bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 10262: High Output Cardiac Failure Due to Kratom
Authors: Gareeb Mohammad , Bhardwaj Chetan , Duvvuri Padmaraj D 
Published: June 2023

Introduction:
Kratom use has been known to the natives of Malaysia to increase energy and to treat pain. Over the recent past there has been an increase in Kratom usage in the U.S. with the ease of access.

Case Summary:
A 24-year-old male presented to the emergency department due to progressive shortness of breath and pedal edema over one month. The patient reported a history of daily Kratom use for the past 2 years. His vitals upon presentation were BP: 90/50 mmHg, HR 101 bpm, O2 saturation 100% and was afebrile. Relevant abnormal labs were: sodium 114 mEq, and a BNP of 2,747 pg/mL. Other labs including TSH and urine drug screen were unremarkable. Initial ECG showed normal sinus rhythm, right axis deviation and QTc of 552 ms. Chest X ray revealed a prominent pulmonary conus.

After being admitted to the ICU, he had an appropriate gradual increase in sodium level over the next 4 days. The transthoracic echocardiogram showed an LVEF of 70-75% and multiple findings suggestive of severe pulmonary hypertension and severe tricuspid regurgitation (Fig. 1 parts A and B). His estimated PASP was 95 mm Hg. Right heart catheterization demonstrated the following pressures (in mmHg): RA 5/6, PA 52/26 (37), mean PCWP 7. Cardiac output and index were 8.9 L/min and 5 L/min/m2 by Fick, 7.7 L/min and 4.3 L/min/m2 by thermodilution.
Four weeks after cessation of Kratom use he underwent a transthoracic echocardiogram which showed complete normalization of abnormal findings shown in Fig. 1 parts C and D. His RVSP normalized to 26 mm Hg.

Conclusion:
Previously reported adverse cardiovascular events from Kratom use include tachycardia, hypertension, chest pain, conduction defects, QTc prolongation as well as cardiac arrest. We present previously unknown complications of Kratom use, namely combined pre and post capillary pulmonary hypertension and high output heart failure.
Abstract 10998: Pulmonary Artery Pulsatility Measured by Cardiac Magnetic Resonance Imaging in Over 42,000 Participants Reveals Novel Genetic Risk Loci
Authors: Johnson Adam L , Morales Manuel A , WOOSTER Luke T , Li Rebecca H , Boerboom Sophie L , Ostrom Katrina , Sigurslid Haakon , Jiang Wanlin , Tian Wenjie , Zeghibe Ana , Singh Kuldeep , Barnes Hanna J , Lino cardenas christian L , Lee Sujin , Yu Paul B , Miller Clint L , Nguyen Christopher T , Malhotra Rajeev 
Published: June 2023

Introduction:
Pulmonary artery (PA) hemodynamics are important predictors of mortality. However, genetic mechanisms underlying increased PA stiffness in diseases such as pulmonary hypertension are poorly understood, and targeted therapies are limited. Evaluation of PA hemodynamics frequently requires invasive right heart catheterization, limiting large-scale studies. This study leveraged cardiac magnetic resonance (CMR) imaging to non-invasively determine and characterize PA pulsatility, an established measure of pulmonary vascular compliance.

Methods and Results:
A deep-learning neural network was implemented to determine PA pulsatility, defined as the relative cross-sectional area change from diastole to systole, in 42,774 UK Biobank participants (intraclass correlation 0.94-0.96 compared with human readers). The mean (SD) PA pulsatility was 0.36 (0.11), and pulsatility decreased by 0.035 for every decade increase in age. Reduction in pulsatility by 0.1 was associated with the presence of congestive heart failure (OR 1.55 [95% CI 1.37-⁠1.76]), chronic obstructive pulmonary disease (OR 1.41 [1.29-⁠1.53]), or diabetes (OR 1.18 [1.13-⁠1.23]), and PA pulsatility was associated with increased all-cause mortality (HR 1.13 [1.03-1.23]) after adjusting for age and sex and excluding those with CHF or COPD (Fig A-B). A genome-wide association study of 40,496 participants identified loci on chromosomes 2 (top SNP: rs6738973) and 10 (rs2077218) associated with PA pulsatility at genome-wide significance (
p
<  5 х 10
–8
; Fig C). Integrative fine-mapping analyses identified
PKDCC
and
PLCE1
among likely effector genes.

Conclusions:
This is the first population-based epidemiologic and genomics study of PA pulsatility. Decreased PA pulsatility is associated with advanced age, increased rates of comorbidities, and higher mortality. The genes
PKDCC
and
PLCE1
are among likely effectors of PA pulsatility and warrant further functional investigation.
Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium
Authors: Smith Christopher T , Rentrop Walter , Raper John , Olsen Daga , Sharifi Sasha , PARKER AMY , George Tara , Thang Sophia , Chib Anjula , Menon Vivek 
Published: June 2023

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA).
-
We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up.
-
Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR).
-
This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.
Abstract 131: Perceived Exertion And Physical Demand Of Performing 10-minutes Of Compression-only CPR
Authors: Flickinger Kate , DeMaio Ryann , Prescott Peter , Weissman Alexandra , Salcido David D , Coppler Patrick J , Ratay Cecelia R , Nagle Elizabeth , Rittenberger Jon , Goss Fredric , Callaway Clifton W , Menegazzi James J 
Published: June 2023

Cardiopulmonary resuscitation (CPR) is physically demanding and must also be performed under emotional distress. Most cardiac arrests (CA) occur at home, making it likely that only one rescuer is available to perform CPR until emergency medical services (EMS) or other lay rescuers arrive.
We performed a study to quantify the physical exertion required of lay-providers performing compression-only CPR for 10 minutes both with (WFB) and without (WOFB) real-time CPR quality feedback.

We recruited healthy, CPR certified lay individuals to perform 10-minute rounds of CPR on two occasions: once WFB and once WOFB. We collected heart rate (HR), oxygen consumption (VO
2
), and rating of perceived exertion (RPE) at baseline and throughout each round of CPR and collected capillary lactate and blood pressures pre- and post-CPR. We used Kruskal Wallis, Wilcoxon signed rank and rank sum tests to compare changes in measures during CPR.

Participants were 15 females and 11 males, age 25 (IQR 22-37). All measures except for diastolic blood pressure, significantly changed over time. Systolic blood pressure increased both WFB (mean difference (MD) 8mmHg; 95% CI 12-5) and WOFB (MD 8mmHg; 95% CI 12-3). VO
2
and HR increased over time, but peak VO
2
and HR did not differ by group. RPE significantly increased WFB and WOFB (WFB MD 8; 95% CI 10-7; WOFB MD 8; 95% CI 9-7) WFB and WOFB, with females reporting a higher RPE immediately post-CPR WFB than males (MD 2; 95% CI 5-1). Lactate increased from baseline immediately post (WFB MD 2.3mmol/L; 95% CI 0.9-3.7; WOFB MD 1.8mmol/L; 95%CI 2.6-1) and 5-minutes post CPR (WFB MD 0.8mmol/L; 95% CI 2.3-0.7; WOFB MD2.1 mmol/L; 95% CI 0.9-3.3).

CPR produces subjective and objective signs of strenuous exertion in both men and women. The presence of feedback does not alter physiologic response to prolonged CPR. However, females reported higher RPEs when performing CPR WFB, despite no significant difference in physiologic response.
Familial Associations of Prevalence and Cause-Specific Mortality for Thoracic Aortic Disease and Bicuspid Aortic Valve in a Large-Population Database
Authors: Glotzbach Jason P. , Hanson Heidi A. , Tonna Joseph E. , Horns Joshua J. , McCarty Allen Chelsea , Presson Angela P. , Griffin Claire L. , Zak Megan , Sharma Vikas , Tristani-Firouzi Martin , Selzman Craig H. 
Published: June 2023

BACKGROUND:
Thoracic aortic disease and bicuspid aortic valve (BAV) likely have a heritable component, but large population-based studies are lacking. This study characterizes familial associations of thoracic aortic disease and BAV, as well as cardiovascular and aortic-specific mortality, among relatives of these individuals in a large-population database.

METHODS:
In this observational case-control study of the Utah Population Database, we identified probands with a diagnosis of BAV, thoracic aortic aneurysm, or thoracic aortic dissection. Age- and sex-matched controls (10:1 ratio) were identified for each proband. First-degree relatives, second-degree relatives, and first cousins of probands and controls were identified through linked genealogical information. Cox proportional hazard models were used to quantify the familial associations for each diagnosis. We used a competing-risk model to determine the risk of cardiovascular-specific and aortic-specific mortality for relatives of probands.

RESULTS:
The study population included 3 812 588 unique individuals. Familial hazard risk of a concordant diagnosis was elevated in the following populations compared with controls: first-degree relatives of patients with BAV (hazard ratio [HR], 6.88 [95% CI, 5.62–8.43]); first-degree relatives of patients with thoracic aortic aneurysm (HR, 5.09 [95% CI, 3.80–6.82]); and first-degree relatives of patients with thoracic aortic dissection (HR, 4.15 [95% CI, 3.25–5.31]). In addition, the risk of aortic dissection was higher in first-degree relatives of patients with BAV (HR, 3.63 [95% CI, 2.68–4.91]) and in first-degree relatives of patients with thoracic aneurysm (HR, 3.89 [95% CI, 2.93–5.18]) compared with controls. Dissection risk was highest in first-degree relatives of patients who carried a diagnosis of both BAV and aneurysm (HR, 6.13 [95% CI, 2.82–13.33]). First-degree relatives of patients with BAV, thoracic aneurysm, or aortic dissection had a higher risk of aortic-specific mortality (HR, 2.83 [95% CI, 2.44–3.29]) compared with controls.

CONCLUSIONS:
Our results indicate that BAV and thoracic aortic disease carry a significant familial association for concordant disease and aortic dissection. The pattern of familiality is consistent with a genetic cause of disease. Furthermore, we observed higher risk of aortic-specific mortality in relatives of individuals with these diagnoses. This study provides supportive evidence for screening in relatives of patients with BAV, thoracic aneurysm, or dissection.
Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
Authors: Shweikialrefaee Bisan , Ko Dennis T. , Fang Jiming , Pang Andrea , Austin Peter C. , Dorian Paul , Singh Sheldon M. , Jackevicius Cynthia A. , Tu Karen , Lee Douglas S. , Abdel‐Qadir Husam 
Published: June 2023

Background
Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF.

Methods and Results

Using linked administrative databases in Ontario, Canada, we conducted a population‐based retrospective cohort study of patients, aged ≥66 years, diagnosed with AF between 2009 and 2019. We used cause‐specific hazard regression to determine the association of statin use with stroke rate. We developed a second model to further adjust for lipid levels in the subset of patients with available measurements in the year before AF diagnosis. Both models adjusted for age, sex, heart failure, hypertension, diabetes, stroke/transient ischemic attack, vascular disease, and P2Y12 inhibitors at baseline, plus anticoagulation as a time‐varying covariate. We studied 261 659 qualifying patients (median age, 78 years; 49% women). Statins were used in 142 834 (54.6%) patients, and 145 673 (55.7%) had lipid measurement(s) in the preceding year. Statin use was associated with lower stroke rates, with adjusted hazard ratios of 0.83 (95% CI, 0.77–0.88;
P
<0.001) in the full cohort and 0.87 (95% CI, 0.78–0.97;
P
=0.01) when adjusting for lipid data. Stroke rates increased in a near‐linear manner as low‐density lipoprotein values increased >1.5 mmol/L.

Conclusions
Statins were associated with lower stroke rates in patients with AF, whereas higher low‐density lipoprotein levels were associated with higher stroke rates, highlighting the importance of vascular risk factor treatment in AF.
Love, Knowledge, and Freedom in Pleasantville, Religious Scripture, and Wider Western Literature
Authors: Carr David 
Published: June 2023

Abstract
Love has long been extolled as a route to human moral and spiritual progress and fulfilment, not only in much past religious literature and narrative but in the more recent work of writers such as the philosopher and novelist Iris Murdoch. In such texts, however, the sentiment (or virtue) of love is clearly more than just blind or brute passion and presupposes distinctive human capacities for knowledge and free agency. That said, the relationship between knowledge and (right or virtuous) agency seems highly problematic or ambivalent on many traditional (perhaps most notably Christian) religious conceptions. This paper addresses such issues and complexities via some exploration of Genesis and the modern movie Pleasantville—with further aid from literary works of Shakespeare, Blake, Heinlein, and others—to the end of a more realistic view of human love and its moral and spiritual implications.
Image and Word
Authors: Houssni Joseph 
Published: June 2023

Abstract
The rapport between religion and film is not only historical but also ontological. The Abrahamic faiths specifically (Islam, Christianity, and Judaism) and the audio-visual medium of cinema share a complex affiliation with reference to two of their foundational elements: image and word. Building on the constitutive kernels of the Abrahamic religion of Islam (image and word), this paper will locate and define its formal manifestations in cinema; in other words, the way in which the conception of image and word at Islam marks film form. This endeavor will be sustained by calling upon some distinctive film cases of the so-called New Iranian Cinema. In particular, Offside (2006) and This Is Not a Film (2011) by Jafar Panahi, and Close-up (1990) by Abbas Kiarostami, as well as other films, will be utilized for analysis in order to delineate the qualities of the claimed religious film form in question. These films are selected as they foreground and thus play out the dialectic of image and word, their absence and their presence.
The Fundamental Word of Christ’s Eschatological Proclamation
Authors: Kelly Declan 
Published: June 2023

Abstract
Whether understood as an expression of the inner attitude or disposition of the Christian, as a description of the kingdom’s inhabitants, or as a Christianizing of virtue theory, the beatitudes have generally been read within the framework of Christian ethics. This is as true of the Protestant tradition as it is of others. This essay considers a notable exception to that general approach: the account of the beatitudes as found in Karl Barth’s Church Dogmatics IV/2. Read as a “word of grace,” the beatitudes are understood by Barth to be a deepening of the revelation that God is for us, and ultimately so, as the “total savior.” More specifically, this essay argues that Barth offers a christological-cosmological reading of the beatitudes orientated to the saving advent of God’s eschatological kingdom in a “wounded” cosmos subjected to foreign lords, and that he thereby taps into the “apocalyptic” character of these sayings.
Weather Effects on the Spread of COVID-19: Characteristics and Critical Analysis of the First and Second Years of Scientific Research
Authors: Tan Ling , Schultz David M. 
Published: June 2023

Abstract
Numerous studies were published quickly in 2020 and 2021 to understand the effect of weather variables on the spread of COVID-19. We examined 289 peer-reviewed empirical publications, focusing on their characteristics and a critical analysis of their quality. Of the 289 publications, 280 (97%) reported an association between one or more weather variables and the transmission of COVID-19. Of those 289 publications, 109 publications (38%) did not consider any time lag between suspected infections and reporting of the COVID-19 cases, meaning that they examined the weather on the day when the COVID-19 case was reported, rather than the day when the infection occurred. The publications used data from as few as 7 days, with an average of 123 days. Most of these data were collected early in the pandemic when the temperatures were rising as the seasons transitioned from winter to summer in the Northern Hemisphere, making it difficult to determine the subtle effects of the weather on spread. Furthermore, the average time between submission and acceptance was 85 days, but the 10 most-cited publications—all in Science of the Total Environment—were accepted within 10 days of submission, with three accepted on the submission date. Twenty-four review articles were published in 2020 and 2021, with few providing critical reflection on strengths and weaknesses of the literature. Our analysis revealed errors in the publications that were not identified or rectified by corrigenda, comment–reply exchanges, or retractions. This article concludes with recommendations on publishing during future pandemics, as well as best practices for publishing research on weather and COVID-19 transmission.
Effects of COVID-19 anxiety and obsession on fear of childbirth in high-risk pregnancy during the pandemic in Turkey
Authors: Aksoy Sena D. , Ozdemir Suzi , Akbal Esra 
Published: June 2023

Objective The COVID-19 pandemic may have significant effects on fear of childbirth among women undergoing a high-risk pregnancy. This study sought to determine the relationship between the COVID-19 obsession and anxiety levels of women with high-risk pregnancies and their fear of childbirth. Methods A total of 326 hospitalized women with high-risk pregnancies were evaluated between March 2021 and March 2022. The COVID-19 Anxiety Scale (CAS), COVID-19 Obsession Scale (OCS), and Fear of Birth Scale (FOBS, composed of two subscales, FOBS1-anxiety and FOBS2-fear) were administered. Results Positive correlations were found between the FOBS1 and FOBS2 scores and CAS and OCS total scores ( p < .001). The participants with secondary school degrees, those who had not given birth before, those who had an unfavorable previous childbirth experience, and those who were planning to have vaginal delivery had significantly higher average FOBS1 and FOBS2 scores ( p < .05). Those living in an extended family were 3.22 times more likely to experience FOBS1 and 2.23 times more likely to experience FOBS2 than those living in a nuclear family. Women following COVID-19 information were 3.69 times more likely than others to experience these symptoms. In addition, those scheduled for vaginal delivery were 1.80 times more likely to experience FOBS2 than those scheduled for caesarean section. Conclusion Women with high-risk pregnancies may experience COVID-19 anxiety, which may worsen their fear of childbirth. Psychosocial interventions focused on addressing COVID-19 anxiety are warranted for women with high-risk pregnancies in Turkey and for those living in other areas of the world as well.
Two-year, real-world erenumab persistence and quality of life data in 82 pooled patients with abrupt onset, unremitting, treatment refractory headache and a migraine phenotype: New daily persistent headache or persistent post-traumatic headache in the majority of cases
Authors: Buture Alina , Tomkins Esther M. , Shukralla Arif , Troy Emma , Conaty Katie , Macken Esther , Lonergan Roisin , Melling Jane , Long Niamh , Birrane Kieran , Shaikh Eamonn , Goadsby Peter J. , Ruttledge Martin H. 
Published: June 2023

Background Patients diagnosed with New Daily Persistent Headache and Persistent Post-Traumatic Headache belong to a heterogeneous group of primary and secondary headache disorders, with the common clinical feature that these conditions start abruptly, continue unabated, and are refractory to conventional migraine preventive treatments. Objective This is a real-world, medium-term audit to explore whether erenumab improves quality of life in a pooled group of 82 abrupt-onset, unremitting and treatment refractory patients, where the diagnosis is new daily persistent headache and persistent post-traumatic headache in the majority of cases. Methods Eighty-two patients were treated with erenumab every 28 days over a two to three-year period, beginning in December 2018. These patients were “longstanding chronic” and refractory with a median of eight (IQR 4–12) prior failed migraine preventive treatments and median duration of disease of seven (IQR 3–11) years. The starting dose of erenumab was 70 mg in 79% of cases and 140 mg in the remaining patients (individuals with a BMI of more than 30). All patients were asked to complete three migraine specific Quality of Life questionnaires or Patient Reported Outcome Measures before starting treatment and typically at 3–12 intervals until the end of June 2021 or cessation of treatment. The Patient Reported Outcome Measures included: Headache Impact Test-6, Migraine Associated Disability Assessment test and Migraine-Specific Quality-of-Life Questionnaire. Patients generally only stayed on treatment after 6–12 months if there was deemed to be an improvement of at least 30% and there were no significant side effects. The longest treated cases have quality of life data for 30 months after starting erenumab. Results Of the 82 patients, 29 (35%) had improvement in Quality of Life scores, with no significant side effects, and wished to stay on treatment. Fifty-three patients (65%) stopped treatment during the first 6–25 months due to lack of efficacy and/or patient reported side effects ( n = 33 and n = 17, respectively) or a combination of both, pregnancy planning ( n = 2), and lost to follow up ( n = 1). Conclusion Significant improvements in Quality of Life scores were recorded by one-third of patients over a period of 11–30 months, with a 35% persistence after a median of 26 months of treatment. This contrasts with our recently published, treatment resistant, chronic migraine cohort where the persistence with erenumab treatment was almost 55% after a median time of 25 months.