Pub Date : 2024-05-24DOI: 10.1016/j.ijcrp.2024.200290
Abdullahi Adejare, Ahmed Oloyo, Yusuf Dahud, Morufat Adeshina, Abiola Agbaje, Clinton Ejim, Khadijah Ismail-Badmus, Smith Jaja
Background
Hypertension is associated with cardiovascular dysfunction, dysregulation of the antioxidant system and alteration of the level of some enzymes in the metabolic pathway. The possible modulatory effect of acute renal denervation (ARD) on cardiovascular function and the antioxidant system is still a subject of intense debate. This study sought to ascertain the ameliorative effects of ARD on cardiovascular parameters, antioxidant system, creatine kinase and lactate dehydrogenase levels.
Methods
Thirty-six Sprague-Dawley rats (5–6 weeks old) were divided into 6 groups of 6 animals each consisting of Normal Salt, High Salt, Normal Salt + Sham Denervation, High Salt + Sham Denervation, Normal Salt + Renal Denervation and High Salt + Renal Denervation. Induction of hypertension with 8 % salt in the diet lasted for 8 weeks. Renal or Sham denervation was thereafter done on selected groups. At the end of the experimental period, cardiovascular parameters, plasma antioxidant status, plasma creatine kinase (CK) and lactate dehydrogenase (LDH) levels were assessed. Significance level was set at p < 0.05.
Results
Salt-loading significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), rate pressure product (RPP) while reducing superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT). Acute renal denervation significantly (p < 0.0001) reduced SBP, DBP, MABP, RPP, LDH and norepinephrine level while increasing SOD, GSH and CAT. ARD did not significantly alter CK level.
Conclusion
Acute renal denervation, by reducing sympathetic activity, ameliorates cardiovascular and antioxidant functions as well as reduces LDH level without significantly altering CK level in salt-induced hypertension.
{"title":"Renal denervation ameliorated salt-induced hypertension by improving cardiac work, cardiac enzyme and oxidative balance in Sprague-Dawley rats","authors":"Abdullahi Adejare, Ahmed Oloyo, Yusuf Dahud, Morufat Adeshina, Abiola Agbaje, Clinton Ejim, Khadijah Ismail-Badmus, Smith Jaja","doi":"10.1016/j.ijcrp.2024.200290","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200290","url":null,"abstract":"<div><h3>Background</h3><p>Hypertension is associated with cardiovascular dysfunction, dysregulation of the antioxidant system and alteration of the level of some enzymes in the metabolic pathway. The possible modulatory effect of acute renal denervation (ARD) on cardiovascular function and the antioxidant system is still a subject of intense debate. This study sought to ascertain the ameliorative effects of ARD on cardiovascular parameters, antioxidant system, creatine kinase and lactate dehydrogenase levels.</p></div><div><h3>Methods</h3><p>Thirty-six Sprague-Dawley rats (5–6 weeks old) were divided into 6 groups of 6 animals each consisting of Normal Salt, High Salt, Normal Salt + Sham Denervation, High Salt + Sham Denervation, Normal Salt + Renal Denervation and High Salt + Renal Denervation. Induction of hypertension with 8 % salt in the diet lasted for 8 weeks. Renal or Sham denervation was thereafter done on selected groups. At the end of the experimental period, cardiovascular parameters, plasma antioxidant status, plasma creatine kinase (CK) and lactate dehydrogenase (LDH) levels were assessed. Significance level was set at p < 0.05.</p></div><div><h3>Results</h3><p>Salt-loading significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), rate pressure product (RPP) while reducing superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT). Acute renal denervation significantly (p < 0.0001) reduced SBP, DBP, MABP, RPP, LDH and norepinephrine level while increasing SOD, GSH and CAT. ARD did not significantly alter CK level.</p></div><div><h3>Conclusion</h3><p>Acute renal denervation, by reducing sympathetic activity, ameliorates cardiovascular and antioxidant functions as well as reduces LDH level without significantly altering CK level in salt-induced hypertension.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200290"},"PeriodicalIF":2.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000552/pdfft?md5=bde730d7d3ea10844068f0e764006c71&pid=1-s2.0-S2772487524000552-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141095656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-23DOI: 10.1016/j.ijcrp.2024.200289
Mirza Faris Ali Baig , Kalyan Chaliki
Background
Third-degree atrioventricular (AV) blocks are rare but cause significant symptoms and require immediate intervention. Coronary artery disease (CAD) is felt to be the most common etiology. Although smoking is a prominent risk factor for CAD, there is a paucity of data assessing the direct effect of smoking on third-degree AV block.
Methods
We performed a retrospective cohort study on adult-weighted admissions in 2019–2020 with a primary diagnosis of third-degree AV block and a history of smoking using the National Inpatient Sample (NIS) database. In-hospital mortality, rates of pacemaker insertion, cardiogenic shock, cardiac arrest, acute kidney injury (AKI), stroke, tracheal intubation, mechanical ventilation, mechanical circulatory support, vasopressor use, length of stay (LOS), and total hospitalization costs were analyzed using regression analysis. We performed a secondary analysis using propensity score matching to confirm the results.
Results
A total of 77,650 admissions met inclusion criteria (33,625 females [43.3 %], 58,315. Caucasians [75 %], 7030 African American [9 %], 6155 Hispanic [7.9 %]; mean [SD] age 75.4.[10.2] years) before propensity matching. A total of 29,380 (37.8 %) patients with AV block were smokers.A total of 5560 patients with and without a history of smoking were matched for the analysis. Smokers had.decreased odds of mortality (aOR, 0.59; CI, 0.44–0.78; p < 0.001), cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, shorter LOS, and lower total hospital costs in both the multivariable regression and propensity-matched analyses.
Conclusion
Third-degree AV block had lower in-hospital mortality, cardiogenic shock, cardiac arrest, LOS, and total hospitalization cost in patients with smoking history.
{"title":"The impact of smoking on third-degree atrioventricular block outcomes: A propensity-matched analysis","authors":"Mirza Faris Ali Baig , Kalyan Chaliki","doi":"10.1016/j.ijcrp.2024.200289","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200289","url":null,"abstract":"<div><h3>Background</h3><p>Third-degree atrioventricular (AV) blocks are rare but cause significant symptoms and require immediate intervention. Coronary artery disease (CAD) is felt to be the most common etiology. Although smoking is a prominent risk factor for CAD, there is a paucity of data assessing the direct effect of smoking on third-degree AV block.</p></div><div><h3>Methods</h3><p>We performed a retrospective cohort study on adult-weighted admissions in 2019–2020 with a primary diagnosis of third-degree AV block and a history of smoking using the National Inpatient Sample (NIS) database. In-hospital mortality, rates of pacemaker insertion, cardiogenic shock, cardiac arrest, acute kidney injury (AKI), stroke, tracheal intubation, mechanical ventilation, mechanical circulatory support, vasopressor use, length of stay (LOS), and total hospitalization costs were analyzed using regression analysis. We performed a secondary analysis using propensity score matching to confirm the results.</p></div><div><h3>Results</h3><p>A total of 77,650 admissions met inclusion criteria (33,625 females [43.3 %], 58,315. Caucasians [75 %], 7030 African American [9 %], 6155 Hispanic [7.9 %]; mean [SD] age 75.4.[10.2] years) before propensity matching. A total of 29,380 (37.8 %) patients with AV block were smokers.A total of 5560 patients with and without a history of smoking were matched for the analysis. Smokers had.decreased odds of mortality (aOR, 0.59; CI, 0.44–0.78; p < 0.001), cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, shorter LOS, and lower total hospital costs in both the multivariable regression and propensity-matched analyses.</p></div><div><h3>Conclusion</h3><p>Third-degree AV block had lower in-hospital mortality, cardiogenic shock, cardiac arrest, LOS, and total hospitalization cost in patients with smoking history.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200289"},"PeriodicalIF":2.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000540/pdfft?md5=e7d46c6285150833aa138c55c4795a46&pid=1-s2.0-S2772487524000540-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141095685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1016/j.ijcrp.2024.200288
Mohammed Mecha , Yordanos Sisay , Tsegaye Melaku
Background
Diabetes mellitus (DM) is a chronic metabolic condition that considerably increases the risk of stroke. According to studies, stroke patients with diabetes have a greater mortality rate and are more likely to have repeated strokes than those without diabetes. Therefore, this systematic review and meta-analysis determined the pooled prevalence of diabetes mellitus among stroke patients in Ethiopia.
Methods
The searches were conducted in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until November 30, 2023, addressing the prevalence of diabetes mellitus among stroke patients were identified. EndNote Citation Manager software version X9 for Windows was used to collect and organize the search outcomes and remove duplicate articles. Relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for outcome measures analyses and subgrouping.
Results
Twenty-eight research articles were included in the final analysis. The studies included an evaluation of 6589 stroke patients, among whom 645 were diagnosed with DM. This resulted in a pooled prevalence estimate of 10 % (95 % CI: 8–13 %)] DM. The subgroup analysis by region revealed that the highest pooled prevalence of DM was 16 % [95 % CI: (9 %–24 %)], which was from the Oromia region, followed by Addis Ababa city 12 % [95 % CI: (10 %–14 %)]. The other three regions (Tigray, South Nations nationalities and people's region and Amhara) had similar pooled prevalence of DM 7 % [95 % CI: (3 %–10 %)], 7 % [95 % CI: (3 %–11 %)], 7 % [95 % CI: (4 %–9%)], respectively.
Conclusion
Overall, the prevalence of DM among stroke patients is high. Notably, the Oromia region exhibited the highest prevalence rate at 16 %, followed by Addis Ababa city at 12 %. Conversely, the other three regions displayed similar rates of 7 %. These findings underscore the critical importance of screening and managing DM in stroke patients.
{"title":"Prevalence of diabetes mellitus among stroke patients in Ethiopia: Systematic review and meta-analysis","authors":"Mohammed Mecha , Yordanos Sisay , Tsegaye Melaku","doi":"10.1016/j.ijcrp.2024.200288","DOIUrl":"10.1016/j.ijcrp.2024.200288","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes mellitus (DM) is a chronic metabolic condition that considerably increases the risk of stroke. According to studies, stroke patients with diabetes have a greater mortality rate and are more likely to have repeated strokes than those without diabetes. Therefore, this systematic review and meta-analysis determined the pooled prevalence of diabetes mellitus among stroke patients in Ethiopia.</p></div><div><h3>Methods</h3><p>The searches were conducted in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until November 30, 2023, addressing the prevalence of diabetes mellitus among stroke patients were identified. EndNote Citation Manager software version X<sub>9</sub> for Windows was used to collect and organize the search outcomes and remove duplicate articles. Relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for outcome measures analyses and subgrouping.</p></div><div><h3>Results</h3><p>Twenty-eight research articles were included in the final analysis. The studies included an evaluation of 6589 stroke patients, among whom 645 were diagnosed with DM. This resulted in a pooled prevalence estimate of 10 % (95 % CI: 8–13 %)] DM. The subgroup analysis by region revealed that the highest pooled prevalence of DM was 16 % [95 % CI: (9 %–24 %)], which was from the Oromia region, followed by Addis Ababa city 12 % [95 % CI: (10 %–14 %)]. The other three regions (Tigray, South Nations nationalities and people's region and Amhara) had similar pooled prevalence of DM 7 % [95 % CI: (3 %–10 %)], 7 % [95 % CI: (3 %–11 %)], 7 % [95 % CI: (4 %–9%)], respectively.</p></div><div><h3>Conclusion</h3><p>Overall, the prevalence of DM among stroke patients is high. Notably, the Oromia region exhibited the highest prevalence rate at 16 %, followed by Addis Ababa city at 12 %. Conversely, the other three regions displayed similar rates of 7 %. These findings underscore the critical importance of screening and managing DM in stroke patients.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200288"},"PeriodicalIF":2.3,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000539/pdfft?md5=73edd33b2f51a8674bf14aafe0191329&pid=1-s2.0-S2772487524000539-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.1016/j.ijcrp.2024.200286
Tian-Kai Shan , Ling-Ling Qian , Xu-Dong Han , Bo Deng , Ling-Feng Gu , Ze-Mu Wang , Ye He , Ting Zhu , Peng Jing , Qi-Ming Wang , Zi-Dun Wang , Ru-Xing Wang , Si-Bo Wang , Lian-Sheng Wang
Background
Ventricular arrhythmias (VAs) mainly occur in the early post-myocardial infarction (MI) period. However, studies examining the association between total myocardial ischemia time interval and the risk of new-onset VAs during a long-term follow-up are scarce.
Methods
This study (symptom-to-balloon time and VEntricular aRrhYthmias in patients with STEMI, VERY-STEMI study) was a multicenter, observational cohort and real-world study, which included patients with ST-segment elevation MI (STEMI) undergoing percutaneous coronary intervention (PCI). The primary endpoint was cumulative new-onset VAs during follow-up. The secondary endpoints were the major adverse cardiovascular events (MACE) and changes in left ventricular ejection fraction (ΔLVEF, %).
Results
A total of 517 patients with STEMI were included and 236 primary endpoint events occurred. After multivariable adjustments, compared to patients with S2BT of 24 h-7d, those with S2BT ≤ 24 h and S2BT > 7d had a lower risk of primary endpoint. RCS showed an inverted U-shaped relationship between S2BT and the primary endpoint, with an S2BT of 68.4 h at the inflection point. Patients with S2BT ≤ 24 h were associated with a lower risk of MACE and a 4.44 increase in LVEF, while there was no significant difference in MACE and LVEF change between the S2BT > 7d group and S2BT of 24 h-7d group.
Conclusions
S2BT of 24 h-7d in STEMI patients was associated with a higher risk of VAs during follow-up. There was an inverted U-shaped relationship between S2BT and VAs, with the highest risk at an S2BT of 68.4 h.
{"title":"Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study","authors":"Tian-Kai Shan , Ling-Ling Qian , Xu-Dong Han , Bo Deng , Ling-Feng Gu , Ze-Mu Wang , Ye He , Ting Zhu , Peng Jing , Qi-Ming Wang , Zi-Dun Wang , Ru-Xing Wang , Si-Bo Wang , Lian-Sheng Wang","doi":"10.1016/j.ijcrp.2024.200286","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200286","url":null,"abstract":"<div><h3>Background</h3><p>Ventricular arrhythmias (VAs) mainly occur in the early post-myocardial infarction (MI) period. However, studies examining the association between total myocardial ischemia time interval and the risk of new-onset VAs during a long-term follow-up are scarce.</p></div><div><h3>Methods</h3><p>This study (symptom-to-balloon time and <strong>VE</strong>ntricular a<strong>R</strong>rh<strong>Y</strong>thmias in patients with <strong>STEMI</strong>, VERY-STEMI study) was a multicenter, observational cohort and real-world study, which included patients with ST-segment elevation MI (STEMI) undergoing percutaneous coronary intervention (PCI). The primary endpoint was cumulative new-onset VAs during follow-up. The secondary endpoints were the major adverse cardiovascular events (MACE) and changes in left ventricular ejection fraction (ΔLVEF, %).</p></div><div><h3>Results</h3><p>A total of 517 patients with STEMI were included and 236 primary endpoint events occurred. After multivariable adjustments, compared to patients with S2BT of 24 h-7d, those with S2BT ≤ 24 h and S2BT > 7d had a lower risk of primary endpoint. RCS showed an inverted U-shaped relationship between S2BT and the primary endpoint, with an S2BT of 68.4 h at the inflection point. Patients with S2BT ≤ 24 h were associated with a lower risk of MACE and a 4.44 increase in LVEF, while there was no significant difference in MACE and LVEF change between the S2BT > 7d group and S2BT of 24 h-7d group.</p></div><div><h3>Conclusions</h3><p>S2BT of 24 h-7d in STEMI patients was associated with a higher risk of VAs during follow-up. There was an inverted U-shaped relationship between S2BT and VAs, with the highest risk at an S2BT of 68.4 h.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200286"},"PeriodicalIF":2.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000515/pdfft?md5=3921e323f95c87618314696ca25b5983&pid=1-s2.0-S2772487524000515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141067380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertensive crises are a leading cause of visits to emergency departments, carrying grave health implications. A significant number of patients presenting with these crises have a known history of hypertension.
Objective
The aim of this systematic review and meta-analysis is to examine the combined prevalence of hypertensive crises among individuals with either a history of hypertension or unknown status (newly diagnosed with a hypertensive crisis).
Methods
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the Prospective Register of Systematic Reviews (PROSPERO). Research databases, including PubMed, Embase, Scopus, Africa Index Medicus, Science Direct, HINARI, and Google Scholar, were systematically searched. Study quality was evaluated using the Newcastle–Ottawa Scale, while publication bias was explored through Egger's regression test, funnel plots, and sensitivity analyses. Data collection adhered to the Joanna Briggs Institute (JBI) format. Meta-analysis was performed using STATA version 17, employing the random-effects DerSimonian–Laird model.
Results
Amongst the 15 studies analyzed, the application of the random-effects DerSimonian-Laird statistical model indicated that the prevalence of hypertensive crisis was determined to be 9.09 %, with a 95 % confidence interval (CI) ranging from 7.41 % to 10.77 %. Factors such as poor medication adherence (POR 5.00; 95 % CI: 3.61, 6.93), patients with comorbidities (POR 4.73; 95 % CI: 3.29, 6.80), patients with a history of hypertension (POR 5.64; 95 % CI: 4.57, 6.94), patients aged >65 (POR 2.77; 95 % CI: 2.16, 6.59), and excessive alcohol intake (POR 5.01; 95 % CI: 3.82, 6.58) were associated with higher odds of hypertensive crisis.
Conclusion
The findings indicate a markedly higher incidence of hypertensive crisis among hospital-presenting patients in Africa. Factors such as medication non-adherence, co-existing comorbidities, historical hypertension, being over 65, and alcohol misuse significantly contribute to this condition. These insights call for a comprehensive healthcare strategy that targets both the management of hypertension and its complications, aiming to improve the overall health outcomes of affected patients.
{"title":"Hypertensive crisis and its predictors in Africa: Systematic review and meta-analysis, 2024","authors":"Ousman Adal , Natnael Kebede , Amare Mebrat Delie , Eyob Ketema Bogale , Tadele Fentabil Anagaw , Misganaw Guadie Tiruneh , Eneyew Talie Fenta , Destaw Endeshaw","doi":"10.1016/j.ijcrp.2024.200285","DOIUrl":"10.1016/j.ijcrp.2024.200285","url":null,"abstract":"<div><h3>Introduction</h3><p>Hypertensive crises are a leading cause of visits to emergency departments, carrying grave health implications. A significant number of patients presenting with these crises have a known history of hypertension.</p></div><div><h3>Objective</h3><p>The aim of this systematic review and meta-analysis is to examine the combined prevalence of hypertensive crises among individuals with either a history of hypertension or unknown status (newly diagnosed with a hypertensive crisis).</p></div><div><h3>Methods</h3><p>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the Prospective Register of Systematic Reviews (PROSPERO). Research databases, including PubMed, Embase, Scopus, Africa Index Medicus, Science Direct, HINARI, and Google Scholar, were systematically searched. Study quality was evaluated using the Newcastle–Ottawa Scale, while publication bias was explored through Egger's regression test, funnel plots, and sensitivity analyses. Data collection adhered to the Joanna Briggs Institute (JBI) format. Meta-analysis was performed using STATA version 17, employing the random-effects DerSimonian–Laird model.</p></div><div><h3>Results</h3><p>Amongst the 15 studies analyzed, the application of the random-effects DerSimonian-Laird statistical model indicated that the prevalence of hypertensive crisis was determined to be 9.09 %, with a 95 % confidence interval (CI) ranging from 7.41 % to 10.77 %. Factors such as poor medication adherence (POR 5.00; 95 % CI: 3.61, 6.93), patients with comorbidities (POR 4.73; 95 % CI: 3.29, 6.80), patients with a history of hypertension (POR 5.64; 95 % CI: 4.57, 6.94), patients aged >65 (POR 2.77; 95 % CI: 2.16, 6.59), and excessive alcohol intake (POR 5.01; 95 % CI: 3.82, 6.58) were associated with higher odds of hypertensive crisis.</p></div><div><h3>Conclusion</h3><p>The findings indicate a markedly higher incidence of hypertensive crisis among hospital-presenting patients in Africa. Factors such as medication non-adherence, co-existing comorbidities, historical hypertension, being over 65, and alcohol misuse significantly contribute to this condition. These insights call for a comprehensive healthcare strategy that targets both the management of hypertension and its complications, aiming to improve the overall health outcomes of affected patients.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200285"},"PeriodicalIF":2.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000503/pdfft?md5=0150cd9ba5dcf624a11bc4150adad1ab&pid=1-s2.0-S2772487524000503-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1016/j.ijcrp.2024.200283
Ruihuan Shen , Xuantong Guo , Tong Zou , Lihong Ma
Background
Metabolic syndrome (MetS) could increase the risk of cardiovascular disease (CVD) by 2-fold. Ideal control of modifiable risk factors in Life's Simple 7 (LS7) could reduce the CVD risk among the general population. This study aimed to investigate the effects of controlling modifiable risk factors using LS7 in MetS to prevent CVD.
Methods
44463 participants in NHANES 1999–2018 were included. The primary endpoint was a composite of CVD, including angina pectoris, coronary artery disease, myocardial infarction, congestive heart failure, and stroke. Multivariable weighted logistic regression analyses estimated the associations. The diagnosis of MetS complied with Harmonized International Diabetes Federation Criteria. Measurement of modifiable risk factors used the 2010 American Heart Association LS7 guideline and was indicated by cardiovascular health (CVH).
Results
14034 individuals were diagnosed with MetS. 4835 participants had CVD. The weighted mean CVH was 8.06 ± 0.03. Intermediate and poor CVH were associated with increased risk for CVD in participants with similar metabolic states compared to ideal CVH. By taking participants with metabolic health and ideal CVH as health control, participants with MetS and poor CVH were demonstrated to have a 3-fold (adjusted odds ratio, 4.00; 95 % confidence interval, 3.21–4.98) greater risk for CVD. Notably, under the condition of ideal CVH, the risk of having CVD was comparable between metabolic health and MetS after fully adjusted.
Conclusion
Ideal control of Life's Simple 7 in metabolic syndrome contributes to a comparable risk of cardiovascular disease with healthy subjects. LS7 could be recognized as a guideline for secondary prevention in MetS.
{"title":"Modifiable risk factors and metabolic health in risk of cardiovascular disease among US adults: A nationwide cross-sectional study","authors":"Ruihuan Shen , Xuantong Guo , Tong Zou , Lihong Ma","doi":"10.1016/j.ijcrp.2024.200283","DOIUrl":"10.1016/j.ijcrp.2024.200283","url":null,"abstract":"<div><h3>Background</h3><p>Metabolic syndrome (MetS) could increase the risk of cardiovascular disease (CVD) by 2-fold. Ideal control of modifiable risk factors in Life's Simple 7 (LS7) could reduce the CVD risk among the general population. This study aimed to investigate the effects of controlling modifiable risk factors using LS7 in MetS to prevent CVD.</p></div><div><h3>Methods</h3><p>44463 participants in NHANES 1999–2018 were included. The primary endpoint was a composite of CVD, including angina pectoris, coronary artery disease, myocardial infarction, congestive heart failure, and stroke. Multivariable weighted logistic regression analyses estimated the associations. The diagnosis of MetS complied with Harmonized International Diabetes Federation Criteria. Measurement of modifiable risk factors used the 2010 American Heart Association LS7 guideline and was indicated by cardiovascular health (CVH).</p></div><div><h3>Results</h3><p>14034 individuals were diagnosed with MetS. 4835 participants had CVD. The weighted mean CVH was 8.06 ± 0.03. Intermediate and poor CVH were associated with increased risk for CVD in participants with similar metabolic states compared to ideal CVH. By taking participants with metabolic health and ideal CVH as health control, participants with MetS and poor CVH were demonstrated to have a 3-fold (adjusted odds ratio, 4.00; 95 % confidence interval, 3.21–4.98) greater risk for CVD. Notably, under the condition of ideal CVH, the risk of having CVD was comparable between metabolic health and MetS after fully adjusted.</p></div><div><h3>Conclusion</h3><p>Ideal control of Life's Simple 7 in metabolic syndrome contributes to a comparable risk of cardiovascular disease with healthy subjects. LS7 could be recognized as a guideline for secondary prevention in MetS.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"22 ","pages":"Article 200283"},"PeriodicalIF":2.3,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000485/pdfft?md5=2816abd5ac7bf2208c565b70b2f3afb5&pid=1-s2.0-S2772487524000485-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiovascular diseases (CVDs) are the leading causes of global mortality and disability. Several studies demonstrated that metabolic risk factors increase cardiovascular mortality. The aim of this study is to examine CVDs deaths and population attributable fractions (PAFs) of their metabolic risk factors in Iran.
Methods
This is a study on 8621 participants aged 45–75 years and older, recruited in the repeated measurement phase of the Golestan cohort study (GCS) in northeast of Iran. The Cox proportional hazards model was used to determine the adjusted hazard ratios (HRs). PAFs were calculated to enumerate CVDs mortality avoidable in the population if metabolic risk factors were eliminated.
Results
The mortality of CVDs was attributable to metabolic factors, including high waist circumference (PAF, 28 %, [95 % CI: 16%–38 %]), high fasting blood sugar (FBS) (20 %, [15%–24 %]), overweight and obesity (19 %, [8%–28 %]), high blood pressure (16 %, [11%–21 %]), high low-density lipoprotein cholesterol (LDL-C) (8 %, [1%–15 %]), and high triglyceride (TG) (7 %, [3%–11 %]). Collectively, these metabolic risk factors accounted for 50 % of CVDs deaths. Females (67 %, [50%–78 %]) had a higher joint PAF of metabolic risk factors compared to males (43 %, [27%–55 %]).
Conclusions
The pattern of CVDs mortality attributable to metabolic risk factors in this study is not the same as similar studies in other parts of the world and previous studies in Iran. It is imperative that CVDs risk factors be specifically evaluated and addressed in various populations due to variety in geographical and temporal patterns in contribution of metabolic risk factors to CVD mortality.
{"title":"The contribution of metabolic risk factors to cardiovascular mortality in Golestan cohort study: Population attributable fraction estimation","authors":"Fateme Gorgani , Maryam Sharafkhah , Sahar Masoudi , Hossein Poustchi , Alireza Delavari , Alireza Sadjadi , Gholamreza Roshandel , Masoud Khoshnia , Layli Eslami , Negar Rezaei , Sadaf G. Sepanlou","doi":"10.1016/j.ijcrp.2024.200279","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200279","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular diseases (CVDs) are the leading causes of global mortality and disability. Several studies demonstrated that metabolic risk factors increase cardiovascular mortality. The aim of this study is to examine CVDs deaths and population attributable fractions (PAFs) of their metabolic risk factors in Iran.</p></div><div><h3>Methods</h3><p>This is a study on 8621 participants aged 45–75 years and older, recruited in the repeated measurement phase of the Golestan cohort study (GCS) in northeast of Iran. The Cox proportional hazards model was used to determine the adjusted hazard ratios (HRs). PAFs were calculated to enumerate CVDs mortality avoidable in the population if metabolic risk factors were eliminated.</p></div><div><h3>Results</h3><p>The mortality of CVDs was attributable to metabolic factors, including high waist circumference (PAF, 28 %, [95 % CI: 16%–38 %]), high fasting blood sugar (FBS) (20 %, [15%–24 %]), overweight and obesity (19 %, [8%–28 %]), high blood pressure (16 %, [11%–21 %]), high low-density lipoprotein cholesterol (LDL-C) (8 %, [1%–15 %]), and high triglyceride (TG) (7 %, [3%–11 %]). Collectively, these metabolic risk factors accounted for 50 % of CVDs deaths. Females (67 %, [50%–78 %]) had a higher joint PAF of metabolic risk factors compared to males (43 %, [27%–55 %]).</p></div><div><h3>Conclusions</h3><p>The pattern of CVDs mortality attributable to metabolic risk factors in this study is not the same as similar studies in other parts of the world and previous studies in Iran. It is imperative that CVDs risk factors be specifically evaluated and addressed in various populations due to variety in geographical and temporal patterns in contribution of metabolic risk factors to CVD mortality.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200279"},"PeriodicalIF":2.3,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000448/pdfft?md5=bf3968b73ec7e238e050d4c9809edc67&pid=1-s2.0-S2772487524000448-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.ijcrp.2024.200282
Fakhar Latif , Muhammad Moiz Nasir , Komail K. Meer , Syed Husain Farhan , Huzaifa Ahmad Cheema , Adam Bilal Khan , Mohammad Umer , Wajeeh Ur Rehman , Adeel Ahmad , Muhammad Aslam Khan , Talal Almas , Sebastian Mactaggart , Abdulqadir J. Nashwan , Raheel Ahmed , Sourbha S. Dani
Background
Dementia is a recognized complication of atrial fibrillation (AF). Oral anticoagulant (OAC) therapy can potentially be protective against this complication.
Methods
A comprehensive search of MEDLINE and Embase for comparative observational studies reporting the efficacy of OAC therapy for the incidence of dementia in patients with AF was conducted from its inception until March 2023. Studies that had patients with prior use of OAC or with a previous history of dementia were excluded.
Results
A total of 22 studies were included in this review involving 617,204 participants. The pooled analysis revealed that OAC therapy, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), was associated with a reduced incidence of dementia in AF patients. Specifically, compared to non-OAC treatment, OACs demonstrated a significant reduction in dementia incidence (HR 0.68, 95 % CI [0.58, 0.80], p < 0.00001), with similar findings observed for DOACs (HR 0.69, 95 % CI [0.51, 0.94], p = 0.02) and VKAs (HR 0.73, 95 % CI [0.56, 0.95], p = 0.02). The comparison of DOAC vs VKA revealed that DOACs are associated with reduced risk of dementia (HR 0.87, 95 % CI [0.79, 0.96], p = 0.004).
Conclusion
Our SR and meta-analysis showed that the use of OAC therapy is associated with a reduced risk of dementia in individuals with AF. However, our results are limited by the potential influence of confounding bias and significant heterogeneity in the analyses.
背景痴呆是公认的心房颤动（房颤）并发症。方法 对 MEDLINE 和 Embase 进行了全面检索，以寻找报告 OAC 治疗对房颤患者痴呆症发病率疗效的比较观察性研究。结果 本综述共纳入 22 项研究，涉及 617204 名参与者。汇总分析显示，包括直接口服抗凝剂 (DOAC) 和维生素 K 拮抗剂 (VKAs) 在内的 OAC 治疗与降低房颤患者痴呆症发病率有关。具体而言，与非 OAC 治疗相比，OAC 可显著降低痴呆症发病率（HR 0.68，95 % CI [0.58，0.80]，p < 0.00001），DOAC（HR 0.69，95 % CI [0.51，0.94]，p = 0.02）和 VKAs（HR 0.73，95 % CI [0.56，0.95]，p = 0.02）也有类似结果。我们的 SR 和荟萃分析表明，使用 OAC 治疗与降低房颤患者的痴呆风险有关。然而，由于混杂偏倚的潜在影响和分析中的显著异质性，我们的结果受到了限制。
{"title":"The effect of oral anticoagulants on the incidence of dementia in patients with atrial fibrillation: A systematic review and meta-analysis","authors":"Fakhar Latif , Muhammad Moiz Nasir , Komail K. Meer , Syed Husain Farhan , Huzaifa Ahmad Cheema , Adam Bilal Khan , Mohammad Umer , Wajeeh Ur Rehman , Adeel Ahmad , Muhammad Aslam Khan , Talal Almas , Sebastian Mactaggart , Abdulqadir J. Nashwan , Raheel Ahmed , Sourbha S. Dani","doi":"10.1016/j.ijcrp.2024.200282","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200282","url":null,"abstract":"<div><h3>Background</h3><p>Dementia is a recognized complication of atrial fibrillation (AF). Oral anticoagulant (OAC) therapy can potentially be protective against this complication.</p></div><div><h3>Methods</h3><p>A comprehensive search of MEDLINE and Embase for comparative observational studies reporting the efficacy of OAC therapy for the incidence of dementia in patients with AF was conducted from its inception until March 2023. Studies that had patients with prior use of OAC or with a previous history of dementia were excluded.</p></div><div><h3>Results</h3><p>A total of 22 studies were included in this review involving 617,204 participants. The pooled analysis revealed that OAC therapy, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), was associated with a reduced incidence of dementia in AF patients. Specifically, compared to non-OAC treatment, OACs demonstrated a significant reduction in dementia incidence (HR 0.68, 95 % CI [0.58, 0.80], p < 0.00001), with similar findings observed for DOACs (HR 0.69, 95 % CI [0.51, 0.94], p = 0.02) and VKAs (HR 0.73, 95 % CI [0.56, 0.95], p = 0.02). The comparison of DOAC vs VKA revealed that DOACs are associated with reduced risk of dementia (HR 0.87, 95 % CI [0.79, 0.96], p = 0.004).</p></div><div><h3>Conclusion</h3><p>Our SR and meta-analysis showed that the use of OAC therapy is associated with a reduced risk of dementia in individuals with AF. However, our results are limited by the potential influence of confounding bias and significant heterogeneity in the analyses.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200282"},"PeriodicalIF":2.3,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000473/pdfft?md5=51682b9157e91f13d88674e63b709a11&pid=1-s2.0-S2772487524000473-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140906308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.ijcrp.2024.200281
Lujing Tang , Mengsha Chen , Jiahao Li , Xiaodong Xu , Xiangyuan Pu
Background
Coronary heart disease (CHD) remains a leading cause of morbidity and mortality, particularly in aging populations. Men typically exhibit higher rates of CHD compared to women, with testosterone levels inversely associated with cardiovascular risk. This study investigates the relationship between testosterone levels and angiographically confirmed CHD, disease severity, and myocardial infarction (MI) among CHD cases.
Methods
A cohort of 1724 male patients undergoing diagnostic or interventional coronary angiography was examined. Demographic, clinical, and biochemical data were collected, including serum total testosterone levels. The severity of CHD was assessed using the Gensini score, and MI cases were diagnosed according to World Health Organization criteria.
Results
Results revealed significant differences in testosterone levels among CHD subtypes, particularly between MI and unstable angina/stable angina groups (p < 0.001). Testosterone levels were inversely correlated with CHD severity, as evidenced by the Gensini score (Pearson coefficient = −0.062, P = 0.004). Cross-validation random forest analysis demonstrated the significant contribution of testosterone to CHD severity discrimination (p < 0.05).
Conclusions
There is an association between testosterone and a predisposition to severe CAD indicated by Gensini score and myocardial infarction.
{"title":"Association of testosterone with myocardial infarction and severity of coronary artery disease among male patients","authors":"Lujing Tang , Mengsha Chen , Jiahao Li , Xiaodong Xu , Xiangyuan Pu","doi":"10.1016/j.ijcrp.2024.200281","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200281","url":null,"abstract":"<div><h3>Background</h3><p>Coronary heart disease (CHD) remains a leading cause of morbidity and mortality, particularly in aging populations. Men typically exhibit higher rates of CHD compared to women, with testosterone levels inversely associated with cardiovascular risk. This study investigates the relationship between testosterone levels and angiographically confirmed CHD, disease severity, and myocardial infarction (MI) among CHD cases.</p></div><div><h3>Methods</h3><p>A cohort of 1724 male patients undergoing diagnostic or interventional coronary angiography was examined. Demographic, clinical, and biochemical data were collected, including serum total testosterone levels. The severity of CHD was assessed using the Gensini score, and MI cases were diagnosed according to World Health Organization criteria.</p></div><div><h3>Results</h3><p>Results revealed significant differences in testosterone levels among CHD subtypes, particularly between MI and unstable angina/stable angina groups (p < 0.001). Testosterone levels were inversely correlated with CHD severity, as evidenced by the Gensini score (Pearson coefficient = −0.062, P = 0.004). Cross-validation random forest analysis demonstrated the significant contribution of testosterone to CHD severity discrimination (p < 0.05).</p></div><div><h3>Conclusions</h3><p>There is an association between testosterone and a predisposition to severe CAD indicated by Gensini score and myocardial infarction.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200281"},"PeriodicalIF":2.3,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000461/pdfft?md5=1b002fc7e53ad161c49f8f37f6ecc861&pid=1-s2.0-S2772487524000461-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140914430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.ijcrp.2024.200278
Hanna K. Gaggin , Stephen J. Greene , Mo Zhou , Dominik Lautsch , Lori D. Bash , Laurence Djatche , Yan Song , James Signorovitch , Andra S. Stevenson , Robert O. Blaustein , Javed Butler
Background
Based on available data from randomized clinical trials, patients with heart failure with reduced ejection fraction (HFrEF) and worsening HF events (WHFE) have substantial disease burden and poor outcomes. WHFE clinical outcome data in non-clinical trial patients, more representative of the US clinical practice, has not been demonstrated.
Methods and results
CHART-HF collected data from two complementary, non-clinical trial cohort with HFrEF (LVEF <45 %): 1) 1,000 patients from an integrated delivery network and 2) 458 patients from a nationwide physician panel. CHART-HF included patients with WHFE between 2017 and 2019 followed by an index outpatient cardiology visit ≤6 months, and patients without WHFE in a given year between 2017 and 2019, with the last outpatient cardiology visit in the same year as the index visit. Compared to patients without WHFE (after covariate adjustment, all p < 0.05), patients with WHFE had a greater risk of HF-related hospitalization (hazard ratio [HR]: 1.53–2.40) and next WHFE event (HR: 1.67–2.41) following index visits in both cohorts.
Conclusion
HFrEF patients with recent WHFE consistently had worse clinical outcomes in these non-clinical trial cohorts. Despite advances in therapies, unmet need to improve clinical outcomes in HFrEF patients with WHFE remains.
{"title":"Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Clinical outcome results from the CHART-HF study","authors":"Hanna K. Gaggin , Stephen J. Greene , Mo Zhou , Dominik Lautsch , Lori D. Bash , Laurence Djatche , Yan Song , James Signorovitch , Andra S. Stevenson , Robert O. Blaustein , Javed Butler","doi":"10.1016/j.ijcrp.2024.200278","DOIUrl":"https://doi.org/10.1016/j.ijcrp.2024.200278","url":null,"abstract":"<div><h3>Background</h3><p>Based on available data from randomized clinical trials, patients with heart failure with reduced ejection fraction (HFrEF) and worsening HF events (WHFE) have substantial disease burden and poor outcomes. WHFE clinical outcome data in non-clinical trial patients, more representative of the US clinical practice, has not been demonstrated.</p></div><div><h3>Methods and results</h3><p>CHART-HF collected data from two complementary, non-clinical trial cohort with HFrEF (LVEF <45 %): 1) 1,000 patients from an integrated delivery network and 2) 458 patients from a nationwide physician panel. CHART-HF included patients with WHFE between 2017 and 2019 followed by an index outpatient cardiology visit ≤6 months, and patients without WHFE in a given year between 2017 and 2019, with the last outpatient cardiology visit in the same year as the index visit. Compared to patients without WHFE (after covariate adjustment, all p < 0.05), patients with WHFE had a greater risk of HF-related hospitalization (hazard ratio [HR]: 1.53–2.40) and next WHFE event (HR: 1.67–2.41) following index visits in both cohorts.</p></div><div><h3>Conclusion</h3><p>HFrEF patients with recent WHFE consistently had worse clinical outcomes in these non-clinical trial cohorts. Despite advances in therapies, unmet need to improve clinical outcomes in HFrEF patients with WHFE remains.</p></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"21 ","pages":"Article 200278"},"PeriodicalIF":2.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772487524000436/pdfft?md5=6a5044797a30655d402392b4266b9ed8&pid=1-s2.0-S2772487524000436-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140906309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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