tbuckley/cabot-search huggingface dataset:
Abstract P384: Healthy Lifestyle Factors and Cardiovascular Disease Risk in a Prospective Cohort of Women With a History of Gestational Diabetes Mellitus
Authors: Frank Qian, Deirdre K Tobias, Sylvia H Ley, Jorge Chavarro, Gang Liu, Stefanie N Hinkle, Edwina Yeung, James L Mills, Aiyi Liu, Qi Sun, Frank Hu, Cuilin Zhang
Journal: Circulation (2020)

Background: Women with a history of gestational diabetes mellitus (GDM) are at increased risk for cardiovascular disease (CVD). Whether healthy lifestyle practices can mitigate this risk is unclear. Aims: To prospectively assess associations of healthy lifestyle factors with CVD risk in women with a history of GDM. Methods: We included 4,372 women from the Nurses’ Health Study II with a prior clinician diagnosis of GDM who were free of cancer or CVD at the time of the index pregnancy. Healthy lifestyle factors, which were updated every 2-4 years, included non-current smoking, body mass index&lt;25 kg/m 2 , regular physical activity (&gt;500 MET-min/week), high-quality diet (above median on the Alternative Healthy Eating Index), and moderate alcohol consumption (&gt;0-15 g/day). A composite outcome of CVD was defined as the combination of nonfatal/fatal myocardial infarction (MI), stroke, angiographically confirmed angina, and coronary artery bypass surgery or angioplasty/stenting. Multivariate-adjusted Cox models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: During a median 28 years of follow-up, 179 incident CVD events were ascertained. Compared to women with 0 or 1 healthy lifestyle factor, HR (95% CI) for risk of CVD among those who had 2, 3, and ≥4 factors were 1.02 (0.68, 1.53), 0.45 (0.28, 0.74), and 0.32 (0.18, 0.60), respectively ( P trend &lt; 0.001) ( Table 1 ). Similar results were observed for clinical CVD events (nonfatal/fatal MI or stroke) and total MI. When modeled continuously, each additional healthy lifestyle factor was associated with a lower risk of the composite outcome, HR (95% CI): 0.67 (0.57, 0.80); clinical CVD, HR (95% CI): 0.74 (0.58, 0.94); and MI, HR (95% CI): 0.61 (0.43, 0.86). We estimated that 62.5% (95% CI: 34.9%, 79.0%) of the CVD risk in this population was potentially avoidable with adherence to ≥4 healthy lifestyle factors. Conclusion: Greater adherence to healthy lifestyle factors was associated with a significant reduction in CVD risk in women with a history of GDM.
Healthy Pollinators: Evaluating Pesticides with Molecular Medicine Approaches
Authors: Federico López-Osorio, Yannick Wurm
Journal: Trends in Ecology & Evolution (2020)

Pollinators have been declining worldwide, and pesticides have contributed to these declines. High-resolution approaches from molecular medicine can provide unparalleled insight into organismal physiology and health. Applying these approaches to pollinators can significantly improve the efficiency and sensitivity of pesticide research and evaluation, and thus the sustainability of modern agriculture.
Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve
Authors: Yusheng Shi, Jiabin Jin, Weihua Qiu, Yuanchi Weng, Jian Wang, Shulin Zhao, Zhen Huo, Kai Qin, Yue Wang, Hao Chen, Xiaxing Deng, Chenghong Peng, Baiyong Shen
Journal: JAMA Surgery (2020)

Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve.To analyze and evaluate the actual advantages of RPD.Between May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019.Robot-assisted pancreaticoduodenectomy and OPD.The short-term operative outcomes of RPD and OPD.After 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9 (11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1 (10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7 [76.3] minutes vs 298.2 [78.3] minutes; P = .02), estimated blood loss (mean [SD], 297.3 [246.8] mL vs 415.2 [497.9] mL; P = .002), and postoperative length of hospital stay (mean [SD], 22.4 [16.7] days vs 26.1 [16.3] days; P = .03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference.After passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.
Women are at serious risk of harm from late diagnosis of ectopic pregnancy
Authors: Jacqui Thornton
Journal: BMJ (2020)

An investigation carried out by the UK’s Healthcare Safety Investigation Branch (HSIB) has uncovered 30 missed ectopic pregnancies in the NHS leading to “serious harm” in a one year period.

A report by HSIB1 said prompt referral to early pregnancy units (EPUs) can make the difference between life and death.

It said, however, that there were differing levels of provision and a mismatch between capacity and demand in the units which heightens the risk that the diagnosis of the time critical condition is delayed or missed. The cases were found in national incident data between April 2017 and August 2018.

Lesley Kay, deputy medical director at HSIB, said that women can suffer “distressing and …
A phase II study of gimatecan as salvage treatment in patients with advanced or metastatic soft tissue sarcoma (STS) relapsing after anthracycline / ifosfamide - based chemotherapy regimens
Authors: P. Biron, P. Reichardt, F. Grosso, A. Le Cesne, A. Poveda, S. McCanna, C. Zanna, S. Brienza, I. Ray-Coquard, J. Y. Blay
Journal: Journal of Clinical Oncology (2007)

10063 Background: Gimatecan, a new oral camptothecin derivative, showed early clinical activity in patients with STS during the phase I clinical development. Methods: Patients with different histological types of STS, including rhabdomyosarcoma and Ewing's sarcoma of soft parts, and advanced or metastatic disease pretreated with anthracycline and ifosfamide were included. The principal inclusion criteria were: disease not curable with surgery and/or radiation, presence of a measurable progressive lesion(s), pretreatment with 1–3 lines of chemotherapy including adjuvant regimens, ECOG PS 0 to 1, age = 18 years. Gimatecan 0.8 mg/m 2 was administered orally daily for five consecutive days every 4 weeks. Radiological response was assessed every two cycles by RECIST. A multicenter two stage Simon's optimal design was used to evaluate the single agent activity of gimatecan, also by means of a hierarchical Bayesian model to evaluate treatment effects within the histological subtypes, using the rate of progression free survival at 4 months (PFS- 4) (Van Glabbeke, Eur J Cancer 38: 543–549, 2002). Other objectives were safety, TTP, pharmacokinetics and biomarker evaluations. Results: From August 2005 to December 2006 40 patients, 24 (60%) males and 16 (40%) females, median age 48 years (range 21 - 77), were included in 5 European sites. As of December 2006, 14 patients (35%) achieved stable disease after a median of 4 (range 3–9) cycles, and the PFS-4 is 15% (hystotypes: leiomyosarcoma, liposarcoma, Ewing, synovial and unclassified); all PFS-4 patients had liver or pleuropulmonary metastases. A prolonged arrest of progression was observed in one Ewing (up to 9 months), in one leiomyosarcoma and one liposarcoma (up to 8 and 7 months respectively, both patients still on treatment). Main G3/4 toxicity was hematological, namely anemia (7.5%), thrombocytopenia (5%) and neutropenia (2.5%). Conclusions: These data suggest that oral gimatecan has produced durable disease stabilization and is well tolerated with less than 10% grade 3/4 haematological toxicities. [Table: see text]
Abstract P178: Relationship of Apolipoproteins With Subclinical Cardiovascular Risk in Youth
Authors: Madeline A Czeck, Elise F Northrop, Nicholas G Evanoff, Donald R Dengel, Kyle D Rudser, Aaron S Kelly, Justin R Ryder
Journal: Circulation (2020)

Introduction: Apolipoproteins are key regulators of cholesterol transport and clearance with each apolipoprotein having a specific protective or atherogenic role. The relationship between subclinical cardiovascular risk and each of the apolipoproteins in the pediatric population is insufficiently described within the literature. Therefore, the purpose of this study was to examine the association of apolipoproteins with measures of vascular structure and function in pediatric population. Hypothesis: We hypothesized apolipoprotein AI, AII, and CII would demonstrate a positive association, and apolipoprotein B, B/AI ratio, CIII, CIII/CII ratio, and E a negative association with carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (PWV). Methods: A cross-sectional study of 338 children and adolescents (160 males, 178 females) aged 8-21 years (mean age 13.0±2.8 years) with a range of adiposities from normal body weight to severe obesity (mean BMI 26.8±8.9 kg/m 2 ). Apolipoproteins (AI, AII, B, CII, CIII, and E) were measured via human apolipoprotein magnetic bead panel (Millipore, MA, USA). Ultrasound imaging of the carotid artery was used to measure cIMT. PWV, a measure of arterial stiffness, was assessed via applanation tonometry (SphygmoCor TM ). Total body fat percent (BF%) was measured using dual X-ray absorptiometry. Linear regression models were adjusted for Tanner stage, sex, and race with further adjustments for BF%. Data are presented as mean [95% CI] with Holms-adjusted p-values to account for multiple testing. All apolipoprotein ratios were scaled to 0.1 μg/mL. Methods: There were significant positive associations between PWV and apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.017, 0.056], p = 0.010), E (0.158 m/sec per 10 μg/mL [0.08, 0.235], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.019). After adding BF% to the models, PWV remained positively associated with higher levels of apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.016, 0.055], p = 0.012), E (0.161 m/sec per 10 μg/mL [0.082, 0.239], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.02). Before accounting for multiple testing, apolipoprotein CIII/CII ratio was positively associated with cIMT (0.001 [0, 0.003], p = 0.033), but failed to maintain significance after p-value correction. Otherwise, there were no significant associations between any apolipoprotein and cIMT in the presence or absence of BF%. Conclusions: These findings suggest higher levels of apolipoprotein AII, E, and CIII/CII ratio are associated with higher arterial stiffness (PWV) in pediatrics, both in the presence and absence of excess body fat. Apolipoproteins, specifically AII, E, and CIII/CII ratio, may exert their effects on vascular function (PWV) before altering vascular structure (cIMT), which is congruent with the chronological pathophysiology of atherosclerosis.
Abstract P254: Daytime Napping is Associated With Incident Stroke in Community
Authors: Xuting Jin, Bin Yan, Ruohan Li, Ya Gao, Jingjing Zhang, Jiamei Li, Gang Wang
Journal: Circulation (2020)

Introduction: There are conflicting reports regarding whether daytime napping is a risk factor for cardiovascular events. The purpose of this study was to investigate the relationship between daytime napping and incident stroke within a community-based cohort study. Hypothesis: We assessed the hypothesis that the duration and the frequency of daytime napping may be associated with incident stroke. Methods: Participants without previous stroke were enrolled in the present prospective study from the Sleep Heart Health Study (registration number, NCT00005275). Daytime napping were assessed with a self-reported Sleep Habits Questionnaire. Duration of daytime napping was divided into the following categories: no naps, 0-30 min, 31-60 min, or &gt;60 min. Frequency of naps were categorised as: no naps, 1-2 times/week, 3-4 times/week, 5-6 times/week, or daily. After combining nap duration and frequency, participants were further divided into groups with regular long naps (≥5 times per week and &gt;30 min), regular short naps (≥5 times per week and ≤30 min), irregular naps or no naps. Subsequently, participants were followed up until the first stroke occurred between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to estimate the relationship between daytime napping and incident stroke. Results: The present study enrolled 4757 participants, of which 220 participants (4.6%) experienced incident stroke during an average follow-up of 10.6 years. There was a higher rate of stroke among participants taking longer and more frequent naps than others. Multivariate Cox regression analysis indicated that, when compared with participants with no naps, those with a nap duration of ≥60 min or of 31-60 min had a higher risk of stroke (HR, 2.182; 95% CI, 1.443-3.301; HR, 1.594; 95% CI, 1.003-2.531, respectively). Moreover, there was an increased risk of stroke among participants taking daily daytime naps (HR, 1.563; 95% CI, 1.059-2.307) or napping 5-6 times per week (HR, 1.548; 95% CI, 1.026-2.335) than those with no naps. And after combining nap duration and frequency, regular long naps and regular short naps were also associated with higher risk of incident stroke (HR, 1.903; 95% CI, 1.182-3.065; HR, 1.451; 95% CI, 1.010-2.084, respectively). Conclusions: In conclusion, daytime napping of long duration and high frequency may increase the risk of incident stroke in community. Modification of sleep habits may improve the life quality among those elderly community-based population.
Hypoxia-induced p21<sup>waf</sup> and p27 regulation in c-myc immortalized cells
Authors: M. Rosati, C. Raimondi, M. Di Seri
Journal: Journal of Clinical Oncology (2007)

21125 Background: Hypoxia is an adaptative response to tissue damage whose mechanisms have not been yet characterized. From a clinical viewpoint, tumours with more necrosis, an indicator of severe hypoxic stress, are often resistant to conventional treatment. Moreover, numerous tumours overexpressed c-myc which strongly enforces proliferation in oxygen deprived conditions. Evidences showed that c-myc blocked cyclin-dependent kinase inhibitors (CDKI) through a complex network of interactions inducing proliferation and G 0 -S transition. We examined whether Rat-1 immortalized fibroblasts underwent cell cycle arrest p21 waf - and p27- mediated in response to O2-deprivation. Materials and Methods: c-myc null cells (-/-) were derived by gene targeting from an immortalized but otherwise non- transformed Rat-1 fibroblast cell line. Oxygen deprivation conditions (0.2% and 1% O 2 ) were achieved in a humidified anaerobic workstation at 37 °C for 6 or 24 hours. Protein concentration was determined by the Lawry assay method. Immunoblots for c-myc and p21 waf and p27 were performed. Results: c-myc (+/+) samples collected after 6 hours of hypoxia, which were supposed to be slowly proliferating, showed lower p21 waf and p27 levels than c-myc (-/-). Over 24 hours of hypoxia, cell cultures were supposed to be oxygen-dependent and we found higher CDKI levels in c-myc (+/+) cells. Discussion: Our data could explain same resistance mechanisms of tumours cells. In fact, 6 hours O 2 -deprived-cells, which are unable to supply autonomous O 2 support (neo-angiogenesis, in vivo), downregulated p21 waf and p27 expression to overcome CDKI cell-cycle arrest. When the cells acquired O 2 -dependent growth mechanism, low O 2 level induced c-myc mediated p21 waf and p27 up-regulation to induce cell cycle arrest. Despite the up-regulation of CDKI, PS 341 (a proteasome inhibitors) has been demonstrated to induce apoptosis. Our data kindly encouraging trials on the use of p21 waf and p27 stabilizers (like PS 341) in those tumours which overexpressed c-myc. No significant financial relationships to disclose.
Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network
Authors: Matthew A. Rysavy, Jeffrey D. Horbar, Edward F. Bell, Lei Li, Lucy T. Greenberg, Jon E. Tyson, Ravi M. Patel, Waldemar A. Carlo, Noelle E. Younge, Charles E. Green, Erika M. Edwards, Susan R. Hintz, Michele C. Walsh, Jeffrey S. Buzas, Abhik Das, Rosemary D. Higgins
Journal: JAMA Pediatrics (2020)

The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) extremely preterm birth outcome model is widely used for prognostication by practitioners caring for families expecting extremely preterm birth. The model provides information on mean outcomes from 1998 to 2003 and does not account for substantial variation in outcomes among US hospitals.To update and validate the NRN extremely preterm birth outcome model for most extremely preterm infants in the United States.This prognostic study included 3 observational cohorts from January 1, 2006, to December 31, 2016, at 19 US centers in the NRN (derivation cohort) and 637 US centers in Vermont Oxford Network (VON) (validation cohorts). Actively treated infants born at 22 weeks' 0 days' to 25 weeks' 6 days' gestation and weighing 401 to 1000 g, including 4176 in the NRN for 2006 to 2012, 45 179 in VON for 2006 to 2012, and 25 969 in VON for 2013 to 2016, were studied. VON cohorts comprised more than 85% of eligible US births. Data analysis was performed from May 1, 2017, to March 31, 2019.Predictive variables used in the original model, including infant sex, birth weight, plurality, gestational age at birth, and exposure to antenatal corticosteroids.The main outcome was death before discharge. Secondary outcomes included neurodevelopmental impairment at 18 to 26 months' corrected age and measures of hospital resource use (days of hospitalization and ventilator use).Among 4176 actively treated infants in the NRN cohort (48% female; mean [SD] gestational age, 24.2 [0.8] weeks), survival was 63% vs 62% among 3702 infants in the era of the original model (47% female; mean [SD] gestational age, 24.2 [0.8] weeks). In the concurrent (2006-2012) VON cohort, survival was 66% among 45 179 actively treated infants (47% female; mean [SD] gestational age, 24.1 [0.8] weeks) and 70% among 25 969 infants from 2013 to 2016 (48% female; mean [SD] gestational age, 24.1 [0.8] weeks). Model C statistics were 0.74 in the 2006-2012 validation cohort and 0.73 in the 2013-2016 validation cohort. With the use of decision curve analysis to compare the model with a gestational age-only approach to prognostication, the updated model showed a predictive advantage. The birth hospital contributed equally as much to prediction of survival as gestational age (20%) but less than the other factors combined (60%).An updated model using well-known factors to predict survival for extremely preterm infants performed moderately well when applied to large US cohorts. Because survival rates change over time, the model requires periodic updating. The hospital of birth contributed substantially to outcome prediction.
Patterns and Trends in Advance Care Planning Among Older Adults Who Received Intensive Care at the End of Life
Authors: Brian L. Block, Sun Young Jeon, Rebecca L. Sudore, Michael A. Matthay, W. John Boscardin, Alexander K. Smith
Journal: JAMA Internal Medicine (2020)

This study uses Medicare claims data to identify and assess disparities in the use of advance care planning among adults 65 years or older who died between 2000 and 2015 and received intensive care during the last 30 days of life.
Abstract P317: Sex and Age Differences in a typical Chief Complains for Heart Failure in Emergency Department Visits
Authors: Michelle L Meyer, Montika Bush, Jason J Bischof, Anna E Waller, Timothy F Platts-Mills
Journal: Circulation (2020)

Background: Around 1 million United States emergency department (ED) visits per year are due to exacerbation of heart failure (HF) symptoms, with ~80% of those patients admitted to the hospital. However, sex and age differences in HF symptom presentation in the ED have not been thoroughly investigated. Objectives: To describe sex and age differences in chief complaints of ED patients with a HF diagnosis. Methods: We included patients ≥18 years old with an ED diagnosis of HF in NC DETECT, a statewide syndromic surveillance system. We defined a HF diagnosis using ICD-9-CM and ICD-10-CM codes from ED visits between 2010 and 2016. We classified the ED chief complaints into categories by symptom groups (e.g. respiratory complaint includes hypoxia, respiratory distress, breathing difficulties). Chief complaint categories are not mutually exclusive. We calculated frequencies of chief complaint categories for ED visits by sex and age (18-44 (n=55,216), 45-64 (n=260,397), ≥65 (n=578,313) years old) and evaluated for a 10% standardized difference between groups. Results: There were 422,720 patients with 893,950 total unique visits (1.6 average visits/person). Of these visits, 55.0% were by women and 59.5% patients were admitted. Overall, the top chief complaint categories were dyspnea (19.1%), chest pain (13.5%), and respiratory complaints (13.4%), and were similar by sex and by ED disposition (admitted or discharged) and sex. When stratified by sex and age group, in those 18-44 years old, women had more reports of nausea/vomiting (6.7%) compared with men (4.1%) and headache (4.2%) compared with men (2.0%). In those 45-64 and ≥65 years old, chief complaint categories were similar between women and men. When stratified by age group alone, reports of chest pain decreased with age (21.4% in 18-44, 17.7% in 45-64, and 10.8% in ≥65 year olds), whereas reports of balance issues (1.2% in 18-44, 2.4% in 45-64, and 6.0% in ≥65 year olds), weakness (1.7% in 18-44, 2.7% in 45-64, and 5.5% in ≥65 year olds), and confusion (0.8% in 18-44, 2.1% in 45-64, and 4.5% in ≥65 year olds) increased with age. Compared to those ≥65 years old, those 18-44 years old had fewer respiratory complaints (10.0% vs. 13.9%), but more reports of headache (3.2% vs. 0.8%) and nausea/vomiting (5.5% vs. 3.2%). Conclusion: In a state-wide population of ED patients with HF diagnoses, sex differences in chief complaint categories that are less obvious symptoms of HF were observed for those 18-44 years old, with women reporting more nausea/vomiting and headache compared to men. Chief complaint categories that are less obvious symptoms of HF were more common among patients 18-44 (nausea/vomiting, headache) and ≥65 (balance issues, confusion, weakness) years old. Characterizing the variation of symptoms of HF patients in the ED may help inform the identification of ED patients with HF and the outpatient management of HF-related symptoms.