bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling electron transport and multiplication in photomultiplier tubes using COMSOL Multiphysics®
Authors: Beavers J. , Huddleston K. , Hines N. , McNeil W. 
Published: December 2022

Abstract
Combining stochastic and finite element methods, a modeling
approach was executed that will inform new photomultiplier tube and
scintillation detector designs. Time-dependent signal formation
within a commercially available photomultiplier tube was modeled
including the release and transport of electrons from the
photocathode through the dynode stages. An ET Enterprises 9214B
photomultiplier tube was digitally reproduced using Computed
Tomography, X-ray radiography, and SolidWorks solid-modeling
software. Simulations were executed with COMSOL
Multiphysics® finite element solving
package. Stochastic models of electron emission from the
photocathode and dynodes were integrated within the COMSOL
framework. Photoelectron emission energy was modeled by combining
NaI(Tl) spectral emission characteristics and K2CsSb
photocathode quantum efficiency. Secondary electron emission yields
were produced to follow nominal photomultiplier gain, while
secondary electron energies were sampled from the Chung-Everhart
distribution. Electron emission trajectories were sampled according
to Lambert's cosine law. Coupling stochastic and finite element
models, simulation reproduced signal formation for the commercial
photomultiplier tube including timing characteristics within 9.5%
and gain within 3% over a voltage range of 900–1250 V.
Checks and balances
Authors: Ritchie Donald A. 
Published: December 2022

Abstract
Legislative results rank high in measuring the success of a president. But as “Checks and balances” makes clear, Congress is sensitive to its independent role as part of government. While the president, the chief legislator, sets out his legislative program in the State of the Union Address at the start of the annual session of Congress, there are many ways in which Congress can influence the success, or otherwise, of a presidency. Cabinet appointments need Senate approval; Congress has to approve treaties and holds the purse strings; and finally congressional hearings can investigate alleged misdeeds. Congress’s relationship with the judiciary, the other wing of government, is also examined.
Welcome to NanoPut
Authors: Moriarty Philip 
Published: December 2022

Abstract
This chapter introduces the fundamental scientific principles at the core of nanoscience, showing nanotechnology as something new, exciting, and different. It begins by defining what is meant by the terms nanotechnology and nanoscience. Nanotechnology and nanoscience dwell on size-dependent change, elaborating how changing the size of an object at the atomic, molecular, or macromolecular scale can radically change its properties. The field of nanotechnology owes much of its origins to the invention of new ultrahigh resolution microscopes, capable of resolving individual atoms and molecules but involving no optics at all. The chapter highlights remarkable instruments that are central to mapping and manipulating matter at the atomic and (sub)molecular levels.
Nanomachines
Authors: Moriarty Philip 
Published: December 2022

Abstract
This chapter describes how nature has harnessed nanotechnology from the start of life on Earth to perform a variety of essential functions. It analyses the sophistication, intricacy, and elegance of nature’s nanomachinery, which far outstrips anything that scientists are capable of creating. It also discusses how the natural world is awash with molecular machines that achieve unidirectional motion with no need for an external guiding intelligence. The chapter mentions the STM-powered nanocar, a biomolecular motor from the kinesin family that leaves its synthetic counterpart in the dust in very many ways. It explains how kinesin converts chemical energy into mechanical movement, transporting its molecular cargo along tracks known as microtubules.
849 EFFECTS OF INTRA-AORTIC BALLOON PUMP DELAYED DEFLATION TIMING ON CAROTID BLOOD FLOW AND CARDIAC MECHANICS
Authors: Boccellino Antonio , Sacchi Stefania , Pazzanese Vittorio , Calvo Francesco , Gramegna Mario , Ingallina Giacomo , Cappelletti Alberto , Baldetti Luca 
Published: December 2022

Abstract

Background
Intra-Aortic Balloon Pump (IABP) efficacy is critically affected by the inflation/deflation timing. Balloon deflation may cause a sucking effect, and a steal phenomenon on carotid flow. Delaying IABP deflation reduces the degree of this flow reversal, but at the same time exposes patients to the risk of increased proto-systolic afterload with detrimental effects on the LV.

Hypothesis
To investigate the effects of a delayed IABP deflation timing on cerebral blood flow and LV hemodynamics.

Methods
We prospectively evaluated 20 consecutive patients who received transfemoral IABP for cardiogenic shock (CS). Central aortic pressures (augmented diastolic [ADP], end-diastolic [EDP], assisted systolic [ASP] and mean aortic [MAP] pressures) were recorded from the IABP console simultaneously with ultrasound data. First ultrasound and haemodynamic measurements were collected during conventional IABP deflation timing (balloon deflation completed before onset of LV systole by automated ECG gating). Then, IABP deflation was manually delayed to the beginning of the QRS (early LV systole). After adjustment, counterpulsation was performed for a minimum of 2 minutes to achieve steady hemodynamics, then the same ultrasound and haemodynamic measurements were recollected.

Results
Mean age was 67±13 years, LVEF was 25±11%. At the carotid ultrasound, the delayed deflation increased the net forward velocity time integral (VTI) in the common carotid artery (18±9 vs 15±8 cm; p=0.001), by reducing the end-diastolic backward VTI (1±1 vs 4±2 cm; p&lt;0.001) while having no effect on the overall forward VTI (19±9 vs 19±9 cm; p=0.294). Specifically, the delayed deflation increased the diastolic forward VTI (12±5 vs 10±4 cm]; p&lt;0.001) while decreasing the systolic forward VTI (7±4 vs 9±4 cm]; p&lt;0.005). On central aortic hemodynamics, the delayed deflation decreased the ASP (91±21 vs 97±20 mmHg; p=0.001), increased the EDP (60±11 vs 48±9 mmHg; p&lt;0.001), the ADP (123±19 vs 119±19 mmHg; p&lt;0.001) and the MAP (89±14 vs 80±12 mmHg; p&lt;0.001). On echocardiography, the delayed deflation increased the LVOT VTI (15±4 vs 13±4 cm; p&lt;0.001), decreased LV ejection time (202±44 vs 211±43 ms; p=0.005) but did not affect the isovolumetric contraction time (119±56 vs 119±58 ms; p=0.989), eventually reducing the total duration of LV systole (321±54 vs 330±50 ms; p=0.009).

Conclusions
In our cohort, a delayed IABP deflation strategy, evaluated by a multi-parametric yet relatively simple approach, demonstrated to be safe and was associated with both an increase cerebral perfusion and an improvement in cardiac mechanics.
386 IMPACT OF REVASCULARIZATION COMPLETENESS ON ONE-YEAR OUTCOMES OF IMPELLA-SUPPORTED PCI IN ACUTE CORONARY SYNDROME: A SINGLE-CENTER EXPERIENCE
Authors: Ruzzarin Alessandro , Pighi Michele , Marin Federico , Zucchelli Federico , Portolan Leonardo , Mainardi Andrea , Mora Francesco Della , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Background
The use of mechanical circulatory support in high-risk percutaneous coronary intervention (HRPCI) has grown over the past decade. We aimed to evaluate the impact of coronary revascularization extent on one-year outcomes of Impella-supported HRPCI in the setting of acute coronary syndrome (ACS).

Methods
We performed a single-center retrospective study including all patients who underwent coronary angiography supported by Impella at our institution. Patients undergoing HRPCI in the setting of ACS with Impella-assistance were identified for the analysis. Revascularization extent was assessed using the British Cardiovascular Intervention Society (BCIS) jeopardy score revascularization index (RI). Patients were classified into two groups according to the completeness of revascularization in high RI (RI&gt;0.75) and low RI (RI&lt;0.75).
The primary study endpoint was survival free from major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke, heart failure hospitalization) at one-year follow-up.

Results
Among fifty patients enrolled in the study, forty ACS patients (mean age 69.2±9 years) were identified for the analysis.
At coronary angiography, 76.3% had multivessel disease, and the mean BCIS-JSPRE-PCI score was 10.2±2.1. After Impella-supported PCI, BCIS-JSPOST-PCI score was 2.1±2.0 (p&lt;0.01) and RI&gt;0.75 was reached in 89.2% of cases (mean RI 0.8±0.2).
In-hospital mortality was 20.5% without a statistical difference between high and low RI (p=0.1).
Within 12 months, time-to-MACCE was statistically higher in patients with high RI as compared to low RI (288.2 vs. 189.8 days, p&lt;0.05) (Figure).

Conclusions
Our single-center experience suggests a more extensive revascularization, aiming for a positive impact on outcomes, when a Impella-protected strategy is performed in the setting of acute coronary syndromes.
918 EARLY RECOGNITION OF SUBCLINICAL ATRIAL FIBRILLATION IN PATIENTS IMPLANTED WITH DIFFERENT DEVICES
Authors: Cardia Giada , Curcio Antonio , Romano Letizia Rosa , Mancuso Cinzia , Fiore Davide , Augusto Florinda Maria , Calvelli Pierangelo , Indolfi Ciro 
Published: December 2022

Abstract

Background
Atrial fibrillation (AF) is the supra-ventricular tachyarrhythmia mostly encountered in the clinical practice.While appearing silent or with a constellation of symptoms, it confers a 5-fold risk of stroke. Early detection is mandatory to establish the diagnosis and recommend anticoagulation. Besides the arrhythmia recognition through several tools, such as Holter ECG and loop recorders, it has been underlined that cardiac implantable electronic devices with an atrial lead can help in recognizing asymptomatic AF periods, also known as atrial high-rate episodes (AHREs).

Materials and Methods
48 patients with AHRE detection at device telemetry checks were enrolled; implanted device were pacemakers (n=31, 64.8%); implantable cardioverter/defibrillators (ICD, n=8, 16.6%); cardiac resynchronization therapy devices with defibrillators (CRT-D, n=9, 18.5%). Male gender was predominant (40 vs. 8), age was &gt; 65years, and mean CHA2DS2VASc was 4.2±2.8. Patients underwent ECG assessment in 6-month intervals (at baseline and during follow-up), MOntreal Cognitive Assessment test, and device interrogation for AHRE of duration &gt;5 minutes and rate &gt;175 beats per minute. Randomization to a direct oral anticoagulant (DOAC) or usual care (aspirin when needed or placebo) was provided in a blind fashion and maintained for the entire study observation until occurrence of overt AF, followed by exclusion from the study.

Results
We found that 13%-16% of patients with device-detected AHRE developed AF over a mean follow-up of 2.5 year (range 4.6±2.0). These cases were given oral anticoagulation since change of indication according to current guidelines. Most important comorbidities were coronary artery disease (n=18 patients, 36.73%); systemic hypertension (n=41, 83.67%); diabetes (n=13, 26.53%); dyslipidemia (n=23, 46.8%); heart failure (n=17, 35.4%). 30 patients were treated with beta-blockers(62.5%). 2 patients died for gastrointestinal bleeding. One patient was excluded for major bleeding after one month from the enrollment. Total AHREs duration was significantly lower in patients with pacemaker (14 hrs) compared to patients with CRT-D (17 hrs) and ICD (20 hrs, p&lt;0.05).

Conclusions
The impact of AHREs was higher in patients affected by cardiac dysfunction and concomitant diseases; none of the patients enrolled in the study developed ischemic stroke; major bleedings were observed in both arms. Further studies are warranted for considering oral anticoagulation based on the sole device interrogation in the context of subclinical atrial fibrillation.
98 ORAL ANTICOAGULANT THERAPY AND RISK OF MACE IN ELDERLY PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: REAL WORLD EVIDENCE DATA.
Authors: Armentaro Giuseppe , Condoleo Valentino , Divino Marcello , Pastura Carlo Alberto , Francica Mattea , Barbara Keti , Monaco Vittoria , Clausi Elvira , Scarcelli Maria Rosangela , Cuda Patrizia , Severini Giandomenico , Marco Mario De , Miceli Sofia , Maio Raffaele , Perticone Maria , Sciacqua Angela 
Published: December 2022

Abstract

Aim
Atrial fibrillation (AF) is the most common cardiac arrhythmia globally and is associated with a five-fold increased risk of stroke compared with patients without AF. Although large clinical trials have demonstrated the noninferiority of NOACs to VKAs in preventing stroke and systemic thromboembolism and their use is recommended by the guidelines, the role of antithrombotic therapies on the risk of major adverse cardiac events (MACE) in a high-risk population, such as the elderly, is still controversial (2). The aim of this work is to evaluate any differences on the occurrence of MACE among NOACs-treated patients versus VKAs in an elderly population with AF and other critical comorbidities.

Materials and Methods
420 caucasian patients with non-valvular AF, aged ≥65 years were enrolled, 136 in treatment with VKAs and 284 with NOACs, with mean age 76.7±5.7. A clinical-instrumental and laboratory evaluation was performed for a follow-up of 93.9 months. Statistical analysis was performed with Wicoxon's test, Student's t-test, log rank test, univariate and multivariate Cox regression model in order to calculate the hazard ratio (HR) for independent predictors associated with the incidence of MACE.

Results
The two groups were overlappings for sex, smoking, T2DM. NOACs group had a higher prevalence of: HF (110 vs 32, p=0.002), COPD (127 vs 39 p = 0.001), arterial hypertension (266 vs 112, p = 0.0003) and they were older than VKAs group (78.4±4.7 vs 73.2±5.9 years; p&lt;0.0001). In the whole general population at baseline, the following values ​​were detected: estimated glomerular filtration rate (eGFR) 64.6 ± 18.2 ml/min/1.73 m2, Systolic blood pressure (BP)132.5±11.6 mmHg, diastolic BP 76.6±9.5 mmHg, BMI 29.4±4.8 Kg/m2. In patients treated with NOACs, MACEs observed were 44 (2.4 events /100 patient-years), while in the group treated with VKAs were 76 (7.2 events/100 patient-years) (p &lt;0.0001). A multivariate analysis model showed that an enhancement of 1g/dl of albuminemia value (HR 0.565, p=0.033), taking a therapy with β-blockers (HR 0.621, p=0.013), ACE inhibitors or ARBs (HR 0.695, p=0.024) were protective factors for the onset of MACE, while VKAs therapy (HR 2.596, p&lt;0.0001) and HF (HR 1.471, p&lt;0.0001) increased the risk of MACE in patients with AF.

Conclusions
The data of present study confirm a better safety profile of NOACs compared to VKAs on the occurrence of MACE in an elderly population with critical comorbidities, even though patients treated with NOACs were older and had a greater burden of comorbidities that negatively affect the risk of MACE such as: arterial hypertension, COPD and heart failure.
7 EXPLOITABILITY AND DISTRIBUTION OF SLEEP APNEA AND ATRIAL FIBRILLATION BURDEN DURING LONG TERM FOLLOW-UP IN UNSELECTED DUAL-CHAMBER PACEMAKER PATIENTS
Authors: Mascioli Giosuè , Aimè Ezio , Contardi Danilo 
Published: December 2022

Abstract

Background
Sleep Apnea (SA) and Atrial Fibrillation (AF) are common comorbidities in paced patients (pts). Modern pacemakers (PMs) are capable of storing continuous long-term reliable daily information about: 1) AF burden (AFB); 2) severity of SA, defined by a respiratory disturbances index (RDI) measured by a minute ventilation sensor-based algorithm.

Aim of the study
This retrospective study aimed to assess exploitability and distributions of daily AFB and RDI over long-term follow-up (FU) in unselected dual-chamber (DC) paced pts implanted with PMs equipped with a dedicated SA monitoring (SAM) algorithm and followed-up in their Institutions. Pts affected by permanent AF were excluded from the study.

Methods
Data from long-term FU have been collected after implant, together with pts clinical baseline characteristics. Between Aug 2013 and Oct 2018, n=210 pts were implanted with Reply 200/Kora 100 PMs (MicroPort CRM, Saluggia-VC, Italy), equipped with the SAM algorithm. At each FU visit all the daily AFB and RDI data were retrieved from the PM memory. Days of FU have been considered exploitable (Expl-FU) when both the daily AFB and RDI information were available.

Results
Data from n=864 visits are available for analysis. Pts characteristics: male 56.2%, mean age 76.4±11.1 yrs, BMI 25.6±4.4 Kg/m2; implant indication: sinus node disease 40.5%, AV block 46.2%; 37.1% of pts had a history of paroxysmal AF. The overall FU / Expl-FU durations were 1.94±1.23 / 1.48±1.14 years (23.7% of days were lost due to various technical reasons). The PMs classified RDI as valid in 92.3%±19.5% of nights (85.7% of pts showed &gt;90% of valid nights, Figure 1). Severe or moderate SA was suspected in 43.8% and 59.5% of pts, respectively. An AFB≥25% / 50% was observed in 9.5% / 5.7% of pts (Figure 2).

Conclusions
In this retrospective study, SA and AF have been shown to highly affect unselected DC paced pts. PM devices proved to be really helpful in consistently and reliably measure both SA (RDI successfully identified in 92.3%±19.5% of nights) and AF (9.5% of pts with AFB≥25%). This is relevant to allow clinicians to implement early preventive actions to improve clinical prognosis.
1094 MULTIVESSEL CORONARY ARTERY SPASM TRIGGERED BY GANGLIONATED PLEXI STIMULATION DURING ATRIAL FIBRILLATION RADIOFREQUENCY CATHETER ABLATYION: A CASE REPORT
Authors: Innocentiis Carlo De , Astore Pasquale , Buonpane Angela , Giannantonio Maria , Ienco Vincenzo , Laborante Renzo , Fumarulo Isabella , Santamaria Matteo 
Published: December 2022

Abstract

Background
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Atrial fibrillation could be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment.

Case summary
We report a case of severe multivessel coronary artery spasm triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent atrial fibrillation, promptly resolved after intracoronary nitrate administration.

Discussion
Although rare, coronary artery spasm is a serious complication of atrial fibrillation catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
791 CAN ALARMINS BECOME A THERAPEUTIC TARGET FOR A PATIENTS WITH ATRIAL FIBRILLATION?
Authors: Orlando Luana , De Fazio Marianna Gigliotti , Terranova Dario , Montemurro Vincenzo , Imbalzano Egidio 
Published: December 2022

Abstract
The link between alarmins and atrial fibrillation is clear and well known in the literature. We performed a non-systematic review about role of alarmins in pathophysiological mechanism of AF, hypothesizing their role in potential novel therapeutic targets for arrhythmia.
Several studies have shown a key role of HMGB1 in AF physiopathology. We have seen an almost direct correlation between HMGB1 and oxidative stress in the inflammatory process of AF. Wu et al. observed that HMGB1 is higher in patients with permanent AF, because they experienced a continuous inflammatory tissue damaging impulse. It was shown a prothrombotic and procoagulative role of HMGB1, increased in patients with AF and atrial thrombosis.
Scherschel et al. showed higher concentration of S100β protein in AF patients undergoing catheter ablation. Neuronal injury by intrinsic cardiac autonomic nervous system (ICSN) upon catheter treatment released damage-associated molecular pattern proteins (DAMPs) as S100β protein. In vitro studies dealing with murine intracardiac neuros showed that S100β decreased potential action and increased neuronal cells growth.
Many studies demonstrate HSP70 protective role when intracellular, at high concentrations in patients who do not develop arrhythmia after cardiac injury, such as bypass, and low concentrations preoperatively in patients who later develop arrhythmia. At the serum level, on the other hand, it becomes an important marker of cellular damage and oxidative stress, also related to increased IL-2 AND IL-4.

Conclusions
These results could be considered for new therapeutic strategies, as inhibition of oxidative stress, novel therapeutic targets of anticoagulant drugs and considering alarmins as predictive or prognostic biomarkers of disease.
19 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AFTER TRANSVENOUS LEAD EXTRACTION: SAFETY, EFFICACY AND OUTCOME
Authors: Pittorru Raimondo , Giacomin Enrico , Migliore Federico , Falzone Pasquale , Bernardo Dall´aglio Pietro , De Lazzari Manuel , Vianello Riccardo , Iliceto Sabino 
Published: December 2022

Abstract

Background
Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy and outcome of S-ICD implantation after TLE of TV-ICD.

Methods
The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD.

Results and Conclusions
Indications for TLE were: infection (63.4%) and lead malfunction (36.4%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n=4;11.1%), pulse generator pocket erosion with no evidence of infection (n=2;5.5%) and ineffective therapy (n=1;2.7%).No pocket or systemic device-related infection, lead/hardware dysfunction were reported.Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF).There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥2 (HR 5.05;95% CI 1.00–26.38;p=0.04), hypertension (HR 22.72;95% CI 1.05–26.31;p=0.02), diabetes (HR 10.64;95% CI 2.05-55.60; p=0.001) and ischemic heart disease (HR 5.92;95% CI 1.17–30.30;p= 0.01).
Our study provides evidences on the use of S-ICD as an ideal alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidity.