bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial
Authors: Sanchis Juan , Bueno Hector , Martí Sánchez David , Martinez-Selles Manuel , Díez Villanueva Pablo , Barrabes Jose A , Marín Francisco , Villa Adolfo , Sanmartin Fernandez Marcelo , Llibre Cinta , Sionis Alessandro , Elizaga Jaime , Alfonso Fernando , Nuñez Eduardo , Núñez Julio , Kunadian Vijay , Ariza-Solé Albert 
Published: February 2025

BackgroundClinical trials and meta-analyses indicate a reduced reinfarction risk with invasive management in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study investigated whether similar benefits might be observed in frail patients.MethodsThe coMOrbilidades Síndrome Coronario Agudo - FRAIL (MOSCA-FRAIL) trial included 167 adults aged ≥70 years with frailty (Clinical Frailty Scale ≥4 points) and NSTEMI, who were randomised to invasive (n=84) or conservative (n=83) strategy during the index hospitalisation. The primary end point of this subanalysis was reinfarction, considering all-cause mortality as a competing event, at a 3-year median follow-up. The time to first reinfarction and all reinfarctions (first and recurrent) were considered. The substudy was not prespecified.ResultsThe total number of deaths (93, 56%) exceeded that of first reinfarctions (32, 19%). Invasive treatment did not influence the reinfarction risk when accounting for death as a competing risk (subdistribution HR=0.87, 95% CI 0.54 to 1.40, p=0.56). An initially increased mortality risk with invasive management (significant between days 131 and 175) shifted to a lower mortality risk over time. A total of 45 reinfarctions (first and recurrent) were observed. The longitudinal trajectories corroborated that the invasive strategy did not reduce the risk of reinfarction over time (p=0.72). However, mortality followed a biphasic pattern, with higher mortality in the invasive group during the first 6 months and a reduction between 9 months and 3 years (p=0.05 for the entire time-dependent trajectory). The win ratio for the invasive strategy versus the conservative strategy was 1.08 (95% CI 0.72 to 1.63, p=0.70).ConclusionsIn older adults with frailty and NSTEMI, routine invasive management did not reduce the reinfarction risk at a 3-year follow-up. The high all-cause mortality associated with frailty may limit the impact of invasive management. Due to the limited sample size and risk for type II error, these findings should be considered hypothesis-generating.Trial registration numberNCT03208153.
Onyx frontier DES in the setting of intracranial atherosclerotic disease: multicenter retrospective insights from early clinical experience
Authors: Davis Pierce , Sioutas Georgios , Reddy Chethan , Napole Alan , Jabarkheel Rashad , Scott Kyle , Kandregula Sandeep , Rahmani Redi , Choudhri Omar , Pukenas Bryan , Catapano Joshua S , Kan Peter , Grandhi Ramesh , Salah Walid K , Alaraj Ali , McGuire Laura Stone , Sheth Sunil A , Altschul David , Essibayi Muhammed Amir , Burkhardt Jan Karl , Srinivasan Visish M 
Published: February 2025

BackgroundIntracranial atherosclerotic disease (ICAD) is a leading cause of stroke, often refractory to aggressive medical therapy. Recent advancements in drug-eluting stents (DES) show promise for improved efficacy in intracranial applications relative to traditional ICAD treatments.MethodsWe retrospectively collected all consecutive deployments of the Onyx Frontier [Medtronic, Santa Rosa, CA] stent in the setting of ICAD between August 2022 and August 2024 at six high-volume neuro-interventional centers across the US. Patients were included if their indication for stenting (eg, acute/recurrent stroke) was secondary to ICAD. Primary outcome was periprocedural stroke (<72 hours) and secondary outcomes included degree of pre- and post-stent vessel stenosis and National Institutes of Health Stroke Scale (NIHSS) scores at most recent follow-up. Secondary outcomes were assessed via paired t-tests.ResultsAmong 55 patients that met our inclusion criteria, the mean age was 62, mean presentation NIHSS was 10, and 40% were female. A total of 62 devices were used. Most common occlusion locations included the middle cerebral and internal carotid arteries. The periprocedural stroke rate was 10.9%, with a mortality rate of 1.8%. Mean vessel stenosis significantly decreased from 84.90% pre-stent to 2.00% post-stent (P<0.05). Mean NIHSS score improved from 10.37 preoperatively to 3.23 at follow-up (p<0.05). Procedural failure did not occur, however complications occurred in 16.4% of cases.ConclusionOur findings suggest that stenting in this setting results in a lower periprocedural stroke rate than appreciated in historical trials such as SAMMPRIS and VISSIT. However, recent CASSISS and BASIS trials demonstrate far reduced periprocedural stroke rates in the context of submaximal angioplasty for ICAD. This, in conjunction with complication rate, suggest that the Onyx Frontier, while promising, may not offer a definitive solution to ICAD.
Flow-based simulation in transverse sinus stenosis pre- and post-stenting: pressure prediction accuracy, hemodynamic complexity, and relationship to pulsatile tinnitus
Authors: Stahl Janneck , Abou-Mrad Tatiana , Stone McGuire Laura , Janiga Gábor , Saalfeld Sylvia , Alaraj Ali , Berg Philipp 
Published: February 2025

BackgroundThe proximity of transverse sinus stenosis (TSS) to inner ear structures and the temporal bone makes it a substantial cause of pulsatile tinnitus (PT). Treatment typically involves venous sinus stenting. This study investigates the hemodynamic stressors in TSS patients with PT along the pulse-transmitting temporal bone area and evaluates its treatment effects.MethodsFour patients with idiopathic intracranial hypertension, PT, and TSS, and four control patients were imaged using MR venography (MRV) and flat panel CT (FP-CT). Patient-specific blood flow simulations were conducted using boundary conditions based on quantitative MR angiography before and after VSS. Catheter-based trans-stenotic pressure gradient measurements were used to validate the simulation results.ResultsThe prediction of pressure gradients was close to catheter-based measurements using FP-CT-based segmentations (absolute deviation of 0.35 mm Hg) and is superior to MRV-based reconstructions (absolute deviation of 6.9 mm Hg). In TSS patients, the sinus temporal bone contact areas revealed notably higher time-averaged wall shear stress by 47±22% and velocity values by 41±18% compared with the sinus brain side. The relative residence time decreased by 57±58%. After stenting, the hemodynamic parameters dropped at the temporal side and throughout the sigmoid sinus. Almost all control patient hemodynamics remained lower than post-interventional results.ConclusionOur simulations based on patient-specific flows highly predicts pressure gradients across the stenosis. Flow conditions in TSS reveal flow jet formation and high shear rates at the temporal bone, potentially causing sound transmission. The treatment reduces these stressors, demonstrating its targeted therapeutic effect.
Dural arteriovenous fistula research and management in China (DREAM-INI): initial characterization and patient cohort outcomes
Authors: Su Xin , Ma Yongjie , Song Zihao , Liu Huiwei , Zhang Chao , Pang Huishen , Chen Yiguang , Zhao Beichuan , Huang Mingyue , Sun Liyong , Hu Peng , Li Guilin , Hong Tao , Ye Ming , Zhang Hongqi , Zhang Peng 
Published: February 2025

BackgroundIntracranial dural arteriovenous fistulas (DAVFs) are rare lesions, making it challenging to fully understand and improve their management. Globally, only two major large-scale studies have focused on DAVFs. This report outlines the design of the DREAM-INI (Dural arteriovenous fistula research and management in China) project and provides an overview of the 1101-patient cohort it includes.MethodsPatient data were sourced from the DREAM-INI database, a retrospective, single-center observational study conducted from January 2001 to December 2022, encompassing a total of 1101 DAVF patients.ResultsThe cohort consists of 367 patients diagnosed with Borden type I DAVFs, 172 patients with Borden type II fistulas, and 562 patients with Borden type III fistulas. 565 patients exhibited flow-related symptoms, 176 patients presented with intracranial hemorrhage, and 275 patients had non-hemorrhagic neurological deficits. A large proportion of patients (95.6%, 1053/1101) underwent treatment through endovascular embolization (83.7%, 922/1101), surgery (8.7%, 96/1101), or multimodal therapy (3.2%, 35/1101). The overall immediate angiographic cure rate was 85.2% (897/1053 treated cases), and the rate of treatment-related permanent neurological morbidity was 3.4% (45/1328 total procedures). The median duration from the final treatment to the last follow-up for DAVF was 39 months. The predictive factors for aggressive symptoms, initial angiographic cure, and complications in DAVFs have also been preliminarily explored.ConclusionsWith over 1100 patients, DREAM-INI represents a large and relatively well-documented registry of DAVF patient data in China and even globally. This database will enable numerous future studies, further advancing our understanding of this rare disease.
Purple urine bag syndrome: case series
Authors: Joseph Jewell , Sundararaj Jenifer Jeba , Shekinah Susan , Murali Shakila , Gladys Anitha , Kandaswamy Ramu 
Published: February 2025

Purple urine bag syndrome is an uncommon condition that occurs in patients with long-standing indwelling urinary catheters, due to urinary tract infection (UTI) by bacteria producing sulfatase or phosphatase enzymes. This results in the formation of the pigments indigo (blue) and indirubin (red), together providing a purple appearance to urine. Management includes a change of catheter and appropriate antibiotics. Although prognosis is usually favourable, rare incidences of complications like Fournier’s gangrene have been reported.We report three patients who developed purple urine bag syndrome: a man in his late 50s, a woman in her early 30s and a woman in her early 70s, who were on home-based care with regular home visits by the specialist palliative care team. None of them had any other signs or symptoms suggestive of UTIs. Their urinary catheters and collection bags were changed and proper catheter care was reinforced. All three patients were given antibiotics based on urine culture and sensitivity results. Following the same, urine colour reverted to normal in all patients and none of them had any recurrence.We would like to underline the importance of identifying purple urine bag syndrome as an indicator of underlying UTI, especially in palliative care settings, where patients may not manifest the classical signs and symptoms of UTI. We also would like to highlight the importance of patient and caregiver education on proper catheter care for prevention.
Empowering recovery: a remote spirometry system and mobile app for monitoring and promoting pulmonary rehabilitation in patients with rib fracture
Authors: Liao Chien-An , Young Tai-Horng , Kuo Ling-wei , Fu Chih-Yuan , Chen Szu-An , Tee Yu-San , Kang Shih-Ching , Cheng Chi-Tung , Liao Chien-Hung 
Published: February 2025

BackgroundMultiple rib fractures commonly result from blunt chest trauma. These fractures can lead to prolonged impairment in pulmonary function and often require long-term rehabilitation. This pilot study aimed to evaluate the feasibility of a remote spirometry device for continuous monitoring of lung function in patients with multiple rib fractures.MethodsBetween January 2021 and April 2021, we implemented a remote spirometry system for adult patients with multiple rib fractures and collected their clinical data. We used a Restart system to monitor the respiratory parameters of patients. This system included a wireless spirometer and a Healthy Lung mobile application. A portable spirometer was used to measure forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume in 1 second.ResultIn total, 21 patients were included in this study. We categorized the participants into two age groups: those older and those younger than 65 years. No significant differences were observed between the two groups regarding demographic characteristics or device adoption rates. However, we observed that patients under 65 years demonstrated more remarkable improvement in pulmonary function than their older counterparts, with significant differences in FVC (110% vs 10%, p=0.032) and PEF (64.2% vs 11.9%, p=0.003).ConclusionThe adoption of the remote spirometry device is similar between older and younger patients with rib fractures. However, the device improves pulmonary function more in patients in a younger age group. This tool may be effective as a real-time, continuous pulmonary function monitoring system for patients with multiple rib fractures.Level of evidenceLevel IV.
Early Complications After Mild to Moderate Ischemic Stroke and Impact on 3‐Month Outcome: The Multicenter Prospective Stroke Unit Plus Cohort Study
Authors: Sobesky Jan , Madai Vince Istvan , Zweynert Sarah , Malsch Carolin , Nabavi Darius Guenther , Audebert Heinrich J. , Kleinschnitz Christoph , Mackert Bruno Marcel , Schmitz Bettina , Wollenweber Frank Arne , Haeusler Karl Georg , Wellwood Ian , Wiedmann Silke , Endres Matthias , Dirnagl Ulrich , Meisel Andreas , Heuschmann Peter Ulrich 
Published: February 2025

Background
Early stroke complications (ESCs) impair recovery and provide an important therapeutic target. Our multicenter prospective cohort study examined the prevalence and amount of poor outcomes attributable to ESCs.

Methods and Results
In patients with stroke, 16 ESCs were monitored by clinical assessment (“basic definition”) and by inclusion of laboratory values and clinical scales (“extended definition”). The association of complications with poor outcome (death or functional impairment: modified Rankin Scale score >3 or Barthel Index <60) at 3 months was analyzed using multiple logistic regression adjusted for stroke severity, age, and sex. Complications were stratified by their early treatment options, and average sequential population‐attributable fractions were estimated for treatable early complications. Of 1202 patients, outcome data were available for 1105 (91.9%; 43.0% women; mean age 68.3 years; baseline median National Institutes of Health Stroke Scale score on admission 3 points). Poor outcome was recorded for 100 patients (9.0%). By basic definition, recurrent stroke, fever, pneumonia, depression, urinary tract infection, and delirium were significantly associated with poor outcomes. The occurrence of 1 or more of these ESCs was associated with up to 19.6% of poor outcomes. By extended definition, urinary tract infection, depression, and delirium were significantly associated with poor outcomes. The occurrence of 1 or more of these ESCs was associated with up to 15.9% of poor outcomes.

Conclusions
In our cohort of patients with mild to moderate stroke, we identified a set of treatable ESCs with clinically relevant impact on outcome that may be targeted in future interventional trials.

Registration

URL:
https://www.bfarm.de
; Unique identifier: DRKS00004712.
One‐Year Functional Outcome of Patients After Surgery for Acute Stanford Type A Aortic Dissection
Authors: Yildiz Murat , Nucera Maria , Mosbahi Selim , Münker Kai , Kapkin Cem , Jungi Silvan , Siepe Matthias , Schoenhoff Florian 
Published: February 2025

Background
Our aim was to report the functional outcome of Stanford type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.

Methods and Results

This is a retrospective analysis including 642 patients with TAAD from January 2005 to December 2021. Mean age at TAAD was 62 years (95% CI, 61–63), and 30% of the population were women. One year after surgery for TAAD, 75% of patients were living at home with New York Heart Association functional class I. No patients were observed with New York Heart Association functional class IV. Less than 2% resided in an assisted‐living facility. Eighty‐five percent of nonretired patients had returned to work. Two hundred twelve (33%) patients were retired after 1 year at a mean age of 73 years (95% CI, 72–74). Stroke (defined as any kind of neurological symptoms) occurred in 148 (23%) patients and was the cause of death in 33 patients. Of the remaining patients with stroke, 115 (30%) had no residual limitations 1 year after TAAD. The cross‐clamp time was significantly higher in patients with stroke (98 minutes [95% CI, 94.0–101.1] in patients without stroke versus 106 minutes [95% CI, 98.5–114.1] in patients with stroke;
P
=0.026). Sixty‐nine percent of patients with stroke lived at home, 28% lived at home with support, and 3% lived in an assisted‐living facility. One year after stroke, 77% of the patients achieved a modified Rankin Scale score ≤2, whereas no patient had a modified Rankin Scale score of 5. There was no significant correlation between sex and recovery rate (
P
=0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted‐living facility or receiving support at home 1 year after TAAD (odds ratio, 9.46 [95% CI, 5.06–17.70];
P
<0.001). Thirty‐day mortality was 11.8%, and 92 patients (14%) died within the first year after TAAD. There was no significant sex difference in mortality (
P
=0.101).

Conclusions
One year after surgery for Stanford acute type A aortic dissection, almost 3 out of 4 patients lived unassisted at home. Stroke survivors have a favorable outcome, with the majority having mild or no residual neurological deficits at 1 year.
Fabry Cardiomyopathy: Myocardial Fibrosis, Inflammation, and Down‐Regulation of Mannose‐6‐Phosphate Receptors Cause Low Accessibility to Enzyme Replacement Therapy
Authors: Frustaci Andrea , Verardo Romina , Magnocavallo Michele , Frustaci Emanuela , Russo Matteo Antonio , Chimenti Cristina 
Published: February 2025

Background
The clinical impact of enzyme replacement therapy on advanced Fabry disease cardiomyopathy appears to be limited. The pathologic mechanisms involved are still unclear.

Methods and Results
Ten male patients with advanced Fabry disease cardiomyopathy on enzyme replacement therapy, whose disease progressed from maximal wall thickness of 15.4±2.2 to 19.3±2.1 mm in 8.6±1.4 years of follow‐up, underwent left ventricular endomyocardial biopsy before and 4 hours after β‐agalsidase infusion (1 mg/kg). Comparative studies between pre‐ and postinfusion samples included the following: histology, electron microscopy and assessment of myocardial α‐galactosidase A activity; immunohistochemistry for α‐galactosidase A and semiquantitative evaluation (from 0 to 3) of its cardiomyocyte content; and ultrastructural immunogold analysis with anti‐α‐galactosidase A ab; and Western blot quantification of mannose‐6‐phosphate receptors. Controls were surgical biopsies from patients with mitral stenosis. Histologic and ultrastructural evaluation showed myocarditis in 7 of 10 patients, There was no removal of storage material while myocardial fibrosis was 9.8%±6.8% versus 3.8%±2.0% of controls. At ultrastructural immunogold analysis, myocardial α‐galactosidase A activity increased in postinfusion samples by overall 1.89‐fold. Alpha‐galactosidase A immunostaining in cardiomyocytes was absent at baseline in all patients and did not significantly improve in postinfusion samples. Immunogold particles increased by 1.33‐fold (17.6±3.6 preinfusion versus 21.5±5.9 postinfusion), remaining far from normal controls (86.9±6.6). Protein analysis showed mannose‐6‐phosphate receptors to be 81% lower than in a normal heart.

Conclusions
In spite of enzyme delivery to cardiac tissue, our study shows a low accessibility to enzyme replacement therapy of cardiomyocytes affected by advanced Fabry disease cardiomyopathy. It is sustained by myocardial fibrosis, inflammation, and severe down‐regulation of mannose‐6‐phosphate receptors.
Spatial Correlates of Dementia and Disability After Intracerebral Hemorrhage
Authors: Chen Yutong , Rivier Cyprien A. , Mora Samantha A. , Torres Lopez Victor , Payabvash Sam , Sheth Kevin , Harloff Andreas , Falcone Guido J. , Rosand Jonathan , Mayerhofer Ernst , Anderson Christopher D. 
Published: February 2025

Background
Dementia and disability are highly prevalent after spontaneous intracerebral hemorrhage (ICH). Previous studies categorizing ICH by large anatomic boundaries have demonstrated that lobar ICH is associated with dementia, while ICH in the basal ganglia is associated with disability. This study aims to refine our understanding of the association between ICH location and post‐ICH dementia and disability at a voxel level, which could improve the prognostic accuracy of these outcomes and provide mechanistic insights into post‐ICH functional outcomes.

Methods and Results

In this cohort study, we segmented the ICH lesions from the noncontrast computed tomography scans from 882 patients from the MGH‐ICH (Massachusetts General Hospital ICH Study) as the discovery data set and from 146 patients from the Yale‐ICH cohort as the validation data set. Using electronic health records and follow‐up telephone interviews, incident dementia (
International Classification of Diseases
,
Ninth Revision
[
ICD‐9
] codes of dementia or modified telephone interview for cognitive status <20) and disability (modified Rankin Scale score >2) were identified. The median follow‐up times of the MGH‐ICH and Yale‐ICH cohorts were 2.9 (interquartile range, 1.0–5.8) years and 1.0 (interquartile range, 0.6–1.0) years, respectively. Two techniques of lesion symptom mapping were applied on the ICH lesions: sparse canonical correlation analysis for neuroimaging and voxel‐based lesion symptom mappings. Dementia conversion after ICH was associated with ICH in the left temporo‐occipital region (mean hazard ratio [HR], 3.62 [95% CI, 2.71–4.63]) and left superior longitudinal fasciculus (mean HR, 2.91 [95% CI, 2.40–3.52]). Development of disability after ICH was linked to the right cerebral peduncle (mean HR, 3.10 [95% CI, 2.44–3.94]), right pallidum (mean HR, 2.96 [95% CI, 1.99–4.25]), and right posterior limb of the internal capsule (mean HR, 2.54 [95% CI, 1.88–3.96]).

Conclusions
Specific distribution of ICH lesions is linked to development of dementia and disability after ICH. These insights have the potential to enhance clinical prognostic models for patients with ICH, facilitating more precise predictions of outcomes based on hemorrhage location.