bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of medical therapy, transcatheter intervention, and surgery on outcomes of patients with functional mitral regurgitation: a systematic review and network meta-analysis
Authors: Teoh S E , Tan E W X , Teo Y N , Basker G , Teo Y H , Chai P , Wong R C C , Yip J W L , Kuntjoro I , Lim Y H , Poh K K , Yeo T C , Kong W K F , Sia C H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme.

Background
Functional mitral regurgitation (FMR) is the most common valvular heart disease worldwide. Despite recent major trials, the relative efficacy between medical therapy, transcatheter intervention, and surgery for the treatment of FMR remains poorly understood.

Purpose
We performed a systematic review and network meta-analysis of all published randomised controlled trials (RCTs) and observational studies to compare the efficacy between medical therapy, transcatheter intervention, and surgery on the clinical outcomes of patients with FMR.

Methods
Four electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) were searched from inception to March 13, 2022, for studies reporting clinical outcomes in patients with FMR and comparing the efficacy between either medical therapy, transcatheter intervention, or surgery. Frequentist network meta-analysis models were utilised to summarise the studies. This study was registered in the International Prospective Register of Systematic Reviews.

Results
10 articles were included in the analysis, comprising a combined cohort of 1,981 patients. Network meta-analysis demonstrated that compared to medical therapy, transcatheter intervention achieved a lower relative risk in the composites of all-cause mortality (risk ratio [RR]: 0.43; 95% confidence interval [CI] 0.22-0.82) and mitral regurgitation (MR) severity grade ≥3+ (RR: 0.06; 95% CI 0.01-0.42). Compared to surgery, transcatheter intervention achieved a lower relative risk in the composites of cardiovascular death (RR: 0.36; 95% CI 0.17-0.75) and MR severity grade ≥3+ (RR: 0.25; 95% CI 0.09-0.70) and higher relative risk in the composite of heart failure hospitalisation (RR: 2.94; 95% CI 1.26-6.82). Compared to medical therapy, surgery achieved a higher relative risk in the composite of cardiovascular death (RR: 2.54; 95% CI 1.18-5.47) and lower relative risks in the composites of all-cause mortality (RR: 0.56; 95% CI 0.34-0.91) and heart failure hospitalisation (RR: 0.28; 95% CI 0.13-0.61).

Conclusion
Medical therapy, transcatheter intervention, and surgery in patients with FMR displayed differing effects on the various clinical outcomes. Further head-to-head trials are required to better understand the optimal treatment modality in this population.
Multicenter review of a tadalafil suspension formulation in infants and children with pulmonary hypertension: a north american experience
Authors: Youssef D , Handler S , Richards S , Sheppard C , Smith J , Tillman K , Pietrosanu M , Kirkpatrick E , Bates A 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary arterial hypertension (PAH) is a disease characterised by an increase in pulmonary vascular resistance and pulmonary artery pressure. Phosphodiesterase type 5 (PDE5) inhibitors, with sildenafil the earliest among them, are widely used in the management of pediatric PAH. There has more recently been a transition to once-daily tadalafil suspensions. Herein, we present a multicenter experience detailing safety, tolerability and haemodynamic data utilizing tadalafil suspension alone or in combination for the management of pediatric PAH.

Methods and materials
We performed a retrospective review of all infants and children at two North American paediatric PH centres between December 2013 and April 2022. We included all patients less than 9 years of age who were treated with a tadalafil suspension after an initial treatment with sildenafil. Demographic, clinical, imaging, and laboratory data were collected.

Results
Over the study period, 158 children were treated with tadalafil therapy: 41 (25.9%) had group 1 PAH, 81 (51.3%) had group 3 PH, and 33 (20.9%) had group 5 PH. The median initial dose of tadalafil was 1.0 mg/kg once daily with a median time to maximum dose of 1 day. The majority of patients required the suspension formulation due to an inability to take oral tablets or the need for nasogastric or nasojejunal feeding. We observed improvements in median echocardiographic parameters in the six months following initiation, namely, in RVFAC from 34.7% (Q1 = 31.0%, Q3 = 42.0%) to 37.0% (Q1 = 31.0%, Q3 = 44.0%) and in TAPSE from 1.0 (Q1 = 0.8, Q3 = 1.7) cm to 1.3 (Q1 = 1.0, Q3 = 1.7) cm. We observed median decreases in RVSp from 51.0 (Q1 = 35.0, Q3 = 69.0) mmHg to 37.0 (Q1 = 30.0, Q3 = 50.0) mmHg and in NT pro BNP levels from 439.0 (Q1 = 217.0, Q3 = 2051.0) ng/L to 313.0 (Q1 = 193.0, Q3 = 1110.0) ng/L. Tadalafil therapy was well tolerated over the six-month period: at baseline, only four patients (2.5%) reported gastrointestinal side effects, two (1.3%) reported adverse skin adverse effects (i.e., rash and flushing), and one (0.6%) reported adverse neurological effects. At six months, 150 patients (94.9%) reported no adverse effects.

Conclusion
Tadalafil, a long-acting PDE5 inhibitor, when administered in a suspension formulation, has a safe and tolerable adverse effect profile once patients are established on sildenafil therapy. Following 6 months of once daily tadalafil suspension, alone or in combination, showed a trend towards improvement in clinical parameters, echocardiographic measurements, and laboratory results for pediatric PAH. All patient adverse effects were managed with non pharmacological measures and there was good patient compliance.
Arterial thromboembolism (ATE) and mortality among COVID-19 patients in the intensive care unit (ICU): prevalence and risk factors
Authors: Zulkifly H , Mansor F , Abdul Halim Zaki I , Kiok L C , Ravi T , Pathmanathan M 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To investigate the prevalence of arterial thromboembolic (TE) complications including stroke, peripheral arterial disease (PAD) and myocardial infarction (MI) and mortality among COVID-19 patients admitted to an ICU at a single centre hospital in the area of Klang Valley, Malaysia. The proportions of patients with ATE complication who died, and factors associated with the occurrence of ATE were explored.

Methods
Patients admitted to a single centre ICU with PCR confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included in this retrospective Malaysian cohort study. ATE event is a combination of ≥1 stroke, PAD and MI.

Results
Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2 % and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, only 58 (10.9%) developed ATE event during their ICU admission. Significantly higher proportions of COVID-19 patients admitted to ICU who developed complications of stroke (12.3% vs. 1.5; p&lt;0.001) and MI (16.4% vs. 4.6%; p&lt;0.001) died. Age, duration of ICU admission, proportion of underlying hypertension, stroke, IHD, diabetes, kidney disease, troponin, D-Dimer were significantly greater among those with ATE events. Predictors of ATE event on multivariate logistic regression analysis were duration of ICU admission [OR 1.0 (95% CI 1.00-1.04)] and troponin [OR 1.3 (95% CI 1.1-1.4)] level.

Conclusion
The overall prevalence of ATE complication among the severely ill COVID-19 patients was low (10.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of ATE events included increased troponin level and duration of ICU admission. Perhaps a more aggressive preventive strategies can be undertaken to prevent further increase in the prevalence of arterial thromboembolism and death.
Angiography alone versus angiography plus intracoronary imaging to guide emergency percutaneous coronary intervention: outcomes from a single-centre retrospective analysis
Authors: Wong S F , Ching S , Yue C S , Chung T S 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is emerging evidence showing improvement in clinical outcomes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS)-guided elective percutaneous coronary intervention (PCI). Yet data supporting their use in emergency setting are still conflicting.

Purpose
We aim to compare the immediate angiographic outcomes, short and long-term clinical outcomes in patients undergoing emergency PCI with intracoronary imaging to those with angiography guidance only.

Methods
We included 426 patients from May 2012 to December 2020 who presented with ST-elevation myocardial infarction (STEMI) and underwent emergency PCI within 24 hours of hospital admission. Intracoronary imaging was used in 196 of them to guide PCI. Immediate angiographic outcomes in terms of TIMI flow grade (TFG), myocardial blush grade (MBG) and corrected TIMI frame count (CTFC) are compared. Clinical outcomes including major adverse cardiac events (MACE), target vessel revascularization (TVR), hospitalization for heart failure and all-cause mortality were also compared.

Results
196 patients (46%) underwent intracoronary imaging-guided PCI. Use of imaging was associated with a higher post procedural CTFC (27.0 vs. 25.8, p=0.11), yet it failed to reach statistical significance. Comparing with angiography-guided PCI, imaging-guided PCI was associated with significantly larger proportion of high CTFC post procedure (slow coronary flow) (OR, 0.62; 95% CI: 0.38-1.0, P=0.05), and this result was consistent after adjustment of variables (adjusted OR, 0.57; 95% CI 0.34-0.98, P=0.04). Subjective measures of TIMI flow grade and MBG, however, were not different between the 2 groups. In the subgroup of patients with high Syntax score and American Heart Association (AHA)/American College of Cardiology (ACC) type C culprit lesion morphology, imaging guided PCI was associated with significantly worse post procedural MBG (OR, 0.36; 95% CI 0.17-0.78, P=0.01 vs. OR, 0.40; 95% CI 0.18-0.94, P=0.04), and the results were consistent after adjusting for variables. In the subgroup of patients with high Syntax score, imaging guided PCI was associated with significantly worse post procedural TIMI flow grade (adjusted OR, 0.35; 95% CI 0.12-0.95, P=0.05) and a trend towards higher CTFC (adjusted OR, 0.26; 95% CI: 0.06-0.94, P=0.05) after adjusting for variables. The cumulative incidences of all clinical outcome measures were not significantly different between the 2 groups before and after adjusting for confounders.

Conclusions
Imaging-guided PCI was not associated with improved angiographic or clinical outcomes in patients with STEMI who underwent emergency PCI. Use of intracoronary imaging in emergency PCI may associate with worse immediate angiographic outcomes.
Comparison of transcatheter, minimally invasive and conventional surgical aortic valve replacement: a systematic review and network meta-analysis
Authors: Fong K , Yap J J L , Chan Y H , Ewe S H , Chao V T T , Rizwan M , Govindasamy S P , Aziz Z A , Tan V H , Ho K W 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but long-term outcomes have yet to be comprehensively explored.

Purpose
To compare long-term mortality among three AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional surgical AVR (CAVR).

Methods
An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI to CAVR, and RCTs or propensity score-matched (PSM) studies comparing MIAVR to CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality was derived from graphical reconstruction of digitized Kaplan-Meier curves. Pairwise comparisons followed by network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk as well as transfemoral (TF-TAVI) patients.

Results
A total of 27 studies involving 16,554 patients were included. In the pairwise comparison of TAVI versus CAVR, TAVI showed superior mortality to CAVR until 39.5 months, beyond which there was no significant difference in longer term mortality. When restricted to TF-TAVI versus CAVR, consistent mortality benefit favoring TAVI was seen (shared-frailty hazard ratio [HR]=1.17, 95%CI=1.03-1.33, p=0.016). In the network meta-analysis involving majority PSM data, MIAVR was associated with significantly lower mortality than TAVI (HR=0.69, 95%CI=0.59-0.82) and CAVR (HR=0.68, 95%CI=0.58-0.80); this significant association was not seen when compared to TF-TAVI patients.

Conclusions
An initial short-medium term mortality benefit for TAVI over CAVR was noted but this benefit was attenuated over the longer term. In the subset of TF-TAVI patients, this long-term mortality benefit persisted, suggesting that non-TF techniques are associated with higher mortality. Amongst majority PSM data, MIAVR showed improved mortality compared to TAVI and CAVR but this was not seen in the TF-TAVI subset. This suggests that MIAVR may have a role in treating patients who are ineligible for TF-TAVI in experienced centers, and future RCTs are needed to conclusively validate this.
Comorbidity patterns in older patients with diabetes in primary care: a cross-sectional study
Authors: Wong W J , Nguyen T N , Harrison C 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Diabetes is a well-known risk factor for cardiovascular diseases and continues to be a global public health challenge. In Australia, prevalence rates of diabetes increase with age with almost 1 in 5 older people reported being diagnosed with diabetes. Older persons with diabetes are also more likely to have multiple comorbidities adding to their complexity. A better understanding of comorbidity patterns and their associated factors in older people with diabetes is instrumental to identify groups of individuals that differ in healthcare needs, resources utilized, and health trajectories.

Purpose
To identify comorbidity patterns in community-dwelling older adults with type 2 diabetes attending general practice settings in Australia.

Methods
This is a cross-sectional study based on the Bettering the Evaluation And Care of Health (BEACH) data. The BEACH program was a continuous, national study of the state of general practice clinical activity in Australia from 1998 to 2016. As part of the program, General Practitioners (GPs) would collect additional patient information during patient visits through structured paper-based recording sheets. For the purposes of this sub-study, a random sample of 1800 participating GPs were invited to record all diagnosed chronic conditions for 30 consecutive patients over twelve five-weeks recording periods between November 2012 and March 2016. The dataset was analyzed with descriptive analysis and exploratory factor analyses were applied to examine comorbidity patterns.

Result
From the dataset, there were 14 042 patients aged ≥65 with recorded chronic conditions. Of these, 2688 reported to have other comorbidities in addition to the diagnosis of diabetes. Hypertension was present in 67.33% (95% CI: 64.62 – 70.04) of these participants, followed by hyperlipidemia, 44.85% (95% CI: 41.80 –47.90), ischemic heart disease, 22.81% (95% CI: 20.74 – 24.87), atrial fibrillation, 10.25% (95% CI: 8.86 – 11.63), congestive heart failure, 7.03% (95% CI: 5.99 – 8.09), stroke/cerebrovascular accident, 6.76% (95% CI:5.36 -8.16) and peripheral vascular disease 5.26% (4.36 – 6.15). Top non-cardiovascular co-morbidities included arthritis, 51.78% (95% CI: 48.80–54.77) and depression, 15.52% (95% CI 13.78 –17.27). We identified two comorbidity patterns among older people with diabetes. The first were primarily psychological and musculoskeletal (Depression, Anxiety, Insomnia, Chronic Back Pain, Arthritis, Gastroesophageal Reflux Disease, Osteoporosis) and the second were cardiovascular conditions (Congestive Heart Failure, Ischaemic Heart Disease, Atrial Fibrillation, Peripheral Vascular Disease) and Chronic Renal Failure.

Conclusion
The prevalence of cardiovascular and non-cardiovascular comorbidities in older patients with diabetes was high. These findings highlight the need for elaborating primary care strategies to reduce cardiovascular risk and improve long-term care for this population.
Pre-diabetes is associated with increases cardiac event in cancer patients treated with anthracyclines
Authors: Cheang I F , Li X L , Yiu K H 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University of Hong Kong, Queen Mary Hospital

Objective
To evaluate the association between pre-diabetes and cardiovascular events in patients treated with anthracyclines containing chemotherapy (ACT).

Methods
Patients treated with ACT between 2000 and 2019 were divided into diabetes, pre-diabetes, and normoglycemia groups based on the baseline glycemic status. Primary outcome was the major adverse cardiovascular composite events (MACE) of heart failure hospitalization and cardiovascular death. Kaplan-Meier, multivariable COX regression, and Fine and Gray model analysis were applied.

Results
Among 12649 patients treated with ACT, 3997 (31.6%, median age 61 years old) had pre-diabetes and 5622 (44.45%, median age 67 years old) had diabetes at baseline. Over a median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in normoglycemia group, 358 (9.0%) in pre-diabetes group, and 728 (12.9%) in diabetes group. Compared with normoglycemia group, both pre-diabetes (adjusted HR=1.20, 95%CI 1.01-1.43) and diabetes (adjusted HR=1.46, 95% CI 1.24-1.70) were significantly associated with an increased risk of MACE. Further analysis showed that there were 475 (18%) progressed to overt diabetes in the pre-diabetes group after 2 years of the index date and were at greater risk of MACE (Adjusted HR=1.76, 95% CI 1.31-2.36).

Conclusions
Pre-diabetes was significantly associated with an increased risk of MACE in patients treated with ACTs. Among, those who progressed to diabetes after 2 years demonstrated an increased risk of MACE. Findings support that pre-diabetes as a risk factor for cardiovascular events might optimize management.
Skeletal muscle area predicts the outcomes of non-small-cell lung cancer after trimodality therapy
Authors: Watanabe Kenji , Kinoshita Fumihiko , Takenaka Tomoyoshi , Nagano Taichi , Oku Yuka , Kosai Keisuke , Ono Yuki , Haratake Naoki , Kohno Mikihiro , Kamitani Takeshi , Yoshitake Tadamasa , Okamoto Tatsuro , Shimokawa Mototsugu , Ishigami Kousei , Yoshizumi Tomoharu 
Published: January 2023

AbstractOBJECTIVESSarcopenia correlates with poor prognosis in various malignancies. However, the prognostic significance of sarcopenia remains to be determined in patients with non-small-cell lung cancer who undergo surgery after receiving neoadjuvant chemoradiotherapy (NACRT).METHODSWe retrospectively reviewed the patients with stage II/III non-small-cell lung cancer who underwent surgery following NACRT. The paravertebral skeletal muscle area (SMA) (cm2) at the 12th thoracic vertebra level was measured. We calculated the SMA index (SMAI) as SMA/squared height (cm2/m2). Patients were divided into low and high SMAI groups, and the association of SMAI with clinicopathological factors and prognosis was assessed.RESULTSThe patients’ [men, 86 (81.1%)] median age was 63 (21–76) years. There were 106 patients including 2 (1.9%), 10 (9.4%), 74 (69.8%), 19 (17.9%) and 1 (0.9%) patients with stage IIA, IIB, IIIA, IIIB and IIIC, respectively. Of the patients, 39 (36.8%) and 67 (63.2%) were classified in the low and the high SMAI groups, respectively. Kaplan–Meier analysis showed that the low group had a significantly shorter overall survival and disease-free survival than the high group. Multivariable analysis identified low SMAI as an independent poor prognostic factor for overall survival.CONCLUSIONSPre-NACRT SMAI correlates with poor prognosis; therefore, assessing sarcopenia based on pre-NACRT SMAI may help determine optimal treatment strategies and suitable nutritional and exercise interventions.
Uniform Resolvent Estimates for Critical Magnetic Schrödinger Operators in 2D
Authors: Fanelli Luca , Zhang Junyong , Zheng Jiqiang 
Published: January 2023

Abstract
We study the $L^{p}-L^{q}$-type uniform resolvent estimates for 2D-Schrödinger operators in scaling-critical magnetic fields, involving the Aharonov–Bohm model as a main example. As an application, we prove localization estimates for the eigenvalue of some non–self-adjoint zero-order perturbations of the magnetic Hamiltonian.
A Nationwide Survey of Training Pathways and Practice Trends of Endoscopic Submucosal Dissection in Canada
Authors: Li Suqing , Mosko Jeffrey , May Gary , Teshima Christopher 
Published: January 2023

AbstractBackgroundEndoscopic submucosal dissection (ESD) has become an established standard for endoscopic removal of large gastrointestinal (GI) lesions and early GI malignancies. However, ESD is technically challenging and requires significant health care infrastructure. As such, its adoption in Canada has been relatively slow. The practice of ESD across Canada remains unclear. Our study aimed to provide a descriptive overview of training pathways and practice trends of ESD in Canada.MethodsCurrent ESD practitioners across Canada were identified and invited to participate in an anonymous cross-sectional survey.ResultsTwenty-seven ESD practitioners were identified; survey response rate was 74%. Respondents were from 15 different institutions. All practitioners underwent international ESD training of some type. Fifty per cent pursued long-term ESD training programs. Ninety-five per cent attended short-term training courses. Sixty per cent and 40% performed hands-on live human upper and lower GI ESD, respectively, before independent practice. In practice, 70% saw an increase per year in number of procedures performed from 2015 to 2019. Sixty per cent were dissatisfied with their institution’s health care infrastructure to support ESD. Thirty-five per cent perceived their institution as supportive of expanding the practice of ESD.ConclusionsSeveral challenges exist to the adoption of ESD in Canada. Training pathways are variable, with no set standards. In practice, practitioners express dissatisfaction with access to necessary infrastructure and feel poorly supported in expanding the practice of ESD. As ESD is increasingly the accepted standard for the treatment of many neoplastic GI lesions, greater collaboration between practitioners and institutions is crucial to standardize training and ensure patient access.