bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient PCI - early discharge PCI, single center experience
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Neves D , Patricio L 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Percutaneous coronary intervention (PCI) has undergone rapid evolution over the last years and is currently a widely generalized therapeutic option. In the past, it was associated with a significant rate of complications, yet, with the improvement of new generation drug eluting stents, and the radial access (RA) development, PCI has become safer and simpler, with a minimum rate of complications. This allows patient’s faster discharge. Besides the pressure from the limited number of beds in wards, the improvement of PCI has given the confidence to urge outpatient PCI programs. However, there are still centers where there is no ambulatory PCI.

Purpose
This study aims to describe our center experience of ambulatory PCI program, in terms of safety and efficacy.

Methods
We analyzed our center’s retrospective cohort of 723 PCI, in 2022. Ambulatory PCI was defined as PCI with same day hospital discharge. Our inclusion criteria were patients submitted to PCI. We excluded patients with acute coronary syndromes and patients needing hospital admission for other non-coronary reasons.

Results
467 (65%), of the 723 PCI were performed in ambulatory setting. Patients mean age was 67,8±11 years and 23% (n=107) were female. In 12% (n=55) of the cases, the coronary anatomy was previously known, from a differed procedure. 63% (n=298) had a normal left ventricle ejection fraction (LVEF), 6% (n=26) had a moderate depression of LVEF and 3% (n=13) had LVEF severe depression. RA was possible in 82% of the cases (n=384), and 18% (n=83) of PCI was done by femoral access (FA). The access size was 6 Fr in 77% (n=359) of the cases, 7Fr in 22% (n=105) and 8Fr in 1% (n=2). The RA hemostasis was by compression (either manually or by external device) and FA hemostasis was first intended by closing device, however in 17% of the transfemoral PCI (n=14) had to be compressed, due to device hemostasis failure. PCI was successful in 97% of the cases (n=449), with revascularization of the goal lesion. The unsuccessful PCI (3% n=18) were because uncrossable lesion in 2% (n=14), and no reflow after PCI in 1% (n=4).
6 patients had to be admitted, after planned outpatient PCI, 5 due to peripheral access complication with hemorrhage of FA (after closing device and manual compression failure) and 1 due to PCI complication, with small coronary perforation. There was a higher probability of admission in patients submitted to transfemoral PCI (p&lt;0,05), and there was no statistically significant relation between unplanned admission and patient’s LVEF. There were no episodes of death, MACE, non-planned hospital readmission and stent failure in the ambulatory PCI population.
PCI has become a predictable and reliable technique, capable to treat outpatients. Patients undergoing successful non-complex PCI, without events, can safely be discharged on the same day. Outpatient PCI helps with the functioning of inpatient care, allowing beds to be freed up for other situations.
Bleeding risk stratification in patients admitted for acute coronary syndrome
Authors: Paula S , Figueiredo M , Coelho M , Santos M , Almeida S , Almeida L 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
The risk of hemorrhagic events should always be accounted for in patients admitted with acute coronary syndromes (ACS). With the increasing frailty of these patients, it is important to identify them and minimize the risk of such events.

Purpose
Identify high-risk patients admitted for ACS for hemorrhagic events during their hospital stay.

Methods
Multicenter retrospective study, data collected from 1/10/2010 and 31/12/2020 with ACS diagnosis. Patients were divided into 3 groups according to hemoglobin (Hb) and platelet (Plat) levels. Group 1 – Hb &lt;8g/dl, Plat &lt;150x109/L; Group 2 – Hb 8-12g/dl, Plat 150-450x109/L; Group 3 – Hb ≥12g/dl, Plat ≥450x109/L. We further divided these patients according to a composite endpoint. Group A without the composite endpoint; Group B with composite endpoint. This composite endpoint was defined as major hemorrhage, intracranial hemorrhage, need of blood transfusions and a Hb decrease of ≥ 2g/dl.

Results
19409 patients were enrolled, of those 4707 (24.3%) had the composite endpoint. Group B was older (68±13 vs 66±12, p&lt;0.001), had higher rates of arterial hypertension (72.5% vs 68.2%, p&lt;0.001), diabetes mellitus (35.6% vs 30.7%, p&lt; 0.001), stroke (9.0% vs 6.6%, p &lt; 0.001) and previous haemorrhage (p= 0.004). No statistically significant differences regarding previous MI (p= 0.240). Hb levels &lt;8g/dL (8.1% vs 0.6%, p&lt;0.001) were associated with a higher risk of hemorrhagic events but not lower levels of Plat, instead higher levels (&gt; 450x109/L) were event associated (1.8% vs 0.9%, p&lt;0.001). The choice of femoral access was related to an increased risk of hemorrhagic events (p&lt;0.001). Logistic regression confirmed that the Hb levels &lt; 12g/dL when compared with normal levels were related to the composite endpoint proportionally to the degree of anemia, the lower the level of Hb the more likely these events occur, Hb &lt;8g/dL p&lt;0.001, OR 4.02, CI (95%) 2.50-6.47 and Hb 8-12g/dL, p&lt;0.001, OR 0.761, CI (95%) 0.693-0.837. Survival analysis also showed that cardiovascular (CV) mortality and re-admission at 1 year were related to the degree of anemia.

Conclusion
Lower levels of Hb correlated well and proportionally to the occurrence of the composite endpoint as well as cardiovascular (CV) mortality and re-admission at 1 year. Contrarily to expected lower levels of Plat did not correlate with a higher risk of hemorrhagic events but instead thrombocytosis did, as a paradoxical risk of bleeding has been noted in patients with thrombocytosis, especially extreme thrombocytosis.
Impact of clinical frailty scale on short and long term outcome in patients with acute coronary syndrome
Authors: Campanile A , Prota C , Iuliano G , Pompa A , Farace C , Sorrentino R , Vigorito F , Ravera A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
As recently outlined in the European Society of Cardiology (ESC) guidelines on acute coronary syndrome (ACS), scarce data still exits about the prognostic role of frailty to guide clinical decision-making for patients with ACS.

Purpose
To assess the potential predictive value of frailty both for short, and long term all-cause mortality, in a contemporary ACS population.

Methods
All consecutive admissions due to ACS, from 01/01/2019 to 31/12/2021, were retrospectively reviewed from an internal database of a tertiary cardiac center in Salerno (Italy). Logistic and Cox proportional regression analysis were performed in order to assess the contribution of frailty on 30-days and long term mortality. Frailty was assessed using the Clinical Frailty Scale (CFS) and patients were classified as non frail (CFS 1-4), and frail (CFS 5-9). Both logistic and Cox regression analysis were adjusted for age, gender, GRACE risk score, comorbidity burden, defined by the Charlson comorbidity score (CCS), and all other relevant covariates associated with outcomes of interest in the univariate analysis.
In order to estimate the survival rates during the follow-up, a Kaplan Meyer analysis was carried out and differences between the CFS groups were assessed using the log-rank test. Robustness of the results were assessed through an internal validation procedure with bootstrapping. All statistical analyses were performed using SPSS software version 25.0 (SPPS Inc., Chicago, Illinois) and R version 4.0.5 (R Foundation for Statistical Computing, Vienna, Austria). A p-value of less than 0.05 was considered significant.

Results
1366 patients were identified. The median age was 68 (58-77). Of these patients, 1087 (79,6%) were classified as non-frail (CFS 1-4), and 279 (20,4%) as frail (CFS 5-9). 120 (8,8%) and 140 (11,2%) deaths occurred, respectively, during the first 30 days from admission, and during long term follow-up (median follow-up time: 15 months; IQR: 10-24). After multivariate regression analysis the CFS was associated with both short and long-term mortality (OR: 1,6, 95% CI: 1,34-1,91; p&lt;0,001 and HR: 1,37, 95% CI: 1,18-1,58; p&lt;0,001, Fig. 1). Patients with CFS ≥ 5 showed significant higher mortality rate during long term follow-up (p&lt;0.001; Fig.2).

Conclusions
The CFS is a strong predictor of both short and long-term mortality in patients affected by ACS also after comprehensive adjustment for baseline differences in other risk factors.Fig. 2
Impact of early administration of beta-blocker and RAS inhibitor during VA-ECMO treatment for cardiogenic shock; the post-hoc study of the EARLY-UNLOAD trial
Authors: Park S , Lim Y W , Kim M C , Jeong I S 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background/introduction
No data about timing and impact of beta-blocker (BB) or renin-angiotensin-aldosterone system inhibitor (RASi) administration for cardiogenic shock (CS) treated with venoatrial extracorporeal membrane oxygenation (VA-ECMO).

Purpose
To analyze an impact of early administration of BB or RASi during VA-ECMO treatment.

Methods
This study is a post-hoc analysis of the EARLY-UNLOAD trial (NCT04775472), the trial evaluated an impact of an early prophylactic unloading strategy using left atrial cannulation (LAC) performed within 12 hours from the initiation of VA-ECMO treatment for CS.
Among total population (N=116), patients whose lactate was normalized during VA-ECMO and survived more than 2 days were included in this analysis (N=103). Patients were classified whether each medication (BB, RASi or one of BB or RASi) was administered during VA-ECMO or not. The primary endpoint was all-cause mortality. Survival analysis for a primary outcome and landmark analysis for all-cause mortality during different periods (&lt;10 days, 10 to 30 days) were performed.

Results
BB, RASi, and BB or RASi were administered in 71.8%, 72.8%, and 83.5% of patients, respectively, during VA-ECMO treatment. In early treatment groups, Both BB and RASi were initiated on day 1 (as median). Duration of VA-ECMO treatment was longer in a group who treated with BB during VA-ECMO (8.5 days, vs 5.0 days as median, P = 0.003), and for RASi, it was comparable (8.0 days vs 7.0 days, P = 0.609).
Incidence of 30-day all-cause mortality at were statistically comparable between groups (figure 1). The results of survival analysis are described in the figure 2. In Kaplan-Meier analysis, BB, RASi, and BB or RASi during VA-ECMO treatment was not associated with lower probability of 30-day all-cause mortality. Landmark analysis, however, showed lower probability of 10-day mortality in the group treated with BB (P by log-rank test = 0.045), RASi (P = 0.008) and BB or RASi (P=0.005) during VA-ECMO. Multivariate Cox proportional modellings also provided lower risk of 10-day all-cause mortality in groups with BB treatment (Hazard ratio [HR] = 0.26, 95% confidence interval [CI]=0.10-0.69, P = 0.007), RASi treatment (HR = 0.22, 95% CI = 0.08-0.56, P = 0.001) or BB or RASi (HR = 0.15, 95% CI = 0.05-0.41, P &lt; 0.001) during VA-ECMO. RASi (HR = 0.47, 95% CI = 0.22-0.97, P = 0.041) or BB or RASi (HR = 0.37, 95% CI = 0.15-0.93, P = 0.038) treatment during VA-ECMO was also associated with lower risk of 30-day all-cause mortality.

Conclusions
In this post-hoc analysis of the EARLY-UNLOAD trial, administration of BB or RASi during VA-ECMO treatment for CS was associated with lower risk of short-term mortality.
The importance of remnant cholesterol particles.Lipid profile in patients with acute coronary syndrome undergoing cardiac rehabilitation
Authors: Lucas Garcia M , Padilla Rodriguez G , Pelaz Sanchez M , Paez Munoz R , Hidalgo Urbano R J , Martinez Quesada M M 
Published: May 2024

Abstract

Funding Acknowledgements
None. Main funding source(s): Ninguno.

Introduction
Recently it has been shown that not all lipid risk for atherosclerosis is due to LDL cholesterol. Both, remnant and small particles have been proposed as risk factors for the first cardiovascular event and recurrences.

Methods
This is an observational, descriptive, prospective, single-centre, descriptive study. We set out to analyse the lipid profile on admission of patients undergoing a cardiac rehabilitation (CR) program in a tertiary hospital. In addition, we studied the association with other analytical parameters, clinical characteristics and CR results in these patients. For this purpose, data were collected from patients who completed the program between January 2022 and March 2023. We compared analytical variables at hospital admission and at the end of the program, as well as clinical and anthropometric data and stress test results. In our study we defined elevated remnants as &gt;30 mg/dl.

Results
We included 170 patients who had a complete analytical profile at hospital admission. In our cohort, 80.5% were male, with a mean age of 57.9+/-9 yrs. A total of 92.5% were referred after acute coronary syndrome. There were 25.6% diabetic, 56.6% smokers and 38.1% obese patients.
Patients with elevated remnants were more likely to be men (90.3 vs 79.8%, p=0.039). No differences were found in age, presence of DM, smoking, obesity or peripheral arterial disease. Functional capacity, quality of life and improvement in these parameters did not differ either. As for baseline lipid profile, it was associated with higher total Ch (190 vs 152, p=0.0), LDL Ch (109 vs 90, p=0.0), TG (227 vs 104, p=0.0) and TG/HDL ratio (6.8 vs 2.5, p=0.0) and lower HDL Ch (37 vs 45, p=0.0).
66.1% of patients with high remnants have an LDL-Ch greater than 100 mg/dl, compared with 29.6% of those with low remnants.(P=0,000).
Regarding the profile at discharge, we found that 34.4% still had elevated remnants at discharge from the CR program (vs 22.2% of those without elevated remnants, P=0.000) and that 75.9% had TG/HDL greater than 2.
After CR, these patients still had higher TG values (156 vs 93, p=0.000), lower HDL-C (43 vs 50, p=0.003) and higher TG/HDL ratio (4 vs 2, p=0.000), despite a greater decrease in remnants and TG/HDL in this group.

Conclusions
More than one third of patients undergoing a Cardiac Rehabilitation Program in our hospital have elevated cholesterol remnants. These particles predominate in male patients and initially, they have a higher prevalence of small and dense LDL and lower HDL cholesterol. In addition, the effect of the cardiac rehabilitation program on the improvement of lipid risk parameters is lower. More powerful intensive treatments are needed to improve cardiovascular risk in this population.
Unveiling the complexity: coexistence of rheumatic heart disease and pulmonary arteriovenous malformation—a unique case report
Authors: Charaniya Riyaz , Shah Jayal , M Apoorva 
Published: May 2024

Abstract

Background
The coexistence of rheumatic heart disease (RHD) and pulmonary arteriovenous malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions.

Case summary
A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac involvement and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography revealed the coexistence of RHD and multiple PAVM in the patient’s left lower lobe of the lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed 1 month later. Her saturation normalized following the intervention. The patient’s progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. The patient remained well in short-term follow-up.

Discussion
This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.
Predicting human epidermal growth factor receptor 2 status of patients with gastric cancer by computed tomography and clinical features
Authors: Li Yin , Dai Wei-Gang , Lin Qingyu , Wang Zeyao , Xu Hai , Chen Yuying , Wang Jifei 
Published: May 2024

Abstract

Background
There have been no studies on predicting human epidermal growth factor receptor 2 (HER2) status in patients with resectable gastric cancer (GC) in the neoadjuvant and perioperative settings. We aimed to investigate the use of preoperative contrast-enhanced computed tomography (CECT) imaging features combined with clinical characteristics for predicting HER2 expression in GC.

Methods
We retrospectively enrolled 301 patients with GC who underwent curative resection and preoperative CECT. HER2 status was confirmed by postoperative immunohistochemical analysis with or without fluorescence in situ hybridization. A prediction model was developed using CECT imaging features and clinical characteristics that were independently associated with HER2 status using multivariate logistic regression analysis. Receiver operating characteristic curves were constructed and the performance of the prediction model was evaluated. The bootstrap method was used for internal validation.

Results
Three CECT imaging features and one serum tumor marker were independently associated with HER2 status in GC: enhancement ratio in the arterial phase (odds ratio [OR] = 4.535; 95% confidence interval [CI], 2.220–9.264), intratumoral necrosis (OR = 2.64; 95% CI, 1.180–5.258), tumor margin (OR = 3.773; 95% CI, 1.968–7.235), and cancer antigen 125 (CA125) level (OR = 5.551; 95% CI, 1.361–22.651). A prediction model derived from these variables showed an area under the receiver operating characteristic curve of 0.802 (95% CI, 0.740–0.864) for predicting HER2 status in GC. The established model was stable, and the parameters were accurately estimated.

Conclusions
Enhancement ratio in the arterial phase, intratumoral necrosis, tumor margin, and CA125 levels were independently associated with HER2 status in GC. The prediction model derived from these factors may be used preoperatively to estimate HER2 status in GC and guide clinical treatment.
Highly homologous miR-135a and miR-135b converting non-small cell lung cancer from suppression to progression via enhancer switching
Authors: Zhou Kaicheng , Li Wenxuan , Chen Lu , Chen Siyue , Liu Mengxing , Yang Zhicong , Mao Zhanrui , Yu Wenqiang 
Published: May 2024

Abstract
microRNAs (miRNAs) are short non-coding RNAs that have been increasingly recognized for their significant roles in the progression of cancer. Distinct miRNAs exhibit diverse functions attributed to variations in their sequences. As a result of possessing highly homologous seed sequences, these miRNAs target overlapping or similar gene sets, thus performing analogous roles. However, different from this sight, our study discovered that miR-135a-5p and miR-135b-5p, despite differing by only one nucleotide, exhibit distinct functional roles. Using non-small cell lung cancer (NSCLC) as a paradigm, our findings unveiled the downregulation of miR-135a-5p and upregulation of miR-135b-5p within NSCLC through TCGA database. Consequently, we further investigated their functional differences in A549 cells. Overexpression of miR-135b-5p enhanced the proliferation and migration capabilities of A549 cells, whereas miR-135a-5p transfection exhibited the opposite effect. We demonstrated that the activation of specific enhancers serves as a crucial mechanism underlying the disparate functions exerted by miR-135a-5p and miR-135b-5p in the context of NSCLC, consequently instigating a shift from inhibition to activation in NSCLC progression. Finally, we validated through animal experiments that miR-135b-5p promoted tumor progression, while miR-135a-5p exerted inhibitory effects on NSCLC development. This study offers a novel perspective for researchers to elucidate functional disparities exhibited by highly homologous miRNAs (miR-135a-5p and miR-135b-5p) in the context of NSCLC, along with the transition from inhibitory to progressive states in NSCLC. This study provides a solid foundation for future investigations into the functional roles of highly homologous miRNAs in pathological situation.
Leader-following consensus of heterogeneous nonlinear multi-agent systems within arbitrary pre-specified time
Authors: Wu Shanggen , Feng Yuanzhen , Wang Ziyang , Wang Zhengxin 
Published: May 2024

Abstract
The leader-following consensus problem of second-order heterogeneous nonlinear multi-agent systems (MASs) is studied in this paper. Based on the free-will arbitrary time (FWAT) theory, a piecewise distributed controller is developed to solve this problem within an arbitrary pre-specified convergence time. It should be noted that the pre-specified convergence time is independent of any system parameters and initial conditions. Furthermore, compared with the existing FWAT methods, consensus can still be maintained after the convergence time under the protocol designed in this work. Finally, numerical examples are given to illustrate the validity of the proposed method.
Annihilating Branching Brownian Motion
Authors: Ahlberg Daniel , Angel Omer , Kolesnik Brett 
Published: May 2024

Abstract
We study an interacting system of competing particles on the real line. Two populations of positive and negative particles evolve according to branching Brownian motion. When opposing particles meet, their charges neutralize and the particles annihilate, as in an inert chemical reaction. We show that, with positive probability, the two populations coexist and that, on this event, the interface is asymptotically linear with a random slope. A variety of generalizations and open problems are discussed.