bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Evaluation of a Deep Learning–Based Pulmonary Hypertension Screening Algorithm Using a Digital Stethoscope
Authors: Guo Ling , Khobragade Nivedita , Kieu Spencer , Ilyas Suleman , Nicely Preston N. , Asiedu Emmanuel K. , Lima Fabio V. , Currie Caroline , Lastowski Emileigh , Choudhary Gaurav 
Published: February 2025

Background
Despite the poor outcomes related to the presence of pulmonary hypertension, it often goes undiagnosed in part because of low suspicion and screening tools not being easily accessible such as echocardiography. A new readily available screening tool to identify elevated pulmonary artery systolic pressures is needed to help with the prognosis and timely treatment of underlying causes such as heart failure or pulmonary vascular remodeling. We developed a deep learning–based method that uses phonocardiograms (PCGs) for the detection of elevated pulmonary artery systolic pressure, an indicator of pulmonary hypertension.

Methods
Approximately 6000 PCG recordings with the corresponding echocardiogram‐based estimated pulmonary artery systolic pressure values, as well as ≈169 000 PCG recordings without associated echocardiograms, were used for training a deep convolutional network to detect pulmonary artery systolic pressures ≥40 mm Hg in a semisupervised manner. Each 15‐second PCG, recorded using a digital stethoscope, was processed to generate 5‐second mel‐spectrograms. An additional labeled data set of 196 patients was used for testing. GradCAM++ was used to visualize high importance segments contributing to the network decision.

Results
An average area under the receiver operator characteristic curve of 0.79 was obtained across 5 cross‐validation folds. The testing data set gave a sensitivity of 0.71 and a specificity of 0.73, with pulmonic and left subclavicular locations having higher sensitivities. GradCAM++ technique highlighted physiologically meaningful PCG segments in example pulmonary hypertension recordings.

Conclusions
We demonstrated the feasibility of using digital stethoscopes in conjunction with deep learning algorithms as a low‐cost, noninvasive, and easily accessible screening tool for early detection of pulmonary hypertension.
KLF12 Aggravates Angiotensin II‐Induced Cardiac Remodeling in Male Mice by Transcriptionally Inhibiting SMAD7
Authors: Hu Min , Huang Shi‐Yu , Gao Yi‐Peng , Hu Yu‐Xin , Wang Sha‐Sha , Teng Teng , Zeng Xiao‐Feng , Tang Qi‐Zhu 
Published: February 2025

Background
Adverse left ventricular remodeling and subsequent heart failure remain a major cause of patient morbidity and mortality worldwide. The KLF family of transcription factors plays crucial roles in heart injury. KLF12 (Krüppel‐like factor 12) is a transcription factor that regulates multiple disease processes, although the specific role of KLF12 in cardiac remodeling remains unclear.

Methods and Results
In our study, we observed a significant upregulation of KLF12 expression in remodeling hearts. The increased expression of KLF12 primarily originated from cardiac fibroblasts during the fibrotic response induced by angiotensin II. To investigate the effects of KLF12, we performed RNA‐seq and found that KLF12 overexpression significantly upregulated the cardiac remodeling associated pathway. Hence, we generated adult mice with cardiac fibroblast‐specific overexpression of KLF12 using lentivirus or miRNA (miR‐1/133TS) technology. Compared with control mice, KLF12‐miR1/133TS transfected mice exhibited exacerbated cardiac remodeling and function. Mechanistically, we discovered that KLF12 directly binds to the promoter of Smad7, leading to the activation of the TGF‐β (transforming growth factor beta)‐Smad3 pathway.

Conclusions
In conclusion, KLF12 promoted the development of angiotensin II‐induced cardiac remodeling in male mice. Targeting KLF12 may be a promising therapeutic approach to treat cardiac remodeling.
Telomere Length Is Associated With Adverse Atrial Remodeling in Patients With Atrial Fibrillation
Authors: Pradhan Kabita , Neupane Balram , Niehues Paul , Kirschner Martin , Beier Fabian , Kuo Chao‐Chung , Hilbold Erika Anneliese , Bär Christian , Thoma Oana‐Maria , Waldner Maximilian , Vieri Margherita , Brümmendorf Tim H. , Tharmapalan Vithurithra , Wagner Wolfgang , Kleines Michael , Emrani Mahdi , Zink Matthias Daniel , Napp Andreas , Marx Nikolaus , Gramlich Michael 
Published: February 2025

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia with a massive burden on global health. The prevalence of AF increases dramatically with age and can be up to 18% in patients older than 80 years. Telomeres, which are short, repeated DNA sequences at the end of chromosomes, are known to act as a biological aging marker. In this study, we investigated the relation of telomere shortening and AF in the context of atrial remodeling. Furthermore, we assessed changes in the gene expression profiles of patients with AF according to telomere length (TL) and left atrial fibrosis.

Methods

We included 72 patients undergoing catheter ablation for AF. Bipolar voltage maps were obtained to determine left atrial low voltage areas as a surrogate for atrial fibrosis. TL was quantified and correlated to low voltage areas. 3′ mRNA sequencing was performed for gene expression profiling. Clonal hematopoiesis of indeterminate potential was assessed by next generation sequencing. Telomerase reverse transcriptase knockout (
Tert
−/−
) and telomerase RNA component knockout (
Terc
−/−
) mice were used to investigate the mechanistic impact of telomere shortening on atrial remodeling.

Results
Patients with advanced left atrial fibrosis had shorter telomeres compared with patients with healthy left atria. Furthermore, there was a strong correlation between the extent of left atrial low voltage areas, TL, and outcome after catheter ablation of AF. 24 months after ablation, only 26.5% of patients with advanced fibrosis and short TL were in sinus rhythm compared with 62.5% of patients with no/low fibrosis and long TL. Gene expression profiles and clonal hematopoiesis of indeterminate potential frequency differed in patients with AF with short and long telomeres. Finally, atrial tissue of mouse models with shortened telomeres showed marked left atrial fibrosis and over‐expression of fibrosis‐related genes.

Conclusions
Telomere shortening is correlated with left atrial remodeling. Shorter telomeres are associated with a series of molecular events which could eventually lead to cardiac fibrosis and perpetuate AF.
Vascular Contractility Relies on Integrity of Progranulin Pathway: Insights Into Mitochondrial Function
Authors: Singh Shubhnita , Bruder Ariane , Costa Rafael M. , Alves Juliano V. , Bharathi Sivakama , Goetzman Eric S. , Bruder‐Nascimento Thiago 
Published: February 2025

Background

The complex interplay between vascular contractility and mitochondrial function is central to cardiovascular disease. The progranulin gene (
GRN
) encodes glycoprotein PGRN (progranulin), a ubiquitous molecule with known anti‐inflammatory property. However, the role of PGRN in cardiovascular disease remains undefined. In this study, we sought to dissect the significance of PGRN in the regulation vascular contractility and investigate the interface between PGRN and mitochondrial quality.

Methods and Results
We used aortae from male and female C57BL6/J wild‐type (PGRN+/+) and B6(Cg)‐Grntm1.1Aidi/J (PGRN−/−) mice. Our results showed suppression of contractile activity in PGRN−/−, followed by reduced α‐smooth muscle actin expression. Mechanistically, PGRN deficiency suppressed mitochondrial respiration, induced mitochondrial fission, and disturbed autophagy process and redox signaling, while restoration of PGRN levels in aortae from PGRN−/− mice via lentivirus delivery ameliorated contractility and boosted mitochondria activity. In addition, in vivo treatment with mitochondrial fission inhibitor restored mitochondrial quality and vascular contractility, while vascular smooth muscle cells overexpressing PGRN displayed higher lysosome biogenesis, accelerated mitophagy flux, and mitochondrial respiration accompanied by vascular hypercontractility. Finally, angiotensin II failed to induce vascular contractility in PGRN−/−, suggesting a key role of PGRN to maintain the vascular tone.

Conclusions
Our findings suggest that PGRN preserves the vascular contractility via regulating mitophagy flux, mitochondrial activity and dynamics, and redox signaling. Therefore, loss of PGRN function appears as a pivotal risk factor in cardiovascular disease.
Environmental Security and Local Livelihoods: Challenges and Opportunities in the West Philippine Sea
Authors: Contreras Antonio P. , Ancog Rico C. 
Published: February 2025

Abstract
The discourse on the West Philippine Sea is framed in the context of traditional security, and the territorial disputes between the Philippines and the People’s Republic of China, and other claimant countries in the region. However, the West Philippine Sea is not just a geographical region that is playing a role in geopolitics. It is also an economic resource providing livelihoods even to local communities. This article frames the discourse on the West Philippine Sea in the context of environmental security and adopts a political-ecological framework that is also cognizant of the role of non-state actors. It explores non-traditional diplomatic channels that would give privilege to the region as an important source of livelihoods for local communities. It also recognizes the fact that the sources of threats are not solely emanating from China, but also from large scale commercial fishing industry in the country.
Linkage between Southeast and South Asian summer monsoons: Relative roles of the Pacific-Japan pattern and the El Niño-Southern Oscillation
Authors: Lu Mengmeng , Ren Hong-Li 
Published: February 2025

Abstract
The various regional summer monsoons over Asia have been known to be highly interactive, but their interrelationships are still under debate. The current study investigates the linkage between the South Asian summer monsoon (SASM) and the Southeast Asian summer monsoon (SEASM) and the involved physical mechanisms. A robust positive correlation is found between the first Empirical Orthogonal Function (EOF) modes of SASM and SEASM precipitations. However, asymmetric features emerge between the mutually-enhanced (ME) and mutually-weakened (MW) SEASM-SASM cases.
Apparent Pacific-Japan (PJ) pattern occurs in the ME SEASM-SASM cases under a relatively weak sea surface temperature (SST) background, causing a southwest-northeast precipitation dipole with a positive center over the northern Bay of Bengal and a negative center over the eastern Arabian Sea and southern India induced by westerly anomalies with anticyclonic curvature associated with the anomalous heating over the tropical western North Pacific and cooling over the Maritime Continent. While in the MW SEASM-SASM cases, the El Niño-Southern Oscillation related SST anomalies (i.e. a transition from the equatorial eastern Pacific warming in winter to cooling in summer) are substantial, which cause simultaneous weakening of the first modes of SEASM and SASM through anomalous western North Pacific anticyclone induced by the Pacific SST anomalies and the capacitor effects of other tropical oceans. In addition, intensified diabatic heating over the Maritime Continent driven by the anomalous zonal circulation related to the eastern Pacific cooling can enhance the precipitation over the eastern Arabian Sea and southern India via the westward-propagating Rossby wave.
Unveiling the clinical spectrum: Exploring the role of anti-β2glycoprotein-1 antibodies (anti-β2GPI) in antiphospholipid syndrome suspects
Authors: Effendi Muhammad Umer Naeem , Majid Hafsa , Moiz Bushra , Jafri Lena , Zehra Nawazish , Khan Aysha Habib 
Published: February 2025

Objectives: The objectives of this study were to determine the prevalence of anti-β2glycoprotein-1 antibodies (anti-β2GPI) in Pakistani patients clinically suspected to have antiphospholipid syndrome (APS) and assess their association with clinical manifestations. Introduction: The antiphospholipid syndrome (APS) is a complex disorder characterized by recurrent thrombotic and obstetric complications. Methods: An analytical cross-sectional study was conducted at Aga Khan University Hospital from January to June 2022, after obtaining ethical approval (ERC ID: 2021-6404-19580). A total of 133 patients aged 18–60 years, clinically suspected of having APS based on the updated international consensus (Sydney) classification criteria, were recruited. Anti-β2GPI antibodies were tested using the same blood samples provided for aCL testing, with verbal consent. Demographic, clinical, and biochemical data were collected via a structured questionnaire, while information on lupus anticoagulant testing was retrospectively obtained from prior records. Results: The study included 120 females (90.2%) and 13 males (9.8%) with a mean age of 31.3 ± 8.8 years. Predominant clinical manifestations included unexplained miscarriages at >10 weeks of gestation ( n = 77/120 female, 64.2%), while deep venous thrombosis (DVT) was a common non-obstetric clinical feature ( n = 18/133, 13.5%). The median level of anti-β2GPI was 2.12 U/ml (1.34–7.04) and 7.5% ( n = 10) were positive. Of the 10 positive patients, 2 displayed positive anti-β2GPI while concurrently testing negative for other aPL antibodies. A significant association was identified between the presence of anti-β2GPI and the occurrence of DVT and other venous thromboembolic events (VTE). Conclusion: This study highlights the prevalence and diagnostic utility of anti-β2GPI in Pakistani patients suspected of APS, identifying cases missed by other aPL tests and showing significant associations with thrombotic manifestations like DVT and VTE. However, the cross-sectional design, lack of confirmatory testing, and absence of locally derived cut-offs limit causal inferences.
Advancement of post-market surveillance of medical devices leveraging artificial intelligence: ECG devices case study
Authors: Hundur Madžida , Spahić Lemana , Bećirović Faruk , Gurbeta Pokvić Lejla , Badnjević Almir 
Published: February 2025

Background After 25 years of implementing the Medical Devices Directive (MDD), in 2017, the new Medical Devices Regulation (MDR) came into force, establishing stricter requirements for post-market surveillance of the safety and performance of medical devices (MD). For electrocardiogram (ECG) devices, which are crucial for monitoring cardiac activities, these requirements are essential to ensure the reliability and accuracy of diagnosing cardiac conditions and timely treatment. Objective This study aims to enhance post-market surveillance of ECG devices by leveraging Machine Learning (ML) algorithms to predict the operational status of these devices. Specifically, the research focuses on classifying the success or failure of ECG device operations based on performance and safety parameters. The ultimate goal is to improve the management strategies of ECG devices in healthcare institutions, ensuring optimal functionality and increasing the reliability of diagnostic procedures. Method During the inspection process of ECG devices conducted by an accredited laboratory in accordance with ISO 17020 standard in numerous healthcare institutions in Bosnia and Herzegovina, a total of 5577 samples were collected. Various machine learning algorithms, including Decision Tree (DT), Logistic Regression (LR), Random Forest (RF), Gaussian Naive Bayes (NB), and Support Vector Machine (SVM), were employed for result comparison and selection of the most accurate algorithm. Results All algorithms demonstrated good performance, but the Random Forest (RF) algorithm stood out, achieving 100% accuracy in predicting the success/unsuccess status of the device. While the results of this research are specific to the collected data from EKG devices, the developed algorithms can be applied to other similar datasets, offering opportunities for broader use in the medical environment. Conclusion Implementing machine learning algorithms for automated systems in healthcare institutions can significantly enhance the quality of patient diagnosis and treatment. Additionally, these systems can optimize costs associated with managing medical devices. Improved post-market surveillance using ML can address challenges related to ensuring device reliability and safety.
Moral sensitivity and attitudes towards patient safety among critical care nurses
Authors: Afshari Ali , Torabi Mohammad , Dehghani Mahsa , Farhadi Mona 
Published: February 2025

Introduction Patient safety is essential for healthcare quality and a global concern. The rapid advancement of medical technology presents ethical challenges for critical care nurses, who navigate complex decision-making processes. Given their close relationships with patients, nurses are uniquely positioned to address patient safety issues. Thus, enhancing nurses’ moral sensitivity and ethical values is increasingly important. Objective This study aims to explore the relationship between moral sensitivity and attitude towards patient safety in critical care nurses. Methods This cross-sectional, descriptive-correlational study was conducted from June to September 2022 in three hospitals affiliated with Hamadan University of Medical Sciences in Iran. Participants were nurses in intensive care units (ICUs), selected via convenience sampling. A total of 382 nurses completed questionnaires assessing demographic information, moral sensitivity, and patient safety attitudes. Data analysis was performed using descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple regression in SPSS 26. Ethical considerations: This research received ethical approval from the Ethics Committee of Hamadan University of Medical Sciences. Participants provided informed consent regarding the study’s objectives, and their confidentiality was strictly upheld throughout the research. Results The nurses’ average age and work experience were 38.6 years and 12.4 years, respectively. Mean scores for moral sensitivity and patient safety attitude were 81.65 ± 2.69 and 51.47 ± 2.21, indicating high levels and a significant positive correlation. Factors such as increasing age, work experience, fewer working hours, and completion of ethics training were linked to more positive attitudes towards patient safety ( p < .05). Regression analysis showed that 42.8% of the variability in attitudes towards patient safety could be explained by moral sensitivity and demographic characteristics. Conclusion This study highlights the relationship between moral sensitivity and patient safety attitudes among critical care nurses, emphasizing the importance of education, experience, and training in shaping ethical values. Enhancing moral sensitivity is vital for reducing risky behaviors and improving patient safety outcomes in critical care settings.
Early Tibial Vessel Recoil Following Treatment With the Bare Temporary Spur Stent System: Results From the DEEPER OUS Vessel Recoil Substudy
Authors: Zeller Thomas , Zhang Zhiyuan , Parise Helen , Mascho Carolyn , Holden Andrew , Schmidt Andrej , Thieme Marcus , Piorkowski Michael , Hertting Klaus , Wissgott Christian , Andrassy Martin , Noory Elias , Weinberg Ido , Kolluri Raghu 
Published: February 2025

Purpose: Vessel recoil is a common phenomenon occurring in the tibial vessels following balloon angioplasty. This study examined the occurrence and short-term impact of acute vessel recoil in a subset of patients treated with retrievable scaffold therapy (RST) via the Spur Peripheral Retrievable Scaffold System (Spur). Methods: Patients with tibial disease underwent angiography immediately following RST, and then 15 minutes post-treatment. Vessel recoil was defined as a ≥10% decrease in lumen diameter after 15 minutes. Recoil was further analyzed by late lumen loss method, subsegmental late lumen loss method, and smallest segment to same segment method. Patient and vessel characteristics were evaluated. Functional recoil (acute vessel spasm), defined as no significant change in minimal lumen diameter (MLD) at baseline compared with 15 minutes post-treatment, was also evaluated. Results: Of the 38 patients (40 lesions; 33 men [87%]; mean [SD] age 75.3 [8.2] years; 26 (68.4%) with diabetes mellitus); recoil was noted in 42.5% of vessels. Prior to treatment, 13 lesions (32.5%) were total occlusions, the mean lesion length was 64.7±30.4 mm, and 27.5% (11/40) were moderate or severely calcified. Mean treated lesion length was 97.8±39.6 mm. For lesions evaluable by duplex ultrasound, 86.7% of vessels (26/30) were patent at 6 months. There was no significant difference in patency between lesions with recoil and lesions without recoil (81.8% vs 89.5%); there was a trend toward patency in the non-recoil group. Two lesions had functional recoil (acute vessel spasm) and were patent at 6 months. There was no statistically significant correlation of recoil to comorbidities or lesion characteristics, including calcification, for which there was also no correlation to patency. Conclusion: Vessel recoil was noted in 42.5% of vessels treated with RST, whereas previous published rates with balloon angioplasty demonstrated vessel recoil up to 97%, suggesting that RST may impact vessel recoil. This exploratory study did not demonstrate a correlation between vessel recoil and patency at 6 months. Clinical Impact Retrievable scaffold therapy may replace scoring devices and cutting devices for vessel preparation before definite (drug) therapy. Retrievable scaffold therapy supplements already established vessel preparation strategies in order to follow the concept of leaving nothing behaind. A temporary retrievable scaffold for changing vessel compliance and potentially releasing antiproliferative drugs represents a new interventional concept.
Narrow-based gait in people with Parkinson's disease: Its mechanisms explored
Authors: Jansen Jamie AF , Buurke Tom JW , van de Venis Lotte , Weerdesteyn Vivian , Keijsers Noël , Nonnekes Jorik 
Published: February 2025

Background People with Parkinson's disease (PD) typically exhibit a narrow-based gait. We previously found that walking with reduced trunk rotation and obliquity led to narrow-based gait in healthy adults; a decrease in trunk motion coincided with a decrease in mediolateral extrapolated center of mass (XCoM) excursion, requiring a smaller step width to maintain a constant mediolateral margin of stability (MoS). Objective To assess whether reduced trunk motion in PD is related to narrow-based gait, without affecting mediolateral MoS. To explore the underlying mechanisms of narrow-based gait, we examined the effects of increasing arm swing (aiming to increase trunk motion), and widening steps on gait in PD. Methods Fifteen people with PD and narrow-based gait and 17 age-matched controls walked on a treadmill for three minutes at a fixed gait speed during three conditions: baseline, increased arm swing and widened step width. Step width, trunk rotation and obliquity were calculated using marker data, and XCoM excursion and MoS using ground reaction forces. Results Trunk rotation, XCoM excursion, and step width were significantly smaller in PD compared to controls, while the MoS did not differ. Increased arm swing did not substantially increase trunk motions in PD, though people with PD were able to widen their step width. Conclusions We provide further evidence for a relation between trunk motion and step width. In PD, reduced trunk motion may contribute to narrow-based gait, without affecting mediolateral MoS; future work is needed to confirm a causal relationship between reduced trunk motion and narrow-based gait in PD.