bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2778Geographic variability in the decline of the incidence of fatal and non-fatal stroke: a statewide study
Authors: Kostis J B , Cabrera J , Zinonos S , Kostis W J 
Published: October 2019

Abstract

Background/Introduction
There is scant information on the geographic variability in the rate of stroke incidence as it relates to the demographics, comorbidities, risk factors, and insurance type.

Purpose/Methods
County-level data on four modifiable groups of health factors including healthy behaviors, clinical care, physical environment, and socioeconomic conditions were obtained from the Robert Wood Johnson Foundation. The percentage of persons 65 years or older, smokers, physically inactive, obese, diabetics, heavy drinkers, college graduates, low income, unemployed, uninsured heads of single parent households, and residence in areas of violent crime was used in predicting fatal or non-fatal stroke. The counties were lumped into 5 categories based on similarities of the above characteristics. The incidence of fatal and non-fatal stroke was compared among the 5 county clusters using a mixed-effects regression model.

Results
The incidence of fatal and non-fatal stroke was significantly lower (p<0.0001) in cluster 3, where residents had higher income, were better educated, and were less likely to be unemployed, to live in single parent households, to have diabetes, to be obese, to smoke, to be physically inactive, or to live in communities with violent crime. The percentage of persons older than 65, violent crime rate, and obesity were identified as significant predictors of stroke using a mixed-effects regression model.

Conclusions
This study indicates that the incidence of stroke is higher in areas with older population, higher rate of obesity, and in regions with more violent crime. In order to improve health outcomes, preventive measures for stroke should address environmental factors in addition to the known cardiovascular risk factors.

Acknowledgement/Funding
Robert Wood Johnson Foundation
P2783Ascending aorta enlargement in patients referred to coronary artery calcium scoring
Authors: Sosnowski M , Czekaj A , Mlynarski R , Brzoska J , Chromik K , Wojakowski W 
Published: October 2019

Abstract

Background
Coronary artery calcium scoring is a main indication for a non-contrast-enhanced cardiac computed tomography (NCE-CCT). Great arterial vessels evaluation should be a part of CCT-based diagnosing.

Purpose
We aimed at analyzing data regarding great thoracic arterial sizes from a single-center cohort of 7950 patients who had NCE-CCT with a 64 raw scanner within the last decade.

Methods
In 5886 persons complete measurements of great arterial vessels' diameters at the level of the main pulmonary artery bifurcation were reported. The diameter of ascending aorta (AAD) was used to detect its enlargement on basis of absolute size, in relation to age and height (rAAD) and proportion to thoracic descending aorta (DAD) and main pulmonary artery (PAD). Respective criteria were: AAD≥43mm, rAAD>UNL for age/height (3.4+15.55*h+0.18*a), and AAD:DAD or AAD:PAD of 1.35 (range 1.1–1.6), both. Data were compared among patients with normal body mass index (BMI, kg/m2), overweight and obesity.

Results
Overall, increased absolute AAD was diagnosed in 149 persons (2.53%), rAAD>UNL in 358 (6.08%) and abnormal proportions AAD:DAD or AAD:PAD in 370 (13.0%) or 959 (16.3%), resp. Relative AAD was normal in 11 and 7 had normal proportions out of those with abnormal measured AAD. Among 138 patients with concordant absolute and relative increases, in 53 normal proportions were stated. In a cohort of 5737 patients with normal AAD (absolute), rAAD>UNL was found in 220 subjects (3.83%). Among remaining 5517 with normal both absolute and relative AAD, at least one abnormal proportion was found in 985 patients (17.9%). Taking into account BMI, the incidence of abnormal AAD was 0.3% in normal BMI patients (n=1409), 2,5% in overweight (n=2503) and 3.2% in obese (n=1974), while incidence of abnormal rAAD>UNL was 2.7%, 3.0% and 5.5%, resp. Abnormal proportions indicating abnormality within DAD or PAD were found in 1.1% and 3.8% normal BMI pts, in 2.4% and 4.7% overweight pts, and in 2.3% and 8.8% obese pts.

Conclusions
Absolute increase in ascending aorta size is relatively infrequent in patients referred to coronary artery calcium scoring. Use of age-height regression-based criteria increased diagnosis of abnormal ascending aorta size. Mutual proportions analysis among large arterial vessels showed further 5–6 fold increase in detection their abnormalities well before absolute or regression-based criteria are met. Great arterial vessels abnormalities are more frequent in overweight and obsese patients. Use of proportion analysis might be a step towards an individually-oriented medicine.
P2824A new Utstein-based model score to predict survival to hospital admission: the TICINUM score
Authors: Baldi E , Caputo M L , Savastano S , Burkart R , Benvenuti C , Palo A , Oltrona Visconti L , Auricchio A , De Ferrari G M 
Published: October 2019

Abstract

Background
The prediction of the possibility of return of spontaneous circulation (ROSC) in the individual patient is one of the major challenges confronting resuscitation science. The RACA score has been proposed to predict the achievement of a ROSC longer than 20 seconds in field (out-of-hospital, OH). However, no score exists to predict a ROSC sustained until arrival at the emergency department, using the standardized Utstein-based categorization of variables.

Purpose
To create a new Utstein-based score to predict the survival to hospital admission of an OH cardiac arrest (CA) victim.

Methods
We performed a retrospective analysis of all prospectively collected OHCAs occurred between 2015 and 2017 in two regions, one in northern Italy and the other in southern Switzerland. All consecutive patients who suffered an OHCA of any aetiology between 01/01/2015 and 31/12/2017 in whom CPR was attempted were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We included the same variables used in the RACA score, re-categorized following Utstein recommendations. For model validation, we computed the model area under the ROC curve (AUC ROC) for discrimination. We derived the TICINUM score using the coefficients estimated in the regression model (multiplied by 10 and rounded to the nearest integer). We plotted the score against the probability of hospital ROSC.

Results
1961 patients were included in our analysis (62% males, mean age 73±16 years old). Age, aetiology, witnessed OHCA, site of OHCA, time of EMS arrival and shockable rhythm were independently associated with survival to hospital admission. The model showed a good discrimination (AUC 0.83, 95% CI 0.81–0.85) for predicting survival to hospital admission. The model variables and their odd ratios are presented in Figure 1 (left). The score value is obtained summing a coefficient calculated for each variable. The nomogram of the probability of survival to hospital admission associated to the different score values is presented in the Figure 1 (right).
Figure 1

Conclusion
The TICINUM score is a new score, which allows to predict with good discrimination the probability of survival to hospital admission of an OHCA victim. The simple calculation and the fact that it is Utstein based makes it easily applicable by EMS personnel during an OHCA scenario.
P2848Electrical reconnections after pulmonary vein isolation with or without contact force-guided catheters: a comparison of the proficiency of atrial fibrillation ablation
Authors: Fujimoto Y , Yodogawa K , Iwasaki Y , Hachisuka M , Mimuro R , Maru Y , Oka E , Hayashi H , Yamamoto T , Shimizu W 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) ablation is the most commonly performed catheter ablation (CA) procedure today. The 2015 ACC/AHA/HRS Advanced Training Statement reported that the success rate of AF ablation is higher in high-volume centers than in low-volume centers. We tested whether the procedure proficiency of each operator was associated with the outcome of AF ablation, and whether the ablation outcome depended on whether contact force (CF)-guided catheters were used or not, in a high-volume center.

Methods
We conducted a retrospective observational study including all AF patients who underwent radiofrequency CA with or without CF support since 2016 at our hospital. The patients who underwent CA at other hospitals or underwent a balloon or surgical ablation in the first session were excluded. Each ipsilateral pulmonary vein (PV) pair was divided into 8 segments. The reconnection numbers and sites of the PV segment were evaluated in the second session. Operators were divided into the experienced group (≥100 AF cases/year, at least every 3 years) and developing group (other than the experienced group), respectively.

Results
Among 728 patients who underwent an initial AF ablation and were followed for 510±306 days, 131 (90 males, 65±10 years) received a second ablation procedure and were analyzed. A total of 260 and 264 PV isolations (PVI) were performed by the experienced and developing group operators in the initial ablation, respectively. Compared to the experienced group, the developing group had a longer procedure time for the PVI (35±15 vs. 28±10 min, p<0.001), higher frequency of reconnections of the PVs (73% vs. 59%, p=0.01) and higher number of reconnection gaps (2.1±2.0 vs. 1.5±2.0, p=0.02), respectively. There were no significantly differences in the number of gaps between the catheters with and without CF (1.6±2.0 vs. 1.4±2.0, p=0.65) in the experienced group, however, in the developing group a smaller total number of gaps (1.5±1.6 vs. 2.4±2.1, p=0.006) and less frequency reconnection gaps of the posterosuperior segment of the right PV (10% vs. 45%, p=0.005) were seen with catheters with CF than without. There was no significant difference in the procedure time for the PVI between catheters with and without CF.

Conclusions
The operator proficiency may predict the outcome after AF ablation even in high-volume centers. It is preferable to perform PVI with a CF-sensing catheter for operators without adequate proficiency.

Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K15865
P2849Prevalence and significance of sustained pulmonary vein isolation in repeat AF ablation procedures
Authors: Nascimento Matos D J , Cavaco D , Rodrigues G , Carmo J , Carvalho M S , Ferreira A M , Costa F , Carmo P , Morgado F , Mendes M , Adragao P 
Published: October 2019

Abstract

Introduction
Pulmonary vein (PV) reconnection is a common cause of relapse after catheter ablation of atrial fibrillation (AF). However, some patients have AF recurrence despite durable PV isolation. The aim of this study was to assess the PV isolation status at the time of a second catheter ablation (redo) procedure, and its relationship with subsequent AF relapse.

Methods
Consecutive patients with symptomatic drug-resistant AF who underwent redo procedures from January 2006 to December 2017 were identified in a single-center observational registry. Pulmonary vein isolation status was assessed during the electrophysiologic study with a circular mapping catheter. Additional radiofrequency (RF) energy applications were also recorded. AF relapse was defined as symptomatic or documented AF/atrial tachycardia/atrial flutter after a 3-month blanking period.

Results
We identified 240 patients (77 [32%] females, median age 61 [IQR 53–67] years, 85 [35%] with non-paroxysmal AF) undergoing redo procedures during the study period. At the time of redo, 17 (7%) of the patients presented bidirectional conduction block of all PVs. PV reconnection occurred in 157 (65%) of cases in the left superior vein, 142 (59%) in the left inferior vein, 177 (73%) in the right superior vein, and 163 (68%) in the right inferior vein (table). All of the PVs were reconducted in 91 (38%) patients. Additional RF applications were performed in the left atrium (LA) roof, LA posterior wall, cavotricuspid isthmus, mitral isthmus, superior vena cava, coronary sinus, and left atrial appendage ostium, at the operator's discretion (table 1).
Over a median follow-up of 2-years (IQR 1–5), 126 patients (53%) suffered AF recurrence, yielding a mean relapse rate of 17%/year. In multivariate Cox regression analysis, the lack of PV reconnection at the time of redo emerged as an independent predictor of subsequent relapse (HR 1.97, 95% CI 1.12–3.49, p=0.019) even after adjustment for univariate predictors including non-paroxysmal AF, body mass index, female sex, and active smoking.

Conclusion
In patients undergoing redo AF ablation procedures, less than 10% present with complete PV isolation. Despite being relatively infrequent, this finding is independently associated with greater likelihood of subsequent recurrence, suggesting that other mechanisms, not fully addressed by additional RF applications, are at play.
P2863Regional specific remodeling of cGMP pathway in human atrial fibrillation
Authors: Bork N I , Pavlidou N G , Reiter B , Reichenspurner H , Christ T , Nikolaev V O , Molina C E 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is accompanied by a profound remodeling of membrane receptors and alterations in cyclic nucleotides-dependent regulation of Ca2+-handling. Thus, while basal ryanodine receptors activity is upregulated, L-type calcium current (ICa,L) density is diminish in AF, due to local microdomain-specific cAMP dynamics. The same seems true for cGMP regulation in AF. In AF cGMP-mediated increase in ICa,L is blunted but NO-mediated attenuation of β-adrenoceptors stimulation-mediated increase is preserved. However, although the role of cGMP in controling atrial function and pathophysiology is controversial, no study has been ever performed in human myocytes to measure cGMP directly.

Methods
We isolated myocytes from the right and/or left atrium of 27 patients in sinus rhythm (SR), and with AF. Cells were then transfected with adenovirus to express the cytosolic FRET-based cGMP sensor red-cGES-DE5 and cultured for 48 hours. Förster resonance energy transfer (FRET) was used to measure cGMP in 61 living human atrial myocytes. We stimulated cells with the C-type natriuretic peptide CNP (100 nM and 1 μM), and the non-selective phosphodiesterases (PDEs) inhibitor IBMX (100 μM). Additionally, PDE specific inhibitors for PDE2 (Bay 60–7550, 100 nM) and PDE3 (Cilostamide, 10 μM) as well as inhibitor of the soluble guanylyl cyclase (ODQ, 50 μM) were used. We also measured PDE2 and PDE3 mRNA levels in atrial tissue samples from both groups of patients using RT-qPCR.

Results
We could show that stimulation with CNP increased cGMP levels in human atrial myocytes. However, in myocytes from patients with AF global cGMP responses to CNP and to IBMX was reduced compared to SR. Additionally, there was a difference in response to CNP and IBMX in patients with AF between the right and the left atria. Whereas in the right atria IBMX could further increase cGMP levels in the cell, in the left atria leaded to a reduction in cGMP levels. RT-qPCR showed a tendency of PDE3 to be reduced in AF. On the other hand, PDE2A gene expression was upregulated in the left atria.

Conclusions
We have shown that PDEs contributes cGMP signaling in the human atria and that they are involved in atrial pathophysiology. Now our data clearly show differences in cGMP regulation in cardiomyocytes isolated from left and right atrium from patients in atrial fibrillation and sinus rhythm. We observe a major role of PDEs, regulating cGMP pathway promoted by the reduced responses in AF, especially PDE2 in the left atria.
P2866Automated ultrasound ablation parameters predict lesion depth in a perfused thigh model
Authors: Marrouche N , Joseph M , Godfrey J , Phillips P , Piazza D , Macnamara F , Harari D 
Published: October 2019

Abstract

Background
The accuracy and safety of lesions created during catheter ablation of cardiac tissue rely on the user's ability to predict the size of lesions that form under variable conditions during treatment. A user-directed robotic system was developed that uses Low-Intensity Collimated Ultrasound (LICU) for cardiac imaging and to produce linear lesions without tissue contact. Molecular absorption of mechanical energy induced in the tissue by LICU causes a temperature rise resulting in thermal tissue necrosis.

Purpose
By varying the speed of the LICU beam as it traces the desired lesion path, while considering the beam intensity, distance from catheter tip to tissue, and relative motion of the target tissue, we demonstrate the capability to deposit lesions of known depth according to a predictive model.

Methods
The LICU catheter was mounted in a servo-controlled, 3 axis stage suspended above a perfused porcine thigh that simulates the thermodynamic properties of the myocardium such as acoustic attenuation, thermal conduction, and specific heat capacity. Therapy was delivered along a linear path while varying the distance to tissue, speed of the beam, and motion of the catheter relative to the tissue in 3 dimensions. Programmed relative motion was representative of typical and extreme motion in humans. Pathological analysis after necropsy was used to quantify lesion depth which was then compared to lesion depth as predicted by a mathematical model from approx. 4–12 mm.

Results
Data from 66 samples were categorized according to typical and extreme motion at 4 different distances (3, 8, 9 and 13 mm). Measured vs predicted lesion depth was well correlated (R = 0.898) with 98.5% of the samples within ±2 mm.
Assessment of LICU lesion depth

Conclusion
Lesion depth using LICU is well controlled in an animal model for the range of distances and relative motion typically encountered in a human subject. The range of acoustic beam speeds and acoustic power density with LICU predictably produces lesions up to 12 mm deep. The LICU thermal model may be useful to create lesions of known depth thus ensuring transmurality of lesions while potentially avoiding unintended extra-cardiac injury.
P2884Complications of cardiac implantable electronic device intervention in patients with left ventricular assist devices
Authors: Kiani S , Black G B , Lloyd M S , Merchant F M , El-Chami M F , Cole R T , Hoskins M H , Westerman S B 
Published: October 2019

Abstract

Background
There are limited data on management of cardiac implantable electronic devices (CIED) in patients with left ventricular assist devices (LVADs). These patients may be at elevated risk of complications after undergoing CIED procedures.

Purpose
In order to better understand these risks, we set out to describe and quantify the complications associated with CIED procedures among patients with LVADs.

Methods
We retrospectively evaluated all patients with LVADs at our institution (n=235) from August 2007 to November 2017 who had any subsequent CIED procedure (initial implant, generator exchange, lead revision or extraction). We identified device-related complications at 30 days and one year from the time of the CIED procedure. Complications were defined as death, stroke, cardiac perforation, pericardial effusion, pneumothorax, lead dislodgment, infection, and any hematoma requiring a direct physician encounter.

Results
Forty-eight CIED interventions were performed on 42 patients after LVAD implant. Mean age was 49.4±15.1 years and 64% were male. Mean duration of LVAD therapy prior to procedure was 396 days. All patients were on warfarin therapy (mean INR 2.33±0.68); in 83% of procedures patients were on at least one anti-platelet agent. All interventions involved placement or revision of an ICD system. Fourteen procedures (29%) were initial implants and 34 (71%) were secondary procedures (19 generator exchanges, 13 lead revisions ± generator exchange and 2 extractions). Seven procedures (14.5%) were complicated by pocket hematoma; all of these were in secondary procedures. Patients with hematomas trended toward higher INR (2.51±0.26 vs 2.31±0.72); this was not statistically significant. Two patients with hematoma developed CIED infection, resulting in a total infection rate of 4.2%. Of those, one developed systemic infection requiring extraction of the system and the other developed a pocket infection managed with pocket washout and prolonged antibiotics. All complications occurred within 30 days of the procedure (Figure 1).
Figure 1. Complication free survival

Conclusion
In this single center study, CIED procedures on patients with preexisting LVAD was associated with a low rate of complications requiring intervention.

Acknowledgement/Funding
Emory University
Decreasing Colectomy Rate for Ulcerative Colitis in the United States Between 2007 and 2016: A Time Trend Analysis
Authors: Barnes Edward L , Jiang Yue , Kappelman Michael D , Long Millie D , Sandler Robert S , Kinlaw Alan C , Herfarth Hans H 
Published: October 2019

Abstract

Background
Improved treatment approaches for ulcerative colitis (UC), including novel medications, might reduce the need for colectomy. We performed a retrospective cohort study of adult patients (age 18–64) with UC in the United States to examine time trends for colectomy and biologic use from 2007 to 2016.

Methods
We estimated quarterly rates for colectomy and biologic use using the IQVIA Legacy PharMetrics Adjudicated Claims Database. We used interrupted time series methods with segmented regression to assess time trends with 95% confidence intervals (CIs) for biologic use and colectomy before and after the emergence of newly available biologic therapies in 2014.

Results
Among 93,930 patients with UC, 2275 (2.4%) underwent colectomy from 2007 to 2016. Biologic use rates increased significantly from 2007 to 2016, from 131 per 1000 person-years in 2007 (95% CI, 121 to 140) to 589 per 1000 person-years in 2016 (95% CI, 575 to 604; P < 0.001). Colectomy rates decreased significantly between 2007 and 2016, from 7.8 per 1000 person-years (95% CI, 7.4 to 8.2) to 4.2 per 1000 person-years in 2016 (95% CI, 3.2 to 5.1; P < 0.001). An interruption in 2014 was associated with a positive trend deflection for biologic use (+72 treatments per 1000 person-years per year (95% CI, 61 to 83) and a negative trend deflection for colectomy (–0.76 per 1000 person-years per year; 95% CI, –1.47 to –0.05).

Conclusions
Among commercially insured patients in the United States from 2007 to 2016, biologic use rates increased, colectomy rates decreased, and both trends were impacted by the interruption in 2014. These findings suggest that new biologic therapies may have contributed to decreased colectomy rates.
GBS type III oligosaccharides containing a minimal protective epitope can be turned into effective vaccines by multivalent presentation
Authors: Carboni F , Angiolini F , Fabbrini M , Brogioni B , Corrado A , Berti F , Adamo R , Margarit I 
Published: October 2019

Abstract
Recent structural studies demonstrated that the epitope recognized by a monoclonal antibody representative of the protective response against the type III Group B Streptococcus polysaccharide was comprised within two of the repeating units that constitute the full-length native structure. Here we took advantage of this discovery to design a novel vaccine based on multivalent presentation of the identified minimal epitope on a carrier protein. We show that highly glycosylated short oligosaccharide conjugates elicit functional immune responses comparable to the full-length native polysaccharide. The obtained results pave the way to the design of well-defined glycoconjugate vaccines based on short synthetic oligosaccharides.