bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Frequency QRS analysis to supplement ST-Analysis for Myocardial Ischemia: multi-center prospective cohort
Authors: Toral R Patel TRP , Jamieson Bourque JMB 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Exercise testing is a well-known non-invasive assessment method for myocardial ischemia in patients with suspected coronary artery disease (CAD). Stress electrocardiography (ECG) alone is underutilized in this population despite guideline recommendations in part due to poor diagnostic accuracy. High frequency QRS analysis (HF-QRS) is a novel tool to supplement standard ST-analysis during stress ECG and has been shown in single-center retrospective analyses to identify any and substantial ischemia with high diagnostic accuracy. We sought to compare the diagnostic accuracy of HF-QRS + standard ST-analysis compared to standard ST-analysis alone for the identification of moderate to severe myocardial ischemia by exercise SPECT MPI.

Methods
The study population included 388 consecutive patients who underwent exercise SPECT MPI. An ischemic HF-QRS pattern was defined as an absolute reduction of ≥1 μV and a relative reduction of ≥50% between maximal and minimal values of the mean root square of the 150-250 Hz band signal in ≥3 leads. The diagnostic accuracy of HF-QRS + ST-analysis was compared with ST-analysis alone for moderate to severe myocardial ischemia using chi-square analysis and semi-quantitative gated SPECT MPI as the gold standard. The incremental diagnostic value of HF-QRS was assessed by logistic regression analysis. The likelihood of any ischemia by number of leads positive for HF-QRS was also determined.

Results
The study cohort was 71% male and 84% Caucasian with a mean age of 58.3 ± 11.8 years. ST- and HF-QRS analyses were positive in 96 (24.7%) and 121 (31.2%) of patients, respectively. HF-QRS had a substantially higher sensitivity than ST-analysis for moderate-severe ischemia (66.7% vs. 40.0%, p &lt;0.003). There was no statistically significant difference in specificities for HF-QRS vs ST-analysis for moderate-severe ischemia. (70.5% vs 75.7%, p = 0.08). There was a stepwise increase in ischemia as number of positive HF-QRS leads increased (p = 0.0004). HF-QRS demonstrated incremental diagnostic value to clinical risk factors without ST-analysis (p = 0.006) compared to Clinical + ST depressions (p &lt; 0.001) versus clinical factors.

Conclusions
This multicenter, prospective study expands the literature showing the benefit of HF-QRS analysis. HF-QRS analysis substantially improves detection of moderate-severe ischemia over ST-analysis and clinical risk factors in patients undergoing exercise stress ECG. This noninvasive adjunct may improve CAD risk stratification and encourage use of stress ECG without imaging, reducing costs and radiation exposure.
Value of regional myocardial flow measurements using Rubidium-82 PET
Authors: Koenders SS , Van Dalen JA , Jager PL , Mouden M , Slump CH , Van Dijk JD 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The combination of myocardial blood flow (MBF) measurements using Rubidium-82 (Rb-82) PET and visual assessment of the PET images is increasingly used due to its high diagnostic and prognostic value. Typically, flow measurements are calculated and used for the myocardium as a whole (global). However, small regional flow deficits may go unnoticed when only looking at global flow values.

Purpose
To compare the diagnostic value of regional and global myocardial flow measurements using Rb-82 PET in the detection of obstructive CAD.

Methods
We retrospectively included 1034 patients with no history of coronary artery disease (CAD) referred for rest and regadenoson-induced stress Rb-82 PET/CT. MBFs were calculated using Lortie’s one-tissue compartment model. Myocardial flow reserve (MFR) was calculated as the ratio of MBF during stress and rest. Regional flow was determined per vessel and per segment. Vessel MFR was defined as the lowest flow reserve of LAD, LCX and RCA territories and segmental MFR as the lowest flow reserve in all 17 segments. Follow-up data were obtained from medical records. Patients were classified to have obstructive CAD if follow-up included a positive invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or all cause death. Receiver-operating characteristic (ROC) analyses were constructed to compare the diagnostic value of global and regional flow values.

Results
Follow-up was obtained in all 1034 patients and the median follow-up time was 2.1 years. Myocardial flow reserve values were significantly lower (p &lt; 0.001) in the 128 patients classified with obstructive CAD than in the 906 patients without obstructive CAD: global MFR (median 1.9 [interquartile range 1.6-2.4] vs. 2.5 [2.1-2.9]); vessel MFR (1.6 [1.3-2.1] vs. 2.3 [1.9-2.6]); Segmental MFR (1.3 [0.9-1.7] vs. 1.9 [1.6-2.2]). The area under the curve of vessel MFR (0.79 ± 0.02) and segmental MFR (0.81 ± 0.02) were similar but significantly (p &lt; 0.001) larger than the area of global MFR (0.75 ± 0.03), as shown in the Figure.

Conclusion
The diagnostic value improved with the use of regional MFR instead of global MFR measurements in the detection of obstructive CAD. Therefore, it seems that visual assessment of PET images can best be combined with regional flow measurements either on a per vessel or a per segment basis in Rubidium-82 PET myocardial perfusion imaging.
The use of a novel method for SPECT/CT quantification of 99m-Tc-PYP uptake in the evaluation of ATTR cardiac amyloidosis
Authors: Duvall WL , Godoy Rivas C , Elsadany M , Hobocan M , Mcmahon S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Bone scintigraphy with 99m-Technecium-Pyrophosphate (99m-Tc-PYP) with planar and SPECT imaging is now commonplace for the non-invasive diagnosis of ATTR cardiac amyloidosis. However, the quantification of 99m-Tc-PYP uptake is based on a semi-quantitative visual score and a heart to contralateral lung ratio which suffer from poor reproducibility. A more robust method of quantifying uptake and reporting results would be beneficial and may be possible using volumetric assessment with fused SPECT/CT acquisition.

Purpose
The aim of this study was to evaluate the performance of a novel semi-automated quantitative software to diagnose ATTR cardiac amyloidosis in patients with a clinical suspicion of cardiac amyloidosis who underwent 99m-Tc-PYP SPECT/CT imaging.

Methods
This was a retrospective, single-center study of consecutive patients who underwent 99m-Tc-PYP SPECT/CT imaging from September to December 2020. Quantification software was used to obtain standardized uptake values (SUVs) of 99m-Tc-PYP activity in the whole heart using SPECT/CT data. The total SUVs, mean SUVs, and percentage of injected tracer dose in the heart, as well as two other sets of these measurements adjusted for residual blood pool activity were obtained. Activity in the lung and bone was used to calculate heart to bone and heart to right lung ratios. The results from the software quantification were compared to the results from planar imaging as well as to the final clinical diagnosis of amyloidosis.

Results
A total of 59 patients were imaged during this time with an average age of 74.1 ± 11.8, and 32 (54.2%) were male. After excluding 8 patients for technical issues, 12 patients were found to be positive for amyloid, 39 were negative, and the average imaging delay time was 75.0 ± 15.2 minutes. 13 methods of assessment were evaluated with the metric of the percentage of injected tracer dose found in the heart that was adjusted for the mean residual blood pool activity having the best discrimination between abnormal and normal studies. The mean percentage of injected dose in positive patients was 2.87% vs 0.98% in the patients without amyloidosis (p &lt; 0.0001). Using a cutoff of 2% to ensure that no patients with amyloid would be missed by screening, there was 100% sensitivity, 94.9% specificity, and 96.1% accuracy. There was a significant difference in the percentage injected dose based on gradations of planar heart to contralateral lung ratio and planar visual score.

Conclusion
Volumetric software quantification may be a superior method of evaluating 99m-Tc-PYP cardiac amyloidosis studies. This methodology may allow for a quantitative definition of a normal or abnormal 99m-Tc-PYP cardiac amyloid study and provide for the potential of following response to therapy.
Value of cardiac 123I-mIBG scintigraphy in prognosis of catheter ablation outcome in patients with atrial fibrillation
Authors: Sazonova S , Varlamova JV , Nikitin NA , Minin SM , Kisteneva IV , Batalov RE , Mishkina AI , Ilushenkova JN , Zavadovsky KV , Popov SV , Romanov AB 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation
Background. Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. Thus, the goal of the present study was to estimate the utility of pre-procedural cardiac 123I-mIBG scintigraphy to identify patients at risk for AF recurrence after CA.
Methods. 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patients were followed for 12 months. A blanking period of 3 months was applied. The primary endpoint of the study was AF recurrence between 3 and 12 months after ablation.
Results. Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate &lt;1.6 (sensitivity 73.53 %, specificity 81.3%, AUC 0,792 , p &lt; 0.001) and WR &gt; 25,11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0,712 , p &lt; 0.001) indicate high probability of AF relapses during 12 months after CA. Kaplan-Meier analysis showed that the H/Mlate &lt; 1.6, WR &gt; 25,11 and LAD &gt; 45 mm significantly increase the risk of AF recurrence after CA (p &lt; 0.001, p &lt; 0.001, p &lt; 0.025 respectively).
Conclusion. Pre CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients.
The emotional evidence of early modern English plague wills
Authors: Formby Olivia 
Published: July 2021

Abstract
For seventeenth-century English Protestants will-making was a legal, religious and emotional practice, and one that continued in plague time. This article charts the resilience and accessibility of will-making in plague epidemics in Louth, Lincolnshire (1630/1–1631/2) and Kingston upon Hull, Yorkshire (1637–8) and analyses both qualitative and quantitative emotional evidence from plague wills to illustrate the historical insights that can be gained into ordinary experiences of plague, the family, friendship, charity and death. By identifying patterns in emotional gestures across the Louth and Hull plague wills, this study shows how early modern emotions could be poignantly conveyed through actions and symbols, revealing in both case studies the high communal value of love and godly fear, of places, names and objects, of caritas and memory.
Percutaneous dilation tracheostomy in a patient with tracheal stent
Authors: Fiorelli Alfonso , Messina Gaetana , Santini Mario , Ferraro Fausto 
Published: July 2021

AbstractWe reported the case of a patient with obstruction of tracheal stent, deployed previously for anaplastic thyroid carcinoma. The extension of malignant stricture above and below the stent and close to the vocal folds made unfeasible the stent recanalization and/or its replacement with another longer. Thus, tracheostomy was the only option to assure ventilation. After partial air-way recanalization with rigid bronchoscope, tracheostomy cannula was inserted through the stenosis using percutaneous dilatation tracheostomy technique.
Determination of Alternaria Toxins in Tomato, Wheat, and Sunflower Seeds by SPE and LC-MS/MS—A Method Validation Through a Collaborative Trial
Authors: Gonçalves Carlos , Tölgyesi Ádam , Bouten Katrien , Robouch Piotr , Emons Hendrik , Stroka Joerg 
Published: July 2021

Abstract

Background
Alternaria toxins are ubiquitous contaminants in highly consumed food products. Therefore, they are candidates to be regulated by EU legislation. In this context, the availability of reliable analytical methods is a keystone both for protecting the health of citizens and smooth functioning of the European market.

Objective
This paper describes an advanced LC-MS/MS method based on isotope dilution quantification suitable for the determination of altenuene, alternariol, alternariol monomethyl ether, tenuazonic acid, and tentoxin in tomato puree, wheat, and sunflower seeds.

Methods
The method has been validated in an interlaboratory study that included the analysis of both spiked and naturally contaminated food commodities. Twenty-three participants contributed with analytical data.

Results
The average recoveries and relative standard deviations for repeatability and reproducibility obtained across the tested matrixes were: 97, 8.0, and 23%, for altenuene, respectively; 95, 9.2, and 17% for alternariol, respectively; 98, 6.4, and 13% for alternariol monomethyl ether, respectively; 97, 4.2, and 9.3% for tenuazonic acid, respectively; and 102, 5.6, and 15% for tentoxin, respectively. The method enabled the determination of all tested Alternaria toxins close to or below 1 µg/kg.

Conclusion
Overall, the method showed a satisfactory trueness and precision, complying with the requirements for the monitoring of mycotoxins in food in the EU. It is currently under evaluation by the European Committee for Standardization for adoption as a standard method.

Highlights
Isotope dilution mass spectrometry method for the determination of Alternaria toxins in food.
The Treaty on trademarks, service marks and appellations of origin of the Eurasian Economic Union and instructions to it entered into force
Authors: Abramov Stepan 
Published: July 2021

Abstract
The Treaty on trade marks, service marks and appellations of origin of the Eurasian Economic Union (entered into force on 26 April 2021)
Instructions to the Treaty on trade marks, service marks and appellations of origin of the Eurasian Economic Union (entered into force on 17 June 2021)
The Treaty on the Eurasian Economic Union (EAEU) trade marks, service marks and appellations of origin, signed on 3 February 2020, came into force on 26 April 2021 upon its ratification by all the EAEU Member States (Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan and Kyrgyz Republic). On 18 May 2021, the Counsel of the Eurasian Economic Commission approved instructions thereto, which came into effect on 17 June 2021.
The Mediterranean Fruit Fly (Diptera: Tephritidae), a Key Pest of Citrus in Egypt
Authors: Abd-Elgawad Mahfouz M M 
Published: July 2021

Abstract
The Mediterranean fruit fly (Mediterranean fruit fly), Ceratitis capitata (Wiedemann), is a key pest of citrus fruit (Sapindales: Rutaceae), and can infect over 300 other economically important fruit-bearing plant species globally. The Mediterranean fruit fly moves to different hosts continuously and has 8–10 overlapping generations a year in Egypt. The female lays the eggs under the fruit peel and hatched larvae use anterior mouth hooks to vigorously feed on fruit flesh until they reach the third and last instar. As tens of eggs are often deposited in a single spot, the fruit becomes juicy and inedible. Larval infection and feeding also facilitate the entry of fungi and microbes that can rot the fruit. Infestation of citrus orchards can result in significant annual losses in crop size and quality. As a quarantine pest with high reproductive potential and dispersive ability, the Mediterranean fruit fly is difficult to manage and poses a major threat to Egyptian citrus export because of concerns over infection or pesticide residues. This review discusses the current state of research on Mediterranean fruit fly biology and ecology as well as host fruit production practices from the standpoint of pest management. Integrated pest management programs consisting of regulatory, cultural, chemical, genetic, and biological control methods that are currently the most effective strategies for Mediterranean fruit fly control are also described.
Substance Use Relapse Among Veterans at Termination of Treatment for Substance Use Disorders
Authors: Betancourt Christian A , Kitsantas Panagiota , Goldberg Deborah G , Hawks Beth A 
Published: July 2021

ABSTRACT

Introduction
Military veterans continue to struggle with addiction even after receiving treatment for substance use disorders (SUDs). Identifying factors that may influence SUD relapse upon receiving treatment in veteran populations is crucial for intervention and prevention efforts. The purpose of this study was to examine risk factors that contribute to SUD relapse upon treatment completion in a sample of U.S. veterans using logistic regression and classification tree analysis.

Materials and Methods
Data from the 2017 Treatment Episode Data Set—Discharge (TEDS-D) included 40,909 veteran episode observations. Descriptive statistics and multivariable logistic regression analysis were conducted to determine factors associated with SUD relapse after treatment discharge. Classification trees were constructed to identify high-risk subgroups for substance use after discharge from treatment for SUDs.

Results
Approximately 94% of the veterans relapsed upon discharge from outpatient or residential SUD treatment. Veterans aged 18-34 years old were significantly less likely to relapse than the 35-64 age group (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.66, 0.82), while males were more likely than females to relapse (OR 1.55, 95% CI: 1.34, 1.79). Unemployed veterans (OR 1.92, 95% CI: 1.67, 2.22) or veterans not in the labor force (OR 1.29, 95% CI: 1.13, 1.47) were more likely to relapse than employed veterans. Homeless vs. independently housed veterans had 3.26 (95% CI: 2.55, 4.17) higher odds of relapse after treatment. Veterans with one arrest vs. none were more likely to relapse (OR 1.52, 95% CI: 1.19, 1.95). Treatment completion was critical to maintain sobriety, as every other type of discharge led to more than double the odds of relapse. Veterans who received care at 24-hour detox facilities were 1.49 (95% CI: 1.23, 1.80) times more likely to relapse than those at rehabilitative/residential treatment facilities. Classification tree analysis indicated that homelessness upon discharge was the most important predictor in SUD relapse among veterans.

Conclusion
Aside from numerous challenges that veterans face after leaving military service, SUD relapse is intensified by risk factors such as homelessness, unemployment, and insufficient SUD treatment. As treatment and preventive care for SUD relapse is an active field of study, further research on SUD relapse among homeless veterans is necessary to better understand the epidemiology of substance addiction among this vulnerable population. The findings of this study can inform healthcare policy and practices targeting veteran-tailored treatment programs to improve SUD treatment completion and lower substance use after treatment.
Malignant Hyperthermia—A Case From Camp Humphreys, South Korea, and Lessons for the Military Health System
Authors: Wren Paige , Chun Sung Min , Vietor Robert 
Published: July 2021

ABSTRACT
Although malignant hyperthermia (MH) is a well-known complication of anesthesia, it presents unique considerations in the military health system. In this case report, the authors present a 26-year-old male active duty service member who experienced an MH crisis during a routine bilateral sagittal split osteotomy. The case presented here, which occurred at Brian D Allgood Army Community Hospital at Camp Humphreys, South Korea, highlights the challenges presented when caring for these patients in minimally staffed environments with frequent turnover of staff. The authors discuss the challenges to the military system such as the importance of adequate documentation of MH-susceptible service members, the benefits of rapidly dissolving dantrolene sodium nanosuspension, and the necessity for frequent training of military medical staff in the recognition and management of MH.
Evaluation of a Stress Management Course for Shipboard Sailors
Authors: Tannenbaum Karen , Hurtado Suzanne L , Yablonsky Abigail Marter 
Published: July 2021

ABSTRACTBackgroundAs part of their day-to-day operational mission, shipboard sailors experience unique stressors that can affect their health and readiness. The San Diego Fleet and Family Support Center (FFSC) conducts in-person classes to teach stress management principles to sailors. The FFSC stress management course covers the causes and consequences of stress, reviews the Navy Operational Stress Control model, and provides information on basic stress management skills. This course has not been rigorously evaluated to determine its impact on the sailors’ ability to manage stress. The purpose of this study was to evaluate the short-term impact of the FFSC stress management class on the (1) sailors’ stress management knowledge, (2) sailors’ intention to share knowledge from the class with others, and (3) sailors’ satisfaction with the class.MethodShipboard sailors (n = 95) who attended a stress management course completed pretest and posttest assessments that measured workplace stress, current stress management behaviors, stress management knowledge, intention to share course information, and participant satisfaction with the course. Most ratings were made on a 5-point scale, where higher scores indicated more positive outcomes.ResultsIn the aggregate, participants gave high marks for the class (M = 3.81, SD = 0.66), gave positive ratings for the class instructors (M = 3.84, SD = 0.67), and were satisfied with the class (M = 4.05, SD = 0.63). Sailors also reported that the class was relevant to their work (M = 3.64, SD = 0.81). Overall, 80% of class participants intended to share information learned in the class with family members and military friends, potentially extending the reach and impact of the FFSC class. Finally, sailors did not show increased stress management knowledge as a result of taking the FFSC stress management class (P = .31).ConclusionThis study was the first evaluation of the short-term impact of the FFSC stress management course on the stress management knowledge of shipboard crews. Study limitations prevented the study team from assessing the long-term impact of the stress management course on future stress levels and stress abatement behaviors. Recommendations are made to enhance future evaluations of FFSC classes for service members.