bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transbronchial cryoablation in peripheral lung parenchyma with a novel thin cryoprobe and initial clinical testing
Authors: Gu Chuanjia , Yuan Haibin , Yang Chi , Xie Fangfang , Chen Junxiang , Zhu Lei , Jiang Yifeng , Sun Jiayuan 
Published: January 2024

BackgroundTransbronchial cryoablation shows potential as a local therapy for inoperable peripheral lung cancer. However, its clinical application for peripheral pulmonary lesions has not been reported yet.MethodsAn improved cryoprobe with an 8-mm-long, 1.9-mm-wide cryotip was used. Initially, the safety and effectiveness of this cryoprobe were assessed in an in vivo porcine model. Transbronchial cryoablation with 2 or 3 freeze-thaw cycles (10 min or 15 min in each freezing time) was performed in 18 pigs under CT monitoring. Radiological and pathological examinations were performed to evaluate the extent of cryoablation. Subsequently, nine patients with stage IA peripheral lung cancer or metastases underwent transbronchial cryoablation with this cryoprobe under the guidance of navigation bronchoscopy and cone-beam CT. Technical success, safety and outcomes were assessed.Results36 cryoablation procedures were performed successfully without any major complications in the porcine model. The extent of cryoablation increased with freezing time and the number of freeze-thaw cycles, which peaked at 24 hours and then gradually decreased. Pathological results showed a change from massive haemorrhage at 24 hours to fibrous hyperplasia with chronic inflammation after 4 weeks. In the clinical trial, 10 cryoablations were performed on 9 tumours with a technical success rate of 100%. One mild treatment-related complication occurred. Of the nine tumours, seven achieved complete ablation, while two exhibited incomplete ablation and subsequent local progression at 6 months.ConclusionOur initial experience indicated that transbronchial cryoablation was a safe and feasible procedure for non-surgical peripheral stage IA lung cancer or pulmonary metastases.Trial registration numberChiCTR2200061544.
Exact massless scalar quasibound states of the Ernst black hole
Authors: Senjaya David 
Published: January 2024

AbstractIn this work, we present a detailed derivation of novel exact massless scalar quasibound state a static magnetized Ernst black hole background. We successfully solve the governing covariant Klein–Gordon equation and discover the exact radial solutions in terms of the Confluent Heun functions. With the exact radial wave solution in hand, applying its polynomial condition leads to the discovery of the quantized energy levels expression that depends on the black hole’s mass M, magnetic field strength $$B_0$$

B
0

and also the magnetic and main quantum number $$(m_\ell , n).$$

(

m
ℓ

,
n
)
.

A massive scalar field around the black hole has complex valued energy levels while massless particle has purely imaginary energy levels. Further investigation in small black hole limit and zero magnetic field, the massless scalar’s purely imaginary energy expression is recovered. We also discover the equivalence between massless scalar field around an Ernst black hole with massive scalar field around a Schwarzschild black hole. In the last section, the Hawking radiation in investigated and applying the Damour–Ruffini method, the Hawking temperature is obtained out of the radiation distribution function.
Rcmp: Reconstructing RDMA-Based Memory Disaggregation via CXL
Authors: Wang Zhonghua , Guo Yixing , Lu Kai , Wan Jiguang , Wang Daohui , Yao Ting , Wu Huatao 
Published: January 2024

Memory disaggregation is a promising architecture for modern datacenters that separates compute and memory resources into independent pools connected by ultra-fast networks, which can improve memory utilization, reduce cost, and enable elastic scaling of compute and memory resources. However, existing memory disaggregation solutions based on remote direct memory access (RDMA) suffer from high latency and additional overheads including page faults and code refactoring. Emerging cache-coherent interconnects such as CXL offer opportunities to reconstruct high-performance memory disaggregation. However, existing CXL-based approaches have physical distance limitation and cannot be deployed across racks.In this article, we propose Rcmp, a novel low-latency and highly scalable memory disaggregation system based on RDMA and CXL. The significant feature is that Rcmp improves the performance of RDMA-based systems via CXL, and leverages RDMA to overcome CXL’s distance limitation. To address the challenges of the mismatch between RDMA and CXL in terms of granularity, communication, and performance, Rcmp (1) provides a global page-based memory space management and enables fine-grained data access, (2) designs an efficient communication mechanism to avoid communication blocking issues, (3) proposes a hot-page identification and swapping strategy to reduce RDMA communications, and (4) designs an RDMA-optimized RPC framework to accelerate RDMA transfers. We implement a prototype of Rcmp and evaluate its performance by using micro-benchmarks and running a key-value store with YCSB benchmarks. The results show that Rcmp can achieve 5.2× lower latency and 3.8× higher throughput than RDMA-based systems. We also demonstrate that Rcmp can scale well with the increasing number of nodes without compromising performance.
Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study
Authors: Pavlovic Noelle , Ndumele Chiadi E. , Abshire Saylor Martha , Szanton Sarah L. , Lee Christopher S. , Shah Amil M. , Chang Patricia P. , Florido Roberta , Matsushita Kunihiro , Himmelfarb Cheryl , Leoutsakos Jeannie Marie 
Published: January 2024

BACKGROUND:
Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes.

METHODS:
We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011–2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression.

RESULTS:
Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue.

CONCLUSIONS:
We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
Role of Biomarkers of Myocardial Injury to Predict Adverse Outcomes in Hypertrophic Cardiomyopathy
Authors: Zhang Yu , Liu Minghao , Zhang Channa , Zou Yubao , Kang Lianming , Song Lei 
Published: January 2024

BACKGROUND:
Serum troponins and CK-MB (creatine kinase-MB) are readily detectable and reliable cardiac-specific biomarkers of subclinical myocardial injury. This study explores the roles of cTnI (cardiac troponin I) and CK-MB in hypertrophic cardiomyopathy (HCM).

METHODS:
This study included 1045 patients with HCM who had baseline cTnI and CK-MB measurements at Fuwai Hospital between 1999 and 2019. Patients were excluded if they had undergone percutaneous coronary intervention or coronary artery bypass grafting, or had renal failure. Five end points were studied: all-cause death, cardiovascular death, noncardiovascular death, sudden cardiac death, and other cardiovascular death. Cox regression was used to assess the associations of cTnI and CK-MB levels with outcomes.

RESULTS:

Nine hundred seventy patients with available follow-up data were finally analyzed (mean age, 49.3 years; 36.4% female). During the median 4.3-year follow-up period, 87 patients reached the end points. Higher cTnI (per 0.05 ng/mL increase) and CK-MB (per 1 IU/L increase) levels were associated with increased risks of all-cause death (cTnI: adjusted hazard ratio [HR], 1.038,
P
<0.001; CK-MB: adjusted HR, 1.021,
P
=0.004), cardiovascular death (cTnI: adjusted HR, 1.040,
P
<0.001; CK-MB: adjusted HR, 1.025,
P
=0.006), and sudden cardiac death (cTnI: adjusted HR, 1.045,
P
<0.001; CK-MB: adjusted HR, 1.032,
P
=0.001). Patients with elevated levels of both cTnI and CK-MB had worse prognoses than patients with an elevated level of either biomarker alone and patients who did not have an elevated level of either biomarker. Addition of the binary indicator elevation of both cTnI and CK-MB significantly improved the discrimination and reclassification abilities of the standard HCM Risk- sudden cardiac death model (C statistics:
P
=0.002; net reclassification improvement, 0.652; integrated discrimination improvement, 0.064).

CONCLUSIONS:
Comprehensive evaluations of biomarkers of myocardial injury, cTnI and CK-MB, have considerable value for predicting adverse outcomes among patients with HCM. Routine cTnI and CK-MB assessments may help to guide implantable cardioverter defibrillator implantation for primary prevention in HCM.
Atlas of Cell Repertoire Within Neointimal Lesions Is Metabolically Altered in Hypertensive Rats
Authors: Sun Xiaolei , Wu Junru , Zhang Xiaolin , Xie Cheng , Wei Haijun , Li Pengyun , Yang Yan , Yuan Hong , Cai Jingjing , Xiao Qingzhong , Cheng Jun , Xu Qingbo 
Published: January 2024

BACKGROUND:
High blood pressure has been suggested to accelerate vascular injury-induced neointimal formation and progression. However, little is known about the intricate relationships between vascular injury and hypertension in the context of arterial remodeling.

METHODS:
Single-cell RNA-sequencing analysis was used to depict the cell atlas of carotid arteries of Wistar Kyoto rats and spontaneously hypertensive rats with or without balloon injury.

RESULTS:
We found that hypertension significantly aggravated balloon injury-induced arterial stenosis. A total of 36 202 cells from carotid arteries with or without balloon injury were included in single-cell RNA-sequencing analysis. Cell composition analysis showed that vascular injury and hypertension independently induced distinct aortic cell phenotypic alterations including immune cells, endothelial cells (ECs), and smooth muscle cells. Specifically, our data showed that injury and hypertension-induced specific EC phenotypic alterations, and revealed a transition from functional ECs to hypermetabolic, and eventually dysfunctional ECs in hypertensive rats upon balloon injury. Importantly, our data also showed that vascular injury and hypertension-induced different smooth muscle cell phenotypic alterations, characterized by deferential expression of synthetic signatures. Interestingly, pathway analysis showed that dysregulated metabolic pathways were a common feature in monocytes/macrophages, ECs, and smooth muscle cells in response to injury and hypertension. Functionally, we demonstrate that inhibition of mitochondrial respiration significantly ameliorated injury-induced neointimal formation in spontaneously hypertensive rats.

CONCLUSIONS:
This study provides the cell landscape changes of the main aortic cell phenotypic alterations in response to injury and hypertension. Our findings suggest that targeting cellular mitochondrial respiration could be a novel therapeutic for patients with hypertension undergoing vascular angioplasty.
Treatment Variability Among Patients Hospitalized for Chronic Limb‐Threatening Ischemia: An Analysis of the 2016 to 2018 US National Inpatient Sample
Authors: Foley Katelyn M. , Kennedy Kevin F. , Lima Fabio V. , Secemsky Eric A. , Banerjee Subhash , Goodney Philip P. , Shishehbor Mehdi H. , Soukas Peter A. , Hyder Omar N. , Abbott J. Dawn , Aronow Herbert D. 
Published: January 2024

Background
Little is known about treatment variability across US hospitals for patients with chronic limb‐threatening ischemia (CLTI).

Methods and Results
Data were collected from the 2016 to 2018 National Inpatient Sample. All patients aged ≥18 years, admitted to nonfederal US hospitals with a primary diagnosis of CLTI, were identified. Patients were classified according to their clinical presentation (rest pain, skin ulceration, or gangrene) and were further characterized according to the treatment strategy used. The primary outcome of interest was variability in CLTI treatment, as characterized by the median odds ratio. The median odds ratio is defined as the likelihood that 2 similar patients would be treated with a given modality at 1 versus another randomly selected hospital. There were 15 896 (weighted n=79 480) hospitalizations identified where CLTI was the primary diagnosis. Medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, and amputation alone were used in 4057 (25%), 5390 (34%), 3733 (24%), and 2716 (17%) patients, respectively. After adjusting for both patient‐ and hospital‐related factors, the median odds ratio (95% CI) for medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, any revascularization, and amputation alone were 1.28 (1.19–1.38), 1.86 (1.77–1.95), 1.65 (1.55–1.74), 1.37 (1.28–1.45), and 1.42 (1.27–1.55), respectively.

Conclusions
Significant variability in CLTI treatment exists across US hospitals and is not fully explained by patient or hospital characteristics.
Atherosclerosis and Hippocampal Volumes in Older Adults: The Role of Age and Blood Pressure
Authors: Kapasi Alifiya , Capuano Ana W. , Lamar Melissa , Leurgans Sue E. , Evia Arnold M. , Bennett David A. , Arfanakis Konstantinos , Schneider Julie A. 
Published: January 2024

Background

Lower hippocampal volume is associated with late‐life cognitive decline and is an important, but nonspecific marker for clinical Alzheimer's dementia. Cerebrovascular disease may also be associated with hippocampal volume. Here we study the role of intracranial large vessel disease (atherosclerosis) in association with hippocampal volume and the potential role of age, average late‐life blood pressure across all visits, and other factors (sex, apolipoprotein ε4 [
APOE
ε4], and diabetes).

Methods and Results

Data came from 765 community‐based older people (91 years old on average at death; 72% women), from 2 ongoing clinical‐pathologic cohort studies. Participants completed baseline assessment, annual standardized blood pressure measurements, vascular risk assessment for diabetes, and blood draws to determine
APOE
genotype, and at death, brains were removed and underwent ex vivo magnetic resonance imaging and neuropathologic evaluation for atherosclerosis pathology and other cerebrovascular and neurodegenerative pathologies. Linear regression models examined the association of atherosclerosis and hippocampal to hemisphere volume ratio and whether age at death, blood pressure, and other factors modified associations. In linear regression models adjusted for demographics and neurodegenerative and other cerebrovascular pathologies, atherosclerosis severity was associated with a lower hippocampal to hemisphere volume ratio. In separate models, we found the effect of atherosclerosis on the ratio of hippocampal to hemisphere volume was attenuated among advanced age at death or having higher systolic blood pressure (interaction terms
P
≤0.03). We did not find confounding or interactions with sex, diabetes, or
APOE
ε4.

Conclusions
Atherosclerosis severity is associated with lower hippocampal volume, independent of neurodegenerative and other cerebrovascular pathologies. Higher systolic blood pressures and advanced age attenuate associations.
Microvascular Dysfunction and Whole‐Brain White Matter Connectivity: The Maastricht Study
Authors: Beran Magdalena , van Gennip April C.E. , Stehouwer Coen D.A. , Jansen Jacobus F.A. , Gupta Monideepa D. , Houben Alfons J.H.M. , Berendschot Tos T.J.M. , Webers Carroll A.B. , Wesselius Anke , Schalkwijk Casper G. , Backes Walter H. , de Jong Joost J.A. , van der Kallen Carla J.H. , van Greevenbroek Marleen M.J. , Köhler Sebastian , Vonk Jet M.J. , Geerlings Mirjam I. , Schram Miranda T. , van Sloten Thomas T. 
Published: January 2024

Background
Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole‐brain white matter connectivity.

Methods and Results
Cross‐sectional data from The Maastricht Study, a Dutch population‐based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light–induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule‐1, vascular cell adhesion molecule‐1, E‐selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017–0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures.

Conclusions
These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole‐brain white matter connectivity.
Cholesterol Crystal Dissolution Rate of Serum Predicts Outcomes in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Al‐Kassou Baravan , Al‐Kassou Lara , Mahn Thorsten , Lütjohann Dieter , Shamekhi Jasmin , Willemsen Nicola , Niepmann Sven Thomas , Baldus Stephan , Kelm Malte , Nickenig Georg , Latz Eicke , Zimmer Sebastian 
Published: January 2024

Background
Aortic stenosis has pathophysiological similarities with atherosclerosis, including the deposition of cholesterol‐containing lipoproteins. The resulting cholesterol crystals activate the NLRP3 (NOD‐like receptor protein 3) inflammasome, leading to inflammation and cardiovascular diseases. We aimed to investigate the cholesterol crystal dissolution rate (CCDR) of serum in patients with aortic stenosis and to assess the prognostic value of this biomarker.

Methods and Results

The study included 348 patients with aortic stenosis undergoing transcatheter aortic valve replacement. The CCDR was measured using flow cytometry to enumerate cholesterol crystals that were added to a serum solution, at baseline and after 2 hours of incubation. Based on the median CCDR, the cohort was stratified into high and low cholesterol crystal dissolvers. The incidence of the primary end point, a composite of 1‐year all‐cause mortality and major vascular complication, was significantly lower in the high CCDR group (7.3 per 100 person‐years) compared with the low CCDR group (17.0 per 100 person‐years,
P
=0.01). This was mainly driven by a lower 1‐year mortality rate in patients with a high CCDR (7.3 versus 15.1 per 100 person‐years,
P
=0.04). Unplanned endovascular interventions were significantly less frequent in high cholesterol crystal dissolvers (12.8 versus 22.6 per 100 person‐years,
P
=0.04). Although low‐density lipoprotein cholesterol levels were comparable in both groups (101.8±37.3 mg/dL versus 97.9±37.6 mg/dL,
P
=0.35), only patients with a low CCDR showed a benefit from statin treatment. In multivariate analysis, low CCDR (hazard ratio, 2.21 [95% CI, 0.99–4.92],
P
=0.04) was significantly associated with 1‐year mortality.

Conclusions
The CCDR is a novel biomarker associated with outcome in patients with aortic stenosis undergoing transcatheter aortic valve replacement. It may provide new insights into patients' anti‐inflammatory capacity and additional prognostic information beyond classic risk assessment.
Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock
Authors: Jentzer Jacob C. , Drakos Stavros G. , Selzman Craig H. , Owyang Clark , Teran Felipe , Tonna Joseph E. 
Published: January 2024

Background
Venoarterial extracorporeal membrane oxygenation (ECMO) provides full hemodynamic support for patients with cardiogenic shock, but optimal timing of ECMO initiation remains uncertain. We sought to determine whether earlier initiation of ECMO is associated with improved survival in cardiogenic shock.

Methods and Results

We analyzed adult patients with cardiogenic shock who received venoarterial ECMO from the international Extracorporeal Life Support Organization (ELSO) registry from 2009 to 2019, excluding those cannulated following an operation. Multivariable logistic regression evaluated the association between time from admission to ECMO initiation and in‐hospital death. Among 8619 patients (median, 56.7 [range, 44.8–65.6] years; 33.5% women), the median duration from admission to ECMO initiation was 14 (5–32) hours. Patients who had ECMO initiated within 24 hours (n=5882 [68.2%]) differed from those who had ECMO initiated after 24 hours, with younger age, more preceding cardiac arrest, and worse acidosis. After multivariable adjustment, patients with ECMO initiated >24 hours after admission had higher risk of in‐hospital death (adjusted odds ratio, 1.20 [95% CI, 1.06–1.36];
P
=0.004). Each 12‐hour increase in the time from admission to ECMO initiation was incrementally associated with higher adjusted in‐hospital mortality rate (adjusted odds ratio, 1.06 [95% CI, 1.03–1.10];
P
<0.001). The association between longer time to ECMO and worse outcomes appeared stronger in patients with lower shock severity.

Conclusions
Longer delays from admission to ECMO initiation were associated with higher a mortality rate in a large‐scale, international registry. Our analysis supports optimization of door‐to‐support time and the avoidance of inappropriately delayed ECMO initiation.