bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acoustic signal dominance in the multimodal communication of a nocturnal mammal
Authors: Zhang Chun-Mian , Sun Cong-Nan , Lucas Jeffrey R , Feng Jiang , Jiang Ting-Lei 
Published: October 2021

AbstractMultimodal communication in animals is common, and is particularly well studied in signals that include both visual and auditory components. Multimodal signals that combine acoustic and olfactory components are less well known. Multimodal communication plays a crucial role in agonistic interactions in many mammals, but relatively little is known about this type of communication in nocturnal mammals. Here, we used male Great Himalayan leaf-nosed bats Hipposideros armiger to investigate multimodal signal function in acoustic and olfactory aggressive displays. We monitored the physiological responses (heart rate [HR]) when H. armiger was presented with 1 of 3 stimuli: territorial calls, forehead gland odors, and bimodal signals (calls + odors). Results showed that H. armiger rapidly increased their HR when exposed to any of the 3 stimuli. However, the duration of elevated HR and magnitude of change in HR increased significantly more when acoustic stimuli were presented alone compared with the presentation of olfactory stimuli alone. In contrast, the duration of elevated HR and magnitude of change in HR were significantly higher with bimodal stimuli than with olfactory stimuli alone, but no significant differences were found between the HR response to acoustic and bimodal stimuli. Our previous work showed that acoustic and chemical signals provided different types of information; here we describe experiments investigating the responses to those signals. These results suggest that olfactory and acoustic signals are non-redundant signal components, and that the acoustic component is the dominant modality in male H. armiger, at least as it related to HR. This study provides the first evidence that acoustic signals dominate over olfactory signals during agonistic interactions in a nocturnal mammal.
Culprit-plaque morphology and residual SYNTAX score for predicting cardiovascular events in acute myocardial infarction: an optical coherence tomography study
Authors: Wang Y , Zhao X X , Zhou P , Liu C , Li J N , Zhou J Y , Chen R Z , Chen Y , Song L , Zhao H J , Yan H B 
Published: October 2021

Abstract

Background
Previous studies reported that different culprit-plaque morphologies [plaque rupture (PR) and plaque erosion (PE) identified by optical coherence tomography (OCT)] might influence clinical outcomes in patients with acute myocardial infarction (AMI). Moreover, residual SYNTAX score (rSS) was proved to be related to worse prognosis.

Purpose
This study aimed to investigate the prognostic implication of culprit-plaque morphologies and rSS for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods
A total of 369 STEMI patients undergoing preintervention optical coherence tomography examination were included and divided into 4 groups based on PR and rSS: PE/low-rSS (n=92), PE/high-rSS (n=82), PR/low-rSS (n=80) and PR/high-rSS (n=115). The rSS was determined as the SYNTAX score remaining after completion of planned PCI. MACE was defined as the composite of all-cause death, recurrence of myocardial infarction (MI), stroke and unplanned revascularization of any coronary artery. K-M survival analysis and cox regression with adjustments for multiple covariates was used for outcome analysis.

Results
During a mean follow-up of 2.2 years, MACE occurred in 58 (15.7%) patients: 7.6% (7 patients) among patients with PE/low-rSS, 13.4% (11 patients) among patients with PE/high-rSS, 6.3% (5 patients) among patients with PR/low-rSS and 25.2% (29 patients) among patients with PR/high-rSS (p=0.001). In fully adjusted analyses, patients with PR/high-rSS presented higher MACE risk than patients with PE/low-rSS (HR: 3.17, 95% CI: 1.37–7.33, P=0.007).

Conclusion
In STEMI patients, patients with PR/high-rSS had worse prognosis, indicating culprit-plaque morphology and residual atherosclerosis burden should be taken into account in risk stratification and management of patients with STEMI.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences FlowchartSurvival curves
Sex and age differences in patients with acute coronary syndrome and non-obstructive coronary arteries: presentation and outcome
Authors: Williams M G L , Dastidar A , Liang K , Johnson T W , Baritussio A , Strange J W , Joshi N , Dorman S , De Garate E , Spagnoli L , Fiori E , Lawton C B , Biglino G , Plein S , Bucciarelli-Ducci C 
Published: October 2021

Abstract

Aims
A substantial number of patients present with acute coronary syndrome (ACS) and non-obstructive coronary arteries. Sex and age differences in these patients are not well understood. This study aims to evaluate the impact of sex and age on clinical presentation and outcome in patients with ACS and non-obstructive coronary arteries, with either an ischaemic or non-ischaemic cause.

Methods and results
Consecutive patients with an ACS and non-obstructive coronary arteries (n=719) from a single tertiary centre underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Patients with an ischaemic or non-ischaemic aetiology (n=529) on CMR were followed prospectively. All-cause mortality was 11% over a median follow up of 4.9 years, with no significant difference between sexes (11% versus 11% p=0.732). Women were more likely to have an ischaemic aetiology on CMR (40% v 31%, p=0.037). Age group (HR 1.48, p=0.002), log peak troponin (HR 0.78, p=0.033) and LVEF (HR 0.98, p=0.032) were independent predictors of mortality. Men aged &gt;60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women &gt;60 years (p=0.003).

Conclusions
There is no difference in all-cause mortality between sexes in patients presenting with ACS and non-obstructive coronary arteries but increasing age is an important predictor of mortality in both sexes.

Funding Acknowledgement
Type of funding sources: None. Sex differences in CMR diagnosisSex, age and mortality
Massive open online learning in basic life support and automated external defibrillation: an efficient way to improve confidence and readiness of lay people to provide help
Authors: Birkun A , Dantanarayana V 
Published: October 2021

Abstract

Background
Education of lay people in cardiopulmonary resuscitation (CPR) is recognised as an important contributor to increased survival from out-of-hospital cardiac arrest. Nowadays, due to the increased risk of COVID-19, it is recommended to withhold traditional face-to-face training in CPR [1]. Whereas Internet-based distance learning is suggested as a suitable alternative to instructor-led training, little is currently known about the effectiveness of the online learning in resuscitation.

Purpose
The objective of this study was to investigate the effects of self-learning in basic life support (BLS) and automated external defibrillation (AED) utilising a massive open online course (MOOC) on lay people's self-confidence and willingness to provide help.

Methods
Lay trainees of the brief (approximately one hour long) theoretical self-paced Russian-language MOOC in BLS/AED were inquired to rate their knowledge of resuscitation and readiness to attempt CPR on a stranger both in the beginning and after completion of the course based on a five-point rating scale. A retrospective analysis of data obtained for one year (July 2018 – July 2019) was conducted.

Results
During the studied period, 11,924 persons joined the MOOC, and 3,445 (29%) trainees have finished the course. Of those who completed the course, 42% had some form of previous training in resuscitation, 45% were males; median age – 23 years. When compared to the pre-training levels, after mastering the course material the average levels of self-perceived knowledge and readiness to attempt CPR on a stranger improved significantly (p&lt;0.001): from 2.2 points to 4.0 points, and from 3.3 points to 4.2 points, respectively. After the training, the proportion of people who expressed a high level of willingness to give CPR (4–5 points) was almost two times higher than at baseline (81% vs. 44%; p&lt;0.001). Completion of the course curriculum and higher levels of self-confidence and readiness to provide CPR were strongly associated with previous resuscitation training (p&lt;0.001).

Conclusions
To the best of the authors' knowledge, no previous study has investigated and demonstrated the motivating effect of online learning in CPR. This study suggests that the free-of-charge massive online course in BLS/AED represent an effective tool for increasing coverage of the population with resuscitation training, improving self-confidence of potential rescuers and their willingness to provide the life-saving help. The distant theoretical training provides an important way to enhance and support laypeople's motivation to attempt CPR during the COVID-19 pandemic. Further research could be conducted to determine the effectiveness of the Internet-based massive self-directed learning supplemented with synchronous or asynchronous hands-on practice.

Funding Acknowledgement
Type of funding sources: None.
Smoky heart: cardiovascular manifestations of carbon monoxide poisoning
Authors: Butt N , Chaus A , Ratnani P , Stewart A 
Published: October 2021

Abstract

Background
Carbon monoxide (CO) poisoning is one of the most critical health concerns worldwide due to severe clinical effects with high morbidity and mortality. Tissue hypoxia and cellular damage from CO poisoning results in oxidative stress. Organs and tissues with high O2 demand including central nervous system (CNS) and cardiovascular (CV) system are the most susceptible to this oxidative stress. We investigate and describe the cardiovascular manifestations in 350 patients who were admitted for moderate to severe CO poisoning and treated with hyperbaric oxygen (HBO2) therapy.

Purpose
This study was conducted to identify the common cardiovascular manifestations of carbon monoxide poisoning.

Methods
We retrospectively collected data on 350 consecutive adult patients treated for CO poisoning between January 2011 to April 2018. Cardiac biomarkers, EKG and carboxyhemoglobin (COHb) levels were obtained from pre-hospital sources including EMS (emergency medical services) and from outside hospital records at the time of transfer. Glasgow Coma Scale (GCS) measurements were obtained at initial pre-hospital evaluation and upon arrival to the emergency room. Patient demographics, CV, CNS history and cardiac risk factors including hypertension, hyperlipidemia, diabetes, smoking history were obtained from electronic medical record. Myocardial injury was defined by cardiac troponin I level of ≥0.05 ng/mL.

Results
There were 350 patients admitted for CO poisoning from 2011 to 2018. 72% of the patients received HBO treatment due to severity of their symptoms. The mean age was 47.3 years with 60% men, 89% of the admissions were accidental exposure. Cardiac biomarkers were elevated in 40% of the patients and with 21% having sinus tachycardia. 6% had ischemic EKG changes with 23% having regional wall motion abnormalities on echocardiogram. In terms of intervention, 83% of the patients with elevated cardiac biomarkers received HBO treatment, 9% underwent coronary angiogram out of which 50% were candidate for either percutaneous intervention (PCI) or coronary artery bypass graft (CABG). In hospital mortality amongst this population was 2%.

Conclusion
Myocardial injury is common and widely seen with CO poisoning as seen by elevated cardiac biomarkers in 40% of the tested population. Initial work up for patients with CO poisoning should include evaluation with an EKG and serial biomarkers. If an abnormality is detected, patient should undergo an echocardiogram. Further evaluation with coronary angiography may be warranted in patients with new left ventricular dysfunction or wall motion abnormalities, especially in patients with risk factors.

Funding Acknowledgement
Type of funding sources: None.
Mobile versus fixed automated external defibrillators (AED deployment in a geographically dispersed population: analysis of the girona territori cardioprotegit project
Authors: Llongueras Espi P , Pons Monne M , Salvans Cirera M , Graterol Torres F , Singh M , Ramos Polo R , Vinas Fernandez D , Kassem Perez H , Pascual Mayans J , Badosa Gali E , Nunez Torras M , Aboal Vinas J , Loma-Osorio Ricon P , Brugada Tarradellas R 
Published: October 2021

Abstract

Introduction/Aim
Public defibrillation doubles out-of-hospital cardiac arrest survival. However, the best way to provide public defibrillation coverage to geographically dispersed populations remains unknown. The aim of this study is to compare usage rates and effectivity between mobile versus fixed Automated External Defibrillators (AED).

Methods
This project is a prospective registry of the usage rate of public AED (542 fixed AED, 241 mobile AED) and the analysis of the electrocardiographic traces, from June 2011 until December 2019. We compared the usage rate, the proportion of shockable rhythms and defibrillation success between fixed versus mobile AED.

Results
Of 566 registered usages, we obtained 494 electrocardiographic traces, of which 108 (21%) were from fixed AED. The usage rate of fixed and mobile AED were 0.022use/AED-year and 0.177use/AED-year respectively. In Fixed AED group we observed a higher proportion of shockable rhythms (34.2% vs. 20.3%, p=0,01) and higher defibrillation success (79% vs. 63%, p=0,02). The proportion of patients with shockable rhythms who were transferred to a hospital were 62.1% and 50% in Fixed AED and Mobile AED group respectively (p=0,306).

Conclusions
In Fixed AED group we observed more shockable rhythms and higher defibrillation success rates. Mobile AED were 8 times more used.

Funding Acknowledgement
Type of funding sources: None.
Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data
Authors: Mughal M , Kaur I , Waxman S , Gandhi H , Kakadia M , Khakwani Z , Okoh A , Shah K , Obaid A , Sirpal V , Azad S , Jaffery A , Jagdey H , Tawfik I , Alam M 
Published: October 2021

Abstract

Background
In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience.

Purpose
To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest.

Methods
This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021.

Results
A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1).

Conclusions
Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families.

Funding Acknowledgement
Type of funding sources: None.
Histological and molecular characterization of human aortic stenosis: a matter of sex
Authors: Matilla L , Jover E , Arrieta V , Garcia-Pena A , Fernandez-Celis A , Navarro A , Gainza A , Alvarez V , Sadaba R , Lopez-Andres N 
Published: October 2021

Abstract

Introduction
Aortic stenosis (AS) is the most common heart valve disease and it is strongly prevalent with elderly. AS is a progressive, degenerative disease associated with fibrosis and calcification of the valve leaflets. Surgical valve replacement is the only treatment available. Molecular, cellular and interstitial events activate multifactorial and complex cues with a significant contribution by valve interstitial cells (VICs). Despite male sex is a risk factor for developing AS, there is scant information on sex-specific differences in aortic valve (AV) biology or pathology.

Purpose
The aim of our study was to analyse sex-specific differences in aortic valves from AS patients.

Methods
185 patients with severe AS undergoing surgical valve replacement were recruited. 149 AVs (66 women; 83 men) were used for ex vivo analyses. Human VICs were isolated from 36 AVs (12 women; 24 men) for in vitro experiments. AVs structure were evaluated by haematoxylin-eosin, Movat, Alizarin Red, Congo red and Alcian blue/Sirius Red staining and immunohistochemistry. Western blot, ELISA and zymography were used for molecular biology studies.

Results
AVs from men presented increased inflammatory infiltrates (CD68 and CD45 positive cells) as compared to women. Complementarily, AVs from men exhibited higher levels of the inflammatory molecules interleukin (IL)-6 and IL-1b and RANTES. In line with these results, oxidative stress markers (eNOS, myeloperoxidase, malondialdehyde and nitrotyrosine) were upregulated in male AVs. Concerning, fibrosis, increased levels of collagen type I, fibronectin and syndecan-1 were found in AVs from men. Extracellular matrix (ECM) remodelling was characterized by reduced metalloproteinase-1 expression and increased tissue inhibitor of metalloproteinase-2 expression in male AVs. Importantly, calcification and osteogenic markers (bone morphogenetic protein-9, periostin, osteocalcin and Sox-9) was greatly enhanced in men AVs as compared to women. These findings were confirmed in isolated VICs. At baseline, male VICs presented higher myofibroblast-like phenotype than female VICs. In line with our ex vivo results, male VICs exhibited increased inflammatory, oxidative stress, fibrotic and osteogenic differentiation markers.

Conclusions
Our results suggest that the mechanisms driving the AV pathogenesis could be different in men and women patients with the same AS severity. Male AVs and isolated VICs presented more inflammation, oxidative stress, fibrosis and ECM remodelling including extensive calcification as compared to female. A better knowledge of the pathophysiological pathways in AVs and VICs will allow developing sex-specific options for AS treatment.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III
Sex related differences in exercise performance in patients with hypertrophic cardiomyopathy: hemodynamic insights through non-invasive pressure volume analysis
Authors: Argiro A , Rosenblum H , Griffin J , Batra J , Cappelli F , Burkhoff D , Maurer M , Olivotto I 
Published: October 2021

Abstract

Background
Women with HCM have worse cardiopulmonary exercise performance compared to men. We used non-invasive pressure-volume (PV) analysis to delineate sex related hemodynamic differences in HCM.

Methods
PV loops were constructed from echocardiograms using left ventricular (LV) volumes indexed to body surface area, Doppler estimates of LV end-diastolic pressure and blood pressure. The end-systolic PV relationship (ESPVR) and end-diastolic PV relationship (EDPVR) were derived from validated single-beat techniques. The area between the ESPVR and EDPVR (isovolumetric PV area), was indexed to an LV end-diastolic pressure of 30mmHg (PVAiso30), as the integrated metric of LV function. LV volume at an end-diastolic pressure of 30mmHg (V30) indexed ventricular capacity.

Results
202 patients were included, 56 women. Women were older (51 vs 44 yrs, p=0.012) and had reduced exercise capacity (5.6 vs 6.9 METs, p&lt;0.001). Only 32 patients (16%) had a peak gradient &gt;30mmHg at rest with no sex differences. Women had significantly lower indexed PVAiso30 (6577 vs 7767 mmHg·mL/m2, p&lt;0.001) driven by reduced ventricular capacitance (V30 54 vs 62 ml/m2, p&lt;0.001). In multivariable linear regression indexed V30 was an independent predictor of exercise capacity.

Conclusion
Impaired exercise capacity in women with HCM appears strongly related to abnormalities in passive diastolic properties, suggesting a unique pathophysiology compared to men, and a potential difference in viable therapeutic molecular targets

Funding Acknowledgement
Type of funding sources: None.