bluuebunny/crossref_metadata_2025_split huggingface dataset:
P363 EFFECTS OF ALIROCUMAB AND EVOLOCUMAB ON THE OUTCOMES AND LIPID PROFILE OF DIABETIC PATIENTS: META–ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Orlando L , Quartuccio S , Vatrano M , Imbalzano E 
Published: May 2023

Abstract

Objective
To evaluate the specific effects of alirocumab and evolocumab on major cardiovascular events (MACE) and lipid profile in patients with diabetes.

Methods
We conducted a systematic review of literature according to the PRISMA statement. A total of 8 randomized control trials (RCTs) enrolling 20651 patients with diabetes were included. Mean follow–up was 51 weeks. We included RCTs which had compared the PCSK9i alirocumab and evolocumab with placebo in subjects with hypercholesterolemia and diabetes mellitus.

Results
MACE occurred in 8.7% of patients with diabetes randomized to PCSK9i vs. 11.0% of those randomized to placebo. Thus, the use of alirocumab or evolocumab reduced MACE by 18% (relative risk [RR] 0.82, 95% confidence interval [CI] 0.74–0.90), without differences between PCSK9i compounds (p= 0.70, I2 0.0%). Compared to control group, the use of PCSK9 inhibitors was associated with a significant % change from baseline in LDL–C (mean difference [MD]–58.48%; 95% CI: –63.73 to –53.22%), p&lt;0.0001), HDL–C (MD5.21%; 95% CI: 3.26 to 7.17 %), triglycerides (MD–14.59%; 95% CI: –19.42 to –9.76%), non–HDL–C (MD –48.84%; 95% CI: –54.54 to –43.14%) and total cholesterol (MD–33.76%; 95% CI: –38.71 to –28.8%). A significant reduction of Lp(a) (MD–32.90%; 95% CI: –38.55 to –27.24%) were observed in PCSK9i group compared to placebo. Moreover, while LDL–C reduction was similar in both subgroups (Evolocumab: MD –63,3%; 95% CI: –74.87 to –51.72%, p&lt;0.0001; alirocumab: MD –55.58%; 95% CI: –61.49 to –49.67%, p&lt;0.0001; Test for subgroup differences: P= 0.24; I226.2%), the percentage of Lp(a) reduction was higher in evolocumab subgroup compared to alirocumab (MD –46.68 %; 95% CI: –60.73 to –32.63%, p&lt;0.0001 vs –22.92 %; 95% CI: –28.58 to –17.25%, p&lt;0.0001, respectively; Test for subgroup differences: P= 0.002; I2=89.4%).

Conclusions
Alirocumab and evolocumab appear to be effective in reducing the risk of MACE in subject with diabetes. Moreover, the use of PCSK9 inhibitors provides enhancement of lipid profile of patients with diabetes and dyslipidemia by reducing LDL–c and Lp(a) values.
P377 PERCUTANEOUS TREATMENT OF INTERMEDIATE AND HIGH–RISK PULMONARY EMBOLISM: A CASE REPORT
Authors: Verrengia E , Pezzi L , Testa S , D’Alleva A , Genovesi E , Magnano R , Forlani D , Fulgenzi F , Vitulli P , Di Marco M , Paloscia L 
Published: May 2023

Abstract
Pulmonary embolism is the third most frequent cardiovascular pathology, with an incidence of 100–200 cases for 100.000 inhabitants and is one of the main causes of mortality, morbidity and hospitalizations. Systematic thrombolysis represents the treatment of first choice in high–risk/high–intermediate–risk patients who experience hemodynamic instability, however there are absolute and relative contraindications that do not allow its use in all patients: in these cases, percutaneous catheter treatment can be attempted. A hypertensive and obese 84–year–old woman arrives at the emergency room with the onset of chest pain associated with dyspnea. In the emergency room, high levels of D–Dimer and highly sensitive Troponin T are found, therefore cardiological advice is requested. The echocardiogram shows severe dilatation of the right ventricle with McConnel sign, D–Shape and multiple thrombotic formations in the right atrium. On the advice of the consultant cardiologist, a pulmonary CT angiography is performed with evidence of thromboembolism of the main arterial trunks, massive at the level of the distal juxta–hilar portions. Therefore, high–intermediate–high risk pulmonary embolism is diagnosed and the patient is transferred to the ICU for proper treatment. Despite the infusion therapy with sodium heparin, there is a sudden worsening of the clinical and hemodynamic picture: thus, in the light of the impossibility of performing a rescue thrombolysis due to the recent patient’s femoral fracture, it is decided to perform a percutaneous treatment by thrombectomy, using an “INARI” thrombus–aspirator catheter positioned to the right femoral route. Pulmonary angiography reveals thrombotic sub–occlusion of booth main branches. Five aspiration cycles are performed, two of which in the right pulmonary artery and the remaining three in the left pulmonary artery. Control angiography shows reperfusion of the left lower lobe and partial reperfusion of the left upper lobe, while partial reperfusion of the right upper lobe is found on the right. Abundant thrombotic and partly fibrous material is found during aspiration. After the 5th cycle, cardio–circulatory arrest occurs and despite the resuscitation maneuvers, the patient dies. At present, percutaneous treatment in acute pulmonary embolism is still scarcely used in daily clinical practice, but it will certainly play an important role in the near future as a valid therapeutic alternative .
P387 “THE IMPORTANCE OF NEW ADVANCED IMAGING TECHNIQUES IN SINE CAUSA VENTRICULAR ARRHYTHMIAS”
Authors: Pugliesi G , Ravaro S , Rella V , Castelletti S , Meda M , Mariani D , Salerno S , Parati G , Muraru D , Crotti L 
Published: May 2023

Abstract

Case Presentation
A 61–years–old woman was referred to our center after her 33 years old daughter suffered a sudden cardiac death. Cardiovascular risk factors: dyslipidemia and family history of ischemic cardiomyopathy.

Diagnostic and Therapeutic Work Up
Patient’s ECG was normal. Holter ECG showed frequent ventricular extrasystoles (2000/die) isolated and not premature, with LBB morphology, associated with not sustained ventricular tachycardias with LLB and low axis morphology (HR mean 140–170 beats/min). Exercise Stress Test did not show a clear correlation between physical activity and arrhythmias. Beta blocker therapy was started and was only partially effective in reducing ventricular arrhythmias, and a loop recorder was implanted. In 2019 a cardiac MRI with adenosine was performed, showing a mild globular shaped left ventricle with a non–specific linear distribution of LGE in the middle septum. Genetic analysis for channelopathies and cardiomyopathies resulted negative. In the last advanced echocardiogram (2022) with 3D reconstruction and strain analyses, characteristics suspected for arrhythmic mitral valve prolapse (MAD and curling of inferolateral wall) were identified. Accordingly, it has been decided to perform a second cardiac MRI to better characterize the underlying cardiac condition and to define the appropriate risk stratification algorithm.

Conclusions
Arrhythmic mitral valve prolapse is defined by ventricular arrhythmias in the absence of other known causes and it is present in up to 13% of sudden cardiac deaths in female patients. According to the recent consensus document by EHRA, sudden cardiac death risk stratification is complex and based firstly on the evaluation of arrhythmic burden, and secondly on symptoms and additional risk factors (i.e. MAD, left ventricle disfunction, flap redundancy, LGE in specific areas and so on). This case shows the importance of advanced imaging techniques and multimodal approach in ventricular arrhythmias evaluation.
P398 ACUTE PERICARDITIS COMPLICATED BY RAPID DEVELOPMENT OF CONSTRICTION: A CASE REPORT
Authors: Passarelli I , Castelli G , Pirondini M , Lesce A , Luciano R , De Concilio A , Perego C , Chiocca E , Dadone V , Pentiricci S , Ornaghi M , Pierini S 
Published: May 2023

Abstract
A 57–years–old man with no previous cardiovascular history presented with fever, hypotension, dyspnoea at rest and chest pain. The electrocardiogram showed sinus tachycardia, PR–segment depression and diffuse concave–upwards ST–segment elevation. Elevated C–reactive protein and low pro–BNP level were found at lab tests, procalcitonin and troponin were negative. Chest X–ray showed bilateral pleural effusion. Transthoracic echocardiogram (TTE) revealed mild–to–moderate serofibrinous pericardial effusion with initial diastolic collapse of right chambers, suggesting cardiac pre–tamponade. Because of the exiguity of liquid component, pericardiocentesis was not performed, patient was stabilized by fluid–challenge with hypertonic solution. Ibuprofen and colchicine were started. Left thoracentesis was performed removing one liter of fluid overall compatible with transudate. Cytological and microbiological examinations were negative. Despite of initial clinical improvement, the patient showed kidney failure and worsening of lung failure; perianal abscess was detected causing sepsis and requiring surgical drainage and antibiotic therapy with vancomycin and piperacillin/tazobactam. Culture exams were negative. After ibuprofen replacement with indomethacin a repeated TTE showed reduced pericardial effusion, but also respiratory variation in ventricular filling with signs of interventricular dependence. Cardiac magnetic resonance showed thickening and high signal intensity of pericardial layers on T2 weighted imaging and ventricular septal shift on free–breathing cine sequences, suggesting effusive–constrictive pericarditis. Left and right cardiac catheterization demonstrated ventricular “dip and plateau” pattern and ventricular discordance. Considering the lack of clinical improvement on medical therapy, off–bypass pericardiectomy was performed. Incomplete adhesion between the two pericardial layers and thick gelatinous material were found. After surgery patient experienced rapid clinical improvement; cardiac index increased from 1.5 to 3.5 L/min/m2. Effusive–constrictive pericarditis is a rare and dreaded complication of acute pericarditis. Surgery, when appropriated, is crucial for prognosis. In our case initial response to anti–inflammatory therapy with reduced pericardial effusion unmasked constrictive physiology in an effusive–constrictive pericarditis. Clinical management was complicated by sepsis which could have played a role in constriction developing.
P420 A CANCER PATIENT WITH PULMONARY THROMBOEMBOLISM: IS IT RIGHT TO APPLY THE CRITERIA FOR DOSE REDUCTION IN THESE PATIENTS?
Authors: Russo G , Guglielmi A , Cherubini A , Faganello G , Bisceglia I , Canale M , Camilli M , Fiscella D , Paccone A , Gallucci G , Turazza F , Lestuzzi C , Cappelletto C , Mazzone C , Bollini M , Grande E , Ius A , Mattei L , Di Lenarda A 
Published: May 2023

Abstract
A 78 years old woman presented in our cardio–oncology out–patient clinic to renew apixaban treatment plan. In her medical history she was a former smoker, with a chronic kidney disease in IIIb stadium according to KDIGOI guidelines with a creatinine of 1,54 mg/dl, GFR according CKD 32 ml/min/1.73m2 and according Cockcroft e Gault 28 ml/min/1.73m2. In 2010, she had a right lobe pulmonary cancer diagnosis treated in neo–adjuvant with gemcitabine. After chemotherapy, she underwent surgical lobectomy. During hospitalization she had a deep venous thrombosis complicated by pulmonary thromboembolism, heparin sc was given with resolution of the clinical picture. In 2012 she had a recurrence of pulmonary thromboembolism. Heparin and warfarin in a second time was given. In 2016 for cancer disease progression, she underwent various oncological treatments and she found a stability disease with osimertinib and stereotaxic radiotherapy. Warfarin was switched to apixaban low–doses for low weight and chronic kidney disease. In 2021 in osimertinib therapy, cancer was under control. She was continuing low–dose apixaban. One year later, a CT scan demonstrated a disease progression and inferior cava venous thrombosis. A cardiac evaluation in our unit was required: patients was asymptomatic. EKG and Echocardiogram were normal. Apixaban low dose was changed to edoxaban 30 mg. There was a complete vein recanalization. Unfortunately, patient died after 8 months for cancer. It is important, in the direct oral anticoagulation therapy in cancer patient, to consider not only the indication for dose reduction known by the registration studies but also cancer and therapy factors.
P421 INTRA–CARDIAC AND ALL LAYERS CARDIAC INVOLVEMENT BY SQUAMOUS NON–SMALL CELL LUNG CANCER
Authors: Bisceglia I , Mistrulli R , Federico A , Petrolati S , Canale M , Camilli M , Paccone A , Russo G , Veneziano F , De Luca L , Cartoni D 
Published: May 2023

Abstract
A 73 year–old man was referred by his general practitioner to our ambulatory for worsening dyspnea. He also reported substantial weight loss (almost 20 kg during the last three months), new onset dysphonia and dry cough. The patient’s medical history also included a former tobacco addiction, arterial hypertension and dyslipidemia. There was not history of cardiomiopathy. Electrocardiogram, showed: sinus rhythm, 60/min with inferior and anterior–lateral abnormality of repolarization. No laboratory exams were available at the first visit. An echocardiogram was performed, showing: marked septal hypertrophy (IVSd= 23 mm), septal hypokinesia, with an ejection fraction at lower limits of normality (EF= 54%), neither systolic anterior motion of the mitral valve. Minimal pericardial effusion was seen. We required a CT scan of the chest, that showed a large (5x8x11cm) mass in the left upper lobe with ipsilateral mediastinal lymphadenopathy. The mass directly extended into the mediastinum with infiltration of pericardial leaflet, left atrium and the left wall of the aortic arch. A hypodense formation of approximately 4 cm in the interventricular septum in the apical portion was reported. PET–CT with FDG was performed, which documented hypercaptation of the radioactive tracer at the level of the above–mentioned lesions. The patient underwent fine–needle aspiration biopsy of the lung mass and the histological examination led to the diagnosis of squamous cell carcinoma of the lung. Systemic treatment with carboplatin plus placlitaxel and pembrolizumab was subsequently started. A cardiac CMR was performed, which documented an area of 30x17x31 mm located at the septal (mid–apical portion), apex and parapical portion of the free wall of the right ventricle with transmural extension. At this area, extensive late gadolinium enanchement (LGE) at marginal level with a central non–capillary core and hyperintense in T2 sequences (compatible with central necrotic lesion). The pericardium also showed LGE and a mild pericardial effusion (maximum 8 mm); left atrium involvement, seen on CT, was not documented . After he completed the third cycle of CHT, at 5 months from the diagnosis, the echocardiogram showed a substantial disappearance of the mass infiltrating the interventricular septum without evidence of pericardial effusion. The ecg was substantially unchanged. The patient stopped carboplatin and paclitaxel after 3 cycles and kept maintenance pembrolizumab still ongoing.
Soil moisture drives differences in the diversity and trophic complexity of high Arctic tundra soils
Authors: Almela Pablo , Rico Eugenio , Velázquez David , Verleyen Elie , Quesada Antonio 
Published: May 2023

Abstract
The Arctic soil communities play a vital role in stabilizing and decomposing soil carbon, which affects the global carbon cycling. Studying the food web structure is critical for understanding biotic interactions and the functioning of these ecosystems. Here, we studied the trophic relationships of (microscopic) soil biota of two different Arctic spots in Ny-Ålesund, Svalbard, within a natural soil moisture gradient by combining DNA analysis with stable isotopes as trophic tracers. The results of our study suggested that the soil moisture strongly influenced the diversity of soil biota, with the wetter soil, having a higher organic matter content, hosting a more diverse community. Based on a Bayesian mixing model, the community of wet soil formed a more complex food web, in which bacterivorous and detritivorous pathways were important in supplying carbon and energy to the upper trophic levels. In contrast, the drier soil showed a less diverse community, lower trophic complexity, with the green food web (via unicellular green algae and gatherer organisms) playing a more important role in channelling energy to higher trophic levels. These findings are important to better understand the soil communities inhabiting the Arctic, and for predicting how the ecosystem will respond to the forthcoming changes in precipitation regimes.
Regulatory Effect of Ellagic Acid on Immune Function in Burned Rats
Authors: Deng Hong-ao , Chen Yong , Yuan Yuan , Zhang Hong-yan 
Published: May 2023

Abstract
To investigate the effect of ellagic acid (EA) treatment on immune function in burned rats. First, 30 Sprague-Dawley rats were established as a deep second-degree burn model. They were randomly divided into three groups: Model group, EA 50 mg/kg, and EA 100 mg/kg group. The wound area of rats at 0–7 days was measured and the wound healing rate was calculated. The levels of inflammatory factors tumor necrosis factor-α (TNF-α), interferon γ (IFN-γ), interleukin (IL)-1β, IL-6, IL-10, and immunoglobulins IgA, IgG, and IgM in rat serum were evaluated by ELISA. Flow cytometry was used to detect the CD4 +/CD8 + T cell ratio, levels of Foxp3 + Treg cells, and CD4 + CD25 + regulatory T cells (Treg) cells levels in the peripheral blood of rats. On the fourth to seventh day of the burn, EA treatment could significantly promote the decrease of the wound area and the increase of the wound healing rate in burned rats. Further examination revealed that the levels of inflammatory factors in serum were remarkedly decreased and immunoglobulins levels were increased in the EA group, compared with the Model group. Meanwhile, the levels of CD4 + CD25 + Treg cells and Foxp3+ Treg cells were significantly decreased, whereas the CD4+/CD8 + T cell ratio was observably increased in a concentration-dependent manner. Altogether, EA effectively promotes the wound healing of burned rats by regulating the levels of inflammatory factors, immunoglobulin, and T cells in burned rats, and improves the symptoms of burn immunosuppression.
Accumulation conditions and patterns of natural gas hydrate in the Muli permafrost area, northeastern margin of the Qinghai‒Tibet Plateau, NW China
Authors: Pei Fagen , Wang Xuben , Fang Hui , He Dashuang , He Meixing , Du Bingrui , Zhang Penghui , Wang Xiaojiang 
Published: May 2023

Abstract
The Muli permafrost area is the only midlatitude permafrost area where natural gas hydrates (NGHs) have been drilled. Although a series of achievements has been made in studies on NGH accumulation conditions in the permafrost area, related studies on gas hydrate stability zones, gas sources and groundwater are still controversial and need further work. Based on geophysical, geological and geochemical data, this paper systematically elaborates the main NGH accumulation conditions in the Muli area in terms of the pressure‒temperature stability conditions, fault structure, gas composition, gas source, reservoir characteristics, groundwater distribution and topographic characteristics. The results show that the thicknesses of the NGH stability zone range from 491.0 to 962.7 m. The fault structure can provide a pathway for hydrocarbon gas migration from deep to NGH stability zones, in which thrust faults can prevent the upwards migration of gas by sealing it below the hanging wall block. Rock fractures in the NGH stability zone can not only be gas migration channels, but also serve as a reservoir space for NGH accumulation. The hydrocarbon gas of NGHs shows multiple origins and is mainly composed of oil-associated gas. The formation of frost mounds related to the overpressured gas ejection caused by NGH decomposition may imply the existence of NGHs. Synthetically, similarities and differences in NGH accumulation conditions between the Muli permafrost area and other high-latitude permafrost areas are proposed, and the ‘regression’ NGH accumulation pattern in the Muli area is constructed. The study results can enrich theoretical knowledge of terrestrial NGH accumulation, and provide scientific guidance for NGH exploration in midlatitude permafrost areas.
Impact of COVID-19 on health care and quality of life in women with breast cancer
Authors: Myers Charlotte , Bennett Kathleen , Kelly Catherine , Walshe Janice , O’Sullivan Nollaig , Quinn Mary , Lyons Therese , Weadick Catherine , Cahir Caitriona 
Published: May 2023

Abstract

Background
The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether the impact varied by social determinants of health (SDH).

Methods
Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models.

Results
A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P &lt; .001) and lower QoL (β = −12.01, SE = 3.37, P &lt; .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction  &lt; .05).

Conclusions
There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.
The Retention of USUHS Military Physicians: An Exploratory Study
Authors: Jung Eulho , McBee Elexis , Reamy Brian V , Durning Steven J , Zarzuela Geddy , Dong Ting 
Published: May 2023

ABSTRACT

Background
Previously, researchers investigated the career accomplishments of USU medical graduates using the data from a USU alumni survey. To better understand if such accomplishments are related to military retention, the current study investigates the relationship between accomplishments (such as military career milestones and academic achievement) and military retention.

Methods
Utilizing the responses to the alumni survey sent to USU graduates in the Classes of 1980 to 2017, the researchers investigated the relationship between a series of survey items (e.g., military rank, medical specialties, and operation experiences) and military retention.

Results
Among the respondents who had a deployment history in support of an operational mission, 206 (67.1%) stayed longer than their initial active duty service or planned on staying longer than their current active duty service commitment. Fellowship directors (n = 65, 72.3%) showed a higher retention rate than other positions. The PHS alumni had the highest retention rate (n = 39, 69%) of the military branches, whereas physicians in medical specialties with higher demand (e.g., otolaryngology and psychiatry) showed less promising retention.

Conclusions
By conducting future research on underlying reasons as to why full-time clinicians, junior physicians, and physicians in medical specialties with higher demand showed less promising retention, stakeholders will be able to identify what needs to be addressed to retain highly skilled physicians in the military.