bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peak VO2 and VE/VCO2 exhibit differential prognostic capacity for predicting cardiac events
Authors: Choi J , Park J S , Choi H J , Choi H M , Hwang I C , Yoon Y E , Cho G Y 
Published: November 2023

Abstract

Background
Cardiopulmonary exercise testing (CPET) are commonly used to assess the functional capacity of patients with heart failure. While both peak oxygen uptake (VO2) and ventilatory efficiency (VE/CO2) are significant prognostic factors in heart failure, their values may not always be concordant.

Methods
This retrospective study included 688 patients who underwent both CPET and supine bicycle echocardiography (SBE) simultaneously. The primary endpoint of the study was defined as heart failure hospitalization or cardiac death. The patients were categorized into subgroups based on their VO2 and VE/VCO2 slope values.

Results
After median follow-up of 89 months, 111 (16.4%) patients developed cardiac events. The mean age and ejection fraction were 58 years and 59%. In multivariate analysis, both VO2 and VE/VCO2 remained powerful predictors of cardiac events after adjusting for age, ejection fraction, baseline or exercise E/e’, and peak TR velocity. Subgroup analysis revealed that Group III (VO2 &gt;20 and VE/VCO2 &gt;30) and IV (VO2 &lt;20 and VE/VCO2 &gt;30) had a significantly higher risk of cardiac events, with hazard ratios of 3.38 (CI 1.36-8.40) and 8.40 (CI 3.86-18.34), respectively, compared to Group I (VO2 &gt;20 and VE/VCO2 &lt;30). Group II (VO2 &lt;20 and VE/VCO2 &lt;30) had a non-significantly increased risk of cardiac events with a hazard ratio of 2.04 (CI 0.80-5.21) compared to Group I (Fig).

Conclusion
Both VO2 and VE/VCO2 slope were found to be excellent predictors of cardiac events in patients who underwent CPET and SBE. However, there is a slight difference between the two parameters, and poorer ventilatory inefficiency was found to be more associated with a worsened prognosis. The study suggests that the risk stratification using the VE/VCO2 slope and peak VO2 values can provide valuable information for clinicians in managing patients with heart failure.
Transcatheter endomyocardial alginate-hydrogel injection for treatment of heart failure
Authors: Wang B , Lee R , Zhu C J , Gao C H A O , Wang R T , Meng X I N , Serruys P W , Tao L I N G 
Published: November 2023

Abstract

Background and Aim
Intramyocardial injection of alginate-hydrogel, an emerging and promising strategy for patients with advanced heart failure (HF), is limited by the paucity of commercially available intramyocardial delivery methods. This study investigates the feasibility and safety of a novel X-DROP catheter injection system (Figure 1) for delivery of the alginate-hydrogel to pre-defined target areas in the treatment of HF with reduced ejection fraction.

Methods and results
Prior to the First-in-man, we demonstrated that transcatheter endo-myocardial alginate-hydrogel implantation (TEAi) was successfully and precisely performed with the X-DROP catheter system under TEE and fluoroscopy guidance in a healthy porcine model (Figure 2). Acute animal results (n = 15) showed no mortality, perforation, and sustained ventricular arrhythmias. Gross examination revealed the retention of the alginate-hydrogel in the pre-defined endocardial area at six months post-procedure (n = 4, Figure 2). The histological assessment showed that alginate-hydrogel was encapsulated by multiple layers of fibrosis without causing damage to the nearby myocardium. Expanding from the animal result, we conducted a first-in-human trial to evaluate the TEAi in patients with heart failure. Ten patients with NYHA class III-IV were enrolled, and all patients were successfully treated with TEAi without the device or procedure-related complications. At the 30-day follow-up, there were no serious adverse device events. One death occurred at a 3-month follow-up. The mean LVEF evaluated by MRI improved from 17.7±3.82 % at baseline to 24.94±11.15 % at 6 months post-procedure (p = 0.046). Also, ESV (297.50±67.85 vs 264.79±101.41, p = 0.029), EDV (359.5±71.92 vs 341.56±67.85, p = 0.105), six minutes walking test (339.7±37.6 m vs 370.4±64.8 m, p = 0.184), NYHA functional class (30% Class III and 70% Class IV vs 100% Class II), and KCCQ score (49.7±3.91 vs 79.0±8.1) were improved at 6-month follow-up. Holter monitor data showed no sustained ventricular arrhythmia during the TEAi or follow-up.

Conclusions
Our results established the safety and feasibility of TEAi using a novel platform, the X-DROP system and paved the way for the clinical application of intramyocardial injection of alginate-hydrogel in patients with HF.Figure 1Figure 2
Uptake of SGLT2i therapy among patients hospitalized with heart failure: Insights from the veterans affairs healthcare system
Authors: Calma J , Varshney A S , Funes Hernandez M , Hsiao S , Sallam K , Heidenreich P A , Sandhu A T 
Published: November 2023

Abstract

Introduction
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes among heart failure (HF) patients. However, the uptake of SGLT2i over time remains unknown.

Purpose
This study describes SGLT2i use in Veteran Affairs (VA) patients hospitalized with HF.

Methods
We identified a patient cohort of VA patients who were hospitalized with HF (primary HF diagnosis or secondary HF diagnosis with intravenous loop diuretics) from January 2019 to December 2022. Patients without VA medication prescriptions, prior allergy to SGLT2i, advanced chronic kidney disease (CKD), end-stage kidney disease (ESKD), and advanced heart failure therapies were excluded. We identified predictors of SGLT2i use in 2022 and compared the SGLT2i prescription rate to the ARNI prescription rate. The hospital-level variation in SGLT2i prescription was assessed via the median odds ratio.

Results
From 2019-2022, 70,344 VA patients were hospitalized with HF and eligible for SGLT2i therapy (Table 1). The average age was 72.6 years (SD 10.2); 45.5% had EF ≤40%, 12.3% EF 41%-49%, and 42.3% ≥50%. Among this cohort, 11.6% were prescribed SGLT2is at discharge. SGLT2i prescription rates increased over time (Figure 1) and were higher among patients with HFrEF and those with a primary hospital diagnosis of HF.
Among 16,426 patients hospitalized in 2022, SGLT2i prescription was more likely among patients with diabetes mellitus (OR 2.27; 95% CI: 2.09-2.46) and ischemic heart disease (OR 1.13; 95% CI: 1.03-1.25) in multivariable models. Patients with CKD were not more likely to receive SGLT2i therapy (OR 1.07; 95% CI: 0.98-1.16). Patients with increased age (OR 0.77 per 10 years; 95% CI: 0.73-0.80) and lower systolic blood pressure (OR 0.94 per 10mmHg; 95% CI: 0.92-0.96) were less likely to be prescribed SGLT2i. There was substantial facility-level variation of SGLT2i prescription with a median odds ratio (MOR) of 1.81 (1.64-2.03), suggesting a 1.8-fold variation in the likelihood that similar patients at 2 random VA sites were prescribed SGLT2i. Among patients with HFrEF, 30.7% (2,231/7,263) were prescribed an SGLT2i compared with 26.7% (1,937/7,263) patients prescribed ARNI.

Conclusion
Although utilization of SGLT2i at the time of discharge is overall low in hospitalized VA patients with HF, SGLT2i prescription rates have increased rapidly compared with ARNI. Opportunities exist to reduce variation in SGLT2i prescription rates in eligible patients across hospitals and to emphasize use in patients with CKD and advanced age.
Torsemide versus furosemide in patients with heart failure: a systematic review and updated meta-analysis of randomised controlled trials
Authors: Teixeira L M F , Felix N S , Navalha D D P , Madeira T M , Farias C F , Clemente M R C , Scabello I F , Ferreira R O M , Nogueira A K S , Tramujas L 
Published: November 2023

Abstract

Background
Furosemide is the most widely used diuretic for the management of heart failure (HF). However, the results of recent randomised controlled trials (RCTs) suggest that torsemide may be superior to furosemide in this setting.

Purpose
We aimed to compare the efficacy of torsemide versus furosemide in patients with HF.

Methods
We systematically searched PubMed, Scopus, and Cochrane Library for randomised controlled trials (RCTs) comparing torsemide with furosemide in patients with HF until February 2023 in accordance with PRISMA guidelines. Our outcomes of interest were all-cause mortality, hospitalisations for HF, and improvement in NYHA class. Review Manager software version 5.4.1 was used for statistical analyses. Between-study heterogeneity was assessed using I2 statistics.

Results
We included nine RCTs comprising 8270 patients with HF, of whom 2529 (30%) were randomised to torsemide. Mean follow-up ranged from 32 weeks to 17.4 years. In the pooled analysis, there was no significant difference between groups in terms of all-cause mortality (OR 0.98; 95% CI 0.85–1.13; p = 0.77; I2 = 0; Fig. 1A), hospitalizations for HF (OR 0.78; 95% CI 0.48–1.27; p = 0.32; I2 = 48; Fig. 1B), or improvement in NYHA class (OR 1.39; 95% CI 0.91–2.12; p = 0.13; I2 = 0; Fig. 1C).

Conclusion
In this meta-analysis, no significant difference was observed between torsemide and furosemide in managing HF with regards to all-cause mortality, hospitalisations for HF, or NYHA class improvement.Figure 1
Mediterranean diet and epicardial adipose tissue in patients with atrial fibrillation treated with ablation: a substudy of the ‘PREDIMAR’ trial
Authors: Barrio-Lopez María Teresa , Ruiz-Canela Miguel , Goni Leticia , Valiente Almudena Martinez , Garcia Silvia Romero , de la O Víctor , Anton Belen Diaz , Fernandez-Friera Leticia , Castellanos Eduardo , Martínez-González Miguel Angel , Almendral Jesus 
Published: November 2023

Abstract

Aims
To analyse the relationship between Mediterranean diet (MedDiet) adherence and epicardial adipose tissue (EAT) in patients with atrial fibrillation (AF) and the association between EAT or MedDiet adherence at baseline with AF recurrence after ablation.

Methods and results
We included 199 patients from the PREDIMAR trial (PREvención con DIeta Mediterránea de Arritmias Recurrentes), in a single centre in this substudy. All of them had a computed tomography with EAT measurement. Lifestyle and clinical characteristics were obtained at baseline. The traditional MedDiet pattern was defined according to the MedDiet Adherence Screener (MEDAS). Any documented AF &gt; 30 s after ablation was considered a recurrence. Multivariable-adjusted linear and logistic regression models were run to assess the cross-sectional association of MedDiet with EAT, and of EAT with the AF type at baseline. Also, Cox regression models were used to prospectively assess the associations of MedDiet adherence and EAT with AF recurrences after ablation. Median EAT was 135 g (interquartile range: 112–177), and the mean MedDiet score was 7.75 ± 2 points. A higher MEDAS ≥ 7 that was associated with lower odds of an EAT ≥ 135 g [multivariable odds ratio (mOR) = 0.45; 95% CI = 0.22–0.91; P = 0.025] was significantly associated with persistent AF after adjusting for traditional risk factors (mOR: 2.22; 95% CI: 1.03–4.79; P = 0.042). No significant associations were observed between EAT ≥ 135 g and the risk of atrial tachyarrhythmia recurrences after ablation [multivariable-adjusted hazard ratio (mHR) = 1.18; 95% CI: 0.72–1.94; P = 0.512], or between MEDAS ≥ 7 and AF recurrence (mHR = 0.78; 95% CI: 0.47–1.31; P = 0.344).

Conclusion
In patients with AF, higher adherence to MedDiet is associated with a significantly lower amount of EAT. Epicardial adipose tissue ≥ 135 g was significantly associated with persistent AF.
Automatic measurement of short-term variability of repolarization to indicate ventricular arrhythmias in a porcine model of cardiac ischaemia
Authors: Loen Vera , Smoczynska Agnieszka , Aranda Hernandez Alfonso , Scheerder Coert O S , van der Linde Britt H R , Beekman Henriëtte D M , Cervera-Barea Aina , Boink Gerard J J , Sluijter Joost P G , van der Heyden Marcel A G , Meine Mathias , Vos Marc A 
Published: November 2023

Abstract

Aims
An automated method for determination of short-term variability (STV) of repolarization on intracardiac electrograms (STV-ARIauto) has previously been developed for arrhythmic risk monitoring by cardiac implantable devices, and has proved effective in predicting ventricular arrhythmias (VA) and guiding preventive high-rate pacing (HRP) in a canine model. Current study aimed to assess (i) STV-ARIauto in relation to VA occurrence and secondarily (ii-a) to confirm the predictive capacity of STV from the QT interval and (ii-b) explore the effect of HRP on arrhythmic outcomes in a porcine model of acute myocardial infarction (MI).

Methods and results
Myocardial infarction was induced in 15 pigs. In 7/15 pigs, STV-QT was assessed at baseline, occlusion, 1 min before VA, and just before VA. Eight of the 15 pigs were additionally monitored with an electrogram catheter in the right ventricle, underwent echocardiography at baseline and reperfusion, and were randomized to paced or control group. Paced group received atrial pacing at 20 beats per min faster than sinus rhythm 1 min after occlusion. Short-term variability increased prior to VA in both STV modalities. The percentage change in STV from baseline to successive timepoints correlated well between STV-QT and STV-ARIauto. High-rate pacing did not improve arrhythmic outcomes and was accompanied by a stronger decrease in ejection fraction.

Conclusion
STV-ARIauto values increase before VA onset, alike STV-QT in a porcine model of MI, indicating imminent arrhythmias. This highlights the potential of automatic monitoring of arrhythmic risk by cardiac devices through STV-ARIauto and subsequently initiates preventive strategies. Continuous HRP during onset of acute MI did not improve arrhythmic outcomes.
Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data
Authors: Silva Cássia S S , Bensenor Isabela M , Goulart Alessandra C , Lotufo Paulo A , Santos Itamar S 
Published: November 2023

Abstract

Background
Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults.

Methods
The primary analyses included 15,051 participants aged 35–74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia.

Results
Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6–3.4%) of men and 7.4% (95%CI: 6.9–8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65–74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races.

Conclusions
Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.
Understanding barriers and facilitators of appropriate antibiotic use: a qualitative analysis of an online parenting forum
Authors: Reblin Maija , Ward Carter , Hammond Alice , Peloquin Jack , Rabinowitz Morgan , Fung Mark , Threlkeld Kirsten , Nowak Sarah 
Published: November 2023

Abstract

Purpose
Antibiotic use and misuse are common in pregnant women and young children. Few studies have assessed real-world discussions of antibiotics in these populations. Using social media posts of pregnant women and parents, our goal was to identify key themes about facilitators and barriers to appropriate antibiotic usage.

Methods
A purposive sample of public posts and comments relevant to antibiotic use was collected from the BabyCenter United States social media site. Using a directed content analysis, themes related to facilitators and barriers to appropriate antibiotic use were identified.

Results
Seven hundred and twenty-six posts and 5227 comments were analysed. Themes centred around individual factors, interpersonal factors, and structural factors. Individual factors included knowledge and beliefs. Though misinformation was present, most parents were aware of appropriate antibiotic usage and perceived antibiotics as safe and effective. Some hesitance around using antibiotics led to recommendations for home remedies or over-the-counter treatments. Interpersonal factors focused on a lack of available offline peer support, the expertise of providers, as well as a potential lack of attention from those providers. Structural factors, including access to care, also impacted parents’ antibiotic use and misuse.

Conclusion
Though most parents demonstrated appropriate knowledge about antibiotics and a willingness to follow guidelines, negative experiences with their providers, a lack of support from peers, and structural factors presented as potential barriers to appropriate antibiotic use. Implementing avenues for peer support for parents, allowing more time for providers to address parents’ concerns, and improving access to providers could improve appropriate antibiotic use in parents.
A Simulation Framework for Modeling the Within-Patient Evolutionary Dynamics of SARS-CoV-2
Authors: Terbot John W , Cooper Brandon S , Good Jeffrey M , Jensen Jeffrey D 
Published: November 2023

Abstract
The global impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable interest in detecting novel beneficial mutations and other genomic changes that may signal the development of variants of concern (VOCs). The ability to accurately detect these changes within individual patient samples is important in enabling early detection of VOCs. Such genomic scans for rarely acting positive selection are best performed via comparison of empirical data with simulated data wherein commonly acting evolutionary factors, including mutation and recombination, reproductive and infection dynamics, and purifying and background selection, can be carefully accounted for and parameterized. Although there has been work to quantify these factors in SARS-CoV-2, they have yet to be integrated into a baseline model describing intrahost evolutionary dynamics. To construct such a baseline model, we develop a simulation framework that enables one to establish expectations for underlying levels and patterns of patient-level variation. By varying eight key parameters, we evaluated 12,096 different model–parameter combinations and compared them with existing empirical data. Of these, 592 models (∼5%) were plausible based on the resulting mean expected number of segregating variants. These plausible models shared several commonalities shedding light on intrahost SARS-CoV-2 evolutionary dynamics: severe infection bottlenecks, low levels of reproductive skew, and a distribution of fitness effects skewed toward strongly deleterious mutations. We also describe important areas of model uncertainty and highlight additional sequence data that may help to further refine a baseline model. This study lays the groundwork for the improved analysis of existing and future SARS-CoV-2 within-patient data.
A role for β-1,6- and β-1,3-glucans in kinetochore function in Saccharomyces cerevisiae
Authors: Kshirsagar Rucha , Munhoven Arno , Tran Nguyen Tra My , Ehrenhofer-Murray Ann E 
Published: November 2023

Abstract
Chromosome segregation is crucial for the faithful inheritance of DNA to the daughter cells after DNA replication. For this, the kinetochore, a megadalton protein complex, assembles on centromeric chromatin containing the histone H3 variant CENP-A, and provides a physical connection to the microtubules. Here, we report an unanticipated role for enzymes required for β-1,6- and β-1,3-glucan biosynthesis in regulating kinetochore function in Saccharomyces cerevisiae. These carbohydrates are the major constituents of the yeast cell wall. We found that the deletion of KRE6, which encodes a glycosylhydrolase/ transglycosidase required for β-1,6-glucan synthesis, suppressed the centromeric defect of mutations in components of the kinetochore, foremost the NDC80 components Spc24, Spc25, the MIND component Nsl1, and Okp1, a constitutive centromere-associated network protein. Similarly, the absence of Fks1, a β-1,3-glucan synthase, and Kre11/Trs65, a TRAPPII component, suppressed a mutation in SPC25. Genetic analysis indicates that the reduction of intracellular β-1,6- and β-1,3-glucans, rather than the cell wall glucan content, regulates kinetochore function. Furthermore, we found a physical interaction between Kre6 and CENP-A/Cse4 in yeast, suggesting a potential function for Kre6 in glycosylating CENP-A/Cse4 or another kinetochore protein. This work shows a moonlighting function for selected cell wall synthesis proteins in regulating kinetochore assembly, which may provide a mechanism to connect the nutritional status of the cell to cell-cycle progression and chromosome segregation.
Palaeomagnetic field intensity measurements from the 2.6 Ga Yandinilling dyke swarm (Western Australia)
Authors: Hawkins Louise M , Biggin Andrew J , Liu Yebo , Grappone J Michael , Li Zheng-Xiang 
Published: November 2023

SUMMARY
Precambrian palaeointensity measurements provide fundamental constraints on the evolution of the deep Earth. Core evolution models predict trends in dipole moment on billion-year timescales that can be tested by palaeomagnetic records. Here, we report new palaeointensity results from the recently identified ∼2.62 Ga Yandinilling dyke swarm of the Yilgarn Craton, Western Australia, and consider them alongside published measurements spanning 500 Myr across the late Archaean to earliest Proterozoic. Rock magnetic and scanning electron microscopy analysis confirm that the magnetic mineralogy is fine-grained magnetite, appearing mostly as exsolved lamellae with ilmenite. Six sites produced acceptable palaeointensity estimates from thermal and microwave IZZI protocol Thellier experiments and from double-heating technique Shaw experiments. These site mean values of 9–26 µT translate to virtual dipole moments of 11–44 ZAm2 that are considerably lower than today's dipole moment of ∼80 ZAm2 and the value predicted for this time period by some thermal evolution models. Their average (median = 41 ZAm2) is, however, similar to the long-term average during both of the intervals 2300–2800 Ma (median = 44 ZAm2; N = 103) and 10–500 Ma (median 41 ZAm2; N = 997). While there is little evidence for a substantial net change in average dipole moment between the late Archaean and Phanerozoic, there is preliminary evidence that its variance has increased between the two intervals. This lower variance more than two billion years ago supports the idea that the geodynamo, even while not producing a stronger magnetic field, was more stable on average at the Archaean–Proterozoic transition than it is today.