bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Oral Anticoagulation Therapy Versus Left Atrial Appendage Occlusion on Cognitive Function and Quality of Life in Patients With Atrial Fibrillation
Authors: Mohanty Sanghamitra , Mohanty Prasant , Trivedi Chintan , Assadourian Joanna , Mayedo Angel Quintero , MacDonald Bryan , Della Rocca Domenico G. , Gianni Carola , Horton Rodney , Al‐Ahmad Amin , Bassiouny Mohamed , Burkhardt John D. , Di Biase Luigi , Gurol M. Edip , Natale Andrea 
Published: June 2021

Background
We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation.

Methods and Results

Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow‐up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHA
2
DS
2
‐VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHA
2
DS
2
‐VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (
P
=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated −2.74 (95% CI, −3.61 to −1.87;
P
<0.0001) points in the OAC group, whereas the change in the LAAO group was nonsignificant (0.79; (95% CI, −0.06 to 1.64;
P
=0.07). After adjusting for baseline clinical characteristics, remaining on OAC was an independent predictor of MoCA change at 1 year (regression coefficient, −3.38; 95% CI, −4.75 to −2.02;
P
<0.0001). Change in Atrial Fibrillation Effect on Quality of Life score did not differ significantly in achieving a clinically important difference between groups.

Conclusions
In this series, a significant difference in the postprocedure MoCA score was observed in postablation patients with atrial fibrillation receiving LAAO versus remaining on OAC with a substantial decline in the score in the OAC group. However, quality of life improved similarly across groups.

Registration

https://www.ClinicalTrials.gov
. Unique identifier: NCT01816308
Predictors of Use and Outcomes of Mechanical Valve Replacement in the United States (2008–2017)
Authors: Alkhouli Mohamad , Alqahtani Fahad , Simard Trevor , Pislaru Sorin , Schaff Hartzell V. , Nishimura Rich A. 
Published: June 2021

Background
Contemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited.

Methods and Results

We identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study's end points included predictors of mechanical valve replacement and risk‐adjusted in‐hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (
P
for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66–0.69;
P
<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33;
P
<0.001). Unadjusted in‐hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk‐adjusted mortality also decreased over time with AVR but did not decrease after MVR.

Conclusions
There is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long‐term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.
Abstract 284: Ovariectomy Exacerbates Mitochondrial Dysfunction, Oxidative Stress and Fibrosis to Cause Diastolic Dysfunction
Authors: Hamilton Dale J , Li Shumin , Zhang Aijun , Vedula Indira , Smith Jessie A , Gupte Anisha A 
Published: June 2021

Heart failure with preserved ejection fraction, characterized by diastolic dysfunction (DD) is most common in post-menopausal women, suggesting a link with estrogen (E2). However, the underlying mechanisms are not well understood. In this study we tested how ovariectomy (OVX)-induced E2-deficiency exacerbates DD.

Female C57BL6/J mice (12 weeks old) underwent a sham or OVX surgery, and were administered either normal drinking water or L-N
G
-Nitroarginine methyl ester (L-NAME, 0.3 mg/ml in 1% NaCl solution) in the drinking water and Angiotensin II (AngII, 1.2 mg/kg/day) via subcutaneous osmotic pumps for 5 weeks to induce DD. Subsets of the OVX-DD mice were treated with E2, E2-receptor (ER) α agonist PPT, ERβ agonist DPN or G-protein ER-1 agonist G1.

Echocardiography revealed reduced left ventricular (LV) internal diameter, LV volume, cardiac output but increased LV posterior wall thickness in OVX-DD mice compared with sham-DD mice. However, ejection fractions and fractional shortening were normal in all groups. Doppler studies showed E/A ratios dramatically suppressed and E/e’ ratios increased in mice treated with L-NAME+AngII, with larger changes in OVX mice.
Extensive fibrosis was seen in OVX-DD hearts than sham-DD hearts. ADP-supported cardiac mitochondrial function with pyruvate-malate was moderately reduced in OVX-DD mice along with greater production of reactive oxygen species. Ionoptix studies revealed delayed relaxation but maintained contraction in cardiomyocytes isolated from OVX-DD mice, similar to effects of low-dose oligomycin in control mice. These data suggest that E2 deficiency is associated with impaired mitochondrial function to cause small decreases in ATP formation, which impair diastolic relaxation but not contraction. Treatment with E2, PPT, DPN and G1 reduced E/e’ ratios in OVX-DD mice, with the greatest effects of G1. Treatment of mice with L-NAME in this model excludes the previously described action of G1 through nitric oxide.
In conclusion, OVX exacerbates mitochondrial dysfunction, oxidative stress and fibrosis in non-ischemic HF, leading to exacerbated DD. These may be some of the mechanisms by which E2 protects the myocardium in females. Activation of GPER1 offers a novel therapeutic target for DD after menopause.
Abstract 47: Treatment With a DNA Vaccine in Experimentally
Trypanosoma
cruzi
-infected Dogs Modulates Cellular Immune Response
Authors: Arce-Fonseca Minerva , Carbajal-Hernández Ana C , Lozano-Camacho Mónica , Carrillo-Sánchez Silvia C , Rios-Castro Martha , Rodríguez-Morales Olivia 
Published: June 2021

Chagas Disease (CD) is caused by the protozoan
Trypanosoma
cruzi
. Eight million people are infected in Latin America and 10,000 die annually; because CD has prolonged chronicity is considered the parasitic disease with greater economic burden in Latin America.

The 30% to 40% of patients develop chronic chagasic cardiomyopathies and disorders of the gastrointestinal tract.
It has not found an effective treatment to cure the chronic disease; nifurtimox and benznidazole in the acute stage offer controversial results.

The objective of this study was to test a treatment with plasmid DNA containing
T.
cruzi
genes in dogs with experimental CD and to determine the cellular immune response.

Thirty Beagle dogs were divided into 6 groups with 5 dogs each. Dogs from five groups were intraperitoneally infected with 3500 metacyclic trypomastigotes / kg body weight. Two weeks after infection, intramuscular therapeutic vaccinations were administered thrice at 2-week intervals. The plasmids used were: pBCSSP4 (containing a gene encoding an amastigote-specific protein), pBCSP (containing a gene encoding a
trans
-sialidase protein), pBCSSP4 + pBCSP and pBK-CMV (empty vector); control groups were saline solution
mock-
treated and non-infected/non-treated dogs. IL-1, IL-6, IL-12, IFN-gamma and TNF-alpha levels were determined by ELISA in each of the serum samples at different times. The proliferative response of spleen cells
in vitro
at 15 and 30 days after last treatment was studied.

IL-6 and IL-12 levels were slightly increased in pBCSSP4 plasmid-treated animals; TNF-alpha and IFN-gamma levels rose after pBCSP plasmid treatment. Treatment with either two recombinant plasmids produced no increase in IL-1 levels. The use of mixed plasmid did not have a synergistic effect.
Cell proliferation was induced by DNA plasmid treatment. The highest stimulation index (2.5) was observed in pBCSSP4 plasmid-treated dogs.
In conclusion, cellular immune responses are stimulated by therapeutic DNA vaccine; pBCSP plasmid treatment showed polarized type Th1 immune response, while there was a balance in Th1 / Th2 response when pBCSSP4 plasmid was used as treatment.

These results support the promising novel therapeutic application with DNA using
TcSSP4
and
TcSP
genes against CD.
Abstract 60: Double Hit Mutations in Thoracic Aortic Aneurysm Disease That Have Variable Impact on Phenotype
Authors: Hambly Brett D , Robertson Elizabeth , Portelli Stefanie , Lu Yaxin , Kekic Murat , Jeremy Richmond 
Published: June 2021

Multiple genes are associated with thoracic aortic aneurysm (TAA) formation, including FBN1, TGFBR1&2, COL3A1 & 5A2, and MYH11. Given the population incidence of mutations in these genes we hypothesise that it is likely that ‘double hit’ mutations occur, which may result in an altered clinical phenotype when compared with the single gene mutation.
Genomic DNA analysis of 19 genes implicated in TAA was performed on 12 patients with inherited TAA disease. Of the patients analysed, one patient (P1) was identified as having a mutation in both MYH11 (c.2517G.C (pW839C)) and FBN1 (splice donor site c.4210+1G>A). Another patient (P2) was identified as having both COL5A2 (c.3794A>G (pD1265G)) and FBN1 (c.5861T>G (p.F1954C)). All mutations were predicted by PolyPhen to be deleterious.
P1 has Marfan Syndrome (MFS), caused by the FBN1 mutation, and has severe aortic dilatation while his mother (M1), who also has MFS but does not have the MHY11 mutation, developed mild aortic dilatation, suggesting that the MHY11 mutation in P1 has resulted in a more aggressive phenotype.
P2, siblings S1 and S2 and father (F2) all have relatively less severe MFS with progressive moderate dilatation of the aorta. Thus, the phenotype of pedigree 2 is similar for all affected members, but only P2 has a double hit mutation, suggesting that the presence of the COL5A2 mutation in P2 has not altered the clinical phenotype.
This is the first instance where double hit mutations have been described in inherited thoracic aortic aneurysm but the effect of multiple mutations on phenotype appears to be variable. Mutation analysis for individuals with inherited thoracic aortic aneurysm should consider the possibility of multiple gene culprits.
Abstract WP305: Uniting Hospital Leaders in a Competitive Region to Improve Intravenous Thrombolysis Rates: Analysis of the SETRAC Stroke Registry
Authors: Jaeger Andrea , Suarez Jose I , Savitz Sean I , Ramos Kate , Pile Darrell , Farquhar Grace , Bissell Catherine 
Published: June 2021

Uniting Hospital Leaders in a Competitive Region To Improve Intravenous Thrombolysis Treatment Rates: Analysis of the SETRAC Stroke Registry

Background:
The Southeast Texas Regional Advisory Council (SETRAC) convenes representatives from area hospitals belonging to different health systems to discuss how to improve the delivery of stroke care in a nine county area that includes Houston, Texas. In 2014, area hospitals agreed to focus upon improving tissue plasminogen activator (tPA) administration rates in the area.

Hypothesis:
By sharing stroke metrics in a blinded fashion on a consistent basis, tPA administration rates will improve. The theory was tested by tracking the following metrics:

a. percent of ischemic stroke patients receiving tPA.
b. percent of treated patients receiving tPA within 60 minutes of arrival at the hospital.

Methods:
SETRAC aligned regional metrics with stroke treatment and timing metrics in Get With The Guidelines®-Stroke beginning in Q3 2014. SETRAC compiled and shared this data with stroke coordinators and hospital administrators on a quarterly basis. Bar graphs were utilized for benchmarking hospitals in a blinded fashion. Linear tests were performed to validate increases in the percent of patients treated with tPA and the percent of patients treated within 60 minutes of arrival at the hospital. Results from hospitals that consistently reported data for each of the six quarters were included in the analysis.

Results:
Twenty-six area hospitals reported 10,396 ischemic stroke patients between Q3 2014 through Q4 2015. In that time, tPA administration increased from 10.3% in Q3 2014 to 12.0% in Q4 2015 (p<0.001). Further, tPA administration within 60 minutes of arrival in emergency room increased from 55.3% in Q3 2014 to 66.7% in Q4 2015 (p<0.001).

In conclusion, following the uniting of hospital leaders and utilizing nationally aligned stroke metrics, a higher percentage of ischemic stroke patients received tPA. Of those that received tPA, an improvement in the timeliness of administration was also realized.
Abstract WP385: Gender Differences in Nutritional Status After a Stroke
Authors: Sanjuan Menendez Estela , Lopez Espuela Fidel , Portilla Juan Carlos , Santana Katherine E , Holguin Mohedas Marta , Casado Naranjo Ignacio , Hidalgo Jimenez Noelia 
Published: June 2021

Introduction:
Malnutrition has been associated with a worse outcome in stroke. Its frequency is not well established and sometimes the impact is not considered.

Objective:
To explore gender differences on nutritional status (NS) after acute stroke and its impact on stroke outcome at 90 days.

Methods:
We evaluated consecutive acute stroke patients admitted to the Stroke Unit. We analyzed baseline demographics, vascular risk factors, analytic and anthropometric parameters, and stroke characteristics. We determined NS at baseline and 90 days by Mini Nutritional Assessment (MNA) scale to detect patients at malnutrition risk (MR). We divided groups by gender. Chi square test was applied for qualitative variables and T student for quantitative. A probability value of <0.05 was considered significant for all tests.

Results:
We included 95 patients, 45 women (47,4%). Differences were found comparing women vs men and age (77,9 ± 1,02 vs 75,1 ± 0,9), alcohol consumption (6,7% vs 60%), smoking (4,4% vs 26%) and body mass index (30,1 ± 5,1 vs 27,3 ± 4,5); p<0.05. There were no significant differences related to gender and stroke type (ischemic 88,9% vs 84%, p=0.49) nor stroke severity at baseline (NIHSS 5±4 vs 4±4 p=0.18), neither in risk factors (hypertension, diabetes, atrial fibrillation, dislipidemia), comorbidities nor socioeconomic differences. There were no gender differences in the occurrence of in-hospital complications (27,3% vs 16,3%; p=0,2), dysphagia (6,7% vs 6,0%; p=0.89) nor in NIHSS scoring at discharge (3±3 vs 2±3; p=0.08). On admission, MR was present in 28,5% of the patients. There were no differences between gender and DR (31,1% vs 26%; p=0.58).

At 90 days, MR increased to 46,4%. We found significant gender differences (57,8% vs 32%; p=0.024).
In the adjusted analysis, female gender was associated with a worst NS at 90days [OR 3,56 (1,1-11,5)]. Modified Rankin scale (mRs) score at 90 days was <=2 in 77,8% of women and 82% of men, p=0.607. MNA score at 90 days was independently associated with a better outcome (mRs<=2) at 90 days adjusted by gender OR 0,13 (0,14-0,46).

Conclusion:
In our series, female gender was independently related to worse nutritional status at 90 days after the stroke.
Abstract WP389: Improving Systems of Care With Stroke Severity Adjusted EMS Triaging and Bypass Criteria Protocols to a Comprehensive Stroke Center
Authors: Deleener Mary E , Greenfield Brett 
Published: June 2021

A validated pre-hospital assessment tool to detect severe strokes including intracranial hemorrhages and large vessel occlusions along with protocols for bypassing to comprehensive stroke centers remains an ongoing debate.

The long term goals align with the emphasis of developing formalized stroke severity adjusted EMS triaging and bypass protocols to recognize both large vessel ischemic and intracerebral hemorrhagic stroke patients early in the pre-hospital setting with the utilization of a recognized, validated assessment tool, formal bypass criteria protocols, and formalized training for emergency medical service personnel. These goals align with the topic of

careful selection of patients who meet strict criteria for bypassing

acute stroke ready and primary stroke centers throughout the Southeastern New Jersey region which includes one acute ready hospital and two primary stroke centers to the closest Comprehensive Stroke Center in Atlantic City, New Jersey. The first specific aim is to analyze the EMS field diagnostic accuracy completed by both AtlantiCare EMS ACLS providers and Mid Atlantic Medevac EMS personnel. A therapeutic bypass yield will be analyzed in order to determine the effectiveness of the formalized training to conduct effective stroke severity EMS triaging assessments and a formal bypass protocol to the Comprehensive Stroke Center in Atlantic City, New Jersey. Sensitivity results of the near-infrared (NIR) technology device as a pre-scanning tool for hemorrhages prior to CT scan and operator error will be analyzed. Final diagnosis, CT results, and the need for comprehensive services will serve as the sole factor for the therapeutic bypass yield analysis.

The second aim is to analyze the percentage of bypassed patients to the Comprehensive Stroke Center that undergo comprehensive interventions or medical services.
Policy/Protocol Design (refer to images)

IRB Information
: FWA#00011915 and RP# 15-039ex IRB
Friendship, Uncertainty, and “Commonplacing” in Renaissance Florence
Authors: Tóth Gábor Mihály 
Published: June 2021

Abstract
In fifteenth-century Florence, friendship—or the client–patron relationship, as contemporaries termed it—was often associated with uncertainties and risks. An investigation of diaries, notebooks, and letter correspondences of the time, from the perspective of game theory and decision theory, reveals how Florentines reasoned about the uncertainties of friendship, deploying an array of knowledge-constructing practices, under the rubric of “commonplacing,” to understand it. The preventive techniques that Florentines applied to cope with the conflicting testimonies of the contemporary information culture (the increase in the variety and the availability of vernacular texts, the expansion of literacy, etc.) only served to intensify their predicament. The fact that clients and patrons largely viewed their relationship in the same way challenges the traditional notion of that relationship as asymmetrical.
Using virtual reality to treat aggressive behavior problems in children: A feasibility study
Authors: Alsem Sophie C , van Dijk Anouk , Verhulp Esmée E , De Castro Bram O 
Published: June 2021

Evidence-based cognitive behavioral therapies (CBTs) for children with aggressive behavior problems have only modest effects. Research is needed into new methods to enhance CBT effectiveness. The aims of the present study were to (1) examine whether interactive virtual reality is a feasible treatment method for children with aggressive behavior problems; (2) investigate children’s appreciation of the method; and (3) explore whether children’s aggression decreased during the ten-session treatment. Six boys (8–12 years) participated at two clinical centers in the Netherlands. Newly developed weekly reports were collected on treatment feasibility (therapist-report), treatment appreciation (child report), and children’s aggression (child/parent report). Results supported treatment feasibility: therapists delivered on average 98% of the session content, provided more than the recommended practice time in virtual reality, experienced few technical issues, and were satisfied with their treatment delivery. Children highly appreciated the treatment. Parents reported decreases in children’s aggression over the treatment period (i.e., between week 1 and week 10), but children did not. The promising findings of this feasibility study warrant randomized controlled trials to determine whether interactive virtual reality enhances CBT effectiveness for children with aggressive behavior problems.
Roles of Angioplasty With Drug-Coated Balloon for Chronic Ischemia in Wound Healing
Authors: Hata Yosuke , Iida Osamu , Ito Nobuhiro , Soga Yoshimitsu , Fukunaga Masashi , Kawasaki Daizo , Fujihara Masahiko , Kozuki Amane , Takahara Mitsuyoshi , Mano Toshiaki 
Published: June 2021

Purpose: Clinical trials have demonstrated sustained benefits of drug-coated balloon (DCB) angioplasty compared with noncoated balloon angioplasty in symptomatic peripheral artery disease (PAD) presenting with femoropopliteal (FP) artery disease. However, there is still controversy whether particulate embolization caused by crystalline paclitaxel, the so-called “downstream effect,” is adversely associated with clinical outcomes after use of FP DCB among chronic limb-threatening ischemia (CLTI) patients. The current RADISH (Roles of Angioplasty with Drug-coated balloon for chronic ISchemia in wound Healing) study investigated wound healing following DCB therapy vs non-DCB therapy for real-world CLTI patients presenting with FP lesions. Materials and Methods: This multicenter, retrospective study analyzed 927 patients with CLTI (mean age, 76±10 years; male, 57.8%; diabetes mellitus, 64.5%; dialysis, 50.7%) presenting with FP lesions and treated endovascularly via DCB (138 patients) vs non-DCB therapy (789 patients) between April 2014 and March 2019. The primary outcome measure was 1-year wound healing, while the secondary outcome measure was 1-year primary patency. Clinically-driven target lesion revascularization (CD-TLR), limb salvage and overall survival were also analyzed by using propensity score matching analysis. Results: The propensity score matching extracted 111 pairs (as many patients in the DCB group and 629 patients in the non-DCB group). The 1-year cumulative incidence of wound healing (95% CI) was 74.4% (62.6% to 82.5%) in the DCB group and 71.9% (60.4% to 80.1%) in the non-DCB group, with no significant intergroup difference (p=0.93). The DCB group had a higher rate of primary patency (p=0.002) and freedom from CD-TLR (p=0.010) than the non-DCB group, whereas there was no significant intergroup difference in limb salvage (p=0.21) or overall survival (p=0.93). Conclusion: The current analysis of data from the RADISH study demonstrated that DCB therapy did not lead to delayed wound healing and reduced restenosis rate in CLTI patients presenting FP lesions. From this results, DCB therapy would be a reasonable treatment option for CLTI patients.