bluuebunny/crossref_metadata_2025 huggingface dataset:
“I can migrate, but why should I?”—voluntary non-migration despite creeping environmental risks
Authors: Mallick Bishawjit , Priovashini Chup , Schanze Jochen
Published: January 2023

‘Environmental non-migration’ refers to the spatial continuity of an individual’s residence at the same place despite environmental risk. Moreover, this is a largely under-researched topic, especially within the climate change adaptation discourse, but is increasingly coming to the attention of scientists and policymakers for sustainable adaptation planning. So far, there exists hardly any conceptual and methodical guidelines to study environmental non-migration. Considering this research gap, this paper explores environmental non-migration based on the notion that factors of livelihood resilience can partly explain the decision to non-migration. Here, livelihood resilience is seen as an outcome of the interactions between societal and environmental conditions of an individual household. These conditions inform the decisions (to stay or to migrate) taken in case of a hazard or creeping environmental change. Their influence generalises the spectrum of migration decision-making (to stay or to migrate), which is conceptualised by four broad outcomes categorised into voluntary and involuntary, and non-migrants and migrants. This analytical concept is operationalised through an empirical example in southwest coastal Bangladesh. The results suggest that the Livelihood Resilience Index (LRI) relates to the voluntary nature of migration decisions once they are made. Still, only a household’s resilience cannot predict the decisions the household makes to stay or migrate. The paper concludes that the proposed analytical concept, with its exemplary factors, maybe an initial means to holistically explore migration decisions in the context of natural hazards and climate and environmental change. However, environmental non-migration remains complex and multi-faceted, and its assessment requires deeper examination at various scales.
Modelling of risk factors that influence malaria infection using Binary Logistic Regression
Authors: Darnius Open , Siahaan Dessy
Published: January 2023

Malaria is a parasitic disease that is currently endemic in many countries, including in Indonesia. Batubara District in North Sumatera is one of the malaria-endemic areas. This study was conducted to make a mathematical model based on risk factors that influence malaria infection. The data used is secondary data from other researchers. The method used to model risk factors that influence malaria infection is the binary logistic regression with a categorical response variable, namely diagnosis by microscopic examination. There are 10 variable predictors; mosquito nets (X
1), quality use of mosquito nets (X
2), condition of the livingenvironment (X
3), knowledge (X
4), attitudes (X
5), actions (X
6), quality of health workers (X
7), use of mosquito coils (X8), use of topical insect repellent (X
9), and access of health workers (X
10). Maximum likelihood estimation is used to findout the parameter estimates. From the 10 predictor variables studied, it was found that only 8 variables had a significant effect on the model. Based on the odds ratio, the most significant variable is the quality of health workers with 16,5. The ability of predictor variables in explaining the response variable in the model is 87, 8%. The classification function in this study is 96, 3%.
Studies on Strength and Flexural Behaviour of Reinforced Concrete Beams with the Corroded Steel Reinforcements as a result of Sodium Chloride (NaCl)
Authors: Aswin M , Andres  , Gotami R
Published: January 2023

Corrosion on embedded reinforcement is a serious structural failure which its deterioration are rarely concerned. Reinforcing steel are frequently found left unattended on corrosive environment where potential corroding substances might expose surface of rebar resulting in corrosion initiation. This paper reports result of a study conducted to investigate the impact of a rebar corrosion on flexural strength of reinforced concrete beam induced by 10.5% NaCl. Tensile test was conducted in this study to determine the degradation of tensile strength on rebar and was later utilized to analyse the reduction of maximum load bearing capacity on reinforced concrete beam. Both flexural rebar and tensile rebar were corroded using manual basting method which is carried out every day from 08.00 A.M-10 P.M (every 2 hours step). The corrosion area on flexural steel samples is at the maximum flexural strength area (400 mm in the middle of the span) and is later used on flexural testing purposes after casting with concrete, the tensile steel samples which is 600 mm span of rebar is later utilized for tensile testing purposes and is corroded in the middle of the span (185 mm in the middle of the span). Based on test results, it was observed that steel bar suffered significant loss of weights due to corrosion induced by 10.5% NaCl with respect to its corroding duration three and four months are 1.85% and 3.34% reduction of weight from its normal form and its tensile strength degraded, respectively, 6.78 % and 9.86%. Meanwhile, the reinforced concrete beam with corroded steel bars happened to experience degradation of maximum load capacity which are, respectively, 10% and 15% reduction for three and 4 months of corroding duration.
Mapping the overlapping paratransit route in Medan City using GIS
Authors: Sembiring I S , Sukor N S A , Anas M R , Hastuti I P , Pandia I J
Published: January 2023

Paratransit is one of Public Transport in Medan City which operates in mixed traffic without a fixed schedule. This paper describes mapping of paratransit network services condition in Medan, Indonesia. Paratransit travel routes are analysed using a geographic information system that maps public transport routes. Analysis of GIS is used to explore paratransit routes, overlapping paratransit, paratransit services in terms of spatial planning. The results of the analysis can be used by the local transport authorities to improve the existing paratransit route. There is a lot of paratransit route overlapping, especially along Sisingamangaraja Road and Gatot Subroto Road, which is 19 paratransit along approximately 15 km.
Spatial distribution of 2019 forest and land fires in Indonesia
Authors: Thoha A S , Istima N , Daulay I A , Hulu D L N , Budi S , Ulfa M , Mardiyadi Z
Published: January 2023

Forest and land fires in 2019 were recorded as major events with extensive impacts on various aspects in Indonesia. An evaluation of forest and land fires in 2019 is required to determine the distribution and pattern of fires to be a significant input in overcoming forest and land fires in the future. This study aimed to evaluate forest fires based on area distribution, land cover, and area functions. This study used hotspot maps, land cover maps and forest area maps in 2019 to analyze the spatial distribution of locations and types of land cover that were indicated to be burning. The 2019 Landsat 8 OLI satellite images were used to identify types of land cover related to fires. We found that forest and land fires in 2019 in Indonesia were mostly spread on non-forest land with the type of land cover of shrubs, swamp shrub, and plantations with an area function for other use. The five provinces with the most fire hotspots detected were Central Kalimantan, West Kalimantan, Jambi, Riau, and South Sumatera. Most of the fire areas in the provinces that are vulnerable to fires are on peatlands. It requires serious and sustainable efforts to increase productivity and land value to reduce the area of unmanaged land and increase supervision of plantation companies that do not have an adequate forest and land fire management system.
Growth of Arengapinnata Seedlings on Three Different Media
Authors: Prakoso Budi , Widarawati R
Published: January 2023

Aren (Arengapinnata) trees are the second most important palm trees in Indonesia. However, little information on the effect of media on growth of aren (sugar palm) tree seedlings. The growth of six monts old seedlings on three media, namely soil, soil+Trichocompost, and sawdust+Trichocompost was studied. It was found that the growth of seedlings 45 days after replanting on soil+Trichocompost was higher than that of on sawdust+Trichocompost; However, the growth of the seedlings on soil media was not significantly lower than that of on soil+Trichocompost, nor significantly higher than that of on sawdust+Trichocompost.It was recommended that soil+Trichocompost and sawdust+Trichocompost can be used for aren seedling growing media.
Analysis of Organic Brown Sugar in Banyumas Regency
Authors: Putri Dindy Darmawati , Suyono S , Wijayanti Irene Kartika Eka
Published: January 2023

Banyumas Regency is one of the most potential organic brown sugar producers in Central Java. Organic brown sugar has a higher selling value than coconut sugar. The comparison of the price of coconut sugar and brown sugar which has a difference of Rp. 6,500.00 / kg with an average farmer production of 8 kg / day. The high price of brown sugar is very beneficial for coconut sugar farmers. This study aims to determine the income of the sugar craftsmen and determine the RC ratio. The research was conducted in two districts, namely Cilongok and Pekuncen districts, with 2 farmer groups, namely the Manggar Jaya farmer group and the Cikal Mas farmer group. The basic method used in this research is descriptive analysis. Data analysis using cost income analysis and RC ratio. The results showed that the craftsmen revenue Rp106,087.00 per day and the value of the RC ratio was 1.40 indicating that the business was feasible to run.
Collaborative Management to support sustainable Community Forest
Authors: Yatim Hertasning , Yusran Yusran , Supratman  , Zaman Nur
Published: January 2023

The current state of social forestry, including community forestry (HKm) in Indonesia, is practically stagnant. Many factors cause stagnation in HKm management, including the main one being the interaction with the Forest Management Unit (FMU) as forest manager at the site level. This study aims to build an institutional model for sustainable forest management through analysis of the arena of action, community attributes, and forest management rules at the Nambo Community Forest, Central Sulawesi. The results of this research found that the collaborative management model between the government and the community is suitable to be applied in Community Forest management, because it provides greater opportunities for recognizing the rights of local communities to forest resources, as well as increasing the empowerment of rural communities.
A study on the hot workability of a novel TNM-RE alloy (RE = Y, La, Ce)
Authors: Chen Zhanxing , Ma Tengfei , Xing Qiuwei , Li Guoju , Zhang Xinzhe , Zhang Xinfang
Published: January 2023

The hot deformation behavior of a novel TNM-RE alloy (RE = Y, La, Ce) was studied using a hot simulation machine (Gleeble-3800), and microstructural evolution was also characterized. Finally, 3D forging was carried out on isothermal forging equipment. It is shown that the as-cast lamellar colony size is about 20 ∼ 30 μm, which is refined by the formation of rare Earth oxides and borides at grain boundaries inhibiting grain growth. The peak stress of the TNM-RE alloy deformed at 1200 °C/0.01 s−1 is about 97 MPa, which is governed by the lamellar colony size and the B2 phase. Based on microstructure observation, it is found that the lamellar is bent and elongated to coordinate plastic deformation, where dynamic recrystallization nucleates preferentially, and full dynamic recrystallization is obtained at 1220 °C/0.01 s−1. The TNM-RE alloy was forged by 3D isothermal forging method, and fine grains with a size of 10 ∼ 20 μm were obtained by controlling the process parameters. The novel TNM-RE alloy shows an excellent hot workability.
Molecular dynamics study on the effects of nanorolling processes on the properties of nickel-based superalloy GH4169
Authors: Yu Fang , Li Jiachun
Published: January 2023

Rolling is a process that can improve the performance and roughness of machined parts and has a special economic value; therefore, the optimization of rolling process parameters is crucial to workpiece performance. In this paper, three rolling methods are used in molecular dynamics (MD) rolling simulations to study their effects on the surface of nickel-based superalloy GH4169 at the nanoscale. The surface and subsurface of the workpiece after rolling with the three different rolling methods are studied separately; in particular, a comparative analysis of the dislocation generation and movement on the subsurface, crystal defect evolution, and surface roughness was performed. The results show that the increase in subsurface dislocation density by average rolling has a significant influence on the work hardening effect, and the average roughness of the rolled groove surface is the lowest. This is an important reference for the optimization of the parameters of actual rolling processes.
A bioinspired modular soft robotic arm
Authors: Hernandez-Barraza Luis , Kalil-Khan Ahmed , Yeow Raye Chen-Hua
Published: January 2023

A human arm is a vital instrument for performing various tasks. To imitate natural design, we developed and characterized a bioinspired modular soft robotic arm fabricated from fabric thermoplastic polyurethane (TPU). The soft robotic arm comprises three link sections, three joints, and an end-effector. Although some soft robotic arms have been designed, they are primarily fabricated with continuous shapes. Therefore, we fabricated a modular and customizable soft robotic arm with different requirements, allowing fast fabrication, prototyping, and assembly, and comprising joint and link sections that can be incorporated together to form an arm with an adjustable number of joints. An analytical approach was used to model the different bending angles at diverse pressures, and a data-driven approach was used to model the angular position with respect to the pressure. Forward and inverse kinematics were performed to calculate the orientation, position, and joint angle of each component. The results showed that the maximum bending angles for each corresponding joint were generally larger for joints number one and three but smaller for joint number two. Moreover, motion analysis data showed that each joint exhibited different bending patterns. Our bio-inspired arm design demonstrated that it could conduct diverse motions at various pressures, in contrast to the soft arms seen in the literature. Additionally, the modular construction of the arm allows it to access larger workplaces, and a gripper should be included in future versions to increase the arm’s capabilities.
Finite-time correlations boost large voltage angle fluctuations in electric power grids
Authors: Tyloo Melvyn , Hindes Jason , Jacquod Philippe
Published: January 2023

Decarbonization in the energy sector has been accompanied by an increased penetration of new renewable energy sources in electric power systems. Such sources differ from traditional productions in that, first, they induce larger, undispatchable fluctuations in power generation and second, they lack inertia. Recent measurements have indeed reported long, non-Gaussian tails in the distribution of local voltage frequency data. Large frequency deviations may induce grid instabilities, leading in worst-case scenarios to cascading failures and large-scale blackouts. In this article, we investigate how correlated noise disturbances, characterized by the cumulants of their distribution, propagate through meshed, high-voltage power grids. For a single source of fluctuations, we show that long noise correlation times boost non-Gaussian voltage angle fluctuations so that they propagate similarly to Gaussian fluctuations over the entire network. However, they vanish faster, over short distances if the noise fluctuates rapidly. We furthermore demonstrate that a Berry–Esseen theorem leads to the vanishing of non-Gaussianities as the number of uncorrelated noise sources increases. Our predictions are corroborated by numerical simulations on realistic models of power grids.
Atlantis Restored
Authors: Wennerlind Carl
Published: January 2023

After success in the Thirty Years’ War, elites in Sweden realized that the nation had to establish a new economic base to support its newfound geopolitical prominence. Drawing on the Pan-European natural-knowledge-based political economy, Swedish reformers developed a version uniquely applicable to the nation’s challenges and opportunities. At the center of this new political economy was the use of scientific knowledge to transform nature into usable wealth. Whether physics, alchemy, mechanics, or botany, any form of knowledge with the power to transform nature through mining, agriculture, or manufacturing was considered valuable. Drawing on either Paracelsian spiritual ideas or those of Cartesian materialism, Swedish improvement thinkers sought to penetrate deep into the inner life of nature and thereby unlock the storehouse of wealth that God had placed therein. This article traces how Johan Risingh, Urban Hiärne, Christopher Polhem, and Carl Linnaeus, in conversation with foreign improvers, combined knowledge of the natural world with commercial considerations to form a discourse they hoped would enable Sweden to embark on a trajectory of economic growth and thereby restore its mythical glory as the cradle of European civilization.
TIVAN-indel: a computational framework for annotating and predicting non-coding regulatory small insertions and deletions
Authors: Agarwal Aman , Zhao Fengdi , Jiang Yuchao , Chen Li
Published: January 2023

Motivation

Small insertion and deletion (sindel) of human genome has an important implication for human disease. One important mechanism for non-coding sindel (nc-sindel) to have an impact on human diseases and phenotypes is through the regulation of gene expression. Nevertheless, current sequencing experiments may lack statistical power and resolution to pinpoint the functional sindel due to lower minor allele frequency or small effect size. As an alternative strategy, a supervised machine learning method can identify the otherwise masked functional sindels by predicting their regulatory potential directly. However, computational methods for annotating and predicting the regulatory sindels, especially in the non-coding regions, are underdeveloped.

Results

By leveraging labeled nc-sindels identified by cis-expression quantitative trait loci analyses across 44 tissues in Genotype-Tissue Expression (GTEx), and a compilation of both generic functional annotations and large-scale epigenomic profiles, we develop TIssue-specific Variant Annotation for Non-coding indel (TIVAN-indel), which is a supervised computational framework for predicting non-coding regulatory sindels. As a result, we demonstrate that TIVAN-indel achieves the best prediction performance in both with-tissue prediction and cross-tissue prediction. As an independent evaluation, we train TIVAN-indel from the ‘Whole Blood’ tissue in GTEx and test the model using 15 immune cell types from an independent study named Database of Immune Cell Expression. Lastly, we perform an enrichment analysis for both true and predicted sindels in key regulatory regions such as chromatin interactions, open chromatin regions and histone modification sites, and find biologically meaningful enrichment patterns.

Availability and implementation

https://github.com/lichen-lab/TIVAN-indel

Supplementary information

Supplementary data are available at Bioinformatics online.
321 Cancer risk with topical pimecrolimus and tacrolimus for atopic dermatitis: systematic review and Bayesian meta-analysis
Authors: Chu Alexandro W L , Devasenapathy Niveditha , Wong Melanie , Srivastava Archita , Ceccacci Renata , Lin Clement , MacDonald Margaret , Wen Aaron , Steen Jeremy , Levine Mitchell , Pyne Lonnie , Wang Julie , Spergel Jonathan M , Silverberg Jonathan I , Ong Peck Y , O’Brien Monica , Martin Stephan A , Lio Peter A , Lind Mary Laura , LeBovidge Jennifer , Kim Elaine , Huynh Joey , Greenhawt Matthew , Frazier Winfred T , Chen Lina , De Benedetto Anna , Boguniewicz Mark , Asiniwasis Rachel N , Schneider Lynda , Chu Derek K
Published: January 2023

Atopic dermatitis affects millions worldwide and is effectively managed by topical treatments, including topical calcineurin inhibitors, pimecrolimus and tacrolimus. In 2005 and 2011, the FDA released reviews associating topical calcineurin inhibitors with a theoretical cancer risk, albeit an uncertain association. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors. We systematically identified randomized controlled trials, comparative, and non-comparative non-randomized studies from database inception to 6 June 2022, from MEDLINE, EMBASE, GREAT, LILACS, ICTRP, FDA, EMA, company registers and relevant citations. We included studies in any language addressing the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors for greater than 3 weeks. We excluded split-body studies. We conducted a Bayesian meta-analysis and used the GRADE approach to determine the certainty of the evidence. A multidisciplinary panel including patients, advocacy groups and care providers, set an a priori threshold of 1 in 1000 risk difference as a clinically important effect. We analysed 121 studies (52 randomized controlled trials and 69 non-randomized studies) including 3.4 million patents followed for a mean of 11 months (range: 0.7–120). The absolute risk of any cancer with topical calcineurin inhibitor exposure was neither different from controls (absolute risk 4.70 per 1000 with topical calcineurin inhibitor exposure vs. 4.56 per 1000 without; odds ratio 1.03 [95% credible interval 0.94–1.11], moderate-certainty evidence) nor the general US population (4.6 per 1000). Findings were similar in infants, children, and adults, and were robust to trial sequential, subgroup and sensitivity analyses. Among infants, children and adults with atopic dermatitis, moderate-certainty evidence shows that topical calcineurin inhibitors do not increase the risk of cancer. These findings support the safe use of topical calcineurin inhibitors in the management of patients with atopic dermatitis. Our findings provide actional information to inform updated clinical practice guidelines, product labels and continuing education for care providers, to clarify the safe usage of topical calcineurin inhibitors.
331 Prior treatment usage in patients with atopic dermatitis initiating dupilumab: an update from the GLOBOSTAD registry
Authors: Ferrucci Silvia M , Rossi Mariateresa , Fomina Daria S , Lapeere Hilde , Chung Wen-Hung , Tzellos Thrasyvoulos , Fougerousse Anne-Claire , Wu Jiangming , Bosman Kwinten , Ardeleanu Marius
Published: January 2023

The efficacy and safety of dupilumab have been reported previously based on data from controlled clinical trials. The GLOBOSTAD study extends the scope of these trials by providing real-world data. This analysis reports prior treatment usage in patients with atopic dermatitis (AD) initiating treatment with dupilumab in a real-world setting. This 5-year, international, multicentre, non-interventional study (GLOBOSTAD; NCT03992417) included patients ≥12 years-old with moderate-to-severe AD (Investigator’s Global Assessment score ≥3) who initiated dupilumab treatment based on country-specific prescribing information. Data reported are for the population at baseline (N = 952, data cut-off: March 2022). At the study entry, the mean (standard deviation) Patient-Oriented Eczema Measure (POEM) score was 19.7 (6.4). POEM range is 0–28 and scores greater than 17 are consistent with severe or very severe disease. The mean (standard deviation) pruritus on the 0–10 Numerical Rating Scale (NRS) at study entry was 6.3 (2.1). Patient use of systemic treatments such as non-steroidal immunosuppressants (32.6%) and systemic corticosteroids (17.8%), as well as non-systemic treatments such as topical corticosteroids (47.2%) and calcineurin inhibitors (14.8%) in the 12 months preceding enrolment were reported. Ultraviolet phototherapy in the past 12 months was reported for 3.4% of patients. Patient-reported outcomes, including POEM and pruritus NRS, indicate a considerable burden of disease in patients with AD initiating dupilumab in the real world. A large proportion of patients from GLOBOSTAD reported the use of AD-specific systemic and non-systemic therapies prior to dupilumab initiation.
Digital technology in informed consent for surgery: systematic review
Authors: Kiernan Aoife , Fahey Brian , Guraya Shaista S , Boland Fiona , Moneley Daragh , Doyle Frank , Harkin Denis W
Published: January 2023

Background

Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery.

Methods

A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice.

Results

A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice.

Conclusion

Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.
Sex differences in the evaluation and outcomes of multi-ethnic asian patients undergoing stress echocardiography
Authors: Seah C H X , Lau J K X , Li T Y W , Tiong C Y , Poh K K , Sia C H , Wong R C C , Kong W K F
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Stress echocardiography is an important test used in the evaluation of myocardial ischemia. Despite this, not much is known about sex differences between men and women undergoing stress echocardiography, with regards to their characteristics and outcomes, especially in the Asian population.

Methods

We performed a retrospective cohort study of 1504 consecutive patients evaluated with dobutamine or exercise stress echocardiography performed for suspected coronary artery disease (CAD) or to evaluate the status of known CAD. We divided the patients into two groups: males and females. The tests were classified as positive, equivocal, or negative for ischemia, and the outcomes at 6 months follow-up was analysed.

Results

48.1% (723) patients were males. The mean age of patients was 52.2 ± 14.9 years for males and 55.8 ± 12.5 years for females. The 3 most common indications for stress echocardiography in both males and females were for the assessment of symptoms for suspected CAD in 787 (52.3%), for the assessment of a prior abnormal test in 408 (27.1%) and for the assessment of the status of pre-existing CAD in 93 (6.2%). In terms of co-morbidities, males were more likely to have ischemic heart disease (<0.001), prior AMI (p<0.001), prior PCI (p<0.001) and CABG (p=0.002). Stress echocardiography was normal in 608 men (84.3%) and 643 women (82.3%). A positive result on stress echocardiography was obtained in 65 men (9.0%) and 63 women (8.1%), and equivocal result in 48 men (6.7%) and 75 women (9.6%). During a mean follow-up of 7.9 ± 0.2 years, 84 men (11.6%) and 44 women (5.6%) (p<0.001) experienced a cardiac event, of which there were 40 (2.7%) deaths, with 26 men (3.6%) and 14 women (1.8%) (p=0.030). 26 men (3.6%) and 6 women (0.8%) (p<0.001) experienced an acute myocardial infarction.

Independent predictors of cardiac events in patients using a Cox proportional hazards regression analysis were age (hazard ratio (HR): 1.05 [range 1.03 to 1.07]), female gender (HR: 0.50 [range: 0.328 to 0.760]) and previous myocardial infarction (HR: 2.50 [range 1.28 to 4.86])

Conclusion

Differences in mean age, prevalence of ischemic heart disease, prior myocardial infarction and prior PCI/CABG were noted between males and females who underwent stress echocardiography. Males experienced a higher incidence of cardiac events compared to females. Gender is an independent predictor of cardiac events in patients undergoing stress echocardiography, together with age and a history of myocardial infarction.
Unraveling the invisible demon: a study of the oxidative stress markers, antioxidant activities and inflammatory markers in patients admitted with complete heart block
Authors: Chaudhary G , Pradhan A K , Shah S , Roy S , Singh V , Dwivedi S K , Sethi R , Chandra S , Vishwakarma P , Sharma A K , Bhandari M , Shukla A , Singh A
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Despite the recent advancements in the management of Complete Heart Block (CHB), the aetiology of CHB is still idiopathic in most of the cases. Our study explores this hitherto untouched aspect of complete heart block.

Purpose

We aimed to assess the aetiological profile of Complete Heart Block patients in our study.

Methods

The study population consisted of 60 patients with complete heart block aged between 30 to 80 years, attending as an inpatient in ER. Oxidative stress was measured by serum MDA, serum GSH, serum Catalase activity and serum SOD activity. Antioxidant activity was obtained by measuring the levels of serum total antioxidant capacity. Inflammatory stress was measured by IL-5 and TNF-alpha levels. These values were compared to 30 healthy controls with no prior history of smoking and diabetes mellitus.

Results

The mean age of the patient was 62.48 ± 7.98 years and the gender distribution was 37 males and 23 females out of 60 patients. The mean value of serum MDA (ng/mL) in cases is 1451.26 ± 206.32, and in controls, the mean value is 1197.98 ± 234.71 (p=<0.001). The mean value of serum GSH (mcg/mL) in cases is 46.982 ± 18.613, and in controls, the mean value is 54.155 ± 10.762 (p=0.027). The mean value of serum Catalase Activity (U/min/mg protein) in cases is 10.763 ± 4.038 and in controls, the mean value is 19.878 ± 7.787 (p=0.003). The mean value of serum SOD Activity (U/g) in cases is 24.950 ± 5.4565, and in controls, the mean value is 46.214 ± 14.6309 (p=0.891). The mean value of serum Total Antioxidant Capacity (U/mL) in cases is 5.546 ± 0.620 and in controls, the mean value is 8.346 ± 2.781 (p=0.025). The mean value of serum IL-5 (pg/mL) in cases is 481.442 ± 28.8995, and in controls, the mean value is 67.347 ± 20.445 (p<0.001). The mean value of serum TNF-ALFA (pg/mL) in cases is 196.741 ± 73.771, and in controls, the mean value is 144.530 ± 42.599 (p= 0.081).

Conclusions

During a complete heart block, SOD (p=0.891), CAT (p=0.003), GSH (p=0.027) and total antioxidant (TAOC) (p=0.025) were significantly decreased in cases, compared to healthy controls, thus suggesting that the elevated levels of oxidative free radicals causes endothelial dysfunctioning. The increase in ROS was observed by a highly significant increase of malondialdehyde (MDA) (p=<0.001) showing high ROS-mediated tissue damage. Besides damage by oxidative stress, our study suggests that there are certain inflammatory markers like TNF-α and IL-5 that actively participate in causing heart block. There was a significant increase in the concentration of IL-5 (p<0.001) in the cases as compared to the controls.
Electrocardiographic findings and incidence of new-onset atrial arrhythmia among patients with severe leptospirosis who underwent veno-venous extracorporeal membrane oxygenation
Authors: Quizon B , Dayao M , Folloso E , Adiong A
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Leptospirosis is a zoonotic disease caused by Leptospira species that remains endemic in the Philippines. In severe cases, patients present with multiple organ system failure such as acute renal failure and acute respiratory distress syndrome(ARDS) requiring renal replacement therapy, mechanical ventilation, and novel treatment modalities such as extracorporeal membrane oxygenation(ECMO). Cardiac complications such as atrial arrhythmia also occur in cases of severe leptospirosis leading to worse outcomes. There is limited data on the electrocardiographic findings in patients with severe leptospirosis undergoing ECMO along with the incidence of new-onset atrial arrhythmia while managed on this intervention with unique hemodynamic system.

Purpose

To determine the baseline electrocardiographic(ECG) findings and incidence of new onset atrial arrhythmia among patients with severe leptospirosis during veno-venous(V-V) ECMO.

Methods

A cross-sectional study among patients with severe leptospirosis and ARDS who underwent V-V ECMO was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of new-onset atrial arrhythmia during ECMO. Secondary outcomes included in-hospital mortality, length of hospital stay, duration of mechanical ventilation, duration of ECMO, and development of thrombotic events.

Results

Among 31 patients included, 90.3%(n=28) were male and median age was 33.48±10.0 years. The most common ECG finding was atrial fibrillation with an incidence of 32.3%(n=10), half of which occurred before ECMO, while the other half were noted after cannulation. During ECMO, the incidence of new-onset atrial arrhythmia was found to be at 19.4% (n=6). Patients with new-onset atrial arrhythmia had higher white blood cell, total bilirubin, creatinine, APACHE-II Scores, use of dopamine, lower platelet count and PaO2/Fio2 ratio. Two patients(33.33%) died among those with new-onset atrial arrhythmia, while five patients(20%) died in the other group. There was no noted thrombotic events such as stroke among groups and no difference on the duration on ventilator, ECMO and hospital stay.

Conclusions

Atrial arrhythmias are under-reported complications during veno-venous ECMO among patients with severe leptospirosis. This study demonstrated a higher mortality among patients with new-onset atrial arrhythmia during ECMO for severe leptospirosis.
Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: a systematic review and meta-analysis
Authors: Jaiswal V I K A S H , Ang S O N G P , Shrestha A B , Sharma P R A C H I , Endurance E O , Khan S H A Z I A , Mukherjee D , Jaiswal A K A S H , Chia J I A E E , Huang H E L E N , Alraies M C , Biswas M
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The Amplatzer Amulet and Watchman devices are the two most frequently used devices for percutaneous LAA closure globally.

Aim

To evaluate the safety and clinical outcomes associated with these two devices in patients undergoing percutaneous LAA closure.

Method

A systematic literature search was performed in PubMed, Scopus, Embase, and Cochrane databases for studies comparing the safety and outcomes of patients undergoing LAA closure using either Amulet or Watchman devices. The primary outcome was all-cause mortality. Secondary outcomes were incidence of ischemic stroke, systemic/pulmonary embolism, major bleeding, and procedure-related complications.

Results

A total of 3 randomized clinical trials with 2150 patients were included in this meta-analysis. The mean age was 75 years and 76 years in the Amplatzer group and in the Watchman group, respectively. The mean CHA2DS2-VASc score (4.2 vs. 4.34) and mean HAS-BLED score (3.46 vs. 3.56) were comparable between both groups. The odds of all-cause mortality (OR, 0.74 (95% CI: 0.48-1.13), p = 0.16), ischemic stroke (OR, 0.81 (95% CI: 0.27-2.49), p = 0.72), systemic/pulmonary embolism (OR, 1.33 (95% CI: 0.29-6.00), p = 0.71), and major bleeding (OR, 1.10 (95%CI: 0.82-1.48), p = 0.51) were comparable between the two devices. In contrast, procedure-related complications (OR, 2.11 (95%CI: 1.31-3.40), p = 0.002) were significantly higher among patients with Amplatzer Amulet compared to the Watchman device.

Conclusion

The Amplatzer Amulet was non-inferior to the Watchman device in terms of safety and efficacy. However, the Amulet occluder was associated with a higher incidence of procedure-related complications.
Optimal international normalized ratio target in east asian populations with atrial fibrillation: systematic review and meta-analysis
Authors: Prana Jagannatha G , Putra Swi Antara I M , Surya Pradnyana I W A , Kamardi S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although current guidelines recommend the use of direct oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF), the use of vitamin K antagonists (VKA) is still very widespread, especially in low to middle-income countries in Asia. If VKA/Warfarin is used, a target international normalized ratio (INR) range of 2.00-3.00 is recommended. Still, various studies conducted in Asia have found bleeding rates to be higher in this range. Thus, the "sweet spot" of INR targets in the Asian population is still under debate.

Purpose

This study aimed to compare bleeding and ischemic outcomes between the lower target INR and the standard target INR in an Asian population.

Methods

We conducted a systematic search in Pubmed, ScienceDirect, Cochrane, SinoMed, CNKI, and Wanfang data for studies conducted in East Asian countries comparing the outcome of standard INR targets (2.00-3.00) with lower INR targets in AF patients on VKA/Warfarin medication. The primary endpoints of interest are thromboembolic events and major bleeding. In addition, we performed a sub-analysis based on the lower INR with homogenized range (1.50-2.00) against the standard INR in primary outcomes. Secondary outcomes in this study were ischemic stroke, hemorrhagic stroke, minor bleeding, all-cause mortality, and treatment adherence. We used Review Manager 5.4 to calculate the result of 95% CI for the outcomes and odds ratios (OR).

Results

A total of 28 studies consisting of 10,533 patients from Japan, Korea, China, Hong Kong, and Thailand were included in our study. The incidence of thromboembolism was significantly higher in patients with a lower INR [OR 1.34 (95% CI 1.10-1.65; p=0.0005; I²=41%)], but if the lower INR was homogenized at range of 1.50–2.00 in the sub-analysis, there was no significant difference in events [OR 1.19 (95% CI 0.85-1.65; p=0.31; I²=0%)]. Major bleeding events [OR 0.36 (95% CI 0.28-0.46; p<0.00001; I²=0%)], hemorrhagic stroke [OR 0.24 (95% CI 0.14-0.42; p<0.00001; I²=0%)], and minor bleeding [OR 0.29 (95% CI 0.09-0.92; p=0.04; I²=0%)] was found to be significantly lower at the lower INR targets. Although there was no significant difference in all-cause mortality and ischemic stroke, a lower INR targets was associated with better treatment adherence in term of fewer patients discontinuing therapy independently [OR 0.48 (95% CI 0.28-0.48; p=0.007; I² =0%)].

Conclusion

The incidence of bleeding was significantly higher in the Asian population treated with the standard target INR. Adjusting the lower target INR to 1.50-2.00 might be the sweet spot for the balance of ischemic and bleeding events to provide better outcomes in the Asian population with AF.
Pregnancy in patients with complete atrioventricular block: management and perinatal outcomes
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although bradyarrhythmias may occur in pregnant patients, there are few data on their management, pregnancy course and perinatal outcomes.

Purpose

To evaluate the effects of bradyarrhythmias on the course and outcomes of pregnancy.

Methods

This single-center, prospective study included 8 cases of complete atrioventricular block in pregnant patients (Mean age of pregnant was 25.4±3.6 years, mean gestation age 17.6 ±2.4 weeks). All patients were without structural heart disease. Pregnancy course, clinical outcomes and bradyarrhythmias management were evaluated.

Results

Complete atrioventricular block was registered in three women prior to pregnancy (37.5%). In 5 cases (62.5%) atrioventricular block diagnosed for the first time during this gestation. All included patients had symptoms of dizziness and syncope during pregnancy. Due to hemodynamic instability pacemakers were implanted in all cases of complete atrioventricular block. Procedure-related complications were not documented. Implantation was performed with the help of echocardiographic guidance and electroanatomical mapping (Ensite Precision system) with minimal fluoroscopy. Pregnancy course in patients with bradyarrhythmias characterized by increased incidence of uterine contractile activity (n=3, 37.5%), uterine blood flow violation was in one case (12.5%). Perinatal outcomes: spontaneous vaginal delivery was in the majority of cases (n=7; 87.5%). One pregnant (12.5%) was delivered by cesarean section. One women had placental abruption and preeclampsia (12.5%). Maternal adverse cardiac events and adverse fetal outcomes were none declared. There were 8 live births (in all cases, 100%). Fetal birth weight was 3158.07±458.2 grams, 5 minute Apgar was 8.87±0.6. There were no maternal and fetal mortality.

Conclusions

Complete atrioventricular block, observed in patients, did not require termination of gestation. Implantation of pacemaker in cases of complete atrioventricular block can be safety performed in pregnancy and associated with benign pregnancy course and outcomes in the majority of cases.
Clinical characteristics, management, and outcomes of acute heart failure patients in Central Asia
Authors: Abdurashidova T , Muller M , Dzhorupbekova K , Kaliev K , Chazymova Z , Toktosunova A , Beishenkulov M , Kirsch M , Hullin R
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease (CVD) is the leading cause of death in Central Asia. In 2019, crude mortality rate in the region was 348.13 per 100,000 population. Heart failure (HF) is important CVD subtype owing to even worse outcome. There has been a dearth of information on the epidemiology of HF in Central Asia.

Purpose

we aimed to describe aetiology, comorbidities, adherence to guideline-directed medical therapy (GDMT), and outcomes in patients hospitalised for heart failure in Central Asian population.

Methods

the retrospective analysis included 538 patients hospitalised for decompensated heart failure in a tertiary hospital from December 2011 to December 2019. Inclusion criteria were (i) age ≥18 years; (ii) hospitalisation for HF treatment. Exclusion criteria were (i) pregnancy; (ii) comorbidity with survival time considered to be <1 year on the basis of patients` medical history; (iii) acute HF caused by acute myocardial infarction, metabolic, toxic or infectious disorders. Primary outcome was one-year all-cause mortality, secondary outcome - readmission for HF at one year. Given that the data had been collected retrospectively, informed consent was not obtained, nevertheless, local ethics committee approved the study.

Results

Central Asian patients were relatively young (mean age 64.0 years), 61.2% of them were male, 77.7% had ischemic heart disease, 8.7% rheumatic heart disease, 32.2% obstructive pulmonary disease, 47.7% atrial fibrillation/flutter, 45.7% hyperlipidemia, 72.1% hypertension, and 31.6% diabetes mellitus. Use of GDMT at discharge was 76.0% for beta-blockers, 29.7% for angiotensin-converting enzyme inhibitors, 21.2% for angiotensin II receptor blockers, 71.9% for mineralocorticoid receptor antagonists. Only 3.9% of patients were implanted with a pacemaker and 0.9% with an implantable cardioverter defibrillator. All-cause mortality at one year was 19.0%, with no difference between patients with preserved and reduced ejection fraction (14.9 vs. 19.9%, p=0.243). However, patients with preserved ejection fraction were less likely to experience a readmission for heart failure at one year (13.9 vs. 29.3%, p=0.002).

Conclusions

results of the analysis showed that Central Asian patients are relatively young, mostly male, with high prevalence of ischemic heart disease, and reduced ejection fraction, and lower rate of GDMT use and device therapy.
Predictors of angiographically normal coronary arteries
Authors: Ayaay T , Mattus M , Mendiola P , Javier S
Published: January 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary angiography (CAG) has been recommended for patients with well-established risk factors. However, striking rates of coronary angiograms were turning out to be normal and very little is known regarding the predictors of having normal coronary arteries.

OBJECTIVES

The primary objective of this study is to determine the predictors that increase the likelihood of having normal coronary arteries as seen in CAG.

Methods

This study analyzed 279 patients who underwent CAG from January 1, 2015 to December 31, 2019. The primary end point was to determine clinical and diagnostic predictors of having angiographically normal coronary arteries.

Results

In total, 46.9% of patients had a normal coronary angiogram. Multiple logistic regression showed that females are more likely to have normal coronary arteries (aOR- 4.6, 95% CI 2.25 – 9.53) as well as higher HDL-C (aOR- 1.027 95% CI 1.00-1.05). On the other hand, older age (aOR 0.936 95% CI 0.91-0.96) and diabetes mellitus (aOR- 0.946 95% CI 0.92-0.97) are less likely to have a normal angiogram. Overall, patients who had abnormal coronary angiograms were found to be older (63.47 years old versus 56.27 years old, p < 0.001), had greater proportions of males (71% vs 52%), with diabetes (39% vs 24%), a positive smoking history (41% vs 27%), higher Framingham score (29.7 [range 1.4–30] vs 15.9 [range 2.3–30], P <.001), higher WBC (8.1 vs 7.4, P = .018) and higher baseline creatinine (1.07 vs 0.95 mg/dl, P = .001) but noted to have lower HDL-C (40.1 vs 44.07 mg/dl, P = .003).

Conclusion

The female gender is highly predictive of having a normal angiogram while diabetes mellitus and older age are less likely to have a normal angiogram. A higher HDL-C is also associated with increased odds of a normal coronary angiogram.