bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic implications of atrial fibrillation in adults with Ebstein anomaly
Authors: Martin de Miguel Irene , Madhavan Malini , Miranda William R , Connolly Heidi M , Egbe Alexander C 
Published: November 2022

ObjectiveSupraventricular arrhythmias are common in adults with Ebstein anomaly (EA). However, there are limited data about prognostic implications of atrial fibrillation (AF) in this population. Accordingly, our aim was to assess the clinical profile and burden of AF in adults with EA, and the relationship between AF and outcomes.Methods and resultsSix hundred eighty-two consecutive adults with a median age of 36 (24–49) years from Mayo Clinic, Minnesota, USA, between 2003 and 2020 were included. Sustained episodes of AF, clinical, echocardiographic, rhythm and surgical data were collected. Prevalence of AF at baseline was 18% (126 patients); the first episode occurred at a mean age of 43±17 years. Patients with AF were older, were more likely men, and had hypertension, renal dysfunction, cardiac devices, and more advanced right-sided and left-sided remodelling. During a median follow-up of 156 (81–240) months, 62 patients (11%) developed incident AF. At the last encounter, prevalence of AF was 28% (188 patients); of those, 63 (34%) had recurrent AF. Hospitalisation for heart failure (HF) occurred in 51 patients (7%). AF (HR 2.32, 95% CI 1.18 to 4.47; p=0.01) was independently associated with hospitalisation for HF. All-cause death occurred in 53 patients (8%); it was more frequent in those with AF in the univariable analysis, although it did not remain significant in the multivariable analysis.ConclusionsAF in EA develops at relatively young ages with one-third of the cohort exhibiting a recurrent pattern. Patients with AF had a higher prevalence of comorbidities and worse right-sided and left-sided cardiac remodelling. AF was independently associated with HF hospitalisation.
Peritext: A CRDT for Collaborative Rich Text Editing
Authors: Litt Geoffrey , Lim Sarah , Kleppmann Martin , van Hardenberg Peter 
Published: November 2022

Conflict-Free Replicated Data Types (CRDTs) support decentralized collaborative editing of shared data, enabling peer-to-peer sharing and flexible branching and merging workflows. While there is extensive work on CRDTs for plain text, much less is known about CRDTs for rich text with formatting. No algorithms have been published, and existing open-source implementations do not always preserve user intent.
In this paper, we describe a model of intent preservation in rich text editing, developed through a series of concurrent editing scenarios. We then describe Peritext, a CRDT algorithm for rich text that satisfies the criteria of our model. The key idea is to store formatting spans alongside the plaintext character sequence, linked to a stable identifier for the first and last character of each span, and then to derive the final formatted text from these spans in a deterministic way that ensures concurrent operations commute.
We have prototyped our algorithm in TypeScript, validated it using randomized property-based testing, and integrated it with an editor UI. We also prove that our algorithm ensures convergence, and demonstrate its causality preservation and intention preservation properties.
Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study
Authors: Cremer Paul C. , Geske Jeffrey B. , Owens Anjali , Jaber Wael A. , Harb Serge C. , Saberi Sara , Wang Andrew , Sherrid Mark , Naidu Srihari S. , Schaff Hartzell , Smedira Nicholas G. , Wang Qiuqing , Wolski Kathy , Lampl Kathy L. , Sehnert Amy J. , Nissen Steven E. , Desai Milind Y. 
Published: November 2022

Background:
In the randomized phase 3 VALOR-HCM study (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) of patients with obstructive hypertrophic cardiomyopathy, mavacamten reduced the need for septal reduction therapy. Because mavacamten improves ventricular compliance, this sub-study examined the effects of treatment with this cardiac myosin inhibitor on diastolic function.

Methods:
Symptomatic obstructive hypertrophic cardiomyopathy patients on maximally tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. At baseline and week 16, a resting and stress echocardiogram was performed with interpretation by a core laboratory. In this exploratory substudy, the principal end point was the change in parameters used to define the grade of diastolic function in patients treated with mavacamten and placebo. A related objective was to assess the proportion of patients with an improvement in diastolic function grade. A secondary aim was to assess for correlation between diastolic function parameters and the secondary end points from VALOR-HCM: New York Heart Association class, quality of life, and cardiac biomarkers.

Results:

Diastolic dysfunction grade was evaluable in 98 patients at baseline and week 16. Among patients treated with mavacamten, 29.4% (15 of 51) demonstrated improvement in diastolic function grade compared with 12.8% (6 of 47) patients with placebo (
P
=0.05). Average E/e’ ratio decreased significantly in patients treated with mavacamten (−3.4±5.3) compared with placebo (0.57±3.5;
P
<0.001). Indexed left atrial volumes (mL/m
2
) also decreased significantly in patients who received mavacamten (−5.2±7.8) compared with placebo (−0.51±8.1;
P
=0.005). After adjustment for change in left ventricular outflow tract gradient and mitral regurgitation, mavacamten was significantly associated with a decrease in average E/e’ ratio and indexed left atrial volumes. Change in average E/e’ ratio was significantly correlated with the secondary end points from VALOR-HCM.

Conclusions:
In this exploratory substudy, after 16 weeks of therapy, mavacamten improved diastolic function, and this change correlated with improvement in clinical and biomarker end points.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04349072.
Dose-Blinded Myosin Inhibition in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Outcomes Through 32 Weeks
Authors: Desai Milind Y. , Owens Anjali , Geske Jeffrey B. , Wolski Kathy , Saberi Sara , Wang Andrew , Sherrid Mark , Cremer Paul C. , Naidu Srihari S. , Smedira Nicholas G. , Schaff Hartzell , McErlean Ellen , Sewell Christina , Balasubramanyam Aarthi , Lampl Kathy , Sehnert Amy J. , Nissen Steven E. 
Published: November 2022

Background:
Septal reduction therapy (SRT) in patients with intractable symptoms from obstructive hypertrophic cardiomyopathy (oHCM) is associated with variable morbidity and mortality. The VALOR-HCM trial (A Study to Evaluate Mavacamten in Adults with Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) examined the effect of mavacamten on the need for SRT through week 32 in oHCM.

Methods:
A double-blind randomized placebo-controlled multicenter trial at 19 US sites included patients with oHCM on maximal tolerated medical therapy referred for SRT with left ventricular outflow tract gradient ≥50 mm Hg at rest or provocation (enrollment, July 2020–October 2021). The group initially randomized to mavacamten continued the drug for 32 weeks, and the placebo group crossed over to dose-blinded mavacamten from week 16 to week 32. Dose titrations were based on investigator-blinded echocardiographic assessment of left ventricular outflow tract gradient and left ventricular ejection fraction. The principal end point was the proportion of patients proceeding with SRT or remaining guideline eligible at 32 weeks in both treatment groups.

Results:
From the 112 randomized patients with oHCM, 108 (mean age, 60.3 years; 50% men; 94% in New York Heart Association class III/IV) qualified for week 32 evaluation (56 in the original mavacamten group and 52 in the placebo cross-over group). After 32 weeks, 6 of 56 patients (10.7%) in the original mavacamten group and 7 of 52 patients (13.5%) in the placebo cross-over group met SRT guideline criteria or elected to undergo SRT. After 32 weeks, a sustained reduction in resting left ventricular outflow tract gradient (−33.0 mm Hg [95% CI, −41.1 to −24.9]) and Valsalva left ventricular outflow tract gradient (−43.0 mm Hg [95% CI, −52.1 to −33.9]) was observed in the original mavacamten group. A similar reduction in resting (−33.7 mm Hg [95% CI, −42.2 to −25.2]) and Valsalva (−52.9 mm Hg [95% CI, −63.2 to −42.6]) gradients was quantified in the cross-over group after 16 weeks of mavacamten. After 32 weeks, improvement by ≥1 New York Heart Association class was observed in 48 of 53 patients (90.6%) in the original mavacamten group and 35 of 50 patients (70%) after 16 weeks in the cross-over group.

Conclusions:
In severely symptomatic patients with oHCM, 32 weeks of mavacamten treatment showed sustained reduction in the proportion proceeding to SRT or remaining guideline eligible, with similar effects observed in patients who crossed over from placebo after 16 weeks.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04349072.
Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial
Authors: Ostadal Petr , Rokyta Richard , Karasek Jiri , Kruger Andreas , Vondrakova Dagmar , Janotka Marek , Naar Jan , Smalcova Jana , Hubatova Marketa , Hromadka Milan , Volovar Stefan , Seyfrydova Miroslava , Jarkovsky Jiri , Svoboda Michal , Linhart Ales , Belohlavek Jan ,   for the ECMO-CS Investigators
Published: November 2022

Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used for circulatory support in patients with cardiogenic shock, although the evidence supporting its use in this context remains insufficient. The ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) aimed to compare immediate implementation of VA-ECMO versus an initially conservative therapy (allowing downstream use of VA-ECMO) in patients with rapidly deteriorating or severe cardiogenic shock.

Methods:
This multicenter, randomized, investigator-initiated, academic clinical trial included patients with either rapidly deteriorating or severe cardiogenic shock. Patients were randomly assigned to immediate VA-ECMO or no immediate VA-ECMO. Other diagnostic and therapeutic procedures were performed as per current standards of care. In the early conservative group, VA-ECMO could be used downstream in case of worsening hemodynamic status. The primary end point was the composite of death from any cause, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device at 30 days.

Results:

A total of 122 patients were randomized; after excluding 5 patients because of the absence of informed consent, 117 subjects were included in the analysis, of whom 58 were randomized to immediate VA-ECMO and 59 to no immediate VA-ECMO. The composite primary end point occurred in 37 (63.8%) and 42 (71.2%) patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively (hazard ratio, 0.72 [95% CI, 0.46–1.12];
P
=0.21). VA-ECMO was used in 23 (39%) of no early VA-ECMO patients. The 30-day incidence of resuscitated cardiac arrest (10.3.% versus 13.6%; risk difference, –3.2 [95% CI, –15.0 to 8.5]), all-cause mortality (50.0% versus 47.5%; risk difference, 2.5 [95% CI, –15.6 to 20.7]), serious adverse events (60.3% versus 61.0%; risk difference, –0.7 [95% CI, –18.4 to 17.0]), sepsis, pneumonia, stroke, leg ischemia, and bleeding was not statistically different between the immediate VA-ECMO and the no immediate VA-ECMO groups.

Conclusions:
Immediate implementation of VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock did not improve clinical outcomes compared with an early conservative strategy that permitted downstream use of VA-ECMO in case of worsening hemodynamic status.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02301819.
Prehospital Stroke Triage to Route Patients Directly to a Thrombectomy Center: New York City First‐Year Experience
Authors: Kim Brian D. , Morey Jacob R. , Marayati Naoum Fares , Matsoukas Stavros , Redlener Michael , Skliut Maryna , Wheelwright Danielle , Zhang Xiangnan , Tuhrim Stanley , De Leacy Reade , Stein Laura , Mocco J. , Fifi Johanna T. 
Published: November 2022

Background
New York City Emergency Medical Services implemented a prehospital triage protocol using a modified Speech–Los Angeles Motor Scale to identify patients with large‐vessel occlusion. Patients with Speech–Los Angeles Motor Scale ≥4 and last known well within 5 hours were routed to the nearest thrombectomy‐capable stroke center. Our aim was to describe the Speech–Los Angeles Motor Scale Triage Positive (STP) cohort and compare to a cohort that ultimately underwent endovascular thrombectomy (EVT) but were missed by the protocol (not triaged as Speech–Los Angeles Motor Scale positive [NSTP]).

Methods
A prospectively collected database identified patients arriving within 5 hours from last known well between April 2019 and March 2020. STP patients (N=145) were assessed for medical history, acute stroke time metrics, and clinical accuracy. NSTP (N=65) was subdivided into those who arrived directly to a thrombectomy‐capable stroke center (direct NSTP, N=30), and those transferred to a thrombectomy‐capable stroke center (transferred NSTP, N=35). Comparisons were made between the cohorts that underwent EVT.

Results

In the STP cohort, stroke was diagnosed in 110 of 145 (75.9%) patients: 31 hemorrhagic, 79 ischemic. There were 45 patients (31.0%) with large vessel occlusion and 34 (23.4%) underwent EVT. STP and NSTP subgroups had no difference in first medical contact‐to‐intravenous thrombolysis (≈90 minutes) despite STP patients taking 5 minutes longer to arrive. Ambulance travel times were similar (11 minutes). First medical contact‐to‐arterial access was similar in STP (137.9 minutes) and direct NSTP (137.9 minutes) groups but significantly shorter against transferred NSTP (252.1 minutes;
P
<0.01).

Conclusion
Through the protocol, a high percentage of identified patients with large‐vessel occlusion undergo EVT with no sacrifice to intravenous thrombolysis. The increased ambulance travel time has minimal effect. As more than half the NSTP cohort required transfer for EVT, these patients would have reaped the greatest benefit. Appropriate implementation that maintains the score specificity would prevent patients with high large‐vessel occlusion likelihood from delayed thrombectomy.
Management of Severe Cerebral Venous Sinus Thrombosis Using Mechanical Balloon Assisted Thrombectomy
Authors: Alwan Anand , Miraclin Angel T , Bal Deepti , Moses Vinu , Mannam Pavithra , Ahmed Munawwar , K.B Santhosh Babu , Muthukumar Kumar , Jasper Anitha , Mani Sunithi Elizabeth , Nair Shalini , Prabhakar Appaswamy Thirumal , Sivadasan Ajith , Mathew Vivek , Alexander Mathew , N Keshava Shyamkumar , Aaron Sanjith 
Published: November 2022

Background
Cerebral venous thrombosis is a devastating condition with, despite optimal medical management, a significant proportion deteriorating due to involvement of the deep venous system, worsening intracranial pressures, and hemorrhage. In this study, we report the characteristics, immediate and long‐term outcomes of mechanical thrombectomy (MT) using a Forgarty balloon catheter among patients with cerebral venous thrombosis.

Methods
A prospective study conducted at the Christian Medical College, Vellore over 5 years (February 2017–February 2022), wherein patients with cerebral venous thrombosis who had clinical deterioration despite best medical management and requiring MT were included. MT was performed through retrograde venous access through internal jugular veins using a Fogarty balloon. The primary outcome was composite end point of mortality and proportion of patients with favorable clinical response at last follow‐up, defined as a disability score in modified Rankin scale 0–2.

Results
Among 546 patients treated in our center during the study period, 57(10%), patients required MT. The median age of the study population was 33 years (interquartile range: 17–70 years) with equal gender predilection. Hemorrhagic venous infarction was seen in 28/57 (50%) patients. The mean duration between starting medical treatment and to MT was 43 hours (interquartile range: 5–260 hours) with the most common indication being clinical deterioration (70%). Five patients (9%) required decompressive hemicraniectomy. The mortality at discharge was 5% (n=3), and at last follow‐up visit was 7% (n=4). Younger patients without hemorrhagic venous infarction and non‐involvement of the frontoparietal lobes seem to benefit the most. Favorable functional outcome at discharge (modified Rankin scale 0–2) was seen in 65% which further improved to 77% at 1‐year follow‐up.

Conclusion
Balloon‐assisted MT is safe and effective in a subset of patients with severe cerebral venous thrombosis, with clinical deterioration despite optimal medical management.
Inter-Korean People-to-People Diplomacy: Social and Cultural Exchanges across the 38th Parallel
Authors: Ayhan Kadir Jun , Jang Siyeon 
Published: November 2022

Summary
The people of the two Koreas cannot communicate directly with one another. Since the early 1990s, South and North Korea have allowed a limited number of people-to-people exchanges. In this article, we map the South Korean government’s theories of change regarding inter-Korean exchanges based on policy documents and semi-structured interviews with five high-level Ministry of Unification bureaucrats. We also explore the outcomes of inter-Korean exchanges, building on ten South Korean participants’ insights. Our findings suggest that the primary goals of inter-Korean social and cultural exchanges have been to expand contact between the two Koreas to alleviate the sense of mutual alienation, to increase empathy and, in turn, to reduce tensions and establish peace on the Korean Peninsula. Participant interviews reveal that direct interpersonal interaction between South and North Koreans reinforces the idea of a superordinate Korean group identity.
The role of iron metabolism in chronic diseases related to obesity
Authors: Qiu Fangyi , Wu Lei , Yang Guang , Zhang Cong , Liu Xiaofang , Sun Xiance , Chen Xin , Wang Ningning 
Published: November 2022

AbstractObesity is one of the major public health problems threatening the world, as well as a potential risk factor for chronic metabolic diseases. There is growing evidence that iron metabolism is altered in obese people, however, the highly refined regulation of iron metabolism in obesity and obesity-related complications is still being investigated. Iron accumulation can affect the body’s sensitivity to insulin, Type 2 diabetes, liver disease and cardiovascular disease. This review summarized the changes and potential mechanisms of iron metabolism in several chronic diseases related to obesity, providing new clues for future research.
Feasibility of contrast-enhanced ultrasonography (CEUS) in evaluating renal microvascular perfusion in pediatric patients
Authors: Zhang Wei , Yi Huiming , Cai Baohuan , He Yonghua , Huang Shi , Zhang Yu 
Published: November 2022

Abstract
Background
Changes in renal microvascular perfusion are involved in several kidney diseases. Contrast-enhanced ultrasonography (CEUS) quantitative analysis can enable the estimation of renal microvascular perfusion non-invasively. However, to date, few pediatric patients with renal disease have been subjected to CEUS quantitative analysis. This study aimed to explore the feasibility of CEUS in evaluating renal microvascular perfusion in pediatric patients and paving its way to clinical practice.

Methods
Seventeen pediatric patients with chronic kidney disease (CKD) and five children without kidney disease were consecutively examined using CEUS. Quantitative analysis of CEUS images based on time-intensity curve (TIC) fittings was performed using specialized software. Quantitative parameters of wash-in microvascular blood flow, including A, k, B, and TtoPk, were generated from three regions of interest (ROIs) each in the cortex and medulla of each kidney.

Results
CEUS was performed in all children successfully and safely without the use of sedatives. All parameters (A, B, k, and TtoPk) demonstrated no statistical differences among the three sampling ROIs in the renal cortex and medulla. All parameters (A, B, k, and TtoPk) showed no statistical differences between the left and right sides of kidneys both in cortices and medullas. Comparing with patients with CKD stage 3–5, both control group and patients with CKD stage 1–2 had significantly higher values of parameter A in the renal cortex (p = 0.025 and p = 0.031, respectively). In control group and patients stage 1–2, the values of parameters k in the renal cortices were significantly higher than that in the renal medullas, while in patients with CKD stage 3–5, parameter k showed no statistically significant differences between the renal cortex and medulla (p = 0.173).

Conclusion
CEUS is safe and practicable in pediatric patients with chronic kidney disease. Renal microvascular perfusion estimated by CEUS could be a robust approach in the evaluation of pediatric renal diseases. Parameters A and k derived from CEUS quantitative analysis can provide great potential in non-invasive assessment of renal microvascular perfusion impairment in pediatric CKD.
A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century
Authors: Alipour Abbas , Hantoushzadeh Sedigheh , Hessami Kamran , Saleh Maasoumeh , Shariat Mamak , Yazdizadeh Bahareh , Babaniamansour Sepideh , Ghamari Azin , Aghajanian Sepehr , Moradi Kamyar , Abdolmaleki Abolfazl Shirdel , Emami Zahra 
Published: November 2022

AbstractIntroductionCaesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates.Material and methodsThis retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels.ResultsThe C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1,p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75,p = 0.005), Europe (r = -0.12,p < 0.001), South-East Asia (r = -0.41,p = 0.01), and Western Pacific (r = -0.13,p = 0.02), a direct correlation in America (r = 0.06,p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01,p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15,p < 0.001) and lower-middle (r = -0.24,p < 0.001) income levels, directly associated in high-income regions (r = 0.02,p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off.ConclusionsThis study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.