bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective validation of a unique pretest probability score for preoperative deep vein thrombosis
Authors: Hamamoto Y , Tokushige A , Tajima A , Uchiyama Y , Horizoe Y , Yasuda H , Ohishi M 
Published: November 2023

Abstract

Background
Venous thromboembolism is a crucial perioperative complication. We developed a pretest probability score (KAGOSHIMA DVT score) for predicting deep vein thrombosis (DVT) before surgery. The purpose of our study was to validate KAGOSHIMA DVT score prospectively.

Methods
KAGOSHIMA DVT score was assigned 2 points to D-dimer ≥ 1.5 μg/mL and 1 point each to age ≥ 60 years, female, ongoing glucocorticoid therapy, cancer with high risk of DVT and prolonged immobility. KAGOSHIMA DVT score of 3 points or higher was defined as intermediate group, 5 or higher as high group. We included a total of 4051 patients planned surgery under general anesthesia between May 2022 and February 2023. 452 patients were performed whole leg ultrasonography suspected DVT using a cutoff point of D-dimer ≥ 1μg/ml, KAGOSHIMA DVT score of 3 points or higher. We excluded aneurysm, pregnancy, ongoing anticoagulant therapy, and other thrombosis. We validated 253 patients of the presence of DVT.

Results
DVT was detected in 93/253 (36.8%) patients, 64/200 (32%) in the intermediate probability group, and 29/53 (54.7%) in the high group, respectively. The prevalence of DVT increased with each increase in KAGOSHIMA DVT score. D-dimer ≥ 1.5 μg/mL (92% vs 100%, p=0.033), age ≥ 60 years (86.5% vs 96.2%, p=0.048), female (53% vs 96.2%, p&lt;0.001), glucocorticoids (6.5% vs 22.6%, p=0.001), active cancer with high risk of DVT (23% vs 64.2%, p&lt;0.001), and prolonged immobility (4.5% vs 22.6%, p&lt;0.001) were significantly higher in the high probability group than the intermediate group.
The number of whole-leg ultrasonography decreased from 461 to 253(54.7%) during the same period. In the intermediate group, the detection rate of DVT was a significantly higher in the prospective study than in the retrospective study (21.4% vs 32%, p=0.012). In the high probability group, there was no significant difference (48.2% vs 54.7%, p=0.49).

Conclusion
KAGOSHIMA DVT score stratified perioperative DVT probability and was useful to detect DVT prospectively.rate of DVT
Insufficient long-term LDL-cholesterol management in patients with familial hypercholesterolemia 5 years after an acute coronary syndrome
Authors: Krasieva K , Gencer B , Carballo D , Muller O , Fournier S , Matter C , Luescher T , Raeber L , Rodondi N , Mach F , Nanchen D 
Published: November 2023

Abstract

Background
Long-term control of cardiovascular risk factors after an acute coronary syndrome (ACS) is a cornerstone in preventing cardiovascular event recurrence. In patients with familial hypercholesterolemia (FH) and ACS, long-term management of LDL-cholesterol has been poorly studied.

Purpose
To investigate the extent of LDL-c and other cardiovascular risk factor management 5 years after ACS in patients with and without FH.

Methods
We collected data from 3,201 patients with an ACS from a Swiss multicenter cohort study and with 5-years follow-up data. At hospital admission for ACS, clinical FH was defined based on personal and familial history of premature cardiovascular disease as well as LDL-c levels, using the Dutch Lipid Clinic and the Simon Broome definitions. At the 5-years follow-up visit after ACS, we assessed LDL-c levels, lipid-lowering drugs, and control of cardiovascular risk factors comparing patients with FH and without FH.

Results
At the time of ACS, mean age of the 3,201 patients was 61.6 years old (SD 12.2), 643 (20.1%) were female, and 740 (23.1%) were diagnosed with clinical FH. At 5-years follow-up post-ACS, mean age was 56.6 years for FH patients and 69.6 years for patients without FH. 5 years after ACS, 15.4% and 33.5% patients with FH had an LDL-cholesterol ≤ 1.4 mmol/l, respectively ≤ 1.8 mmol/l, compared with 21.0% and 44.3% of those without FH (p=0.01, respectively &lt;0.001) (see Figure and Table). Use of statins was similar between groups, but patients with FH were more frequently using high-dose statins compared to patients without FH (51.0% vs 42.9%, p&lt;0.001). Use of lipid-lowering therapy in general such as statins, ezetimibe, fibrates, or niacin was more frequent in patients with FH than in those without FH (91.0% vs 87.0%, p=0.01). Beside LDL-c management, 5-year control of other cardiovascular risk factors tended to be superior in FH patients as compared to patients without FH: 78.5% vs 69.0% p&lt;0.001 for systolic blood pressure (BP) &lt; 140 mmHg; 46.2% vs 38.9% p=0.4 for reaching HbA1c &lt; 7% in patients with diabetes; 46.9% vs 42.7% p=0.27 for smoking cessation, and 28.2% vs 21.0% p=0.1 for reduction of alcohol consumption &lt;14 units/week .

Conclusion
Five years after an ACS, patients with FH had less optimal control of LDL-c levels despite being younger and more frequently using high dose statins compared to patients without FH. Combination of lipid-lowering therapy needs to be studied for optimal long-term management of patients with ACS and FH.Figure:CVRF 5 years post-ACS FH/non-FHTable:CVRF 5 years post-ACS FH/non-FH
Early diagnosis and treatments in childhood are associated with better prognosis in patients with familial hypercholesterolemia
Authors: Tada H , Nomura A , Nohara A , Usui S , Sakata K , Takamura M , Kawashiri M 
Published: November 2023

Abstract

Objective
The early diagnosis and treatment initiation for children with familial hypercholesterolemia (FH) has been recommended in guidelines. However, there is limited data on the impact of early treatments on the prognosis of children with FH. To investigate if the early initiation of lipid-lowering therapies among Japanese pediatric patients with FH reduced the occurrence of cardiovascular disease (CVD) events in them.

Methods
We retrospectively investigated the occurrence of CVD events (myocardial infarction, unstable angina, or coronary artery revascularization) in patients with FH (N = 1050, male/female = 490/560), including 106 children below 20 years. We compared a variety of phenotypes, including genetic backgrounds, other complications, LDL cholesterol, medical therapies, and their prognoses between the patients’ diagnoses before the age of 20 years (children, mean age = 15 years) and after that age (adults, mean age = 52 years). Overall, 290 patients (27.6%) had a history of prior CVD events.

Results
The median follow-up duration was 12.6 [9.5–17.9] years. The baseline LDL cholesterol level, 239 mg/dL, dropped to 112 mg/dL with the treatments. The Achilles tendon thickness was significantly lower in children than that of adults (7.2 vs. 8.9 mm, P &lt; 0.001). Over the follow-up duration, 119 CVD events were observed. Importantly, no CVD event was observed in children despite their median LDL cholesterol level at follow-up being significantly higher than that of adults (122 vs. 111 mg/dL, P &lt; 0.001).

Conclusion
The likelihood of CVD events in those with FH diagnosed and treated in childhood is low.
Survey on lipid management in cardiovascular primary prevention: do physicians follow the guidelines?
Authors: Alami M , Mouine N , Iraqi H , Moustaghfir A 
Published: November 2023

Abstract

Background
Cardiovascular (CV) primary prevention (PP) is crucial at both the individual-level and community-level. Cholesterol "controversies" and misinformation may impact many physicians (and patients) in the implementation of the lipid management in CV primary prevention. Do most physicians follow the guidelines? Do they believe in the guidelines?

Purpose
The main aim of this survey is to assess physicians' level of implementation of the lipid guidelines in PP (ESC Guidelines of Cardiovascular Prevention 2021). The secondary aim of the survey is to evaluate physicians’ degree of agreement on recommended LDL targets in primary prevention. The third aim is to compare the results of the 3 physicians’ groups: cardiologists, endocrinologists, and General Practitioners (GPs).

Methods
The questionnaire was distributed electronically to approximately 2500 physicians (cardiologists, endocrinologists, and GPs) with a link to the hosting website. Data collected was anonymous. A chi-square statistical analysis was used to compare results among physicians’ groups.

Results
559 physicians answered the questionnaire (267 cardiologists, 90 endocrinologists, and 202 GPs). First session related to the everyday practice (4 out of 10 questions) showed that 49.9% of physicians are using the SCORE2 tool at least once a week. Significative differences were observed among physicians’ groups: 69.8% of endocrinologists vs 51.1% of cardiologists (p&lt;0,02) are using the tool at least once a week. 38% of GPs are using the SCORE2 at least once a week (p&lt;0,03 vs cardiologists and p&lt;0,00001 vs endocrinologists). For the 3 questions related to 3 different pts profile who should be on statin (ESC Guidelines), 63.2% agree to prescribe the drug. There were no differences between the 3 physicians’ groups. The second session (6 questions), about physicians’ beliefs, 98.2% think that lowering LDL is a priority to avoid a Myocardial Infarction (MI) but only 54.9% believe that focusing on LDL is more important than A1c to reduce the risk of MI in diabetic pts. Statistical analysis showed no differences between the 3 physicians’ groups. 55.9% believe that LDL targets in the Guidelines for PP are too low and 72% think that an LDL target &lt;1g/l (&lt;2.6mmol/l) is enough in PP.

Conclusions
SCORE2 tool is more used by endocrinologists than cardiologists but it is still underused by both. In terms of lipids management, most of the surveyed physicians are following the guidelines. They are aware of the importance of lowering LDL, but the majority thinks that primary prevention’s guidelines targets are too low. An urgent awareness on the importance of risk calculation and reaching LDL targets is needed for many physicians that follow but do not believe.
Remnant cholesterol in atherosclerotic cardiovascular disease: a systematic review and meta-analysis
Authors: Delialis D D , Georgiopoulos G G , Aivalioti E A , Konstantaki C K , Oikonomou E O , Bampatsias D B , Mavraganis G M , Maneta E M , Patras R P , Papaioannou M P , Dimopoulou A M D , Angelidakis L A , Liberopoulos E L , Stellos K S , Stamatelopoulos K 
Published: November 2023

Abstract

Background
Accumulating evidence suggests a substantial contribution of remnant cholesterol (RC) to residual risk for the development or relapse of atherosclerotic cardiovascular disease (ASCVD).

Purpose
We aimed to evaluate the association of RC levels with ASCVD risk by different risk categories and method of RC assessment. We also assessed available evidence on the effect of lipid-lowering therapies (LLTs) on RC levels.
Data sources: English-language searches of Medline, Pubmed and Embase (inception to 31 January 2023); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews.
Study selection: Studies reporting on the risk of the composite endpoint [all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE)] by RC levels. Moreover, we searched for studies reporting differences in RC levels after administration of LLT(s).
Data extraction: Dual extraction and quality assessment of individual studies.
Data synthesis: Among n=29 studies with 257,387 participants, we found a pooled linear (pooled HR:1.27 per 1-SD increase,95% CI:1.12-1.43,P&lt;0.001,I2=95%,n=15 studies) and non-linear association (pooled HR:1.59 per quartile increase,95% CI:1.35-1.85,P&lt;0.001,I2=87.9%,n=15 studies) of RC levels and the risk of MACE both in patients with and without established ASCVD. Interestingly, the risk of MACE was higher in studies with directly measured vs. calculated RC levels. In a limited number of studies and participants, LLTs reduced RC levels.
Limitation: Publication bias and heterogeneity regarding the number of participants per study, follow-up duration, ASCVD prevalence, measurement of RC levels and endpoints.

Conclusion
RC levels are associated with ASCVD risk both in primary and secondary prevention. Directly measured RC levels are associated with ASCVD risk more evidently. Available LLTs tend to decrease RC levels, although the clinical relevance of RC decrease merits further investigation.
Attainment of LDL-cholesterol goals in patients with previous myocardial infarction: a real-world cross-sectional analysis
Authors: Gomes D , Sousa Paiva M , Freitas P , Albuquerque F , Lima R , Reis Santos R , Presume J , Bello R , Maltes S , Trabulo M , Aguiar C , Ferreira J , Ferreira A M , Mendes M 
Published: November 2023

Abstract

Background
ESC guidelines recommend an LDL-cholesterol (LDL-C) &lt;55mg/dL for patients with established cardiovascular disease. While the Friedewald’s equation to estimate LDL-C is still widely used, the newer Martin-Hopkins’ formula has shown greater accuracy. The aims of this work were: 1) to assess the proportion of patients reaching their LDL-C goal and the therapies used, and 2) to assess the impact of using the Martin-Hopkins' method instead of Friedewald’s formula on the proportion of controlled patients.

Methods
Single-centre cross-sectional study including consecutive post-myocardial infarction patients followed by 20 different cardiologists in a tertiary hospital. Data were collected retrospectively from clinical appointments that took place after April 2022. Only those with an available ambulatory lipid profile were considered. For each patient, LDL-C levels and goal attainment were estimated by both Friedewald’s and Martin-Hopkins’ equations.

Results
A total of 400 patients were included (age 67±13 years, 77% male, 31% diabetics). The last myocardial infarction had occurred a median of 4,5 years before the appointment. Using Friedewald’s equation, median LDL-C under therapy was 64 mg/dL [IQR (50-81)]. Overall, 125 patients (31%) had LDL-C within target (Figure 1). High intensity statins were used in 256 patients (64%), 146 (37%) were under ezetimibe, and 2 (0.5%) were under PCSK9 inhibitors. Combination therapy of high intensity statin + ezetimibe was used in 102 patients (26%) (Figure 2). These patients had a median LDL-C of 61mg/dL [IQR (45-75)], with 35% attaining LDL-C levels &lt;55 mg/dL, and 11% remaining above 100 mg/dL. Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8% of total). Among those deemed controlled by the Friedewald’s equation, 27 (21.6%) would have a Martin-Hopkins’ LDL-C above the target, while 4 (1.5%) of the uncontrolled patients would have a recalculated LDL-C &lt;55mg/dL. The following medical appointment was scheduled a median of 8 months (IQR 6-11) later.

Conclusion
Less than one third of post-myocardial infarction patients followed in a tertiary hospital’s cardiology clinic had LDL-C values within the goal, with a prescription pattern suggesting a large underutilization of readily available therapies. Applying the Martin-Hopkins’ formula to calculate LDL-C would reclassify roughly one fifth of presumably controlled patients into the non-controlled group.Figure 1Figure 2
Cardiovascular outcomes in patients with coronary artery disease and elevated lipoprotein(a): Implications for the OCEAN(a)-Outcomes trial population
Authors: Shiyovich A , Berman A , Besser S , Biery D , Huck D , Weber B , Cannon C , Januzzi J , Booth J , Nasir K , Di Carli M , Lopez A , Kent S , Bhatt D , Blankstein R 
Published: November 2023

Abstract

Background
Lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular (CV) disease. The ongoing Olpasiran Trials of Cardiovascular Events and Lipoprotein(a) Reduction [OCEAN(a)]-Outcomes trial is evaluating whether Lp(a) lowering can reduce the incidence of CV events among patients with prior myocardial infarction (MI) or percutaneous coronary intervention (PCI) and elevated Lp(a) (≥ 200 nmol/L).

Purpose
To evaluate the association of elevated Lp(a) with CV outcomes in an observational cohort resembling the OCEAN(a)-Outcomes trial main enrollment criteria.

Methods
This retrospective study leveraged a large Lp(a) registry derived from electronic health records at two large academic medical centers in the US. The registry included patients aged 18-85 years with Lp(a) measured as part of their clinical care between 2000 and 2019. While patients were required to have a history of MI, or PCI, those with severe kidney dysfunction or a malignant neoplasm were excluded. Elevated Lp(a) was defined as ≥ 200 nmol/L consistent with the OCEAN(a) -Outcomes trial. The primary outcome was a composite of coronary heart disease (CHD) death, MI, or coronary revascularization. A combination of natural language processing algorithms, billing and ICD codes, laboratory data, and the National Death Index were employed to identify outcomes and covariates.

Results
Among the 16,821 patients in the registry, 3,142 (18.7%) met the established inclusion and exclusion criteria. Among eligible patients, the median age was 61 (IQR: 52-73) years, 28.6% were women, and 12.3% had elevated Lp(a). Patients with elevated Lp(a), versus non-elevated Lp(a), were more likely to be women (37.6% vs. 27.3%, p&lt;0.001) and to have hyperlipidemia (90.2% vs. 86.0%, p=0.024). Over a median follow-up of 12.2 years (IQR: 6.2-14.3), the primary composite outcome occurred more frequently in patients with versus without elevated Lp(a) (46.0% vs. 38.0%, HR=1.30 [95%CI: 1.09-1.53], p=0.003; Figure 1). Following adjustment for measured confounders, elevated Lp(a) remained independently associated with the primary outcome (adjHR=1.33 [95%CI: 1.12-1.58], p=0.001). Elevated Lp(a) was also associated with increased risk for most secondary outcomes (Table 1).

Conclusions
In an observational cohort resembling the main OCEAN(a)-Outcomes Trial enrollment criteria, patients with an Lp(a) ≥ 200 nmol/L had a higher risk of CV outcomes.
Severe biventricular cardiomyopathy in both current and former long-term users of anabolic–androgenic steroids
Authors: Abdullah Rang , Bjørnebekk Astrid , Hauger Lisa E , Hullstein Ingunn R , Edvardsen Thor , Haugaa Kristina H , Almaas Vibeke M 
Published: November 2023

Abstract

Aims
This study aims to explore the cardiovascular effects of long-term anabolic–androgenic steroid (AAS) use in both current and former weightlifting AAS users and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS.

Methods and results
In this cross-sectional study, 101 weightlifting AAS users with at least 1 year cumulative AAS use (mean 11 ± 7 accumulated years of AAS use) were compared with 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Sixty-nine were current, 30 former (&gt;1 year since quitted), and 2 AAS users were not available for this classification. Anabolic–androgenic users had higher left ventricular mass index (LVMI) (106 ± 26 vs. 80 ± 15 g/m2, P &lt; 0.001), worse left ventricular ejection fraction (LVEF) (49 ±7 vs. 59 ± 5%, P &lt; 0.001) and right ventricular global longitudinal strain (−17.3 ± 3.5 vs. −22.8 ± 2.0%, P &lt; 0.001), and higher systolic blood pressure (141 ± 17 vs. 133 ± 11 mmHg, P &lt; 0.001) compared with WLC. In current users, accumulated duration of AAS use was 12 ± 7 years and in former 9 ± 6 years (quitted 6 ± 6 years earlier). Compared with WLC, LVMI and LVEF were pathological in current and former users (P &lt; 0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11 vs. 10%, not significant (NS)). In current users, estimated lifetime AAS dose correlated with reduced LVEF and LVGLS, P &lt; 0.05, but not with LVMI, P = 0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF was not coexisting strength training or hypertension but history of AAS use (β −0.53, P &lt; 0.001).

Conclusion
Long-term AAS users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discontinued use.
Co-factor independent oxidases ncnN and actVA-3 are involved in the dimerization of benzoisochromanequinone antibiotics in naphthocyclinone and actinorhodin biosynthesis
Authors: Baral Bikash , Matroodi Soheila , Siitonen Vilja , Thapa Keshav , Akhgari Amir , Yamada Keith , Nuutila Aleksi , Metsä-Ketelä Mikko 
Published: November 2023

Abstract
Streptomyces produce complex bioactive secondary metabolites with remarkable chemical diversity. Benzoisochromanequinone polyketides actinorhodin and naphthocyclinone are formed through dimerization of half-molecules via single or double carbon-carbon bonds, respectively. Here we sequenced the genome of S. arenae DSM40737 to identify the naphthocyclinone gene cluster and established heterologous production in S. albus J1074 by utilizing direct cluster capture techniques. Comparative sequence analysis uncovered ncnN and ncnM gene products as putative enzymes responsible for dimerization. Inactivation of ncnN that is homologous to atypical co-factor independent oxidases resulted in the accumulation of fogacin, which is likely a reduced shunt product of the true substrate for naphthocyclinone dimerization. In agreement, inactivation of the homologous actVA-3 in S. coelicolor M145 also led to significantly reduced production of actinorhodin. Previous work has identified the NAD(P)H-dependent reductase ActVA-4 as the key enzyme in actinorhodin dimerization, but surprisingly inactivation of the homologous ncnM did not abolish naphthocyclinone formation and the mutation may have been complemented by an endogenous gene product. Our data suggests that dimerization of benzoisochromanequinone polyketides require two-component reductase-oxidase systems.
Development of a multiplex recombinase polymerase amplification coupled with lateral flow dipsticks for the simultaneous rapid detection of Salmonella spp., Salmonella Typhimurium and Salmonella Enteritidis
Authors: Zhan Zeqiang , He Shoukui , Cui Yan , Yang Jinzeng , Shi Xianming 
Published: November 2023

Abstract

Objectives
Salmonella spp. is a world-leading foodborne pathogen and its rapid detection is essential for ensuring food safety. Conventional methods require expensive instruments, considerable operational skills and cannot provide fast mobile on-site systems to detect Salmonella in food.

Materials and Methods
A visual method was established based on multiple recombinase polymerase amplification (RPA) coupled with lateral flow dipsticks (LFD) for the simultaneous detection of Salmonella spp., Salmonella Enteritidis and Salmonella Typhimurium in vitro and food.

Results
The optimal volume and temperature for the multiplex RPA-LFD method were determined to be 25 μL and 38 °C, respectively. The reaction process was completed within 25 min and the results were observed visually. The limits of detection (LODs) were 2.8×102, 5.9×102, and 7.6×102 CFU/mL for Salmonella spp., S. Enteritidis and S. Typhimurium, respectively. Meanwhile, the results of the established method showed no cross-reactivity between the Salmonella cells and other common foodborne bacteria, which was highly specific for Salmonella. More importantly, the developed method exhibited good performance in artificially contaminated chicken samples with the LODs of 2.8×103, 5.9×103, and 7.6×103 CFU/mL for Salmonella spp., S. Enteritidis, and S. Typhimurium, respectively. Finally, the application of the multiple RPA-LFD methods in retailed food samples displayed that this method was effective and practical for the detection of Salmonella spp. in food.

Conclusion
The developed multiplex RPA-LFD method provides a new sensitive and rapid alternative for the specific detection of Salmonella spp. and its important serovars in food.