the discrete velocity is established by deriving a priori error estimates. Numerical results verify the convergence rates.
Homotopy theory of algebras of substitudes and their localisation
Authors: Batanin Michael , White David
Published: February 2022

We study the category of algebras of substitudes (also known to be equivalent to the regular patterns of Getzler and operads coloured by a category) equipped with a (semi)model structure lifted from the model structure on the underlying presheaves. We are especially interested in the case when the model structure on presheaves is a Cisinski style localisation with respect to a proper Grothendieck fundamental localiser. For example, for

W

=

W

∞

\mathtt {W}= \mathtt {W}_{\infty }

the minimal fundamental localiser, the local objects in such a localisation are locally constant presheaves, and local algebras of substitudes are exactly algebras whose underlying presheaves are locally constant.

We investigate when this localisation has nice properties. We single out a class of such substitudes which we call left localisable and show that the substitudes for

n
n

-operads, symmetric, and braided operads are in this class. As an application we develop a homotopy theory of higher braided operads and prove a stabilisation theorem for their

W

k

\mathtt {W}_k

-localisations. This theorem implies, in particular, a generalisation of the Baez-Dolan stabilisation hypothesis for higher categories.
Primary Pancreatic Lymphoma Evaluated by Fine-Needle Aspiration
Authors: Gan Qiong , Caraway Nancy P , Ding Cady , Stewart John M
Published: February 2022

Objectives

Primary pancreatic lymphoma (PPL) is rare, mimicking pancreatic ductal adenocarcinoma (PDAC) clinically and radiologically. The aim of this study is to evaluate the clinical, radiologic, and pathological characteristics of PPL diagnosed by fine-needle aspiration (FNA) in our institution.

Methods

Patient clinical, radiologic, and pathological information was collected from the electronic health record system.

Results

In total, 11 of 4,353 pancreatic FNAs met the criteria. The most common clinical symptom was jaundice, followed by abdominal pain, weight loss, and diarrhea. Abnormal laboratory findings included elevated alkaline phosphatase, total bilirubin, lactate dehydrogenase, and cancer antigen 19-9. Abnormal radiologic findings included pancreatic mass, biliary dilatation, vessel encasement, and common bile duct encasement and thickening. Five patients underwent more than 1 tissue sampling procedure before the final diagnosis of lymphoma. Final pathologic diagnosis included 7 large B-cell lymphomas and 4 follicular lymphomas. Flow cytometric analysis was performed on 9 specimens, and all demonstrated an aberrant monoclonal B-cell population.

Conclusions

PPL mimics PDAC clinically and radiologically and could be a challenge for pathologic diagnosis if lymphoma is not included in the differential diagnosis during immediate evaluation. If lymphoma is suspected during immediate evaluation, PPL could be reliably diagnosed by FNA with the aid of ancillary studies.
Promoting β-lactam utilization through suppression of electronic medical record cross-allergy alerts
Authors: Boesch Teryl S , Eischen Edward , Ries Amanda M , Quinn Andrea , Dave Ankur , Beezhold David W
Published: February 2022

Purpose

Current literature surrounding management of patients with reported β-lactam allergies focuses on allergy delabeling. Standard clinical decision support tools have not been optimized to be compatible with the currently accepted cross-reaction rate of 1% to 2%. This potentially promotes use of non–β-lactam antibiotics, which are often not first-line therapy and may carry increased risks. The impact of electronic medical record (EMR) clinical decision support tool optimization on utilization of β-lactam antibiotics in β-lactam–allergic patients was evaluated.

Methods

A retrospective pre-post β-lactam cross-allergy EMR alert suppression quality improvement intervention cohort study of β-lactam–allergic adult inpatients prescribed antibiotics was conducted. Preintervention baseline data were collected for an initial cohort admitted during September 2018. The intervention, in which clinical decision support rules were updated to display β-lactam cross-sensitivity allergy alerts only for β-lactam–allergic patients with documentation of organization-defined high-severity reactions of anaphylaxis, hives, and shortness of breath, was implemented August 20, 2019. The postintervention cohort included patients admitted during September 2019.

Results

A 91% increase in the percentage of β-lactam–allergic patients who received a β-lactam agent at any time during their admission was noted after the intervention (26.6% vs 51%, P < 0.001). Statistically significant decreases in prescribing of alternative antibiotic classes were seen for fluoroquinolones (decrease from 45.3% to 26%, P < 0.001), aminoglycosides (decrease from 9.4% to 2.9%, P = 0.002), and aztreonam (decrease from 30% to 16.7%, P < 0.001).

Conclusion

EMR β-lactam cross-allergy alert optimization consistent with current literature significantly improved the utilization of alternative β-lactam subclasses, mostly through β-lactam prescribing as initial therapy in β-lactam–allergic patients.
Adherence to goal-directed therapy for patients with cirrhosis hospitalized with spontaneous bacterial peritonitis
Authors: Eberhard Chrysten M , Davis Kyle A , Nisly Sarah A
Published: February 2022

Purpose

The American Association for the Study of Liver Diseases has developed a standard of care for the treatment of patients with spontaneous bacterial peritonitis (SBP). Evidence examining the adherence rate to these guideline recommendations is limited. This study aimed to determine the adherence rate to guideline-directed therapy for patients with cirrhosis hospitalized with SBP.

Methods

This institutional review board–approved retrospective cohort study conducted at a large academic hospital evaluated the adherence rate to guideline-directed therapy in adult patients with cirrhosis hospitalized with SBP. Included hospitalized patients had a documented diagnosis of cirrhosis and acute SBP. The adherence rate to guideline-directed therapy was determined by receipt of paracentesis within 24 hours of admission, request of Gram stain and culture tests, avoidance of fresh frozen plasma, receipt of albumin on days 1 and 3, receipt of empiric antibiotics within 6 hours, receipt of SBP prophylaxis, receipt of deep vein thrombosis prophylaxis, and offer of pneumococcal vaccination.

Results

A total of 110 patients were included. Provider adherence to goal-directed therapy was poor, with criteria met for only 10 (9.1%) patients. The therapies with the lowest adherence rates included SBP prophylaxis on discharge (54.5%), receipt of albumin on day 3 (42.7%), and offer of pneumococcal vaccination during admission (43.6%). Patients with a gastrointestinal consult were more likely than those without a consult to obtain albumin on day 1 (69.4% vs 36.8%, P = 0.001) and albumin on day 3 (52.8% vs 23.7%, P = 0.004).

Conclusion

This study demonstrated a lack of adherence to guideline-directed therapy for the management of SBP.
Retrospective evaluation of a delirium order set utilizing nonpharmacologic and pharmacologic interventions for the treatment of delirium in medical intensive care unit patients
Authors: Taylor Alex D , Chen Alyssa , Reddy Anita J , Lewandowski Adriane , Torbic Heather
Published: February 2022

Purpose

To describe the use of a medical intensive care unit (MICU) delirium order set pilot and its associated impact on utilization of nonpharmacologic and pharmacologic interventions, pharmacologic continuation at transitions of care, and resolution of ICU delirium.

Methods

This was a retrospective cohort analysis of MICU patients who received delirium management using an order set pilot compared to standard care. Patients 18 years of age or older admitted to the MICU between May 2019 and January 2020 who received an antipsychotic or valproic acid for the treatment of delirium were included.

Results

Pharmacologic treatment continuation past ICU discharge occurred in 30% of patients in the pilot cohort (n = 50) compared to 54% of patients receiving standard care (n = 50; P = 0.027). On treatment days 1 through 7, utilization of deliriogenic medications was significantly lower in the pilot cohort (78% vs 96%, P = 0.007). No differences were observed between the groups in delirium resolution, delirium recurrence, hospital and ICU length of stay, or mortality.

Conclusion

A MICU order set prioritizing nonpharmacologic management and limiting the duration of pharmacologic agents for delirium may aid providers in the management of ICU delirium and reduce exposure to pharmacologic interventions.
Physiological Demands of Common Occupational Tasks among Australian Police Officers: A Descriptive Analysis
Authors: Decker Amy , Hilton Benjamin , Dawes Jay , Lockie Robert , Orr Robin M
Published: February 2022

Objectives

The aim of this study was to investigate the physiological demands placed on Australian police officers carrying out common operational tasks.

Methods

Forty participants (n = 40) from an Australian police force (mean age = 33.58 ± 7.78 years, mean height = 177.70 ± 7.28 cm, mean weight = 85.68 ± 14.52 kg, mean years of service: 6.74 ± 6.29 years) were recruited through preidentified local area commands. Spanning nine police stations from the same Australian state, volunteers wore monitoring devices to collect physiological measures (heart rate, respiratory rate, and skin temperature) throughout the course of four consecutive shifts (two day shifts and two night shifts). Descriptive data were recorded and analyzed by task and changes in physiological measures.

Results

Of the 345 duty calls attended by participants, the four most commonly reported tasks were as follows: ‘check bona fides’ (n = 76; 22%), ‘driving urgently’ (n = 45; 13%), ‘attending a domestic incident’ (n = 37; 10%), and ‘attending a concern for welfare’ (n = 30; 8%). Mean percentages of maximum heart rates (%HRmax) were considered of very light exercise intensity and ranged from 47.11 (± 7.18) to 50.15 (± 9.35) % for checking bona fides through to driving urgently respectively. Fifteen percent of tasks attended had officers exceed 100 %HRmax (near maximal to maximal exercise intensity). Mean skin temperatures varied little (36.02–36.27°C) between tasks, while mean respiratory rates were lowest when attending a domestic incident and highest when driving urgently (22.56 ± 3.83 and 24.72 ± 6.12 breaths/min, respectively).

Conclusion

Police officers experienced numerous physiological challenges ranging from an intensity of very light exercise through to near maximal and maximal exercise throughout their working day with occasions where their heart rates exceeded 100 %HRmax. These findings highlight the physiological stress associated with common occupational policing tasks, highlighting the importance of cardiovascular health in police officers and the need for cardiovascular monitoring and conditioning.
Psychological First Aid Intervention after Exposure to a Traumatic Event at Work among Emergency Medical Services Workers
Authors: Tessier Marine , Lamothe Josianne , Geoffrion Steve
Published: February 2022

Psychological First Aid (PFA) is a promising early intervention for managing mental health symptoms and providing psychosocial support after exposure to a traumatic event (TE) among high-risk organizations such as Emergency Medical Service (EMS). However, recipients’ experience with PFA remains understudied. This study aimed to explore the perception of EMS workers (n = 13) who received PFA administered by a peer helper using a qualitative inductive approach. Findings from a thematic analysis indicated that the PFA intervention addresses EMS workers’ immediate needs in congruence with Hobfoll’s five essential principles to enhance coping and recovery after a TE. Specific components of the intervention, such as its time-sensitive nature and the closeness with peers, were especially appreciated by EMS workers. The PFA intervention appeared to have a beneficial impact on recipients, regarding the reduction of stigma, the increase of help-seeking behaviors, and the decrease of organizational difficulties. In conclusion, the PFA intervention offered by peer helpers is appreciated by recipients and is a beneficial first step toward supporting EMS workers in the aftermath of workplace trauma. These qualitative findings contribute to the current literature by informing further research about PFA intervention in other high-risk organizations and quantitative studies aiming to test PFA’s efficacy in such settings.
Ice crystal recrystallization inhibition of type I antifreeze protein, type III antifreeze protein, and antifreeze glycoprotein: effects of AF(G)Ps concentration and heat treatment
Authors: Ma Qingbao , Shibata Mario , Hagiwara Tomoaki
Published: February 2022

This study compared ice recrystallization behaviors of frozen dessert model systems containing type I antifreeze protein (AFP I), type III antifreeze protein (AFP III), and antifreeze glycoprotein (AFGP) at −10 °C. Specifically, effects of AF(G)P concentration and heat treatment (95 °C for 10 min) were examined. The concentration dependence of the ice recrystallization rate constant reasonably well fit a sigmoidal function: the fitting procedure was proposed, along with cooperative coefficient α, and a new index of AF(G)P ice recrystallization inhibition (IRI) activity (C50). After 95 °C heat treatment for 10 min, AFP III lost its ice crystal recrystallization inhibitory activity the most: AFP I was less affected; AFGP was almost entirely unaffected. These different thermal treatment effects might reflect a lower degree of protein aggregation because of hydrophobic interaction after heat treatment or might reflect the simplicity and flexibility of the higher order structures of AFP I and AFGP.
The Effect of Preanalytical and Physiological Variables on Cell-Free DNA Fragmentation
Authors: van der Pol Ymke , Moldovan Norbert , Verkuijlen Sandra , Ramaker Jip , Boers Dries , Onstenk Wendy , de Rooij Johan , Bahce Idris , Pegtel D Michiel , Mouliere Florent
Published: February 2022

Background

Assays that account for the biological properties and fragmentation of cell-free DNA (cfDNA) can improve the performance of liquid biopsy. However, preanalytic and physiological differences between individuals on fragmentomic analysis are poorly defined.

Methods

We analyzed the impact of collection tube, plasma processing time, and physiology on the size distribution of cfDNA, their genome-wide representation, and sequence diversity at the cfDNA fragment ends using shallow whole-genome sequencing.

Results

Neither different stabilizing collection tubes nor processing times affected the cfDNA fragment sizes, but could impact the genome-wide fragmentation patterns and fragment-end sequences of cfDNA. In addition, beyond differences depending on the gender, the physiological conditions tested between 63 individuals (age, body mass index, use of medication, and chronic conditions) minimally influenced the outcome of fragmentomic methods.

Conclusions

Fragmentomic approaches have potential for implementation in the clinic, pending clear traceability of analytical and physiological factors.
Systematic Review With Meta-analysis: Safety and Effectiveness of Combining Biologics and Small Molecules in Inflammatory Bowel Disease
Authors: Alayo Quazim A , Fenster Marc , Altayar Osama , Glassner Kerri L , Llano Ernesto , Clark-Snustad Kindra , Patel Anish , Kwapisz Lukasz , Yarur Andres J , Cohen Benjamin L , Ciorba Matthew A , Thomas Deborah , Lee Scott D , Loftus Edward V , Fudman David I , Abraham Bincy P , Colombel Jean-Frederic , Deepak Parakkal
Published: February 2022

Background

Combining biologics and small molecules could potentially overcome the plateau of drug efficacy in inflammatory bowel disease (IBD). We conducted a systematic review and meta-analysis to assess the safety and effectiveness of dual biologic therapy (DBT), or small molecule combined with a biologic therapy (SBT) in IBD patients.

Methods

We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Clinical trials.gov until November 3, 2020, including studies with 2 or more IBD patients on DBT or SBT. Main outcome was safety assessed as pooled rates of adverse events (AEs) and serious AEs (SAEs) for each combination. Effectiveness was reported as pooled rates of clinical, endoscopic, and/or radiographic response and remission. The certainty of evidence was rated according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.

Results

Of the 3688 publications identified, 13 studies (1 clinical trial, 12 observational studies) involving 266 patients on 7 different combinations were included. Median number of prior biologics ranged from 0 to 4, and median duration of follow-up was 16–68 weeks. Most common DBT and SBT were vedolizumab (VDZ) with anti-tumor necrosis factor (aTNF, n = 56) or tofacitinib (Tofa, n = 57), respectively. Pooled rates of SAE for these were 9.6% (95% confidence interval [CI], 1.5–21.4) for VDZ-aTNF and 1.0% (95% CI, 0.0–7.6) for Tofa-VDZ. The overall certainty of evidence was very low due to the observational nature of the studies, and very serious imprecision and inconsistency.

Conclusions

DBT or SBT appears to be generally safe and may be effective in IBD patients, but the evidence is very uncertain.
Effects of early myocardial reperfusion and perfusion on myocardial necrosis/dysfunction and inflammation in patients with ST-segment and non-ST-segment elevation acute coronary syndrome: results from the PLATelet inhibition and patients Outcomes (PLATO) trial
Authors: Batra Gorav , Renlund Henrik , Kunadian Vijay , James Stefan K , Storey Robert F , Steg P Gabriel , Katus Hugo A , Harrington Robert A , Gibson C Michael , Budaj Andrzej , Siegbahn Agneta , Wallentin Lars
Published: February 2022

Aims

Restoration of myocardial blood flow and perfusion during percutaneous coronary intervention (PCI) measured using Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and perfusion grade (TMPG) is associated with improved outcomes in acute coronary syndrome (ACS). Associations between TFG/TMPG and changes in biomarkers reflecting myocardial damage/dysfunction and inflammation is unknown.

Methods and results

Among 2606 patients included, TFG was evaluated in 2198 and TMPG in 1874 with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment ACS (NSTE-ACS). Biomarkers reflecting myocardial necrosis [troponin T (TnT)], myocardial dysfunction [N-terminal prohormone brain natriuretic peptide (NT-proBNP)], inflammation [interleukin-6 (IL-6) and C-reactive protein (CRP)], and oxidative stress/ageing/inflammation [growth differentiation factor-15 (GDF-15)] were measured at baseline, discharge, and 1- and 6-month post-randomization. Associations between TFG/TMPG and changes in biomarker levels were evaluated using the Mann–Whitney–Wilcoxon signed test. In total, 1423 (54.6%) patients had STEMI and 1183 (45.4%) NSTE-ACS. Complete reperfusion after PCI with TFG = 3 was achieved in 1110 (85.3%) with STEMI and in 793 (88.5%) with NSTE-ACS. Normal myocardial perfusion with TMPG = 3 was achieved in 475 (41.6%) with STEMI and in 396 (54.0%) with NSTE-ACS. Levels of TnT, NT-proBNP, IL-6, CRP, and GDF-15 were substantially lower at discharge in patients with complete vs. incomplete TFG and STEMI (P < 0.01). This pattern was not observed for patients with NSTE-ACS. Patients with normal vs. abnormal TMPG and NSTE-ACS had lower levels of NT-proBNP at discharge (P = 0.01).

Conclusions

Successful restoration of epicardial blood flow in STEMI was associated with less myocardial necrosis/dysfunction and inflammation. Attainment of normal myocardial perfusion was associated with less myocardial dysfunction in NSTE-ACS.
Speckle tracking echocardiography (STE) in patients with primary hyperoxularia type 1 (PH1)
Authors: Bruin De- Bon H , Garrelfs SF , Kuiper IM , Hulton S , Bouma BJ , Oosterveld MJS , Groothoff JW , Chikermane A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Primary Hyperoxaluria type 1 (PH1) is a rare, inherited metabolic disorder of glyoxylate metabolism characterized by oxalate overproduction, leading to end-stage kidney disease (ESKD) in more than half of all patients. As renal function deteriorates the ability of the kidneys to excrete the excess of oxalate is increasingly compromised resulting in elevated concentrations of oxalate in the blood and progressive systemic deposition of calcium-oxalate crystals in virtually all tissues, a situation referred to as systemic oxalosis. A wide spectrum of cardiac abnormalities are reported in PH1 patients, including presymptomatic myocardial disease early in the disease course. We aimed to further determine cardiac manifestations in a heterogenous cohort of PH1 patients by conventional and speckle tracking echocardiography (STE).

Methods

Data from 38 genetically confirmed PH1 patients were included in this two-centre study and compared to age- and sex-matched controls. Comprehensive echocardiographic analysis (including STE) was performed. PH1 patients were subdivided in three groups based on stage of chronic kidney disease (CKD) and transplantation status (CKD1-4 (n = 24), CKD5 (n = 7) and post-liver transplantation (n = 7)).

Results

Left-ventricle ejection fraction (LV EF) was preserved in all subjects. PH1 patients had a decreased global longitudinal strain compared to healthy controls, with a mean difference of -2.28 (p < 0.001). In patients with CKD1-4 decreased LS values were solely found in all apical segments, with a mean difference of -5.3 (p < 0.001) as compared to healthy controls. In patients whom already progressed to end-stage kidney disease (ESKD, defined as CKD5) diastolic dysfunction is noted, with preserved systolic function.

Conclusion

Pre-symptomatic myocardial dysfunction is present in PH1 patients with mild renal impairment and relatively normal plasma oxalate values. This indicates that cardiac screening is warranted in all PH1 patients, irrespective of renal function.
How myocardial work could be relevant in patients with an aortic valve stenosis?
Authors: Taconne M , Le Rolle V , Panis V , Hubert A , Auffret V , Galli E , Hernandez A , Donal E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Speckle tracking based myocardial work calculation is an attractive method to assess left ventricular (LV) myocardial function. In case of aortic stenosis (AS), assessment of work indices is challenging because it requires an accurate evaluation of LV-pressure curves. Therefore, we sought to evaluate the performances of two distinct methods for the estimation of myocardial work indices and to provide a quantitative comparison with invasively measured data.

Methods

Model-based and template-based methods were defined and applied for the evaluation of LV pressures on 67 AS patients. Global Constructive (GCW), Wasted (GWW), Positive (GPW), Negative (GNW) myocardial work and Global Work Efficiency (GWE) and Index (GWI) parameters were calculated using the available software computing the indices using brachial blood pressure and trans-aortic mean pressure gradient for estimating the LV pressures versus using a model-based and homemade software. A complete comparison was performed with invasive measurements.

Results

Patients were characterized by mean pressure gradient of 49.8 ± 14.8 mmHg, LV ejection fraction of 59 ± 8%, the global longitudinal strain was -15.0 ± 4.04%, GCW was 2107 ± 800mmHg.% (model-based method) and 2483 ± 1068mmHg.% (template-based method). The root mean square error (RMSE) and correlation were calculated for each patient and for each pressure estimation methods. The mean RMSE are 33.9mmHg and 40.4mmHg and the mean correlation coefficients are 0.81 and 0.72 for the model-based and template-based methods respectively. Correlation coefficient and Bland-Altman analysis were performed for the six work indices. The two methods present correlation coefficient r2 > 0.75 for almost all the indices.

Conclusion

The two non-invasive methods of LV pressure estimation and the work indices computation correlate with invasive measurements and computations for AS patients. Although the model-based approach requires less information and is associated with slightly better performances, the implementation of template-based method is easier and seems more appropriate in a clinical practice. Abstract Figure. SUMMARY
A new approach to artefact detection and its effect on the normal range of segmental strain and strain rate values
Authors: Kornev M , Rosner A , Caglayan HA
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Nord HNF1458-19

Background

Definition of normal ranges of myocardial segmental deformation are important in clinical studies and routine echocardiographic practice. It is known that artefacts hamper segmental strain and strain rate (S/SR) analysis.

Purpose

This study is based on a new approach for artefact detection. We intended to investigate to what degree different types of artefacts and their localization bias the result of measurements and to establish corrected normal ranges for segmental S/SR parameters.

Methods

The study is based on a collaboration project between the Russian cross-sectional study "Know your heart" and the Norwegian "Tromso-7" study. From 2207 participants we identified 840 individuals (511 females and 329 males, age range 40-79) with normal cardiac function by excluding left ventricular ejection fraction <50%, moderate or severe valvular heart disease, LV- dilatation, pulmonary hypertension, Q-waves and bundle branch block signs on ECG, high blood pressure, history of heart attack, use of antihypertensive drugs or high level of NT-proBNP. End-systolic longitudinal epi- myo- and endocardial strain and peak systolic SR and diastolic SR E and SR A were assessed for the calculation of segmental normal ranges.

In addition to noise and foreshortening artefacts, we introduced a concept of "curve artefact" which can be defined as unphysiological strain curve shapes. Panel A of the figure shows examples of these curve artefacts, A: diastolic mismatch B: blunted curve, and C: floating curve. All strain curves were assessed for the presence of one of these unphysiological shapes and 2D images were visually assessed for the presence of noise, reverberations, or missing parts of the myocardium.

Results

The bar-chart for segmental strain demonstrates significantly reduced strain values at the presence of curve artefacts and increased strain at the presence of foreshortening. Normal ranges for basal septal, basal, medial, and apical segments excluding segments with artefacts and foreshortening are displayed in the table. The presence of curve artefacts matched the presence of noise or other 2D image artefacts in 88% of cases.

Conclusions

Strain artefacts result in systematically reduced peak-strain values. Thus, the detection and exclusion of curve artefacts seem to be an important measure for the correct interpretation of strain curves for a definition of normalcy and pathology. The selection of artefact-free strain curves reveals high strain and SR gradients increasing from epi to endocardial position and basal-septal towards apical segments. Abstract Figure. normal range  Abstract Figure. artefacts
Feasibility of blood speckle imaging parameters as predictors of intracavitary thrombus in apical aneurysm
Authors: Montes A , Cecconi A , Martinez Vives P , De Rueda C , Gamarra A , Perich J , Roquero P , Martinez Avial M , Rojas AM , Lopez Melgar B , Diego G , Benedicto A , Dominguez L , Jimenez Borreguero LJ , Alfonso F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In patients with apical aneurysm, left ventricular thrombus (LVT) is a major complication associated with systemic embolism. Likely, abnormalities in apical wall contraction produce stagnant flow which leads to the thrombus formation. Currently, there is a lack of knowledge about predictors of thrombus in such patients. However, new imaging techniques might be able to identify flow properties useful for risk stratification. Specifically, blood speckle imaging (BSI), a technology based on high-frame rate ultrasound, is a promising pattern-matching technique that could allow a comprehensive assessment of blood flow in patients with apical aneurysms (1,2).

Purpose

The aim of the study was to demonstrate the feasibility of obtaining quantitative and qualitative measurements with BSI in patients with apical aneurysms and to explore which parameters may be associated with LVT.

Methods

We examined cases of patients with apical aneurysm and LVT studied in our tertiary center. In order to exclude from our analysis the pro-inflammatory effects of the acute event, patients with thrombus formation within the first month after the ischemic event were excluded. Patients with current presence of thrombus were also discarded. A control group of patients with apical aneurysm but without history of LVT was included.

A basic 2-dimensional echocardiography study was obtained, along with BSI images. BSI acquisitions were performed with a 29 cm/s (2.5 mHz) scale. Data regarding vortex flow were collected, including its presence, area, length, besides area without BSI vectors (Image 1). All measures were indexed by telediastolic left ventricular volume.

Results

Eight patients with apical aneurysms were enrolled in the study, four of them with history of LVT. Although in patients with history of thrombus a larger vortex area was found  (Table 1), none of the differences in the BSI parameters was statistically significant.

Conclusion

This study shows for the first time the feasibility of BSI for characterizing complex flow patterns such as vortex in patients with apical aneurysms. Explorations in larger cohorts of patients are needed to prove significant findings with this technology in the future. Abstract Figure. Image 1  Abstract TABLE 1
Left ventricular strain analysis-the importance of being expert
Authors: Cvijic M , Ambrozic J , Bervar M , Podlesnikar T , Toplisek J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

-

Background

Myocardial strain imaging using speckle-tracking echocardiography is widely used in both research and clinics. Left ventricular global longitudinal strain (GLS) has proven to be a reproducible and useful tool in clinical practice.  However, data about the variability in global and segmental strain among novice are limited.

Purpose

The aim of this study was to evaluate how the variability of strain measurements depends on the experience of the physician performing the analysis. Furthermore, we tried to assess how image quality and presence of pathology influence the diagnostic performance of the analysis.

Methods

Twenty novice (no or limited experiences with strain analysis) and 5 experts analysed offline 3 cases: a healthy adult and a patient with ischemic cardiomyopathy, both with high image quality, and a healthy adult with suboptimal image quality (insufficient tracking in two segments). Frame rates were 65, 51, and 70 fps, respectively. Left ventricular GLS and segmental longitudinal peak systolic strain were quantified using the automated function imaging protocol from vendor-specific offline analysis software. The absolute difference in GLS and segmental strain between each novice readers and experts was calculated. Mean strain measurements from the experts were used as a comparator.

Results

Absolute values of GLS ranged from -13.6% to -20.1% in the novice group, while GLS ranged from -15.6% to -18.8% in the expert group. The absolute difference in GLS was significantly higher in the novice group compared to the expert group (P < 0.001). Absolute differences in GLS varied significantly among cases, with low variability in healthy adult with high image quality (Panel A) and with significantly higher variability between novices and experts in case with suboptimal image quality and ischemic cardiomyopathy (Panel B-C). The absolute differences in segmental longitudinal peak systolic strain were up to 11.9% strain unit in novice group and up to 6,8% strain unit in experts (P < 0.001 between groups). In novice group, highest absolute differences in segmental strain were observed in the region with suboptimal tracking and in infarct region in patient with ischemic cardiomyopathy (Panel D-E).

Conclusion

Left ventricular strain analysis by a reader with no or limited experiences severely affects the diagnostic potential of this method. Significant variability in strain measurements should be considered especially in cases with suboptimal image quality and in cases with regional left ventricular pathology. Abstract Figure.
Early predictors of systolic right ventricular dysfunction in the diagnostic algorithm in young patients with pulmonary sarcoidosis
Authors: Naiden TV , Bartosh-Zelenaya SJ , Evsikova IA , Mamaeva OP
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Sarcoidosis can affect not only the lungs, but also the heart, particularly, the right ventricle (RV), by both primary (5-25% of patients) or secondary mechanism due to PH.  People of young, working age are at higher risk.

Purpose

to study global longitudinal strain (GLS), RV ejection fraction in 3D mode (EF-3D), TAPSE and S", pulmonary artery systolic pressure (SPAP) at rest and at peak of exercise in patients with sarcoidosis and to determine the role of these parameters in diagnostic algorithm.

Methods. The main group consisted of 66 patients with histologically confirmed stage I-II pulmonary sarcoidosis: 42 men (63.6%) and 24 women (36.4%); mean aged 31.9 ± 5.59 years. The control group included 33 healthy, nonsmoking people: 24 men (72.7%) and 9 women (27.3%); mean aged 30.18 ± 5.3 years.

Results. There were no deviations from the normal values of S’and TAPSE at rest, as well as at rest at the peak of exercise in both groups (p> 0.05). EF-3D RV was within the normal values and didn’t differ significantly at rest and at the peak of exercise (p > 0.05). RV GLS in both groups at rest and at the peak of exercise, were also normal. RV GLS in patients with sarcoidosis during exercise didn"t increase, but decreased (p = 0.004): from -22.8 ± 3.4% at rest to -21.2 ± 4.7% at the peak of exercise, by 7% (in control group:  -24.1 ± 2.7 to -25.1 ± 3, p = 0.002). 

Values of SPAP at rest in patients with sarcoidosis was slightly higher than in healthy individuals (28.5 ± 8.3 and 24.8 ± 5.21 mm Hg; p = 0.03), in normal ranges. At the peak of exercise SPAP in patients with sarcoidosis increased greater than in the control group (32.9 ± 10.1 and 48.36 ± 14.4 mm Hg; p = 0.000001).

In the control group at rest, the upper quartile of the SPAP was 29 mm Hg, at the peak of exercise - 38 mm Hg. In the main group, these indicators were significantly higher: 35 and 62 mm Hg. In the main group, at the peak of exercise, the SPAP value exceeded the upper quartile of the control group (38 mm Hg) in 79% of cases. These data may indicate the presence of subclinical pulmonary hypertension in the main group.

To determine the border of normal and pathology in study groups, the threshold values of the RV GLS were obtained at the peak of exercise by the method of constructing classification trees. For RV GLS at the peak of exercise, this value turned out to be -21.6%. This means that when RV GLS is less than -21.6% in young patients with pulmonary sarcoidosis, the likelihood of subclinical RV dysfunction is 90%. In combination with an increase in SPAP at the peak of exercise more than 39.5 mm Hg these patients have an even higher rank of the significance of RV dysfunction, namely 100%.

So, we propose to complete the diagnostic algorithm in patients with pulmonary sarcoidosis by RV GLS SPAP at the peak of exercise for defining the early RV systolic disfunction.
Hemodynamic responses associated with post-exercise hypotension in hypertensive patients with ischemic heart disease: concurrent circuit exercise versus high intensity interval exercise
Authors: Caminiti G , Iellamo F , D"antoni V , Catena M , Perrone M , Morsella V , Volterrani M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Concurrent aerobic plus resistance exercise (RAE) and high intensive interval exercise (HIIE) are both effective on inducing post-exercise hypotension (PEH) in patients with hypertension. However central hemodynamic changes asssociated to PEH in hypertensive subjects with underlying ischemic heart disease (IHD) have been poorly investigated. Aim: to compare the acute effects produced by these two  exercise modalities on left ventricular diastolic function and left atrial function .

Methods. Twenty untrained male patients with history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent 3 exercise sessions: RAE, HIIE and a control session without exercise each lasting 45 minutes. Echocardiography examination was performed before and between 30 minutes and 40 minutes  from the end of the exercise sessions.

Results. In the first hour post exercise BP values decreased in a similar way in RAE and HIIE and were unchanged after control.  Compared to pre-session, E/E1 ratio increased after

HIIE and remained unchanged  after both RAE snd control sessions (between-sessions p 0.002). PALS increased sligthly after RAE (+1.4 ± 1.1%), decreased  after HIIE (-4.6 ± 2.4%) .  and was unchanged after control.  (between-sessions p 0.03). PACS was mildly increased after RAE, was reduced after HIIE.  and was unchanged after control. Atrial volume was unchanged after both sessions.  Left ventricular and left atrial stiffness increased significantly after HIEE while remained unchanged after RAE and control. Stroke volume and cardiac output increased after RAE, decreased after HIIE, anùd were unchanged after control.

Conclusion.  Single sessions of RAE and HIIE determined similar PEHs in hypertensive subjects with IHD, while they evoked different central hemodinamyc adjustements. Given its  neutral effects of on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in  hypertensive patients with IHD .
Prognostic impact of right ventricular function in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Goncalves A , Pereira Da Silva T , Soares R , Galrinho A , Timoteo AT , Branco L , Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In patients with heart failure with reduced ejection fraction (HFrEF), the presence of coexistent right ventricular (RV) systolic dysfunction is associated with a worse functional capacity and outcome. However, the measurement of RV function is often overshadowed by its left counterpart.

Purpose

To assess the prognostic impact of RV dysfunction in a population of advanced HF patients.

Methods

Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team for possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. RV systolic dysfunction was defined by a tricuspid annular plane systolic excursion (TAPSE) < 17 mm and/ or fractional area change (FAC) < 35%. A survival analysis was performed to evaluate the prognostic impact of RV dysfunction and survival curves were compared using the log-rank test.

Results

A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and RV FAC of 37 ± 6%), of which 30.4% had RV dysfunction. Thirty patients (6.7%) met the primary endpoint. Patients with RV dysfunction had a higher NT-proBNP value (3278.9 ± 296.7 pg/mL, p = 0.005) and a lower LVEF (26.7 ± 6.4 vs 31.4 ± 5.1, p < 0.001), as well as a worse cardiopulmonary fitness (CPET duration: 7.2 ± 3.8 vs 8.6 ± 4.1, p = 0.019; pVO2: 13.6 ± 4.9 vs 16.2 ± 6.1 ml/kg/min, p = 0.006; VE/VCO2 slope: 41.8 ± 11.9 vs 37.0 ± 10.6, p = 0.015; cardiorespiratory optimal point: 33.0 ± 8.9 vs 28.4 ± 6.2, p < 0.001). RV dysfunction was associated with a lower survival free of events during the first follow-up year (log-rank p = 0.046).

Conclusion

RV is associated with a poor survival in advanced HF patients and it may improve risk stratification in this population. Abstract Figure.
Relationship between oxidative stress and three-dimensional echocardiographic changes in myxomatous mitral valves with severe regurgitation - a pilot study
Authors: Sosdean R , Ionica LN , Pescariu SA , Goanta FS , Lazar MA , Mornos C , Ionac A , Sturza A , Muntean DM , Luca CT , Feier H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Reactive oxygen species (ROS) have been reported to contribute to the molecular pathogenesis of severe mitral regurgitation induced by myxomatous degeneration. Data about oxidative stress and the possible relationship with the extent of prolapsing and/or flail elements is scarce in the literature. The pathogenic mechanism may prompt the development of therapeutic approaches aimed at delaying extensive valvular alteration.

Purpose. The aim of the study is to investigate the possible correlation between ROS expression in myxomatous mitral valves with severe regurgitation and the extent of valvular alteration.

Material and methods. Samples from myxomatous mitral valves with ruptured chordae and severe regurgitation were harvested during surgical intervention for valve repair/replacement from 9 patients. Besides transthoracic echocardiography, all patients were evaluated before surgery by transesophageal echocardiography (TEE) with three-dimensional (3D) reconstruction of the mitral valve, using 3D zoom mode acquisition with qualitative and quantitative analysis through the 4D Auto MVQ technology. Tissue from the valvular samples was further analysed for the assessment of ROS by 2 methods: spectrophotometry (ferrous oxidation xylenol orange - FOX assay) and confocal microscopy (dihydroethidium staining).

Results. Patients had a mean age of 51.88 ± 13.54 years, with a left ventricular ejection fraction of 62.55 ± 7.33%, left ventricular end-diastolic diameter of 5.4 ± 0.72cm and end-diastolic volume of 168.55 ± 62.57ml, a mitral annulus area of 17.91 ± 5.74 cm2 and a number of prolapsing/flail scallops varying between 1 and 5 (average of 2 ± 1 scallops). All patients had diffuse thickening of the mitral leaflets with at least one primary and one secondary ruptured chordae and flail of the P2 scallop. Two patients had significant prolapse of at least 2 anterior mitral leaflet scallops and three patients had supplemental significant prolapse and/or flail of at least 1 posterior scallop, besides flail of P2. The mean value for ROS in the valvular tissue was 9.46 ± 2.03nM H2O2/mg tissue/h at FOX assay. A significant positive correlation between the ROS values and the extent of prolapsing/flail segments was found (R = 0.67, p = 0.04).

Conclusion. Besides the diagnosis and accurate preoperatory valve description, 3D TEE along with molecular investigations contribute to the understanding of myxomatous mitral valves’ pathogenesis. Oxidative stress increased in the mitral valves with advanced myxomatous degeneration. Whether this occurs as a cause or a consequence contributing to the disease progression as well as the sources of ROS are worth further investigation.