bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P453: Racial Disparities in Early Use of Transcarotid Artery Revascularization Among High-Risk and Symptomatic Black and White Adults With Carotid Artery Stenosis
Authors: McDermott Katherine M , Bose Sanuja , White Midori , Selvin Elizabeth , Hicks Caitlin W
Published: May 2024

Introduction:
Differential access to new technologies may contribute to racial disparities in health outcomes. We examined the adoption of transcarotid artery revascularization (TCAR) among high-risk Black and white adults undergoing surgery for carotid artery stenosis.

Hypothesis:
We hypothesized that Black adults would be less likely than white adults to receive TCAR since its introduction to the US market in 2015.

Methods:
We conducted a retrospective analysis of the prospectively collected Vascular Quality Initiative surgical database from 1/2015 to 12/2021, which includes 100% of the TCAR procedures performed during this period. Non-Hispanic Black and non-Hispanic white adults were included if they met Centers for Medicare & Medicaid Services high-risk criteria due to anatomy, medical comorbidities, and/or recent symptoms (ipsilateral stroke or transient ischemic attack). We used logistic regression to quantify associations of race with receipt of TCAR (versus other surgical procedure for carotid stenosis) overall and by specific high-risk features.

Results:
There were 119,128 surgical procedures performed for carotid artery stenosis (14.3% TCAR) (mean age 72 years, 5.3% Black, 38.5% female). Black patients were less likely than white patients to receive TCAR after adjustment for patient and disease characteristics (aOR 0.91, 95% CI 0.83, 0.99). Among patients with only one high-risk feature (e.g., only high-risk anatomy), TCAR use did not vary by race. However, Black patients were less likely to receive TCAR in subgroups with multiple high-risk features (
Figure
). Not all hospitals performed TCAR, and Black patients were less likely to be treated at TCAR-capable hospitals (aOR 0.93, 95% CI 0.88, 0.98). TCAR use did not vary by race at TCAR-capable hospitals (
Figure
).

Conclusions:
Adoption of TCAR was lower among Black compared to white high-risk patients, for whom TCAR offers the most benefit. Differential access to hospitals with newer technology may explain these disparities.
Abstract P468: Correlation Among A1c Improvement, Weight Reduction, and Decreased ASCVD Risk in Participants Enrolled for Type 2 Diabetes Remission: Outcomes at 1 Year From an RCCT Using Whole-Body Digital Twin Technology
Authors: Shamanna Paramesh , Dharmalingam Mala , Vadavi Arun , Thajudeen Mohamed , Keshavamurthy Ashok , Bhonsley Suchitra , Joshi Shashank
Published: May 2024

Background and Aims:
The effects of digital twin (DT) technology for remission of T2D on cardiovascular risk reduction is unknown. We evaluated the effectiveness of the DT to improve A1c and body weight and ASCVD risk, in patients enrolled to achieve remission of T2DM. DT platform uses AI and Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the mobile app and by coaches.

Materials and Methods:
Data from 208 participants who had been on DT for 1 year were analyzed. Remission was defined as A1C levels less than 6.5% without medication for over 3 months. Outcomes included the change in HbA1c, body weight and change in ASCVD risk scores. The DT uses a machine learning algorithm to integrate clinical and sensor data to predict personal glucose response. Patients were connected to continuous glucose monitoring (CGM) throughout the study and self-recorded dietary intake using the mobile app.

Results:
The study participants had a mean diabetes duration of 3.7±2.7 years and a mean age of 44±8.5 years. Based on the ADA criteria, at 1 year, 72.6% (n=151/208) continued to be under remission. The mean 10-year ASCVD risk (%) at baseline was 7.9 (±7.8, 95% CI 6.8 to 8.9) which reduced to 3.6 (±4, 95% CI 3.1 to 4.2) at 360 days, p<0.0001. A1c (%) at baseline was 8.9 (±1.8, 95% CI 8.7 to 9.2, minimum 5.5, maximum 16.2) which reduced to 6 (±0.6, 95% CI 5.9 to 6.1, minimum 4.7, maximum 9.2), p<0.0001. Body weight (kg) at baseline was 78 (±14.3, 95% CI 76.1 to 79.9) which reduced to 70.4 (±12.9, 95% CI 68.7 to 72.1), p<0.0001. There was a significant correlation between the reduction in A1c and ASCVD (Pearson r 0.41, 95% CI 0.31 to 0.5, p<0.0001). Similarly, there was a significant correlation between the reduction in body weight and ASCVD (Pearson r 0.25, 95% CI 0.12 to 0.3, <0.0001). At baseline, there were 49% of participants who had low risk score (<5%), 16% as borderline risk (5-7.5%), 27% as intermediate risk (7.5-19.9), 8% as high risk (>20%) that at 1 year shifted to 77% as low risk, 11% as borderline, 11% as intermediate risk and 1% as high-risk scores.

Conclusion:
The implementation of digital twin (DT) technology, utilizing AI and Internet of Things, demonstrated significant potential in T2DM management in participants enrolled to achieve remission. In our study with 208 participants, DT effectively reduced A1c levels, body weight, and ASCVD risk scores over 360 days. The correlations between reductions in A1c, body weight, and ASCVD underscore the potential of DT as a transformative tool in diabetes and cardiovascular risk management.
Abstract P470: The Virtual Home Clinic: Feasibility and Challenges for Longitudinal Cohorts
Authors: Urbina Elaine M , Russell Marta , Cain Erin , Fernandez Camilo , Bazzano Lydia A , Woo Jessica G
Published: May 2024

Longitudinal studies provide rich sources of data to explore early risk factors for future CV diseases. However, cohort participants often move away from their initial recruitment site. Our study assesses feasibility of mailing of devices to the home for collection of biometric data and user acceptability of this approach. Participants (N=308) from the Bogalusa Heart Study, National Growth & Health Study and the Princeton Lipid Research Study who were initially enrolled as children in the 1970s and 1980s were recruited to conduct on-line surveys. A subset (N=74) had biometric measurement devices sent to the home (
Table
) for anthropometrics, BP, HR, heart rhythm, resting metabolic rate, O
2
saturation, glucose, total cholesterol, physical activity, diet, sleep duration/quality, and arterial stiffness. Stool and saliva were also collected for microbiome, and DNA. Of the 74 agreeing to participate in the home study, 62 (84%) successfully completed at least some testing. Among those 62, 72% of participants on average (range: 23% for AimStrip total cholesterol to 97% for Oragene) completed all requested readings for a given device. The total cholesterol test had the highest proportion of missing requested readings (45%). Of the 46 of 62 (74%) participants who completed the user acceptability survey, 28% preferred an in-clinic visit, 46% preferred home, and 26% did not have a preference. More males (63% vs 42% females) preferred home assessment. There was little difference between Black and White participants. On a scale of 1 (hard to use, poor directions, took too long) to 5 (easy to use, easy to follow directions, took little time), most devices scored near 4.5. The cholesterol test elicited the most negative responses, and several devices scored lower on the impression of the time it took to complete the at-home test. This feasibility study demonstrates that home biometric assessment is feasible and acceptable as we continue to follow our participants who have provided invaluable contributions to science for the last 40 years.
Abstract P481: Diet Significantly Influences the Gastrointestinal Microbial Content in Male Mice Fed a Commercially Available Probiotic Supplement
Authors: Singh Shreya C , Kagel Brian , Westlake Jonathan D , Lichti Nathan , Houghton Jeffrey , Gigliotti Joseph
Published: May 2024

The gut microbiome is a growing topic of discussion due to its varying effects on the gut brain barrier, infections, obesity, allergies, and mental health. With a newfound public desire to ameliorate gut health, there has been an increase in probiotic consumption and dietary changes; however more research is needed to understand the mechanisms responsible for the observed phenotypes. In the current study, we set out to determine how different diets and administration of a commercially available probiotic influence the gastrointestinal microbiome in mice. Weanling, male C57Bl/6 mice were purchased and given a week to acclimate to a solid diet and group housing. Mice were then randomly assigned to receive one of three diets
ad libitum
: chow, the American Institute of Nutrition 93-formulation (AIN93), and our novel Americanized diet (AD). Mice from each diet were then administered a control solution (distilled water) or 30 uL of a commercially available probiotic mixture, orally five days a week for two weeks. After 8-weeks, mice were euthanized and the cecal content was collected and stored in RNAlater solution. Total DNA was isolated from the cecal samples using a commercially available assay, and the presence of microbial species was determined by 16S rRNA sequencing and RT-PCR analysis of
Firmicutes, Bifidobacterium, Lactobacillus
, and
Bacteroides
specifically. Data were analyzed using General Linear Models in SPSS with significant difference identified as P<0.05. Diet significantly impacted
Bifidobacterium
(P=0.015)
, Lactobacillus
(P=0.001), and
Bacteroides
(P<0.001) levels, with mice fed the AIN diet having the greatest
Bifidobacterium
levels but lower
Lactobacillus
and
Bacteroides
. Mice fed the AD had the highest
Lactobacillus
and
Bacteroides
. Probiotics significantly decreased
Bifidobacterium
and
Firmicutes
, with a decrease in
Firmicutes
being associated with improved physiological phenotypes in other studies. This preliminary study highlights that dietary changes, even within “normal” ranges, significantly influence the gut microbiome. Furthermore, our data supports the claim that commercially available probiotics modulate GI microbial flora and that this effect is modified by the diet consumed. More research is needed to understand the mechanisms underlying this change to maximize its potential benefits and improve gut and overall health.
Abstract P496: Proteomic BMI Signature and Incidence of Type 2 Diabetes
Authors: Wang Xuan , Ma Hao , Li Xiang , Heianza Yoriko , Qi Lu
Published: May 2024

Background:
Obesity exhibits heterogeneity in physiological states and metabolic phenotypes cross individuals. A recent study identified a proteomics signature of obesity which better captures such heterogeneity than classical Body Mass Index (BMI).

Aims:
We aimed to create a proteomics-inferred BMI signature and investigate whether the proteomic-inferred BMI was associated with incident Type 2 Diabetes (T2D).

Methods:
This study included 34,317 adults in the UK Biobank who were free of T2D and had complete data on proteomics metrics assessed by antibody-based Olink assay. Sixty-seven pre-identified proteins were available and used to create the proteomic BMI signature. Cox proportional models were used to estimate the association between proteomic BMI signature and incident T2D.

Results:
The proteomic BMI signature was strongly correlated with actual BMI (Pearson correlation coefficients=0.75,
P
<0.001). During a mean follow-up of 13.2 years, a total of 1,651 T2D events were documented. We observed that per standard deviation increase in proteomic BMI signature was significantly associated with a 250% higher risk of T2D (HR, 2.50, 95%CI, 2.37, 2.64). Compared with the lowest Quartile, the HR (95%CI) for the Quartile 2 to the Quartile 4 of proteomic BMI signature were 2.06 (1.61, 2.64), 3.56 (2.83, 4.48), and 10.0 (8.08, 12.4), respectively (
P
-trend<0.001). Also, we observed that the associations between proteomic BMI signature and incident T2D were stronger in women than men (
P
for interaction < 0.001). Compared with the lowest Quartile, the HR (95%CI) for highest Quartile of proteomic BMI signature were 16.63 (9.75, 28.36) for women and 8.06 (6.37, 10.19) for men.

Conclusions:
Higher proteomics-inferred BMI was significantly associated with higher risk of incident T2D, and such association was stronger in women than men. Our results suggest that proteomic BMI signature may serve as a surrogate metabolic indicator to better understand the mechanism underlying the association of BMI and T2D.
Abstract P503: Syphilis Infection and Increased Odds of Cardiovascular Morbidity
Authors: Briggs Aaron , Risser Joseph , Newman Bernard
Published: May 2024

Background:
Cardiovascular disease (CVD) is the number one cause of death in the United States and around the world. Syphilis is a sexually transmitted infection conferred by the spirochete
Treponema pallidum
which demonstrates a unique affinity for the human CV system. It is understood that Treponemal invasion of vascular and cardiac tissue, in the absence of treatment, may result in the CV manifestations of late, tertiary syphilis including: aortic aneurysm, aortic insufficiency, coronary artery disease (CAD), and stroke. Recent literature has suggested that chronic kidney disease (CKD) may also be among these sequalae. It is the current understanding that syphilitic CVD morbidity is effectively prevented and treated with the standard of care (SOC) antimicrobial therapy dictated for early and late syphilis, however, there is a relative paucity of data to support this. In light of the ongoing syphilis epidemic in the United States, our group sought to revisit and evaluate these central tenets of syphilis care.

Methods:
A preliminary, 10-year retrospective analysis (01/2013-12/31/2022) of deidentified electronic medical records (EMR) from a California-based academic health system was undertaken. The study population consisted of all health system patients >18 who were seen during the study period. The exposure of interest consisted of ICD-10 codes representative of syphilis infection with CVD outcomes defined as ICD-10 diagnoses reflective of the known, principle clinical manifestations of tertiary syphilis as well as CKD and HTN. Unadjusted, bivariate analysis was performed for preliminary assessment of exposure-outcome association.

Results:
3,559,370 unique EMR were included in final analysis. 5,915 patients were found to have a diagnosis of syphilis. The majority of patients diagnosed with syphilis had documentation of treatment. Patients with history of syphilis infection had significantly higher odds of aortic aneurysm (OR = 6.17; 95%CI = 5.07-7.5), CAD (OR = 5.81; 95%CI = 5.37-6.27), aortic insufficiency (OR = 5.52; 95%CI = 4.47-6.81), stroke (OR = 5; 95%CI = 4.58-5.46), HTN (OR = 8.38; 95%CI = 7.94-8.85), and CKD (OR = 10.94; 95%CI = 10.28-11.64) relative to uninfected patients.

Conclusion:
Preliminary analysis indicates syphilis infection to be associated with significantly increased odds of CVD morbidity across all outcomes measured including CKD. These data suggest that the CV impact of syphilis may be broader than previously understood and raise concern for a clinically significant limitation to the current SOC in protection against CVD morbidity. A follow-up study is underway which will utilize multivariate logistic regression analysis to determine the independent effect of syphilis infection adjusting for multiple confounders to further clarify our preliminary results.
Abstract P505: Investigating Sudden Death in a Large North Carolina County: Methods and Findings of a Population-Based Registry
Authors: Day Gabriella , Davy-Mendez Thibaut , Beyer Rebecca E , Keen Susan , Joodi Golsa , Cesmat Andrew , Capone Alia , Williams Jefferson , Simpson Ross J
Published: May 2024

Introduction:
Evidence on drivers of sudden death (SD) is needed to understand its persistently high incidence and inform prevention interventions. SD studies have been hampered by data limitations and restrictive SD criteria. We conducted a population-based study of all-cause, out-of-hospital SD using Emergency Medical Services (EMS) data from Wake County, a large North Carolina county with >1 million residents.

Methods:
We screened EMS records of out-of-hospital deaths between 2013-2015 among persons aged 18-64 years, collected medical and death records, and adjudicated 399 SD cases according to a standardized protocol. Deaths occurring in hospices or nursing homes were excluded, as were those due to unnatural death or cancer. Deaths were not excluded by time last seen or coronary artery disease (CAD) criteria. Frequency matched living controls were identified from the same county and time. We compiled and summarized findings based on peer-reviewed papers and published abstracts in Table 1.

Results:
Cardiovascular disease risk factors were common among decedents, including hypertension (60.4%, 244 of 371), though only 14.8% (55 of 371) had documented CAD. SD cases had lower adjusted mean total cholesterol, low-density lipoprotein and high-density lipoprotein levels compared to controls. Furthermore, left ventricular hypertrophy and inflammation suggested nodes on a common causal pathway. Poor health care management was frequent as well as mental health and substance use problems. Environmental factors such as poverty, air pollution and absence of nearby greenways were associated with SD.

Conclusions:
Conducting a population-based registry of adjudicated SD cases was feasible and provided high quality data for study. Our findings suggest that SD is not only tied to CAD but a syndrome with potentially different environmental and inflammatory etiologies. Future studies should investigate modifiable risk factors for interventions to prevent SD.
Abstract P515: Multimorbidity in Rural Alabama: Rural Heart and Lung Study
Authors: Tisminetzky Mayra , Platz Sara , Montenario Matheus , Revoori Ritika , Anzenberg Paula , Wang Ziyue , Agyapong Nakesha , Soni Apurv , van den Heuvel Edwin , Tejan Joseph , Judd Suzanne E , Vasan Ramachandran , McManus David D
Published: May 2024

Background:
Multimorbidity, defined as the co-occurrence of two or more chronic conditions, is highly prevalent and associated with adverse clinical outcomes. Yet, there are limited data on the most prevalent chronic conditions and overall multimorbidity in the rural Southern in US. We described the prevalence of chronic conditions, risk factors, and overall burden of multimorbidity by race and sex in participants of the Risk Underlying Rural Areas Longitudinal (RURAL) Study.

Methods:
Our sample included 942 RURAL study participants from two counties in Alabama. Questionnaires were administered at the mobile examination unit and through a smartphone-based application to collect information on eight chronic conditions and three risk factors at baseline. Differences in the prevalence of chronic conditions by self-reported race and sex were examined.

Results:
The mean age of the RURAL Study sub-cohort was 49 years, 70% were women, 80% were Black individuals and 46% had a high school education or more. Overall, the most common chronic conditions among Black participants were hypertension, diabetes, and asthma (82%, 29%, and 17%, respectively). Alcohol and marijuana use (78% and 24%, respectively) were the most common risk factors. Similar patterns of chronic conditions and risk factors were found in White people and, in men vs. women. Overall, multimorbidity was present in 47% of the participants, while a higher proportion of Black individuals had multimorbidity (50%) as compared to White people (38%). Furthermore, in regression analyses adjusting for age, Black participants had twice the odds of presenting with multimorbidity as compared to their White counterparts.

Conclusions:
Multimorbidity was highly prevalent in RURAL Study participants in Alabama, especially in Black individuals. Our findings emphasize the challenge of caring for underserved populations residing in rural areas and highlight the importance of implementing strategies to reduce barriers that impede access to healthcare, especially in the rural Southeast.
Abstract P517: Age-Stratified Prevalence of Cardiovascular Risk Factors Among Asian American Subgroups
Authors: Vemu Prasantha L , Elfassy Tali , Yang Eugene
Published: May 2024

Introduction:
Cardiovascular disease (CVD) is the leading cause of death in the US. The prevalence of CVD risk factors and CVD mortality are heterogeneous among disaggregated Asian American subgroups; but little is known about when in the life course these differences arise.

Hypothesis:
We hypothesize that there are age-specific differences in the prevalence of CVD risk factors across Asian American subgroups that may predispose some subgroups to developing CVD at younger ages.

Methods:
We analyzed data from 78,559 Asian American adults enrolled in the National Health Interview Survey (2000-2018). CVD risk factors (hypertension, diabetes, high BMI, nicotine exposure, alcohol consumption, insufficient physical activity, and suboptimal sleep) and age were self-reported. We estimated the age-stratified prevalence of each CVD risk factor among Asian American subgroups (Filipino, Indian, Chinese, and “Other Asian”). Analyses accounted for the complex survey design.

Results:
The study population included 20.3% Chinese, 23.6% Filipino, 18.4% Indian, and 37.7% Other Asian groups. Filipinos had the highest prevalence of hypertension (6.4%, 95% CI: 5.1, 8.1), obesity (24.8%, 95% CI: 22.1, 27.7), alcohol consumption (67%, 95% CI: 63.7, 70.1), and suboptimal sleep (37.3%, 95% CI: 34.3, 40.4) at younger ages (18 - 34). The highest prevalence of diabetes was found in the Indian subgroup starting at ages 35 - 44 years. The Other Asian subgroup had highest prevalence of nicotine exposure (16.1%, 95% CI: 14.6, 17.7) at younger ages (18 - 34). The Chinese subgroup consistently had the lowest prevalence of CVD risk factors across age strata.

Conclusions:
Our findings show that Indian, Filipino, and Other Asian subgroups have a higher prevalence of most CVD risk factors at earlier ages compared to Chinese subgroup. This may explain why CVD prevalence among Chinese Americans is lower than other Asian subgroups. Our study demonstrates the importance of targeting CVD risk factors among susceptible Asian subgroups earlier in the life course.
Abstract P536: The Association of Adipokines With Cardiac Structure and Function Among Older Adults Without Clinical Cardiovascular Disease
Authors: Kyrvasilis Andreas , Ozkan Bige , Echouffo-Tcheugui Justin B , Nambi Vijay , Michos Erin D , Post Wendy S , Gerstenblith Gary , Blumenthal Roger S , Hoogeveen Ron C , Ballantyne Christie M , Shah Amil M , Selvin Elizabeth , Coresh Josef , Ndumele Chiadi E
Published: May 2024

Background:
Heart failure (HF) is a growing public health concern. While dysfunctional adipose tissue is a key driver of HF risk in the population, the role of altered adipokine production by adipose tissue in the development of cardiac dysfunction is unknown.

Methods:
We conducted a cross-sectional analysis of ARIC Visit 5 (2011-13) participants free of coronary heart disease and HF. Using linear regression, we assessed the adjusted associations between the adipokines adiponectin, leptin, apelin, and resistin (per 1-SD) and echocardiographic parameters indicative of cardiac structure and function.

Results:
We included 3244 participants (mean age 75±5 years, 61% female, 16% Black, 31% with obesity). After adjusting for sociodemographic/lifestyle factors and eGFR, 1-SD higher adiponectin was associated with lower (worse) LV ejection fraction (LVEF), but a more negative (better) longitudinal strain (LS). Higher adiponectin was also associated with higher lateral and medial e’ and lower E/e’, reflecting better diastolic function. Conversely, higher leptin was associated with worse systolic and diastolic function, indicated by a less negative LS, lower lateral and medial e’, and higher E/e’. Higher leptin/adiponectin ratio was associated with better LVEF (β: 1.73, 95% CI: 0.04, 3.41), but worse LS (β: 1.87, 95% CI: 1.17, 2.57), as well as uniformly worse diastolic function (lateral e’ [β: -2.39, 95% CI: -2.99, -1.79], medial e’ [β: -1.43, 95% CI: -1.86, -0.99], E/e’ [β: 2.61, 95% CI: 1.56, 3.67]). Adjustment for clinical variables and BMI attenuated some associations, but resulted in associations of adiponectin with greater LV mass index, and leptin with lower LV mass index. Apelin and resistin had weak associations with cardiac function.

Conclusion:
Adiponectin and leptin are differentially associated with systolic and diastolic function. Further investigation of the adipokines’ opposing roles in the development of cardiac dysfunction may help elucidate the effect of dysfunctional adipose tissue on myocardium.
Abstract P540: Sleep Duration, Rapid Eye Movement Sleep, and Subclinical Myocardial Damage
Authors: Zhao Henry , Daya Natalie , Fang Michael , Lucey Brendan P , Redline Susan , Punjabi Naresh , Ballantyne Christie M , Shah Amil M , Spira Adam , Lutsey Pamela L , Selvin Elizabeth
Published: May 2024

Introduction:
Sleep is strongly linked to clinical cardiovascular disease and was added in 2022 to the AHA’s Life’s Essential 8. Optimizing sleep duration and quality may reduce the risk of cardiovascular disease. Few studies have examined self-reported sleep duration and percent time in rapid eye movement (REM) sleep measured by single night in-home polysomnography with high sensitivity cardiac troponin T (hs-troponin T), a biomarker of subclinical cardiovascular disease.

Methods:
We conducted a cross-sectional study of adults without a history of cardiovascular disease who participated in both the Atherosclerosis Risk in Communities (ARIC) Study and the Sleep Heart Health Study (SHHS) in 1995-1998. We used linear regression with sleep duration and percentage time of REM sleep modeled as predictors with restricted cubic splines and examined associations with the outcome, hs-troponin T. We adjusted for age, sex, body mass index, waist-to-hip ratio, alcohol intake, smoking status, systolic blood pressure, hypertension medication use, diabetes, HDL- and LDL-cholesterol, and cholesterol-lowering medication use.

Results:
Among 1,587 participants (mean age 63, 54% female), the mean sleep duration was 7.3 hours, and mean % REM time was 20.7. Sleep duration was not associated with hs-troponin T (
Figure, Panel A
). However, percentage REM sleep was negatively associated with hs-troponin T, but with a threshold effect; there was a negative linear association of hs-troponin T with % REM sleep but only at values <15% (
Figure, Panel B
).

Conclusion:
While self-reported sleep duration was not associated with TnT levels, there was evidence that low % REM sleep, a specific neurophysiological sleep state, was associated with subclinical cardiovascular disease. These findings suggest that multiple sleep dimensions should be considered in efforts to optimize cardiovascular health.
Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial
Authors: Rohner Roman , Kneihsl Markus , Goeldlin Martina B. , Hakim Arsany , Branca Mattia , Abend Stefanie , Valenzuela Pinilla Waldo , Fenzl Sabine , Rezny-Kasprzak Beata , Strbian Daniel , Trelle Sven , Paciaroni Maurizio , Thomalla Götz , Michel Patrik , Nedeltchev Krassen , Gattringer Thomas , Sandset Else C. , Bonati Leo , Aguiar de Sousa Diana , Sylaja P.N. , Ntaios George , Koga Masatoshi , Gdovinova Zuzana , Lemmens Robin , Bornstein Natan M. , Kelly Peter , Katan Mira , Horvath Thomas , Dawson Jesse , Fischer Urs ,   for the ELAN Investigators
Published: May 2024

BACKGROUND:

Whether hemorrhagic transformation (HT) modifies the treatment effect of early compared with late initiation of direct oral anticoagulation in people with ischemic stroke and atrial fibrillation is unknown.

METHODS:

This is a post hoc analysis of the ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation). The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, major extracranial bleeding, systemic embolism, or vascular death within 30 days. Secondary outcomes were the individual components, 30- and 90-day functional outcome. We estimated outcomes based on HT, subclassified as hemorrhagic infarction (HI) or parenchymal hemorrhage (PH) on prerandomization imaging (core laboratory rating) using adjusted risk differences between treatment arms.

RESULTS:

Overall, 247 of 1970 participants (12.5%) had HT (114 HI 1, 77 HI 2, 34 PH 1, 22 PH 2). For the primary outcome, the estimated adjusted risk difference (early versus late) was −2.2% (95% CI, −7.8% to 3.5%) in people with HT (HI: −4.7% [95% CI, −10.8% to 1.4%]; PH: 6.1% [95% CI, −8.5% to 20.6%]) and −0.9% (95% CI, −2.6% to 0.8%) in people without HT. Numbers of symptomatic intracranial hemorrhage were identical in people with and without HT. With early treatment, the estimated adjusted risk difference for poor 90-day functional outcome (modified Rankin Scale score, 3–6) was 11.5% (95% CI, −0.8% to 23.8%) in participants with HT (HI: 7.4% [95% CI, −6.4% to 21.2%]; PH: 25.1% [95% CI, 0.2% to 50.0%]) and −2.6% (95% CI, −7.1% to 1.8%) in people without HT.

CONCLUSIONS:

We found no evidence of major treatment effect heterogeneity or safety concerns with early compared with late direct oral anticoagulation initiation in people with and without HT. However, early direct oral anticoagulation initiation may worsen functional outcomes in people with PH.

REGISTRATION:

URL:
http://www.clinicaltrials.gov
; Unique identifier: NCT03148457.
Placental Methylglyoxal in Preeclampsia: Vascular and Biomarker Implications
Authors: Vangrieken Philippe , Al-Nasiry Salwan , Remels Alex H.V. , Schiffers Paul M.H. , Janssen Emma , Nass Stefanie , Scheijen Jean L.J.M. , Spaanderman Marc E.A. , Schalkwijk Casper G.
Published: May 2024

BACKGROUND:

Preeclampsia is a multifaceted syndrome that includes maternal vascular dysfunction. We hypothesize that increased placental glycolysis and hypoxia in preeclampsia lead to increased levels of methylglyoxal (MGO), consequently causing vascular dysfunction.

METHODS:

Plasma samples and placentas were collected from uncomplicated and preeclampsia pregnancies. Uncomplicated placentas and trophoblast cells (BeWo) were exposed to hypoxia. The reactive dicarbonyl MGO and advanced glycation end products (N
ε
-(carboxymethyl)lysine [CML], N
ε
-(carboxyethyl)lysine [CEL], and MGO-derived hydroimidazolone [MG-H]) were quantified using liquid chromatography-tandem mass spectrometry. The activity of GLO1 (glyoxalase-1), that is, the enzyme detoxifying MGO, was measured. The impact of MGO on vascular function was evaluated using wire/pressure myography. The therapeutic potential of the MGO-quencher quercetin and mitochondrial-specific antioxidant mitoquinone mesylate (MitoQ) was explored.

RESULTS:

MGO, CML, CEL, and MG-H2 levels were elevated in preeclampsia-placentas (+36%, +36%, +25%, and +22%, respectively). Reduced GLO1 activity was observed in preeclampsia-placentas (−12%) and hypoxia-exposed placentas (−16%). Hypoxia-induced MGO accumulation in placentas was mitigated by the MGO-quencher quercetin. Trophoblast cells were identified as the primary source of MGO. Reduced GLO1 activity was also observed in hypoxia-exposed BeWo cells (−26%). Maternal plasma concentrations of CML and the MGO-derived MG-H1 increased as early as 12 weeks of gestation (+16% and +17%, respectively). MGO impaired endothelial barrier function, an effect mitigated by MitoQ, and heightened vascular responsiveness to thromboxane A2.

CONCLUSIONS:

This study reveals the accumulation of placental MGO in preeclampsia and upon exposure to hypoxia, demonstrates how MGO can contribute to vascular impairment, and highlights plasma CML and MG-H1 levels as promising early biomarkers for preeclampsia.
Risk of Stroke in Women Using Levonorgestrel-Releasing Intrauterine Device for Contraception
Authors: Letnar Gasper , Andersen Klaus Kaae , Olsen Tom Skyhøj
Published: May 2024

BACKGROUND:

The commonly used combined hormonal contraceptives with progestins and ethinylestradiol are associated with an increased risk of ischemic stroke (IS). Progestin-only preparations, including levonorgestrel-releasing intrauterine devices (LG-IUDs), are not associated with an increased risk, and in smaller studies, the risk is even reduced. The risk of intracerebral hemorrhage (ICH) has never been investigated. We studied the risk of IS and ICH in women using LG-IUDs compared with women not using hormonal contraceptives.

METHODS:

In this Danish historical cohort study (2004–2021), we followed nonpregnant women (18–49 years) registering incident IS and ICH in relation to use of LG-IUDs/nonuse of hormonal contraceptives utilizing Danish high-quality registries with nationwide coverage. Poisson regression models adjusting for age, ethnicity, education, calendar year, and medication use for risk factors were applied.

RESULTS:

A total of 1 681 611 nonpregnant women contributed 11 971 745 person-years (py) of observation. Mean age at inclusion was 30.0 years; mean length of follow-up was 7.1 years; 2916 women (24.4 per 100 000 py) had IS; 367 (3.1 per 100 000 py) had ICH. Of these, 364 784 were users of LG-IUD contributing 1 720 311 py to the investigation; mean age at start of usage was 34.6 years. Nonusers of hormonal contraceptives contributed 10 251 434 py; mean age at inclusion was 30.0 years. The incidence rate of IS/ICH among LG-IUD users was 19.2/3.0 and among nonusers, it was 25.2/3.1 per 100 000 py. After adjustment, incidence rate ratio for IS was 0.78 (CI, 0.70–0.88), and for ICH it was 0.94 (CI, 0.69–1.28).

CONCLUSIONS:

The use of LG-IUD was associated with a 22% lower incidence rate of IS without raising the incidence rate of ICH. The finding raises the question of whether levonorgestrel, in addition to its contraceptive properties, could have the potential to prevent IS.
Cross-lingual Cross-temporal Summarization: Dataset, Models, Evaluation
Authors: Zhang Ran , Ouni Jihed , Eger Steffen
Published: May 2024

While summarization has been extensively researched in natural language processing (NLP), cross-lingual cross-temporal summarization (CLCTS) is a largely unexplored area that has the potential to improve cross-cultural accessibility and understanding. This article comprehensively addresses the CLCTS task, including dataset creation, modeling, and evaluation. We (1) build the first CLCTS corpus with 328 instances for hDe-En (extended version with 455 instances) and 289 for hEn-De (extended version with 501 instances), leveraging historical fiction texts and Wikipedia summaries in English and German; (2) examine the effectiveness of popular transformer end-to-end models with different intermediate fine-tuning tasks; (3) explore the potential of GPT-3.5 as a summarizer; and (4) report evaluations from humans, GPT-4, and several recent automatic evaluation metrics. Our results indicate that intermediate task fine-tuned end-to-end models generate bad to moderate quality summaries while GPT-3.5, as a zero-shot summarizer, provides moderate to good quality outputs. GPT-3.5 also seems very adept at normalizing historical text. To assess data contamination in GPT-3.5, we design an adversarial attack scheme in which we find that GPT-3.5 performs slightly worse for unseen source documents compared to seen documents. Moreover, it sometimes hallucinates when the source sentences are inverted against its prior knowledge with a summarization accuracy of 0.67 for plot omission, 0.71 for entity swap, and 0.53 for plot negation. Overall, our regression results of model performances suggest that longer, older, and more complex source texts (all of which are more characteristic for historical language variants) are harder to summarize for all models, indicating the difficulty of the CLCTS task. Regarding evaluation, we observe that both the GPT-4 and BERTScore correlate moderately with human evaluations, implicating great potential for future improvement.
Patient Satisfaction: The Role of Artificial Intelligence in Healthcare
Authors: Jabbar M. A. , Iqbal Hena , Chawla Udit
Published: May 2024

Applications of artificial intelligence (AI) can be seen in almost every aspect of the healthcare system, as it has potential to affect almost every facet of the healthcare, from detection of ailments and serious or complex chronic diseases to their control, prevention and cure. With technological innovations, upgradation and adoption in the field of healthcare, healthcare professionals are required to be well prepared to accept the continuously evolving technology and its application to provide best healthcare facilities, which gave rise to the various studies on the role of the machine learning (ML), AI, deep learning (DL), etc., in the field of healthcare. Similarly, the rise in digitalised hospitals, medical facilities, records and data has resulted in the improvisation in the field of healthcare, which in turn has increased the need of experts, professionals, experienced and digitally literate workforce teams in the field of entire healthcare system. Understanding the roles of these advanced technologies, impacts being created on the health, lifestyle and the entire healthcare system, along with the perception of the patients towards it, will shape the way for the improvements and the applications of AI and its outcomes to be achieved, resulting in healthier world for the patients and the society. The objective of the study is to create a patient satisfaction model and validate it with respect to factors influencing patient satisfaction of several patients undergoing AI treatment factors. In the study, the United States, Canada, Australia, UAE and China were chosen as a place of survey, as these are advanced countries and the use of AI is highest in these countries compared to other countries, and survey was done with the help of structured questionnaire. In our earlier study, exploratory factor analysis (EFA) was performed for initial knowledge development on the construct of patients undergoing AI treatment. Patient satisfaction rests on six broad dimensions: First factor is personal touch (PT), second factor is comprehensive gap (CG), third factor is answerability (AB), fourth factor is nerve racking (NR), fifth factor is wrong reporting (WR) and sixth factor is enlightened (EL). With the help of confirmatory factor analysis (CFA) and structured equation modelling (SEM), it has emerged from the study that patient satisfaction level of the construct suggests that PT will have a greater impact on patient satisfaction, and it is the most significant factor of patient satisfaction compared to other constructs. Thus, we can conclude that PT still remains the most important factor in the minds of patients before undergoing AI treatment.
Relationship Between the Gut Microbiota and Neurological Deficits in Patients With Cerebral Ischemic Stroke
Authors: Bao Wangxiao , Sun Yun , Wang Juehan , Wei Shuang , Mao Lin , Zheng Jinjin , Liu Ping , Yang Xiaofeng , Chen Zuobing
Published: May 2024

Objective

The aim of the paper was to investigate the composition and structure of intestinal flora in patients with cerebral ischemic stroke (CIS), and to investigate the relationship between gut microbiota (GM) and different levels of stroke severity.

Methods

In this study, 47 CIS patients (16 mild, 21 moderate, and 10 severe) and 15 healthy controls were included. General information, clinical data, and behavioral scores of the enrolled subjects were collected. Deoxyribonucleic acid in fecal intestinal flora was extracted and detected using high-throughput Illumina 16S ribosomal ribonucleic acid sequencing technology. Finally, the correlation between the community composition of intestinal microbiota and National Institutes of Health Stroke Scale (NIHSS) score in CIS patients was analyzed.

Results

Compared with healthy controls, there was no statistically significant difference in Alpha diversity among CIS patients, but the principal coordinate analysis showed significant differences in the composition of the GM among stroke patients with different degrees of severity and controls. In CIS patients, Streptococcus was significantly enriched, and Eshibacter—Shigella, Bacteroides, and Agathobacter were significantly down-regulated ( P < .05). In addition, the relative abundance of Blautia was negatively correlated with the NIHSS score.

Conclusions

Our results show that different degrees of CIS severity exert distinct effects on the intestinal microbiome. This study reveals the intestinal microecological changes after brain injury from the perspective of brain–gut axis. Intestinal microorganisms not only reveal the possible pathological process and indicate the severity of neurologic impairment, but also make targeted therapy possible for CIS patients.
Research on high sensitivity piezoresistive sensor based on structural design
Authors: Li Wei , Liu Xing , Wang Yifan , Peng Lu , Jin Xin , Jiang Zhaohui , Guo Zengge , Chen Jie , Wang Wenyu
Published: May 2024

With the popularity of smart terminals, wearable electronic devices have shown great market prospects, especially high-sensitivity pressure sensors, which can monitor micro-stimuli and high-precision dynamic external stimuli, and will have an important impact on future functional development. Compressible flexible sensors have attracted wide attention due to their simple sensing mechanism and the advantages of light weight and convenience. Sensors with high sensitivity are very sensitive to pressure and can detect resistance/current changes under pressure, which has been widely studied. On this basis, this review focuses on analyzing the performance impact of device structure design strategies on high sensitivity pressure sensors. The design of structures can be divided into interface microstructures and three-dimensional framework structures. The preparation methods of various structures are introduced in detail, and the current research status and future development challenges are summarized.
AMRViz enables seamless genomics analysis and visualization of antimicrobial resistance
Authors: Le Duc Quang , Nguyen Son Hoang , Nguyen Tam Thi , Nguyen Canh Hao , Ho Tho Huu , Vo Nam S. , Nguyen Trang , Nguyen Hoang Anh , Cao Minh Duc
Published: May 2024

We have developed AMRViz, a toolkit for analyzing, visualizing, and managing bacterial genomics samples. The toolkit is bundled with the current best practice analysis pipeline allowing researchers to perform comprehensive analysis of a collection of samples directly from raw sequencing data with a single command line. The analysis results in a report showing the genome structure, genome annotations, antibiotic resistance and virulence profile for each sample. The pan-genome of all samples of the collection is analyzed to identify core- and accessory-genes. Phylogenies of the whole genome as well as all gene clusters are also generated. The toolkit provides a web-based visualization dashboard allowing researchers to interactively examine various aspects of the analysis results. Availability: AMRViz is implemented in Python and NodeJS, and is publicly available under open source MIT license at https://github.com/amromics/amrviz.
Comparative and phylogenetic analyses of Loranthaceae plastomes provide insights into the evolutionary trajectories of plastome degradation in hemiparasitic plants
Authors: Tang Lilei , Wang Tinglu , Hou Luxiao , Zhang Guangfei , Deng Min , Guo Xiaorong , Ji Yunheng
Published: May 2024

Background

The lifestyle transition from autotrophy to heterotrophy often leads to extensive degradation of plastomes in parasitic plants, while the evolutionary trajectories of plastome degradation associated with parasitism in hemiparasitic plants remain poorly understood. In this study, phylogeny-oriented comparative analyses were conducted to investigate whether obligate Loranthaceae stem-parasites experienced higher degrees of plastome degradation than closely related facultative root-parasites and to explore the potential evolutionary events that triggered the ‘domino effect’ in plastome degradation of hemiparasitic plants.

Results

Through phylogeny-oriented comparative analyses, the results indicate that Loranthaceae hemiparasites have undergone varying degrees of plastome degradation as they evolved towards a heterotrophic lifestyle. Compared to closely related facultative root-parasites, all obligate stem-parasites exhibited an elevated degree plastome degradation, characterized by increased downsizing, gene loss, and pseudogenization, thereby providing empirical evidence supporting the theoretical expectation that evolution from facultative parasitism to obligate parasitism may result in a higher degree of plastome degradation in hemiparasites. Along with infra-familial divergence in Loranthaceae, several lineage-specific gene loss/pseudogenization events occurred at deep nodes, whereas further independent gene loss/pseudogenization events were observed in shallow branches.

Conclusions

The findings suggest that in addition to the increasing levels of nutritional reliance on host plants, cladogenesis can be considered as another pivotal evolutionary event triggering the ‘domino effect’ in plastome degradation of hemiparasitic plants. These findings provide new insights into the evolutionary trajectory of plastome degradation in hemiparasitic plants.
Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population
Authors: Arevalo Fernando , Rayme Soledad , Ramírez Rocío , Rolando Romy , Fustamante Jaime , Monteghirfo Mario , Chavez Rocio , Monge Eduardo
Published: May 2024

Introduction

The diagnosis of intestinal tuberculosis is challenging even nowadays. This study aims to report the positivity rates of new diagnostic methods such as immunohistochemistry and Real-Time Polymerase Chain Reaction in patients with intestinal tuberculosis, as well as describe the pathological and endoscopic features of intestinal tuberculosis in our population.

Methods

This was a retrospective observational study conducted in patients diagnosed with intestinal tuberculosis, between 2010 to 2023 from the Hospital Nacional Daniel Alcides Carrion and a Private Pathology Center, both located in Peru. Clinical data was obtained, histologic features were independently re-evaluated by three pathologists; and immunohistochemistry and real-time Polymerase Chain Reaction evaluation were performed. The 33 patients with intestinal tuberculosis who fulfilled the inclusion criteria were recruited.

Results

Immunohistochemistry was positive in 90.9% of cases, while real-time Polymerase Chain Reaction was positive in 38.7%. The ileocecal region was the most affected area (33.3%), and the most frequent endoscopic appearance was an ulcer (63.6%). Most of the granulomas were composed solely of epithelioid histiocytes (75.8%). Crypt architectural disarray was the second most frequent histologic finding (78.8%) after granulomas, but most of them were mild.

Conclusion

Since immunohistochemistry does not require an intact cell wall, it demonstrates higher sensitivity compared to Ziehl–Neelsen staining. Therefore, it could be helpful for the diagnosis of paucibacillary tuberculosis.