Vulnerability Characteristics Research Articles

Relationship between coronary artery calcium score and plaque vulnerability in patients with established coronary artery disease

Abstract Introduction Coronary artery calcium (CAC) score is widely used for risk stratification. However, in patients with established coronary artery disease (CAD), its clinical implication and relationship with plaque vulnerability have not been fully investigated. Purpose We sought to investigate the relationship between CAC score and plaque vulnerability assessed by optical coherence tomography (OCT). Methods Patients with CAD who had both CAC score and OCT prior to percutaneous coronary intervention were included. The patients with a prior history of coronary revascularization were excluded. Patients were divided into five groups based on CAC score; CAC score of 0, 1-99, 100-399, 400-999, and over 1000. Vulnerable features in culprit plaque assessed by OCT were compared among these five groups. Results In 460 patients, the prevalence of lipid-rich plaque, macrophage, and cholesterol crystal significantly differed among the five groups: lowest in the patients with a CAC score of zero. The prevalence of thin-cap fibroatheroma (TCFA) tended to be lower in those with a CAC score of zero (Figure). In the two-group comparison between the group with a CAC score of zero and the other four groups, the prevalence of lipid-rich plaque (60.5 vs. 85.9%, p < 0.001), macrophage (48.8 vs. 74.1%, p < 0.001), TCFA (16.3 vs. 35.0%, p = 0.013), and cholesterol crystal (11.6 vs. 32.9%, p = 0.004) was significantly lower in the patients with CAC score of zero. No significant difference in vulnerable features was observed among the four groups with CAC scores > 0. CAC score of zero was independently negatively associated with the lipid-rich plaque (odds ratio [OR] 0.246, p < 0.001), macrophage (OR 0.348, p = 0.003), TCFA (OR 0.285, p = 0.006), and cholesterol crystal (OR 0.273, p = 0.010) after adjustment with patient characteristics. Conclusion This is the first study that investigated the relationship between CAC score and plaque vulnerability assessed by OCT in patients with known CAD. Patients with CAC score of zero have a significantly lower prevalence of vulnerable plaque features compared to those with CAC score > 0.

Coronary CT angiography using photon counting CT for the detection of coronary artery stenoses and coronary atherosclerotic plaque: comparison of reconstructions with 0.2 mm and 0.4 mm slice thickness

Abstract Photon Counting CT allows the acquisition of high-resolution data sets with 0.2 mm reconstructed slice thickness. It is unknown whether the detection of coronary artery stenoses, of coronary plaque or of vulnerable plaque characteristics is improved in data sets that employ maximum resolution. We therefore compared the identification of above characteristics in data sets reconstructed with 0.2 mm and 0.4 mm slice thickness In 30 patients with suspected coronary artery disease, sinus rhythm, a heart rate ≤65 beats/min, and body weight ≤ 100 kg, high-resolution data sets were acquired by photon counting CT (60 ml contrast i.v. at 6 ml/s) after s.c. application of nitrates in inspiratory breathhold. Data were reconstructed with 0.2 mm slice thickness at 0.1 mm increment and 0.4 mm slice thickness at 0.2 mm increment. Next to quantitative analysis of image quality parameters, all data sets were evaluated by two independent expert reviewers concerning subjective image quality as well as the ability to determine the presence of coronary artery stenoses, calcified and non- calcified plaque, as well as parameters of plaque vulnerability (positive remodeling, necrotic core, density < 30 HU and napkin-ring sign) using a 5-point Likert scale (-2 to +2) and a dedicated 11-segment coronary model. Of the 30 patients, 47% were male (mean age 58±12 years, mean heart rate 53±6 bpm, mean body weight 80±15 kg). The median dose length product was 508 mGy*cm. Mean image noise was 42±7 HU vs. 34±7 HU for 0.2 mm vs. 0.4 mm reconstructions (p < 0.001). The median image quality score was significantly higher for 0.2 mm reconstructions (3.8±0.8 vs 3.6±0.7). Of 335 coronary segments, none were classified as "unevaluable" while 87% vs. 76% were classified as "perfect" in 0.2 mm vs. 0.4 mm reconstructions (p < 0.001). Full confidence to rule-in or rule out significant coronary stenoses was achieved in 93% of segments in both reconstructions. The number of non-calcified plaques identified in 0.2 mm reconstructions was numerically higher than in 0.4 mm reconstructions (77 vs. 71, p = n.s.). On the Likert scale, the confidence to identify parameters of plaque vulnerability was significantly higher for 0.2 mm reconstructions (1.93 vs. 1.85, p < 0.001). In a selected patient group, photon counting CT coronary angiography demonstrated excellent image quality and an extremely low rate of unevaluable coronary segments. High-resolution reconstructions improve subjective image quality as was as the assessment of vulnerable plaque characteristics.

Trend in culprit plaque phenotype in ACS patients over the past 10 years

Abstract Background Although the incidence of acute myocardial infarction has been declining over the past decade, the etiology of this trend is unknown. One possible explanation could be changes in coronary plaque phenotype. Purpose The aim of this study was to investigate the changes in plaque characteristics over the last 10 years. Methods Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography (OCT) imaging from 2008 to 2018 were included. Patients were divided into 4 periods: (P1) 2008-2010, (P2) 2011-2013, (P3) 2014-2015, and (P4) 2016-2018. Plaque characteristics at culprit lesion in each period were compared. Results Among 1144 patients, 594 (51.9%) presented with ST-segment–elevation myocardial infarction (STEMI). The prevalence of thin-cap fibroatheroma decreased from P1 to P4 in both STEMI group (57.4% to 24.6%, P<0.001) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) group (40.4% to 17.0%, P<0.001) (Figure). Conclusions The prevalence of OCT features of plaque vulnerability has decreased over the past 10 years. A decrease in plaque vulnerability may explain the favorable trend in cardiovascular events.Prevalence of thin-cap fibroatheroma

Clinical significance of 12-lead electrocardiogram QRS scores on admission in ST-segment elevation myocardial infarction

Abstract Background A QRS scoring system by 12-lead electrocardiography (ECG) is a quick and simple method to evaluate degree and extension of myocardial infarction. Previous studies have shown that high QRS scores (≥5) at hospitalization (before reperfusion) related to impaired myocardial reperfusion during percutaneous coronary intervention (PCI) and subsequent poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI) (Figure 1). However, the pathogenesis and associated factors with high QRS scores remain poorly defined. Therefore, this study aimed to explore clinical and lesion characteristics associated with QRS scores at hospitalization in patients with STEMI. Methods This retrospective observational study enrolled 138 broad anterior-wall STEMI patients who underwent PCI in the proximal left anterior descending artery and achieved reperfusion within 3 hours of onset. Patients were divided by QRS scores at hospitalization into low (<5: n=97) and high (≥5: n=41) QRS-scores, and clinical and lesion characteristics were compared between the 2 groups. Lesion characteristics were evaluated by intravascular ultrasound (IVUS). Results Despite early phase of STEMI, QRS scores at hospitalization varied (3 [2-5] points). Clinical characteristics, including onset-to-door time (66 [41-101] min vs. 55 [42-76] min) and onset-to-reperfusion time (112 [88-145] min vs. 106 [81-120] min), were comparable between patients with low and high QRS-scores. In contrast, significantly higher percentages of lipid plaques, plaque rupture and large thrombus were seen at the culprit lesion sites in patients with high versus low QRS scores (Figure 2). As a result, patients with high QRS scores had higher incidence of no-reflow phenomenon during PCI (36.6% vs. 12.6%, p<0.05) and larger infarct size assessed by peak CK values (5333 [3307-7443] IU/l vs. 1941 [759-3559], p<0.05) compared with those with low QRS-scores. Conclusions High QRS scores at hospitalization were associated with vulnerable lesion characteristics, as well as impaired coronary reperfusion and large infarct size. Although the exact mechanisms of the associations require future studies, QRS scores may help risk stratification before reperfusion and prognostic prediction after reperfusion.Figure 1.Figure 2.

Characterization of plaque hemorrhage with optical coherence tomography imaging in statin-treated patients with coronary artery disease: comparison with noncontrast T1-weighted MRI

Abstract Background Plaque hemorrhage is a phenotypic feature of coronary lesions associated with future coronary events. Noncontrast T1-weighted MRI has a potential to non-invasively identify plaque hemorrhage. Plaque to myocardium ratio (PMR) evaluated by noncontrast T1-weighted MRI has been shown to pathohistologically correspond to plaque hemorrhage. In several case reports comparing OCT images with coronary specimens, low intensity area without its attenuation was observed at lesions presenting plaque hemorrhage. However, whether the association of this OCT-derived feature with PMR remains to be elucidated yet. Purpose To characterize plaque hemorrhage in vivo by comparing with OCT and noncontrast T1-weighted MRI. Methods The current study prospectively enrolled 80 statin-treated patients with coronary artery disease requiring elective PCI. A total of 103 target lesions were imaged by both noncontrast T1-weighted MRI and OCT prior to PCI. Plaque hemorrhage on noncontrast T1-weighted MRI was defined as PMR>1.0. On OCT imaging analysis, low intensity area without attenuation (LIA) was defined according to the following criteria; (1) area presenting homogeneous low intensity signals, (2) clear border and (3) no signal attenuation behind its area. The maximum arc of LIA was manually measured. OCT-derived plaque features were compared in lesions with and without PMR>1.0. Results PMR>1.0 was observed at 49.5% of analyzed lesions. Patients with PMR>1.0 were more likely older (72 vs. 66 years, p=0.02), whereas there was no significant difference in on-treatment LDL-C levels (median: 80 vs. 77 mg/dL, p=0.62) (Table). On lesion-based analysis, while fibrous cap thickness was similar between the two groups (80 vs. 100um, p=0.10), a larger lipid arc (270 vs. 230º, p=0.02) and a greater frequency of macrophage (90.2 vs. 53.9%, p<0.01), layered plaque (62.8 vs. 32.7%, p=0.003) and cholesterol crystal (70.6 vs. 30.8%, p<0.001) were observed at lesions with PMR>1.0. Furthermore, lesions with PMR>1.0 more frequently exhibited LIA (66.7 vs. 19.2%, p<0.001) and its greater maximum arc (33 vs. 0º, p<0.001) (Figure). Of note, PMR was significantly correlated to the maximum arc of LIA (r=0.51, p<0.001) (Figure). Multivariate analysis demonstrated LIA and cholesterol crystal as independent OCT-derived features associated with PMR>1.0 (Table). Conclusion In statin-treated patients, 49.5% of analyzed lesions presented PMR>1.0. Coronary lesions with PMR>1.0 more frequently harbored LIA and cholesterol crystals, in addition to other vulnerable OCT features. Our findings suggest OCT-derived LIA as a potential signature of plaque hemorrhage. Given that cholesterol crystal was another feature of PMR>1.0, plaque inflammation driven by cholesterol crystallization may exist at plaque hemorrhage despite statin use. Whether anti-inflammation agent could modulate plaque hemorrhage requires future investigation.

Intraplaque hemorrhage in carotid atherosclerotic plaques is associated with a local increase in inflammatory cytokines

Abstract Background One of the main features of vulnerability in atherosclerotic carotid plaques is intraplaque hemorrhage (IPH), which is related to a higher incidence of cerebrovascular events in patients with carotid artery disease. Additionally, inflammation plays a pivotal role in the progression of atherosclerotic disease. Purpose We aimed to determine plasma and tissue levels of inflammatory cytokines in patients with carotid artery disease hypothesizing that plaques with IPH are characterized by the presence of a more inflamed environment. Methods We retrospectively enrolled 104 consecutive patients undergoing carotid endarterectomy (CEA) with symptomatic (ischemic stroke, TIA, amaurosis fugax) or asymptomatic ipsilateral carotid artery disease. Plasma and carotid plaque specimens were collected at CEA. The tissue samples were stained with H&E to identify IPH and classified as specimens with and without IPH. Frozen homogenates of both plasma and tissue were analyzed using a customized 10-plex Luminex assay to determine the levels of inflammatory cytokines such as MCP-1/CCL2, IL-8/CXCL8, IFN-gamma, IL-10, IL-1beta/IL-1F2, IL-6, PDGF-AA, PDGF-AB/BB, TNF-alpha, and VEGF. Results IPH was identified in 53 patients (51.0 %). Cytokine levels in plasma and tissue from patients with and without IPH are reported in Table 1. In the univariate logistic regression MCP-1/CCL2, IL-8/CXCL8, IFN-gamma, IL-10, IL6, PDGF-AA, and PDGF-AB/BB were associated with IPH (Table 2). In the multivariate logistic regression, IL-6 was an independent predictor of IPH (HR 1.026 [95% CI 1.005-1.047]; p=0.014) after adjusting for cardiovascular risk factors such as age, BMI, sex, hypertension, diabetes mellitus, hyperlipidemia, ipsilateral carotid stenosis %. Conclusions Carotid plaques with IPH have an elevated inflammatory burden, potentially impacting adverse outcomes in this patient cohort. The local inflammatory cytokines in carotid plaques with IPH might serve as biomarkers and therapeutic targets in patients with carotid artery disease.

C-C motif chemokine ligand 3 is associated with atherosclerotic plaque vulnerability and increased risk of mortality

Abstract Background and Purpose Chemokines play a crucial role in the inflammatory process underlying atherosclerotic plaque formation, progression and subsequent cardiovascular events. However, the specific role of C-C motif chemokine ligand 3 (CCL3) in atherosclerosis remains largely unexplored. This study aims to explore associations between intra-plaque levels of CCL3 and plaque vulnerability as well as to investigate the prognostic role of circulating CCL3 levels in patients undergoing carotid endarterectomy. Methods The CCL3 protein expression was measured using a proximity extension assay in 207 human carotid plaques and 558 plasma samples from patients undergoing carotid endarterectomy, all enrolled in the Carotid Plaque Imaging Project (CPIP) cohort. Protein expression is quantified as normalized protein expression (NPX), an arbitrary unit on a log2-scale. Plaque components and extracellular matrix including smooth muscle cells, macrophages, neutral lipids, intraplaque hemorrhage, collagen (by histology), and matrix metalloproteinases (assessed biochemically), were quantified. Plaque vulnerability index was calculated as the sum percentage of plaque areas stained for lipids, macrophages and hemorrhage, divided by the sum percentage of smooth muscle cells and collagen. Patients were followed up to 10.2 years to record cardiovascular events and mortality. Results Plaque and circulating levels of CCL3 were higher in symptomatic patients compared to asymptomatic patients (plaque, median NPX (interquartile range, IQR): 18.2 (17.4–19.1) vs 17.2 (16.4–18.0), P<0.001; plasma, median NPX (IQR): 1.78 (1.42–2.21) vs 1.56 (1.28–1.97), P<0.001). Plaque levels of CCL3 showed positive correlations with neutral lipids, macrophages, intraplaque hemorrhage, plaque vulnerability index and matrix metalloproteinases including MMP1, MMP2, MMP9, MMP10 and TIMP1, but inversely with smooth muscle cells. Among 511 patients with complete follow-up and circulating CCL3 measures, 144 (28.2%) patients developed cardiovascular events and 123 (24.1%) patients died. Elevated circulating CCL3 levels were associated with increased risk of cardiovascular events (hazard ratio (HR) per standard deviation (SD) = 1.40, 95% CI 1.06–1.84) and mortality (HR per SD=1.77, 95% CI 1.34–2.33), respectively. Higher levels of circulating CCL3 remained independently associated with an increased risk of mortality (HR per SD=1.50, 95% CI 1.09–2.04) even after adjustment for potential confounders. Conclusions Plaque levels of CCL3 are associated with plaque vulnerability features. Circulating levels of CCL3 predict higher risk of cardiovascular events and mortality among carotid endarterectomy patients.

Narcissism-Normal, pathological, grandiose, vulnerable?

Personality psychology subdivides the narcissism of healthy persons into the grandiose and the vulnerable types (2 factor model), which can be further described in a more differentiated way with the three personality factors extroversion, intolerance/antagonism and neuroticism (3 factor model). The grandiose and the vulnerable types of narcissism can also be found in narcissistically disturbed patients. The narcissistic personality disorder (NPD), which in DSM‑5 is exclusively characterized by the grandiose features also shows vulnerable features; however, these are hidden behind the grandiose features. Grandiose narcissism is relatively rare in the clinical routine. So far vulnerable narcissism could not be diagnosed in DSM‑5 or ICD-10; however, in the future this will be demonstrable in ICD-11 by the dimensional concept of personality disorder even if it does not exist as an official diagnosis in ICD-11.

Independent role of atherosclerotic plaque composition and extension in predicting the risk of cardiac events: a CLIMA substudy.

To investigate two different approaches to determine patient risk to develop cardiac events: the burden of coronary atherosclerosis, as assessed by the Gensini score, and plaque morphology, as assessed by intracoronary optical coherence tomography (OCT). We assessed the Gensini score and OCT features of plaque vulnerability in 847 patients from the CLIMA registry. Patients were divided into four Gensini quartiles. The main study endpoint was the 1-year composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR). A total of 56 patients (6.6%) experienced the one-year main composite endpoint. The composite endpoint was significantly affected by the Gensini score (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.11-1.81, p = 0.005), with a low incidence in the first Gensini quartile (Q1 1.3%) and a higher incidence in the remaining groups (Q2 8.3%, Q3 8.9% and Q4 8.3%). At the multivariable analysis, the combined four OCT criteria (HR 6.4, 95%CI 3.0-13.7, p < 0.001), thin fibrous cap (HR 2.9, 95%CI 1.7-5.0, p < 0.001), lipid arc > 180° (HR 2.1, 95%CI 1.2-3.6, p = 0.010), minimum lumen area < 3.5 mm2 (HR 1.7, 95%CI 1.01-3.0, p = 0.047) and the Gensini score (HR 1.4, 95%CI 1.1-1.8, p = 0.017) were independent predictors of the main composite endpoint. In this post-hoc analysis of the CLIMA study, the burden of coronary atherosclerosis as assessed by the Gensini score and OCT plaque characteristics were independent predictors of cardiac events. Patients with the largest atherosclerosis burden and with plaque vulnerability by OCT were at the highest risk of poor outcome. Clinicaltrials.gov identifier: NCT02883088.

Evaluating Ecological Drought Vulnerability from Ecosystem Service Value Perspectives in North China

Existing studies on the vulnerability assessment of ecological drought often focus on analyzing vegetation phenotypic characteristics, overlooking the impact of drought on ecosystem services. This study proposes an ecosystem vulnerability assessment method under ecological drought stress from the perspective of ecosystem service value (ESV), considering the characteristics and interactions of hazard-causing factors and hazard-bearing bodies. The spatiotemporal evolution of ecological drought, the spatial characteristics of ecosystem vulnerability, and the vulnerability characteristics of different ecosystem types in the North China region from 1991 to 2021 were evaluated. The results showed that: (1) ecological drought exhibited a trend of intensification followed by alleviation, with the most severe droughts occurring between 2002 and 2011, affecting up to 64.3% of the region; (2) ESV was mainly influenced by vegetation cover and precipitation gradients, displaying a spatial pattern of high values in the southeast and low values in the northwest, with total ESV averaging CNY 18.23 trillion; (3) grasslands exhibited higher sensitivity to drought compared to forests, and the sensitivity was higher in summer and autumn than in winter and spring. This method assessed the vulnerability of ecological drought from the perspective of ecosystem services, providing a new approach for a more comprehensive understanding of the impact of drought on ecosystem service functions.

MicroRNA Inhibiting Atheroprotective Proteins in Patients with Unstable Angina Comparing to Chronic Coronary Syndrome

Patients with unstable angina present clinical characteristics of atherosclerotic plaque vulnerability, contrary to chronic coronary syndrome patients. The process of athersclerotic plaque destabilization is also regulated by microRNA particles. In this study, the investigation on expression levels of microRNAs inhibiting the expression of proteins that protect from atherosclerotic plaque progression (miR-92a inhibiting KLF2, miR-10b inhibiting KLF4, miR-126 inhibiting MerTK, miR-98 inhibiting IL-10, miR-29b inhibiting TGFβ1) was undertaken. A number of 62 individuals were enrolled—unstable angina (UA, n = 14), chronic coronary syndrome (CCS, n = 38), and healthy volunteers (HV, n = 10). Plasma samples were taken, and microRNAs expression levels were assessed by qRT-PCR. As a result, the UA patients presented significantly increased miR-10b levels compared to CCS patients (0.097 vs. 0.058, p = 0.033). Moreover, in additional analysis when UA patients were grouped together with stable patients with significant plaque in left main or proximal left anterior descending (“UA and LM/proxLAD” group, n = 29 patients) and compared to CCS patients with atherosclerotic lesions in other regions of coronary circulation (“CCS other” group, n = 25 patients) the expression levels of both miR-10b (0.104 vs. 0.046; p = 0.0032) and miR-92a (92.64 vs. 54.74; p = 0.0129) were significantly elevated. In conclusion, the study revealed significantly increased expression levels of miR-10b and miR-92a, a regulator of endothelial protective KLF factors (KLF4 and KLF2, respectively) in patients with more vulnerable plaque phenotypes.

Predictive models for cholesterol crystals and plaque vulnerability in acute myocardial infarction: Insights from an optical coherence tomography study

BackgroundCholesterol crystals (CCs) are recognized as a risk factor for vulnerable atherosclerotic plaque rupture (PR) and major adverse cardiovascular events. However, their predictive factors and association with plaque vulnerability in patients with acute myocardial infarction (AMI) remain insufficiently explored. Therefore, This study aims to investigate the association between CCs and plaque vulnerability in culprit lesions of AMI patients, identify the factors influencing CCs formation, and develop a predictive model for CCs. MethodsA total of 431 culprit lesions from AMI patients who underwent pre-intervention optical coherence tomography (OCT) imaging were analyzed. Patients were divided into groups based on the presence or absence of CCs and PR. The relationship between CCs and plaque vulnerability was evaluated. A risk nomogram for predicting CCs was developed using the least absolute shrinkage and selection operator and logistic regression analysis. ResultsCCs were identified in 64.5 % of patients with AMI. The presence of CCs was associated with a higher prevalence of vulnerable plaque features, such as thin-cap fibroatheroma (TCFA), PR, macrophage infiltration, neovascularization, calcification, and thrombus, compared to patients without CCs. The CCs model demonstrated an area under the curve (AUC) of 0.676 for predicting PR. Incorporating CCs into the TCFA model (AUC = 0.656) significantly enhanced predictive accuracy, with a net reclassification improvement index of 0.462 (95 % confidence interval [CI]: 0.263–0.661, p < 0.001) and an integrated discrimination improvement index of 0.031 (95 % CI: 0.013–0.048, p = 0.001). Multivariate regression analysis identified the atherogenic index of plasma (odds ratio [OR] = 2.417), TCFA (OR = 1.759), macrophage infiltration (OR = 3.863), neovascularization (OR = 2.697), calcification (OR = 1.860), and thrombus (OR = 2.430) as independent risk factors for CCs formation. The comprehensive model incorporating these factors exhibited reasonable discriminatory ability, with an AUC of 0.766 (95 % CI: 0.717–0.815) in the training set and 0.753 (95 % CI: 0.704–0.802) in the internal validation set, reflecting good calibration. Decision curve analysis suggested that the model has potential clinical utility within a threshold probability range of approximately 18 % to 85 %. ConclusionsCCs were associated with plaque vulnerability in the culprit lesions of AMI patients. Additionally, this study identified key factors influencing CCs formation and developed a predictive model with potential clinical applicability.

Health care disparities and bladder cancer mortality in the United States: A closer look at the social vulnerability index.

150 Background: Bladder cancer is a significant public health concern, with various factors influencing mortality rates. The Social Vulnerability Index (SVI) measures community resilience to external health stresses. This study investigates the association between bladder cancer mortality (BCM) and county-level SVI in the United States (U.S.). Methods: Mortality data from U.S. counties were obtained from the Centers for Disease Control (CDC) and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 2015 to 2019 using the International Classification of Diseases-10th Edition (Code C67). The CDC and Agency for Toxic Substances and Disease Registry (ATSDR) county-level SVI was used as a composite measure of social vulnerability. The SVI includes several U.S. census variables grouped into four themes: Socioeconomic Status (SES), Household Characteristics, Racial and Ethnic Minority Status, and Housing Type and Transportation. Vulnerable SES variables include individuals with incomes below 150% of the federal poverty line, unemployment, those with housing cost burdens, and those without high school diplomas or health insurance. Vulnerable household variables include seniors over 65 years, children under 17 years, disabled civilians, single-parent households, and those with limited English proficiency. SVI Quartiles (Q1 being the least vulnerable and Q4 the most vulnerable) were compared to assess their impact on BCM. Negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) with 95% Confidence Intervals (CIs) using SAS software. Results: From 2015 to 2019, a total of 82,994 people died from bladder cancer, and the age-adjusted mortality rate per 1,000,000 was 42.4. A higher SVI in intermediate vulnerability quartiles was associated with a higher risk of BCM (Q2 and Q3: IRR = 1.06; 95% CI = 1.01-1.10; p = 0.009) compared to the least vulnerable quartile, Q1. Vulnerable SES had an increased risk of BCM (Q2 and Q3: IRR = 1.07; 95% CI = 1.03-1.12; p &lt; 0.001) compared to Q1. BCM was also increased in individuals with vulnerable household characteristics (Q2 and Q3: IRR = 1.06; 95% CI = 1.02-1.10; p = 0.004) compared to Q1. Q4 was not significant in comparison to Q1 for the groups mentioned above. Interestingly, Racial and Ethnic Minority Status (Hispanic, Latino, African American, etc.) was associated with lower BCM in Q2 and Q3 (IRR = 0.88; 95% CI = 0.84-0.92; p &lt; 0.001) and Q4 (IRR = 0.77; 95% CI = 0.73-0.81; p &lt; 0.001) compared to Q1. No significant mortality differences were observed among vulnerable Housing Types and Transportation. Conclusions: Bladder cancer mortality is linked to vulnerable socioeconomic and household characteristics, while racial and ethnic minority status correlates with decreased risk. Future targeted public health interventions are needed to reduce bladder cancer mortality in vulnerable populations. Bladder cancer mortality and its association with social vulnerability quartiles. Bladder Cancer Mortality Characteristic IRR 95% CI p-value Social Vulnerability Index Q1 — — Q2&amp;Q3 1.06 1.01, 1.10 0.009 Q4 0.98 0.93, 1.03 0.4 Socioeconomic Status Q1 — — Q2&amp;Q3 1.07 1.03, 1.12 &lt;0.001 Q4 1.00 0.95, 1.05 &gt;0.9 Household Characteristics Q1 — — Q2&amp;Q3 1.06 1.02, 1.10 0.004 Q4 1.05 1.00, 1.10 0.052 Racial &amp; Ethnic Minority Status Q1 — — Q2&amp;Q3 0.88 0.84, 0.92 &lt;0.001 Q4 0.77 0.73, 0.81 &lt;0.001 Housing Type &amp; Transportation Q1 — — Q2&amp;Q3 1.03 0.99, 1.08 0.2 Q4 0.98 0.93, 1.03 0.4 IRR = Incidence Rate Ratio, CI = Confidence Interval.

TCT-1018 Plaque Risk Is Directly Related to the Type and Number of Combined Vulnerability Features: Insights From a Pooled Patient-Level Analysis From COMBINE FFR_OCT and PECTUS-OBS Studies

TCT-1018 Plaque Risk Is Directly Related to the Type and Number of Combined Vulnerability Features: Insights From a Pooled Patient-Level Analysis From COMBINE FFR_OCT and PECTUS-OBS Studies

VulTR: Software vulnerability detection model based on multi-layer key feature enhancement

Software vulnerabilities pose a huge threat to current network security, which continues to lead to data leaks and system damage. In order to effectively identify and patch these vulnerabilities, researchers have proposed automated detection methods based on deep learning. However, most of the existing methods only rely on single-dimensional data representation and fail to fully explore the composite characteristics of the code. Among them, the sequence embedding method fails to effectively capture the structural characteristics of the code, while the graph embedding method focuses more on the global characteristics of the overall graph structure and is still insufficient in optimizing the representation of nodes. In view of this, this paper constructs the VulTR model, which incorporates an importance assessment mechanism to strengthen the key syntax levels of the source code (from lexical elements to nodes and graph-level structures), significantly improving the importance of key vulnerability features in classification decisions. At the same time, a relationship connection diagram is constructed to describe the spatial characteristics of the correlations between functions. Experimentally verified, VulTR's F1 scores on both synthetic and real data sets exceed those of the compared models (VulDeePecker, SySeVR, Devign, VulCNN, IVDetect, and mVulPreter).

Association between elevated lipoprotein(a) levels and vulnerability of carotid atherosclerotic plaque: A systematic review

BackgroundThe role of lipoprotein(a) [Lp(a)] as a potential risk factor for atherosclerotic arterial disease has been extensively studied. However, the available data regarding its association with the vulnerability of carotid atherosclerotic plaque is limited. The main objective of the present systematic review was to assess the association between elevated Lp(a) levels and carotid vulnerable plaque features. MethodsThis systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search to identify studies examining the association between Lp(a) levels and vulnerability of carotid atherosclerotic plaque. Experimental or observational studies were eligible, without language, country, or publication type restrictions. ResultsNine studies including 2058 patients were eligible for this systematic review. Five cross-sectional studies, 3 prospective/retrospective cohorts, and 1 subanalysis of a randomized controlled trial were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without vulnerable carotid plaque showed discordant results. Nevertheless, all the studies that evaluated the prevalence or incidence of vulnerable carotid plaque according to Lp(a) levels showed a positive association. Similarly, one study found a significant correlation between vulnerability of carotid plaque and Lp(a) levels. ConclusionAlmost all studies analyzed in the present review showed a positive association between elevated Lp(a) levels and carotid vulnerable plaque features. However, further research is needed to clarify this issue.

Gender bias in assessing narcissistic personality: Exploring the utility of the ICD-11 dimensional model.

Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other 'feminized' personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations. Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting 'grandiose' and 'vulnerable' narcissism in hypothetical male or female patients. The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models. While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.

Evolving patterns of COVID-19 mortality in US counties: A longitudinal study of healthcare, socioeconomic, and vaccination associations.

The COVID-19 pandemic emphasized the need for pandemic preparedness strategies to mitigate its impacts, particularly in the United States, which experienced multiple waves with varying policies, population response, and vaccination effects. This study explores the relationships between county-level factors and COVID-19 mortality outcomes in the U.S. from 2020 to 2023, focusing on disparities in healthcare access, vaccination coverage, and socioeconomic characteristics. We conduct multi-variable rolling regression analyses to reveal associations between various factors and COVID-19 mortality outcomes, defined as Case Fatality Rate (CFR) and Overall Mortality to Hospitalization Rate (OMHR), at the U.S. county level. Each analysis examines the association between mortality outcomes and one of the three hierarchical levels of the Social Vulnerability Index (SVI), along with other factors such as access to hospital beds, vaccination coverage, and demographic characteristics. Our results reveal persistent and dynamic correlations between various factors and COVID-19 mortality measures. Access to hospital beds and higher vaccination coverage showed persistent protective effects, while higher Social Vulnerability Index was associated with worse outcomes persistently. Socioeconomic status and vulnerable household characteristics within the SVI consistently associated with elevated mortality. Poverty, lower education, unemployment, housing cost burden, single-parent households, and disability population showed significant associations with Case Fatality Rates during different stages of the pandemic. Vulnerable age groups demonstrated varying associations with mortality measures, with worse outcomes predominantly during the Original strain. Rural-Urban Continuum Code exhibited predominantly positive associations with CFR and OMHR, while it starts with a positive OMHR association during the Original strain. This study reveals longitudinal persistent and dynamic factors associated with two mortality rate measures throughout the pandemic, disproportionately affecting marginalized communities. The findings emphasize the urgency of implementing targeted policies and interventions to address disparities in the fight against future pandemics and the pursuit of improved public health outcomes.

Exposure to an acute stress impaired the metabolic plasticity of resilient rats by enhancing fatty acid β-oxidation in the ventral hippocampus

The concept of resilience has changed over time and nowadays it refers to the positive adaptation to life adversities, rather than to the absence of a pathological response normally occurring in susceptible people. Based on our previous data showing that the exposure to the chronic mild stress (CMS) paradigm differently affected bioenergetics in the ventral hippocampus of vulnerable and resilient animals, here we investigated whether resilience is a stable trait or if the energetic strategy set in motion to sustain resilience unveils a vulnerability feature in a more dynamic situation. To this aim, vulnerable and resilient rats after 6 weeks of CMS were subjected to a further acute, unfamiliar restraint stress (ARS) and metabolomic studies were conducted in the ventral hippocampus. We observed that exposure to a single novel challenge negatively affects the fuel utilization of resilient animals. Indeed, while they increase glycolysis to sustain the non-hedonic phenotype when exposed to CMS, they shift to fatty acid β-oxidation after ARS, as vulnerable animals following CMS, suggesting that the energy strategy that guarantees resilience is fragile and can be negatively modified by a different environmental condition. These results suggest that strengthening resilience to foster individuals to bounce back from stressful life events may represent a strategy to decrease vulnerability or prevent the risk of relapsing to a pathological state.

Business continuity as self-efficacy: Augmenting existing business continuity practice

The COVID-19 pandemic has highlighted the shortcomings of traditional business continuity principles. As much of the novel response to COVID-19 involved a curtailment or cessation of in-person commercial activity, businesses and communities were at unprecedented financial risk. Traditional methods of ensuring business continuity were likely insufficient; thus, an improved understanding of business continuity through disaster is needed for both business and community well-being. Canonically, academic studies examining business survival post-disaster have emphasized vulnerability characteristics and focused on factors outside the businesses’ locus of control. Recently, studies have found that business survival is related to features of self-efficacy that are not easily developed through succinct templates: creativity, flexibility, and improvisation. By critically examining ninety-three publicly available business continuity guides in a content analysis approach, we point to the need for further research on business preparedness as the building of self-efficacy and the effectiveness of converting these scientific findings into useful formats for business operators.