bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19105: β2 Integrin-Dependent HuR-Mediated mRNA Stabilization in Macrophages is Required for Lymphatic Vessel Formation in Inflammatory Lymphangiogenesis
Authors: Young Bryan D , Zhang Jiange , Mohan Arvind , Robinson Nathaniel D , Morrison Alan R , Yarovinsky Timur O , Bender Jeffrey R
Published: April 2024

Macrophages play a central role in the response to acute and chronic tissue injuries including infection, ischemia, and atherosclerosis, where their effector functions in injured tissue include cytokine, growth factor, and matrix remodeling factor production. β2 integrin engagement promotes stabilization of labile mRNAs bearing adenylate-uridylate-rich elements (AREs) by inducing the rapid nuclear-to-cytoplasmic translocation of the RNA binding protein HuR. The secretory role of macrophages in lymphangiogenesis, together with predicted HuR binding sites in the VEGF-C 3’-UTR, led us to hypothesize that HuR regulates VEGF-C production in macrophages in response to integrin engagement. In bone marrow-derived macrophages from mice harboring a myeloid-specific deletion of HuR, we observed that VEGF-C production is impaired due to an increase in the rate of VEGF-C mRNA decay. A conserved ARE was the degradation target and was necessary to mediate HuR-dependent transcript stability that in turn resulted in increased VEGF-C protein. The HuR knockout mice exhibit an abnormal lymphangiogenic response to intraperitoneal LPS injection despite intact macrophage recruitment. Preliminary data indicates a functional interaction between the mRNA stabilizing effect of HuR and the destabilizing effect of microRNA recognition sequences in the 3’-UTR of VEGF-C and that of other integrin-induced lymphangiogenic gene products including cytokines and matrix remodeling proteins. VEGF-C likely acts in concert with these other factors to help guide vessel formation at sites of tissue injury. In conclusion, β2 integrin signaling through HuR promotes VEGF-C production as a central component of a post-transcriptional gene regulatory program essential for macrophage-directed lymphangiogenesis, a finding with implications for processes including tissue ischemia, wound repair, extracellular fluid trafficking, and atherosclerosis.
Abstract 19107: Trends in Atrial Fibrillation Hospitalization and Cost of Care in the United States From 1998-2010
Authors: Pant Sadip , Deshmukh Abhishek , Mehta Kathan , Raina Sameer , Badheka Apurva O , Patel Nileshkumar , Arora Shilp , Shah Neeraj , Tuliani Tushar , Mehta Jawahar L , Paydak Hakan
Published: April 2024

Introduction:
The aim of our study was to investigate time trend in atrial fibrillation (AF) related hospitalization and the cost of hospitalization over the last decade in the United States and make projections for 2020.

Methods:
The Nationwide Inpatient Sample database was used to estimate the annual number and prevalence of hospitalizations with AF from 1998-2010.

Identification of AF-related hospitalizations was based on the designation of the International Classification of Diseases (9th Edition)

Clinical Modification (ICD-9-CM) diagnosis code 427.31 (AF) as the principal discharge diagnosis.

Results:
There were total 4,676,758 AF related hospitalizations from 1998-2010 in the US. The relative percentage increase in hospitalizations from 1998 to 2010 was 46%. We used exponential model to identify the trend (R2=0.88).

Assuming a similar trend in AF hospitalization over next decade, 541,000 hospitalizations can be expected in 2020 (28% relative increment from 2010). The cost of hospitalization follows a linear trend (R2=0.98) and is expected to rise by 55% in 2020 as compared to cost of care in 2010.

Conclusions:
These data indicate that AF related hospitalizations and the cost of care has increase tremendously over the last decade and is likely to pose a large public health burden in the future.
Abstract 19130: Characteristics of Atrial Fibrillation in Hemodialysis Patients
Authors: Ata Naim , Yavuz BÜnyamin , Oto Emre , Katircioglu öztÜrk Deniz , Aytemir Kudret , Aytemir Kudret , Karaismailoglu Eda , GÜvenir Altay , özcan SelÇuk , Ertugay Emre , Ertugay Emre , Koselerli Rasim , BÜrkan AbdÜlkadir , Kuruca Mustafa , Gokalp Ilhan Yadigar , Camm John , Oto Ali
Published: April 2024

Objectives:
Atrial fibrillation (AF) is the most common sustained arrhythmia in general population. Although several studies reported a high incidence and prevalence of AF in haemodialysis patients there is no substantial data on thromboembolic risk scales such as CHADS2 or CHADS-Vasc predicting stroke and mortality. The aim of this analysis was to evaluate the effectivenes of these scales for predicting stroke and mortality in haemodialysis patients with AF.

Methods:
A total of 402674 patients over the age 18 who had the diagnosis of non-valvular atrial fibrillation (AF). From this database haemodialysis patients were separated and reanalyzed. The main descriptive statistics of population contained in the database include major bleeding including intracranial and gastrointestinal bleeding, mortality, hospitalizations, and thoromboemboli risk scales.

Results:
There were 5505 haemodialysis patients with AF (52.4 % men).The four year follow-up data of the 2008 cohort of 992 haemodialysis patients with AF demonstrated 67.4 % mortality and 38.6 % ischemic stroke in four years. Mortality among hemodialysis patients have been shown to be significantly higher than the rest of the cohort (67.4% vs. 31.4% in the rest of the cohort, p < 0.000). The median CHA2DS2-VASc and CHADS score were 4 and 2 respectively among the 5505 heamodialysis patients in the registry. Acording to time dependent ROC curve analysis, CHADS2 was a more accurate scale than CHA2DS2-VASc for predicting stroke in heamodialysis patients upto 40 months-to-stroke after first AF diagnosis, beyond which CHADS2 and CHA2DS2-VASc perform similarly.

Hemorrhagic stroke and major bleeding including GI bleeding were higher in warfarin users of haemodialysis patients than the rest of the cohort under warfarin ( 3.2% and 2 % respectively .p < 0.000).

Conclusion:
This analysis demonstrated that 1) The prevalence of AF in haemodialysis patients were significantly higher than those of general population, with higher mortality,2) CADS2 was a more accurate scale to CHA2DS2-VASc for predicting stroke up to 40 months. 3) Among the warfarin users ,in the Registry population major bleeding was much higher in the haemodialysis patients.
Abstract 19131: Stent-Based Vascular Cell Delivery for Therapeutic VEGF-Induced Angiogenesis
Authors: Caplice Noel M , Doyle Brendan , Kumar Arun H , Martin Kenneth , Ali Mohammed T , Skelding Kimberley A , Wang Shaohua , Gleeson Birgitta , Ritman Erik L , Russell Stephen J
Published: April 2024

Site specific targeting remains an elusive goal for stem cell and gene therapies in the cardiovascular field. One promising option involves use of modified 3D stent designs that deliver larger cell/gene payloads to specific disease sites using the versatility of percutaneous vascular access. Here, we engineered smooth muscle cells (SMCs) placed in a 3D metallic stent scaffold to deliver high local concentrations of an angiogenic gene (VEGF165) in a porcine model of chronic total occlusion involving ameroid placement on the proximal left circumflex (LCx) artery(n≥8 per group). Engineered SMCs were retained within the mesh stent structure (479 ± 47.4 SMC/mm2) and were competent for VEGF production in vitro (8.8 ± 1.8 ng/ml in media). Following implantation, micro CT analyses revealed that stents loaded with VEGF producing SMCs significantly enhanced vasa vasora microvessel density (5.43 ± 0.46 vs 2.14 ± 0.19 vessels/mm2, p<0.001) with a concomitant increase in tissue VEGF protein levels (277.9 ± 85.7 vs 18.8 ± 4.4 pg/mg protein, p<0.0001). Formation of endothelial cell colonies from peripheral blood mononuclear cells was significantly increased with the implantation of VEGF-secreting cells suggesting increased angiogenic potential (7.0 ± 2.0 versus 41.6 ± 4.5, EC:CFU p<0.0001). VEGF secreting mesh stent placement enhanced regional blood flow analyses determined by microsphere analyses as well as improving regional wall motion in the LCx-related territory (p<0.05) as well as left ventricular function assessed in terms of ejection fraction (34.2 ± 6.7% vs 61.2 ± 5.2% P<0.001) and dp/dt (p<0.001) Our data indicate robust clinically relevant angiogenesis can be achieved in a human scale porcine chronic vascular occlusion model following stent based delivery of angiogenic cells. This may have implications for percutaneous delivery of stem cells, genes and secreted therapeutic factors in cardiovascular disease in general and in creation of percutaneous microvascular bypass networks in the setting of chronic vaso-occlusive disease in particular.
Abstract 19160: Prevention of Strokes in Patients With Mechanical Aortic Prostheses: Use of Clopidrogel or Prasugrel and Aspirin as Sole Anticoagulants
Authors: Garcia-Rinaldi Raul , Rodriguez-Acosta Juan , Bermudez David , Quinones Shaira , Quinones Jeannette
Published: April 2024

Objective:
Embolization from mechanical aortic- prostheses is due to platelet activation and aggregation secondary to shear forces and the release of ADP from RBC. Anti-thrombotic therapy should be directed to the prevention of platelet activation instead of the suppression of coagulation factors. We summarize the long terms results of patients with mechanical aortic prostheses treated exclusively with antiplatelet agents.

Methods:
Starting in 2001 two hundred three (203) patients average age 63.8 ± 11.8 years received mechanical aortic prostheses alone or with other cardiac or thoracic procedures received a loading dose of clopidogel (300mg) or prasugrel (60mg) and aspirin (325mg) one hour after extubation. The maintenance dose was 75mg clopidrogel or 10mg prasugrel and 81mg ASA daily. Beginning 2006 we measured platelet reactivity with Accumetrics® and Thromboelectrography (TEG).

Platelet inhibition was measured 6 hours after loading. Patients not responsive to clopidogrel were changed to prasugrel. Follow up was at 1 and every 6 months by echocardiography and platelet reactivity.

Results:
Total months at risk were 9016.7(751.5 pt-yr) average follow up is 44.4 ± 37.8 months.

34 (16.7%) patients died. Seven patients had strokes (0.93% patient-years). Five strokes occurred in patients who discontinued the antiplatelet medication, one in a patient non responsive to clopidrogel and one in a compliant patient prior to 2006. We have not observed strokes since 2007 (5½ years).

9 patients bled (4%)(1.2% pt-yr), 8 from the GI tract and 1 from a cerebral aneurysm.

One non-compliant patient formed a clot in the prosthesis.

Conclusions:
Embolism from aortic prostheses is platelet mediated and should be treated with antiplatelet agents. We employed an antiplatelet regimen of clopidrogrel or prasugrel and aspirin as sole anticoagulants in patients with aortic mechanical prostheses. It is mandatory that the patient respond to the antiplatelet agent employed. In patients non responsive to clopidrogel, prasugrel is utilized.

With this protocol the incidence of bleeding is 1.2% pt-yr, and the incidence of stroke 0.93%/ pt-yr.

Our date is suggestive that dual antiplatelet therapy medications can prevent strokes in patients with aortic mechanical prostheses.
Abstract 19169: Best Method for Right Atrial Volume Assessment by Two-Dimensional Echocardiography: Validation With Magnetic Resonance Imaging
Authors: Ebtia Mahasti , Murphy Darra , Nair Parvathy , Lee PK , Gin Kenneth , Jue John , Mayo John , Barnes Marion , Tsang Teresa S
Published: April 2024

Background:
In contrast to left atrial volume, 2D echocardiographic methods for estimating right atrial (RA) volume have not been standardized and therefore not used in clinical assessment.

Methods:
RA volume was assessed in patients who underwent comprehensive 2D echocardiography and MRI assessment of the heart for clinically indicated reasons. The volumes obtained using three 2D echocardiography methods, and linear RA major and minor dimensions were compared correlated with RA volume determined by MRI. The 3 echocardiographic methods for assessing RA volume included: 1) biplane area length method using 4 chamber view twice (Biplane 4C-4C); 2) biplane area length method using 4 chamber and subcostal view (Biplane 4C-Subcostal); and 3) Single plane Simpson’s method of disc (Single plane 4C-Simpson’s). These echocardiographic methods were also evaluated for their accuracy in discriminating RA enlargement.

Results:
A total of 51 persons (33 female, 18 male), mean age 53 ± 14 years underwent cardiac MRI and echocardiography. All 3 echocardiography volumetric methods performed well with correlation being 0.98 for each. In terms of bias and limits of agreement, biplane 4C-4C (bias -4.81 mL, limits of agreement ± 9.8 mL) and single plane Simpson’s (bias -5.15 mL, limits of agreement ± 10.1 mL) outperformed biplane 4C-subcostal (bias -8.36 mL, limits of agreement ± 12.5 mL). Linear measurements performed poorly with low correlation (RA major, 0.49; RA minor 0.54), high degree of bias and wide limits of agreement. Using MRI as reference, the accuracy for discriminating large from non-large was high for all 3 methods (all >90% if a cut-off at 55 mL was used). In contrast, accuracy for RA major was at best only 80% and 62% respectively, cutting at 50 mm for major, and 36 mm for minor. The interobserver variability was satisfactory across all three volume methods (range 5.8- 7.3 mL).

Conclusions:
Using MRI as reference, biplane 4C-4C and single plane Simpson’s are highly accurate 2D echocardiography methods, superior to biplane 4C-Subcosta method for estimating RA volume. Linear methods are inaccurate and should be abandoned.
Abstract 214: Therapeutic Hypothermia Promotes Arrhythmogenic Calcium-Mediated Delayed Afterdepolarizations During Sympathetic Stimulation
Authors: Fukaya Hidehira , Kouk Shalen , Plummer Bradley N , Cheng Aurelia , Piktel Joseph S , Laurita Kenneth R , Wilson Lance D
Published: April 2024

Introduction:
Most patients who undergo therapeutic hypothermia (TH) suffer cardiac arrest due to ischemia-induced ventricular fibrillation (VF). Ischemia and hypothermia both cause cellular calcium (Ca) overload, a substrate for Ca-mediated triggered arrhythmias. Previously, we showed that under non-ischemic conditions, TH suppresses Ca-mediated arrhythmias. However, the mechanistic relationship between hypothermia-induced Ca dysregulation and arrhythmias during ischemia, the most common clinical scenario, is unknown. We hypothesized that TH and ischemia would synergistically promote spontaneous Ca release and subsequent arrhythmogenic delayed afterdepolarizations (DADs). We examined this relationship during sympathetic stimulation, as occurs when epinephrine is given during resuscitation from VF.

Methods and Results:
Dual optical mapping of Ca transients and action potentials was performed in canine left ventricular wedge preparations during 10 minutes of no flow ischemia during normothermia (NT, 36°C, n=5) and TH (32°C, n=7) with and without beta-sympathetic stimulation (isoproterenol, 0.2uM, each n=5).

Multicellular spontaneous Ca release events (mSCRs) and resultant DADs were induced by rapid pacing. During ischemia, TH increased mSCR amplitude (44±3%) vs. NT (26±4%, p<0.04). In contrast, the slope (amplitude/rise time) of mSCRs, an important determinant of triggered activity (TA), and DAD amplitudes were similar in TH and NT (24±6 and 21%±2% respectively, both p=NS). Importantly, when sympathetic stimulation was present during ischemia, TH increased the amplitude mSCRs compared to NT (61±5 vs. 31±7%, respectively p<.01) and the slope of mSCRs was 2-fold greater (p<.01), resulting in greater amplitude of DADs (50±9 vs. 28±7%, p=.08) and TA was observed.

Conclusions:
During ischemia, TH is not arrhythmogenic unless sympathetic stimulation is introduced, where it promotes spontaneous Ca release and DADs. Moreover, these data suggest that when TH is initiated during ischemia, as in intra-arrest cooling, sympathetic stimulation during cardiac arrest may be proarrhythmic by increasing susceptibility to Ca-mediated triggered arrhythmias.
Abstract 215: Post Arrest Head CT Imaging: Commonly Done, but not a Determinant of Early Care Withdrawal
Authors: Albaeni Aiham , Eid Shaker M , Vaidya Dhanajay , Chandra-Strobos Nisha
Published: April 2024

Background:
The decision to perform head CT, following non-traumatic cardiac arrest, is based on clinical judgment. We examined whether such expensive testing, factored into early care decisions.

Methods:
We studied 202 out-of-hospital, non traumatic, cardiac arrest survivors and analyzed patients who had Head CT imaging performed within 72 hours of admission. Grossly abnormal results were defined as severe diffuse brain edema, herniation or bleeding. Demographics, cardiac arrest characteristics and hospital care were studied in patients with and without abnormal CT finding using Chi square and t test. Logistic regression was used to identify the impact of abnormal head CT findings on early care withdrawal.

Results:
Of 202 patients studied, 137 had CT imaging (67%). Of these 112 patients (81%) had an unremarkable (“normal”) head CT (group1) whereas 25 patients (18%) had abnormal head CT findings as described above (group2). Mean age for patients receiving a head CT was 61 years (SD±15).No obvious demographic feature emerged as a characteristic or a predictor of an abnormal head CT (PNS, Table1). An abnormal head CT prompted more family meetings, further neurological evaluation (all P<0.05) but did not result in early care withdrawal {within 72 hours of admission} as compared to those with an unremarkable study [OR=1.2, 95% CI (0.4-3) P=0.64].

Conclusion:
Although head CT is often performed post arrest, grossly abnormal findings are uncommonly found, and do not predict early care withdrawal. The clinical usefulness of this test in guiding decision making remains unclear and unsubstantiated.
Abstract 216: The Cerebral Blood Flow Threshold for Membrane Repolarization is 3 Times Higher Than That for Membrane Depolarization and is Lowered by Intraischemic Hypothermia
Authors: Mizoue Ryoichi , Takeda Yoshimasa , Sato Sachiko , Takata Ken , Morimatsu Hiroshi
Published: April 2024

Introduction:
It has been reported that cerebral blood flow (CBF) supplied by chest compression (20-40% of control levels) exceeds the CBF threshold for membrane depolarization (20%). However, the CBF threshold for membrane repolarization has not been studied. It is unknown whether chest compression can restore membrane potential. In the present study, we compared the CBF threshold for depolarization with that for repolarization. In addition, the effects of brain hypothermia on the repolarization threshold were evaluated.

Methods:
Rats (10 in each group) were anesthetized with isoflurane. CBF was measured by placing a laser-Doppler flow probe placed adjacent to a direct current (DC) potential electrode in the parietal cerebral cortex. Following bilateral occlusion of common carotid artery, CBF was continuously decreased by exsanguination at a speed of 5% of the baseline level every 2 min until a sudden negative DC shift was observed. After 5 or 10 min of ischemic depolarization, the CBF was restored at the same rate by returning blood until a positive DC shift was observed. In the hypothermia groups, brain temperature was decreased to 31°C by initiating nasopharyngeal cooling after depolarization.

Result:
The threshold for repolarization (46.5 ± 12%) was significantly higher than that for depolarization (19.2 ± 5%, p < 0.001) after 5 min of depolarization time, and further increased to 61.5 ± 14% (p < 0.05) after 10 min of depolarization time. Brain hypothermia significantly decreased the threshold for repolarization (5 min of ischemic depolarization: 33.8 ± 10%, p < 0.05 compared with normal temperature, 10 min: 36.6 ± 6%, p < 0.05).

Conclusion:
Thresholds for repolarization were significantly higher than those for depolarization and are likely to exceed the levels supplied by chest compression. Induced brain hypothermia during ischemia lowered CBF thresholds for repolarization and may help protect the brain during CPR.
Abstract 219: Systolic Blood Pressure on ER Arrival and its Impact on In-Hospital Mortality in Patients With Acute Heart Failure
Authors: Shiraishi Yasuyuki , Kohsaka Shun , Miyata Hiroaki , Takahashi Masashi , Takagi Atsutoshi , Harada Kazumasa , Miyamoto Takamichi , Iida Kiyoshi , Tanimoto Shuzou , Sakai Tetsuo , Sato Naoki , Nagao Ken , Yamamoto Takeshi , Takayama Morimasa
Published: April 2024

Background:
Evaluating patients with acute heart failure (AHF) in ER is still a significant challenge. Accurate management of AHF is a time-dependent event and the triage process must be initiated immediately once the symptoms of HF are identified. However, detailed clinical information is often unknown in patients presenting with AHF. Large controlled trials conducted on chronic heart failure have identified therapies that improve clinical outcomes. In contrast, few large and randomized AHF trials have been conducted over the last 2 decades, and few significant predictors and treatments are available for AHF.

Purpose:
To determine whether the ER assessment information could be used to predict patients’ acute outcome.

Methods:
We extracted data of patients admitted with acute HF from Tokyo CCU Network database (TCND) from 2005 to 2007. TCND collected information of patients who were emergently admitted to acute cardiac care facilities from 62 participating hospitals in the Tokyo metropolitan area. We identified 2220 patients who were admitted for AHF. AHF was defined as a rapid onset or change in the signs and symptoms of HF, resulting in a need for urgent therapy. Patients with ACS were excluded from this analysis. A logistic regression analysis was performed to detect the predictors of in-hospital mortality.

Results:
The patients were predominantly elderly (74.4±12.6) and male (55.1%). There were 154 (6.9%) in-hospital deaths. Significant predictors of in-hospital death were age (OR 1.02; p<0.001), history of chronic lung disease (OR 2.06; p=0.02), and systolic blood pressure values on presentation (OR 3.12; p<0.001 for SBP <90mmHg, and OR 0.64; p<0.001 for SBP 90-130mmHg).

Conclusion:
Systolic BP on presentation was the key indicator for AHF risk stratification, and it was inversely correlated with in-hospital mortality.
Abstract 222: Cerebral Performance Category at Hospital Discharge Predicts Long-Term Survival of Cardiac Arrest Patients Who Received Targeted Temperature Management
Authors: Hsu Cindy H , Li Jiaqi , Cinousis Marisa J , Abella Benjamin , Leary Marion
Published: April 2024

Background:
Little is known about the correlation between cerebral performance category (CPC) score and long-term survival of post-cardiac arrest survivors who received targeted temperature management (TTM).

Methods:
We performed retrospective chart review of initial cardiac arrest survivors at two tertiary academic centers from 5/2005 to 12/2012. The CPC scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients were determined by reviewing hospital records, querying the Social Security Death Index, and follow-up telephone calls. Kaplan-Meier survival estimates were calculated to compare unadjusted rates of long-term survival as well as log rank statistic to determine whether differences in survival were statistically significant.

Results:
Of the 2,417 identified cardiac arrest patients, 24.1% (582/2417) survived, of which 24.1% (140/582) received post-arrest TTM. The mean age of the TTM cohort was 54.4±15.7 yrs; 64.3% (90/140) were male, 43.6% (61/140) had initial shockable rhythms, and 55.7% (78/140) experienced out-of-hospital cardiac arrests. Overall, 42.9% (60/140) were discharged with CPC 1, 27.1% (38/140) with CPC 2, 18.6% (26/140) with CPC 3, and 11.4% (16/140) with CPC 4. The survival percentages of each CPC group and of the overall cohort were calculated . CPC 1 survivors had the highest long-term survival followed by CPC 2 and 3, with CPC 4 having the lowest long-term survival (p < 0.001, log-rank test).

Conclusion:
Patients with different CPC scores at discharge have significantly divergent survival trajectories. Favorable CPC at hospital discharge predicts better long-term outcomes of cardiac arrest survivors who received TTM than those with less favorable CPC scores. Further studies and neurocognitive testing of these survivors may help to predict the duration and types of outpatient resources necessary after their hospital discharge.
Abstract 262: Teaching Laypersons BLS and AED Using a Two-stage Teaching Technique is Non-inferior to Four-stage Teaching Technique: A Randomized Controlled Study
Authors: Bjørnshave Katrine , Krogh Lise Q , Hansen Svend B , Kristensen Mette A , Thim Troels , Løfgren Bo
Published: April 2024

Introduction:
Laypersons performing bystander basic life support (BLS) and using automated external defibrillation (AED) increase survival from cardiac arrest. Laypersons often hesitate to perform BLS and use an AED due to self-perceived lack of knowledge and skills. Training may reduce the barrier to intervene. Reducing training costs can allow more laypersons to be trained at the same expense. Reducing the classic four-stage technique to a two-stage technique can shorten course duration and thereby reduce costs.

Hypothesis:
Teaching laypersons BLS and AED, a two-stage teaching technique is non-inferior to the classic four-stage teaching technique.

Methods:
Laypersons (exclusion: health care professionals/students) were randomized to courses using either the two-stage (3 hours and 15 minutes) or the four-stage (4 hours) teaching technique. Immediately after training, the laypersons were tested in a simulated cardiac arrest scenario to assess their BLS and AED skills. Tests were video recorded and reviewed by two independent observers blinded to training technique. Skills were assessed using the European Resuscitation Council BLS/AED assessment form. Chest compression and rescue breathing quality data were collected electronically from the manikin. The primary endpoint was passing the test. A non-inferiority margin of 20% was pre-specified.

Result:
The two-stage teaching technique was non-inferior to the four-stage technique (difference -1.6%; 95%CI -17.9%; 14.6%). Pass rates were 57% among laypersons trained with the two-stage technique (n=72) and 59% among those trained with the four-stage technique (n=70). There were no significant differences between the two groups regarding number of chest compressions delivered per compression cycle (30.0±0.6 vs 30.0±0.7), chest compression rate (114±12 vs 115±14 minute
-1
), chest compression depth (47.2±9.3 vs 47.6±8.8 mm), number of effective rescue breaths between compression cycles (1.7±0.5 vs 1.6±0.7) and tidal volume (0.5±0.3 vs 0.5±0.3 L). In both groups, all participants felt that their training improved their skills.

Conclusion:
Teaching laypersons BLS and AED using a two-stage teaching technique is non-inferior to the classic four-stage teaching technique.
Abstract 268: Improvements in Emergency Department CPR Quality Utilizing Real-Time Audiovisual CPR Feedback
Authors: Crowe Christopher , Bronnenkant Tyler , Silver Annemarie , Hefner Marcia , Vadeboncoeur Tyler , LoVecchio Frank , Stolz Uwe , Spaite Daniel , Bobrow Bentley
Published: April 2024

Background:
CPR quality is closely linked to outcome in cardiac arrest. The AHA 2010 Guidelines recommend monitoring CPR quality performed by healthcare providers both inside and outside the hospital. However, most EDs currently do not monitor CPR quality. The goal of the present investigation was to assess the quality of CPR performed in an urban ED and determine the influence of training and real-time audiovisual feedback (RTAVF) on CPR quality and patient outcome.

Methods:
CPR quality was monitored using an R Series defibrillator (ZOLL Medical) during the treatment of adult cardiac resuscitation attempts. During phase 1 (P1; 11/2010-11/2012), real-time audiovisual chest compression feedback was disabled. During phase 2 (P2; 11/2012-3/2013), clinicians underwent a 60 minute didactic/hands-on CPR training session after which the RTAVF and the ECG artifact filtering feature were enabled. CPR quality data (fraction, depth, rate, release, peri-shock pause) were reviewed using Code Review software (ZOLL Medical). Student’s t-test and Wilcoxon-signed rank test were employed.

Results:
A total of 44 OHCA patients were treated in P1 (mean age 57±18 yrs, 59% male) and 24 in Phase 2 (mean age 63±15 yrs, 88% male). The majority of patients (89% P1; 96% P2) suffered prehospital arrest and were transported to the ED. Chest compression (CC) depth increased from 1.8±0.5 inches in P1 to 2.3±0.4 in P2 (p<0.001), with the percentage of compressions exceeding 2 inches more than doubling from 36% in P1 to 79% in P2 (p<0.001). CC release velocity increased from 1.25±0.36 inch/sec in P1 to 1.69±0.28 in P2 (p<0.001). No significant differences were identified in CC rate (125±12 cpm P1 vs. 121±15 cpm P2, p=0.3) or CC fraction (82% P1 vs. 87% P2, p=0.1). Pre-shock pause (11.5±10.4 sec P1 vs. 8.0±6.2 P2, p=0.4) and post-shock pause (5.2±3.4 sec vs. 3.8±0.6, p=0.9) were statistically similar in P1 and P2.

Conclusion:
The bundle of real time audiovisual CPR feedback and training were associated with an improvement in chest compression depth and recoil and closer adherence to guidelines for CPR quality in this large urban ED.
Abstract 306: Use of Real-Time Audiovisual CPR Feedback is Associated With Improved CPR Quality During Patient Transfer From the Scene to the Ambulance in Out-of-Hospital Cardiac Arrest
Authors: Vadeboncoeur Tyler , Silver Annemarie , Murphy Ryan Anne , Moon Sungwoo , Tobin John , Venuti Mark , Karamooz Madalyn , Spaite Daniel , Bobrow Bentley
Published: April 2024

Background:
In the simulation setting, chest compression (CC) quality is reduced when out-of-hospital cardiac arrest “patients” are prepared for transport (i.e. packaged and moved to ambulance). It is unknown whether use of real-time audiovisual CPR feedback (RTAVF) affects manual CC quality when the patient is prepared for transport during actual out-of-hospital resuscitations. We tested the hypothesis that CC quality during patient transfer would be better when using RTAVF.

Methods:
CC quality was monitored at two EMS agencies using an E Series monitor/defibrillator with CC sensing capability (ZOLL Medical) during the treatment of consecutive out-of-hospital cardiac arrest patients who received CC on scene and were transported with ongoing CC. Data were collected during study phases; P1: RTAVF disabled, P2: RTAVF enabled following scenario-based training. Student’s t-test and Wilcoxon-Mann Whitney tests were used to compare CC quality in P1 vs. P2 during early scene and late scene treatment. Late scene was defined as the 3 minutes prior to transport (when packaging and transfer to the ambulance occurs) and early scene was all prior minutes at the scene.

Results:
211 cardiac arrest cases were included: mean age 64±15 yrs, 67% male, 8% survival to hospital discharge. The Table shows that CC quality was superior during both early scene and late scene treatment in P2, when RTAVF was enabled, vs. P1, when RTAVF was disabled.

Conclusion:
CC quality, particularly the CC fraction, declines when a patient is packaged for transport and moved to the ambulance. While this decline is not prevented by RTAVF, CC quality during the late scene period is significantly better when using RTAVF. Further study is required to determine the impact of this improvement on outcomes.
Abstract 317: Pre-Hospital Predictors of Post-Cardiac Arrest Left Ventricle Dysfunction
Authors: Yao Yuan , Grossestreuer Anne V , Perman Sarah M , Ramjee Vimal , Gaieski David F
Published: April 2024

Background:
A proportion of patients with out-of-hospital cardiac arrest are initially resuscitated; however, few survive to hospital discharge. A common cause of this high mortality rate is post-cardiac arrest myocardial dysfunction, a temporal phenomenon that can be fully recovered from with appropriate treatment.

Objectives:
This study aims to explore the predictors of post-cardiac arrest myocardial dysfunction and evaluate their influence on survival and neurologic outcome. We hypothesized that there would be an association between pre-hospital resuscitative strategies (such as witnessed arrest, bystander CPR, and the use of a publicly accessible AED) and development of LV dysfunction after resuscitation.

Methods:
A retrospective chart review was performed of 238 out-of-hospital cardiac arrest patients who underwent echocardiography after resuscitation at three hospitals. Pre-hospital arrest characteristics and echocardiography results were abstracted. The primary outcome was left ventricular ejection fraction (LVEF; abnormal defined as <40%) in the first 24 hours.

Results:
191 (80%) patients had an echo completed in the first 24 hours, of which abnormal LVEF was observed in 90 (47%).Having a witnessed arrest predicted abnormal LVEF in first 24 hours (OR, 3.7; 95% CI, 1.04-13.22). No association was detected between initial rhythm, bystander CPR, use of AED, total downtime and the development of LVEF. No difference was observed in both neurologic outcome and survival in patients with a normal versus abnormal 24 hour echo. Among the 51 patients with serial echos, 28 (55%) patients had an abnormal initial LVEF; 15 (54%) of these patients had an LVEF that returned to normal by 72 hours.

Conclusions:
In survivors of out-of-hospital cardiac arrest, abnormal LVEF after resuscitation is not predictive of outcome; however, witnessed arrest is associated with the development of abnormal LVEF.
Abstract 344: Periodic Acceleration (pGz) Improves Left Ventricular Function and Remodeling in Rats After Myocardial Infarction
Authors: Uryash Arkady , Kurlansky Paul , Adams Jose A
Published: April 2024

BACKGROUND:
Heart Failure (HF) post MI remains a important cause of mortality and morbidity Whole body periodic acceleration (pGz) is the repetitive motion of the supine body in a sinusoidal head to foot direction achieved with a motorized platform. pGz induces pulsatile shear stress on the vascular endothelium. Pulsatile shear stress activates endothelial nitric oxide synthase (eNOS) to produce increased release of nitric oxide (eNO). pGz pre-and postconditioning can induce cardioprotective affects in an in-vivo rat model of myocardial infarction (MI) reducing mortality, arrhythmias and infarct size. The effects of pGz on myocardial function and remodeling after MI are unknown. Left ventricular (LV) pressure-volume (PV) relationships are an invasive but comprehensive method to assess myocardial function.

OBJECTIVE:
We investigated the effects of pGz on LV function and remodeling induced by chronic MI in rats.

Methods:
After MI, rats (SD-300gms) were randomized to receive pGz (MI-pGz) (n=5) Control (MI-C) (n=5) for 4 weeks and a separate sham surgery group (n=5). In vivo LV pressure-volume relationships were analyzed using a conductance catheter (Millar Instruments, Texas). LV fibrosis was analyzed using trichrome staining and digital microscopy.

RESULTS:
pGz after MI reduced left ventricular fibrosis by 40% [MI-C 36( 4 )% vs MI-pGz 21(2)% (p < 0.01) as a % of the LV]. There were no differences in heart rate between groups. pGz significantly improved ejection fraction (EF), left ventricular end systolic pressure (LVESP), dP/dtmax, and both end systolic (ESPVR) and diastolic (EDPVR) pressure volume relations (Table). Data: X(SD) * p< 0.01 (Sham vs. MI-C) and † p< 0.01 (MI-C vs MI-pGz)

Conclusions:
In a rat model HF induced by chronic MI, pGz markedly improved LV function. These findings have implications for cardiac rehabilitation post MI.
Abstract 358: Predictors for Not Transferring the Major Trauma Patients to Trauma Centers. A Nation-wide Population Based Research in Taiwan
Authors: Harnod Dorji , Chang Chu-Hui , Chang Ray-E , Harnod Tomor
Published: April 2024

Background:
The predictors for not-transferring the major trauma patients to trauma centers were analyzed in a logistic regression model.

Methods:
From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP 90 was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis one year before trauma admission for calculating Charlson Comorbidity Index. We set up the rule for transferring major trauma patients to trauma centers as (1)Triage class I & II or (2)ISS>25 or (3)age>55. Factors like age, genders, intubation, ICU admission, different SES levels and triage classifications were adjusted in a logistic regression model for finding out the predictors of “not transferring to trauma centers”.

Results:
There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). All the variables like age, genders, co-morbidity, injury severity, triage classifications and the SES were not the significant predictors for not transferring major trauma patients to the trauma centers. But, intubation and ICU admission in the first hospitals were significant predictors for not transferring the major trauma patients to the trauma centers. Compared with the patients not admitted to ICU, the odds ratio for “patients admitted to ICU” was 0.54 (OR=0.54, P
<
0.001).

Compared with the patients were not intubated, the odds ratio for “patients who were intubated” was 0.65 (OR=0.65, P=0.013).

Conclusions:
Our results hint that pre-hospital transfer protocols are important for sending major trauma patients to trauma centers. Based on our results, once the major trauma patients were intubated or admitted to ICU in the first regional hospitals, the patients got lower chance to be transferred to trauma centers.
Abstract 15058: RhoG Regulates GPVI/FcRγ-Mediated Platelet Activation and Thrombus Formation
Authors: Kim Soochong , Dangelmaier Carol , Bhavanasi Dheeraj , Meng Shu , Wang Hong , Goldfinger Lawrence E. , Kunapuli Satya P.
Published: April 2024

Soochong Kim, 2013 Finalist and Presenting Author
Abstract 15536: Cardiopulmonary resuscitation with chest compressions during sustained inflations: A new technique of Neonatal Resuscitation that improves recovery and survival in a neonatal porcine model
Authors: Schmölzer G.M. , O'Reilly M. , LaBossiere J. , Lee TF T.F. , Cowan S. , Qin S. , Bigam D.L. , Cheung P.H.Y.
Published: April 2024

Georg Schmölzer, 2013 Finalist and Presenting Author
Abstract 17772: Dimer conversion of PPARα/RXR to PPARα/Sirt1 suppresses fatty acid oxidation genes
Authors: Oka Shinichi , Zhai Peiyong , Yamamoto Takanobu , Sadoshima Junichi
Published: April 2024

Shinichi Oka, 2013 Finalist and Presenting Author
Abstract 12562: Uncertainty Can Help Identify Risk for Stress and Burden in Caregivers of Stroke Survivors
Authors: Byun Eeeseung , Evans Lois K. , Sommers Marilyn S. , Tkacs Nancy C. , Riegel Barbara J.
Published: April 2024

Eeeseung Byun, 2013 Finalist and Presenting Author
Abstract 17536: Abnormal Cardiac Formation In Hypertrophic Cardiomyopathy - Fractal Analysis Of Trabeculae Detects Pre-Phenotypic Gene Expression
Authors: Captur Gabriella , Lopes Luis , Patel Vimal , Li Chunming , Bassett Paul , Sado Daniel , Baldini Michael , Anderson Sarah , Maestrini Viviana , McKenna William J , Muthurangu Vivek , Elliott Perry M , Moon James C
Published: April 2024

Gabriella Captur, 2013 Finalist and Presenting Author
Abstract 16076: Anti-angiogenic actions of VEGF-A165b, a novel isoform of VEGF-A, in human obesity
Authors: Ngo Doan TM , Farb Melissa G. , Karki Shakun , Tiwari Stephanie , Bigornia Sherman , Hamburg Naomi M. , Vita Joseph A. , Hess Donald T. , Walsh Kenneth , Gokce Noyan
Published: April 2024

Doan Ngo, 2013 Finalist and Presenting Author
Abstract 18226: Finding the Ideal Biomaterial for Aortic Valve Repair
Authors: Toeg Hadi , Abessi Ovais , Al-Atassi  , Kerchove Laurent de , El-Khoury Gebrine , Labrosse Michel , Boodhwani Munir
Published: April 2024

Hadi Toeg, 2013 Finalist and Presenting Author
Abstract XXXXX: Duration of resuscitation eff orts and survival after in-hospital cardiac arrest: an observational study
Authors: Goldberger Zachary D. , Chan Paul S. , Berg Robert A. , Kronick Steven L. , Cooke Colin R. , Lu Mingrui , Banerjee Mousumi , Hayward Rodney A. , Krumholz Harlan M. , Nallamothu Brahmajee K.
Published: April 2024

Zachary D. Goldberger, 2013 Finalist and Presenting Author
Abstract XXXXX: Antipsychotic drugs are associated with pulseless electrical activity: The Oregon Sudden Unexpected Death Study
Authors: Teodorescu Carmen , Reinier Kyndaron , Uy-Evanado Audrey , Chugh Harpriya , Gunson Karen , Jui Jonathan , Chugh Sumeet S.
Published: April 2024

Carmen Teodorescu, 2013 Finalist and Presenting Author
Future Directions in Vascular and Interventional Radiology
Authors: Gomes Antoinette
Published: April 2024

The field of vascular interventional radiology remains a fertile area of development for minimally invasive techniques to diagnose and treat vascular disease. Innovative scientists and physicians actively collaborate to develop new treatment paradigms and to refine and enhance previously developed methodology. Exciting new areas of activity, including sympathetic renal denervation for the management of refractory hypertension, the application of nanotechnology and stem cells to stent development, and new balloon catheters, will be described.

Some of the organizational and scientific challenges to the development and implementation of these novel techniques will also be addressed.
Polyphosphate: A Novel Modulator of Hemostasis and Thrombosis
Authors: Morrissey James
Published: April 2024

Although inorganic polyphosphate is widespread in biology and plays diverse roles in many organisms, most of our knowledge of its functions comes from studies of microorganisms. In 2004, Docampo and colleagues showed that polyphosphate is a major component of the dense granules in human platelets, and furthermore that platelets secrete polyphosphate upon activation. Studies from my laboratory and others have now demonstrated that polyphosphate is a novel and potentially important modulator of the human blood clotting system. Many infectious microorganisms contain long-chain polyphosphate, which is a highly potent, pathophysiologic activator of the contact pathway of blood clotting and may help explain the role of this limb of the clotting pathway in inflammation and host responses to pathogens. Shorter-chain polyphosphate—of the size range secreted by activated platelets—has multiple downstream effects on clotting, including accelerating factor V activation, abrogating the function of tissue factor pathway inhibitor (TFPI), and enhancing fibrin clot structure. Interestingly, platelet polyphosphate also greatly accelerates the back-activation of factor XI by thrombin, which may help explain the otherwise perplexing contribution of factor XI to normal hemostasis. Polyphosphate is an interesting therapeutic and diagnostic target, including the use of polyphosphates in novel hemostatic agents, as well as the use of inhibitors of polyphosphate function as a novel approach to antithrombotic/anti-inflammatory therapy. Many more contributions of polyphosphate to hemostasis, thrombosis and inflammation are doubtless waiting to be discovered.
Less Invasive Heart Surgery: Will It Fail or Prevail?
Authors: Chitwood W. Randolph
Published: April 2024

Dr. William W. L. Glenn was a cardiac pioneer surgeon and innovator. He practiced and taught during what many have called “The Golden Era of Cardiac Surgery”. During this time most of the inaugural cardiac operations were developed and were based on solid physiologic principles. Although many of them were effective, most were superseded by better techniques to treat the same malady. However, many of these “obsolete operations” became the springboard for the development of current catheter-based and less invasive operations, as well as implantable devices, that we use today. With rapidly advancing technology in our specialty many current operations seem to be in jeopardy of replacement by effective least invasive cardiac procedures. Yet, a majority of cardiac surgeons still considered minimally invasive cardiac surgery a fading fad and that the proven excellent results of traditional cardiac operations will prevail. Nevertheless, the expanding adoption of effective minimally invasive and catheter-based cardiac operations in Europe and the United States is a strong predictor of a sustained “disruptive change” in our specialty. To this end, the lecture will try to unravel the conundrum of: Less Invasive Heart Surgery: Will it fail or prevail?
Abstract 7: Myocardial Electrical Remodeling and Arrhythmogenic Substrate in Hemorrhagic Shock-Induced Heart
Authors: Takase Bonpei , Tanaka Yoshihiro
Published: April 2024

Rationale:
Lethal arrhythmias such as ventricular tachycardia and ventricular fibrillation (VT/VF) is one of the most serious complications after the resuscitation of severe hemorrhagic shock, even though systemic hemodynamics seems to recover.

Objectives:
To investigate the mechanisms of arrhythmogenesis after hemorrhagic shock and a role of oxygenated hemoglobin transfusion, optical mapping analysis (OMP), electrophysiological study (EPS), and pathological examination were performed using an acute hemorrhagic shock model of rats.

Measurement and Main Results:
After cannulating 22G catheter into the lower abdominal aorta, rats were subjected to acute hemorrhagic shock by withdrawing 30% of total blood volume (TBV) for 25 min, and observed for 15 min (shock alone). After acute hemorrhagic shock, the rats were immediately resuscitated by transfusing exactly the same amount of saline, 5% albumin (5%ALB), oxygenated liposome-encapsulated human hemoglobin (LHb), or oxygenated autologous washed red blood cells (wRBC) (n = 7, per group). After excising the heart, OMP and EPS were performed in isolated Langendorff-perfused hearts. OMP revealed abnormal ventricular conduction delay in conjunction with impaired action potential duration (APD) dispersion in both ventricles in shock alone, saline, and 5%ALB. In contrast, myocardial conduction velocity and APD dispersion in both ventricles were substantially attenuated in LHb or wRBC. VT/VF spontaneously occurred in shock alone. Furthermore, sustained VT/VF was easily provoked by burst pacing stimulus to the LV in saline and 5%ALB. No VT/VF was induced in the LV when the heart was resuscitated with oxygenated LHb or wRBC. Pathology including electron microscopy and immunohistochemistry demonstrated myocardial structural damages characterized by degradation of sarcometric actin and connexin43 in shock, saline, and 5%ALB. However, these histological changes were substantially attenuated in LHb and wRBC.

Conclusion:
Ventricular structural remodeling after hemorrhagic shock causes VT/VF only in the presence with APD dispersion. Oxygenated hemoglobin transfusion prevents VT/VF by preserving myocardial structures caused by ischemia-reperfusion injury in hemorrhagic shock.