bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and laboratory findings characterizing the need for systemic corticosteroids and nonsteroidal systemic therapies and the predicted outcomes in cutaneous polyarteritis nodosa: a single-centre retrospective analysis
Authors: Tanaka Ryo , Tanese Keiji , Ito Yoshihiro , Takeuchi Sakiko , Morimoto Ari , Sujino Kazuyo , Amagai Masayuki , Tanikawa Akiko 
Published: May 2024

Abstract

Background
Cutaneous polyarteritis nodosa (cPN) is a necrotizing arteritis of medium-sized vessels limited to the skin. Because of its rarity and the diversity of its clinical manifestations, there is no consensus treatment. Moreover, there are no established indicators that predict disease severity or its outcome.

Objectives
To investigate clinicolaboratory features that predict patients requiring systemic therapy, including corticosteroids, to control disease activity.

Methods
Thirty-six patients with cPN who had not received systemic corticosteroids at their initial visit were retrospectively analysed by correlating the treatment and its response with clinicolaboratory findings.

Results
The major medications administered were antiplatelet agents [64% (23/36)], vasodilators [39% (14/36)] and prednisolone (PSL) [36% (13/36)]. In total, 23 patients achieved remission without PSL, 5 were managed with compression therapy alone or even observation and 18 received antiplatelet monotherapy or combined with vasodilator/dapsone whereas 13 required PSL. Of the 13 who required PSL, 10 achieved remission with PSL monotherapy or PSL and single/multiple medications and 3 with PSL and multiple drugs then failed to achieve remission and underwent limb amputation. There were more skin ulcers and an elevated peripheral white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) before corticosteroid induction in patients requiring PSL. Three patients with treatment failure had a markedly elevated ESR (&gt; 50 mm h–1).

Conclusions
More than half of patients with cPN can achieve remission without corticosteroids. An elevated WBC, an elevated ESR and the presence of skin ulcers predict the need for PSL. A high ESR before corticosteroid induction predicts treatment resistance, even with PSL.
Prevalence of omalizumab-resistant chronic urticaria and real-world effectiveness of dupilumab in patients with omalizumab-refractory chronic urticaria: a single-centre experience
Authors: Zhu Catherine , BinJadeed Hessah , Gabrielli Sofianne , Prosty Connor , Rahme Elham , Shand Greg , Fein Michael , Ben-Shoshan Moshe , Netchiporouk Elena 
Published: May 2024

Abstract
Chronic urticaria (CU) is characterized by weals (hives) angio-oedema (or both) that last for ≥ 6 weeks, with chronic spontaneous urticaria (CSU) being the most common subtype. Patients with omalizumab-refractory CSU represent an unmet clinical need. In this study, we aimed to assess the prevalence and predictors of omalizumab failure in a large cohort of patients with CU and assess the effectiveness of dupilumab for omalizumab-refractory CU. Of 338 patients with CU, 33 received omalizumab; 69.7% (n = 23) were responders and 30.3% (n = 10) were nonresponders. Bivariate regression demonstrated that female sex [adjusted odds ratio (aOR) 1.53, 95% confidence interval (CI) 1.14–2.06], higher baseline weekly urticaria activity score (aOR 1.05, 95% CI 1.01–1.09) and older age (controlling for sex) (aOR 1.00, 95% CI 1.00–1.01) were associated with omalizumab failure. Of 10 patients with omalizumab-refractory CU, 3 were well controlled with ciclosporin (all children), whereas the 7 adults failed a mean [standard deviation (SD)] of 5.6 (2.6) treatments, including ciclosporin. All seven achieved a complete response with dupilumab, with time to response varying between 1 and 6 months. While our results suggest a favourable efficacy of dupilumab in patients with omalizumab-refractory CU, future confirmatory studies are required.
Pneumococcal vaccination effectiveness (PCV13 and PPSV23) in individuals with and without reduced kidney function: a test-negative design study
Authors: Le Dustin , Chang Alexander , Grams Morgan E , Coresh Josef , Ishigami Junichi 
Published: May 2024

ABSTRACTBackgroundStreptococcus pneumoniae vaccination effectiveness (VE) in individuals with reduced kidney function is unknown. We estimated pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and combined PCV13 and PPSV23 effectiveness against pneumococcal disease in individuals with and without reduced estimated glomerular filtration rate (eGFR).MethodsAll eligible individuals (case and controls) were adults (aged ≥18 years) hospitalized within the Geisinger Health System and required to have S. pneumoniae urinary antigen testing (i.e. test-negative design). Vaccination records were obtained from the electronic health record and statewide vaccination registry. After controlling for the probability of receiving a pneumococcal vaccine, we used multivariable logistic regression models to estimate the odds ratios (ORs) of vaccination between those who did and did not meet the S. pneumoniae case definition. VE was calculated as (1 – OR) × 100%.ResultsThere were 180 cases and 3889 controls (mean age 69 years, female 48%, white 97%, mean eGFR 71 mL/min/1.73 m2). The adjusted population PCV13 VE was 39% (95% CI 13%–58%), and combination PCV13 and PPSV23 was 39% (95% CI 12%–58%). PPSV23 VE was –3.7% (95% CI –57% to 32%). Stratified by eGFR, adjusted PCV13 VE was consistent in eGFR ≥60 [VE 38% (95% CI 2.9%–61%)] and 30–59 [VE 61% (95% CI 24%–80%)] without significant interaction. VE was not calculable for eGFR &lt;30 due to small sample size.ConclusionPCV13 vaccination was associated with reduced risk of S. pneumoniae hospitalization in individuals with a reduced eGFR (30–59 mL/min/1.73 m2).
Role of endothelial Raptor in abnormal arteriogenesis after lower limb ischaemia in type 2 diabetes
Authors: Liu Ting , Zhang Jiachen , Chang Fangyuan , Sun Mengyu , He Jinlong , Ai Ding 
Published: May 2024

Abstract

Aims
Proper arteriogenesis after tissue ischaemia is necessary to rebuild stable blood circulation; nevertheless, this process is impaired in type 2 diabetes mellitus (T2DM). Raptor is a scaffold protein and a component of mammalian target of rapamycin complex 1 (mTORC1). However, the role of the endothelial Raptor in arteriogenesis under the conditions of T2DM remains unknown. This study investigated the role of endothelial Raptor in ischaemia-induced arteriogenesis during T2DM.

Methods and results
Although endothelial mTORC1 is hyperactive in T2DM, we observed a marked reduction in the expression of endothelial Raptor in two mouse models and in human vessels. Inducible endothelial-specific Raptor knockout severely exacerbated impaired hindlimb perfusion and arteriogenesis after hindlimb ischaemic injury in 12-week high-fat diet fed mice. Additionally, we found that Raptor deficiency dampened vascular endothelial growth factor receptor 2 (VEGFR2) signalling in endothelial cells (ECs) and inhibited VEGF-induced cell migration and tube formation in a PTP1B-dependent manner. Furthermore, mass spectrometry analysis indicated that Raptor interacts with neuropilin 1 (NRP1), the co-receptor of VEGFR2, and mediates VEGFR2 trafficking by facilitating the interaction between NRP1 and Synectin. Finally, we found that EC-specific overexpression of the Raptor mutant (loss of mTOR binding) reversed impaired hindlimb perfusion and arteriogenesis induced by endothelial Raptor knockout in high-fat diet fed mice.

Conclusion
Collectively, our study demonstrated the crucial role of endothelial Raptor in promoting ischaemia-induced arteriogenesis in T2DM by mediating VEGFR2 signalling. Thus, endothelial Raptor is a novel therapeutic target for promoting arteriogenesis and ameliorating perfusion in T2DM.
Reclassification of CADILLAC risk score with lung ultrasound at admission in patients with STEMI in a one-year follow-up
Authors: Carreras J , Vidal-Burdeus M , Rodriguez-Gonzalez C , Simon-Ramon C , Rodriguez-Sotelo L , Sionis A , Giralt-Borrell T , Izquierdo-Marquisa A , Cainzos-Achirica M , Tizon-Marcos H , Rivas-Lasarte M , Ribas-Barquet N 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): JC-M received Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology.

Introduction
Lung ultrasound (LUS) has emerged as a valuable diagnostic and prognostic tool in heart failure (HF) and shows promise in risk stratification for ST-segment elevation myocardial infarction (STEMI) during the acute phase. Current risk stratification scales for STEMI primarily rely on the Killip scale to assess the severity of heart failure (HF) upon admission. However, these scales were developed before the widespread use of LUS, and as a result, LUS findings have not been incorporated into any existing risk stratification scales for STEMI.

Purpose
To assess the potential improvement in prognostic predictive value achieved by incorporating LUS findings into a current risk score for STEMI.

Methods
In a prospective multicenter cohort study, an independent operator conducted LUS, and offline B-line counting was performed upon admission. Patients were categorized as having wet lung (at least one site with ≥3 B-lines) or dry lung based on LUS results. The CADILLAC score was calculated, and patients were classified as either low risk (≤2 points) or medium/high risk (&gt;2 points). We evaluated the Net Reclassification Index (NRI) and conducted a Receiver Operating Characteristics (ROC) comparison based on the prediction of a composite endpoint which included death, hospitalization for HF, acute coronary syndrome, or stroke within one year following revascularization.

Results
The CADILLAC score was computed for 353 patients after excluding those admitted with Killip IV. Among these, 216 (61.2%) had a low-risk score (≤2), and 137 (38.8%) had a medium-high score. LUS significantly reclassified CADILLAC results, resulting in an absolute NRI of 12.4%. ROC comparison of models comprising CADILLAC and CADILLAC + LUS demonstrated that the addition of LUS significantly improved the accuracy of predicted risk (0.722 vs. 0.770, p=0.05).

Conclusion
The inclusion of LUS findings in the CADILLAC score enhances its prognostic capacity.Figure 1
SCAI SHOCK stage classification: valid for all indications and devices in patients with short-term mechanical circulatory support?
Authors: Hernandez Martos A , Alonso Fernandez De Gatta M , Diego Nieto A , Gonzalez Cebrian M , Toranzo Nieto I , Barrio Rodriguez A , Martin Herrero F , Merchan Gomez S , Gonzalez Calle D , Hernandez Hidalgo M , Barreira De Sousa G J , De Avila Neila A , Sanchez Fernandez P L 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
The Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stage has demonstrated prognostic value in patients with cardiogenic shock (CS), including patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. It has also been validated in different scenarios as acute coronary syndrome -ACS- or out-of-hospital cardiac arrest.

Purpose
Our objective was to study the prognostic value of SCAI SHOCK stage in different indications and etiologies requiring different types of short-term mechanical circulatory support (MCS).

Methods
Retrospective analysis of consecutive patients supported with VA-ECMO or Impella CP® in a referral center. We studied the SCAI SHOCK stage at MCS implantation according different devices, indication and etiology, and its relationship with in-hospital and follow-up survival.

Results
263 patients were included between 2014-March 2023 (Table). The SCAI SHOCK stage was less advanced in complex high risk percutaneous coronary intervention (CHIP-PCI) indication and more advanced in postcardiotomy shock, myocarditis, pulmonary embolism (PE), refractory cardiac arrest or electric storm (Figure A).
In-hospital survival was 41.1% and it was significantly lower as SCAI SHOCK stage increased (A 83.9%, B 100%, C 66.7%, D 39.2%, E 24.5%; p=0.000), as well as in follow-up for a median time of 24.5 [47] months (figure B). This association was maintained with both types of devices separately: VA-ECMO (A 80%, B 100%, C 33.3%, D 38.9%, E 24.5%, p=0.001) and Impella (A 84%, B 100%, C 75%, D 42.9%, E 25%, p=0.005).
Regarding the indication and etiology for MCS, SCAI SHOCK classification was significantly related with survival in CS indication, as well as in ACS and heart failure (HF) etiology (Figure B).
However, no relationship between SCAI and survival was observed in indications as CHIP-PCI (A 83.9%, B 100%, C 50%; p=0.386), electrical storm (C 0%, D 100%, E 70%; p=0.075) and postcardiotomy shock (D 35.6%, E 20%; p=0.470), neither in etiologies as PE (D 0%, E 28.6%; p=1), infective endocarditis (D 28.6%, E 0%; p=1), myocarditis (D 100%, E 0%; p=0.250),and other causes of cardiac arrest (D 0%, E 25%; p=1), nor in patients admitted for elective cardiac surgery.

Conclusions
SCAI SHOCK stage classification showed prognostic value in patients with short-term MCS indicated by diverse etiologies, including both VA-ECMO and Impella CP devices. The prognostic value was maintained for the indication of CS, and in ACS and HF etiologies, but not in electrical storm, CHIP-PCI, PE, myocarditis or postcardiotomy shock. Studies are needed to validate this classification in other settings.TableFigure
Using continuous electronic urine output monitoring for the management of acute cardio-renal syndrome in patients with acute decompensated heart failure
Authors: Shacham Y , Stern T , Stern T , Banai S , Banai S , Rozenfeld A , Rozenfeld A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome (CRS) related to venous congestion and diuretic resistance.
Positive fluid balance has been associated with adverse outcomes including acute kidney injury (AKI) and mortality. In critically ill patients urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance .We investigated the possible effect of real-time UO monitoring, fluid balance, renal outcomes and 30-day mortality of patients admitted to the cardiac intensive care unit (ICU) with ADHF.

Methods
We performed a case series of 50 patients admitted to the cardiac ICU from July 2021 and June 2023 with ADHF. Their standard foley catheter was connected to an electronic monitoring system that continuously monitors UO in real-time. Its technology is described elsewhere (1). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included change in fluid balance, incidence of AKI and 30-day mortality. The case series group was than compared to a historical group of 50 matched controlled patients admitted between 2019-2020. Patients were matched according to cause of admission, age and glomerular filtration rate.

Results
In the study cohort the median age was 71±12 years, and 36 (72%) were men. In the historical cohort the median age was 71±13 years, and 36 (72%) were men.
Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P&lt;0.001 for all, Figure 1). Incidence of AKI and the combined endpoint of AKI and 30-day mortality was significantly lower in the electronic UO monitoring cohort (24% vs. 46%, p=0.0197 and 40% vs 78%, P&lt;0.0001 respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (Figure 2).

Conclusion
We demonstrated that real time monitoring of UO was associated with better prevention of fluid overload and the management of type I CRS in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.Fluid balance renal senseAKI and 30-day mortality
Temporal trends in acute coronary syndrome by subtype
Authors: Crljenko K , Jerkic H , Babic Z 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU).

Methods
We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data.

Results
Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p&lt;0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p&lt;0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= &lt;0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= &lt;0.001).

Conclusion
We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.
The prognostic value of remnant cholesterol in patients with ST segment elevation myocardial infarction
Authors: Zhou Y , Melissa Madsen J , Tas Oezbek B , Koeber L , Thomsen Loenborg J , Engstroem T 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Remnant cholesterol (RC) is the cholesterol content within triglyceride rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond low density lipoprotein cholesterol (LDL-C).

Purpose
The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We aimed to estimate RC-related risk beyond LDL-C in patients with STEMI.

Methods
A total of 6602 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) from 1999 to 2016 were included. RC was calculated as total cholesterol minus LDL-C minus high-density lipoprotein cholesterol. Adjusted Cox models were used to estimate the association between continuous RC levels and all-cause mortality, cardiovascular death, ischemic stroke, and recurrent myocardial infarction (MI) at long-term (median follow-up of 6.0 years). Besides, discordance analyses were applied to examine the risk of the discordantly high RC (RC percentile rank minus LDL-C percentile rank&gt; 10 units) compared to the discordantly low RC (LDL-C percentile rank minus RC percentile rank&gt; 10 units). The concordance was defined as the percentile rank difference between RC and LDL-C ≤ 10 units.

Results
The median age of patients was 63 years old [interquartile range (IQR) 54–72] and 74.8% of them were men. There were 2441, 1651 and 2510 people in the discordantly low RC group, concordant group and discordantly high RC group. All outcomes in the discordantly high RC group were higher than the other groups and its event rate of all-cause mortality was 31.87 (event number/patient number in the group*100). In the unadjusted analysis, the discordantly high RC was associated with increased all-cause mortality [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.63–2.04] and increased cardiovascular death (HR 1.79, 95% CI 1.55–2.06) compared to the discordantly low RC. In an adjusted model RC was associated with higher all-cause mortality (HR 1.14, 95% CI 1.07–1.22). The discordantly high RC was associated with increased all-cause mortality (HR 1.55, 95% CI 1.37–1.75) and increased cardiovascular death (HR 1.47, 95% CI 1.25–1.72) compared to the discordantly low RC. There were no associations between RC and ischemic stroke or recurrent MI.

Conclusions
In patients with STEMI treated with primary PCI, elevated RC levels beyond LDL-C were independently associated with increased all-cause mortality.Graphical summaryLong-term survival probability
Long-term prognostic ability of the GRACE 3.0 risk score in patients hospitalized for acute coronary syndromes
Authors: Kofos C , Douki E , Rousopoulou S , Takas A , Karagiannidis E , Samaras A , Tzikas A , Fragakis N , Kassimis G 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
The GRACE 3.0 (GRS 3.0) is a risk assessment tool for in hospital mortality for patients admitted with acute coronary syndrome (ACS). This study sought to validate the accuracy of GRS 3.0 in predicting long-term mortality following a hospitalization for ACS.

Methods
We measured retrospectively all various factors included in GRS 3.0 such as age, heart rate, systolic blood pressure, creatinine, sex, cardiac arrest, ST-segment deviation on ECG, troponin elevation, and Killip Class. Multivariable Cox regression analysis was used. The discriminative ability of the GRACE 3.0 risk score was calculated by the c-index, which corresponds to the area under the ROC curve.

Results
223 patients with ACS were included. During a median follow-up of 3 years, 57 (25.6%) patients died. Among the variables of GRS 3.0, age, heart rate, and troponin elevation at admission were the only independent predictors of mortality. The score had good discrimination for all-cause mortality (c-index=0.82, 95% CI 0.75–0.89) [Figure]. It performed equally well in both sexes.

Conclusions
The newly developed GRS 3.0 is well-performing for predicting long-term mortality in patients hospitalized for ACS. Thus, it may assist in tailored risk stratification and management of these patients following hospital discharge.