bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insights into a regional collaboration for improving heart care across the complete care chain
Authors: Dekker L R C , Van Veghel D , Theunissen L J H , Janssen J H P , Burg M P , Van De Pol J A A , Cremers H P 
Published: October 2021

Abstract

Background
The Netherlands Heart Network is a joint-effort of all relevant healthcare providers in primary, secondary, and tertiary care across the complete care chain in a region with an adherence of approximately 1,000,000 inhabitants. This regional collaboration features four non-academic hospitals, over 450 general practitioners and various other healthcare professionals who cooperate for the continuous improvement of cardiac patient care using Value Based Healthcare principles.

Purpose
Due to predicted demographic changes and the expected rise of cardiovascular diseases, novel initiatives are needed to optimize present-day healthcare systems. Therefore, the NHN has focused on the implementation of transmural integrated care delivery systems and impactful innovations for four major cardiovascular diseases: atrial fibrillation (AF), heart failure (HF), coronary artery disease and valvular diseases.

Methods
Various new health care initiatives and innovations have been implemented and evaluated in the region. For example, dedicated outpatient clinics and transmural care standards have been implemented for AF and HF across the full care cycle. The effect of the implementation of these care standards on patient-relevant outcomes and healthcare costs has been evaluated using large scale prospective and retrospective quality registries. Furthermore, new health care innovations include, among others, the opportunistic screening for AF within general practices and an optimized pre-hospital triage protocol for NSTEMI patients.

Results
Patient-relevant outcomes in 446 AF patients who visited dedicated outpatient clinics improved within 6 months of follow-up (EHRA score (1.93 to 1.36; p&lt;0.01), hypertension (55.4% to 52.7%; p&lt;0.01) and persistent AF (30.1% to 12.5%; p&lt;0.01)). The introduction of transmural care standards for HF led to significant improvements in patient-relevant outcomes when comparing data before and after implementation (NYHA class (X2=9.1; p=0,03) and LVEF (41.7% vs. 38.4%; p&lt;0.01)) and a reduction of mean healthcare costs by 25%. Moreover, the results of various innovations, including the AF screening protocol and potential benefits of pre-hospital triage of NSTEMI patients, are currently being evaluated.

Conclusion(s)
This regional collaboration by health professionals is unique in its approach and highlights that healthcare improvements are not exclusively reserved to large academic centers or referral hospitals. The present approach may serve as a blueprint for the organization of healthcare in other regions.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMWHealth insurance CZ/VGZ
Water hardness and its impact on arterial stiffness and carotid atherosclerotic burdens; insights from the 'Corinthia study'
Authors: Vogiatzi G , Oikonomou E , Lazaros G , Kostakis M , Kypritidou Z , Christoforatou E , Chasikidis C H , Mystakidi V , Theofilis P , Vavouranaki G , Goliopoulou A , Argyraki A , Thomaidis N , Tousoulis D 
Published: October 2021

Abstract

Introduction
It has been long investigated the potential role of water quality in cardiovascular health.

Purpose
The aim of this study was to examine the association between water hardness, arterial stiffness and atheromatic burden in carotid arteries.

Design and methods
Corinthia study is a cross-sectional epidemiological study conducted in subjects aged 40–99 years. Intima media thickness (IMT) was measured in the left and right common carotid artery, carotid bulb and internal carotid artery. The average of the measurements (mean IMT) and the maximum IMT were determined as the representative value of carotid atherosclerosis burden. Pulse wave velocity (PWV) was used to evaluate arterial stiffness. Tap-water samples were collected from the study area, and analyzed for major, minor and trace elements, as well as pH and total hardness.

Results
In this analysis we included data from 1.404 participants. In subjects consuming water with a hardness above 250mg/dL, especially in those above &gt;65 years old maximum and mean IMT was significantly increased compared to those consuming water with a hardness above 250mg/dL (1.61mm vs. 1.34mm respectively, p&lt;0.001 and 1.15mm vs. 1.05, p=0.005 for WH ≥250mg/dL and WH &lt;250mg/dL, respectively). Similarly, the prevalence of atheromatic plaques was higher in subjects of the first category (15,2% vs. 7,6%, p=0.004). No differences emerged for the arterial stiffness in the individual subgroups. statistically significant correlation was revealed (p=0.004).

Conclusions
There seem to be a negative association between extra hard water and carotid atheromatic burden highlighting the possible impact of water quality in cardiovascular health.

Funding Acknowledgement
Type of funding sources: None. Table 1
Global representation of heart failure clinical trial leaders and collaborators: a systematic bibliometric review 2000–2020
Authors: Zhu J , Le N , Wei S , Zuhlke L , Lopes R , Zannad F , Van Spall H G C 
Published: October 2021

Abstract

Aims
Heart Failure (HF) has a disproportionate burden in low- and middle-income countries. The geographic representation of those who lead HF randomized clinical trials (RCTs) may not reflect the geographic burden of disease. We assessed temporal trends and trial characteristics associated with leadership outside Europe and North America, and explored whether there was a geographic association between trial leadership and participant enrolment.

Methods and results
We searched MEDLINE, EMBASE, and CINAHL for HF RCTs published in journals with an impact factor ≥10 between January 1, 2000, and June 17, 2020. We used the Jonckheere-Terpstra test to assess temporal trends and multivariable logistic regression models to determine associations between predictor and outcome variables.
There were 414 eligible RCTs. Only 80 of 828 trial leaders (9.7%; 95% CI: 7.8% to 11.8%), and 453 of 4656 collaborators (9.7%; 95% CI: 8.8% to 10.6%) were from regions outside Europe and North America, with no temporal change in geographic representation. The odds of trial leadership outside Europe and North America were significantly lower with industry versus public funding (OR: 0.33; 95% CI: 0.15 to 0.75; P=0.008). Trial leadership outside Europe and North America was associated with enrolment of patients outside Europe and North America (OR: 10.0; 95% CI 5.6–19.0; P&lt;0.001).

Conclusion
Trial leadership outside Europe and North America is rare, particularly in industry funded trials, and is associated with participant enrolment in regions with disproportionate disease burden. Building research capacity and networks in under-represented regions could increase generalizability of trial results.

Funding Acknowledgement
Type of funding sources: None.
The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients
Authors: Stavileci B , Ozdemir E 
Published: October 2021

Abstract

Introduction
Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally.

Purpose
The aim of this study is to analyses the daily Troponin-I and D-dimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients.

Methods
206 patients who were hospitalized between 20.03.2020–05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days.

Results
Average age was higher in mortality group compared to non-mortality group (respectively 67.79±14.9, 56.87±18.15, p:&lt;0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p&lt;0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin-I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p&lt;0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p&lt;0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity %78.3, p&lt;0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p&lt;0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC: 0.738, sensitivity %68.4, specificity: %65.9, p&lt;0.001).

Conclusion
We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.

Funding Acknowledgement
Type of funding sources: None.
Beta-blocker/ACE inhibitor therapy differentially impacts the steady state signaling landscape of failing and non-failing hearts
Authors: Sorrentino A , Bagwan N , Linscheid N , Poulsen P , Kahnert K , Thomsen M , Delmar M , Lundby A 
Published: October 2021

Abstract

Background
The molecular underpinnings of heart failure with reduced ejection fraction (HFrEF) involves a complex remodeling of the contractile, metabolic and electrical functions. Current pharmacotherapy for patients presenting HFrEF includes combination of angiotensin-converting enzyme inhibitors (ACEi) and β-adrenergic receptor blockers (β-AR blockers). Yet, a knowledge gap exists regarding the molecular changes accompanying such treatment.

Purpose
The present study takes an omics approach to study protein and phosphorylation signaling derangement in HFrEF and to define the global changes resulting from treatment with β-AR blocker (metoprolol) and ACE inhibitor (enalapril) in control- and HFrEF hearts.

Methods and results
For induction of HFrEF, a tight and permanent ligature was applied to constrict the transverse aorta in male C57BL6 mice. Eight weeks post-surgery, an osmotic pump was implanted delivering either vehicle or treatment (enalapril, ACE inhibitor, and metoprolol, β-AR blocker) for a two week period. The proteome- and phosphoproteome of left ventricular tissue was resolved using high-resolution liquid chromatography-mass spectrometry. The resulting dataset covered 6,004 proteins and 14,967 phosphorylation events. HFrEF was characterized by profound downregulation of mitochondrial proteins coupled with derangement of β-adrenergic and pyruvate dehydrogenase signaling. Upon treatment, phosphorylation changes consequent to HFrEF were reversed, including a reversal of Pdhk4 activity. In controls, treatment mainly led to downregulation of canonical PKA signaling. Overall, the signaling response elicited by treatment was profoundly different for failing than for control hearts.

Conclusions
We used state-of-the-art proteomics and phosphoproteomics approaches to analyze changes in protein abundance and phosphorylation state of the left ventricle resulting from combination therapy with a β-AR blocker and an ACE inhibitor in failing and non-failing hearts. Our observation of divergent signaling outcomes depending on the disease state of the heart underscores the importance of evaluating drug effects within the context of the specific conditions present in the recipient heart.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Council for independent ResearchLundbeck FoundationFondation Leducq Transatlantic Network of Excellence
Molecular background of impairments in skeletal muscle of heart failure patients
Authors: Ivanova O , Komarova M Y , Ignatieva E V , Lelyavina T A , Galenko V L , Sitnikova M Y U , Gusev O A , Shagimardanova E V , Kostareva A A , Dmitrieva R I 
Published: October 2021

Abstract

Background
Heart failure (HF) is characterised by systematic inflammation and chronic metabolic dysregulation. HF enhances the release of pro-inflammatory cytokines, induces activation of the complement system, production of autoantibodies, and over-expression of the major histocompatibility (MHC) complex class II molecules. It is known that skeletal muscles are exposed to the immunologic injury in disease; and muscle tissue appeared to be affected by HF leading to the muscle weakness and exercise intolerance development. However, molecular abnormalities occurring in HF patients' muscles and the mechanisms underlying its development are not clarified.

Purpose
To understand the molecular mechanisms underlying skeletal muscle immune and non-immune impairments in HF.

Methods
8 health donors and 5 HF patients with reduced ejection fraction (NYHA Class II and III) were enrolled in this study in accordance with the principles under the Declaration of Helsinki (1989). mRNA of skeletal muscle biopsies of gastrocnemius lateralis were sequenced on Illumina HiSeq. RNA-seq analysis was performed using STAR with reference genome GRCh38 and featureCounts program; differentially expressed genes (DEGs) were assessed using R package DESeq2 with FDR=0.01 and log2 fold change (l2fc) &gt;1.5 filter; pathway analysis was performed using clusterProfiler in R (FDR=0.01).

Results
1404 differentially expressed genes distinguish muscles of HF patients and controls. Among upregulated genes there are different classical MHC molecules and specific one HLA-G (l2fc=2) that has been previously shown appeared in muscles under autoimmune myopathies, and potentially protect them. Unregulated DEGs were responsible for the activation of many molecular immunological pathways: type I interferon signaling pathway (16 DEGs out of total 89), regulation of T cell proliferation (14/153), neutrophil degranulation (31/485), granulocyte differentiation (7/32), negative regulation of viral process (11/53), that indicates about specific inflammatory response in HF muscles. Response to hypoxia (22/314) and gluconeogenesis pathways (12/87) were also activated. Downregulated genes include SLC5A1 (l2fc=−4) sodium glucose cotransporter; NRP3 (l2fc=−4) that plays a role in modulating intravascular volume and vascular tone; MMP1 (l2fc=−13) involved in the breakdown of extracellular matrix; the expression of many genes responsible for DNA-repair (44/534) and cilium assembly (34/366) was also suppressed.

Conclusion
Transcriptome analysis shows immunological and non-immunological alterations in HF skeletal muscles and provides the information about molecular mechanisms of its development.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation grant
Role of QRS amplitude, fractionation and duration in predicting clinical response to anti-inflammatory treatment in cardiac sarcoidosis
Authors: Arceluz M , Frankel D , Tschabrunn C , Santangeli P , Bravo P , Supple G , Muser D , Callans D , Schaller R , Hyman M , Kumareswaran R , Riley M , Lin D , Arkles J , Marchlinski F 
Published: October 2021

Abstract

Background
Low QRS amplitude (QRSa), QRS fractionation (QRSf) and longer QRS duration (QRSd) are markers of myocardial fibrosis and inflammation in non-ischemic cardiomyopathy (NICM).

Objective
To determine if reduction of inflammation with treatment of cardiac sarcoidosis (CS) may reverse these 12 lead ECG parameter changes.

Methods
21 patients (pts) with CS and VT ablation with a positive baseline positron emission tomographic (PET 1) scan were studied. All pts received prednisone ≥40 mg for 4 to 8 weeks followed by a taper and maintenance with methotrexate ± low-dose prednisone, &lt;10 mg/day, until clinically stable and resolution of inflammation on PET 2 one year after initial. In addition, pts with low LV ejection fraction (13/21) received guideline directed medical therapy for heart failure. Pts at 1yr with positive PET2 (9) were compared to those with negative PET2 (12). Baseline and 1yr 12-lead ECGs were analyzed for QRSd, ≥2QRSf contiguous leads and QRSa in the limb leads.

Results
Pts in PET2(+) vs PET2(−) groups has similar gender (men 89% vs 100%, p=0.42), age (57±8 vs 56±10 years, p=0.8) and LV ejection fraction (41±11 vs 46±11, p=0.31). Baseline 12-lead ECGs showed similar QRSd, ≥2QRSf contiguous leads and QRSa for PET2(+) vs PET2(−); P all &gt;0.15 (Table 1). At 1 yr there was a lower prevalence of ≥2QRSf contiguous leads and strong trend for shorter QRS duration and larger QRSa in lead DI if PET2(−) vs PET2(+). 4 pts demonstrated loss of QRSf 2 contiguous leads and/or increase in QRSa in DI by at least 0.15 mV from baseline if PET2(−) and none if PET2(+).

Conclusions
In pts with CS and VT, reversal of inflammation may result in a greater QRSa and reduction in QRSf. An increase in QRSa in lead 1 by &gt;0.15mV and/or loss of QRSf identifies a clear positive response to treatment and negative PET at 1 year.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Richard T and Angela Clark Innovation Fund in Cardiovascular Medicine, the Mark S Marchlinski EP Research and Education Fund and the Winkelman Family Fund in Cardiovascular Innovation. Table 1
The effect of COVID-19 on schoolteachers’ emotional reactions and mental health
Authors: Nabe-Nielsen K , Christensen KB , Fuglsang NV , Larsen I , Nilsson CJ 
Published: October 2021

Abstract

Background
Schoolteachers play a major role in the society's response to the COVID-19 pandemic. When schools are open teachers are responsible for hindering spread of SARS-CoV-2, while carrying out their core task of teaching. This double role as well as the risk of infection may affect mental health in this occupational group. Therefore, we investigated schoolteachers' emotional reactions to COVID-19 and mental health during three phases of the COVID-19 pandemic in Denmark. We further analyzed if teachers, who belonged to a COVID-19 risk group, had more emotional reactions and poorer mental health than “non-risk” groups.

Methods
We collected questionnaire data in May, June, and November-December 2020 and used data from 2665 teachers employed at public schools (871 individuals participated in all three surveys). Participants reported their fear of infection, fear of transmission of infection to their home or pupils, perceived burnout and stress, and worries about their ability to manage the working conditions. We also had information about COVID-19 risk group status, sex, age, organization of teaching (physical presence or remote teaching), and the pupils' grade. We estimated prevalence ratios and took repeated measures into account.

Results
Fear of infection and transmission of infection as well as burnout, stress, and worries increased statistically significantly with 27-84% from May to November-December 2020 (p &lt; 0.05). We also found that teachers, who were particularly vulnerable to the adverse consequences of COVID-19, had the highest prevalence of fear of infection and poor mental health.

Conclusions
The dual role of teaching and virus control along with concerns regarding the health consequences of an infection may contribute to the observed increase in emotional reactions to COVID-19 and poor mental health from the beginning of the pandemic to the beginning of the second wave.

Key messages
The results raise attention to the working conditions, exposure to infection and mental health of teachers being in the frontline when schools were open during the COVID-19 pandemic. School teachers play a major role in pandemic control along with teaching obligations, which warrants allocation of resources, clear guidelines, and possibilities for protection from infection.
Listening to community concerns in the COVID-19 infodemic: A WHO digital approach
Authors: Mahajan A , Czerniak C , Lamichhane J , Phuong L , Purnat T , Briand S , Nguyen T 
Published: October 2021

Abstract

Background
The Infodemic (too much information including false or misleading information in digital and physical environments) during the COVID-19 pandemic has led to confusion, risk-taking and behaviors that can amplify outbreaks, and reduce effectiveness of pandemic response efforts. To address this challenge, the WHO Information Network for Epidemics (EPI-WIN), in collaboration with research partners, developed a public health Infodemic intelligence analysis methodology for weekly analysis of digital media data to identify, categorize, and understand key concerns expressed in online conversations.

Methods
Thirty-five keyword-based searches (per language) using Meltwater Explore and Google Trends were created and grouped according to a set of pandemic public health taxonomy categories developed specifically for this analysis. The taxonomy has five thematic categories of conversation about COVID-19 and public health response: (1) the cause of the illness, (2) the illness, (3) the treatment, (4) the interventions and (5) Information.

Results
The two most recurring topics to attract increasing interest were Vaccines and Asymptomatic transmission followed by Immunity, Cause of the virus, Vulnerable communities and Reduction of movement, and Risk factors based on demographics and risk of misinformation.

Conclusions
The application of this taxonomy to online social listening week-on-week resulted in a better in-time understanding of the evolution and dynamics of high velocity conversations about COVID-19 globally during the pandemic and proposes a quantifiable approach to support planning of risk communication response.

Key messages
Describe widespread innovation in social listening methods for greater accountability to affected populations. Formulate insights into how digital media can be better utilized for more rapidly responding to the evolving needs of communities.