bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of left atrial appendage thrombus by dual-energy computed tomography-derived imaging biomarkers in patients with atrial fibrillation
Authors: Li Wenhuan , Liu Mingxi , Yu Fangfang , Zhu Weiwei , Yu Xianbo , Guo Xiaojuan , Yang Qi 
Published: July 2022

AimsThis study aimed to assess the diagnostic performances of dual-energy computed tomography (CT)-derived iodine concentration and effective atomic number (Zeff) in early-phase cardiac CT in detecting left atrial appendage (LAA) thrombus and differentiating thrombus from spontaneous echo contrast (SEC) in patients with atrial fibrillation using transesophageal echocardiography (TEE) as the reference standard.Methods and resultsA total of 389 patients with atrial fibrillation were prospectively recruited. All patients underwent a single-phase cardiac dual-energy CT scan using a third-generation dual-source CT. The iodine concentration, Zeff, and conventional Hounsfield units (HU) in the LAA were measured and normalized to the ascending aorta (AA) of the same slice to calculate the LAA/AA ratio. Of the 389 patients, TEE showed thrombus in 15 (3.9%), SEC in 33 (8.5%), and no abnormality in 341 (87.7%) patients. Using TEE findings as the reference standard, the respective sensitivity, specificity, positive predictive value, and negative predictive value of the LAA/AA HU ratio for detecting LAA thrombus were 100.0, 96.8, 55.6, and 100.0%; those of the LAA/AA iodine concentration ratio were 100.0, 99.2, 83.3, and 100.0%; and those of the LAA/AA Zeff ratio were 100.0, 98.9, 79.0, and 100.0%. The areas under the receiver operator characteristic curve (AUC) of the LAA/AA iodine concentration ratio (0.978; 95% CI 0.945–1.000) and Zeff ratio (0.962; 95% CI 0.913–1.000) were significantly larger than that of the LAA/AA HU ratio (0.828; 95% CI 0.714–0.942) in differentiating the thrombus from the SEC (both P &lt; 0.05). Although the AUC of the LAA/AA iodine concentration ratio was larger than that of the LAA/AA Zeff ratio, no significant difference was found between them (P = 0.259).ConclusionThe dual-energy CT-derived iodine concentration and the Zeff showed better diagnostic performance than the conventional HU in early-phase cardiac CT in detecting LAA thrombus and differentiating the thrombus from the circulatory stasis. However, these results need to be validated in large-cohort studies with late-phase images.
Atrioventricular conduction in PM recipients after transcatheter aortic valve implantation: Implications using Wenckebach point measurement
Authors: Pelargonio Gemma , Scacciavillani Roberto , Donisi Luca , Narducci Maria Lucia , Aurigemma Cristina , Pinnacchio Gaetano , Bencardino Gianluigi , Perna Francesco , Spera Francesco Raffaele , Comerci Gianluca , Ruscio Eleonora , Romagnoli Enrico , Crea Filippo , Burzotta Francesco , Trani Carlo 
Published: July 2022

BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up.ObjectivesThe aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing.MethodsWe enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination.ResultsA total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP &lt; 100; 26) and patients with valid AV conduction (WP ≥ 100; 17). In the first group patients had a significantly higher number of intraprocedural atrioventricular block (AVB) (20 vs. 1, p &lt; 0.005), showed a significant higher implantation depth in LVOT (7.7 ± 2.2 vs. 4.4 ± 1.1, p &lt; 0.05) and lower ΔMSID (−0.28 ± 3 vs. −3.94 ± 2, p &lt; 0.05).ConclusionAV conduction may recover in a significant proportion of patients. In our study, valve implantation depth in the LVOT and intraprocedural AV block are associated with severely impaired AV conduction. Regular PM interrogation and reprogramming are required to avoid unnecessary permanent right ventricular stimulation in patients with AV conduction recovery.
Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation
Authors: Zhao Mingzhong , Zhao Mengxi , Hou Cody R. , Post Felix , Herold Nora , Walsleben Jens , Yuan Qingru , Meng Zhaohui , Yu Jiangtao 
Published: July 2022

BackgroundHigher CHA2DS2-VASc score is associated with an increased risk of adverse cardio-cerebrovascular events in patients with non-valvular atrial fibrillation (NVAF), regardless of oral anticoagulation (OAC) status. However, whether this association still exists in patients undergoing left atrial appendage closure (LAAC) is unknown. We evaluated the impact of CHA2DS2-VASc score on LAAC efficacy and outcomes.MethodsA total of 401 consecutive patients undergoing LAAC were included and divided into 3 groups based on CHA2DS2-VASc score (0–2, 3–4, and ≥5). Baseline characteristics, periprocedural complications, and long-term outcomes were collected and compared across all groups.ResultsThere were no significant differences in implantation success, periprocedural complications, and long-term outcomes across all score groups. Kaplan-Meier estimation showed that the cumulative ratio of freedom from all-cause mortality (P = 0.146), cardiovascular mortality (P = 0.519), and non-cardiovascular mortality (P = 0.168) did not differ significantly by CHA2DS2-VASc score group. LAAC decreased the risks of thromboembolism and major bleeding, resulting in a relative risk reduction (RRR) of 82.4% (P &lt; 0.001) and 66.7% (P &lt; 0.001) compared with expected risks in the overall cohort, respectively. Subgroup analysis indicated that observed risks of thromboembolism and major bleeding were significantly lower than the expected risks in score 3–4 and score ≥5 groups, respectively. The level of RRR increased with CHA2DS2-VASc score (P &lt; 0.001 for trend) for thromboembolism but not for major bleeding (P = 0.2729 for trend).ConclusionPatients with higher CHA2DS2-VASc score did not experience worse outcomes, which may be partly attributed to more benefits provided by LAAC intervention in such patients compared to those with a low score.
Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors
Authors: Papazoglou Andreas S. , Farmakis Ioannis T. , Zafeiropoulos Stefanos , Moysidis Dimitrios V. , Karagiannidis Efstratios , Stalikas Nikolaos , Kartas Anastasios , Stamos Konstantinos , Sofidis Georgios , Doundoulakis Ioannis , Giannopoulos Georgios , Giannakoulas George , Sianos Georgios 
Published: July 2022

BackgroundRoutine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated.MethodsAfter propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period.ResultsWe analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0–22.1) in 56 SMuRF-less patients and 14 (IQR 5–25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03–4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79–1.24); the overall distribution of the SYNTAX score was similar between the two groups (p = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30–9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83–3.57).ConclusionAmong patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.
Novel classification for simple peripheral arteriovenous malformations based on anatomic localization: Prevalence data from the tertiary referral center in China
Authors: Shen Yuchen , Wang Zhenfeng , Yang Xitao , Zheng Lianzhou , Wen Mingzhe , Han Yifeng , Li Xiao , Zhang Liming , Wang Jingbing , You Jianxiong , Jiang Chunyu , Su Lixin , Fan Xindong , Wang Deming 
Published: July 2022

BackgroundIn absence of the large-sample study of simple peripheral arteriovenous malfomations (pAVM), we aimed to perform the epidemiological analysis of over 1,000 simple pAVM patients from our center in the past 5 years, and establish a novel classification based on the anatomical localization of the primary lesion.ResultsBetween March 27, 2016, and March 31, 2021, Chinese patients who were diagnosed with simple pAVM were taken into account. Those who suffered from simple arteriovenous malformations of the central nervous system (cnsAVM), combined types of AVM, and syndromes, such as CLOVES syndrome, etc. were all excluded from this study. A total of 1,070 simple pAVM patients were screened out. All of the simple pAVM patients were diagnosed by clinical manifestations and imaging examinations. Demographic data were obtained from the National Bureau of Statistics of China. The 5-year prevalence of simple pAVM was about (2.15–6.60) /1,000,000 population. The male-female ratio was approximately 1.22:1. The pAVM inpatients that were included in the age group of 21~30 years old had the highest constituent ratio (P= 0.01). The classification included four groups: Type I (primarily occurring in soft tissue); Type II (primarily occurring in bone); Type III (primarily occurring in the viscus) and Type IV (simple pAVM coexisting with CNS lesions). There were two subtypes of Type I: the A subtype (involving one major anatomical region) and the B subtype (involving two or more major anatomical regions); two subtypes of Type II: the A subtype (the cortex was intact) and the B subtype (the lesion had broken through the cortex). Generally, 657 patients were classified as Type IA (61.4%), 232 patients were Type IB (21.7%), 82 patients were Type IIA (7.7%) and 79 were categorized as Type IIB (7.4%); the number of patients who had Type III and Type IV pAVM were 9 (0.8%) and 11 (1.0%), respectively. The clinical manifestations and diagnostic standards for each type were also systematically summarized.ConclusionsPrevalence data for simple pAVM were analyzed, and a novel classification was proposed based on the anatomy of the lesions. The present work was expected to facilitate the diagnosis of simple pAVM in clinical works.
Five-year comparative study of thin-strut rapamycin-eluting bioabsorbable scaffold with metallic drug-eluting stent in porcine coronary artery
Authors: Liu Yaokun , Zheng Bo , Zhang Bin , Ndondo-lay Robert , Nie Fangfang , Tang Naijie , Miao Yongsheng , Li Jianping , Huo Yong 
Published: July 2022

ObjectivesUsing quantitative coronary angiography (QCA), optical coherence tomography (OCT), histomorphometry, and pharmacokinetics, this study tried to evaluate the safety and efficacy of Biomagic rapamycin-eluting bioabsorbable scaffold (BVS) in non-atherosclerotic porcine coronary arteries.BackgroundBiomagic BVS is a new generation of thin-strut bioabsorbable scaffold. We conducted comparative study detailing pathological response, safety and efficacy of Biomagic BVS and the Firebird2 rapamycin-eluting cobalt-based alloy stent (DES) in a porcine coronary artery model. The animals were followed up at 14 days, 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after stent implantation.MethodsA total of 143 devices (95 Biomagic and 48 Firebird2) were implanted in 2 or 3 main coronary arteries of 76 nonatherosclerotic swine and examined by QCA, OCT, light microscopy, and pharmacokinetics analyses at various time points.ResultsVascular responses to Biomagic and Firebird2 were largely comparable at all time points, with struts being sequestered within the neointima. The degree of inflammation of both devices was mild to moderate, although the Biomagic score was higher at 14 days to 24 months. However, there was no statistical difference between the two groups except 14 days. At each follow-up time point, the percentage of area stenosis in the Biomagic group was greater than that in the Firebird 2 group, but there was no statistical difference between the two groups at 3 and 12 months. The extent of fibrin deposition was similar between Biomagic and Firebird2, which peaked at 1 month and decreased rapidly thereafter. Pharmacokinetic study showed that coronary tissue sirolimus concentration remained above 2 ng/mg of tissue at 28 day. Histomorphometry showed expansile remodeling of Biomagic-implanted arteries starting after 12 months, and lumen area was significantly greater in Biomagic than Firebird2 at 36 and 42 months. These changes correlated with dismantling of Biomagic seen after 12 months. OCT images confirmed that degradation of Biomagic was complete by 36 months.ConclusionsBiomagic demonstrates comparable long-term safety to Firebird2 in porcine coronary arteries with mild to moderate inflammation. Although Biomagic was associated with greater percent stenosis relative to Firebird2 within 36 months, expansile remodeling was observed after 12 months in Biomagic with significantly greater lumen area at ≥36 months. Scaffold resorption is considered complete at 36 months.
Intracoronary artery retrograde thrombolysis combined with percutaneous coronary interventions for ST-segment elevation myocardial infarction complicated with diabetes mellitus: A case report and literature review
Authors: Shen Mingzhi , Liao Yichao , Wang Jian , Zhou Xinger , Guo Yuting , Nong Yingqiao , Guo Yi , Lu Haihui , Jin Rongjie , Wang Jihang , Fu Zhenhong , Li Dongyun , Zhao Shihao , Tian Jinwen 
Published: July 2022

BackgroundThe management of a large thrombus burden in patients with acute myocardial infarction and diabetes is still a worldwide problem.Case presentationA 74-year-old Chinese woman presented with ST-segment elevation myocardial infarction (STEMI) complicated with diabetes mellitus and hypertension. Angiography revealed massive thrombus formation in the mid-segment of the right coronary artery leading to vascular occlusion. The sheared balloon was placed far from the occlusion segment and urokinase (100,000 u) was administered for intracoronary artery retrograde thrombolysis, and thrombolysis in myocardial infarction (TIMI) grade 3 blood flow was restored within 7 min. At last, one stent was accurately implanted into the culprit’s vessel. No-reflow, coronary slow flow, and reperfusion arrhythmia were not observed during this process.ConclusionIntracoronary artery retrograde thrombolysis (ICART) can be effectively and safely used in patients with STEMI along with diabetes mellitus and hypertension, even if the myocardial infarction exceeds 12 h (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).
Isotopic and Hydrogeochemical Characteristics and Genesis of Warm Springs in the Jiangcang Basin, Qinghai, China
Authors: Liu Lingxia , Qi Shihua , Zhang Yongbin , Gao Ming , Hu Jing , Wang Wenzhong 
Published: July 2022

The Jiangcang Basin is a Cenozoic faulted basin, where many low-temperature warm springs are exposed, with the highest temperature being 36.6°C. The study of the hydrogeochemical characteristics of the geothermal fluids of these warm springs can effectively clarify the genetic mechanisms of the geothermal resources in the Jiangcang Basin and thus is of great significance for the development and utilization of geothermal resources in the Qinghai Province. Using the geothermal and geological conditions of the Jiangcang Basin, this study analyzed the hydrochemical and isotopic characteristics of water samples collected from cold water and from four warm springs in the Jiangcang Basin, obtaining the following results. The four warm springs have the hydrochemical types of HCO3-Ca·Mg, HCO3-Ca·Na·Mg, and HCO3·SO4-Na·Ca and total dissolved solids (TDSs) of 720.4–1,663 mg/L. Moreover, no significant positive correlation is found between Cl− and other ions in the warm springs. The results of isotopic analysis show that the warm springs are mainly recharged by atmospheric precipitation and meltwater from ice and snow, with a recharge elevation of 4,401–4,501 m. Furthermore, the geothermal reservoirs in the Jiangcang Basin have temperatures of 51–83°C and circulation depths of 1,848–2,610 m. Atmospheric precipitation and the meltwater from ice and snow infiltrate downward in high mountain areas and form runoffs along the tectonic channels in the basin. After being heated through deep circulation, they migrate upward along fault fracture zones under the influence of faults and the water blocking of mudstones, during which they cool by thermal conduction and mixing with shallow cold groundwater. Finally, the mixed water is exposed in the form of low-temperature tectonic warm springs. The results of this study can provide data for the exploitation and utilization of geothermal resources in the Qinghai Province.
Mapping and assessing ecosystem service supply–demand to identify critical areas: A case study of a waterside area in Shanghai metropolitan area
Authors: Ni Yuchun , Wei Jiaxing , Wu Tao , Guo Min , Han Qiyao , Zhang Mingjuan 
Published: July 2022

In the past decades, rapid urbanization in China has dramatically transformed natural spaces into construction land, leading to serious degradation and supply–demand imbalance of ecosystem services (ESs). The identification of critical areas and ecological security patterns is crucial for balancing ESs and improving human well-being in rapidly urbanized regions. The purpose of this study was to establish a comprehensive assessment framework of ES supply–demand including provisioning, regulating, supporting, and cultural services, so as to provide theoretical support for the identification and refined management of regional critical areas. Taking a typical waterside area in Shanghai metropolitan area as an example, based on multi-source data and ES quantitative models, we used ecological supply–demand ratio and bivariate local indicators of spatial association to quantify the relationship and matching patterns of ES supply–demand, then explored the identification, protection, and restoration of ecologically critical areas at the regional scale. The results showed that: 1) the ES supply–demand relationship in the study area was quantitatively determined. The ecological supply–demand ratio was as follows: regulating &gt; provisioning &gt; supporting &gt; cultural, in which the supply of supporting and cultural services was less than the demand, and the problem of the supply–demand mismatch is prominent; 2) we have identified 41 supply critical areas that require priority protection, with a total area of 206.79 km2 accounting for 9.65% of the total study area, showing a spatial pattern of more in the northwest and less in the southeast; 3) a total of 11 demand critical areas that need ecological restoration were identified, accounting for 31.43% of the 35 administrative towns in the study area, which are mainly distributed around three urban centers and a high-tech zone. The study is of great significance for the construction of regional ecological security patterns and rational ES allocation, and can provide a scientific framework for the ecological protection and restoration of critical areas around metropolises in developing countries.
Active crustal deformation model of the Fen–Wei rift zone, North China: Integration of geologic, geodetic, and stress direction datasets
Authors: Song Shangwu , Li Yuhang , Hao Ming 
Published: July 2022

The Fen–Wei rift zone (FWRZ) of North China is an important zone of active crustal deformation representing a transition from extrusion tectonics related to the Tibetan Plateau to subduction tectonics related to the potential far-field influence of the west Pacific plate. In this study, we determined the kinematic constraints of active crustal deformation in the FWRZ, which are fundamental for forecasting seismicity. NeoKinema, a kinematic finite-element model, was employed to estimate the long-term fault slip rates, distributed crustal deformation field, and on- and off-fault strain-rate fields in the FWRZ by fitting updated geological fault slip rate, geodetic GPS velocity, and principal compressive stress direction datasets. Our results show that the FWRZ is a characteristic low-strain kinematic setting, with most active faults exhibiting slip rates of less than 1 mm/a. The total sinistral shear rate from the southern Ordos block to the Qinling Mountains is approximately 1 mm/a, indicating limited tectonic extrusion along the EW-trending Qinling Mountains. Additionally, the central Shanxi rift exhibits prominent dextral shear of ∼0.5 mm/a that decreases toward its north and south ends, corresponding to crustal extension of 1.1–1.2 mm/a in the Datong and Yuncheng basins, respectively. However, this significant crustal extension cannot be solely attributed to terminal effects caused by dextral shear in the central Shanxi rift. A comparison between predicted seismicity and historical earthquake records reveals some remarkable seismic gaps, particularly in the Datong, Hancheng, and Yuncheng basins, indicating higher seismic potential in these locations. This study provides insights into the long-term crustal deformation processes and regional seismic potential of the FWRZ.