bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct oral anticoagulants versus warfarin in patients with non-valvular atrial fibrillation and CKD G3–G5D
Authors: Welander Frida , Renlund Henrik , Dimény Emöke , Holmberg Henrik , Själander Anders 
Published: January 2023

ABSTRACT

Background
The use of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD) including dialysis is growing. Several studies have shown favorable results of DOAC compared with warfarin regarding bleeding risk but no difference in stroke protection. However, these studies had poor time in therapeutic range (TTR), in the warfarin comparison group.

Methods
This was a Swedish national cohort study investigating the risk of ischemic stroke and major bleeding on DOAC compared with warfarin in patients with NVAF, glomerular filtration rate category 3–5D (G3–G5D), kidney transplant recipients excluded, between 2009 and 2018. Data extracted from high-quality national healthcare registries including the Swedish Renal Registry, AuriculA (the Swedish national quality register for AF and anticoagulation) and The Stroke Register.

Results
At enrolment, of 2453 patients 59% were treated with warfarin (mean TTR 67%) and 41% with DOAC. Overall, 693 (28.3%) had G3, 1113 (45.4%) G4, 222 (9.1%) G5 and 425 (17.3%) G5D. DOAC compared with warfarin showed lower hazard of major bleeding [hazard ratio 0.71 (95% confidence interval 0.53–0.96)] but no difference in ischemic stroke risk. Mortality was increased during DOAC treatment [1.24 (1.01–1.53)], presumably not a causal association since fewer fatal bleedings occurred on DOAC.

Conclusions
DOAC treatment, compared with warfarin, is associated with almost 30% lower risk of bleeding in patients with NVAF and CKD G3–G5D. The stroke risk is comparable between the treatments. This is the first study comparing DOAC and well-managed warfarin (TTR 67%) in advanced CKD. Ongoing and planned randomized controlled trials need to confirm the possible benefit of DOAC.
Using physiology to better support wild bee conservation
Authors: Leroy Clementine , Brunet Jean-Luc , Henry Mickael , Alaux Cedric 
Published: January 2023

Abstract
There is accumulating evidence that wild bees are experiencing a decline in terms of species diversity, abundance or distribution, which leads to major concerns about the sustainability of both pollination services and intrinsic biodiversity. There is therefore an urgent need to better understand the drivers of their decline, as well as design conservation strategies. In this context, the current approach consists of linking observed occurrence and distribution data of species to environmental features. While useful, a highly complementary approach would be the use of new biological metrics that can link individual bee responses to environmental alteration with population-level responses, which could communicate the actual bee sensitivity to environmental changes and act as early warning signals of bee population decline or sustainability. We discuss here through several examples how the measurement of bee physiological traits or performance can play this role not only in better assessing the impact of anthropogenic pressures on bees, but also in guiding conservation practices with the help of the documentation of species’ physiological needs. Last but not least, because physiological changes generally occur well in advance of demographic changes, we argue that physiological traits can help in predicting and anticipating future population trends, which would represent a more proactive approach to conservation. In conclusion, we believe that future efforts to combine physiological, ecological and population-level knowledge will provide meaningful contributions to wild bee conservation-based research.
Is systematic formal crural repair mandatory at the time of magnetic sphincter augmentation implantation?
Authors: Bell Reginald 
Published: January 2023

Summary
Laparoscopic placement of the LINX Magnetic Sphincter Augmentation (MSA) device has become an accepted alternative to fundoplication in appropriate patients. Initial studies of MSA targeted to patients with ‘early’ disease allowed for the most minimal dissection of the esophagus to place the device, without hiatal dissection or repair (NoHHR), in patients with no or minimal hernia findings at surgery. Subsequent studies have compared systematic formal hiatal dissection and repair (Formal HHR) with the original minimal dissection technique. Review of published literature on MSA includes discussion on treatment of hiatal hernia at the time of implantation, accompanying the review of the physiology of the crural diaphragm. Formal hiatal hernia repair at the time of MSA implantation results in better control of reflux with less dysphagia and risk of postoperative hernia than NoHHR, regardless of the presence or size of hiatal hernia. Systematic crural repair should accompany any MSA implantation regardless of the presence or size of hiatal hernia.
A nonparametric test for cooperation in discrete games
Authors: Aradillas-López Andrés , Kosenkova Lidia 
Published: January 2023

Summary
We propose a nonparametric test for cooperative behaviour among players in discrete, static games. Assuming that certain exchangeability conditions hold if we match observable characteristics across all players, we obtain testable implications for cooperative (coalitional) behaviour, which we define as occurring when players maximise an unknown joint objective function that is symmetric conditional on the matching. Cooperation implies the existence of a class of outcomes $\mathcal {Y}$ such that, conditional on the matching, the probability of observing an outcome $y\in \mathcal {Y}$ must be equal to the probability of observing any permutation of y. We present a nonparametric econometric test and we characterise its asymptotic properties. We apply our test to expansion/entry decisions of Lowe’s and Home Depot in the contiguous United States and we find that, while outcomes are consistent with noncooperative behaviour in larger markets, we fail to reject cooperation in smaller markets.
Case report: diagnosis of chronic Chagas cardiomyopathy using a multimodality imaging approach
Authors: Li Shannon X , Soles Estefania Oliveros , Sharma Parikshit S , Rao Anupama K 
Published: January 2023

Abstract

Background
In the USA, ∼300 000 people are affected by Chagas heart disease, a growing, but commonly overlooked, public health issue. Chagas as a potential aetiology of dilated cardiomyopathy remains under-recognized. We present a case where multimodality imaging was essential in the diagnosis and management of Chagas heart disease.

Case summary
A 54-year-old man, originally from Mexico, presented to the emergency department with chest pain and recurrent syncopal episodes, found to be in haemodynamically unstable ventricular tachycardia (VT) requiring urgent cardioversion. Urgent coronary angiography revealed no obstructive disease. A transthoracic echocardiogram revealed moderately reduced left ventricular systolic function (left ventricular ejection fraction 35–40%) with apical akinesis and an aneurysm of the apical septum. Cardiac magnetic resonance (CMR) confirmed a prominent apical aneurysm with dyskinesis of the apical septum, with the evidence of transmural myocardial late gadolinium enhancement of the entire left ventricular apex and a small apical thrombus. Serologic testing was positive for Trypanosoma cruzi IgG antibody, which was confirmed on repeat testing at the Centers for Disease Control and Prevention. Patient underwent VT ablation and was discharged on guideline-directed medical therapy including a regimen of anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor therapies. He has had no subsequent syncope or VT.

Discussion
Chagas heart disease remains under-recognized and under-diagnosed despite the growing burden of T. cruzi infection in the USA. Suspicion for Chagas heart disease should be considered in patients presenting with heart failure symptoms and ventricular arrhythmias with the right corresponding history and imaging findings on echocardiogram and CMR.
Metal in motion: a case report of inferior vena cava filter migration
Authors: Aun Jonathan A , Hulten Edward A , Nguyen Binh T , Twerdahl Eric H 
Published: January 2023

Abstract

Background
Inferior vena cava (IVC) filter migration, particularly to the heart, is a rare complication. Small metal fragments may be inadequately characterized on transthoracic echocardiography and may be missed entirely on chest radiograph. Managing the adverse outcomes of IVC filters is a formidable challenge as retrieval carries the risk of arrhythmia, right ventricular perforation, and damage to the tricuspid valve.

Case summary
A woman in her fifties underwent routine computed tomography (CT) calcium score screening and was found to have a metallic fragment in the right ventricle of her heart. Subsequent contrast enhanced, ECG-gated cardiac CTA was completed and images were reconstructed to yield cine images on syngo.via (Siemens, Erlangen, Germany) and vitrea workstation (version: 6.6.3; Vital, Toshiba Medical Systems) to guide heart team discussion and clinical management.

Discussion
Our case illustrates the benefit of CTA with cineography in characterizing the location, size, and extent of fragment involvement within the myocardium. Moreover, this case serves as a reminder to medical professionals to carefully consider IVC filter placement in the appropriate patient, remain vigilant regarding potential complications, and to aspire follow-up of removable filters.
Case report of rare highly aggressive cardiac tumour: the intimal sarcoma
Authors: Yafasova Adelina , Møller Jacob E , Smerup Morten H , Dahl Jordi S , Fosbøl Emil L 
Published: January 2023

Abstract

Background
Primary cardiac tumours are rare, and diagnosis may be difficult, as symptoms and cardiac imaging may mimic other cardiac diseases. The intimal sarcoma is the least commonly reported cardiac tumour with only few cases reported worldwide. In this case report, we present a case of an intimal sarcoma with a highly aggressive disease course.

Case summary
A 60-year-old male with a history of prior aortoplasty due to congenital aortic stenosis, mechanical aortic valve replacement, and aortic stenting due to aortic dilatation presented with night sweats, malaise, and dyspnoea. Initial imaging (including transthoracic and transoesophageal echocardiography and emergency computed tomography) revealed masses suspected to be thrombi in the left atrium and ventricle. However, a positron emission tomography/computed tomography scan revealed that the masses were suspicious for malignancy. The patient underwent non-radical tumour resection and insertion of biological valve prostheses. Subsequent tissue analysis and pathology assessment revealed an intimal sarcoma. There were no curative treatment options, and the patient succumbed to his illness &lt;3 months after surgery.

Discussion
This case report presents a case of a highly aggressive intimal sarcoma. As complete tumour resection is of great importance when it comes to life expectancy in cardiac sarcomas, early diagnosis using non-invasive and invasive imaging modalities is essential to start early treatment and to improve outcomes in this patient group.
Minimizing drug-drug interactions between dabigatran and levetiracetam through clinical management: a case report
Authors: Menichelli Danilo , Pastori Daniele , Pignatelli Pasquale , Pani Arianna 
Published: January 2023

Abstract

Background
Direct oral anticoagulants (DOACs) are useful for stroke prevention in atrial fibrillation (AF) patients. However, the concomitant administration of Levetiracetam limited their use in clinical practice, although some authors raise doubts about clinical relevance of the interaction.

Case summary
We report a case of a 54-year-old male with AF, cirrhosis, and seizures, in which the assessment of Dabigatran plasma concentration was needed due to the concomitant use of Levetiracetam. In this case, no relevant reduction of trough Dabigatran plasma concentration was found. An increased peak serum level of dabigatran may be obtained delaying levetiracetam administration. The patient was then followed in our clinic and during 32 months of follow-up no ischaemic or haemorrhagic events occurred.

Discussion
The evaluation of DOACs concentration could be helpful to start a tailored therapy in frailty patients.
Demand- Versus Supply-Side Climate Policies with a Carbon Dioxide Ceiling
Authors: Eichner Thomas , Kollenbach Gilbert , Schopf Mark 
Published: January 2023

AbstractIn a Hotelling model with a climate coalition and a free-riding fringe, we compare demand-side and supply-side climate policies aimed at keeping CO$_2$ concentration below a ceiling equivalent to global warming of $2^\circ{\rm C}$. With the demand-side policy, the coalition caps its fuel demand. The corresponding allocation is intra-temporally distorted. With the supply-side policy, the coalition purchases deposits. The corresponding allocation is inter-temporally distorted and the fuel extraction path can be discontinuous. In an empirically calibrated economy, a medium-sized (the grand) coalition is stable with the demand-side (supply-side) policy. If the coalition acts strategically, the stable grand coalition implements first best.
Electromagnetic navigation bronchoscopy-guided radiofrequency identification marking in wedge resection for fluoroscopically invisible small lung lesions
Authors: Yutaka Yojiro , Sato Toshihiko , Hidaka Yu , Kato Takao , Kayawake Hidenao , Tanaka Satona , Yamada Yoshito , Ohsumi Akihiro , Nakajima Daisuke , Hamaji Masatsugu , Menju Toshi , Date Hiroshi 
Published: January 2023

Abstract

OBJECTIVES
We developed a novel wireless localization technique after electromagnetic navigation bronchoscopy-guided radiofrequency identification marker placement for fluoroscopically invisible small lung lesions. We conducted an observational study to investigate the feasibility of this technique and retrospectively compared 2 marking approaches with or without cone-beam computed tomography (CBCT).

METHODS
Consecutive patients from January 2021 to March 2022 in our institution were enrolled. Markers were placed central to the lesions either in a bronchoscopic suite under intravenous anaesthesia or a hybrid operation theatre with CBCT under general anaesthesia. The efficacy of the 2 marking methods was compared using an inverse probability of treatment weighting adjusted analysis.

RESULTS
Totally 80 markers were placed (45 under CBCT and 35 under fluoroscopy) for 74 patients with 80 lesions [mean size: 6.9 mm (interquartile range: 5.1–8.4) at a median depth from the pleura of 14.0 mm (interquartile range: 8.5–19.5)]. The median distance from marker to lesion was 9.1 mm, with a pleural depth of 15.5 mm. The tumour resection rate was 97.5% (78/80) with the median surgical margin of 10.0 mm (interquartile range: 8.0–11.0). Although the bronchoscopy time was longer using CBCT because of the need for 2.8 scans per lesion, the distance from the marker to the lesion was shorter for marking using CBCT than marking using fluoroscopy (adjusted difference: −4.56, 95% confidence interval: −6.51 to −2.61, P &lt; 0.001).

CONCLUSIONS
Electromagnetic navigation bronchoscopy-guided radiofrequency identification marking provided a high tumour resection rate with sufficient surgical margins.
Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma
Authors: Liu Qun-Hong , Tan Ju-Xiang , Hu Cai-Xia , Zhang Xiao-Pei , Liu Shu-Ying , Wan Li-Hong 
Published: January 2023

Abstract

Aims
Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship.

Methods and results
A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman’s correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02–0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02–0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay.

Conclusion
Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.
Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)
Authors: Purcell Carrie , Purvis Anthony , Cleland John G F , Cowie Aynsley , Dalal Hasnain M , Ibbotson Tracy , Murphy Clare , Taylor Rod S 
Published: January 2023

Abstract

Aims
Alternative models of cardiac rehabilitation (CR) are required to improve CR access and uptake. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a comprehensive home-based rehabilitation and self-management programme, facilitated by trained health professionals, for people with heart failure (HF) and their caregivers. REACH-HF was shown to be clinically effective and cost-effective in a multi-centre randomized trial. The SCOT:REACH-HF study assessed implementation of REACH-HF in routine clinical practice in NHS Scotland.

Methods and results
A mixed-method implementation study was conducted across six regional Health Boards. Of 136 people with HF and 56 caregivers recruited, 101 people with HF and 26 caregivers provided 4-month follow-up data, after participating in the 12-week programme. Compared with baseline, REACH-HF participation resulted in substantial gains in the primary outcome of health-related quality of life, as assessed by the Minnesota Living with Heart Failure Questionnaire (mean difference: −9.8, 95% CI: −13.2 to −6.4, P &lt; 0.001). Improvements were also seen in secondary outcomes (PROM-CR+; EQ-5D-5L; Self-Care of Heart Failure Index (SCHFI) domains of maintenance and symptom perception; Caregiver Contribution to Self-Care domains of symptom perception and management). Twenty qualitative interviews were conducted with 11 REACH-HF facilitators, five supporting clinicians, and four national stakeholders. Interviewees were largely positive about REACH-HF, considering it to have ‘filled a gap’ where centre-based CR was not an option. Key issues to support future roll-out were also identified.

Conclusion
Our findings support wider roll-out of REACH-HF as an alternative to centre-based models, to improve CR access and uptake for people with HF.
Optimal or standard control of systolic and diastolic blood pressure across risk factor categories in patients with chronic coronary syndromes
Authors: Vidal-Petiot Emmanuelle , Elbez Yedid , Mesnier Jules , Ducrocq Gregory , Ford Ian , Tendera Michal , Ferrari Roberto , Tardif Jean-Claude , Fox Kim M , Steg Philippe Gabriel 
Published: January 2023

Abstract

Aims
Guidelines have lowered blood pressure (BP) targets to &lt;130/80 mmHg. We examined the benefit of intensive control for each BP component, vs. the burden of other modifiable risk factors, in patients with chronic coronary syndromes (CCS).

Methods and results
The CLARIFY registry (ISRCTN43070564) enrolled 32 703 patients with CCS, from 2009 to 2010, with a 5-year follow-up. Patients with either BP component below European guideline safety boundaries (120/70 mmHg) were excluded, leaving 19 167 patients (mean age: 63.8 ± 10.1 years, 78% men) in the present analysis. A multivariable-adjusted Cox proportional hazards model showed a gradual increase in cardiovascular risk (cardiovascular death, myocardial infarction, or stroke) when the number of uncontrolled risk factors (active smoking, no physical activity, low-density lipoprotein cholesterol ≥100 mg/dL, and diabetes with glycated haemoglobin ≥7%) increased [adjusted hazard ratio (HR): 1.34; 95% confidence interval (CI): 1.17–1.52, 1.65 (1.40–1.94), and 2.47 (1.90–3.21) for 1, 2, and 3 or 4 uncontrolled risk factors, respectively, vs. 0], without significant interaction with BP. Although uncontrolled systolic (≥140 mmHg) and diastolic (≥90 mmHg) BP were both associated with higher risk than standard BP, standard BP was associated with higher risk than optimal control for only the diastolic component (adjusted HR: 1.08; 95% CI: 0.94–1.25 for systolic BP 130–139 vs. 120–129 mmHg and 1.43; 95% CI: 1.27–1.62 for diastolic BP 80–89 vs. 70–79 mmHg).

Conclusions
Our results suggest that the optimal BP target in CCS may be ≤139/79 mmHg and that optimizing the burden of other risk factors should be prioritized over the further reduction of systolic BP.
Right ventricular epicardial arrhythmogenic substrate in long-QT syndrome patients at risk of sudden death
Authors: Pappone Carlo , Ciconte Giuseppe , Anastasia Luigi , Gaita Fiorenzo , Grant Edward , Micaglio Emanuele , Locati Emanuela T , Calovic Zarko , Vicedomini Gabriele , Santinelli Vincenzo 
Published: January 2023

AbstractAimsThe long-QT syndrome (LQTS) represents a leading cause of sudden cardiac death (SCD). The aim of this study was to assess the presence of an underlying electroanatomical arrhythmogenic substrate in high-risk LQTS patients.Methods and resultsThe present study enrolled 11 consecutive LQTS patients who had experienced frequent implantable cardioverter-defibrillator (ICD discharges triggered by ventricular fibrillation (VF). We acquired electroanatomical biventricular maps of both endo and epicardial regions for all patients and analyzed electrograms sampled from several myocardial regions. Abnormal electrical activities were targeted and eliminated by the means of radiofrequency catheter ablation. VF episodes caused a median of four ICD discharges in eleven patients (6 male, 54.5%; mean age 44.0 ± 7.8 years, range 22–53) prior to our mapping and ablation procedures. The average QTc interval was 500.0 ± 30.2 ms. Endo-epicardial biventricular maps displayed abnormally fragmented, low-voltage (0.9 ± 0.2 mV) and prolonged electrograms (89.9 ± 24.1 ms) exclusively localized in the right ventricular epicardium. We found electrical abnormalities extending over a mean epicardial area of 15.7 ± 3.1 cm2. Catheter ablation of the abnormal epicardial area completely suppressed malignant arrhythmias over a mean 12 months of follow-up (median VF episodes before vs. after ablation, 4 vs. 0; P = 0.003). After the procedure, the QTc interval measured in a 12-lead ECG analysis shortened to a mean of 461.8 ± 23.6 ms (P = 0.004).ConclusionThis study reveals that, among high-risk LQTS patients, regions localized in the epicardium of the right ventricle harbour structural electrophysiological abnormalities. Elimination of these abnormal electrical activities successfully prevented malignant ventricular arrhythmia recurrences.