bluuebunny/crossref_metadata_2025_split huggingface dataset:
Probable tirofiban-induced thrombotic microangiopathy after stent thrombosis: a case report
Authors: Mattioli Maria , Paoli Giorgia , Cambò Benedetta , Bonura Rosario 
Published: January 2023

Abstract

Background
Glycoprotein (GP) IIb–IIIa inhibitors are antithrombotic drugs used in selected patients during and after percutaneous coronary interventions (PCIs), usually as a bail-out in the setting of no-reflow or thrombotic complications. A notorious life-threatening adverse effect of this drug class is immune-mediated drug-induced thrombocytopenia (DITP). Thrombotic microangiopathy (TMA) induced by GP IIb–IIIa inhibitors has never been reported.

Case summary
A 72-year-old woman admitted for anterior myocardial infarction treated with primary PCI and stent implantation underwent a first tirofiban infusion as a bail-out strategy. After a new procedure for stent thrombosis, she received a second tirofiban infusion and developed sudden severe thrombocytopenia (platelet count &lt;20 000/µL). Tirofiban was stopped but no observed increase in platelet count. Acute kidney injury due to renal ischaemia and left ventricular thrombosis followed. Unexpectedly, evidence for haemolysis and schistocytosis at peripheral blood smear prompted a diagnosis of TMA. Plasma exchange was immediately started with evidence for initial increase in platelet count, but the patient died due to sudden haemodynamic and respiratory deterioration.

Discussion
Tirofiban is known to rarely cause immune-dependent DITP. However, it has never been associated with TMA. This case report not only describes the first case of probable tirofiban-induced TMA, but also highlights the importance of a systematic approach to severe thrombocytopenia, even in the setting of low platelet count from a known DITP-related drug. Treatment of TMA in the difficult context of recent myocardial infarction and stent thrombosis requires a complex interplay between cardiologist, haematologist, transfusionist, and nephrologist, carefully balancing thrombotic and haemorrhagic risk.
Electrical storm in hypertrophic cardiomyopathy: Cardiac magnetic resonance and sudden cardiac death risk stratification: a case report
Authors: Garcia Brás Pedro , Rosa Sílvia Aguiar , Portugal Guilherme , Oliveira Mário Martins 
Published: January 2023

Abstract

Background
Risk stratification for sudden cardiac death (SCD) is a key factor in the management of patients with hypertrophic cardiomyopathy (HCM). Cardiac magnetic resonance (CMR) has a unique role in the evaluation of HCM and offers superior diagnostic and prognostic information to assess the indication for a prophylactic implantable cardioverter-defibrillator (ICD).

Case summary
A 39-year-old patient with non-obstructive HCM with a low ESC HCM Risk-SCD score underwent a CMR revealing a left ventricular apical aneurysm and extensive late gadolinium enhancement; a prophylactic ICD was thus implanted. A month later, the patient was admitted in refractory electrical storm with over 50 appropriate ICD shocks due to sustained ventricular tachycardia. Despite anti-arrhythmic therapy and mechanical ventilation, the evolution was unfavourable with haemodynamic instability; veno-arterial extracorporeal membrane oxygenation was implanted. The patient was submitted to CMR-guided epicardial VT catheter ablation with complications of LV thrombus and severe pericardial effusion.

Discussion
This case details the complex risk stratification for SCD in patients with HCM, highlighting the important role of CMR in the integrated approach to risk stratification.
Proteinuria is independently associated with heart failure events in patients with atrial fibrillation: the Fushimi AF registry
Authors: Ikeda Syuhei , An Yoshimori , Iguchi Moritake , Ogawa Hisashi , Nakanishi Yumiko , Minami Kimihito , Ishigami Kenjiro , Aono Yuya , Doi Kosuke , Hamatani Yasuhiro , Yoshizawa Takashi , Ide Yuya , Fujino Akiko , Ishii Mitsuru , Masunaga Nobutoyo , Esato Masahiro , Tsuji Hikari , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu 
Published: January 2023

Abstract

Aims
Previous studies have shown that proteinuria is independently associated with the incidence of atrial fibrillation (AF), and is also associated with the incidence of cardiovascular events such as stroke and thromboembolism in patients with AF. However, the association of proteinuria with heart failure (HF) events in patients with AF remains unclear.

Methods and results
The Fushimi AF Registry is a community-based prospective study of patients with AF. Of the entire cohort of 4489 patients, 2164 patients had available data of proteinuria. We compared the clinical background and outcomes between patients with proteinuria (n = 606, 28.0%) and those without (n = 1558, 72.0%). Patients with proteinuria were older and had a higher prevalence of major co-morbidities. During the median follow-up of 5.0 years, the incidence rates of HF events (composite of cardiac death or HF hospitalization) were higher in patients with proteinuria than those without (4.1% vs. 2.1% person-year, P &lt; 0.01). Multivariate analyses revealed that proteinuria was an independent risk factor of the incidence of HF events [adjusted hazard ratio (HR): 1.40, 95% confidence interval (CI): 1.13–1.74]. This association was consistent among the various subgroups, except for the age subgroup in which there was a significant interaction (P &lt; 0.01) between younger (&lt;75 years) (unadjusted HR: 3.03, 95% CI: 2.12–4.34) and older (≥75 years) patients (unadjusted HR: 1.59, 95% CI: 1.23–2.05).

Conclusion
Our community-based large prospective cohort suggests that proteinuria is independently associated with the incidence of HF events in Japanese patients with AF.
Benignant and malignant epidemiology among surgical resections for suspicious solitary lung cancer without preoperative tissue diagnosis
Authors: Armand Elsa , Boulate David , Fourdrain Alex , Nguyen Ngoc-Anh-Thu , Resseguier Noémie , Brioude Geoffrey , Trousse Delphine , Doddoli Christophe , D’journo Xavier-Benoit , Thomas Pascal-Alexandre 
Published: January 2023

Abstract

OBJECTIVES
The aim of this study was to describe the epidemiology of patients undergoing diagnostic and/or curative surgical pulmonary resections for lung opacities suspected of being localized primary lung cancers without preoperative tissue confirmation.

METHODS
We performed a single-centre retrospective study of a prospectively implemented institutional database of all patients who underwent pulmonary resection between January 2010 and December 2020. Patients were selected when surgery complied with the Fleischner society guidelines. We performed a multivariable logistic regression to determine the preoperative variables associated with malignancy.

RESULTS
Among 1392 patients, 213 (15.3%) had a final diagnosis of benignancy. We quantified futile parenchymal resections in 29 (2.1%) patients defined by an anatomical resection of &gt;2 lung segments for benign lesions that did not modified the clinical management. Compared with patients with malignancies, patients with benignancies were younger (57.5 vs 63.9 years, P &lt; 0.001), had lower preoperative risk profile (thoracoscore 0.4 vs 2.1, P &lt; 0.001), had a higher proportion of wedge resection (50.7% vs 12.2%, P &lt; 0.01) and experienced a lower burden of postoperative complication (Clavien–Dindo IV or V, 0.4% vs 5.6%, P &lt; 0.001). Preoperative independent variables associated with malignancy were (adjusted odd ratio [95% confident interval]) age 1.02 [1.00; 1.04], smoking (year-pack) 1.005 (1.00; 1.01), history of cardiovascular disease 2.06 [1.30; 3.30], history of controlled cancer 2.74 [1.30; 6.88] and clinical N involvement 4.20 [1.11; 37.44].

CONCLUSIONS
Futile parenchymal lung resection for suspicious opacities without preoperative tissue diagnosis is rare (2.1%) while surgery for benign lesions represented 15.3% and has a satisfactory safety profile with very low postoperative morbi-mortality.
Temporal changes in the surgical management of patients with tetralogy of Fallot in Denmark: a nationwide cohort study
Authors: Gröning Mathis , Smerup Morten Holdgaard , Nielsen Dorte Guldbrand , Nissen Henrik , Munk Kim , Mortensen Ulrik Markus , Andersen Helle , Engholm Morten , Bjerre Jesper , Vejlstrup Niels , Juul Klaus , Søndergaard Eva Vad , Jensen Annette Schophuus , Jørgensen Troels Højsgaard , Thyregod Hans Gustav Hørsted , Andersen Henrik Ørbæk , Jøns Christian , Helvind Morten , Sondergaard Lars 
Published: January 2023

Abstract

OBJECTIVES
To assess temporal changes in the surgical management of patients with tetralogy of Fallot including the timing of interventions, surgical techniques, reinterventions and survival in a nationwide cohort.

METHODS
Patients with tetralogy of Fallot in Denmark were divided into 3 eras based on their year of birth: early (1977–1991), intermediate (1992–2006) and late (2007–2021).

RESULTS
The cohort consisted of 745 patients. Median follow-up was 21.2 years (13.7–30.5). There was a temporal trend towards less shunt palliation (–0.3% per year, 95% CI –0.05 to –0.1). Median age at intracardiac repair was 2.9 years (1.8–5.0), 0.8 years (0.5–1.3) and 0.5 years (0.4–0.7) (P &lt; 0.001) in the early, intermediate and late era, respectively. There was a temporal trend towards less valve-sparing repair (–0.7% per year, 95% CI –0.5 to –1.0) and more repair with transannular patches (0.7% per year, 95% CI 0.5–1.0). Survival at 10 years was 79% (64–76), 90% (87–93) and 95% (92–98) (P &lt; 0.001) and pulmonary valve replacement within the first 10 years after intracardiac repair was performed in 3% (1–6), 12% (8–16) and 21% (13–29) (P &lt; 0.001) in the early, intermediate and late era, respectively.

CONCLUSIONS
There was a temporal trend towards less shunt palliation and intracardiac repair at a younger age with more use of transannular patches. While survival throughout childhood and adolescence has improved, more patients undergo pulmonary valve replacement during the first 10 years after intracardiac repair.
Practising critical visual literacy through redesign in ELT classrooms
Authors: Brown Cecilie Waallann , Savić Milica 
Published: January 2023

AbstractThe aim of this article is to argue for the relevance of critical visual literacy (CVL) in relation to intercultural learning in ELT and present a redesign task that has been implemented with secondary school EFL learners in Norway. CVL is an approach to reading images which acknowledges that all texts are constructed, rather than neutral, and that they work to position the reader to accept a particular view of the world. Redesign tasks encourage learners to engage critically with these positions and create alternative texts that better reflect their personal worldviews. Through presenting examples of learner redesigns of a multimodal advertisement created in a different cultural context, we discuss how the task facilitated critical reading, exploration of multiple perspectives and engagement with sociopolitical issues. Such critical reading skills are crucial for navigating the increasingly more complex visual and intercultural landscapes the learners encounter in their everyday lives.
Teachers’ digital technology use after a period of online teaching
Authors: Moorhouse Benjamin Luke 
Published: January 2023

Abstract
This article reports on a study that investigated primary-school English-language teachers’ use of digital technologies in their in-person classrooms after a period of online teaching necessitated by the COVID-19 pandemic. It also explored the perceived effects the period of online teaching had on the teachers’ practices. Data were collected through in-depth interviews with sixteen experienced Hong Kong primary-school English-language teachers approximately one year after they returned to in-person teaching. The findings suggest that the period of online teaching has led to a greater utilization of technology for teaching. In addition, they suggest digital technologies are now embedded in teachers’ regular teaching practices, with the digital technologies adopted primarily those that enhance existing practices. Common digital technologies include: (1) learning management systems; (2) digital noticeboards; (3) interactive digital worksheets and quizzes; and (4) interactive presentation software. Examples of how teachers use digital technologies, and considerations for their use, are provided.
Artificial intelligence to enhance clinical value across the spectrum of cardiovascular healthcare
Authors: Gill Simrat K , Karwath Andreas , Uh Hae-Won , Cardoso Victor Roth , Gu Zhujie , Barsky Andrey , Slater Luke , Acharjee Animesh , Duan Jinming , Dall'Olio Lorenzo , el Bouhaddani Said , Chernbumroong Saisakul , Stanbury Mary , Haynes Sandra , Asselbergs Folkert W , Grobbee Diederick E , Eijkemans Marinus J C , Gkoutos Georgios V , Kotecha Dipak ,   BigData@Heart Consortium and the cardAIc group, Bunting Karina V , Tica Otilia , Mobley Alastair R , Wang Xiaoxia , Champsi Asgher , Haider Nafeesah Ahmad , Ventura Maximina , Young Alice , McGreavy Paul , Castellani Gastone , Bradlow William , O'Regan Declan , Center Julius 
Published: January 2023

AbstractArtificial intelligence (AI) is increasingly being utilized in healthcare. This article provides clinicians and researchers with a step-wise foundation for high-value AI that can be applied to a variety of different data modalities. The aim is to improve the transparency and application of AI methods, with the potential to benefit patients in routine cardiovascular care. Following a clear research hypothesis, an AI-based workflow begins with data selection and pre-processing prior to analysis, with the type of data (structured, semi-structured, or unstructured) determining what type of pre-processing steps and machine-learning algorithms are required. Algorithmic and data validation should be performed to ensure the robustness of the chosen methodology, followed by an objective evaluation of performance. Seven case studies are provided to highlight the wide variety of data modalities and clinical questions that can benefit from modern AI techniques, with a focus on applying them to cardiovascular disease management.Despite the growing use of AI, further education for healthcare workers, researchers, and the public are needed to aid understanding of how AI works and to close the existing gap in knowledge. In addition, issues regarding data access, sharing, and security must be addressed to ensure full engagement by patients and the public. The application of AI within healthcare provides an opportunity for clinicians to deliver a more personalized approach to medical care by accounting for confounders, interactions, and the rising prevalence of multi-morbidity.
Causal associations of sleep apnea, snoring with cardiovascular diseases, and the role of body mass index: a two-sample Mendelian randomization study
Authors: Wang Jiao , Campos Adrian I , Rentería Miguel E , Xu Lin 
Published: January 2023

Abstract

Aims
Previously, observational studies have identified associations between sleep apnea (SA) and cardiovascular diseases (CVDs), whereas whether the associations are causal remain unclear.

Methods and results
We used the bi-directional, two-sample Mendelian randomization (MR) study to assess the existence and direction of the causal relationship between SA or snoring and CVDs. Multivariable MR (MVMR) was used to assess the direct effect of SA on CVDs after adjusting for body mass index (BMI). Single-nucleotide polymorphisms (SNPs) associated with SA and snoring were obtained from the latest genome-wide association study, which combined five cohorts with a total number of 25 008 SA cases and 172 050 snoring cases (total = 523 366). Among the analytic sample of 523 366 individuals (25 008 SA cases and 172 050 snoring cases), and after correcting for multiple testing, inverse-variance weighted (IVW) showed that SA and snoring increased the risk of hypertension [odds ratio (OR) = 1.03, 95% CI 1.02–1.05 and 1.05, 1.03–1.07], and coronary artery disease (CAD) (1.41,1.19–1.67 and 1.61,1.26–2.07) with all false-discovery rate (FDR) &lt; 0.05, but such associations were decreased dramatically after adjusting for BMI using MVMR-IVW (0.06 &lt; FDRBMI adjusted &lt; 0.20). SA and snoring were not associated with atrial fibrillation (AF), heart failure (HF), or stroke. The presence of hypertension may increase the risk of SA (1.53, 1.04–2.25), but this association did not pass multiple comparisons (FDR &gt; 0.05).

Discussion
Our results suggest that SA and snoring increased the risk of hypertension and CAD, and these associations may partly be driven by BMI. Conversely, no evidence of CVDs causally influencing SA or snoring was found.
Constraints to speciation despite divergence in an old haplochromine cichlid lineage
Authors: Müller Claudio , Moser Florian N , Frei David , Seehausen Ole 
Published: January 2023

AbstractMost of the 500+ cichlid species of Lake Victoria evolved very rapidly in the wake of an adaptive radiation within the last 15,000 years. All 500 species have evolved from just one out of five old cichlid lineages that colonized the lake. Endemic to the Lake Victoria region, Astatoreochromis alluaudi is a member of an old haplochromine lineage that never speciated in the region. Even though the species occurs in a wide range of habitats, there were no indications of evolutionary diversification. Here, we tested predictions of several hypothetical mechanisms that might constrain speciation, including high dispersal rates, a generalist life style and the lack of behavioral assortative mating. Genomic analyses of individuals from 13 populations revealed several genomically distinct groups, associated with major habitat classes, indicating the existence of two distinct ecotypes. We found significant phenotypic differences between these ecotypes in the wild, which were retained under common-garden conditions, potentially indicating heritable phenotypic adaptations. Female mate choice experiments revealed the absence of behavioral assortative mating despite genetic and phenotypic differentiation between ecotypes. We suggest that the lack of coupling between behavioral mating preferences and phenotypic and genetic divergence constrains speciation in this cichlid.
Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India
Authors: Pati Sandipana , van den Akker Marjan , Schellevis F (François) G , Sahoo Krushna Chandra , Burgers Jako S 
Published: January 2023

Abstract

Background
Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities.

Methods
All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities.

Results
All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients.

Conclusion
Our study highlights the existing gaps in India’s healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India’s Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients.
Validation of a diagnostic prediction tool for colorectal cancer: a case–control replication study
Authors: Nemlander Elinor , Rosenblad Andreas , Abedi Eliya , Hasselström Jan , Sjövall Annika , Carlsson Axel C , Ewing Marcela 
Published: January 2023

Abstract

Background
Early detection of colorectal cancer (CRC) is crucial for survival. Primary care, the first point of contact in most cases, needs supportive risk assessment tools. We aimed to replicate the Swedish Colorectal Cancer Risk Assessment Tool (SCCRAT) for non-metastatic CRC in primary care and examine if risk factor patterns depend on sex and age.

Methods
2,920 adults diagnosed with non-metastatic CRC during the years 2015–2019 after having visited a general practitioner the year before the diagnosis were selected from the Swedish Cancer Register and matched with 11,628 controls, using the same inclusion criteria except for the CRC diagnosis. Diagnostic codes from primary care consultations were collected from a regional health care database. Positive predictive values (PPVs) were estimated for the same 5 symptoms and combinations thereof as in the baseline study.

Results
The results for patients aged ≥50 years old in the present study were consistent with the results of the SCCRAT study. All symptoms and combinations thereof with a PPV &gt;5% in the present study had a PPV &gt;5% in the baseline study. The combination of bleeding with abdominal pain (PPV 9.9%) and bleeding with change in bowel habit (PPV 7.8%) were the highest observed PPVs in both studies. Similar risk patterns were seen for all ages and when men and women were studied separately.

Conclusion
This external validation of the SCCRAT for non-metastatic CRC in primary care replicated the baseline study successfully and identified patients at high risk for CRC.
Diyne inactivators and activity-based fluorescent labeling of phenol hydroxylase in Pseudomonas sp. CF600
Authors: Oyarzun Mejia Alejandra P , Hyman Michael R 
Published: January 2023

Abstract
An activity-based labeling (ABL) approach was investigated for the phenol-oxidizing bacterium, Pseudomonas sp. CF600. Phenol-grown cells were exposed to several different terminal diynes, and following cell breakage, extracts of these cells were added to copper-catalyzed alkyne/azide cycloaddition reactions containing Alexa Fluor 647 azide. Analysis of total cell proteins by sodium dodecyl sulfate–polyacrylamide gel electrophoresis and near-infrared scanning demonstrated covalent fluorescent labeling of a 58- and a 34-kDa polypeptide in all diyne-treated cell types. Further studies using 1,4-diethynylbenzene (DEB) demonstrated that these labeled polypeptides were consistently detected in cells grown on substrates that exhibited phenol-dependent O2 uptake activity but not observed when cells were grown on substrates such as dextrose or catechol that did not support this activity. Fluorescent labeling of the two polypeptides in DEB-treated, phenol-grown cells was time dependent and was inhibited by several known substrates for phenol hydroxylase. These results suggest that diverse diynes act as mechanism-based inactivators of phenol hydroxylase in Pseudomonas sp. CF600 and that this effect can be exploited by ABL approaches to selectively label the major 58- and 34-kDa subunits of the hydroxylase component of this complex enzyme.