bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infective endocarditis on interventricular communication as cause of massive haemoptysis: a case report
Authors: Rodríguez Torres Diego José , Segura-Rodríguez Diego , Escobar Eduardo Moreno , Orta Rocío García 
Published: September 2022

AbstractBackgroundHaemoptysis is a rare symptom associated with endocarditis. We describe the unusual clinical manifestation of endocarditis on regurgitant bicuspid aortic valve and (probably) secondarily on a perimembranous ventricular septal defect (VSD) as massive haemoptysis.Case summaryA 24-year-old male with aortic coarctation, bicuspid aortic valve, and VSD since birth. Previously asymptomatic, he came after an episode of haemoptysis. A computed tomography (CT) scan showed a cavitated lesion in lung. Streptococo viridans was identified in serial blood cultures. Transthoracic echocardiography showed a bicuspid aortic valve with vegetations, suggesting infectious involvement, and severe aortic insufficiency. Transoesophageal echocardiography (TEE) study showed a bicuspid aortic valve with complete fusion of coronary valves. An elongated oscillating tumour, 9.5 mm in length, was observed in the centre of the ventricular side of the non-coronary valve. Another vegetation was seen on the VSD. During his hospital stay and under antibiotic treatment, he reported abdominal pain. Computed tomography examination showed splenic infarction. In the echocardiogram no vegetation masses were observed on the aortic valve or on the VSD closure aneurysm.DiscussionThe main debate about this patient’s treatment concerned the indication of surgery, especially after the onset of fever with splenic septic embolism while under appropriate antibiotic treatment. He was stable, with no signs of heart failure and the echocardiogram repeated after the septic splenic embolism showed no residual vegetations on the aortic valve or VSD, and the TEE study ruled out a local complication. Finally, the multidisciplinary team decided against surgical management.
Recurrent giant cell myocarditis after heart transplant: a case report
Authors: Frankel Eitan S , Hajduczok Alexander G , Rajapreyar Indranee N , Brailovsky Yevgeniy 
Published: September 2022

Abstract

Background
Giant cell myocarditis (GCM) is a rare but well-known cause of fulminant myocarditis. Despite optimal medical therapy, many patients progress to orthotopic heart transplant (OHT). We present a case of recurrent GCM following OHT, including complex considerations in patient management and infectious sequelae.

Case summary
A 33-year-old previously healthy male presented with 2 months of worsening shortness of breath. Transthoracic echocardiogram (TTE) demonstrated a left ventricular ejection fraction of 30–35%. After ruling out an ischaemic aetiology, he was discharged on guideline-directed medical therapy and later presented with productive cough, worsening dyspnoea on exertion, and diarrhoea. He was found to have elevated troponins and N-terminal pro-brain natriuretic peptide, lactic acidosis, progression of severe bi-ventricular dysfunction on TTE and right heart catheterization, and low cardiac index (1.0 L/min/m2) requiring inotropes. He then required left ventricular assist device as a bridge to OHT. Pathology of the apical core diagnosed GCM as the cause of his fulminant heart failure. He eventually underwent heart transplantation, which was complicated by recurrent GCM. Treatment required intensification of his immunosuppressive regimen, which led to multiple infectious sequelae including norovirus, Shiga-like toxin producing Escherichia coli, and disseminated nocardia of the lung and brain. As of the most recent follow-up, the patient is currently clinically stable.

Discussion
Although recurrent GCM after OHT has been reported in the literature, the prognosis is not well understood and there are no clear guidelines regarding management. This case summarizes clinical considerations, treatment strategies, and adverse effects of recurrent GCM treatment.
Incorporating clinical parameters to improve the accuracy of angiography-derived computed fractional flow reserve
Authors: Gosling Rebecca C , Gunn Eleanor , Wei Hua Liang , Gu Yuanlin , Rammohan Vignesh , Hughes Timothy , Hose David Rodney , Lawford Patricia V , Gunn Julian P , Morris Paul D 
Published: September 2022

Abstract

Aims
Angiography-derived fractional flow reserve (angio-FFR) permits physiological lesion assessment without the need for an invasive pressure wire or induction of hyperaemia. However, accuracy is limited by assumptions made when defining the distal boundary, namely coronary microvascular resistance (CMVR). We sought to determine whether machine learning (ML) techniques could provide a patient-specific estimate of CMVR and therefore improve the accuracy of angio-FFR.

Methods and results
Patients with chronic coronary syndromes underwent coronary angiography with FFR assessment. Vessel-specific CMVR was computed using a three-dimensional computational fluid dynamics simulation with invasively measured proximal and distal pressures applied as boundary conditions. Predictive models were created using non-linear autoregressive moving average with exogenous input (NARMAX) modelling with computed CMVR as the dependent variable. Angio-FFR (VIRTUheart™) was computed using previously described methods. Three simulations were run: using a generic CMVR value (Model A); using ML-predicted CMVR based upon simple clinical data (Model B); and using ML-predicted CMVR also incorporating echocardiographic data (Model C). The diagnostic (FFR ≤ or &gt;0.80) and absolute accuracies of these models were compared. Eighty-four patients underwent coronary angiography with FFR assessment in 157 vessels. The mean measured FFR was 0.79 (±0.15). The diagnostic and absolute accuracies of each personalized model were: (A) 73% and ±0.10; (B) 81% and ±0.07; and (C) 89% and ±0.05, P &lt; 0.001.

Conclusion
The accuracy of angio-FFR was dependent in part upon CMVR estimation. Personalization of CMVR from standard clinical data resulted in a significant reduction in angio-FFR error.
Automated interpretation of stress echocardiography reports using natural language processing
Authors: Zheng Chengyi , Sun Benjamin C , Wu Yi-Lin , Ferencik Maros , Lee Ming-Sum , Redberg Rita F , Kawatkar Aniket A , Musigdilok Visanee V , Sharp Adam L 
Published: September 2022

AbstractAimsStress echocardiography (SE) findings and interpretations are commonly documented in free-text reports. Reusing SE results requires laborious manual reviews. This study aimed to develop and validate an automated method for abstracting SE reports in a large cohort.Methods and resultsThis study included adult patients who had SE within 30 days of their emergency department visit for suspected acute coronary syndrome in a large integrated healthcare system. An automated natural language processing (NLP) algorithm was developed to abstract SE reports and classify overall SE results into normal, non-diagnostic, infarction, and ischaemia categories. Randomly selected reports (n = 140) were double-blindly reviewed by cardiologists to perform criterion validity of the NLP algorithm. Construct validity was tested on the entire cohort using abstracted SE data and additional clinical variables. The NLP algorithm abstracted 6346 consecutive SE reports. Cardiologists had good agreements on the overall SE results on the 140 reports: Kappa (0.83) and intraclass correlation coefficient (0.89). The NLP algorithm achieved 98.6% specificity and negative predictive value, 95.7% sensitivity, positive predictive value, and F-score on the overall SE results and near-perfect scores on ischaemia findings. The 30-day acute myocardial infarction or death outcomes were highest among patients with ischaemia (5.0%), followed by infarction (1.4%), non-diagnostic (0.8%), and normal (0.3%) results. We found substantial variations in the format and quality of SE reports, even within the same institution.ConclusionsNatural language processing is an accurate and efficient method for abstracting unstructured SE reports. This approach creates new opportunities for research, public health measures, and care improvement.
Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology
Authors: Russo Vincenzo , Parente Erika , Groppelli Antonella , Rivasi Giulia , Tomaino Marco , Gargaro Alessio , Giacopelli Daniele , Ungar Andrea , Parati Gianfranco , Fedorowski Artur , Sutton Richard , van Dijk J Gert , Brignole Michele 
Published: September 2022

Abstract
This review addresses tilt-testing methodology by searching the literature which reports timing of asystole and loss of consciousness (LOC). Despite the Italian protocol being the most widely adopted, its stipulations are not always followed to the letter of the European Society of Cardiology guidelines. The discrepancies permit reassessment of the incidence of asystole when tilt-down is early, impending syncope, compared with late, established LOC. Asystole is uncommon with early tilt down and diminishes with increasing age. However, if LOC is established as test-end, asystole is more common, and it is age-independent. Thus, the implications are that asystole is commonly under-diagnosed by early tilt-down. The prevalence of asystolic responses observed using the Italian protocol with a rigorous tilt down time is numerically close to that observed during spontaneous attacks by electrocardiogram loop recorder. Recently, tilt-testing has been questioned as to its validity but, in selection of pacemaker therapy in older highly symptomatic vasovagal syncope patients, the occurrence of asystole has been shown to be an effective guide for treatment. The use of head-up tilt test as an indication for cardiac pacing therapy requires pursuing the test until complete LOC. This review offers explanations for the findings and their applicability to practice. A novel interpretation is offered to explain why pacing induced earlier may combat vasodepression by raising the heart rate when sufficient blood remains in the heart.
Variation in general practice referral rate to acute medicine services and association with hospital admission. A retrospective observational study
Authors: Lyall Marcus J , Beckett Dan , Price Anna , Strachan Mark W J , Jamieson Clare , Morton Catriona , Begg Drummond , Simpson Johanne , Lone Nazir , Cameron Allan 
Published: September 2022

AbstractBackgroundVariation in general practice (GP) referral rates to outpatient services is well described however variance in rates of referral to acute medical units is lacking.ObjectiveTo investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission.MethodsA retrospective cohort study of acute medical referrals from 88 GPs in Lothian, Scotland between 2017 and 2020 was performed using practice population size, age, deprivation, care home residence, and distance from hospital as explanatory variables. Patient-level analysis of demography, deprivation, comorbidity, and acuity markers was subsequently performed on referred and clinically assessed acute medical patients (n = 42,424) to examine how practice referral behaviour reflects clinical need for inpatient hospital care.ResultsVariance in GP referral rates for acute medical assessment was high (2.53-fold variation 1st vs. 4th quartile) and incompletely explained by increasing age and deprivation (adjusted R2 0.67, P &lt; 0.001) such that significant variance remained after correction for confounders (2.15-fold). Patients from the highest referring quartile were significantly less likely to require hospital admission than those from the third, second, or lowest referring quartiles (adjusted odds ratio 1.28 [1.21–1.36, P &lt; 0.001]; 1.30 [1.23–1.37, P &lt; 0.001]; 1.53 [1.42–1.65, P &lt; 0.001]).ConclusionsHigh variation in GP practice referral rate for acute medical assessment is incompletely explained by practice population socioeconomic factors and negatively associates with need for urgent inpatient care. Identifying modifiable factors influencing referral rate may provide opportunities to facilitate community-based care and reduce congestion on acute unscheduled care pathways.
Transcription factors regulating the fate and developmental potential of a multipotent progenitor in Caenorhabditis elegans
Authors: Soukup Evan M , Bettinger Jill C , Mathies Laura D 
Published: September 2022

Abstract
Multipotent stem and progenitor cells have the capacity to generate a limited array of related cell types. The Caenorhabditis elegans somatic gonadal precursors are multipotent progenitors that generate all 143 cells of the somatic gonad, including complex tissues and specialized signaling cells. To screen for candidate regulators of cell fate and multipotency, we identified transcription factor genes with higher expression in somatic gonadal precursors than in their differentiated sister, the head mesodermal cell. We used RNA interference or genetic mutants to reduce the function of 183 of these genes and examined the worms for defects in the somatic gonadal precursor cell fate or the ability to generate gonadal tissue types. We identify 8 genes that regulate somatic gonadal precursor fate, including the SWI/SNF chromatin remodeling complex gene swsn-3 and the Ci/GLI homolog tra-1, which is the terminal regulator of sex determination. Four genes are necessary for somatic gonadal precursors to generate the correct number and type of descendant cells. We show that the E2F homolog, efl-3, regulates the cell fate decision between distal tip cells and the sheath/spermathecal precursor. We find that the FACT complex gene hmg-4 is required for the generation of the correct number of somatic gonadal precursor descendants, and we define an earlier role for the nhr-25 nuclear hormone receptor-encoding gene, in addition to its previously described role in regulating the asymmetric division of somatic gonadal precursors. Overall, our data show that genes regulating cell fate are largely different from genes regulating developmental potential, demonstrating that these processes are genetically separable.
Identification of genetic mechanisms for tissue-specific genetic effects based on CRISPR screens
Authors: Dvir Elad , Shohat Shahar , Flint Jonathan , Shifman Sagiv 
Published: September 2022

Abstract
A major challenge in genetic studies of complex diseases is to determine how the action of risk genes is restricted to a tissue or cell type. Here, we investigate tissue specificity of gene action using CRISPR screens from 786 cancer cell lines originating from 24 tissues. We find that the expression pattern of the gene across tissues explains only a minority of cases of tissue-specificity (9%), while gene amplification and the expression levels of paralogs account for 39.5% and 15.5%, respectively. In addition, the transfer of small molecules to mutant cells explains tissue-specific gene action in blood. The tissue-specific genes we found are not specific just for human cancer cell lines: we found that the tissue-specific genes are intolerant to functional mutations in the human population and are associated with human diseases more than genes that are essential across all cell types. Our findings offer important insights into genetic mechanisms for tissue specificity of human diseases.
Blind broad-band (0–10 Hz) numerical prediction of the 3-D near field seismic response of anMW6.0 extended fault scenario: application to the nuclear site of Cadarache (France)
Authors: Castro-Cruz D , Gatti F , Lopez-Caballero F , Hollender F , El Haber E , Causse M 
Published: September 2022

SUMMARYIn this paper, physics-based numerical simulation (PBS) is employed to render a broad-band (0–10 Hz) realization of the near-field seismic response of the experimental nuclear site of Cadarache, located nearby the active Middle Durance Fault (southeastern France). The sensitivity of the earthquake numerical model to geological features is investigated by comparison with geophysical measurements and past aftershock and by highlighting the amplification induced by the soft sediments below Cadarache. The blind prediction of an MW6 target earthquake is approached by synthesizing four different finite-fault scenarios. The outcome is compared to the standard ground motion prediction equations (GMPEs), unveiling a possible GMPE overestimation of the pseudospectral acceleration ordinates at short natural periods, supporting the actual need to integrate synthetic and empirical predictions when direct observations are not available.
In vitro activity of imipenem/relebactam against Pseudomonas aeruginosa isolates recovered from ICU patients in Spain and Portugal (SUPERIOR and STEP studies)
Authors: Hernández-García Marta , García-Castillo María , Melo-Cristino José , Pinto Margarida F , Gonçalves Elsa , Alves Valquíria , Vieira Ana Raquel , Ramalheira Elmano , Sancho Luísa , Diogo José , Ferreira Rui , Cruz Hugo , Chaves Catarina , Bou Germán , Cercenado Emilia , Delgado-Valverde Mercedes , Oliver Antonio , Pitart Cristina , Rodríguez-Lozano Jesús , Tormo Nuria , Díaz-Regañón Jazmín , Pássaro Leonor , Duarte Joana , Cantón Rafael ,   STEP and SUPERIOR study groups, Oliver Antonio , Mulet Xavier , Cercenado Emilia , Bou Germán , Fernández M Carmen , Pascual Álvaro , Delgado Mercedes , Gimeno Concepción , Tormo Nuria , Calvo Jorge , Rodríguez-Lozano Jesús , Alonso Ana Ávila , Vila Jordi , Marco Francesc , Pitart Cristina , del Castillo María García , García-Fernández Sergio , Hernández-García Marta , Cantón Rafael , Díaz-Regañón Jazmín 
Published: September 2022

Abstract

Objectives
To study the in vitro activity of imipenem/relebactam and comparators and the imipenem/relebactam resistance mechanisms in a Pseudomonas aeruginosa collection from Portugal (STEP, 2017–18) and Spain (SUPERIOR, 2016–17) surveillance studies.

Methods
P. aeruginosa isolates (n = 474) were prospectively recovered from complicated urinary tract (cUTI), complicated intra-abdominal (cIAI) and lower respiratory tract (LRTI) infections in 11 Portuguese and 8 Spanish ICUs. MICs were determined (ISO broth microdilution). All imipenem/relebactam-resistant P. aeruginosa isolates (n = 30) and a subset of imipenem/relebactam-susceptible strains (n = 32) were characterized by WGS.

Results
Imipenem/relebactam (93.7% susceptible), ceftazidime/avibactam (93.5% susceptible) and ceftolozane/tazobactam (93.2% susceptible) displayed comparable activity. The imipenem/relebactam resistance rate was 6.3% (Portugal 5.8%; Spain 8.9%). Relebactam restored imipenem susceptibility to 76.9% (103/134) of imipenem-resistant isolates, including MDR (82.1%; 32/39), XDR (68.8%; 53/77) and difficult-to-treat (DTR) isolates (67.2%; 45/67). Among sequenced strains, differences in population structure were detected depending on the country: clonal complex (CC)175 and CC309 in Spain and CC235, CC244, CC348 and CC253 in Portugal. Different carbapenemase gene distributions were also found: VIM-20 (n = 3), VIM-1 (n = 2), VIM-2 (n = 1) and VIM-36 (n = 1) in Spain and GES-13 (n = 13), VIM-2 (n = 3) and KPC-3 (n = 2) in Portugal. GES-13-CC235 (n = 13) and VIM type-CC175 (n = 5) associations were predominant in Portugal and Spain, respectively. Imipenem/relebactam showed activity against KPC-3 strains (2/2), but was inactive against all GES-13 producers and most of the VIM producers (8/10). Mutations in genes affecting porin inactivation, efflux pump overexpression and LPS modification might also be involved in imipenem/relebactam resistance.

Conclusions
Microbiological results reinforce imipenem/relebactam as a potential option to treat cUTI, cIAI and LRTI caused by MDR/XDR P. aeruginosa isolates, except for GES-13 and VIM producers.
Improving sow welfare and outcomes in the farrowing house by identifying early indicators from pre-farrowing assessment
Authors: Vargovic Laura , Athorn Rebecca Z , Hermesch Susanne , Bunter Kim L 
Published: September 2022

AbstractPoor outcomes reflect low performance during the farrowing and lactation periods and unanticipated sow removals. Since the period around farrowing has the highest risk for sow health issues, monitoring of sows in that time-period will improve both welfare and productivity. The aim of this study was to identify the most relevant risk factors for predicting poor outcomes and the implication for sow welfare. Identifying these factors could potentially enable management interventions to decrease incidences of compromised welfare or poor performance. Data from 1,103 sows sourced from two nucleus herds were recorded for a range of variables investigated as potential predictors of poor outcomes in the farrowing house. Poor outcomes (scored as binary traits) reflected three categories in a sow’s lifecycle: farrowing, lactation, and removals. Univariate logistic regression was used to identify predictors in the first instance. Predictors from univariate analyses were subsequently considered together in multi-variate models. The least square means representing predicted probabilities of poor outcomes were then reported on the observed scale. Several predictors were significant across two different environments (farms) and for all three categories. These predictors included feed refusal (lack of appetite), crate fit, locomotion score, and respiration rate. Normal appetite compared to feed refusals reduced the risk of farrowing failure (13.5 vs. 22.2%, P = 0.025) and removals (10.4 vs. 20.4%, P &lt; 0.001). Fit in the crate was significant (P &lt; 0.001) for farrowing and lactation outcomes, and was more informative than parity. Sows with sufficient space had two to three times reduced risk of poor outcomes compared to restrictive crates relative to sow dimensions. Sows with good locomotion score pre-farrowing had two to three times less risk of farrowing failure (P = 0.025) and reduced piglet mortality (P &lt; 0.001), weaned two piglets more relative to affected sows (P &lt; 0.001), and were less likely to be removed before weaning (3.24 vs. 12.3%, P = 0.014). Sows with higher respiration rates had a significantly (P &lt; 0.001) reduced risk of poor farrowing outcomes. This study demonstrated it is possible to predict poor outcomes for sows prior to farrowing, suggesting there are opportunities to decrease the risk of poor outcomes and increase overall sow welfare.
Contribution of Alate and Apterous Morphs to Demographic Characteristics, and Stable Stage Distribution ofAcyrthosiphon pisum(Hemiptera: Aphididae) on Four Different Alfalfa Varieties
Authors: Luo Lan , Liu Zhao-Liang , Yuan Jing , Chi Hsin , Yuan Zhong-Lin 
Published: September 2022

AbstractLife table data of the green pea aphid, Acyrthosiphon pisum (Harris) reared on four different resistant alfalfa varieties, i.e., 5S43, TG4 CW044026 (abbreviated as TG4), TG7 CW2883 (abbreviated as TG7), and Aurora were analyzed using the age-stage, two-sex life table. A higher proportion of alate adults were observed on 5S43, TG7, and Aurora; while a higher proportion of apterous adults occurred on TG4. The contributions of alate aphids to the finite rate of increase (λ), intrinsic rate of increase (r), and net reproductive rate (R0) were higher than apterous aphids on 5S43, TG7, and Aurora, while apterous aphids contributed more to λ, r, and R0 on TG4. The highest population parameters were observed on TG4 (r = 0.208 d−1, λ = 1.231 d−1, and R0 = 18.8 offspring/individual), while the lowest values were on TG7 (r = 0.129 d−1, λ = 1.138 d−1, and R0 = 9.9 offspring/individual). Because the age-stage, two-sex life table is capable of describing the stage differentiation, it enables the calculation of the stable stage distribution (SSD). A higher proportion of adult A. pisum was observed in SSD than in fourth instar nymphs. Population simulation showed the stage structure will approach SSD. Because the R0 and the mean generation time (T) values do not reflect the population growth rate, their use as population fitness parameters should be avoided. These findings can be utilized in helping to select resistant alfalfa varieties to effectively manage the pea aphid.