bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing doppler-echocardiography and thermodilution for cardiac output measurements in resuscitated out-of-hospital cardiac arrest patients undergoing targeted temperature management
Authors: Grand J , Hassager C , Kjaergaard J , Moller JE , Bro-Jeppesen J 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular dysfunction is common after out-of-hospital cardiac arrest (OHCA). Cardiac output measurements can be used to guide treatment during post-resuscitation care and echocardiography allows noninvasive cardiac output estimation.

Purpose
The aim of the present study was to compare Doppler echocardiography (doppler_CO) with thermodilution using pulmonary artery catheters (PAC_CO) for cardiac output estimation in a large and consecutively included cohort of comatose OHCA-patients undergoing targeted temperature management (TTM).

Methods
Single-center substudy of 171 patients included in the TTM-trial randomly assigned to 33 or 36 degrees C for 24 hours after OHCA. We measured PAC_CO and doppler_CO simultaneously shortly after admission and again after 24 hours.

Measurements and Main Results
We excluded 19 (11%) patients without PAC-measurement and 31 (18%) without doppler-measurements resulting in 120 paired measurements at admission. Patients were 61 (±11) years old, 86% were men and 91% had a witnessed OHCA. At ICU-admission, PAC_CO was 4.81 (±1.81) L/min. and doppler_CO was 3.74 (±1.38) L/min., with a mean bias of 1.07 (±1.65) L/min (with 95% limits of agreement of –2.16 to 4.04) L/min. Examining the Bland-Altman plot, precision fell with higher cardiac output (figure). A statistically significant, but moderate correlation was found between doppler_CO and PAC_CO at admission (r = 0.49), p &lt; 0.0001). After 24 hours, PAC_CO was 4.63 (±1.38) L/min. and doppler_CO was 3.61 (±1.14) L/min, with a mean bias of 0.96 L/min. Assessing the change from admission to 24 hours, PAC_CO decreased averagely -0.12 (±2.22) L/min. and doppler_CO decreased -0.19 (±1.91) L/min. The changes from admission to 24 hours correlated between doppler_CO and PAC_CO (r = 0.55), p &lt; 0.0001) with a mean bias of the changes of 0.07 L/min, with 95% limits of agreement of –3.76 to 3.91 L/min.

Conclusions
Changes in cardiac output during TTM may be evaluated with Doppler echocardiography with little mean bias compared to changes in CO measured with thermodilution, but relatively large changes are needed in the individual patient before it can be considered as real. Abstract Figure. Comparing Doppler vs. thermodilution
The impact of percutaneous coronary intervention versus coronary artery bypass grafting surgery in left main coronary disease
Authors: Oliveira CC , Guerra A , Braga C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Although coronary artery bypass grafting (CABG) has been considered the gold-standard method for the treatment for left main stable ischemic coronary disease (s-LMCAD), percutaneous coronary intervention (PCI) has shown good results.

Objective
To evaluate patients with s-LMCAD who performed CABG or PCI and compare their outcomes.

Study design
Single center, retrospective study that included all s-LMCAD patients who performed LM PCI or CABG between January 2015 and November 2018 (n = 35 in the PCI group and 35 in the CABG group after propensity score and matches in a ratio of 1:1). Clinical and imaging information of patients was collected, relating to the pre- and post-procedure and with 3 years of follow-up (FUP).

Results
Overall, baseline clinical and angiographic characteristics were balanced between the groups. The PCI group had higher prevalence of previous coronary disease (54.3%% vs 28.6%, p = 0.029) and chronic obstructive pulmonary disease (22.9% vs 5.7%, p = 0.04). The anatomical complexity estimated through the calculation of the SYNTAX score showed no significant differences between groups (16 vs 19, p = 0.151). 50% of PCI group performed IVUS, 2.8% OCT and 2.8% FFR. All CABG grafts used were arterial. There were no registries of events during hospitalization. At 30 days, cardiovascular-mortality was higher in the PCI group than in CABG group (n = 2 (5.56%) vs 0, respectively), representing all cases of cardiovascular death in PCI group through the 3-years follow-up. In CABG group, cardiovascular-related death was more substantial at 3 years. At 3 years of FUP, no significant differences were found between the PCI and CABG groups in MACCE (hazard ratio (HR) of the PCI group, 2,786; confidence interval (CI) of 95%, 0.873 to 8,889; p = 0.084). However, patients submitted to PCI with a SYNTAX score≥23 had worse MACCE results (HR 9.022, 95% CI, 1,054 to 77.210; p = 0,045), though a large confidence interval was also registered. Though not significantly different, cardiac-related hospital admissions were more frequent in the CABG group (18 (25.00%) vs 6 (16.67%) in the PCI group), but occurred more acutely in the PCI group (&lt; 30 days). Stroke events happened more frequently in the CABG group, with a total of 4 cases reported (5.56%) whereas in the PCI group none happened. Myocardial infarction rate was also higher in the PCI group (2, 5.71%) and 1 happened in the first 30 days which was related to a target lesion failure. Revascularization through PCI due to restenosis had only 1 (2.78%) case registered. Graft failure happened in only 1 patient.

Conclusion
In conclusion, for the treatment of patients with stable s-LMCAD and low anatomical complexity, PCI was noninferior to CABG. Our results suggest that PCI is an acceptable alternative to CABG for patients with stable left main coronary artery disease, except for the ones with high anatomical complexity.
Cardiovascular disease risk factors in the community of the western region of Saudi Arabia
Authors: Alsafrani T , Abukhodair A , Khojah O , Jastania E , Alamri R , Kinsara A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
To estimate the prevalence of the risk factors for coronary artery disease (CAD) in the community of the Western Region, Saudi Arabia.

Background
CAD is a significant cause of mortality globally, particularly in developing countries, and predicted to increase significantly. The risk factors for CAD, such as hypertension, diabetes mellitus, hyperlipidemia, and smoking are increasingly prevalent, in addition to an increased prevalence of obesity.
Design/Methods:
A cross-sectional study was conducted in a mall, using a consecutive sampling technique. Individuals were interviewed in terms of clinical signs and symptoms as well as the risk factors. The anthropometric measurements were done on site to identify asymptomatic risk factors.

Results
In total, 193 individuals participated in this study. The mean age of the sample was 36.3 ± 12.4 years, with 53% male. Smoking was the most frequent risk factor (36.1%), followed by dyslipidemia (22.5%), hypertension (16.6%), and diabetes mellitus (14.5%). Less than half (40%) of the sample participated in sport for one to two hours per week. Almost all consumed fast food at least once a week, and 16.6% consumed fast food more than four times a week. The average systolic blood pressure was 129.41± 22.5 mmHg and the average body mass index (BMI) 28.6 ± 9.5 kg/m2.

Conclusion
Dyslipidemia was the most prevalent risk factor, followed by hypertension and diabetes mellitus. These three risk factors are first in the risk factor pyramid in commonality, and preventative interventions are pivotal to decrease the incidence of cardiovascular disease. The consumption of fast food is relatively high with a low level of physical activity. Educating the community regarding measures to reduce the modifiable risk factors is foundational to avoid catastrophic results.
Meta-analysis on the safety and efficacy of Lumbrokinase in peripheral arterial disease
Authors: Agoncillo A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Lumbrokinase, an oral anti-thrombotic and fibrinolytic agent, was not yet part of the recommendations of any recommendations but had shown in two studies that it could increase the Ankle Brachial Index (ABI). ABI was used to evaluate the drug efficacy for PAD.

Purpose
Peripheral Arterial Disease was one of the most neglected, under-screened, and undertreated high-risk groups among cardiovascular diseases like myocardial infarction and stroke. Few studies were done to evaluate the treatment of fibrinolytic such as Lumbrokinase for this population.

Methods
We appraised two randomized control trials that evaluated the safety and efficacy of Lumbrokinase compared to placebo with the standard regimen and another study of Lumbrokinase compared to placebo with standard regimen versus Lumbrokinase with Prostaglandin E1 (PGE1) among adult patients for the reduction of symptoms of PAD and increase in ABI. Both trials treatment period lasted for 2 weeks.
Two independent reviewers assess the identified trials for inclusion by applying the selection criteria and quality was assessed using the JADAD scale. The data was analyzed using Meta analyst statistical software.
Main results
After weeks of treatment, the effect size is 0.90; this is an increase of at least +0.06 from the baseline that supports the trend in increasing the ankle-brachial index. The study did not show significant side effects by Lumbrokinase

Conclusions
Lumbrokinase at 460 to 490 mg three times a day for 2 weeks to 3 months has no significant relationship but has a trend in increasing the ankle-brachial index to a borderline level compared to placebo. Additional studies regarding the effect of Lumbrokinase in increasing ABI must be done with larger sample size. Further research is needed to illuminate whether a longer duration of treatment with Lumbrokinase can increase the ankle-brachial index more.
Eligible Trials Table 1. Eligible trials, characteristics, and demographics.AuthorYearControlPatient enrolled (N)Patient Analysed (%)Age Mean SDMales %Diabetes %Dyslipidemia %1. NDRAHA2013PlaceboL = 10 C= 10L = 100 C = 100L = 55.8 C = 53.2L = 5 C = 5L = 35 C = 25L = 30 C = 302. LUL= 31 C = 31L = 100 C = 100L = 68 C = 68.4L = 74 C = 74NANASUM/RAW MEANSL= 41 C = 41L = 100 C = 100L = 61.9 C = 60.8L = 39.4 C = 39.4NANAL= Lumbrokinase groupC= Control groupNA = not availableAbstract Figure. Efficacy of Lumbrokinase
The efficacy and safety of prolonged dual antiplatelet therapy beyond 12 months in patients with high risk of ischemic or bleeding events after PCI
Authors: Wang HY , Ge JZ , Dou KF 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The relative benefit-risk profile of continuing DAPT beyond 1 year for patients undergoing PCI who are at high risk for ischemic or hemorrhagic complications in real-world practice remains to be determined. For this reason, we sought to evaluate the benefits and harms of DAPT beyond 1 year as compared with ≤1-year DAPT among high ischemic or bleeding risk patients undergoing PCI with DES from a prospective, real-world registry.

Methods
All consecutive patients undergoing PCI were prospectively included in the Fuwai PCI Registry from January 2013 to December 2013. We evaluated 7521 patients who were at high risk for thrombotic or hemorrhagic complications and were events free at 1 year after the index procedure. "TWILIGHT-like" patients with high risk of bleeding or ischemic events were defined by clinical and angiographic criteria. The clinical criteria chosen to enroll patients at high risk for either bleeding or ischemic complications after PCI were: ≥65 years, female sex, troponin-positive ACS, established vascular disease (previous myocardial infarction [MI], documented peripheral arterial disease [PAD] or CAD/PAD revascularization), diabetes mellitus treated with medication, and chronic kidney disease (CKD). Angiographic criteria included multivessel CAD, total stent length &gt;30 mm, a bifurcation lesion treated with two stents, thrombotic target lesion, left main (≥50%) or proximal left anterior descending (LAD) (≥70%) lesion, and calcified target lesions requiring atherectomy. The primary ischemic outcome was major adverse cardiac and cerebrovascular events [MACCE] (a composite of all-cause death, myocardial infarction, or stroke).

Results
Median follow-up duration was 2.4 years. The risk of MACCE was significantly lower in DAPT &gt; 12- group (n = 5252) than DAPT ≤ 1-year group (n = 2269) (1.5% vs. 3.8%; hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.27-0.50; P &lt; 0.001). This difference was largely driven by a lower risk of all-cause death. In contrast, the risk of Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding was statistically similar between the 2 groups (1.0% vs. 1.1%; HR: 0.80; 95% CI: 0.50-1.28; P = 0.346). Results were consistent after multivariable regression and propensity-score matching. Relative treatment effects were consistent for the outcomes of MACCE and clinically relevant bleeding independent of the number of clinical and angiographic high-risk features (1-3 [n = 310], 4-5 [n = 3560], or 6-9 [n = 854]).

Conclusions
Prolonged DAPT beyond 1 year after DES implantation resulted in a significantly lower rate of atherothrombotic events, including a mortality benefit, with no higher risk of clinically relevant bleeding in "TWILIGHT-like" patients who were at high-risk for ischemic or bleeding events. Abstract Figure.
Combined improvement of insulin resistance and hypertension using whole body digital twin technology in diabetic hypertensives- a real world study
Authors: Shamanna P , Joshi S , Shah L , Mohammed J , Mohammed M , Poon T , Mohamed T , Keshav A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Twin Health

OnBehalf
TWIN Study Group

Introduction
Insulin resistance is multifaceted phenomenon that affects blood pressure homeostasis

Methods
207 patients (163 male), with T2DM and concomitant hypertension were evaluated for impact of the Twin Precision Nutrition (TPN) Program, which utilises a whole-body digital twin technology, powered by artificial intelligence and Internet of Things. As part of the assessment, the change in, insulin resistance (HOMA2-IR) and systemic hypertension (Systolic BP, Diastolic BP), as measured by HBPM (Home Blood Pressure Monitoring) were evaluated longitudinally for three months. Student-t test and Pearson r was utilised for statistical analysis

Results
49.7% (n = 103) achieved HbA1c less than 7%, 37.1% (n = 77) achieved hypertension control (SBP &lt; 130 mmHg, DBP &lt;80 mmHg) and 20.2% (n = 42) achieved both hypertension and targeted glycemic control (SBP &lt; 130 mmHg, DBP &lt;80 mmHg, HbA1c &lt;7%). Mean duration of diabetes was 8.9 years (±7.2, minimum 0, maximum 35, 95% CI 7.9 to 9.9). The reduction in the HbA1c (%), SBP (mmHg), DBP (mmHg) and HOMA2 IR was -1.8 ± 0.1, -10.67 ± 1.51, -6.28 ± 1.01 and -0.93 ± 0.16, was highly statistically significant, respectively (p &lt; 0.0001) (Table). There was a positive correlation between insulin resistance (HOMA2-IR) and both SBP (r = 0.17, p = 0.0098) and DBP (r = 0.14, p = 0.0382). The association between the insulin resistance was relatively stronger for SBP than for DBP. Of initial 69 patients who had high HOMA2-IR (≥2.9) reduced to just 6 patients

Conclusion
Our study is distinct to demonstrate the clinical utility of digital health intervention to utilise mutli-pronged approach provided by technology enabled precision nutrition, to address multiple pathways simultaneously. Our results provide insights into the acute benefits for hypertension and need corroboration with long term follow up to provide insights for end organ protection that directly mitigates the complications of diabetes and hypertension Change in the HbA1c, SBP, DBP and HOMA2-ParameterTime PointMean (±SD)MinimumMaximumRange95% CIp valueHba1cDay 08.8 ± 1.95.1159.88.5 to 9&lt;0.0001 ****Day 906.9 ± 0.94.8105.36.8 to 7.1Systolic BPDay 0136 ± 179419096134 to 139&lt;0.0001 ****Day 90126 ± 138716073124 to 127Diastolic BPDay 088 ± 12641437986 to 90&lt;0.0001 ****Day 9082 ± 8.8561115581 to 83HOMA2-IRDay 02.6 ± 2.10.318182.3 to 2.9&lt;0.0001 ****Day 901.6 ± 10.111111.5 to 1.8Abstract Figure. Correlation: Hypertension and HOMA2-IR
Canine exposure: open or closed?
Authors: Camilleri Simon 
Published: April 2021

SummaryEvidence for open or closed exposure of palatally displaced canines is equivocal, but this study sheds light on new facets which may influence the method of choice. The aim of this article is to give a short perspective on this field, highlight the merits of a study published in this issue of the European Journal of Orthodontics by Björksved et al. the study, place the findings into context and show how it may influence clinical practice.
Informed proposal Monte Carlo
Authors: Khoshkholgh Sarouyeh , Zunino Andrea , Mosegaard Klaus 
Published: April 2021

SUMMARY
Any search or sampling algorithm for solution of inverse problems needs guidance to be efficient. Many algorithms collect and apply information about the problem on the fly, and much improvement has been made in this way. However, as a consequence of the No-Free-Lunch Theorem, the only way we can ensure a significantly better performance of search and sampling algorithms is to build in as much external information about the problem as possible. In the special case of Markov Chain Monte Carlo (MCMC) sampling we review how this is done through the choice of proposal distribution, and we show how this way of adding more information about the problem can be made particularly efficient when based on an approximate physics model of the problem. A highly non-linear inverse scattering problem with a high-dimensional model space serves as an illustration of the gain of efficiency through this approach.
Wellbeing as a policy framework for health promotion and sustainable development
Authors: Corbin J Hope , Abdelaziz Faten Ben , Sørensen Kristine , Kökény Mihály , Krech Rüdiger 
Published: April 2021

AbstractFor years Gross Domestic Product (GDP) has served as a key indicator of human progress and “successful” societies. Unfortunately, GDP has failed to robustly capture the human experience or predict resilience through crises; and obscures the presence of inequity -- a key determinant of suffering. It is clear the global community needs a new organizing principle: one that envisions and measures progress by focusing on the conditions that support health, resilience, and overall wellbeing. This paper examines key health promotion concepts and approaches, juxtaposed with philosophical underpinnings of the concept of wellbeing, alternative measurement strategies, and examples of wellbeing policy initiatives. In doing so, the paper highlights the relevance of wellbeing policy frameworks to health promotion, the utility of health promotion strategies for implementing wellbeing policy frameworks, and controversies and pitfalls that require consideration. The paper concludes by outlining how health promotion is uniquely poised to contribute to wellbeing policy frameworks that promote the sources of human and planetary thriving through sustainable development, and that promoting a wellbeing agenda can strengthen efforts to promote health by addressing social determinants and ensuring universal access to resources that support coping with emerging challenges and strengthen resilience.
Assessment of intra-sample variability in HIV-1 DNA drug resistance genotyping
Authors: Millière Laurine , Bocket Laurence , Tinez Claire , Robineau Olivier , Veyer Nathalie , Wojciechowski Fanny , Lambert Valérie , Meybeck Agnès , Huleux Thomas , Ajana Faiza , Hober Didier , Alidjinou Enagnon Kazali 
Published: April 2021

AbstractBackground and objectivesHIV-1 drug resistance testing can be performed in proviral DNA. The non-homogenous distribution of viral variants in cells can impact the performance of this method. We assessed the variability of HIV-1 DNA genotyping results in the same blood sample using a next-generation sequencing (NGS) method.MethodsFor each included patient, a blood sample from a single venipuncture was split into five 1 mL aliquots, which were independently tested in the same run. HIV-1 DNA was quantified in blood samples using real-time PCR, and NGS was performed with the Sentosa platform combined with the Sentosa SQ HIV genotyping Assay.ResultsA total of 60 aliquots from 12 samples (12 patients) were tested. The median age was 45.50 years old, and all patients were treated with antiretrovirals. A significant variability can sometimes be observed in HIV-1 DNA quantification between aliquots from the same sample, with a coefficient of variation ranging from 23% to 89%. The analysis of resistance-associated mutations (RAMs) with a 20% cut-off found some discordances in RAMs profile between aliquots from the same sample for 5, 3 and 3 patients in the reverse transcriptase, protease and integrase genes, respectively. The analysis with a lower cut-off (10%) showed additional mutations, but did not improve the intra-sample concordance.ConclusionsThere is an intra-sample variability in HIV-1 DNA resistance test results, and repetition may sometimes bring additional information, but the extent of its clinical impact still requires further investigation.
Validation of the Eclipse Farm 4G & COMET for Detection of Antibiotics in Raw Bovine Milk: AOAC Performance Tested MethodSM 022101
Authors: Razquin Pedro , Sanz David , Marco Adrián , Carrascón Vanesa , Andaluz Sofía , Soler Lourdes , Antón Alejandra , Mata Luis 
Published: April 2021

Abstract

Background
The Eclipse Farm 4G test coupled to the COMET device allows for automatic and easy screening of a broad range of antimicrobials in raw bovine milk. All results obtained with this system are available in real-time through a smartphone application (App) and in the Test4all cloud platform.

Objective
The objective of this study was to validate Eclipse Farm 4G & COMET for the screening of antimicrobials in raw bovine milk according to AOAC Performance Tested MethodSM procedures.

Method
The test is based on the inhibition of microbial growth of Geobacillus stearothermophilus in the presence of antimicrobials. When sample tubes are incubated in the absence of antibiotics, spores germinate and cells grow, changing the medium color from purple to yellow (negative result). The presence of antimicrobials in the milk sample hinders bacterial growth, preventing the tubes from changing color from purple to yellow (positive result). The COMET device automatically integrates all assay steps (incubation, time control, and results interpretation) and communications between the device, smartphone, and cloud.

Results
LODs and detection capabilities were confirmed to be at or below the European Union (EU) maximum residue limit (MRL) for most of the evaluated molecules representing the main families of antimicrobials (penicillins, cephalosporins, tetracyclines, sulfonamides, macrolides, and aminoglycosides). False-positive rates and the effect of potentially interfering substances showed sufficient selectivity/specificity. The Eclipse Farm 4G & COMET system was shown to be robust, consistent, and stable during shelf life.

Conclusions
The Eclipse Farm 4G & COMET system has been shown to be suitable for screening antibiotics in raw bovine milk.

Highlights
The assay is an automatic and easy system for the detection of a broad range of antibiotics in raw bovine milk consistent with EU MRLs and can provide results any time and anywhere through a smartphone App and a cloud platform.