bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17107: CHA2DS2VASC Score and Frailty Index as Mortality Predictors in Patients Hospitalized With SARS-CoV-2 Infection
Authors: Colina Ibett , Igbinomwanhia Efehi , Sanchez Alejandro , Treminio Quezada Miguel , Kabir Christopher , Brady Peter
Published: November 2020

Introduction:
The current pandemic with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has impacted healthcare around the globe. The CHADS2VASC and frailty scores have not been studied as tool predictors for outcomes in this population.

Hypothesis:
CHA2DS2VASC and frailty scores can be used as predictors of mortality and unfavorable outcomes in patients hospitalized with SARS-CoV-2 infection.

Methods:
We included patients ages 18 years and older who required in-hospital treatment for SARS-CoV-2 infection at a Community Hospital between February and April of 2020. CHA2DS2VASC score and frailty index (FI) were calculated at time of admission and were used as continuous variables in a multivariate logistic regression model. Cardiovascular (CV) outcome was a composite variable that included non-fatal MI, decompensated heart failure, unstable arrhythmia and CVA.

Results:
Amongst 109 patients, 55% were male, mean age was 61.7 years (standard deviation 17.7) and 73% of the patients were admitted from home. 21.1% (23) of the patients died during their stay. The mean CHA2DS2VASC score was 2.5 (SD 1.7). For every point increase in the CHA2DS2VASC score the odds of mortality increased by 78% (aOR 1.78; 95% CI; 1.07-2.97). The mean frailty score was 6.2 (SD 5.7). For every point increase in the frailty score the odds of mortality increased by 22% (aOR: 1.22; 95% CI 1.07-1.39) [Figure]. There was a trend between higher CHA2DS2VASC and frailty scores with worse CV outcomes during hospital stay but this did not meet statistical significance (aOR: 1.31; 95% CI 0.86-2.0, aOR: 1.04; CI 0.93-1.17 respectively).

Conclusions:
Higher CHA2DS2VASC and frailty scores are associated with increased risk of mortality. Although statistical significance was not reached for predicting CV outcomes, this was likely related to a small sample size. CHA2DS2VASC and frailty scores are a readily available and novel tool that can be used to predict mortality in hospitalized patients.
Abstract 17109: Real World Assessment of Atrial Fibrillation and Other Arrhythmias After Cryptogenic Stroke
Authors: Pothineni Naga Venkata K , Batnyam Uyanga , Arkles Jeffrey , Bullinga John , CUCCHIARA Brett L , Dixit Sanjay , Andrew Epstein E , Frankel David S , Garcia Fermin C , Kumareswaram Ramanan , Luebbert Jeffrey J , Mendelson Todd , Messé Steven , Santangeli Pasquale , Lin David , Kasner Scott E , Marchlinski Francis E , Deo Rajat
Published: November 2020

Introduction:
Long-term monitoring for atrial fibrillation (AF) is recommended in patients, who have experienced a cryptogenic stroke (CS). Clinical trials have identified AF in ~30% of patients after 3 years of continuous monitoring with insertable cardiac monitors (ICMs).

Hypothesis:
In a real-world analysis from a large academic healthcare system, we sought to evaluate a CS population with ICMs and a) determine the yield of AF and subsequent initiation of anticoagulation; and b) identify the presence of other arrhythmias.

Methods:
We evaluated all CS patients who had received an ICM between October 2014 and April 2020. We manually reviewed all stored electrocardiograms that were automatically labeled as AF by the ICM and adjudicated them as either a) AF or b) other cardiac arrhythmia including premature atrial contractions (PAC), premature ventricular contractions (PVC), supraventricular tachycardia (SVT), or nonsustained ventricular tachycardia (NSVT).

Results:
A total of 84 CS patients with ICMs were included: 51% men, mean age 63 years, and mean CHA
2
DS
2
-VASc 4.1. Over a median follow-up duration of 15.7 months, there were 34 patients (40% of the cohort) who did not have any AF alerts. In the remaining 50 patients, there were 960 stored electrograms that were adjudicated. Only 154 recordings from 16 patients (19% of the entire cohort) were adjudicated as AF. Oral anticoagulation was initiated in all these patients with adjudicated AF. The remaining tracings, which had been automatically categorized by the ICM as AF alerts, represented 34 patients (40% of the cohort). These patients had other arrhythmias including frequent PACs or PVCs, SVT, or NSVT.

Conclusions:
Compared to clinical trials, our real-world assessment suggests that the yield of AF following CS is lower - approximately 20%. Our findings highlight the importance for reviewing device tracings given the high rates of false positive for AF. Further research to refine AF detection algorithms in ICMs is needed.
Abstract 17121: Initiation of Anti-Hypertensive Therapy and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction (HFpEF) and a History of Hypertension (HTN)
Authors: Bhyan Poonam , Lam Phillip H , arundel cherinne , faselis charles , Deedwania Prakash , Tsimploulis Apostolos , Allman Richard M , White Michel , Aronow Wilbert S , Singh Steven , Fonarow Gregg C , Ahmed Ali
Published: November 2020

Background:
According to the ACC/AHA HF guideline, in patients (pts) with HFpEF and HTN, optimal systolic blood pressure (SBP) target is <130 mm Hg. Although SBP <130 has been shown to be associated with a higher risk of death in HFpEF (PMC5875342), the use of anti-HTN therapy in those with SBP ≥130 has not been well studied. We tested the hypothesis that anti-HTN therapy in pts with HFpEF, HTN and SBP ≥130 would be associated with improved outcomes.

Methods:
Of the 8873 hospitalized pts with HF w EF ≥50% in Medicare-linked OPTIMIZE-HF, 6781 (76%) had a history of HTN, of whom 3680 (54%) had a discharge SBP ≥130 mmHg. We assembled an inception cohort by excluding 1611 (44%) receiving anti-HTN drugs (HCTZ, hydralazine, or a CCB) before admission. Of the remaining 2069 pts, 430 (21%) received a new discharge prescription for anti-HTN drugs. Propensity scores for anti-HTN drug initiation, estimated for each of the 2069 pts, were used to assemble a cohort of 427 pairs of pts started and not started on anti-HTN therapy, balanced on 60 baseline characteristics including use of ACEI/ARBs and BBs.

Results:
The 854 matched pts had a mean age of 77 years, mean SBP of 149 mmHg, 67% were women, and 17% African American. 3-year all-cause mortality occurred in 45% and 53% of matched pts started vs. not started on anti-HTN therapy, resp. (HR 0.77; 95% CI, 0.64-0.94; p=0.009;
Figure
). There was no association with readmissions.

Conclusion:
In pts with HFpEF, HTN and SBP ≥130 mm Hg, initiation of anti-HTN therapy is associated with a lower risk of death.
Abstract 17135: Promoting Early Mobility and Discharge in Patients Post-Transcatheter Aortic Valve Replacement
Authors: Hart Lindsey , Frankel Robert , Crooke Gregory , Moors Mary Alice , Noto Stefanie , Granger Bradi B
Published: November 2020

Background:
Aortic stenosis is a common disease that affects older adults. With an expanded indication, low-risk patients can now be offered the option of TAVR. Hospitals will need to effectively and efficiently accommodate the expected increase in demand for the TAVR procedure without compromising patient outcomes.

Objective:
The purpose of this study was to evaluate the development of a post-transcatheter aortic valve replacement protocol to standardize care and progress the patient from the operating room to discharge.

Methods:
We used a prospective pre-post design to evaluate the effect of education and a technology-supported intervention on length of stay, quality of life (measured by the Kansas City Cardiomyopathy Questionnaire; KCCQ12), and early mobility in TAVR patients between April 2019 and March 2020.

Interventions:
Two components of the intervention included team-based education and integration of guideline-based orders in the electronic record (EHR). Education regarding expectations for early mobilization and discharge plan was provided to patient and staff to ensure a timely discharge home.

Results:
Overall and post-procedural length of stay were significantly improved (5.26 days vs 2.45; p<0.001 and 3.05 days vs 2.16 days; p<0.004) respectively. Quality of life improved in both groups from baseline to 30 day follow up (p=0.012) No significant difference was shown in the 5-meter walk test.

Conclusion:
These findings suggest that implementation of an evidence based EHR-embedded order set is associated with a significant improvement in overall and post-procedure length of

stay at 6 moths and a significant improvement in post-procedure quality of life. Future work is needed to examine strategies to ensure safe next day discharge.
Abstract 17136: Pulmonary Arterial and Venous Fractal Dimension as a Marker of Pulmonary Arterial Hypertension
Authors: Tsao Andrew , Nardelli Pietro , Harder Eileen , Vegas Sanchez-Ferrero Gonzalo , Ross James C , Ash Samuel Y , Singh Inderjit , Hunsaker Andetta , Waxman Aaron B , Washko George , San Jose Estepar Raul , Rahaghi Farbod
Published: November 2020

Introduction:
PAH is characterized by a loss of pulmonary vascular complexity. In this study, total, arterial, and venous vasculatures of patients with PAH and with ePAH were analyzed using fractal analysis and compared against controls

Methods:
Data from 1514 consecutive right heart catheterizations from 4/27/2011 to 10/2/2018 representing subjects referred to our dyspnea center were searched for availability of imaging. 388 CT angiography (CTA) scans were identified (used given retrospective availability of thin slice reconstructions). Three initial cohorts (no overlap) were identified from individuals in this set. Control patients had normal resting and exercise hemodynamics and no history of cardiopulmonary disease. The second group met the current definition of PAH (resting mean pulmonary arterial pressure >20mmHg, pulmonary vascular resistance >3 Wood Units, pulmonary capillary wedge pressure <15mmHg). The third group (ePAH) had normal resting hemodynamics but age adjusted evidence of PAH with exercise. Pulmonary vascular trees were reconstructed; total, arterial, and venous trees were separated; and fractal dimensions were measured using a 3D box counting method for each tree. Comparisons were made using the Wilcoxon Rank Sum test (R 3.5).

Results:
Venous fractal dimensions of controls (2.10±0.07) were higher than those of PAH (2.03±0.08; p=3e-6) and of ePAH (2.04±0.13; p=0.008). Total fractal dimension also yielded higher values for controls (2.30±0.05) compared against PAH (2.28±0.07; p=0.009) and ePAH (2.26±0.10; p=0.04). No significant differences were found between arterial fractal dimensions of controls (2.17±0.04) against those of PAH (2.16±0.07; p=0.15) and of ePAH (2.15±0.10; p=0.14).

Conclusions:
Fractal dimension allows for non-invasive characterization of pulmonary vascular complexity. Using this method, patients with PAH or ePAH were found to have lower total and venous vascular complexities than controls without PAH or ePAH.
Abstract 17152: Artificial Intelligence ECG for the Detection of Cardiac Injury as Confirmed by High Sensitivity Cardiac Troponin T-Concentrations
Authors: Attia Zachi I , Sandoval Yader , Carter Rickey , Kapa Suraj , Lopez-jimenez Francisco , Noseworthy Peter A , Jaffe Allan S , Friedman Paul
Published: November 2020

Background:
High-sensitivity cardiac troponin (hs-cTn) assays quantify cTn in patients at very low concentrations. Myocyte injury due to ischemia or other pathologies cause blood levels to increase, which is prognostic. A noninvasive, rapid, broadly available, home-based test to detect hs-cTn increases would facilitate risk-stratification. Since myocyte injury is associated with ECG changes, we hypothesized an artificial intelligence ECG (AI-ECG) could non-invasively predict current or impending hs-cTnT elevations.

Objective:
To develop an AI-ECG convolutional neural network (CNN) to detect an abnormal hs-cTnT (5
th
Gen cTnT, Roche Diagnostics) concentration using a 12-lead ECG, and a single lead ECG (lead I), which would enable smartphone, home-based detection.

Methods:
We developed single lead and 12-lead ECG CNNs to detect a) hs-cTnT concentrations that were at or above the 6ng/L limit that can be reported b) above the 99
th
percentile upper limits of >15ng/L for men and >10ng/L for women. All ECGs were recorded within one hour of the hs-cTnT measurements. We used 73,012 ECG and hs-cTnT pairs from 47,542 unique patients to train the network, 9031 ECGs from 5,811 patients for internal validation to optimize hyperparameters, and 18,276 ECG and hs-cTnT pairs from 11,904 different patients as a holdout test set to determine the area under the receiver-operator curve (AUC).

Results:
The mean age was 63.9±17.5 years, and 30,348 of the 59,446 patients (51%) were male. Of the 91,288 hs-cTnT pairs 73,271 (80.2%) were above 6ng/L and 50,799 (55.6%) are above the 99
th
percentile. In the test set, the AUC for the detection of a hs-cTnT level higher than 6ng/L was 0.88 using the 12 lead ECG and 0.834 with the single lead. For the detection of hs-cTnT level above of 99
th
percentile, the 12 lead ECG AUC was 0.853 and the single lead was 0.806.

Conclusion:
The AI-ECG permits detection of levels of hs-cTnT consistent with myocardial injury. This may allow a home-based, non-invasive test that would be massively scalable and could further enhance rapid-risk stratification and patient triage with potentially significant cost reductions and enable novel triage strategies at sites without hs-cTn assays.
Abstract 17169: Endothelium-Specific Reduction in Mitochondrial ROS Induces Coronary Angiogenesis in Ischemic Myocardium via Activation of PI3k/Akt/ERG, ERK1/2, and Jag-1 Signaling
Authors: Brinck Teixeira Rayane , Pfeiffer Melissa , Karbasiafshar Catherine , Blume Corssac Giana , Ahsan Nagib , Sellke Frank W , Abid Ruhul
Published: November 2020

Introduction:
Global reduction in reactive oxygen species (ROS) failed to improve outcomes in cardiovascular disease patients. Recent reports suggest that subcellular, rather than global ROS, play a crucial role in endothelial cell (EC) health. To that end, we generated a novel transgenic mouse model that overexpresses mitochondrial antioxidant MnSOD in EC-specific manner (MnSODVE-OE).

Hypothesis:
We hypothesized that decreased EC mitochondrial-ROS will improve post-myocardial infarction (MI) cardiac function by inducing coronary angiogenesis in ischemic myocardium.

Methods:
MnSODVE mice were assigned to Tet-ON (control) or Tet-OFF (MnSODVE-OE) group. To turn off the transgene, Tetracycline (Tet) (2mg/kg) was added to the drinking water (Tet-ON), while Tet-OFF mice did not receive Tet. Both groups underwent left anterior descending coronary artery (LAD) ligation surgery to mimic acute MI. Echocardiography was done 28 days after LAD ligation. Capillaries, arteriole density, and proliferating ECs were measured in heart sections using anti-CD31, anti-αSMA, and anti-PCNA immunofluorescence. Western blot, proteomic and phosphoproteomic analyses of mouse heart ECs isolated from MnSODVE (Tet-ON and Tet-OFF) animals were performed to study modulation of signaling cascades.

Results:
MnSODVE-OE mice demonstrated improved cardiac function (EF and FS increased by 16±7.87% and 21.73±10.31%, respectively,
p
<0.01), increase in capillary and arteriole densities by 4.13±4.10-fold, p<0.05 and 5.48±3.51-fold, p<0.001, respectively, and in EC proliferation by 1.46±0.80-fold,
p
<0.01, suggesting
de novo
coronary angiogenesis. Western blots showed activation of Akt (80.46±3.95% increase in p-Akt/ t-Akt ratio, p<0.05) and ERK1/2 (21.05±4.45% increase in p-ERK/ t-ERK 1/2 ratio, p<0.05). Proteome and phosphoproteome analyses showed upregulation of mitochondrial complex I biogenesis, RNA metabolism, and upregulation of Notch-related proteins ERG and Jag-1 (p<0.05). Student’s t-test was used for data analyses.

Conclusions:
Taken together, these results suggest that decreased mito-ROS in ECs improves post-MI cardiac function by inducing coronary angiogenesis through activation of PI3k/Akt/ERG, ERK1/2, and Jag-1 signaling.
Abstract 17179: Stress-Mediated Platelet Activation Contributes to Thrombosis: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network
Authors: Barrett Tessa J , Corr Emma M , Lee Angela , Spruill Tanya M , Reynolds Harmony , Hochman Judith S , Moore Kathryn J , Berger Jeffrey S
Published: November 2020

Background:
Psychological stress is a risk factor for cardiovascular disease (CVD). Despite advancements in CV-prevention, CVD remains the global leading cause of disease burden, suggesting that additional factors contribute to sustained CV risk. The mechanisms by which stress contributes to increased CVD are largely unknown. However, in preclinical models increased sympathetic nervous system activity promotes systemic inflammation (e.g. monocyte activation, cytokine production), and may underlie increased CVD risk. We investigated perceived stress in women with MI and its association with platelet activity, and validated our findings in a murine model.

Methods:
Monocyte-platelet aggregates (MPA) and psychological stress, using the validated Perceived Stress Scale (PSS4), were measured in women post MI (n=96; median age 62.2 years) and in control women (n=31; 66.7 years). A mouse model of chronic variable stress was utilized to explore the impact of stress on platelet activity and risk of thrombosis-mediated death.

Results:
Perceived stress was higher in MI patients than matched women (p=0.009). Platelet activity, assessed by MPA, was significantly elevated in MI vs. controls (p=0.0025). MPA significantly correlated with PSS4 scores (R=0.412,
p
=0.009). In a female mouse model of chronic variable stress, circulating MPA was increased in stressed mice compared to controls (p<0.05), and platelet activation markers P-selectin and JON/A were increased on platelets from stressed mice relative to stress free mice (p<0.05). Using a platelet mediated thrombosis model, time to thrombosis and survival was reduced in stressed mice.

Conclusion:
Platelet activity was increased at the time of MI in women, and positively associated with stress. In a mouse model, we find that stress is a significant contributor to increased platelet reactivity, and promotes thrombosis-mediated death. Cross-talk between platelets and monocytes is a critical mechanism linking thrombosis and inflammation, thus stress-induced MPAs may represent an unexplored pathway linked to stress-mediated CVD-risk. Future studies will examine whether reducing stress reduces platelet hyperactivity and MI risk.
Abstract 17200: Improving the Early Detection of Cardiac Amyloidosis: Experience From a Large Urban Academic Center
Authors: Effoe Valery S , Echols Melvin R , Yan Fengxia , Abe Temidayo , Onwuanyi Anekwe
Published: November 2020

Introduction:
Cardiac amyloidosis (CA) is associated with a poor prognosis and the condition is often overlooked or the diagnosis is delayed by an average of 2 years. With the availability of treatment, identifying patients early in the course of the disease could significantly improve outcomes associated with CA. We describe the characteristics of patients with suspected CA and factors associated with obtaining a
99m
Technetium-pyrophosphate (
99m
Tc-PYP) scan.

Methods:
We systematically reviewed and abstracted data from electronic medical records of 199 patients at the Grady Memorial Hospital in Atlanta, Georgia, between January 2018 to October 2019. Eligible patients had an echocardiographic left ventricular posterior wall (LVPWd) or interventricular septal wall (IVSd) thickness in diastole ≥ 1.4 cm and no evidence of aortic stenosis. Descriptive analyses were performed using SAS 9.4.

Results:
Mean age of sample was 65 ± 13 years (96% blacks, 40% women). Over 72% had health insurance, 87% had an LV ejection fraction > 50%, 52% had a diagnosis of heart failure (HF), and 31% had associated peripheral neuropathy. Fifty-nine (30%) patients had a
99m
Tc-PYP scan, 10 had a cardiac MRI and only 1 had an endomyocardial biopsy. Of the 4 patients with confirmed CA, mean age was 79 ± 5 years, mean IVSd was 1.7 ± 02 cm and mean LV mass index was 184 ± 33. All 4 patients were black males, had a
99m
Tc-PYP scan and 3/4 had health insurance. Table 1 compares characteristics of patients who received a
99m
Tc-PYP scan with those who did not. Overall, age, sex, health insurance status, presence of HF and LVH were not associated with the odds of obtaining a
99m
Tc-PYP scan.

Conclusion:
These preliminary results appear to demonstrate variability in diagnostic testing for CA among patients with similar demographic and bioclinical profiles. Understanding the reasons for these differences may be key in improving early testing and diagnosis of CA among our patient population.
Abstract 17221: Stable Flow-Induced Expression of KLK10 Inhibits Endothelial Inflammation and Atherosclerosis
Authors: Williams Darian , Mahmoud Marwa , Jo Hanjoong
Published: November 2020

Introduction:
Atherosclerosis preferentially occurs in arterial regions exposed to disturbed blood flow (
d-flow
) while the straight regions exposed to stable flow (
s-flow
) are protected. The proatherogenic and atheroprotective effects of flow are mediated in large part by the global changes in endothelial cell gene expression, which regulate endothelial dysfunction and inflammation. Previously, we identified Kallikrein-Related Peptidase 10 (KLK10) as one of the most flow-sensitive genes in arterial endothelial cells using the partial carotid ligation model of
d-flow
-induced atherosclerosis. KLK10 is a secreted serine protease, but its role in endothelial function and atherosclerosis is unknown.

Methods/Results:
Here, we validated that KLK10 was upregulated under
s-flow
conditions and downregulated under
d-flow
conditions using the
in vivo
mouse models and
in vitro
studies using endothelial cells (ECs). Through
in vitro
functional studies using ECs, we found that KLK10 produced by
s-flow
protected against endothelial inflammation and permeability dysfunction. Furthermore, treatment with rKLK10 or overexpression of KLK10 plasmids
in vivo
decreased endothelial inflammation the mouse model. Further, rKLK10 injection or ultrasound-mediated transfection of KLK10 plasmids in the hind leg muscles led to inhibition of atherosclerosis in ApoE-/- mice with the partial carotid ligation surgery. Studies using the pharmacological inhibitors and siRNAs showed that the anti-inflammatory effects of KLK10 was mediated by the Protease Activated Receptors 1 and 2, but without directly cleaving them. Further studies show that KLK10’s anti-inflammatory effect was mediated by the NFκB and VCAM1 and ICAM1 expression pathway. In addition, immunostaining showed that KLK10 expression is significantly reduced in human coronary arterial sections with atherosclerotic plaques compared to the non-diseased controls.

Conclusions:
We found that KLK10 is a potent flow-sensitive secreted protein, which serve as a novel anti-inflammatory and anti-atherogenic factor. KLK10 may be a potential anti-atherogenic therapeutic.
Abstract 17272: Frequency of Acute Vasodilator Response in Incident and Prevalent Patients With Pulmonary Arterial Hypertension (Group 1): Results From the Pulmonary Vascular Disease Omics (PVDOMICS) Study
Authors: Hassoun Paul , Larive Armand , Rosenzweig Erika B , Frantz Robert , Hemnes Anna R , Horn Evelyn M , Jacob Miriam , Leopold Jane A , Rischard Franz
Published: November 2020

Introduction:
The prevalence of acute vasodilator response (AVR) to inhaled NO (defined as a reduction in mPAP ≥ 10 mmHg with an absolute value of mPAP ≤ 40 mmHg with increased/unchanged CO) is reported to be around 12% in incident patients with idiopathic PAH (IPAH). The prevalence of AVR, however, is reportedly lower in other disease-associated PAH in Group 1, such as connective tissue disease (CTD). Furthermore, the prevalence of AVR for combined inhaled NO and oxygen, and in patients on PAH therapy (prevalent cohort), is less known.

Hypothesis:
We hypothesized there would be differences in the prevalence of AVR in PAH subgroups in the large PVDOMICS cohort of incident and prevalent patients.

Methods:
Group 1 PAH patients enrolled in PVDOMICS underwent right heart catheterization for baseline measurements. AVR was then measured in response to 100% inhaled oxygen (O
2
) and 100% O
2
plus NO at 40 ppm (O
2
+NO) for 5 min each before hemodynamic measurements. Details of the PVDOMICS methodology and core adjudication of hemodynamic measurements were reported previously. Rates of AVR to 100% O
2
and 100% O
2
+NO were compared between incident and prevalent patients in each PAH subgroup.

Results:
351 patients, mostly female (73%), average age of 52.9 years, with mostly prevalent disease (87%) and an average of 4 years from PAH diagnosis, underwent AVR assessment. A positive AVR was found in 0.6% of patients in response to 100% oxygen and 6% of patients in response to 100%+NO for the overall cohort. AVR was similar in incident and prevalent IPAH patients (6 and 6.9%, respectively). It was, however, 0% and 6.9%, in incident vs. prevalent CTD-PAH patients, respectively. There were no responders to either challenge in any other PAH subgroup.

Conclusions:
The prevalence of AVR is relatively rare in IPAH and CTD-PAH (~ 6%) and absent in other subgroups. There was no response to 100% O2 alone, suggesting specificity of AVR to NO in PAH. AVR is more common than previously reported in CTD-PAH, but only in prevalent disease. Whether the latter is related to long-term PAH therapy affecting pulmonary vasomotor response and/or vascular remodeling in these patients would warrant further studies.
Abstract 17279: Elevated Interleukin-6 Levels in COVID-19-Infected Patients Are Associated With Major Adverse Cardiac Events and/or Mortality
Authors: Nguyen Nicholas , Nguyen Hao , Patel Chirag , Ikram Farukh , Acharya Priyanka , Dhillion Anmol , Sidhu Manavjot S
Published: November 2020

Introduction:
Interleukin-6 (IL-6) is an inflammatory cytokine marker produced in response to infection and tissue injury. As the COVID-19 pandemic continues to thrive, uncertainties remain regarding COVID-19-related cardiovascular outcomes, specifically major adverse cardiovascular events (MACE). High IL-6 levels correlate with disease severity in COVID-19 patients; however, studies have not shown an association between elevated IL-6 levels and MACE and/or mortality.

Methods:
Two hundred twenty-five patients tested positive for COVID-19 at a major Southwest quaternary United States hospital between March 2020 and May 2020. Chart review of these patients was used to identify cases of MACE/ mortality and their respective IL-6 levels. This data was extracted for clinical analysis to identify any correlation between IL-6 levels and incidence of MACE and/or death. MACE was defined as a composite of myocardial infarction, stroke, deep venous thrombosis/ pulmonary embolism, or shock requiring vasopressor support.

Results:
Of the 225 patients with COVID-19, 112 patients had an IL-6 level drawn. Patients with elevated IL-6 levels had a higher incidence of MACE compared to patients with normal IL-6 levels (81.8% vs. 48.5%, p=0.0004, OR=4.77, 95% CI=1.81-13.50). There was a significant difference between the percentage of patients with elevated IL-6 levels who expired and patients with elevated IL-6 levels who did not expire (90.4% vs. 53.9%, p=0.0023, OR=8.11, 95% CI=1.76-74.86). IL-6 levels were significantly higher in patients who developed MACE and expired compared to levels in patients that did not (81.6% vs. 46%, p=0.0001, OR=5.21, 95% CI=2.03-14.13).

Conclusions:
MACE and/or death in COVID-19 patients were associated with elevated IL-6 levels. It is advisable to obtain IL-6 levels in all COVID-19 infected patients to help risk stratify these patients and treat IL-6 positive patients more aggressively.
Abstract 17298: Validation of Beat-to-Beat Blood Pressure and Left Ventricular Ejection Time by the Caretaker Physiological Monitor Against Invasive Central Aortic Measurement
Authors: Harmon Evan , Kwon Younghoon , Stafford Patrick , Baruch Martin , Kim Sung-Hoon , Mazimba Sula , Gimple Lawrence W
Published: November 2020

Objective:
There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. We examined the accuracy of noninvasive Caretaker device against invasively measured central aortic BP.

Methods:
Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. We derived correlations and Bland-Altman comparisons, after calibrating the Caretaker with 20 seconds of the initial catheter readings, as well as trend analyses for both systolic (SBP) and diastolic BP (DBP). We also measured left ventricular ejection time (LVET) from both aortic pressure tracing and Caretaker and compared the two.

Results:
A total of 47 patients were included in the study. A total of 31,369 beats obtained during the diagnostic portion of coronary angiogram were used for analysis. The correlations for SBP and DBP were 0.89 and 0.78, respectively (p < 0.001 for both). The Bland-Altman comparison yielded overall mean differences of 2.11 mmHg (SD 7.40) for SBP and 1.46 mmHg (SD 6.12) for DBP respectively (p <0.001 for all comparisons). The trend analysis yielded concordances of 86% and 85% for SBP and DBP, respectively. The correlation and Bland-Altman analyses for the LVET comparison yielded 0.89 (p< 0.001) with a mean difference of 13.9 ms (SD 14.4 ms).

Conclusion:
Beat-to-beat BP by Caretaker showed excellent agreement and high concordance in the direction and the degree of BP change with central aortic BP. This study supports the satisfactory performance of the Caretaker device in continuous tracking of beat-to-beat BP and LVET measurements.
Beat the AI: Investigating Adversarial Human Annotation for Reading Comprehension
Authors: Bartolo Max , Roberts Alastair , Welbl Johannes , Riedel Sebastian , Stenetorp Pontus
Published: November 2020

Innovations in annotation methodology have been a catalyst for Reading Comprehension (RC) datasets and models. One recent trend to challenge current RC models is to involve a model in the annotation process: Humans create questions adversarially, such that the model fails to answer them correctly. In this work we investigate this annotation methodology and apply it in three different settings, collecting a total of 36,000 samples with progressively stronger models in the annotation loop. This allows us to explore questions such as the reproducibility of the adversarial effect, transfer from data collected with varying model-in-the-loop strengths, and generalization to data collected without a model. We find that training on adversarially collected samples leads to strong generalization to non-adversarially collected datasets, yet with progressive performance deterioration with increasingly stronger models-in-the-loop. Furthermore, we find that stronger models can still learn from datasets collected with substantially weaker models-in-the-loop. When trained on data collected with a BiDAF model in the loop, RoBERTa achieves 39.9F1 on questions that it cannot answer when trained on SQuAD—only marginally lower than when trained on data collected using RoBERTa itself (41.0F1).
Proximate mechanisms responsible for random mating by size in the Himalayan toad Duttaphrynus himalayanus
Authors: Zhang Lixia , Sheng Yongsun , Yuan Xiangyu , Yu Fei , Zhong Xueting , Liao Jiahong , Liu Zhenhao , Chen Wei
Published: November 2020

Exploring the mechanisms that affect mating pattern with respect to body size has implications for understanding the evolution of sexual selection. Theory predicts that the absence of a relationship between female body size and fecundity, unbiased operational sex ratio, and a short breeding season will lead to random mating by body size in anuran amphibians. We tested these predictions in the Himalayan toad Duttaphrynus himalayanus inhabiting southeastern Tibet. Our study did not detect any correlation between female body size and number of eggs laid, nor was there a significant difference in the sex ratio of toads captured from the breeding site. In addition, the toads were reproductive for only a short period, from late April to early May (typical of an explosively breeding species). As expected, we detected a weak but not significant relationship between body size of amplexing males and females. Our results revealed no apparent size-assortative pairing in the study population of the Himalayan toad and may contribute to an increasing body of literature on mating patterns in relation to body size in animals with indeterminate growth.
Faces of God: The Ilan of Rabbi Sasson ben Mordechai Shandukh
Authors: Baumgarten Eliezer
Published: November 2020

Rabbi Sasson ben Mordechai Shandukh was one of the leaders of the renewed Jewish community in Baghdad in the second half of the eighteenth century and at the beginning of the nineteenth century. Among the literary heritage left by Rabbi Sasson Shandukh, which includes moral literature, liturgical poems, halakhic literature and prominent Kabbalistic literature, are the unique Kabbalistic ilanot (rotuli “trees”) he created. The four long rotuli that he created that have reached us are the subject of this article. The kabbalistic ilanot of Shandukh are distinctive for their great length, their eclectic sources, for their interpretation of the Lurianic theory of emanation, and for their anthropomorphic representations of divine faces, drawn in accordance with the teachings of the famed Safed kabbalist R. Isaac Luria.
Protean Passions
Authors: Essary Kirk
Published: November 2020

The purpose of this essay is to evaluate the manner in which Erasmus employs examples from and the genres of classical mythology in order to explain the emotions, but also to show how he utilizes affective meanings of myths to describe current events. Given Erasmus’ influence, and the burgeoning field of emotions history, my aim is to interject Erasmus more fully into the ongoing conversation about the ways in which emotions were understood in the past. I will do so by considering 1) his adaptation of Quintilian’s taxonomy of emotions as either tragic or comic; 2) his use of classical literature to explore and explain the emotions; and 3) his affective analysis of what he deems the “tragedy” of Martin Luther’s reform movement.
The Agricultural and Industrial Revolutions in England and China: A View through the Lens of Dynamic Property Rights Theory
Authors: Pei Xiaolin
Published: November 2020

This article presents a dynamic land property rights theory based on the law of the limit to land productivity, and then uses this theory and a large amount of data to compare the history of the agricultural and industrial revolutions in England and China. The article finds that, in England, the arable land—especially sown land—per capita of the agricultural population trended downward before the Black Death, but after the Black Death, experienced a long-term upward trend. In China, however, over the same period, the sown area per capita of the rural population shrank. It is these opposing trends that account for the historical divergence between the economies of England and China. This article concludes that the agricultural and industrial revolutions in England, as well as England’s capitalist market and private property rights regime, are the result of the expansion of the sown area per capita of the agricultural population. The article also concludes that the claim that England’s capitalist system of markets and private property rights gave birth to its agricultural and industrial revolutions cannot be sustained.
Local Fiscal Autonomy in China: Historical Evolution and Hierarchical Differences, 1990–2014
Authors: Jiao Changquan , Xu Chenxi
Published: November 2020

Local fiscal autonomy has a great influence on government behavior. However, there are substantial regional gaps and hierarchical differences in local fiscal autonomy in China. On the whole, although for many years most of China’s counties have enjoyed little fiscal autonomy, counties in the east have gradually won increased autonomy. Counties in the central and western regions, however, have continued to lose fiscal autonomy. Some have even lost the most basic level and now rely on transfer payments from higher-level governments for most of their local public expenditures. County expenditures make up the majority of national expenditures. Therefore, a low level of county fiscal autonomy impedes China’s county-based fiscal system reform and has a marked impact on government behavior and local governance.
The Art of Dying
Authors: Osztroluczky Sarolta
Published: November 2020

This paper will discuss three gardens and garden metaphors which represent such abstract ideas as temporality, transience, sickness or death. Even though these gardens do exist in reality, more of us are familiar with them from literature. The gardens of Sylvia Plath in Devonshire, Derek Jarman in Dungeness and Péter Nádas at Gombosszeg have acquired a metaphoric existence due to literary texts, they have been filled with meaning in the imagination of the readers, and they point to something beyond themselves. While constant change is part of the natural existence of gardens, these metaphoric gardens or garden metaphors are transferred to a certain timelessness, an everlasting present by the literary texts. This aesthetic existence or metaphoric overdetermination also affects the actual gardens themselves: if we are familiar with the poems or narratives written about them, we are no longer able to regard them as neutral spaces devoid of meaning.
Correctly mating: on the actual female of Hibana talmina Brescovit and the description of H. labonita sp. n. (Araneae, Anyphaenidae)
Authors: GALVIS WILLIAM , BRESCOVIT ANTONIO D.
Published: November 2020

Brescovit (1993), in the revision of the genus Hibana, described H. talmina, based on males from Venezuela, Colombia, Guyana and northern Brazil. Subsequently, Brescovit & Lise (1993) described its female, in an attempt to associate with the male, based on specimens collected in Dominica and Trinidad. Unfortunately, there was no justification for this mating. Recently Galvis et al. (2019) collected several couples of Hibana talmina in mangrove forests in some surrounding areas of Cartagena (Bolívar, Colombia), during a study of predation of crabs on these spiders. The detailed study of these couples showed that there was a wrong mating by Brescovit & Lise (1993) and this is corrected here. The original distribution is updated, with the exclusion of Dominica. The females previously assigned to H. talmina are treated here as Hibana labonita sp. nov., which is diagnosed in relation to the other species of Hibana.
The nomenclatural status of Phoenicurusia Verity, 1943 (Lepidoptera: Lycaenidae: Lycaeninae)
Authors: BALLETTO EMILIO , BOZANO GIAN CRISTOFORO
Published: November 2020

Roger (Ruggero) Verity published Phoenicurusia as a subgenus of Lycaena Fabricius, on p. 21 of vol. 2 of Farfalle Diurne d’Italia (1943), since in the male genitalia the falces were bent like an acute elbow after one-quarter of their length, rather than smoothly curved as they are in species of the subgenus Lycaena. Verity contextually designated Polyommatus phoenicurus Lederer, 1870 (Locus Typicus: [LT] ‘Hadschyabad’ [N. Iran]) as the Type Species [TS] of Phoenicurusia and described the male genitalia of phoenicurus Lederer, 1870, “razza” scintillans Christoph, 1887, labelled as from Germab (Askhabad [Turkmenistan]), and those of Polyommatus dimorphus Staudinger, 1881, labelled as from Passo Taldyk [Kyrgyzstan: Alai Mts]. Although Verity included both species in his new subgenus, he also highlighted an important difference existing between them, since, contrary to those of dimorphus, the genitalia of phoenicurus were ‘enormous’ with respect to the size of the butterfly. Both the aedeagus and the valvae were extremely elongate, much more than those of dimorphus and the latter were terminally toothed.
The spatial structure debate in spatial interaction modeling: 50 years on
Authors: Oshan Taylor M
Published: November 2020

Spatial interaction and spatial structure are foundational geographical abstractions, though there is often variation in how they are conceptualized and deployed in quantitative models. In particular, the last five decades have produced an exceptional diversity regarding the role of spatial structure within spatial interaction models. This is explored by outlining the initiation and development of the notion of spatial structure within spatial interaction modeling and critically reviewing four methodological approaches that emerged from ongoing debate about the topic. The outcome is a comprehensive coverage of the past and a sketch of one potential path forward for advancing this long-standing inquiry.
FEM analysis of inspection manhole on large steel tanks
Authors: Tomović Radoslav , Dizdar Samir , Isić Safet , Tuka Smajo , Karabegović Isak
Published: November 2020

The aim of this paper is to demonstrate how the correct application of FEM analysis can be used to find effective solutions for the design of mechanical structures. The design of the inspection openings on the tanks is being considered. There are several existing tanks of the same dimensions (20 m high and diameter 10,2 m), but they have different wall thicknesses (9,6; 15; 20 and 25 mm). For inspection purposes, assembly of manhole hatch on all tanks is required. The manhole hatch is designed applying standard API 650. All tanks are filled with the water to the top 20 m high. Several different analyses have been carried out in order to ensure that there are not too high stresses in the materials of the existing tanks due to the insertion of the manhole hatch and finally qualify construction according to EN-13445 norm. The elastic analysis shows that stresses in the material are too high and the design hasn’t been approved. In order to avoid redesign procedures, which can be expensive and sometimes difficult to do in reality, plastic analysis has been done. After plastic analysis, the design could be approved with the restriction on the max. preload force in the bolts 40 kN/per bolt.
Biomechanical and Biophysical Properties of Breast Cancer Cells Under Varying Glycemic Regimens
Authors: Dutta Diganta , Palmer Xavier-Lewis , Ortega-Rodas Jose , Balraj Vasundhara , Dastider Indrani Ghosh , Chandra Surabhi
Published: November 2020

Diabetes accelerates cancer cell proliferation and metastasis, particularly for cancers of the pancreas, liver, breast, colon, and skin. While pathways linking the 2 disease conditions have been explored extensively, there is a lack of information on whether there could be cytoarchitectural changes induced by glucose which predispose cancer cells to aggressive phenotypes. It was thus hypothesized that exposure to diabetes/high glucose alters the biomechanical and biophysical properties of cancer cells more than the normal cells, which aids in advancing the cancer. For this study, atomic force microscopy indentation was used through microscale probing of multiple human breast cancer cells (MCF-7, MDA-MB-231), and human normal mammary epithelial cells (MCF-10A), under different levels of glycemic stress. These were used to study both benign and malignant breast tissue behaviors. Benign cells (MCF-10A) recorded higher Young’s modulus values than malignant cells (MCF-7 and MDA-231) under normoglycemic conditions, which agrees with the current literature. Moreover, exposure to high glucose (for 48 hours) decreased Young’s modulus in both benign and malignant cells, to the effect that the cancer cells showed a complete loss in elasticity with high glucose. This provides a possible insight into a link between glycemic stress and cytoskeletal strength. This work suggests that reducing glycemic stress in cancer patients and those at risk can prove beneficial in restoring normal cytoskeletal structure.
Classification of Dementia Severity in Taiwan Based on History-Based Clinical Diagnosis System
Authors: Chang Yun Fah , Loi Woan Yee , Chiu Pai-Yi , Huang Huang-Nan
Published: November 2020

Background/Aims:

This study used HAICDDS screening questionnaire to classify the severity of dementia in Taiwan based on the clinical dementia rating scale.

Methods:

LDA was applied to 6,328 Taiwanese clinical patients for classification purposes. Clustering method was used to identify the associated influential symptoms for each severity level.

Result:

LDA shows only 36 HAICDDS questions are significant to distinguish the 5 severity levels with 80% overall accuracy and it increased to 85.83% when combining normal and MCI groups. Severe dementia patients have the most serious declination in most cognitive and functionality domains, follows by moderate dementia, mild dementia, MCI and normal patients.

Conclusion:

HAICDDS is a reliable and time-saved diagnosis tool in classifying the severity of dementia before undergoing a more in-depth clinical examination. The modified CDR may be indicated for epidemiological study and provide a solid foundation to develop a machine-learning derived screening instrument to detect dementia symptoms.
Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective observational study
Authors: Feyissa Mechessa Desalegn , Dessalegn Dula , Melaku Tsegaye
Published: November 2020

Background:

Drug-related problem is any event involving drug therapy that may interfere in a patient’s desired clinical outcome. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Thus, this study aimed to assess drug-related problems and its predictors among pediatric patients diagnosed with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia.

Methodology:

A prospective observational study was conducted among pediatric patients with infectious diseases admitted to the Jimma University Medical Center. Drug-related problems were classified based on Cipolle, Morley, and Strand’s drug-related problems classification method. The patient’s specific data were collected using a structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug-related problems occurrence, multiple stepwise backward logistic regression analysis was done. Statistical significance was considered at a p-value < 0.05.

Results:

Of the total 304 participants, 226 (74.3%) of them had at least one drug-related problem during their hospital stay. A total of 356 drug-related problems were identified among 226 patients. Anti-infective medication was the major class of drug involved in drug-related problems. Noncompliance (28.65%) and dose too low (27.53%) were the most common type of drug-related problems identified. Presence of disease comorbidity (adjusted odds ratio = 3.39, 95% confidence interval = 1.89–6.08), polypharmacy (adjusted odds ratio = 3.16, 95% confidence interval = 1.61–6.20), and more than 6 days stay in hospital (adjusted odds ratio = 3.37, 95% confidence interval = 1.71–6.64) were independent predictors for the occurrence of drug-related problems..

Conclusion:

Drug-related problems were high among pediatric patients with infectious disease in the study setting. The presence of comorbidity, polypharmacy, and prolonged hospital stay were predictors of drug-related problems in this finding. Therefore, to prevent these problems, the collaboration of clinical pharmacists, pediatricians, and other health care professionals is needed during the provision of pharmaceutical care.