bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular imaging of valvular fibroblast activation and established fibrosis in aortic stenosis: analysis from the SALTIRE programme
Authors: Craig N , Geers J , Loganath K , Clark L , White A , Whittington B , Barton A , Balmforth C , Dey D , Slomka P , Newby D , Dweck M 
Published: June 2024

Abstract

Introduction
Progressive leaflet thickening in aortic stenosis is driven by fibrosis and calcification. Recent studies have quantified valvular fibrosis using contrast enhanced computed tomography (CT) techniques, with the combined fibro-calcific score correlating better with disease severity than CT-calcium scoring alone. However, understanding fibrosis activity within the aortic valve may allow detection of disease prior to extracellular matrix remodelling and progressive valve thickening. Gallium68 Fibroblast Activation Protein Inhibitor (68Ga-FAPI) binds to activated fibroblasts, the key effector cell of fibrosis formation, and provides a readout of fibroblast activation and fibrosis activity. We aimed to identify the relationship between 68Ga-FAPI intensity, CT calcium score, and quantified fibrocalcific volume.

Methods
In a prospective cohort, patients across the spectrum of aortic stenosis severity and a control population with normal aortic valves underwent combined 68Ga-FAPI Positron Emission Tomography (PET), non-contrast CT and contrast-enhanced CT. Valvular 68Ga-FAPI uptake was quantitatively assessed in a standardised fashion, with the maximal standardised uptake value (SUVmax) recorded within the defined region of interest, and divided by right atrial bloodpool uptake to provide a tissue-to-background ratio (TBRmax). CT-Calcium Scores were quantified in Agatston Units. The fibrocalcific volume was quantified by the sum of non-calcific and calcific tissue volume using bespoke software (Autoplaque, Cedars-Sinai).

Results
29 patients with aortic valve disease (mean age 71 ± 8 years; 76% male; peak velocity 3.4 ± 0.7 m/s) and 4 control participants (mean age 66 ± 7 years; 50% male) were included. 5 patients had aortic sclerosis or mild stenosis, 15 had moderate stenosis and 8 had severe aortic stenosis. Increased 68Ga-FAPI activity was observed in the aortic valves of all patients with aortic stenosis (mean SUVmax 2.1 ± 0.3; TBRmax 1.5 ± 0.1), of higher intensity than that of controls (mean TBRmax 1.3 ± 0.0, p&lt;0.05; Figure 2). There was a moderate relationship between 68Ga-FAPI uptake and the CT-Calcium Score (r = 0.371, p&lt;0.05), but a stronger correlation between the combined fibrocalcific volume and 68Ga-FAPI TBRmax (r = 0.562, p = 0.002).

Conclusion
In patients with aortic stenosis, valvular fibrosis activity can be measured using 68Ga-FAPI PET. Increased 68Ga-FAPI uptake correlates better with complete anatomical quantification combining calcific and non-calcific leaflet thickening than with CT-Calcium Score alone. 68Ga-FAPI PET is a promising technique to assess fibroblast activation and fibrosis activity in aortic stenosis.Figure 1 Figure 2
Safety, tolerability and diagnostic ability of a novel 18F-labelled tracer, [18F]SYN2, for PET myocardial perfusion imaging (SAFER) in patients with suspected coronary artery disease - phase II trial
Authors: Dziuk M , Knuuti J , Krajewski S , Gerszewska M , Steczek L , Gotowicz K , Wlostowska J , Towpik J , Kozanecki P , Kozanecki C 
Published: June 2024

Abstract

Aim
To assess safety and tolerability of [18F]SYN2 in phase 2 trial in patients with suspected CAD and referred to invasive coronary angiography (ICA). To test diagnostic ability of [18F]SYN2 PET perfusion in the detection of CAD using ICA or ICA with fractional flow reserve (FFR)in patients with coronary stenoses as the reference standard.

Method
The study was performed in 7 centers, and 40 subjects were enrolled. Patients were screened within 28 days prior to first dosing day. The patients were asked to admit to investigational site 2-3 hours before the first dosing and PET scan (resting baseline). The second dosing and stress PET scan (during regadenosone vasodilation) was performed 1 day – 7 days after the first. All patients returned to the investigational site 5 ± 2 days after the last dosing for a follow-up safety visit. During the follow-up period the ICA was performed for all patients at dedicated sites. All subjects also received an additional folow-up telephone call 30 ± 7 days after the last PET examination.

Results
Out of 34 reported adverse events (AE), 27 (79%) were not related to [18F]SYN2, 3 (9%) (chest pain, peripheral edema, musculoskeletal pain) were unlikely related and 4 (12%) were possibly related (diarrhea, musculoskeletal pain, palpitations). AEs of the highest incidence were general disorders and administration site conditions (5 cases in 5 (12.5%) patients), cardiac disorders (6 cases in 4 (10.0%) patients), and nervous system disorders (6 cases in 4 (10.0%) patients). The most common AE was headache (n = 4, 12%). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SYN2 PET/CT MPI (results provided by independent panel of cardiologists) in comparison to ICA or ICA/FFR in diagnosis of CAD were 80% , 75%, 77%, 62% and 88%, respectively. The inter-rater agreement (results provided by the each of the experts included in the independent panel of cardiologists and by local laboratory were taken in the analysis) for [18F]SYN2 PET/CT MPI was almost perfect in terms of inter-rater agreement in diagnosis of CAD and diagnosis of fixed defect (Fleiss' kappas = 1.000), and moderate in terms of agreement in diagnosis on reversible defect (Fleiss' kappa = 0.593), which corresponds to the almost perfect agreement in SSS and SDS (ICC of 0.900 and 0.903 respectively), and good agreement in SRS (ICC of 0.784).

Conclusion
[18F]SYN2 tracer administration for PET/CT myocardial perfusion imaging in subjects with suspected coronary artery disease was feasible and safe and shows reproducible diagnostic results to be confirmed in larger population.
Prognostic value of myocardial flow reserve for all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality in hemodialysis patients
Authors: Ohshima S 
Published: June 2024

Abstract

Background
We have reported the prognostic value of myocardial flow reserve (MFR) in hemodialysis (HD) patients. Some prior studies showed that low MFR would predict poor prognosis for not only cardiovascular event but also all-cause mortality, however it is limited about that. In this study, we investigated the prognostic value of MFR in all-cause mortality, cardiovascular (CV) mortality and non- CV mortality.

Methods
1020 HD patients who underwent N13-NH3-PET myocardial perfusion imaging (MPI) suspected for ischemic heart disease were included. They are divided into two groups according to median value of MFR (2.0). We collected all-cause mortality, CV mortality and non- CV mortality. We have followed them for 1282 days.

Results
Kaplan-Meier curve analysis and Cox regression model showed the low MFR groups had poor prognosis for all-cause mortality, CV mortality and non-CV mortality. Furthermore, multivariate cox regression model showed the continuous value of MFR was an independent predictor for both all-cause mortality and non-CV mortality.

Conclusion
In HD patients, low MFR would be an important predictor for all-cause mortality, CV mortality and non-CV mortality.
Deceived by the Fick principle: blood flow distribution in heart failure
Authors: Agostoni Piergiuseppe , Cattadori Gaia , Vignati Carlo , Apostolo Anna , Farina Stefania , Salvioni Elisabetta , Di Marco Silvia , Sonaglioni Andrea , Nodari Savina , Marenzi Giancarlo , Schmidt-Trucksäss Arno , Myers Jonathan 
Published: June 2024

Abstract

Aims
The Fick principle states that oxygen uptake (V̇O2) is cardiac output (Qc) * arterial-venous O2 content difference [ΔC(a-v)O2]. Blood flow distribution is hidden in Fick principle, and its relevance during exercise in heart failure (HF) is undefined. To highlight the role of blood flow distribution, we evaluated peak exercise V̇O2, Qc, and ΔC(a-v)O2, before and after HF therapeutic interventions.

Methods and results
Symptom-limited cardiopulmonary exercise tests with Qc measurement (inert gas rebreathing) was performed in 234 HF patients before and 6 months after successful exercise training, cardiac resynchronization therapy, or percutaneous edge-to-edge mitral valve repair. Considering all tests (n = 468), a direct correlation between peakV̇O2 and peakQc (R2 = 0.47) and workload (R2 = 0.70) was observed. Patients were grouped according to treatment efficacy in Group 1 (peakV̇O2 increase &gt;10%, n = 93), Group 2 (peakV̇O2 change between 0 and 10%, n = 60), and Group 3 (reduction in peakV̇O2, n = 81). Post-treatment peakV̇O2 changes poorly correlated with peakQc and peakΔC(a-v)O2 changes. Differently, post-procedure peakQc vs. peakΔC(a-v)O2 changes showed a close negative correlation (R2 = 0.46), becoming stronger grouping patients according to peakV̇O2 improvement (R2 = 0.64, 0.79, and 0.58 in Groups 1, 2, and 3, respectively). In 76% of patients, peakQc and ΔC(a-v)O2 changes diverged regardless of treatment.

Conclusion
The bulk of these data suggests that blood flow distribution plays a pivotal role on peakV̇O2 determination regardless of HF treatment strategies. Accordingly, for assessing HF treatment efficacy on exercise performance, the sole peakV̇O2 may be deceptive and the combination of V̇O2, Qc and ΔC(a-v)O2, must be considered.
Clinical outcomes of catheter ablation for atrial fibrillation, atrial flutter, and atrial tachycardia in wild-type transthyretin amyloid cardiomyopathy: a proposed treatment strategy for catheter ablation in each arrhythmia
Authors: Kanazawa Hisanori , Takashio Seiji , Hoshiyama Tadashi , Ito Miwa , Kaneko Shozo , Kiyama Takuya , Kawahara Yusei , Sumi Hitoshi , Tsuruta Yuichiro , Kuyama Naoto , Hirakawa Kyoko , Ishii Masanobu , Tabata Noriaki , Yamanaga Kenshi , Fujisue Koichiro , Hanatani Shinsuke , Sueta Daisuke , Arima Yuichiro , Araki Satoshi , Matsuzawa Yasushi , Usuku Hiroki , Nakamura Taishi , Yamamoto Eiichiro , Soejima Hirofumi , Matsushita Kenichi , Tsujita Kenichi 
Published: June 2024

Abstract

Aims
Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is often accompanied by atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), which are difficult to control because beta-blockers and antiarrhythmic drugs can worsen heart failure (HF). This study aimed to investigate the outcomes of catheter ablation (CA) for AF/AFL/AT in patients with ATTRwt-CM and propose a treatment strategy for CA.

Methods and results
A cohort study was conducted on 233 patients diagnosed with ATTRwt-CM, including 54 who underwent CA for AF/AFL/AT. The background of each arrhythmia and the details of the CA and its outcomes were investigated. The recurrence-free rate of AF/AFL/AT overall in ATTRwt-CM patients with multiple CA was 70.1% at 1-year, 57.6% at 2-year, and 44.0% at 5-year follow-up, but CA significantly reduced all-cause mortality [hazard ratio (HR): 0.342, 95% confidence interval (CI): 0.133–0.876, P = 0.025], cardiovascular mortality (HR: 0.378, 95% CI: 0.146–0.981, P = 0.045), and HF hospitalization (HR: 0.488, 95% CI: 0.269–0.889, P = 0.019) compared with those without CA. There was no recurrence of the cavotricuspid isthmus (CTI)–dependent AFL, non-CTI–dependent simple AFL terminated by one linear ablation, and focal AT originating from the atrioventricular (AV) annulus or crista terminalis eventually. Twelve of 13 patients with paroxysmal AF and 27 of 29 patients with persistent AF did not have recurrence as AF. However, all three patients with non-CTI–dependent complex AFL not terminated by a single linear ablation and 10 of 13 cases with focal AT or multiple focal ATs originating beyond the AV annulus or crista terminalis recurred even after multiple CA.

Conclusion
The outcomes of CA for ATTRwt-CM were acceptable, except for multiple focal AT and complex AFL. Catheter ablation may be aggressively considered as a treatment strategy with the expectation of improving mortality and hospitalization for HF.
‘Disturbing the Work of the Office’: The Limits of Refugee Collective Action on ‘UNHCR Territory’ in Beirut
Authors: Janmyr Maja 
Published: June 2024

Abstract
There is a tension in the policy and practice of refugee presence in and around the offices of the United Nations High Commissioner for Refugees (UNHCR). The core principle of direct accessibility to UNHCR is continuously balanced against other competing concerns. But what, in policy and practice, are these competing concerns? And at what point does the presence of refugees and other protection seekers become illegitimate from the perspective of UNHCR? Building on original empirical research, this article explores collective action by Sudanese protection seekers at UNHCR’s office in Beirut, Lebanon. It shows how the spatial practices of UNHCR influence its relationship with protection seekers, and how these relations intersect with broader dynamics of securitization. In Beirut, once a presence was considered to ‘disturb the work of the Office’, a more restrictive policy involving host state security was triggered. The article interrogates what it means to ‘disturb the work of the Office’ in the context of a heavily securitized city and spotlights the blocking of UNHCR entrance doors in Beirut as a pivotal example of when collective action is considered by UNHCR to be so disturbing that protection seekers are to be forcibly removed from UNHCR ‘territory’.
Carbapenemase gene blaOXA-48 detected at six freshwater sites in Northern Ireland discharging onto identified bathing locations
Authors: Brooks Catherine , Mitchell Elaine , Brown James , O'Donovan Sinéad , Carnaghan Kelly-Anne , Bleakney Eoin , Arnscheidt Joerg 
Published: June 2024

Abstract
Faecal contamination of surface waters has the potential to spread not only pathogenic organisms but also antimicrobial resistant organisms. During the bathing season of 2021, weekly water samples, from six selected coastal bathing locations (n = 93) and their freshwater tributaries (n = 93), in Northern Ireland (UK), were examined for concentrations of faecal indicator bacteria Escherichia coli and intestinal enterococci. Microbial source tracking involved detection of genetic markers from the genus Bacteroides using PCR assays for the general AllBac marker, the human HF8 marker and the ruminant BacR marker for the detection of human, and ruminant sources of faecal contamination. The presence of beta-lactamase genes blaOXA-48, blaKPC, and blaNDM-1 was determined using PCR assays for the investigation of antimicrobial resistance genes that are responsible for lack of efficacy in major broad-spectrum antibiotics. The beta-lactamase gene blaOXA-48 was found in freshwater tributary samples at all six locations. blaOXA-48 was detected in 83% of samples that tested positive for the human marker and 69% of samples that tested positive for the ruminant marker over all six locations. This study suggests a risk of human exposure to antimicrobial resistant bacteria where bathing waters receive at least episodically substantial transfers from such tributaries.
50 Studies Every Orthopaedic Surgeon Should Know
Authors: Doudoulakis Konstantinos 
Published: June 2024

Abstract
50 Studies Every Orthopaedic Surgeon Should Know is a compilation of landmark studies from all subspecialties within emergency and elective trauma and orthopaedic practice. It is written in an accessible way, appropriate for an array of practicing experts, allied healthcare professionals, and students with the goal of disseminating findings from high-quality studies that have led to standardized clinical guidelines for front-line clinicians and real-world gains for patients. Chapters focus on key findings, implications for practice, study funding sources and conflicts of interest, criticisms and limitations, and results from associated studies. Each chapter also concludes with a case study, offering readers the opportunity to conceptualize the key findings in practice. Like other books in the 50 Studies series, an objective selection criterion was conducted by an international consensus to identify the most influential landmark publications that took into account the citations per year, high levels of evidence, clinical studies and trials, and available references and guidelines. This book will simplify, consolidate, and reinforce the current literature of the most important research published into digestible, manageable, and reader-friendly content for trauma and orthopaedic surgeons, practicing clinicians, trainees, students, and those led by data-driven evidence-based clinical care. The general public and patients on the receiving end of clinical care may benefit from understanding the surgical decision-making backed by international evidence and professional guidelines.
Treatment for Acute Anterior Cruciate Ligament Tears
Authors: Blucher Nicola , Bhattee Ghias 
Published: June 2024

Abstract
A randomized trial compared the patient-reported outcomes of knee function following acute anterior cruciate ligament (ACL) reconstruction with structured rehabilitation versus potential delayed ACL reconstruction in young, active adults. It randomized patients who had sustained an acute ACL injury into two groups. Twenty-three (38.9%) of the patients in the structured rehabilitation group went on to have ACL reconstruction within the study period. There was no difference in patient-reported outcomes of knee function at two years between patients who had acute surgery and those who had rehabilitation followed by delayed surgery in symptomatic patients.
Open Reduction and Internal Fixation versus Primary Arthrodesis for Primarily Ligamentous Lisfranc Joint Injuries
Authors: Rafferty Michael , Ieong Edmund , Gill Ian 
Published: June 2024

Abstract
Lisfranc injuries can often result in chronic disability. There is still controversy over the optimal treatment for a Lisfranc injury. There is no consensus as to whether outcomes are better with open reduction and internal fixation (ORIF) or with primary arthrodesis for the treatment of Lisfranc injuries. This prospective randomized trial compares the complication rate, patient satisfaction, functional outcomes, American Orthopaedic Foot and Ankle Society score, and visual analog scale scores between primary arthrodesis or ORIF for primarily ligamentous Lisfranc injuries. Advantages of arthrodesis over ORIF are discussed in this level 1 study from the United States.
Surgical versus Nonoperative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcome Research Trial
Authors: Nazeer Moideen Abdul , Khurana Ashish 
Published: June 2024

Abstract
The SPORT trial, published in 2010 with a review of 654 patients, analyzed surgical vs. nonsurgical treatment for lumbar spinal stenosis. All patients with neurogenic claudication or radicular symptoms with confirmatory imaging showing lumbar stenosis at one or more levels and symptoms for a minimum of twelve weeks were included. Patients in the surgical group received a standard posterior decompressive laminectomy. Patients in the nonsurgical group received physiotherapy, education/counseling with home exercise, nonsteroidal anti-inflammatories, and spinal injections as appropriate. Patients with spinal stenosis treated surgically showed significantly greater improvement in pain, function, satisfaction, and self-rated progress over four years compared to patients treated nonoperatively.
Vertebroplasty versus Sham Procedure for Management of Painful Osteoporotic Vertebral Fractures
Authors: Ibish Shireen , Brown Chris 
Published: June 2024

Abstract
This randomized controlled trial compares vertebroplasty to a sham procedure. Vertebroplasty has been used for the treatment of painful osteoporotic vertebral fractures, and this chapter analyzes a study comparing the outcomes of seventy-eight patients after randomization to either vertebroplasty or a sham procedure with a six-months posttreatment follow-up period. The authors concluded that no superior benefit was noted in the vertebroplasty cohort compared to the control group. Despite its limitations, the conclusion is backed by more recent studies with a longer follow-up period showing a similar pattern. Guidelines recommend that vertebroplasty should be reserved for patients with pain clearly linked to the site of the vertebral fracture who remain in significant discomfort despite optimal pain management.
Autologous Chondrocyte Implantation Compared with Microfracture in Isolated Symptomatic Chondral Defect of the Knee
Authors: Abukar Amin , Sri-Ram Kesavan 
Published: June 2024

Abstract
This was a randomized trial comparing autologous chondrocyte implantation with microfracture in patients with an isolated symptomatic chondral defect in the knee. This study published the initial short-term results at the two-year follow-up for the treatment groups. Compared with baseline, there were significant clinical improvements in both groups (using Lysholm, visual analog, and SF-36 scores). Between the treatment groups, the clinical results were similar; however, the microfracture group had a significantly better SF-36 physical component score. Additionally, patients within the microfracture group with smaller chondral defects (&lt; 4 cm2) had significantly better clinical results; this association between chondral size defect and clinical outcome was not found in the autologous chondrocyte implantation group. No association was found between the histological quality of the cartilage biopsy and the clinical outcomes in both groups.
A Meta-Analysis of Ankle Arthrodesis versus Replacement
Authors: Milnes Lydia , Sugand Kapil , Ramesh Palanisamy 
Published: June 2024

Abstract
The efficacy of ankle replacement versus arthrodesis remains a contentious issue. Medline was searched for relevant articles reporting outcome of ankle arthroplasty or arthrodesis. This systematic review revealed to date no direct comparisons of the two treatment options. Included were forty-nine primary studies: ten (20%) evaluating arthroplasty and thirty-nine (80%) evaluating arthrodesis. The means and counts of each study were collated for ankle function, pain, revision, and quality of life and weighted according to sample size. Both ankle replacement and arthrodesis have good results; neither one has been shown by this review to be superior to the other.
A Multicenter, Prospective, Randomized, Controlled Trial of Open Reduction—Internal Fixation versus Total Elbow Arthroplasty for Displaced Intra-Articular Distal Humeral Fractures in Elderly Patients
Authors: Khan Yasmeen , Sugand Kapil , Ahearne David 
Published: June 2024

Abstract
This chapter reviews the management of complex intra-articular distal humeral fractures in the elderly population. It is a multicenter prospective randomized controlled trial comparing the treatment options of open reduction and internal fixation (ORIF) against total elbow arthroplasty (TEA). Twenty patients were randomized to each group with clear inclusion and exclusion criteria. The outcome measures included the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Complications, duration of procedure, and reoperations were reported with statistical analysis. Patients treated with TEA had significantly improved MEPSs at all time points in the follow-up period.