bluuebunny/crossref_metadata_2025_split huggingface dataset:
The validity of SOFA score to predict mortality in adult patients with cardiogenic shock on Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Laimoud M , Alanazi M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
veno-arterial ECMO is increasingly used in resuscitation of adults patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality and to determine the validity of the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality . Results : one hundred and six patients were retrospectively included in our study between 2015 and 2019 with in-hospital mortality of 56.6% . The mean age of patients was 40.2 ± 14.4 years and mostly males (69.8%) with a mean BMI of 26.5 ± 7 . Presence of CKD , chronic AF , cardiotomies were significantly more frequent in the non-survivors group . The non-survivors had more frequent AKI , more haemodialysis , more GI bleeding , more ICH, higher peak and 24 hours blood lactate and less ICU days as compared to the survivors group. Initial SOFA score ≥ 13 had a 85 % sensitivity and 73.9 % specificity [AUROC = 0.862 , 95% CI: 0.791 – 0.932 ; p &lt;0.001 ] while SOFA score ≥ 13 at day 3 had 100 % sensitivity and 91.3 % specificity for predicting mortality [AUROC =0.995 , 95% CI : 0.986 – 1 ; p &lt;0.001 ]. SOFA score ≥ 15 at day 5 had 98 % sensitivity and 100 % specificity for predicting mortality [AUROC =0.994 , 95% CI : 0.982 – 1 ; p &lt;0.001 ]. The Δ 1 SOFA (3-1) ≥ 2 had 95% sensitivity and 93.5% specificity [AUROC = 0.958 , 95% CI: 0.913 – 1 ; p &lt;0.001 ] while the Δ 2 SOFA (5-1) ≥ 2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958 , 95% CI: 0.909 – 1 ; p &lt;0.001 ] . Increasing Δ 1 SOFA score (OR = 2.506, 95% CI : 1.681 – 3.735,p &lt; 0.001) and increasing lactate level (OR = 1.388 , 95% CI : 1.015 – 1.898 , p = 0.04) were significantly associated with hospital mortality . Conclusion: the use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality . Serial evaluation with SOFA score during first few days of VA-ECMO support is a good predictor of hospital mortality . Increase of SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORCentral VA-ECMO0.2483.1020.455 - 21.154lactate peak level0.0401.3881.015 - 1.898Haemodialysis0.7121.6140.127 - 20.473Δ 1 SOFA (3-1)&lt; 0.0012.5061.681 - 3.735GI bleeding0.9170.8910.102 - 7.815ICH0.42414.5850.020 - 204.51Abstract Figure. SOFA scoring of studied VA-ECMO patients
Association between early Q-waves and microvascular injury in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention
Authors: Rusak T , Gelis LG , Miadzvedzeva EA , Shibeko NA , Haidzel IK 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pathological early Q-waves (QW) are associated with adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). It is still not clear how admission Q-waves are related to microvascular injury (microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for STEMI.

Aim
to determine the association between admission Q-waves and microvascular injury in STEMI patients treated with primary PCI.

Methods
This prospective study included 98 STEMI patients who underwent pPCI within 12 hours and had no contraindication of CMR investigation. Admission 12-lead electrocardiography was evaluated for the presence of pathological QW, defined as a depth of &gt;0,1 mV and a QW duration of &gt; 30 ms. The patients underwent a cardiac magnetic resonance imaging scan at 6 (interquartile range [IQR]: 5-7) days after pPCI to determine infarct characteristics including MVO (late gadolinium enhancement) and IMH (T2* mapping).

Results
The 98 first-attack STEMI patients included 87 men and 11 women with a mean age of 55,6 ± 9,7 years in this study. Early QW was observed in 23 (23,5%) patients. These patients were more frequent smokers (p = 0,041), had a significantly more frequent left anterior descending artery as culprit lesion (p = 0,03), and had higher rates of pre-interventional TIMI flow 0 (p = 0,001). Patients with QW was related to larger infarct size (21% vs. 8% of left ventricular mass, p = 0,002), lower ejection fraction (44% vs. 51%, p = 0,004), and larger MVO (53% vs. 32%, p = 0,001) and IMH (34% vs. 17%, p = 0,003). Q-waves remained associated with both MVO (odds ratio: 5,13, 95% confidence interval: 1,98 to 11,2, p &lt; 0,001) and IMH (odds ratio: 3,66, 95% confidence interval: 1,06 to 7,21, p &lt; 0,001) after adjusting for potential confounders (total ischemia time, ST-segment elevation, pre-interventional TIMI flow 0).

Conclusions
Admission Q-waves in the ECG were as independent early markers of microvascular obstruction and intramyocardial haemorrhage in STEMI patients undergoing pPCI.
Prognosis and follow-up of young patients admitted to a critical coronary care unit with acute coronary syndrome
Authors: Arroyo Monino DF , Barea Gonzalez C , Ruiz Garcia MP , Seoane Garcia T , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The presence of young patients admitted to a Critical Coronary Care Unit (CCCU) with the diagnosis of Acute Coronary Syndrome (ACS) is very common nowadays. The prognosis of these patients seems to be better than the elderly ones, although there are few records that endorse this statement.

Objective
Our aim is to carry out a follow-up of this population and study their prognosis during the index hospitalization and the follo-up.

Methods
Retrospective, descriptive, unicentric and observational registry of young patients (&lt;45 years old) admitted to one CCCU with the diagnosis of ACS between January 2.010 and November 2.020. The follow-up of these patients was performed using the electronic platform of Andalusian Health Security System.

Results
A total number of 252 patients were included in the registry, with a mean age of 40 years old, being male 206 (81,7%). The main reason of the admission was ACS with persistent ST segment elevation (STEMI) (177 patients – 70,2%). The most prevalent risk factor in this population was active smoking (198 patients – 78,6%). The main underlying mechanism of the ACS was the rupture of an atherosclerotic plaque (194 patients – 77%) and in most cases, there was only 1 coronary artery affected (153 patients – 60,7%). Intra-hospital mortality was low (2 patients died of cardiovascular cause – 0,8%, and 1 died of non-cardiovascular cause – 0,4%). Left ventricle ejection fraction (LVEF) at the discharge was preserved in 166 patients (65,9% - mean 58%), and reduced (&lt;40%) in 37 patients (14,7%). The median of the follow-up was 77 months (minimum 1 month and maximum 132 months). A total number of 5 patients died during this follow-up (2%, 3 during the first year), 3 of them of cardiovascular cause; these 3 patients had reduced LVEF at the discharge. During this follow-up, 64 (25,4%) patients were re-admitted to the hospital due to cardiovascular causes, most of them (30 – 11,9%) with the diagnosis of chest pain and 20 of them (7,9%) with the diagnosis of a new ACS.

Conclusions
Young patients admitted to our CCCU with the diagnosis of ACS presented most frequently with STEMI, affecting predominantly one coronary artery. Most of them had preserved LVEF at the discharge. The prognosis of this group of patients is good, with a low intra-hospital mortality and during the follow-up, with clear relation with the presence of reduced LVEF at the discharge. Re-admission was relatively frequent, mostly due to chest pain.
Impact of COVID-19 pandemic on admissions and management of acute coronary syndrome: a single tertiary cardiac centre experience in the United Kingdom
Authors: Tomson J , Khanra D , Ntoskas T , Wrigley B 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Global reports are suggestive of decline in number of patients attending hospital with acute coronary syndromes (ACS) and a reduction in the number of cardiac procedures since the onset of COVID-19 pandemic.

Purpose
The aim of the study was to compare the trend of presentations and management among ACS patients in a single tertiary cardiac centre in the West midlands of United Kingdom (UK) during the early lock down period of COVID-19 pandemic (Group 2020) in comparison to the same period of 2019 (Group 2019).

Methods
In this descriptive study patients’ records were extracted retrospectively from the electronic database who presented with ST segment elevation myocardial infarction (STEMI), non- ST segment elevation myocardial infarction (NSTEMI) and Unstable angina (UA), during the 30 day period from mid-March to mid-April of 2020 (Group 2020), and the same period of 2019 (Group 2019).

Results
In comparison to group 2019, total number of ACS (153 vs 91) including STEMI (70 vs 59), NSTEMI (76 vs 31) and UA (7 vs 1) were lower in group 2020 (Fig 1A). Inter-hospital transfer (IHT) dropped from 2019 to 2020 (55 vs 17). In group 2020, percutaneous coronary angioplasty (PCI) for STEMI was similar to group 2019 (83.05% vs 88.57%) but PCI for NSTEMI were higher (80.65% vs 48.68%). No coronary artery bypass graft (CABG) services were available during the studied period (Fig 1B). In terms of troponin I (Trop I) levels at the time of admission, 47.25% of all ACS presentations were over 1000ng/L in group 2020 compared to 28.76% in group 2019 (Fig 1C). On assessment of left ventricular ejection fraction (LVEF) at the time of admission, 24% of all ACS were severely impaired (LVEF &lt; 40%) compared to 13.79% in 2019 (Fig 1D). 37 (31 IHT) patients in group 2019 and 16 (11 IHT) patients in group 2020 had no transthoracic echocardiogram data. There was an overall reduction in number of days spent in hospital per ACS patient from 4.78 days in 2019 to 3.70 days in 2020 and a further reduction for STEMI patients from 5.16 days in 2019 to 3.83 days in 2020. 5 ACS patients died in 2020 in comparison to 6 patients in 2019.

Conclusion
The reduced number of admissions is likely to be a result of nation-wide lock-down and public fear. Proportion of ACS patients with high level of troponin I values and severely impaired LVEF may be explained due to late presentation. It remains necessary to address public fear and to ensure that ACS patients are managed in accordance with ACS management guidelines even in the times of COVID-19 pandemic. Abstract Figure.
Time to awakening tendency and withdrawal of life supporting treatment (WLST) in patients treated with therapeutic hypothermia after cardiac arrest
Authors: Rivadeneira Ruiz M , Olivares Martinez B , Seoane Garcia T , Arroyo Monino DF , Altarejos Salido F , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives
Treatment with therapeutic hypothermia after cardiac arrest remains controversial. It is still unclear how long it takes these patients to recover neurological responsiveness, and the time until awakening varies widely. The aim of our study was to identify the patients who had a later awakening and the factors related to late post-arrest awakening.

Methods
We performed a retrospective analysis of patients admitted in the Coronary Care Unit between 2006 and 2020 after a cardiac arrest. Patients were eligible if they remained comatose after return of spontaneous circulation (ROSC), with a Glasgow Coma Scale less than 10. We measured the time until awakening, defined as obedience to verbal commands.

Results
Amongst 271 cardiac arrest survivors, 182 remained comatose. Mean age was 65,8 ± 0,98 and there were 29% of females. 70 patients (38,5%) were treated with therapeutic hypothermia with a target temperature of 33ºC using an endovascular device. 60 patients (33%) awakened and median time of awakening was 4 days. The tendency of the awakening was similar if the patient was or not cooled before (Figure1: median: 4, p25: 3, p75: 6). 18 patients (30%) regained neurological responsiveness 5 days after cardiac arrest without differences between groups (p &gt;0,001) (Figure 2: 28,2% cooling group versus 33,3% no control temperature group). We did not find variables associated with a later awakening in the multiple logistic regression analysis adjusted for age, sex, hospital admission year, initial rhythm and Glasgow Scale, and therapeutic hypothermia use.

Conclusions
The main cause of mortality after a cardiac arrest is the withdrawal of life support treatment. In our cohort, one third of the patients were late awakaners. Therefore, and in consistency with previous reports, we consider that the observation period to assess the neurological outcome should be extended to more than five days before WLST. Abstract Figure 1 and 2
Early vs late development of acute kidney injury and its prognostic relevance in ACS patients
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
Acute kidney injury (AKI) in acute coronary syndrome (ACS) patients is a well-known marker of worse prognosis. However, it remains unclear how timing of AKI development correlates with mortality and morbidity;

Objective
Assess the timing of AKI development and evaluate its short and long term prognostic impact.

Methods
Retrospective study of patients with ACS periodically included in our center registry between March/2013 and December/2018. AKIwas defined as increase in creatinine ≥0.3 mg/dl or ≥50% within 48 h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI development : no-AKI(NA), early-AKI(EA)(&lt;48h) and late-AKI(LA) (&gt;48 h). The primary endpoints were all cause mortality and a composite of all cause mortality, nonfatal myocardial infarction/stroke and readmission in the follow-up.

Results
We included 518 patients (67 ± 13 years; 73% males, 46% STEMI) of whom 17% developed AKI(8% EA and 9% LA). Patients with AKI, particularly EA, were older (NA: 67± 17; EA 80± 12; LA 74 ± 16, p&lt; 0.001), had more hypertension, previous heart failure (9% vs 1.5%, p &lt; 0.001) and dementia (7 vs 0.5%, p &lt; 0.001). Coronariograhy was performed more often in NA patients (98%), followed by LA (100%) and lastly EA (87.5%), p &lt; 0.001. During hospitalization, those who developed AKI had a higher Killip Kimball class (p = 0.043) and lower ejection fraction (EF) (p = 0.05). In-hospital mortality was significantly higher in patients with EA (12,5%) than LA (2.2%) or LA (2.3%)( p= 0.029) ; During a median follow-up of 35 months, the composite endpoint was particularly higher in the EA group, but no differences were found between LA and NA group. In multivariate analysis, only EA was an independent predictor of all-cause mortality (HR: 3.8 IC 95% 1.8-8.1, p = 0.001) and composite endpoint (HR:2.02 IC95%1.1-3.8; p = 0.032), even after adjusting for age, EF and Killip Kimball class;

Conclusion
In this population of ACS patients, AKI is a frequent complication and the timing of its development has major prognostic implications, since early AKI(&lt;48h) is associated with worse outcomes. Curiously, mortality and CV events in patients with LA are not different from those who do not develop AKI.
Ageing forests and carbon storage: a case study in boreal balsam fir stands
Authors: Harel Antoine , Thiffault Evelyne , Paré David 
Published: April 2021

AbstractThe pattern of change in carbon (C) accumulation with forest ageing can vary greatly amongst different forest types. Documenting how C accumulates in various forest ecosystems in the absence of logging makes it possible to predict what would be the outcome of extending forest rotations or in dedicating more land to conservation on C storage. This study was conducted in boreal balsam fir (Abies balsamea (L.) Mill.) forests of Quebec, in eastern Canada. We compared carbon stocks in forest pools (aboveground (live) biomass, deadwood, FH horizon and mineral soil) of mature (70 years after harvest) vs old-growth stands (stands with no signs or history of human disturbance). Total ecosystem C stocks were not significantly different between mature and old-growth stands. However, as mature stands transition to old-growth stage, there appears to be a shift of C from live biomass pools towards deadwood and soil FH horizons. Coarse woody debris in old-growth stands were also found to be at more advanced stages of decay. The variability of C stocks was also high amongst old-growth stands; however, there was no obvious difference in structural diversity between mature and old-growth stands. Results suggest that ageing balsam fir stands through the lengthening of forest rotations (e.g. past the maturity age of 70 years) or by placing them under conservation, while not creating an important C sink, still contributes to maintain large forest C stocks across landscapes. Preserving or increasing the presence of old-growth forests is an important aspect of ecosystem-based forest management; our study concludes that it could also be compatible with sustainable forest carbon management.
Multimodal Integration Across Spatiotemporal Scales to Guide Invertebrate Locomotion
Authors: Mongeau Jean-Michel , Schweikert Lorian E , Davis Alexander L , Reichert Michael S , Kanwal Jessleen K 
Published: April 2021

SynopsisLocomotion is a hallmark of organisms which has enabled adaptive radiation to an extraordinarily diverse class of ecological niches, and allows animals to move across vast distances. Sampling from multiple sensory modalities enables animals to acquire rich information to guide locomotion. Locomotion without sensory feedback is haphazard; therefore, sensory and motor systems have evolved complex interactions to generate adaptive behavior. Notably, sensory-guided locomotion acts over broad spatial and temporal scales to permit goal-seeking behavior, whether to localize food by tracking an attractive odor plume or to search for a potential mate. How does the brain integrate multimodal stimuli over different temporal and spatial scales to effectively control behavior? In this review, we classify locomotion into three ordinally ranked hierarchical layers that act over distinct spatiotemporal scales: stabilization, motor primitives, and higher-order tasks, respectively. We discuss how these layers present unique challenges and opportunities for sensorimotor integration. We focus on recent advances in invertebrate locomotion due to their accessible neural and mechanical signals from the whole brain, limbs, and sensors. Throughout, we emphasize neural-level description of computations for multimodal integration in genetic model systems, including the fruit fly, Drosophila melanogaster, and the yellow fever mosquito, Aedes aegypti. We identify that summation (e.g., gating) and weighting—which are inherent computations of spiking neurons—underlie multimodal integration across spatial and temporal scales, therefore suggesting collective strategies to guide locomotion.
Modified capitonnage technique for giant pulmonary hydatid cyst surgery
Authors: Aydin Yener , Ulas Ali Bilal , Ince Ilker , Kuran Emre , Keskin Hilmi , Kirimli Sevde Nur , Kasali Kamber , Ogul Hayri , Eroglu Atilla 
Published: April 2021

Abstract

OBJECTIVES
This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts.

METHODS
Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded.

RESULTS
Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients.

CONCLUSIONS
The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.
Effect of COVID-19 on hospital visits in Ningbo, China: an interrupted time-series analysis
Authors: Yang Zong-ming , Wu Meng-yin , Lu Jie-ming , Li Tie-zheng , Shen Peng , Tang Meng-ling , Jin Ming-juan , Lin Hong-Bo , Shui Li-ming , Chen Kun , Wang Jian-bing 
Published: April 2021

Abstract

Objective
Unprecedented rigorous public health measures were implemented during the coronavirus disease 2019 (COVID-19) epidemic, but it is still unclear how the intervention influenced hospital visits for different types of diseases. We aimed to evaluate the impact of the intervention on hospital visits in Yinzhou District, Ningbo, Zhejiang province, China.

Methods
We conducted an interrupted time-series analysis from 1 January 2017 to 6 September 2020 based on the Yinzhou Health Information System in Ningbo, Zhejiang province. The beginning of the intervention was on 23 January 2020, and thus, there were 160 weeks before the intervention and 32 weeks after the implementation of the intervention. Level changes between expected and observed hospital visits in the post-intervention period were estimated using quasi-Poisson regression models.

Results
Compared with the expected level, there was an estimated decrease of −22.60% (95% confidence interval (CI): −27.53%, −17.36%) in the observed total hospital visits following the intervention. Observed hospital visits for diseases of the respiratory system were found to be decreased dramatically (−62.25%; 95% CI: −65.62%, −58.60%). However, observed hospital visits for certain diseases were estimated to be increased, including diseases of the nervous system (+11.17%; 95% CI: +3.21%, +19.74%); diseases of pregnancy, childbirth and the puerperium (+27.01%; 95% CI: +17.89%, +36.85%); certain conditions originating in the perinatal period (+45.05%; 95% CI: +30.24%, +61.56%); and congenital malformation deformations and chromosomal abnormalities (+35.50%; 95% CI: +21.24%, +51.45%).

Conclusions
Our findings provided scientific evidence that cause-specific hospital visits evolve differently following the intervention during the COVID-19 epidemic.