bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary Valvular Mechanisms of Aortic Regurgitation in Tricuspid Aortic Valves: Importance in Repair Versus Replacement Strategy
Authors: Almaghrabi Saifalislam , Michelena Hector , Jelenc Matija , Abeln Karen B. , Ehrlich Tristan , Schäfers Hans‐Joachim 
Published: April 2024

Background
This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement.

Methods and Results

We retrospectively reviewed surgical reports of consecutive adults with tricuspid aortic valves undergoing surgery for clinically significant aortic regurgitation within a prospective registry from January 2005 to September 2019. Valvular mechanisms were determined by systematic in vivo intraoperative quantification methods. Of 516 patients, 287 (56%) underwent repair (AVr; mean±SD age, 59.9±12.4 years; 81% men) and 229 (44%) underwent replacement (aortic valve replacement; mean±SD age, 62.8±13.8 years [
P
=0.01 compared to AVr]; 67% men). A single valvular mechanism was present in 454 patients (88%), with cusp prolapse (46%), retraction (24%), and perforation (18%) being the most common. Prolapse involved the right cusp in 86% of cases and was more frequent in men (
P
<0.001). Two‐dimensional transesophageal echocardiography accuracy for predicting mechanisms was 73% to 82% for the right cusp, 55% to 61% for the noncoronary cusp, and 0% for the left‐coronary cusp. Cusp prolapse, younger age, and larger patient size were associated with successful AVr (all
P
<0.03), whereas retraction, perforation, older age, and concomitant mitral repair were associated with aortic valve replacement (all
P
<0.03).

Conclusions
Right cusp prolapse is the most frequent single valvular mechanism in patients with tricuspid aortic valve aortic regurgitation, followed by cusp retraction and perforation. The accuracy of 2‐dimensional transesophageal echocardiography is limited for left and noncoronary cusp mechanistic assessment. Prolapse is associated with successful AVr, whereas retraction and perforation are associated with aortic valve replacement. With systematic intraoperative quantification methods and current surgical techniques, more than half of tricuspid aortic valve aortic regurgitation cases may be successfully repaired.
Prognostic Value of Depressive Symptoms for Cardiovascular Events in Female Patients With Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction
Authors: Zhao Hengli , Jiang Jiaxue , Zhong Guoheng , Peng You , Wen Yihong , Liang Yu , Shan Zhixin 
Published: April 2024

Background
Among those with heart failure (HF), women are more likely to develop depression than men. Few studies have focused on the outcomes of female patients with HF with depressive symptoms.

Methods and Results

A total of 506 female patients with HF with preserved ejection fraction were included in this secondary analysis from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) cohort, and 439 female patients with HF with reduced ejection fraction were included from the HF‐ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) cohort. Depressive symptoms were measured using the Patient Health Questionnaire‐9 and Beck Depression Inventory‐II. The depression class was categorized by severity, and the change in clinical depression class was defined as aggravated (1‐grade increase) or improved (1‐grade decrease). The prognostic value of depressive symptoms was determined by using multivariable Cox proportional hazards models. Female patients with improved depressive symptoms had worse depressive status at baseline and lower baseline Kansas City Cardiomyopathy Questionnaire scores. Depression class at the 12‐month visit and depression class change were the dominant prognostic factors for cardiovascular death in female patients with HF with preserved ejection fraction (hazard ratio [HR], 1.43 [95% CI, 1.02–2.01],
P
=0.036; HR, 1.71 [95% CI, 1.14–2.55],
P
=0.009). Among the patients with HF with reduced ejection fraction, both the depression class at baseline and depression class change had significant prognostic effects on cardiovascular death (HR, 3.30 [95% CI, 1.70–6.39],
P
<0.001; HR, 2.21 [95% CI, 1.28–3.80],
P
=0.004). However, the prognostic value of depressive assessments for hospitalization in patients with HF is unclear.

Conclusions
In female patients with HF with reduced ejection fraction, the depression class at baseline was most strongly associated with cardiovascular death, whereas in female patients with HF with preserved ejection fraction, the change in depression class exhibited a more significant prognostic trend.
Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records
Authors: Brush John E. , Lu Yuan , Liu Yuntian , Asher Jordan R. , Li Shu‐Xia , Sawano Mitsuaki , Young Patrick , Schulz Wade L. , Anderson Mark , Burrows John S. , Krumholz Harlan M. 
Published: April 2024

Background
The digital transformation of medical data enables health systems to leverage real‐world data from electronic health records to gain actionable insights for improving hypertension care.

Methods and Results
We performed a serial cross‐sectional analysis of outpatients of a large regional health system from 2010 to 2021. Hypertension was defined by systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or recorded treatment with antihypertension medications. We evaluated 4 methods of using blood pressure measurements in the electronic health record to define hypertension. The primary outcomes were age‐adjusted prevalence rates and age‐adjusted control rates. Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by ≈5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, increased during 2018 to 2019, and decreased during 2020 to 2021. The proportion of patients with a hypertension diagnosis ranged from 45.5% to 60.2% initially and improved during the study period. Non‐Hispanic Black patients represented 25% of our regional population and consistently had higher prevalence rates, higher mean systolic and diastolic blood pressure, and lower control rates compared with other racial and ethnic groups.

Conclusions
In a large regional health system, we leveraged the electronic health record to provide real‐world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings, with prevalence increasing, one‐quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care.
Clinical Benefit of Fixed‐Dose Combination of Amlodipine and Potent Atorvastatin in Patients With Concomitant Hypertension and Hypercholesterolemia
Authors: Lin Chia‐Pin , Hsu Tzyy‐Jer , Tung Ying‐Chang , Hsiao Fu‐Chih , Chou Shing‐Hsien , Lin Yu‐Sheng , Chen Shao‐Wei , Chu Pao‐Hsien 
Published: April 2024

Background
Hypertension and hypercholesterolemia are important risk factors for cardiovascular disease, and treatment with fixed‐dose combination (FDC) regimens is recommended by current guidelines. However, the clinical outcomes of different FDC dosages remain unknown. This study aimed to examine the clinical outcomes of FDC regimens and the free combination of amlodipine and atorvastatin at different dosages.

Methods and Results
Patients with concurrent hypertension and hypercholesterolemia treated daily with an FDC of 5 mg amlodipine and 10 mg atorvastatin (5/10 fixed group), and FDC of 5 mg amlodipine and 20 mg atorvastatin (5/20 fixed group), or free combination of 5 mg amlodipine and 20 mg atorvastatin (5/20 free group) were identified from the National Health Insurance Research Database of Taiwan. The primary outcome was the composite cardiovascular outcomes, including cardiovascular death, acute myocardial infarction, stroke, and coronary intervention. A total of 9095 patients were eligible for inclusion. The incidence of primary outcome per 1000 person‐years was 16.6 in the 5/10 fixed group, 12.6 in the 5/20 fixed group, and 16.5 in the 5/20 free group (5/20 fixed versus 5/20 free: hazard ratio [HR], 0.76 [95% CI, 0.64–0.91]; 5/20 fixed versus 5/10 fixed: HR, 0.76 [95% CI, 0.63–0.90]).

Conclusions
Among patients with concomitant hypertension and hypercholesterolemia, treatment with an FDC of amlodipine and high‐dose atorvastatin led to a lower risk of a composite of cardiovascular outcomes than treatment with the free combination or a similar FDC with a lower dose of atorvastatin.
Heart Failure–Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020
Authors: Zuin Marco , Bertini Matteo , Vitali Francesco , Turakhia Mintu , Boriani Giuseppe 
Published: April 2024

Background
Population‐based data on heart failure (HF)‐related death in patients with atrial fibrillation (AF) are lacking. We assessed HF‐related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region.

Methods and Results

Data were extracted from the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research to determine trends in age‐adjusted mortality rates per 100 000 people, due to HF‐related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF‐related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age‐adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8–4.4];
P
<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2–7.4];
P
<0.001) in men (AAPC, +4.8% [95% CI, 4.4–5.1];
P
<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6];
P
<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7–8.4];
P
<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID‐19 pandemic, a significant excess in HF‐related deaths among patients with AF aged >65 years was observed.

Conclusions
A worrying increase in the HF‐related mortality rate among patients with AF has been observed in the United States over the past 2 decades.
Comparison of Windup and Stretch Pitching Biomechanics in Baseball With Implications for Safety and Performance
Authors: Fleisig Glenn S. , Slowik Jonathan S. , Kutz Charles B. , Escamilla Rafael F. 
Published: April 2024

Background: Historically, it was assumed by some that high leg lift with windup pitching generated more ball velocity whereas pitching from the stretch was quicker to reduce the risk of base stealing but also more stressful on the arm. However, many now believe that velocity and stress do not differ between windup and stretch and always pitching from the stretch is simpler than mastering 2 techniques. Purpose/Hypothesis: The purpose of this study was to compare windup and stretch fastball pitching biomechanics. It was hypothesized that there would be statistically significant and clinically important differences in ball velocity, timing of angular velocities, joint kinetics, and pitching kinematics. Study Design: Controlled laboratory study. Methods: Fastball pitching biomechanics previously captured for 221 healthy baseball pitchers (105 professional, 52 collegiate, and 64 high school level) were analyzed. For each pitcher, data for 3 to 10 windup trials and 3 to 10 stretch trials were available. Ball velocity was recorded using a radar gun. A 12-camera, 240-Hz automated motion capture system was used to track 39 reflective markers attached to the pitcher. A total of 24 kinematic parameters, 4 temporal parameters, and 5 kinetic parameters were calculated. Data for each parameter were compared across the 2 techniques and 3 competition levels using 2-way repeated-measures analysis of variance ( P < .01). Based on previous studies and the expertise of the investigators, the minimal clinically important difference (MCID) was set as 2° for angle measurements, 20 deg/s for angular velocities, 0.5 m/s for fastball velocity, and 0.3% body height × weight for normalized joint torque. Results: Fastball velocity was statistically greater from the windup than stretch for the collegiate subgroup but not for the other 2 levels. The collegiate level difference was below the MCID. Pitching from the windup generated greater front knee height and required more time from initiation of leg lift to front foot contact. From foot contact to ball release, there were 11 additional small, statistically significant differences between windup and stretch; however, each of these was well below the MCID. Conclusion: Pitching from the stretch was quicker and should be used with runners on base to prevent stealing. Pitching from the windup and stretch produced similar ball velocity, joint kinetics, and kinematics. Thus, pitchers may choose to use both techniques or stretch only based on comfort and personal preference. Clinical Relevance: The decision to pitch from both the windup and stretch or only from the stretch should not affect a pitcher's performance or joint stress (and injury risk).
Outcomes for Patients With Chronic Limb-Threatening Ischemia After Direct and Indirect Endovascular and Surgical Revascularization: A Meta-Analysis and Systematic Review
Authors: Tarricone Arthur , Gee Allen , de la Mata Karla , Rogers Lee , Wiley Jose , Lavery Lawrence A. , Krishnan Prakash 
Published: April 2024

Purpose: The purpose of this review and meta-analysis is to determine the clinical outcome differences between patients with chronic limb-threatening ischemia who underwent direct versus indirect angiosome revascularization using either the surgical or endovascular approach. Materials and Methods: The data sources used for article selection included PubMed, Embase/Medline, Cochrane reviews, and Web of Science (All studies were in English and included up to September 2023). All articles included were comparative in design, including retrospective, prospective, and randomized controlled trials that compared the clinical outcomes between direct and indirect angiosome-guided revascularization in chronic limb-threatening ischemia. A random-effects model was used to determine the measure of association between direct revascularization and amputation-free survival, wound healing, and overall survival. Publication bias was assessed with both Begg’s and Egger’s test, and heterogeneity was calculated using an I2. Results: Data from 9 articles were analyzed and reported in this review. Direct revascularization was associated with improved amputation-free survival (odds ratio [OR]=2.632, confidence interval [CI]: 1.625, 4.265), binary wound healing (OR=2.262, CI: 1.518, 3.372), and overall survival (OR=1.757, CI: 1.176, 2.625). Time until wound healed was not associated with either direct or indirect revascularization (Standard Mean Difference [SMD]=−2.15, p=0.11). There was a low risk of bias across all studies according to the RoB 2.0 tool. Conclusion: Direct revascularization is associated with improved amputation-free survival, overall survival, and wound healing in chronic limb-threatening ischemic patients compared to the indirect approach. Clinical Impact Preservation of the lower extremity is critical for preventing mortality and maintaining independence. The benefit of angiosome-guided revascularization for chronic limb-threatening ischemia remains controversial. The authors of this article aim to review the current literature and compare direct and indirect angiosome-guided intervention for preserving the lower extremity. Current findings suggest direct angiosome-guided intervention reduces amputation rates and improves survival; however, many trials neglect to address the multifactorial approach needed in wound care management.
Effects of adherence to treatment for repositioning therapy, physical therapy, and cranial remolding orthoses in infants with cranial deformation
Authors: Moses Victoria , Deville Caitlin , Simpkins Susan , Wang Jijia , Marlow Tally , Holley Cayman , Briggs Shea , Sheffer Olivia , Payne Amy , Pauline Lindsay , Lam Tristine , Blasingim Ashton , Graham Tiffany 
Published: April 2024

Deformational head shapes are most often treated through repositioning therapy (RT) and/or cranial remolding orthotic (CRO) treatment. However, there is conflicting evidence about the effectiveness of each method, and treatment compliance is suspected to affect treatment effectiveness. This study examines participant adherence with these treatment methods and explores if cranial correction is related to compliance. This study also reviews effects of developmental milestones and explores other potential impacts on compliance. A total of 45 infants with cranial deformation were consented and those with congenital muscular torticollis (CMT) concurrently received physical therapy. Infants were followed from 2 to 12 months of age and initially assigned to RT. Caregivers continued RT until the head shape corrected, caregivers chose to switch to a CRO, or infants turned 12 months of age. All participants were scheduled for a final visit at 12 months of age. Throughout treatment, caregiver surveys were used to examine compliance and developmental milestones. Results show promise for future investigation into the relationship between treatment modalities and adherence with treatment for deformational head shapes. Our findings provide preliminary support that treatment adherence may be linked with treatment success and concurrent enrollment in physical therapy increases patient compliance.
Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study
Authors: Victorson David , Mishra Kavita K. , Sauer Joseph , Langford Grace , Maletich Carly , Horowitz Bruriah , Sauer Christina , Sejpal Samir V. , Kalapurakal John 
Published: April 2024

Background The most common and debilitating side effects of radiation therapy (RT) for prostate cancer (PC) are fatigue, sleep disturbance, anxiety, and depression. Previous research has reported palliative benefits from certain self-management approaches, such as mindfulness meditation. Objective To develop, pre-test, and evaluate the feasibility, acceptability and initial benefit of brief, audio-based mindfulness delivered during daily RT for PC compared to a relaxing music control. Methods Following intervention development, participants were randomized to either brief guided mindfulness audio recordings or a relaxing music control during daily RT. A pre-testing phase was first conducted to determine optimal program start time, length, and content most associated with retention. A final program (n = 26) was delivered daily, starting on day one of week 2 of RT and lasting 4 consecutive weeks. Feasibility was defined as ≥70% on enrollment rate, retention, and audio program adherence. Acceptability was measured with a 12-item post-study survey. A secondary focus compared between group changes on patient reported outcomes of fatigue, anxiety, depression, sleep disturbance, and related outcomes at baseline and follow up assessments. Descriptive statistics and general linear models were used. Results Overall, 76% (n = 38) of approached men enrolled. Pre-testing retention rates were <70% while the final program’s retention rate was 89%. The majority of acceptability criteria were met in both conditions, with relatively higher ratings in the mindfulness arm. Compared to music controls, mindfulness participants demonstrated significantly less uncertainty intolerance at 4-weeks ( P = .046, d = .95); and significantly lower fatigue scores ( P = .049, d = 1.3) and lower sleep disturbance scores ( P = .035, d = 1.1) at the 3 months follow up. Conclusion The final intervention met feasibility and acceptability criteria. Pre-testing refinements played a key role for optimal program delivery and retention. Audio-based mindfulness delivered during RT for PC hold potential to help decrease RT-related physical and emotional side effects.
Molecular and clinical presentation of UBA1-mutated myelodysplastic syndromes
Authors: Sirenko Maria , Bernard Elsa , Creignou Maria , Domenico Dylan , Farina Andrea , Arango Ossa Juan E. , Kosmider Olivier , Hasserjian Robert , Jädersten Martin , Germing Ulrich , Sanz Guillermo , van de Loosdrecht Arjan A. , Gurnari Carmelo , Follo Matilde Yung , Thol Felicitas , Zamora Lurdes , Pinheiro Ronald Feitosa , Pellagatti Andrea , Elias Harold K. , Haase Detlef , Sander Birgitta , Orna Elisa , Zoldan Katharina , Eder Lea Naomi , Sperr Wolfgang R. , Thalhammer Renate , Ganster Christina , Adès Lionel , Tobiasson Magnus , Palomo Laura , Della Porta Matteo Giovanni , Huberman Kety , Fenaux Pierre , Belickova Monika , Savona Michael R. , Klimek Virginia M. , Santos Fabio P. S. , Boultwood Jacqueline , Kotsianidis Ioannis , Santini Valeria , Solé Francesc , Platzbecker Uwe , Heuser Michael , Valent Peter , Finelli Carlo , Voso Maria Teresa , Shih Lee-Yung , Ogawa Seishi , Fontenay Michaela , Jansen Joop H. , Cervera Jose , Ebert Benjamin L. , Bejar Rafael , Greenberg Peter L. , Gattermann Norbert , Malcovati Luca , Cazzola Mario , Beck David B. , Hellström-Lindberg Eva , Papaemmanuil Elli 
Published: April 2024

Abstract
Mutations in UBA1, which are disease-defining for VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, have been reported in patients diagnosed with myelodysplastic syndromes (MDS). Here, we define the prevalence and clinical associations of UBA1 mutations in a representative cohort of patients with MDS. Digital droplet polymerase chain reaction profiling of a selected cohort of 375 male patients lacking MDS disease-defining mutations or established World Health Organization (WHO) disease classification identified 28 patients (7%) with UBA1 p.M41T/V/L mutations. Using targeted sequencing of UBA1 in a representative MDS cohort (n = 2027), we identified an additional 27 variants in 26 patients (1%), which we classified as likely/pathogenic (n = 12) and of unknown significance (n = 15). Among the total 40 patients with likely/pathogenic variants (2%), all were male and 63% were classified by WHO 2016 criteria as MDS with multilineage dysplasia or MDS with single-lineage dysplasia. Patients had a median of 1 additional myeloid gene mutation, often in TET2 (n = 12), DNMT3A (n = 10), ASXL1 (n = 3), or SF3B1 (n = 3). Retrospective clinical review, where possible, showed that 82% (28/34) UBA1-mutant cases had VEXAS syndrome–associated diagnoses or inflammatory clinical presentation. The prevalence of UBA1 mutations in patients with MDS argues for systematic screening for UBA1 in the management of MDS.