bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gigantic biatrial myxoma in a young female with an atrial septal defect: a case report
Authors: Radner Caroline , Grefen Linda , Dashkevich Alexey , Hagl Christian , Mueller Christoph S 
Published: April 2024

Abstract

Background
Myxomas are uncommon and benign cardiac neoplasms that can present with various cardiac, systemic, embolic, or without symptoms depending on their location and size. Very few cases of large, truly biatrial, or tumours connected via the cardiac atria have been reported throughout the years.

Case summary
We present an unusual case of an apparently healthy 25-year-old French woman, who presented with dyspnoea at Munich’s Octoberfest. Echocardiography and computed tomography identified gigantic masses in left and right atrium, which were connected through an atrial septal defect. They were successfully removed by emergent cardiac surgery.

Discussion
This case describes an uncommon tumour and highlights the importance of a quick diagnosis and prompt surgery. We describe the management and surgery for atrial myxomas as well as demonstrating pre- and intraoperative pictures.
A case series of eight amateur athletes: exercise-induced pre-/syncope during the Zurich Marathon 2023
Authors: Hametner Greta , Eis Doris , Kruijver Muriel , Stiefel Michael , van der Stouwe Jan Gerrit , Stüssi-Helbling Melina , Forrer Anja , Niederseer David 
Published: April 2024

Abstract

Background
Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers.

Case summary
Eight athletes (2 females, 6 males) aged 21–35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat.

Discussion
From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events.
Repeated occurrence of severe hypotension associated with azithromycin infusion in a patient with fulminant myocarditis: a case report
Authors: Lenz Max , Krychtiuk Konstantin A , Zilberszac Robert , Speidl Walter S , Heinz Gottfried 
Published: April 2024

Abstract

Background
Intravenous administration of azithromycin has been linked to severe hypotension in some case reports in the past. We report a further case of profound shock requiring excessive use of vasopressors and extracorporeal membrane oxygenation (ECMO).

Case summary
An 18-year-old Caucasian male was admitted due to fulminant myocarditis and signs of cardiogenic shock. He had to be put on venoarterial ECMO only hours after admission. Due to the occurrence of disseminated intravascular coagulation and heparin-induced thrombocytopenia, haemodynamic support was discontinued on Day 8. On Day 11 of his stay, the patient started to exhibit signs of severe infection and a single 1500 mg dose of azithromycin was prescribed. Immediately after starting the infusion, the patient developed profound hypotension and signs of cardiogenic shock. Consecutively, venoarterial ECMO had to be re-established, and the azithromycin infusion was stopped in the process. It took the restart of the compound to recognize the connection between the administration of the therapy and the occurrence of cardiogenic shock. After discontinuing azithromycin, no further sudden hypotensive episodes were recorded, and the patient received left ventricular assist device implantation as a bridge to recovery or transplant.

Discussion
Rapid-onset hypotension appears to be a very rare but important adverse drug reaction associated with intravenous administration of azithromycin. Factors such as preceding infection and reduced biventricular function may facilitate the described occurrence.
Spot urinary sodium-guided titration of intravenous diuretic therapy in acute heart failure: a pilot randomized controlled trial
Authors: Khorramshahi Bayat Maryam , Chan Wandy , Hay Karen , McKenzie Scott , Adhikari Polash , Fincher Gavin , Jordan Faye , Ranasinghe Isuru 
Published: April 2024

Abstract

Background
Spot urinary sodium concentration (UNa) is advocated in guidelines to assess diuretic response and titrate dosage in acute heart failure (AHF). However, no randomized controlled trial data exist to support this approach. We performed a prospective pilot trial to investigate the feasibility of this approach.

Methods and results
Sixty patients with AHF (n = 30 in each arm) were randomly assigned to titration of loop diuretics for the first 48 h of admission according to UNa levels (intervention arm) or based on clinical signs and symptoms of congestion (standard care arm). Diuretic insufficiency was defined as UNa &lt;50 mmol/L. Endpoints relating to diuretic efficacy, safety, and AHF outcomes were evaluated. UNa-guided therapy patients experienced less acute kidney injury (20% vs. 50%, P = 0.01) and a tendency towards less hypokalaemia (serum K+ &lt;3.5 mmol, 7% vs. 27%, P = 0.04), with greater weight loss (3.3 kg vs. 2.1 kg, P = 0.01). They reported a greater reduction in the clinical congestion score (−4.7 vs. −2.6, P &lt; 0.01) and were more likely to report marked symptom improvement (40% vs. 13.3%, P = 0.04) at 48 h. There was no difference in the length of hospital stay (median length of stay: 8 days in both groups, P = 0.98), 30-day mortality, or readmission rate.

Conclusion
UNa-guided titration of diuretic therapy in AHF is feasible and safer than titration based on clinical signs and symptoms of congestion, with more effective decongestion at 48 h. Further large-scale trials are needed to determine if the superiority of this approach translates into improved patient outcomes.

Trial registration number
ACTRN12621000950864
Current treatments for the management of homozygous familial hypercholesterolaemia: a systematic review and commentary
Authors: Gu Jing , Gupta Rupal N , Cheng Henry K , Xu Yingxin , Raal Frederick J 
Published: April 2024

Abstract

Aims
Homozygous familial hypercholesterolaemia (HoFH) is a rare disorder characterized by markedly elevated circulating low-density lipoprotein cholesterol (LDL-C) from birth. This review aimed to critically evaluate treatments for HoFH with respect to their efficacy, safety, accessibility, overall context and position within the treatment pathway.

Methods and results
A mixed-methods review was undertaken to systematically identify and characterize primary interventional studies on HoFH, with a focus on LDL-C reduction as the primary outcome. Interventions assessed were ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), lomitapide, evinacumab, with or without LDL apheresis. Twenty-six seminal studies reporting unique patient data were identified. Four studies were randomized controlled trials (RCTs) with the remainder being single-arm trials or observational registries. Data extracted were heterogeneous and not suitable for meta-analyses. Two RCTs, assessed at being low risk of bias, demonstrated PCSK9i were safe and moderately effective. A randomized controlled trial (RCT) demonstrated evinacumab was safe and effective in all HoFH subgroups. Lomitapide was reported to be efficacious in a single-arm trial, but issues with adverse events, tolerability, and adherence were identified. An RCT on ezetimibe showed it was moderately effective when combined with a statin. LDL apheresis was reported as effective, but its evidence base was at very high risk of bias. All interventions lowered LDL-C, but the magnitude of this, and certainty in the supporting evidence, varied.

Conclusion
In practice, multiple treatments are required to treat HoFH. The sequencing of these should be made on an individualized basis, with consideration made to the benefits of each intervention.
Ethnicity and sudden cardiac death in athletes: insights from a large United Kingdom registry
Authors: Finocchiaro Gherardo , Radaelli Davide , D’Errico Stefano , Bhatia Raghav , Papadakis Michael , Behr Elijah R , Westaby Joseph , Sharma Sanjay , Sheppard Mary N 
Published: April 2024

Abstract

Aims
The relationship between ethnicity and causes of sudden cardiac death (SCD) in athletes is poorly understood.

Objectives
To investigate aetiology of SCD among different ethnicities in a large cohort of athletes.

Methods and results
Between 1994 and November 2022, 7880 cases of SCD were consecutively referred from all over the United Kingdom to our national cardiac pathology centre; 848 (11%) were athletes. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners. Most of athletes were white (n = 758; 89%). Black and Asian athletes were in number of 51 (6%) and 39 (5%), respectively. A structurally normal heart, indicative of sudden arrhythmic death syndrome (SADS) was the most common autopsy finding (n = 385; 45%), followed by myocardial diseases (n = 275; 32%), atherosclerotic coronary artery disease (CAD) (n = 58; 7%), and coronary artery anomalies (n = 29; 3%). In most of cases, death occurred during exercise (n = 737; 87%). Arrhythmogenic cardiomyopathy (ACM) was more common in black (n = 13; 25%) than in white (n = 109; 14%) and Asian (n = 3; 8%) athletes (P = 0.03 between black and white athletes; P = 0.04 between black and Asian athletes); in contrast, CAD was more common in Asians (n = 6; 15% vs. n = 51; 7% in whites vs. n = 1; 2%; in blacks, P = 0.02 between Asian and black athletes). Among white athletes, ACM was more common in individuals who died during exercise than in the ones who died at rest (P = 0.005). Such a difference was not observed in Asian and black athletes. In Asian athletes, CAD was the diagnosis at autopsy in 18% of individuals who died during exercise and in none of individuals who died at rest.

Conclusion
A structurally normal heart at autopsy and myocardial diseases are the most common findings in athletes who died suddenly. While ACM is more common in black athletes, atherosclerotic CAD is more common in Asian athletes, with a strong association with exercise-induced SCD. ACM appears to be a driver of exercise-induced SCD in white athletes, however this is not the case in black and Asian athletes.
Hypoxia, hypoxia-inducible factors and inflammatory bowel diseases
Authors: Hou Fei , Bian Xixi , Jing Dehuai , Gao Huikuan , Zhu Fengqin 
Published: April 2024

AbstractAdequate oxygen supply is essential for maintaining the body's normal physiological function. In chronic inflammatory conditions such as inflammatory bowel disease (IBD), insufficient oxygen reaching the intestine triggers the regulatory system in response to environmental changes. However, the pathogenesis of IBD is still under investigation. Recent research has highlighted the significant role of hypoxia in IBD, particularly the involvement of hypoxia-inducible factors (HIF) and their regulatory mechanisms, making them promising therapeutic targets for IBD. This review will delve into the role of hypoxia, HIF, and the associated hypoxia-inflammatory microenvironment in the context of IBD. Potential interventions for addressing these challenging gastrointestinal inflammatory diseases will also be discussed within this framework.
Convalescent Growth Differentiation Factor-15 and Long-Term Outcomes after an Acute Coronary Syndrome
Authors: Greer Charlotte E , Chew-Harris Janice , Adamson Philip D , Pemberton Chris J , Pickering John W , Pilbrow Anna P , Frampton Chris M , Troughton Richard W , Doughty Robert N , Richards A Mark 
Published: April 2024

Abstract

Background
Growth differentiation factor-15 (GDF-15) has been shown to be associated with adverse clinical outcomes in patients after an acute coronary syndrome when measured soon after an event. Although dynamic in the acute phase after myocardial injury, GDF-15 has been shown to remain stable during convalescence. In this study, we aimed to assess the value of GDF-15 as a long-term prognostic marker for clinical outcomes when measured in the convalescent phase following an acute coronary syndrome.

Methods
GDF-15 concentrations were measured in 1945 patients who were recruited between 2002 and 2009 to the Coronary Disease Cohort Study. For this analysis, follow-up was curtailed at 10 years and association of GDF-15 with all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure hospitalizations were assessed with multivariate Cox proportional hazard regression analysis.

Results
After 10 years of follow-up, there were 648 deaths (348 from cardiovascular causes), 500 admissions for myocardial infarction, and 436 for heart failure. Four-month convalescent GDF-15 demonstrated a robust independent association with all endpoints, which remained after adjustment for Global Registry of Acute Coronary Events score and other convalescent biomarkers. When compared to the lowest quartile of GDF-15 concentrations, those in the highest quartile had a 3-fold increased risk of all-cause death.

Conclusions
Convalescent plasma GDF-15 is a strong and independent predictor of 10-year all-cause death, cardiovascular death, recurrent myocardial infarction, and heart failure admission following an acute coronary syndrome.

Australian New Zealand Clinical Trials Registry Trial ID
ACTRN12605000431628.
1 Burn Center Verification and Safety-net Status. Are There Differences in Discharge to Inpatient Rehabilitation?
Authors: Lakhlani Devi , Bailey John Kevin , Steeman Samantha , Stanton Eloise , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Discharge to acute rehabilitation is the gold standard following major burn injury. However, numerous barriers to rehabilitation exist, including race, payor type, and burn center type. It remains unclear whether the organizational structure of burn centers is associated with differences in discharge to rehabilitation. This study aims to investigate associations between race and burn center type in relation to the rate of discharge to acute rehabilitation.

Methods
Using the California Health Care Access and Information from 2009-2019, all inpatient encounters at verified and non-verified burn centers were identified using International Classification of Diseases 9/10 and Diagnosis Related Group codes. The primary outcome of interest was proportion of patients discharged to acute rehabilitation. Key covariates included race, burn center safety-net status, American Burn Association (ABA) verification status, and American College Surgeons (ACS) Level 1 trauma center designation. Adjusted covariates included burn total body surface area (TBSA), gender, and age. Logistic regression modeling was performed, and multiple testing was accounted for using Bonferroni adjustment.

Results
There were 27,496 encounters of which 0.8% (228) were discharged to inpatient rehabilitation. By race/ethnicity, the proportion of admission to inpatient rehabilitation was 0.9% for White, 0.6% for Black, 0.7% for Hispanic, and 1% for Asian. After adjusting for TBSA and age, notable predictors for discharge to inpatient rehabilitation included Medi-Cal (Medicaid) as payor (OR 1.24-2.22, p=0.005) compared to commercial insurance, trauma center status (OR 1.37-3.16, p=0.005), ABA verification status (OR 1.16-2.69, p=0.040), and safety-net facility (OR1.12-2.01, p=0.030). On univariate testing Black race and Hispanic ethnicity were associated with decreased odds of discharge to inpatient rehabilitation (p=0.033). This relationship was erased when these patients were treated at verified burn centers and/or burn centers with safety-net status.

Conclusions
Discharge to inpatient rehabilitation remains variable between burn centers and races. Notably, verified burn centers with safety-net designation had more patients that discharged to inpatient rehabilitation adjusting for burn severity and payor. Governmental insurance was favorable for discharge to acute rehabilitation.

Applicability of Research to Practice
The organization of burn centers and triage of burn patients may consider the benefits of verification and safety-net designation as it relates to discharge to inpatient rehabilitation.
30 A Qualitative Descriptive Exploration of the Experiences of Burn Therapists
Authors: Yelvington Miranda L , Wood Rachel E , Corson Tyler , Hu Jiale , Reynolds Stacey 
Published: April 2024

Abstract

Introduction
Exposure to patients who have experienced major traumatic events places burn therapists at risk for developing high levels of anxiety and stress, directly impacting their quality of life. Poor professional quality of life has been associated with negative physical and emotional characteristics in healthcare professionals and can subsequently influence patient safety and satisfaction, job retention, and productivity. The purpose of this study was to understand and describe the experiences of occupational and physical therapists who provide acute therapy to people who have sustained burn injuries.

Methods
The study utilized a qualitative descriptive approach. Participants were selected using a maximum variation sampling strategy. Years of burn experience ranged from 2 to 37 years, and participants practiced in adult (40%), pediatric (20%), or mixed burn care (40%). Participating therapists represented all five American Burn Association Regions. Semi-structured interviews were completed with 10 participants (8 female, 7 physical therapists) to explore their experiences in their own words. Conventional content analysis was used to analyze the data collected from semi-structured interviews.

Results
Six themes emerged after content analysis. These themes were: 1) the importance of therapeutic relationships to patient successes and therapists’ retention; 2) the autonomy and flexibility of burn therapists; 3) the impact of career longevity on compassion; 4) the uniqueness of burn team relationships and camaraderie; 5) the challenges of operating within the business of a healthcare system; and 6) the physical, mental and emotional challenges to the burn therapists’ resiliency.

Conclusions
The overarching themes reflected the importance of therapeutic relationships to patient successes and therapists’ retention. The autonomy and flexibility of burn therapists were found to be a driver of professional quality of life as therapists were empowered by their ability to lead patient change. Therapists endorsed developing boundaries and methods to decrease the emotional impact of patient losses as their career progresses. Participants spoke about the positive and negative impact of being part of a multidisciplinary team, often feeling limited by the challenges inherent in operating within the business of a healthcare system.

Applicability of Research to Practice
This research brings to light the physical, mental, and emotional challenges that impact burn therapists’ resiliency and which should be considered when creating programs to increase retention and professional quality of life in this population.
32 HANDFULS: A New Clinically Feasible Measure of Hand Outcome for Children with Burns and Trauma
Authors: Parry Ingrid , James Michelle , Wilson Machelle , Greenhalgh David G 
Published: April 2024

Abstract

Introduction
Fine motor dexterity is important for children's normal hand function and development. In-hand manipulation (the collection and repositioning of items in the hand) and palmar workspace (functional volume in the palm) are two aspects of hand function that often become simultaneously impaired after hand trauma or burn injury. Rehabilitation emphasizes recovery of these hand functions yet few functional outcome measures address both of these constructs and even fewer are appropriate for children.

Methods
This study developed a new hand outcome measure to specifically assess these constructs and tested it on 192 children between the ages of 2-21. The test, called ‘HANDFULs’, uses simple instructions and inexpensive materials (i.e. marbles) shown in Figure 1. Means, standard deviations, and 95% confidence limits were estimated for children in seven age groups. Associations between age and the HANDFULs variables were examined using one-factor ANOVA. Multiple regressions were fit to test for associations between age and the HANDFULs variables after controlling for height, hand size, and hand strength. A stepwise selection procedure was then implemented, holding age into the model, to remove otherwise non-significant variables. Test-retest reliability was tested with the Shrout Fleiss Reliability Index and significance was set at p&lt; 0.05.

Results
Expected normal values are reported in Figure 2 for palmar workspace volume (marbles that fit in the hand) and in-hand manipulation (collection time per marble) by age group. Age (0.16 (0.06), p=0.009), hand span (0.47 (0.09), p&lt; 0.0001) and hand width (0.9 (0.29), p=0.003) were significantly associated with number of marbles that fit in the hand, representing palmar workspace capacity. Although hand strength and size characteristics were tested, only age (-0.02 (0.01), p=0.001) was significantly associated with the HANDFULs score of time per marble. The Intraclass Correlation Coefficient was 0.94 demonstrating excellent test-retest reliability.

Conclusions
This study developed a new pediatric hand outcome measure to address hand function to address a gap related to burn and trauma recovery. The measure was tested on able-bodied, noninjured children to establish validity and reliability, provide reference values for patients with injuries by age groups, and is clinically feasible to administer.

Applicability of Research to Practice
Outcome test for burn injured hands.