bluuebunny/crossref_metadata_2025 huggingface dataset:
“Cell blocking” the parasitic imposter: In a rare case of isolated pulmonary cysticercosis
Authors: Singh Kush Kumar , Kochhar Abhilasha , Bansal Chakshu , Gupta Latika , Malhotra Samir
Published: April 2024

Isolated pulmonary cysticercosis is a rare manifestation of human cysticercosis which mainly affects central nervous system, skeletal muscles, eyes and subcutaneous tissues. Pulmonary involvement is usually a part of disseminated disease and mainly presents as bilateral pulmonary nodules. We report a rare case of isolated pulmonary cysticercosis presenting as lung cyst with pleural effusion. The diagnosis was made on pleural fluid cytology and cell block preparation. Herein we wish to recapitulate the importance of cell block as a diagnostic aid for parasitic infections, where morphological features and architectural patterns are as clearly discernable as in histopathology.
Latitude or altitude as the future refugium? A case for the future of forests in Asia Minor and its surroundings
Authors: Ekberzade Bikem , Yetemen Omer , Ezber Yasemin , Sen Omer Lutfi , Dalfes Hasan Nuzhet
Published: April 2024

At the current juncture with climate change, centennial projections of species distributions in biodiversity hotspots, using dynamic vegetation models may provide vital insight into conservation efforts. This study aims to answer: (1) if climate change progresses under a business‐as‐usual scenario of anthropogenic emissions for this century, how may the forest ranges be affected? (2) will there be potential regional extinctions of the taxa simulated? (3) may any site emerge as a potential refugium? Study Area: Anatolian Peninsula and its surroundings, longitudes 24–50° E, latitudes 33–46° N. Time Period: 1961‐2100. Major Taxa Studied: 25 woody species and a C3 grass‐type. Method: Keeping a spatial window large enough to track potential changes in the vegetation range and composition especially in the mountain ranges within the study area, we parameterized a process‐based regional‐to‐global dynamic vegetation model (LPJ‐GUESS v 4.1), forced it with ERA5‐Land reanalysis for the historical period, and five different bias‐corrected centennial global circulation model (GCM) datasets under SSP5‐8.5, and simulated the dynamic responses of key forest species. Bivariate spatio‐temporal maps from the simulation results were constructed for final analysis. Results: A significant increase in woody taxa biomass for the majority of our study area, towards the end of the century was simulated, where temperate taxa with high tolerance for drought and a wider range of temperatures took dominance. The mountain ranges in our study area stood out as critical potential refugia for cold favoring species. There were no regional extinctions of taxa, however, important changes in areal dominance and potential future forest composition were simulated. Main Conclusions: Our simulation results suggest a high potential for future forest cover in our study region by the end of the century under a high emissions scenario, sans human presence, with important changes in vegetation composition, including encroachment of grasslands ecosystems by woody taxa.
Rehydration of degraded wetlands: Understanding drivers of vegetation community trajectories
Authors: Nocentini Andrea , Redwine Jed , Gaiser Evelyn , Hill Troy , Hoffman Sophia , Kominoski John S. , Sah Jay , Shinde Dilip , Surratt Donatto
Published: April 2024

Degradation of wetland ecosystems results from loss of hydrologic connectivity, nutrient enrichment, and altered fire regimes, among other factors. It is uncertain how drivers of wetland ecosystem processes and wetland vegetation communities interact in reversing the ecological trajectory from degraded to restored conditions. We analyzed biogeochemical and vegetation data collected in wetlands of the Florida Everglades at the start of (2015) and during (2018 and 2021) the initial stages of rehydration. Our objectives were to analyze the allocation of carbon and nutrients among ecosystem compartments and correlated trajectories of vegetation community change following rehydration, to identify the drivers of change, including fire, and analyze macrophyte species‐specific responses to drivers. We expected to see changes in vegetation toward more hydric communities that would differ based on wetland baseline conditions and the magnitude of the hydrologic change. During the study period, both length of inundation and surface water depth increased throughout wetlands in the region, and four fires occurred, which affected 51% of the sampling locations. We observed biogeochemical shifts in the wetland landscape, driven by both hydrology and fire. Total phosphorus concentrations in soil and flocculent detrital material decreased, while soil carbon:phosphorus and nitrogen:phosphorus mass ratios increased at sites further away from water management infrastructure. Transitions in vegetation communities were driven by an increase in hydroperiods and by the distinct changes in nutrient concentrations or soil stoichiometric ratios in each subregion. The abundance of macrophyte species typical of short‐hydroperiod prairies strongly decreased, while dominant long‐hydroperiod species, such as Eleocharis cellulosa, expanded. Fire facilitated the expansion of thickly vegetated plumes of invasive Typha at sites close to the water inflow sources. Overall, restored hydrology shifted vegetation community composition toward higher abundance of long‐hydroperiod species within six years. In contrast, removal of invasive vegetation controlled by soil phosphorus concentrations will likely require long‐term and interactive restoration strategies.
Management implications of habitat selection by whooping cranes (Grus americana) on the Texas coast
Authors: Lehnen Sarah E. , Sesnie Steven E. , Butler Matthew J. , Pearse Aaron T. , Metzger Kristine L.
Published: April 2024

Effective habitat management for rare and endangered species requires a thorough understanding of their specific habitat requirements. Although machine learning models have been increasingly used in the analyses of habitat use by wildlife, the primary focus of these models has been on generating spatial predictions. In this study, we used machine learning models in combination with simulated management actions to guide planning and inform managers. We used data from 61 whooping cranes (Grus americana) tagged with GPS telemetry collars between 2009 and 2018 near Aransas National Wildlife Refuge in coastal Texas. We included variables based on topography, land use classification, vegetation height, plant phenology, drought, storm surge events, and both wild and prescribed fires. We then built models at multiple scales: population level, home range level, and roosting and daytime within home range level. We simulated responses to the two primary management actions used to enhance whooping crane habitat on Aransas National Wildlife Refuge: prescribed fire and removal of woody vegetation. At the population and home range scales, land use classification variables had the highest importance values, whereas the combined elevation and bathymetry layer was the most important predictor at both roosting and daytime within home range scales. Our findings revealed that the effects of fire, although generally modest, varied spatially. Areas dominated by estuarine wetlands exhibited higher predicted use within the first months after a fire, whereas those dominated by palustrine wetlands were more likely to be avoided in the immediate postfire years. Our simulation of vegetation removal identified the areas on Aransas National Wildlife Refuge where whooping cranes were predicted to benefit the most if vegetation were removed. These techniques can be used by other researchers wanting to examine and predict the effects of potential management actions on target species habitat.
Idiosyncrasy and predictability in intraspecific trait–climate relationships of grasses
Authors: Sandel Brody , Griffin‐Nolan Robert J.
Published: April 2024

Many plant species can exhibit remarkable variation in leaf characteristics, depending on their abiotic and biotic environment. Environmental changes therefore have the potential to alter leaf traits, which in turn scale up to influence ecosystem processes including net primary productivity, susceptibility to fire, and palatability to herbivores. It is not well understood how consistent trait–environment relationships are among species, across sites and over time. This presents a fundamental challenge for functional ecology, because no study can measure all relevant species in all places at all times. Thus, understanding the limits of transferability is critical. We collected leaf trait measurements on 13 species of grass (family: Poaceae) across 11 sites and five years (n = 3091 individuals). Sites were arrayed along a spatial precipitation gradient in coastal northern California (annual precipitation of 590–1350 mm) with substantial interannual precipitation variability (from 60% below the 30‐year average to 100% above average). Temporal and spatial linear relationships between precipitation and specific leaf area (SLA) appear at first idiosyncratic, with each species sometimes displaying positive and sometimes negative responses. However, this variation arises from sampling different portions of an underlying hump‐shaped relationship, which was shared across most species. This hump‐shaped relationship was driven primarily by changes in leaf tissue density. These results suggest the potential for transferability among species, as well as between space and time, as long as the gradients are sufficiently long to capture the nonlinear response. Future work could explore the physiological basis of the nonlinear SLA response, including the possibility that distinct physiological mechanisms are operating at the two extremes of the gradient.
Flow similarity model predicts allometric size dependence, curvature, and covariation of 285 North American tree species
Authors: Price Charles A. , Schroeder Todd A.
Published: April 2024

Scaling patterns in plants have long interested biologists, particularly whether different species share similar patterns of growth, and whether differences in growth trajectories depend on plant size. Using 8,794,737 measurements for 285 species from the U.S. Forest Inventory and Analysis database, we test several predictions emerging from a recently published “flow similarity” model for plant growth and allometry. We show that the model's predicted curvature for intraspecific relationships between height, dbh, and biomass is found in 88.1% of examined cases, and empirical slopes fall as predicted between the elastic similarity and flow similarity predictions in 71.1% of cases. We also find a strong size dependence in observed intraspecific allometric exponents, with large species, particularly gymnosperms, converging near the expectation for elastic similarity and the central tendency among small species approaching the expectations for flow similarity in most cases. Our results support the idea that differences in growth patterns across plant species depend on plant size and their attendant hydraulic and/or biomechanical demands and helps to delineate the bounds of the theoretical morphospace in which they occur.
Successional dynamics of carbon sequestration in forests of the eastern United States
Authors: Canham Charles D. , Murphy Lora , Hansen Winslow D.
Published: April 2024

Carbon sequestration in the forests of the eastern United States is an important offset to the country's CO2 emissions. Much of the eastern forestland is the product of reforestation of abandoned agricultural land or recovery following clear‐cutting over a century ago. This has led to concerns that eastern forests are even‐aged and that rates of carbon sequestration will decline as forests increase in carbon. Our objective was to examine the successional dynamics of forest carbon sequestration—using live tree carbon stocks as a proxy for successional status—for the six broadly defined forest types present in the region. We used datasets from the National Forest Inventory (NFI) for the 31 US states from Minnesota south to Louisiana and eastward and analyzed live tree net carbon increment for 2007–2021, the period for which NFI plot remeasurement data were available for all 31 states. Spruce–fir and southern pines were the only forest types for which carbon increment declined even modestly over a significant fraction of the range of live tree carbon observed in the region, and southern pine–hardwood forests were the only forests in which predicted sequestration in live tree carbon declined to zero within the range of carbon stocks observed in the region. Northern hardwood–conifer forests, oak–hickory forests, and lowland forests experienced either no decline or a slight increase in sequestration in live tree carbon across the range of successional status observed in the region. Thus, the average stocks of live tree carbon per unit area increased steadily over the study period. At some point in succession, rates of mortality are expected to increase and balance gross growth, leading to zero net sequestration in live tree carbon. Mature and old‐growth stands, however, are rare in all six forest types, and mortality as a fraction of live tree carbon for all six forest types declined across the range of successional status present in the region. Our results thus provide no support for the hypothesis that the successional dynamics of forests in this region can be expected to lead to near‐term declines in net carbon sequestration.
Using density surface models to assess the ecological effectiveness of a protected area network in Tanzania
Authors: Giliba Richard A. , Kiffner Christian , Fust Pascal , Loos Jacqueline
Published: April 2024

Given recent global endeavors to increase protected area coverage, it is crucial to comprehensively evaluate the efficacy of various area‐based conservation strategies in effectively reducing biodiversity loss. Here, we investigated the responses of wildlife populations to different protection levels and environmental variables at the landscape scale in the Katavi–Rukwa Ecosystem, western Tanzania. To this end, we conducted line distance sampling surveys and counted the dung of six target mammal species (elephant, giraffe, buffalo, zebra, topi, and hartebeest) along foot transects within areas differing in protection levels (from strict to less‐strictly protected: national park, game reserve, forest reserve, game‐controlled area, and unprotected areas). Based on these dung counts, we modeled the spatial distribution of these six mammal species using a species‐specific density surface modeling framework. We found consistent effects of protection level and land use variables on the spatial distribution of the target mammal species: dung densities were highest in the national park and game reserves, intermediate in less‐strictly protected areas, and lowest in unprotected areas. Beyond species‐specific environmental predictors for dung densities, our results highlight consistent negative associations between dung densities of the target species and distance to cropland and avoidance of areas in proximity to houses. Our findings underpin differences in ecological effectiveness of protected areas within one ecosystem. Protection level and land use play crucial roles in moderating the spatial distribution of all considered mammal species. Our findings suggest that a landscape approach needs to guide effective conservation across the entire protection gradient of the Katavi–Rukwa Ecosystem.
Litter accumulation suppresses grass production but facilitates shrub expansion in a long‐term fenced grassland
Authors: Zhang Yiwen , Chang Xiaofeng , Zhang Yuwei , Wilkes Andreas , Wang Guojie
Published: April 2024

Shrub expansion is increasing in grasslands worldwide and has profound effects on biodiversity and ecosystem functions. Shrub expansion has primarily been explained by extrinsic factors such as climate change and human activities, yet the roles of intrinsic shrub demographic population dynamic and shrub–grass interaction remain poorly understood. With a paired mown and exclosure comparison experiment and baseline levels of shrub abundance in a semiarid grassland, we confirmed that long‐term livestock exclusion promotes expansion of two native shrubs, Artemisia sacrorum and Caragana brachypoda. Shrub abundance increased during the livestock exclusion period. Shrub biomass in fenced plots was about 5‐ to 10‐fold greater than in mown plots. Both increase in population density and individual size (especially height) contributed to shrub increase. The mechanism behind this was the divergent effects of litter accumulation on shrubs and grasses. Litter accumulation suppressed grass production, while facilitating shrub recruitment and growth. Our findings highlight the potential role of litter accumulation‐mediated shifts in shrub–grass interactions, which should be incorporated into grazing top‐down control to better predict the restoration outcomes of grassland management changes. The identified internal biotic mechanism raises the possibility that removal of accumulated litter by grazing or mowing may be an alternative way to maintain or restore a grass‐dominated state in shrub expansion areas.
ECMO for drug‐refractory electrical storm without a reversible trigger: a retrospective multicentric observational study
Authors: Durães‐Campos Isabel , Costa Catarina , Ferreira Ana Rita , Basílio Carla , Torrella Pau , Neves Aida , Lebreiro Ana Margarida , Pestana Gonçalo , Adão Luís , Pinheiro‐Torres José , Solla‐Buceta Miguel , Riera Jordi , Chico‐Carballas Juan Ignacio , Gaião Sérgio , Paiva José Artur , Roncon‐Albuquerque Roberto
Published: April 2024

Aims

Drug‐refractory electrical storm (ES) is a life‐threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in drug‐refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking.

Methods and results

Retrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug‐refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti‐arrhythmic drugs, requiring VA‐ECMO for circulatory support. Thirty‐four (6%) out of 552 patients with VA‐ECMO for cardiogenic shock were included [71% men; 57 (44–62) years], 65% underwent cardiopulmonary resuscitation before VA‐ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA‐ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter‐defibrillator. The drug‐refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty‐one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA‐ECMO, and 29% had heart transplantation. Twenty‐seven (79%) survived to hospital discharge (48 (33–82) days). Non‐survivors were older [62 (58–67) vs. 54 (43–58); P < 0.01] and had a higher first rhythm disorder‐to‐ECMO interval [0 (0–2) vs. 2 (1‐11) days; P = 0.02]. Seven (20%) had rehospitalization during follow‐up [29 (12–48) months], with ES recurrence in 6%.

Conclusions

VA‐ECMO bridged drug‐refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.
Outcomes with T‐wave discordance of left bundle branch block and preserved or mildly reduced ejection fraction
Authors: Huang Hui‐Chun , Chien Kuo‐Liong , Liu Yen‐Bin
Published: April 2024

Aims

Left bundle branch block (LBBB) is associated with an increased risk of adverse outcomes for patients with heart failure. The prognosis of LBBB in patients with a preserved ejection fraction (EF) remains controversial. This study investigated the predictive value of T‐wave discordance for the prognosis of patients with LBBB and preserved or mildly reduced EF.

Methods and results

We enrolled 707 patients with complete LBBB and left ventricular (LV) EF ≥ 40% observed using electrocardiograms (ECGs) and echocardiograms between January 2010 and December 2018. Their serial ECGs were reviewed during the follow‐up period. The T‐wave pattern was classified as discordant LBBB (dLBBB) or concordant LBBB (cLBBB) according to the 12‐lead ECG T‐wave morphology. The primary outcome was the composite of cardiovascular death or hospitalization for heart failure during a median follow‐up period of 3.1 years. A multivariable Cox regression analysis was used to evaluate the independent predictors of the primary outcome. Patients with dLBBB had more comorbidities, a higher heart rate, a longer QRS and QTc duration, a larger LV end‐systolic volume and left atrial dimension, a lower LVEF, and a higher mitral E/A ratio and E/e′, compared with those with cLBBB. Older age [hazard ratio (HR) = 1.023, 95% confidence interval (CI) = 1.001–1.046, P = 0.023], history of heart failure (HR = 2.440, 95% CI = 1.524–3.905, P = 0.001), chronic kidney disease (HR = 1.917, 95% CI = 1.182–3.110, P = 0.008), larger LV end‐systolic volume (HR = 1.046, 95% CI = 1.017–1.075, P = 0.002), lower LVEF (HR = 0.916, 95% CI = 0.885–0.948, P = 0.001), and presence of dLBBB (HR = 1.63, 95% CI = 1.011–2.628, P = 0.032) were independent predictors of the primary outcome in patients with LBBB and LVEF ≥ 40%. The discordant or concordant T‐wave morphology of LBBB could transform from one subtype to the other in up to 23% of the study population during the follow‐up period, and individuals with persistent or transformed dLBBB faced an increased risk of cardiovascular death or non‐fatal heart failure hospitalization.

Conclusions

In patients with LBBB and EF ≥ 40%, dLBBB serves as an independent predictor of a higher risk of cardiovascular death or non‐fatal heart failure hospitalization.
Transition from asymptomatic to symptomatic systolic chronic heart failure: rationale and design of TransitionCHF
Authors: Sandek Anja , Edelmann Frank , Gertler Christoph , Friede Tim , Wachter Rolf , Hasenfuß Gerd ,   TransitionCHF consortium
Published: April 2024

Aims

Chronic systolic heart failure (CHF) is a major health burden. A relevant number of patients shows asymptomatic left ventricular dysfunction (ALVSD) before symptomatic CHF or becomes asymptomatic after initiating heart failure therapy. Clinical course, prognosis, and response to pharmacological and device‐based treatment are largely unknown in these two distinct groups of patients. Current pharmacological and interventional therapies do neither properly address the underlying pathophysiology nor prevent malignant loss of function. New therapeutic paradigms are needed to stop the progression from asymptomatic to symptomatic heart failure. Key questions are what causes progression of clinically asymptomatic New York Heart Association (NYHA) I heart failure to overt heart failure (>NYHA I) in some but not all patients and the underlying reasons for this transition. This requires the identification of disease mechanisms and biomarkers that predict outcome in well‐defined cohorts for innovative preclinical and clinical trials.

Methods and results

TransitionCHF is a prospective, multicentre, longitudinal pathophysiological evaluation cohort study in patients with asymptomatic systolic dysfunction NYHA I and left ventricular ejection fraction ≤40%. The cohort comprises both incidental findings and patients who had become asymptomatic after a previous symptomatic event. TransitionCHF has recruited 1000 patients with ALVSD caused by various aetiologies in 20 university heart failure clinics across Germany. Both patients with and without comorbidities at study entry will be recruited. Patients will be systematically investigated and followed up annually over the course of the study. The primary composite endpoint is time to hospitalization for heart failure and cardiovascular death. The secondary endpoints assess time to all‐cause mortality, to cardiovascular mortality, to heart failure mortality, to all‐cause hospitalization, to heart failure hospitalization, and to recurrent heart failure hospitalizations, as well as time to assist device implantation/transplantation. Additional investigations focusing on biomarkers, comorbidities, gender aspects, nutrition, and functional parameters including quality of life will be performed.

Conclusions

TransitionCHF will provide a more thorough pathophysiological understanding of the progression of asymptomatic systolic dysfunction into symptomatic heart failure that will help develop therapies tailored to prevent progressive heart failure.
Impact of guideline‐directed medical therapy on systolic blood pressure and cardiovascular outcomes in patients with heart failure and low blood pressure: A systematic review and meta‐analysis
Authors: Li Jingwei , Chen Yunlong , Wang Yi , Liu Xiaoyan , Li Ping , He Yongming , Hao Yang , Huang Lan , Jin Jun , Wang Jiang , Anderson Craig
Published: April 2024

Aims

Existing research indicates that patients with heart failure (HF) may have restricted access to guideline‐directed medical therapy (GDMT) when their blood pressure (BP) is comparatively low. However, recent clinical trials suggest that HF patients with low BP could still benefit from certain HF medications, which have a minimal impact on BP. This systematic review and meta‐analysis was conducted to determine whether this applies to all GDMT.

Methods and results

A systematic search of MEDLINE and EMBASE was conducted for studies published from inception to 10 January 2024. Randomized controlled trials were selected if they reported on the longitudinal change of systolic BP (SBP) due to GDMT, or the risks of cardiovascular events in HF patients based on SBP categories. Weighted mean difference (WMD), hazard ratio or relative risk, and corresponding 95% confidence intervals (CI) were pooled for meta‐analysis where possible. Data from 20 studies, encompassing information on 84 782 individuals, were analysed. Overall, GDMT is associated with lower SBP (WMD, −2.16; 95% CI −2.86 to −1.46), with no significant difference between baseline low and non‐low BP subgroups (interaction p = 0.810). However, SBP of the treatment group increased by 5.8 mmHg from baseline in the low SBP subgroup during follow‐up, while it decreased by 4.0 mmHg in the baseline non‐low SBP subgroup. GDMT demonstrated similar cardiovascular benefits and risk of hypotension between low and non‐low SBP subgroups (interaction p = 0.318 and 0.903, respectively).

Conclusions

Guideline‐directed medical therapy is associated with a negligible decrease in SBP, but can provide similar cardiovascular benefits in both low and non‐low SBP HF patients, with no significant interaction with SBP as to hypotension. Therefore, GDMT should be initiated and maintained in HF patients with low BP.
N‐terminal pro‐B‐type natriuretic peptide post‐discharge monitoring in the management of patients with heart failure and preserved ejection fraction – a randomized trial: The NICE study
Authors: Pascual‐Figal Domingo A. , Hernández‐Vicente Alvaro , Pastor‐Pérez Francisco , Martínez‐Sellés Manuel , Solé‐González Eduard , Alvarez‐García Jesús , García‐Pavía Pablo , Varela‐Román Alfonso , Sánchez Pedro Luis , Delgado Juan F. , Noguera‐Velasco Jose A. , Bayes‐Genis Antoni ,   NICE study investigators
Published: April 2024

Aims

There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post‐discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) into the post‐discharge management of HFpEF patients.

Methods and results

Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open‐label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT‐proBNP monitoring (n = 79) or no access to NT‐proBNP (control group, n = 78) during pre‐scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT‐proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47–2.81, p = 0.760). Regarding secondary endpoints, the NT‐proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02–0.98; p = 0.048), whereas non‐HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance [Correction added on 29 April 2024, after first online publication: In the preceding sentence, “95% CI 0.02 ‐ 0.09” has been corrected to “95% CI 0.02 ‐ 0.98; p = 0.048” in this version.]. Awareness of NT‐proBNP levels were associated with higher doses of diuretics and renin–angiotensin system inhibitors (angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers) in the NT‐proBNP monitoring group.

Conclusions

Post‐discharge monitoring of NT‐proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
Left atrial to coronary sinus shunting for treatment of heart failure with mildly reduced or preserved ejection fraction: The ALT FLOW Early Feasibility Study 1‐year results
Authors: Urey Marcus A. , Hibbert Benjamin , Jorde Ulrich , Eckman Peter , Simard Trevor , Labinaz Marino , Nazer Babak , Wiley Mark , Gupta Bhanu , Sauer Andrew , Shah Hirak , Sorajja Paul , Pineda Andres M. , Missov Emil , Mahmud Ehtisham , Kahwash Rami , Lilly Scott , Latib Azeem , Murthy Sandhya , Fam Neil , Garcia Santiago , Chung Eugene S. , Klein Liviu , Cheng Richard , Houston Brian A. , Amoroso Nicholas S. , Chang Lee , Gafoor Sameer , Chaudhry Sunit‐Preet , Hermiller James , Schwartz Jonathan G. , Aldaia Lillian , Koulogiannis Konstantinos , Gray William A. , Zahr Firas
Published: April 2024

Aims

Patients with heart failure and mildly reduced or preserved ejection fraction have limited therapeutic options. The ALT‐FLOW Early Feasibility Study evaluated safety, haemodynamics and outcomes for the APTURE transcatheter shunt system, a novel left atrium to coronary sinus shunt in these patients.

Methods and results

Safety and shunt implantation success was evaluated for all 116 enrolled patients. An analysis population of implanted patients with a left ventricular ejection fraction (LVEF) >40% (n = 95) was chosen to assess efficacy via paired comparison between baseline and follow‐up haemodynamic (3 and 6 months), and echocardiographic, clinical and functional outcomes (6 months and 1 year). Health status and quality of life outcomes were assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ‐OSS). The primary safety endpoint, major adverse cardiac, cerebral, and renal events, and reintervention through 30 days, occurred in 3/116 patients (2.6%). All implanted shunts were patent at 1 year. In patients with LVEF >40%, the mean (95% confidence interval) reduction in exercise pulmonary capillary wedge pressure (PCWP) at 20 W was −5.7 (−8.6, −2.9) mmHg at 6 months (p < 0.001). At baseline, 8% had New York Heart Association class I–II status and improved to 68% at 1 year (p < 0.001). KCCQ‐OSS at baseline was 39 (35, 43) and improved at 6 months and 1 year by 25 (20–30) and 27 (22–32) points, respectively (both p < 0.0001). No adverse changes in haemodynamic and echocardiographic indices of right heart function were observed at 1 year. Overall, the reduction in PCWP at 20 W and improvement in KCCQ‐OSS in multiple subgroups were consistent with those observed for the entire population.

Conclusions

In patients with heart failure and LVEF >40%, the APTURE shunt demonstrated an acceptable safety profile with significant sustained improvements in haemodynamic and patient‐centred outcomes, underscoring the need for further evaluation of the APTURE shunt in a randomized trial.
Vagal tone, pain sensitivity and exercise‐induced hypoalgesia: The effect of physical activity level
Authors: Michaeli Izak Ela , Kodesh Einat , Weissman‐Fogel Irit
Published: April 2024

Background

Vagal activity has analgesic effects that are attributed to exercise‐induced hypoalgesia (EIH). High vagal tone and low pain sensitivity are reported in individuals who routinely exercise yet, their association is unclear. Furthermore, it is unknown if the heightened vagal tone following high physical activity predicts and intensifies EIH.

Methods

Fifty‐one healthy participants (27 low–moderately physically active; 27 females) underwent a resting‐state electrocardiogram followed by heart rate variability analysis. Pain measurements, including pressure (PPT) and heat (HPT) pain thresholds, ratings of tonic heat pain (THP) and conditioned pain modulation (CPM) paradigm, were conducted pre‐ and post‐exercise on a cycle ergometer.

Results

The highly active group demonstrated higher vagal tone compared to the low–moderately active (root mean square of successive differences between R–R intervals: 63.96.92 vs. 34.78 ms, p = 0.018; percentage of successive R–R intervals that exceed 50 ms: 24.41 vs. 11.52%, p = 0.012). Based on repeated‐measure ANOVA, the highly active group showed higher PPT at pre‐exercise, compared to the low–moderately active group (382 kPa vs. 327 kPa; p = 0.007). Post‐exercise, both groups demonstrated EIH, increased HPT (p = 0.013) and decreased THP ratings (p < 0.001). Linear regression revealed that only in the low–moderately active group, higher vagal tone was associated with more efficient pre‐exercise CPM and a greater reduction in THP ratings post‐exercise (p ≤ 0.01).

Conclusions

Highly active individuals demonstrate greater vagal tone and lower pain sensitivity but no greater EIH. Vagal tone moderates pain inhibition efficiency and EIH only in low–moderately active individuals. These findings suggest that physical activity level moderates the vagal–pain association via the endogenous analgesia system.

Significance

Highly physically active individuals exhibit greater vagal tone and reduced sensitivity to experimental pain, yet they do not benefit more from exercise‐induced hypoalgesia (EIH) compared to low–moderately active individuals. Moreover, low–moderately active individuals with greater vagal tone exhibited more efficient endogenous pain inhibition and greater EIH, suggestive of the moderation effect of physical activity level on vagal–pain associations.
Photoreforming Light Alcohols for Value‐Added Resources: A Mini Review
Authors: Liu Ruhan , Yin Hang , Guo Peiqi , Liu Xu , Yin Zongyou
Published: April 2024

Hydrogen gas as a clean energy source, it is a promising alternative to fossil fuels. Therefore, people are actively seeking effective ways to produce hydrogen to cope with the imminent global energy shortage. However, the current production of hydrogen relies on the catalytic reforming of fossil fuels, inducing inevitable environmental pollution. Alternatively, photocatalysis for produce hydrogen gas from reforming alcohols is a promising approach. Especially, other value‐added hydrocarbon products, such as acetone, acetaldehyde, acetic acid, etc., can also be produced during the photoreforming process of alcohols. Meanwhile, reducing the production of COx, making it an environmentally friendly conversion process. Outstandingly, TiO2 and its derivative are excellent photocatalysts. Among them, TiO2 cocatalyzed with noble metal can easily increase the H2 evolution rate to the mmol g−1 h−1 scale. Among the light alcohols isopropyl alcohol has fewer side reactions, methanol and ethanol have higher reaction rate, but they require to reduce the by‐product COx. In this review, the recent developments in this field are summarized; various studies regarding H2 evolution rate, illumination condition, quantum efficiency, etc., are compared; and the development prospects of this field, with the hope of sparking widespread research interest, are proposed.
Reverse flow anterolateral thigh free flap in a case with significant atherosclerosis: A viable alternative for arterial microvascular anastomosis
Authors: Garneau Jonathan C. , Rezaee Rod
Published: April 2024

Background

The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or “supercharge” a large ALT to optimize skin perforator supply or lengthen the vascular pedicle.

Methods

We report a case of a 77‐year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed.

Results

We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction.

Conclusion

This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle.
The affective, cognitive, and physiological effects of implementing antecedent‐focused emotion regulation strategies in childhood
Authors: Davis Elizabeth L. , Brady Shannon M. , Pankratz Kasey , Tolman Zariah , Parsafar Parisa , Shih Emily W.
Published: April 2024

Different components of emotional responding may be affected by using specific emotion regulation strategies that enable children's volitional self‐regulation. This study examined the affective, cognitive, and physiological effects of experimentally instructing children to deploy distraction or reappraisal to regulate negative emotion during an evocative film clip. One‐hundred eighty‐four 4‐ to 11‐year‐old children [M = 7.66 years; SD = 2.33 years; 94 girls; mixed race (36%), Latino/Latina (30%), European American (19%), African American (11%), Asian American (2%), or other (2%)] participated. Neither strategy affected observed distress or self‐reported negative emotion. Relative to a control condition, children instructed to use reappraisal reported attenuated rumination. Distraction also predicted attenuated rumination, as well as a pattern of parasympathetic reactivity indicative of disengagement that correlated with parents' reported use of minimizing and punitive emotion socialization practices. Findings underscore the utility of multi‐method approaches that examine parasympathetic activity in conjunction with volitional measures of self‐regulation.
Chemotherapy versus chemotherapy plus immune checkpoint inhibitors for the first‐line treatment of unresectable thymic carcinoma: A multicenter retrospective study
Authors: Zhang Baishen , Liu Yao , Chen Zhiting , Chen Jing , Yu Hui , Li Meichen , Ma Shudong , Cheng Chao , Chen Likun
Published: April 2024

Thymic carcinoma (TC) is a rare malignant tumor with a poor prognosis, and there is currently limited data on the use of immunotherapy in patients with unresectable TC. In this study, data of patients with unresectable TC diagnosed from January 2017 were retrospectively collected from multiple centers. Treatment response, progression‐free survival (PFS), overall survival (OS), survival‐independent prognostic factor, and adverse events (AEs) were further analyzed. As a result, a total of 93 patients with unresectable TC were enrolled, of which 54 received first‐line chemotherapy, and 39 received chemotherapy plus immune checkpoint inhibitors (ICIs). The objective response rate was 50% (27/54) in the chemotherapy group and 76.9% (30/39) in the chemotherapy plus ICIs group. The chemotherapy plus ICIs group achieved significant median PFS benefit (8.8 vs. 34.9 months, p < .001) and median OS benefit (41.8 months vs. not reached, p = .025). Multivariate analysis showed that ICIs and local therapy were independent prognostic factors for PFS. In addition, 17 patients developed immune‐related AEs (IRAEs), of which 15 (38.5%) had Grade 1 or 2 IRAEs and 2 (5.1%) had Grade 3 IRAEs in the chemotherapy plus ICIs group. In conclusion, the efficacy of chemotherapy plus ICIs is superior to chemotherapy, and the adverse effects are manageable in patients with unresectable TC.
Prevalence of survivors of childhood cancer based on a population‐based cancer registry in Osaka, Japan
Authors: Kudo Haruka , Nakata Kayo , Morishima Toshitaka , Kato Mizuki Shimadzu , Kuwabara Yoshihiro , Sawada Akihisa , Fujisaki Hiroyuki , Hashii Yoshiko , Miyashiro Isao
Published: April 2024

Although the survival rate of patients with childhood cancer has greatly improved, long‐term survivors face specific problems such as the late effects of cancer treatment. In this study, we estimated the number of people who had experienced childhood cancer to predict their needs for medical care and social resources. Using data from the population‐based Osaka Cancer Registry, we identified children aged 0–14 years who were diagnosed with cancer between 1975 and 2019. We estimated the prevalence on December 31, 2019, and the 5‐ and 10‐year prevalence (i.e., the number of survivors living up to 5 or 10 years after the diagnosis of cancer) over time. The prevalence proportion was age‐standardized using a direct standardization method. The prevalence estimates for Osaka were applied to the national population to determine the national prevalence in Japan. Among 8186 patients diagnosed with childhood cancer in Osaka, 5252 (987 per million) survived until December 31, 2019. The 5‐year prevalence per million increased from 194 in 1979 to 417 in 2019 (+116%), while the 10‐year prevalence increased from 391 in 1984 to 715 in 2019 (+83%). Based on the long‐term registry data, an estimated 73,182 childhood cancer survivors were living in Japan by the end of 2019. The increasing 5‐year and 10‐year prevalence proportions indicate the continued need for cancer survivorship support for children, adolescents, and young adults. These estimates of the prevalence of childhood cancer survivors, including long‐term survivors, may be useful for policymakers and clinicians to plan and evaluate survivorship care.
On the Fibonacci Tiling and its Modern Ramifications
Authors: Baake Michael , Gähler Franz , Mazáč Jan
Published: April 2024

In the last 30 years, the mathematical theory of aperiodic order has developed enormously. Many new tilings and properties have been discovered, few of which are covered or anticipated by the early papers and books. Here, we start from the well‐known Fibonacci chain to explain some of them, with pointers to various generalisations as well as to higher‐dimensional phenomena and results. This should give some entry points to the modern literature on the subject.
Development of a semi‐automated tool to measure fetal abdominal wall thickness during ultrasound at 20 weeks' gestation
Authors: Seshadri Suresh , Pudhukudi Sindhu , Vajiravelu Jayanti , Saravanan Ponnusamy , Hyett Jon , Ram Uma
Published: April 2024

Objectives

To develop a semi‐automated tool for measuring fetal abdominal wall thickness (AWT). To validate the software using images captured by other centers and create a nomogram for fetal AWT between 18 and 20 weeks.

Methods

A semiautomated tool that measured AWT was developed using images captured at the routine 20‐week morphology scan. The software was developed using digital images captured routinely during scans of low‐risk women. Inter‐ and intraobserver reliability was assessed between manual and semi‐automated measures. The tool was validated using images acquired from other centers. Linear regression and quadratic polynomials were used to create a nomogram for AWT.

Results

The semi‐automated tool was able to measure AWT in all images. Interoperator reliability was 0.90 and 0.97 (P < 0.05) for manual and semi‐automated methods, respectively. Measurement agreement varied between three operators from moderate to excellent (0.77, 0.87, 0.92), with overall agreement being good (0.85). The tool could be successfully applied to 89% of images from other centers. A nomogram was generated for AWT measurements of fetuses at 18–20 weeks in normal, low risk mothers.

Conclusion

Semi‐automated measurement of AWT was feasible using images captured during the routine 20‐week scan. This approach had lower inter‐ and intraobserver variability compared to manual measurement.
Advancing System Engineering's Relevance in a Changing World
Authors: Brook Peter , Pennotti Michael , Rousseau David
Published: April 2024

The future value of systems engineering may well be measured by its contribution to INCOSE's vision of “a better world through a systems approach.” To stay relevant, systems engineering must expand its scope beyond the technical realm by addressing today's most pressing and complex problems, which span technical, social, and ecological domains. This paper builds on our previous work on the evolving architecture of the systems engineering discipline, detailing how it can maintain its value by effectively engaging in eco‐socio‐technical challenges. We propose collaborative strategies with other disciplines to enhance and broaden its foundational base, which will be crucial for realizing its potential as a transdisciplinary field in an increasingly complex world.
Assessing negative reinforcement through simultaneous observing and committed concurrent progressive‐ratio procedures: Preliminary investigations
Authors: Witts Benjamin N. , Bruzek Jennifer L.
Published: April 2024

Efficient methods for assessing the relative aversiveness of stimuli are sparse and underresearched. Having access to efficient procedures that can identify aversive stimuli would benefit researchers and practitioners alike. Across three experiments, 13 participants helped to pilot, refine, and test two approaches to identifying negative reinforcers. The first experiment presented two conditions, one in which computerized button pressing started or stopped one of two recorded infant cries (or silence, when the control button was selected). Choices were presented either in a modified observing‐response procedure (i.e., simultaneous observing) or in a modified progressive‐ratio procedure (i.e., committed concurrent progressive ratio; CCPR). Results were favorable though not conclusive on their own. A second experiment, using more distinct stimuli (i.e., one likely aversive, one likely not aversive), replicated the first, and clearer results emerged. Finally, the third experiment tested the stimuli from the second experiment in a CCPR arrangement where sound was terminated contingent on responding and idiosyncratic negative reinforcement hierarchies emerged. The utility of these two procedures is discussed, and future work that addresses the limitations is outlined.
Graphs with girth 9 and without longer odd holes are 3‐colourable
Authors: Wang Yan , Wu Rong
Published: April 2024

For a number , let denote the family of graphs which have girth and have no odd hole with length greater than . Wu, Xu and Xu conjectured that every graph in is 3‐colourable. Chudnovsky et al., Wu et al., and Chen showed that every graph in , and is 3‐colourable, respectively. In this paper, we prove that every graph in is 3‐colourable. This confirms Wu, Xu and Xu's conjecture.