tbuckley/cabot-search huggingface dataset:
Abstract P333: National Trends in the Quality of Office Blood Pressure Measurements, 2014-2019
Authors: Kathryn Foti, Lawrence J Appel, Kunihiro Matsushita, Josef Coresh, G Caleb Alexander, Elizabeth Selvin
Journal: Circulation (2020)

Introduction: Clinical practice guidelines emphasize the importance of accurate blood pressure measurement and recording to diagnose and treat hypertension. Trends in terminal digit preference (typically manifest by a terminal digit of ‘0’) have not been examined nationally. The growing use of automated blood pressure devices may have reduced terminal digit preference and improved accuracy over time. Objective: To evaluate trends in terminal digit preference in office blood pressure measurements among adults with hypertension by patient and provider characteristics. Methods: We used IQVIA National Disease and Therapeutic Index (NDTI) data from January 2014 through June 2019. The NDTI is designed to be nationally-representative of all patient visits to office-based physicians and uses a two-stage stratified sampling design to sample ~4,000 physicians per quarter who report information on all patient visits on 2 random workdays. We included all hypertension treatment visits (~60M/year) among adults aged ≥18. We examined trends in the proportion of hypertension treatment visits with recorded systolic (SBP) and diastolic (DBP) blood pressure measurements with a terminal digit ‘0’. The expected percent of blood pressures with ‘0’ is 10% for automated and 20% for manual readings. Results: There was a decrease in the percent of visits with SBP (43.0% to 37.4%) or DBP (44.3% to 38.1%) recordings ending in zero ( Table ). The decrease in percent of SBPs with a terminal zero was similar by patient and provider characteristics, though the percentage of SBPs with a terminal ‘0’ was consistently higher among patients aged ≥60, when SBP ≥140 mmHg, and among cardiologists. Conclusions: Terminal digit preference is common indicating systematic error in blood pressure measurement and recording, despite some improvement over time. This may lead to under- and overtreatment of patients with hypertension. Improving the quality of blood pressure measurement is central to improving hypertension diagnosis and control in clinical practice.
Abstract P507: Interplay Between Diet and Gut Microbiota, and Circulating Levels of Trimethylamine N-oxide: Findings From the Men’s Lifestyle Validation Study
Authors: Jun Li, Yanping Li, Kerry Ivey, Dong Wang, Jeremy Wilkinson, Adrian Franke, Andrew Chan, Curtis Huttenhower, Frank B Hu, Eric Rimm, Qi Sun
Journal: Circulation (2020)

Background: Trimethylamine N-oxide (TMAO) is proposed as a possible culprit linking red meat intake and poor cardiovascular health. The relationship between diet, microbial metabolism, circulating TMAO levels, and cardiometabolic health in free-living individuals, is yet to be elucidated. Hypothesis: Specific microbial taxa may modulate associations of choline/L-carnitine and red meat intake with plasma TMAO levels and cardiometabolic traits. Method: We collected 2 pairs of fecal samples (n=925) and, simultaneously, 2 blood samples (n=473), 6 months apart, from 307 healthy men in the Men’s Lifestyle Validation Study in 2012. We performed Shotgun metagenomic sequencing using fecal samples and identified microbial taxonomic features using MetaPhlAn2. We measured hemoglobin A1c (HBA1c), and plasma levels of TMAO, lipids, and other cardiometabolic risk markers. Diet was assessed repeatedly using validated food-frequency questionnaires and dietary records. Results: Multivariable random-effect linear regressions identified 10 bacterial species that were significantly associated with TMAO levels ( FDR &lt;0.05; Figure A ), and these species significantly modified the associations of dietary choline/L-carnitine and/or red meat intake with TMAO levels ( P interaction &lt;0.05). In particular, Alistipes s hahii and Clostridium c itroniae significantly strengthened the association between red meat intake and TMAO levels, whereas Eubacterium b iforme attenuated this association ( P interaction &lt;0.05). Consistently, the associations of higher red meat intake with higher HBA1c and lower high-density lipoprotein cholesterol levels were more pronounced in the presence of A. s hahii and C. c itroniae or in the absence of E. b ifome ( Figure B ). Conclusions: We identified microbial taxa that modify the associations of red meat intake with circulating TMAO levels and cardiometabolic traits, in free-living men, suggesting an interplay between diet and microbial metabolism in producing TMAO and affecting cardiometabolic health.
Prognostic Value of Teratoma in Primary Tumor and Postchemotherapy Retroperitoneal Lymph Node Dissection Specimens in Patients With Metastatic Germ Cell Tumor
Authors: Fadi Taza, Michal Chovanec, Anna Snavely, Nasser H. Hanna, Clint Cary, Timothy A. Masterson, Richard S. Foster, Lawrence H. Einhorn, Costantine Albany, Nabil Adra
Journal: Journal of Clinical Oncology (2020)

Presence of teratoma in patients with metastatic testicular germ cell tumor (GCT) is of unknown prognostic significance. We report survival outcomes of patients with or without teratoma in primary tumor and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen and assess impact on prognosis.
Abstract P101: Cardiovascular Health in US Adults Before and After Publication of the American Heart Association 2020 Impact Goals: Results From NHANES 2005-2016
Authors: Jiang He, Zhengbao Zhu, Joshua D Bundy, Katherine T Mills, Lydia A Bazzano, Tanika N Kelly, Yonghong Zhang, Jing Chen
Journal: Circulation (2020)

Background: The dissemination of the American Heart Association (AHA) 2020 Impact Goals might promote nationwide efforts to improve cardiovascular health in the US general population. We aimed to compare cardiovascular health metrics in US adults before and after the release of the AHA 2020 Impact Goals. Methods: A total of 32,327 adults aged ≥20 years from the National Health and Nutrition Examination Surveys (NHANES) 2005-2016 were included in this analysis. Cardiovascular health comprised 7 health metrics (smoking status, body-mass index, physical activity, healthy diet score, total cholesterol, blood pressure, and fasting plasma glucose), and each metric was scored as poor (0 points), intermediate (1 point), or ideal (2 points). Cardiovascular health score (0-14) was calculated as the sum of all 7 cardiovascular health metric scores. Age-standardized proportions of cardiovascular health metrics and means of cardiovascular health scores were calculated overall and in age, sex, and race/ethnicity subgroups for NHANES 2005-2010 and 2011-2016. Results: The age-standardized mean of cardiovascular health score was not significantly different between 2005-2010 and 2011-2016 (7.86 vs. 7.99, P =0.14) in the US adult population. However, the cardiovascular health scores significantly increased in young adults aged 20-39 years (8.62 vs. 8.96, P =0.002) and non-Hispanic blacks (7.02 vs. 7.30, P =0.004). Additionally, although the cardiovascular health behaviors score was not significantly different (3.64 vs. 3.71, P= 0.24), the cardiovascular health factors score significantly improved (5.74 vs. 5.82, P =0.02). Age-standardized proportions of non-current smoking (74.1% vs. 77.0%), ideal physical activity (35.7% vs. 39.0%), and total cholesterol &lt;200 mg/dL (43.3% vs. 48.1%) significantly increased, but body-mass index &lt;25.0 kg/m 2 (32.2% vs. 29.8%) significantly decreased, from 2005-2010 to 2011-2016 in US adults. Conclusions: Since the release of the AHA 2020 Impact Goals, cardiovascular health has improved in young adults and non-Hispanic blacks. In addition, the proportions of non-current smoking, ideal physical activity, and ideal total cholesterol have increased in the entire US adult population. However, several cardiovascular health metrics have not significantly improved, or have even worsened. Further nationwide efforts are warranted to promote cardiovascular health, especially weight loss, in the US general population.
Regulatory T Cells Keep Pancreatic Cancer at Bay
Authors: Berk Aykut, Ruonan Chen, George Miller
Journal: Cancer Discovery (2020)

Abstract Summary: Although CD4+ FOXP3+ T regulatory (Treg) cells are well-known mediators of immunologic tolerance, their influences in the tumor microenviroment are incompletely understood. Writing in this issue of Cancer Discovery, Zhang and colleagues demonstrate that in pancreatic cancer, Treg cells promote the differentiation of tumor-restraining myofibroblastic cancer-associated fibroblasts, challenging the existing notion that Treg cells enable tumor progression. See related article by Zhang et al., p. 422.
Abstract P528: Normal Weight Metabolic Obesity and Risk of Coronary Artery Disease: The Million Veteran Program
Authors: Petra Schubert, Yuk-lam Ho, David R Gagnon, Kelly Cho, Peter W Wilson, J. M Gaziano, Luc Djousse
Journal: Circulation (2020)

Introduction: Obesity and metabolic dysfunction, individually, are known risk factors of stroke, coronary artery disease (CAD), and mortality. However, few studies have examined the long-term risk for CAD among non-obese people with metabolic dysfunction, and no studies have been conducted for Veterans of the United States. Hypothesis: Veterans who are metabolically obese normal weight (MONW) at baseline have an increased risk of developing CAD compared to metabolically healthy normal weight (MHNW) veterans enrolled in the Million Veteran Program (MVP). Methods: We included MVP participants who had a stable normal body mass index (18.5-25kg/m 2 ) five years prior to enrollment. Metabolic obesity was defined as having three or more of the Adult Treatment Panel III criteria [diabetes, hypertension, low HDL-C (≤40 mg/dl for men, ≤50 mg/dl for women), and high triglycerides (≥150 mg/dl)] at enrollment. CAD was defined as non-fatal myocardial infarction, ischemic heart disease or angina pectoris. Participants with prevalent CAD, major cancers and incomplete lifestyle information were excluded. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CAD incidence. In secondary analyses, we stratified by sex and race to evaluate possible effect modification. Results: Of the 16,764 people identified as normal weight with complete data, 15% were MONW, 84.5% were male, 84.4% were White and the mean age was 63.1 ± 14.2. Over a median follow up of 3.6 (IQR 1.8-5.2) years, there were 847 incident CAD events observed. MONW individuals had a 64% (95% CI: 40 -91%) higher risk of CAD compared to normal weight individuals, controlling for age, race, sex, education, smoking status, physical activity, alcohol use and diet. In secondary analyses, we observed a nominally higher risk among women who were MONW [HR (95% CI): 2.74 (1.30-5.77) for women vs. 1.60 (1.37-1.88) for men], however the interaction of MONW and sex was not statistically significant (interaction p=0.19). Similarly, the interaction of MONW and race was not statistically significant [1.62 (1.37-1.92) for White, 1.55 (0.97-2.48) for Black, and 2.26 (1.03-4.95) for other, interaction p=0.83)]. Conclusions: MONW Veterans had a higher risk of CAD compared to MHNW Veterans. This risk was magnified in female Veterans and attenuated in White and Black Veterans compared to other races (Asian, Pacific Islander, Native American, other). These findings will need to be validated in future studies.
Trends in Bone Mineral Density, Osteoporosis, and Osteopenia Among U.S. Adults With Prediabetes, 2005–2014
Authors: Chi Chen, Qi Chen, Bin’en Nie, Haojie Zhang, Hualing Zhai, Li Zhao, Pu Xia, Yingli Lu, Ningjian Wang
Journal: Diabetes Care (2020)

We aimed to evaluate trends in bone mineral density (BMD) and the prevalence of osteoporosis/osteopenia in U.S. adults with prediabetes and normal glucose regulation (NGR) and further investigate the association among prediabetes, osteopenia/osteoporosis, and fracture.We collected and analyzed data from the U.S. National Health and Nutrition Examination Surveys during the period from 2005 to 2014. Femoral neck and lumbar spine BMD data were available for 5,310 adults with prediabetes and 5,162 adults with NGR >40 years old.A shift was observed toward a lower BMD and a higher prevalence of osteopenia/osteoporosis at the femoral neck and lumbar spine in U.S. adults >40 years old with prediabetes since 2005, especially in men <60 and women ≥60 years old. A shift toward a higher prevalence of osteopenia/osteoporosis at the femoral neck was also observed in adults >40 years old with NGR. Moreover, prediabetes was associated with a higher prevalence of hip fracture, although participants with prediabetes had higher BMD and a lower prevalence of osteopenia/osteoporosis at the femoral neck.There was a declining trend in BMD from 2005 to 2014 in U.S. adults >40 years old with prediabetes and NGR, and this trend was more significant in men <60 years old. Populations with prediabetes may be exposed to relatively higher BMD but a higher prevalence of fracture.
A simplified staging system in cutaneous melanoma to select patients for adjuvant trials
Authors: S. L. Beam, E. G. Elias
Journal: Journal of Clinical Oncology (2007)

19003 Background: Most clinical trials with adjuvant therapy in melanoma concentrate on high-risk patients including those with metastases to regional lymph nodes (LN), stage III and locally advanced T4, i.e., stage IIB and IIC. These trials may be missing the advantageous results in the relatively earlier stages. Methods: We reviewed the new American Joint Committee on Cancer (AJCC) for cancer staging of cutaneous melanoma and Balchs’ data for the prognostic factors. The data was correlated to patients’ survival expressed by the natural history of the disease. Results: We grouped the reported survival data into 3 risk groups, excluding patients with distant metastases. Group 1: 2–4mm deep primary with ulceration, &gt;4mm deep primary without ulceration, micrometastases to 1–3 LN, primary not ulcerated; Group 2: &gt;4mm deep primary with ulceration, micrometastases to 1–3 LN ulcerated primary, macrometastases to 1–3 LN, primary not ulcerated intransit metastases/satellitosis, without LN metastases; Group 3: macrometastases to 1–3 LN, ulcerated primary, metastases to 4 or more LN, matted LN, and/or intransit, metastases/satellitosis with LN metastases. The table summarizes the results. Conclusions: 1. Over one-third of the patients in group 1 died of disease in the first 5 years. They should be considered at intermediate risk and should receive adjuvant therapy. 2. Patient prognosis should determine the intensity of target therapy utilized in the adjuvant arena. While anti-CTLA-4 may be sufficient for group 1, the addition of anti-kinases may be required in group 2 and more so in group 3. [Table: see text] No significant financial relationships to disclose.
Updated emm-typing protocol for Streptococcus pyogenes
Authors: H.R. Frost, M.R. Davies, S. Velusamy, V. Delforge, A. Erhart, S. Darboe, A. Steer, M.J. Walker, B. Beall, A. Botteaux, P.R. Smeesters
Journal: Clinical Microbiology and Infection (2020)
Recurrent primary central nervous system lymphoma (PCNSL) treated with pemetrexed
Authors: J. K. Altman, L. Gallot, R. Cohn, J. Chandler, R. Levy, C. Getch, M. Marymont, C. Tellez, J. J. Raizer
Journal: Journal of Clinical Oncology (2007)

2086 Introduction: Untreated, survival in PCNSL is approximately 2 months. However using high dose methotrexate based regimens, median survival is up to 60 months. A significant number of patients relapse. There is currently no standard therapy, but many regimens have been used with variable results. Pemetrexed is a multi-targeted anti-folate agent approved for first line treatment of malignant pleural mesothelioma and second-line for locally advanced or metastatic non-small cell lung cancer. A phase II trial was initiated for patients with recurrent gliomas, PCNSL or brain metastases. Pemetrexed, in addition to inhibiting dihydrofolate reductase, targets other sites of inhibition, giving it a broader spectrum of activty. This suggests that pemetrexed could be effective in PCNSL. Patients and Methods: The dose of pemetrexed used was 900 mg/m 2 every 3 weeks; based on phase I data where the MTD was 800 mg/m 2 in heavily pretreated patients and not reached in lightly pretreated patients. Patients received dexamethasone 4 mg twice daily on the day before, the day of, and the day after each infusion of pemetrexed and supplemental folic acid and B12. Eligibility criteria for PCNSL patients included failure of at least one prior chemotherapy regimen. Patients had to be &gt; 18 year of age with KPS status of &gt; 60. Adequate bone marrow, liver, and renal function were required. An MRI was done every 6 weeks and for patients who attained a CR, a maximum of six doses was given. Results: To date, five patients with recurrent PCNSL have been treated on this trial after signing IRB approved consent. Patient Characteristics Discussion: We report our experience of pemetrexed in 5 patients with recurrent PCNSL. Toxicity has been minimal except in the one patient who was heavily pretreated (including a stem cell transplant). Activity was seen in all patients but transient in two. Pemetrexed is active in relapsed PCNSL. The optimal dose and schedule need to be determined, as well as activity in a larger group of patients. We continue to enroll patients in this study. [Table: see text] No significant financial relationships to disclose.
Abstract 12222: Inhibition of Xanthine Oxidase in the Acute Phase Preserves Mitochondrial Function in Skeletal Muscle and Exercise Capacity in Heart Failure After Myocardial Infarction
Authors: Hideo Nambu, Shingo Takada, Satoshi Maekawa, Junichi Matsumoto, Naoya Kakutani, Ryosuke Shirakawa, Takashi Katayama, Katsuma Yamanashi, Yoshikuni Obata, Takaaki Furihata, Akimichi Saito, Takashi Yokota, Shintaro Kinugawa, Toshihisa Anzai
Journal: Circulation (2018)

Introduction: Reduced exercise capacity is an independent predictor of poor prognosis in heart failure (HF) patients and is closely associated with skeletal muscle abnormalities including impaired ...
Seeing other perspectives: evaluating the use of virtual and augmented reality to simulate visual impairments (OpenVisSim)
Authors: Pete R. Jones, Tamás Somoskeöy, Hugo Chow-Wing-Bom, David P. Crabb
Journal: npj Digital Medicine (2020)

Simulations of visual impairment are used to educate and inform the public. However, evidence regarding their accuracy remains lacking. Here we evaluated the effectiveness of modern digital technologies to simulate the everyday difficulties caused by glaucoma. 23 normally sighted adults performed two everyday tasks that glaucoma patients often report difficulties with: a visual search task in which participants attempted to locate a mobile phone in virtual domestic environments (virtual reality (VR)), and a visual mobility task in which participants navigated a physical, room-scale environment, while impairments were overlaid using augmented reality (AR). On some trials, a gaze-contingent simulated scotoma-generated using perimetric data from a real patient with advanced glaucoma-was presented in either the superior or inferior hemifield. The main outcome measure was task completion time. Eye and head movements were also tracked and used to assess individual differences in looking behaviors. The results showed that the simulated impairments substantially impaired performance in both the VR (visual search) and AR (visual mobility) tasks (both P < 0.001). Furthermore, and in line with previous patient data: impairments were greatest when the simulated Visual Field Loss (VFL) was inferior versus superior (P < 0.001), participants made more eye and head movements in the inferior VFL condition (P < 0.001), and participants rated the inferior VFL condition as more difficult (P < 0.001). Notably, the difference in performance between the inferior and superior conditions was almost as great as the difference between a superior VFL and no impairment at all (VR: 71%; AR: 70%). We conclude that modern digital simulators are able to replicate and objectively quantify some of the key everyday difficulties associated with visual impairments. Advantages, limitations, and possible applications of current technologies are discussed. Instructions are also given for how to freely obtain the software described (OpenVisSim).
Abstract 16938: Late Gadolinium Enhancement on Cardiac Magnetic Resonance as Predictor of Overall Mortality in Patients With Non-Ischemic Cardiomyopathy
Authors: Farid Foroutan, Juan Gaztañaga, James White, Marco Merlo, David Alonso-Rodriguez, Victor Vallejo-García, Rafael Vidal-Perez, Cecilia Corros-Vicente, Stuart Katz, Jacqueline Flewitt, Gianfranco Sinagra, Michael Farkouh, Ana Carolina Alba
Journal: Circulation (2018)

Background: Patients with heart failure due to non-ischemic cardiomyopathy (NICM) constitute a heterogenous group of patients with diverse prognosis. The presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging represents a measure of myocardial damage and can provide prognostic information. Objective: This study aimed to evaluate the prognostic role of the presence and pattern of LGE in patients with NICM . Methods: Using the NICM registry, we conducted a retrospective cohort study of adult patients with NICM, undergoing CMRI between 1999–2016. Using multivariable Cox regression model and Fine and Gray’s competing risk regression model, we evaluated the association between LGE presence and patterns with all-cause mortality, heart transplant, and ventricular assist device (VAD). We adjusted the model for clinically important covariates. Results: Our cohort of 1842 patients showed a mean age of 56 ± 14, 73% male sex, 30% NYHA class III-IV, 15% diabetic and 89% had idiopathic dilated cardiomyopathy. During a median follow-up of 2.3 years, we observed 215 composite outcome of all-cause mortality, transplant, or VAD. LGE was present in 56% of our cohort: 18% subendocardial, 18% mid-wall, 17% diffuse pattern, and 3% subepicardial. LGE was significantly associated with a 2-fold increased risk of events (HR 2.0, 95%CI 1.4-3.0) (figure). Of all LGE patterns, subendocardial, midwall, and diffuse LGE patterns were associated with the worst prognosis. (table). Conclusions: In patients with NICM, LGE in significantly associated with increased risk of death or need for advanced heart failure therapies. The use of CMR in patients with NICM provides both diagnostic and prognostic information.
Abstract 17233: Gender Differences in Bone Marrow microRNA Expression in Patients With Ischemic Cardiovascular Disease
Authors: Lourdes Chacon, Ernesto C da Costa, Shundar Ahad, Hassan Virk, Luiz Sampaio, Doris A Taylor
Journal: Circulation (2019)

Background: Cardiovascular disease is the primary cause of death in men and women worldwide. However, our understanding of disease presentation and progression in females is lacking, leading to CVD...