bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulsed-Field Ablation in Ventricular Myocardium Using a Focal Catheter
Authors: Yavin Hagai D. , Higuchi Koji , Sroubek Jakub , Younis Arwa , Zilberman Israel , Anter Elad 
Published: August 2021

Background:
Pulsed-field ablation (PFA) is a rapid and nonthermal energy with higher selectivity to myocardial tissue in comparison to radiofrequency ablation. However, its effects on ventricular myocardium and titration of lesion dimensions have not been well studied. This study examined the effect of PFA on ventricular myocardium and the influence of application repetition on lesion dimensions.

Methods:
An 8-Fr lattice catheter with a compressible 9-mm nitinol tip was used with a PFA generator (Affera, Inc) applying a bipolar and biphasic waveform (±1.3–2.0 kV, 4 second per application). We examined the impact of single applications (1×) versus 4 repetitive applications (4×) interspaced by 10 seconds. The latter was performed to determine whether repetitions of a similar electrical field can increase lesion dimensions. Experiments were performed in an in vivo porcine model and a survival period of 24 hours (n=6) or 23±5.4 days (n=6) for evaluation of early and late histopathologic effects.

Results:

PFA in ventricular myocardium showed repetition dependency. Acute lesion depth and volume increased from 5.6±1.43 mm and 860±362 mm3 to 8.8±0.74 mm and 2383±548 mm3 for 1× and 4× applications, respectively (
P
<0.001 for both comparisons). This effect was maintained in the chronic lesion phase with lesion depth and volume of 3.9±0.92 mm and 655±286 mm3 compared with 7.3±0.83 mm and 2170±488 mm3, respectively (
P
<0.001 for both comparisons). Acute lesions showed well demarcated necrotic core without coagulation necrosis while chronic lesions showed tissue thinning with fibro-fatty replacement.

Conclusions:
PFA in ventricular myocardium exhibits repetition dependency as lesion dimension increases with consecutive applications of a similar electrical field.
Cardiovascular Disease Risk–Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network
Authors: Saeed Anum , Zhu Jianhui , Thoma Floyd , Marroquin Oscar , Aiyer Aryan , Agarwala Anandita , Virani Salim S. , Gulati Martha , Lee Joon S. , Reis Steven , Saba Samir , Ballantyne Christie , Mulukutla Suresh 
Published: August 2021

Background:
Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk.

Methods:
Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013–2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%–7.4%), intermediate (7.5%–19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization.

Results:
Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07–1.24]) and high risk (hazard ratio=1.27 [1.17–1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI.

Conclusions:
In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention.
Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial
Authors: Fröbert Ole , Götberg Matthias , Erlinge David , Akhtar Zubair , Christiansen Evald H. , MacIntyre Chandini R. , Oldroyd Keith G. , Motovska Zuzana , Erglis Andrejs , Moer Rasmus , Hlinomaz Ota , Jakobsen Lars , Engstrøm Thomas , Jensen Lisette O. , Fallesen Christian O. , Jensen Svend E , Angerås Oskar , Calais Fredrik , Kåregren Amra , Lauermann Jörg , Mokhtari Arash , Nilsson Johan , Persson Jonas , Stalby Per , Islam Abu K.M.M. , Rahman Afzalur , Malik Fazila , Choudhury Sohel , Collier Timothy , Pocock Stuart J. , Pernow John 
Published: August 2021

Background:
Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease.

Methods:
We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis.

Results:

Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52–0.99];
P
=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39–0.89];
P
=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39–0.90];
P
=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50–1.46];
P
=0.57) in the influenza vaccine and placebo groups, respectively.

Conclusions:
Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02831608.
Novel Diffusion-Weighted Imaging Score Showed Good Prognostic Value for Acute Basilar Artery Occlusion Following Endovascular Treatment: The Pons-Midbrain and Thalamus Score
Authors: Liu Lian , Wang Meiping , Deng Yiming , Luo Gang , Sun Xuan , Song Ligang , Huo Xiaochuan , Gao Feng , Ma Ning , Mo Dapeng , Miao Zhongrong 
Published: August 2021

Background and Purpose:
Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score.

Methods:
Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging–based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression.

Results:

A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1–5] versus 7 [5–9];
P
<0.001) and Brain Stem Score (median [interquartile range], 2 [1–4] versus 3 [2–5];
P
=0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49–0.71];
P
=0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78,
P
=0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0–80.8],
P
<0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05–10.55],
P
<0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5–25.6],
P
<0.001) were associated with improved good outcome.

Conclusions:
In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.
Patent Foramen Ovale Closure Decreases the Incidence but Not the Size of New Brain Infarction on Magnetic Resonance Imaging: An Analysis of the REDUCE Trial
Authors: Messé Steven R. , Erus Guray , Bilello Michel , Davatzikos Christos , Andersen Grethe , Iversen Helle K. , Roine Risto O. , Sjöstrand Christina , Rhodes John F. , Søndergaard Lars , Kasner Scott E. ,   on behalf of the Gore REDUCE Study Investigators
Published: August 2021

Background and Purpose:
Randomized patent foramen ovale closure trials have used open-label end point ascertainment which increases the risk of bias and undermines confidence in the conclusions. The Gore REDUCE trial prospectively performed baseline and follow-up magnetic resonance imaging (MRIs) for all subjects providing an objective measure of the effectiveness of closure.

Methods:
We performed blinded evaluations of the presence, location, and volume of new infarct on diffusion-weighted imaging of recurrent clinical stroke or new infarct (>3 mm) on T2/fluid attenuated inversion recovery from baseline to follow-up MRI at 2 years, comparing closure to medical therapy alone. We also examined the effect of shunt size and the development of atrial fibrillation on infarct burden at follow-up.

Results:

At follow-up, new clinical stroke or silent MRI infarct occurred in 18/383 (4.7%) patients who underwent closure and 19/177 (10.7%) medication-only patients (relative risk, 0.44 [95% CI, 0.24–0.81],
P
=0.02). Clinical strokes were less common in closure patients compared with medically treated patients, 5 (1.3%) versus 12 (6.8%),
P
=0.001, while silent MRI infarcts were similar, 13 (3.4%) versus 7 (4.0%),
P
=0.81. There were no differences in number, volumes, and distribution of new infarct comparing closure patients to those treated with medication alone. There were also no differences of number, volumes, and distribution comparing silent infarcts to clinical strokes. Infarct burden was also similar for patients who developed atrial fibrillation and for those with large shunts.

Conclusions:
The REDUCE trial demonstrates that patent foramen ovale closure prevents recurrent brain infarction based on the objective outcome of new infarcts on MRI. Only clinical strokes were reduced by closure while silent infarctions were similar between study arms, and there were no differences in infarct volume or location comparing silent infarcts to clinical strokes.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00738894.
Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke
Authors: Martí-Fàbregas Joan , Guisado-Alonso Daniel , Delgado-Mederos Raquel , Martínez-Domeño Alejandro , Prats-Sánchez Luis , Guasch-Jiménez Marina , Cardona Pere , Núñez-Guillén Ana , Requena Manuel , Rubiera Marta , Olivé Marta , Bustamante Alejandro , Gomis Meritxell , Amaro Sergio , Llull Laura , Ustrell Xavier , Castilho de Oliveira Gislaine , Seró Laia , Gomez-Choco Manuel , Mena Luis , Serena Joaquín , Bashir Viturro Saima , Purroy Francisco , Vicente Mikel , Rodríguez-Campello Ana , Ois Angel , Catena Esther , Carmen Garcia-Carreira Maria , Barrachina Oriol , Palomeras Ernest , Krupinski Jerzky , Almeria Marta , Zaragoza Josep , Esteve Patricia , Cocho Dolores , Moreira Antia , van Eendenburg Cecile , Emilio Codas Javier , Pérez de la Ossa Natalia , Salvat Mercè , Camps-Renom Pol ,   for the COVICTUS Collaborators
Published: August 2021

Background and Purpose:
We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection.

Methods:
A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses.

Results:

We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3–18] versus 6 [2–14],
P
=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10–4.71];
P
<0.001).

Conclusions:
Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups.
De Afstamming in de Landen van de Maghreb
Authors: van Mensel Alfons 
Published: August 2021

Parentage - Protection of the Legitimate Biological Family – Adoption
The modern codices which govern the personal and family law of islamic people, stay totally absorbed and influenced, by traditional Islamic law.
The main issue in the parentage problem is marriage. Only within marriage, children can legally be procreated. The few adoptations brought about, such as the possibility to adopt, the recognition of natural children in Tunisia, do not change the public image in many ways.
Large attention is focused at the protection of the legitimate biological family-unit. This does not prevent that a very human treatment, in respect of the parentage of children, has been elaborated.
Children are being placed, as much as possible, in the case of a legimitate family through techniques as there exists : recognition by men and women of children with unknown origin, the appointment by children of men and women as their father and mother, …
Belgian judges, confronted with the application of Islamic law, are showing signs of shortsightedness.
Too frequently, Islamic law is put aside in favor of international public order.
The Togolese Chiefs: Caught Between The Scylla and Charibdis?
Authors: van Rouveroy Emile A. B. 
Published: August 2021

In recent years, political and other scientists have wondered whether the African One Party system is able to cope with all the problems a modern state administration has to deal with.
One of the most intriguing questions is to what extent the One Party Rule, as a political system, produces a structural and fundamental weakness in itself by which an effective (local) government is nearly been obstructed.
It is noticeable, however, that in those African States where the (neo)traditional elite still plays an important role, their socio-legal and socio-political position in the day-to-day interaction between the (local) administration has - scientifically - received too little attention.
It appears, that chieftaincy possesses a remarkable capacity for adapting itself to social and political changes. The chief can probably fulfil a crucial role in future efforts aimed at socio-economic transformations at regional and even national levels.
The Togolese Government, in 1990 started opening the door to a multiparty system, it hereby recognizes the fact that the (neo )traditional elite is an outstanding means to maintain the interaction and the communication between the State and the people.
This contribution focuses on the interaction between the State in Togo and - in this very example: the Head of the State himself- and chiefs in North Togo particulary in the district of Sokodé in the period 1989 and 1987 at the moment that the paramount chief of the Tern (Kotokoli) has passed away and his succession to the throne has been the start of a strong, long and vehement struggle for power inside the Têm society and to a negotiation between the Head of State and the traditional political elite of that society.
Modern museums in the palaces of the western Grassfields, Cameroon
Authors: Fubah Mathias Alubafi 
Published: August 2021

Introduction: This paper suggests that the recent interest in modern museums in the palaces of the Grassfields is obscurely associated with the need to transform the palaces and, more importantly to address the multiple problems plaguing the royal treasury or traditional palace museums. The paper argues that unlike the royal treasury, the modern museum is significant, partly because it constitutes a democratic space, and partly because it articulates and can be associated with the irony of change and continuity.
Method: The findings are based on qualitative data collected from documents and from ethnographic studies on the emergence of modern museums across the region.
Results: The paper has contributed to the scholarship on Cameroon, and, in particular, extended Michael Rowlands’ (2008) seminal work on curating postcolonial pasts in the Grassfields by unveiling the modern museum as a democratic lens through which to view the undemocratic royal treasury.
Policy implications: The study suggests among others, the need for the Grassfields population to embrace the modern museum – and to see it as a continuation of the royal treasury. The practical implication is to tailor the modern museum to the socio-cultural needs of the target population-particularly women and youths since they are generally excluded from the activities of the royal treasury.
Fine-scale characteristics of summer precipitation over Cang Mountain
Authors: Zhang Mengke , Li Jian , Li Nina 
Published: August 2021

AbstractFine-scale characteristics of summer precipitation over Cang Mountain, a long and narrow mountain with a quasi-north-south orientation in Southwest China, are studied based on station and radar data. Three kinds of rainfall processes are classified according to the initial stations of regional rainfall events (RREs) by utilizing minute-scale rain gauge data. RREs initiating in the western part of Cang Mountain exhibit eastward evolution and tend to reach their maximum rainfall intensity on the mountaintop. The results indicate differences in the precipitation evolution characteristics between short-duration (1–3 h) and long-duration (at least 6 h) events. Short-duration events begin farther from the mountaintop and then propagate eastward, while long-duration events remain longer around the mountaintop. RREs that initiate from the eastern part of Cang Mountain display westward propagation and frequently reach their maximum rainfall intensity over the eastern slope of the mountain. Among them, short-duration events tend to propagate farther west of Cang Mountain at high speeds, but the westward evolution of long-duration events is mainly confined to the eastern part of Cang Mountain. For mountaintop-originated RREs, precipitation quickly reaches its maximum intensity after it starts and then continues for a long time around the mountaintop during the period from late afternoon to early morning. These findings provide references for the fine-scale prediction of precipitation evolution in small-scale mountainous areas.
A High-precision and Fast Solution Method of Gamma Raindrop Size Distribution based on 0-Moment and 3-Moment in South China
Authors: LIU XIANTONG , LI HUIQI , Hu SHENG , WAN QILIN , XIAO HUI , ZHENG TENGFEI , LI MINGHUA , YE LANGMING , GUO ZHEYONG , WANG YAO , YAN ZHAOCHAO 
Published: August 2021

AbstractAccording to the high accuracy linear shape-slope (μ-Λ) relationship observed by several 2-Dimensional-Video-Distrometers (2DVD) in South China, a high-precision and fast solution method of gamma (Γ) raindrop size distribution (RSD) function based on the zeroth order moment (M0) and the third order moment (M3) of RSD has been proposed. The 0-moment (M0) and 3-moment (M3) of RSD can be easily calculated from rain mass mixing ratio (Qr) and total number concentration (Ntr) simulated by the two-moment (2M) microphysical scheme, respectively. Three typical heavy rainfall processes and all RSD samples observed during 2019 in South China were selected to verify the accuracy of the method. Compared to the current widely used exponential RSD with a fixed shape parameter of zero in 2M microphysical scheme, the Γ RSD function using the linear constrained gamma (C-G) method agreed better with the Γ fit RSD from 2DVD observations. The characteristic precipitation parameters (e.g., rain rate, M2, M6 and M9) obtained by the proposed method are generally consistent with the parameters calculated by Γ fit RSD from 2DVD observations. The proposed method has effectively solved the problem that the shape parameter in the 2M microphysical scheme set to a constant, so that the Γ RSD functions are closer to the observations and have obviously smaller errors. This method has a good potential to be applied to the 2M microphysical schemes to improve the simulation of heavy precipitation in South China, but also paves the way for in-depth applications of radar data in numerical weather prediction models.