bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abnormal Conduction Zone Detected by Isochronal Late Activation Mapping Accurately Identifies the Potential Atrial Substrate and Predicts the Atrial Fibrillation Ablation Outcome After Pulmonary Vein Isolation
Authors: Kuo Ming-Jen , Ton An Nu-Khanh , Lo Li-Wei , Lin Yenn-Jiang , Chang Shih-Lin , Hu Yu-Feng , Chung Fa-Po , Tuan Ta-Chuan , Chao Tze-Fan , Liao Jo-Nan , Chang Ting-Yung , Lin Chin-Yu , Kuo Ling , Wu Cheng-I , Liu Chih-Min , Cheng Wen-Han , Liu Shin-Huei , Chhay Chheng , Kao Pei-Heng , Chen Wei-Tso , Hsu Chu-Yu , Chen Shih-Ann 
Published: January 2023

Background:
The presence of abnormal substrate of left atrium is a predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation. We aimed to investigate the isochronal late activation mapping to access the abnormal conduction velocity for predicting AF ablation outcome.

Methods:
Forty-five paroxysmal AF patients (30 males, 57.8±8.7 years old) who underwent pulmonary vein isolation were enrolled. Isochronal late activation mapping was retrospectively constructed with 2 different windows of interest: from onset of P wave to onset of QRS wave on surface electrocardiography (W1) and 74 ms tracking back from the end of P wave (W2). Deceleration zone was defined as regions with 3 isochrones (DZa) or ≥4 isochrones (DZb) within a 1 cm radius on the isochronal late activation mapping, and the estimated conduction velocity (ECV) are 0.27 m/s and <0.20 m/s for DZa and DZb, respectively in W2. The distribution of deceleration zone was compared with the location of low-voltage zone (bipolar voltage ≤0.5 mV). Any recurrence of atrial arrhythmias was defined as the primary end point during follow ups after a 3-month blanking period.

Results:

Pulmonary vein isolation was performed in all patients, and there were 2 patients (4.4%) received additional extrapulmonary vein ablation. After a mean follow-up of 12.7±4.5 months, recurrence of AF occurred in 14 patients (31.1%). Patients with the presence of DZb in W2 had higher AF recurrence (Kaplan-Meier event rate estimates: HR, 9.41 [95% CI, 2.61–33.90]; log-rank
P
<0.0001). There were 52.6% of the DZb locations in W2 comparable to the distributions of low-voltage zone and 47.4% DZb were distributed in the area without low-voltage zone.

Conclusions:
Deceleration zone detected by isochronal late activation mapping represents a critical AF substrate, it accurately predicts the AF recurrence following ablation in patients with paroxysmal AF.
Validity of International Classification of Diseases (ICD)-10 Diagnosis Codes for Identification of Acute Heart Failure Hospitalization and Heart Failure with Reduced Versus Preserved Ejection Fraction in a National Medicare Sample
Authors: Bates Benjamin A. , Akhabue Ehimare , Nahass Meghan M. , Mukherjee Abhigyan , Hiltner Emily , Rock Joanna , Wilton Brandon , Mittal Garima , Visaria Aayush , Rua Melanie , Gandhi Poonam , Dave Chintan V. , Setoguchi Soko 
Published: January 2023

Background:
Heart failure (HF) is a leading cause of hospitalization in older adults. Medicare data have been used to assess HF outcomes. However, the validity of ICD-10 diagnosis codes (used since 2015) to identify acute HF hospitalization or distinguish reduced (heart failure with reduced ejection fraction) versus preserved ejection fraction (HFpEF) is unknown in Medicare data.

Methods:
Using Medicare data (2015–2017), we randomly sampled 200 HF hospitalizations with ICD-10 diagnosis codes for HF in the first/second claim position in a 1:1:2 ratio for systolic HF (I50.2), diastolic HF (I50.3), and other HF (I50.X). The primary gold standards included recorded HF diagnosis by a treating physician for HF hospitalization, ejection fraction (EF)≤50 for heart failure with reduced ejection fraction, and EF>50 for HFpEF. If the quantitative EF was not present, then qualitative descriptions of EF were used for heart failure with reduced ejection fraction/HFpEF gold standards. Multiple secondary gold standards were also tested. Gold standard data were extracted from medical records using standardized forms and adjudicated by cardiology fellows/staff. We calculated positive predictive values with 95% CIs.

Results:
The 200-chart validation sample included 50 systolic, 50 diastolic, 47 combined dysfunction, and 53 unspecified HF patients. The positive predictive values of acute HF hospitalization was 98% [95% CI, 95–100] for first-position ICD-10 HF diagnosis and 66% [95% CI, 58–74] for first/second-position diagnosis. Quantitative EF was available for ≥80% of patients with systolic, diastolic, or combined dysfunction ICD-10 codes. The positive predictive value of systolic HF codes was 90% [95% CI, 82–98] for EFs≤50% and 72% [95% CI, 60–85] for EFs≤40%. The positive predictive value was 92% [95% CI, 85–100] for HFpEF for EFs>50%. The ICD-10 codes for combined or unspecified HF poorly predicted heart failure with reduced ejection fraction or HFpEF.

Conclusions:
ICD-10 principal diagnosis identified acute HF hospitalization with a high positive predictive value. Systolic and diastolic ICD-10 diagnoses reliably identified heart failure with reduced ejection fraction and HFpEF when EF 50% was used as the cutoff.
Effects of Ablation Versus Drug Therapy on Quality of Life by Sex in Atrial Fibrillation: Results From the CABANA Trial
Authors: Zeitler Emily P. , Li Yanhong , Silverstein Adam P. , Russo Andrea M. , Poole Jeanne E. , Daniels Melanie R. , Al‐Khalidi Hussein R. , Lee Kerry L. , Bahnson Tristram D. , Anstrom Kevin J. , Packer Douglas L. , Mark Daniel B. ,   for the CABANA Investigators
Published: January 2023

Background
Women with atrial fibrillation (AF) demonstrate more AF‐related symptoms and worse quality of life (QOL). Whether increased use of ablation in women reduces sex‐related QOL differences is unknown. Sex‐related outcomes for ablation versus drug therapy was a prespecified analysis in the CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial.

Methods and Results
Symptoms were assessed periodically over 60 months with the Mayo AF‐Specific Symptom Inventory (MAFSI) frequency score, and QOL was assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary and component scores. Women had lower baseline QOL scores than men (mean AFEQT scores 55.9 and 65.6, respectively). Ablation patients improved more than drug therapy patients with similar treatment effect by sex: AFEQT 12‐month mean adjusted treatment difference in women 6.1 points (95% CI, 3.5–8.6) and men 4.9 points (95% CI, 3.0–6.9). Participants with baseline AFEQT summary scores <70 had greater QOL improvement, with a mean treatment difference at 12 months of 7.6 points for women (95% CI, 4.3–10.9) and 6.4 points for men (95% CI, 3.3–9.4). The mean adjusted difference in MAFSI frequency score between women randomized to ablation versus drug therapy at 12 months was −2.5 (95% CI, −3.4 to −1.6); for men, the difference was −1.3 (95% CI, −2.0 to −0.6).

Conclusions
Compared with drug therapy for AF, ablation resulted in more QOL improvement in both sexes, primarily driven by improvements in those with lower baseline QOL. Ablation did not eliminate the AF‐related QOL gap between women and men.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00911508.
Sex Difference in Capillary Reperfusion After Transient Middle Cerebral Artery Occlusion in Diabetic Mice
Authors: Zhu Wenbin , Davis Catherine M. , Allen Elyse M. , Feller Sarah L. , Bah Thierno M. , Shangraw Robert E. , Wang Ruikang K. , Alkayed Nabil J. 
Published: January 2023

Background:
Type 2 diabetes (DM2) exacerbates stroke injury, reduces efficacy of endovascular therapy, and worsens long-term functional outcome. Sex differences exist in stroke incidence, response to therapy, poststroke microvascular dysfunction, and functional recovery. In this study, we tested the hypotheses that poor outcome after stroke in the setting of DM2 is linked to impaired microvascular tissue reperfusion and that male and female DM2 mice exhibit different microvascular reperfusion response after transient middle cerebral artery occlusion (MCAO).

Methods:
Transient MCAO was induced for 60 minutes using an intraluminal filament in young adult DM2 and nondiabetic control male and female mice. Capillary flux in deep cortical layers was assessed using optical coherence tomography–based optical microangiography (OMAG), and associated regional brain infarct size was evaluated by hematoxylin and eosin staining.

Results:

Compared to baseline, MCAO reduced absolute capillary red blood cell flux by 84% at 24 hours post-MCAO in male DM2 (
P
<0.001) but not male control mice. When normalized to pre-MCAO baseline, red blood cell flux 24 hours after stroke was 64% lower in male DM2 mice than male nondiabetic controls (
P
<0.01). In females, MCAO decreased capillary flux by 48% at 24 hours post-MCAO compared with baseline in DM2 (
P
<0.05) but not in control mice. Red blood cell flux of female DM2 mice did not differ from that of nondiabetic controls either before or 24 hours after MCAO. Furthermore, normalized capillary flux 24 hours after MCAO failed to differ between female DM2 mice and nondiabetic controls. Concomitantly, male but not female DM2 mice experienced 25% larger infarct in caudate-putamen versus respective nondiabetic controls (
P
<0.05).

Conclusions:
DM2 impairs capillary perfusion and exacerbates ischemic deep brain injury in male but not female young adult mice. Premenopausal females appear to be protected against DM2-related capillary dysfunction and brain injury.
Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment
Authors: Rodrigo-Gisbert Marc , Requena Manuel , Rubiera Marta , Khalife Jane , Lozano Prudencio , De Dios Lascuevas Marta , García-Tornel Álvaro , Olivé-Gadea Marta , Piñana Carlos , Rizzo Federica , Boned Sandra , Muchada Marian , Rodríguez-Villatoro Noelia , Rodríguez-Luna David , Juega Jesús , Pagola Jorge , Hernández David , Molina Carlos A. , Tomasello Alejandro , Ribo Marc 
Published: January 2023

Background:
Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes.

Methods:
We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments.

Results:

Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%;
P
<0.001) or non-IAC (13.4%;
P
<0.001). Rescue procedures were more frequently performed in symptomatic-IAC (26.9%) than in asymptomatic-IAC (1.3%;
P
<0.001) and non-IAC (4.1%;
P
<0.001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11.89 [95% CI, 3.94–35.91];
P
<0.001), adoption of rescue procedures (odds ratio, 12.38 [95% CI, 2.22–69.09];
P
=0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02–12.00];
P
=0.046).

Conclusions:
The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
Maternal Health Outcomes After Pregnancy-Associated Stroke: A Population-Based Study With 19 Years of Follow-Up
Authors: Yu Amy Y.X. , Nerenberg Kara A. , Diong Christina , Fang Jiming , Chu Anna , Kapral Moira K. , Edwards Jodi D. , Dancey Sonia R. , Austin Peter C. , Auger Nathalie 
Published: January 2023

Background:
Pregnancy-associated stroke carries high short-term morbidity and mortality, but data on subsequent maternal outcomes are limited. We evaluated long-term maternal health outcomes after pregnancy-associated stroke.

Methods:
In this retrospective cohort study, we used administrative data to identify pregnant adults aged ≤49 years with stroke between 2002-2020 in Ontario, Canada and 2 comparison groups: (1) non-pregnant female patients with stroke and (2) pregnant patients without stroke. Patients who survived the index admission were followed until 2021. After propensity score matching, we used Cox regression with a robust variance estimator to compare pregnant patients with stroke and the 2 comparison groups for the composite outcome of death and all-cause non-pregnancy readmission. Where proportional hazard assumption was not met, we reported time-varying hazard ratios (HR) with 95% CIs by modeling the log-hazard ratio as a function of time using restricted cubic splines.

Results:
We identified 217 pregnant patients with stroke, 7604 non-pregnant patients with stroke, and 1 496 256 pregnant patients without stroke. Of the 202 pregnant patients with stroke who survived the index stroke admission, 41.6% (6.8 per 100 person-years) subsequently died or were readmitted during follow-up. Median follow-up times were 5 years (pregnancy-associated stroke), 3 years (non-pregnant stroke), and 8 years (pregnant without stroke). Pregnant patients with stroke had a lower hazard of death and all-cause readmission compared with non-pregnant patients with stroke at 1-year follow-up (HR, 0.64 [95% CI, 0.44–0.94]), but this association did not persist during longer-term follow-up. Conversely, pregnant patients with stroke had higher hazard of death and readmission compared with pregnant patients without stroke at 1-year follow-up (HR, 5.70 [95% CI, 3.04–10.66]), and this association persisted for a decade.

Conclusions:
Stroke during pregnancy is associated with long-term health consequences. It is essential to transition care postpartum to primary or specialty care to optimize vascular health.
Worsened Stroke Outcome in a Model of Preeclampsia is Associated With Poor Collateral Flow and Oxidative Stress
Authors: Cipolla Marilyn J. , Tremble Sarah M. , DeLance Nicole , Johnson Abbie C. 
Published: January 2023

Background:

Preeclampsia increases the incidence of maternal stroke, a devastating condition that is on the rise. We investigated stroke outcome in a model of experimental preeclampsia with and without treatment with clinically relevant doses of magnesium sulfate (experimental preeclampsia+MgSO
4
) compared to normal late-pregnant and nonpregnant rats.

Methods:
Transient middle cerebral artery occlusion was used to induce focal stroke for either 1.5 or 3 hours. Infarct volume and hemorrhagic transformation were determined as measures of stroke outcome. Changes in core middle cerebral artery and collateral flow were measured by dual laser Doppler. The relationship between middle cerebral artery perfusion deficit and infarction was used as a measure of ischemic tolerance. Oxidative stress and endothelial dysfunction were measured by 3-nitrotyrosine and 8-isoprostane, in brain and serum, respectively.

Results:

Late-pregnant animals had robust collateral flow and greater ischemic tolerance of brain tissue, whereas experimental preeclampsia had greater infarction that was related to poor collateral flow, endothelial dysfunction, and oxidative stress. Importantly, pregnancy appeared preventative of hemorrhagic transformation as it occurred only in nonpregnant animals. MgSO
4
did not provide benefit to experimental preeclampsia animals for infarction.

Conclusions:
Stroke outcome was worse in a model of preeclampsia. As preeclampsia increases the risk of future stroke and cardiovascular disease, it is worth understanding the influence of preeclampsia on the material brain and factors that might potentiate injury both during the index pregnancy and years postpartum.
Computed tomography-based texture assessment for the differentiation of benign, borderline, and early-stage malignant ovarian neoplasms
Authors: He Ziying , Chen Jia , Yang Fei , Pan Xinwei , Liu Chanzhen 
Published: January 2023

Objective This study was performed to examine the value of computed tomography-based texture assessment for characterizing different types of ovarian neoplasms. Methods This retrospective study involved 225 patients with histopathologically confirmed ovarian tumors after surgical resection. Two different data sets of thick (5-mm) slices (during regular and portal venous phases) were analyzed. Raw data analysis, principal component analysis, linear discriminant analysis, and nonlinear discriminant analysis were performed to classify ovarian tumors. The radiologist’s misclassification rate was compared with the MaZda (texture analysis software) findings. The results were validated with the neural network classifier. Receiver operating characteristic curves were analyzed to determine the performances of different parameters. Results Nonlinear discriminant analysis had a lower misclassification rate than the other analyses. Thirty texture parameters significantly differed between the two groups. In the training set, WavEnLH_s-3 and WavEnHL_s-3 were the optimal texture features during the regular phase, while WavEnHH_s-4 and Kurtosis seemed to be the most discriminative features during the portal venous phase. In the validation test, benign versus malignant tumors and benign versus borderline lesions were well-distinguished. Conclusions Computed tomography-based texture features provide a useful imaging signature that may assist in differentiating benign, borderline, and early-stage ovarian cancer.
Urine Output and Mortality in Patients Resuscitated from out of Hospital Cardiac Arrest
Authors: Sarma Dhruv , Tabi Meir , Rabinstein Alejandro A. , Kashani Kianoush , Jentzer Jacob C. 
Published: January 2023

Background Limited data exist regarding urine output (UO) as a prognostic marker in out-of-hospital-cardiac-arrest (OHCA) survivors undergoing targeted temperature management (TTM). Methods We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017, excluding patients with end-stage renal disease. Three groups were defined based on mean hourly UO during the first 24 h: Group 1 (<0.5 mL/kg/h, n = 73), Group 2 (0.5−1 mL/kg/h, n = 81) and Group 3 (>1 mL/kg/h, n = 93). Serum creatinine was used to classify acute kidney injury (AKI). The primary and secondary outcomes respectively were in-hospital mortality and favorable neurological outcome at hospital discharge (modified Rankin Scale [mRS]<3). Results In-hospital mortality decreased incrementally as UO increased (adjusted OR 0.9 per 0.1 mL/kg/h higher; p = 0.002). UO < 0.5 mL/kg/h was strongly associated with higher in-hospital mortality (adjusted OR 4.2 [1.6−10.8], p = 0.003) and less favorable neurological outcomes (adjusted OR 0.4 [0.2−0.8], p = 0.007). Even among patients without AKI, lower UO portended higher mortality (40% vs 15% vs 9% for UO groups 1, 2, and 3 respectively, p < 0.001). Conclusion Higher UO is incrementally associated with lower in-hospital mortality and better neurological outcomes. Oliguria may be a more sensitive early prognostic marker than creatinine-based AKI after OHCA.
Improved flame retardancy and smoke suppression properties of phenolic resin by incorporating MoO3 particles
Authors: Yang Xiong , Zhi Maoyong , Li Yuchuan , Xin Hui , Fan Rong , Chen Xiantao , Liu Quanyi , He Yuanhua 
Published: January 2023

Phenolic resin (PF) is widely used in aerospace, composite materials, and other fields. However, large amount of heat and smoke are produced during its combustion process, which is an important factor limiting its usage. To solve this problem, additive flame retardant MoO3 has been incorporated into PF for improving its flame retardancy and smoke suppression properties. Thermogravimetric analyses results show that the T5% of PF composites was gradually decreased from 264°C to 184°C and the char yield of PF-10% MoO3 is 57 wt.%, higher than that of neat PF (50 wt.%). The PF composites with 10 wt.% MoO3 passed UL-94 V-0 rating with a limiting oxygen index value of 29.8%. Meanwhile, the total heat release and total smoke production of PF-10% MoO3 are 37.60 MJ/m2 and 5.79 m2 respectively, which are reduced by 30.5% and 24.8% compared with neat PF. Only 10 wt.% MoO3 provide a 56.5% reduction (from 255 to 111) in maximal smoke density, meaning the good smoke suppression properties of MoO3. The pyrolysis products components are determined by thermogravimetric analysis combined with Fourier transform infrared spectroscopy. Furthermore, the micromorphology and chemical structure of char residue are also investigated by scanning electron microscopy, x-ray diffraction and Raman spectroscopy techniques. The promoting carbonization effect of MoO3 significantly reduces the heat release and toxic smoke production of PF composites.
Effect of telemonitoring on readmissions for acute exacerbation of chronic obstructive pulmonary disease: A randomized clinical trial
Authors: Andersen Frank D , Trolle Christian , Pedersen Asger Roer , Køpfli Maria L , Børgesen Sanne , Jensen Michael S , Hyldgaard Charlotte 
Published: January 2023

Introduction Acute exacerbations of chronic obstructive pulmonary disease are associated with high morbidity and mortality. Telemonitoring may reduce the frequency of hospitalization. The aim of this study was to investigate the effect of telemonitoring on hospitalization rates for acute exacerbations of chronic obstructive pulmonary disease. Methods Patients were recruited during hospitalization and equally randomized to telemonitoring or usual care. Telemonitoring participants recorded symptoms and monitored oxygen saturation, heart rate, peak expiratory flow, and body weight. Alerts were generated if readings breached thresholds. Acute exacerbations of chronic obstructive pulmonary disease hospitalizations during the 6 months intervention were compared using logistic regression, and time to first hospitalization was assessed using Cox proportional hazard modeling. The incidence rates for acute exacerbations of chronic obstructive pulmonary disease hospitalization were compared using a negative binomial regression model with between-group comparisons expressed as incidence rate ratios. The telemonitoring group was used as reference. Results A total of 222 patients were randomized. 37/112 (33%) in the control group and 31/110 (28%) in the telemonitoring group experienced acute exacerbations of chronic obstructive pulmonary disease hospitalization during the intervention period, odds ratio of 1.26, confidence interval 0.71–2.23, p = 0.4. No difference was seen in time to first hospitalization, hazard ratio 1.23, CI 0.77–1.99, p = 0.4. The number of hospitalizations in the intervention period was 66 in the control group and 42 in the telemonitoring group, with incidence rate ratio 1.42, confidence interval 1.04–1.95, p = 0.03. Adjustment for dyspnea score, smoking, and cohabitation status did not change the results, incidence rate ratio 1.44, confidence interval 1.05–1.99, p = 0.02. Discussion Patients who received telemonitoring experienced significantly fewer acute exacerbations of chronic obstructive pulmonary disease hospitalizations, although the overall risk of having at least one hospitalization and the time to first hospitalization was similar between the two groups.