bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive electrophysiology study guided loop recorder implantation in myotonic dystrophy type 1: a prospective single-center study
Authors: Debreceni D , Janosi K , Fodi E , Faludi R , Simor T , Pal E , Tenyi D , Lovadi E , Varga D , Becze T , Kupo P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In one third of the patients with myotonic dystrophy type 1 (DMT1) the cause of death is of cardiac origin. The most common cardiac manifestations are arrhythmias and conduction disturbances.

Purpose
Due to its extreme long monitoring properties, implantable loop recorders (ILRs) are highly suitable to detect rare cardiac arrhythmias. To date, there are only limited data using ILRs in DMT1. We aimed to evaluate the role of the invasive electrophysiology study (EPS)-guided loop recorder implantation in patients with DMT.

Methods
In our prospective study 18 genetically confirmed DMT1 patients underwent non-invasive cardiac examination including transthoracic echocardiography, 24-hour Holter monitoring and surface ECG. In addition, EPS was performed in all cases to evaluate the risk of sudden cardiac death and infra-Hisian conduction properties. Based on the performed non-invasive diagnostic evaluation and EPS findings, patients were divided into low, intermediate and high-risk groups. For patients with normal investigation results and normal HV interval (&lt;55 ms) only annual cardiac follow-up visits were planned (low-risk group). Patients with increased PR interval (&gt;240 ms), QRS duration (&gt;120 ms), or slightly prolonged HV interval (55-70 ms) underwent implantable loop recorder (ILR) implantation (intermediate-risk group). Permanent pacemaker (PM) or implantable cardiac defibrillator (ICD) was implanted in patients with 2nd/3rd degree atrioventricular block (AVB), significantly prolonged HV interval (&gt;100 ms) or if sustained ventricular tachyarrhythmia could be induced during EPS. All patients were followed for at least 3 years.

Results
According to our study criteria, 8 patients could be categorized as "intermediate risk", 7 of them received implantable loop recorder (ILR). 1 ILR had to be removed 3 weeks after implantation due to skin infarction. During three-years of follow-up, 2 patients had many asymptomatic atrial high-rate episodes, but no 2nd or 3rd degree AVB, significant asystole or malignant ventricular arrhythmia were detected.

Conclusions
Our single-center prospective study examined the EPS-guided ILR implantation for the risk stratification of DMT1 patients for the first time. A more extensive, multicenter study is warranted to define optimal management of DMT1 patients with slightly impaired infrahisian conduction.
Zero or minimal fluoroscopy catheter ablation: feasibility, efficacy, and safety results
Authors: Melero Polo J , Cabrera Ramos M , Montilla Padilla I , Ruiz Arroyo J R , Ramos Maqueda J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Fluoroscopy has been used to guide catheter ablation since the beginning of this technique, despite its important secondary effects on both patients and operators. However, three-dimensional electroanatomic mapping systems (3D-EAMP) enable ablation of some substrates using zero or minimal fluoroscopy. The aim of this study is to explore the feasibility, efficacy and safety of a zero or minimal fluoroscopy approach in our center.

Methods
We performed a retrospective observational study with consecutive patients that underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), accessory pathways (AP), focal atrial tachycardia and typical atrial flutter in our center, between January 2020 and November 2022. Vascular access was obtained by ultrasound guidance. The objective was zero-fluoroscopy for all patients except those with left AP, in which minimal fluoroscopy was allowed for the transseptal access (ablations with retrograde aortic approach were excluded).

Results
319 consecutive patients were included. 56% were male, mean age was 55 ± 16 years. The following substrates were included: AVNRT (43%), typical atrial flutter (41%), AP (12%) and focal atrial tachycardia (5%). We achieved zero-fluoroscopy use in 99.3% of right substrates, using fluoroscopy in just two cases to introduce catheters through femoral access. Mean fluoroscopy time in left AP was 6.1 minutes. Ablation was successful in 97% of cases, and we just experienced three complications (moderate pericardial effusion, femoral hematoma and femoral arteriovenous fistula, all of them solved without requiring intervention). After a mean follow- up of 17 ± 14 months, we noticed three recurrences, performing in all of them a successful second ablation procedure. Baseline characteristics and procedure details are shown in table 1.

Conclusions
Catheter ablation of simple substrates with zero or minimal fluoroscopy using 3D mapping systems is feasible, effective and safe, with high success rate and low complications rate.
Impact of hemodynamic support in high-risk VT ablation procedures
Authors: Luik A , Haas A , Schmidt K , Widder J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
It is an ongoing debate whether VT ablation is better performed in SR or during VT. During SR patients are in stable conditions, however, VT mechanisms can only be visualized during VT. Hemodynamic stability during VT is critical and is shorter in patients with structural heart disease and severely reduced left ventricular ejection fraction (LVEF). In unstable VT with need for cardioversion, the risk of map anatomy shifts is increased, but a precise anatomical reconstruction is crucial for successful ablation. Considering hemodynamic support during VT ablation, handling must be easy and as little disruptive to the ablation procedure as possible. Percutaneous left ventricular support systems with appropriate access size seem to be the most suitable, but are limited in their support capacity. The aim of this study was to evaluate, whether a hemodynamic support of a maximum of 3,5 L/min is sufficient to ensure hemodynamic stability even in faster VT.

Methods
The study enrolled patients with a history of one or more sustaining VTs and severely reduced LVEF. Procedure was performed under deep sedation. Transseptal and transaortal access was prepared to access the LV. In epicardial cases an additional subxiphoidal access was used. Impella CP with SmartAssist was introduced via the opposite groin. Hemodynamic support was started immediately after placement. VTs were induced via programmed RV and burst pacing. VT was mapped and ablated with the Carto 3 Mapping system. The need to frequently adjust pump setting, duration of hemodynamic stability during VT, identification of VT mechanism and ablation success were evaluated.

Results
8 patients with a total of 21 VTs have been mapped, analyzed and ablated. 4/8 patients received epi-/endocardial ablation. With hemodynamic support, all VTs could be mapped under stable conditions (CLmedian VT = 360ms). 87,5% could be terminated during catheter ablation, in 50% no VT was reinducible after ablation. The median time for Impella placement was 20min. The Smart Assist Mode enabled an easy handling without the necessity of manual adjustments during the course of the case. The Impella could be explanted at the end of the procedure in 7 out of 8 cases. Femoral closure was done with either Proglide or AngioSeal closure device. Post procedural, one patient developed a segmental stenosis of the A. femoralis superficialis, most likely due to the Proglide device. This case was treated conservatively and recovered after a few months.

Conclusion
Hemodynamic support of a maximum of 3,5L/min provides adequate and effective support for mapping of sustained VTs. No manual adjustment was required and patients could in general be weaned directly at the end of the procedure. Broader benefits of this concept need to be evaluated in further studies.
High-density open window mapping vs conventional mapping in accessory pathways ablation
Authors: Martinez-Sande J L , Minguito-Carazo C , Gonzalez-Melchor L , Garcia-Seara J , Fernandez-Lopez X A , Rodriguez-Manero M , Gonzalez-Ferrero T , Ruiz-Donate J , Tasende-Rey P , Jimenez-Ramos V , Gonzalez-Juanatey J R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and purpose
High density (HD) mapping is associated with a reduction in fluoroscopy time compared to conventional mapping in accessory pathway (AP) ablation. The Open Window (OW) technique (CARTO 3, Biosense Webster) is a new tool that automatically uses conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation). However, no studies comparing its feasibility to conventional mapping have been conducted. Therefore, the aim of the present study was to assess the feasibility and the clinical implications of high-density OW mapping when compared to conventional HD mapping.

Methods
A prospective, unicentric cohort study was conducted. Consecutive patients which were referred to our institution for AP ablation with OW mapping technique were included and compared to a recent retrospective cohort of patients who underwent conventional HD mapping. Total fluoroscopy time, total mapping time and the rate of recurrence of the AP were compared between groups.

Results
A total of 29 consecutive patients (32.28 ± 18 years, 58% males) were included in the OW group and compared with a cohort of 29 patients (29.6 ± 18 years, 52% males) who underwent conventional HD mapping. An example of Right Superior AP ablation is showed in figure 1. No differences in the location of the AP were observed (p=NS). OW mapping was associated to a lower mapping time (29.3 vs 37.8 min; p=0.04), lower fluoroscopy time (14.3 vs 21.3 min; p= 0.04) and lower radiofrequency time (p=0.007). After a median follow up of 6 months, there were no differences in the rate of recurrence of the AP conduction between groups (p=NS). A schematic step by step graphic of the workflow procedure is represented in figure 2.

Conclusions
In our experience, OW mapping was a feasible tool for AP location associated to a lower mapping time, lower radiofrequency time and lower X-ray exposure time with no differences in recurrence rate when compared to conventional HD mapping. However, more studies should be performed to corroborate these conclusions.
Dielectric response in relation to other ablation parameters
Authors: Abeln B G S , Van Dijk V F , Balt J C , Wijffels M C E F , Boersma L V A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Dielectric imaging is used by the KODEX-EPD system to provide information that can be used to guide catheter ablation of cardiac arrhythmia. This includes assessment of catheter-tissue contact (No touch, Touch, or High touch) and local atrial wall thickness (mm). Additionally, the system can detect changes in local dielectric tissue properties to assess the effect of a radiofrequency energy application. This assessment is used to classify ablation points into low or high dielectric response (LDR or HDR), which was designed to indicate the extent of lesion transmurality.

Objectives
To evaluate the relation between dielectric response and other ablation parameters.

Methods
The KODEX-EPD system was used to guide ablation in patients with prior pulmonary vein isolation. Ablation included re-isolation of the pulmonary veins and isolation of the superior vena cava if deemed necessary. We downloaded system data from all procedures that were performed with software that provided dielectric response (version 1.5.0, 1.5.0a, 1.5.1 and 1.5.1a) and analyzed the parameters of all individual ablation points.

Results
The cohort includes 55 patients, in which 135 pulmonary veins and 19 superior venae cavae were targeted. A total of 860 energy applications were applied, resulting in 1458 ablation points. The system classified 31% of ablation points as HDR and 19% as LDR. The system did not provide a dielectric response in 49%. The system’s ability to determine dielectric response was related to the software version(oldest version 71% no DR, newest version 18%) and duration of ablation. High dielectric response (versus LDR or no DR) was multivariably associated with longer energy applications, higher mean ablation power and lower local wall thickness (Table). Mean ablation temperature and impedance drop were not multivariably associated with dielectric response.

Conclusion
Dielectric response is independently associated with local wall thickness, ablation power and duration, but not with ablation temperature and impedance drop. Newer software versions have reduced the proportion of ablation points for which no dielectric response was provided.
Retrograde access of the left atrium for catheter ablation using robotic magnetic navigation in atrial fibrillation: a case series
Authors: Tijskens M , Wolf M , De Greef Y , Schwagten B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation for which the left atrium (LA) is usually accessed by the antegrade femoral venous route and transseptal puncture. However, in rare cases, alternative routes must be used to overcome anatomical challenges. A retrograde approach via the femoral artery and by subsequently passing the aortic and mitral valve is virtually impossible using conventional catheters.

Purpose
To investigate the feasibility of a retrograde approach for AF ablation by robotic magnetic navigation (RMN) using floppy radiofrequency ablation catheters.

Methods
Between June 2014 and December 2021, a total of 6 consecutive patients underwent a total of 8 ablation procedures for AF by retrograde approach using a RMN at tour center. A magnetic catheter was introduced through the right femoral artery and manually advanced retrogradely to the aortic arch. Thereafter, it was further advanced to the LA using RMN by switching the magnets to navigation mode, passing through both aortic and mitral valve (Figure 1). Circumferential PVI was performed by antral point-by-point radiofrequency ablation and additional atrial lines were targeted when deemed necessary. Bidirectional conduction block was proven by loss of pulmonary vein potentials on the ablation catheter which automatically moved in a radial manner collecting 16 mapping points.

Results
The patient group (Figure 2) consisted of 4 females and 2 males with a mean age of 58,0±10,8years. 4 patients (67%) presented with persistent AF. The mean time between diagnosis and catheter ablation was 5,3±3,5 years. 2 patients (33%) had an acquired mechanical obstruction of the conventional transseptal route. The other 4 patients (67%) had an anatomical abnormality precluding conventional access to the LA. These 4 patients all underwent an unsuccessful ablation attempt via conventional approach elsewhere, before referral to our center. Patients 3 and 4 also underwent an epicardial ablation for AF respectively 1,3 and 6,2 years before catheter ablation using RMN. Patient 3 also underwent a failed attempt on manual catheter ablation using the retrograde route in another center. AF catheter ablation via retrograde access using RMN was possible in all patients and no complications occurred. The mean follow-up was 3,4±3,3 years.

Conclusion
Our findings indicate that a retrograde transaortic approach for catheter ablation in AF using magnetic navigation system and electroanatomical mapping is technically feasible and safe in patients with anatomical challenges precluding the use of a conventional antegrade transseptal approach. This technique may serve as an indispensable component of the management of this subgroup of patients in experienced centers.
Addition of dissolved inorganic carbon stimulates snow algae primary productivity on glacially eroded carbonate bedrock in the Medicine Bow Mountains, WY, USA
Authors: Hamilton Trinity L , Havig Jeff R 
Published: May 2023

AbstractSnow is a critical component of the Earth system. High-elevation snow can persist into the spring, summer, and early fall and hosts a diverse array of life, including snow algae. Due in part to the presence of pigments, snow algae lower albedo and accelerate snow melt, which has led to increasing interest in identifying and quantifying the environmental factors that constrain their distribution. Dissolved inorganic carbon (DIC) concentration is low in supraglacial snow on Cascade stratovolcanoes, and snow algae primary productivity can be stimulated through DIC addition. Here we asked if inorganic carbon would be a limiting nutrient for snow hosted on glacially eroded carbonate bedrock, which could provide an additional source of DIC. We assayed snow algae communities for nutrient and DIC limitation on two seasonal snowfields on glacially eroded carbonate bedrock in the Snowy Range of the Medicine Bow Mountains, Wyoming, United States. DIC stimulated snow algae primary productivity in snow with lower DIC concentration despite the presence of carbonate bedrock. Our results support the hypothesis that increased atmospheric CO2 concentrations may lead to larger and more robust snow algae blooms globally, even for sites with carbonate bedrock.
The First Genome of the Cold-Water Octocoral, the Pink Sea Fan, Eunicella verrucosa
Authors: Macleod Kirsty L , Paris Josephine R , Jenkins Tom L , Stevens Jamie R 
Published: May 2023

Abstract
Cold-water corals form an important part of temperate benthic ecosystems by increasing three-dimensionality and providing an important ecological substrate for other benthic fauna. However, the fragile three-dimensional structure and life-history characteristics of cold-water corals can leave populations vulnerable to anthropogenic disturbance. Meanwhile, the ability of temperate octocorals, particularly shallow-water species, to respond to adjustments in their environment linked to climate change has not been studied. This study reports the first genome assembly of the pink sea fan (Eunicella verrucosa), a temperate shallow-water octocoral species. We produced an assembly of 467 Mb, comprising 4,277 contigs and an N50 of 250,417 bp. In total, 213 Mb (45.96% of the genome) comprised repetitive sequences. Annotation of the genome using RNA-seq data derived from polyp tissue and gorgonin skeleton resulted in 36,099 protein-coding genes after 90% similarity clustering, capturing 92.2% of the complete Benchmarking Universal Single-Copy Orthologs (BUSCO) ortholog benchmark genes. Functional annotation of the proteome using orthology inference identified 25,419 annotated genes. This genome adds to the very few genomic resources currently available in the octocoral community and represents a key step in allowing scientists to investigate the genomic and transcriptomic responses of octocorals to climate change.
Sensitized piRNA reporter identifies multiple RNA processing factors involved in piRNA-mediated gene silencing
Authors: Brown Jordan S , Zhang Donglei , Gaylord Olivia , Chen Wenjun , Lee Heng-Chi 
Published: May 2023

Abstract
Metazoans guard their germlines against transposons and other foreign transcripts with PIWI-interacting RNAs (piRNAs). Due to the robust heritability of the silencing initiated by piRNAs in Caenorhabditis elegans (C. elegans), previous screens using C. elegans were strongly biased to uncover members of this pathway in the maintenance process but not in the initiation process. To identify novel piRNA pathway members, we have utilized a sensitized reporter strain which detects defects in initiation, amplification, or regulation of piRNA silencing. Using our reporter, we have identified Integrator complex subunits, nuclear pore components, protein import components, and pre-mRNA splicing factors as essential for piRNA-mediated gene silencing. We found the small nuclear processing cellular machine termed the Integrator complex is required for both type I and type II piRNA production. Notably, we identified a role for nuclear pore and nucleolar components NPP-1/Nup54, NPP-6/Nup160, NPP-7/Nup153, and FIB-1 in promoting the perinuclear localization of anti-silencing CSR-1 Argonaute, as well as a role for Importin factor IMA-3 in nuclear localization of silencing Argonaute HRDE-1. Together, we have shown that piRNA silencing in C. elegans is dependent on evolutionarily ancient RNA processing machinery that has been co-opted to function in the piRNA-mediated genome surveillance pathway.
Alterations in the Fungal Microbiome in Ulcerative Colitis
Authors: Hsia Katie , Zhao Naisi , Chung Mei , Algarrahi Khalid , Montaser Kouhsari Laleh , Fu May , Chen Hannah , Singh Siddharth , Michaud Dominique S , Jangi Sushrut 
Published: May 2023

AbstractBackgroundAlthough gut fungi have been implicated in the immunopathogenesis of inflammatory bowel disease, the fungal microbiome has not been deeply explored across endohistologic activity and treatment exposure in ulcerative colitis.MethodsWe analyzed data from the SPARC IBD (Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease) registry. We evaluated the fungal composition of fecal samples from 98 patients with ulcerative colitis across endoscopic activity (n = 43), endohistologic activity (n = 41), and biologic exposure (n = 82). Across all subgroups, we assessed fungal diversity and differential abundance of taxonomic groups.ResultsWe identified 500 unique fungal amplicon sequence variants across the cohort of 82 patients, dominated by phylum Ascomycota. Compared with endoscopic remission, patients with endoscopic activity had increased Saccharomyces (log2 fold change = 4.54; adjusted P &lt; 5 × 10-5) and increased Candida (log2 fold change = 2.56; adjusted P &lt; .03). After adjusting for age, sex, and biologic exposure among patients with endoscopic activity, Saccharomyces (log2 fold change = 7.76; adjusted P &lt; 1 × 10-15) and Candida (log2 fold change = 7.28; adjusted P&lt; 1 × 10-8) remained enriched during endoscopic activity compared with quiescence.ConclusionsEndoscopic inflammation in ulcerative colitis is associated with an expansion of Saccharomyces and Candida compared with remission. The role of these fungal taxa as potential biomarkers and targets for personalized approaches to therapeutics in ulcerative colitis should be evaluated.
From the simplex to the sphere: faster constrained optimization using the Hadamard parametrization
Authors: Li Qiuwei , McKenzie Daniel , Yin Wotao 
Published: May 2023

Abstract
The standard simplex in $\mathbb{R}^{n}$, also known as the probability simplex, is the set of nonnegative vectors whose entries sum up to 1. It frequently appears as a constraint in optimization problems that arise in machine learning, statistics, data science, operations research and beyond. We convert the standard simplex to the unit sphere and thus transform the corresponding constrained optimization problem into an optimization problem on a simple, smooth manifold. We show that Karush-Kuhn-Tucker points and strict-saddle points of the minimization problem on the standard simplex all correspond to those of the transformed problem, and vice versa. So, solving one problem is equivalent to solving the other problem. Then, we propose several simple, efficient and projection-free algorithms using the manifold structure. The equivalence and the proposed algorithm can be extended to optimization problems with unit simplex, weighted probability simplex or $\ell _{1}$-norm sphere constraints. Numerical experiments between the new algorithms and existing ones show the advantages of the new approach. Open source code is available at https://github.com/DanielMckenzie/HadRGD.