bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative myocardial blood flow and long-term outcome benefit from revascularization
Authors: Maaniitty T , Nammas W , Jukema R , Van Diemen P , Stenstrom I , Harjulahti E , Raijmakers P G , Sprengers R , Planken R N , Bax J J , Knaapen P , Knuuti J , Danad I , Saraste A 
Published: June 2024

Abstract

Background
There is controversy regarding the outcome benefit from myocardial revascularization in patients with chronic coronary artery disease (CAD). We hypothesized that severely reduced regional stress myocardial blood flow (MBF) quantified by [15O]H2O positron emission tomography (PET) is associated with prognostic benefit from early revascularization.

Purpose
To study the interaction of regional stress MBF in absolute terms and early myocardial revascularization in predicting long-term clinical outcome in chronic CAD.

Methods
From pooled cohort of two academic medical centers, we identified consecutive symptomatic patients who underwent [15O]H2O PET myocardial perfusion imaging for evaluation of CAD. The lowest regional stress MBF (ml/g/min) was calculated as an average of two adjacent segments with the lowest MBF. Early revascularization was defined as percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) within 3 or 6 months after MPI (depending on the institution). Statistical interaction between stress MBF and revascularization in predicting composite endpoint of all-cause mortality, myocardial infarction (MI), and unstable angina pectoris (UAP) was analyzed by Cox regression. Hazard ratio (HR) for early revascularization was visualized across MBF values with the use of spline function.

Results
Out of 1600 patients (age 62 ± 9 years, 54% male), 318 (20%) underwent early revascularization (240 PCI and 78 CABG) and 228 (14%) experienced the composite endpoint during median follow-up of 7.0 years (25th–75th percentiles: 4.9–8.6 years). The cumulative incidence of the composite endpoint was higher in revascularized than non-revascularized patients (18% vs. 13%, p=0.036). There was a significant interaction (p=0.042) between the lowest regional stress MBF (adjusted HR 1.71 (95%CI 1.43-2.04) per 1 ml/g/min decrease, p&lt;0.001) and effect of early revascularization (adjusted HR 0.44 (95%CI 0.21-0.93), p=0.032) on the incidence of the composite endpoint. In terms of long-term outcome, the effect of early revascularization was indifferent (i.e., HR=1) when the lowest regional MBF was approximately 2.0 ml/g/min (Figure). When the lowest regional stress MBF was less than 2.0 ml/g/min, early revascularization was associated with reduced long-term risk of the composite endpoint (HR&lt;1).

Conclusion
In chronic CAD, early myocardial revascularization was associated with improved outcome among patients with the lowest regional stress MBF below a cut-off value of 2.0 ml/g/min by [15O]H2O PET. Quantitative severity of regional myocardial ischemia shows promise in identification of patients who gain prognostic benefit from revascularization.
Role of [18F]FDG PET/CT in patients with suspected ventricular assist device infection
Authors: Garcia Sanchez L M , Hervas-Sanz B , Sanchez-Rodriguez I E , Notta P C , Diez-Lopez C , Gonzalez-Costello J , Escrihuela-Vidal F , Sabe-Fernandez N , Ortiz-Berbel D , Osorio-Higa K , Cortes-Romera M 
Published: June 2024

Abstract

Objectives
Ventricular assist devices (VAD) are used in patients with heart failure either as bridge therapy to cardiac transplantation or as destination therapy.
The aim of this study is to evaluate the usefulness and diagnostic capability of [18F]FDG PET/CT in patients carrying VADs with suspected underlying infectious processes.

Material and methods
Retrospective descriptive study of patients (p) carrying VAD, with performance of [18F]FDG PET/CT for suspected infection between July 2018 and January 2023.
Demographic data, baseline pathology, VA purpose and PET/CT findings were studied.

Results
11p (5 female, 5 male, 1 transgender female) with a mean age of 55.4 years [31-76], affected by dilated cardiomyopathy (8 ischaemic, 2 toxic secondary to chemotherapeutic treatment, 1 idiopathic) were analysed. 7p were VAD carriers as bridging therapy and 4p as destination.
The reasons for requesting PET/CT were in 10p clinical suspicion of device infection and in 1p suspicion of interstitial nephritis.
5p presented PET/CT suggestive of infection (4 on driveline entry and subcutaneous tract; 1 on ventricular device and mediastinal cannulae). Microbiological analysis was performed in all of them and was positive in only 3p. Despite this, all 5p received antibiotic treatment with beta-lactams (4p with resolution of the infectious condition and 1p requiring cardiac transplantation).
1p presented a discrete increase in metabolism at the level of the subcutaneous driveline tract attributable to an inflammatory process.
5p showed no findings suggestive of infection by PET/CT and the final diagnosis was unrelated to the VAD (2p without infection and 3p with infection in locations other than the VAD).
The median SUVmax of patients with extrathoracic infection (driveline entry and subcutaneous tract) was 2.5 g/ml vs. 1.36 g/ml in relation to the rest of the patients without infection.
The median SUVmax of patients with intrathoracic infection was 4.99 g/ml vs. 3.6 g/ml for the rest of the patients without infection.

Conclusion
18F]FDG PET/CT has been able to detect in our sample, in a non-invasive way, infection related to ventricular assist devices, presenting higher diagnostic yield and a high negative predictive value with respect to microbiological analysis.
Prognostic value of left ventricular mechanical dyssynchrony in left bundle branch block and preserved left ventricular ejection fraction patients
Authors: Cortes C , Creta V , Klin P , Embon M 
Published: June 2024

Abstract

Background
Patients with left bundle branch block (LBBB) patterns on the electrocardiogram and preserved left ventricular ejection fraction (LVEF) represent a heterogeneous group of patients with different prognosis, including patients with or without left ventricular mechanical dyssynchrony (LVMD). LVMD obtained by gated 99m-technetium single photon emission computed tomography (SPECT) imaging could be a useful tool to detect early myocardial damage, identifying a higher risk group of patients.

Purpose
The aim of this study was to assess the prognostic value of LVMD in patients with LBBB and LVEF ≥ 50%.

Methods
Three hundred and seventy-seven consecutive patients with LBBB and LVEF ≥ 50% were referred for gated-SPECT from August 2011 to June 2019. Phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) were obtained in rest gated SPECT imaging.
LVMD was defined when the HB and the SD exceeded the abnormality threshold values for men (SD ≥ a 24,39° y HB ≥ 62,39°) and women (SD≥ 22,1° y HB ≥ a 49.7) as derived from a normal database. (Threshold = mean plus two standard deviation for each parameter). (1)
Follow-up was performed by telephone contact or medical history review. Endpoint were the composite of all-cause death and myocardial infarction (MI). Logistic regression model and event-free survival curves were obtained. Univariate and multivariate cox regression analysis were performed.

Results
Three hundred and sixty-four patients completed follow-up (median 106.08 months (58.08-176.12)). LVMD was observed in 84 (23%) patients. Fig. 1 shows the population clinical characteristics, perfusion and function results.
The composite of all-cause death and MI occurred in 12 patients (3.3%).
In the multivariate analysis models performed, the LVMD had an OR:8.32 (2.50-32.54, p 0.001) and age ≥ 70 an OR 5.43 (1.54-25.39, p 0.014) for the composite outcome.
Fig. 2 shows Kaplan-Meier curve of event-free survival in relation to LVMD and age ≥ 70 years.
The presence of LVMD was a predictor of high-risk of the composite outcome: adjusted hazard ratio: 7.10 (2.14-23.60; p 0.001), in the multivariate analysis adjusted for age ≥ 70 years.

Conclusion
In our population of patients with LBBB and LVEF ≥ 50%, the presence of LVMD assessed by rest gated SPECT imaging identifies patients with higher risk of adverse events adjusted for age ≥ 70 year.Table 1
Transthyretin cardiac amyloidosis by Cardiac Scintigraphy with 99mTc-diphosphonates and cardiovascular magnetic resonance imaging
Authors: Gracia Sanchez L , Pudis M , Notta P C , Sanchez-Rodriguez I E , Hervas-Sanz B , Diaz-Moreno J L , Claver Garrido E , Diez Lopez C , Rodriguez Gasen A , Martin Marcuartu J J , Cortes-Romera M 
Published: June 2024

Abstract

Aim
Classic imaging features on echocardiography and cardiac magnetic resonance, although typical for cardiac amyloidosis, are not specific enough to distinguish light chain amyloidosis from transthyretin amyloidosis (ATTR-CA). Myocardial bone-avid radiotracer uptake is highly specific for ATTR-CA when plasma cell dyscrasia has been excluded; it is now replacing the need for biopsy in many patients.
The purpose of this study is to analyze the prevalence of ATTR-CA diagnosed by Cardiac Scintigraphy (CS) and Cardiovascular Magnetic Resonance Imaging (CMRI) and the characteristics of these patients.

Materials and Methods
A retrospective study of 894 patients (p) with clinical suspicion and/or genetic background predisposing to ATTR-CA. 139p were scintigraphically positive and we divided them into 3 groups:
Group A: senile ATTR (ATTRwt).
Group B: ATTR associated with genetic mutation (ATTRm).
Group C: recipients of domino liver transplant (DLT) from patients with familial amyloid polyneuropathy.
We analyzed sex, average age, arterial hypertension, electrocardiogram (ECG) alterations, interventricular septum thickness (IVST), clinical signs of heart failure (HF), peripheral nervous system (PNS) involvement, Perugini score (PS) and CMRI results.

Results
Group A: 121p, 95 males, 84-years-old, 103 with hypertension, 98p with ECG alterations (24p with pacemaker). Average IVST of 16,6±3,9mm. 121p (100%) with HF. 15p (12,4%) with PNS involvement. 51p with PS3, 49p with PS2, 21p with PS1. 13p with recent CMRI: 12p of them with a result compatible with CA and 1p with an alternative diagnosis (Fabry disease).
Group B: 17p, 8 males, 68-years-old, 12 with hypertension, 9p with ECG alterations (none with pacemaker). Average IVST of 15,9±4,1mm. 5p (29%) with HF. 9p (53%) with PNS involvement. 12p with PS3, 4p with PS2, 1p with PS1. 5p with recent CMRI: 3p of them with a result compatible with CA and 2p with non-conclusive results. The most frequent genetic mutation was Val30Met in 5p.
Group C: 1p, 70-year-old male with hypertension, without ECG alterations. 16mm of IVST. With HF. Without PNS involvement. PS2. CMRI non-conclusive for CA. 8 years have passed since the DLT.

Conclusion
The senil group had the highest prevalence of ATTR-CA, more cardiac symptoms and ECG abnormalities±pacemakers and less neurological involvement than the other groups.
The most frequent mutation in the genetic group was Val30Met. This group had greater neurological involvement and the CMR was less specific for the diagnosis of CA.
CS should be performed in all the patients with clinical suspicion of CA because it has better diagnostic performance than CMRI.
Correlation between cardiac glycolytic metabolism and clinical-epidemiological variables of cancer patients
Authors: Soares Brandao S , Duarte Ribeiro Sobrinho J M D R S , Lima De Matos Leao E D L M L , Barbosa Accioly B B A , Saura Martins A G S M , Cavalcanti Amorim Martins R J C A M , De Moraes Chaves Becker M M C B , De Oliveira Buril R O B , De Oliveira Menezes V O M , Alves Mourato F A M 
Published: June 2024

Abstract

Introduction
Significant advances in the diagnosis and treatment of cancer have improved the life expectancy of cancer patients. However, these therapies can impact the quality of life and survival of these patients due to the detrimental effects of these treatments, especially on the heart. In this context, early diagnosis of cardiotoxicity to chemotherapy drugs is crucial for the implementation of strategies to prevent progression and death from cardiovascular diseases. Positron Emission Tomography-Computed Tomography (PET/CT) with Fluorodeoxyglucose-Fluorine-18 (FDG) is an examination that evaluates glycolytic metabolism and is routinely used in the staging and therapeutic evaluation of various neoplasms. Furthermore, studies have shown the potential benefit of PET/CT in the evaluation of cardiotoxicity through myocardial FDG uptake.

Objective
To evaluate the association between myocardial FDG uptake and clinical-epidemiological data of cancer patients.

Materials and methods
Cross-sectional and retrospective study. From January to June 2023, clinical-epidemiological data and the presence of myocardial FDG uptake were evaluated in patients referred for FDG PET/CT oncology study at a public and university nuclear medicine service in Northeast Brazil. Patients were grouped according to the absence (G1) or presence (G2) of myocardial FDG uptake, and clinical-epidemiological data were compared between them. Myocardial FDG uptake was considered significant if higher than blood pool uptake in the aorta. A p-value &lt;0.05 was considered statistically significant.

Results
We selected 428 exams, with 63.3% being female, mean age 54 ± 16 years, 34.8% hypertensive, 16.8% diabetic, and 9.6% with dyslipidemia. The analyzed types of cancers were: lymphoma (31.5%), breast (17.8%), melanoma (8.4%), cervical (8.2%), colorectal (6.8%), and lung (6.8%). The most common indications were treatment response evaluation (43.7%), restaging (22.2%), staging (19.4%), and follow-up (12.1%). Cardiac FDG uptake was present in 39.5% of the sample (G2). In the univariate analysis, diabetes was more frequent in G1 (19.1% vs 12.4%, G1 vs G2, respectively, p 0.0498), and male sex was more prevalent in G2 (30.89% vs 45.56%, G1 and G2, respectively, p 0.0021). In the logistic regression analysis, only male sex remained statistically significant between the groups, p= 0.0022.Conclusion: In oncological PET/CT exams, significant myocardial FDG uptake was more prevalent in men. This result may indicate differences between sexes in cellular susceptibility and myocardial mechanisms of metabolic response to oncological treatment toxicity.
A systematic review and meta-analysis of acupuncture for De Quervain’s tenosynovitis treatment
Authors: Qin Yuxi , Luo Dan , Qiu Heng , Zhang Jingyu , Yong Huang , Yu Shuguang 
Published: June 2024

Abstract

Background
De Quervain's tenosynovitis (DQt) is a prevalent chronic inflammatory musculoskeletal disorder predominantly affecting the radial aspect of the wrist. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain’s tenosynovitis (DQt). Although there is evidence suggesting that acupuncture can alleviate symptoms of DQt–characterized by pain, swelling, and functional impairment–higher-level evidence is still required to further substantiate its efficacy and safety. This study conducted a comprehensive review of the efficacy of acupuncture in treating De Quervain's tenosynovitis (DQt).

Methods
By systematically searching databases such as PubMed, Science Direct, Web of Science, Google Scholar, EMbase, PEDro, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chongqing VIP China Science, Technology Journal Database (VIP), we retrieved randomized controlled trial (RCT) literature on acupuncture for DQt, with the search period extending to November 1, 2023. After extracting and assessing data from the included literature, we performed Meta-analysis using RevMan 5.4.1 software.

Results
The results encompassed 14 RCT papers, involving 851 patients. The Meta-analysis findings indicated that, when compared to topical analgesics, acupuncture demonstrated a significant increase in treatment effectiveness (RR = 1.24; 95% CI = 1.11, 1.39, P = 0.0002) and a notable reduction in VAS pain scores (MD = −1.06; 95% CI = −1.51, −0.61, P &lt; 0.00001). However, no statistically significant difference was observed in conney wrist joint scores. Furthermore, acupuncture was found to reduce VAS pain scores compared to the waiting list group. In comparison to corticosteroid injections (CSI), acupuncture did not show statistical significance in VAS, effectiveness rate, and conney wrist scores.

Conclusion
Acupuncture exhibited a promising trend in alleviating pain associated with DQt and enhancing treatment effectiveness. Nonetheless, due to limitations in the quantity and quality of the included studies, these findings warrant further validation through additional research.
Comparison of Bilateral Versus Unilateral 5 Hz or 1 Hz Repetitive Transcranial Magnetic Stimulation in Subacute Stroke: Assessment of Motor Function in a Randomized Controlled Study
Authors: Abdelkader Ann A. , Afifi Lamia M. , Maher Eman A. , Atteya Abdulalim A. , El Salmawy Dina A. 
Published: June 2024

Purpose:
Repetitive transcranial magnetic stimulation (rTMS) can enhance brain plasticity after stroke. At low frequencies, rTMS has an inhibitory effect, whereas at high frequencies, it has an excitatory effect. Combining both frequencies in bilateral stimulation is a new rTMS protocol under investigation, especially in the subacute stage.

Methods:
Fifty-five patients with subacute stroke were divided into four groups according to the rTMS protocol delivered: bilateral, inhibitory, excitatory, and control groups. All groups received concomitant task-oriented physiotherapy. Pretreatment to posttreatment assessment was performed twice, immediately after sessions and 1 month later. Volitional motor control was evaluated by Fugl-Meyer and Wolf motor function tests, and for spasticity, the Ashworth scale was used.

Results:
All groups showed significant improvement. Bilateral, inhibitory, and excitatory groups showed same efficacy, but the bilateral protocol was superior in spasticity. No correlations were found between improvement and stroke duration and site except for spasticity.

Conclusions:
Bilateral rTMS shows a comparable effect to inhibitory and excitatory rTMS in improving motor disability in subacute stroke. However, it is superior for spasticity.
Escaping the Procrustean Bed: A Perspective on Pediatric Stereoelectroencephalography
Authors: Kheder Ammar 
Published: June 2024

Summary:
Stereoelectroencephalography is an established, hypothesis-driven method for investigating refractory epilepsy. There are special considerations and some limitations that apply to children who undergo stereoelectroencephalography. A key principle in stereoelectroencephalography is taking an individualized approach to investigating refractory epilepsy. A crucial factor for success in a personalized pediatric epilepsy surgery is understanding some of the fundamental and unique aspects of it, including, but not limited to, diverse etiology, epilepsy syndromes, maturation, and age-related characteristics as well as neural plasticity. Such features are reflected in the ontogeny of semiology and electrophysiology. In addition, special considerations are taken into account during cortical stimulation in children. Stereoelectroencephalography can guide a tailored surgical intervention where it is sufficient to render the patient seizure-free but it also lessens collateral damage with a minimum or no functional deficit. Epilepsy surgery outcomes remain stagnant despite advances in noninvasive testing modalities. A stereoelectroencephalography “way of thinking” and guided mentorship may influence outcomes positively.
The Voyage of SEEG
Authors: Chauvel Patrick 
Published: June 2024

Summary:
It took 50 years for stereoelectroencephalography (SEEG) to cross the Atlantic. Conceived and designed before the advent of computers and modern technology, this method turned out to be perfectly suited to brain imaging and modern video and electrophysiological tools. It eventually benefited from robotics and signal processing. However, a critical step remains accurate electrode implantation, which is based on individual patients' noninvasive phase I data. A limiting factor, especially in MRI-negative cases, is a thorough perictal and postictal clinical testing for ensuring meaningful electroclinical correlations. Adapted epilepsy monitoring units' architecture and specific technicians and nurses training are required to improve the granularity of information needed to generate valid hypotheses on localization. SEEG interpretation is based on a knowledge base in neural networks, cognitive/behavioral neuroscience, and electrophysiology quite distinct from electroencephalography. Tailored to the needs of focal epilepsy complexity exploration, SEEG does not fit well with simplification. Specific teaching and development of clinical research inside the epilepsy monitoring units will help to flatten the team learning curve and to build knowledge base from shared clinical experience.
Temporal patterns of haplotypic and allelic diversity reflect the changing selection landscape of the malaria parasitePlasmodium falciparum
Authors: Early Angela M. , Pelleau Stéphane , Musset Lise , Neafsey Daniel E. 
Published: June 2024

ABSTRACTPopulations of the malaria parasitePlasmodium falciparumregularly confront orchestrated changes in frontline drug treatment that drastically alter the parasite’s selection landscape. When this has occurred, the parasite has successfully adapted to the new drugs through novel resistance mutations. These novel mutations, however, may emerge in a genetic background already shaped by prior drug selection. In some instances, selection imposed by distinct drugs has targeted the same loci in either synergistic or antagonistic ways, resulting in genomic signatures that can be hard to attribute to a specific agent. Here, we use two approaches for detecting sequential bouts of drug adaptation: haplotype-based selection testing and temporal changes in allele frequencies. Using a set of longitudinally acquired samples from French Guiana, we determine that since the introduction of the drug artemether-lumefantrine (AL) in 2007 there have been rapid hard selective sweeps at both known and novel loci. We additionally identify genomic regions where selection acted in opposing directions before and after widespread AL introduction. At four high-profile genes with demonstrated involvement in drug resistance (crt,mdr1,aat1, andgch1), we saw strong selection before and after drug regime change; however, selection favored different haplotypes in the two time periods. Similarly, the allele frequency analysis identified coding variants whose frequency trajectory changed sign under the new drug pressure. These selected alleles were enriched for genes implicated in artemisinin and/or partner drug resistance in other global populations. Overall, these results suggest that drug resistance inP. falciparumis governed by known alleles of large effect along with a polygenic architecture of more subtle variants, any of which can experience fitness reversals under distinct drug regimes.