bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study
Authors: Bergonti Marco , Spera Francesco Raffaele , Ferrero Teba Gonzalez , Nsahlai Michelle , Bonomi Alice , Tijskens Maxime , Boris Wim , Saenen Johan , Huybrechts Wim , Miljoen Hielko , González‐Juanatey Jose Ramón , Martínez‐Sande Jose Luis , Vandaele Lien , Wittock Anouk , Heidbuchel Hein , Valderrábano Miguel , Rodríguez‐Mañero Moises , Sarkozy Andrea 
Published: December 2022

Background
Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low‐voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation.

Methods and Results

We conducted a prospective multicenter study on consecutive patients undergoing pulmonary vein isolation‐only approach. LVZs and transition zones (0.5–1 mV) were analyzed offline on high‐density electroanatomical maps collected before pulmonary vein isolation. Overall, 262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow‐up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF was associated with recurrence (hazard ratio [HR], 4.4 [95% CI, 2.0–9.8],
P
<0.001 and HR, 1.9 [95% CI, 1.1–3.7],
P
=0.04, respectively). Significant association was found between LVZs and transition zones and between LVZs and left atrial volume index (LAVI) (both
P
<0.001). Thirty percent of patients had significantly increased LAVI without LVZs. Eight percent of patients had LVZs despite normal LAVI. Older age, female sex, oncological history, and increased AF recurrence characterized the latter subgroup.

Conclusions
In patients undergoing first pulmonary vein isolation, the impact of LVZs on outcomes occurs with lower burden in paroxysmal than persistent AF, suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZs, suggesting a continuous substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZs, but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.
Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study
Authors: Patel Raumil V. , Ravindran Mithunan , Qiu Feng , Manoragavan Ragavie , Sud Maneesh , Tam Derrick Y. , Madan Mina , Marcus Gil , Elbaz‐Greener Gabby , Mamas Mamas A. , Wijeysundera Harindra C. 
Published: December 2022

Background
Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood‐level social deprivation and post‐TAVR mortality and hospital readmission.

Methods and Results
We conducted a population‐based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co‐primary outcomes were 1‐year postprocedure mortality and 1‐year postprocedure readmission. Using Cox proportional hazards models for mortality and cause‐specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood‐level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post‐TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1‐year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1‐year readmission (hazard ratio, 1.23 [95% CI, 1.01–1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post‐TAVR outcomes.

Conclusions
Residential instability was associated with increased risk for post‐TAVR mortality, and the highest quintile of residential instability was associated with increased post‐TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.
Proteolytic Degradation Is a Major Contributor to Bioprosthetic Heart Valve Failure
Authors: Kostyunin Alexander E. , Glushkova Tatiana V. , Lobov Arseniy A. , Ovcharenko Evgeny A. , Zainullina Bozhana R. , Bogdanov Leo A. , Shishkova Daria K. , Markova Victoria E. , Asanov Maksim A. , Mukhamadiyarov Rinat A. , Velikanova Elena A. , Akentyeva Tatiana N. , Rezvova Maria A. , Stasev Alexander N. , Evtushenko Alexey V. , Barbarash Leonid S. , Kutikhin Anton G. 
Published: December 2022

Background
Whereas the risk factors for structural valve degeneration (SVD) of glutaraldehyde‐treated bioprosthetic heart valves (BHVs) are well studied, those responsible for the failure of BHVs fixed with alternative next‐generation chemicals remain largely unknown. This study aimed to investigate the reasons behind the development of SVD in ethylene glycol diglycidyl ether–treated BHVs.

Methods and Results
Ten ethylene glycol diglycidyl ether–treated BHVs excised because of SVD, and 5 calcified aortic valves (AVs) replaced with BHVs because of calcific AV disease were collected and their proteomic profile was deciphered. Then, BHVs and AVs were interrogated for immune cell infiltration, microbial contamination, distribution of matrix‐degrading enzymes and their tissue inhibitors, lipid deposition, and calcification. In contrast with dysfunctional AVs, failing BHVs suffered from complement‐driven neutrophil invasion, excessive proteolysis, unwanted coagulation, and lipid deposition. Neutrophil infiltration was triggered by an asymptomatic bacterial colonization of the prosthetic tissue. Neutrophil elastase, myeloblastin/proteinase 3, cathepsin G, and matrix metalloproteinases (MMPs; neutrophil‐derived MMP‐8 and plasma‐derived MMP‐9), were significantly overexpressed, while tissue inhibitors of metalloproteinases 1/2 were downregulated in the BHVs as compared with AVs, together indicative of unbalanced proteolysis in the failing BHVs. As opposed to other proteases, MMP‐9 was mostly expressed in the disorganized prosthetic extracellular matrix, suggesting plasma‐derived proteases as the primary culprit of SVD in ethylene glycol diglycidyl ether–treated BHVs. Hence, hemodynamic stress and progressive accumulation of proteases led to the extracellular matrix degeneration and dystrophic calcification, ultimately resulting in SVD.

Conclusions
Neutrophil‐ and plasma‐derived proteases are responsible for the loss of BHV mechanical competence and need to be thwarted to prevent SVD.
General Surgery Trainee Cases Over Time: Postgraduate Year Matters
Authors: Ore Ana Sofia , Liu Betty S. , Chen Hao W. , Kent Tara S. , Parsons Charles S. , Narula Nisha 
Published: December 2022

Background Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year. Methods Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program’s main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time. Results There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases. Conclusions This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.
Ernest Amory Codman and the End Result Idea in Surgical Quality
Authors: Nakayama Don K. 
Published: December 2022

The quality movement in 21st century healthcare—quality, patient safety, and the value equation (value equals quality divided by cost)—had their start with Ernest Amory Codman (1869-1940), the quixotic surgeon who started it all a century before. He was on track for prosperity and success, given a Boston Brahmin pedigree and his impeccable credentials from Harvard College, its medical school, and the Massachusetts General Hospital. In 1910, nearing 40, Codman instead detoured toward a revolutionary idea that he called the End Result system, the seemingly unachievable goal of reaching “perfection” in surgery: complete recovery without death, complications, or lasting disability. He scrutinized any case that fell short, seeking honest explanations and improvements so that his next case would more likely reach a perfect outcome. The system that was so clear to him was audacious to his colleagues, who summarily rejected it. When Codman suspected greed and self-interest, he was ostracized from the Boston medical community. To apply his concepts, he opened a proprietary hospital called the End Result Hospital that drove him to insolvency. His career never recovered from the debacle even when he later reached prominence as an authority on bone malignancies and shoulder pathology. When he died, his resting place went unmarked. As quality became central to healthcare at the end of the 20th century, Codman’s prescient End Result system was recognized as a fundamental contribution to medicine.
A Comparison of Ordered Categorical versus Discrete Choices within a Stated Preference Survey of Whole-Blood Donors
Authors: Sadique Zia , Cairns John , De Corte Kaat , Willis Sarah , Miners Alec , Bansback Nick , Grieve Richard 
Published: December 2022

There are different stated preference (SP) approaches, including discrete choice experiments (DCEs). DCEs are a popular SP approach, but in some settings, alternative ways of framing survey questions may be more appropriate. The Health Economic Modelling Of Alternative Blood Donation Strategies (HEMO) study required choice tasks to be framed so that the study could estimate the effect of attribute levels on the frequency of a behavior—in this case, blood donation. SP questions were formulated to require ordered categorical responses from a single profile of attribute levels. However, it is unknown whether this way of framing SP questions leads to estimates of marginal rates of substitution (MRS) that are different from traditional DCE choices between 2 alternative profiles. The aim of this article is to compare estimates of relative preferences from SP questions requiring ordered categorical versus discrete choice responses. We compared relative preferences elicited from the 2 approaches for a common set of attributes and levels, formulated as choice tasks for 8,933 whole-blood donors. We found that the 2 forms of survey questions provided similar MRSs estimates. For example, respondents were willing to trade off only a small increase in travel time to receive a health report, irrespective of whether the choice given was binary (DCE response; approximately 3 min) or from an ordered category (about 8 min). The finding that any differences in the estimated MRSs are not of substantive importance offers some reassurance for policy makers in that estimates of relative preference may be robust to alternative ways of framing the survey questions. These findings can encourage future studies to frame choice tasks that align with the study’s objective. Highlights This article compares the relative preferences from stated preference (SP) questions requiring ordered categorical versus discrete choice responses. The approaches were contrasted for blood donation service characteristics that offer opportunities to donate blood. The estimates of relative preferences for alternative blood donation service characteristics were similar between the 2 forms of SP approach. This study illustrates how SP survey questions can be formulated to provide responses on an ordered categorical scale and to estimate marginal rates of substitution between different attributes, which can be compared with those derived from discrete choice experiment (DCE) choices. The article highlights the potential value of considering alternative choice framings rather than relying solely on DCEs.
Plasma advanced oxidation products as an additional tool in assessment of post-infarction heart failure
Authors: Cvetkovic Tatjana , Saric Sandra , Stefanovic Nikola , Stojiljkovic Vladana , Djordjevic Branka , Stojanovic Dijana , Cvetkovic Mina , Deljanin Ilic Marina 
Published: December 2022

Objective To define which oxidative stress markers could be used as diagnostic tools in the assessment of post-infarction heart failure (HF). Methods This observational study enrolled patients with HF that were divided into three subgroups (ejection fraction [EF] ≥ 50%; EF 40–49%; EF < 40%) and age- and sex-matched healthy control subjects. The plasma concentrations of advanced oxidation protein products (AOPP), thiobarbituric acid reactive substances, catalase activity and free thiols were determined in all participants. Results The study enrolled 81 patients with HF and 68 healthy control subjects. There were significant differences in the values ​​of oxidative stress markers between patients and controls. Oxidative stress parameters did not differ between the subgroups of patients, except for AOPP, which was significantly higher in the EF < 40% group. Univariate and multivariate logistic regression analyses showed an association between AOPP and HF in the EF ≥ 50% group, while receiver operating characteristic (ROC) curve analysis identified a cut-off value of 60.89 µmol/l for AOPP. Conclusions Based on the ROC curve analysis of AOPP and the higher significance in the multivariate analyses for patients with EF ≥ 50%, these current results suggest that AOPP could be a useful additional tool in the assessment of post-infarction HF.
Haematopoietic cytopenia associated with cyclin-dependent kinase 4/6 inhibitors: A real-world study of data from the food and drug administration adverse event reporting system database
Authors: Ren Xiayang , Yan Cilin , Tian Le , Cui Xiangli 
Published: December 2022

Objective The haematopoietic cytopenia (HC) of the cyclin-dependent kinase (CDK)4/6 inhibitors was evaluated using the Food and Drug Administration Adverse Event Reporting System (FAERS). Method Data from 1 January 2015 to 31 December 2021 has been retrieved from the FAERS database. Disproportionality analysis and Bayesian analysis were utilized in the data mining. The reporting odds ratio (ROR) with 95% confidence interval (CI) for HC was calculated for each CDK 4/6 inhibitor agent. Clinical features of the patients were collected and compared between death outcome and non-death outcome groups. Time to onset (TTO), proportion of deaths, life-threatening and hospitalizations of CDK 4/6 inhibitors-associated HC were also studied. Results A total of 17,235 cases of HC associated with CDK 4/6 inhibitors were identified with a median age of 65 years (interquartile range [IQR] 57–73). Palbociclib appeared the strongest signal, with the highest (ROR 9.64, 95% CI 9.46–9.83), followed by ribociclib (ROR 6.38, 95% CI 6.04–6.73) and then abemaciclib (ROR 2.72, 95% CI 2.49–2.97). Patients aged 18–64 had a higher proportion of deaths than those aged 65–84 (12.21% vs. 9.91%, p = 0.001). In Africa and Asia, the proportions of deaths were higher (31.65% and 26.13%, respectively). The median TTO was 26 days (IQR 14–65) for abemaciclib, 33 days (IQR 15–134) for palbociclib and 23 days (IQR 14–69) for ribociclib, respectively. The highest proportion of deaths, life-threatening and hospitalizations all occurred in abemaciclib (13.00%, 5.42% and 44.04%, respectively). Conclusions Greater proportions of deaths occurred in Africa and Asia. HC may occur early in any CDK 4/6 inhibitor regimen. Abemaciclib had the highest proportion of deaths, life-threatening and hospitalizations. Health care workers should be more concerned about CDK 4/6 inhibitors. The higher proportions of serious events, including deaths, from Africa and Asia, as well as for abemaciclib, deserve further investigations through additional pharmacoepidemiological approaches.
Corneal sustained delivery of hyaluronic acid from nanofiber-containing ring-implanted contact lens
Authors: Akbari Elham , Imani Rana , Shokrollahi Parvin , Heidari keshel Saeed 
Published: December 2022

Dry eye syndrome, as a persist corneal epithelial defect (PED), is an inconvenient ocular disorder that is generally treated by high-dosage, conventional eye drops. Addressing low efficacy and rather restricted bioavailability of the conventional eye drops, drug-eluting contact lenses (CLs) are widely used as alternatives in ophthalmic drug delivery applications. In the present study, a nanofiber-containing ring implant poly (vinyl alcohol) (PVA) hydrogel is designed as a carrier for hyaluronic acid (HA) delivery. hyaluronic acid is physically encapsulated in a nanofiber-containing ring-shaped hydrogel with a 2 mm width that is implanted in the final CLs hydrogel. The designed CL has 59% porosity, 275% swelling ratio and undergoes no weight loss at physiological conditions in14 days. In-vitro release studies were performed on the CLs with and without nanofibers. The results showed that nanofiber incorporation in the designed CL was highly influential in decreasing burst release and supported sustained release of HA over 14 days. In addition, nanofiber incorporation in the designed system strengthened the lens, and the young modulus of the PVA hydrogel increased from 6 to 10 kPa. Cell viability study also revealed no cell cytotoxicity and cell attachment. Overall, the study demonstrated the effective role of nanofibers in the physical strengthening of the CL. Also, the designed system holds promise as a potential candidate for HA delivery over an extended period for treating dry eye syndrome.
Resveratrol and lycopene ameliorate contrast-induced nephropathy in a rabbit model
Authors: Fragkiadoulaki Eirini , Tsatsakis Aristides , Nikitovic Dragana , Georgiadis Georgios , Kalogeraki Alexandra , Kaloudis Konstantinos , Alegkakis Athanasios , Karzi Vasiliki , Mamoulakis Charalampos 
Published: December 2022

Oxidative stress appears to possess a central role in CIN pathophysiology. Resveratrol (Res) and lycopene (Lyc) are strong natural antioxidants evaluated in a limited number of CIN animal studies in vivo. The aim of the study was to evaluate the potential renoprotective effects of Res/Lyc in a CIN rabbit model. Twenty-four adult male New Zealand white rabbits were equally assigned into four groups: control (saline), CIN (intravenous iopromide; 7.5 g iodine/kg), Res + CIN (per os Res; 5 mg/kg), and Lyc + CIN (per os Lyc; 4 mg/kg). Serum Cr (sCr); symmetric/asymmetric dimethylarginine (SDMA/ADMA); oxidative stress biomarkers: malondialdehyde; total antioxidant capacity; catalase; glutathione) were evaluated in blood samples at three time points: right after (0 h); 24 h; 48 h after iopromide/saline administration. CD20+/CD3+ lymphocytes were determined (48 h). All animals were sacrificed at 48 h and both kidneys collected. Oxidative stress biomarkers were measured in renal tissue. sCr and SDMA/ADMA levels increased significantly in CIN compared to all groups. Oxidative stress secondary to CIN in blood/kidneys was suppressed by Res/Lyc. B and T lymphocytes decreased significantly in CIN compared to all groups. The present study provides emerging evidence that Res/Lyc ameliorate CIN by modulating oxidant/antioxidant balance in blood/renal tissue and by inhibiting vasoconstriction/blood cytotoxicity.
Response Rates to Methylnaltrexone in Hospitalized Cancer Patients
Authors: Harris David , Kalir David , Chevalier Cory , Dobbie Krista , Fielding Flannery , Lagman Ruth , Makhoul Ahed , McInnes Susan , Najafi Sina , Neale Kyle , Rybicki Lisa , Robbins-Ong Melanie , Neuendorf Kathleen 
Published: December 2022

Context: Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist studied in both cancer and non-cancer patients with opioid-induced constipation (OIC), but mostly in the outpatient setting. For adult hospitalized cancer patients with OIC, its effectiveness is unknown. Objectives: Describe the efficacy of methylnaltrexone for OIC in the inpatient setting, defined as bowel movement (BM) within 24 hours of methylnaltrexone administration. Methods: We performed a single-center, retrospective chart review of all hospitalized, adult patients with a cancer diagnosis who received methylnaltrexone from the palliative care team between January 1st, 2012 and July 1st, 2019. Results: We identified 194 patients. The mean age was 59, 50.5% were male and 88% were white. 192 patients (98%) received the 8 mg dose subcutaneously. The median oral morphine equivalent (OME) was 135 mg (IQR 70-354 mg). 45% (95% confidence interval, 38-53%) had a BM within 24 hours. Higher OME was correlated with successful BM, with a response in 93% (86/92) of patients receiving ≥150 OME and 2% (2/102) of patients receiving <150 OME ( P < .0001). Prior laxative use did not predict response at 24 hours whether these were osmotic laxatives (40.7% vs 47.1%, P = .52), stimulant laxatives (45.7% vs 45.2%, P > .99), or stool softeners (44.7% vs 46.1%, P = .89). Conclusion: Methylnaltrexone has a high response rate when used as treatment for OIC in hospitalized adult cancer patients, especially for patients taking ≥150 OME.