bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTERATRIAL BLOCK AS A FIRST CLINICAL PRESENTATION OF ATRIAL CARDIOMYOPATHY RELATED TO A NOVEL LMNA VARIANT: A CASE REPORT
Authors: Iavarone M , Covino S , Pettillo R , Russo V 
Published: May 2024

Abstract
Interatrial block (IAB) is a conduction delay in Bachmann’s bundle with a well–described association with structural heart disease, supraventricular arrhythmias, and cardiovascular events. We report the case of an asymptomatic 35–year–old man in whom the presence of IAB at electrocardiogram led to a comprehensive evaluation including speckle–tracking echocardiography, 24 h Holter monitoring, and genetic testing. Speckle–tracking echocardiography demonstrated a decrease in the longitudinal strain of interventricular septum, a typical feature of LMNA–related cardiomyopathy, and decreased indices of left atrial deformation. A diagnosis of cardiac laminopathy related to the frame shift variant c.1367 (p.Asn456Thrfs*24) of the LMNA gene was made. A dual–chamber implantable cardioverter defibrillator implantation was performed for the high risk of life–threatening ventricular tachyarrhythmias. This case demonstrates that IAB could be a rare presentation of a life–threatening laminopathy. Strain echocardiography is an essential tool to evaluate the deposition of fibrosis tissue in subclinical cardiomyopathies. Our report describes a novel variant of LMNA gene associated with a high risk of sudden cardiac death.
LMNA–RELATED DILATED CARDIOMYOPATHY PRESENTING WITH REGIONAL WALL AKINESIS AND TRANSMURAL LATE GADOLINIUM ENHANCEMENT
Authors: Pongetti G , Lofiego C , Vagnarelli F , Maurizi K , Capodaglio I , Patani F , Matassini M , Battistoni I , Tofoni P , Brugiatelli L , Pietrucci F , Tortora G , Schicchi N , Marini M , Dello Russo A , Perna G 
Published: May 2024

Abstract
A 26–year–old girl was admitted at hospital in December 2022 for a syncopal episode. She referred fatigue and dyspnea in the last 2 months. EKG was markedly abnormal showing peripheral low voltages, poor R wave progression in prechordial leads, negative T waves V4–V6, DII, DIII and aVF, fragmented QRS (Fig.1). Echo showed moderately dilated left ventricle (LV) with apical akinesia and apical aneurysm (no thrombi) and hypo–akinesia and hyperechoic appearance of the middle segments of the infero–posterior and lateral wall (Fig.2a). EF was 38%. There was no family history for sudden cardiac death and cardiomyopathy. Creatine kinase and neurological examination were normal. The diagnostic work–up included: myocardial scintigraphy which showed fixed tracer uptake deficit at apical and posterolateral levels (Fig.2b); cardiac magnetic resonance (CMR): apical aneurysm with extended late gadolinium enhancement (LGE) due to fibrosis, focally transmural, on the left ventricle’s midapical and infero–lateral thinned–hypokinetic myocardial walls (Fig.3a, 3b); Coronary angiography showed no stenosis. Due to myocardial aneurysm in absence of CAD, Chagas disease was excluded. We performed LV endomyocardial biopsy which showed cardiomyopathic changes and replacement fibrosis. Due to fibrosis extension, complex ventricular extrasystoles detected on monitoring and syncope, ICD was implanted. Finally genetic testing showed c.1621C&gt;Tp.Arg541Cys LMNA pathogenetic mutation leading to the diagnosis of LMNA–related LV cardiomyopathy, with extensive fibrosis in multiple areas of left ventricle including the apical segments at a very young age. Patients with LMNA mutation-related heart disease are characterized by conduction abnormalities, ventricular tachyarrhythmias (VA) and high risk of sudden cardiac death with mildly impaired systolic function, often without chamber dilation. About 88% LMNA– cardiomyopathy have typical myocardial fibrosis, predominantly in the mid-myocardium of the basal septum. However, our patient and previous reported cases with the same p.R541 LMNA mutation presents with a specific phenotype including regional LV akinesis, segmental transmural LGE, significant LV dilatation and systolic dysfunction and VA without conduction abnormality. Of note, EKG shows normal A–V conduction but low voltage and negative T waves in precordial and inferior leads. These features are not typical for LMNA–disease and underline the phenotypic variability of cardiomyopathies.
CARDIAC MAGNETIC RESONANCE IN A CASE OF RECURRENT MESALAZINE–INDUCED MYOCARDITIS
Authors: Dicorato M , Caretto P , Colucci C , Colonna P 
Published: May 2024

Abstract

Introduction
Mesalazine represents a key treatment for Intestinal Bowel Diseases (IBD) and only in rare cases produces cardiac toxicity, presenting mainly as myocarditis, with a not completely known mechanism.

Case Report
We report the case of a 25–year–old man in apparent good health status, mild smoker, who accessed our Emergency Department for burning chest pain. In the last month he referred episodes of fever associated with bloody diarrhea and abdominal pain, because of which he underwent colonoscopy, that was not conclusive for IBD. However, therapy with mesalazine was started, with quite alleviation of gastro–intestinal symptoms. After about 2 weeks, the patient accessed our Emergency Department for burning chest pain and fever, with an increase of high–sensitivity cardiac troponin–I at blood tests. The transthoracic echocardiogram evidenced ipocontractility of the inferior and posterior medium left ventricular segments and cardiac magnetic resonance confirmed the suspicion of myocarditis. Antinflammatory and analgesic drugs were started with improvement of patient‘s condition, but mesalazine was not interrupted. 3 weeks after discharge, he came again to our attention for myocarditis recurrence. Auto–immunity and microbiological laboratory tests, including blood cultures, were negative. The patient was evaluated by a multidisciplinary team, that excluded any other possible cause of myocarditis, except for drug–induced form. Thus, we decided to stop treatment with mesalazine and discharged the patient with lifelong ban of assuming this drug. He didn‘t show any recurrence of cardiological impairment at our follow–up (8 months) and is in good health status at now.

Discussion
Mesalazine–induced myocarditis is extremely rare. The diagnosis of this condition can be made only by ruling out other causes of myocarditis (in our case through a multidisciplinary team), and considering 2 main features (both present in our patient): symptoms onset within 2–4 weeks after the first drug intake (differently from IBD–related myocarditis) and improvement of patient’s status only thanks to mesalazine interruption. The peculiarity of this case is also represented by the myocarditis recurrence: since the only effective treatment for this condition is stopping mesalazine, in our patient after the first hospitalization myocarditis has recurred because the drug was continued, further supporting our diagnostic suspicion.
VERY MOBILE LEFT VENTRICULAR PAPILLARY FIBROELASTOMA PRESENTING WITH ISCHEMIC STROKE
Authors: Maffè S , Paffoni P , Facchini E , Bergamasco L , Prenna E , Ariotti S , Ticozzi S , Paino A , Dellavesa P 
Published: May 2024

Abstract
Papillary fibroelastomas are small and pedunculated left side valves associated mass, that frequently causing cerebral embolization; they are composed of collagen and elastic fibers and are usually connected with a pedicle to the endocardial layer. Differential diagnosis with endocarditis can rely on the side of attachement: Papillary fibroelastomas are more frequently found downstream the valves, instead, endocarditis are mostly found upstream the valves. They are mostly located (&gt;80%) on valvular surfaces, more commonly on left side cardiac valves (44% on the aortic valve and 35% on the mitral valve); therefore, in the present knowledge, papillary fibroelastomas arising from left ventricular myiocardial wall are rare and mostly anecdotally descripted. We present the case of a 78–year–old man, diabetic, with no cardiac history, hospitalized with a right capsulo–lenticular stroke. Symptomatic due to left hemiparesis, he did not undergo thrombolysis due to a delay in hospitalization of almost 24 hours. The transthoracic and then transesophageal echocardiogram showed the presence of a hyperechogenic, floating mass of approximately 3 cm at the level of the left ventricle, separate from the mitral valve and attached to the mid–distal anterior septum and the ventricular apex (Figure 1). Cardiac MRI confirmed the presence of a peduncolate left ventricular mass, isointense on cine sequences, without myocardial infiltration, isointense on T1–weighted images and mildy hyperintense on T2–weighted images, with mild uniform late–gadolinium enhancement (Figure 2). The patient underwent surgical removal of the mass: histological analysis showed multiple, branching fronds of paucicellular, avascular fibroelastic tissue lined by a single layer of endocardium, with positive stains at Weigert coloration for elastic fibers (Figure 3). Histomorphological analysis was compatible with papillary fibroelastoma. This is a very atypical case of papillary fibroelastoma, due to the large size of the mass and the intraventricular and not–valvular location, which determined its emboligenicity and which, if not removed, would have exposed the patient to an enormous risk of recurrence of stroke.
MECHANICAL PROSTHETIC MITRAL VALVE THROMBOSIS COMPLICATED BY AN ACUTE CORONARY SYNDROME AFTER SYSTEMIC FIBRINOLYSIS: A CASE REPORT
Authors: Collareta M , Vera–Mondazzi L , Abd Almhmoud Sidiq M , Mohmed Ahmed Ibrahem H , Giovanella E , Portella G , Masini F 
Published: May 2024

Abstract
The annual incidence of blocked mechanical valvular prosthesis (BMVP) is 0.3–5.7%. 78% of cases are due to thrombosis and development of pannus is the second more frequent etiology. The risk of thrombosis is higher for mitral prosthesis, during the 1st year after valve replacement, and for poor INR trend. TEE is the gold standard for diagnoses, but it is seldom required if adequate TTE and cine–fluoroscopy are performed. As therapy, redo surgery is recommended in case of NYHA III–IV patients or in presence of big thrombi: if surgery is contraindicated or too high–risk, systemic thrombolysis is a reasonable option. In less compromised patients, upgrading of the anti–thrombotic therapy can be considered. In our Centre (around 600 valve replacement surgeries/year, mainly high risk patients) we use thrombolysis for BMVP in decompensated patients, choosing between two different protocols: the so called “fast” protocol (alteplase 15 mg iv bolus, then 0.75 mg/kg over 30’ and 0.5 mg/kg over 1h) is provided for NYHA IV patients, while the “slow” protocol (25 mg over 6 h) is the treatment of choice for the NYHA III ones. Many complications, mainly bleeding, are associated to thrombolysis. A 30 years old lady who underwent MVR in 08/2021, already successfully treated with thrombolysis in 11/2021 due to BMVP, presented in 01/2023 due to NYHA IV heart failure. TTE and cine–fluoroscopy showed BMVP (grad. 29/21 mmHg, area 0.7 cm2). The LV was hypekynetic (EF 81%), and severe pulmonary hypertension (calcSPAP 82 mmHg) was present. Fast thrombolysis was performed, with decrease of gradients (11/6 mmHg) and of pulmonary pressure (45 mmHg), and preserved LV function (EF 55%), without acute complications. On the 2nd day, the patient developed generalized seizures and pulsless VT, with ROSC after DC shock (7’ low–flow time). The neurological recovery was complete, but haemodynamic instability developed; new onset LBBB, and progressive worsening of the LV function (EF 40%, then 25%, medioapical hypokinesia) were documented. The coronary angiography showed a thrombus in the proximal LAD, not occluding the vessel, and TIMI 3 downstream flow. Heparin continuous infusion was provided for 48 h with a 1.8–2.3 aPTT ratio target. The patient was eventually discharged home with normal gradients (12/7 mmHg), EF (67%), ECG and pulmonary pressure. Coronary embolism is a possible complication of BMVP, and can follow systemic thrombolysis. Close multimodal clinical monitoring is mandatory.
AORTIC VALVE FIBROELASTOMA PRESENTING WITH MYOCARDIAL INFARCTION WITH NON–OBSTRUCTIVE CORONARY ARTERIES (MINOCA)
Authors: Pepe M , Tritto R , Naccarati M , Quarta S , Marzullo A , Ciccone M 
Published: May 2024

Abstract
A 35–year–old woman with known mitral valve prolapse and history of migraine presented to the Emergency Department because of several episodes of chest pain in the previous three days arising at rest and followed by spontaneous relief within few minutes. No electrocardiographic abnormalities were found but an oscillating trend of high sensitivity Cardiac troponin I (hs–cTnI) was reported. After an urgent coronary angiography which showed non obstructive coronary artery disease, the patient was referred to intensive care unit (ICU) with a working diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA). Hence, an integrated imaging assessment was performed: trans–thoracic echocardiogram (TTE) and trans–esophageal echocardiogram (TEE) excluded segmental wall motion abnormalities and pericardial effusion but revealed a round–shaped hyperechoic floating mass attached to the aortic valve. Cardiac nuclear magnetic resonance (CMR) allowed to rule out an acute myocarditis and demonstrated on the T1–weightened imaging an isointense mass on the right cusp of the aortic valve. During the assessment of LGE in phase–sensitive inversion recovery (PSIR) the mass appeared hyperintense. The hypothesis of repetitive episodes of myocardial ischemia due to the transient obstruction of the coronary ostium determined by the pedunculated mass was formulated. After successful surgical excision, the histopathological examination of the specimen revealed mesenchymal tissue with the characteristics of cardiac papillary fibroelastoma (CPF).
PERCUTANEOUS EDGE–TO–EDGE REPAIR OF MITRAL REGURGITATION IN CARDIAC AMYLOIDOSIS: DO IT BUT NOT TOO MUCH
Authors: Paparoni F , Tomassoni G , Marrangoni A , Marrone G , Lezzi A , De Remigis F 
Published: May 2024

Abstract
We report the case of a 68 year old man with history of wild type TTR cardiac amyloidosis, treated with tafamidis since 1 year, symptomatic for advanced cardiac failure, already in optimal medical treatment, CRT–D, oral anticoagulation for permanent atrial fibrillation. The patient was hospitalised in our intensive care unit for refractory NYHA IV cardiac failure, anuria, very low ejection fraction combined with severe mitral regurgitation. He was treated with inotropes and diuretics then levosimendan however he remained in very critical state and we discussed the opportunity to reduce the mitral regurgitation by percutaneous edge to edge repair. In this setting of restrictive physiology literature is not unanimous and preload reduction secondary to mitral regurgitation treatment may sometimes be deleterious. We decided to offer our patient edge to edge repair by targeting a moderate reduction of mitral regurgitation and also considering some challenges linked to this pathology as atrial septal involvement with ovalis fossa relevant thickness. The procedure was successful with a reduction of mitral regurgitation grade from severe to mild–to moderate and this allowed the patient to re equilibrate his hemodynamic balance and he was able to be dismissed with a short term follow up program.
A low-carbon multigeneration system based on a solar collector unit, a bio waste gasification process and a water harvesting unit
Authors: Demir Nadir , Shadjou Amir Mohammad , Abdulameer Maha Khalid , Almasoudie Najah Kadum Alian , Mohammed Nerain , Fooladi Hadi 
Published: May 2024

Abstract
In this study, we introduce and examine a novel multigeneration cycle powered by low-carbon bio-waste and integrated with a solar thermal component. This system is designed to convert sewage sludge into a variety of useful products. The cycle utilizes anaerobic digestion and gasification to produce biogas and syngas. Additionally, it incorporates processes for generating water and hydrogen energy, utilizing the atmospheric water harvesting unit and water/gas shift reaction, sequentially. The system employs a Rankine cycle, a Brayton cycle and two organic Rankine cycles (ORCs) for electricity generation. A significant portion of the heat and electricity in this proposed project is sourced from a waste heat recovery system. This innovative project not only presents a new structure and configuration for product generation but also addresses energy, water and environmental challenges concurrently. The energy system’s performance has been thoroughly assessed in terms of thermodynamics, environmental impact and economic feasibility. The proposed plant is capable of producing an estimated 17 920 kW of electric power, 3207.6 kg/h of hydrogen energy and 5.14 × 10−3 L/s of freshwater. Under these design conditions, the energy and exergy efficiencies of the system were determined to be 35.76% and 40.49%, respectively. Additionally, the exergy sustainability factor, the levelized total emitted carbon dioxide and the unit cost of total products were characterized to be 52.28%, 0.2145 kg per kWh and 0.05219 $ per kWh, respectively.
Implementation of improved shuffled frog leaping algorithm for optimum landscape space environment design
Authors: Liu Kaizhu , Su Chen , Gu Chengwei , Jiang Yupeng 
Published: May 2024

Abstract
Landscape design is a complex process, requiring the seamless integration of various elements such as the senses, environment, morphology and optimization techniques. In this study, a new approach called the Interactive Enhanced Shuffled Frog Leaping Algorithm (IISFLA), specifically has been designed to optimize spatial environments in landscape design. The IISFLA is a hybrid optimization method that combines the Shuffled Frog Leaping Algorithm (SFLA), Bacterial Foraging Algorithm and human–computer interaction to address intricate nonlinear challenges. To demonstrate its effectiveness, IISFLA has been applied in the design of a garden community and contrasted with conventional design of landscape methodologies. To tackle the problem at hand, a optimality model of search that is layer-by-layer, which allows us to divide the problem space into manageable subsolution spaces, has been employed. Also, a participatory evaluation strategy has been adopted to assess the impact of the landscape design on different user groups. The results of this study reveal that IISFLA surpasses conventional methods in terms of performance and user satisfaction, making it a versatile and user-friendly tool for landscape designers. The research emphasizes the innovation, significance and implications of our work in the field of landscape design and optimization. Key numerical findings include a 22.6% increase in landscape space evaluation value when using IISFLA compared to traditional methods, a 34.7% reduction in computational time and a 28.9% improvement in user satisfaction rates. These outcomes highlight the effectiveness and potential of IISFLA in enhancing landscape design outcomes.
A meta-analysis of randomized controlled trials comparing breast-conserving surgery and mastectomy in terms of patient survival rate and quality of life in breast cancer
Authors: Li Shuangjian , Li Xin , Li Dan , Zhao Qian , Zhu Liping , Wu Tao 
Published: May 2024

Abstract
The study aimed to assess the effects of breast-conserving surgery (BCS) versus mastectomy on survival and quality of life in Stages I, II, and III breast cancer, providing solid evidence for clinical decisions. We conducted a meta-analysis of randomized controlled trials on breast cancer treatments, searching databases such as PubMed and the Cochrane Library to compare BCS, and mastectomy’s effects on survival and quality of life. A combined total of 16 734 patients in the control group and 17 435 patients in the experimental group were included in this analysis. This meta-analysis used RevMan 5.3 (Cochrane Collaboration, Copenhagen, Denmark) software for analysis. Our meta-analysis of 34 169 patients from 11 studies showed that BCS significantly reduced the overall recurrence rate at a median follow-up of 29 months, with a mean difference of 1.27 and a 95% confidence interval of 1.19–1.36, strongly supporting its effectiveness (P &lt; .00001). Furthermore, our analysis found no significant increase in 5-year local recurrence rates for BCS versus mastectomy, indicating its long-term effectiveness with a mean difference of 1.13 (95% confidence interval: [1.03, 1.24], P = .01). Additionally, there was a notable decrease in tissue ischaemic necrosis among patients who had received BCS, with a mean difference of 0.37 (95% confidence interval: [0.33, 0.42], P &lt; .00001), underscoring its benefits and long-term viability. BCS resulted in fewer cases of tissue ischaemic necrosis and higher body image scores compared with mastectomy, suggesting that it is a preferable option for better cosmetic outcomes and potentially favourable effects on prognosis and quality of life.
Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement
Authors: Kelleher Jennifer , Durkin Kristine , Fedele David A , Moffett Kathryn , Filigno Stephanie S , Lynn Courtney , Everhart Robin S , Stark Lori J , Duncan Christina L 
Published: May 2024

Abstract

Objective
Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF.

Methods
37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence.

Results
43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant.

Conclusions
When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.