bluuebunny/crossref_metadata_2025 huggingface dataset:
First tungsten radiation studies in DIII-D’s ITER baseline demonstration discharges
Authors: Turco F. , Luce T.C. , Sips ACC. , Greenfield C. , Osborne T. , Odstrcil T. , Hanson J.M. , McLean A. , Hyatt A.W.
Published: June 2024

ITER Baseline Scenario plasmas were studied in DIII-D using krypton and xenon gases as a proxy for the tungsten that will be present in ITER. These impurities were chosen for having the same radiative loss rate Lz as tungsten would exhibit in the hotter ITER core. Results show that the scenario with these core radiators spans the range of impurity concentration and W radiated fraction expected for ITER, and up to 50% higher values, explored at zero injected torque, as well as 1 Nm and full co-torque injection with T ∼ 3 Nm. Stationary discharges with duration >2–4 τR are achieved with f
rad

⩾

30% leading to a reduction in confinement of ∼10%, and a comparison with real metal radiators in the same range of f
rad shows that the higher Lz at the lower temperatures in these plasmas yields too pessimistic results on the survivability and performance of this scenario in ITER. Simulations of ITER power balance including W radiation show that with concentration up to three times higher than in the DIII-D plasmas the scenario can be stationary, remaining at acceptable core radiated fraction values.
Bi-LSTM-based load forecasting for power grid
Authors: Xu Shouzhi , Sun Haowen , Li Bitao , Zhao Dongpeng , Li Hao , Wang Ke , Liu Jingwen , Wang Xiaoyu
Published: June 2024

It is very important to optimize the power supply and alleviate the conflict of electric load demand, so an accurate and reasonable power load prediction technology has been the focus of research. An evolutional LSTM named Bi-LSTM processes two independent input sequences with two opposite time directions, which aims to improve the efficiency of load forecasting for the power grid. The four main processes are illustrated, which include preprocessing the historical electrical load data, setting the parameters of the model, training the model, and testing the model. Comprising with typical models of RNN, LSTM, and GRU, the performance is verified, and the comparison result shows that it is better in several typical evaluation metrics. The proposed Bi-LSTM model effectively leverages historical data to forecast the imminent state of the power grid, providing valuable insights for electrical load management.
Real-time operation risk monitoring method for power grid based on cloud edge collaboration technology
Authors: Yang Sheng , Luo Tianyun , Shen Siqi , Zhou Bo , Chen Zhangguo
Published: June 2024

As a huge and complex system, the power grid involves multiple levels and various interconnected components, making it difficult to monitor operational risks in real-time. Therefore, this study proposes a real-time risk monitoring method in the power grid operation based on cloud-edge collaboration technology. Through cloud edge collaboration technology, data processing results are designed and an extreme gradient boosting clustering (XGBoost) algorithm is used to complete data clustering. The risk level of real-time operation in the power grid is calculated and the real-time operation risk monitoring in the power grid is completed. The experimental results indicate that the application process of the research method has a shorter delay and higher accuracy.
Design of safe sharing method of power core data in smart grid environment
Authors: Li Ce , Su Rui , Yan Runzhen , Wen Jinmei , Wang Yating , Li Yijing , Huang Jianxiong , Peng Jian
Published: June 2024

In order to ensure the effective intercommunication of information resources in the power supply chain, a safe sharing method of power core data in a smart grid environment is proposed. By constructing a feature extraction process of power core data security sharing under a smart grid, processing similar heterogeneous data based on each node center, taking the result as a standard, eliminating similar data, thereby determining the node center value and obtaining the power core data sharing encryption result, the power core data to be shared is shared so that the power core data can be shared safely. The experimental results show that the shared throughput of this method is high. It can take less time to complete the calculation in the same number of samples and it has higher running efficiency.
Research on system planning methods for large-scale grid connection of photovoltaics
Authors: Jiang Yumen , Li Haoen , Qi Yuchen , Miao Linxin , Huang Ruanming , Song Tianli , Xue Kun , Cui Min , Liu Ziqiu
Published: June 2024

With technological advancements, the extent of distributed photovoltaic grid connections has expanded. Optimizing the integration capacity of photovoltaic sources into the grid is key to reducing network loss and voltage deviations in power systems. This study first examines the effects of photovoltaic grid connections on these parameters, then it introduces a calculation method for grid integration capacity using the particle swarm optimization algorithm. The performance of this method, compared against two other algorithms, is validated through simulations in an IEEE33 node system.
Research on bundling optimization of wind-solar-hydro based on wind-solar cluster convergence
Authors: Zhao Yuanyuan , Wu Yaowu , Yao Xun , Lou Suhua , Yang Xiaojuan , Liu Peiyu
Published: June 2024

To solve the problem of cooperative dispatching of wind-solar power stations and cascade hydropower stations along the coast of the basin, an optimization method of bundling of wind-solar-hydro (WSH) in the basin based on the convergence of wind-solar (WS) clusters is proposed. This method takes into account the spatial distribution characteristics and output characteristics of WS-power stations in the basin and constructs the cluster division strategy based on the geographical location distribution peculiarity of power stations and the cluster convergence criterion based on the complementary properties of wind and solar. To optimize the load-matching characteristics of the output of the WSH system, based on the hydraulic coupling characteristics of upstream and downstream cascade hydropower stations, an optimization model of cascade wind-solar-hydro bundling is constructed. Taking the data of wind, solar, and hydro stations in a river basin as an example, the results show that the method proposed in this paper is suitable for solving the problem of gradual bundling of wind-solar-hydro in the basin.
Fast power flow calculation method for power system based on heterogeneous edge graph convolutional neural network
Authors: Wu Gang , Liu Shangjia , Xie Tao , Luo Wenbo , Liu Junlei
Published: June 2024

A deep learning-based power flow calculation model can directly fit the mapping relationship between the initial and final values of the power flow in a system, providing extremely fast computational speeds without causing ill-conditioned power flow issues. However, existing deep learning power flow calculation methods are often based on homogeneous graph neural networks, which do not differentiate between different types of nodes in power flow calculations and neglect the influence of line admittance on power flow distribution. A power flow calculation method based on a heterogeneous edge graph convolutional neural network is proposed in response to this issue. The proposed model underwent comprehensive simulations on a dataset expanded from the IEEE 57-node system, generating 10, 000 samples of different system configurations. Simulation experiments validated that the proposed model’s computational time is approximately one-tenth of the Newton-Raphson method, with a power flow distribution calculation accuracy reaching 98.44%. Comparative experiments further confirmed the effectiveness of the proposed model’s improvements in graph convolution.
An instruction level attack detection method for new power load system based on LSTM
Authors: Yao Qigui , Zhang Xiaojian , Fei Jiaxuan , Yao Minglu , Li Ye
Published: June 2024

To realize the efficient instruction level attack detection of the new power load resource management system under the load resource coordination and control interactive service scenario, this article proposes a novel LSTM adaptive sequence classification detection method combining MTM feature modeling and GAN countermeasure sample generation. In this method, the system operation instruction model based on MTM is established, and the generalized instruction features are expressed in detail. Simultaneously, large quantities of confrontation samples are generated by the GAN Network, which is similar to the real samples, and the problem of data imbalance in model training is solved. Finally, this paper proposes an adaptive coefficient-based LSTM for system instruction feature learning and testing and realizes the detection and recognition of hidden instruction level attacks in the new power load resource management system, which is more accurate and efficient than other methods.
Satellite mapping and demarcation analysis for coastal regulation zones assessment
Authors: Eldo Joel , Ntantis Efstratios L
Published: June 2024

Rapid urbanization and expanding tourism have led to widespread encroachments, particularly in flood-prone areas, where land degradation is more likely. Conventional methods of on-foot inspections for detecting these encroachments are intricate and time-consuming. A scarcity of data has resulted in undocumented violations, prompting the need for advanced technologies like satellite remote sensing. The current paper focuses on demonstrating the effectiveness of satellite remote sensing in detecting large-scale encroachments near flood-prone zones. Due to frequent undetected illegal constructions, Coastal Regulation Zones (CRZ) are a specific area of interest. This study employs a well-established method of analysis acquired from an extensive literature review to investigate illegal construction and encroachments via remote sensing advances. The research advocates for a practical analysis to combat illegal constructions in CRZs, presenting a comprehensive database through a concise portal for easy accessibility and analysis. The case study in Kerala, India, a region prone to natural disasters like monsoon floods, provides crucial data for measuring the boundaries required to preserve the ecosystem. The research underscores the significance of satellite remote sensing in efficiently addressing environmental threats posed by encroachments, offering insights applicable to regions facing similar challenges. This analysis has proven effective in diverse global settings and offers a standardized approach for demarking CRZ throughout the globe. Its adaptability and reliability across different terrain types and climatic conditions underscore its potential as a valuable tool in mapping encroachments. The current study contributes to the discourse on sustainable urban development, aiming to inform policies promoting resilience and ecological consciousness in rapid urbanization and tourism expansion.
Optimizing friction stir welding of AA7075 and AA8090 aluminum alloys: a desirability-driven investigation into mechanical and microstructural enhancement
Authors: Singh Naveen , Gupta Meenu
Published: June 2024

This research explores the multifaceted analysis of a friction-welded joint, employing Central Composite Design of Response Surface Methodology. The study integrates microstructural investigations and fracture analyses to explain the effect of process parameters on mechanical properties. The optimum settings for Friction Stir Welding of AA7075 and AA8090 were determined by assessing desirability indices. These settings comprised a tool rotation speed of 1927.7 rpm, a tool travel speed of 35 mm min−1, and a tool tilt angle of 0.9°. This specific combination yielded a noteworthy combined desirability index of 0.79, considering both Ultimate Tensile Strength (UTS) and Tensile Elongation (TE). Microstructural examinations revealed distinct characteristics in the Heat-Affected Zone (HAZ), Thermo-Mechanically Affected Zone (TMAZ), and Nugget Zone (NZ). Notably, fine grain structure in the NZ was attributed to the stirring effect created by the tool pin. Fracture analyses indicated ductile fractures, with dimple size variation correlating to tensile strength. Lower dimple density in low-strength joints suggested insufficient material mixing during welding. The maximum tensile strength sample exhibited a high dimple density. These findings contribute to a comprehensive understanding of the welding process’s influence on microstructure and fracture characteristics, providing valuable insights for optimizing mechanical properties in friction-welded joints.
Introduction to liquids
Authors: Abraham Nitzan
Published: June 2024

This chapter discusses concepts from the physics of liquid used later in this book. (1) Statistical mechanics of classical liquids. (2) Time and ensemble average. (3) Reduced configurational distribution functions. (4) Observable implications of the pair correlation function (X-ray scattering, the average energy, pressure). (5) The potential of mean force and the reversible work theorem. (5) The virial expansion and the second virial coefficient.
Introduction to stochastic processes
Authors: Nitzan Abraham
Published: June 2024

This chapter introduces and discusses concepts from the theory of stochastic processes. (1) The nature of stochastic processes. (2) Stochastic modeling of physical processes. (3) The random walk problem (time evolution, moments, the probability distribution). (4) Some concepts from the general theory of stochastic processes (distributions and correlation functions, Markovian stochastic processes, Gaussian stochastic processes, a digression on cumulant expansions). (5) Harmonic analysis (the power spectrum, the Wiener–Khinchin theorem, application to absorption, the power spectrum of a randomly modulated harmonic oscillator). (6) Shot noise.
An overview of quantum electrodynamics and matter–radiation field interaction
Authors: Davidson P A
Published: June 2024

This chapter reviews the theory of light–matter interaction in the quantum and classical regimes. (1) Classical electrodynamics. (2) Quantum electrodynamics. (3) Spontaneous emission. (4) Classical spontaneous emission. (5) Spontaneous emission in confined environments: The Purcell effect. (6) Light scattering. (7) Photon detection.
Residential proximity to agricultural pesticide use and cardiovascular disease risk factors among adult Latina women in California’s Salinas Valley
Authors: Calderon Lucia , Warner Marcella , Gunier Robert B , Rauch Stephen , Hazard Kimberly G , Kogut Katherine , Eskenazi Brenda , Torres Jacqueline M
Published: June 2024

Cardiovascular disease is a leading cause of death worldwide. There is limited evidence that exposure to current-use pesticides may contribute to cardiovascular disease risk. We examined the association between residential proximity to the application of agricultural pesticides and cardiovascular risk factors among 484 adult women in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) Study, a cohort based in an agricultural region of California. Outcome assessment was completed between 2010 and 2013. Using participant residential addresses and California’s Pesticide Use Reporting database, we estimated agricultural pesticide use within 1 km of residences during the 2-year period preceding outcome assessment. We used Bayesian hierarchical modeling to evaluate associations between exposure to 14 agricultural pesticides and continuous measures of waist circumference, body mass index, and blood pressure. Each 10-fold increase in paraquat application around homes was associated with increased diastolic blood pressure (β = 2.60 mm Hg; 95% credible interval [CrI], 0.27-4.89) and each 10-fold increase in glyphosate application was associated with increased pulse pressure (β = 2.26 mm Hg; 95% CrI, 0.09-4.41). No meaningful associations were observed for the other pesticides examined. Our results suggest that paraquat and glyphosate pesticides may affect cardiovascular disease development in women with chronic environmental exposure.

This article is part of a Special Collection on Environmental Epidemiology.
Klotho accelerates the progression of polycystic ovary syndrome through promoting granulosa cell apoptosis and inflammation
Authors: Ye Wenting , Xia Siyu , Xie Tingting , Ye Huiyun , Yang Yi , Sun Yan , Cai Jing , Luo Xiaoqing , Zhou Lili , Song Yali
Published: June 2024

The morbidity of polycystic ovary syndrome (PCOS) is in highly increasing rate nowadays. PCOS not only affects the fertility in women, but also threatens the health of whole life. Hence, to find the prognostic risk factors is of great value. However, the effective predictors in clinical practice of PCOS are still in blackness. In this study, we found Klotho (KL) was increased in follicular fluid (FF) and primary luteinized granulosa cells (GCs) from PCOS patients with hyperandrogenism. Furthermore, we found follicular KL was negatively correlated with numbers of mature oocytes, and positively correlated with serum testosterone, LH, and LH/FSH levels menstrual cycle and number of total antral follicles in PCOS patients. In primary luteinized GCs, the increased KL was accompanied with upregulation of cell apoptosis and inflammation-related genes. In ovaries of PCOS mice and cultured human KGN cell line, KL was up-regulated and accompanied by apoptosis, inflammation, and mitochondrial dysfunction. Therefore, our findings suggest new mechanisms for granulosa cell injury and revealed to target inhibit KL maybe a new therapeutic strategy for treatment of PCOS.
Implementation of plate reader-based indooxine and Nessler protocols for monitoring L-asparaginase serum activity in childhood acute lymphoblastic leukaemia
Authors: Vergov Bozhidar , Sbirkov Yordan , Minchev Danail , Todorova Tatyana , Baldzhieva Alexandra , Burnusuzov Hasan , Spasova Мariya I , Sarafian Victoria
Published: June 2024

Monitoring the blood serum activity of L-asparaginase in children with acute lymphoblastic leukaemia (ALL) has been highly recommended to detect enzyme inactivation that can cause relapse and to avoid unwanted toxicity. Nevertheless, perhaps at least partially due to the lack of clinically approved commercially available kits or standardized and independently reproduced and validated in-house protocols, laboratory assay-based determination of the optimal doses of L-asparaginase is not carried out routinely. In this study, we adapted previously published protocols for two plate reader-based colorimetric methods, indooxine and Nessler, to measure asparaginase activity. Mock samples with dilutions of the enzyme for initial optimization steps, and patient samples were used as a proof of principle and to compare the two protocols. For the first time the indooxine and the Nessler methods are adapted for a plate reader and L-asparaginase serum activity levels are compared by both protocols. Passing–Bablok and Bland–Altman’s statistical analyses found very little difference, strong correlation (r = 0.852), and bias of only 6% between the data from the two methods when used for fresh patient samples. Furthermore, we demonstrate that the Nessler method could also be applied for frozen sera as the results, compared to fresh samples, showed little difference, strong correlation (r = 0.817), and small bias (9%). We successfully adapted and validated two methods for measuring L-asparaginase activity in cALL and provided the most detailed description to date on how to reproduce and implement them in other clinical laboratories.
Radioactive iodine therapy for thyroid cancer coexisting with Hashimoto’s thyroiditis: a systematic review and meta-analysis
Authors: Chen Xiang-Yi , Tan Yang , Wang Dawei , Wei Zhi-Xiao
Published: June 2024

Objectives

To investigate the clinical character of differentiated thyroid cancer (DTC) coexisting with Hashimoto’s thyroiditis (HT) and provide state-of-art evidence for personalized radioactive iodine-131 therapy (RAIT) for patients coexisting with HT.

Methods

From January 2000 to January 2023, PubMed, Embase, and Web of Science databases were searched for relevant original articles that published in English on the RAIT efficacy for DTC with HT. RevMan 5.4 and Stata 17.0 were used for data analysis.

Results

Eleven studies involving 16 605 DTC patients (3321 with HT) were included. HT was more frequent in female (OR: 2.90, 95% confidence interval [CI]: 1.77-4.76, P < .00001). The size of tumour (MD: −0.20, 95% CI: −0.30 to −0.11), extrathyroidal extension rate (OR: 0.77, 95% CI: 0.67-0.90), and metastasis rate (OR: 0.18, 95% CI: 0.08-0.41) were less in HT, but tumour, node, metastasis (TNM) stage had no significant difference among HT and non-HT group. Disease-free survival (DFS) rate (OR: 1.96, 95% CI: 1.57-2.44, P < .00001), 5-year DFS (OR: 1.73, 95% CI: 1.04-2.89, P = .04), and 10-year DFS (OR: 1.56, 95% CI: 1.17-2.09, P = .003) were higher in HT group. The recurrent (OR: 0.62, 95% CI: 0.45-0.83, P = .002), RAIT dosage (MD = −38.71, 95% CI: −60.86 to −16.56, P = .0006), and treatment (MD: −0.13, 95% CI: −0.22 to −0.03, P = .008) were less in HT group.

Conclusions

DTC coexisting with HT was associated with less invasion. DFS of HT group was higher than non-HT group after RAIT. Low-dose treatment did not impair the efficacy of RAIT in DTC with HT.

Advances in knowledge

Hashimoto’s thyroiditis is a risk for DTC, but it minimalizes the progression of cancer and enhance the efficacy of RAIT, which should be considered in personalizing RAIT.
Survey of Scottish Dermatological Society members on the new Medicines and Healthcare products Regulatory Agency isotretinoin recommendations
Authors: Dubash Faisal , Dawe Robert , Affleck Andrew
Published: June 2024

Recent Medicines and Healthcare products Regulatory Agency (MHRA) isotretinoin legislation includes significant changes that will affect clinical practice for dermatologists across the UK. We obtained opinions from members of the Scottish Dermatological Society on these recommendations. The survey yielded an adequate number of responses with significant results and free-text comments of interest to practising UK dermatologists. Overall responses from SDS members highlighted many concerns with the MHRA guidance and its impact on patient care. The results of this survey question the credibility of the MHRA. We propose the creation of an objective working group, with no conflicts of interest.
Cutaneous angiosarcoma arising over rhinophyma: an unusual variant of lymphoedema-associated angiosarcoma?
Authors: Lanzetti Michele , Colantuono Virginia A , Francalanci Stefano , Massi Daniela , Antonini Pietro , Grandi Vieri
Published: June 2024

Cutaneous angiosarcoma is a rare tumour with a poor prognosis. When arising on a phymatous nose, its diagnosis can be difficult, delaying treatment and resulting in metastasis. Our case report highlights red flags such as oedema, ulceration, unresponsiveness to conventional rosacea treatments or bluish vascular structures at dermoscopy that should prompt biopsy to rule out malignancy.
microRNA profile of inflammatory response in COVID-19 participants
Authors: Russell S L , Lozahic C , Rahman M , Okwose N , Raleigh S M , Mcgregor G , Maddock H , Banerjee P , Jakovljevic D G , Sandhu H
Published: June 2024

Background

COVID-19 is associated with a cytokine storm leading to a pro-inflammatory response. Little is known about the miRNA expression profile associated with inflammatory signalling pathways i.e. high vascular endothelin growth factor (VEGF) and/ or creatine kinase (CK) in people with a history of COVID-19.

Purpose

To identify the signalling profile of circulating miRNAs associated with a high inflammatory level and analyse their pro-inflammatory signalling pathways in people following COVID-19 infection.

Methods

VEGF and CK levels were assessed in a cohort of 84 participants who tested positive for COVID-19 within the past 18 months. Plasma samples were pooled in the following groups: ‘high VEGF’ (>115pg/mL), ‘high CK’ (>200U/L) and ‘low inflammation’ (standard cardiovascular/metabolic biomarkers within normal range). High inflammation VEGF and CK versus low inflammation pools were analysed. Global miRNA was extracted from pooled plasma samples and analysed using the TaqMan Array Human MicroRNA A cards. Using Ingenuity Pathway Analysis (IPA, Qiagen), we identified relevant miRNA-regulated target genes associated with pro-inflammation.

Results

Twelve participants (15%, age: 58 ± 6.8 years, 9 females) were identified as having high VEGF (153±43 pg/mL), 13 participants (15%, age: 61 ± 7.02 years, 3 females) with high CK (281 ± 81U/L) and 20 participants (24%, age: 59 ± 6.26 years, 12 females) had low inflammation. Significant upregulated expression of 98 miRNAs was identified in the high VEGF group and two miRNAs in the CK group. Significant downregulated expression of five miRNAs was identified in the high VEGF group, and 178 in the high CK group. IPA analysis revealed changes in expression levels of circulating miRNAs relate to inflammatory pathways, i.e. miR-196b (associated with inhibition of angiogenesis) was 2.16-fold downregulated in high VEGF and 3.24-fold downregulated in high CK groups. This downregulation of miR-196b supports the knowledge of the angiogenic/ vasculogenic role of VEGF. Additionally, high circulating CK is linked to general inflammation which is known to promote vascular growth in acute inflammation environments. Conversely, miR-361 was 429.00-fold upregulated in high VEGF groups and 4.00-fold downregulated in high CK groups. Knockdown of miR-361 leads to increased neovascularisation, however the high VEGF group show increased miR-361 expression.

Conclusion

Pro-inflammatory-associated miRNAs are identified in people following COVID-19 infection. Exploring miRNA signatures and their involvement in pro-inflammatory signalling pathways improves understanding of the inflammatory response in middle age and older adults with a history of COVID-19.
Cardiovascular health assessment using Life's Essential Eight in Israeli adults aged 65 years or older and its association with long-term cancer incidence
Authors: Marzooq A , Hayek S , Cohen G , Kittany L , Gerber Y
Published: June 2024

Background

Cardiovascular disease (CVD) and cancer, leading global causes of death, share risk factors and frequently coexist. Understanding their underlying mechanisms remains incomplete, particularly regarding the association between cardiovascular health (CVH) and cancer incidence among older adults.

Objective

This retrospective cohort study determines the association between CVH, indicated by Life's Essential 8 (LE8) metric, and risk of cancer incidence in older Israeli adults.

Methods

A cohort of 1799 Israeli adults aged 65 or older participated in the 2005-2006 National Health and Nutrition Survey. After excluding individuals with cancer history at baseline, 1541 participants were included. Baseline data, including CVD risk factors, physical activity, diet, and sleep, were used to categorize participants based on the LE8 CVH construct (0-100 scale). Cancer diagnoses were obtained from the Israeli National Cancer Registry until December 2019. Cox Proportional Hazards Regression Models estimated hazard ratios (HR) and 95% confidence intervals (CI) for incident cancer, adjusting for sociodemographic variables.

Results

In this cohort (mean age, 74 years; 53% women), LE8 scores ranged from 7 to 97 [mean (SD), 56 (14)]. Higher LE8 scores were positively associated with age, education, and residential socioeconomic status and inversely related to male sex and Arab ethnicity. Over 11 years of follow-up, 345 participants (22%) were newly diagnosed with cancer. LE8 was inversely associated with cancer incidence [adjusted HR = 0.88, 95% CI: 0.79-0.98, per 1 standard deviation increase]. This association persisted after accounting for death as a competing risk (see figure). The reduced risk was more pronounced in CVD-free participants [HR = 0.84, 95% CI: 0.74-0.97 (n=936)] than in prevalent CVD patients [HR = 0.99, 95% CI: 0.81-1.21 (n=605)].

Conclusions

Higher LE8 scores, indicative of robust cardiovascular health, were associated with lower long-term cancer incidence in older adults. Integrating LE8 metrics into risk assessment may inform targeted cancer prevention strategies, extending its role beyond cardiovascular health assessment. Cumulative incidence of new cancer cases
From reactive to proactive preventive cardiovascular risk management in primary care: a feasibility study
Authors: Bongaerts V , Van Os H , Hageman S , Van Gestel L , Bonten T , Van Peet P , Dorresteijn J , Numans M , Vos R
Published: June 2024

Background

Empanelment – identification and systematic categorization of patients sharing the same risk for cardiovascular disease (CVD) in primary care – provides the opportunity to tailor preventive treatment strategies to the care needs of individual patients in a proactive manner. It might provide opportunities to allocate resources to alleviate the disease burden for patient and society. In practice however, interventions using routinely collected health care data for proactive risk stratification are challenging to develop and implement. These challenges are related to practical constraints such as high safety and availability demands of data infrastructure, quality of the health care data and heterogeneity in the population working with the intervention – relating to both patients and health care professionals (HCPs).

Purpose

The overall aim of the feasibility study was to assess health care professionals' attitudes towards implementation of the PROSPERA-tool: a multilevel guideline adherence tool directed at an organizational change towards proactive cardiovascular risk management in primary care on both a population- and individual patient level.

Methods

This study was designed as a qualitative study using consecutive focus group sessions to assess the feasibility, acceptability, usability and appropriateness of the PROSPERA-tool as perceived by HCPs in primary care in the Netherlands. Constructs of the Theoretical Domain Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) were used for the focus group topic guide and thematic analysis.

Results

In total 9 HCP (4 practice nurses, 5 general practitioners) participated in four consecutive focus groups. Preliminary results included major facilitators identified in the increased insight that was provided to the HCPs in their cardiovascular population and the possibility of time allocation between well-controlled and poor-controlled patients. Other facilitators were found in the design of parts of the PROSPERA-tool and in external support in learning how to work with the tool. Main identified barriers were changing professional roles (‘letting go of the driver’s seat’) and fear of degradation of the confiding doctor-patient relationship. Other barriers were related to routines and the concern of having insufficient (digital) skills to work with the PROSPERA-tool.

Conclusions

Various facilitators and barriers were identified for implementation of the PROSPERA-tool in the workflow of HCPs. This highlights the importance for implementation strategies matched to the identified barriers. Attention should be paid to preservation of the doctor-patient relationship, the construction of a safety net, and a supportive environment including training for HCPs with the opportunity for skill-improvement.
Effects of cardiac rehabilitation on the functional capacity of hypertensive elderly people in primary care
Authors: Lopes Do Nascimento L L N , Carvalho Y F , Pacheco M P , Coelho G G , Santos G F , Leite Y A , Oliveira L C M , Silva R E N S
Published: June 2024

Background

Cardiac rehabilitation (CR) is a comprehensive and multidisciplinary intervention that improves functional capacity (FC), quality of life (QOL) and reduces morbidity and mortality of patients with cardiovascular diseases. Improving exercise tolerance is an important outcome of cardiac rehabilitation for both patients and clinicians.

Purpose

The objective of this study was to investigate the benefits of CR program in hypertensive elderly people.

Methods

The sample consisted of 40 hypertension elderly randomized into two groups: control group (CG) with 20 patients and rehabilitation group (RG) with 20 patients. Functional capacity assessment was performed using the incremental shuttle walk test (ISWT), and 1-min sit-to-stand test (1-MSTS). Patients were submitted to a supervised exercise program lasting 90 minutes, twice a week, for a period of 16 weeks. Each session consisted of a warm-up phase (10 minutes), conditioning (60 minutes), calm down (10 minutes) and health education (10 minutes). The CG maintained its usual activities. At the end of 16 weeks, the elderly underwent a reassessment on the ISWT and 1-MSTS.

Results

The sample was predominantly female (66%), with a mean age of 66.0 (±5.6) years in RG and 70.5 (±7.2) years in CG. Functional assessments at the end of CR showed a statistically significant improvement in 1-min sit-to-stand test (p<0.001) and on distance travelled (p<0.001), VO2est (p<0.001) in ISWT (table 1). The mean improvement was 78.5m after rehabilitation (p<0.001 pre/post), which was an important clinical difference. During the CR period, no complications prevented the completion of the protocol.

Conclusion

CR is well tolerated, safe and significantly improves functional capacity on hypertensive elderly people in primary care.
Is cognitive function a determinant of exercise capacity in patients with coronary artery disease?
Authors: Saklica D , Vardar-Yagli N , Ates A H , Yorgun H
Published: June 2024

Background

Exercise is often referred to as a 'polypill' due to its numerous beneficial effects on cardiovascular risk factors and the physiology of the cardiovascular system. Skeletal muscle weakness, cardiac ischemia, angina, and medications adversely affect exercise capacity in patients with coronary artery disease. In atherosclerotic patients, the presence of coronary microvascular dysfunction as determined by low coronary flow reserve is associated with abnormal cerebral flow hemodynamics and mild but significant impairment in cognitive function.

Purpose

The aim of our study was to investigate the relationship between cognitive status and exercise capacity in patients with coronary artery disease.

Methods

The study included 30 patients (59.8 ±7.20 years, 73% men) diagnosed with coronary artery disease. Patients were evaluated for cognitive impairments with the Montreal Cognitive Assessment (MoCA), and for exercise capacity with incremental shuttle walk test (ISWT). Additionally, the study documented sociodemographic, and physiological variables, number of cardiac risk factors with the cardiovascular risk factors questionnaire (obesity, physical inactivity, hyperlipidemia, hypertension, diabetes mellitus, smoking), International Physical Activity Questionnaire-Short Form, and comorbidities.

Results

Patients' waist hip ratio was 0.93±0.08, and body mass index was 27.54±4.24. About 43.3% (n=13) of the patients were actively employed. The number of risk factors was median 4 (min-max=2-7) and the number of comorbidities was median 0 (min-max: 0-5). Among the study participants, 96.6% (n=29) were physically inactive. There was a positive, high level, and statistically significant correlation between the ISWT distance and MoCA score (r=0.82, p=0.004).

Conclusion

The cognitive status of the patients significantly influenced their exercise capacity. Physiotherapists should consider patients' cognitive status when determining exercise capacity to ensure accurate measurements. Considering the cognitive status of patients with coronary artery disease when planning rehabilitation programs may be crucial for the success of these programs. Assessing cognitive functions and exercise ability before starting a cardiac rehabilitation program is critical for participation and commitment to exercise regimens.
Angiotensin II receptor blockers is associated a decreased left ventricular fibrosis in patients with obstructive hypertrophic cardiomyopathy
Authors: Nie C , Meng Y H , Xiao M H , Zhu C S , Lu Z Y , Wang S Y
Published: June 2024

Background

Myocardial fibrosis (MF) was implicated as a major risk factor for sudden cardiac death (SCD), which can lead to fatal ventricular arrhythmias. Angiotensin II receptor blockers (ARBs) have been reported to reduce MF in patients with nonobstructive HCM, whereas results were inconsistent. Here, we aimed to investigate the association between ARB use and the severity of MF in patients with obstructive HCM (oHCM).

Method

We analyzed data from 1324 consecutive hospitalized oHCM patients from January 2012 to December 2019. All patients underwent gadolinium-based contrast agent-enhanced cardiac magnetic resonance (CMR) examinations prior to surgery. The extent of late gadolinium enhancement (LGE%) was compared between patients with and without ARBs treatment (termed ARB+ group and ARB- group).

Results

Of 1324 included patients, 86 (6.5%) patients had ARBs treatment. Compared to patients in ARB- group, patients in ARB+ group seemed much older, had a higher body mass index (BMI), a higher proportion of hypertension, a smaller intraventricular septal thickness (IVST), and a lower LGE% (3.6 [0.86, 6.68] vs. 4.4 [1.38, 9.74], p= 0.023). After propensity score matching with confounding variables at baseline, 86 paired patients were included in the matched cohort. The LGE% was still lower in ARB+ group than ARB - group (3.6 [0.86, 6.68] vs. 4.5 [1.28, 9.45], p = 0.043), respectively (Figure 1). The multiple linear analysis revealed that ARB use was independently associated with a lower LGE% (β= -2.12, 95% confidence interval (CI) [-4.19, -0.05], p=0.044) after adjusting for age, gender, BMI, hypertension, IVST and left ventricular outflow gradient (Figure2).

Conclusion

Our study suggested that ARB use was associated with a decreased left ventricular fibrosis in patients with oHCM, which may help SCD prevention in those patients. The extent of LGE% between groups  Multiple linear regression analysis
Factors related to one-year mortality in nonagenarians with acute myocardial infarction: a nationwide analysis
Authors: Kupisz-Urbanska M K U , Teisseyre P T , Topor-Madry R T M , Jankowski P J
Published: June 2024

Background

Myocardial infarction (MI) has been stated as a major cause of death in the elderly. The prevalence of MI and mortality of patients with MI is strongly influenced by age.

Purpose

To characterize factors related to one-year mortality in patients with acute myocardial infarction aged at least 90 years.

Methods

We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and followed them for one year.

Results

A total of 14970 patients (mean age 92.7±2.3 years; 4666 men and 10304 women) were included. Coronary angiography was performed in 47.0% of patients, PCI in 39.8%, and CABG in 0.2% of patients. In-hospital mortality was 27.8% (25.1% in men and 29.0% in female patients; P<0.001), 23.0% in patients managed invasively and 32.1% in those managed conservatively (P<0.001). All-cause mortality following discharge was 38.1% (females: 38.4%, males: 37.5%, P=0.27), the endpoint consisting of all-cause death, MI or stroke occurred in 42.6% patients (females: 42.8%, males: 42.2%, P=0.44), while all-cause death or cardiovascular hospitalization in 59.0% (females: 58.2%, males: 60.7%, P=0.046). The one-year all-cause mortality (in-hospital and post-discharge deaths combined) was 54.3% (females: 56.3%, males: 53.2%, P<0.001), but sex was not related to one-year mortality after adjustment in multivariable analysis. Variables independently related to the higher risk of one-year mortality were: age per one year (HR 1.05 [CI 95% 1.04-1.06]), heart failure (1.09 [1.04-1.14]), diabetes (1.08 [HR 1.02-1.13]), and chronic obstructive pulmonary disease (HR 1.09 [1.01-1.18]). Meanwhile, hospitalisation in a department of cardiology or internal medicine respectively (0.76 [0.70-0.83]) and (0.85 [0.78-0.93]), invasive management (at least coronary angiography) (0.65 [0.62-0.69]), and hypertension (0.87 [0.82-0.92]) were linked to lower risk of one-year mortality.

Conclusion

Age and comorbidities, but not sex, are independent predictors of one-year mortality. Variables related to one-year mortality
Predictive value of glycated hemoglobin in multivessel coronary artery disease in STEMI patients with type 2 diabetes mellitus
Authors: Krasniqi X , Bakalli A , Kocinaj D , Vincelj J , Sejdiu B , Morina V , Morina P , Keka L , Krasniqi A , Bashota L , Zijabeg D , Veliu F , Krasniqi A , Mahmutaj V , Sejdiu J
Published: June 2024

Background

Increased level of glycated hemoglobin may be used to identify STEMI patients at risk for multivessel coronary artery disease, either insulin depending or non-insulin depending type 2 diabetes mellitus.

Purpose

We evaluated diabetic patients who presented with ST-segment elevation myocardial infarction according to the level of HbA1C.

Methods

In this study we included eighty-two consecutive type 2 diabetes mellitus patients with STEMI of onset <12h who underwent primary percutaneous coronary intervention. The levels of creatine kinase, the MB fraction of creatine kinase, troponin T, HbA1C, CRP, and other routine laboratory parameters were measured. Measurement of HbA1C was performed on the day of admission with ion-exchange high performance liquid chromatography. Thereafter patients were divided in two groups according to the percentage of HbA1C.

Results

In total 42 (51.2%) patients suffered from multivessel coronary artery disease, 17 (40.5%) of whom with HbA1C ≤9.5% and 25 (59.5%) with value >9.5% (p <0.001). As for the patients with insulin depending type 2 diabetes mellitus, the total number was 22 (26.8%), 10 (45.4%) of whom had HbA1C ≤9.5% and 12 (54.6%) with value >9.5% (p < 0.03) (Table 1). A receiver operating characteristics (ROC) curve plots the true positive rate against the false positive rate at different cut-off points, AUC=0.704 (95% CI: 0.59-0.81), p=0.001 (Figure 1). Table 2 presents the area under the curve for biochemical analysis (HbA1C, Hb, cholesterol, triglyceride, creatine kinase, creatine kinase-MB, troponin T and C-reactive protein). The AUC of 0.704 (95% CI: 0.59-0.81) for HbA1C is significant (p=0.001) as well as for creatine kinase-MB (AUC= 0.67, 95% CI: 0.55-0.80) with a p value of 0.006.

Conclusions

The value for the HbA1C above 9.5% in type 2 diabetes mellitus may be used to identify patients at risk for multivessel coronary artery disease, therefore warranting a more rigorous glycemic control.
Sex differences in risk factor relationships with subarachnoid haemorrhage and intracranial aneurysms: a Mendelian randomisation study
Authors: Tschiderer L , Bakker M K , Gill D , Burgess S , Willeit P , Ruigrok Y M , Peters S A E
Published: June 2024

Background

The prevalence of intracranial aneurysms (IAs) and incidence of aneurysmal subarachnoid haemorrhage (aSAH) is higher in women than in men. Although several cardiometabolic and lifestyle factors have been related to IAs or aSAH, it is unclear whether there are sex differences in causal relationships.

Purpose

The aim of this study was to determine sex differences in causal relationships between cardiometabolic and lifestyle factors and risk of aSAH and IA.

Methods

We conducted a sex-specific Mendelian randomisation study using summary-level data from genome-wide association studies. We analysed low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, non-HDL-C, total cholesterol, fasting glucose, systolic and diastolic blood pressure, smoking initiation, and alcohol use as exposures, and aSAH and IA (i.e., aSAH and unruptured IA combined) as outcomes.

Results

We found statistically significant sex differences in the relationship between genetically proxied non-HDL-C and aSAH risk, with odds ratios (ORs) of 0.72 (95% CI 0.58, 0.88) in women and 1.01 (0.77, 1.31) in men (P-value for sex difference 0.044). Moreover, genetic liability to smoking initiation was related to a statistically significantly higher aSAH risk in men compared to women (P-value for sex difference 0.007) with ORs of 3.81 (1.93, 7.52) and 1.12 (0.63, 1.99), respectively, and to a statistically significantly higher IA risk in men compared to women (P-value for sex difference 0.036) with ORs of 3.58 (2.04, 6.27) and 1.61 (0.98, 2.64), respectively.

Conclusion

Higher genetically proxied non-HDL-C was related to a lower risk of aSAH in women compared to men. Moreover, genetic liability to smoking initiation was associated with a higher risk for aSAH and IA in men compared to women. These findings may help improve understanding of sex differences in the development of aSAH and IA.
Elevated BNP and NT-proBNP levels as prognostic biomarkers of short-term walking independence in post-acute stroke rehabilitation
Authors: Kai G , Noda T , Ueno K , Ogura K , Miki T , Yamashita M , Kanai M , Nozoe M , Kamiya K
Published: June 2024

Background

The comorbidity of heart failure (HF) and stroke is associated with delayed stroke recovery, prolonged hospitalization, and a decreased quality of life. HF can lead to acute cerebral injury, while conversely, acute cerebral injury can exacerbate HF by disrupting neural and cardiovascular regulation. This association is now recognized as the "cardio-cerebral syndrome" and the "stroke-heart syndrome," endorsed by the European Society of Cardiology (ESC). However, in many cases of newly diagnosed stroke patients, the appropriate diagnosis of HF is often overlooked.

Brain natriuretic peptide (BNP) and the N-terminal prohormone of BNP (NT-proBNP) are used for HF screening and risk assessment. Nevertheless, their potential as predictive markers for functional independence in post-acute stroke patients remains uncertain.

Purpose

This study aimed to investigate the correlation between BNP or NT-proBNP levels and walking independence in patients with ischemic or hemorrhagic stroke during the post-acute phase.

Methods

This retrospective observational study included 650 post-acute phase ischemic or hemorrhagic stroke patients admitted to our hospital for rehabilitation between February 2019 and December 2022, all of whom underwent BNP or NT-proBNP testing upon admission. Patients were categorized into two groups: those with BNP≥200 pg/ml or NT-proBNP≥900 pg/ml ("High group") and those without ("Low group"). We examined the relationship between BNP or NT-proBNP levels and ambulatory independence within 90 days using multivariable logistic regression analysis. We also performed subgroup analyses to take into account factors such as age, atrial fibrillation, obesity and renal function that may affect BNP or NT-proBNP levels. Walking independence was defined as the ability to walk without assistance or supervision, irrespective of the use of walking aids and orthoses.

Results

The mean age of the subjects was 75.1±11.2 years, with males comprising 53.2% of the population. One hundred and seven patients (16.4% of the total) were classified as the High group. High BNP or NT-proBNP levels were significantly associated with difficulty walking independently within 90 days after adjusting for other functional prognostic factors (odds ratio, 2.62; 95% confidence interval, 1.30-5.27; p=0.007). Furthermore, even in subgroup analyses with factors influencing BNP or NT-proBNP levels, elevated BNP or NT-proBNP levels were associated with difficulty walking independently within 90 days (p<0.05, respectively).

Conclusions

Our findings suggest that elevated serum levels of BNP or NT-proBNP may serve as functional prognostic indicators in post-acute stroke patients.