bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence But Not Severity of Intracerebral Hemorrhage Shows a Strong Pattern of Seasonal Variation
Authors: Martinez Oeckel Ariane , Misselwitz Bjoern , Foerch Christian 
Published: February 2025

Background
A strong risk factor for intracerebral hemorrhage (ICH) is elevated arterial blood pressure, which is known to vary by season, with highest values in winter months. The objective was to assess seasonal trends of ICH incidence, clinical severity, and case fatality according to demographic and clinical characteristics.

Methods

This study was conducted on adult patients hospitalized for ICH between 2003 and 2022. Cases were identified from a stroke inpatient quality assurance registry covering the entire Federal State of Hesse, Germany. Population data were derived from the Hessian Bureau of Statistics. Incidence rates (IRs) per 100 000 person‐years of ICH, recorded with 4‐digit
International Statistical Classification of Diseases, Tenth Revision, German Modification
(
ICD‐10‐GM
) I61.x codes, were estimated by season, calendar month, and bleeding location. Seasonal variations and subgroup analyses were tested using Poisson distribution and the Wald test.

Results

A total of 33 444 patients were included (mean age, 72.4±13.6 years, 52% men). ICH IR correlated with the season of occurrence, demonstrating a peak in winter (IR winter, 34.6 [95% CI, 33.9–35.4], IR summer, 29.4 [95% CI, 28.7–30.1];
P
<0.01). Seasonal variation was equally present in men and women but was more pronounced in older compared with younger patients (peak at age 60–90 years;
P
<0.01). IR showed seasonal variation both for cortical and subcortical bleeding locations (
P
<0.01). Clinical severity and case fatality did not vary between seasons (mean, 24.3±0.8%).

Conclusions
This large cohort study demonstrates a seasonal incidence peak of ICH in winter. Whether ICH can be prevented by better control of arterial blood pressure in seasons with expected incidence peaks will require further studies.
Heart Failure Is Associated With Increased Stroke Severity, In‐Hospital Mortality, Major Adverse Cardiovascular Events, and Complications: Insights From the Chinese Stroke Center Alliance
Authors: Hu Guoliang , Gu Hongqiu , Jiang Yingyu , Wang Chunjuan , Jiang Yong , Li Zixiao , Wang Yongjun , Wang Yilong 
Published: February 2025

Background
Heart failure (HF) constitutes the source of various damaging pathophysiological mechanisms in acute ischemic stroke (AIS). The effect of a previous HF on the in‐hospital outcomes for patients with AIS still lacks effective research. We aimed to evaluate the severity of stroke, in‐hospital mortality, major adverse cardiovascular events, and complications associated with a previous HF in these patients.

Methods and Results
This cross‐sectional study was conducted at 1476 hospitals in the Chinese Stroke Center Alliance. Multivariable logistic regression and propensity score–matched analyses were used to evaluate the association between a history of HF and in‐hospital outcomes. Of 836 885 patients with AIS, 1.1% (n=8950) patients had a history of HF. Patients with a history of HF had a higher National Institutes of Health Stroke Scale score at admission (6.0 versus 3.0) than those without a history of HF. Multivariable analysis revealed that a history of HF was associated with an 80% higher risk of all‐cause mortality (odds ratio [OR], 1.80 [95% CI, 1.54–2.10]), a 34% higher risk of major adverse cardiovascular events (OR, 1.34 [95% CI, 1.26–1.43]), and a 92% higher risk of complications (OR, 1.92 [95% CI, 1.83–2.02]). Further propensity score matching showed that patients with a history of HF had higher risks of adverse in‐hospital outcomes (all‐cause mortality: OR, 1.62 [95% CI, 1.30–2.02]; major adverse cardiovascular events: OR, 1.39 [95% CI, 1.26–1.53]; complications: OR, 1.70 [95% CI, 1.58–1.82]).

Conclusions
Patients with AIS and a history of HF have increased risks of severe stroke, in‐hospital mortality, major adverse cardiovascular events, and complications. Systematic cardiovascular evaluation and integrated multidisciplinary care for patients with AIS in clinical practice are warranted.
Role of Biological Age in the Determination of Long‐Term Cause‐Specific Death Following Percutaneous Coronary Interventions
Authors: Singh Mandeep , Friedman Paul A. , Gulati Rajiv , El Sabbagh Abdallah , Lewis Bradley R. , Kanwar Amrit , Raphael Claire E. , Al‐Hijji Mohammed A. , Attia Zachi I. , Behfar Atta , Kirkland James L. 
Published: February 2025

Background
We tested whether biologic age, as estimated by deficits, functional impairments, or Age‐Gap or their combination, provide improved estimation of cause‐specific death as compared with chronological age.

Methods
Cardiovascular and noncardiovascular deficits, functional impairments, and Age‐Gap were prospectively collected in 535 patients aged ≥55 years undergoing percutaneous coronary interventions between August 1, 2014, and March 31, 2018. Age‐Gap was calculated as the difference between chronological age and age estimated by artificial intelligence ECG using a convolutional neural network. The full biological age model included deficits, functional impairments, and Age‐Gap >2 SD. A multivariable reduced model with the least number of variables was also created to provide a comparable C index to the full model.

Results

The average chronological age was 72.1±9.5 years, and there were 68% of men. During a median follow‐up of 2.61 years, 124 (23%) patients died. There was a modest correlation between Age‐Gap and biological age (
r
=0.28 [95% CI, 0.20–0.35];
P
<0.001). When modeled with chronologic age as a covariate, Age‐Gap predicted all‐cause (hazard ratio [HR], 1.07 [95% CI, 1.04–1.10];
P
<0.001) and cardiovascular (HR, 1.07 [95% CI, 1.04–1.11];
P
<0.001) mortality. As compared with chronological age, the full biological age model noted significant improvement in the prediction of long‐term overall (95% CI, 0.65–0.78), cardiovascular (95% CI, 0.69–0.77), and noncardiovascular (95% CI, 0.55–0.86) mortality. In the reduced models, most prognostic information for noncardiovascular mortality (C index: 0.79) was obtained by subjective difficulty in performing tasks, whereas the deficit‐based estimation predicted cardiovascular mortality (C index: 0.72).

Conclusions
Estimated biological age from deficits and functional impairments was superior to chronological age in predicting long‐term cause‐specific mortality following percutaneous coronary interventions.
Right Ventricular Stiffening and Anisotropy Alterations in Pulmonary Hypertension: Mechanisms and Relations to Right Heart Failure
Authors: Neelakantan Sunder , Vang Alexander , Mehdi Rana Raza , Phelan Haley , Nicely Preston , Imran Tasnim , Zhang Peng , Choudhary Gaurav , Avazmohammadi Reza 
Published: February 2025

Background
Pulmonary hypertension (PH) results in increased right ventricular (RV) afterload, leading to RV dysfunction and failure. The mechanisms underlying maladaptive RV remodeling are poorly understood. In this study, we investigated the multiscale and mechanistic nature of RV free‐wall (RVFW) biomechanical remodeling and its correlations with RV function adaptations.

Methods
Mild and severe models of PH, consisting of a hypoxia model in Sprague–Dawley rats (n=6 each, control and PH) and a Sugen‐hypoxia model in Fischer rats (n=6 each, control and PH), were used. Organ‐level function, tissue‐level stiffness, and microstructure were quantified through in vivo and ex vivo measures, respectively. Multiscale analysis was used to determine the association between fiber‐level remodeling, tissue‐level stiffness and anisotropy, and organ‐level dysfunction.

Results
Decreased RV–pulmonary artery coupling correlated strongly with RVFW stiffening but showed a weaker association with the loss of RVFW anisotropy. Machine‐learning classification identified the range of adaptive and maladaptive RVFW stiffening. Multiscale modeling revealed that increased collagen fiber tautness was a key remodeling mechanism that differentiated severe from mild stiffening. Myofiber orientation analysis indicated a shift away from the predominantly circumferential fibers observed in healthy RVFW specimens, leading to a significant loss of tissue anisotropy.

Conclusions
Multiscale biomechanical analysis indicated that, although hypertrophy and fibrosis occur in both mild and severe PH, certain fiber‐level remodeling events, including increased tautness of collagen fibers and significant reorientations of myofibers, contributed to excessive biomechanical maladaptation of the RVFW leading to severe RV–pulmonary artery uncoupling. Collagen fiber remodeling and the loss of tissue anisotropy can provide an improved understanding of the transition from adaptive to maladaptive RV remodeling.
OPTILOW: A Low‐Profile Approach for Implanting Optimus‐L Stents in Infants and Children
Authors: Gendera Katarzyna , Bentham James R. , Georgiev Stanimir , Kasem Mohamed , Ewert Peter , Michel Jörg , Haddad Raymond N. 
Published: February 2025

Background
Stent implantation poses challenges in small children due to their limited vessel size and rapid growth. This multicenter study evaluates in vivo efficacy of implanting Optimus‐L stents in small patients using a low‐profile approach.

Methods
We retrospectively reviewed data from children weighing ≤20 kg with congenital heart stenotic lesions who received Optimus‐L stents manually mounted on small‐sized balloon catheters (diameter ≤12 mm) using a hand‐actuated compression tool and implanted through small‐sized sheaths (≤8 Fr) at our institutions between May 2022 and January 2024. Stent performance was assessed.

Results

We identified 28 patients (67.8% male) with median age and weight of 3.4 years (interquartile range [IQR], 1.5–5.5) and 12.9 kg (IQR, 9.1–16.4). Six (21.4%) were infants, 11 (39.3%) ≤10 kg. Stenotic lesions included 16 branch pulmonary arteries, 9 aortic isthmus, 2 right ventricular outflow tracts, and 1 Glenn anastomosis. Percentage of stenosis was 50% (IQR, 36%–58%). All implantations were successful without complications. The procedures mostly used 7 Fr sheaths for stents on 6, 7, and 8 mm balloons and 8 Fr sheaths for 9, 10, 12 mm balloons. Median stent expansion percentage was 95% (IQR, 90%–96%). Median vessel diameters increased from 4.6 mm (IQR, 3.8–5.1) to 8.8 mm (IQR, 7.5–9.5) (
P
<0.001), with median stenosis expansion at 103% (IQR, 51%–146%). Median stent shortening was 1.9% (IQR, 0%–3.9%). Two patients required redo stent balloon dilation after 18 and 20 months. Median follow‐up was 8 months (IQR, 3.2–13.2). Median last recorded Doppler velocity on implanted stents was 1.6 m/s (IQR, 1.2–2).

Conclusions
Optimus‐L stents can safely treat arterial and venous stenosis in infants and small children via a low‐profile approach with good outcomes.
Suboptimal Control of Small Dense Low‐Density Lipoprotein Cholesterol Is Associated With Coronary Plaque Progression: An Intravascular Ultrasound Study
Authors: Amuti Abulikemu , Li You Ran , Yuan He , Feng Shuo , Tay Guan Poh , Tang Si Yi , Wu Xin Rui , Tao Le Yuan , Lu Lin , Zhang Rui Yan , Yang Chen Die , Wang Xiao Qun 
Published: February 2025

Background
Plaque progression (PP) is critical between subclinical atherosclerosis and plaque rupture. Small dense low‐density lipoprotein cholesterol (sdLDL‐C) is considered as the most atherogenic lipoprotein. This study aims to investigate the relationship between sdLDL‐C level and PP in patients with stable coronary artery disease.

Methods
We conducted a retrospective analysis of 146 lesions in 86 patients by repeat intravascular ultrasound examinations from January 2020 to May 2023. PP was determined by increases in percent atheroma volume, defined as the atheroma volume in proportion to the volume occupied by the entire vascular wall, ≥5% during follow‐up. Time‐averaged values were calculated for all cardiometabolic parameters including sdLDL‐C. Multivariate logistic regression analysis was performed to interrogate the association between time‐averaged sdLDL‐C and PP.

Results

During a median follow‐up of 12.6 months, PP was found in 65 lesions (44.5%), and mean changes in percent atheroma volume were 4.1%±10.2%. A positive correlation was observed between time‐averaged sdLDL‐C and changes in total atheroma volume (Pearson
r
=0.29,
P
=0.006), especially in diabetic patients (Pearson
r
=0.58,
P
<0.001). After multivariate adjustment, every 0.1‐mmol/L increase in time‐averaged sdLDL‐C conferred a 1.2‐fold increased risk of PP.

Conclusions
Our findings suggest that sdLDL‐C is an independent risk factor of PP in patients with coronary artery disease. Intensive control of sdLDL‐C along with other risk factors should be considered to mitigate PP and improve cardiovascular outcomes.
Association Between No‐Flow Time, Prehospital Low‐Flow Time, and Conversion to Nonshockable Rhythm in Patients With Out‐of‐Hospital Cardiac Arrest Presenting With Initial Shockable Rhythm: A Nationwide Prospective Study in Japan
Authors: Kandori Kenji , Nakajima Satoshi , Matsuyama Tasuku , Kitamura Tetsuhisa , Narumiya Hiromichi , Hitosugi Masahito , Okada Yohei 
Published: February 2025

Background
Out‐of‐hospital cardiac arrest (OHCA) with initial shockable rhythm generally has a favorable prognosis. However, the prognosis worsens when this rhythm transitions to nonshockable rhythm on hospital arrival. This study aimed to investigate the association between no‐flow time (NFT), prehospital low‐flow time (LFT), and the conversion to nonshockable rhythm on hospital arrival in patients with OHCA initially exhibiting shockable rhythm.

Methods
We analyzed adult patients with OHCA from the JAAM‐OHCA (Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest) registry (June 2014–December 2020) with initial shockable rhythm. The primary outcome was rhythm conversion to nonshockable on hospital arrival. Adjusted odds ratios (aORs) with 95% CIs were calculated using a logistic model to examine the associations between NFT, prehospital LFT, and rhythm conversion.

Results
Of 68 110 patients, 3720 patients were included in our analysis. On hospital arrival, 27.9% patients achieved return of spontaneous circulation, 32.8% maintained shockable rhythm, and 39.3% transitioned to nonshockable rhythm (718 to pulseless electrical activity, 744 to asystole). Median NFT was 4 minutes (interquartile range [IQR], 1–9 minutes), and median prehospital LFT was 22 minutes (IQR, 14–31 minutes). Longer NFT and prehospital LFT were associated with higher aORs of rhythm conversion: NFT (5–9 minutes: aOR, 1.38 [95% CI, 1.14–1.67]; ≥10 minutes: aOR, 1.75 [95% CI, 1.44–2.14]); and prehospital LFT (15–19 minutes: aOR, 2.56 [95% CI, 2.00–3.27]; 20–29 minutes, aOR, 4.73 [95% CI, 3.83–5.85]; ≥30 minutes, aOR, 6.85 [95% CI, 5.49–8.56]).

Conclusions
Prolonged NFT and prehospital LFT were significantly associated with rhythm conversion to nonshockable on hospital arrival in patients with OHCA with initial shockable rhythm at the scene.
Growth Rate Assessed by Vascular Deformation Mapping Predicts Type B Aortic Dissection in Marfan Syndrome
Authors: Campello Jorge Carlos Alberto , Marway Prabhvir Singh , Tjahjadi Nicasius S. , Knauer Heather A. , Patel Himanshu J. , Hofmann Bowman Marion , Eagle Kim , Burris Nicholas S. 
Published: February 2025

Background
Patients with Marfan syndrome (MFS) are at a high risk of type B aortic dissection (TBAD). Aortic growth and elongation have been suggested as risk factors for TBAD. Vascular deformation mapping is an image analysis technique for mapping 3‐dimensional aortic growth on routine computed tomography angiography (CTA) scans. We aimed to use vascular deformation mapping to examine the value of aortic growth rate in the descending thoracic aorta, among other imaging biomarkers, to identify the factors associated with risk of TBAD in MFS.

Methods
Computed tomography angiography scans spanning 2004 to 2023 from adult patients with MFS with native descending thoracic aorta were analyzed by vascular deformation mapping. Other measurements included multilevel thoracoabdominal aortic diameters and the length of the descending thoracic aorta by centerline analysis.

Results

Among the 105 patients with MFS analyzed, 63.8% were men, with median age of 40 (range, 18–73) years and a median surveillance interval of 5.3 (range, 2.0–18.3) years. During surveillance, 12 (11.4%) patients developed TBAD. Patients with TBAD had a higher radial growth rate (0.63 versus 0.23 mm/year;
P
<0.001) and elongation rate (2.4 versus 0.5 mm/year;
P
<0.001), on univariate and multivariable analysis, but predissection descending aortic diameter was not significantly different. Predictors of growth rate included younger age, higher baseline maximal diameter of the descending thoracic aorta, smoking history, and warfarin use.

Conclusions
Radial growth and elongation rates of the descending thoracic aorta were independent predictors of TBAD occurrence in MFS. TBAD often occurred at nonaneurysmal diameters (<4.0 cm). These findings emphasize the role of growth over absolute diameter in risk stratification for TBAD in MFS.
RORγt Mediates Angiotensin II‐Induced Pressor Responses, Microglia Activation, and Neuroinflammation by Disrupting the Blood–Brain Barrier in Rats
Authors: Yu Yang , Xue Baojian , Tong Lei , Bassuk Alexander G. , Johnson Alan K. , Wei Shun‐Guang 
Published: February 2025

Background
The RORγt (nuclear receptor retinoid‐related orphan receptor γt) has been identified as a master transcription factor critical for the differentiation of T helper 17 cells, the primary source of IL‐17A (interleukin‐17A). We previously demonstrated that IL‐17A promotes neuroinflammation and sympathetic excitation, contributing to cardiac dysfunction in heart failure and angiotensin II (ANG II)‐induced hypertension. The present study sought to determine whether inhibiting RORγt, thereby reducing IL‐17A production, could attenuate microglial activation, neuroinflammation, and sympathetic excitation by preserving the integrity of the blood–brain barrier (BBB) in ANG II‐induced hypertensive rats.

Methods
Rats underwent a 2‐week subcutaneous infusion of ANG II, with concurrent daily subcutaneous administration of the RORγt inhibitor digoxin or vehicle.

Results
Compared with controls, ANG II‐infused rats exhibited elevated IL‐17A levels in both the periphery and brain, along with increased blood pressure and sympathetic tone—effects that were significantly attenuated by inhibiting RORγt with digoxin. ANG II‐infused rats also displayed heightened BBB permeability, decreased expression of the BBB regulator Mfsd2a (major facilitator superfamily domain‐containing protein 2a), increased caveolar transcytosis, and degradation of tight junction proteins in BBB endothelial cells within the hypothalamic paraventricular nucleus, a key autonomic regulatory brain center, all of which were alleviated by digoxin. Additionally, ANG II‐infused rats showed marked microglial activation and elevated expression of proinflammatory cytokines within the paraventricular nucleus, both of which were mitigated by digoxin.

Conclusions
These findings suggest that RORγt inhibition reduces neuroinflammation and sympathetic activation to ameliorate ANG II‐induced hypertension, likely by mitigating IL‐17A‐induced BBB disruption and microglial activation in the paraventricular nucleus.
New data on the presence of species of the genus Anapagurus (Anomura, Paguridae) in the Canary Islands
Authors: Almón Bruno , González José A. , Telle Arthur 
Published: February 2025

Abstract
This study examines the occurrence of species of the hermit crab genus Anapagurus in the Canary Islands, based on historical and recent information. The presence of Anapagurus laevis (Bell, 1845) and A. pusillus Henderson, 1888 is confirmed, albeit supported by a single record, while previous reports of A. longispina A. Milne-Edwards & Bouvier, 1900 and A. chiroacanthus (Liljeborg, 1856) are considered erroneous due to the misleading nature of the map on which they were based. The first documented record of A. chiroacanthus in the Canary Islands is provided and the list of Anapagurus species is updated accordingly.
Morphometrics, length-weight relationships and relative condition factor in Portunus sanguinolentus (Herbst, 1783) from the southeastern Arabian Sea
Authors: Josileen Jose , Najmudeen Theparambil Mohamed , Retheesh Thankappan , Sunil Karayil Tharayil Sadanandan , Vijayan Manakkathara Thathi 
Published: February 2025

Abstract
Portunus sanguinolentus is widely distributed all along the Indian coast and constitutes the most dominant marine crab landed in the country. In Kerala also, the species’ share is maximal in the marine landings and recorded an average of 1200 tonnes during 2007-2020. The bulk of the catch is contributed by trawlers and the species is mainly fished from the 20-30 m depth zone. It grows to a maximum size of 20 cm in carapace width (CW) and the estimated life span is approximately three years. Knowledge on the body weight-length/width relationships and relative condition factor in populations is important for estimating the population size of a stock and its exploitation. Hence, morphometric relationships between various characters, viz., carapace width (CW) and length (CL) and chelar propodus length (CPL) and height (CPH) in males, as well as CW and CL and abdominal width (AW) and length (AL) in females, were estimated using a total of 2476 male and 2965 female crabs. The CW/CL-weight relationship was studied in both sexes on a total of 5595 crabs using the allometric growth equation. The allometric relationships between the characters of this set suggest that most relationships are positive and highly significant (). The b values for CW-weight in males (55-171 mm/CW), females (54-170 mm/CW), and pooled were 2.9657, 2.8028, and 2.8914, respectively. The results show an isometric growth pattern for males and considerable deviation from isometric growth in females, also when all sizes are pooled. An analysis of covariance indicates that there is a significant difference between sexes () with respect to the carapace width-weight relationship. The relative condition factor () values estimated in males and females (based on CW) were 0.942 ± 0.145 and 1.371 ± 0.255, respectively, and the estimated values based on CL were 0.985 ± 0.204 and 1.022 ± 0.233, respectively.
Shaping the Evolution of International Law in View of its Core Effects
Authors: Vestner Tobias 
Published: February 2025

Abstract
In an international system that is undergoing change, states use international law in a strategic manner. Thereby, they shape the evolution of international law. This article explores how states proceed in this regard. It reviews the role of international law and its strategic use in international politics as well as describes the core effects of international law, namely to constrain, screen, and authorize state behavior. It then examines these effects in terms of the modes that states can use to influence the evolution of international law – agreements and related initiatives, legal positions, state activity, adjudication, and scholarship – and deduces states’ respective strategic options. The article then discusses overarching dynamics and implications for the international legal order. It concludes by arguing that negotiation theory and analysis should give broader attention to the processes that shape the evolution of international law other than by treaty-making.