bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Clinical Success After Transcatheter Paravalvular Leak Closure: An International Prospective Multicenter Registry
Authors: Hascoët Sébastien , Smolka Grzegorz , Blanchard David , Kloëckner Martin , Brochet Eric , Bouisset Frederic , Leurent Guillaume , Thambo Jean-Benoit , Combes Nicolas , Dumonteil Nicolas , Bauer Fabrice , Nejjari Mohammed , Pillière Rémy , Dauphin Claire , Bonnet Guillaume , Ciobotaru Vlad , Kételers Régis , Gallet Romain , Hammoudi Nadjib , Mangin Lionel , Bouvaist Hélène , Spaulding Christian , Aminian Adel , Kilic Teoman , Popovic Batric , Armero Sébastien , Champagnac Didier , Gérardin Benoît 
Published: October 2022

Background:
Transcatheter closure of a symptomatic prosthetic paravalvular leak (PVL) is feasible, but there is presently no conclusive evidence to show consistent efficacy. We aimed to identify predictors of clinical success after transcatheter PVL closure.

Methods:

Consecutive patients referred to 24 European centers for transcatheter PVL closure in 2017 to 2019 were included in a prospective registry (
Fermeture de Fuite ParaProthétique
, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death.

Results:

We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. Symptoms were heart failure, hemolytic anemia, or both in 48.9%, 7.8%, and 43.3% of patients, respectively. One, 2, and 3 leaks were treated during the same procedure in 69.6%, 26.6%, and 3.8% of patients, respectively. The PVL was pinpoint or involved 1/8 or 1/4 of the valve circumference in 18.6%, 52.4%, and 28.1% of cases, respectively. The most frequently used devices were the Vascular Plug 3, Ventricular Septal Defect Occluder, Vascular Plug 2, and Paravalvular Leak Device (45.0%, 16.6%, 14.2%, and 13.6% of cases, respectively). Successful device(s) implantation with leak reduction to ≤grade 2 was obtained in 85.0% of mitral and 91.4% of aortic procedures, respectively (
P
=0.164); with major periprocedural adverse event rates of 3.3% and 1.2%, respectively (
P
=0.371); and clinical success rates of 70.3% and 88.0%, respectively (
P
=0.004). By multivariate analysis, technical failure, mechanical valve, and hemolytic anemia were independently associated with absence of clinical success (odds ratios [95% CIs], 7.7 [2.0–25.0];
P=
0.002; 3.6 [1.1–11.1];
P
=0.036; and 3.7 [1.2–11.9];
P
=0.025; respectively).

Conclusions:
Transcatheter PVL closure is efficient and safe in symptomatic patients but is associated with a lower clinical success rate in patients with hemolysis and/or a mechanical valve.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT05089136
Preemptive Septal Radiofrequency Ablation to Prevent Left Ventricular Outflow Tract Obstruction With Transcatheter Mitral Valve Replacement: A Case Series
Authors: Killu Ammar M. , Collins Jeremy D. , Eleid Mackram F. , Alkhouli Mohamad , Simard Trevor , Rihal Charanjit , Asirvatham Samuel J. , Guerrero Mayra 
Published: October 2022

Background:
Left ventricular outflow tract obstruction may occur following transcatheter mitral valve replacement in the setting of mitral annular calcification.

Methods:
We present a case series whereby preemptive septal radiofrequency ablation (RADIO-TMVR) was used to augment the left ventricular outflow tract for transcatheter mitral valve replacement in 4 patients at risk for left ventricular outflow tract obstruction despite alcohol septal ablation.

Results:

All patients were female, average age of 74.9 (68.8–80.4) years. Baseline ejection fraction was 71% (63%–75%). Mean mitral valve area was 1.28 (range, 1.0–1.59) cm
2
. Mean mitral valve gradient at rest was 9.5 (range, 7–11) mm Hg. New York Heart Association symptoms were III to IV at baseline. Patients underwent preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement a range between 69 and 154 days after alcohol septal ablation. Procedural time was 384 (337–424) minutes with a fluoroscopic time of 31 (14–71) minutes. Radiofrequency ablation time was 132 (100–175) minutes. As anticipated, 3 patients developed complete heart block and underwent pacemaker implantation, whereas 1 had a preexisting pacemaker. One patient developed groin hematoma and heart failure exacerbation. There were no peri-procedural deaths. Preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement resulted in septal end-diastolic wall thickness reduction compared with baseline (28.6%, 30.4%, 30.3%, and 11.1%) and following alcohol septal ablation (23.1%, 12%, 8.5%). Valve replacement in the setting of mitral annular calcification was performed in all patients 89 (range, 38–45) days after preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement. Two patients had concomitant laceration of the anterior mitral leaflet to further augment the neo-left ventricular outflow tract. Postprocedure, New York Heart Association symptoms improved to class I (3 patients) and class II (1 patient).

Conclusions:
In at-risk individuals, preemptive septal radiofrequency ablation may be an effective strategy at preventing left ventricular outflow tract obstruction with transcatheter mitral valve replacement.
Increased Placental sFLT1 (Soluble fms-Like Tyrosine Kinase Receptor-1) Drives the Antiangiogenic Profile of Maternal Serum Preceding Preeclampsia but Not Fetal Growth Restriction
Authors: Gaccioli Francesca , Sovio Ulla , Gong Sungsam , Cook Emma , Charnock-Jones D. Stephen , Smith Gordon C.S. 
Published: October 2022

Background:
Preeclampsia and fetal growth restriction (FGR) are both associated with an increased ratio of sFLT1 (soluble fms-like tyrosine kinase-1) to PlGF (placenta growth factor) in maternal serum. In preeclampsia, it is assumed that increased placental release of sFLT1 results in PlGF being bound and inactivated. However, direct evidence for this model is incomplete, and it is unclear whether the same applies in FGR.

Methods:
We conducted a prospective cohort study where we followed 4212 women having first pregnancies from their dating ultrasound, obtained blood samples serially through the pregnancy, and performed systematic sampling of the placenta after delivery. The aim of the present study was to determine the relationship between protein levels of sFLT1 and PlGF in maternal serum measured at ≈36 weeks and placental tissue lysates obtained after term delivery in 82 women with preeclampsia, 50 women with FGR, and 132 controls.

Results:

The sFLT1:PlGF ratio was increased in both preeclampsia and FGR in both the placenta and maternal serum. However, in preeclampsia, the maternal serum ratio of sFLT1:PlGF was strongly associated with placental sFLT1 level (r=0.45;
P
<0.0001) but not placental PlGF level (r=−0.17;
P
=0.16). In contrast, in FGR, the maternal serum ratio of sFLT1:PlGF was strongly associated with placental PlGF level (r=−0.35;
P
=0.02) but not sFLT1 level (r=0.04;
P
=0.81).

Conclusions:
We conclude that the elevated sFLT1:PlGF ratio is primarily driven by increased placental sFLT1 in preeclampsia, whereas in FGR, it is primarily driven by decreased placental PlGF.
Trial of Intrapartum Extended-Release Nifedipine to Prevent Severe Hypertension Among Pregnant Individuals With Preeclampsia With Severe Features
Authors: Cleary Erin M. , Racchi Nicholas W. , Patton K. Grace , Kudrimoti Meghana , Costantine Maged M. , Rood Kara M. 
Published: October 2022

Background:
Preeclampsia is associated with maternal and perinatal morbidity. Besides acute therapy for severe hypertension, best practices are lacking for intrapartum hypertension management. Our objective was to test the hypothesis that intrapartum initiation of extended-release nifedipine in individuals with preeclampsia with severe features prevents severe hypertension.

Methods:

Randomized, triple-blind, placebo-controlled trial of individuals with preeclampsia with severe features undergoing labor induction between 22
0/7
and 41
6/7
weeks gestation. Participants were randomized to oral extended-release nifedipine 30 mg or identical placebo every 24 hours. Primary outcome is defined as receipt of ≥1 dose of acute hypertension therapy for severe blood pressure (≥160/110 mm Hg) sustained ≥10 minutes. Secondary outcomes included route of delivery, neonatal intensive care unit admission, and a composite of adverse neonatal outcomes.

Results:
Of 365 individuals screened, 55 were randomized to nifedipine and 55 to placebo. Primary outcome was observed in 34.0% of individuals in nifedipine group versus 55.1% in placebo group (relative risk [RR] 0.62 [95% CI, 0.39–0.97]); number needed to treat to prevent receipt of acute treatment was 4.7 (95% CI, 2.5–44.3). Fewer individuals in nifedipine group required cesarean delivery compared with placebo group (20.8% versus 34.7%, RR, 0.60 [95% CI, 0.31–1.15]). Neonatal intensive care unit admission rate was lower in nifedipine group compared with placebo (29.1% versus 47.1%; RR 0.62 [95% CI, 0.37–1.02]). Neonatal composite was similar between groups (35.8% versus 41.2%, RR, 0.83 [95% CI, 0.51–1.37]).

Conclusions:
Initiation of extended-release nifedipine is effective in reducing intrapartum acute hypertensive therapy among individuals with preeclampsia with severe features.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04392375.
Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension
Authors: Badrov Mark B. , Yoo Jeung-Ki , Hissen Sarah L. , Nelson David B. , Shoemaker J. Kevin , Fu Qi 
Published: October 2022

Background:
We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32–36 weeks), both at supine rest and during postural stress.

Methods:
Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology.

Results:

At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all
P
≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all
P
<0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all
P
<0.0001). In pregnancy, AP frequency is related directly to systolic (R
2
=46%) and diastolic (R
2
=20%) blood pressure (both
P
≤0.01). Unlike CTRL (both
P
<0.01), women who developed GH were unable to increase within-burst AP firing (
P
=0.71) or recruit latent subpopulations of larger-sized APs (
P
=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all
P
<0.05).

Conclusions:
Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.
Characteristics and Outcomes of Thrombolysis-Treated Stroke Patients With and Without Saccular Intracranial Aneurysms
Authors: Virta Jyri J. , Strbian Daniel , Putaala Jukka , Kaprio Jaakko , Korja Miikka 
Published: October 2022

Background:
Intravenous thrombolysis seems safe in acute ischemic stroke patients with saccular, unruptured intracranial aneurysms (UIAs), but little is known about the differences in cardiovascular risk factors and outcomes between intravenous thrombolysis-treated stroke patients with and without UIAs. We hypothesized that UIA patients would have a higher burden of cardiovascular risk factors and, therefore, a higher risk of an unfavorable outcome.

Methods:
In this prospective cohort study conducted in Helsinki University Hospital, we identified intravenous thrombolysis-treated patients with concurrent saccular UIAs admitted to a comprehensive stroke center between 2005 and 2019 using 2 overlapping methods. For each UIA patient, a control patient was identified and matched (1:1) for age, sex, admission year, and stroke severity. The primary outcome was an unfavorable outcome at 3 months, defined as a modified Rankin Scale (mRS) score 3 to 6. The secondary outcomes were an excellent outcome (mRS score 0–1) at 3 months and mRS difference in shift analysis.

Results:

In total, 118 UIA patients and 118 matched control patients were identified. The UIA patients were more often current smokers, and their admission systolic blood pressure was higher. The rate of hemorrhagic complications did not differ between the groups. UIAs were not associated with an unfavorable outcome in the conditional logistic regression analysis (odds ratio, 1.41 [95% CI, 0.79–2.54];
P
=0.25). However, the UIA patients were less likely to have excellent outcomes (odds ratio for non-excellent outcome, 2.09 [95% CI, 1.13–3.85];
P
=0.02). In shift analysis, UIAs were associated with higher mRS (odds ratio, 1.61 [95% CI, 1.03–2.49];
P
=0.04).

Conclusions:
The intravenous thrombolysis-treated stroke patients with UIAs were more often current smokers and had higher systolic blood pressure than the matched patients without UIAs. They were as likely to have unfavorable outcomes at 3 months but seemed less likely to achieve excellent outcomes and were more likely to have higher mRS in shift analysis.
A Forward Energy Flux at Submesoscales Driven by Frontogenesis
Authors: Srinivasan Kaushik , Barkan Roy , McWilliams James C. 
Published: October 2022

Abstract
Submesoscale currents, comprising fronts and mixed-layer eddies, exhibit a dual cascade of kinetic energy: a forward cascade to dissipation scales at fronts and an inverse cascade from mixed-layer eddies to mesoscale eddies. Within a coarse-graining framework using both spatial and temporal filters, we show that this dual cascade can be captured in simple mathematical form obtained by writing the cross-scale energy flux in the local principal strain coordinate system, wherein the flux reduces to the sum of two terms, one proportional to the convergence and the other proportional to the strain. The strain term is found to cause the inverse energy flux to larger scales while an approximate equipartition of the convergent and strain terms captures the forward energy flux, demonstrated through model-based analysis and asymptotic theory. A consequence of this equipartition is that the frontal forward energy flux is simply proportional to the frontal convergence. In a recent study, it was shown that the Lagrangian rate of change of quantities like the divergence, vorticity, and horizontal buoyancy gradient are proportional to convergence at fronts, implying that horizontal convergence drives frontogenesis. We show that these two results imply that the primary mechanism for the forward energy flux at fronts is frontogenesis. We also analyze the energy flux through a Helmholtz decomposition and show that the rotational components are primarily responsible for the inverse cascade while a mix of the divergent and rotational components cause the forward cascade, consistent with our asymptotic analysis based on the principal strain framework.
Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone–Patellar Tendon–Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group
Authors: Pioger Charles , Gousopoulos Lampros , Hopper Graeme P. , Vieira Thais Dutra , Campos Joao Pedro , El Helou Abdo , Philippe Corentin , Saithna Adnan , Sonnery-Cottet Bertrand 
Published: October 2022

Background: Bone–patellar tendon–bone (BPTB) autografts are widely considered the standard for anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The aims of this study were to compare the clinical outcomes after ACLR with gold standard BPTB autografts versus combined ACLR + anterolateral ligament reconstruction (ALLR) with hamstring tendon (HT) autografts at medium-term follow-up in a large series of propensity-matched patients. The hypothesis was that combined ACLR + ALLR with HT autografts would result in lower graft rupture rates and non–graft rupture-related reoperation rates. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing combined ACLR + ALLR using HT autografts between January 2003 and December 2019 were propensity matched in a 1:1 ratio to patients undergoing isolated ACLR using BPTB autografts. At the end of the study period, graft ruptures, contralateral knee injuries, and any other reoperations or complications after the index procedure were identified by a search of a prospective database and a review of medical records. Results: A total of 1009 matched pairs were included. The mean duration of follow-up was 101.3 ± 59.9 months. Patients in the isolated group were >3-fold more likely to have graft failure than those in the combined group (hazard ratio, 3.554 [95% CI, 1.744-7.243]; P = .0005). Patients aged <20 years were at a particularly high risk of graft ruptures compared with patients aged >30 years (hazard ratio, 5.650 [95% CI, 1.834-17.241]; P = .0002). Additionally, there was a significantly higher reoperation rate after isolated ACLR than after combined ACLR + ALLR (20.5% vs 8.9%, respectively; P < .0001). The overall rate of subsequent contralateral ruptures was 9.1% after index surgery (isolated: 10.2%; combined: 8.0%; P = .0934), indicating that the risk profiles for both groups were similar. Conclusion: Patients who underwent isolated ACLR with BPTB autografts experienced significantly worse graft survivorship and overall reoperation-free survivorship compared with those who underwent combined ACLR + ALLR with HT autografts. The risk of graft ruptures was >3-fold higher in patients who underwent isolated ACLR using BPTB autografts.
A Retrospective Cohort Study of Multiple Immune-Related Adverse Events and Clinical Outcomes Among Patients With Cancer Receiving Immune Checkpoint Inhibitors
Authors: Hata Hiroki , Matsumura Chikako , Chisaki Yugo , Nishioka Kae , Tokuda Misaki , Miyagi Kazuyo , Suizu Tomoki , Yano Yoshitaka 
Published: October 2022

Background and Objectives Immune checkpoint inhibitors (ICIs) are effective in various types of cancer and cause immune-related adverse events (irAEs). The occurrence of irAEs is associated with improved survival outcome. We investigated the association between the occurrence of irAEs and overall survival (OS) and progression free survival (PFS), and the risk factors for the development of irAEs, in patients with non–small-cell lung cancer (NSCLC), gastric cancer (GC) and melanoma (MM) treated with ICIs. Methods This was a retrospective observational cohort study, and the data were taken from inpatients in a hospital. OS and PFS were compared among patients with different numbers of irAEs. Log-rank test and Cox regression and logistic regression analysis were applied, and details of irAEs characteristics were summarized. Results We obtained data from 200 patients. The major tumor types were NSCLC, GC, and MM. Median OS and PFS in all patients were 9.3 and 3.5 months, respectively. Patients without irAEs tended to have shorter OS or PFS compared with those with a single irAE or multi-system irAEs. Covariate analysis suggested that age (≥75 years), albumin (≥3.5 g/dL) and smoking history were significant for increased occurrence of irAEs. Pneumonitis and thyroiditis tended to occur frequently in patients with NSCLC and MM. The irAE grade was ≤2 in 67.3% of all irAEs, and days of irAEs onset varied. Conclusion We observed patients with irAEs tended to have better OS or PFS in patients with various types of cancers treated with ICIs. We suggest that ICIs should be used appropriately by continuously monitoring the irAEs.
FRailty and Arterial stiffness – the role of oXidative stress and Inflammation (FRAXI study)
Authors: Mensah Ekow , Ali Khalid , Banya Winston , Kirkham Frances Ann , Mengozzi Manuela , Ghezzi Pietro , Rajkumar Chakravarthi 
Published: October 2022

Objective: There is an association between frailty and arterial stiffness. However, arterial stiffness does not uniformly correlate with the spectrum of frailty states. Both oxidative stress and inflammaging contribute to vascular ageing. There are no human studies exploring links between arterial stiffness, oxidative stress, inflammaging and frailty. Our objective is to investigate arterial stiffness and inflammaging as predictors of frailty states. Methods: An observational longitudinal cohort study will be used to examine the association between arterial stiffness, oxidative stress and inflammation in 50 older adults (⩾70 years) with clinical frailty scores (CFS) ⩽6 over 6 months. All study measurements will be taken at baseline. Frailty assessment will include hand-grip strength, timed-up and go test, mini-mental state examination, geriatric depression scale and sarcopenia using body composition measurements with Tanita®. Arterial stiffness measurements will include carotid-femoral pulse wave velocity (cfPWV) and carotid-radial pulse wave velocity (crPWV) using Complior (Alam Medical, France). CAVI device will measure Cardio-ankle vascular index and ankle brachial index (ABI). Oxidative stress blood markers nitrotyrosine (NT) and 8-hydroxy-2’-deoxyguanosin (8-oxo-dG) and inflammation markers high-sensitive C-reactive protein (hs-CRP) and interlukin-6(IL-6) will be measured at baseline and 6 month along with lipid profile and glycated haemoglobin. Results (data analysis plan): Descriptive statistics for continuous data using means and standard deviations for normality distributed variables or medians and inter-quartile ranges for skewed variables will be used. Participants will be categorised into CFS 1-3, and CFS 4-6. Categorical data will use frequencies and comparison between groups. Change in frailty between the groups over 6 months will be compared using paired t-test. Simple linear regression will be done between frailty measures, arterial stiffness, inflammation and oxidative stress biomarkers. Significance will be at P < .05. Conclusion: This study data will inform a larger, multi-centre study exploring further the interplay between frailty, biomarkers and arterial stiffness parameters.