bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating Fatty Acids Associated with Advanced Liver Fibrosis and Hepatocellular Carcinoma in South Texas Hispanics
Authors: Jiao Jingjing , Kwan Suet-Ying , Sabotta Caroline M. , Tanaka Honami , Veillon Lucas , Warmoes Marc O. , Lorenzi Philip L. , Wang Ying , Wei Peng , Hawk Ernest T. , Almeda Jose Luis , McCormick Joseph B. , Fisher-Hoch Susan P. , Beretta Laura
Published: June 2021

Background:

Hispanics in South Texas have high rates of hepatocellular carcinoma (HCC) and nonalcoholic fatty liver disease (NAFLD). Liver fibrosis severity is the strongest predictive factor of NAFLD progression to HCC. We examined the association between free fatty acids (FA) and advanced liver fibrosis or HCC in this population.

Methods:

We quantified 45 FAs in plasma of 116 subjects of the Cameron County Hispanic Cohort, 15 Hispanics with HCC, and 56 first/second-degree relatives of Hispanics with HCC. Liver fibrosis was assessed by FibroScan.

Results:

Advanced liver fibrosis was significantly associated with low expression of very long chain (VLC) saturated FAs (SFA), odd chain SFAs, and VLC n-3 polyunsaturated FAs [PUFA; AOR; 95% confidence interval (CI), 10.4 (3.7–29.6); P < 0.001; 5.7 (2.2–15.2); P < 0.001; and 3.7 (1.5–9.3); P = 0.005]. VLC n3-PUFAs significantly improved the performance of the noninvasive markers for advanced fibrosis - APRI, FIB-4, and NFS. Plasma concentrations of VLC SFAs and VLC n-3 PUFAs were further reduced in patients with HCC. Low concentrations of these FAs were also observed in relatives of patients with HCC and in subjects with the PNPLA3 rs738409 homozygous genotype.

Conclusions:

Low plasma concentrations of VLC n-3 PUFAs and VLC SFAs were strongly associated with advanced liver fibrosis and HCC in this population. Genetic factors were associated with low concentrations of these FAs as well.

Impact:

These results have implications in identifying those at risk for liver fibrosis progression to HCC and in screening this population for advanced fibrosis. They also prompt the evaluation of VLC n-3 PUFA or VLC SFA supplementation to prevent cirrhosis and HCC.
CD86+ Antigen-Presenting B Cells Are Increased in Cancer, Localize in Tertiary Lymphoid Structures, and Induce Specific T-cell Responses
Authors: Wennhold Kerstin , Thelen Martin , Lehmann Jonas , Schran Simon , Preugszat Ella , Garcia-Marquez Maria , Lechner Axel , Shimabukuro-Vornhagen Alexander , Ercanoglu Meryem S. , Klein Florian , Thangarajah Fabinshy , Eidt Sebastian , Löser Heike , Bruns Christiane , Quaas Alexander , von Bergwelt-Baildon Michael , Schlößer Hans A.
Published: June 2021

The role of B cells in antitumor immunity and their impact on emerging immunotherapies is increasingly gaining attention. B-cell effector functions include not only secretion of antibodies, but also presentation of antigens to T cells. A physiologic B-cell subset with immunostimulatory properties was described in humans, defined by a high expression of CD86 and downregulation of CD21. We used multicolor flow cytometry and IHC to elucidate abundance and spatial distribution of these antigen-presenting B cells (BAPC) in blood (peripheral blood mononuclear cells, PBMC) and tumor samples of 237 patients with cancer. Antigen-specific T-cell responses to cancer testis antigens were determined using tetramer staining and sorted BAPCs in FluoroSpot assays for selected patients. We found that BAPCs were increased in the tumor microenvironment of 9 of 10 analyzed cancer types with site-specific variation. BAPCs were not increased in renal cell carcinoma, whereas we found a systemic increase with elevated fractions in tumor-infiltrating lymphocytes (TIL) and PBMCs of patients with colorectal cancer and gastroesophageal adenocarcinoma. BAPCs were localized in lymphoid follicles of tertiary lymphoid structures (TLS) and were enriched in tumors with increased numbers of TLSs. BAPCs isolated from tumor-draining lymph nodes of patients with cancer showed increased percentages of tumor antigen–specific B cells and induced responses of autologous T cells in vitro. Our results highlight the relevance of BAPCs as professional antigen-presenting cells in tumor immunity and provide a mechanistic rationale for the observed correlation of B-cell abundance and response to immune checkpoint inhibition.
Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey
Authors: Saeed Fahad , Duberstein Paul R. , Epstein Ronald M. , Lang Valerie J. , Liebman Scott E.
Published: June 2021

Introduction: Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one’s values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. Methods: We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0–4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define “frequent” and “moderate-to-severe” moral distress. Results: The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. Conclusion: A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.
The Use of Neuroprotective Agents in Treating Geographic Atrophy
Authors: Scholl Hendrik P.N. , Boyer David , Giani Andrea , Chong Victor
Published: June 2021

Geographic atrophy (GA) secondary to age-related macular degeneration accounts for close to one-quarter of cases of legal blindness in the USA and the UK. Despite this notable disease burden, the pathophysiology of GA is complex and not fully understood, and there is currently no approved treatment to prevent or slow its progression. GA is heterogeneous in its appearance and extent, and underlying associated traits such as drusen and complement factor polymorphisms vary between patients and by ethnicity, posing a challenge for treatment development. The root cause of vision loss in GA is photoreceptor death; therefore, protecting photoreceptors from damage and delaying their degeneration are key to successful GA treatment. There are multiple neuroprotective pathways that may contribute to protecting photoreceptors from damage, and compounds that target these pathways include antioxidants, neurotrophic factors, and catalases. However, the efficacy of previously trialled neuroprotective therapies in GA, such as brimonidine, tandospirone, and NT-501, has been inconsistent; this may be due to their target of action, method of delivery, and/or suboptimal duration of action. Neurotrophic factors, or molecules involved in neuroprotective signalling cascades, may be ideal agents for further investigation for the treatment of GA. Future neuroprotective strategies in GA must focus on the development of agents with a long duration of action that can combat the progression of chronic damage in GA to provide clinically meaningful benefits for patients.
МОРФОЛОГІЧНІ ЗМІНИ СУДИН ЄМНІСНОЇ ЛАНКИ ГЕМОМІКРОЦИРКУЛЯТОРНОГО РУСЛА ЛЕГЕНЬ МОРСЬКИХ СВИНОК, СЕНСИБІЛІЗОВАНИХ ОВАЛЬБУМІНОМ
Authors: Попко С. С.
Published: June 2021

Актуальною проблемою сучасної медицини є реакція мікросудин легень при хронічних алергічних захворюваннях дихальної системи, адже саме від стану судин гемомікроциркуляторного русла залежить повноцінне функціонування тканин та клітин організму.
Мета – вивчити морфологічні зміни судин ємнісної ланки гемомікроциркуляторного русла легень морських свинок, сенсибілізованих овальбуміном.
Матеріал та методи. За допомогою гістологічного, морфометричного та статистичного методів вивчали легені 48 самців морських свинок в умовах експериментального овальбумін-індукованого алергічного запалення, яке моделювали шляхом триразової підшкірної сенсибілізації та наступної 8-денної інтраназальної інгаляції овальбуміном. Для визначення структурної та функціональної перебудови посткапілярних та м᾽язових венул визначали величину внутрішнього діаметра судин.
Результати. Встановлено загальну закономірність реактивності ємнісної ланки гемомікроциркуляторного русла легень морських свинок при експериментальному овальбумін-індукованому алергічному запаленні, що полягає в структурній та функціональній перебудові посткапілярних та м᾽язових венул у вигляді збільшення діаметра їх просвіту та проникності їх стінки. Більш виражені морфологічні зміни виявлені в посткапілярних венулах у ранньому періоді розвитку алергічного запалення, що підтверджує максимальний коефіцієнт збільшення діаметра просвіту посткапілярних венул, який спостерігається в 1-ій експериментальній групі, порівняно з контролем, і становить 1,7.
Висновки. Сенсибілізація та інгаляційна алергізація овальбуміном призводять до структурної реорганізації у вигляді вазодилатації посткапілярних та м᾽язових венул гемомікроциркуляторного русла легень морських свинок, яка має односпрямований стадійний характер в залежності від діаметра судин і тривалості експерименту та є проявом порушення відновно-адаптаційних процесів гемомікроциркуляції. Найбільш виражені зміни виявляються впродовж раннього періоду розвитку алергічного запального процесу в посткапілярних венулах.
РОЛЬ ІНФОРМАЦІЙНО-КОМУНІКАТИВНИХ ТЕХНОЛОГІЙ У НАВЧАЛЬНОМУ ПРОЦЕСІ
Authors: Данилевич Ю. О. , Наумова Л. В. , Мілевська-Вовчук Л. С.
Published: June 2021

У статті розглянуто провідні стратегії організації навчання студентів в умовах дистанційного викладання на практичних кафедрах Тернопільського національного медичного університету.

Показано, що зростання творчої компоненти освіти та підвищення активності всіх учасників навчального процесу як студентів, так і викладачів сприяє модифікації інтерактивного навчання, пов’язаного з використанням комп’ютерних систем, мультимедійних технологій; навчально-методичної продукції нового покоління.

Розглянуто інноваційну навчальну технологію та сучасні методи викладання як загальнодидактичний процес, що полягає у використанні сукупності оригінальних способів і прийомів спільної діяльності суб’єктів освітнього процесу, спрямованих на досягнення мети навчання, розвитку особистості та креативно-фахового здобуття знань і компетенцій відповідно до завдань підготовки професіоналів нового часу. 

Проаналізовано і доведено, що найкращого результату в навчанні можна досягнути тоді, коли ролі викладача й студента врівноважені: обидва працюють для того, щоб навчатися, ділитися своїми знаннями, досягненнями свого життєвого досвіду.

Впровадження інформаційно-комунікаційних технологій у навчальний процес, на практичних заняттях з терапії, сприяє більш повному оволодінню системою знань та вмінь, розвиває творчу спрямованість пізнавальної діяльності студентів, забезпечує об’єктивний самоконтроль і самоперевірку отриманих знань, допомагає формуванню відповідних професійних компетентностей та особистісних якостей, дозволяє викладачам забезпечити диференційований підхід у навчанні.

У роботі проаналізовано доступні  інтерактивні методики та форми навчання, узагальнено найоптимальніші способи, форми і методи оцінювання роботи студентів на онлайн-платформах, доступних у даний час.

Автори стверджують, що педагогічні підходи до викладання постійно вимагають пошуку новітніх засобів, які здатні принести в навчальний процес елемент новизни, підвищити інтерес здобувачів вищої освіти, особливо в період карантину.
A importância dos cantos de Goghten para a cultura armênia
Authors: Camargo Yêda de Moraes
Published: June 2021

As origens da literatura armênia perdem-se no tempo. É importante observar que as criações literárias armênias, de que se tem informação, foram transmitidas pela expressão oral, bem antes de Cristo. O que se sabe é que, no milênio que antecedeu a cristianização (301 d.C.), existiu e floresceu uma criatividade literária em versos, transmitidas de geração a geração, de teor mitológico, histórico- épico, dramático e, também, humorístico.
O mito do Oriente Antigo - o mito bíblico
Authors: Leftel Ruth
Published: June 2021

Um mito é uma estória sobre o universo, que é considerada sagrada.Os gregos denominavam mitos as estórias sobre os feitos dos deuses na antigüidade. (gr.mythos: “a coisa falada”, “palavra”, “narrativa”). Estórias assim são encontradas, não apenas na literatura grega antiga, mas também na literatura de outros povos da antigüidade, como os do Oriente Antigo e também na tradição de povos primitivos da nossa época. Podemos, então, dizer que os mitos são um fenômeno humano geral.
Hassan Massoudy e a arte da caligrafia árabe
Authors: Hanania Aida Ramezá
Published: June 2021

Emblemática de um povo que viu no signo sua forma maior de manifestação estética, a arte de Hassan Massoudy enraíza-se na tradição árabe, buscando incessantemente a universalidade que caracteriza a pintura contemporânea. Ao mirar a obra de Massoudy, a sensação primeira é a de surpreendente perplexidade, como se de antiga cepa, surgisse ramo novo e vigoroso, independente em seu desenvolvimento, mas inegavelmente alimentado pela seiva ancestral.
A álgebra como ciência árabe
Authors: Lauand Luiz Jean
Published: June 2021

Neste estudo, analisaremos a Álgebra como ciência árabe. Comecemos por antecipar alguns tópicos de discussão sobre que significado pode ter falar em ciência desta ou daquela nação ou cultura – para além do mero fato de indicar o estágio de desenvolvimento ou a produção dos cientistas de uma nacionalidade, como quando se diz: “a Física russa está bastante adiantada e é detentora de diversos Prêmios Nobel” ou “só a Medicina americana consegue fazer esse tipo de transplante” etc.
A essência do hebraico
Authors: Szpiczkowski Ana
Published: June 2021

A palavra hebraica é gerada, de uma raíz, composta, geralmente, por três letras consonantais. Essas três letras consistem na essência da palavra e irão permitir, por sua derivação, a formação de outras. É possí- vel, portanto, à partir de sua raíz, analisá-la semânticamente e obter a revelação de seu verdadeiro sentido. Entretanto, em alguns casos, o radical diz respeito à mais de um campo semântico, pelo fato de serem de origens diferentes, pois no hebraico moderno coexistem, indistintamente, elementos lingüísticos de todas as fases anteriores de sua utilização (período bí- blico, período talmúdico e literatura da Idade Média). Como exemplo, para esse estudo, foram escolhidas as palavras אמן – Amen e Eden – עדן, que transmitem algo, não somente para os hebraístas, mas que, por sua abrangêcia, fazem parte do saber universal
O ciclo épico do corvo no Paleoasiático e o mito do desaninhador de pássaros dos índios Bororo no Brasil: em busca de elos
Authors: Nazário Helena S.
Published: June 2021

Este trabalho visa estabelecer comparações entre o ciclo épico do Corvo, estudado por Eleazar Meletínski em O Epos Mitólogico Paleoasiático, e o mito bororo denominado “o desaninhador de pássaros” estudado por Claude Lévi-Strauss em O Cru e o Cozido.
Elementos formadores do imaginário sobre o japonês no Brasil
Authors: Dezem Rogério
Published: June 2021

A partir da análise de artigos e imagens publicadas entre 1903 e 1908 nos periódicos nacionais O Malho e Revista da Semana, este artigo tem como objetivo apresentar como se deu a construção/desconstrução dos discursos relativos aos imigrantes orientais no Brasil. Enfatiza-se a pluralidade dos discursos produzidos, que são comparados, com o objetivo de identificar os estereótipos que vieram a estigmatizar primeiramente os chineses (chins) e depois os japoneses que estavam prestes a vir para o Brasil.
A "fórmula do horror à Rússia" na Belle Époque Brasileira
Authors: Gomide Bruno Barretto
Published: June 2021

Quando leitores de todas as partes do mundo descobriram a literatura russa em fins do século dezenove, freqüentemente associaram-na a noções de contraste e de excesso. Este trabalho apresenta brevemente alguns textos (narrativas pseudo-russas, fantasias literárias, ensaios) publicados no Brasil do fim de século e da belle époque e marcados pela tonalidade patética.
Abstract 46: Bile Acid Synthesis and 12-Hydroxylation are Increased, and Bile Acid Transport is Impaired in Human Obesity
Authors: Haeusler Rebecca , Camastra Stefania , Nannipieri Monica , Astiarraga Brenno , Castro-Perez Jose , Xie Dan , Wang Liangsu , Chakravarthy Manu , Ferrannini Ele
Published: June 2021

Bile acids (BAs) are now recognized as important signaling molecules. They have the ability to regulate a variety of physiologic processes, including those governing metabolism of glucose, triglycerides, and cholesterol. We hypothesize that obesity is associated with alterations in BA synthesis or turnover that may contribute to metabolic dysregulation. To test this, we measured serum BAs and markers of BA synthesis after overnight fasting, during a hyperinsulinemic-euglycemic clamp, or a mixed meal tolerance test in 11 nonobese and 32 obese subjects. We also analyzed BA transporter expression in specimens of human liver, duodenum, jejunum, ileum, colon, and pancreas. We found that BA synthesis markers were twofold higher (P<0.01) and preferentially 12-hydroxylated (P<0.05) in obese subjects, and both measures were correlated with clamp-derived insulin sensitivity (r=-0.62, P<0.0001 and r=-0.39, P=0.01, respectively). Insulin infusion acutely reduced serum BAs in nonobese subjects, but this effect was blunted in obese subjects (-44.2% versus -4.2%, P<0.05). The rise in serum BAs postprandially was also relatively blunted in obese subjects (+402% versus +133%, P<0.01). Liver expression of the Na+-taurocholate cotransporting polypeptide (NTCP) and the bile salt export pump (BSEP) were negatively correlated with BMI (r=-0.37, P=0.02 and r=-0.48, P=0.001, respectively). We conclude that obesity is associated with increased BA synthesis, preferential 12-hydroxylation, and decreased hepatic BA transport. These findings reveal new pathophysiological aspects of BA action in obesity that may lend themselves to therapeutic targeting in metabolic disease.
Abstract 106: Differential Effects of Mild Therapeutic Hypothermia Against Normothermia for Post-Cardiac Arrest Syndrome According to the Severity Scale
Authors: Nishikimi Mitsuaki , Ogura Takayuki , Nishida Kazuki , Iwami Taku
Published: June 2021

Introduction:
There are few studies on the differential effects of mild therapeutic hypothermia (MTH) according to the risk class in post-cardiac arrest syndrome (PCAS) patients.

Objective:
The aim of this study was to evaluate the differential effects of MTH against therapeutic normothermia (TN) for PCAS patients according to our risk classification tool (rCAST).

Methods:
We used data from the out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multi-center, prospective registry of OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department across Japan. We classified eligible PCAS patients treated with MTH or TN on the basis of our rCAST score which was previously developed by us: low severity group (≤5.5), moderate severity group (6-14), and high severity group (≥14.5). The differential effects of MTH vs. TN for their neurological outcome in the 3 severity categories were evaluated by interaction analysis, and the effect of MTH vs. TN in each group was assessed by multivariate logistic regression analysis and propensity score analysis. The good neurological outcome was defined as a Cerebral Performance Categories score ≤2 at 30 days.

Results:
Among 12,024 OHCA patients in the registry, data of 460 PCAS patients treated by MTH or TN were analyzed (96 patients; the low score, 192; the moderate score, and 172; the high score group). There was a statistically significant interaction effect between MTH/TN and their neurological outcome at 30 days in the 3 categories (p = 0.022). MTH was significantly associated with good neurological outcome at 30 days in PCAS patients of moderate severity group both in the multivariate logistic regression analysis (adjusted odds ratio, 3.09; 95% confidence interval, 1.13-8.49; p = 0.029) and the propensity score analysis (p = 0.030), while it was not in low and high severity group.

Conclusions:
The effect of MTH in PCAS patients differed according to the severity of PCAS, and MTH was significantly associated with a good neurological outcome as compared to TN in the moderate severity group.
Abstract 12: Outcomes After Pediatric Extracorporeal Cardiopulmonary Resuscitation: Do Quantitative CPR Metrics Matter?
Authors: Raymond Tia T , Esangbedo Ivie , Yu Priscilla , Sweberg Todd , Lasa Javier J , Niles Dana E , Zhang Xuemei , Griffis Heather , Hanna Richard , Nadkarni Vinay M
Published: June 2021

Introduction:
Duration of conventional cardiopulmonary resuscitation (CPR) prior to ECMO cannulation (ECPR) has been shown to be associated with worse survival outcomes, yet conflicting reports exist.

Hypothesis:
ECPR patients who receive guideline-compliant CPR will have improved survival to hospital discharge (SHD) compared to patients who do not receive guideline-compliant CPR, regardless of CPR duration.

Methods:
Prospective cohort from PediRES-Q sites of IHCA in children ≤ 18 yo requiring ECMO to achieve ROSC. We assessed compliance of 60-sec chest compression (CC) epochs via metric data (Zoll R-series, Chelmsford, MA) with 2015 AHA guideline targets. Guideline-compliant CPR was defined as an IHCA with >60% epochs meeting compliance criteria for metric data. Differences were assessed utilizing Wilcoxon rank-sum and Chi-square tests. Logistic regression assessed the association between compliance and SHD, adjusting for age, arterial line, and duration of CPR.

Results:
From 10/2015 to 3/2019, 62 index ECPR events (> 5 epochs) in 20 infants (<1 yo), 24 children (1-<8 yo), and 18 adolescents (8-≤18 yo) with CPR quality metric data were utilized from 15 sites. Median CPR duration 52 mins (IQR 45,70), median weight 11.6 kgs (IQR 6.8,29.8), and 38/62 patients (61%) had a cardiac diagnosis. Guideline compliance was not associated with SHD. Adjusting for age, presence of arterial line, and duration of CPR, guideline compliance was not significantly associated with SHD. However, age and duration of CPR were significantly associated to SHD, as 8-<18 yo had 85% lower odds of SHD than < 1 yo (aOR=0.15 {0.03, 0.73}; P=0.019) and every minute increase in duration of CPR decreased odds of survival by 4% (aOR=0.96 {0.94,0.99}; P=0.009).

Conclusion:
No SHD benefits were found among ECPR patients who received guideline-compliant CPR compared to patients who do not. Older patients and those with longer CPR duration had worse SHD outcomes irrespective of guideline-compliant CPR.
Abstract 123: Field Accuracy of Paramedic Shock Delivery Using a Filtered ECG Rhythm
Authors: Stoecklein Hill , Pugh Andrew , Stroud Michael , Youngquist Scott
Published: June 2021

Introduction:
Recognition and rapid defibrillation of shockable rhythms is strongly associated with increased survival from out-of-hospital cardiac arrest (OHCA). The Salt Lake City Fire Department (SLCFD) adopted ECG rhythm filtering technology in 2011, along with a protocol to rapidly defibrillate shockable rhythms without awaiting the end of the 2-minute CPR epoch. Paramedics were also trained to empirically shock asystole, as studies have shown poor agreement in cases of fine and moderate amplitude Ventricular Fibrillation (VF).

Hypothesis:
We hypothesized that the mandate to shock perceived asystole plus the use of filtering technology would result in high case sensitivity for shockable rhythms at the expense of an unknown frequency of shock delivery to organized rhythms.

Methods:
Prospectively collected defibrillator data from cardiac arrest cases treated by SLCFD between Dec 2011 and June 2019 were analyzed. Timing of rhythm changes and defibrillation events was manually abstracted using the manufacturer’s review software. The gold standard for rhythm interpretation was post-incident physician interpretation.

Results:
Paramedics attempted resuscitation in 942 OHCAs. We excluded 41 pediatric cases, 140 cases of BLS or bystander-only AED resuscitation, and 65 cases in which the defibrillator file was unavailable. Overall, 696 adult cardiac arrests with 1,389 shocks delivered were available for analysis. Shocks were delivered to 958 (69%) shockable, 261 (19%) asystole, 158 (11%) PEA, 4 (0.3%) SVT, and 8 (0.6%) unknown underlying rhythms. In 280 cases no shock was delivered despite an initial shockable rhythm in 3 of these cases. Shock delivery case sensitivity was 180/183 (0.98, 95% confidence interval [CI]:0.97-1.0) with false positive proportion of delivered shocks of 158/1,389 (0.11, 95% CI:0.10-0.13) for PEA only and 419/1,389 (0.30, 95% CI:0.28-0.33) for combined PEA and asystole. Neurologically intact (CPC 1-2) overall and Utstein survival rates were 15% and 46% respectively.

Conclusions:
Using ECG rhythm-filtering technology and an aggressive protocol to defibrillate VF and empirically shock asystole, we demonstrated high case sensitivity for VF at the expense of an 11% rate of shock delivery to underlying PEA.
Abstract 126: ’Tick Tock’ it’s Time to Shock; Increased Shock Latency is Associated With Intra-Arrest Transport and Reduced Survival From Out-Of-Hospital Cardiac Arrest
Authors: Pugh Andrew , Stoecklein Hill , Stroud Michael , Youngquist Scott T
Published: June 2021

Introduction:
Timely defibrillation of shockable rhythms during out of hospital cardiac arrest (OHCA) is an important link in the chain of survival. In 2011 the Salt Lake City Fire Department (SLCFD) adopted ECG filtering technology to allow rhythm interpretation during CPR and a protocol to defibrillate shockable rhythms immediately upon identification.

Hypothesis:
We hypothesized that, under the new protocol, time from observing VF to defibrillation would, on average, be less than the 2 minutes expected by guidelines. We also hypothesized that increased shock latency would be associated with intra-arrest transport and decreased survival.

Methods:
Prospectively collected and abstracted defibrillator data from non-traumatic cardiac arrest cases treated by ALS providers from SLCFD between Dec 2011 and June 2019 were analyzed along with Utstein variables and outcomes. Using the defibrillator manufacturer’s review software, the timing of observed rhythm changes and defibrillation events was manually abstracted based on post-incident physician interpretation. Generalized linear and Poisson mixed models were used for analysis.

Results:
A total of 696 cardiac arrests with 965 shocks delivered to shockable rhythms were analyzed after excluding pediatric cases, non-ALS cases, and cases in which the defibrillator file was lost or corrupted. Median time to defibrillation was 67 sec (IQR 30-143 sec) with mixed-effects grand mean of 106 sec (95% CI 96-117 sec). Delayed defibrillation (> 2 min) occurred in 293/965 (30%) of shocks. Transport of patients in arrest was associated with an increase in shock latency of 42 sec (95% CI 21-63 sec) compared to patients treated on scene. Among patients with an initial shockable rhythm, time from VF appearance to defibrillation was, on average, 40 sec (95% CI 15-66 sec) shorter among survivors than non-survivors.

Conclusions:
Use of an aggressive defibrillation protocol enabled by ECG filtering software resulted in a median time to defibrillation of under 2 minutes. Increasing shock latency was associated with intra-arrest transport providing a causal hypothesis for the poor outcomes observed in this population. We observed a negative association between survival and average time to defibrillation of shockable rhythms.
Abstract 127: Machine Learning Techniques to Predict Cardiac Re-Arrest in Out-Of-Hospital Setting
Authors: Elola Andoni , Aramendi Elisabete , Irusta Unai , Amezaga Naroa , Urteaga Jon , Owens Pamela , Idris Ahamed H
Published: June 2021

Background:
Re-arrest occurs when a cardiac arrest patient being treated by the emergency medical services experiences another cardiac arrest after return of spontaneous circulation (ROSC).The incidence of re-arrest is high, close to 40% in out-of-hospital cardiac arrest (OHCA), and it is associated with lower survival. Prediction of re-arrest could improve prehospital care. The aim of this study was to develop a re-arrest prediction model based on heart rate variability (HRV) features.

Materials and methods:
OHCA cases treated by Dallas-FortWorth Center of Resuscitation Research were analyzed. Patients with at least two minutes of ROSC were included. Re-arrest was ascertained by the presence of life-threatening ECG and/or presence of chest compressions within 12 minutes after ROSC. Eighteen HRV characteristics for 1 min and 2 min intervals after ROSC were computed. Features were fed into a Random Forest (RF) classifier with 100 trees to predict re-arrest cases. Ten-fold cross-validation with 30 repetitions was applied to train the model and assess the performance in terms of area under the curve (AUC).

Results:
Inclusion criteria were met by 98 patients, 41 of which suffered re-arrest. The median time (interquartile range) to re-arrest from ROSC onset was 5 (3-7) min. The re-arrest prediction model showed a median AUC of 0.71 and 0.75 for 1 and 2 min post ROSC intervals, respectively. The most important HRV features in the RF predictor were the SD1/SD2 ratio (where SD1 and SD2 are the dispersions of points both perpendicular and parallel to the line-of-identity in the Poincaré plot), SD2, the interquartile range of the RR intervals, peak frequency in the high frequency band (0.15-0.4 Hz) and coefficient of variation of RR intervals (the ratio between the mean and standard deviation of RR intervals).

Conclusions:
HRV metrics predict re-arrest in OHCA. Further studies with larger datasets are needed to better understand re-arrest dynamics and confirm conclusions.
Abstract 131: Elevated Serum MPEG-1 Protein is Associated With Reduced Survival and Poor Neurological Recovery in Resuscitated Out-Of-Hospital Sudden Cardiac Arrest
Authors: Kattel Sharma , Bhatt Hardik , Xu Shirley , Pokharel Saraswati , Sharma Umesh C
Published: June 2021

Background:
For decades, bio-markers involved in inflammation and stress response were implicated in patients who were successfully resuscitated from out of hospital cardiac arrest (sR-OHCA). Here we report that increased serum levels of Macrophage-expressed gene 1 (MPEG1), an evolutionary conserved protein with membrane attack complex domain, is associated with increased mortality and poor neurological outcomes after sR-OHCA.

Objectives:
To examine the association between circulating MPEG-1 protein measured within the first 6-hours of sR-OHCA, and inpatient survival and neurological outcomes.

Methods:
We prospectively enrolled 144 sR-OHCA patients from 4 different tertiary care centers. We measured MPEG-1 protein, and other conventional clinical bio-markers including troponin-I and CK-MB in the sera obtained within the first 6-hours of resuscitation. The clinical covariates during hospitalization (till the time death or discharge) were obtained via medical record review. We compared MPEG-1 protein, troponin-I, and CK-MB between survivors
vs
. non-survivors, and neurological outcomes dichotomized as
poor
or
good
according to cerebral performance score (CPS).

Results:
At the end of the hospital stay, 47% of the patients had poor neurological status based on the CPS score of ≥ 4. Within these patients, 95% had inhospital mortality. The mean serum MPEG-1 levels were significantly higher in patients with
poor
neurological status, compared to the ones with
good
neurological recovery (ng/ml, 15.17 ± 48.04 vs 1.15 ± 6.73, p=0.017). There were no differences in other conventionally measured bio-markers, such as peak troponin , CK-MB or left ventricular ejection fraction. Elevated MPEG-1 of more than 8.8 ng/ml had significantly higher odds of predicting poor neurological outcome (OR: 8.37, 95% CI: 1.79-39.14, p=0.006).

Conclusions:
This study reports a novel macrophage-expressed circulating bio-marker strongly associated with reduced survival and poor neurological outcomes in sR-OHCA. These data can guide clinicians to prognosticate survival and neurological outcomes in sR-OHCA, and also form the basis for future therapeutic approaches.
Abstract 133: Cardiovascular Protective Effect of Thyroxine and Nano- Thyroxine Against Ischemic Insults
Authors: Mousa Shaker A , Sallam Abeer , Darwish Noureldien
Published: June 2021

Introduction:
Cardioprotection is a key purpose for therapeutic interventions in cardiology that aim to reduce infarct size, and thus prevent progression toward heart failure, after acute ischemic and cardiac arrest. Triiodothyronine/thyroxine (T3) therapy has been used to reverse myocardial stunning. Hyperthyroidism prevents the stunning with high dependence on the mitochondrial sodium-calcium exchanger and mitochondrial K+ channels.

Hypothesis:
This study aimed to investigate the positive protective role of T3 and PRO-AL 616 (Nano-T3) and PRO-AL 617 (Nano-T3 with Phosphocreatine, Pcr) in hypoxia-mediated cardiac cell insults, as well as its influences on vascularization and neuronal protection.

Methods:
The effects of T3 and Nano-T3
+
Pcr on angiogenesis were studied in a CAM model. Their cardioprotective effect under hypoxia was studied using isolated neonatal cardiomyocytes treated with PBS (control), T3 (3 uM), Pcr (30 uM) and T3 + Pcr. Mitochondrial function and sarcomere integrity were studied using an ATP- bioluminescence assay, and cardiac Troponin T levels using flow cytometry, respectively. The effect of Nano-T3 on induced neuronal cells under hypoxia was also studied. Finally, Nano-T3-Cy7 were injected into mice tail veins to monitor their biodistribution in real time.

Results:
Nano-T3 activate the cell surface receptor αvβ3 and is distributed into the cytoplasm, but not the nucleus. Nano-T3 enhanced angiogenesis in the CAM model (~3 fold) versus T3. Under hypoxia, cardiac ATP improvement was achieved with T3+Pcr (
p
<0.001) while maintaining normal Troponin T levels. (
Figure 1
). Nano-T3 produced a significant upregulation of the neural protection markers, PAX6 and DLX2 by ~ 50%. In vivo, the Cy7 signal intensity was detected primarily in mice brains, and hearts, within minutes of administration.

Conclusion:
Nano-T3
+
Pcr represents a potentially new therapeutic for the control of tissue damage in cardiac ischemia and resuscitation.
Abstract 15: Public Access Defibrillators: Sex-Based Inequities in Access and Application
Authors: Grunau Brian E , Awad Emad , Kawano Takahisa , Scheuermeyer Frank , Stenstrom Robert , Brooks Steven , Van Diepen Sean , Humphries Karin H , Pennington Sarah , Gu Bobby , Al Assil Rahaf , Christenson James
Published: June 2021

Introduction:
It is unclear if the benefits of public access defibrillator (PAD) programs are similar between men and women. We investigated the location of out-of-hospital cardiac arrests (OHCA) stratified by sex to determine what proportion was eligible for PAD application. Second, we sought to determine if patient sex was associated with PAD utilization.

Methods:
We analyzed prospectively collected data from the North American Resuscitation Outcomes Consortium (ROC) Epistry dataset (2011 - 2015), excluding emergency medical services (EMS)-witnessed cases, those not treated by EMS, and children aged less than 10. We compared sex-based differences in public vs private location, and location type (street or highway, public building, place of recreation, industrial place, home residence, farm or ranch, healthcare facility, residential institution, other public property, or other private location). Among public location OHCAs with bystander interventions, we fit an adjusted logistic regression model to estimate the association between sex and PAD application.

Results:
Among the 61,473 cases, 20,933 (34%) were female, 30,353 had resuscitation attempted by bystander, and 13,597 had initial shockable rhythms. The OHCA incidence in a public location for women and men was 8.8% and 18%, respectively (95% CI for difference 8.7 - 9.7). Women had a significantly lower proportion of OHCAs on the street/highway, in public buildings, places of recreation, and farms, but a significantly higher proportion in the home, healthcare facilities, and residential institutions. Among public location OHCAs with bystander interventions, female sex was associated with a lower odds of bystander PAD application (adjusted OR 0.83, 95% CI 0.70-0.99).

Conclusion:
Women had fewer OHCAs in public locations eligible for PAD application. Further, among public OHCAs with bystander interventions, women were less likely to have PADs applied.
Abstract 156: Lower Body Temperature ’Dose’ Associated With Higher Likelihood of Survival Following Cardiac Arrest
Authors: Buckler David G , Totolos Konstantinos , Abdulhay Nabil M , Zebrowski Alexis M , Abella Benjamin S
Published: June 2021

Introduction:
Post-cardiac arrest pyrexia is associated with poor outcomes following successful resuscitation and return of spontaneous circulation (ROSC). Prior studies have used highest recorded temperature and duration of fever as markers for the severity of pyrexic events. The objective of this research was to evaluate the association of body temperature and survival to discharge. We hypothesized that a lower body temperature “dose” in the 8 days post-arrest would be associated with a higher likelihood of survival.

Methods:
Using consecutive cardiac arrest cases from a single healthcare system with integrated electronic medical record (EMR), we identified cardiac arrest patients with ROSC. Vital signs for these patients, including body temperature, were queried from the EMR and linked to individual records. We included all temperature measures within 8 days of the cardiac arrest event. Patients with fewer than 5 temperature values during the study period were excluded. For each temperature observation the difference between the recorded temperature value and 37 degrees Celsius, the time since the last observation, and the product of these values was calculated. For each patient, the total ‘dose’ was calculated as the sum of these dose products. The resulting measure has units of degree*hours and represents a measure of duration about or below normal. Multiple logistic regression was used to assess the relationship between body temperature dose and survival to discharge, controlling for age and sex.

Results:
Between 3/2006 and 3/2016, 352 patients were linked to serial body temperature measurements. 58% were male, mean age was 61 ± 16 years, and 52% survived to discharge. The median body temperature dose measure was 28 degree*hours, (IQR: -0.6 - 98, min: -740, max 390). Results from the multiple logistic regression indicated that for every 10 degree*hour increase in patient body temperature, the odds of survival decreased 3.1 percent (OR: 0.969, p = 0.01) when controlling for age and sex.

Conclusion:
In this study, lower serial body temperature ‘dose’ was associated with increased odds of survival. These findings are consistent with international guidance around the strong avoidance of fever in post-arrest patients.
Abstract 162: A Novel Approach to Quality Improvement in a Hospital’s Targeted Temperatue Management Program for Post Arrest Patients
Authors: Russell Delia R
Published: June 2021

Introduction:
Studies indicate that initiating therapeutic hypothermia (THT) in a timely manner after return of spontaneous circulation (ROSC) decreases mortality. Our hospital has had an established protocol for THT since 2014; however, we believed that there were opportunities to improve our practice, particularly around time to initiation of therapy and time to target temperature.

Goal:
Initiate THT as soon as feasible to reach target temperature within 6 hours after ROSC.

Methods:
Data was downloaded from our Targeted Temperature Management (TTM) devices for post-arrest cases from January to December 2018. The data was used to calculate various metrics including time from ROSC to therapy initiation (time to initiation) and time to target temperature (time to target). These metrics were compared to our THT protocol to identify areas for practice improvement. Concurrently, a product training verification assessment designed to determine the level of knowledge of our TTM device was conducted with our Intensive Care Unit (ICU) staff.

Results:
Case data was collected, analyzed, and reviewed quarterly with ICU staff and leadership. The product training verification assessment reveled gaps in staff knowledge, including patient management while on TTM therapy, which was addressed with clinician education. Over the four quarters of 2018, there was a decrease in both in time to initiation and time to target. By quarter four, the combined measure of time to initiation and time to target had decreased from over 6 hours in quarter one to 5 hours. Our quarter 4 patient outcomes revealed a 43% survival to discharge rate with a Cerebral Performance Category of 1 or 2 (positive neurological outcomes).

Conclusions:
Review of the current process, analyzing and comparing data to current protocol, and assessment of staff knowledge revealed gaps in our hospital’s THT program. Implementation of new processes and education using a collaborative approach lead to positive patient outcomes with a measurable decrease in time to initiation and time to target temperature.
Abstract 169: Association Between Time to First Administration of Epinephrine After Defibrillation and Outcome in Out-Of-Hospital Cardiac Arrest Patients With Shockable Rhythm
Authors: Kawakami Shoji , Tahara Yoshio , Noguchi Teruo , Yasuda Satoshi , Yonemoto Naohiro W , Nonogi Hiroshi , Nagao Ken , Ikeda Takanori , Sato Naoki , Tsutsui Hiroyuki ,   and JCS-ReSS group
Published: June 2021

Introduction:
In out-of-hospital cardiac arrest (OHCA) patients during shockable rhythm, the epinephrine administration after second defibrillation is recommended by the 2015 ILCOR/CoSTR guidelines. However, there is insufficient evidence regarding the proper timing of epinephrine administration particularly in relation to defibrillation.

Hypothesis:
The timing of epinephrine after first defibrillation (D-E interval) was associated with clinical outcome in OHCA patients.

Methods:
Between 2011 and 2016, we enrolled 753,025 OHCA patients from nationwide prospective population-based registry in Japan. Following exclusion criteria, a total of 1,559 patients with witnessed by bystanders and shockable rhythm on the initial electrocardiogram who administrated epinephrine after defibrillation by emergency medical service personnel and obtained return of spontaneous circulation in prehospital setting were eligible for the study. We evaluated the association between D-E interval and favorable neurological outcome (cerebral performance category: 1 or 2) at 30 days. To evaluate predictor for better neurological outcome, study patients were categorized as every 2 minutes up to 20 minutes, and more than 20 minutes.

Results:
Patients with favorable neurological outcome were 22% (N=348). Patients with favorable neurological outcome had a shorter D-E interval than those with non-favorable neurological outcome (7.9±4.1vs 10.2±5.3 min, p<0.001). Multivariate logistic regression analysis showed that D-E interval at more than 10 minutes, when D-E interval at 2 to 3 minutes as defined reference, was a significant predictor for non-favorable neurological outcome (
Table
).

Conclusion:
Delayed epinephrine administration after first defibrillation (D-E interval >10 minutes) was significantly associated with non-favorable neurological outcome.
Abstract 17: Cognitive, Psychological, and Functional Limitations After Sudden Cardiac Arrest Among a Racially and Ethnically Diverse United States Population
Authors: Agarwal Sachin , Sobczak Evie , Presciutti Alex , Roh David , Park Soojin , Claassen Jan , Elkind Mitchell S , Edmondson Donald
Published: June 2021

Background:
To estimate the frequency of post-sudden cardiac arrest survivorship (PSCAS) problems (i.e., cognitive impairment, disability in activities of daily living, depression and posttraumatic stress disorder (PTSD)).

Methods:
We prospectively enrolled adults with return of spontaneous circulation after in-hospital or out-of-hospital CA between 9/2015-8/2018 at a high-volume, major academic center. A consecutive sample of survivors at hospital discharge and at one-year follow-up able to engage in the Repeatable Battery for Neuropsychological Status (RBANS) or Telephone Interview for Cognitive Status (TICS), Barthel Index (BI) as a measure of disability, Center for Epidemiological Studies Depression Scale (CES-D), and PTSD Checklist - Specific (PCL-S) were included.

Results:
Of 159 patients included, average age was 54±15 years, 41% were women, 30% identified themselves as Latinos and 18% as African-American. There were 14 deaths and 13 lost to follow-up at one-year. As shown in table 1, 1 out of 2 patients at discharge, and 1 out of 4 at one-year had global cognition scores similar to scores for patients with moderate traumatic brain injury and patients with mild Alzheimer’s disease, respectively. The majority had physical disability at hospital discharge, which showed improvement within one-year. A significant proportion of patients experienced depressive and PTSD symptoms at hospital discharge and the symptoms persisted at one-year.

Conclusions:
In a racial and ethnically diverse cohort in a major academic center in the US, one or more PSCAS problems were present and persisted in the majority of CA survivors, and co-occurring problems were present in one out of four at one-year. Future studies are needed to understand better the heterogeneous subtypes of PCAS and to identify modifiable risk factors and potential ameliorating factors.

Table 1. Estimates of post-sudden cardiac arrest survivorship problems at discharge and one-year