bluuebunny/crossref_metadata_2025_split huggingface dataset:
High venous to arterial CO2 gap is related to cardiovascular death in cardiogenic shock
Authors: Lopez-Sobrino T , Gazquez Toscano A , Soler Selva M , Romeu Mirabete N , Parellada Vendrell M , Casado Pena M , Ruiz Falques C , Guzman Bofarull J , Forado Benatar I , Calvo Lopez M , Izquierdo Montilla L , Lopez Domenech G , Vleasco Ortiz I , Ortiz Perez JT , Andrea Riba R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Venous to arterial CO2 gap (CO2gap) is calculated by subtracting partial pressure of arterial CO2 to central venous partial pressure of CO2 (ScvCO2). This marker has been studied in septic shock and indicates hypoperfusion when exceeds 6mmHg. Its kinetics and applicability in cardiogenic shock (CS) are unclear, being mixed/central venous saturation and lactate more commonly used.

Purpose
The objective of the study is to describe CO2gap kinetics in patients with CS. Secondary objective is to analyze if CO2gap is as marker of prognosis in CS.

Methods
Prospective observational study that included patients admitted for CS in the Acute Cardiovascular Care Unit of a tertiary hospital. Gasometric samples were obtained at admission, 6, 12, 24 and 48 hours from the onset of shock. In-hospital mortality was registered.

Results
We included 40 patients with CS during 1 year. Most patients were male (80%), average age was 68 years. There was a high incidence of cardiac arrest (58%), most frequent cause of CS was STEMI (45%), in-hospital mortality was 45%, most cases from non-cardiovascular causes (61%). Refractory shock was frequent (28%). Average lactate peak was 6.02 mmol / L. CO2gap kinetics consisted in a peak at admission (8.8mmHg), a valley 6h (7.7mmHg), new peak at 12h (8.5mmHg) and progressive decrease at at 24 (6.8mmHg) and 48h (5.7 mmHg). Significantly, higher CO2gap values at admission (10.97mmHg vs 8.16mmHg, p = 0.007) was predictor of cardiovascular mortality. Lactate values at 6, 12 and 48 hours were also predictors of cardiovascular mortality, as well as ScvO2 at admission.

Conclusions
Patients with CS present with high CO2gap values during first hours of admission. The kinetics of this marker consists in two peaks at admission and 12 hours from CS onset, a valley at 6 hours and a progressive decrease at 24 and 48 hours. Its determination at admission is associated with cardiovascular mortality. We suggest the potential benefit of combining this marker, along with lactate and ScvO2 values, to guide management of patients with CS. Abstract Figure. CO2 gap and cardiovascular mortality
Validation of quantitative pupillometry, for neuroprognostication in patients resuscitated from cardiac arrest
Authors: Nyholm B , Obling L , Hassager C , Grand J , Moeller JE , Othman MH , Kondziella D , Kjaergaard J 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): NovoNordisk Foundation grant
Background/Introduction
Quantitative pupillometry is being recommended as part of a multimodal approach to the bedside armamentarium, for obtaining prognostic information in post-cardiac arrest management. However, recent guidelines are still based on limited evidence, and lack of knowledge about the variability of pupillary measurements may impair clinical usefulness.

Purpose
To assess precision and accuracy of quantitative pupillometry to validate its clinical use in neuroprognostication.

Methods
We conducted a prospective blinded validation study, based on repeated patient assessments in a cardiac intensive care unit. Each assessment was made by two trained staff nurses and consisted of one manual and one quantitative pupillometry each, performed on the same patient within 2 minutes. Data from each measurement was stored in the pupillometers head guard, blinded to the other observer.
To investigate inter-observer variation (precision), the repeated measures of pupillary size (both quantitative and manual individually) were compared, and for accuracy by comparing quantitative with manual assessment. Further we assessed the variation in neurological pupil index (NPi), a scalar value (between 0 and 5) calculated from an algorithm comprising several measured pupillary variables.
Bland–Altman analysis was performed with mean difference between the two methods of measurement and 95% limits of agreement (LoA), and intraclass correlation coefficient (ICC) assessed for absolute agreement between the methods.

Results
A total of 56 measurements (left and right eye) were included in this study. Fifty-seven percent were male, with a mean age of 65 years (SD 14). Out of hospital cardiac arrest constituted 57 %, and 65 % of the measurements were made, while patients were sedated. The 30-day mortality of this population was 50 %.
Bland-Altman analysis showed mean inter-observer differences equal to -0.14 mm (LoA: 0.71, -1.00) for pupillary size measured by manual pupillometry, and 0.03 mm (LoA: 0.36, -0.31) for pupillary size measured by quantitative pupillometry. Mean pupillary size by automated pupillometry and manual assessment, was 2.28 mm (SD 0.84) and 2.22 mm (SD 0.84) respectively, with significant correlation between manual and quantitative pupillometry (R = 0.84, p &lt; 0.001; ICC 0.83). Mean inter-observer differences for NPi measured by quantitative pupillometry was -0.02 (LoA: 0.40, -0.43).
Conclusion(s)
Quantitative pupillometry has twice the precision in assessment of pupillary size compared with manual assessment. Both pupillary size and NPI may, however, still have a challenging reproducibility. Abstract Figure.
Are high NT-proBNP levels more related to inflammation than to left ventricular systolic dysfunction in acute myocarditis?
Authors: Sara B , Monteiro JJ , Carvalho P , Ribeiro Carvalho C , Chemba J , Ferreira C , Moreira JI 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Plasma levels and N-terminal pro B-type natriuretic peptide (NT- proBNP), a cardiac neurohormone released in response to increased ventricular stress, represent an important predictor of clinical outcomes and left ventricular (LV) dysfunction; Although, its diagnostic and prognostic role in patients with acute myocarditis is not completely established; Our aim was to evaluate the relationship of BNP levels and LV ejection fraction (LVEF) in patients with myocarditis;

Methods
Data from patients (pts) discharged with the diagnosis of myocarditis, from 2008 and 2018 were retrospectively analysed.

Results
62 pts were included. Mean age was 39.7 17 years and 89% (58 patients) were men. Plasma levels of NT-proBNP measured at admission ranged from 24 to 3110 pg/mL (median 514, IQR 947), and exceeded upper normal levels in 51 pts (82%). This values positively correlated with C- reactive protein (CRP) (p= 0.005, r = 0.36), leucocytes (p = 0.03, r= 0.37) and neutrophil-to-lymphocyte ratio (p= 0.05, r= 0.35), but not with left ventricular ejection fraction (LVEF) (p= 0.829). Higher levels of BNP were associated with higher troponin peak levels but not with increased mortality (p = 0.811), need of inotropic support (p= 0.059) or arrhythmic events (p= 0.130). Inflammatory parameters were significantly increased when BNP&gt; 514 pg/mL vs BNP &lt;514 pg/mL (CRP 7.2 vs 4 mg/dL, p= 0.008). This relationship was maintained at BNP &gt; 900. LVEF was comparable in both groups (p = 0.938); In this population, the magnitude of recovery of the NT- proBNP values (variation between NT-proBNP at admission and discharge) strongly correlated with the magnitude of the inflammatory markers at admission (all p &lt; 0,005)

Conclusion
In patients with acute myocarditis, there is a significant relationship between NT-proBNP levels and inflammation (as measured by leucocytes, NLR or CRP), but not with LVEF; Despite the limitation of a small sample size, we could hypothesize that NTproBNP in this subset of patients appears to be regulated not only by hemodynamic changes but also by the underlying systemic inflammatory process and, therefore, it interpretation should take that into account;
Steroids for the prevention of postpericardiotomy syndrome: a meta-analysis
Authors: Saleiro C , Teixeira R , Lopes J , Decampos D , Sousa JP , Puga L , Gomes ARM , Costa M , Goncalves L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Postpericardiotomy syndrome (PPS) can occur in up to 40% of patients after cardiac surgery. Corticosteroid therapy has long been used for pericarditis and pericardial effusion due to its anti-inflammatory proprieties. The benefit of corticosteroids for the prevention of post pericardiotomy syndrome (PPS) in not consensual.

Purpose
We performed a systematic review and meta-analysis of trials assessing the efficacy of corticosteroids to prevent PPS in patients submitted to cardiac surgery.

Methods
We searched MEDLINE, Google Scholar and the Cochrane Library databases using the key terms "corticosteroids" and "post pericardiotomy syndrome" without language or date restriction. Articles were considered for inclusion in the analysis if they comprised a population of patients submitted to cardiac surgery and a comparison between patients treated with corticosteroids for the prevention of PPS and those who were not. Three studies were identified, comprehending a total of 1268 patients. The primary endpoint was the occurrence of PPS. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated based on a random effects meta-analysis and were obtained from the pooled adjusted OR of primary studies.

Results
Studies included in the analysis comprehend a controlled randomized trial in children (1 mg/kg methylprednisolone pre-operative and four additional doses over 24h vs placebo); a controlled randomized trial in adults (1 mg/kg dexamethasone intra-operative vs placebo) and a retrospective study in adults (1 mg/kg intra-operative methylprednisolone vs standard care). Of the total 1268 patients included, 641 received glucocorticoids for the prevention of PPS. Main reason for surgery was correction of a congenital heart defect in 19% of the patients; coronary artery bypass graft in 15% and valvular disease in 66% of the cases. 217 patients had PPS during the follow-up time; 15% in the corticosteroid prophylaxis group and 18% in the placebo/standard care group. Overall, corticosteroid prophylaxis was not useful for the prevention of PPS compared to placebo/standard care (pooled OR: 0.78, 95% CI: 0.51–1.20, I2 = 46%) – Figure 1.

Conclusion
According to our data, steroid therapy has no role as a preventive therapy of post-pericardiectomy syndrome. Abstract Figure 1 - Pooled analysis
Levosimendan, milrinone and dobutamine in acute experimental pulmonary embolism
Authors: Lyhne MD , Dragsbaek SJ , Hansen JV , Schultz JG , Andersen A , Nielsen-Kudsk JE 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Laerdal Foundation for Acute Medicine, Novo Nordisk Foundation
Background/Introduction: Acute pulmonary embolism (PE) is a frequent condition in acute cardiac care and is potentially fatal. Cause of death is right ventricular (RV) failure due to increased RV afterload from both pulmonary vascular obstruction and vasoconstriction. Inodilators are interesting drugs of choice as they may improve RV function and lower its afterload.

Purpose
We aimed to investigate the cardiovascular effects of three clinically relevant inodilators: levosimendan, milrinone and dobutamine in acute PE.

Methods
We conducted a randomized, blinded, animal study using 18 female pigs. Animals received large autologous PE until doubling of baseline mean pulmonary arterial pressure and were randomized to four logarithmically increasing doses of each inodilator. Effects were evaluated with bi-ventricular pressure-volume loop recordings, right heart catheterization and blood gas analyses.

Results
Induction of PE increased RV afterload and pulmonary pressure (p &lt; 0.05) causing RV dysfunction. Levosimendan and milrinone showed beneficial hemodynamic profiles by lowering RV pressures and volume (p &lt; 0.001) and improved RV function and cardiac output (p &lt; 0.05) without increasing RV mechanical work. Dobutamine increased RV pressure and function (p &lt; 0.01) but at a cost of increased mechanical work at the highest doses, showing an adverse hemodynamic profile. See Figure.
Conclusion(s): In a porcine model of acute PE, levosimendan and milrinone reduced RV afterload and improved RV function, whereas dobutamine at higher doses increased RV afterload and RV mechanical work. The study motivates clinical testing of inodilators in patients with acute PE and RV dysfunction. Abstract Figure. Inodilators in acute pulmonary embolism
Outcome of post cardiac surgery acute myocardial infarction and role of emergency percutaneous coronary interventions
Authors: Laimoud M , Qureshi R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The rapid haemodynamics deterioration and presence of myocardial ischemia early after cardiac surgical operations is a complex life threatening condition where rapid diagnosis and management is of fundamental importance. Objective: to analyse the factors associated with mortality of patients with post cardiotomy MI and to study the role of emergency coronary angiography in management and outcome . Methods: we retrospectively enrolled adult patients diagnosed to have post cardiotomy MI and underwent emergency coronary angiography at our tertiary care hospital between January 2016 and August 2019. Results: Sixty one patients from consecutive 1869 adult patients who underwent cardiac surgeries were enrolled in our study. The studied patients had a mean age of 49 ±16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the non-survivors of perioperative MI had significant preoperative CKD , postoperative AKI , longer CPB time , frequent histories of previous PCI , previous cardiotomies , pre and postoperative ECMO use , higher median troponin I levels , higher peak and 24 hours mean lactate levels. Regression analysis revealed that re-operation for revascularization (OR:23 ; 95% CI: 8.27-217.06; p = 0.034) and hyperlactataemia (OR: 3.21 ; 95% CI:1.14-9.04 ; p = 0.027) were independent factors associated with hospital mortality after perioperative MI . Hospital mortality occurred in ( 25.7% vs 86.7% ,p &lt; 0.001 ) , AKI occurred in ( 37.1% vs 93.3 %,p &lt; 0.001 ) , haemodialysis was used in (28.6 % vs 80%. P = 0.002), mediastinal exploration for bleeding done in (31.4% vs 80%, p = 0.006 ) in PCI and re-operation groups respectively while there were no significant differences regarding gastrointestinal bleeding , cerebral strokes nor intracerebral bleeding . Absence of significant angiographic findings occurred in 18% of patients. Conclusions: Perioperative MI is associated with significant morbidities and hospital mortality . Re-operation for revascularization and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI. Predictors of hospital mortality.Significant variablesP valueOR95% CIPost-op ECMO0.1360.0390.001 -2.775Troponin0.6611.0000.998 -1.001Lactate peak0.0273.2121.141 - 9.042Re-operation0.03423.0058.27 - 217.06Abstract Figure. Hospital outcomes of PCI and Reoperation
Surgical and endovascular treatment of adult aortic coarctation : tewenty years experience center
Authors: Ben Mabrouk J , Mleyhi S , Ziadi J , Boudiche S , Miri R , Farhati A , Ben Mrad M , Mourali S , Denguir R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic coarctation accounts for 5 to 8 % of the congenital heart diseases. In adult patients, an expected mortality of 75 % at 43 years old was reported.
conventional surgery was the gold standard in the treatment of these patients. Currently with the advancement of endovascular procedures, angioplasty with ou no stenting is increasingly indicated.

Methods
We report a retrospective, monocentric observational study of 57 patients treated for aortic coarctation surgically or by endovascular approach over a period of 20 years, from 2000 until 2020.

Results
The median age was 22 years with extremes of 15 and 65 years and the sex ratio was 1.42. All patients were hypertensive. The median of the trans-stenotic gradient was 60 mmHg. Surgical repair consisted mainly of resection-anastomosis using the Crafoord technique in 25 patients (44%) and interposition of a Dacron tube in 22 patients (39%). Endovascular treatment with stenting was done in seven patients.
Post treatment gradient was 10 mm Hg ± 5 and no deaths were observed at 30 days. After an average follow-up of 70 months, residual hypertension was found in seven cases without any re-coarctation and in the univariate analysis, the main factors significantly associated with this residual hypertension were: age (p = 0.11), pre and post-operative gradient (p = 0.097), severe hypertension (p = 0,12), developed collateral circulation (p = 0.07), bicuspid aortic valve (p = 0.15) and diaphragm shape (p = 0.07).

Conclusion
The gold standard treatment remains the surgical correction but in selected patients, the endo-vascular repair is a valid option.we propose a decision-making algorithm based on the results of our study (Fig) Abstract Figure. decision-making algorithm
Adherence to recommendations for secondary prevention medications after myocardial infarction in Estonia
Authors: Loiveke P , Marandi T , Ainla T , Fischer K , Eha J 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council

Introduction
High rates of adherence to myocardial infarction (MI) secondary prevention medications have been reported by several studies in Europe. However, results derived from unselected populations registry based data is scarce.

Purpose
Aim of our study was to analyse adherence to guideline recommended medications for secondary prevention of MI of unselected patient population in Estonia in 2017-2018 and compare the results with data from 2004-2005.

Methods
Population studied in 2004-2005 was based on Estonian Health Insurance Fund"s (EHIF) database and in 2017-2018 on Estonian Myocardial Infarction Registry (EMIR). EMIR is an ongoing registry recording data from all patients in Estonia diagnosed with MI (ICD-10 I21 – I22). Patients hospitalised due to MI and survived &gt; 30 days formed the study population. By linking to EHIF"s prescription database medication adherence for angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), statins, beta blockers (BB) and P2Y12 inhibitors clopidogrel and ticagrelor was assessed during one year follow-up period from first hospitalisation during period studied (at least one reimbursed prescription for the drug group during follow-up period).
Results
4900 and 5067 index episodes were defined in 2004-2005 and 2017-2018, respectively. Mean age in the study population was 64.7 (+/- 11.5) and 66.5 (+/- 12.1) for men and 72.7 +/- 9.9 and 76.4 +/- 10.9 for women in 2004-2005 and 2017-2018. Rates of medication adherence among patients who survived &gt; 30 days are presented in the Table.

Conclusion
Adherence to guideline recommended medication for secondary prevention of MI in Estonia has improved considerably over 13 years. Based on our data there is room for advancement, especially among women and the elderly. Rates of medication adherence.2004-20052017-2018p value (comparison between studies)MEN (n = 2365)WOMEN (n = 1660)TOTAL (n = 4025)MEN (n = 2704)WOMEN (n = 1668)TOTAL (n = 4372)BB, No. (%)1907 (80.6)1344 (81.0)3251 (81.0)2265 (84.0)1385 (83.0)3650 (83.5)0.001ACE/ARB, No. (%)1780 (75.3)1317 (79.3)3097 (76.9)1817 (67.2)1070 (64.1)2887 (66.0)&lt; 0.001Statins, No. (%)946 (40.0)826 (50.0)*1772 (44.0)1910 (70.6)1020 (61.2)*2930 (67.0)&lt; 0.001Statin + ACE/ARB + BB, No. (%)999 (42.2)647 (39.0)1646 (40.9)1336 (49.4)686 (41.1)*2022 (46.2)&lt; 0.001None of the above medications, No. (%)130 (5.5)96 (6.0)226 (5.6)214 (7.9)148 (9.0)362 (8.3)&lt; 0.001P2Y12 inhibitorsNANANA2194 (81.1)1147 (69.0)*3341 (76.4)NABB, beta-blockers; ACE/ARB, angiotensin converting enzyme inhibitors/angiotensin II receptor blockers. NA, not available *P &lt; 0.01 for comparison between men and women with Pearson"s χ2 test. Pearson"s χ2 test used for comparison between studies.
Identification and characterization of rapidly accumulatingsch9Δsuppressor mutations inSaccharomyces cerevisiae
Authors: Peterson Patricia P , Liu Zhengchang 
Published: April 2021

AbstractNutrient sensing is important for cell growth, aging, and longevity. In Saccharomyces cerevisiae, Sch9, an AGC-family protein kinase, is a major nutrient sensing kinase homologous to mammalian Akt and S6 kinase. Sch9 integrates environmental cues with cell growth by functioning downstream of TORC1 and in parallel with the Ras/PKA pathway. Mutations in SCH9 lead to reduced cell growth in dextrose medium; however, reports on the ability of sch9Δ mutants to utilize non-fermentable carbon sources are inconsistent. Here, we show that sch9Δ mutant strains cannot grow on non-fermentable carbon sources and rapidly accumulate suppressor mutations, which reverse growth defects of sch9Δ mutants. sch9Δ induces gene expression of three transcription factors required for utilization of non-fermentable carbon sources, Cat8, Adr1, and Hap4, while sch9Δ suppressor mutations, termed sns1 and sns2, strongly decrease the gene expression of those transcription factors. Despite the genetic suppression interactions, both sch9Δ and sns1 (or sns2) homozygous mutants have severe defects in meiosis. By screening mutants defective in sporulation, we identified additional sch9Δ suppressor mutants with mutations in GPB1, GPB2, and MCK1. Using library complementation and genetic analysis, we identified SNS1 and SNS2 to be IRA2 and IRA1, respectively. Furthermore, we discovered that lifespan extension in sch9Δ mutants is dependent on IRA2 and that PKA inactivation greatly increases basal expression of CAT8, ADR1, and HAP4. Our results demonstrate that sch9Δ leads to complete loss of growth on non-fermentable carbon sources and mutations in MCK1 or genes encoding negative regulators of the Ras/PKA pathway reverse sch9Δ mutant phenotypes.
A Chromosome—Level Genome Assembly of the Spotted Scat (Scatophagus argus)
Authors: Huang Yuanqing , Mustapha Umar Farouk , Huang Yang , Tian Changxu , Yang Wei , Chen Huapu , Deng Siping , Zhu Chunhua , Jiang Dongneng , Li Guangli 
Published: April 2021

AbstractThe spotted scat, Scatophagus argus is a member of the family Scatophagidae found in Indo-Pacific coastal waters. It is an emerging commercial aquaculture species, particularly in East and Southeast Asia. In this study, the first chromosome-level genome of S. argus was constructed using PacBio and Hi-C sequencing technologies. The genome is 572.42 Mb, with a scaffold N50 of 24.67 Mb. Using Hi-C data, 563.28 Mb (98.67% of the genome) sequences were anchored and oriented in 24 chromosomes, ranging from 12.57 Mb to 30.38 Mb. The assembly is of high integrity, containing 94.26% conserved single-copy orthologues, based on BUSCO analysis. A total of 24,256 protein-coding genes were predicted in the genome, and 96.30% of the predicted genes were functionally annotated. Evolutionary analysis showed that S. argus diverged from the common ancestor of Japanese puffer (Takifugu rubripes) approximately 114.8 Ma. The chromosomes of S. argus showed significant correlation to T. rubripes chromosomes. A comparative genomic analysis identified 49 unique and 90 expanded gene families. These genomic resources provide a solid foundation for functional genomics studies to decipher the economic traits of this species.