bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-tumor Necrosis Factor Alpha Versus Corticosteroids: A 3-fold Difference in the Occurrence of Venous Thromboembolism in Inflammatory Bowel Disease－A Systematic Review and Meta-analysis
Authors: Székely Hajnal , Tóth Laura Mária , Rancz Anett , Walter Anna , Farkas Nelli , Sárközi Miklós Domonkos , Váncsa Szilárd , Erőss Bálint , Hegyi Péter , Miheller Pál 
Published: November 2023

Abstract

Background and Aims
Patients with inflammatory bowel disease [IBD] have a more than two fold higher risk of venous thromboembolic events [VTE] than the general population. The aetiology is complex, and the role of medication is not precisely defined. We aimed to assess the effects of anti-tumor necrosis factor alpha [anti-TNFα] drugs and conventional anti-inflammatory therapy, namely corticosteroids [CS], immunomodulators [IM], and 5-aminosalicylates [5-ASA] on VTE in IBD.

Methods
A systematic search was performed in five databases on November 22, 2022. We included studies reporting VTE in the distinct categories of medications, determined the proportions, and calculated the odds ratios [OR] with 95% confidence intervals [CI], using the random-effects model. The risk of bias was evaluated with the Joanna Briggs Institute Critical Appraisal Checklist and the Risk of Bias in Non-randomized Studies of Interventions tool.

Results
The quantitative analysis included 16 observational studies, with data from 91 322 IBD patients. Patients receiving anti-TNFα medication had significantly less VTE [proportion: 0.05, CI: 0.02–0.10], than patients treated with CS [proportion: 0.16, CI: 0.07–0.32], with OR = 0.42 [CI: 0.25–0.71]. IMs resulted in similar proportions of VTE compared with biologics [0.05, CI: 0.03–0.10], with OR = 0.94 [CI: 0.67–1.33]. The proportion of patients receiving 5-ASA having VTE was 0.09 [CI: 0.04–0.20], with OR = 1.00 [CI: 0.61–1.62].

Conclusions
Biologics should be preferred over corticosteroids in cases of severe flare-ups and multiple VTE risk factors, as they are associated with reduced odds of these complications. Further studies are needed to validate our data.
Veno-arterial extracorporeal membrane oxygenation as a perioperative support to redo cardiac surgery for inoperable adult patients: a case series
Authors: Peña Alvaro Diego , Moreno-Angarita Alejandro , Estacio Mayra , Bautista Diego Fernando , Quintero Ivan Fernando , Olaya Stephany , Cadavid Eduardo Alberto 
Published: November 2023

Abstract

Background
The present article describes three cases of patients in cardiogenic shock (CS) with previous cardiac surgery that made them initially inoperable. Perioperative support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) improved haemodynamic status and results in these high-risk patients.

Case summary
Case 1 is a 57-year-old male morbidly obese with previous aortic valve replacement (AVR) who presented with chest pain and developed cardiac arrest. Cardiopulmonary resuscitation and femoral VA-ECMO were initiated. Three days later, a redo AVR was performed. Veno-arterial extracorporeal membrane oxygenation was maintained for 12 days, followed by 7 days of veno-venous ECMO for complete recovery. Case 2 features a 39-year-old male with two previous mitral valve replacements (MVRs). The first is due to papillary muscle rupture, and the second is due to endocarditis of the mitral prosthesis. He presented with CS and pulmonary oedema. Emergency surgery was performed and the patient was then placed in VA-ECMO. Weaning off was achieved 3 days after surgery. Case 3 is a 21-year-old female with a previous MVR due to rheumatic disease. She presented with CS, severe mitral prosthesis stenosis, and a pulmonary embolism. Femoral VA-ECMO was initiated, and one day later, she underwent a redo MVR operation. Extracorporeal membrane oxygenation was discontinued 4 days later.

Discussion
Dysfunctional prosthetic valves leading to CS may benefit from a redo cardiac operation supported by a perioperative VA-ECMO to optimize haemodynamic status. Despite the results from risk prediction scores, this approach has the potential to reduce operative mortality in initial inoperable patients and allow a definitive redo cardiac surgery.
An interesting observation: prolonged green urine can be a combined effect of decreased liver and renal function in a patient with heart failure—a case report
Authors: Çöllüoğlu Tuğçe , Aksu Melahat Hicran , Önalan Orhan , Akın Yeşim 
Published: November 2023

Abstract

Background
The administration of propofol and methylene blue (MB) can be associated with the appearance of prolonged green urine discoloration, particularly in patients with heart failure (HF) concomitant with renal and liver dysfunction. Understanding the reasons behind this phenomenon is of clinical significance.

Case summary
A 79-year-old woman with a history of HF experienced dyspnoea and persistent green urine discoloration for a week, leading to her hospitalization for acutely decompensated HF. A recent dual-chamber rate-modulated-pacemaker implantation had necessitated propofol sedation and the administration of 100 mg of MB due to methaemoglobinaemia. Upon admission, the patient exhibited elevated levels of brain natriuretic peptide (BNP) and liver function tests, as well as a significant decrease in glomerular filtration rate (GFR). Initial therapy with intravenous furosemide yielded an inadequate response, requiring the initiation of combined diuretic therapy (CDT). The patient's condition improved with CDT, resulting in the normalization of BNP, liver function tests, and GFR, along with the restoration of normal urine colour lasting 12 days.

Discussion
Our case report sheds light on the complex interaction between drug metabolic pathways and their potential for prolonged side effects, particularly in patients with multiorgan dysfunction. The association between propofol, MB, and green urine discoloration in the context of HF warrants further investigation, emphasizing the need for increased awareness of drug interactions and their implications in complex clinical scenarios.
The Effect of Posterior Pericardiotomy on the Incidence of Atrial Fibrillation After Cardiac Surgery–Extended Follow-Up study (PALACS-EF): rationale and design
Authors: Gaudino Mario , Harik Lamia , Redfors Bjorn , Sandner Sigrid , Alexander John H , Di Franco Antonino , Dimagli Arnaldo , Weinsaft Jonathon , Perezgrovas-Olaria Roberto , Soletti Giovanni Jr , Lau Christopher , Mack Charles , Girardi Leonard 
Published: November 2023

Abstract

Aims
Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery and has been associated with increased postoperative morbidity and hospital costs. The Posterior left pericardiotomy for the prevention of AtriaL fibrillation After Cardiac Surgery (PALACS) trial found that posterior pericardiotomy significantly reduced the incidence of POAF (17% vs. 32%, P &lt; 0.001). We present the protocol for The Effect of Posterior Pericardiotomy on the Incidence of Atrial Fibrillation After Cardiac Surgery–Extended Follow-Up study (PALACS-EF): a prospective, extended follow-up of the original PALACS trial. The aim of PALACS-EF is to gain more data regarding the effect of posterior pericardiotomy on postdischarge clinical outcomes. The primary outcome is the time to the first occurrence of the composite of all-cause mortality or hospital cardiovascular readmission. The key secondary outcome is the time to the first occurrence of the composite of all-cause mortality and all-cause hospital readmission. Hospital readmission, myocardial infarction, stroke, transient ischaemic attack, heart failure, systemic embolism, or new arrhythmias with onset since 30-day follow-up will also be recorded.

Methods and results
All 420 patients enrolled in the PALACS trial will be included; extended follow-up will be conducted via telephone by blinded research personnel utilizing a standardized script to ensure uniformity and completeness of follow-up. If an event has occurred, documentation will be obtained, and an independent adjudication committee blinded to group assignment will adjudicate outcome events. Results will be reported when a median follow-up of 5 years is achieved.

Conclusion
PALACS-EF will provide data to answer the question of whether posterior pericardiotomy improves postdischarge outcomes in patients undergoing cardiac surgery, and it will provide information on the relationship between POAF and adverse postdischarge outcomes including mortality, hospitalization, heart failure, and stroke.

Registration
PALACS: NCT02875405, PALACS-EF: NCT05903222
Repairable ex vivo model of functional and degenerative mitral regurgitation
Authors: Morimura Hayato , Okamoto Yusei , Takada Jumpei , Tabata Minoru , Iwasaki Kiyotaka 
Published: November 2023

Abstract

OBJECTIVES
Transcatheter mitral valve repair is an emerging alternative to the surgical repair. This technology requires preclinical studies to assess efficacy in mitigating mitral regurgitation (MR). However, ex vivo MR models are not established. We developed 2 novel repairable models, functional and degenerative, which can quantitatively assess regurgitation and effect of intervention.

METHODS
We used porcine mitral valves and a pulsatile flow circulation system. In the functional MR model, the annulus was immersed in 0.1% collagenase solution and dilated using 3D-printed dilators. To control the regurgitation grade, the sizes of the dilator and silicone sheet in which the valve was sutured to were adjusted. Chordae of P2 were severed in the degenerative model, and the number of severed chordae was adjusted to control the regurgitation grade. Models were repaired using the edge-to-edge or artificial chordae technique.

RESULTS
The mean regurgitant fraction of the moderate–severe functional and degenerative models were 47.9% [standard deviation (SD): 2.2%] and 58.5% (SD: 8.0%), which were significantly reduced to 28.7% (SD: 4.4%) (P &lt; 0.001) and 26.0% (SD: 4.4%) (P &lt; 0.001) after the valve repair procedures. Severe functional model had a mean regurgitant fraction of 59.4% (SD: 6.0%).

CONCLUSIONS
Both functional and degenerative models could produce sufficient MR levels that meet the interventional indication criteria. The repairable models are valuable in evaluating the efficacy of valve repair procedures and devices. The ability to control the amount of regurgitation enhances the versatility and reliability of these models. These reproducible models could expedite the development of novel devices.
Statistical primer: using prognostic models to predict the future: what cardiothoracic surgery can learn from Strictly Come Dancing
Authors: Mawhinney Jamie A , Mounsey Craig A , O'Brien Alastair , Sádaba J Rafael , Freemantle Nick 
Published: November 2023

Abstract

OBJECTIVES
Prognostic models are widely used across medicine and within cardiothoracic surgery, where predictive tools such as EuroSCORE are commonplace. Such models are a useful component of clinical assessment but may be misapplied. In this article, we demonstrate some of the major issues with risk scores by using the popular BBC television programme Strictly Come Dancing (known as Dancing with the Stars in many other countries) as an example.

METHODS
We generated a multivariable prognostic model using data from the then-completed 19 series of Strictly Come Dancing to predict prospectively the results of the 20th series.

RESULTS
The initial model based solely on demographic data was limited in its predictive value (0.25, 0.22; R2 and Spearman’s rank correlation, respectively) but was substantially improved following the introduction of early judges’ scores deemed representative of whether contestants could actually dance (0.40, 0.30). We then utilize our model to discuss the difficulties and pitfalls in using and interpreting prognostic models in cardiothoracic surgery and beyond, particularly where these do not adequately capture potentially important prognostic information.

CONCLUSION
Researchers and clinicians alike should use prognostic models cautiously and not extrapolate conclusions from demographic data alone.
The genetic basis of apparently idiopathic ventricular fibrillation: a retrospective overview
Authors: Verheul Lisa M , van der Ree Martijn H , Groeneveld Sanne A , Mulder Bart A , Christiaans Imke , Kapel Gijs F L , Alings Marco , Bootsma Marianne , Barge-Schaapveld Daniela Q C M , Balt Jippe C , Yap Sing-Chien , Krapels Ingrid P C , Ter Bekke Rachel M A , Volders Paul G A , van der Crabben Saskia N , Postema Pieter G , Wilde Arthur A M , Dooijes Dennis , Baas Annette F , Hassink Rutger J 
Published: November 2023

Abstract

Aims
During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. The aim of this study was to evaluate genetic testing and its results in idiopathic VF patients.

Methods and results
We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry. Genetic testing was performed in 379 (91%) patients [median age at event 39 years (27–51), 60% male]. Single-gene testing was performed in 87 patients (23%) and was initiated more often in patients with idiopathic VF before 2010. Panel testing was performed in 292 patients (77%). The majority of causal (likely) pathogenic variants (LP/P, n = 56, 15%) entailed the DPP6 risk haplotype (n = 39, 70%). Moreover, 10 LP/P variants were found in cardiomyopathy genes (FLNC, MYL2, MYH7, PLN (two), TTN (four), RBM20), and 7 LP/P variants were identified in genes associated with cardiac arrhythmias (KCNQ1, SCN5A (2), RYR2 (four)). For eight patients (2%), identification of an LP/P variant resulted in a change of diagnosis. In 113 patients (30%), a VUS was identified. Broad panel testing resulted in a higher incidence of VUS in comparison to single-gene testing (38% vs. 3%, P &lt; 0.001).

Conclusion
Almost all patients from the registry underwent, albeit not broad, genetic testing. The genetic yield of causal LP/P variants in idiopathic VF patients is 5%, increasing to 15% when including DPP6. In specific cases, the LP/P variant is the underlying diagnosis. A gene panel specifically for idiopathic VF patients is proposed.
Phage selection drives resistance–virulence trade-offs in Ralstonia solanacearum plant-pathogenic bacterium irrespective of the growth temperature
Authors: Wang Jianing , Wang Xiaofang , Yang Keming , Lu Chunxia , Fields Bryden , Xu Yangchun , Shen Qirong , Wei Zhong , Friman Ville-Petri 
Published: November 2023

Abstract
While temperature has been shown to affect the survival and growth of bacteria and their phage parasites, it is unclear if trade-offs between phage resistance and other bacterial traits depend on the temperature. Here, we experimentally compared the evolution of phage resistance–virulence trade-offs and underlying molecular mechanisms in phytopathogenic Ralstonia solanacearum bacterium at 25 °C and 35 °C temperature environments. We found that while phages reduced R. solanacearum densities relatively more at 25 °C, no difference in the final level of phage resistance was observed between temperature treatments. Instead, small colony variants (SCVs) with increased growth rate and mutations in the quorum-sensing (QS) signaling receptor gene, phcS, evolved in both temperature treatments. Interestingly, SCVs were also phage-resistant and reached higher frequencies in the presence of phages. Evolving phage resistance was costly, resulting in reduced carrying capacity, biofilm formation, and virulence in planta, possibly due to loss of QS-mediated expression of key virulence genes. We also observed mucoid phage-resistant colonies that showed loss of virulence and reduced twitching motility likely due to parallel mutations in prepilin peptidase gene, pilD. Moreover, phage-resistant SCVs from 35 °C-phage treatment had parallel mutations in type II secretion system (T2SS) genes (gspE and gspF). Adsorption assays confirmed the role of pilD as a phage receptor, while no loss of adsorption was found with phcS or T2SS mutants, indicative of other downstream phage resistance mechanisms. Additional transcriptomic analysis revealed upregulation of CBASS and type I restriction-modification phage defense systems in response to phage exposure, which coincided with reduced expression of motility and virulence-associated genes, including pilD and type II and III secretion systems. Together, these results suggest that while phage resistance–virulence trade-offs are not affected by the growth temperature, they could be mediated through both pre- and postinfection phage resistance mechanisms.
Marine nitrogen-fixers in the Canadian Arctic Gateway are dominated by biogeographically distinct noncyanobacterial communities
Authors: Robicheau Brent M , Tolman Jennifer , Rose Sonja , Desai Dhwani , LaRoche Julie 
Published: November 2023

Abstract
We describe diazotrophs present during a 2015 GEOTRACES expedition through the Canadian Arctic Gateway (CAG) using nifH metabarcoding. In the less studied Labrador Sea, Bradyrhizobium sp. and Vitreoscilla sp. nifH variants were dominant, while in Baffin Bay, a Stutzerimonas stutzeri variant was dominant. In comparison, the Canadian Arctic Archipelago (CAA) was characterized by a broader set of dominant variants belonging to Desulfobulbaceae, Desulfuromonadales, Arcobacter sp., Vibrio spp., and Sulfuriferula sp. Although dominant diazotrophs fell within known nifH clusters I and III, only a few of these variants were frequently recovered in a 5-year weekly nifH times series in the coastal NW Atlantic presented herein, notably S. stutzeri and variants belonging to Desulfobacterales and Desulfuromonadales. In addition, the majority of dominant Arctic nifH variants shared low similarity (&lt; 92% nucleotide identities) to sequences in a global noncyanobacterial diazotroph catalog recently compiled by others. We further detected UCYN-A throughout the CAG at low-levels using quantitative-PCR assays. Temperature, depth, salinity, oxygen, and nitrate were most strongly correlated to the Arctic diazotroph diversity observed, and we found a stark division between diazotroph communities of the Labrador Sea versus Baffin Bay and the CAA, hence establishing that a previously unknown biogeographic community division can occur for diazotrophs in the CAG.
The response of different-aged saplings to light gradients reveals new insights into the light requirements of an endangered woody plant species, Phoebe chekiangensis
Authors: Zhang Junhong , Xu Wenting , Zhou Shengcai , Liu Qiyan , Yang Qi , Tong Zaikang 
Published: November 2023

Abstract
Phoebe chekiangensis is endemic to China and highly valued for art ware, furniture, and timber architecture, having a special status in Chinese history. Natural sources of P. chekiangensis are being depleted, and the species was listed as ‘VULNERABLE’ on the IUCN Red List of Threatened Species in 1998 (https://www.iucnredlist.org/) due to excessive anthropogenic deforestation and the plant’s weak self-regeneration ability. Most studies have attempted to elucidate this weak natural regeneration by culturing seedlings and community surveys, ignoring the different light requirements of seedlings at distinct ages. In this study, we examined five consecutive age groups of seedlings/saplings with current-year (seedling) and 1–4-year-olds exposed to four shading treatments (100%, 40%, 15%, and 5% of full sunlight) for 2 years, based on a randomized complete block design. Using analysis of variance and Duncan’s multiple comparison, the growth rate, photosynthetic response, photosynthetic pigments, and ultrastructure of chloroplasts were evaluated among the shading treatments. The results show that the light requirements of P. chekiangensis change during the development process. Moderate shading (40% of full sunlight) is beneficial for the early development of Phoebe seedlings, increasing height growth, photosynthetic efficiency, and photosynthetic pigment content and protecting the development of chloroplast structures. However, full exposure to sunlight is necessary for growing saplings (more than 2 years old) to meet the increased energy demands for growth and development. Overall, this study elucidates P. chekiangensis light utilization during the early regeneration phase, informing seedling cultivation activities and the development of silvicultural strategies of this endangered species.
Slip partitioning between subparallel strands of the North Anatolian Fault in the Marmara Region
Authors: Okur Yağızalp , Bulut Fatih , Garagon Aslı 
Published: November 2023

SUMMARY
Marmara Region hosts a substantial part of the inhabitants in Turkey, more than 30 per cent of the total population in the cities of Istanbul, Bursa and Kocaeli. This region has experienced several large earthquakes in the past and is still under threat of destructive earthquakes in the future. There, subparallel strands of the North Anatolian Fault (NAF) expand into the region, distributing the earthquake hazards across the whole region. Thus, it is a key issue to investigate how the tectonic process is distributed between these subparallel strands to discriminate their individual earthquake hazards. In this context, we used GPS slip rates to quantify the slip partitioning of the subparallel strands of the fault system. In addition to available slip rates compiled by Bulut et al. and Kreemer et al., we analysed 71 GPS sites (51 continuous and 20 campaign-based) to intensify the GPS network in the region. GPS observations reveal 81.7, 7.7 and 10.7 per cent slip ratios for northern, middle and southern strands. These ratios are also verified by the time series analysis of continuous GPS stations, leading us to the conclusion that the northern strand of the NAF hosts substantially shorter recurrence periods and, therefore, in the long term, the highest earthquake hazard in the Marmara Region.