bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of obesity and adipokines in coronary microvascular dysfunction: a systematic review and meta-analysis
Authors: Spezia M , Bonato A , De Fortunato G , Bossi A , Glauber M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with obesity present structural and functional changes in the heart and in the coronary circulation, which ultimately leads to an increased risk of cardiovascular disease. Obesity is associated with a low chronic state of inflammation which seems to be linked to a compromised coronary vasoreactivity, which is shown to be a forerunner and a long-term predictor of clinically relevant cardiovascular events.

Methods
A systematic review was performed by searching PubMed, Embase and Cochrane Library database. Selection criteria were applied leading to the inclusion of studies of any level of evidence published in peer-reviewed journals reporting clinical or preclinical results. Relative data were extracted and critically analysed. PRISMA guidelines were applied and risk of bias was assessed, as well as the methodological quality of the included studies. After this assessment, we excluded all the articles with serious risk of bias and/or low quality. Meta-analysis was conducted on the data collected regarding coronary blood flow (CFR) and hyperemic myocardial blood flow (MBF), while for the other parameters a descriptive analysis was performed.

Results
After applying the described criteria, we included 15 articles on human and animal literature assessed as medium or high quality. The data of 1399 patients were examined, 456 of which with obesity (BMI ≥ 30). A pooled effect size analysis shows that coronary flow reserve (CFR) is significantly reduced in patients with obesity [Random Effect (RE): -47.7%, 95% confidence interval (CI) -80.2% – -15.2%; n = 422]. Increased BMI is associated with reduced CFR. The same trend is found evaluating pharmacological induced stress MBF, which was reduced in patients with obesity [RE: -47.8%, 95% CI -73.7% – -21.8%; n = 409]. Nevertheless, MBF at rest did not show a significant difference in patients with obesity from our analysis [RE: 15%, 95% CI -24% - 53%; n = 409]. Pro-inflammatory adipokines secretion, as leptin and CRP, seems to correlate with a significant decrease of stress-induced MBF and reduced CFR.

Conclusions
Obesity is associated with a significant higher risk of coronary microvascular disfunction, which is reflected by diminished CFR and stress MBF. Systemic inflammation and the imbalance of adipokines related to obesity has been closely linked to a blunt coronary flow. CMD is a pre-clinical heart conditions that often remains undiagnosed. Further evidence is required to clear out the role of Obesity from a molecular point of view on the coronary endothelium.
Association between microvascular dysfunction and impaired myocardial deformation in hypertrophic cardiomyopathy
Authors: Aguiar Rosa S , Branco L , Thomas B , Fiarresga A , Lopes L , Galrinho A , Selas M , Silva F , Branco G , Pereira R , Barao A , Baquero L , Mota Carmo M , Cruz Ferreira R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To analyze the relationship between coronary microvascular dysfunction (MCD) and left ventricular (LV) myocardial deformation in hypertrophic cardiomyopathy (HCM).

Methods
Prospectively inclusion of HCM patients (P). MCD was assessed by CMR, during regadenoson-induced hyperemia. For perfusion assessment, the myocardium was divided into 32 subsegments (16 AHA segments subdivided into an endocardial and epicardial layer). Ischemic burden was calculated as the number of involved subsegments, assigning 3% of myocardium to each subsegment. Epicardial coronary artery disease was excluded by computed tomography or invasive coronary angiography.
LV myocardial deformation was evaluated by 2D and 3D speckle-tracking echocardiography (STE), including global longitudinal strain (GLS), peak systolic dispersion (PDS), global circumferential strain (GCS), global radial strain (GRS), area strain, twist and torsion.

Results
31 P enrolled (51%male,age57.8 ± 15.5years). Asymmetric septal hypertrophy was seen in 55%, apical in 29%, concentric in 16%,maximal wall thickness (MWT) of 20.5 ± 4.9mm; 26% with LVOT obstruction; LV ejection fraction 67.9 ± 7.9%.
In 2DSTE analysis, P with more ischemia (&gt;20%of LV) presented more severe impaired GLS and greater PDS, comparing with patients with ≤20% of ischemia.
Similarly, 3DSTE imaging showed worse LV performance in P with greater ischemic burden, expressed by significant difference in GLS, GRS and area strain. GCS also trended to be worse in the presence of &gt;20% of ischemia.
The stronger correlation was found between 2D GLS and ischemic burden (Pearson correlation factor 0.545; p = 0.002).

Conclusion
In HCM, the severity of ischemia secondary to MCD was associated with impairment in LV myocardial deformation evaluated by 2D and 3D STE.
Table 1. Echocardiography Ischemic burden (% of LV) 2D parameters ≤ 20% (n = 15) &gt; 20% (n = 16) p-value GLS (%) -15.6 ± 2.7 -12.1 ± 4.7 0.016 PSD (ms) 73.2 ± 25.6 102.1 ± 57.6 0.150 3D parameters GLS (%) -10.3 ± 4.5 -7.3 ± 3.0 0.010 GCS (%) -12.6 ± 3.0 -10.1 ± 4.5 0.079 GRS (%) 30.8 ± 8.5 22.8 ± 11.4 0.035 Area strain(%) -20.8 ± 4.9 -15.8 ± 6.3 0.020 Twist (deg) 6.0 ± 4.8 4.1 ± 4.0 0.175 Torsion (deg/cm) 1.2 ± 0.9 0.8 ± 0.7 0.232
Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin
Authors: Kamperidis V , Vlachou M , Pappa Z , Pantelidou D , Karamitsos T , Papadopoulou D , Kartas A , Vlachaki E , Giannakoulas G , Karvounis H 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.
Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.
Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin &gt;2000ng/ml (HR: 3.517, p = 0.03), and &gt;950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP &gt;34mmHg(HR: 10,134, p = 0.003), CMR T2* &lt;20msec (HR: 4.900, p = 0.018) and &lt;36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP &gt;34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin &gt;950ng/ml than &gt;2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*&lt;36msec than &lt;20msec (C index 0.825 vs. 0.810 respectively).
Conclusions. In haemoglobinopathy patients, RVSP &gt;34mmHg, ferritin &gt;2000ng/ml and CMR T2* &lt;20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin &lt;950ng/ml and CMR T2* &gt;36ms appears to improve their prognosis.
Abstract Figure.
Cardiovascular magnetic resonance normal values for pulmonary arteries and ventricular volumes in paediatric patients with transposition of the great arteries after arterial switch operation
Authors: Voges I , Boll C , Caliebe A , Uebing A , Krupickova S 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The anatomy of the pulmonary arteries (PA) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects and stenoses of the PA are known to occur. Cardiovascular magnetic resonance (CMR) imaging is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease specific normal values for PA size do not exist. Furthermore, the impact of pulmonary artery size, age and gender on ventricular volumes and function is unknown. Therefore, we sought to establish disease specific normative ranges for PA dimensions as well as biventricular volumes and function.

Methods
70 CMR scans of paediatric patients with TGA after ASO with Lecompte manoeuvre (mean age 12.3 ± 3.6 years; range 5-18 years; 57 males) were included. Cine CMR sequences as well as contrast-enhanced magnetic resonance angiography (CE-MRA) data were used to measure pulmonary artery dimensions. Right and left PA were each measured at three locations during its course around the aorta. Ventricular volumes, mass and ejection fraction were measured from a stack of short axis cine images.

Results
Mean systolic and diastolic diameters of the MPA were 15.0 ± 2.3 mm (10.5 ± 2.7 mm/m²) / 13.2 ± 2.9 mm (9.2 ± 2.9 mm/m²) and mean cross-sectional MPA area was 286.7 ± 81.7 mm². Mean systolic and diastolic diameters for the RPA and LPA at the narrowest point were: RPA 10.5 ± 2.8 mm (7.8 ± 2.4 mm/m²) / 8.1 ± 2.2 mm (6.0 ± 1.9 mm/m²); LPA 8.4 ± 2.8 mm (6.2 ± 2.1 mm/m²) / 7.4 ± 2.3 mm (5.4 ± 1.6 mm/m²). Mean values for biventricular volumes, ejection fraction and mass were as follows: 1) left ventricular (LV) end-diastolic volume (EDV) 89.0 ± 20.3 ml/m² and end-systolic volume (ESV) 35.1 ± 11.7 ml/m², 2) right ventricular (RV) EDV 76.4 ± 15.4 ml/m² and ESV 32.4 ± 9.1 ml/m², 3) LV and RV ejection fraction 61.1 ± 6.5 % / 58.9 ± 6.1 % and 4) LV and RV mass 59.6 ± 15.2 g/m² / 23.3 ± 7.4 g/m². Separate centile charts for boys and girls for PA dimensions as well as biventricular volumes, mass and ejection fraction were created.

Conclusion
We established disease specific CMR normal values for the PA dimensions as well as for ventricular volumes, mass and ejection fraction in paediatric patients with TGA after ASO. Our data will improve CMR image interpretation and may serve as a reference in future studies.
Pulsatile and resistive systolic loads as determinants of left ventricular remodelling after physical training
Authors: Torlasco C , D"silva A , Bhuva AN , Faini A , Augusto JB , Knott KD , Benedetti G , Scully P , Parati G , Lloyd G , Hughes A , Sharma S , Manisty C , Osculati G , Moon JC 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Barts Cardiovascular Biomedical Research Centre

onbehalf
The Marathon Study Consortium

Introduction
Cardiovascular function depends on the inter-relation between heart and vasculature. The contribution of aorta and peripheral vessels to the total systolic load of the left ventricle (LV) can be represented respectively by a "pulsatile" and a "resistive" component. We sought to understand their interrelation by exploring how LV remodelling occurred with altered load associated with an external stimulus (training). Methods: 237 untrained healthy male and female subjects volunteering for their first-time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided into 4 groups according to the variation (positive versus null or negative) in Total Arterial Compliance Index (TACi), representing the pulsatile component of the LV load, and in Systemic Vascular Resistance Index (SVRI), representing the resistive component of the LV load. Results: 138runners (age 21-69 years; F: 51%) completed the race. Data are reported for each variable as Δ mean [95% Confidence Interval]. In the whole cohort, training was associated with a small increase in LV mass index (+3g/m2, [0, 6 g/m2]), indexed LV end-diastolic volume (EDVi) (+3ml/m2, [-2, 5 3ml/m2]), in LV mass/LVEDV ratio (+0.02g/ml, [0.00, 0.04 g/ml]) and in TACi (+0.02ml/m2, [0.02, 0.38 ml/m2]). SVRi mildly fell (-43dyn·s/cm2[-103, 17dyn·s/cm2]). TACi increase was associated with LVEDVi increase and no change in LV mass/EDV (eccentric remodelling). On the other hand, both TACi reduction and SVRi increase were associated with increase in LV mass/EDV and no significant change in LVEDVi (concentric remodelling). A similar increase in LV mass was observed in all groups. See Table. Conclusion: Cardiac remodelling observed after mild, medium term, unsupervised training seems to be related to the modifications of aorta and peripheral vessels. In particular, a reduction in pulsatile load seems associated with eccentric LV remodelling, while an increase in both pulsatile and resistive with concentric LV remodelling. Further research is needed to understand the interaction between TACi and SVRi.
Table 1 LV EDVi (ml/m2) LV mass index (g/m2) LV mass/EDV TACi increase (n = 75) +4 [0, 9] +3 [0, 7] 0 [-0.03, 0.03] TACi decrease (n = 62) -1 [-6, 4] +3 [0, 8] 0.04 [0.01, 0.07] SVRi increase (n = 63) 0 [-4,4] +3 [0, 7] +0.03 [0, 0.06] SVRi decrease (n = 73) +3 [-3, 7] +3 [-1, 6] +0.01 [-0.02, 0.04]
Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient
Authors: Christ Torsten , Borck Robin , Dushe Simon , Sündermann Simon Harald , Falk Volkmar , Grubitzsch Herko 
Published: February 2021

Abstract

OBJECTIVES
The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).

METHODS
All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.

RESULTS
Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P &lt; 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0)

CONCLUSIONS
Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.
Laryngotracheal resection can be performed safely without a guardian Chin stitch—a single-centre experience including 165 consecutive patients
Authors: Schweiger Thomas , Evermann Matthias , Roesner Imme , Frick Anna-Elisabeth , Denk-Linnert Doris-Maria , Klepetko Walter , Hoetzenecker Konrad 
Published: February 2021

Abstract

OBJECTIVES
A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. However, the evidence for or against is sparse.

METHODS
We performed a retrospective analysis of all adult patients receiving a (laryngo-)tracheal resection at our department from October 2011 to December 2019. According to our institutional standard, none of the patients received a chin stitch. Instead, a head cradle was used to obtain anteflexion of the neck during the first 3 days and patients were instructed to avoid hyperextension of the neck during the hospital stay. The postoperative outcome and the rate of anastomotic complications were analysed.

RESULTS
A total of 165 consecutive patients were included in this study. Median age at surgery was 53 years (18–80). Seventy-four patients received a tracheal resection, 24 a cricotracheal resection, 52 an extended cricotracheal resection including dorsal mucosectomy and 15 a single-stage laryngotracheal reconstruction. The median resection length was 25 mm (range 10–55 mm). One hundred and sixty-two out of 165 (98.2%) patients had an unremarkable postoperative course. One patient (0.6%) had partial anastomotic rupture after a traumatic reintubation, which required revision surgery and re-anastomosis. Two patients (1.2%) after previous radiation therapy (&gt;60 Gy) developed a partial necrosis of the anastomosis, resulting in prolonged airleak and fistulation. At follow-up, bronchoscopy 3 months after surgery, 92.7% (127/137) of the patients had a proper anastomosis, 6.6% (9/137) had minor granuloma formations at the site of the anastomosis, which were all treated successfully by endoscopic removal. One patient received dilatation for restenosis (0.7%).

CONCLUSIONS
After sufficient mobilization of the central airways, postoperative anteflexion of the neck supported by a head cradle is sufficient to prevent excessive anastomotic tension and dehiscence. Considering the risk for severe neurological complications associated with the chin stitch, the routine use of this manoeuvre in laryngotracheal surgery should not be recommended.
Pareto-improving carbon-risk taxation
Authors: Kotlikoff Laurence , Kubler Felix , Polbin Andrey , Scheidegger Simon 
Published: February 2021

SummaryAnthropogenic climate change produces two conceptually distinct negative economic externalities. The first is an expected path of climate damage. The second, the focus of this paper, is an expected path of economic risk. To isolate the climate-risk problem, we consider three mean-zero, symmetric shocks in our 12-period, overlapping generations model. These shocks impact dirty energy usage (carbon emissions), the relationship between carbon concentration and temperature and the connection between temperature and damages. By construction, our model exhibits a de minimis climate problem absent its shocks. However, due to non-linearities, symmetric shocks deliver negatively skewed impacts, including the potential for climate disasters. As we show, Pareto-improving carbon taxation can dramatically lower climate risk, in general, and disaster risk, in particular. The associated climate-risk tax, which is focused exclusively on limiting climate risk, can be as large as, or larger than, the carbon average-damage tax, which is focused exclusively on limiting average damage.
The role of computer-assisted systems for upper-endoscopy quality monitoring and assessment of gastric lesions
Authors: Lazăr Daniela Cornelia , Avram Mihaela Flavia , Faur Alexandra Corina , Romoşan Ioan , Goldiş Adrian 
Published: February 2021

Abstract
This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions. Current data show promising results in upper-endoscopy quality control and a satisfactory detection accuracy of gastric premalignant and malignant lesions, similar or even exceeding that of experienced endoscopists. Moreover, artificial systems enable the decision for the best treatment strategies in gastric-cancer patient care, namely endoscopic vs surgical resection according to tumor depth. In so doing, unnecessary surgical interventions would be avoided whilst providing a better quality of life and prognosis for these patients. All these performance data have been revealed by numerous studies using different artificial intelligence (AI) algorithms in addition to white-light endoscopy or novel endoscopic techniques that are available in expert endoscopy centers. It is expected that ongoing clinical trials involving AI and the embedding of computer-assisted diagnosis systems into endoscopic devices will enable real-life implementation of AI endoscopic systems in the near future and at the same time will help to overcome the current limits of the computer-assisted systems leading to an improvement in performance. These benefits should lead to better diagnostic and treatment strategies for gastric-cancer patients. Furthermore, the incorporation of AI algorithms in endoscopic tools along with the development of large electronic databases containing endoscopic images might help in upper-endoscopy assistance and could be used for telemedicine purposes and second opinion for difficult cases.
Impact of Nonpharmaceutical Interventions for Severe Acute Respiratory Syndrome Coronavirus 2 on Norovirus Outbreaks: An Analysis of Outbreaks Reported By 9 US States
Authors: Kraay Alicia N M , Han Peichun , Kambhampati Anita K , Wikswo Mary E , Mirza Sara A , Lopman Benjamin A 
Published: February 2021

Abstract
In April 2020, the incidence of norovirus outbreaks reported to the National Outbreak Reporting System dramatically declined. We used regression models to determine if this decline was best explained by underreporting, seasonal trends, or reduced exposure due to nonpharmaceutical interventions (NPIs) implemented for severe acute respiratory syndrome coronavirus 2 using data from 9 states from July 2012 to July 2020. The decline in norovirus outbreaks was significant for all 9 states, and underreporting and/or seasonality are unlikely to be the primary explanation for these findings. These patterns were similar across a variety of settings. NPIs appear to have reduced incidence of norovirus, a nonrespiratory pathogen.
A composite framework for supporting user emotion detection based on intelligent taxonomy handling
Authors: Cuzzocrea Alfredo , Pilato Giovanni 
Published: February 2021

Abstract
One of the most relevant issues of a social robot is its capability of catching the attention of a new acquaintance and empathize with her. The first steps towards a system which can be used by a social robot in order to be empathetic are illustrated in this paper. The system can analyze the Twitter ID of the new acquaintance, trying to detect the IAB (Interactive Advertising Bureau) Tier 1 categories that possibly can let arise in him/her a joyful feeling. Furthermore, it can retrieve news about that category and report them to the user, hopefully increasing his/her curiosity towards the system, improving the naturalness of the interaction. Moreover, the system is capable of querying Wikipedia in order to clarify any doubts that may arise in the user. A sample of a possible interaction is reported at the end of the paper.