bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women with acute heart failure receive help from a cardiologist faster than men-gender disparities in acute heart failure
Authors: Plonka J , Chruscicki D , Wezyk N , Dabrowska K , Rzepiela L , Zielinski R , Feusette R , Gierlotka M 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Acute heart failure (AHF) is a life-threatening condition that requires quick diagnosis and immediate treatment. Emergency Department (ED) is a major stage for hospitalized patients with AHF. Recent studies have highlighted that the efficacy of any intervention and treatment may be time dependent.

Purpose
The aim of the study was to analyze the management of patients with AHF depending on gender before treatment in Intensive Cardiac Care Unit (ICCU).

Materials and methods
In the period from 06/2019 to 01/2021, 767 patients with a diagnosis of acute heart failure (AHF) were urgently admitted to the ED. The most severely unwell 122 patients diagnosed with AHF required treatment in the ICCU . The time of onset of AHF symptoms (SYMPTOMS), first medical contact (FMC) and the time of cardiologist consultation (CC) in the Emergency Department were determined.

Results
In the study group of 767 patients with AHF presenting to the ED, women constituted 37%.They were less likely to be admitted to the Cardiology Department with a diagnosis of AHF than men (29.5% versus 40.2%) however they died more often in the ED (6.0% versus 2.7%). Among the 122 patients with AHF treated in the ICCU, the majority were men (72%), the mean age was 68 years and the median LVEF = 30% [IQR 20-38%]. In both sexes, the phe.notype of acute decompensated heart failure predominated (68% in women and 82% in men), although acute pulmonary oedema was slightly more common in women (26% versus 15% in men). Women contacted a doctor or called an ambulance faster than men (median time SYMPTOMS to FMC shorter by 1.6 days) and the time from FMC to consultation with a cardiologist was shorter (median time SYMPTOMS to FMC shorter by 0.17th day). Consequently, the delay time from the onset of symptoms to cardiology consultation was twice shorter in women than in men: 3.1 [IQR 0.3-8.4] days vesus 6.9 [IQR1.3-15.3], p=0.05.

Conclusion
Women with acute heart failure treated in the Intensive Cardiac Care Unit see a doctor faster and also receive specialist help from a cardiologist faster than men.
Left ventricular systolic function in patients with acute coronary syndrome-risk profile
Authors: Dobjani A , Bogevska Naumovska I , Vraynko E , Shehu E , Taravari H , Andova V , Pejkov H , Vavlukis M 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introductions and objectives
Left ventricular (LV) systolic dysfunction is one of the most important determinants of long-term outcome in acute coronary syndrome (ACS).

Aim
To determine the impact of the patient’s risk profile on the LV systolic function.

Methods
A single-center cross-sectional cohort study that included 3093 patients with ACS without pre-existing LV dysfunction. The comparison was performed between patients who did or did not develop a reduction in LV systolic function during the index event (&lt;50%/≥50%), analyzing patients’ demographic, clinical, biochemical data, LV functional data, and anatomical distribution of the coronary artery disease (CAD).

Result
1369 patients out of 3093 developed LV systolic dysfunction (44.3%). They were predominantly males 75.1% (1028), p=0.002; older (63.39±11.04 vs 61.21±11.12, p&lt;0.00000); had higher level of cardiac troponin (p=0.00002), higher stress glycemia (9.2±5.3; p=0.0000001), HbA1c (6.9±1.8, p=0.000003), WBC (11.7±4.1, p=0.00001), blood urea nitrogen (BUN) (6.8±3.7, p=0.000003), and creatinine (93.2±45.1 p=0.000167), and had anemia (OR 0.35 (CI 0.29–41, p=0.000012). They had more severe CAD (SINTAX score 16.8±8.4 p=0.000012). Patients with preserved LV systolic function were predominantly females (29.7%, OR 1.1 95% CI 1.0-1.2), p = 0.002), younger (p&lt;0.00000), and severely metabolically burdened (hypothyreosis (2.7%, OR 1.28 95% CI 0.93-1.76, p=0.052), higher levels of triglycerides (2.2±1.7 vs 1.9±1.5, p = 0.001), cholesterol (5.3±1.4 vs 5.2±1.4, p = 0.002), non-HDL-C (4.1±1.5 vs 3.9±1.3, p=0.006), however less likely to have pre-existing DM (OR 0.8 (CI 0.78–0.92), p=0.000094). They were more often NSTEMI [851 (49.4%), p = 0.000012]. Independent variables associated with a reduction in LV function were: advanced age, male gender, previous DM and anemia, stress glycemia, WBC, creatinine, and BUN.

Conclusion
Patients who developed reduced LV function had a very specific risk profile with bigger neuro-hormonal activation and inflammation, higher degree of myocardial damage, and worse renal function, whereas those with preserved LV systolic function after ACS were younger, predominantly females, more severely metabolically burdened, more often with NSTEMI and without LAD involvement.
Exploring the utility of the CSWG SCAI classification in patients with HF-CS requiring inotropic therapy
Authors: Ris T , Atazadah M , Van De Veerdonk M C , Nap A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
The Society for Cardiovascular Angiography and Interventions (SCAI) classification has been a well-established tool for risk stratification in heart failure cardiogenic shock (HF-CS). The recent CSWG SCAI classification provides easily obtainable parameters to classify CS severity. However, its utility has been mostly investigated in an intensive care unit (ICU) setting. Therefore, data on a more broad cohort of patients in whom inotropic therapy is deemed necessary is lacking.

Purpose
This study aimed to analyze the trajectory of patients necessitating inotropic therapy due to HF-CS and the utility of the proposed CSWG SCAI criteria in time.

Methods
We retrospectively analyzed patients admitted with acute HF who received inotropic therapy due to developing HF-CS at any time during admission. Patients with out-of-hospital cardiac arrest and acute coronary syndrome were excluded. SCAI stages were assigned retrospectively using the latest CSWG SCAI criteria during admission, pre-inotropic therapy, and at worst SCAI. The diagnostic performance of the CSWG SCAI criteria for predicting mortality during admission was assessed.

Results
This study included 333 patients with HF-CS. Of these patients, 221 (66%) were male, with a mean age of 70 years. The majority of patients were admitted with SCAI A (45%) and B (36%), and inotropic therapy was most often initiated in SCAI stage B (46%). Notably, 21% patient of the patients at time of inotropic therapy were still in SCAI A. In 52% of all patients inotropes was initiated within 24 hours of admission. The most frequently observed worst SCAI classification was C (41%). Lactate and blood pressure (BP) were responsible for the majority of SCAI B-D classifications at admission and pre-inotropic therapy, while pH was an important determent for SCAI E. However, vasoactive therapy was the most common determent for worst SCAI (71%), followed by BP (24%). Mortality rates for pre-inotropic therapy SCAI for classes A-E were 30%, 39%, 47%, 55%, and 48%. Mortality rates for worst SCAI C-E were 29%, 39%, and 59%. The area under the curve for predicting mortality was higher for worst SCAI as compared to pre-inotropic therapy SCAI (0.633 vs. 0.573, p=0.03). There was no difference in mortality between early (&lt;24h) vs. late (&gt;24h) initiation of inotropic therapy (p=0.43).

Conclusion
In our study the CSWG SCAI criteria proved to be challenging to apply in patients in whom inotropic therapy is considered, especially for patients classified as SCAI E. However, improvement of the CSWG SCAI performance was observed when it was applied at the time corresponding to the worst SCAI stage to predict mortality. More studies are required to further optimize the SCAI criteria in this specific subset of patients. In summary, our study provides valuable insights into the application of the CSWG SCAI classification in a diverse HF-CS population, specifically those requiring inotropic therapy.
Pulmonary artery catheter and veno-arterial ECMO training for cardiology fellows: evaluation of a simulation-based program
Authors: Alviar C , Lorin J , Andriotis A , Pradhan D , Pashun R , Wan K L , Schimmer H , Padilla-Lopez M , Tarabanis C , Keller N M , Bangalore S , Baneras Rius J 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Proficiency in pulmonary artery catheter (PAC) use and extracorporeal membrane oxygenation (ECMO) therapy is crucial for delivering high-quality critical care and improving patient outcomes in cardiac intensive care units (CICUs). Both procedures are conducive to immersive simulation training. Our study focuses on evaluating the efficacy of a simulation-based training program in these specific domains for cardiology fellows.

Methods
Cardiology fellows participated in two blended learning courses: one on PAC and one on veno-arterial ECMO. The PAC course consisted of a pre-course test of 12 multiple-choice questions assessing knowledge of indications, contraindications, and interpretation of PAC, a 45-minute didactic lecture, followed by a case-based, hands-on simulation training session for 60 minutes. The ECMO course consisted of a pre-course test of 15 multiple-choice questions assessing indications, contraindications, ECMO physiology, and circuit management, a 30-minute didactic lecture, followed by a case-based, hands-on simulation training session. Fellows completed a multiple-choice post-course test within 72 hours post-simulation training. All test questions were designed by experts in cardiac critical care.

Results
A total of 18 cardiology fellows completed the PAC simulation and 16 completed the ECMO simulation. For the PAC group the average score on the pre-exam was 60%, while on the post exam, the average score increased significantly to 86%, representing a 26% increase (p=0.04). For the ECMO training, the average score on the pre-exam was 67%, and on the post exam, the average score increased substantially to 90% in the ECMO exam, there was a 23% increase in the average post-exam score compared to the pre exam was recorded (p=0.05).

Conclusion
Simulation-based training in PAC and ECMO has a highly positive impact on the knowledge acquisition of cardiology fellows, with statistically significant increases in average post-exam scores in both areas. These findings not only validate the value of immersive simulation-based training programs but also underscore the need for further investigation into the implementation of educational initiatives aimed at enhancing care in cardiogenic shock.
Referral and outcomes of mechanical thrombectomy for pulmonary embolism - a single-centre experience
Authors: Aguiar Neves A I , Teixeira R , Leite M , Nunes F , Almeida M , Lobo A , Pires-Morais G , Santos L , Melica B , Rodrigues A , Braga P , Fontes-Carvalho R 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Acute pulmonary embolism (PE) is a significant cause of morbidity and mortality, and percutaneous catheter-based treatments have emerged as an effective treatment option alongside thrombolysis. However, data concerning long-term outcomes are scarce.

Methods
All patients referred to a tertiary centre for pulmonary angiography with the intent to perform mechanical thrombectomy in the context of acute PE between January 2016 and August 2023 were retrospectively included and clinical data and outcomes were collected.

Results
Fifty-two patients (58% female; mean age 66±18 years) were referred to pulmonary angiography in the setting of acute PE, of whom 40 patients (77%) underwent continuous aspiration mechanical thrombectomy with an overall success rate of 70%. Twenty-eight percent of patients had bilateral thrombus. Thirty-two patients had intermediate-high risk or high-risk PE, and the mean Pulmonary Embolism Severity Index (PESI) was 146 points. Thirteen patients (25%) underwent thrombolysis prior to angiography, while 15 patients (28%) had an absolute or relative contraindication for thrombolysis.
Ventilation/perfusion scans were performed in ten patients (19%) during the follow-up period, of whom five patients (10%) had evidence of residual illness, with no significant differences between the thrombectomy and non-thrombectomy groups (p=0.8).
The overall mortality rate over the complete follow-up period was 39%, while 25% of patients died within 48 hours of the procedure. Predictors of mortality on univariate analysis included older age (HR 1.06 [95% CI 1.00-1.11, p = 0.03]), history of chronic obstructive pulmonary disease (HR 3.88 [95% CI 1.41-10.69, p = 0.01]), history of previous deep vein thrombosis or PE (HR 3.40 [95% CI 1.34-8.63, p = 0.01]), thrombolysis prior to referral for mechanical thrombectomy (HR 5.94 [95% CI 1.93-18.26, p &lt;0.01), shock or haemodynamic instability (HR 8.50 [95% CI 2.44-29,52, p &lt;0.01]) and resuscitated cardiac arrest (HR 5.98 [95% CI 2.34-15.30, p &lt;0.01]). On Cox multivariate analysis, the presence of shock or haemodynamic instability was a predictor of increased mortality (HR 5.23 [95% CI 1.12-24.3, p = 0.04]).

Conclusions
Intermediate and high risk acute PE is a clinical entity with a high morbidity and mortality rate regardless of treatment strategy, particularly during the index hospitalization and in patients with shock or haemodynamic instability.
Microvascular dysfunction associated with reduced nailfold capillary density in patients with ischemia with no obstructive coronary artery disease
Authors: Sakalidis A , Dimitriadis K , Bora M , Karanikola A E , Aznaouridis K , Papanikolaou A , Dris I , Leontsinis I , Mantzouranis E , Iliakis P , Vlachakis P K , Tsioufis P , Koulouriotis A , Aggeli K , Tsioufis K 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
The impairment of microvascular function present in coronary microcirculation with chronic angina without obstructive coronary arteries. There are insufficient data in the literature regarding possible generalized microangiopathy in this population.

Aim
The aim of this study is to demonstrate whether patients with Angina with No Obstructive Coronary Artery Disease (ANOCA) compared to individuals without coronary microvascular dysfunction (CMD) are characterized by a different level of nailfold capillaroscopy abnormalities.

Methods
We examined 18 participants without CMD - non-CMD group [9 female, 50%, mean age: 54.4±8.1 years) and 26 patients with ANOCA - CMD group (22 female, 84,6%, mean age : 53.2±10.7 years).
Functional coronary angiography was performed for the assessment of coronary microcirculation in all patients. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured in the left anterior descending coronary artery using a temperature/pressure sensor-tipped guidewire.
In addition, the assessment of skin microcirculation was performed by capillaroscopy, a non-invasive technique to evaluate small vessels of the microcirculation in the nailfold, using stereomicroscope in all patients.

Results
In CMD group, mean CFR and IMR were 1.34±0.6 and 44.8±28, respectively. Out of the 26 MVD patients with abnormal CFR, 7 of them (27%) had a normal value of IMR, indicating functional microvascular dysfunction. On the other hand, 18 patients (69%) had an abnormal IMR, indicating structural microvascular dysfunction. Capillary density in patients with MVD was significantly decreased compared to the control group (7.6±2.2 vs 10.9±1.8 vessels/mm, p=0.04). The difference in capillary density between the two groups was statistically significant after adjustment for multiple comparisons (p&lt;0.05). No significant difference was found in body mass index, renal function, medical history of dyslipidemia, diabetes mellitus and smoking status between the two groups (p&lt;0.05).

Conclusion
Nailfold capillary density was reduced in ANOCA patients compared to control group. These data may provide new insights regarding possible generalized microangiopathy in CMD patients.
These results suggest that there is an association between microcirculatory impairment at both heart and peripheral vascular bed level.
Is International Criminal Law Ready to Accommodate Online Harm?
Authors: Zarmsky Sarah 
Published: May 2024

Abstract
New technologies have the potential to both advance accountability for international crimes and to aid in their perpetration. Most of the existing literature to date focuses on the former, such as how digital evidence can be used in international criminal law (ICL) proceedings, or in the case of the latter, has taken a mainly rights-based approach (such as how technology can infringe upon rights to privacy or freedom of expression). This article answers the understudied question of how technology can serve as the vehicle by which certain international crimes are committed or lead to new offences, and how current ICL frameworks may be able to accommodate these ‘online harms’ to ensure that the law recognizes the full scope of harms caused to victims, who currently may not be able to access redress through the international criminal justice system. It identifies three examples of online harm that have a foreseeable nexus to the perpetration of international crimes, including hate speech and disinformation, sharing footage of crimes to the internet, and online sexual violence. The article evaluates the online harms alongside similar harms that have been encompassed by core ICL crimes, including genocide, crimes against humanity, and war crimes, to assess how online harms might fit into ICL frameworks (e.g. as an aggravating factor at sentencing, a new mode of commission of an existing crime, or a new crime). It concludes that some types of online harm may be more feasible to account for than others, and identifies where the existing ICL architecture falls short, which is important for providing a basis for future research as to how to best include novel online harms under ICL. Finally, the article emphasizes that as technology will only continue to develop and serve as a vehicle for an increasing array of harms, finding ways to account for online harm and bring redress to victims should be an issue at the forefront of ICL.
The FAcilitates Chromatin Transcription complex regulates the ratio of glycolysis to oxidative phosphorylation in neural stem cells
Authors: Lou Yuhan , Wu Litao , Cai Wanlin , Deng Huan , Sang Rong , Xie Shanshan , Xu Xiao , Yuan Xin , Wu Cheng , Xu Man , Ge Wanzhong , Xi Yongmei , Yang Xiaohang 
Published: May 2024

Abstract
Defects in the FAcilitates Chromatin Transcription (FACT) complex, a histone chaperone composed of SSRP1 and SUPT16H, are implicated in intellectual disability. Here, we reveal that the FACT complex promotes glycolysis and sustains the correct cell fate of neural stem cells/neuroblasts in the Drosophila 3rd instar larval central brain. We show that the FACT complex binds to the promoter region of the estrogen-related receptor (ERR) gene and positively regulates ERR expression. ERR is known to act as an aerobic glycolytic switch by upregulating the enzymes required for glycolysis. Dysfunction of the FACT complex leads to the downregulation of ERR transcription, resulting in a decreased ratio of glycolysis to oxidative phosphorylation (G/O) in neuroblasts. Consequently, neuroblasts exhibit smaller cell sizes, lower proliferation potential, and altered cell fates. Overexpression of ERR or suppression of mitochondrial oxidative phosphorylation in neuroblasts increases the relative G/O ratio and rescues defective phenotypes caused by dysfunction of the FACT complex. Thus, the G/O ratio, mediated by the FACT complex, plays a crucial role in neuroblast cell fate maintenance. Our study may shed light on the mechanism by which mutations in the FACT complex lead to intellectual disability in humans.
Sandwich boosting for accurate estimation in partially linear models for grouped data
Authors: Young Elliot H , Shah Rajen D 
Published: May 2024

Abstract
We study partially linear models in settings where observations are arranged in independent groups but may exhibit within-group dependence. Existing approaches estimate linear model parameters through weighted least squares, with optimal weights (given by the inverse covariance of the response, conditional on the covariates) typically estimated by maximizing a (restricted) likelihood from random effects modelling or by using generalized estimating equations. We introduce a new ‘sandwich loss’ whose population minimizer coincides with the weights of these approaches when the parametric forms for the conditional covariance are well-specified, but can yield arbitrarily large improvements in linear parameter estimation accuracy when they are not. Under relatively mild conditions, our estimated coefficients are asymptotically Gaussian and enjoy minimal variance among estimators with weights restricted to a given class of functions, when user-chosen regression methods are used to estimate nuisance functions. We further expand the class of functional forms for the weights that may be fitted beyond parametric models by leveraging the flexibility of modern machine learning methods within a new gradient boosting scheme for minimizing the sandwich loss. We demonstrate the effectiveness of both the sandwich loss and what we call ‘sandwich boosting’ in a variety of settings with simulated and real-world data.
Civilian and Military Medical School Graduates’ Readiness for Deployment: Areas of Strength and Opportunities for Growth
Authors: Cole Rebekah , Durning Steven J , Shen Cynthia , Reamy Brian V , Rudinsky Sherri L 
Published: May 2024

ABSTRACT

Introduction
Past research has examined civilian and military medical schools’ preparation of physicians for their first deployment. Most recently, our research team conducted a large-scale survey comparing physicians’ perceptions of their readiness for their first deployment. Our results revealed that military medical school graduates felt significantly more prepared for deployment by medical school than civilian medical school graduates. In order to further investigate these results and deepen our understanding of the two pathways’ preparation of military physicians, this study analyzed the open-ended responses in the survey using a qualitative research design.

Materials and Methods
We used a descriptive phenomenological design to analyze 451 participants’ open-ended responses on the survey. After becoming familiar with the data, we coded the participants’ responses for meaningful statements. We organized these codes into major categories, which became the themes of our study. Finally, we labeled each of these themes to reflect the participants’ perceptions of how medical school prepared them for deployment.

Results
Four themes emerged from our data analysis: (1) Civilian medical school equipped graduates with soft skills and medical knowledge for their first deployment; (2) Civilian medical school may not have adequately prepared graduates to practice medicine in an austere environment to include the officership challenges of deployment; (3) Military medical school prepared graduates to navigate the medical practice and operational aspects of their first deployment; and (4) Military medical school may not have adequately prepared graduates for the realism of their first deployment.

Conclusions
Our study provided insight into the strengths and areas for growth in each medical school pathway for military medical officers. These results may be used to enhance military medical training regardless of accession pathway and increase the readiness of military physicians for future large-scale conflicts.