bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic implication of residual inflammatory risk according to disease status in patients treated with percutaneous coronary intervention
Authors: Song H G , Ahn J H , Koh J S , Bae J S , Park Y W , Hwang S J , Hwang J Y , Jeong Y H 
Published: October 2022

Abstract

Background
Compared with stable angina, acute myocardial infarction (AMI) phenotype is related with the elevated inflammatory activity. However, time-dependent change of inflammatory level and its prognostic implication has not been fully understood according to the disease entity.

Methods
We enrolled total 4,263 patients who underwent percutaneous coronary intervention (PCI) with serial measurement of high-sensitivity C-reactive protein (hsCRP) at on-admission and 1-month post-PCI. The risks of MACE (a composite of death, MI or stroke), and major bleeding were evaluated up to 4 years after procedure.

Results
Compared with the non-AMI group (n=1,887), the AMI group (n=2,376) showed the significant decrease of hs-CRP during 1 month (∇0.5 vs. ∇0.1 mg/L; P&lt;0.001). However, 1-month hs-CRP value still was higher in the AMI group than in the non-AMI group (median: 1.0 vs. 0.9 mg/L; P=0.001). During 1-month follow-up, high vs. low inflammatory risk (upper vs. lower tertile of hs-CRP) was significantly associated with increased rate of MACE in the AMI group (HR: 7.66; 95% CI: 2.29–25.59; P&lt;0.001), but not in the non-AMI group (HR: 0.74; 95% CI: 0.12–4.40; P=0.736). From 1-month to 4-years, patients with high inflammatory risk showed the greater rate of MACE compared to those with low inflammatory risk, in both the AMI (HR: 2.40; 95% CI: 1.73–3.45; P&lt;0.001) and non-AMI (HR: 2.67; 95% CI: 1.80–3.94; P&lt;0.001) groups.

Conclusion
In PCI-treated patients, patients presented with AMI showed the greater values of inflammatory activity and its prognostic implication during the early phase, but combined inflammatory risk appeared similar across the disease entity during the late phase. This result may support that clinical benefit of post-PCI anti-inflammatory treatment would be constant regardless of the disease entity during the stabilized phase.

Funding Acknowledgement
Type of funding sources: None.
Impact of recent 2021 ESC guideline changes on postoperative survival of patients with severe aortic regurgitation: insights from the AVIATOR registry
Authors: Hanet V , De Azevedo D , Krug P , Schafers H J , Lansac E , De Kerchove L , El-Hamamsy I , Vojacek J , Contino M , Pouleur A C , Beauloye C , Pasquet A , Vanoverschelde J L , Vancraeynest D , Gerber B 
Published: October 2022

Abstract

Background
Until 2021, the strongest guidelines on surgical correction of severe aortic regurgitation (AR) focused on the left ventricular systolic function (LVEF) and the presence of symptoms. However, those situations lead to an outcome penalty, even after surgical correction. Left ventricle end-systolic diameter (LVESD) gained in strength in 2021 European guidelines. Moreover, more inclusive cut-off values are now recommended (class IIb) in patients at low surgical risk, reflecting the will to recommend surgery before developing heart failure and its consequences on post-operative outcome.

Purpose
We sought to evaluate the impact of guidelines triggers and their recent changes on postoperative survival of patients with severe AR from a large multicentric international registry.

Method and results
Postoperative overall survival of 1899 patients operated for severe and chronic AR (mean age 49±15 years, 85% male) in the international multicenter surgery registry for aortic valve surgery, AVIATOR, was evaluated over a median of 37 months. Twelve patients (0.6%) died postoperatively, and 68 within 10 years. By multivariable Cox analysis, presence of heart failure symptoms (HR 2.60; 95% CI [1.20–5.66]; p=0; 016), and either LVESD &gt;50 mm or &gt;25 mm/m2 (HR 1.64; 95% CI [1.05–2.55]; p=0.029) predicted survival independently over and above age (HR 2.25 per SD, 95% CI [1.67–3.03], p&lt;0.001), female gender and bicuspid phenotype. Therefore, patients operated on when meeting either old or new 2021 class I triggers had worse adjusted survival (respectively 86±2% and 87±2%) than patients operated on without meeting triggers (97±2%, p&lt;0.01). However asymptomatic patients operated on while meeting new 2021 ESC class IIb triggers (ie LVESD &gt;20 mm/m2 or LVEF between 50–55%, 10-year survival 97±3%). Moreover, the sub-group of patients having a dilated LVESD &gt;50 mm or &gt;25 mm/m2 but a preserved LVEF &gt;50% had excellent survival (10-year survival 95±3%).

Conclusions
In severe AR, patients operated on when meeting any class I trigger have postoperative survival penalty. Asymptomatic patients operated on earlier have better survival. This supports early surgery in AR as encouraged by the recent ESC/EACTS guidelines.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fondation Nationale de la Recherche Scientifique of the Belgian Government
Cardiopulmonary arrest and in-hospital outcomes in young patients with acute myocardial infarction: insights from the Japanese nationwide registry
Authors: Ando H , Yamaji K , Kohsaka S , Ishii H , Sakakura K , Goto R , Nakano Y , Takashima H , Ikari Y , Amano T 
Published: October 2022

Abstract

Background
Cardiopulmonary arrest (CPA) is the most serious presentation of acute myocardial infarction (AMI). However, the frequency and prognostic impact of CPA in young patients with AMI have been still unclear.

Objectives
This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention using large-scale nationwide all-comer registry data in Japan (J-PCI registry).

Methods
Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed within the J-PCI registry between 2014 and 2018.

Results
Among 213,297 patients with AMI, 23,985 (11.2%) were young (age, 20–49 years). Compared with the older group (age, 50–79 years; n=189,312), the young group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with CPA (Figure 1). Further, concomitant CPA was strongly associated with in-hospital mortality in the young group (Table 1).

Conclusions
Young patients with AMI presented a higher risk of CPA than older patients, which was strongly associated with in-hospital mortality.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI
Age-related difference in the impact of diabetes mellitus on all-cause mortality after acute myocardial infarction
Authors: An S Y , Um R B , Park J H , Jeong J O , Song P S 
Published: October 2022

Abstract

Background
Diabetes mellitus (DM) is highly prevalent among individuals hospitalized with acute myocardial infarction (AMI) and is associated with increased risk for cardiovascular complications and short-term and long-term mortality. However, most existing data are from older patients. Little is known about the incidence of diabetes in individuals who experience AMI at a young age. Whether the presence of DM is associated with worse outcomes in these patients is not clear.

Purpose
To test the hypothesis that the impact of DM on clinical outcomes after AMI can vary by age.

Methods
A total of 12,600 AMI patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 was classified into young (n=3,590 [28.5%]) and elderly (n=9,010 [71.5%]). Those less than 55 years of age were considered young. We performed comparisons of baseline characteristics, in-hospital treatments, and long-term clinical outcomes between patients with and without diabetes after stratification according to age group.

Results
The prevalence of diabetes mellitus was 26.5% in the young AMI group. In the multivariable-adjusted model of the entire cohort, diabetes mellitus was associated strongly with 3-year all-cause mortality (12.6% vs. 6.8%; adjusted hazard ratio [HR], 1.318; 95% confidence interval [CI], 1.138–1.526; P&lt;0.001). When the entire cohort was subdivided into two age groups, young diabetic patients showed a 107.0% higher mortality rate than those without diabetes (adjusted HR, 2.070; 95% CI, 1.150–3.724; P=0.015). Meanwhile, elderly diabetic patients had a 25.3% higher risk of mortality than non-diabetic patients (adjusted HR, 1.253; 95% CI, 1.076–1.459; P=0.004). The interaction of diabetes with age was significant (adjusted P for interaction = 0.008).

Conclusion
DM is not uncommon in younger AMI patients, and the relative risk of long-term mortality is significantly higher in young patients than in older counterparts. More aggressive treatments are needed to prevent future cardiovascular events in younger patients after AMI.

Funding Acknowledgement
Type of funding sources: None.
1-year mortality after myocardial injury in COVID-19 patients
Authors: Gomes B F O , Silva T M B , Dutra G P , Peres L S , Camisao N D , Menezes I R R , Goudar H C , Butter A , Petriz J L F , Carmo Junior P R , Pereira B B , Oliveira G M M 
Published: October 2022

Abstract

Background
Myocardial injury is a known complication of COVID-19 and is related to a worse prognosis on admission. However, its impact on 1-year mortality is unknown.

Methods
Retrospective cohort study with patients admitted to intensive care and confirmed diagnosis of COVID-19 by RT-PCR and with at least one measurement of troponin during hospitalization. The study period was from March/2020 to June/2021. Clinical characteristics and the occurrence of myocardial were assessed between deaths and survivors using the chi-square test and Student's t-test. Variables with p&lt;0.01 in the univariate analysis were included in the Cox regression model to identify predictor variables of 1-year mortality.

Results
1037 patients were included, with a mean follow-up of 1.06±0.58 years, mean age = 59.9±16.2 years, and 62.7% men. The prevalence of myocardial injury was 42.8% and occurred 204 deaths (19.7%). In the univariate analysis, the variables associated with 1-year mortality were: myocardial injury (OR 7.5; CI95% 5.2–10.9), age &gt;60 years (OR 5.65; CI95% 3.9–8.2), arterial hypertension (OR 2.8; CI95% 2.0–3.9), diabetes (OR 2.3; CI95% 1.6–3.1), chronic kidney failure (OR 3.9; CI95% 2.2–6.8), dementia (OR 1.8; CI95% 1.2–2.6) and mechanical ventilation (OR 50.5; CI95% 33.9–77.3). In Cox regression, the predictor variables were: myocardial injury (HR 2.4; CI95% 1.7–3.5), age &gt;60 years (HR 2.5; CI95% 1.8–3.6), chronic kidney disease (HR 1.9; CI95% 1.2–2.9), dementia (HR 3.2; CI95% 2.1–5.0) and mechanical ventilation (HR 17.5; CI95% 12.2–25.2).

Conclusion
In patients admitted to intensive care by COVID-19, the detection of myocardial injury more than doubled the risk of death in 1 year.

Funding Acknowledgement
Type of funding sources: None.
High-sensitivity troponin is a biomarker of medium term mortality in 20,000 consecutive hospital patients undergoing a blood test for any reason
Authors: Hinton J , Mariathas M , Gabara L , Allan R , Nicholas Z , Kwok C S , Ramamoorthy S , Martin G , Cook P , Mamas M A , Curzen N 
Published: October 2022

Abstract

Introduction
High sensitivity troponin (hs-cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in patients without a clinical presentation consistent with type 1 myocardial infarction. There is increasing evidence that these concentrations may act as a marker of prognosis in a range of conditions. However, previous studies have been limited because they have only included patients in whom the clinician has requested the test. The aim of this study was to assess the relationship between medium term mortality and hs-cTn concentration in a large consecutive hospital population undergoing a blood test, regardless of whether there was a clinical indication for performing the hs-cTn.

Method
This single centre study included 20,000 consecutive patients undergoing a blood test for any reason, in whom hs-cTnI was added, regardless of the clinical indication (CHARIOT population). Mortality data up to 2.25 years was obtained via NHS Digital. The association between hs-cTnI concentration and one year mortality was evaluated using Kaplan-Meier plots (with log-rank test) and Cox proportional hazards analyses. After the cohort was considered as a whole, each of the clinical areas (inpatient (IPD), outpatient (OPD), emergency department (ED)) were considered separately. Furthermore, in the IPD and ED populations, a landmark analysis was performed excluding those patients who died within 30 days to assess whether any longer term relationship was driven by short term mortality.

Results
Overall, 2825 (14.1%) patients had died at 2.25 years. The mortality at 2.25 years was significantly higher if the hs-cTnI concentration was above the ULN (45.3% versus 12.3%, p&lt;0.001 (log rank) in the entire cohort (Figure 1). Multivariable Cox regression analysis demonstrated that the log10hs-cTnI concentration was independently associated with 2.25 year mortality (hazard ratio (HR) 1.69 (95% confidence interval (CI): 1.59–1.80)). This relationship was demonstrated for patients in each of the clinical areas (IPD HR 1.46 (95% CI: 1.33–1.60), OPD HR 2.19 (95% CI: 1.84–2.60), ED HR 1.87 (95% CI: 1.68–2.07)). Further analysis by excluding those patients that died within 30 days demonstrated that the relationship between hs-cTnI concentration and mortality persisted and it was not driven by short term mortality.

Conclusion
In a large, unselected hospital population of both in- and out-patients, the majority of whom there was no clinical indication for testing, hs-cTnI concentration was independently associated with medium term mortality. These data suggest that hs-cTnI may have a role as a biomarker of future risk.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter
Educational Differences in Life Expectancies With and Without Pain
Authors: Sun Feinuo , Zimmer Zachary , Zajacova Anna 
Published: October 2022

AbstractObjectivesThis study computes years and proportion of life that older adults living in the United States can expect to live pain-free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations.MethodsData are from National Health and Aging Trends Study, 2011–2020. The sample contains 10,180 respondents who are age 65 and older. Pain expectancy estimates are computed using the Interpolated Markov Chain software that applies probability transitions to multistate life tables.ResultsThose with higher educational levels expect not only a longer life but also a higher proportion of life without pain. For example, a 65-year-old female with less than high school education expects 18.1 years in total and 5.8 years, or 32% of life, without pain compared with 23.7 years in total with 10.7 years, or 45% of life without pain if she completed college. The education gradient in pain expectancies is more salient for females than males and narrows at the oldest ages. There is no educational disparity in the percent of life with nonlimiting pain.DiscussionEducation promotes longer life and more pain-free years, but the specific degree of improvement by education varies across demographic groups. More research is needed to explain associations between education and more and less severe and limiting aspects of pain.
Performance effectiveness of vital parameter combinations for early warning of sepsis—an exhaustive study using machine learning
Authors: Rangan Ekanath Srihari , Pathinarupothi Rahul Krishnan , Anand Kanwaljeet J S , Snyder Michael P 
Published: October 2022

Abstract

Objective
To carry out exhaustive data-driven computations for the performance of noninvasive vital signs heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and temperature (Temp), considered both independently and in all possible combinations, for early detection of sepsis.

Materials and methods
By extracting features interpretable by clinicians, we applied Gradient Boosted Decision Tree machine learning on a dataset of 2630 patients to build 240 models. Validation was performed on a geographically distinct dataset. Relative to onset, predictions were clocked as per 16 pairs of monitoring intervals and prediction times, and the outcomes were ranked.

Results
The combination of HR and Temp was found to be a minimal feature set yielding maximal predictability with area under receiver operating curve 0.94, sensitivity of 0.85, and specificity of 0.90. Whereas HR and RR each directly enhance prediction, the effects of SpO2 and Temp are significant only when combined with HR or RR. In benchmarking relative to standard methods Systemic Inflammatory Response Syndrome (SIRS), National Early Warning Score (NEWS), and quick-Sequential Organ Failure Assessment (qSOFA), Vital-SEP outperformed all 3 of them.

Conclusion
It can be concluded that using intensive care unit data even 2 vital signs are adequate to predict sepsis upto 6 h in advance with promising accuracy comparable to standard scoring methods and other sepsis predictive tools reported in literature. Vital-SEP can be used for fast-track prediction especially in limited resource hospital settings where laboratory based hematologic or biochemical assays may be unavailable, inaccurate, or entail clinically inordinate delays. A prospective study is essential to determine the clinical impact of the proposed sepsis prediction model and evaluate other outcomes such as mortality and duration of hospital stay.
Filovirus helical nucleocapsid structures
Authors: Hu Shangfan , Noda Takeshi 
Published: October 2022

Abstract
Filoviruses are filamentous enveloped viruses belonging to the family Filoviridae, in the order Mononegavirales. Some filovirus members, such as Ebola virus and Marburg virus, cause severe hemorrhagic fever in humans and non-human primates. The filovirus ribonucleoprotein complex, called the nucleocapsid, forms a double-layered helical structure in which a non-segmented, single-stranded, negative-sense RNA genome is encapsidated by the nucleoprotein (NP), viral protein 35 (VP35), VP24, VP30 and RNA-dependent RNA polymerase (L). The inner layer consists of the helical NP–RNA complex, acting as a scaffold for the binding of VP35 and VP24 that constitute the outer layer. Recent structural studies using cryo-electron microscopy have advanced our understanding of the molecular mechanism of filovirus nucleocapsid formation. Here, we review the key characteristics of the Ebola virus and Marburg virus nucleocapsid structures, highlighting the similarities and differences between the two viruses. In particular, we focus on the structure of the helical NP–RNA complex, the RNA binding mechanism and the NP–NP interactions in the helix. The structural analyses reveal a possible mechanism of nucleocapsid assembly and provide potential targets for the anti-filovirus drug design.
Attention-guided multi-scale deep object detection framework for lymphocyte analysis in IHC histological images
Authors: Rauf Zunaira , Sohail Anabia , Khan Saddam Hussain , Khan Asifullah , Gwak Jeonghwan , Maqbool Muhammad 
Published: October 2022

AbstractTumor-infiltrating lymphocytes are specialized lymphocytes that can detect and kill cancerous cells. Their detection poses many challenges due to significant morphological variations, overlapping occurrence, artifact regions and high-class resemblance between clustered areas and artifacts. In this regard, a Lymphocyte Analysis Framework based on Deep Convolutional neural network (DC-Lym-AF) is proposed to analyze lymphocytes in immunohistochemistry images. The proposed framework comprises (i) pre-processing, (ii) screening phase, (iii) localization phase and (iv) post-processing. In the screening phase, a custom convolutional neural network architecture (lymphocyte dilated network) is developed to screen lymphocytic regions by performing a patch-level classification. This proposed architecture uses dilated convolutions and shortcut connections to capture multi-level variations and ensure reference-based learning. In contrast, the localization phase utilizes an attention-guided multi-scale lymphocyte detector to detect lymphocytes. The proposed detector extracts refined and multi-scale features by exploiting dilated convolutions, attention mechanism and feature pyramid network (FPN) using its custom attention-aware backbone. The proposed DC-Lym-AF shows exemplary performance on the NuClick dataset compared with the existing detection models, with an F-score and precision of 0.84 and 0.83, respectively. We verified the generalizability of our proposed framework by participating in a publically open LYON’19 challenge. Results in terms of detection rate (0.76) and F-score (0.73) suggest that the proposed DC-Lym-AF can effectively detect lymphocytes in immunohistochemistry-stained images collected from different laboratories. In addition, its promising generalization on several datasets implies that it can be turned into a medical diagnostic tool to investigate various histopathological problems.Graphical Abstract
Vibration of two in-plane simply supported bending cables interconnected by a flexible cross-link
Authors: Wang Chung-Yue , Nguyen Van-Son , Syamsi M I , Wang Hao-Lin 
Published: October 2022

ABSTRACT
Most of the existing analytical solutions to the vibration of cable networks interconnected by cross-ties are developed based on string theory, where the effect of cable bending rigidity on cable vibration is ignored. However, the bending rigidity of cables strongly influences the natural frequencies and vibration mode shapes of short and stout cables and long cables at higher modes. Hence, this paper considers cable bending rigidity to form a closed-form solution that can be used in determining the natural frequencies and mode shapes of cable networks. The analytical solution of the cable network model with hinged-end boundary conditions is derived. It can be combined with other existing techniques to analyze the dynamic behaviors of a two-cable network with partly fixed supports. The analytical solution derived from this paper can be degenerated to the same solution without considering the cable bending rigidity in previous studies. The accuracy of this analytical solution considering cable bending rigidity is verified by finite element analysis. The effects of bending rigidity on the vibration frequencies and modes of the cable network with inclined and flexible cross-link are investigated in detail. This analytical solution can be applied to backward analysis to identify the cable tension of a two-cable network with partly fixed supports.