bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transgastric Laparoscopic Resection of Gastric Submucosal Tumors: An Alternative Approach in Anatomically Challenging Locations?
Authors: Kröll D , Fischer J , Borbély Y , Haltmeier T , Candinas D , Aeschbacher P 
Published: May 2024

Abstract

Background
Surgical resection remains the recommended method in treatment for patients with Gastrointestinal stromal tumors (GIST). However, resection in anatomically challenging locations, e.g., lesser curvature of the stomach or gastroesophageal (GE) junction, might be challenging.

Aims
We report the feasibility and the safety outcomes of a case series of patients who underwent trans gastric resection of gastric GISTs.

Methods
Patients with intraluminal GIST at the fundus, GE junction, lesser curvature, or pre-pyloric region resected with transgastral resection were included between 2023 and 2024 in a single-center institution. Data on the demographics, comorbidities, lesion parameters, operative findings, complications, and histopathology were collected.

Results
A total of 8 patients (47.5 % female; mean age 60.5 years) were identified. The average tumor size was 3.2 (range 2.7–4.1) cm. The average tumor size was 4.6 cm. No intra- or postoperative complications occurred.

Conclusion
The transgastric resection technique for GIST at anatomically challenging locations was feasible and safe and presented an alternative and additional armamentarium of resection techniques.
Mobile vs Fixed Fluoroscopy System for EVAR Image Quality and Radiation Doses for Patients and Professionnals: Mobile C-Arm vs Hybrid Room for EVAR
Authors: Déglise S , Nowak M , Labarbe A , Caldas Rodrigues J , Côté E , Trunfio R , Longchamp J , Deslarzes-Dubuis C 
Published: May 2024

Abstract

Background
Allowing less invasive treatments, endovascular aortic repair (EVAR) has become the gold standard worldwide for the treatment of abdominal aortic aneurysms, leading to questions regarding staff and patients’ exposure to radiation. Widely performed in our center, EVAR was initially carried out on mobile C-arm (Cios-alpha, Siemens). Since 2022, EVAR was then performed in a hybrid room (Artis-Pheno, Siemens).

Aims
The aim of this study is to compare image quality and patients and professionals’ radiation exposure between both systems.

Methods
Image quality has been tested for fluoroscopy and fluorography mode on the moving system, with PMMA plates and copper disc. A Radcal ionization chamber was used to measure patient skin dose. Dosimetric and clinical parameters (e.i. Kerma, fluoroscopy time, BMI…) were recorded for 79 and 43 patients, respectively, on mobile C-arm and hybrid room. Staff exposure was measured with thermoluminescent detectors, on an anthropomorphic phantom, representative of the physician. Scattered radiation was created by irradiating PMMA plates. Different radiation protection gears have been tested comparable to daily clinical use.

Results
We showed that using the fluoroscopy mode, Cios-alpha was more irradiating for similar image quality as compared to the Artis-Pheno. Moreover, using the fluorography mode, Artis-Pheno provided a comparable dose rate but significantly better image quality.
When comparing similar patient cohorts (BMI, sex), kerma was twice higher on Artis-Pheno due to fluorography, accounting for 27% of the total dose.
In terms of staff exposure, the dose rate decreased by 51% and 99% in fluoroscopy, and 22% and 99% in fluorography when using Artis-Pheno compared to Cios-alpha (respectively, without any and with radiation protection gear).

Conclusion
Our study highlights the advantage of a fixed system (hybrid room) in term of both image quality and staff exposure compared to mobile system. However, particular attention must be paid to optimize protocols of such a machine to guarantee the best possible radiation protection for the patient.
Neuroplasticity of visual brain network induced by hypoxia
Authors: Zhang Xinjuan , Liu Yanqiu , Yuan Fengjuan , Hang Yang , Zhang Ran , Lin Jianzhong , Wang Xiaochuan , Zhang Jiaxing 
Published: May 2024

Abstract
The effects of hypoxia on brain function remain largely unknown. This study aimed to clarify this issue by visual-stimulated functional magnetic resonance imaging design. Twenty-three college students with a 30-d high-altitude exposure were tested before, 1 week and 3 months after returning to sea level. Brain functional magnetic resonance imaging and retinal electroretinogram were acquired. One week after returning to sea level, decreased blood oxygenation level dependent in the right lingual gyrus accompanied with increased blood oxygenation level dependent in the frontal cortex and insular cortex, and decreased amplitude of electroretinogram a-wave in right eye; moreover, the bilateral lingual gyri showed increased functional connectivity within the dorsal visual stream pathway, and the blood oxygenation level dependent signals in the right lingual gyrus showed positive correlation with right retinal electroretinogram a-wave. Three months after returning to sea level, the blood oxygenation level dependent signals recovered to normal level, while intensively increased blood oxygenation level dependent signals in a broad of brain regions and decreased retinal electroretinogram were also existed. In conclusion, hypoxic exposure has long-term effects on visual cortex, and the impaired retinal electroretinogram may contribute to it. The increased functional connectivity of dorsal stream may compensate for the decreased function of retinal photoreceptor cells to maintain normal visual function.
Dual-layer cocatalysts of Co–Pi and Ni(OH)2 on BiVO4 photoanodes for efficient water oxidation
Authors: Zhang Yu , Guo Peng , Tang Yonghua , Li Hongxing , Mo Rong 
Published: May 2024

Abstract
Slow oxygen evolution kinetics and severe corrosion limit the further application of BiVO4 photoelectrodes in photoelectrochemical water splitting. Here, BiVO4/Co–Pi/Ni(OH)2 photoanodes were synthetized with the aim of improving their photoelectric conversion efficiency and stability. Compared with a pure BiVO4 photoanode, the BiVO4/Co–Pi/Ni(OH)2 photoanode enhanced the photocurrent from 1.1 to 4.5 mA/cm2 at 1.23 V versus the reversible hydrogen electrode. In addition, Ni(OH)2 acted as a corrosion protection layer on the surface of the photoanode, allowing the BiVO4/Co–Pi/Ni(OH)2 photoanode to exhibit excellent stability.
ULTRASOUND GUIDED STELLATE GANGLION BLOCK BEYOND ELECTRICAL STORM: EXPANDING CLINICAL INDICATIONS
Authors: Morena A , Angelini F , Gravinese C , Frea S , Gallone G , Bocchino P , Boretto P , De Lio G , Bruno F , Pidello S , Saglietto A , Ferraris F , Toscano A , Costamagna A , Trompeo A , Anselmino M , Rinaldi M , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Background
Percutaneous stellate ganglion block (PSGB) is recommended by the latest American as well as European guidelines for patients with drug and eventually ventricular tachycardia (VT) ablation refractory ventricular arrhythmias (VAs) in form of electrical storm (ES). Yet, due to the strong antiarrhythmic potential, combined with the good safety profile, we’ve recently started to expand its usage to the prophylaxis of VAs in high–risk patients and the prophylaxis/treatment of atrial arrhythmias.

Methods
We hereby describe our single center experience with PSGB from 2/2021 to 12/2023.

Results
51 patients (92% male, mean age 65 ± 12 years) received a total of 69 PSGB performed with the lateral, ultrasound (US) guided technique. All procedures except for 3 in a single patient who had previously received left cardiac sympathetic denervation, were performed on the left side. Most of the patients (63%) suffered ischemic cardiomyopathy (CMP), including 6 with an over imposed acute coronary syndrome; the rest had non ischemic CMP, including 1 patient with acute myocarditis and 1 with hypertrophic CMP. Mean LVEF was 25 ± 13%. Most of the procedures (n=59, 86%) were performed due to refractory VAs, yet, 6 (8%) aimed to prevent VAs in high risk patients, mostly in the setting of recent VAs and need for levosimendan to support cardiac output, in one case due to recent stereotactic VT ablation, to prevent early VAs in the phase of acute radiation induced vascular damage. All 6 were effective in preventing clinically significant VAs. Additionally, 4 PSGBs (6%) were performed due to atrial arrhythmias with high ventricular rate despite intravenous drugs. Specifically, 3 patients had atrial fibrillation, in 2 cases with concomitant need for inotropes, and 1 patient suffered 2:1 atrial flutter. Left–sided PSGB significantly reduced ventricular rate during AF but not during the single case of 2:1 atrial flutter. Most of the procedures consisted in a single bolus anesthetic injection of lidocaine plus ropivacaine, 19 (28%) in an additional continuous infusion, mostly with ropivacaine. No major complications occurred, while minor complications were observed in 12% of PSGBs (mostly transient left arm weakness).

Conclusions
Our data suggest that US–guided PSGB usage, thanks to its easy feasibility and good safety profile, may expand, beyond ES, to not only VAs prevention in high–risk settings, but also to prophylaxis/treatment of atrial arrhythmias.
LINAC–BASED STEREOTACTIC ARRHYTHMIA RADIOABLATION (STAR) FOR PAROXYSMAL ATRIAL FIBRILLATION IN ELDERLY: A PROSPECTIVE PHASE II TRIAL
Authors: Romanazzi I , Di Monaco A , Valenti N , Troisi F , Vitulano N , Quadrini F , Grimaldi M 
Published: May 2024

Abstract

Background and Aims
The aim of this trial is to investigate the feasibility of radiotherapy for the treatment of paroxysmal atrial fibrillation (AF) in elderly patients.

Method
inclusion criteria were: age &gt; 70 years, symptomatic AF, antiarrhythmic drugs failure or intolerance. All patients underwent to 4D cardiac Computed Tomography simulation. The clinical target volume was identified in the area around pulmonary veins (PV). STAR was performed with a total dose of 25 Gy (single fraction) delivered in 3 minutes.

Results
Twenty patients were enrolled and 18 underwent STAR. One patient withdrew informed consent before treatment and 1 patient was excluded due to unfavorable esophagus position. With a median follow–up (FU) of 16 months (range 12–23), no acute toxicity more than grade 3 was reported. Five patients had a grade 1 esophagitis 24 hours after STAR; eight patients had an asymptomatic grade 1 pericardial effusion, one patient had a torsade de pointes treated effectively by electrical cardioversion and subsequent cardiac ICD implantation. Most patients had a significant reduction in AF episodes. Five patients, due to arrhythmias recurrences after STAR, performed electrophysiological study documenting successful PV isolation. Finally, a significant improvement of quality of life was documented (48 ± 15 at enrollment vs 75 ± 15 at 12 months FU; p &lt; 0.001).

Conclusion
The present phase II trial demonstrated the feasibility of STAR in paroxysmal AF elderly patients and its potential role in increasing the quality of life. Surely, more robust data are needed about safety and efficacy.
A NETWORK META–ANALYSIS COMPARING PULSED–FIELD ABLATION (PFA) AND OTHER CURRENT ABLATION THERAPIES FOR PAROXYSMAL ATRIAL FIBRILLATION
Authors: Piccolo S , Varotto L , Borio G , Paccanaro M , Rossillo A , Vittadello S , Caprioglio F , Bonanno C 
Published: May 2024

Abstract

Introduction
Pulsed–field ablation (PFA) has emerged as a non–thermal catheter–based treatment for paroxysmal atrial fibrillation. This study aimed to compare the efficacy of PFA with various conventional thermal ablation methods that are currently available.

Method
Randomised controlled trials were retrieved to compare atrial tachyarrhythmia recurrence among any combination of ablation modalities. A Bayesian and frequentist network meta–analysis (NMA) using risk ratio (RR) was conducted with MetaInsight v5.1.1. Treatment strategies were ranked using the surface under the cumulative ranking area (SUCRA).

Results
Across 14 studies comparing five ablation therapies (3,233 patients), Bayesian NMA–derived RRs of atrial arrhythmia recurrence compared to PFA were 0.90 (95% Credible Interval [CrI]=0.57–1.45) for cryoballoon ablation (CBA), 0.99 (95% CrI=0.61–1.55) for radiofrequency ablation (RFA), 1.07 (95% CrI=0.61–1.87) for combined CBA and RFA, and 0.81 (95% CrI=0.43–1.51) for laser–balloon ablation (LBA) (Figure 1). Similarly, the frequentist–based NMAs showed no significant benefit of all ablation therapies over PFA. The direct and indirect comparison among the various ablation techniques showed similar outcomes within the different ablation modalities evaluated in this NMA. The higher SUCRA value for LBA (80%) indicated the likelihood that the treatment is the best, followed by CBA (67%), PFA (48%), and RFA (45%) (Figure 2).

Conclusions
This NMA demonstrated that among patients with paroxysmal atrial fibrillation receiving a catheter–based therapy, PFA was non–inferior to conventional thermal ablation concerning freedom from documented atrial tachyarrhythmia during follow–up.
INITIAL EXPERIENCE IN TOTAL ENDOSCOPIC MITRAL VALVE SURGERY WITH THREE–DIMENSIONAL VIDEO–ASSISTED TECHNOLOGY
Authors: Fiorentino M , Mikus E , Vostantino A , Sangiorgi D , Tenti E , Tremoli E , Savini C 
Published: May 2024

Abstract

Background
Minimally invasive approach is nowadays the gold standard for mitral valve disease treatment. New technological tools are the key to improve surgical results and to reduce the biological invasiveness. We report our initial experience in total endoscopic mitral valve surgery using three–dimensional video–assisted technology (EinsteinVision® 3.0, B. Braun, Aesculap AG, Tuttlingen, Germany).

Methods
From July 2023 to December 2023, 29 patients underwent total endoscopic mitral valve surgery with three–dimensional video–assisted technology and discharged.

Results
Median (Q1–Q3) age of our population was 60 years (47–67) and 65.5% were males. Median (Q1–Q3) logistic Euroscore was 2.09 (1.5–4.4) and median (Q1–Q3) EuroSCORE II was 0.84 (0.6–1.2). The majority of patients were in NYHA class II and the 48.3% presented with pulmonary hypertension (PAPs &gt; 30 mmHg). Median PAPs resulted 34.5 mmHg. One patient (3.4%) suffered from mitral valve endocarditis. No conversion to full sternotomy was necessary. In six patients with left coronary dominance (20.6%) we used indocyanine green fluorescence to conduct a real–time analysis of the course of the circumflex artery during surgery. No perioperative acute myocardial infarction was observed. No 30–day mortality was reported. One patient (3.4%) suffered from renal failure requiring dialysis, respiratory failure with tracheostomy and pneumonia. Post–operative atrial fibrillation was observed in 7 patients (24.1%) and 1 patient (3.4%) required Pace–maker implantation due to third degree AV block. No re–thoracotomy for bleeding was observed and 24.1% of patients required transfusions with packed blood cells. Non stroke were detected. Median (Q1–Q3) ventilation time was 5 hours (4–7). Median (Q1–Q3) intensive care unit postoperative length of stay were 2 (2–2) days and 7 (7–8) days respectively.

Conclusions
In our experience, total endoscopic mitral valve surgery with three–dimensional video–assisted technology is safe and feasible with good postoperative outcomes. Moreover, the possibility to use indocyanine green fluorescence to detect the course of the circumflex artery significantly assist surgeons in localizing and avoiding it, thus reducing the risk of perioperative myocardial infarction.
GENOTYPE–PHENOTYPE CORRELATION IN A SINGLE CENTRE COHORT OF PATIENTS AFFECTED BY HYPERTROPHIC CARDIOMYIOPATHY
Authors: Manai R , Pidello S , Dusi V , Bocchino P , Angelini F , De Lio G , Gallone G , Gobello G , Deaglio S , Marcelli G , Raineri C , Brach Del Prever G , De Ferrari G 
Published: May 2024

Abstract

Background
Over the last 30 years, major advances have been made in the identification of the genetic basis of Hypertrophic Cardiomyopathy (HCM) and the spectrum of sarcomeric genes has been gradually extended to non–sarcomeric genes. Multiple attempts to identify genes with an unfavorable impact on prognosis failed; data for genotype–phenotype relationships are still insufficient.

Objective
Assess the clinical presentation and genotype–phenotype correlation of patients (pts) and the prognostic impact and clinical relevance of genetic tests.

Methods
130 adults pts with HCM were enrolled from January 2019 to May 2023. The included patients underwent blood sampling for genetic investigation.

Results
34 pts were HCM phenocopies (see figure 1). Our analysis was focused on the 96 (74%) pts with HCM. 40 pts carried likely pathogenetic/pathogenetic (LP/P) variants;23 pts carried a variant of uncertain significance; 33 pts had a negative genetic test. The majority of the pts carried MYH7 gene variants, followed by variants of MYBPC3 (see figure 1). Age at diagnosis had a significant effect on the likelihood of identifying a LP/P or VUS variant (54.44±12.7 for genetic test negative, 41.09±16.9 for VUS carriers, 35.4±15.3 for LP/P carriers, p.0.001). The presence of hypertension significantly affected the likelihood of identifying a negative genetic test (p 0.002). LP/P/VUS variants were significantly more common in patients with a family history of cardiomyopathies (p 0.001). 26% of VUS carriers and 17% of LP/P carriers had advanced heart failure; only 3% of patients with negative genetic test showed advanced heart failure (p 0.04). Carriers of LP/P variants showed more asymmetric hypertrophy, while patients with a genetic test negative showed more concentric hypertrophy. The composite endpoint (hospitalization for heart failure, cardiovascular death and cardiac transplantation) occurred in 8 (24.2%) patients with negative genetics, 16 (69.5%) patients with VUS and 14 (35%) patients with LP/P variants with a statistically significant difference (p=0.03) (see table 1). On multivariable analysis, having a positive genetic test (VUS/LP/P) was found to increase the probability of having the event by 3.8 fold compared to patients with a negative genetic test having a negative variant(see table 2).

Conclusion
We demonstrated the correlation between anamnestic data, cardiac phenotype and genotype. Genetic testing has also a prognostic value.
CARDIAC CT–PERFUSION IMAGING IN MYOCARDIAL BRIDGING EVALUATION: A NOVEL WEAPON FOR NON–INVASIVE ASSESSMENT OF A SILENT KILLER
Authors: Paolini E , Fogante M , Cela F , Schicchi N , Esposto Pirani P , Perna G 
Published: May 2024

Abstract

Introduction
Myocardial bridging (MB) is a congenital anomaly characterized by the intramyocardial course of one or more coronary arteries that provokes endothelial dysfunction and can generate myocardial ischemia with its pathological consequences. Because of the dynamic nature of the ischemic mechanism, a high–sensitivity myocardial perfusion stress test is often needed to decide on the correct management of the patient, mainly single photon emission computed tomography (SPECT). As an alternative to SPECT, our center offers the possibility of performing a dynamic stress–rest cCT–MPI (cardiac computed tomography – myocardial perfusion imaging).

Hypothesis
To compare the feasibility of performing cCT–MPI for the functional evaluation of MBs.

Methods
All cases underwent cCT (192–slice dual–source Somatom Force CT scanner, Siemens Healthcare, Germany), cCT–MPI with administration of a standard intravenous dose of 0.4 mg of regadenoson (Rapiscan®, GE Healthcare), and SPECT with physical stress (the latter not performed in one case of a minor patient, in favor of a coronary angiography with functional tests). Image processing was performed using Siemens Syngo® software, which can provide perfusion maps of myocardial blood flow (MBF) and volume (MBV) in a planar and 17 segments Bull‘s eye view. The interpretation of the results was performed toghether by an expert radiologist and cardiologist, both on a qualitative (color map) and quantitative basis (MBF ratio).

Results
From May 2022 to September 2023, 15 cases of MB with otherwise intact coronary arteries were collected, all involving the LAD and with anatomical characteristics considered "dangerous", i.e. length &gt;2.5 cm and depth &gt;2 mm. The investigations carried out revealed two relevant results: the first is that, despite all the selected MBs had anatomical features of complexity, a reversible perfusion defect related to MB was detected in only 2 cases (13%), one of which was confirmed by SPECT investigation and the other by functional tests during coronary angiography; the second is the high positive and negative concordance between cCT–MPI with pharmacological stress and SPECT with physical stress.

Conclusion
Myocardial bridging is an increasing finding detected through cCT investigations, but in a minority of cases it carries hemodynamic consequences. cCT followed in the same session by cCT–MPI with regadenoson administration constitutes two stages of the same exam.
CHARACTERISTICS AND OUTCOME OF PATIENTS WITH VARIOUS TYPE OF ACUTE CORONARY SYNDROME
Authors: Aleksova A , Fluca A , Munaretto L , Chiaradia V , Barbati G , Derin A , D‘Errico S , Di Lenarda A , Hiche C , Sinagra G , Janjusevic M 
Published: May 2024

Abstract

Background and Aim
Acute coronary syndrome with non–critical coronary arteries comprises distinct entities with unique pathophysiological, diagnostic, therapeutic and prognostic characteristics. The aim was to compare the clinical and prognostic features of cohorts presenting NSTEMI and non–critical coronary arteries disease, i.e. MINOCA, type 2 myocardial infarction (MI), Takotsubo syndrome (TTS), with a cohort of classical type 1 MI with critical coronary arteries disease.

Methods
In this single–center observational retrospective study, 18223 patients who underwent invasive coronary angiography between 2005 and 2022 were screened. Overall, 1162 patients were included (301 MINOCA, 237 type 2 MI, 138 TTS, and 486 with type 1 MI). The primary endpoint was a composite of non–fatal acute MI, non–fatal TIA or stroke, hospitalization for HF (hHF), and death. Secondary endpoints were (1) hHF, (2) a composite event of atrial fibrillation (AF), TIA, and/or stroke, and (3) all–cause mortality.

Results
The average age was 68.2 years, with 47% being male. At admission, the TTS group was the most hypotensive and echocardiographic compromised, with lower incidence of obesity and diabetes mellitus (DM). Type 2 MI group was more prone to hypertension and had a similar incidence of DM and diastolic dysfunction compared to type 1 MI. However, compared to type 1 MI, type 2 MI patients received less frequent DAPT, nitrates, beta–blockers, and statins upon discharge. The MINOCA group received therapy similar to type 1 MI. Over a median follow–up of 62 [30–102] months, 358 patients reached the primary endpoint, 84 had hHF, 76 had AF/TIA/stroke, and 253 died. At Kaplan–Meier analysis, type 2 MI patients were more likely to reach the primary endpoint, following type 1 MI (Fig.1). TTS group had the best outcomes (p&lt;0.01) for death (p&lt;0.01) and HFh. (p&lt;0.01), while type 2 MI had higher probability of developing AF/TIA/stroke (p&lt;0.01) (Fig.2). Cox Regression analysis confirmed type 1 MI as a predictor of worse outcomes compared to other groups, after adjustment for male gender, older age, DM, anemia, reduced systolic function, high C–reactive protein, left bundle branch block, and statins on discharge (Fig.3).

Conclusions
Critical coronary disease is confirmed to have the worst prognosis. Although type 2 MI had similar clinical characteristics as type 1 MI, the former was more burdened by arrhythmic and embolic events and diverged in therapy at the time of discharge.