bluuebunny/crossref_metadata_2025 huggingface dataset:
A machine learning framework for the prediction of antibacterial capacity of silver nanoparticles
Authors: Mary Priya , Mujeeb A
Published: May 2024

The biocompatibility property has made silver nanoparticles powerful candidates for various nanomedical applications. Research interest in silver nanoparticles as a viable alternative to antibiotics is gaining more attention due to their enhanced antimicrobial activity, better antibacterial activity and low cytotoxicity. Machine Learning (ML) has become a state-of-the-art analytic and modelling tool in recent times, due to its prediction capabilities and increased accuracy of the results. In this work, we present machine-learning techniques to predict the antibacterial capacity of silver nanoparticles and extended the work on antifungal studies. In the first phase, we reviewed 50 articles and collected data points for training the model, which consists of features such as core size, shape of the nanoparticle, dosage, bacteria/fungi species and zone of inhibition (ZOI). Then, we trained the data using eight different machine-learning regression algorithms and validated the models’ performance using four metrics such as RMSE, MSE, MAE and R2. Furthermore, the importance of features used in the prediction models has been evaluated. The feature importance revealed that the core size of silver nanoparticles is the prominent feature in the prediction of the antibacterial capacity. The optimum model for the prediction of antibacterial and antifungal activity has been identified. Finally, the model’s validation has also been demonstrated. This work enables researchers to utilize Machine Learning which in turn can address the challenges of time consumption, and cost in laboratory experiments while minimising the reliance on trial and error.
Transcriptome sequencing data provide a solid base to understand the phylogenetic relationships, biogeography and reticulated evolution of the genus Zamia L. (Cycadales: Zamiaceae)
Authors: Lindstrom Anders , Habib Sadaf , Dong Shanshan , Gong Yiqing , Liu Jian , Calonje Michael , Stevenson Dennis , Zhang Shouzhou
Published: May 2024

Background and Aims

Cycads are a key lineage to understand the early evolution of seed plants and their response to past environmental changes. However, tracing the evolutionary trajectory of cycad species is challenging when the robust relationships at inter- or infrageneric level are not well resolved.

Methods

Here, using 2901 single-copy nuclear genes, we explored the species relationships and gene flow within the second largest genus of cycads, i.e. Zamia, based on phylotranscriptomic analyses of 90 % extant Zamia species. Based on a well-resolved phylogenetic framework, we performed gene flow analyses, molecular dating and biogeographical reconstruction to examine the spatiotemporal evolution of Zamia. We also performed ancestral state reconstruction of a total of 62 traits of the genus to comprehensively investigate its morphological evolution.

Key Results

Zamia comprises seven major clades corresponding to seven distinct distribution areas in the Americas, with at least three reticulation nodes revealed in this genus. Extant lineages of Zamia initially diversified around 18.4–32.6 (29.14) million years ago in Mega-Mexico, and then expanded eastward into the Caribbean and southward into Central and South America. Ancestral state reconstruction revealed homoplasy in most of the morphological characters.

Conclusions

This study revealed congruent phylogenetic relationships from comparative methods/datasets, with some conflicts being the result of incomplete lineage sorting and ancient/recent hybridization events. The strong association between the clades and the biogeographic areas suggested that ancient dispersal events shaped the modern distribution pattern, and regional climatic factors may have resulted in the following in situ diversification. Climate cooling starting during the mid-Miocene is associated with the global expansion of Zamia to tropical South America that has dramatically driven lineage diversification in the New World flora, as well as the extinction of cycad species in the nowadays cooler regions of both hemispheres, as indicated by the fossil records.
Revision Breast Reconstruction With Biologic or Synthetic Mesh: An Analysis of Postoperative Capsular Contracture Rates
Authors: Bai Jennifer , Ferenz Sarah , Fracol Megan , Kim John Y
Published: May 2024

Background

Both biologic and synthetic mesh have been found to reduce the risk of capsular contracture, yet there is limited data assessing the use of these scaffold materials in revision breast reconstruction.

Objectives

This investigation sought to assess the ability of either biologic or synthetic mesh to prevent capsular contracture in the revision breast reconstruction population.

Methods

A retrospective chart review was conducted of implant-based revision reconstructions performed by the senior author between 2008 and 2023. Patient demographics and outcomes were assessed, including the incidence of Baker Grade III or IV capsular contractures. Results were compared between biologic and synthetic mesh groups using univariate and multivariate analysis.

Results

Ninety-five breasts underwent revision reconstruction with 90 (94.7%) for correction of malposition, 4 (4.2%) for size change, and 1 (1.1%) for revision after additional oncologic breast surgery. Of these breasts, 26 (27.4%) used biologic mesh and 69 (72.6%) used synthetic mesh. Capsular contracture occurred in 1 (3.8%) biologic mesh breast and 4 (5.8%) synthetic mesh breasts. There was no significant difference in the incidence of capsular contracture between the 2 groups (P = 1.000). None of the recorded demographics were risk factors for capsular contracture, including the use of biologic or synthetic mesh (P = .801).

Conclusions

Both biologic and synthetic mesh are successful at preventing capsular contracture in patients undergoing implant-based revision reconstruction. This adds to the growing evidence that both scaffold materials can be used in complex revision breast reconstruction to aid in preventing capsular contracture.

Level of Evidence: 4
Co-Delivery of Recombinant Super-Affinity VEGF and PDGF-BB Accelerates Diabetic Wound Healing by Improving Angiogenesis, Arteriogenesis and Blood Flow
Authors: D’amico R , Bicker P , Uccelli A , Hubbell J , Gürke L , Wolff T , Mujagic E , Gianni Barrera R , Banfi A
Published: May 2024

Background

Diabetic ulcers are characterized by local ischemia, usually without macroangiopathy. We have previously found that the combination of VEGF and PDGF-BB in a fibrin matrix is effective in stimulating arterial growth to diabetic wounds.

Aims

We developed modified forms of VEGF and PDGF-BB to bear super-affinity for the extracellular matrix (SA-VP), in order to decorate the wound tissue without the need for a biomaterial. We investigated the dose-dependent effects on local blood flow and wound healing, by applying the treatment either to the healthy tissue around the wound or to the damaged wound bed.

Methods

Full thickness wounds were created on the dorsal skin of diabetic (db/db) mice. SA-VP or saline were applied to the wound bed or divided into 4 injections around the wound edge. Wound closure and blood flow were measured on days 4 and 8 after treatment and tissues were harvested for histology on day 8. Data were analysed by Anova with Tukey’s post-hoc test for multiple comparisons.

Results

Wound healing was improved dose-dependently by SA-VP by both delivery routes. Histologically, angiogenic areas and total amount of angiogenesis were significantly increased by the highest SA-VP dose, again independent of delivery route (p = 0.034). However, the total amount of recruited arterioles was significantly increased only in the healthy tissue around the wound and only by intradermal injections of SA-VP (p = 0.008). In agreement with the arteriogenic effect, the blood flow at day 4 was significantly increased only by injections of the highest SA-VP dose around the wound (p = 0.018).

Conclusion

SA-VP treatment significantly accelerates wound healing in a diabetic murine model with a clear dose-dependent effect. Targeting the undamaged tissue around the wound by injections induces more effective arteriogenesis. However, direct treatment of the wound bed is equally effective for healing. These results support further development for a potential clinical use.
Use of Fish Skin Grafts for Wound Management: Report of 5 Pediatric Cases
Authors: Doan M , Cherry I , Tarhini L , de Buys Roessingh A
Published: May 2024

Background

Managing wounds and scars in children presents a significant challenge for surgical and rehabilitation teams. Studies have already explored the potential of fish skin grafts with Omega-3 in hard-to-heal lower extremity chronic ulcers and deep-burn management.

Aims

The purpose of this study is to assess the safety and outcome of intact fish skin grafts with Omega-3 when used as skin replacement therapy in the pediatric population.

Methods

This article was conducted in adherence to our hospital's ethical guidelines. Patients enrolled in this study were identified retrospectively. Their medical records were reviewed, and data was collected concerning patient demographics, initial mode of injury, indication for fish skin placement, operative data, postoperative care, complications and outcomes. The acellular dermal matrix was obtained from North Atlantic codfish skin (Gadus morhua) farmed in Isafjordur, Iceland.

Results

All patients underwent meticulous wound debridement and patch application under general anesthesia and were discharged the same day. Wound surface ranged between 10 and 110 cm2 (mean: 53 cm2). Standard analgesic medications were taken for a maximum period of 48 hours in all patients. Upon follow-up at our outpatient clinic, shrinkage in the wound surface was observed in all patients after a few days, followed by early wound granulation. Two patients underwent subsequent split-thickness grafting to achieve healing. The mean time required to achieve complete epithelialization was 48.6 days (range: 29 – 62 days). No hypersensitivity or allergic reaction was reported. The definitive outcome was satisfactory in all wounds, meaning complete wound coverage.

Conclusion

The findings from this case series reveal that fish skin grafts with Omega-3 can be an effective and a safe scaffold in the process of repairing damaged tissues in the pediatric population. We have been able to accomplish a quality skin replacement therapy, with no donor site morbidity.
Ultrasound-Based Measurement of Dorsal Scaphoid Displacement During Watson Test in Scapholunate Ligament Lesion
Authors: Huber N , Schweizer A , Reissner L
Published: May 2024

Background

Scapholunate ligament lesion (SLL) is the most common ligament lesion in the wrist. The diagnosis of scapholunate ligament injuries in clinical practice is not standardised and there are various clinical and radiological methods that have varying degrees of reliability.

Aims

The aim of our work was to find a method that was simple, easily reproducible and did not require expensive and time- consuming second-tier examinations. We therefore assessed the reliability of sonography during Watson test (WT) in detecting SLL.

Methods

20 patients with MRI and intraoperatively confirmed SLL were assessed preoperatively between July 2020 and April 2023. Sonography was performed on the scaphoid dorsal subluxation (DS) in wrist neutral and during WT and compared with the healthy contralateral side. The DS was measured by two independent investigators and intra- and interobserver reliability were assessed.

Results

We found a statistically significant difference between DS of the scaphoid of the healthy (0.89 mm, SD 0.67 mm) compared to the pathological side (1.67 mm, SD 0.95 mm). Reliability was very good, and SEM was lower than 0.4 mm for all measurements.

Conclusion

Sonographic measurement during WT showed promising results with very good reliability; this method could be routinely adopted for the detection and diagnosis of SLL without the need for second-tier examinations.
A Multicenter Exploration of the APRI/ALBI Score in Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy’ (ALPPS)
Authors: Jonas J P , Linecker M , Müller P C , Sander S , Ardiles V , Wen Z , Romic I , Kysela M , Truant S , Reese T , Rauchfuss F , Ullmer F , Wahba R , Hahn O , Guidetti C , Fernandez-Placencia R , Robles Campos R , Sparrelid E , Petrowsky H , Santol J , Eshmuminov D , Oberkofler C , Rössler F , Amann M , Ignatavicius P , Oberholzer J , Starlinger P
Published: May 2024

Background

Perioperative morbidity and mortality remain a point of concern for the Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS) procedure. Post-hepatectomy liver failure (PHLF) after the second step poses the most significant risk factor for futile outcome. Recovery of liver function after the first step of ALPPS is critically important to allow for sufficient liver function after this surgery. The APRI+ALBI score has been proposed as an easily assessable score to monitor liver function and its dynamic recovery.

Aims

We explored if the APRI+ALBI score was able to assess liver function recovery after the first step of ALPPS and allow for optimal timing of the 2nd step.

Methods

Based on the ALPPS registry, patients from 2012 to 2020 with available APRI+ALBI score were included. Postoperative outcomes (PHLF A – C, PHLF B + C, 90-day mortality and severe morbidity) were defined as per standard definitions. The APRI/ALBI score was monitored perioperatively.

Results

Overall, 464 patients from 16 international participating centers in the ALPPS registry were included. Clinically relevant PHLF (B + C) was observed in 7.5 % and of these 63 % of patients ultimately died due to liver failure. The APRI+ALBI score immediately increased after each surgical intervention and continuously decrease thereafter. Failure of the APRI+ALBI score to decrease until the 2nd step of ALPPS predicted PHLF B+C (p = 0.001; AUC 0.78). Particularly patients with high APRI+ALBI scores and short interstage intervals were at risk to develop PHLF B+C.

Conclusion

The APRI+ALBI score objectifies liver function recovery after the 1st step of ALPPS and failure to sufficiently decreased is associated with a higher risk for PHLF B+C. This might allow for optimized planning of the 2nd step of ALPPS to allow for sufficient liver function recovery to minimize the risk for PHLF B+C and associated futile outcome.
Full Robotic Versus Open ALPPS: A Bi-Institutional Comparison of Perioperative Outcomes
Authors: Müller P C , Guidetti C , Magistri P , Jonas J P , Odorizzi R , Kron P , Guerrini G , Oberkofler C E , Di Sandro S , Clavien P A , Petrowsky H , Di Benedetto F
Published: May 2024

Background

In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access.

Aims

The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS.

Methods

The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.

Results

Open and full robotic ALPPS was performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418±237ml vs. 319±197ml; P=0.04 and 631±354ml vs. 258±53ml; P=0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P=0.02). OT was longer with robotic ALPPS after both stages (371±70min vs. 449±81min; P=0.01 and 282±87min vs. 373±90min; P=0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P=1.00) and major complications (43% vs. 39%; P=0.86). The total length of hospital stay was similar (23±17 days vs. 26±13; P=0.56).

Conclusion

Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.
Robotic-Assisted Treatment of Large Incisional Abdominal Wall Hernias: A Cost Analysis
Authors: Mongelli F , Sabbatini F , la Regina D , Murgante Testa N , Pini R
Published: May 2024

Background

Robotic-assisted treatment of ventral hernia offers many advantages, however, studies reported higher costs for robotic surgery compared to other surgical techniques.

Aims

We aimed at comparing hospital costs in patients undergoing large ventral hernia repair with either robotic or open surgery.

Methods

We retrospectively searched from a prospectively maintained database patients who underwent robotic or open surgery for the treatment of the large ventral hernias from January 2016 to December 2022. The primary endpoint was to assess the costs incurred by the hospital in both groups. For eligible patients, data was extracted analyzed using a propensity score-matching.

Results

During the study period, 67 patients were retrieved from our database. 34 patients underwent robotic-assisted surgery while 33 underwent open surgery. Mean age was 66.4 years ±4.1 years, 50% of patients were male. After a propensity score-matching, a similar total cost of 18,297±8,435 EUR vs. 18,024±7,514, p=0.913 in robotic-assisted and open surgery groups were noted. Robotic surgery showed higher operatory theatre-related costs (7,532±2,091 EUR vs. 3,351±1,872 EUR, p<0.001), which were fully compensated by a shorter hospital stay of 5.3±4.5 vs. 10.4±5.2 days, p=0.002 (costs: 4,265±4,366 EUR vs. 7,373±4,698 EUR, p=0.032).

Conclusion

Our study showed that in the treatment of large ventral hernia, robotic surgery had higher operatory theatre-related costs, however, they were fully compensated by shorter hospital stays and resulting in similar total costs.
Mapping the differential impact of spontaneous and conversational laughter on brain and mind: an fMRI study in autism
Authors: Cai Ceci Qing , Lavan Nadine , Chen Sinead H Y , Wang Claire Z X , Ozturk Ozan Cem , Chiu Roni Man Ying , Gilbert Sam J , White Sarah J , Scott Sophie K
Published: May 2024

Spontaneous and conversational laughter are important socio-emotional communicative signals. Neuroimaging findings suggest that non-autistic people engage in mentalizing to understand the meaning behind conversational laughter. Autistic people may thus face specific challenges in processing conversational laughter, due to their mentalizing difficulties. Using fMRI, we explored neural differences during implicit processing of these two types of laughter. Autistic and non-autistic adults passively listened to funny words, followed by spontaneous laughter, conversational laughter, or noise-vocoded vocalizations. Behaviourally, words plus spontaneous laughter were rated as funnier than words plus conversational laughter, and the groups did not differ. However, neuroimaging results showed that non-autistic adults exhibited greater medial prefrontal cortex activation while listening to words plus conversational laughter, than words plus genuine laughter, while autistic adults showed no difference in medial prefrontal cortex activity between these two laughter types. Our findings suggest a crucial role for the medial prefrontal cortex in understanding socio-emotionally ambiguous laughter via mentalizing. Our study also highlights the possibility that autistic people may face challenges in understanding the essence of the laughter we frequently encounter in everyday life, especially in processing conversational laughter that carries complex meaning and social ambiguity, potentially leading to social vulnerability. Therefore, we advocate for clearer communication with autistic people.
Effects of Different Storage Times on the Stability of 12 Traditional Chinese Medicine Decoction Pieces
Authors: Xie Rui-Fang , Feng Yi-Ming , Li Shan-Ni , Kong Wei-Song , Zhou Gui , Zhou Xin
Published: May 2024

As storage time increases, the quality of traditional Chinese medicines (TCMs) may change, and stability is an essential aspect of ensuring the safety and efficacy of TCMs. In this study, the effects of different storage times on the stability of 12 decoction pieces were evaluated. High-performance liquid chromatography was used to determine the contents of the active components in the 12 decoction pieces. The chemical composition data were analyzed using fingerprinting and clustering heatmap (CH). Results showed that during storage, significant variations (relative standard deviation > 10%) were observed in the levels of paeoniflorin in Paeoniae Radix Alba and Paeoniae Radix Rubra, hesperidin in Citri Reticulatae Pericarpium and Citri Reticulatae Pericarpium Viride, bufothionine in Siccus Bufo and chlorogenic acid in White Chrysanthemi Flos and Lonice Raejaponicae Caulis. However, calycosin-7-glucoside and calycosin in Astragali Radix Praeparata Cum Melle and chlorogenic acid in Lonicerae Japonicae Flos, Yellow Chrysanthemi Flos and Mori Folium were all <10%, which is consistent with the CH. Decoction pieces can be stored for up to six months, but it is recommended that volatile oil-containing and animal-based decoction pieces should not be stored for more than one month. This study provides new perspectives for the stability and quality control studies of TCM.
Privacy-Preserving Breast Cancer Prediction Based on Logistic Regression
Authors: Chen Shuangquan , Li Jinguo , Zhang Kai , Di Aoran , Lu Mengli
Published: May 2024

With the increasing strain on today’s healthcare resources, there is a growing demand for pre-diagnosis testing. In response, researchers have suggested diverse machine learning models for disease prediction, among which logistic regression stands out as one of the most effective models. Its objective is to enhance the accuracy and efficiency of pre-diagnosis testing, thereby alleviating the burden on healthcare resources. However, when multiple medical institutions collaborate to train models, the untrusted cloud server may pose a risk of private data leakage, enabling participants to steal data from one another. Existing privacy-preserving methods often suffer from drawbacks such as high communication costs, long training times and lack of security proofs. Therefore, it is imperative to jointly train an excellent model collaboratively and uphold data privacy. In this paper, we develop a highly optimized two-party logistic regression algorithm based on CKKS scheme. The algorithm optimizes ciphertext operations by employing ciphertext segmentation and minimizing the multiplication depth, resulting in time savings. Furthermore, it utilizes least squares to approximate sigmoid functions within specific intervals that cannot be handled by homomorphic encryption. Finally, the proposed algorithm is evaluated on a breast cancer dataset, and simulation experiments demonstrate that the model’s prediction accuracy, after machine learning training, exceeds 96% for two-sided encrypted data.
Australian innovative activity and international technology, 1854–2016
Authors: Fleming Grant , Liu Zhangxin Frank , Merrett David , Ville Simon
Published: May 2024

Has Australia’s focus as a producer and exporter of natural resources—often considered low technology industries—constrained the development of its innovation system? We exploit a new digital database from the Commonwealth Patent Office to investigate this question. We find that the focus of domestic innovativeness supported key industries for Australian development and complemented technological specialization by foreign patent applicants, particularly in European and American manufacturing. The results support the argument that shifts in national technological orientation is a relatively long game and that technical advantage is shaped by a nation’s stage of economic development.
Quantifying the mortality impact of Il Piano Marshall
Authors: Vilà Gregori Galofré
Published: May 2024

The Marshall Plan is often hailed as history’s most successful structural adjustment program. However, its direct impacts and its impact on public health outcomes, particularly mortality rates, remain uncertain. Using data for Italian provinces, I find that each additional million dollars in the Italian European Recovery Program was related to a decrease of one to two deaths per 1,000 people or a decline in the Italian crude death rate by 3–7 percent. The effect is driven by the grants in food and drugs (rather than reconstruction grants). This finding is robust to a range of specifications using models in levels and differences, region dummies, placebo tests, a difference-in-differences framework, coarsened exact matching, and a border-municipal research design. The largest mortality reductions came from drops in communicable and infectious diseases.
Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure
Authors: Gharios Charbel , van Leent Mandy M T , Chang Helena L , Abohashem Shady , O’Connor David , Osborne Michael T , Tang Cheuk Y , Kaufman Audrey E , Robson Philip M , Ramachandran Sarayu , Calcagno Claudia , Mani Venkatesh , Trivieri Maria Giovanna , Seligowski Antonia V , Dekel Sharon , Mulder Willem J M , Murrough James W , Shin Lisa M , Tawakol Ahmed , Fayad Zahi A
Published: May 2024

Background and Aims

Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis.

Methods

Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala).

Results

Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (−0.098, 0.138), and of the carotids 0.014 (−0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score.

Conclusions

In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.
Italian Association of Hospital Cardiologists Position Paper ‘Gender discrepancy: time to implement gender-based clinical management’
Authors: Lucà Fabiana , Pavan Daniela , Gulizia Michele Massimo , Manes Maria Teresa , Abrignani Maurizio Giuseppe , Benedetto Francesco Antonio , Bisceglia Irma , Brigido Silvana , Caldarola Pasquale , Calvanese Raimondo , Canale Maria Laura , Caretta Giorgio , Ceravolo Roberto , Chieffo Alaide , Chimenti Cristina , Cornara Stefano , Cutolo Ada , Di Fusco Stefania Angela , Di Matteo Irene , Di Nora Concetta , Fattirolli Francesco , Favilli Silvia , Francese Giuseppina Maura , Gelsomino Sandro , Geraci Giovanna , Giubilato Simona , Ingianni Nadia , Iorio Annamaria , Lanni Francesca , Montalto Andrea , Nardi Federico , Navazio Alessandro , Nesti Martina , Parrini Iris , Pilleri Annarita , Pozzi Andrea , Rao Carmelo Massimiliano , Riccio Carmine , Rossini Roberta , Scicchitano Pietro , Valente Serafina , Zuccalà Giuseppe , Gabrielli Domenico , Grimaldi Massimo , Colivicchi Furio , Oliva Fabrizio
Published: May 2024

It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women’s diseases.
AL–AMYLOIDOSIS RELATED ADVANCED HEART FAILURE DIAGNOSED THROUGH F–18–FLUTEMETANOL PET SCAN
Authors: Calabrese A , Ghisletti A , Gori M , Iorio A , Giammarresi A , Quarta G , Cirelli C , Limonta R , Monticelli M , Fiori E , Galli M , Erba P , Senni M
Published: May 2024

Background

Systemic amyloidosis (SA) is a group of rare diseases in which abnormal misfolded proteins, amyloid fibrils, accumulate in tissue. The gold standard for diagnosis is tissue biopsy of the affected organ, but it is invasive and needs specific proteomic or immunohistochemistry analyses to characterize the involved protein. We report a case of a complex diagnosis of SA in an advanced heart failure (HF) patient.

Methods and Results

A 68–year–old woman with history of recurrent uveitis started to complain dyspnea in 2022, after Covid19. Since her symptoms worsened, in June 2023 she was diagnosed in another center with restrictive cardiomyopathy with preserved left ventricular (LV) ejection fraction. She underwent coronary angiography (unremarkable), cardiac MRI (aspecific fibrosis), and a FDG–PET scan which showed non–homogeneous LV fixation. The patient was treated with steroids for the suspicion of an immunologic–inflammatory disease, without benefit. Fourteen months after the initial presentation, she was admitted to our centre for advanced inotrope–dependent HF. She had mildly increased LV hypertrophy and severe systolic dysfunction with restrictive physiology and, notably, peri–orbital subcutaneous hemorrhages (Figure 1). Hematological screening for amyloidosis showed elevated serum free lambda light chains. Repeated cardiac MRI scan was consistent with infiltrative disease. A total–body PET scan with dual tracer was performed. The control session with F–18–FDG showed mild aspecific cardiac uptake in the basal septum and lateral wall (Figure 2), while off–label use of F–18–Flutemetanol, an Alzheimer‘s disease approved experimental tracer that binds to amyloid fibrils beta sheets with very high sensitivity and specificity, showed intense cardiac, hepatic, pulmonary and muscular uptake, with wash–out–timing diagnostic for AL–SA (Figure 3). Periumbilical fat biopsy confirmed the clinical suspicion of SA. Hematological investigations led to the diagnosis of stage I–A lambda micromolecular multiple myeloma, with systemic amyloidosis and a IIIb cardiac prognostic score.

Conclusions

Endomyocardial biopsy is an invasive procedure and periumbilical fat biopsy discriminates the amyloid protein type only by proteomic analysis, which is available in very few Italian centres. The off–label use of Alzheimers’ PET tracers could reduce the delay of cardiac AL–SA diagnosis, allowing early disease identification and prompting timely hematological therapy.
NUTRITIONAL STATUS IN PATIENTS WITH ACS: PRESENTATION OF THE DIET–ACS PILOT PROJECT
Authors: Sammartino A , Dainotto E , Pelli S , Gianni E , Gori P , Valenziano A , Toso A
Published: May 2024

Background and Aims

Recent evidence showed that malnutrition is an important poor prognostic factor for cardiovascular (CV) disease. Malnutrition is often considered a consequence of a state of undernutrition and, therefore, is believed to only affect underweight people. In fact, a major malnutrition problem affects the overweight and obese population due to inadequate consumption of micronutrients and poor food quality. This study sought to report the prevalence, clinical associations, and short–term prognostic consequences of malnutrition in patients with acute coronary syndrome (ACS).

Methods

This is a prospective observational pilot study that includes patients with a final diagnosis of ACS admitted consecutively to the UTIC of the Santo Stefano hospital in Prato. All patients (all spectrum ACS) are subjected to an early invasive strategy and treated with routine pharmacological therapy. In all cases the standard prevention protocol against contrast–induced acute kidney injury is applied. On admission, we measure: anthropometric parameters, indirect measurement of lipid and protein reserve; body composition with BIVA method; routine blood tests. The following nutritional indices are calculated: the Controlling Nutritional Status score (CONUT), the Nutritional Risk Index (NRI) and the Prognostic Nutritional Index score (PNI). Clinical end–points are: incidence of acute kidney injury (defined as an increase in serum creatinine ≥ 0.3 mg/dl within 48 hours of the invasive procedure); maximum increase in high sensitivity C reactive protein value; maximum decrease in hemoglobin value. During hospitalization, death, re–infarction, acute heart failure are recorded as major adverse clinical events.

Results

The study, which began on November 1, 2023, plans to enroll 120 consecutive patients. The prevalence of the state of malnutrition will be evaluated according to the various indices and its association with the pre–established clinical end–points will be analyzed.

Conclusions

The results will allow us to establish whether the evaluation of malnutrition in patients with ACS is decisive in quantifying the risk of complications, evaluating the response to therapy and impacting the prognosis. The results of this study will be presented and discussed at the congress.
LIFETIME MANAGEMENT OF AORTIC STENOSIS IN EXTREME SETTING
Authors: Esposito R
Published: May 2024

A 51–year–old male patient returned to our attention due to symptomatic severe aortic stenosis. Despite the severity of the aortic valve disease, he had been previously turned down from aortic valve replacement by us because of lack of symptoms and very unfavorable anatomy. Indeed he had been irradiated at the age of 3 due to Hodgkin’s Lymphoma and presented with porcelain aorta, small ascending aorta and aortic annulus. The patient returned to us with a 3–month history of progressive dyspnea (NYHA class IIa) and one episode of lipothymia during physical exercise. Physical examination, hematologic and biochemical investigations at admission were normal. Our trans–thoracic echocardiogram confirmed a trileaflet aortic valve (AV) that was severely stenotic and calcified with a mean gradient of 60 mmHg and an AV area of 0.5 cm2 (0.3 cm2/m2), in presence of good left ventricular systolic function with an ejection fraction (EF) of 60%. CT excluded coronary disease but, confirmed severe calcified aortic stenosis and porcelain aorta with small calcific sino–tubular junction and ascending aorta and protruding LVOT calcium. (Ascending aorta 19 mm; STJ 19 mm). The heart–team judged the patient not suitable for AVR and decided to perform a high–risk TAVI, leaving apical conduit as the last resort. From a technical standpoint, the LVOT calcium and the short and narrow STJ were high risk features for rupture with balloon expandable devices. On the other hand the short and narrow STJ with the narrow ascending aorta would represent a serious issue for the expansion of self–expanding devices and an even more troublesome feature for future coronary access and coronary occlusion in the setting of TAVI–in–TAVI down the road. Given the patient’s young age, a balloon expandable SAPIEN ultra 23 mm was chosen to be implanted with a two–step inflation to minimize the risk of STJ rupture. The prosthesis was partially expanded until anchoring was achieved on the aortic leaflets then, on continuous pacing, the balloon was rapidly collapsed, pushed down deeper under the STJ and fully inflated to achieve prosthesis’ inflow expansion. Intra–procedural and post–procedural course were uneventful and the patient was discharged home in 5th Day. Transthoracic echocardiogram at the dismission reveal a trans–aortic mean gradient of 18 mmhg, the absence of significant paravalvular leaks and a preserved ejection fraction. Pre–discharge CT scan confirmed feasibility of future TAVI–in–TAVI in case of need.
THE IMPACT OF HEART FAILURE ON QUALITY OF LIFE: A MIXED METHOD STUDY
Authors: Li Vigni M , Ghiadoni L , Pugliese N
Published: May 2024

Introduction

Heart failure (HF) is a significant global health problem, affecting over 64,000 people annually and resulting in high mortality rates (Savarese et al., 2023). However, for those receiving follow–up care, there is a 20% increase in 5–year survival (Braunwald, 2013). Globally, heart failure affects 1–3% of the population in developed countries, with 15 million patients in Europe and a 2% prevalence in Italy, accompanied by a 20% mortality rate (Heidenreich et al., 2022). Patients with heart failure often experience a reduction in quality of life (QoL), impacting their psychosocial well–being (Lupón, 2013). Indeed, those with lower QoL tend to experience more adverse events, such as rehospitalization and mortality (Ly et al., 2023). Therefore, it becomes crucial to assess QoL over time, utilizing new technologies for home monitoring. Continuous evaluation of QoL and the use of home monitoring technologies, such as telemedicine and telemonitoring, are essential and can have a positive impact on promoting QoL (Morken et al., 2022). OBJECTIVE: Investigate the perceived quality of life in geriatric patients with heart failure, describing the impact of the condition on QoL.

Materials and Methods

This mixed–methods study aims to explore QoL perception in a cohort of real–life outpatient geriatric patients with HF based on different stages of the disease. The study consists of two phases: a quantitative survey and a qualitative investigation. The KCCQ 23 scale was used to quantitatively assess self–reported QoL during in–person follow–up appointments and subsequently through phone follow–ups at 6 and/or 12 months. Additionally, the qualitative phase involved conducting semi–structured interviews via video calls.

Results, Discussion and Conclusions

The study involved 478 patients with heart failure, with women, who were underrepresented, reporting lower QoL than men. Analysis of interviews and subsequent triangulation of quantitative and qualitative data revealed that the QoL of HF patients is influenced by six identified themes: future perspectives, self–care, social interactions, emotional state, functional status, awareness of the disease, and awareness of one‘s health status. Furthermore, it was observed that deceased patients who received follow–up care reported significantly worse QoL scores compared to those who did not receive follow–up.
SAFETY AND EFFICACY OF EVOLOCUMAB IN PATIENTS WITH ACUTE CORONARY SYNDROME UNDERWENT TO CORONARY ARTERY BYPASS GRAFT: A COMPARATIVE RETROSPECTIVE ANALYSIS
Authors: Nasso G , La Rosa C , Bartolomucci F , Brigiani M , De Mola M , Valenti G , Amodeo V , Contegiacomo G , Hila D , Condello I , Speziale G , Santarpino G
Published: May 2024

Background

In–hospital reduction of low–density lipoprotein cholesterol (LDL–C) levels following the acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors (Evolocumab) in these patients undergoing surgical coronary revascularization has not been demonstrated.

Methods

From January 2022 to June 2023, we analyzed 74 patients presenting with ACS whose LDL–C levels were higher than guideline–recommended targets and underwent coronary bypass surgery. In the first period (January 2022– January 2023), the patients increased the Statin dosage and/or added Ezetimibe (Group STEZE 43 patients). At a later time (February 2023 – July 2023), the patients received not only Statin and ezetimibe but also evolocumab 140 mg every 2 weeks started as early as possible (Group STEVO 31 patients). One and three months after discharge the patients underwent a clinical and laboratory control with evaluation of the efficacy lipid measurements and every adverse event.

Results

The two groups not differ in terms of risk factors as mean age (STEVO: 68.5±6.8 y.o. vs. STEZE 70±7.4 y.o. p=0.38), Diabetes (STEVO: 12–38.7% vs. STEZE 18–41.8%, p=0.79), previous myocardial infarction (STEVO: 7–22.6% vs. STEZE 10–23.2%, p=0.91) and Euroscore II (STEVO: 2.14±0.75 vs. STEZE 2.05±0.6, p=0.29). Also in terms of ACS (ST–, Instable angina or NSTE) and time of symptom onset, there is no difference between groups. Most patients (74.4% in STEZE and 71% in STEVO, p=0.88) were on no statin at baseline. Cholesterol, LDL–C and HDL trends from preprocedural to 3 months follow up in both groups demonstrating a more significative reduction in LDL–C and Cholesterol in STEVO group and no difference in HDL–C raising. No deaths were reported. In 3 STEZE group a recurrence of angina poses the need of re–revascularization. No of STEVO patients occur one major adverse event. The statistic difference in terms of these serious events 7% in STEZE vs. 0% in STEVO was not significant (p=0.26).

Conclusions

Evolocumab initiated “as soon as possible” in ACS submitted to CABG with high–intensity statin therapy and ezetimibe was well tolerated and resulted in a substantial reduction in LDL–C levels at dismission, 1 and 3 months. This laboratory result is associated with a reduction in repeated–revascularization.
MULTIDISCIPLINARY PROJECT FOR DELIRIUM IN CICU
Authors: Lauretani F , Maggio M , Ardissino D , Paoli G , Bonura R , Dicembrino R , La Sala R , Baio A , Delsanto R , Gavagni S
Published: May 2024

Background

Delirium could be considered a geriatric syndrome encompassing an array of neuropsychiatric symptoms, which represents a disarrangement of the cerebral function in response to one or more pathophysiological stressors. The prevalence of delirium is high even in Intensive Care Units, where this condition may reach 80% in patients undergoing invasive technique. An estimated 30–40% of cases of delirium are preventable, and prevention is the most effective strategy to minimize the manifestation of delirium and its adverse outcomes. However, predictable episodes of delirium do not seem to be managed effectively.

Aim and Methods of the Study

Between May 2022 and June 2023, all patients aged 65 years or older admitted to the cardiac intensive care unit (CICU) were enrolled and followed for 1 year. This study is prospective observational cohort study aimed at evaluating the incidence of delirium in CICU patients and the relationship between delirium and predisposing and precipitating risk factors for example restraints, comorbidities. Multidisciplinary evaluation was realized for all patients who admitted in cardiac intensive care unit (CICU). The study was approved by the local ethics committee and was carried out in accordance with the Helsinki declaration. All patients provided written informed consent. Exclusion criteria were terminal status and patient refusal to participate in the study. A physician specialist in cardiology recorded all relevant information related to the patient‘s acute clinical conditions, baseline medical history mental, sociodemographic status and comorbidity through Cumulative Illness Rating Scale. Functional, nutritional and risk for delirium was assessed by a nurse.

Results

During the study period, 105 patients aged 65 years or older were assessed in CICU. The majority (n. 56, 53,33%) was male, the delirium incidence rate was 15 (14,29%). In the multivariable model, age (p 0.004), CIRS_ severity index (p 0.008), ADL (p 0.007), BMI ≥ 35 (p 0.01), BDZ (p 0.001), SSRI (p 0.05) were significantly associated with 4AT.

Discussion

In our study, CICU patients with delirium showed worse short and long–term clinical outcomes; similar data were shown in other studies (Falsini et al., 2018; Zipser et al., 2021). The presence of delirium itself had a strong clinical impact.

Conclusion

The results of the study allowed us to prepare a quality improvement plan for elderly CICU patients at risk of delirium.
WHEN CLINICAL FINDINGS TAKE YOU DOWN THE WRONG PATH: PERSISTENT FEVER IN A PATIENT WITH PREVIOUS CARDIAC SURGERY
Authors: Pedio E , Savino L , Giovannico L , Gentile M , Nucci G , Zaccaro S , Parigino D , Ostuni V , Bottio T
Published: May 2024

Introduction

In a patient who underwent previous cardiac surgery, persistent fever may be related to endocarditis. Symptoms and cardiovascular imaging, such as echocardiogram and PET/CT, may guide clinicians and surgeons to the correct diagnosis.

Discussion

A 43–years–old man came to our attention because of persistent fever (lasting several months) associated with cough and asthenia. When he was 5 years old, he underwent cardiac surgery for partial atrioventricular canal defect (atrial septal defect was about 4 cm) and mitral valve cleft. 14 years ago he undertook chemotherapy due to Hodgkin‘s lymphoma. Recently a cerebral artery aneurysm, radiologically defined as mycotic but proved to be fusiform, was diagnosed and treated with neurosurgery. During a recent hospitalization, blood culture positive for Streptococcus Mitis and brachial rash were reported and antibiotic therapy was started. Suspecting endocarditis, he was referred to our department. Echocardiogram revealed anterior mitral leaflet fissure, resulting in severe mitral regurgitation. Moreover a periannular cavity of doubtful interpretation (seemingly an abscess) was described. Subsequent 18FDG–PET/CT did not detect any abnormal cardiac metabolic activity. Due to severe valve regurgitation, cardiac surgery was performed: myxomatous degenerative mitral valve leaflets, failure of mitral valve cleft closure and anomalous coronary sinus communication to the left atrium (mimicking echocardiogram findings of suspected empty abscess cavity) were observed. Thus mitral valve replacement using a biological valve prosthesis was performed. Macroscopically there was no evidence of endocarditis, confirming PET/CT scan results. During the post–surgery period, third–degree atrioventricular block episodes were noted. Therefore a bicameral pacemaker was implanted.

Conclusions

This case report demonstrates the importance of not stopping at the first impression, as failure of previous mitral valve repair in a patient presented with persistent fever can mimic endocarditis. Therefore, the results of diagnostic tests should be compared to patients’ medical history and their clinical presentation.