bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of stone–wales defects of carbon nanotubes on the elastic properties of the carbon nanotube-polyethylene nanocomposite and its interface
Authors: Lei Wen-Jie , Gou Xiao-Fan
Published: May 2022

Carbon nanotube (CNT) filling in a polymer is an advanced approach to improve and manage the mechanical behaviors of polymer-matrix nanocomposites. However, some structural defects exist in CNTs, e.g., Stone–Wales (SW) defects on single-walled carbon nanotubes (SWCNT), which reduces the strength and changes the mechanical properties of CNT-reinforced nanocomposites. The influences of CNTs’ SW defects on the Young’ modulus of the CNT-polyethylene (PE) composite and its interface were investigated. All studies were performed through molecular dynamics (MD) simulations with the consistent force field (PCFF) on the platform of a large-scale atomic/molecular massively parallel simulator (LAMMPS). In the MD model of the CNT-PE nanocomposite, CNTs contained SW defects. The elastic modulus of the nanocomposite was obtained from its stress-strain relation, and that of the CNT-PE interface varied with strain according to the interfacial interaction energy. The correctness and rationality of the work were verified by comparing the results from references, experiments, and the rule of mixtures (ROM). The results showed that SW defects of CNTs reduced the mechanical strength no matter for the interface and integral nanocomposite. Specifically, with increased SW defect concentration (defined as the ratio of atoms in the SW defect region to total atoms of a CNT), the interfacial strength significantly weakened, and the elastic modulus of the integral nanocomposite reduced on the macro level. These results are beneficial to understanding the mechanical properties of CNT-PE composites and the design of related products.
Electromagnetic characteristic estimation on spiral antennas through AOI, ML, and AI
Authors: Wu Meng-Jhu , Chang Min-Chi , Chung Chin-Chien , Pancham Padmanabh Pundrikaksha , Yen Ta-Jen , Lo Cheng-Yao
Published: May 2022

In this study, a method that is able to estimate the electromagnetic characteristic of spiral antennas was proposed and realized through consecutive procedures of automatic optical inspection (AOI), machine learning (ML), and artificial intelligence (AI), providing a solution to smart manufacturing. Two-arm self-complementary Archimedean spiral antennas (SCASAs) were introduced as examination targets with pattern distortions from potential process variations, in which bulges and neckings were mathematically generated to imitate uncontrollable ink rheology in printed and flexible electronics, covering the unexplored parts in previous works. The SCASAs in the training group were fabricated by standard printed circuit board procedures, and their pattern integrity in terms of line edge roughness (LER) and coupling frequency were collected through AOI for ML as the feature and label, respectively. The established AI model was based on Gaussian process regression with covariance function of exponential that showed the smallest root-mean-square-error and the largest coefficient of determination through iterative lazy-learning. By feeding the LERs of the SCASAs into the testing group, their corresponding coupling frequencies were estimated by the established AI model with high confidence level. Good linearity between the estimated and measured responses indicated that a reliable AI model and procedure were built, which outperforms existing methods that are unable to project off-line active characteristics of microelectronic components from their in-line pattern integrities.
An automatic numerical approach to optimize flexible serpentine structure design
Authors: Ye Chong , Chen Rui , Sitaraman Suresh K
Published: May 2022

The serpentine shape has been increasingly popular for the conductor design in flexible electronics due to its superior compliance and stretchability performance. The stretchability of the serpentine structure is highly dependent on the material strain threshold, serpentine geometry design, and the attachment substrate property. Therefore, identifying the parameters and their corresponding importance factors to the stretchability of the structure will help optimize the serpentine geometry. In the current work, a fully automated finite-element model has been developed to calculate the normalized maximum strain in the free-standing serpentine structure under uniaxial stretch loading conditions. A parametric study has been conducted to understand the serpentine geometry impacts on the maximum strain in the serpentine structure under the equivalent 10% uniaxial strain loading condition. The study shows that longer straight-line length, larger arc segment angle, and smaller serpentine with a fixed arc segment radius can help to reduce the maximum strain in the serpentine structure under uniaxial stretching. A random forest machine learning model suggests that the serpentine width and arc segment angle have the highest impact on the maximum strain in the serpentine structure. In the end, the proposed optimization strategy has also been used to optimize the strain distribution when the serpentine structure is attached to a polymer substrate.
Impact of ethanol-gasoline implementation on vehicle emission based on remote sensing test
Authors: Zhang Qijun , Wei Ning , Mao Hongjun
Published: May 2022

The vehicle exhaust remote sensing system was used to quantify the carbon monoxide (CO), hydrocarbon (HC), and nitrogen oxide (NO) concentrations of vehicles before and after the ethanol-gasoline implementation. The purpose was to investigate gasoline vehicle emissions for two distinct periods: before and after the ethanol-gasoline implementation. A comprehensive vehicle emission remote sensing data set collected in 2018 and 2019. The remote sensing test data was screened for duplicate vehicles in both two years. The average emission concentration of HC-CO-NO showed a continuous downward trend after ethanol-gasoline implementation. The three pollutant emission factors of small passenger cars are all lower than those of light trucks. Overall, the HC-CO-NO emission factors obtained through remote sensing tests have a small range of variation. From the results of the two-year test data, the emission levels of the 10% worst emission vehicles have shown a certain reduction compared with before the ethanol-gasoline implementation. Compared with random test errors of dynamometer emission test and portable emission measurement system, statistical results based on remote sensing test big data are more accurate.
Ultrafast dynamics of adenine following XUV ionization
Authors: Månsson Erik P , Latini Simone , Covito Fabio , Wanie Vincent , Galli Mara , Perfetto Enrico , Stefanucci Gianluca , De Giovannini Umberto , Castrovilli Mattea C , Trabattoni Andrea , Frassetto Fabio , Poletto Luca , Greenwood Jason B , Légaré François , Nisoli Mauro , Rubio Angel , Calegari Francesca
Published: May 2022

The dynamics of biologically relevant molecules exposed to ionizing radiation contains many facets and spans several orders of magnitude in time and energy. In the extreme ultraviolet (XUV) spectral range, multi-electronic phenomena and bands of correlated states with inner-valence holes must be accounted for in addition to a plethora of vibrational modes and available dissociation channels. The ability to track changes in charge density and bond length during ultrafast reactions is an important endeavor toward more general abilities to simulate and control photochemical processes, possibly inspired by those that have evolved biologically. By using attosecond XUV pulses extending up to 35 eV and few-femtosecond near-infrared pulses, we have previously time-resolved correlated electronic dynamics and charge migration occurring in the biologically relevant molecule adenine after XUV-induced sudden ionization. Here, using additional experimental data, we comprehensively report on both electronic and vibrational dynamics of this nucleobase in an energy range little explored to date with high temporal resolution. The time-dependent yields of parent and fragment ions in the mass spectra are analyzed to extract exponential time constants and oscillation periods. Together with time-dependent density functional theory and ab-initio Green’s function methods, we identify different vibrational and electronic processes. Beyond providing further insights into the XUV-induced dynamics of an important nucleobase, our work demonstrates that yields of specific dissociation outcomes can be influenced by sufficiently well-timed ultrashort pulses, therefore providing a new route for the control of the multi-electronic and dissociative dynamics of a DNA building block.
A Trefftz method with reconstruction of the normal derivative applied to elliptic equations
Authors: Després Bruno , El Ghaoui Maria , Sayah Toni
Published: May 2022

This article deals with the application of the Trefftz method to the Laplace problem. We introduce a new discrete variational formulation using a penalisation of the continuity of the solution on the edges which is compatible with the discontinuity of the Trefftz basis functions in the cells. We prove the existence and uniqueness of the discrete solution. A high order error estimate is established. The theory is validated with several numerical experiments for different values of the mesh size, the order of the method and the penalisation coefficient. It is found that the penalisation coefficient has an influence on the conditioning of the method.
Kähler manifolds and mixed curvature
Authors: Chu Jianchun , Lee Man-Chun , Tam Luen-Fai
Published: May 2022

In this work we consider compact Kähler manifolds with non-positive mixed curvature which is a “convex combination” of Ricci curvature and holomorphic sectional curvature. We show that in this case, the canonical line bundle is nef. Moreover, if the curvature is negative at some point, then the manifold is projective with canonical line bundle being big and nef. If in addition the curvature is negative, then the canonical line bundle is ample. As an application, we answer a question of Ni [Comm. Pure Appl. Math. 74 (2021), pp. 1100–1126] concerning manifolds with negative

k
k

-Ricci curvature and generalize a result of Wu-Yau [Comm. Anal. Geom. 24 (2016), pp. 901–912] and Diverio-Trapani [J. Differential Geom. 111 (2019), pp. 303–314] to the conformally Kähler case. We also show that the compact Kähler manifold is projective and simply connected if the mixed curvature is positive.
The short-chain fatty acid acetate modulates epithelial-to-mesenchymal transition
Authors: Lyu Junfang , Pirooznia Mehdi , Li Yuesheng , Xiong Jianhua
Published: May 2022

Epithelial-to-mesenchymal transition (EMT) has been linked to various human diseases including cancer. The underlying metabolic regulators, however, remain poorly understood. Here we show how the short-chain fatty acid acetate restrains EMT. Our findings indicate that acetate is a potent metabolic regulator of EMT.
Atypical and distinct microtubule radial symmetries in the centriole and the axoneme of Lecudina tuzetae
Authors: Bezler Alexandra , Woglar Alexander , Schneider Fabian , Douma Friso , Bürgy Léo , Busso Coralie , Gönczy Pierre
Published: May 2022

Centrioles template flagella and impart their ninefold radial symmetry of microtubules. We use EM, ET, and U-Ex-STED to show that in Lecudina tuzetae a six- or fivefold radial symmetry in the axoneme is accompanied by an eightfold radial symmetry in the centriole, revealing unexpected plasticity in the transition from centriole to axoneme.
Antiresorptive treatments for corticosteroid-induced osteoporosis: a Bayesian network meta-analysis
Authors: Migliorini Filippo , Colarossi Giorgia , Eschweiler Jörg , Oliva Francesco , Driessen Arne , Maffulli Nicola
Published: May 2022

Introduction

Corticosteroid-induced osteoporosis (CIO) is the most common type of secondary osteoporosis, leading to fractures, and increased morbidity and mortality.

Source of data

Pubmed, EMBASE, Scopus and Google Scholar databases.

Areas of agreement

Prolonged glucocorticoids administration leads to secondary osteoporosis.

Areas of controversy

The optimal management for CIO is controversial.

Growing points

The present study compared bone mineral density, fractures and adverse events in patients undergoing treatment with risedronate, alendronate, zoledronate, denosumab or etidronate for CIO.

Areas timely for developing research

For selected patients with CIO, alendronate performed better overall. These results must be interpreted within the limitations of the present study.

Level of evidence

I, Bayesian network meta-analysis of randomized clinical trials.
Geometric Searchable Encryption Without False Positive And Its Applications
Authors: Chen Zhenhua , Nie Jingjing , Li Zhanli , Ge Chunpeng , Susilo Willy
Published: May 2022

As a prominent cryptographic tool, geometric searchable encryption (GSE) can be applied in many scenarios, such as location-based services (LBS), social networks and vehicle networks. Unfortunately, most of existing searchable encryption schemes supporting the functionality of geometric range searches suffer from false positives, which will lead people to make a wrong decision and further raise some serious consequences such as financial loss. In addition, some of them are designed under a symmetric system, which is not enough flexible deployed in LBS since in a symmetric system only a private key holder creates ciphertext, whereas in a public-key system anyone who holds a public key can produce ciphertext. In this paper, we intend to design a novel GSE scheme without any false positive under a public-key system supporting arbitrary geometric area searches, which is able to guarantee an accurate query result. Toward this goal, we develop a novel technique in handling the relation between a point and any convex polygon in combination with an inner product encryption, which is able to support arbitrary convex polygon range searches without any false positive. A comprehensive experiment demonstrates that, compared with the known schemes, our scheme possesses a 100% accuracy as well as an acceptable efficiency in the sense that it can guarantee that all files retrieved by users are exactly matched ones. Finally, we provide two practical examples of our GSE scheme: privacy-preserving friend-nearby notification with a common point of interest and privacy-preserving parking monitor and guiding system.
Selenium deficiency is associated with new-onset atrial fibrillation in PREVEND: a prospective general population cohort
Authors: Al-Mubarak AA , Grote Beverborg N , Zwartkruis V , Van Deutekom C , Gansevoort RT , Bakker SJL , De Boer RA , Rienstra M , Van Der Meer P , Bomer N
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): A grant of the Dutch Kidney Foundation (E0.13)Dutch Research Council (NWO) Open Competition ENW-M grant (OCENW.KLEIN.483)

Background

Recent studies suggest a link between nutritional status and new-onset atrial fibrillation (AF). Both selenium deficiency (SeD) and iron deficiency (ID) are known to impair mitochondrial function in human cardiomyocytes and both have been associated with worse prognosis in patients with cardiovascular disease. However, little is known about the role of these micronutrients in the development of AF.

Purpose

To elucidate the association of SeD and ID with new-onset AF in the general population.

Methods

Selenium and iron parameters were measured in a well-characterized Dutch prospective cohort study (N = 5591) with a mean follow-up of 6.2 years. SeD was defined as selenium concentrations < 70ug/L, and ID as ferritin concentrations <30 ug/L. New-onset AF was the primary outcome. All cases with suspected AF as determined by electronic screening were manually reviewed and validated by 2 independent experts. Competing-risk regression analyses were performed with death as a competing risk. We tested for interaction between SeD and smoking status because it was previously reported and because of the known lower serum selenium concentrations in smokers.

Results

In the PREVEND cohort, mean age was 53.5 (±12) years and 2917 subjects (52%) were females. SeD and ID were observed in 1212 (21%) and 891 (15%) subjects, respectively. Both deficiencies had similar associates, including sex, BMI, smoking status, cholesterol levels and anemia. Of the subjects who developed AF, 25% had SeD and 5% had ID. There was a significant interaction between SeD and smoking in association with the outcome (P= 0.084). After adjusting for the validated CHARGE-AF model in the addition of potential confounders, SeD was independently associated with new onset AF in nonsmokers (Hazard Ratio (HR): 1.72, 95% Confidence Interval (CI): 1.07 to 2.76, P = 0.024), but not in smokers (HR: 0.81, 95% CI: 0.32 to 2.05, P = 0.658). ID, however, was not associated with new-onset AF (HR: 0.62, 95% CI: 0.26 to 1.46, P = 0.272), regardless of sex stratification or smoking status.

Conclusion

In a general population cohort, SeD was independently associated with new-onset AF in nonsmokers. No association was found between ID and AF. Interventional studies that investigate the effects of selenium supplementation in a population at risk are needed.
Optimizing healthcare utilization in atrial fibrillation complicated by cancer
Authors: Singh SOHRAB , Heaton JOSEPH , Reddy SARATH
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Previous studies have shown that atrial fibrillation is a significant cause of healthcare utilization and readmissions. Cancer is also an extenuating burden and has been shown to complicate management strategies, inducing higher utilization.1 We aimed to discover the impact of atrial fibrillation in the setting of non-metastatic cancer and managements which optimize healthcare consumption.

Methods

We queried the 2016-2018 National Readmission Database (NRD) for adults with a primary atrial fibrillation diagnosis and a secondary non-metastatic cancer diagnosis using ICD-10-CM codes and the Elixhauser Comorbidity Software. Patients were included if the admission was between January and November. Patients were excluded if the index admission was in December (to allow for 30-day readmissions), included cardiac arrest, cardiogenic shock, or they previously had a cardiac pacemaker inserted. Survey weighting methodology was used in accordance with NRD best practices. Propensity score matching was implemented to assess the average treatment effect on the treated (ATET) using a percutaneous loop recorder. Patients were matched on socioeconomic and hospital characteristics, in-hospital medical or procedural complications, and comorbidities.

Results

From 2016-2018, 21,922 patients met the inclusion criteria for index admissions. The average index admission age was 74.7 years, and 47.3% were female. Length of stay for index admissions was not significantly different between the two groups (4.33 days versus 4.90 days; p = 0.496). In-hospital mortality occurred in 1.65% of admissions, none of which had undergone insertion of a loop recorder. Overall, 18.8% of index admissions were readmitted within 30-days. The readmission rate for patients receiving a loop recorder was 5.5%, compared to 18.9% in the control group. Propensity score matching revealed a 70.2% reduction in 30-day readmissions (OR, 0.099 to 0.907; p = 0.033) for patients discharged with a loop recorder. Patients with a loop recorder have no significant difference in length of stay (5.72 days versus 5.79 days; p = 0.944) when readmitted.

Conclusions

Patients admitted for atrial fibrillation complicated by cancer had significantly lower readmission rates when discharged with a loop recorder. This phenomenon may be related to the increased ambulatory monitoring and early intervention ability. In the absence of increased length of stays or in-patient mortality, the decrease in healthcare utilization may be of significant benefit. The mechanisms involving factors between atrial fibrillation and cancer are yet to be understood.2,3 Further studies are needed to confirm these findings and evaluate the mechanism by which readmission rates are decreased.
A new angle on atrial fibrillation risk prediction; the role of P-wave axis in future AF
Authors: Chattopadhyay R , Chousou PA , Pugh PJ , Vassiliou V
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

There is growing interest in the prediction of incident atrial fibrillation. This is driven by the vast amounts of data in electronic records that may act as a substrate for prediction, and has led to demographic, biochemical and electrophysiological strategies (figure 1a). The 12-lead ECG has been a particularly rich target for possible prediction strategies, with a variety of individual parameters and even artificial intelligence methods being examined.

Purpose

The P-wave axis is an ECG parameter that reflects the dominant vector of atrial depolarisation. The normal P-wave axis is considered to be 0-75º. There is a large body of literature suggesting that AF reflects structural and conduction abnormalities of the atria, and thus the P-wave axis may represent a sensitive parameter to detect such changes, prior to the onset of AF (figure 1b).

Methods

A systematic review and meta-analysis of published literature associating abnormal P-wave axis and the development of incident AF was performed. The electronic databases PUBMED, EMBASE, Web of Science and Cochrane were systematically searched using the key words "P-wave axis" and "P wave axis" from inception to October 2021. An initial titular analysis, followed by abstract and full text screening was performed. Data was extracted using a pre-specified collection form. A random-effects model with generic inverse variance weights was utilised to pool the most adjusted effect measure from each paper. A funnel plot was used to assess publication bias.

Results

After excluding duplicate studies, 568 studies were screened. A total of twelve studies were identified that associated an abnormal p-wave axis with the subsequent detection of atrial fibrillation. The eight studies that considered abnormal P-wave axis as being <0º or >75º were pooled for meta-analysis.

In the pooled studies a total of 78,222 patients were included with 5656 cases of incident atrial fibrillation identified. The meta-analysis of the studies suggested that an abnormal P-wave axis was associated with a pooled risk ratio of 2.10 (95% CI 1.48 to 2.72) for the detection of incident atrial fibrillation (figure 2). Sensitivity analysis by removing one study at each time did not alter the results.

Conclusion

This comprehensive systematic review and meta-analysis including 78,327 patients from 8 studies, indicates the positive association of abnormal P wave axis and future detection of AF. It thus confirms a two-fold risk of abnormal p wave axis in parallel with other established factors such as hypertension, age and abnormal systolic heart function. Utilisation of abnormal p wave axis, can allow clinicians to better risk-stratify individuals at increased risk of AF. This may lead to more tailored and precision strategies for prolonged cardiac monitoring or targeted anticoagulation approaches.
Influence of the method of calculating the Ve / VCO2 slope on its value in a cohort of 700 successive Cardiopulmonary exercise testing
Authors: Lamotte M , Chaumont M , Forton K , Gillet A , Strapart J
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

The Cardiopulmonary exercise testing (CPET) is the gold standard for cardiorespiratory and metabolic function at exercise. This CPEThighlight the limiting factors, but also provides prognostic indicators. Among the prognostic factors, maximal oxygen uptake (peak VO2) has been used for many years, particularly in heart failure, but some studies have highlighted the limitations of isolated use of peak VO2. The measurement of the Ve / VCO2 slope is currently recognized as having a complementary prognostic value. However, the manner of determining the Ve / VCO2 slope is not universally established. A single CPET could therefore deliver several slope measurements depending on the method used to calculate it. This lack of clarity would lead to possible variations affecting the reflection of the severity of the disease or the prognostic power of this parameter.

Our work consisted in calculating and comparing, over nearly 700 successive CPET, the slope Ve / VCO2: 1) by calculating it up to SV1, 2) by calculating it up to SV2, 3) by the calculating on all the data beyond SV2 (in the 44% of patients in whom SV2 could be determined). The patients were classified according to the indication of the examination in 1) cardiac (54%), 2) pulmonary (15%), 3) dyspnea assessment (10%) and 4) various (oncology, obesity, diabetes, rheumatic disease: 21%). The "cardiac" category was subdivided into HTP, IC, operated CPI and non operated CPI) (results not detailed in this abstract).

We have found systematic and significant differences depending on how the slope is calculated. On the whole population: in patients who did not reach SV2 (n = 389), the Ve / VCO2 slope reaches 33.8 +/- 8.5 when it is calculated up to SV1 while it reaches 38.5 + / - 8.7 (p <0.001) when it is calculated over the entire CPET. On the whole population: in patients with SV2 (n = 308), the Ve / VCO2 slope reaches 29.4 +/- 5.9 when it is calculated up to SV1, 33.5 +/- 6 (p <0.001) when it is calculated up to SV2 and 37.8 +/- 6.9 (p <0.001 and p <0.001) when it is calculated over the entire examination. When we analyze in more detail the population according to the indication of the examination, we observe differences of 3.8 to 5.2 units depending on the calculation method in patients not achieving SV2 and from 7 to 8.5 units. depending on the method of calculation in patients exceeding SV2. In subdivisions of the cardiac population the differences are also large : for example in HTP, the values ranging from 34.7 +/- 7.1 to 42.9 +/- 8.9 (p <0.001) depending on the calculation method.

Our work highlights that the way of determining the Ve / VCO2 slope greatly influences its value. The significant variations observed certainly limit the prognostic value of the Ve / VCO2 slope and homogenization of the calculation method seems essential in order to improve its prognostic value.
Moderate-to-vigorous physical activity of HFrEF patients is strongly associated with age, but not with functional capacity (6MWT), ejection fraction, NYHA, NT-proBNP, sex or BMI
Authors: Siranec M , Vetrovsky T , Parenica J , Miklikova M , Pelouch R , Precek J , Vesely J , Griva M , Linhart A , Belohlavek J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council of the Ministry of Health of the Czech Republic

Introduction

Patients with heart failure with reduced ejection fraction (HFrEF) commonly have impaired functional capacity and exercise intolerance which negatively affect their daily living activities and quality of life. Patients’ level of moderate-to-vigorous physical activity (MVPA) remains low. A popular, easily incorporated into everyday life activity is walking, which at a pace of 5 km/h can be considered moderate intensity physical activity. We explored whether the level of MVPA in HFrEF patients is associated with certain demographic and clinical parameters.

Methods

We analysed baseline values of HFrEF patients recruited in a multicentre randomised controlled trial of a six-month walking intervention (WATCHFUL trial, ClinicalTrials.gov identifier: NCT03041610). Their physical activity was objectively measured over seven days using accelerometer ActiGraph wGT3X-BT worn on the waist. Weekly minutes of MVPA were calculated using Freedson (1998) algorithm. The association between minutes of MVPA and sex, age, body mass index (BMI), HF symptoms (NYHA class), left ventricular ejection fraction (LVEF), serum levels of NT-proBNP, and distance walked in a six-minute walk test (6MWT) was explored in a series of univariate and multivariate linear regression models.

Results

One hundred twenty-two patients were included in the analysis (31 females and 81 males, age 63.2±11.7 years, BMI 30.1±5.4, NYHA class II/III: 99/13, LVEF 30.5±7.0%, NT-proBNP 1169±1888 ng/L, 6MWT 365±61 m). They accumulated 33.8±40.3 min/week of MVPA. The weekly minutes of MVPA were negatively associated with patients' age: being one year older was associated with 1.8 min (SE 0.3) less MVPA (p < 0.001). Neither sex, BMI, NYHA Class, distance walked in 6MWT, nor serum levels of NT-proBNP were associated with weekly minutes of MVPA.

Conclusion

Our results show that moderate-to-vigorous physical activity of HFrEF patients was strongly associated only with age. Surprisingly, commonly used prognostic markers of heart failure such as ejection fraction, NYHA, NT-proBNP, and functional capacity (6MWT) did not show significant. Neither did sex nor BMI. Exercise rehabilitation and increased physical activity improve functional capacity and should be regularly recommended, and even emphasised with age.
Home-based cardiac rehabilitation can reduce anxiety and depression in heart failure patients
Authors: Gois P , Magalhaes S , Alexandre A , Barreira A , Fernandes P , Ribeiro F , Schmidt C , Santos M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6].

Introduction

The current COVID-19 pandemic has led to significant changes in physical and mental health and has become a major challenge for cardiac rehabilitation (CR) programs. CR is an essential component in the treatment of heart failure (HF), as it improves cardiorespiratory fitness and quality of life, as well as reducing hospitalization rates. COVID-19 pandemic increased social isolation, and the CR centers were closed. Center-based CR requires the patient to travel to the hospital, which increases the risk of SARS-CoV-2 infection in this high-risk population. In this context, home-based CR can be an excellent strategy to reduce the physical and mental consequences of the social isolation imposed by the COVID-19 pandemic.

Objective

To test the effectiveness of a home-based CR program on cardiorespiratory fitness and anxiety and depression levels in individuals with HF during covid-19 pandemic.

Methods

Forty-two individuals with HF (age: 61.3±12.0; LVEF: 37.5±11.2) were included in this study. The exercise training program consisted in 12 weeks of combined exercise training (2x/week; 60min/day, 60-80% VO2peak), with 4 supervised exercise sessions in the hospital context and the remaining at home. Patients were monitored using a heart rate monitor and weekly phone calls. The following parameters were evaluated: cardiorespiratory fitness through the 6-minute walk test (6MWT) and anxiety and depression levels through the Hospital Anxiety and Depression Scale (HADS).

Results

After the home-based CR program, there was a significant increase in the 6MWT of 49 meters (95%IC: 38 to 60; p<0.001) and a significant decrease in anxiety levels of -1.12 points (95%CI: - 2.163 to -0.075 p=0.036). No significant changes were found in depression levels (p=0.954). Furthermore, the improvements in cardiorespiratory fitness were significantly associated with the reduction in the levels of anxiety (r= -0.281; p=0.028) and depression (r=: -0.278; p=0.030).

Conclusions

The home-based CR program was able to improve cardiorespiratory fitness and this improvement was associated with a decrease in anxiety and depression levels in individuals with HF. The results suggest that home-based CR can be an important strategy to minimize the physical and mental impact induced by social isolation imposed by COVID-19 pandemic in HF patients.
Left ventricular remodeling in patients with NSTEMI depending on the risk by the GRACE score
Authors: Maslovskyi VI , Mezhiievska IA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

To identify the features of the structural and functional condition of the myocardium and diastolic transmitral blood flow in patients with NSTEMI depending from GRACE score.

Methods

90 patients with NSTEMI were examined. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes.

All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association.

Results

Patients were divided into two groups: the first - low and moderate risk, the second - high risk by GRACE score. Thus, it was determined that the patients of the second group in comparison with the first group there was a significant increase in the value of left atrium (40 mm vs. 36 mm, p = 0.03), the index of LA (20.9 mm / m2 vs. 19.2 mm / m2, p = 0.005). Arterial stiffness (AS) was 0.65 mm Hg / ml vs. 0.53 mm Hg / ml (p = 0.02), and aortic diameter index (idA) was 17.3 mm / m2 vs. 17.0 mm / m2 (p = 0.53). The ratio of LA to RA was 1.10 vs. 1.06 (p = 0.04). The Ve / Va ratioin the comparison groups was 0.61 vs. 0.74 (p = 0.02) (Tab. 1).

Analysis of structural-geometric remodeling of the left ventricle showed no statistically significant differences in the studied parameters in all comparison groups. In turn, the analysis of the nature of diastolic transmitral blood flow showed significant differences in the type of pseudonormalization in patients with low and moderate risk compared with high risk by GRACE score (9 (16.7%) vs. 14 (38.9%), p = 0.02).

Conclusion

The main statistical differences between the groups of low and medium risk compared to high according to GRACE score relate mainly to structural parameters.
Effects of once-weekly semaglutide on coronary outcomes in patients with type 2 diabetes mellitus with or at high risk for cardiovascular disease: insights from the SUSTAIN-6 trial
Authors: Kolkailah A , Aharonovich A , Lingvay I , Dobrecky-Mery I , Rasmussen S , Tetens Hoff S , Mcguire DK
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Nordisk A/S

Background/introduction

In the randomised, double-blind, placebo-controlled SUSTAIN-6 cardiovascular (CV) outcomes trial, once-weekly (OW) semaglutide (a glucagon-like peptide-1 receptor agonist), compared with placebo, reduced the risk of major adverse CV events (CV death, non-fatal myocardial infarction [MI], or non-fatal stroke) and the risk for revascularisation (pre-specified secondary outcome) in patients with type 2 diabetes mellitus (T2DM) with or at high risk for CV disease (CVD). However, the effects of OW semaglutide on composite coronary-specific outcomes have not been explored.

Purpose

The aim of these post-hoc, exploratory analyses was to assess the effects of OW semaglutide, compared with placebo, on composite coronary outcomes in the SUSTAIN-6 trial population.

Methods

In these post-hoc analyses of the SUSTAIN-6 trial, the following coronary outcomes were assessed with OW semaglutide (0.5 and 1.0 mg doses pooled) vs placebo, both in addition to standard of care: the main coronary outcome (composite of MI [both fatal and non-fatal] or coronary revascularisation [defined as coronary artery bypass graft surgery or percutaneous coronary intervention]); and the expanded coronary outcome (composite of MI, coronary revascularisation, or unstable angina). Coronary outcomes were assessed overall, as well as in subgroups with or without a prior coronary event (MI or coronary revascularisation) at baseline. Cox proportional hazards regression models were used to analyse time to first event for the outcomes.

Results

Overall, 3,297 patients were included in these analyses. Key cohort characteristics included a mean age of 64.6 ± 7.4 years with an average T2DM duration of 13.9 ± 8.1 years; 39.3% were female and 48.3% had prior MI or coronary revascularisation (32.5% and 40.3% for each prior event, respectively). The median follow-up duration was 2.1 years. The proportion of patients experiencing a first event was lower with OW semaglutide vs placebo for the main coronary outcome (6.1% vs 8.1%; hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.57–0.97]) and the expanded coronary outcome (6.3% vs 8.6%; HR 0.73 [95% CI 0.56–0.94]) (Figure 1). The time to the first main coronary outcome event is shown in Figure 2. Prior coronary event status at baseline did not modify the treatment effects of semaglutide (all p-interaction >0.05) (Figure 1).

Conclusions

In these post-hoc analyses of the SUSTAIN-6 trial, OW semaglutide reduced the risk of composite coronary outcomes vs placebo in patients with T2DM with or at high risk for CVD, irrespective of prior MI or revascularisation status. These findings support the beneficial effects of OW semaglutide in this high risk population.
Admission HbA1c and post-MI prognosis in patients without known diabetes: a meta analysis
Authors: Soman B , Sathyapalan T , Chattopadhyay S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The association between newly diagnosed abnormal HbA1c and post-MI prognosis is unclear. Previous meta-analyses have included studies with both diabetic and non-diabetic patients or subsets of these patients.

Purpose

To assess the association between HbA1c and post-MI prognosis in patients without known diabetes.

Method

Cohort studies (up to Oct 2021) were retrieved from PubMed and Embase. We included studies that compared events in patients with newly diagnosed hyperglycaemia on admission HbA1c to those without. Studies where the hyperglycaemic groups had mixed known and newly diagnosed patients were excluded. Pooled risk ratios (RRs) and the 95% confidence interval (CI) were calculated using random effect model to assess the association between newly diagnosed diabetes and pre-diabetes and in-hospital, 30-day and ≥1-year mortality and MACE.

Results

29 studies comprising 279719 patients were included. The pooled RR for in-hospital, 30-day and ≥1 year mortality in diabetic patients (Fig 1) were 1.94 [1.41-2.67], p<0.0001; 1.55 [1.02-2.34], p=0.04 and 1.69 [1.50-1.90], p<0.0001 respectively. Corresponding data for MACE were 1.78 [0.51, 6.18], p=0.36; 1.14 [1.01-1.28], p=0.03 and 1.40 [1.19-1.65], p<0.0001. In prediabetic patients (Fig 2), the corresponding RR for mortality was 1.28 [1.06, 1.55], p=0.009; 1.05 [0.85, 1.29], p=0.66 and 1.49 [1.21, 1.84], p=0.0002 and for MACE it was 4.63 [1.80, 11.90], p=0.001; 1.19 [1.05, 1.36], p=0.008 and 1.57 [1.24, 1.99], p=0.0002.

Conclusions

High HbA1c at admission in patients without known diabetes is associated with worse post-MI outcomes both in diabetic and prediabetic groups.
Tricuspid valve repair versus a conservative approach in patients with functional tricuspid regurgitation undergoing mitral valve surgery. A systematic review and meta-analysis
Authors: K Awad A , Elseidy S , Elgenidy A , Elbadawy M A , Mohamad T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Tricuspid valve repair (TVR) at the time of mitral valve (MV) surgery is still a debatable part of literature whether to do a concomitant valve repair or not, and if TVR is indicated, whether to perform it in patients with severe functional tricuspid regurgitation (TR) or mild-to-moderate TR. We assessed the benefits of a concomitant TVR during MV surgery, focusing on mortality and echocardiographic TR-related outcomes.

Methods

Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of concomitant TVR during MV surgery on all causes, cardiovascular, non-cardiovascular mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

Results

27 studies were included for a total of 5460 patients with mean follow up period of 80 months. During MV surgery doing a concomitant TVR has been associated with significant reduction in all-cause mortality (RR: 0.35, 95% CI [0.21 to 0.52], p<0.00001), cardiac-related mortality (RR: 0.34, 95% CI [0.30 to 0.42], p<0.00001), and non-cardiac related mortality (RR: 0.42, 95% CI [0.31 to 0.72], p=0.005). Furthermore, regarding echocardiographic TR outcomes, the presence of more-than-moderate TR (RR: 0.19; 95% CI [0.11–0.34], p = 0.001), TR progression (RR 0.04; 95% CI [0.01–0.07], p =0.001) were significantly lower in the TV repair group at a mean weighted follow-up of 60 months.

Conclusions

A concomitant TVR during MV surgery showed a significant improvement not only in cardiac-related mortality, non-cardiac-related mortality, but also in TR echocardiographic outcomes with long period of follow up.
The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme: a pilot randomised controlled study
Authors: Elfghi M , Jordan F , Dunne D , Gibson I , Mcevoy JW , Jones J , Sultan S , Tawfick W
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Atherosclerotic risk factor modification plays an important role in reducing adverse outcomes in patients with atherosclerotic disease1. Despite the high prevalence of peripheral arterial disease (PAD) and strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive structured treatment for their atherosclerotic risk factors than patients with coronary artery disease2,3.

Purpose

We aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.

Methods

This is a pilot randomised controlled study comparing a risk factor modification intervention programme to standard healthcare, for the reduction of modified risk factors in PAD patients. Patients randomised to the intervention arm underwent a 12-week supervised programme adjusting their risk factors. Primary outcome was patients reaching target risk factor improvement.

Results

Seventy-five patients were randomised. 36 were allocated to Standard Healthcare. 39 completed a 12-week Structured Programme. There was no significant difference between groups in baseline demographics, incidence and severity of risk factors, mobility and quality of life.

At 12-weeks the intervention group showed a significant improvement in target body weight (6.7±9.57 p=0.002), waist circumference (7.4±9.5 p=0.001), HbA1c (4.12±7.22 p=0.009), total cholesterol (0.63±0.99 p=0.004), low-density lipoprotein (0.59±1.040 p=0.00), triglycerides (0.24±0.38 p=0.005), Mediterranean diet score (2.48±1.35 p=0.0001), Absolute Walking Distance (8.2±7.8 p=0.0001), Claudication Distance (9.2±7.4 p=0.0001). There was no significant difference in the change of any of the other risk factors.

Conclusion

Risk factor modification intervention programme can significantly aid PAD patients reach their target risk factor improvement goals.
Factors associated with hospital arrival time of acute stroke patients in rural India
Authors: Inamdar ANIKET
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Delays in the treatment of acute stroke leads to unfavorable prognosis. Shortening the delay time in the health care of these patients is essential in order to reduce the morbidity and mortality rates of this disease. Eligibility for acute stroke interventions depends on the time from symptom onset to hospital arrival. The socio-cultural profile in rural India is different from that in urban India. Lot of people in rural India prefer living in joint families, general level of education and awareness is low and they opt for alternative modalities of treatment for stoke. There is lack of adequate and fast transport facilities that worsen the scenario. Delay in arrival of acute stroke cases may be caused by organizational, educational, socioeconomic and demographic factors.

Purpose

This study was conducted to understand the factors associated with hospital arrival time of acute stroke patients in Rural India.

Materials and Methods

Hospital data of 27 acute stroke patients admitted to our clinic from January 2019 to December 2019 was retrospectively studied. Stroke was defined, according to the WHO definition, as 'rapidly developing clinical sign of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than of vascular origin'. Chi square test and Mann Whitney U tests were used to analyze the data.

Results

Only 8 (29.62%) patients arrived within 3 hours of stroke onset whereas 3 (11.11%) patients arrived after 12 hours. Mean and standard deviation of hospital arrival time in minutes for patients < 50 years was 125±116, for 51-60 years was 279±127, for 61-70 years was 379±191 and for >70 years was 1127±716.Younger patients reported significantly earlier than older ones (p <0.001). Males reported earlier than females (p: 0.032). Patients with stroke onset in the night time arrived significantly late compared to stroke onset in the day time (p:0.001). Prior ayurvedic treatment delayed hospital arrival (p <0.001).

Conclusions

A nationwide public awareness campaign is needed to improve the public awareness of stroke and importance of timely treatment when acute stroke symptoms are suspected. Lot of patients in rural India still delay emergency treatment of acute stroke due to preference to ayurvedic remedies which should be strongly discouraged. Gender and age bias need to be further studied and strategies to reduce the bias should be considered. This study shows that there is substantial room for reducing the time from symptom onset to hospital arrival in acute stroke. Strategies to improve stroke awareness and referral protocols together with the use of tele-medicine and mobile stroke unit should be considered to reduce the hospital arrival time.