bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short term Outcomes of left main coronary artery Percutaneous Coronary Intervention A large tertiary care dedicated Cardiac Centre experience.
Authors: Ullah Abid , Ishaq Muhammad , Jan Rafiullah , Raza Ali 
Published: March 2023

Background: Left main coronary artery intervention is getting common throughout the world. Data in our local population are still lacking. Our aim was to study the short-term outcomes after revascularization of left main coronary artery (LMCA) at a tertiary care Centre at public sector hospital in Pakistan.
Methodology: In this descriptive study conducted at Peshawar Institute of Cardiology, we enrolled consecutive patients who underwent LMCA intervention from January 2021 till November 2021. Direct patients’ interviews, reviewing charts and records were used for in-hospital outcomes and telephonic and physical follow up were used to document three months outcome. Results were expressed as means, standard deviations and percentages for different variables.
Results: Total number of patients in the study were 68. The mean age was 61 ± 11.7 years, 73.5% (50 cases) were males. Six patients (8.8%) were in cardiogenic shock and five of them were put on mechanical ventilation. Thirty-two (47.1%) patients had presentation as acute coronary syndrome (ACS) within the last seven days. Mean follow up time was 170 ± 71 days. Mortality in-hospital was 5.8%, at the mean follow up it was 8.8%.
Conclusion: Comparable short-term outcomes of left main coronary artery PCI, to national and international data can be achieved in a public sector hospital in our country where resources are scarce. Hence LMCA PCI is an acceptable alternative to CABG in suitable patients.
Comparative outcomes of MACE after Drug eluting balloon Vs. Drug Eluting Stent in treatment of in-stent restenosis (ISR) patients presented with acute coronary syndrome.
Authors: Khan Shahsawar , Khan Adnan , Bukhari Jasia , Idrees Khan Muhammad , Uddin Imad 
Published: March 2023

Background: Currently, patients with coronary artery disease are advised to use coronary stenting as their primary revascularization method. This study aims to compare outcome of MACE after DEB Vs DES in treatment of patients within stent restenosis (ISR) presented with chest pain.
Methodology: The current study was Quasi experimental study carried out at the Department of Cardiology, MTI-HMC Peshawar for duration of six months from 21 April 2021 to 21 Nov 2021. In this study, 94 patients in DEB group and 94 patients in DES group were followed for 06 months to look for development of MACE. All data was collected through a well-defined proforma. Data was entered on computer software SPSS version 22.
Results: In DEB group, 52 (55.3%) male patients and 42 (44.7%) female patients were recorded whereas in DES group, 57 (60.6%) male patients while 37 (39.4%) female patients were recorded. In DEB group, 15 (16.0%) patients were recorded with MACE whereas in DES group, 38 (40.4%) patients were recorded with MACE.
Conclusion: Our study showed that DEB is superior to DES in the management of in-stent restenosis and results in fewer major adverse cardiovascular events (MACE), so DEB may be considered as a treatment option for CAD patients admitted to our setting in in order to reduce mortality and morbidity associated to restenosis in such patients.
Comparison of Outcomes of Different Balloon Sets in Patients undergoing Percutaneous Transvenous Mitral Commissurotomy – Bigger and Differ is Better!
Authors: Tariq Farman Muhammad , Hashim Muhammad , Khan Naveedullah , Saghir Tahir 
Published: March 2023

Background: Although the Inoue balloon technique is said to be more popular worldwide for PTMC in those who have severe MS, the Bonhoeffer multi-track (double balloon technique) system is used in our center. On the other hand, it is unknown which balloon set size will produce the best results. The current study's objective is to assess the efficacy of different balloon sets utilized in symptomatic patients with moderate to severe mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC).
Methodology: There were 203 consecutive patients. In 154 patients, a 14x14mm balloon set was used, and in the other 49 patients, a 14x16mm balloon set. PTMC was deemed successful when MVA 1.5 cm2 was attained with just minimal MR. Patients with valve areas less than 1.5 cm2 and more severe MR are regarded as failed.
Results: With a 14x16mm balloon set, post-procedure examination revealed noticeably better accomplishment in the valve area (2.960.84 cm2 versus 3.260.95 cm2; P=0.024). With a 14x16mm balloon set, a tendency towards a lower post-procedure mean pressure gradient across the mitral valve was seen (6.052.19 mmHg versus 5.472.24 mmHg; P=0.107). There was no discernible change in post-procedure MR, tamponade, or procedural failure. However, there was no significant statistical difference in the treatment efficacy between the groups (87.7% with a 14x16mm balloon set versus 77.9% with a 14x14mm balloon set; P=0.153).
Conclusion: A 14x16 mm balloon set might be a better and safer option, particularly for taller and older patients with larger annuli.
Left Main Coronary Artery Stenosis following Bentall Procedure: A case report.
Authors: Hameed Hannah , Anne John Tara , Tahirkheli Mashal , Cannon Bruce , Ellen White Julie , Zafar Hussnain , Baig M Almas , Sani Zarrar , Chohan Amad , Weitzel Ann-Marie , Razaq Humza , Siddiqi Alysha , Ali Mehak , Rizvi Ilsa , Ahmad Arslan , Muzaffar Bireera , Batool Sakina , Imtiaz Karamat Riyan , Manzoor Amjad Qasim , Karim Adil , Tahirkheli Naeem 
Published: March 2023

Since its introduction, Bentall procedure has remained the standard of care for management of ascending aortic aneurysms with associated aortic valve pathologies. It involves replacement of aortic root, ascending aorta and the aortic valve, using a hybrid vascular graft with built in valves. The openings of the main coronary arteries are then rejoined with the graft. The procedure has satisfactory long term survival rate. However, there are some complications including graft infection, stroke from dislodged plaques and coronary insufficiency due to kinking of the reconnected main coronary arteries.
Here, we report a rare and life-threatening complication following Bentall procedure. A 76-year-old female developed left main stenosis following Bentall procedure, successfully treated with percutaneous coronary intervention (PCI). We discuss various etiologies and treatment options for this complication. We recommend routine surveillance with coronary angiography at six months post Bentall.
Recurrent coronary spasm presenting as acute STEMI; To stent or not to stent?
Authors: Ullah Abid , Keshavarzi F , Fraser D 
Published: March 2023

Coronary artery spasm is a relatively uncommon cause of ST segment elevation myocardial infarction. However, the clinical presentation and electrocardiographic findings are remarkably similar to STEMI secondary to plaque rupture.
Recurrent presentation with coronary vasospasm as STEMI presents a unique clinical dilemma especially if they present to different centers where the previous history is not well known. Management in the acute settings continue to pose significant challenges in these acutely unwell patients.
We describe and explore a similar clinical situation in which a patient with severe recurrent STEMI presentations was found to have coronary artery vasospasms.
The case was twice misinterpreted as having plaque rupture STEMI leading to percutaneous coronary intervention and then further difficulties in long term management in view of need for long term antiplatelet and suspected association of eosinophilia with coronary vasospasm which in turn can be caused by Aspirin.
Effects of stumping on fine root architecture, growth, and physiology of Hippophae rhamnoides
Authors: Wang Haoyue , Qi Wei , Guo Yuefeng , Xu Yajie 
Published: March 2023

Background
Fine roots are vital to a plant’s ability to absorb water and nutrients. Stumping is a practice that may encourage fine root growth and the rapid recovery of decaying Hippophae rhamnoides plants. However, the effect of stumping on the fine roots and physiological indices is still unknown. The differential indices between stumped forests and non-stumped forests must also be defined.

Methods
We recorded the changes in the fine roots of structure H. rhamnoides one year after stumping. Using single factor analysis of variance and general linear models we comprehensively analyzed the number of root tips and the plant’s growth and physiological indices in response to stumping. Partial least squares discriminant analysis (PLS-DA) was used to compare fine root growth and physiological indices with and without stumping in order to identify the differential indices.

Results
The proportion of root tips in the vertical layers at 30–40 cm and 40–50 cm and in the horizontal layers at 60–80 cm and 80–100 cm, increased after stumping by 1.85%, 2.60%, 1.96% and 4.32%, respectively. In the 0–50 cm soil layer, the fine root dry weight rose by 27.6% compared with the control, which was not significant. However, other indices were significantly different from the control. The proportions in the growth indices in the 30–40 cm and 40–50 cm layers increased after stumping. Stumping had a significant, negative effect on proline and malondialdehyde content, which dropped by 40.95% and 55.32%, respectively, indicating that the harms caused by these two chemicals was alleviated. Stumping had a significant positive effect on root activity and soluble sugar contents, which increased by 68.58% and 36.87%, respectively, and improved the growing ability of fine roots. PLS-DA revealed that malondialdehyde, soluble sugars, root density, and the number of root tips ranked from having the least to greatest effect on the classification of stumping and no-stumping.

Conclusions
The process of stumping may promote fine roots growth in H. rhamnoides, and is favorable for their longitudinal development. The fine root growing indices of H. rhamnoides responded positively to this process. Stumping promotes root activity and the creation of soluble sugar to maintain the growth and development of fine roots. It also inhibits the negative effects of proline and malondialdehyde on fine roots. Our study showed that the differential physiological indices were more important for classification than the differential growing indices.
Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction
Authors: Reddy Yogesh N. V. , Koepp Katlyn E. , Carter Rickey , Win Sithu , Jain Christopher Charles , Olson Thomas P. , Johnson Bruce D. , Rea Robert , Redfield Margaret M. , Borlaug Barry A. 
Published: March 2023

ImportanceReduced heart rate during exercise is common and associated with impaired aerobic capacity in heart failure with preserved ejection fraction (HFpEF), but it remains unknown if restoring exertional heart rate through atrial pacing would be beneficial.ObjectiveTo determine if implanting and programming a pacemaker for rate-adaptive atrial pacing would improve exercise performance in patients with HFpEF and chronotropic incompetence.Design, Setting, and ParticipantsSingle-center, double-blind, randomized, crossover trial testing the effects of rate-adaptive atrial pacing in patients with symptomatic HFpEF and chronotropic incompetence at a tertiary referral center (Mayo Clinic) in Rochester, Minnesota. Patients were recruited between 2014 and 2022 with 16-week follow-up (last date of follow-up, May 9, 2022). Cardiac output during exercise was measured by the acetylene rebreathe technique.InterventionsA total of 32 patients were recruited; of these, 29 underwent pacemaker implantation and were randomized to atrial rate responsive pacing or no pacing first for 4 weeks, followed by a 4-week washout period and then crossover for an additional 4 weeks.Main Outcomes and MeasuresThe primary end point was oxygen consumption (V̇o2) at anaerobic threshold (V̇o2,AT); secondary end points were peak V̇o2, ventilatory efficiency (V̇e/V̇co2 slope), patient-reported health status by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.ResultsOf the 29 patients randomized, the mean age was 66 years (SD, 9.7) and 13 (45%) were women. In the absence of pacing, peak V̇o2 and V̇o2 at anaerobic threshold (V̇o2,AT) were both correlated with peak exercise heart rate (r = 0.46-0.51, P &amp;lt; .02 for both). Pacing increased heart rate during low-level and peak exercise (16/min [95% CI, 10 to 23], P &amp;lt; .001; 14/min [95% CI, 7 to 21], P &amp;lt; .001), but there was no significant change in V̇o2,AT (pacing off, 10.4 [SD, 2.9] mL/kg/min; pacing on, 10.7 [SD, 2.6] mL/kg/min; absolute difference, 0.3 [95% CI, −0.5 to 1.0] mL/kg/min; P = .46), peak V̇o2, minute ventilation (V̇e)/carbon dioxide production (V̇co2) slope, KCCQ-OSS, or NT-proBNP level. Despite the increase in heart rate, atrial pacing had no significant effect on cardiac output with exercise, owing to a decrease in stroke volume (−24 mL [95% CI, −43 to −5 mL]; P = .02). Adverse events judged to be related to the pacemaker device were observed in 6 of 29 participants (21%).Conclusions and RelevanceIn patients with HFpEF and chronotropic incompetence, implantation of a pacemaker to enhance exercise heart rate did not result in an improvement in exercise capacity and was associated with increased adverse events.Trial RegistrationClinicalTrials.gov Identifier: NCT02145351
Dynamic changes in circulating tumor DNA assessed by shallow whole‐genome sequencing associate with clinical efficacy of checkpoint inhibitors in NSCLC
Authors: Carbonell Caterina , Frigola Joan , Pardo Nuria , Callejo Ana , Iranzo Patricia , Valdivia Augusto , Priano Ilaria , Cedrés Susana , Martinez‐Marti Alex , Navarro Alejandro , Lenza Laura , Soleda Mireia , Gonzalo‐Ruiz Javier , Vivancos Ana , Sansó Miriam , Carcereny Enric , Morán Teresa , Amat Ramon , Felip Enriqueta 
Published: March 2023

Immune checkpoint inhibitors (ICIs) targeting the PD‐1/PD‐L1 axis are the main therapeutic option for patients with advanced non‐small cell lung cancer (NSCLC) without a druggable oncogenic alteration. Nevertheless, only a portion of patients benefit from this type of treatment. Here, we assessed the value of shallow whole‐genome sequencing (sWGS) on plasma samples to monitor ICI benefit. We applied sWGS on cell‐free DNA (cfDNA) extracted from plasma samples of 45 patients with metastatic NSCLC treated with ICIs. Over 150 samples were obtained before ICI treatment initiation and at several time points throughout treatment. From sWGS data, we computed the tumor fraction (TFx) and somatic copy number alteration (SCNA) burden and associated them with ICI benefit and clinical features. TFx at baseline correlated with metastatic lesions at the bone and the liver, and high TFx (≥ 10%) associated with ICI benefit. Moreover, its assessment in on‐treatment samples was able to better predict clinical efficacy, regardless of the TFx levels at baseline. Finally, for a subset of patients for whom SCNA burden could be computed, increased burden correlated with diminished benefit following ICI treatment. Thus, our data indicate that the analysis of cfDNA by sWGS enables the monitoring of two potential biomarkers—TFx and SCNA burden—of ICI benefit in a cost‐effective manner, facilitating multiple serial‐sample analyses. Larger cohorts will be needed to establish its clinical potential.
Reproducibility and stability of spirometer‐guided deep inspiration breath‐hold in left‐breast treatments using an optical surface monitoring system
Authors: Cilla Savino , Romano Carmela , Craus Maurizio , Viola Pietro , Macchia Gabriella , Boccardi Mariangela , De Vivo Livia P. , Buwenge Milly , Morganti Alessio G. , Deodato Francesco 
Published: March 2023

AbstractThe aim of this study was to evaluate the reproducibility and stability of left breast positioning during spirometer‐guided deep‐inspiration breath‐hold (DIBH) radiotherapy using an optical surface imaging system (AlignRT). The AlignRT optical tracking system was used to monitor five left‐sided breast cancer patients treated using the Active Breathing Coordinator spirometer with DIBH technique. Treatment plans were created using an automated hybrid‐VMAT technique on DIBH CTs. A prescribed dose of 60 Gy to the tumor bed and 50 Gy to the breast in 25 fractions was planned. During each treatment session, the antero‐posterior (VRT), superior‐inferior (LNG), and lateral (LAT) motion of patients was continuously recorded by AlignRT. The intra‐breath‐hold stability and the intra‐ and inter‐fraction reproducibility were analyzed for all breath‐holds and treatment fractions. The dosimetric impact of the residual motion during DIBH was evaluated from the isocenter shifts amplitudes obtained from the 50%, 90%, and 100% cumulative distribution functions of intra‐fractional reproducibility. The positional variations of 590 breath‐holds as measured by AlignRT were evaluated. The mean intra‐breath‐hold stability during DIBH was 1.0 ± 0.4 mm, 2.1 ± 1.9 mm, and 0.7 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 8.8 mm in LNG direction. Similarly, the mean intra‐breath‐hold reproducibility was 1.4 ± 0.8 mm, 1.7 ± 1.0 mm, and 0.8 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 4.1 mm in LNG direction. Inter‐fractional reproducibility showed better reliability, with difference in breathing levels in all fractions of 0.3 mm on average. Based on tolerance limits corresponding to the 90% cumulative distribution level, gating window widths of 1 mm, 2 mm, and 5 mm in the LAT, VRT, and LNG directions were considered an appropriate choice. In conclusion, despite the use of a dedicated spirometer at constant tidal volume, a non‐negligible variability of the breast surface position has been reported during breath‐holds. The real‐time monitoring of breast surface using surface‐guided optical technology is strongly recommended.
Enhancing Care Partnerships Using a Rheumatology Dashboard: Bringing Together What Matters Most to Both Patients and Clinicians
Authors: Van Citters Aricca D. , Taxter Alysha J. , Mathew Stephanie D. , Lawson Erica , Eseddi Joad , Del Gaizo Vincent , Ahmad Jabeen , Bajaj Puneet , Courtnay Stacy , Davila Lesley , Donaldson Brittany , Kimura Yukiko , Lee Tzielan , Mecchella John N. , Nelson Eugene C. , Pompa Scott , Tabussi Doreen , Johnson Lisa C. 
Published: March 2023

ObjectiveDashboards can support person‐centered care by helping people partner with their clinicians to coproduce care based on preferences, shared decision‐making, and evidence‐based treatments. We engaged caregivers of children with juvenile idiopathic arthritis (JIA), adults with rheumatoid arthritis (RA), and clinicians in a pilot study to assess their experiences and the utility and impact of an electronic previsit questionnaire and point‐of‐care dashboard to support coproduction of rheumatology care.MethodsWe employed a mixed‐methods design to assess users’ perceptions of a customized electronic health record rheumatology module at four pediatric rheumatology practices and two adult rheumatology practices. We surveyed a convenience sample of caregivers of children with JIA (n = 113), adults with RA (n = 116), and clinicians (n = 12). We conducted semistructured interviews with 13 caregivers and patients and six care teams. Experiences were evaluated using descriptive statistics and thematic analyses.ResultsCaregivers of children with JIA and adults with RA reported the dashboards were useful during discussions (88%) and helped them talk about what mattered most (82%), make health care decisions (83%), and create a treatment plan (77%). Clinicians provided similar feedback. Two‐thirds (67%) of caregivers and adults and 55% of clinicians would recommend the dashboard to peers. System usability scores (77.1 ± 15.6) were above average. Dashboards helped users make sense of health information, communicate more effectively, and make decisions. Improvements to the dashboards and workflows could enhance patient self‐management and clinician efficiency.ConclusionVisual point‐of‐care dashboards can support caregivers, patients, and clinicians to coproduce rheumatology care. Findings demonstrate a need to spread and scale for broader benefit and impact.
N‐Containing Carbons Derived from Microporous Coordination Polymers for Use in Post‐Combustion Flue Gas Capture
Authors: Karve Vikram Vinayak , Espín Jordi , Asgari Mehrdad , Van Gele Samuel , Oveisi Emad , Queen Wendy Lee 
Published: March 2023

AbstractHerein, novel carbons that, owing to a high density of micropores (up to 79%) and N‐content (up to 14.9%), offering exciting potential for post‐combustion CO2 capture are reported. Given that little is known about how starting materials impact the structure and performance of carbons, three different microporous materials are pyrolyzed. These include a Co‐(metal‐organic framework) (MOF), a Co‐MOF‐polymer composite, and a coordination polymer derived from the same monomer and cobalt ions. Notably, the cobalt, which is required to drive the polymerization, is subsequently leached from the carbons via acid for its reuse in MOF synthesis. Next, various metrics including CO2 capacity, selectivity, isosteric heat of adsorption, breakthrough time and cyclability are assessed. The acid treated carbons adsorb 0.21, 0.99, and 1.11 mmol CO2 g−1, respectively, (313 K, 0.15 bar) with CO2/N2 selectivity ranging from 37 to 52. Due to superior capacity, the polymer‐derived carbons also reveal impressive breakthrough times in simulated flue gas mixtures (15% CO2/85% N2, 80% RH, 313 K) ranging from 33 to 40 min g−1. Similar performance is also observed under dry conditions and after pre‐saturation with water for 1.5 h. Remarkably, no loss in working capacity is observed after 100 CO2 TSA cycles (313 K/393 K).
Lantern‐Inspired On‐Skin Helical Interconnects for Epidermal Electronic Sensors
Authors: Li Ding , Cui Tianrui , Jian Jinming , Yan Jianlan , Xu Jiandong , Li Xin , Li Zhen , Yan Anzi , Chen Zhikang , Shao Wancheng , Tang Zeyi , Xu Zigan , Wu Guohua , Liu Houfang , Yang Yi , Ren Tian‐Ling 
Published: March 2023

AbstractEpidermal electronics have been attracting considerable attention due to their various potential applications in human‐computer interaction and health monitoring. However, because of the lack of a self‐adhesive and stable interconnect method between epidermal electronic sensors and rigid circuit boards, there remain difficulties in detecting body signals accurately by epidermal electronic sensors in daily life. Here, a 3D helical on‐skin interconnect is first introduced for epidermal electronics sensors. Inspired by the structure of the accordion lantern, the interconnect is composed of two electrospinning polyurethane (PU) fiber films and a helical metal fiber. The helical metal fiber acts as a stable conductor with stretchability, and the PU fiber film with polydimethylsiloxane provides a self‐adhesive substrate. Mechanical simulations and tests prove that the proposed interconnect can laminate conformally and unobtrusively onto human skin with excellent electrical stability (less than 0.5% electrical resistance change upon 100% elongation). Furthermore, based on the proposed interconnect, an all‐in‐one sensor‐interconnect design is presented, which endows the epidermal electronic systems with anti‐motion interference capability. A gesture identification wristband system realized by a single all‐in‐one strain sensor is demonstrated. Besides, a wireless on‐skin system that accurately monitors dynamic 12‐lead electrocardiographic is successfully built using all‐in‐one electrodes.