bluuebunny/crossref_metadata_2025_split huggingface dataset:
LEFT ATRIAL COMPRESSION BY HIATAL HERNIA IN A PATIENT WITH INTESTINAL OCCLUSION
Authors: Cangemi S , Bartolotta T , Geraci G 
Published: May 2024

Abstract

Introduction
A 93–year–old woman was admitted to the emergency department due to undifferentiated shock, she was unconscious and hypotensive. A 12–leads EKG was unremarkable except for sinus tachycardia. The patient was reanimated using volume filling. The objective examination showed cold and sweaty skin, the thoracic auscultation was normal and the abdomen was bloated without tenderness. The cardiologist consultant was called to perform a complete echocardiography Investigation Following volemic filling, the patient became conscious. She reported to have difficulty evacuating for the past three days. The echocardiogram evidenced:” Left ventricle of small dimension hyperkinetic. Left atrium was very small and compressed by a massive external mass. Due to a displacement of mitral leaflet and severe hypovolemia, there was systolic anterior movement of anterior mitral leaflet with moderate mitral regurgitation and significant aortic gradient“. Considering the possibility that the mediastinal mass was the dilated gastric fundus of a hiatal hernia, we placed a nasogastric tube with aspiration of fecal material. After stabilizing, we took the patient for a complete total body CT scan, which confirmed the picture of intestinal obstruction with the presence of a massive hiatal hernia in the mediastinum.

Management
After volume refilling and aspiration of the gastric contents using a nasogastric tube, the patient reported a significant clinical improvement. The patient underwent intestinal resection and repair of the crural hernia. The patient was discharged home and a control echocardiogram showed good biventricular kinetics without significant valvular disease.

Discussion
A hiatal hernia is a condition in which the upper part of the stomach or other internal organ bulges through the hiatus of the diaphragm often causing gastroesophageal reflux disease. In our clinical case the hiatal hernia modified the clinical expression of the intestinal occlusion, i.e. not only a hypovolemic shock but the dilation of the gastric fundus present in the mediastinum determined the compression of the atrium with consequent reduction in cardiac output. The timely identification of these causes via echocardiogram allowed correct treatment.

Conclusion
We present a clinical case of initial undifferentiated shock where the use of echocardiography helped to understand a rare mechanism of shock: hypovolemia plus cardiogenic shock due to left atrial compression by a massive hiatal hernia.
RENAL INFARCTION: AN ACUTE COMPLICATION OF APICAL THROMBOSIS IN A PATIENT WITH STEMI
Authors: Pedio E , Tauro S , Perfetti S , Zaccaro S , Greco G , Mandunzio D , Caldarola P 
Published: May 2024

Abstract

Introduction
Left ventricular thrombosis (LVT) is a complication that can be found in up to 12% patients with anterior ST–elevation myocardial infarction (STEMI).

Discussion
We reported a case of a 50–years–old male referred to our department for chest pain and ischemic ECG abnormalities. At admission he was hemodynamically stable, complaining of angina. ECG showed sinus rhythm and ST–segment elevation in V1–V4 and Q waves in the anterior leads. Thus diagnosis of anterior STEMI was made and urgent coronary angiography was performed: left descending artery occlusion was treated with primary angioplasty. Laboratory tests pointed out high troponin levels (13124 ng/L, normal &lt;14 ng/L). Transthoracic echocardiogram (TTE) showed severe LV dysfunction (ejection fraction 30%); akinesia of apex, septum, anterior and mid inferior segments and spontaneous echo contrast in LV. TTE performed 6 days later revealed two mobile thrombi (1.2 x 0.5 cm and 2,1 x 0,7 cm) in LV lateral and septal apex. Anticoagulant therapy with Warfarin was started and low–molecular weight heparin was administered until International Normalized Ratio (INR) value reached a therapeutic range. Moreover de–escalation of P2Y12 receptor inhibitor therapy (switch from ticagrelor to clopidogrel) was carried out. Few days later, because of flank pain and vomiting, an abdominal CT was performed. It showed two right renal infarcts. The following TTE revealed just the presence of the thrombus located in LV septal apex. After one week LVT was no longer detected at TTE and the patient was discharged to cardiac rehabilitation, continuing therapy with Vitamin K antagonists (VKA).

Conclusions
LVT may lead to systemic embolism and consequently, in some cases, to renal infarction. This case report proves the importance of serially evaluating, with TTE, STEMI patients, in particular when apex akinesia is known. Treatment of LVT is anticoagulant therapy, extended for 3–6 months, usually with VKA, with an target INR of 2,5. New ESC guidelines for acute coronary syndromes pave the way to the use of new oral anti–coagulants (NOAC), after results of a meta–analysis and studies conducted on Rivaroxaban. In our case, administration of NOAC was not taken into account due to Chronic Kidney Disease. In conclusion, the treatment of LVT is nowadays a challenge for cardiologists, given the lack of data and the unstable balance between the hemorrhagic and thrombotic risk related to STEMI patients.
CARDIAC REMODELING AND OUTCOME AFTER SURGICAL INTERVENTION FOR ATRIAL FUNCTIONAL MITRAL REGURGITATION
Authors: Cortese F , Costantino M , Luisiana S , Serena D , Luzi G 
Published: May 2024

Abstract
The atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease. To better define this new entity and understand the benefits of surgery in patients with severe regurgitation, we conducted an observational analysis on 28 subjects with atrial functional mitral regurgitation who underwent surgical treatment between February 2020 and December 2022, at the Cardio Surgery Department of the “San Carlo” Hospital in Potenza. Twenty–eight subjects (11 males, 39.3%), mean age ± standard deviation 72.7 ± 8.4 years, who underwent surgical correction (mitral annuloplasty and tricuspid ring annuloplasty when needed) for significant atrial functional mitral regurgitation, sometimes associated with significant tricuspid insufficiency, were evaluated. No surgical treatment of atrial fibrillation has been performed. Subjects were assessed at enrollment and at one–year follow–up. We evaluated clinical and echocardiographic parameters. There was no in–hospital mortality. Mitral valve repair determined a reverse remodeling of the left ventricle and left atrium, with a significant reduction of the end–diastolic volume of the left ventricle [110 ml (95–148 ml)] vs. (55 ml (48–59 ml), z: –0,7, p&lt;0.001]) and of left atrial volume [83.5 ml (63.2–96.5 ml) vs. 63 ml (45.5–78.7 ml), z: –3.2, p: &lt;0.01]. We also observed a significant reduction of the estimated pressure in the pulmonary artery, an expression of reduced pressures in the left ventricle that affect the pulmonary circulation [35 mmHg (30–43) vs. 25 (22–32.7), z: –3.9, p&lt; 0.001]. Results were not altered by the presence or absence of atrial fibrillation. The overall 1–year survival rates were 100% and all the patients recovered to NYHA functional class I/II at the follow up (z: –6, p &lt; 0.001). Our results suggest that mitral valve repair for atrial functional mitral regurgitation is safe and effective. It improves heart failure symptoms and results in reverse–remodeling of both the left atrium and left ventricle. The presence of atrial fibrillation did not alter the outcome.
CHRONIC INFECTION AND SEVERE MITRAL REGURGITATION: A TRICKY CASE REPORT
Authors: Pozzi A , Bartesaghi G , Refugjati T , Bonfanti P , Berlinghieri N , Foglia Manzillo G , Esposito G , Corrado G 
Published: May 2024

Abstract

Background
Techniques of mitral valve repair has improved in the last decades. Percutaneous approach is now a reliable and safe therapy in those patients with high surgical risk. Of note, the presence of implanted prothesis may increase the risk of endocarditis, especially in those patients experiencing recurrent infection.

Case Summary
We describe a case of a 75–year–old with medical history of chronic lymphedema. It was characterized by periodical episode (yearly) of cellulitis, with a rapid onset of fever (38.5–39° C), lasting for a few days after paracetamol therapy. Patients had severe mitral valve regurgitation due to prolapse of the posterior leaflet (P2). In December 2022, he had percutaneous edge–to–edge mitral valve. Three months later the patient was admitted to the emergency department of our hospital due to fever without any specific symptoms. The patient was well compensated, normal blood pressure, heart rate and oxygen saturation. He had emocolture which revealed the presence of Staphilococcus lugdunensis. Transesophageal echocardiogram confirmed the presence endocarditis, showing a huge (10x12 mm) vegetation at the level of mitral device (Fig 1 and 2). Patients was then referred to cardiac surgery for urgent mitral valve replacement with mitral bioprothesis (Fig 3). He was treated with ev antibiotic for six weeks after cardiac surgery. Additionally, chronic treatment with amoxicillin 500 mg/day was also prescribed at discharge. After six months follow–up, patients had no signs of endocarditis.

Conclusion
The management and treatment of chronic infection is of paramount importance to reduce the risk of prothesis infection procedure in patients needing a prothesis implantation. The last European Society of Cardiology guidelines on endocarditis do not provide any recommendation regarding a long–term treatment of patients with high risk of infection (i.e. due to chronic infection) and with an implanted cardiac device/prothesis. We believe this represents an important unmeet need.
RIGHT VENTRICULAR TO PULMONARY ARTERY COUPLING AND IN–HOSPITAL OUTCOMES IN PATIENTS WITH SEVERE PRIMARY MITRAL REGURGITATION UNDERGOING CARDIAC SURGERY
Authors: Grieco M , Bonelli A , Guasti S , Di Simone V , De Sanctis G , De Chiara B , Cerrito L , Russo C , Giannattasio C , Moreo A 
Published: May 2024

Abstract

Background
Recent data suggests that right ventricular to pulmonary artery (RV–PA) uncoupling negatively influences prognosis in several clinical conditions. Little is known about the role of RV–PA coupling in patients with mitral regurgitation (MR).

Objectives
Our study aimed to investigate the role of RV–PA coupling in a cohort of patients with chronic severe primary MR (PMR) undergoing cardiac surgery.

Methods
We retrospectively assessed patients with severe PMR undergoing surgical repair or replacement from January 2018 to December 2021. Patients underwent preoperative transthoracic echocardiography and speckle tracking analysis. RV–PA coupling was assessed by the ratio of RV global longitudinal strain (RVGLS) and pulmonary artery systolic pressure (PASP). Patients were divided into tertiles according to RVGLS/PASP values. We studied the association between RV–PA coupling and the length of stay in the intensive care unit (ICU), the length of hospitalization and NYHA class at discharge.

Results
A total of 120 patients (mean age 65.2 ± 11.9 y) were included in the study. 84 (70%) patients underwent surgical valve repair while 36 (30%) underwent surgical valve replacement. Patients with lower RVGLS/PASP values had lower left ventricular ejection fraction (LVEF: 58.1±10.5% vs 62.0±7.4% vs 62.9±5.3%, p=0.018), more dilated left atrial volume (LAV: 71.0±21.9ml/m2 vs 62.3±21.2ml/m2 vs 55.9±23.9ml/m2, p=0.012) and lower peak atrial longitudinal strain values (PALS: 21.1 ± 10.1% vs 29.7 ± 11.0% vs 34.1 ± 9.4%, p&lt;0.001). Patients with lower RVGLS/PASP ratio had longer hospital stay (11.5 ± 3.9 vs 10.4 ± 3.4 vs 8.5 ± 2.2 days, p&lt;0.001) and stay in ICU (3.7 ± 2.0 vs 2.8 ± 2.4 vs 1.9 ± 1.3 days, p&lt; 0.001). There was a significant inverse association between RVGLS/PASP and hospital stay and length of stay in ICU [for each 0.1%/mmHg increase: respectively β=–0.59 (–0.89; –0.29), p&lt; 0.001 (Figure 1) and β=–0.35 (–0.53;–0.17), p&lt;0.001 (Figure 2)]. Moreover, RVGLS/PASP was also associated with the probability of having a NYHA class ≥ 2 at discharge [OR 0.69(0.54; 0.89), p= 0.004 (Figure 3)]. These relationships were confirmed after adjustment for other variables.

Conclusions
Our study suggests that in patients with PMR undergoing cardiac surgery RV–PA coupling may identify a more compromised group of patients and that it is related to clinical outcomes in the very short–term after surgery.
Diverse Gene Regulatory Mechanisms Alter Rattlesnake Venom Gene Expression at Fine Evolutionary Scales
Authors: Gopalan Siddharth S , Perry Blair W , Francioli Yannick Z , Schield Drew R , Guss Hannah D , Bernstein Justin M , Ballard Kaas , Smith Cara F , Saviola Anthony J , Adams Richard H , Mackessy Stephen P , Castoe Todd A 
Published: May 2024

Abstract
Understanding and predicting the relationships between genotype and phenotype is often challenging, largely due to the complex nature of eukaryotic gene regulation. A step towards this goal is to map how phenotypic diversity evolves through genomic changes that modify gene regulatory interactions. Using the Prairie Rattlesnake (Crotalus viridis) and related species, we integrate mRNA-seq, proteomic, ATAC-seq and whole-genome resequencing data to understand how specific evolutionary modifications to gene regulatory network components produce differences in venom gene expression. Through comparisons within and between species, we find a remarkably high degree of gene expression and regulatory network variation across even a shallow level of evolutionary divergence. We use these data to test hypotheses about the roles of specific trans-factors and cis-regulatory elements, how these roles may vary across venom genes and gene families, and how variation in regulatory systems drive diversity in venom phenotypes. Our results illustrate that differences in chromatin and genotype at regulatory elements play major roles in modulating expression. However, we also find that enhancer deletions, differences in transcription factor expression, and variation in activity of the insulator protein CTCF also likely impact venom phenotypes. Our findings provide insight into the diversity and gene-specificity of gene regulatory features and highlight the value of comparative studies to link gene regulatory network variation to phenotypic variation.
Copyright in the Artificial Intelligence Act – A Primer
Authors: Peukert Alexander 
Published: May 2024

Abstract
The European Union’s AI Act as adopted by the European Parliament on 13 March 2024 contains two provisions of particular relevance for copyright. According to Art. 53(1)(c) and (d), providers of general-purpose AI models shall (1) put in place a policy to comply with Union copyright law, and in particular to identify and comply with, including through state of the art technologies, a reservation of rights expressed pursuant to Art. 4(3) of Directive (EU) 2019/790, and (2) draw up and make publicly available a sufficiently detailed summary about the content used for training of the general-purpose AI model. This article summarizes the history of these provisions, explains that the EU legislature has merged two different types of laws, identifies the addressees of the copyright-related obligations, and gives an overview of their legal nature, content and enforcement.
Ensemble machine learning for managing the required thermal energy from the architectural characteristics of residential buildings
Authors: Gan HuiHui , Gao Wei 
Published: May 2024

Abstract
Forecasting the amount of required energy is a primary task for sustainable building design. In recent decades, machine learning (ML) has provided effective solutions to this problem, particularly thermal energy forecasting. This study aims to develop new ML paradigms for predicting annual thermal energy demand (EDAT) based on the building’s architecture. A valid dataset is obtained from the previous literature to feed the ML models. It is then synthesized with four of the most recent optimization algorithms, namely gazelle optimization algorithm (GOA), incomprehensible but intelligible-in-time logics (ILA), osprey optimization algorithm (OOA) and sooty tern optimization algorithm (STOA), which are responsible for training the ML. The quality of training and validation of the ensembles used are checked using relative and absolute accuracy quantifiers. According to the results, all four ensembles of ML-GOA, ML-ILA, ML-OOA and ML-STOA are trained and validated with excellent accuracy, and therefore, they can be recommended for the practical forecast of the EDAT. A comparison, however, disclosed the superiority of the GOA-based model. This model has also been successfully validated against several hybrid algorithms used in earlier efforts. In short, the introduced models can directly contribute to the energy–construction sectors by assisting decision-makers in effectively designing residential buildings and their energy systems.
Wombat burrows are hotspots for small vertebrates in a landscape subject to gigafire
Authors: Linley Grant D , Geary William L , Jolly Chris J , Spencer Emma E , Ashman Kita R , Michael Damian R , Westaway Dylan M , Nimmo Dale G 
Published: May 2024

Abstract
Ecosystem engineers modify their environment and influence the availability of resources for other organisms. Burrowing species, a subset of allogenic engineers, are gaining recognition as ecological facilitators. Burrows created by these species provide habitat for a diverse array of other organisms. Following disturbances, burrows could also serve as ecological refuges, thereby enhancing ecological resistance to disturbance events. We explored the ecological role of Common Wombat (Vombatus ursinus) burrows using camera traps in forests of southeastern Australia. We compared animal activity at paired sites with and without burrows, from the same fire severity class and habitat. We examined how animal activity at Common Wombat burrows was affected by the 2019–20 Black Summer bushfires in Australia. We predicted that burrows would serve as hotspots for animal activity and as refuges in burned areas. The activity of several species including Bush Rat (Rattus fuscipes), Agile Antechinus (Antechinus agilis), Lace Monitor (Varanus varius), Painted Button-quail (Turnix varius), and Grey Shrike-thrush (Colluricincla harmonica) increased at sites where Common Wombat burrows were present, while other species avoided burrows. Species that were more active at burrows tended to be smaller mammal and bird species that are vulnerable to predation, whereas species that avoided burrows tended to be larger mammals that might compete with Common Wombat for resources. Species composition differed between sites with and without burrows, and burrow sites had higher native mammal species richness. The association of several species with burrows persisted or strengthened in areas that burned during the 2019–20 Black Summer bushfires, suggesting that Common Wombat burrows may act as ecological refuges for animals following severe wildfire. Our findings have relevance for understanding how animals survive, persist, and recover following extreme wildfire events.
Shepherd’s Accounts of Space and Time
Authors: Landy David 
Published: May 2024

Abstract
There is an apparent tension in Shepherd’s accounts of space and time. Firstly, Shepherd explicitly claims that we know that the space and time of the unperceived world exist because they cause our phenomenal experience of them. Secondly, Shepherd emphasizes that empty space and time do not have the power to effect any change in the world. My proposal is that for Shepherd time has exactly one causal power: to provide for the continued existence of self-same or changing objects. Because Shepherd takes causation to be a relation whereby two objects combine to form a third, their effect, whenever we perceive a continually existing object, since time is a proper part of such objects, our perception of time is caused by time itself. Likewise, space’s causal power is to provide for the possibility of the motion or rest of objects, and so when we perceive objects with space as a proper part, we come into causal contact with space.
Beyond Hasidism: Tracing the Cultural Legacies of Israel Ba’al Shem Tov
Authors: Moseson Elly 
Published: May 2024

Abstract
While Israel Ba’al Shem Tov (the Besht) is traditionally considered the founder of Hasidism, modern scholarship has shown that the Hasidic movement emerged only in the decades following his death. This image of the Besht as the founder of Hasidism poses significant challenges in assessing his impact both during his lifetime and independently of the movement. This study seeks to extricate him from the Hasidic context that has historically defined him by analyzing four distinct types of traditions that preserve his cultural legacy—mystical pietistic teachings, kabbalistic intentional formulae (kavvanot), medico-magical recipes, and biographical narratives—and tracing their oral and written transmission histories. It argues that the initial dissemination of traditions attributed to the Besht both preceded and exceeded the Hasidic movement and that recognizing this fact allows for a better appreciation of his contributions to Jewish culture on their own terms, as well as a more accurate assessment of their subsequent influence on the Hasidic movement.
(Successful) Democracies Breed Their Own Support
Authors: Acemoglu Daron , Ajzenman Nicolás , Aksoy Cevat Giray , Fiszbein Martin , Molina Carlos 
Published: May 2024

AbstractUsing large-scale survey data covering more than 110 countries and exploiting within-country variation across cohorts and surveys, we show that individuals with longer exposure to democracy display stronger support for democratic institutions, and that this effect is almost entirely driven by exposure to democracies with successful performance in terms of economic growth, control of corruption, peace and political stability, and public goods provision. Across a variety of specifications, estimation methods, and samples, the results are robust, and the timing and nature of the effects are consistent with our interpretation. We also present suggestive evidence that democratic institutions that receive support from their citizens perform better in the face of negative shocks.