bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17160: Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Cardiomyopathy Presenting With Syncope
Authors: Kuo Ling , Yu Wen-Chung , Lin Yenn-Jiang , Hsu Po-Kuei , Higa Satoshi
Published: December 2021

A 35-year-old previous healthy man presented with palpitations and nearly syncope. Electrocardiography showed first degree atrioventricular block (PR interval 316 milliseconds) and premature ventricular complex (PVC) possibly originating from right ventricle (RV). The transthoracic echocardiography disclosed dilated RV with preserved right ventricular systolic function with a RV systolic pressure of 33mmHg, and thickened interventricular septum (12.7mm) with normal left ventricular size and function. At this point, the initial diagnosis was arrhythmogenic right ventricular cardiomyopathy (ARVC) with ventricular arrhythmias. The 24-hour Holter study showed 904 monomorphic PVCs and short-run ventricular tachycardia. The chest computed tomography demonstrated dilated RV with scalloping over free wall and multiple lung nodules mainly located in both upper lung fields (Figure A&B). Radiofrequency catheter ablation and implantation of implantable cardioverter defibrillator were suggested under the impression of ARVC. Therefore, he visited our hospital for second opinion. Since the diseased conduction system was unusual in patient with ARVC, CMR imaging was performed which revealed late gadolinium enhancement over both ventricles and basal interventricular septum (Figure C), raising the suspicion of cardiac sarcoidosis. Thereafter, the 18F-fluorodeoxyglucose (FDG)-Positron Emission Tomography study was arranged and showed FDG uptake over basal septum and lateral wall of LV, and multiple lung nodules (Figure D). Endomyocardial biopsy of RV showed myocardial fibrosis without a specific diagnosis. Thoracoscopic wedge resection of the lung nodule was performed, and pathology showed non-necrotizing granulomas distributed along with broncho-vascular bundles and subpleural area. No microorganism could be demonstrated. Sarcoidosis with cardiac and pulmonary involvement was impressed. Further steroid treatment will be initiated.
Abstract 17233: Primary Intimal Sarcoma Of The Pulmonary Artery In A Patient With Laboratory Confirmed Heterozygous Factor V Leiden Mutation: A Case Report
Authors: Pintea Mark , Hermel Melody , Mehta Sandeep , Stinis Curtiss , Mohan Rajeev , Srivastava Ajay
Published: December 2021

Pulmonary artery intimal sarcoma (PAIS) is a rare tumor associated with progressively increasing dyspnea, atypical chest pain, and pulmonary hypertension. Owing to overlap in presentation, PAIS can be misdiagnosed as pulmonary thromboembolism (PTE). Here we present the case of a 59-year-old male with heterozygous Factor V Leiden mutation, history of deep vein thrombosis (DVT), and recent PTE presenting to urgent care with cough, mild orthopnea, and exertional dyspnea. Transthoracic echocardiogram (TTE) revealed severely dilated right ventricle with moderately decreased function and severe pulmonary hypertension with pulmonary arterial (PA) pressure of 93mmHg. Computed tomography angiography of the chest revealed massive central PTE. Given hemodynamic stability, saturating well on room air and simplified PESI score of 0, Pulmonology recommended discharge with anticoagulation. The patient returned a month later with three weeks of increased dyspnea on exertion, worsened right ventricular function as well as possible new mobile thrombus extending into the right ventricular outflow tract (RVOT). Due to presumed failure of medical therapy, Cardiology placed the patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) followed by attempted mechanical thrombectomy using both the Angiovac and Penumbra CAT12 systems. Both systems failed to remove substantial material from the PA. The next day, TTE revealed increased PA pressure of 132mmHg.The patient underwent emergent bilateral thromboendarterectomy with a mass discovered involving the pulmonary valve (PV), RVOT, both left and right PAs, along with invasion into the PA wall. The mass was resected, the PV valve replaced, the main PA and left PA reconstructed, and pericardial patch reconstruction of the RVOT was performed. The mass was determined to be a PAIS of French Federation of Comprehensive Cancer Centres (FNCLCC) Grade 3. Two months after uncomplicated recovery, chemotherapy was initiated. Securing the diagnosis of PAIS is challenging. However, collaboration between clinicians, radiologists, and pathologists increases the likelihood of recognizing subtle markers that can differentiate PAIS from illnesses with a similar presentation.
Abstract 17237: A Pair Of Diaphragm-Crossed Organs: A Pancreatico-Pericardial Fistula
Authors: Pelling Mary , Chu Lena , Patel Krishan J , Aldredge Amalia , Brown Matthew T
Published: December 2021

Introduction:
Pseudocysts are a known complication of chronic pancreatitis, occurring in 30-40% of patients. They form when disruption of the pancreatic duct system creates fluid-filled pockets with high concentrations of digestive enzymes. Leakage of these enzymes can create pancreatic fistulas. Here, we present a case of an unusual fistula that occurred in an immunocompromised individual.

Case Description:
A 34-year-old man with a history of Acquired Immunodeficiency Syndrome, alcohol use disorder, and chronic pancreatitis who had recently recovered from acute pancreatitis complicated by pericardial effusion was readmitted with worsening pleuritic chest pain and shortness of breath. He was hemodynamically stable with a normal cardiopulmonary exam without jugular venous distention or pulsus paradoxus. Labs were at his baseline other than an elevated d-dimer level. Computed tomography scan revealed a large, loculated pericardial effusion with a fistula extending through the diaphragm to a large peripancreatic pseudocyst. Gastroenterology performed pancreatic ductal stenting via endoscopic retrograde cholangiopancreatography and Interventional Radiology placed a percutaneous drainage catheter to facilitate resolution of the pseudocyst.

Discussion:
A pancreatico-pericardial fistula is a very rare complication of chronic pancreatitis. A 2016 review detailed only fifteen cases over a 40-year span with surgical management providing the best outcomes. Given this patient’s immunocompromise and malnutrition surgery was not offered, but endoscopic stenting and percutaneous drainage allowed for successful resolution of his fistula.
Abstract 9115: Determining Optimal Hemoglobin Transfusion Threshold for Patients With Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Authors: Sood Nitish , Goyal Arnav , Grogan Dayton , Reddy Vamsi
Published: December 2021

Introduction:
Multiple randomized controlled trials have found that a conservative approach to transfusing critically ill patients reduces mortality, with current guidelines recommending a hemoglobin (HgB) transfusion threshold of 7 g/dL. However, little work has examined whether this transfusion threshold reduces mortality in patients with severe traumatic brain injury (TBI). Here, we present a systematic review and meta-analysis of the literature.

Methods:
A systematic search was conducted on PubMed, Ovid, and Web of Science. Full-text articles were eligible if patients with TBI, defined as Glasgow Coma Score <= 8, were divided into multiple groups with varying hemoglobin transfusion thresholds and reported any outcome of interest including mortality, number of packed red blood cell (PRBC) units transfused, length of stay in ICU, and length of stay in the hospital. Eight studies were eligible (n = 3663). We compared mortality rates at HgB transfusion thresholds of < 7 g/dL, < 8 g/dL, < 9 g/dL, and < 10 g/dL.

Results:
We found that traditionally ‘conservative’ approaches to anemia management (HgB < 7 g/dL, < 8 g/dL, and < 9 g/dL) were associated with decreased mortality when compared to traditionally ‘liberal’ approaches (HgB < 10 g/dL), with p < 0.05. Results were robust across both frequentist and Bayesian analysis. As a surrogate for cost of care and use of hospital resources, the total number of PRBC units transfused to patients, length of stay in ICU, and length of stay in hospital were analyzed. We found that using a transfusion threshold < 7 g/dL compared to < 10 g/dL substantially decreased the number of PRBC units transfused. In three of five cohorts, the cohort with the lower HgB transfusion threshold or no transfusion had a significantly shorter length of stay in the ICU and in the hospital. The remaining two cohorts found no significant difference in the length of stays in ICU or hospital.

Conclusion:
This study demonstrates that conservative approaches to transfusions ( < 7 g/dL, < 8 g/dL, or < 9 g/dL) significantly reduce mortality and the number of PRBC units transfused when compared to more liberal approaches ( < 10 g/dL). Current evidence is unclear on the benefits of conservative approaches in reduction of ICU or hospital length of stay.
Abstract 9123: Plasma Biomarkers Associated With PICU Mortality in Children With Cardiac Arrest and Acute Respiratory Distress Syndrome
Authors: Gardner Monique M , Kirschen Matthew , Thompson Jill , Himebauch Adam , Yehya Nadir , Topjian Alexis A
Published: December 2021

Introduction:
The post-cardiac arrest state is comprised of an ischemic and reperfusion syndrome, with inflammation similar to sepsis and acute respiratory distress syndrome (ARDS). However, it is unknown whether cardiac arrest has a distinct inflammatory profile relative to these other critical illness syndromes. Using plasma biomarkers of systemic inflammation measured in children with ARDS, we aimed to evaluate identify unique biomarkers in a sub-cohort with cardiac arrest, and the association of these biomarkers with mortality.

Methods:
This was a retrospective single-center cohort study of 17 biomarkers prospectively collected from pediatric subjects with ARDS between 2014-2019. Biomarkers were drawn within 24 hours after both ARDS diagnosis and cardiac arrest. Clinical characteristics and biomarkers were compared between those with ARDS and those with ARDS and cardiac arrest (ARDS+CA) using nonparametric tests. In ARDS+CA subjects, associations of biomarkers with mortality were tested with univariate and bivariate logistic regression.

Results:
Biomarkers were measured in 333 subjects: 301 with ARDS (median age 5.3 years, 55.5% male) and 32 ARDS+CA (median age 8 years, 53.1% male). Majority of arrests (68.7%) were out-of-hospital with median 11 minutes of CPR. ARDS+CA subjects were more likely to be immunosuppressed and present after aspiration or drowning than the ARDS cohort. ARDS severity, PRISM III score, vasoactive-ionotropic score and extra-pulmonary organ failure were worse in the ARDS+CA group (p<0.05). Eight biomarkers were elevated in ARDS+CA compared to the ARDS cohort: sRAGE, nucleosomes, SP-D, CCL22, IL-6, HSP70, IL-8, and MIP-1b (p<0.05). In the ARDS+CA cohort, 3 biomarkers were associated with mortality when controlling for markers of disease and cardiac arrest severity: sRAGE (unadjusted odds ratio 3.48 [IQR 1.35, 8.99], p=0.010), IL-6 (OR 1.75 [1.13, 2.71], p=0.012) and granzyme B (OR 3.74 [1.46, 9.57], p=0.006).

Conclusion:
sRAGE, IL-6 and granzyme B were independently associated with mortality after pediatric cardiac arrest in ARDS. This exploratory work suggests that cardiac arrest may induce a distinct inflammatory state that differs from other critical illness syndromes and further investigation is needed.
Abstract 9152: Incidence of Cardiac Arrest Among Medicare Beneficiaries
Authors: Rasmussen Tyler P , Riley Danielle , Vaughan-Sarazzin Mary , Chan Paul , Girotra Saket
Published: December 2021

Introduction:
Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last two decades, survival rates have plateaued in recent years. Our understanding of incidence of IHCA remains limited. We measured incidence of IHCA among Medicare beneficiaries and evaluated hospital variation in incidence of IHCA.

Methods:
We used an observational cohort study using data from 2014-2017 Get with the Guidelines-Resuscitation (GWTG-R) data linked with Medicare inpatient data summarized by hospital. Hospital incidence of IHCA among Medicare beneficiaries was calculated as the total number of patients 65 years and older with an IHCA divided by the total number of Medicare admissions. Multivariable hierarchical regression models were used to adjust hospital incidence rates for differences in case-mix across study hospitals and evaluate its the association with hospital variables.

Results:
Among a total of 4.5 million admissions at 170 hospitals, 38,630 patients experienced an IHCA. The median risk-adjusted IHCA incidence was 8.3 per-1000 admissions. Even after adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals (Figure 1) ranging from 2.1 per-1000 admissions to 24.7 per-1000 admissions (interquartile range: 6.5-11.4; median odds ratio: 1.52; 95% credible interval 1.45-1.59). Among hospital variables, a higher case-mix index, higher nurse staffing and teaching status were associated with a lower hospital incidence of IHCA.

Conclusions:
Incidence of IHCA varies markedly across hospitals, even after adjustment for differences in patient case-mix. Hospital variables including case-mix severity, nurse staffing and teaching status were significantly associated with incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.
Abstract 9160: Epinephrine-Dominant versus Non-Epinephrine Dominant Resuscitation for In-Hospital Cardiac Arrest
Authors: Chou Jennifer W , Lin Amy , Toledo Juan , Wardi Gabriel , Derry Katrina , Sell Rebecca E
Published: December 2021

Introduction:
Vasopressors are used during CPR to increase arterial resistance and aortic diastolic pressure, improving coronary perfusion and likelihood of ROSC. In comparison to epinephrine, vasopressin remains effective in an acidemic environment, has favorable cerebral perfusion, and does not directly increase myocardial oxygen demand. Studies comparing epinephrine and vasopressin report variable ROSC, survival, and neurological outcome. Most studies used few vasopressin doses and it is unclear whether greater vasopressin use leads to clinical benefit.

Hypothesis:
We hypothesized that a non-epinephrine dominant CPR approach with vasopressin would lead to greater ROSC than an epinephrine-dominant approach.

Methods:
This was a retrospective, single-center study conducted at an 800-bed academic medical center. All first cardiac arrests among adult inpatients between Jan 2018 and Mar 2021 were screened, and those with at least 2 vasopressor doses used were included. Patients who received epinephrine-dominant resuscitation (epinephrine-to-vasopressin dose ratio >2 or CPR using only epinephrine) were compared to patients who received a non-epinephrine dominant approach (epinephrine-to-vasopressin dose ratio ≤2). The incidence of ROSC was analyzed using a Chi-squared test where p <0.05 was considered significant. Secondary outcomes included survival to discharge with favorable neurologic outcome, survival to discharge, and Cerebral Performance Category scores.

Results:
Of 663 in-hospital cardiac arrests screened, 264 were included. Two hundred twenty-eight (86%) presented with PEA/asystole as the initial rhythm, and the most common etiologies were circulatory (41%) and respiratory (26%). The epinephrine-dominant arm achieved ROSC in 89 (66%) patients compared to 87 (67%) patients in the non-epinephrine dominant arm (RR 0.99, 95% CI 0.84-1.18, p=0.93). Survival to discharge was higher in the epinephrine-dominant arm (25% vs 15%, p=0.04).

Conclusion:
There was no difference in ROSC between epinephrine-dominant and non-epinephrine dominant resuscitation for adult in-hospital cardiac arrest. Future studies should examine the impact of non-epinephrine dominant CPR on long term neurologic outcomes.
Abstract 9180: Importance of Preventing Decreased Levels of Lysophosphatidylcholine—DHA in Brain and Plasma for Attenuating Brain Injury After Cardiac Arrest
Authors: Nishikimi Mitsuaki , Shoaib Muhammad , Aoki Tomoaki , Choudhary Rishabh , Miyara Santiago J , Yagi Tsukasa , Yin Tai , Becker Lance B , Kim Junhwan
Published: December 2021

Introduction:
Lysophosphatidylcholine (LPC) was found to be decreased in plasma in the early phase of resuscitation after cardiac arrest (CA), including a species containing docosahexaenoic acid (LPC-DHA). Supplementing this deficiency of plasma LPC-DHA post-CA significantly attenuated brain dysfunction implicating a causative role of plasma decreased LPC-DHA for brain injury. Previous studies showed the importance of LPC-DHA as a carrier of DHA to maintain proper brain function. However, the role of LPC-DHA for brain function has not been fully understood.

Objective:
This study is aimed at determining the importance of maintaining proper brain LPC-DHA level via plasma supplementation to prevent brain damage after CA using human patients, animal model, and
in-vitro
cell studies.

Methods and Results:
We first evaluated associations between the plasma LPC-DHA levels and neurological outcomes using 45 post-CA patients. We then measured LPC-DHA levels and histological, biochemical, metabolic alterations in the plasma and brain after 10 min CA rat model and examined how these alterations were attenuated by supplementing LPC-DHA. Finally, we further investigated the beneficial effect of LPC-DHA using cell cultures. We found that the decreased plasma LPC-DHA was strongly associated with neurological outcomes and disappearance of difference between gray and white matter in the brain after CA in human patients. In rats, the decreased plasma LPC-DHA was associated with decreased level of brain LPC-DHA after CA, and supplementing plasma LPC-DHA normalized the brain levels of LPC-DHA and alleviated neuronal cell death, activation of astrocyte, and expression of various inflammatory and mitochondrial dysfunction genes. We also found normalized overall metabolic alterations from the untargeted metabolomics analysis. Furthermore, LPC treatment showed a similar protective effect for neurons and astrocytes in mixed primary brain cell cultures.

Conclusion:
The attenuation of biochemical and physiologic alterations, and the normalization of decreased brain LPC-DHA post-CA with LPC-DHA supplementation demonstrate plasma LPC-DHA is important for the maintenance of proper brain LPC-DHA levels, which is essential for preventing brain damage post-CA.
Abstract 9382: Outcomes After Traumatic Out-of-Hospital Cardiac Arrest in Vietnam: A Multicenter Prospective Cohort Study
Authors: Do Son N , Luong Chinh Q , Pham Dung T , Nguyen My H , Ton Tra T , Hoang Quoc T , Nguyen Dat T , Pham Thao T , Hoang Hanh T , Khuong Dai Q , Nguyen Quan H , Nguyen Tuan A , Tran Tung T , Vu Long D , Nguyen Chi V , McNally Bryan F , Ong Marcus E , Nguyen Anh D
Published: December 2021

Introduction:
Pre-hospital services are not well developed in Vietnam, especially the immature of a trauma system of care. The prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. This study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country.

Hypothesis:
Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam.

Methods:
We performed a multicenter prospective observational study of consecutive patients (>16 years) presenting with traumatic OHCA to 3 central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients with traumatic OHCA and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital.

Results:
Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 26.1% (29/111) of the patients were taken by the emergency medical services (EMS), 90% (27/30) received pre-hospital advanced airway, and 54.7% (29/53) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P>0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P=0.649; respectively).

Conclusion:
Improvements are needed in the EMS in Vietnam, such as increasing bystander first-aid and developing a trauma system of care, as well as developing a standard emergency first-aid program for both healthcare personnel and the community.
Abstract 9934: High Mean Arterial Pressure Aggravates Cerebral Hemodynamics After Extracorporeal Resuscitation in Swine
Authors: Levy Yael , Hutin Alice , Polge Nicolas , lidouren fanny , Kohlhauer Matthias , Fernandez Para Rocio , Leger Pierre-Louis , Debaty Guillaume , Lurie Keith G , Lamhaut Lionel , Ghaleh Bijan , Tissier Renaud
Published: December 2021

Introduction:
Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest but the optimal target to reach for mean arterial pressure (MAP) remains to be determined.

Hypothesis:
We hypothesized that MAP levels modify cerebral hemodynamics during E-CPR. Accordingly, we tested two MAP targets (65-75
vs
80-90 mmHg) in a porcine model of E-CPR.

Methods:
Pigs were anesthetized and instrumented for the evaluation of cerebral and systemic hemodynamics. They were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Electric attempts of defibrillation were then delivered until resumption of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min with a standardized volume expansion in both groups. The dose of epinephrine was set to reach either a standard or a high MAP target level (65-75
vs
80-90 mmHg, respectively). Animals were followed during 120 min after ROSC.

Results:
Six animals were included in both groups. After cardiac arrest, MAP was maintained at the expected level (Figure). During E-CPR, high MAP transiently improved carotid blood flow as compared to standard MAP. This blood flow progressively decreased after ROSC in high vs standard MAP, while intra-cranial pressure increased. Interestingly, this was associated with a significant decrease in cerebral oxygen consumption (26±8
vs
54±6 L O
2
/min/kg at 120 min after ROSC, respectively; p<0.01) (Figure). The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, became positive in high MAP (0.47±0.02) vs standard MAP group (-0.16±0.10), demonstrating altered cerebral autoregulation with high MAP.

Conclusion:
Increasing MAP above 80 mmHg with epinephrine aggravates cerebral hemodynamics after E-CPR.

Figure:
Mean arterial pressure (MAP), cerebral blood flow and oxygen consumption (*, p<0.05)
Exercise Training Protects Against Heart Failure Via Expansion of Myeloid-Derived Suppressor Cells Through Regulating IL-10/STAT3/S100A9 Pathway
Authors: Feng Lifeng , Li Guangru , An Jiale , Liu Chang , Zhu Xiaolong , Xu Yang , Gao Yang , Li Jing , Liu Jie , Yan Jie , Wang Yachen , Ren Jiling , Yang Liang , Qi Zhi
Published: December 2021

Background:

Exercise training (ET) has a protective effect on the progression of heart failure, however, the specific mechanism has not been fully explored. Myeloid-derived suppressor cells (MDSCs) are a group of myeloid-derived immunosuppressive cells, which showed a protective effect in the progression of heart failure. Thus, we hypothesized that the protective effect of ET on heart failure may be related to the infiltration of MDSCs.

Methods:

C57BL/6 mice were made to run on a treadmill 6× a week for 4 weeks followed by isoproterenol injection from third week. Heart function was evaluated by echocardiography and the proportion of MDSCs was detected by flow cytometry. Hypertrophic markers, cardiac fibrosis, and inflammatory factors were detected by real-time PCR, ELISA, histological staining, and Western blot.

Results:

ET treatment in isoproterenol-induced heart failure mice (n=7) enhanced cardiac function (57% increase in FS%,
P
=0.002) and improved morphological changes compared with isoproterenol mice (n=17). ET further caused 79% increasing in cardiac MDSCs in isoproterenol mice (
P
<0.001). In addition, depletion of MDSCs by 5-Fluorouracil blunted the cardio-protective effect of ET. T-cell proliferation assay showed that ET did not affect the suppressive activity of MDSCs. Furthermore, we found that ET activated the secretion of IL (interleukin)-10 by macrophages in isoproterenol mice. MDSCs expansion and cardio protection was not present in tamoxifen-inducible macrophage-specific IL-10 knockout mice. Western blot results confirmed that IL-10 regulated the differentiation of MDSCs through the translocation of p-STAT3 (signal transducer and activator of transcription 3)/S100A9 (S100 calcium-binding protein A9) to the nucleus.

Conclusions:

ET could increase MDSCs by stimulating the secretion of IL-10 from macrophage, which was through IL-10/STAT3/S100A9 signaling pathway, thereby achieving the role of heart protection.
One‐Year Change in Walking Performance and Subsequent Mobility Loss and Mortality Rates in Peripheral Artery Disease: Longitudinal Data From the WALCS
Authors: Hammond Michael M. , Tian Lu , Zhao Lihui , Zhang Dongxue , McDermott Mary M.
Published: December 2021

Background

Associations of 1‐year change in functional performance measures with subsequent mobility loss and mortality in people with lower extremity peripheral artery disease are unknown.

Methods and Results

Six‐minute walk and 4‐meter walking velocity (usual and fastest pace) were measured at baseline and 1 year later in 612 people with peripheral artery disease (mean age 71±9 years, 37% women). Participants were categorized into tertiles, based on 1‐year changes in walking measures. Cox proportional hazards models were used to examine associations between 1‐year change in each walking measure and subsequent mobility loss and mortality, respectively, adjusting for potential confounders. Compared with the best tertile, the worst tertile (ie, greatest decline) in 1‐year change in each performance measure was associated with higher rates of mobility loss: 6‐minute walk (Tertile 1 [T1] cumulative incidence rate [IR], 72/160; Tertile 3 [T3] IR, 47/160; hazard ratio [HR], 2.35; 95% CI, 1.47–3.74), usual‐paced 4‐meter walking velocity (T1 IR, 54/162; T3 IR, 57/162; HR, 2.21; 95% CI, 1.41–3.47), and fast‐paced 4‐meter walking velocity (T1 IR, 61/162; T3 IR, 58/162; HR, 1.81; 95% CI, 1.16–2.84). Compared with the best tertile, the worst tertiles in 1‐year change in 6‐minute walk (T1 IR, 66/163; T3 IR, 54/163; HR, 1.61; 95% CI, 1.07–2.43) and fast‐paced 4‐meter walking velocity (T1 IR, 63/166; T3 IR, 44/166; HR, 1.75; 95% CI, 1.16, 2.64) were associated with higher mortality.

Conclusions

In people with peripheral artery disease, greater 1‐year decline in 6‐minute walk or 4‐meter walking velocity may help identify people with peripheral artery disease at highest risk for mobility loss and mortality.
Absolute Cardiovascular Disease Risk Assessed in Old Age Predicts Disability and Mortality: A Retrospective Cohort Study of Community‐Dwelling Older Adults
Authors: Makino Keitaro , Lee Sangyoon , Bae Seongryu , Chiba Ippei , Harada Kenji , Katayama Osamu , Shinkai Yohei , Shimada Hiroyuki
Published: December 2021

Background

Evidence is limited on the predictive validity of absolute cardiovascular disease (CVD) risk, estimated by multivariable assessments in old age, for disability and mortality. We aimed to examine the longitudinal associations of absolute CVD risk assessed using region‐specific risk estimation charts with disability and mortality among community‐dwelling people aged ≥65 years.

Methods and Results

This retrospective cohort study included 7456 community‐dwelling people aged ≥65 years (mean age, 73.7 years) without CVD and functional decline at baseline. They lived in either Obu City or Midori Ward of Nagoya City, Aichi Prefecture, Japan. We estimated absolute CVD risk using the revised World Health Organization CVD risk estimation charts and stratified risk levels into 3 categories: low (<10%), mid (10% to <20%), and high (≥20%). We followed up the functional disability incidence and all‐cause mortality monthly for 5 years. The prevalence of each CVD risk level based on the laboratory‐based model was as follows: low CVD risk, 1096 (14.7%); mid CVD risk, 5510 (73.9%); and high CVD risk, 850 (11.4%). During follow‐up, the incidence rates of disability and mortality were 33.4 per 1000 and 12.4 per 1000 person‐years, respectively. Cox regression analysis showed that the adjusted hazard ratios (95% CIs) for disability incidence were 1.32 (1.13–1.56) and 1.44 (1.18–1.77) in mid and high CVD risk levels, respectively (reference: low CVD risk level); for mortality incidence, they were 1.53 (1.16–2.01) and 2.02 (1.45–2.80) in mid and high CVD risk levels, respectively (reference: low CVD risk level).

Conclusions

Absolute CVD risk was associated with both disability and mortality in people aged ≥65 years. Estimated CVD risk levels may be useful surrogate markers for disability and mortality risks even when assessed in old age.
Inequity in Cardio‐Oncology: Identifying Disparities in Cardiotoxicity and Links to Cardiac and Cancer Outcomes
Authors: Ohman Rachel E. , Yang Eric H. , Abel Melissa L.
Published: December 2021

Minority and underresourced communities experience disproportionately high rates of fatal cancer and cardiovascular disease. The intersection of these disparities within the multidisciplinary field of cardio‐oncology is in critical need of examination, given the risk of perpetuating health inequities in the growing vulnerable population of patients with cancer and cardiovascular disease. This review identifies 13 cohort studies and 2 meta‐analyses investigating disparate outcomes in treatment‐associated cardiotoxicity and situates these data within the context of oncologic disparities, preexisting cardiovascular disparities, and potential system‐level inequities. Black survivors of breast cancer have elevated risks of cardiotoxicity morbidity and mortality compared with White counterparts. Adolescent and young adult survivors of cancer with lower socioeconomic status experience worsened cardiovascular outcomes compared with those of higher socioeconomic status. Female patients treated with anthracyclines or radiation have higher risks of cardiotoxicity compared with male patients. Given the paucity of data, our understanding of these racial and ethnic, socioeconomic, and sex and gender disparities remains limited and large‐scale studies are needed for elucidation. Prioritizing this research while addressing clinical trial inclusion and access to specialist care is paramount to reducing health inequity.
A Neurodynamic Model of Saliency Prediction in V1
Authors: Berga David , Otazu Xavier
Published: December 2021

Lateral connections in the primary visual cortex (V1) have long been hypothesized to be responsible for several visual processing mechanisms such as brightness induction, chromatic induction, visual discomfort, and bottom-up visual attention (also named saliency). Many computational models have been developed to independently predict these and other visual processes, but no computational model has been able to reproduce all of them simultaneously. In this work, we show that a biologically plausible computational model of lateral interactions of V1 is able to simultaneously predict saliency and all the aforementioned visual processes. Our model's architecture (NSWAM) is based on Penacchio's neurodynamic model of lateral connections of V1. It is defined as a network of firing rate neurons, sensitive to visual features such as brightness, color, orientation, and scale. We tested NSWAM saliency predictions using images from several eye tracking data sets. We show that the accuracy of predictions obtained by our architecture, using shuffled metrics, is similar to other state-of-the-art computational methods, particularly with synthetic images (CAT2000-Pattern and SID4VAM) that mainly contain low-level features. Moreover, we outperform other biologically inspired saliency models that are specifically designed to exclusively reproduce saliency. We show that our biologically plausible model of lateral connections can simultaneously explain different visual processes present in V1 (without applying any type of training or optimization and keeping the same parameterization for all the visual processes). This can be useful for the definition of a unified architecture of the primary visual cortex.
Additional comments on the types and nomina of several North American ratsnakes (Pantherophis obsoletus complex, Colubridae, Serpentes)
Authors: PYRON R. ALEXANDER , GOTTE STEVE , BURBRINK FRANK T.
Published: December 2021

Here, we provide updates to our recent paper reviewing the taxonomy and nomenclature of the Eastern ratsnakes (Pantherophis obsoletus complex, Colubridae, Serpentes). Specifically, we clarify that Coluber alleghaniensis Holbrook, 1836 is a subjective, rather than objective, senior synonym of Elaphis holbrookii Duméril, Bibron & Duméril, 1854. Contrary to our statement that USNM 1733–4 were syntypes of Scotophis lindheimerii Baird & Girard, 1853, the former is the holotype and the latter is the paratype. The holotype is lost and the paratype is in poor condition, but no neotype designation is warranted at present. We note that USNM 248870, which we designated as the lectotype of Coluber obsoletus lemniscatus Cope, 1888, was originally cataloged as USNM 4710. This catalog number was shared with the type of the salamander Amblystoma tenebrosum Baird & Girard, 1852, and the snake was re-cataloged as USNM 248870 in 1985. Finally, we originally treated C. reticulatus La Cépède, 1789 and C. reticularis Daudin, 1803 as senior subjective synonyms of C. corais Boie, 1827, but here corroborate recent authors in designating it a senior subjective synonym of C. obsoletus Say in James, 1823. As the Commission suppressed C. reticulatus La Cépède, 1789 (an exoplonym), this subsequently rendered C. reticularis Daudin, 1803 (an exoploneonym) unavailable as well.
A second species of Gegeneophis Peters (Amphibia: Gymnophiona: Caeciliidae) lacking secondary annular grooves
Authors: GIRI VARAD , GOWER DAVID J. , GAIKWAD KSHAMATA , WILKINSON MARK
Published: December 2021

A new species of caecilian amphibian, Gegeneophis pareshi sp. nov., is described based on a series of 16 type specimens from the Western Ghats region of southern Goa, India. This species differs from all other congeners except G. seshachari Ravichandran, Gower & Wilkinson, 2003 in lacking secondary annular grooves and possessing an unsegmented terminal ‘shield’. It differs from G. seshachari in having many more primary annuli and a distinct colour pattern with a largely unpigmented head and pale anterior body.
Two nematode species of the family Tobrilidae (Enoplida) De Coninck, 1965 from Lake Baikal, Russia
Authors: GAGARIN VLADIMIR G. , NAUMOVA TATYANA V.
Published: December 2021

Two nematode species found in Lake Baikal, Gorevoi Utes (Russia) are presented. Eutobrilus mirandus sp. n. differs from all other species of the genus Eutobrilus by the markedly anterior position of the vulva (V=26–31%). The new species is similar to E. andrassyi Altherr, 1963 in body size and stoma structure but differs in the comparatively thicker body (males, a = 32–45 versus a = 60–75), shorter stoma (males, 26–27 µm long versus 35–40 µm long), longer spicules (48–53 µm versus 40 µm), and absence of crystalloids. A redescription and new illustrations of Paratrilobus delicatus (Shoshin, 1988) Andrássy, 2007, including a description of the previously unknown females, are also given.
Systematics of the Lower Ordovician pliomerid trilobite Hintzeia, with species from the Great Basin, western USA
Authors: MCADAMS NEO E. B. , ADRAIN JONATHAN M.
Published: December 2021

The pliomerid trilobite genus Hintzeia Harrington, 1957, includes only species from the early Tulean (upper Tremadocian) of the Great Basin, USA, and from the Northwest Territories, Canada. Previously assigned species reported from Scandinavia, China, South Korea, and Australia do not appear to be closely related to the western Laurentian species and are excluded from the genus. The monophyly of the group needs to be tested in the context of a broader phylogenetic analysis, but Hintzeia is rediagnosed with potential synapomorphies including a long, wide anterior border with a large, semicircular median arcuate anterior curve in the posterior margin. Hintzeia celsaora (Ross, 1951) and H. firmimarginis (Hintze, 1953) are redescribed based on large new collections from Utah and Idaho. Ontogenetic material of H. celsaora includes an articulated silicified M13 meraspid. Hintzeia parafirmimarginis n. sp. is described on the basis of both abundant disarticulated sclerites and a large articulated individual. Large topotype collections indicate that Hintzeia celsaora (Ross, 1951) is a senior synonym of Protopliomerops aemulus Hintze, 1953; previously claimed differences appear to reflect small original sample sizes, ontogenetic change, and differing photographic orientation.
New records of water mites of the genus Atractides Koch, 1837 (Acari: Hydrachnidia, Hygrobatidae) from South Africa, with descriptions of five new species
Authors: PEŠIĆ VLADIMIR , SMIT HARRY , GERECKE REINHARD
Published: December 2021

New records of water mites of the genus Atractides Koch, 1837 (Acari: Hydrachnidia, Hygrobatidae) from South Africa are presented. Five species new to science, Atractides cooki, A. dracomontanus, A. meridianus, A. capensis and A. neoscutifer are described; a first description of the male is given for A. pulcher K. Viets, 1956 and A. assimilis K.O. Viets, 1964. A key to the species of Atractides from South Africa is presented.
The tensile properties of weft-knitted biaxial tubular fabrics and reinforced composites
Authors: Zhou Mengmeng , Jiang Gaoming , Gao Zhe
Published: December 2021

Weft-knitted biaxial tubular (WKBT) fabrics have been infiltrated via a resin film infusion technique to fabricate reinforced composites. To understand the mechanical properties of WKBT fabrics and the reinforced composites, the strength efficiency of insertion yarns and insertion fiber volume fraction are used to evaluate the tensile strength. The tensile properties of WKBT fabrics and the reinforced composites are studied in the 0° and 90° directions. The results show that both have two failure stages. The first stage is the fracture of insertion yarns which provide the main tensile strength, and the second stage is the fracture of stitch yarns which have significant effect on the tensile strength of WKBT fabrics and the reinforced composites. It is observed that the deformation behavior and failure mechanism of WKBT fabric reinforced composites are closely related to the structure of WKBT fabric, which can be used to predict the failure mode and morphology of WKBT fabric reinforced composites.
Exploring the transverse wicking behavior of mechanically robust warp super-elastic woven fabric for tight-fitting garments
Authors: Wang Yong , Qiao Qifan , Wang Zongqian , Li Changlong , Gordon Stuart
Published: December 2021

The ability of a fabric to wick moisture away from the human body directly determines the moisture management ability of any given textile, and thereby has a great influence on the comfort offered by garments made from that textile. In this paper, the effects of tensile extension and liquid drop height on the transverse wicking behavior of a warp stretch woven fabric were systematically investigated. By virtue of the unique structure of the nylon/spandex air-covered warp yarn, the woven fabric has a denser and tighter surface, which facilitates its warp elastic stretchability beyond 60%. Furthermore, an acceptable cyclic tensile behavior at an extension of 30% was obtained, indicating the superior mechanical robustness of the fabric to a certain extent. The experimental results demonstrated that the transverse wicking performances of the fabric, including the wetting time and liquid spreading area, were dependent on the tensile extensions and the heights between the water droplet and the fabric surface. Specifically, the wetting time increased with an increase of tensile extension or a decrease of liquid drop height. The spreading area of the water droplet increases as a function of the wicking time, and it fits a power relation appropriately. In addition, the water vapor transmission behavior of our fabric during stretch was clarified. Such work is essential to get an in-depth evaluation of the wicking behavior of complex stretchable fabric structures.
Low Amount and Intensity of Leisure-time Physical Activity in Asian Indian Adults
Authors: Visaria Aayush , Nagaraj Bharath , Shah Megh , Kethidi Nikhit , Modak Anurag , Shahani Jai , Chilakapati Rachana , Raghuwanshi Maya
Published: December 2021

Purpose

We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities.

Design, Setting, and Sample

We utilized the 2011–2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions.

Measures

PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial.

Analysis

We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status.

Results

While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: −164 [-314,-15]) without diabetes (−185 [-319,-52]), and low/normal BMI (−422 [-623,-222]).

Conclusion

Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.
Numerical simulation of a class of space fractional bistable systems based on the Fourier spectral method
Authors: Liu Haitao , Yulan Wang , Cao Li , Zhang Wei
Published: December 2021

Nonlinear vibration arises everywhere in a bistable system. The bistable system has been widely applied in physics, biology, and chemistry. In this article, in order to numerically simulate a class of space fractional-order bistable system, we introduce a numerical approach based on the modified Fourier spectral method and fourth-order Runge-Kutta method. The fourth-order Runge-Kutta method is used in time, and the Fourier spectrum is used in space to approximate the solution of the space fractional-order bistable system. Numerical experiments are given to illustrate the effectiveness of this method.
Combining fMRI and Eye-tracking for the Study of Social Cognition
Authors: Rusch Kristin Marie
Published: December 2021

The study of social cognition with functional magnetic resonance imaging (fMRI) affords the use of complex stimulus material. Visual attention to distinct aspects of these stimuli can result in the involvement of remarkably different neural systems. Usually, the influence of gaze on neural signal is either disregarded or dealt with by controlling gaze of participants through instructions or tasks. However, behavioral restrictions like this limit the study’s ecological validity. Thus, it would be preferable if participants freely look at the stimuli while their gaze traces are measured. Yet several impediments hamper a combination of fMRI and eye-tracking. In our recent work on neural Theory of Mind processes in alexithymia, we propose a simple way of integrating dwell time on specific stimulus features into general linear models of fMRI data. By parametrically modeling fixations, we were able to distinguish neural processes asssociated with specific stimulus features looked at. Here, I discuss opportunities and obstacles of this approach in more detail. My goal is to motivate a wider use of parametric models — usually implemented in common fMRI software packages — to combine fMRI and eye-tracking data.
Clinician perspectives on having point of care tests made available to them during out of hours home visiting
Authors: Dixon S. , Glogowska M. , Garland S. , Hunt H. , Lasserson D. , Hayward G.
Published: December 2021

Background

Little is known about clinicians’ perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them.

Method

To explore clinicians’ perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams.

We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results

The clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were “appropriate” and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients’ homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families.

Conclusion

Clinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.