bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances in GLP-1 receptor agonists for the treatment of type 2 diabetes
Authors: Hong Shurui
Published: June 2023

Glucagon-like peptide-1 (GLP-1), an incretin secreted by intestinal L cells, has become a critical target for the treatment of type 2 diabetes because of its physiological effects of augmenting insulin secretion, suppressing glucagon secretion, and decelerating gastric emptying. Human endogenous GLP-1 is found to be proteolytically degraded and inactivated by DPP-4, which considerably limits the therapeutic effects of GLP-1. In contrast, GLP-1RAs undergo significant improvement in drug stability. In this context, several successful strategies for the development of GLP-1RAs and the corresponding problems are fully elaborated. The assay gives a brief overview of the pharmacological effects, advantages and common adverse effects of GLP-1RAs, shedding light on the latest research progress of GLP-1RAs, including new dosage forms, new drug targets and new clinical applications.
Research on China's economic model changed since the COVID-19 epidemic
Authors: Kang Xiaocheng , Liu Lirui , Chen Jiahe , Gao Yiting
Published: June 2023

The Covid-19 pandemic of 2019 was a global public health emergency, resulting in millions of deaths worldwide. The origin of pandemic was in China, where the disease was first reported in 2019 and in 2020, it became a global pandemic. Because of the economic and social effects caused by COVID-19, changes were made to China's economic model. The Chinese government wanted to protect their economy and people from the virus, so they invested a lot of money into combating the pandemic. Economic development is when a country's economy becomes more advanced than other countries. If it has good infrastructure and employment opportunities, it will become richer (McBryde et al., 2020). An economy can advance quickly through technological advancement, education, and increasing demand for goods and services. When China first experienced the pandemic, it had a rich economy and grew quickly. China was rapidly developing in terms of technology, education, and infrastructure. China's economic model took a turn for the worse when the COVID-19 pandemic hit it. The virus spread quickly, causing millions of deaths in China (Dhar, 2020). The Chinese government was forced to invest billions of RMB into research and to treat those affected by the virus. After COVID-19, China's economy fell into a slight recession. This could have been caused by a drop in exports, an increased mortality rate, and the government spending billions on stopping the pandemic. This paper will first give an overview of previous economic models that China used, then it will discuss how the COVID-19 pandemic changed China's economic model, and finally, this paper will look at the impact that COVID-19 had on China's economy.
The curative effect of fallopian tube interventional recanalization and ethiodode oil
Authors: He Bin , Li Yamin , Hu Jihong , Zhao Wei
Published: June 2023

Objective: To analyze the efficacy of fallopian tube interventional recanalization and ethiodized oil in treating fallopian tube obstruction. Methods: 84 patients were selected from August 2020 to August 2021. Patients were randomly divided into control group and observation group, with 42 patients in each group. The control group was treated by conventional uterine laparoscopic combined surgery, and the observation group adopted the method of tubal interventional recanalization combined with ethiodized oil. To compare the treatment effect of the two groups, the serum inflammatory factor levels before and after the treatment, and the postoperative recovery. Results: In terms of treatment effect, the total response rate was 95.24% higher than 71.43% in the control group, and P <0.05. In terms of serum inflammatory factor levels, there was no significant difference between the two groups before treatment, with P> 0.05; and IL-6 (64.02±12.52)ng/L, TNF-α (21.03±2.20) ng/L, respectively, lower than the control group (72.35±16.39) ng/L, (28.35±2.34)ng/L,P<0.05. In terms of postoperative recovery, the observation group had a postoperative pain score (2.02±0.41) Break up and get out of bed activity time (16.31±2.82) h, length of stay (2.31±0.82) d, lower than the control group (4.56±1.42) component, (24.42±5.47)h, (4.42±0.47) d, P<0.05. Conclusion: In the treatment of fallopian tube obstruction, the treatment method of fallopian tube interventional recanalization combined with ethylene iodized oil can improve the overall treatment efficiency, reduce the inflammation, improve the postoperative recovery, and the curative effect is more ideal.
The role of mechanical channel in the proliferation and migration of colon cancer
Authors: Wang Pinchun
Published: June 2023

Piezo channel is the first family of mechanically gated cation channels found in mammals and has been shown correlated with the proliferation and metastasis of tumors in recent years. In a variety of cancer tissues, colon cancer tissues are particularly affected by mechanical stimulation. In this paper, we reported that the role of piezo1 in the proliferation and migration of colon cancer. Firstly, bioinformatics indicated that high levels of piezo1 expression existed in CRC tissues and were associated with poor prognosis. In vitro experiments, SW1116 cells were cultured in DMSO solutions, and CCK-8 assay and transwell assay were separately performed. It turned out that the inhibition of PIEZO1 by Dooku1 resulted in diminished cell proliferation and metastasis, while the activation of PIEZO1 by Yoda1 led to enhanced proliferation and migration of colon cells. Collectively, these findings demonstrated the facilitation role of piezo1 in colon cancer proliferation and migration, suggesting that piezo1 has the potential as a novel therapeutic target for drug design and treatment of colon cancer.
Vorstellung eines Patienten mit Rothmund-Thomson-Syndrom mit einer Transformation eines myelodysplastischen Syndroms in eine akute myeloische Leukämie
Authors: Özbaş Hasan Mücahit , Çinar Esma , Oğuz Işıl Deniz , Baylan Alev Gül , Çubukcu Damla , Dikbaş Oguz
Published: June 2023

Das Rothmund-Thomson-Syndrom (RTS) ist eine seltene, autosomal-rezessiv vererbbare Genodermatose mit ungefähr 300 Fallberichten. Es tritt mit einem charakteristischen Gesichtsausschlag als Leitsymptom im Kindesalter auf, der sich zu einer typischen Poikilodermie entwickeln kann. Es besteht eine Prädisposition für Erkrankungen am Auge und für die Entstehung von Osteosarkomen. Darüber hinaus sind in diesem Zusammenhang eine progressive Leukopenie und eine chronische, mikrozytäre, hypochrome und transfusionserfordernde Anämie bekannt. Allerdings finden sich in der Literatur lediglich drei Fallberichte über das myelodysplastische Syndrom (MDS), wobei keiner über eine Transformation in eine akute myeloische Leukämie (AML) berichtet.

Anhand dieser Fallvorstellung werden wir detailliert darstellen, wie die Diagnose des RTS gestellt wurde, über den langen klinischen Verlauf berichten, die Entwicklung in ein MDS und die Transformation in eine AML sowie den Behandlungsverlauf erläutern.

Diese Fallvorstellung soll Ärzten/-innen bei Patienten mit diagnostiziertem RTS helfen, frühzeitig die Entwicklung von AML zu erkennen.
Balneo- und Hydrotherapie bei rheumatischen Erkrankungen
Authors: Lange Uwe , Schulz Nils , Klemm Philipp
Published: June 2023

Bei rheumatischen Erkrankungen hat sich die Balneo- und Hydrotherapie über Jahrhunderte empirisch bewährt. Die Therapieziele fokussieren auf die Schmerzreduktion, die muskuläre Entspannung, die Erhöhung der Muskelkraft und die Verbesserung der funktionellen Mobilität sowie die Verbesserung des Wohlbefindens, der Lebensqualität und eine Senkung des Medikamentenverbrauchs. Der Einsatz balneotherapeutischer Anwendungen wird im Statement des American College of Rheumatology als essenzielle komplementäre Therapieform empfohlen. Ziel der vorliegenden Übersichtsarbeit ist, das aktuelle Wissen über die Wirkungen der Balneo- und Hydrotherapie darzulegen und mögliche Wirkmechanismen bei verschiedenen rheumatischen Erkrankungen aufzuzeigen.
Old habits die hard
Authors: Holzhauer Peter
Published: June 2023

Dieser Song, dessen Titelzeile gerade meine Gedanken und Gefühle
beschäftigen, stammt aus dem Kinofilm Alfie. Mick Jagger schrieb die Lyrics
und Jude Law spielte die Hauptrolle. Der gar nicht so bekannte Song gewann 2004
immerhin den Golden Globe Award.
Possible Rates of Detection of Neonatal Sepsis Pathogens in the Context of Microbiological Diagnostics in Mothers – Real World Data
Authors: Kuld Raffael , Krauth Alexander , Kühr Joachim , Krämer Janine , Dittrich Ralf , Häberle Lothar , Müller Andreas
Published: June 2023

The aim of this study was to identify the rate of detection of neonatal sepsis pathogens
in maternal microbiological smears.

This is a retrospective study conducted at a Level 1 perinatal center in the context of
routine care from 2014 to 2019. For all premature infants and neonates with neonatal sepsis,
the neonatal and maternal microbiological findings were examined to see if there was a
match.

During the study period, a total of 948 premature or newborn infants were identified as
having a neonatal infection. Among all of the premature or newborn infants, 209 (22%) met
the diagnostic criteria for neonatal sepsis; of these, 157 were premature births and 52 were
full-term births. We evaluated the microbiological findings for these 209 mother and child
pairs. No pathogens were detected in 27 out of 157 mothers of premature infants (17.1%) and
in 31 out of 52 mothers of full-term infants (59.6%). In the premature infant group there
were pairs with matching pathogens in 30 out of 130 cases (23.1%, 95% CI: 16.1–31.3), and in
the full-term infant group there was a match in 4 out of 21 cases (19%, 95% CI: 5.4–41.9).
The number needed to test to have a 90% probability of success for pathogen detection varies
between 9 and 11 in the most favorable case and 26 and 32 in the least favorable case,
depending on the evaluation method.

In cases of neonatal sepsis, the sepsis-causing pathogen was successfully detected
through prior analysis of a maternal smear in 7% of full-term infants and in 19% of
premature infants. The number needed to test was relatively high in all groups. The value of
maternal smears for identifying neonatal sepsis-causing pathogens needs to be critically
questioned.
A Study on Enumeration of Factors Prone to the Development of COVID-19-Associated Mucormycosis
Authors: Velusamy Sivakumar , Rajagopal Jayakumar , Jayakumar Jessica , Parthiban Dharshini , Hussain Adeeb Ismail Zahir
Published: June 2023

Background Patients with pre-existing chronic medical conditions with altered immunity are prone to COVID-19-associated mucormycosis (CAM).

Objective In this study, our objectives were to identify the risk factors that increase the chances of developing CAM and to determine the severity of the risk factors of CAM. Thereby, we can optimize the modifiable risk factors for developing CAM in coronavirus disease 2019 (COVID-19) patients. For instance, better control of blood glucose levels in COVID-19 patients can decrease the risk of developing CAM.

Materials and Methods The data was collected retrospectively from 1000 COVID-19 infected patients, above the age of 18 years during the time period of March 2021 to August 2021, in which 86 patients had confirmed CAM.

Statistical Analysis Binary logistic regression and curve estimation analysis were performed using SPSS software version 29 for identifying the associated risk factors of CAM with the significance of p-value less than 0.05.

Results Factors such as severe inflammation (p = 0.048), high dose of steroid administration (p = 0.005), increasing age (p < 0.001), and prolonged hospital stay (p < 0.001) were statistically proven to be significant risk factors, associated with CAM.

Conclusion Increasing age, severe inflammation, high dose of steroid administration, and prolonged hospital stay have association with occurrence of CAM.
Anti-M Alloimmunization following Term Stillbirth: A Case Report and Review of the Literature
Authors: Beck Manisha M. , V. Hamsavardhini , Navaneethan Preethi , Kumar Manish
Published: June 2023

Alloimmunization due to anti-M antibodies are rare since they present as naturally occurring immunoglobulin M antibodies, which do not cross the placenta. Very rarely, these may convert to immunoglobulin G antibodies and cause hemolytic disease of the fetus and newborn. We present the case of a fifth gravida, with previous two miscarriages and an unexplained stillbirth, booked with us for the 8 weeks. At booking, she was found to have anti-M antibodies with titers of 1:2, which was stable throughout pregnancy. At 35 weeks, there was evidence of severe fetal anemia and features of hydrops on the ultrasound scan, requiring delivery. Neonatal direct Coombs test was positive. Baby had a hemoglobin of 8.8 mg/dL and a reticulocyte count of 5.5% at birth, requiring two units of blood transfusion. He also required 6 days of intensive phototherapy. Alloimmunization due to anti-M antibodies should be suspected in women with previous bad obstetric history. The maternal antibody titers may not be a true reflection of the severity of fetal affection, and hence not reliable for monitoring in pregnancy
Prenatal Diagnosis and Fetal Sonographic Features of Swyer Syndrome
Authors: Kane Daniel T. , Dempsey Mark A. , Burke Annette L. , Morrison John J.
Published: June 2023

Swyer syndrome, also known as complete gonadal dysgenesis, is characterized by an individual who has an XY karyotype but is phenotypically female. It is typically diagnosed in adolescence after investigations for primary amenorrhea. The estimated prevalence is 1 in 20,000 to 80,000 births. Mutations in the DNA-binding region of the SRY gene account for approximately 15 to 20% of cases, with the remaining cases caused by other gene mutations. There are no reports of the established diagnosis of Swyer syndrome prenatally, or of the sonographic features that may be associated with it. This report outlines the details of a 33-year-old primigravida in whom a fetal cystic hygroma was noted on ultrasound at 12 weeks gestation. Chorionic villous sampling revealed a diagnosis of fetal Swyer syndrome. The fetus progressed to develop severe fetal hydrops and a parental decision for termination of pregnancy was made at 15 weeks of gestation.
Climate change adaptation responses and human mobility in the Mekong Delta: local perspectives from rural households in An Giang Province, Vietnam
Authors: Bayrak Mucahid Mustafa , Van Hieu Tran , Tran Thong Anh , Hsu Yi-Ya , Nien Tung , Quynh Dang Thi Thanh
Published: June 2023

Climate change influences the adaptation responses and mobility patterns of smallholder farmers across multiple scales. This study employed an inductive approach to observe smallholder farmers in An Giang Province in the Vietnamese Mekong Delta to compare the effects of various environmental and climate-related stressors on households with and without contributing migrant household members and on households of different income levels in two rural communes. We looked into the roles that adaptation responses and human mobility patterns play in the daily livelihoods of (translocal) households. We adopted a mixed-methods approach, which involved the administration of a livelihood survey among households in two rural communes (N = 106) and, subsequently, two focus group discussions, unstructured in-depth interviews, and secondary data analysis. We discovered that human mobility, adaptation responses, and climate change are interwoven in a web of complex relationships. No clear differences in effects and climate adaptation responses were discovered between emigrant and nonemigrant households. Hence, paradigms that either portray migration as a failure to adapt or as a form of adaptation in the context of climate change do not adequately explain the findings of this study. Differences between income groups were, however, observed. Relative to other income groups, middle-income farmers were disproportionally affected by climate-related disasters. Additionally, out-migration, aging, upstream hydropower development, and COVID-19 lockdowns posed significant challenges to the livelihoods of smallholder farmers. The compound effects of these multiple stressors indicate that human mobility, climate change and adaptation patterns should be best approached as ‘wicked’ problems.
System modeling and simulation of flyer acceleration and explosive detonation in exploding foil initiator
Authors: Kim Kyoungjin , Jang Seung-gyo
Published: June 2023

In this theoretical study on an exploding foil initiator (EFI), the sequential events in an EFI system were numerically modeled and investigated from metallic bridge burst by ohmic heating and flyer acceleration by plasma expansion to explosive detonation by high-speed flyer impact. The EFI system modeling employed mass, momentum, and energy conservation coupled with the resistance–inductance–capacitance circuit equation of the initiation circuit and plasma property calculations of highly dense metallic plasma as well as a semi-empirical detonation model. The aim was to predict transient bridge behavior, flyer velocity, and detonation initiation threshold. Through comparisons and verifications with measured data from several existing EFI firing tests, the present system model was shown to predict bridge burst and flyer velocity very well. The numerical results indicated two different thresholds of charging voltage for flyer creation out of plastic film and impact detonation of explosive charge to be quite consistent with the measurements. The system behaviors in three different ranges of charging voltage were discussed in terms of discrete nature of this high-voltage explosive charge initiator.
Hydroides of the World
Authors: Kupriyanova Elena , Sun Yanan , Wong Eunice , ten Hove Harry
Published: June 2023

Serpulid polychaetes are a unique and highly specialised group of marine segmented worms that have adapted to inhabiting self-secreted calcareous tubes attached to a wide range of hard substrates. These animals are found across all depths and habitats of the world’s oceans, and some form mutually beneficial associations with live corals. The genus Hydroides is of special concern and importance, as it is not only the largest, but also one of the most ecologically and economically important groups of marine invertebrates because it includes notorious biofoulers and common bioinvaders that travel around the world hitchhiking on ships’ hulls.

This is the first fully illustrated guide to this notorious serpulid genus of calcareous tubeworms, providing a comprehensive diagnostic treatment of all known species of the genus Hydroides. This important reference provides reliable identification tools to distinguish Australian tubeworms from potential alien invaders that constantly arrive from overseas and threaten Australia’s maritime transport, trade and mariculture.
Analysis of mortars with old plastering waste using state-of-the-art method: nuclear magnetic resonance
Authors: Saitis C , Manea D L , Fechete R , Plesa L M , Saitis L
Published: June 2023

One of the major problems we face today is the correct management of waste generated in all spheres of activity. Thus, the concept of sustainable development aims to develop strategies that prevent and solve problems already generated. Domain construction is the one that generates the most waste worldwide, according to recent studies, which requires the imposition of clear, effective, and future-proof measures to improve the environment and the health of the population. This paper is the continuation of a research program in which 3 types of mortar recipes are analyzed. The study involves replacement of aggregates, in different percentages (10% and 15%), with plaster waste from historic buildings. The obtained results show that the values fall within the limits stipulated in the norms in force, so the study will continue with the analysis of the samples using the state-of-the-art method: nuclear magnetic resonance. The paper aims to analyze the properties of the proposed mortars at the nanoscopic level, following the relationship between the plaster mortar matrix and the plaster waste introduced in different percentages in the samples. In addition, the impact of these wastes on the hydration of the cement and on the porosity of the composition of these mortars is also observed, being noticed that the relationship between the porosity of the samples and the mechanical resistances is inversely proportional, that is, the resistances decrease as the porosity increases. It will also be identified the location of hydrogen in the structure: in hydrated mineralogical compounds of cement and in large, medium and small pores. For each studied sample, the investigations were conducted at the age of 7, 14 and 28 days (even at 3 days for samples with 10% and 15% substitution of aggregates with old plastering mortars). The results for the proposed samples will be compared to the standard recipe.
Identification method of unbalanced fault characteristics of horizontal shaft of rotary table of drilling rig
Authors: Wang Z , Lu C Q , Ma J , Du S Y
Published: June 2023

The horizontal shaft of rotary table is an important rotating part of drilling rig. The vibration caused by the mass imbalance of the horizontal shaft will seriously affect the normal operation of drilling rig and lead to faults. Therefore, taking the horizontal shaft rotor system of rotary table of the drilling rig as the research object, the unbalanced vibration characteristics of the rotor are extracted by the improved all-phase fast Fourier transform method. Through the cross-correlation operation of the signal, the data of the discrete signal is weighted and superimposed, the vibration amplitude, time delay of the phase and the spectrum analysis can be obtained. The experimental results show that the accuracy and stability of the vibration amplitude and phase extracted by the improved all-phase fast Fourier transform method are better, and the accuracy of the vibration phase extraction can reach 98%, which verifies the effectiveness of the proposed method.
The influence of variability on fire weather conditions in high latitude regions under present and future global warming
Authors: Lund Marianne T , Nordling Kalle , Gjelsvik Astrid B , Samset Bjørn H
Published: June 2023

Recent years have seen unprecedented fire activity at high latitudes and knowledge of future wildfire risk is key for adaptation and risk management. Here we present a systematic characterization of the probability distributions (PDFs) of fire weather conditions, and how it arises from underlying meteorological drivers of change, in five boreal forest regions, for pre-industrial conditions and different global warming levels. Using initial condition ensembles from two global climate models to characterize regional variability, we quantify the PDFs of daily maximum surface air temperature (SATmax), precipitation, wind, and minimum relative humidity (RHmin), and their evolution with global temperature. The resulting aggregate change in fire risk is quantified using the Canadian Fire Weather Index (FWI). In all regions we find increases in both means and upper tails of the FWI distribution, and a widening suggesting increased variability. The main underlying drivers are the projected increase in mean daily SATmax and decline in RHmin, marked already at +1 and +2 °C global warming. The largest changes occur in Canada, where we estimate a doubling of days with moderate-or-higher FWI between +1 °C and +4 °C global warming, and the smallest in Alaska. While both models exhibit the same general features of change with warming, differences in magnitude of the shifts exist, particularly for RHmin, where the bias compared to reanalysis is also largest. Given its importance for the FWI, RHmin evolution is identified as an area in need of further research. While occurrence and severity of wildfires ultimately depend also on factors such as ignition and fuel, we show how improved knowledge of meteorological conditions conducive to high wildfire risk, already changing across the high latitudes, can be used as a first indication of near-term changes. Our results confirm that continued global warming can rapidly push boreal forest regions into increasingly unfamiliar fire weather regimes.
Boundaries of modular symbols
Authors: Ash Avner
Published: June 2023

Let

G
G

be a connected reductive algebraic group defined over

Q

\mathbb {Q}

. We determine the intersection of a minimal modular symbol with a face in the boundary of the Borel-Serre bordification associated to

G
G

. We give an explicit formula for this in the case of

G

L
n

GL_n

. We apply the formula to modular symbols for

G

L
3

(

Q

)

GL_3(\mathbb {Q})

, constructed from the units of a totally real cubic field, to show that such symbols lie in the cuspidal cohomology.
The E3 ligase Poe promotes Pericentrin degradation
Authors: Galletta Brian J. , Varadarajan Ramya , Fagerstrom Carey J. , Yang Bing , Haase Karen Plevock , McJunkin Katherine , Rusan Nasser M.
Published: June 2023

In this study, we demonstrate that Pericentrin-like protein (PLP) is regulated by posttranslational protein degradation in the germ line. In a screen for regulators of PLP positioning along spermatocyte centriole, we identified proteins critical for this regulation, including the E3 ligase Poe. Our data indicate that PLP is under multiple levels of regulation to ensure the proper timing of its availability during centriole elongation.
Echocardiographic findings in COVID: incidence of carditis and correlations with COVID variants
Authors: Fazio G , Manfre V
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID-19 infection. The guidelines for the diagnosis of COVID-19 introduced the echocardiogram for diagnosis of carditis in these patients

Pourpose

In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonistic certification.

Methods

From march 2020 to October 2022 we enrolled 1540 consecutive patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centers to perform a return to play agonistic certificate. All patients perfomed an echocardiogram during the evaluation. We subdivided the incidence of carditis depend on the period and the variant of the covid (alpha, beta, gamma, delta, epsilon). Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12–67 years). None presented note risk factor of a cardiac disease.

Results

The incidence of Echocardiographic abnormality was 3,2% in all period. By the echocardiogram we recognize 8 dilated cardiomiopathy (0,4%), 8 regional kinetic dysfunction (0,4%), 30 pericardial effusion (1,9%), 4 non-specific alterations (0,2%). Also we evaluated the incidence of the echocardiographic disease during the quarters and in correlation of COVID Variant. The results was showed in figure 1.

Conclusions

Based on our evaluation the incidence of echocardiographic findings in COVID was 3,2%, with a progressive reduction long the time, from alpha to omicron variants.
The use of quality improvement interventions in reducing inappropriate cardiac imaging
Authors: Tao M , Al-Sadawi M , Ghosalkar D , Frye J , Despotidis G , Miller A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The utilization of cardiac imaging has become increasingly prevalent worldwide over the last decade. Approximately 10–15% of non-invasive cardiac imaging is ordered for inappropriate indications. Professional societies have created appropriate use criteria (AUC) in order to decrease unnecessary testing and reduce healthcare costs. However, it remains unclear whether these efforts have been successful. This meta-analysis evaluates whether AUC-based quality improvement (QI) interventions are effective at reducing inappropriate cardiac imaging.

Methods

Databases were searched for studies reporting the effect of QI interventions aiming to reduce rarely appropriate noninvasive cardiac imaging based on AUC. Imaging modalities assessed include echocardiography, CT imaging, and nuclear imaging.

We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary endpoint was a reduction of rarely appropriate testing. The search was not restricted to time or publication status.

Results

The literature search identified 2391 possible studies, 12 studies and 26,557 patients were included. Mean follow-up was 12 months (1–60 months). QI interventions utilized included education tools, decision support tools, and feedback tools. QI interventions were statistically significant in reducing rarely appropriate tests after the intervention compared to the control group (OR 0.51, 95% CI 0.41–0.64; p<0.01). The QI interventions were also assessed for persistence based on short-term (<3 months) and long-term (>3 months) efficacy. Both the short term effect and long term effect were persistent (OR 0.6, 95% CI: 0.47–0.77; p<0.01 and OR 0.47, 95% CI: 0.37–0.61; p<0.01 respectively) (Figure 1).

Conclusion

AUC QI interventions are associated with the successful reduction of inappropriate non-invasive cardiac testing with these effects persisting over time.
Dapagliflozin improves radial and longitudinal strain, increases pAMPK and reduces myocardial and renal NF-kB expression in preclinical models of doxorubicin cardiotoxicity through NLRP3 and Myd-88
Authors: Maurea N , Canale M L , Bisceglia I , Iovine M , Palma G , Luciano A , Bruzzese F , Barbieri M , Maurea C , Zito F , Sabetta R , Montella M , Franco R , Quagliariello V
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ricerca Corrente, Ministero della Salute.

Background

Doxorubicin-mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently been shown to be of therapeutic value in patients with type 2 diabetes, chronic kidney disease, and heart failure with reduced ejection fraction (HFrEF), conditions that commonly coexist and are interrelated pathophysiologically.

Purpose

We hypothesized that Dapagliflozin (an SGLT2i), administered during doxorubicin, could improve cardiac function in preclinical models.

Methods

Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO-DAPA, n=6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd88, DAMPs (galectine 3 and calgranulinS100), pAMPK, NF-kB, and 13 chemokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF) were quantified through ELISA and western blot methods.

Results

DAPA improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of NLRP3, MyD88, DAMPs and NF-kB in cardiac tissues was seen in DOXO-DAPA group compared to DOXO mice (p<0.001). Cardiac expression of IL-1β, IL-6, TNF-α, G-CSF and GM-CSF were significantly reduced after treatment with DAPA indicating anti-inflammatory properties. Expression of pAMPK was strongly enhanced in DAPA-DOXO compared to DOXO group. Levels of Calgranulin S100 and galectine-3 were strongly enhanced in DOXO group; on the other hand their expression were reduced by 47.7 and 52.3% in DAPA-DOXO group vs DOXO (p<0.005). Hystology evaluation indicate reduction NF-kB expression in myocardial and renal tissue in DOXO-DAPA vs DOXO. Radial strain (RS) is 38.8% in DAPA-DOXO vs 14.1% in DOXO groups (P < 0.05); longitudinal strain (LS) is – 23.4 % in DAPA-DOXO vs – 10.5% in DOXO groups (P < 0.001).

Conclusion

In this preclinical study, DAPA is able to improve cardiac function and reduce biomarkers involved in heart failure and fibrosis. The overall picture of the study pushes the use of DAPA in prevention of cardiomyopathies induced by anthracyclines in cancer patients.
Impact of the longitudinal changes of myocardial remodeling on cardiovascular outcomes of kidney transplantation recipients
Authors: Cho D , Kang S H , Choi J M , Gwon J G , Park S M , Kim M G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Kidney transplantation (KT) improves the hemodynamic burden associated with volume overload, and anemia in patients with chronic kidney disease, but cardiovascular disease remains the leading cause of death after KT. This study evaluated the longitudinal change of eccentric and concentric myocardial remodeling and its impact on cardiovascular outcomes after KT.

Methods

A total of 600 patients who underwent echocardiography before and 3 years after KT were included from a multi-center observational cohort (KNOW-KT). Conventional echocardiograph evaluated left ventricular ejection fraction (LV EF), LV mass index (LVMI) LV end-diastolic dimension (LVEDD), and relative wall thickness (RWT) at baseline and after KT, and the changes of these parameters and their effect on the cardiovascular events were investigated.

Results

After KT, LV EF, LVMI, and the myocardial eccentricity represented by LVEDD were significantly improved for 3 years (LV EF; 61.4±7.9 to 64.8±6.0 %, LVMI; 113.4 ± 31.8 to 94.4 ± 23.4 g/m2, LVEDD; 51.2 ± 5.6 to 47.1 ± 4.8 mm), however, the myocardial concentricity represented by RWT were increased from 0.39 ± 0.07 to 0.41 ± 0.07. The proportion of LV concentric remodeling significantly increased after KT compared to the baseline (Figure 1). In the correlation analysis between the change of echocardiographic and clinical parameters, the change of LVEDD was associated with change of hemodynamic stress such as hemoglobin or systolic blood pressure, whereas the change of RWT showed significant association with change of metabolic stress such as HbA1c and triglycerides. There were 30 major adverse cardiovascular events (MACE, myocardial infarction, angina, or strokes) after KT, and the incidence of MACE significantly increased in patients with the increased RWT group, but not in the increased LVEDD group after KT (Figure 2). In multivariate analysis corrected for baseline echocardiographic parameters, age, sex, diabetes, etc., an increase in RWT, independently predicted the occurrence of MACE (HR 2.20 CI 1.21–3.99, p<0.01), but other echocardiographic parameters including LVEF, LVMI, and LVEDD did not.

Conclusions

Longitudinal changes in myocardial concentricity is associated with the metabolic stress and have a significant impact on the new onset cardiovascular disease in KT patients. Improving metabolic burden after KT should be considered as an important strategy for amelioration of cardiac remodeling and adverse event.
Echocardiographic myocardial stiffness for the diagnosis and tissue characterization of cardiac amyloidosis
Authors: Benz D , Sadeghi A , Rafter P , Clerc O , Canseco Neri J , Ho C Y , Cuddy S A M , Falk R H , Dorbala S
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Philips Healthcare.

Introduction

Intrinsic cardiac elastography in echocardiography estimates myocardial stiffness by measuring the propagation of the myocardial stretch generated by atrial contraction. The aims of the present study were (A) to assess its value in differentiating cardiac amyloidosis (CA) from hypertrophic cardiomyopathy (HCM) and healthy volunteers (controls), and B) to correlate it with an established marker of cardiac amyloid burden and fibrosis.

Methods

This prospective study evaluated myocardial stiffness in 52 participants with CA (n=27), HCM (n=9) and controls (n=16) by ultra-high-frame rate (above 250 frames/sec) ultrasound imaging using diverging beam mode. The slope of the isovelocity wave front was measured as the intrinsic velocity propagation of myocardial stretch (iVP, in m/s). Additionally, participants with CA and HCM underwent comprehensive transthoracic echocardiography including quantification of global longitudinal strain (GLS) by speckle-tracking imaging. The relative apical sparing (RELAPS) ratio was calculated as the average GLS of apical segments / average GLS of midventricular and basal segments. Extracellular volume (ECV) by native and post-contrast T1 mapping from cardiac magnetic resonance (CMR) was quantified in 12 participants with CA and 4 with HCM.

Results

iVP was significantly higher in CA (i.e., 2.6 m/s [1.7–3.8]) than in HCM (1.2 m/s [1.0–1.8], p = 0.001) and controls (1.4 m/s [1.3–1.5], p = 0.004) but did not differ between HCM and controls (p = 0.928; Panel A). The diagnostic accuracy of iVP to identify CA was 82% and similar to the RELAPS ratio (i.e., 84%). iVP > 2.0 m/s has a sensitivity, specificity, positive predictive value and negative predictive value of 59%, 100%, 100%, and 69% to diagnose CA among the 52 participants. There was a strong correlation of iVP with ECV (rho=0.747, p = 0.001; Panel B). In contrast, iVP correlated weakly to moderately with GLS (rho=0.514, p = 0.001), RELAPS ratio (rho=0.433, p = 0.008), E/e’ (rho=0.413, p = 0.014) and NT-proBNP (rho=0.476, p = 0.006).

Conclusions

Echocardiographic myocardial stiffness is highly specific to diagnose cardiac amyloidosis and provides unique insights into myocardial tissue composition.
Early lesion visualization after catheter ablation for atrial fibrillation: rationale and preliminary results of the CALAMARI study
Authors: Guglielmo M , Rier S , De Zan G , Van Driel V , Ramanna H , Van Der Bilt I
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Incomplete atrial lesion is related to high atrial fibrillation (AF) recurrence after Pulmonary vein antrum isolation (PVAI).

Objectives

The CALAMARI study is a single-center, prospective, observational study with a longitudinal design. The primary aim is to assess PVAI lesion and its development over time using cardiovascular magnetic resonance (CMR). The secondary objective is to identify possible predictors of AF recurrence.

Methods

96 consecutive patients undergoing PVAI for paroxysmal AF will undergo four sequential CMR: 1) pre-PVAI CMR 2) post-PVAI CMR, immediately after the ablation 3) CMR one-day or one-week post-PVAI 4) CMR 3-months post-PVAI. Dark-blood short-inversion-time recovery (DB-STIR) will identify oedema. Pre- and post-contrast prepped inversion-recovery with long inversion time (IR-prep) and three-dimensional late gadolinium enhancement (3D-LGE) images will be used to visualize atrial lesion (AL). Qualitative and quantitative assessments of AL will be performed. Patients will be followed-up for 2 years to identify AF recurrence.

Preliminary results

Ten patients (63.1±5.7 years old, 80% male) completed a pre-PVAI CMR and a post-PVAI-CMR. The AL post-PVAI was visible in 9 patients (90%) using post-contrast IR-prep sequences and in 6 patients (60%) using pre-contrast IR-prep and 3D-LGE. Microvascular obstruction was identified in 7 (70%) patients using IR-prep-post-contrast. On DB-STIR, edema was visualized in all patients with a significant increase in the left atrium wall thickening in CMR post-PVAI vs. pre-PVAI CMR (6.4±2.9 vs. 3.4±1.5, p = 0.09).

Conclusion

Post-PVAI AL visualization with CMR is feasible in most patients. The CALAMARI study will better understand the AL modifications over time.
Functional tricuspid regurgitation after transcatheter closure of atrial septal defect
Authors: Hashimoto K
Published: June 2023

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): none

Background

Significant functional tricuspid regurgitation (FTR) often improves during the long-term follow-up after transcatheter atrial septal defect (ASD) closure. However, the timing of TR improvement and its relationship with right ventricle (RV) reverse remodeling are unknown.

Methods

A total of 50 patients (age: mean age 58 +/- 16 years old, range:18–88; male: 66%) who underwent transcatheter ASD closure were enrolled. Echocardiography was performed at baseline, 1month and 1year after transcatheter ASD closure.

Results

TR improved significantly 1month after treatment compared to baseline, but no further significant improvement in TR severity was observed up to 1 year after treatment. Tricuspid annulus diameter decreased gradually over 1 year, while RV diameter decreased significantly at 1 month and throughout 1 year after treatment. (Figure).

Conclusion

Reverse remodeling of the RV was achieved immediately after ASD closure and continued thereafter, whereas significant improvement in TR severity was demonstrated only immediately after ASD closure. Meticulous follow-up with more intensive therapies should be considered for patients with residual significant TR after ASD closure.
Genetics, patterns of hypertrophy and fibrosis on myocardial mechanics in hypertrophic cardiomyopathy
Authors: Kim M J , Chung H M , Seo J W , Kim Y J , Park C H , Rim S J , Choi E Y
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Asymmetrical hypertrophy, myocyte disarray and fibrosis due to genetic cause are underlying pathology of hypertrophic cardiomyopathy (HCM). However, their contribution to myocardial functional mechanics are not extensively evaluated yet.

Purpose

In this study, we sought to investigate effects of genetic mutation, patterns of ventricular hypertrophy and fibrosis on myocardial mechanics in HCM.

Methods

In 133 patients with HCM, chamber geometry, segmental late gadolinium enhancement (LGE), extracellular volume fraction (ECV) by cardiac magnetic resonance imaging (CMR), echo-derived diastolic function analyses and genetic test were performed. Left ventricular (LV) segmental and global longitudinal strain (LS), circumferential strain (CS), and rotation were measured by feature tracking analysis of CMR.

Results

Patients with sarcomere gene mutation (SM) had lower LV-CS (global and all three slices) along with higher prevalence of midwall type LGE, LGE amount and ECV. Despite global LS was not lower in SM, anteroseptal-LS was significantly impaired accompanying with higher septal wall thickness. To compensate impaired anteroseptal LS, basal endocardial rotation was paradoxically increased in SM. Augmented basal segmental was significantly related to obstructive HCM. In apical HCM, although apical segmental LS was significantly lower, higher apical rotation and preserved apical CS along with lower prevalence of SM. The E/e’ was significantly related to LV mass index, LGE extent but not with SM.

Conclusion

Circumferential myocardial function was significantly reduced in SM independent of fibrosis extent, suggesting primary phenotype. However, longitudinal fiber function was more related to hypertrophy regardless of SM. LV diastolic function was more related to LV mass, extent and degree of fibrosis including non-thickened myocardium regardless of SM.
How should right ventricle remodeling be assessed in women and men with chronic mitral regurgitation?
Authors: Berg-Hansen C E , Urheim S , Rogge B , Kokorina M , Valeur A , Cramariuc D
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Haukeland University Hospital

Introduction

Right ventricular (RV) dysfunction has a negative impact in patients with mitral regurgitation (MR), yet its assessment by two-dimensional (2D) echocardiography remains challenging. It is unclear which echocardiographic parameter best reflects RV remodeling in chronic MR.

Purpose

To assess 2D and three-dimensional (3D) measures of RV size and function in relation to MR severity.

Methods

Patients in the 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study with moderate or severe MR by combined transthoracic/transesophageal assessment and no other severe valve disease were examined at our heart valve clinic between 2020–2022. RV remodeling was assessed in 2D by the basal diameter, tissue Doppler peak systolic velocity at the lateral tricuspid ring (RV s´), tricuspid annular plane systolic excursion (TAPSE), and RV free wall longitudinal strain (RV FWS); and in 3D by end-diastolic volume (3D RVEDV), end-systolic volume (3D RVESV), ejection fraction (3D RVEF) and fractional area change (3D RVFAC).

Results

100 patients with moderate or severe MR (54 with degenerative MR; 26 with atrial functional MR; 20 with ventricular functional MR) were included. Women (n=38) had smaller MR regurgitation volumes and RV size, similar TAPSE and RV s´, but higher 3D RVEF, 3D RVFAC and RV strain normalized for 3D RVEDV (all p <0.05). More severe RV remodeling with larger volumes, and lower 3D RVFAC (all p <0.05), and 3D RVEF (p = 0.05) was detected in severe MR by 3D, but not by 2D RV measures (Figure).

In ROC analyses, 3D RVESV was strongest associated with severe MR (area under curve 0.68, p <0.01, Figure). In linear regression analysis, increasing 3D RVESV was associated with higher body mass index, larger MR regurgitation volume, male sex, and larger 3D left atrial volumes (R2 0.48, p <0.001).

Conclusion

RV remodeling in severe MR is detected by 3D, but not by routine 2D echocardiography. The 3D RV end-systolic size best reflects MR severity.