bluuebunny/crossref_metadata_2025_split huggingface dataset:
EFFECT OF ANTI-PCSK9 ANTIBODIES ON ARTERY STRUCTURE AND FUNCTION: THE NIGUARDA HOSPITAL COHORT
Authors: Maloberti Alessandro , Toscani Giorgio , Busti Andrea , Tognola Chiara , Intravaia Rita Cristina Mi , De Censi Lorenzo , Galasso Michele , Daus Franesca , Giani Valentina , Gualini Elena , Garofani Ilaria , Riccio Alfonso , Biolcati Marco , Fabbri Saverio , Algeri Michela , Merlini Piera , Giannattasio Cristina , Morelli Marco 
Published: May 2024

Objective:
PCSK9 inhibitors antibodies (PCSK9-i) are a valid option to reduce LDL cholesterol in patients who failed to reach therapeutic target with maximized lipid-lowering therapies or in patient with statins intolerances. These antibodies reduce the frequency of new cardiovascular events, however if this effect is due only to LDL reduction or also to an improvement in arterial function and structure is yet to be proved. Our study aim was to evaluate aortic stiffness (Pulse Wave Velocity - PWV), carotid's Intima-Media Thickness (IMT) and endothelial function (brachial Flow Mediated Dilatation - FMD) in patients treated with Alirocumab and Evolocumab.

Design and method:
This is a monocentric prospective longitudinal study on patients who received PCSK9-i administrations at the Niguarda Hospital's cardiovascular rehabilitation and prevention unit. They underwent 3 evaluations of PWV, FMD and IMT (T0 the same day of the first injection, T1 after 6 months and T2 after 12 months of therapy).

Results:
39 patients concluded the 12 months period. The group average age is 66.8 ± 7.6 years, most of them were male (64.1%). LDL cholesterol average levels were significantly reduced by the therapy (128.3 ± 27.7 vs 44.7 ± 29.3 mg/dL, p<0.001), however, there were no significant changes in PWV (10.2 ± 3.0 vs 10.6 ± 2.5 m/s, p=0.404), FMD (8.6 ± 7.0 vs 8.9 ± 7.4%, p=0.560) and IMT (768.7 ± 175.4 vs 733.5 ± 147.2 μm, p=0.270) values.

Conclusions:
It was not possible to prove a significant effect of PCSK9-i on vascular properties, however, the stability of these indexes may suggest a deceleration of the atherosclerotic disease which it could have worsen in this population, especially considering the risk factors of our patients.
ANALYSING THE RELATIONSHIP BETWEEN SFLT-1/PLGF RATIO AND PREMATURE BIRTH
Authors: Rodríguez Claudia Martín , Morales Eduardo Martínez , González Esther Rubio , Sánchez Paula López , Testillano Lucía Martín , Pujol Javier Relea , García Irene García , Sánchez Paola Carolina Villegas , García M Mercedes Pérez , Fernández M Isabel Galán , Arroyo Ana María Huerta , Briales Paula Sánchez , Vidas María Marques , Recio María De Valdenebro , Sánchez Ana Muñoz , Menéndez Estefanya Lisset García , Marín Darío Janeiro , Salazar María Luisa Serrano , Carratalá Rosario Llópez , Pérez Jose María Portolés 
Published: May 2024

Objective:
To analyse the relationship between sFlt-1/PlGF ratio and the occurrence of premature birth (<37 week)

Design and method:
An observational, retrospective, cross-sectional study that includes pregnant women who under sFlt-1/PlGF ratio determination since January until September 2022 in a tertiary hospital. Baseline characteristics and data related with the pregnancy, birth and the development of hypertensive disorders of pregnancy (HDP) were included. A multivariate logistic regression was applied to identify risk factors.

Results:
Out of 109 recruited patients, 104 were analyzed (5 were excluded due to the lost of follow-up). The mean age was 33.9 years (SD 5.0), 52.5% were primiparous and 4.8% were twin pregnancies. 7.7% had pre-pregnancy hypertension and 15.4% had a prior HDP. Additional data are specified in Table 1.
During pregnancy, a total of 64.4% women developed HDP; 45.2% presented pre-eclampsia (PE) / eclampsia; 4.8% had chronic hypertension and 14.4% had gestational hypertension.
The mean week of birth presentation was 37.9 (SD 2.4).18.3% were preterm births (<37 week). Among patients with PE, 30.6% had a preterm birth compared with 7.3% of preterm births in cases without PE (p-value 0.002).
Fifty-four percent women obtained a pathological sFlt-1/PlGF ratio (>38). 30.4% of patients with a pathological ratio underwent preterm birth, whereas only 4.2% with a normal ratio developed preterm birth (p-value 0.001). 73.7% of preterm births had a ratio >65, and 26.3% had a ratio between 26-65. No differences in neonate weight (p- value 0.058) between women with a pathological ratio (2.9 kg, SD 90.1) and a normal one (3.1 kg, SD 82.4)
In multivariate analysis, excluding twin pregnancies, patients with a pathological ratio had a higher risk of preterm birth, OR 5.2 (CI95% [1.0-28.0]), regardless of patient's age or the presence or not of preeclampsia.

Conclusions:
The sFlt-1/PlGF ratio could be a valuable tool to predict the risk of preterm birth, as patients with a pathological ratio had higher risk of preterm birth, regardless women's age or the presence of preeclampsia. More studies are necessary to establish thisratio in clinical practice for this purpose.
GENDER DIFFERENCES IN THE IMPACT OF VENTRICULAR-ARTERIAL COUPLING ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH HYPERTENSION
Authors: Joo Seungjae , An Soyeon , Boo Kiyoung , Lee Jaegeun , Choi Joonhyouk , Kim Songyi 
Published: May 2024

Objective:
Increased arterial stiffness elevates aortic load, which can have adverse impacts on left ventricular (LV) function and contribute to the onset of heart failure. This impact is known to be more pronounced in women. Optimal coordination between ventricular contraction and the arterial system is required to maintain efficient cardiac function. This study aimed to investigate gender differences in the impact of ventricular-arterial coupling (VAC) on LV function in patients with hypertension at rest and after handgrip exercise.

Design and method:
Echocardiographic indexes of LV volumes, systolic function, and diastolic function were obtained in the usual way. Effective arterial elastance (EA) and index (EAI) were calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root and reflection magnitude (RM) was calculated after Fourier transformation of both aortic pressure and flow waveforms.

Results:
Sixty-four patients (31 women and 33 men) with hypertension were enrolled. Women showed higher ELVI (1.33±0.34 vs. 1.10±0.29 mmHg/ml/m2, P=0.004) and EAI (1.14±0.25 vs. 0.93±0.26 mmHg/ml/m2, P=0.001), but VAC was not different (women: 0.88±0.17 vs. men: 0.85±0.11, P=0.431). Zc and RM were not different between women and men. After handgrip exercise, an increase in ELVI (P=0.021) and a decrease in VAC (P=0.035) were observed specifically in men, with no corresponding changes noted in women. In women, VAC was significantly associated with E’ velocity (beta -0.344, P=0.029) and left ventricular global longitudinal strain (beta 0.470, P=0.012) after adjustment, but in men, no association was found.

Conclusions:
Hypertensive women demonstrated greater stiffness in both the left ventricle and arterial systems, along with impaired LV contractile reserve in response to handgrip exercise, as compared to men. The ventricular-arterial mismatch had a notable impact on LV diastolic and systolic dysfunction only in women, but not in men.
EFFECTS OF VITAMIN D ON CAROTID STRUCTURE AND FUNCTION IN A RAT MODEL OF POLYCYSTIC OVARY SYNDROME
Authors: Horváth Eszter Mária , Benkö Rita , Süli Anita , Kiss Stella Tímea , Bányai Bálint , Vezér Márton , Kim Dongwoog , Várbíró Szabolcs , Szekeres Mária 
Published: May 2024

Objective:
Polycystic ovary syndrome (PCOS) is a common gynecological disorder of endocrine origin that can be associated with increased cardiovascular morbidity and vitamin D deficiency. The effects of vitamin D deficiency on cardio-metabolic risk in PCOS have been shown in previous studies. In the present experiments, we investigated the effect of vitamin D supplementation in light of optimal vitamin D intake on rat carotid artery function in a rat model of PCOS.
Our aim was to investigate the effects of vitamin D supplementation and hyperandrogenism on functional and morphological changes of the carotid artery.

Design and method:
Adolescent female Wistar rats were provided with normal (C: 1000 IU/day/kg/week) or increased (D: 3000 IU/day/kg/week) vitamin D intake for 8 weeks. In half of these animals hyperandrogenism was induced by testosterone treatment (T and T+D: daily cutaneous testosterone: 3.3 mg/100 g) (N=8 in all 4 groups). After 8 weeks, carotid arteries were isolated and phenylephrine (Phe)-induced contraction and acetylcholine (Ach)-induced relaxation of the vascular rings were examined by myography. Wall thickness and intima-media ratio were determined in hematoxylin-eosin stained tissue sections, vessel wall connective tissue fiber density in resorcin-fuchsin stained sections, and vessel smooth muscle densitometry by -αsmooth muscle actin immunostaining.

Results:
The hyperandrogenic state induced a decreased contractility as a response to Phe (10-6 M Phe expressed in the % of K+-induced contraction: T: 62±22% p<0.001 vs. C: 116±33%; D: 101±39%), that was reversible by Vitamin D treatment (T+D: 95±16%, ns.). Endothelium-mediated relaxation did not differ between groups. Hyperandrogenic state significantly increased vessel wall thickness (T: 74.81 ±4.48 μm, p<0.05 vs. C: 57.92±2.96 μm; D: 53.21±10.8 μm), which was prevented by Vitamin D (58.99±8.75 μm, ns.) whereas intima-media ratio did not change. No significant differences were found for smooth muscle actin and connective tissue fiber density.

Conclusions:
Our results suggest that the hyperandrogenism increased vessel wall thickness and, in comparison to media thickness the alpha1-adrenerg sensitivity decreased, leading to a limited capacity of regulation. The morphological remodeling of the vascular wall induced by testosterone treatment did not cause significant endothelial functional changes yet.
LONG-TERM IMPACT OF PREVIOUS GESTATIONAL HYPERTENSIVE DISORDERS ON BLOOD PRESSURE PROFILE AND HEART STRUCTURE
Authors: Verardino Renata , Macedo Thiago , Rodrigues Sara , Baptista Fernanda , Pulcinelli Rossana , Bortolotto Luiz 
Published: May 2024

Objective:
To evaluate subclinical cardiac repercussions and blood pressure (BP) profile by noninvasive methods in women with previous severe preeclampsia (PE).

Design and method:
Cross-sectional study was carried out in a tertiary hospital. Women were evaluated 2 to 5 years after delivery and divided into 3 groups: isolated preeclampsia (IPE=30), superimposed preeclampsia and/or chronic hypertension (Sup/CH) =60 and normal gestation (NG) =30. Variables analyzed: age, body mass index (BMI), office systolic blood pressure (SBP), diastolic BP (DBP), 24-hours ambulatory blood pressure monitoring (ABPM-24h), central pressure (BPc) by Sphigmocor®; and echocardiographic variables (ViviDI-GE®).

Results:
Table
∗ = p <0,05, Sup/CH vs. NG; # = IPE vs. NG; & = Sup/CH vs. IPE

Conclusions:
Women with previous gestational hypertensive disorders, either Sup/CH or isolated PE, had elevated BP values (office, ABPM and central) and cardiac repercussions, 2 to 5 years after delivery compared to previous normal gestation.
BENEFICIAL ROLE OF DIETARY CHANGES IN MENOPAUSE: IMPACT ON CARDIOVASCULAR RISK
Authors: Tikhonoff Valerie , Ciaghi Gioele , Poncina Gianluca , Lievore Nicole , Zandi Pouya 
Published: May 2024

Objective:
The changing hormonal milieu in post-menopausal women (PMW) predisposes them to increase cardiovascular (CV) risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia and arterial hypertension. Our ongoing study aims to evaluate the impact of dietary changes in CV risk in PMW.

Design and method:
For 1 year, 65 PMW with BMI 24-39 Kg/m2 and at least another CV risk factor were followed. Anthropometric parameters, plicometry and blood pressure (BP) were taken. Questionnaires on medical history, physical activity, and food frequency (FFQ) were administered. Balanced low-calorie dietary plan with quantitative advice were released. Repeated measures ANOVA at 1 year were performed.

Results:
We observed at 1 year significant reductions (p<0.01) in weight (δ=-4.5 Kg), BMI (δ=-1.7 Kg/m2), waist (δ=-4.3cm) and hips (δ=-3.1cm) circumferences, subscapular (δ=-5.8mm), suprailiac (δ=-3.3mm) and triceps (δ=-5.5mm) skinfolds, adipose area of the arm (AFA) (δ=-7.3cm2), and fat mass (δ=-4.5kg) without variation of the lean mass (δ=-0.1 kg, p=0.48). All those reductions were followed by change in the obesity prevalence (-21.1%), in the fat mass distribution with 10% reduction in abdominal and truncular obesity and 5.2% reduction on waist-to-height ratio, and in systolic (δ=-8.8 mmHg) and diastolic (δ=-4.3 mmHg) BP. Significant positive correlations (p<0.0001) were observed between weight reduction and the following variables: waist (r=0.61) and hip (r=0.77) circumferences, subscapularis (r=0.56) and triceps (r=0.66) skinfolds, and AFA (r=0.73). Significant reductions (p<0.05) were observed in daily caloric intake (δ=-99.8Kcal/day), due to the reduction in fat intake (36.6->33.6%), specially saturated fatty acids (12->10.8%) and cholesterol (δ=-23.1mg/day), with maintenance of the average level of physical activity and in agreement with a significant reductions in consumption of animal meats, visible fat, processed meats, olive oil, sweets and baked goods detected by FFQ.

Conclusions:
The study underlines the medium-term utility of a 1 year balanced low-calorie diet in PMW with elevated CV risk factors with a clear reduction in CV risk.
Risk of Recurrent Severe Maternal Morbidity: A Population-Based Study
Authors: Ukah Ugochinyere Vivian , Platt Robert W. , Auger Nathalie , Lisonkova Sarka , Ray Joel G. , Malhamé Isabelle , Ayoub Aimina , El-Chaâr Darine , Dayan Natalie 
Published: May 2024

(Abstracted from Am J Obstet Gynecol 2023;229:545.e1–545.e11
Severe maternal morbidity (SMM) is a composite outcome that encompasses life-threatening maternal complications and eclampsia around the time of delivery and up to 42 days after birth. It is associated with a higher incidence of cardiovascular disease and all-cause mortality long-term, beyond the postpartum period, as well as prolonged hospitalization.
Genetic Causes of Sporadic and Recurrent Miscarriage
Authors: Melo Pedro , Dhillon-Smith Rima , Islam Md Asiful , Devall Adam , Coomarasamy Arri 
Published: May 2024

(Abstracted from Fertil Steril 2023;120:940–944
Early pregnancy loss, or miscarriage, is a relatively common occurrence. Of these losses, 80% occur in the first 12 weeks of gestation and 50% of them are diagnosed with chromosomal abnormalities.
Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancer: A Randomized Controlled Trial
Authors: Anastasio Mary Katherine , Unnithan Shakthi , Scott Amelia , Hayes Taylor , Shah Suma , Moss Haley A. , Erkanli Alaattin , Havrilesky Laura J. 
Published: May 2024

(Abstracted from Obstet Gynecol 2024;143:53–66
Between 30% and 40% of patients treated with neurotoxic chemotherapy, including taxanes and platinum drugs commonly used to treat gynecologic malignancies, experience peripheral neuropathy. Symptoms of these neuropathies include numbness, tingling, and pain in the hands and feet and often result in chemotherapy dose delay, reduction, or discontinuation along with a lower quality of life.
Machine Learning–Driven Analysis of Individualized Treatment Effects Comparing Buprenorphine and Naltrexone in Opioid Use Disorder Relapse Prevention
Authors: Afshar Majid , Graham Linck Emma J. , Spicer Alexandra B. , Rotrosen John , Salisbury-Afshar Elizabeth M. , Sinha Pratik , Semler Matthew W. , Churpek Matthew M. 
Published: May 2024

Objective
A trial comparing extended-release naltrexone and sublingual buprenorphine-naloxone demonstrated higher relapse rates in individuals randomized to extended-release naltrexone. The effectiveness of treatment might vary based on patient characteristics. We hypothesized that causal machine learning would identify individualized treatment effects for each medication.

Methods
This is a secondary analysis of a multicenter randomized trial that compared the effectiveness of extended-release naltrexone versus buprenorphine-naloxone for preventing relapse of opioid misuse. Three machine learning models were derived using all trial participants with 50% randomly selected for training (n = 285) and the remaining 50% for validation. Individualized treatment effect was measured by the Qini value and c-for-benefit, with the absence of relapse denoting treatment success. Patients were grouped into quartiles by predicted individualized treatment effect to examine differences in characteristics and the observed treatment effects.

Results
The best-performing model had a Qini value of 4.45 (95% confidence interval, 1.02–7.83) and a c-for-benefit of 0.63 (95% confidence interval, 0.53–0.68). The quartile most likely to benefit from buprenorphine-naloxone had a 35% absolute benefit from this treatment, and at study entry, they had a high median opioid withdrawal score (P < 0.001), used cocaine on more days over the prior 30 days than other quartiles (P < 0.001), and had highest proportions with alcohol and cocaine use disorder (P ≤ 0.02). Quartile 4 individuals were predicted to be most likely to benefit from extended-release naltrexone, with the greatest proportion having heroin drug preference (P = 0.02) and all experiencing homelessness (P < 0.001).

Conclusions
Causal machine learning identified differing individualized treatment effects between medications based on characteristics associated with preventing relapse.
Changes in the Term Neonatal Electroencephalogram with General Anesthesia: A Systematic Review with Narrative Synthesis
Authors: Corlette Sebastian J. , Walker Suellen M. , Cornelissen Laura , Brasher Christopher , Bower Janeen , Davidson Andrew J. 
Published: May 2024

Background
Although effects of general anesthesia on neuronal activity in the human neonatal brain are incompletely understood, electroencephalography provides some insight and may identify age-dependent differences.

Methods
A systematic search (MEDLINE, Embase, PubMed, and Cochrane Library to November 2023) retrieved English language publications reporting electroencephalography during general anesthesia for cardiac or noncardiac surgery in term neonates (37 to 44 weeks postmenstrual age). Data were extracted, and risk of bias (ROBINS-I Cochrane tool) and quality of evidence (Grading of Recommendations Assessment, Development, and Evaluation [GRADE] checklist) were assessed.

Results
From 1,155 abstracts, 9 publications (140 neonates; 55% male) fulfilled eligibility criteria. Data were limited, and study quality was very low. The occurrence of discontinuity, a characteristic pattern of alternating higher and lower amplitude electroencephalography segments, was reported with general anesthesia (94 of 119 neonates, 6 publications) and with hypothermia (23 of 23 neonates, 2 publications). Decreased power in the delta (0.5 to 4 Hz) frequency range was also reported with increasing anesthetic dose (22 neonates; 3 publications).

Conclusion
Although evidence gaps were identified, both increasing sevoflurane concentration and decreasing temperature are associated with increasing discontinuity.

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The Role of the Glymphatic System in Perioperative Neurocognitive Disorders
Authors: Roy Bhaswati , Kumar Rajesh , Sarovich Stephanie-Dee , Vacas Susana 
Published: May 2024

Background:
The glymphatic system plays a crucial role in clearing metabolic waste from the central nervous system and is most active during sleep. Patients with obstructive sleep apnea (OSA) have a dysfunctional glymphatic system that correlates with disease severity. In addition, these patients have worse outcomes after surgery. The status of the glymphatic system during the perioperative period is unclear and can be examined with magnetic resonance imaging (MRI)-based diffusion tensor imaging (DTI). This study assessed perioperative glymphatic system changes in OSA surgical patients and possible relationships with perioperative neurocognitive disorders.

Methods:
DTI data from 13 OSA patients having laparoscopic abdominal surgery with general anesthesia were acquired and analyzed using a 3.0-T MRI scanner. Diffusivity maps in the x-axis (D
xx
), y-axis (D
yy
), z-axis (D
zz
), x-y axis (Dxy), y-z axis (Dyz), and x-z axis (Dxz) were calculated. Diffusion values for the projection and association fibers were extracted, and DTI analysis along the perivascular space (ALPS) was performed. The patients’ cognition was assessed using the Montreal Cognitive Assessment tool. Evaluations were carried out within 5 days before surgery and within the first 48 hours after surgery.

Results:
The ALPS index decreased after surgery, and this correlated with a decrease in general cognition scores and specific memory domains, including visuospatial and delayed recall.

Conclusions:
The glymphatic system in OSA patients is worsened after surgery and this may contribute to an increased risk for long-term postoperative cognitive disorders. This study suggest that the glymphatic system might play a role in the pathophysiology of perioperative neurocognitive disorders and be a potential therapeutic target.
Association of Fluid Balance and Hemoglobin Decline With Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage*
Authors: Truckenmueller Peter , Wolf Stefan , Wasilewski David , Vajkoczy Peter , Früh Anton ,   for the Earlydrain Study Group
Published: May 2024

OBJECTIVES:
To explore the relationship between fluid balance and hemoglobin decline with secondary infarctions and neurologic outcome in aneurysmal subarachnoid hemorrhage (aSAH) patients.

DESIGN:
Secondary analysis of the Earlydrain trial, a prospective randomized controlled study investigating prophylactic lumbar drain use in aSAH patients.

SETTING:
Patients with aSAH treated in ICUs at 19 tertiary hospitals in Germany, Switzerland, and Canada.

PATIENTS:
From January 2011 to January 2016, 287 patients were enrolled in the Earlydrain trial. Only files with complete information on both daily hemoglobin and balance values were used, leaving 237 patients for analysis.

INTERVENTIONS:
Investigation of fluid balance management and hemoglobin levels during the initial 8 days post-aSAH to establish thresholds for unfavorable outcomes and assess their impact on secondary infarctions and 6-month neurologic outcome on the modified Rankin Scale (mRS).

MEASUREMENTS AND MAIN RESULTS:
Patients with unfavorable outcome after 6 months (mRS > 2) showed greater hemoglobin decline and increased cumulative fluid balance. A significant inverse relationship existed between fluid balance and hemoglobin decline. Thresholds for unfavorable outcome were 10.4 g/dL hemoglobin and 4894 mL cumulative fluid balance in the first 8 days. In multivariable analysis, fluid balance, but not fluid intake, remained significantly associated with unfavorable outcome, while the influence of hemoglobin lessened. Fluid balance but not hemoglobin related to secondary infarctions, with the effect being significant after inverse probability of treatment weighting. Transfusion was associated with unfavorable outcomes.

CONCLUSIONS:
Increased fluid balance influences hemoglobin decline through hemodilution. Fluid overload, rather than a slight decrease in hemoglobin levels, appears to be the primary factor contributing to poor outcomes in aSAH patients. The results suggest aiming for euvolemia and that a modest hemoglobin decline may be tolerated. It may be advisable to adopt a restrictive approach to transfusions, as they can potentially have a negative effect on outcome.