bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypertensive Urgency: An Emergency Department Pipeline to Primary Care Pilot Study
Authors: Giaimo Antonio A , Kang Angela J , Huot Stephen J 
Published: November 2020

Abstract

BACKGROUND
Optimal triage of patients with hypertensive urgency (HU) in the emergency department (ED) is not well established. 2017 ACC/AHA hypertension (HTN) guidelines recommend treatment initiation and follow-up within 1 week. Objectives of our pilot study were to evaluate feasibility and impact of directly connecting ED patients with HU to outpatient HTN management on blood pressure (BP) control and ED utilization.

METHODS
ED patients with HU and no primary care physician were scheduled by a referral coordinator for an initial appointment in a HTN clinic embedded within a primary care practice. BP control and ED utilization over the subsequent 90 days were tracked and compared with BP at time of the referral ED visit, and ED utilization in the 90 days preceding referral.

RESULTS
Data are reported for the first 40 referred patients. Average time to first visit was 7.8 days. Mean age was 51 years (range 28–76), 75% were African-American, and mean pooled 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 20.8%. Mean BP declined from 198/116 mm Hg at ED visit to 167/98 mm Hg at HTN clinic visit 1 to 136/83 by 6 weeks and was sustained at 90 days. Total ED visits for the group decreased from 61 in the 90 days prior to referral, to 18 in the 90 days after the first HTN clinic visit.

CONCLUSIONS
In this pilot study, coordinated referral between the ED and primary care provides safe, timely care for this high ASCVD risk population and leads to sustained reductions in BP and ED utilization.
Testing Routine Activity Theory in Mexico
Authors: Vilalta Carlos , Fondevila Gustavo 
Published: November 2020

Abstract
Using a comprehensive victimization survey data set, we develop the first test of routine activity (RA) theory in a Latin American country. Estimating a complementary log–log multilevel model of the theory in several stages, we investigate what factors in the theory predict residential burglary risk. We find that measures associated with the exposure to potential offenders, target attractiveness, target accessibility, personal guardianship, social guardianship, and natural guardianship predict residential burglary in our sample of Mexican cities. As such, residential burglary is a complex crime with multiple factors at play, for which RA theory is a suitable theory given the conciseness of its propositions and operational definitions. We foresee RA theory successfully influencing future studies of crime in the Latin American region.
Asynchronous Glutamate Release at Autapses Regulates Spike Reliability and Precision in Mouse Neocortical Pyramidal Cells
Authors: Li Junlong , Deng Suixin , He Quansheng , Ke Wei , Shu Yousheng 
Published: November 2020

Abstract
Autapses are self-synapses of a neuron. Inhibitory autapses in the neocortex release GABA in 2 modes, synchronous release and asynchronous release (AR), providing precise and prolonged self-inhibition, respectively. A subpopulation of neocortical pyramidal cells (PCs) also forms functional autapses, activation of which promotes burst firing by strong unitary autaptic response that reflects synchronous glutamate release. However, it remains unclear whether AR occurs at PC autapses and plays a role in neuronal signaling. We performed whole-cell recordings from layer-5 PCs in slices of mouse prefrontal cortex (PFC). In response to action potential (AP) burst, 63% of PCs showed robust long-lasting autaptic AR, much stronger than synaptic AR between neighboring PCs. The autaptic AR is mediated predominantly by P/Q-type Ca2+ channels, and its strength depends on the intensity of PC activity and the level of residual Ca2+. Further experiments revealed that autaptic AR enhances spiking activities but reduces the temporal precision of post-burst APs. Together, the results show the occurrence of AR at PC autapses, the delayed and persistent glutamate AR causes self-excitation in individual PCs but may desynchronize the autaptic PC population. Thus, glutamatergic autapses should be essential elements in PFC and contribute to cortical information processing.
Deep Belief Network and Closed Polygonal Line for Lung Segmentation in Chest Radiographs
Authors: Peng Tao , Xu Thomas Canhao , Wang Yihuai , Li Fanzhang 
Published: November 2020

Abstract
Due to the varying appearance in the upper clavicle bone region, sharp corner at the costophrenic angle, the presence of strong edges at the rib cage and clavicle and the lack of a consistent anatomical shape among different individuals, accurate segmentation of lung on chest radiographs remains challenging. In this work, we propose a novel segmentation method for lung segmentation, containing two subnetworks, where few manually delineated points are used as the approximate initialization. The first one is a preprocessing subnetwork based on a deep learning model (i.e. Deep Belief Network and K-Nearest Neighbor). The second one is a refinement subnetwork, designed to make the preprocessed result to be optimized by combining an improved principal curve method and a machine learning method. To prove the performance of the proposed method, several public datasets were evaluated with Dice Similarity Coefficient (DSC), overlap score (Ω), Sensitivity (Sen), Positive Predictive Value (PPV), global Error (E) and execution time (t). Compared with state-of-the-art methods, our method reaches superior segmentation performance.
Robust Anomaly Detection in Feature-Evolving Time Series
Authors: Wambura Stephen , Huang Jianbin , Li He 
Published: November 2020

Abstract
This paper addresses the anomaly detection problem in feature-evolving systems such as server machines, cyber security, financial markets and so forth where in every millisecond, $N$-dimensional feature-evolving heterogeneous time series are generated. However, due to stochasticity and uncertainty in evolving heterogeneous time series coupled with temporal dependencies, their anomaly detection are extremely challenging. Furthermore, it is practically impossible to train an anomaly detection model per single time series across millions of metrics, leave alone memory space required to maintain the model and evolving data points in memory for timely processing in feature-evolving data streams. Thus, this paper proposes $\underline{o}$ne sketch $\underline{f}$its all $\underline{a}$lgorithm (OFA), which is a real-time stochastic recurrent deep neural network anomaly detector built on assumption-free probabilistic conditional quantile regression with well-calibrated predictive uncertainty estimates. The proposed framework is capable of detecting anomalies robustly, accurately and efficiently in real time while handling randomness and variabilities in feature-evolving heterogeneous time series. Extensive experiments and rigorous evaluation on large-scale real-world data sets showcase that OFA outperforms other competitive state-of-the-art anomaly detector methods.
Orthogonal electrical cardioversion in atrial fibrillation refractory to biphasic shocks: a case series
Authors: Velázquez-Rodríguez Enrique , Pérez-Sandoval Hipólito Alfredo , Rangel-Rojo Francisco Javier 
Published: November 2020

Abstract

Background
Biphasic waveform shock has been established as the standard method for cardioversion of atrial fibrillation (AF). Depending on various factors, standard electrical cardioversion for AF may be unsuccessful in some cases, even with biphasic shocks.

Case summary
We report the safety and efficacy of orthogonal electrical cardioversion (OECV) as an alternative in patients with paroxysmal AF refractory to standard biphasic electrical cardioversion after up to three subsequent shocks of increasing energy and/or two or three initial shocks with maximum energy of 200-Joules. Shocks were delivered with two external defibrillators via two sets of adhesive electrode pads to apply two perpendicular electrical vectors in a simultaneous-sequential mode in antero-lateral and antero-posterior configuration. Five patients, mean age 54.4 ± 11, three with hypertensive heart disease and a body mass index 27.2 ± 2 kg/m2. All individual mean impedance before OECV was 79 ± 5 Ω with a mean peak current applied of 22 ± 4.5 A. Restoration of sinus rhythm with OECV was achieved acutely and sustained in all five patients. No patients developed haemodynamic instability or thromboembolic events.

Discussion
Double simultaneous shocks in an orthogonal configuration could theoretically decrease the defibrillation threshold through the ability of sequential pulses applying a more efficient and uniform current density. OECV using lower/medium energy may be another useful rescue strategy in AF refractory to standard biphasic shocks.
Lipoprotein(a) and PCSK9 inhibition: clinical evidence
Authors: Ruscica Massimiliano , Greco Maria Francesca , Ferri Nicola , Corsini Alberto 
Published: November 2020

Abstract
Compelling evidence has emerged from epidemiological and Mendelian randomization analyses relative to the causality of lipoprotein(a) [Lp(a)] in atherosclerotic cardiovascular diseases (ASCVD), being elevated Lp(a) a strong risk factor regardless of the reduction of LDL-C achieved by statins. So far, no specific available agent can lower Lp(a) to the extent required to achieve a cardiovascular (CV) benefit, i.e. approximately 100 mg/dL. The most recent outcomes trial FOURIER with evolocumab showed that a 25 nmol/L (12 mg/dL) reduction in Lp(a) corresponded to a 15% decrement in the relative risk of cardiovascular disease. The ODYSSEY OUTCOMES trial with alirocumab has been the first demonstrating that a reduction in Lp(a) associates with less major adverse cardiovascular events (MACE), i.e. hazard ratio: 0.994 per 1 mg/dL decrement in Lp(a). The Lp(a) lowering effect driven by PCSK9 inhibition was confirmed in carriers of PCSK9 loss-of-function mutations in which Lp(a) and oxPL-apoB levels were decreased compared to non-carriers as was for a slight larger number of apo(a) Kringle IV repeats. Although PCSK9 inhibitors are not able to decrease Lp(a) to the extent required to achieve a CV benefit, their use has led to a higher discontinuation rate in lipoprotein apheresis in patients with progressive ASCVD and high plasma Lp(a).
Challenges in ischaemic heart disease: not sleeping enough, not brushing your teeth, and skipping breakfast—three ways of increasing your risk of myocardial infarction?
Authors: Muscente Francesca , De Caterina Raffaele 
Published: November 2020

Abstract
Despite optimal medical therapies, there is currently a persistent residual cardiovascular risk. The most likely pathway responsible for this residual risk has been identified in the inflammatory state. Recent studies have confirmed that inflammation increases cardiovascular risk independently from LDL cholesterol levels. Addressing traditional risk factors, such as obesity, cigarette smoking, diabetes, arterial hypertension, and dyslipidaemia, also provides an important reduction of the levels of inflammation. Nonetheless, inflammation is also a target for specific and focused therapeutic interventions. Recent studies have outlined an association between oral hygiene, sleep deprivation, and nutritional patterns on the one hand, with the development of multi-districts atherosclerosis and/or adverse cardiovascular events on the other. These lifestyle patterns appear to be involved in fostering inflammation associated with atherosclerosis. There is, however, a persistent need for further studies to clarify whether such associations with cardiovascular disease are direct and causal, and if they are all channelled through vascular inflammation.
Sodium-glucose co-transporter-2 drugs: are we sure they are useful only in the treatment of diabetes?
Authors: Vassiliki’ Coutsoumbas Gloria , Zagnoni Silvia , Corona Giovanni , Di Pasquale Giuseppe 
Published: November 2020

Abstract
The sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new class of oral anti-diabetic drugs acting through the inhibition of renal reabsorbtion of glucose. Three important randomized clinical trial in diabetic patients receiving SGLT2 inhibitors (vs. placebo), demonstrated a significant reduction of major adverse cardiovascular events, but only in patients with known atherosclerotic disease, and a clear-cut and early reduction in hospital admissions for heart failure in patients in primary as well as secondary prevention settings. This latter information prompted the design of a recent study the DAPA-HF (Dapagliflozin And Prevention Of Adverse-outcomes In Heart Failure) trial, comparing dapagliflozin vs. placebo, and showing a significant reduction of clinical relevant episodes of heart failure in patients with reduced left ventricular ejection fraction, regardless the presence of diabetes mellitus. The mechanism by which the SGLT2 inhibitors exert their anti-heart failure action is not well understood but appears to be independent from its hypoglycaemic action. These results, along with the scarcity of adverse side effects of the drug, render dapagliflozin a new tool in the treatment of heart failure.
Acute coronary syndromes with high thrombotic burden: therapeutic innovations
Authors: Menozzi Alberto , Caretta Giorgio 
Published: November 2020

Abstract
Antiplatelet agents represent one of the cornerstones of drug therapy for acute coronary syndromes (ACS). In the last decade, the arrival of prasugrel and ticagrelor, faster and more powerful oral platelet receptor P2Y12 inhibitors compared to clopidogrel, significantly improved platelet inhibition in patients with ACS. However, the reduction of thrombotic risk came at the cost of increased bleeding risk. Despite having similar indications, prasugrel and ticagrelor have different characteristics and methods of use, essentially due to a different design of the trials in which they have been studied. The optimal use of these antiplatelets in clinical practice should therefore be tailored in individual patients. In the acute phase of ACS with high thrombotic burden, all oral P2Y12 inhibitors have limitations, mainly due to the delay of onset of action related to oral administration. In this scenario, parenteral antiplatelet agents (glycoprotein inhibitors IIb/IIIa and cangrelor) may play a key role in case of percutaneous coronary interventions of high thrombotic coronary lesions and in the prevention of early thrombotic complications. Cangrelor, an intravenous inhibitor of the P2Y2 receptor, has peculiar pharmacokinetic and pharmacodynamic characteristics that make it particularly suitable to be used as an antiplatelet during coronary angioplasty as it achieves a rapid and powerful antiplatelet effect in patients not pretreated with oral medications, and has a favourable safety profile in relation to the bleeding risk.
Considerations on the use of MitraClip in the treatment of mitral regurgitation
Authors: Musumeci Giuseppe , Rossini Roberta 
Published: November 2020

Abstract
Mitral regurgitation (MR) is, by occurrence, the second most common valvular heart disease in the Western world, with a significant impact on prognosis and mortality. A significant number of patients with significant mitral incompetence cannot be submitted to conventional surgery due to high surgical risk. The need for an adequate therapeutical strategy prompted the development of innovative endovascular techniques. Among them, the MitraClip percutaneous system, mimicking the ‘edge-to-edge’ surgical technique introduced by Alfieri in 2003 has emerged as the treatment of choice in patients not suitable for conventional surgery. Since its introduction, this procedure has been effectively carried out in more than 35 000 patients. The evidences from the first randomized clinical trial, EVEREST II, suggested that the MitraClip system is effective in improving survival and quality of life in patients with severe MR. Further randomized trials, MITRA-FR and COAPT, added some more information, showing that an appropriate patient selection, close attention to the specific anatomical characteristics of the mitral valve, and adequate experience of the centre providing the treatment, are important determinants of the outcome of the procedure.
What connection is there between intestinal microbiota and heart disease?
Authors: Poli Andrea 
Published: November 2020

Abstract
Information on the correlation between intestinal microbiota and cardiovascular risk is growing. Some species of the microbiota influence the metabolism of specific food components (such as carnitine, choline, phosphatidyl-choline), synthesizing the precursor of trimethylamine oxide, a molecule with documented harmful activity on the vascular wall. Other strains, on the other hand, metabolize dietary fibre by synthesizing short-chain fatty acids, which have a significant anti-inflammatory activity, or produce secondary metabolites originating from molecules present in food (such as enterodiol, which derives from lignin), characterized by a vascular protection activity. Prebiotic effects from plant compounds (such as berberine or resveratrol) are also documented, which would induce favourable changes in the composition of the microbiota. The possibility of influencing the composition and activity of the intestinal microbiota will probably represent, in the future, an important component of cardiovascular prevention strategies.
Scientific progress and clinical uncertainty
Authors: Tavazzi Luigi 
Published: November 2020

Abstract
In the path underway towards Precision Medicine, two areas are in rapid development: genetics and artificial intelligence. In the genetic area, there are two current problems, both of the highest social importance. The first concerns the project, emerging in some countries, of systematic sequencing of the genome in the whole population. The problem is that reading the genome is very complex, requires specific knowledge, and the medical class is now unprepared. The second problem concerns the now achieved ability to modify the genome, which might be applied in the treatment of genetic diseases previously considered incurable. The techniques that can be used today are extremely delicate and expose to high risks. Artificial intelligence (AI) is a branch of neuroscience (‘computational neuroscience’) and advanced computer science which aims to apply the operational models of the human mind with the mnemonic and calculating power of advanced cybernetics. It is applied by conventional smartphone ‘apps’ to the most advanced computers used in various areas of diagnostic and prognostic medicine, image reading, big data management, setting of new pharmacological molecules, up to completely different applications, such as spoken language, automatic driving of vehicles, insurance plans, financial strategies, etc. Of course, with enormously different degrees of complexity. Will the doctors’ role survive?
Dose-related and contextual aspects of suboptimal adherence to antiretroviral therapy among persons living with HIV in Western Europe
Authors: Akinwunmi Babatunde , Buchenberger Daniel , Scherzer Jenny , Bode Martina , Rizzini Paolo , Vecchio Fabio , Roustand Laetitia , Nachbaur Gaelle , Finkielsztejn Laurent , Chounta Vasiliki , Van de Velde Nicolas 
Published: November 2020

AbstractBackgroundThe daily oral dosing requirement for antiretroviral therapy (ART) may be challenging for some people living with HIV (PLWHIV) with comorbid conditions, confidentiality concerns or pill fatigue. We investigated suboptimal adherence from the perspective of PLWHIV and HIV physicians.MethodsPLWHIV on ART (n = 688) and HIV physicians (n = 120) were surveyed during 2019 in France, Germany, Italy and the UK. Suboptimal adherence was a report the participant missed taking their dose as prescribed ‘Sometimes’/‘Often’/‘Very often’. Physicians’ interest in offering a hypothetical long-acting HIV regimen for suboptimally adherent patients was assessed. Descriptive and multivariable analyses were performed (P &lt; 0.05).ResultsOf PLWHIV, 23.8% (164/688) reported suboptimal adherence vs. providers’ estimated prevalence of 33.6% (SD = 28.8). PLWHIV-reported prevalence of specific suboptimal adherence behaviors were: mistimed dose [16.1% (111/688)]; missed a dose [15.7% (108/688)]; dosed under wrong conditions [e.g. food restrictions, 10.5% (72/688)] and overdosed [3.3% (23/688)]. Odds of suboptimal adherence were higher among those with vs. without a report of the following: dysphagia (AOR = 3.61, 95% CI = 2.28–5.74), stress/anxiety because of their daily dosing schedule (AOR = 3.09, 95% CI = 1.97–4.85), gastrointestinal side effects (AOR = 2.09, 95% CI = 1.39–3.15), neurocognitive/mental health conditions (AOR = 1.88, 95% CI = 1.30–2.72) or hiding their HIV medication (AOR = 1.51, 95% CI = 1.04–2.19). Of providers, 84.2% indicated they Definitely/Probably will offer a hypothetical long-acting HIV regimen ‘for patients who have suboptimal levels of adherence to daily oral therapy (50–90%) for non-medical reasons’.ConclusionsDysphagia, stressful daily oral dosing schedule, gastrointestinal side effects, neurocognitive/mental health conditions and confidentiality concerns were associated with suboptimal adherence in our study. Adherence support and alternative regimens, such as long-acting antiretroviral therapies, could help address these challenges.
The impact of the Fungus-Host-Microbiota interplay uponCandida albicansinfections: current knowledge and new perspectives
Authors: d'Enfert Christophe , Kaune Ann-Kristin , Alaban Leovigildo-Rey , Chakraborty Sayoni , Cole Nathaniel , Delavy Margot , Kosmala Daria , Marsaux Benoît , Fróis-Martins Ricardo , Morelli Moran , Rosati Diletta , Valentine Marisa , Xie Zixuan , Emritloll Yoan , Warn Peter A , Bequet Frédéric , Bougnoux Marie-Elisabeth , Bornes Stephanie , Gresnigt Mark S , Hube Bernhard , Jacobsen Ilse D , Legrand Mélanie , Leibundgut-Landmann Salomé , Manichanh Chaysavanh , Munro Carol A , Netea Mihai G , Queiroz Karla , Roget Karine , Thomas Vincent , Thoral Claudia , Van den Abbeele Pieter , Walker Alan W , Brown Alistair J P 
Published: November 2020

ABSTRACTCandida albicans is a major fungal pathogen of humans. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. The importance of the interplay between fungus, host and microbiota in driving the transition from C. albicans commensalism to pathogenicity is widely appreciated. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.