bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emulating a Target Trial of Shorter Compared to Longer Course of Antibiotic Therapy for Gram-Negative Bacteremia
Authors: Tingsgård Sandra , Bastrup Israelsen Simone , Østergaard Christian , Benfield Thomas 
Published: November 2023

Abstract

Background
Despite the availability of antimicrobial therapies, gram-negative bacteremia remains a significant cause of morbidity and mortality on a global level. Recent randomized controlled trials support shorter antibiotic treatment duration for individuals with uncomplicated gram-negative bacteremia. The target trial framework using the cloning approach utilizes real-world data but eliminates the issue of immortal time bias seen in observational studies by emulating the analysis of randomized trials with full adherence.

Method
A hypothetical target trial allocating individuals with gram-negative bacteremia to either short antibiotic treatment duration (5–7 days) or longer antibiotic treatment duration (8–14 days) was specified and emulated using the cloning, censoring, and weighting approach. The primary outcome was 90-day all-cause mortality. Secondary outcome was a composite endpoint of clinical and microbiological relapse. The emulated trial included individuals from four hospitals in Copenhagen from 2018 through 2021.

Results
In sum, 1040 individuals were included. The median age of the cohort was 76 years, the majority were male (54%), had community-acquired gram-negative bacteremia (86%), urinary tract infection as the source of the infection (78%), and Escherichia coli as the pathogen of the infection (73%). The adjusted 90-day risk difference in all-cause mortality was 1.3% (95% confidence interval [CI]: −.7, 3.3), and the risk ratio was 1.12 (95% CI: .89, 1.37). The adjusted 90-day risk difference in relapse was 0.7% (95% CI: −2.3, 3.8), and the risk ratio was 1.07 (95% CI: .71, 1.45).

Conclusions
We found comparative outcomes for shorter treatment duration compared to longer treatment duration in patients with gram-negative bacteremia.
Kidney and urine cell transcriptomics in IgA nephropathy and lupus nephritis: a narrative review
Authors: Schena Francesco P , Chiurlia Samantha , Abbrescia Daniela I , Cox Sharon N 
Published: November 2023

ABSTRACT
This narrative review sheds light on the use of transcriptomics in the analysis of kidney biopsies and urinary cell samples from patients with immunoglobulin A nephropathy or lupus nephritis. The conventional methods of examining kidney biopsy through light microscopy, immunofluorescence and electron microscopy provide valuable clinical information for diagnosis and prognosis but have some limitations that transcriptomics can address. Some recent studies have reported that kidney transcriptomics has uncovered new molecular biomarkers implicated in the inflammatory process induced by the deposition of circulating immune complexes in the investigated kidney diseases. In addition, transcriptomics applied to urinary cells mirrors the inflammatory process that occurs in the kidney. This means that we can study urinary cell transcriptomics in clinical practice to diagnose the stage of the inflammatory process. Furthermore, the transcriptomics of urinary cells can be used to make therapy decisions during patient follow-up to avoid the stress of a second kidney biopsy. The studies analyzed in this review have a significant limitation. Biomarkers have been identified in small cohorts of patients but none of them has been validated in independent external cohorts. Further prospective studies in large cohorts of patients are necessary for accurate and complete validation. Only after that can these biomarkers be widely used in clinical practice.
An incidental finding of a right atrial myxoma with undiagnosed Ebstein anomaly: a case report
Authors: McClenaghan Lisa , Sandhu Manraj , Caputo Massimo , Brennan Paul F 
Published: November 2023

Abstract

Background
Ebstein anomaly (EA) is a rare congenital abnormality of the tricuspid valve which can lead to progressive right heart dilatation and arrhythmias. While often seen in conjunction with other congenital cardiac lesions, such as atrial septal defects, it is not normally associated with atrial myxomas.

Case summary
We present a case report of an incidental finding of a right atrial myxoma in the context of undiagnosed EA, in a 16-year-old male who presented with appendicitis. Subtle cardiomegaly on routine chest X-ray prompted further investigation, which demonstrated characteristic findings of both conditions and culminated in surgical repair using the Cone procedure. At 4-month follow-up, the patient was asymptomatic, and transthoracic echocardiography demonstrated a mean gradient of 4.5 mmHg across the tricuspid valve with mild regurgitation.

Discussion
The combination of EA with right-sided myxoma is exceedingly rare, and, in this case, it may be that the apical displacement of the tricuspid valve was protective against right atrioventricular obstruction. We are reminded that although subtle abnormalities on routine investigations can be of limited significance, they can also indicate more serious underlying pathology and so consideration should be given to an appropriate cascade of further investigations to yield a timely diagnosis and enable prompt treatment.
In-hospital triggers of takotsubo syndrome: a case report on witnessing sudden death in a hospital roommate
Authors: Aweimer Assem , El-Battrawy Ibrahim , Beck Patrick , Mügge Andreas 
Published: November 2023

Abstract

Background
Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, mimicking an acute myocardial infarction, in the absence of obstructed coronary arteries. It is often triggered by physical or emotional stress, with catecholamines playing a central role in its pathophysiology. Recent advances have been made in categorizing TTS patients based on trigger events and comorbidities, as well as proposed classifications differentiating primary and secondary TTS. In-hospital triggers for (secondary) TTS appear to be quite common, and our aim is to bring attention of this prevalent phenomenon.

Case summary
We present the clinical course of an 80-year-old man who developed TTS after witnessing the sudden death of his roommate during his hospital stay. Initially hospitalized for bradycardia and complete atrioventricular block, the patient was discharged after a pacemaker implantation. However, he returned to the hospital 3 days later with chest pain and other symptoms indicative of TTS. Diagnostic tests confirmed apical ballooning consistent with TTS, and subsequent echocardiograms showed a substantial improvement in left ventricular function.

Discussion
The case is classified as in-hospital TTS, occurring unexpectedly during medical care, and suggests that secondary TTS could represent a certain ‘basic risk’ for hospitalized patients. We want to emphasize the importance of reducing pain and fear in the hospital setting and encourage further research to understand the association between TTS and medical procedures and therapies. Overall, this case underscores the need for strategies to reduce the frequency of TTS in hospitalized patients.
Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation
Authors: Bække Pernille Steen , Jørgensen Troels Højsgaard , Thuraiaiyah Jani , Gröning Mathis , De Backer Ole , Sondergaard Lars 
Published: November 2023

Abstract

Aims
Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within 1 year following TAVI.

Methods and results
All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was three-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P &lt; 0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with preexisting comorbidities. Predictors of heart failure (HF) rehospitalization included ischaemic heart disease, the extent of cardiac damage, atrial fibrillation, and New York Heart Association class at baseline. HF rehospitalization within 30 days and 1 year post-TAVI was associated with a markedly increased 1- and 5-year mortality risk [hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P&lt; 0.001].

Conclusions
Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure related, whereas late rehospitalization is related to preexisting comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.
Making the voice matter in English Studies Teaching
Authors: Holmes-Henderson Arlene , Wright Tom F 
Published: November 2023

Abstract
This introduction frames the guest edition of the journal on ‘Oracy and English Studies’. The pieces in this special forum explore how a renewed focus on speaking can re-imagine what it means to ‘do English’. We are two university-level teachers, one from Classics, one from English, eager to explore the potential of this idea. We have brought together a series of short provocations from leading UK-based practitioners both within and beyond the subject area: including a speech-writer, university teachers of Shakespeare and contemporary poetry, charity leaders, and political communication specialists. Their pieces reflect on classroom practices including reading aloud and vocalization, impersonation, the analysis of political speeches and argumentation, or getting students to interrogate their attitudes to their own voices. In each case, our contributors have been asked to respond to the concept from educational theory known as ‘oracy’ (simply put, ‘listening and speaking skills’). English studies clearly need to grapple with this suddenly ubiquitous concept. Not just for its political resonances, but because it is rich in implications for teachers of English at all levels, and deserves greater recognition and interrogation beyond the world of education.
An empirical approximation of the effects of trade sanctions with an application to Russia
Authors: Imbs Jean , Pauwels Laurent 
Published: November 2023

SUMMARY
We propose a data-based approximation of the effects of trade sanctions that can readily be computed on the basis of international input–output data. Approximated effects are very close to the exact responses obtained from a canonical multi-country multi-sector model, without having to make difficult calibration choices. We illustrate the approximation with trade sanctions against Russia and obtain estimates well within the existing range. Russia is much more affected by trade sanctions than the EU, even though the importance of EU markets for Russia has been falling, especially since 2014, with China picking up the slack. Within the EU the consequences are largest in ex-‘satellite’ countries of the Soviet Union: These countries do not typically have access to substitute markets and in fact have historically been highly dependent on Russia. This extreme and persistent dependence is at least partly explained by the existence of specific energy transport infrastructure (pipelines) that appears to constrain tightly the production of electricity. Our proposed approximation is practical and can be implemented in a variety of contexts: We have developed a web-based dashboard, accessible at https://exposure.trade/ that can be used to approximate the costs of trade sanctions for any combinations of sanctioning and sanctioned countries or sectors.
Shelter from the storm: do partnerships buffer the well-being costs of unemployment?
Authors: Prechsl Sebastian , Wolbring Tobias 
Published: November 2023

Abstract
This article contributes to the existing literature on the effects of unemployment on subjective well-being (SWB) by partnership status. We argue that material and latent deprivation can explain the effects of becoming and remaining unemployed on SWB by partnership status, as both partners and their employment status crucially shape the extent of deprivation. To test our hypothesis about partnership-specific unemployment effects on SWB and the mediating roles of latent deprivation (in terms of status loss) and material deprivation, we use 14 waves of German panel data. To identify time-varying unemployment effects, we rely on time-distributed fixed effects models. Our results suggest a strong negative and rather time-constant impact of unemployment on SWB, buffered over time for those with working or nonworking partners. Furthermore, our results indicate in particular material deprivation but also latent deprivation to be relevant mechanisms for explaining partnership-specific trajectories in the loss of SWB.
Is myocardial fibrosis appropriately assessed by 2D strain derived integrated backscatter?
Authors: Lima M R L , Abecasis J A , Reis Santos R R S , Maltes S M , Guerreiro S G , Campino Padrao C P P , Freitas P F , Ferreira A F , Ribeiras R R , Andrade M J A , Cardim N C , Madeira M M , Ramos S R , Mendes M M 
Published: November 2023

Abstract

Introduction
Calibrated integrated backscatter (cIB) may be obtained from bidimensional (2D) strain echocardiography as a quantification measurement of myocardial ultrasound reflectivity. Increased collagen content of the myocardium modifies tissue reflectivity and cIB is suggested as a marker of left ventricular (LV) fibrosis. However, its diagnostic accuracy is not fully established.

Aim
To assess the correlation between cIB by 2D strain and LV myocardial fibrosis (MF), as evaluated by non-invasive imaging and histopathology.

Methods
Correlation study from a cohort of 157 patients with severe symptomatic aortic stenosis (AS) referred for surgical aortic valve replacement (AVR). Patients with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of AVR were selected. Two groups of 30 patients were evaluated, with and without late gadolinium enhancement (LGE) at CMR. Integrated Backscatter was obtained at QRS peak in decibels (dB) from both parasternal long axis (PLAX) and apical-three-chamber (A3C) cine clips at Qanalysis. cIB was calculated by subtracting the pericardial intensity from the average of the anteroseptal and basal inferolateral wall values. Correlation analysis was performed for the whole group of patients with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) from Masson´s Trichrome staining. IBS values were compared in both group of patients.

Results
60 patients (74 [36-74] years, 45% male) with high gradient (mean gradient: 63±20mmHg), normal flow (45±10mL/m2), preserved ejection fraction (60±9%) AS were included. Basal septal cIB was –9.17±9.45dB and –17.45 (–31.2–10.95) dB from A3C and PLAX views, respectively. These indexes did not correlate with basal septum thickness or global LV mass. Absolute and cIB did not correlate neither with global and regional T1 and ECV values, nor with CVF at EMB. These were not significantly different in both groups of patients and there was no correlation between cIB values and mass of replacement MF in patients with LGE.

Conclusion
In these cohort of patients with classical severe AS, there was no correlation of cIB with imaging markers of both replacement and diffuse MF. cIB also didn´t correlate with CVF at histopathology. These findings suggest that reflectivity indexes are not suitable for myocardial tissue characterization in this setting.
Calcification of aortic valve cusps as independent predictor for permanent pacemaker requirement after transcatheter aortic valve implantation
Authors: Jung S , Ammon F , Smolka S , Moshage M , Marwan M , Achenbach S 
Published: November 2023

Abstract

Background
High-degree atrioventricular (AV) block represents a frequent complication after transcatheter aortic valve implantation (TAVI). Extension of indication for TAVI towards subjects with lower surgical risk requires to reduce the likelihood for the need of permanent pacemaker (PPM) implantation.

Purpose
We examined the role of calcification of the aortic valve cusps and left ventricular outflow tract (LVOT) as potential predictors for PPM implantation after TAVI.

Methods
In a cohort of 1200 consecutive patients without PPM who underwent transfemoral TAVI, clinical and procedural characteristics as well as requirement for PPM implantation after TAVI were assessed systematically. In all patients, cardiac computed tomography (CT) was performed before TAVI including quantitative assessment of calcium volume of the aortic valve cusps and the LVOT in mm3 (see figure).

Results
Median patient age was 81 (IQR 7) years, 50% were male. 9.8% of patients had a pre-existing complete right bundle branch block (RBBB) in ECG. 68% of subjects received a balloon-expandable valve, 32% a self-expandable valve. Postinterventional PPM implantation was necessary in n=155 subjects (13%) due to high-degree AV block. In this group of subjects, calcification of the aortic valve cusps was more pronounced than in the group of subjects without high-degree AV block (see table). Univariate regression analysis revealed pre-existing complete RBBB (p&lt;0.001, OR 8.564), implantation of a self-expandable prosthesis (p=0.013, OR 1.549) as well as calcification of the non-coronary (p=0.016, OR 1.001) and left-coronary cusp (p=0.025, OR 1.001) as significant predictors for PPM implantation. In multivariate regression analysis, these predictors – including calcification of the non-coronary cusp (p=0.037, OR 1.001) remained significant. With every mm3 of calcification, risk for high-degree AV block and PPM implantation increases by 0.1%. With a median calcification of 225 mm3 of the non-coronary cusp, this would make a 22.5% relative risk increase.

Conclusion
In a large cohort of 1200 patients, the volume of aortic cusp calcification, in particular calcification of the non-coronary cusp, was identified as independent predictor for PPM implantation following transcatheter aortic valve implantation. This might be explained by the anatomical proximity of both the AV node and left Tawara branch to the non-coronary cusp, resulting in a higher risk of compression during valve implantation. Our results may contribute to improved risk stratification regarding the need for PPM implantation after TAVI.Assessment of calcium volumeComparison of calcification
Non-invasive assessment of myocardial stiffness by the two-dimensional shear wave elastography ultrasound technique in patients with amyloidosis and Fabry disease
Authors: Cafezeiro C , Alencar Neto A C , Bueno B V K , Rissato J H , Pereira N M , Pereira F L , Ramires F J A , Mathias W , Rochitte C E , Hotta V T , Dabarian A L , Fernandes F 
Published: November 2023

Abstract

Background
Cardiac amyloidosis and Fabry disease are cardiomyopathies that evolve with structural alteration of the ventricular walls, diastolic dysfunction and heart failure. Diastolic dysfunction encompass myocardial stiffness and impaired relaxation. Cardiac elastography has been proposed as a diagnostic modality for the non-invasive assessment of myocardial stiffness.

Purpose
The aim of this study was to investigate if myocardial shear wave elastography could assess myocardial stiffness in Healthy volunteers, Fabry disease and variant transthyretin amyloidosis (ATTRv) patients with cardiac involvement and correlate with other complementary imaging and laboratory tests (electrocardiogram, 2D echocardiogram, troponin and BNP) and with the 6-minute walk test.

Methods
We prospectively included 60 adults: 20 patients with Fabry disease, 20 patients with ATTRv and 20 patients as control group. Echocardiography, electrocardiogram and laboratory evaluations were performed. Elastography assessment of myocardial stiffness was performed using an ultrasound equipment with a multifrequency convex transducer, under specific adjustment of the equipment for performing myocardial elastography.

Results
Myocardial Stiffness was significantly higher in Cardiac Amyloidosis patients than in healthy volunteers in anteroseptal basal segment (ASB) (PLAX 6.95 ± 1.4 kPa vs. 5.45 ± 1.1 kPa, respectively, p=0.02; PSAX 6.85 ± 1.4 kPa vs. 5.4 ± 1.2 kPa, respectively, p=0.02) and right ventricle (RV) (5.9 ± 2.6 kPa vs. 4.0 ± 0.7 kPa, respectively, p=0.003) and no difference in anteroseptal mid and septal apical. Statistically difference between Fabry Disease patients and Cardiac Amyloidosis group was found in right ventricle (5.9 ± 2.6 kPa vs. 4.4 ± 1.0 kPa, respectively, p=0.01).

Conclusion
Myocardial Stiffness was significantly higher in patients with Cardiac Amyloidosis compared with healthy volunteers in anteroseptal basal and right ventricle, but with no difference in anteroseptal mid and septal apical. Cardiac Amyloidosis myocardial stiffness was statistically higher in right ventricle compared with Fabry Disease group.