bluuebunny/crossref_metadata_2025_split huggingface dataset:
Apolipoprotein C3-rich low-density lipoprotein (AC3RL) increases BBB permeability and deteriorates cerebral ischemic stroke injury
Authors: Tsai P H , Tseng K F , Lin M C , Wang J S , Chang Y H , Chen F Y , Shen M Y 
Published: November 2023

Abstract

Background
Ischaemic stroke causes disability due to brain damage resulting from blood supply obstruction or increased permeability of the blood-brain barrier (BBB) that exposes the blood to toxic substances during reperfusion. Apolipoprotein C3 is a crucial triglyceride transport modulator, and its overexpression raises the risk of dyslipidemia and cardiovascular disease. Clinically, we observed that stroke patients have higher levels of apolipoprotein C3-rich low-density lipoprotein (AC3RL) expression than healthy individuals, and they also have worse prognoses. Simultaneously, we found that an increase in AC3RL is involved in endothelial cell apoptosis and inflammatory response, which may be linked to the occurrence of brain injury after stroke.

Purpose
This study aimed to explore whether the high expression of AC3RL would increase the permeability of the blood-brain barrier, and aggravate brain damage.

Methods
The intraluminal monofilament model of middle cerebral artery occlusion (MCAO) experiment was carried out using C57BL/6 and apolipoprotein E gene knockout mice (ApoE-/-). WT receive an IV injection of AC3RL, which was separate from stroke patients' plasma. APOE-/- was fed a high-fat diet to promote AC3RL higher expression. We performed 60-minute ischaemic and 7-day reperfusion. The modified neurological severity score (mNSS) method was used to assess motor and neurological scores. Evans blue dye was injected through the tail vein one hour before euth
(A) AC3RL, which was separated from stroke patients' plasma. (B) AC3RL concentration in individuals. (C) The white portion of the mice brains TTC stain indicates the site of the injury. (D) Evans blue dye leakage study in mice brains exhibited BBB permeability changes. (E) Assessment of mice's motor and neurological performance using the mNSS. anasia to assess BBB permeability. TTC staining of brain tissue after euthanasia to pinpoint the site of brain damage.

Results
Evans blue dye leakage was observed in the brain tissues of the group with high AC3RL expression, indicating that the BBB permeability has expanded. The mNSS method revealed a significant rise in mice with high levels of AC3RL expression, which suggested a decline in motor and nervous function.

Conclusions
Whether endogenous or exogenous, increased expression of AC3RL leads to more severe cerebral ischemic injury and motor dysfunction, which we believe may be due to increased BBB permeability caused by AC3RL. Therefore, AC3RL can be used as a disease predictor in the future, reducing AC3RL will be the main indicator for reducing severe brain injury.Figure 1.Figure 2.
Long-term incidence of ischemic stroke following transient ischemic attack: a nationwide cohort study during 2014-2020
Authors: Vinding N E , Butt J H , Lauridsen M D , Kristensen S L , Johnsen S P , Kroell J , Graversen P L , Kruuse C , Torp-Pedersen C , Koeber L , Fosboel E L 
Published: November 2023

Abstract

Background
The short-term incidence of ischemic stroke after a transient ischemic attack (TIA) is high. However, data on the long-term incidence are sparse but relevant in order to guide preventive strategies.

Purpose
Estimate 5-year incidence of ischemic stroke after TIA.

Methods
Using the Danish Stroke Registry, patients with first-time TIA during the period September 2014-December 2020 were identified and matched 1:4 with individuals from the background population, and 1:1 with patients with a first-time ischemic stroke, based on age, sex, and calendar year. The cumulative incidences of ischemic stroke and mortality were estimated by the Aalen-Johansen and Kaplan-Meier estimators, respectively, and compared between groups by use of conditional multivariable Cox regression.

Results
After matching, we included 23,244 patients with TIA, 92,976 patients from the background population, and 23,244 patients with ischemic stroke (median age 70 years [25th-75th percentile 60-78]: 53% men). Patients with TIA had more comorbidities than the background population, yet less than the ischemic stroke population. The five-year incidence of ischemic stroke following TIA (6.5% [95% CI 6.1-7.0]) was higher than for the background population (2.3% [95% CI 2.2-2.4], hazard ratio (HR) 3.31 [95% CI 3.04-3.61]), but lower than for the control stroke population (10.3% [95% CI 9.8-10.8], HR 0.60 [95% CI 0.55-0.66]). Five-year mortality for patients with TIA (18.0% [95% CI 17.8-19.1]) was higher than for the background population (15.0% [95% CI 14.7-15.3], HR 1.20 [95% CI 1.14-1.26]), but lower than for the control stroke population (29.9% [95%CI 29.2-30.6], HR 0.41 [95% CI 0.39-0.44]) (Figure 1).

Conclusion
Patients with first-time transient ischemic attach had a 5-year incidence of ischemic stroke of 6.5%. After adjustment for potential confounders, the rate of ischemic stroke was approximately three-fold higher than that of the background population, and 40% lower than that of patients with ischemic stroke.Figure 1.Cumulative incidence of stroke
Risk of delayed intracranial hemorrhage according to antithrombotic treatment in patients with traumatic brain injury: systematic review and meta-analysis
Authors: Cimini L A , Giomi E , Becattini C , Vedovati M C 
Published: November 2023

Abstract

Background
Antithrombotic treatment is a risk factor for the development of delayed (DICH) intracranial hemorrhage after head trauma. However, it is not known whether i) the risk of DICH differs according to antithrombotic treatments and ii) prescription of serial brain-CT after a first normal CT scan is indicated.

Aim
The aims of this study are: i) to evaluate the risk of DICH after traumatic brain injury (TBI) according to different antithrombotic treatments (vitamin K antagonist [VKA], direct oral anticoagulants [DOACs], antiplatelets [AP]); ii) to evaluate the usefulness of serial CT scans vs clinical observation to rule out a DICH.

Methods
Medline and Embase databases were searched from inception up to June 2022 to find studies that met the following characteristics: i) enrolling TBI patients admitted to emergency departments within 24 hours since trauma; ii) enrolling patients were receiving VKA, DOACs or APs at time of TBI; iii) had a normal brain-CT scan at admission. Primary study outcome was DICH, defined as the presence of subdural, epidural or parenchymal haematoma, subarachnoid haemorrhage or cerebral contusion.

Results
3070 records were identified, and 27 observational studies were included. No significant difference in the risk of DICH was observed in patients receiving VKAs or DOACs (23 studies, 6078 patients) at time of TBI: 2.52% vs 2.01%, risk ratio (RR) 1.40, 95% CI 0.91;2.14, : 0% (Fig.1A). Similarly, no difference was observed between patients receiving VKAs or APs (10 studies, 3864 patients): 1.43% vs 1.54%, RR 0.92, CI 95% 0.40;2.14, : 0%; and between DOACs or APs (6 studies, 1916 patients): 0.87% vs AP 1.81 %, RR 0.62, 95% CI 0.10-3.71, = 0% (Fig. 1B). No studies comparing serial brain-CT vs clinical observation were found.

Conclusion
Our study shows that the risk of developing DICH after TBI does not differ across the antithrombotic treatments. Further studies should assess the role of serial brain-CT in this setting.
Validation of the resting full-cycle ratio and diastolic pressure ratio through myocardial perfusion imaging with [15O]H2O positron emission tomography
Authors: Dahdal J , Bakker F , Svanerud J , Danad I , Driessen R , Raijmakers P , Harms H , Lammertsma A , Van De Hoef T , Appelman Y , Van Royen N , Knaapen P , De Waard G 
Published: November 2023

Abstract

Background
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive techniques used to evaluate the hemodynamic significance of coronary artery stenosis. These methods have been validated through perfusion imaging techniques and clinical trials. However, new invasive pressure indices that do not require hyperemia have recently emerged, and it is essential to confirm their diagnostic efficacy.

Purpose
To validate the resting full-cycle ratio (RFR) and the diastolic pressure ratio (dPR), against [15O]H2O positron emission tomography (PET) imaging.

Methods
A total of 129 symptomatic patients with an intermediate risk of coronary artery disease (CAD) were included. All patients underwent cardiac [15O]H2O PET with quantitative assessment of myocardial perfusion, and within 2 weeks coronary angiography was performed. Intracoronary pressure measurements were obtained in 320 vessels and RFR, dPR, and FFR were computed. In the case of RFR and dPR, values ≤ 0.89, and for FFR, values ≤ 0.8 were classified as abnormal. PET myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) served as reference standards. The index tests and gold standard results were evaluated by blinded researchers.

Results
Figure 1 shows the diagnostic performance of each ratio in coronary arteries with stenoses (136 of 320 vessels, 38%). The overall diagnostic accuracies of RFR, dPR and FFR did not differ when PET MBF &lt; 2.3 ml · min-1 and PET MPR &lt; 2.5 were considered as the reference standard. No significant differences were observed in the areas under the receiver-operating-characteristic (ROC) curve among the indices (Figure 2). In addition, the indices demonstrated comparable performance when the analysis included all of the vessels.

Conclusion
The novel non-hyperemic pressure ratios, RFR and dPR, have a diagnostic performance that is comparable to FFR when using [15O]H2O PET to assess myocardial perfusion abnormalities. These findings suggest that RFR and dPR may be considered for clinical use in symptomatic patients with CAD.Figure 1Diagnostic performance;StenosisFigure 2ROC curve analysis;Stenosis
Efficiency of orbital atherectomy for eccentric calcium in bending vessels: in-vitro vessel models
Authors: Tanaka Y , Mitsui H , Murakami K , Saito S , Iwasaki K 
Published: November 2023

Abstract

Background/Introduction
The mode of action of orbital atherectomy (OA) consists of a fast elliptical rotation of the crown, allowing for focal treatment with slow forward and backward movements. However, reports on the efficiency of OA for eccentric calcium in bending vessels are limited.

Purpose
This study aimed to clarify the mechanism of action of the crown and elucidate the anatomical condition for an efficient OA on eccentric calcium in bending lesions, via in vitro experimental models.

Methods
In total, 40 in vitro stenotic vessel models with eccentric calcium were developed; five models with a combination of two calcium positions (inner or outer side bending), two curvature radiuses (R, 10 or 20 mm), and two bending angles (A, 100º or 60º). Each model was connected to a whole aorta model and the procedures were performed using the Diamondback 360 coronary OA system through a 6F short-tip amplatz 1.0 guiding catheter. The protocol included two 30-second low-speed ablations followed by one 30-second high-speed ablation. Micro-computed tomography analyses of the models were performed before and after ablation to evaluate the ablated calcium volume and maximum depth.

Results
Eccentric calcium at inner side of the bending was more ablated than at outer side (6.6 mm3 vs 2.7 mm3, P &lt; 0.0001). Among the inner side, the ablated calcium volume was higher in the R20/A60 model (8.28 mm3) than in R10/A100 (6.30 mm3; P = 0.14), R10/A60 (5.62 mm3, P = 0.04), and R20/A100 (6.06 mm3, P = 0.09) models (Figure 1A). The ablated maximum depth was also higher in the R20/A60 model (0.98 mm) than in other models (R10/A100: 0.84 mm, R10/A60: 0.90 mm, R20/A100: 0.78 mm); however, there were no significant differences. Moreover, among the outer side, the ablated calcium volume was higher in the R20/A100 model (5.17 mm3) than in the R10/A100 (1.95 mm3, P &lt; 0.001), R10/A60 (2.12 mm3, P = 0.002), and R20/A60 (1.73 mm3, P &lt; 0.001) models (Figure 1B). The ablated maximum depth was also significantly higher in the R20/A100 model (0.47 mm) than in other models (R10/A100: 0.32 mm, P = 0.03; R10/A60: 0.33 mm, P = 0.05; R20/A60: 0.27 mm, P = 0.01).

Conclusions
Curvature radius and bending angles could be associated with efficiency of OA for eccentric calcium in bending vessels. Although small curvature radiuses may be unsuitable for OA in the inner or outer side, it may be effective for inner side lesions with a large curvature radius and low bending angles, and outer side lesions with a large curvature radius and high bending angles.
Twelve-months vessel healing profile following the novel resorbable magnesium scaffold implantation: an intravascular OCT analysis of the BIOMAG-I trial
Authors: Seguchi M , Aytekin A , Xhepa E , Haude M , Wlodarczak A , Van Der Schaaf R J , Torzewski J , Ferdinande B , Escaned J , Iglesias J F , Bennett J , Toth G , Toelg R , Garcia-Garcia H M , Joner M 
Published: November 2023

Abstract

Background
The first-in-human trial of the latest resorbable magnesium scaffold (RMS), DREAMS 3G, showed favorable clinical and angiographic outcomes up to 6-months. An intravascular optical coherence tomography (OCT) assessment of the vascular healing profile at 6 months and 12 months follow-up may serve as additional supportive evidence for device safety and efficacy.

Purpose
The aim of this study was to evaluate the vessel healing process by quantifying the presence of strut protrusion (SP) and strut degradation following DREAMS 3G implantation as per intravascular OCT imaging.

Methods
Patients from the BIOMAG-I trial who underwent OCT imaging at both 6- and 12-months were deemed eligible. This resulted in the inclusion of a total of 51 patients and 52 lesions in the current analysis. The acquired intravascular imaging data were evaluated every 1 mm to visualize and quantify the SP and the number of visible struts at 6- and 12-months. In addition, we investigated the potential impact of SP on mean and minimum lumen area (mm2) at both time point.

Results
At 12 months, the mean SP area was significantly smaller in comparison to 6 months follow-up (1.87±2.22 mm2 at 6 months vs. 0.99±1.27 mm2 at 12 months, p&lt;0.001). There was a positive correlation between SP area and mean lumen area at both 6 months (p&lt;0.001) and 12 months (p=0.014) follow-up. Similarly, a positive correlation was observed between SP area and minimum lumen area up to 6 months (p=0.006 at 6 months, p=0.323 at 12 months). The number of visible struts was 6.44±7.59 at 6 months and 1.79±0.85 at 12 months (p&lt;0.001).

Conclusion
The SP area was larger in lesions with greater lumen area following the implantation of the novel RMS. The observed SP area was significantly smaller at 12 months in comparison to 6 months follow-up. These results suggest that the presence of SP is part of a favorable vascular healing process following the treatment with the latest resorbable magnesium scaffold.
Sutureless and rapid-deployment versus conventional bioprosthetic aortic valve replacement in patients with aortic stenosis: a systematic review and meta-analysis of randomised controlled trials
Authors: Yadee J , Chotnoppharatphatthara P , Permsuwan U 
Published: November 2023

Abstract

Background
Sutureless aortic valve replacement (SUAVR) has become an alternative to conventional bioprosthetic aortic valve replacement (CAVR) for the treatment of aortic stenosis. This procedure was designed to shorten surgery time, enable optimal valve insertion, and improve surgical outcomes.

Purpose
This study aimed to compare the clinical outcomes between SUAVR and CAVR for treating patients with aortic stenosis.

Methods
Systematic searches were conducted from the inception to December 2022, using 4 databases: PubMed, Scopus, Embase, and Web of Sciences. Randomised controlled trials comparing SUAVR versus CAVR were included for analyses. Data were extracted and analysed using predefined clinical outcomes. The revised Cochrane risk-of-bias tool for randomized trials version 2.0 was used to assess the quality of included RCTs. A meta-analysis with risk ratio (RR) or mean difference (MD) was performed to compare clinical outcomes such as aortic cross-clamp (ACC) time, cardiopulmonary bypass (CPB) time, mortality, and complications at 30 days and 1 year.

Results
The study included 4 articles with a total of 478 SUAVR and 485 CAVR patients. Compared to CAVR, SUAVR had a significantly shorter ACC time (MD -25.1 minutes, 95%CI -44.5 to -5.8, I2 =97%, p 0.01) and CPB time (MD -22.8 minutes, 95% CI -42.4 to -3.2, I2 =93%, p 0.02). There was no significant difference in mortality at 30-day (RR 1.04, 95%CI 0.34-3.15, I2 =0%, p 0.952) and 1-year follow-up (RR 1.08, 95%CI 0.56-2.06, I2 =0%, p 0.822). Complications including myocardial infarction, stroke, major bleeding, renal failure, and endocarditis, did not significantly differ between the two groups. However, permanent pacemaker implantation was significantly higher after SUAVR at 30 days (RR 3.25, 95%CI 1.81-5.84, I2 =0%, p &lt;0.01) and 1 year (RR 2.97, 95%CI 1.71-5.16, I2 =0%, p &lt;0.01).

Conclusions
SUAVR had significantly shorter ACC and CPB times than CAVR. SUAVR required more permanent pacemaker implantation than CAVR. Mortality and other complications were comparable between the two groups.
Vascular closure after TAVI: assessing the safety and efficacy of a collagen-based device in a real-world population
Authors: Grine M , Borges-Rosa J , Martinho S , Morgado Gomes A R , Campos G M , Marinho A V , Oliveira-Santos M , Jorge E , Delgado Silva J , Leite L , Costa M , Goncalves L 
Published: November 2023

Abstract

Background
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of symptomatic severe aortic stenosis. However, the high rates of vascular complications (5-20%) associated with the large-bore access hinder clinical outcomes. There are several options available for access site closure, including MANTA, a dedicated collagen plug-based device that showed promising results in recent trials.

Purpose
We sought to evaluate the safety and efficacy of large calibre arteriotomy closure with MANTA during transfemoral TAVI in a real-world cohort.

Methods
We retrospectively analysed all consecutive patients who underwent transfemoral TAVI access closure with the MANTA device in our centre between March 2020 and May 2022. The primary safety endpoints were the rates of closure device failure, and access-related vascular and bleeding complications. The secondary endpoint was periprocedural all-cause mortality. All endpoints were defined according to the Valve Academic Research Consortium (VARC) 3 criteria.

Results
A total of 299 patients were included, mean age of 81.09 ± 6.34 years, 50.5% females, median EuroSCORE II of 3.11% [IQR 2.08–4.75]. Approximately two-thirds were under antithrombotic treatment (36.4% on oral anticoagulation and 33.0% on antiplatelet therapy). Closure device failure occurred in 8.4% cases (n=25), nevertheless only one required bailout surgical closure. Vascular complications occurred in 11.4% (n=34), most minor and related to the access site (9.0%, n=27): arterial occlusion (5.0%, n=15), haematomas (3.0%, n=9) and pseudoaneurysms (1.0%, n=3). Bleeding complications occurred in 4.3% (n=13), most VARC type 1 (3.3%, n=10). Both smaller minimal femoral artery diameter (6.6 ± 1.1 mm vs 7.7 ± 1.4mm, p&lt;0.001) and bigger sheath to femoral artery diameter ratio (0.76 ± 0.15 vs 0.68 ± 0.14, p=0.02) were associated with device failure. The secondary endpoint occurred in 7 patients (2.3%), both from cardiovascular (aortic dissection, n=3; ischemic stroke; n=2) and non-cardiovascular causes (sepsis, n=2). Device failure did not prolong the index hospitalization (4.00, IQR 3.00-5.00 days vs 4.00, IQR 3.00-5.00; p=0.36).

Conclusions
In a large real-world cohort, MANTA was a safe and effective solution for femoral arteriotomy closure after TAVI. Device failure was infrequent, rarely associated with severe complications and did not lengthen the hospital stay.
Characterizing patients ineligible for mitral valve intervention: Phenotypic clustering sub-analysis from the CHOICE-MI Registry
Authors: Ludwig S , Coisne A , Hamzi K , Ben Ali W , Duncan A , Makkar R , Webb J G , Rudolph T K , Nickenig G , Ruge H , Denti P , Conradi L , Modine T , Pezel T , Granada J F 
Published: November 2023

Abstract

Background/Introduction
Transcatheter mitral valve replacement (TMVR) is emerging as a therapeutic option for surgcal high-risk patients with mitral regurgitation (MR). However, a large proportion of these patients are still rejected due to clinical or anatomical reasons. The majority of these patients remain ineligible for any mitral valve (MV) intervention and continue medical treatment. Phenotypic characterization of these patients may assist in the identification of the anatomical challenges and drive future innovation efforts as well as assist in the risk stratification process of these patients.

Purpose
To characterize patients ineligible for TMVR and other MV interventions from a large international registry using an unsupervised phenotypic clustering approach integrating clinical, echocardiographic and computed tomography data to unveil differences between phenogroups.

Methods
Between 2014 and 2022, the CHOICE-MI registry included 984 patients undergoing screening for TMVR at 33 international sites. For this study, only patients with screening failure resulting in medical therapy alone were included. Patients receiving transcatheter or surgical treatment were excluded (Figure 1). A cluster analysis using K-means algorithm was performed on baseline clinical and imaging variables, and predictors of all-cause mortality within these clusters were assessed.

Results
Among 284 patients (77.4±8.82 years, 56.0% female, EuroSCORE II 6.6±5.8%) considered ineligible for any MV intervention, two clinically distinct phenogroups (PG) were identified using unsupervised hierarchical clustering of principal components (Figure 2): (PG1) Elderly women with primary MR, high left ventricular (LV) ejection fraction, and annular calcification (N=173, 60.9%); (PG2) Patients with secondary or mixed MR, LV and annular dilation, and high prevalence of comorbidities (N=111, 39.1%). There were no differences regarding Kaplan-Meier estimated 1-year all-cause mortality (PG1 vs. PG2, 21.4% vs. 23.4%, p=0.89) and 1-year cardiovascular mortality (10.4% vs. 13.5%, p=0.53). Predictors of mortality were albumin, renal function, extracardiac arteriopathy for PG1, and albumin, coronary artery disease, and prior myocardial infarction for PG2.

Conclusions
Using cluster analysis, this study identified two major subgroups among patients ineligible for mitral interventions with profound differences in clinical and anatomical profiles, and predictors of outcome. The combination of elderly women with primary MR, preserved LV ejection fraction and annular calcification was the most common phenogroup among patients rejected for mitral intervention. Identifying these factors may drive technological evolution to address unmet clinical and technical needs.