tbuckley/cabot-search huggingface dataset:
Abstract 17240: A Pilot Clinical Trial to Study Racial Differences in Natriuretic Peptide Response to a High-Carbohydrate Challenge
Authors: Nirav Patel, Griffin Russell, Orlando M Gutierrez, Ganesh Halade, Vasundhara Kain, Sumanth D Prabhu, Garima Arora, Thomas J Wang, Pankaj Arora
Journal: Circulation (2018)

Introduction: Human genetic studies have shown a greater risk of cardiometabolic disease with genetically lower natriuretic peptide (NP) levels. We have previously shown that blacks have lower NP levels than whites albeit in older individuals, which is partly explained by genetic factors. A high-carbohydrate challenge in young healthy whites was associated with a reduction in N-terminal pro atrial NP (NTproANP) levels, but no data exist in blacks. Hypothesis: We hypothesized that 1) the baseline differences in NP levels by race would be evident in young adults with no comorbidities; 2) blacks would have a reduction in NTproANP levels in response to high-carbohydrate challenge similar to whites but the magnitude of change would differ. Methods: Healthy self-identified blacks and whites were screened for the presence of laboratory abnormalities. Each eligible participant was provided 3 days of study diet to standardize salt intake. After the dietary intervention, subjects were brought to the clinical research unit for a high-carbohydrate challenge. Venous blood was collected every hour for 8 hours to perform biochemical assays. African ancestry proportions among self-identified blacks were also determined. Results: We recruited 56 healthy participants with a mean age of 26 years, 48% female, 54% whites, mean body mass index 26 kg/m 2 , and an average proportion of 90% African ancestry among self-identified blacks. We found that BNP levels were 24% (95% CI 53 to 6) and N-terminal-proB-type NP (NTproBNP) levels were 44% (95% CI 99 to 17) lower in blacks compared with whites. The decrease in NTproANP levels in response to carbohydrate challenge differed by race (p for interaction=0.03). In response to a carbohydrate challenge, blacks had a 24% reduction in the NTproANP levels (p=0.01) vs. a 47% decrease in the NTproANP in whites (p&lt;0.001) ( Figure, Panel A ), with no change in NTproBNP levels in both races ( Figure, Panel B ). Conclusions: Blacks have an endogenously suppressed NP system which may be a biologic determinant contributing to racial disparities in cardiometabolic disease. We have shown that high-carbohydrate diet has a differential effect on NP system by race which needs to be considered while individualizing strategies for disease prevention. ( NCT# 03072602 ).
Physiological and Clinical Assessment of Resting Physiological Indexes
Authors: Joo Myung Lee, Ki Hong Choi, Jonghanne Park, Doyeon Hwang, Tae-Min Rhee, Jinseob Kim, Jinhyoung Park, Hyung Yoon Kim, Hae Won Jung, Yun-Kyeong Cho, Hyuck-Jun Yoon, Young Bin Song, Joo-Yong Hahn, Chang-Wook Nam, Eun-Seok Shin, Joon-Hyung Doh, Seung-Ho Hur, Bon-Kwon Koo
Journal: Circulation (2019)

Recently, resting pressure-derived indexes such as resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have been introduced to assess the functional significance of epicardial coronary stenosis. The present study sought to investigate the agreement of RFR or dPR with other pressure-derived indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve), the sensitivity of RFR or dPR for anatomic or hemodynamic stenosis severity, and the prognostic implications of RFR or dPR compared with iFR Methods: RFR and dPR were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The changes in resting physiological indexes according to diameter stenosis were compared among iFR, RFR, and dPR. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indexes according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between resting physiological indexes and the risk of 2-year vessel-oriented composite outcomes (a composite of cardiac death, vessel-related myocardial infarction, and vessel-related ischemia-driven revascularization) was analyzed among 864 deferred vessels.Both RFR and dPR showed a significant correlation with iFR ( R=0.979, P<0.001 for RFR; and R=0.985, P<0.001 for dPR), which was higher than that with fractional flow reserve ( R=0.822, P<0.001; and R=0.819, P<0.001, respectively). RFR and dPR showed a very high agreement with iFR (C index, 0.987 and 0.993). Percent difference of iFR, RFR, and dPR according to the increase in anatomic and hemodynamic severity was almost identical. The diagnostic performance of iFR, RFR, and dPR was not different in the prediction of myocardial ischemia defined by both low hyperemic myocardial blood flow and low coronary flow reserve by 13N-ammonia positron emission tomography. All resting physiological indexes showed significant association with the risk of 2-year vessel-oriented composite outcomes (iFR per 0.1 increase: hazard ratio, 0.514 [95% CI, 0.370-0.715], P<0.001; RFR per 0.1 increase: hazard ratio, 0.524 [95% CI, 0.378-0.725], P<0.001; dPR per 0.1 increase: hazard ratio, 0.587 [95% CI, 0.436-0.791], P<0.001) in deferred vessels.All resting pressure-derived physiological indexes (iFR, RFR, and dPR) can be used as invasive tools to guide treatment strategy in patients with coronary artery disease.URL: https://www.clinicaltrials.gov . Unique identifier: NCT01621438.
Identification of Novel Lncrnas That Predict Survival in AML Patients and Modulate Leukemic Cells
Authors: Sarah Grasedieck, Christoph Rueß, Nicole Pochert, Susanne Lux, Adrian Schwarzer, Jan-Henning Klusmann, Mojca Jongen-Lavrencic, Jonathan R. Pollack, Arefeh Rouhi, Florian Kuchenbauer
Journal: Blood (2018)
Use of standardised patients to assess gender differences in quality of tuberculosis care in urban India: a two-city, cross-sectional study
Authors: Benjamin Daniels, Ada Kwan, Srinath Satyanarayana, Ramnath Subbaraman, Ranendra K Das, Veena Das, Jishnu Das, Madhukar Pai
Journal: The Lancet Global Health (2019)

In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice.We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender.Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76-1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification.Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India.Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.
Prosthetic Replacement of the Mitral Valve
Authors: FREDERICK H. LEVINE, JACK G. COPELAND, ANDREW G. MORROW
Journal: Circulation (1973)

The late postoperative results of isolated mitral valve replacement in 100 patients operated upon from 1961 to 1965 are summarized. Eighty-three of the patients survived operation, and 52 are still alive. Seventy-six percent of patients surviving operation were alive 5 years later, and 64% after 8 years. Of the entire group of 100 patients operated upon, 63% were alive after 5 years and 51% after 8 years. Sixteen of the 31 late deaths were definitely attributable to the presence of the prosthesis: systemic arterial emboli (eight patients), valve thrombosis (two), perivalvular leak (one), ball variance (two), endocarditis (two), and intracerebral hemorrhage due to anticoagulants (one). Congestive heart failure was the primary cause of death in the remaining patients. Predominance of either stenosis or regurgitation preoperatively did not significantly alter late survival, nor did coexistent tricuspid regurgitation. High operative and early postoperative mortality was seen in patients with associated aortic regurgitation. Patients who were in class IV preoperatively had a higher mortality (50% alive at 5 years) than those in class III (70% alive), but no difference in mortality was noted between patients who preoperatively had normal sinus rhythm and those who had atrial fibrillation. Forty-nine percent of patients have sustained systemic emboli, and these have occurred throughout the postoperative period. Currnetly, 50% of patients are class I, 42% are class II, and only 8% are class III. Prosthetic mitral valve replacement has provided gratifying long-term symptomatic improvement in the majority of patients.
Violence and mortality in the Northern Rakhine State of Myanmar, 2017: results of a quantitative survey of surviving community leaders in Bangladesh
Authors: Parveen K Parmar, Jennifer Leigh, Homer Venters, Tamaryn Nelson
Journal: The Lancet Planetary Health (2019)

BackgroundIn August, 2017, Myanmar security forces initiated a widespread response against the Rohingya ethnic minority in Northern Rakhine State, displacing thousands of people to Bangladesh. This attack was purportedly in response to attacks committed by the Arakan Rohingya Salvation Army, a non-state insurgent group, on Myanmar police, Border Guard Police, and military posts, killing 12 security personnel on Aug 25, 2017. This study aimed to capture the experiences of the population from all Rohingya hamlets in the Northern Rakhine State who have been displaced to Bangladesh.MethodsA quantitative survey was done among Rohingya leaders displaced to refugee camps in Bangladesh. Community leaders from 590 Rohingya hamlets and eight urban wards provided hamlet-level data on the extent, nature, and perpetrators of the violence in Northern Rakhine State in August, 2017, and the resulting morbidity and mortality.ResultsFrom May 28 to July 25, 2018, 462 (77%) of 604 hamlet leaders reported that the primary reason they and their community members fled was because of violence in their hamlet or in a neighbouring hamlet. 568 (94%) respondents reported that they had experienced destruction in their hamlets, including burning or destruction of fields or farms, homes, and mosques; 531 (89%) of 599 respondents reported violence in their hamlets before flight and 373 (64%) of 586 reported violence against civilians in flight. The main perpetrators of violence included but were not limited to Border Guard Police, Myanmar military, and Rakhine extremists. Of the 531 respondents who reported violence in their hamlets, 408 (77%) reported that military forces used helicopters, 372 (70%) reported military vehicles, and 113 (21%) reported tanks in these assaults on civilian communities. We estimate that 7803 Rohingya died from violent and non-violent causes associated with the August, 2017, attacks and subsequent displacement.InterpretationIn 2017, the Rohingya ethnic minority population of Northern Rakhine State were the targets of a campaign of widespread and systematic violence, including violence by state forces.FundingAn anonymous grant to Physicians for Human Rights.
Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation
Authors: Jongwook Oh, Jong Man Kim
Journal: Clinical and Molecular Hepatology (2019)

Antibody mediated rejection (AMR) after adult ABO-incompatible living donor liver transplantation (ABO-I LDLT) induced hepatic necrosis or diffuse intrahepatic biliary complications, which were related with poor graft and patient survival. Various desensitization protocols have been used to overcome these problems. Since using rituximab, the outcomes of ABO-I LDLT show a similar survival rate to those of ABO-compatible living donor liver transplantation. However, diffuse bile duct complications still occur after ABO-I LDLT. We have reviewed the past and current immune strategies for desensitization and to provide outcomes and ABO incompatibility-related complications in ABO-I LDLT. Keywords: Immunosuppression; Rejection; Graft survival; Complications
Management of acute upper gastrointestinal bleeding
Authors: Adrian J Stanley, Loren Laine
Journal: BMJ (2019)

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.
Amphiphysin 2 modulation rescues myotubular myopathy and prevents focal adhesion defects in mice
Authors: Valentina M. Lionello, Anne-Sophie Nicot, Maxime Sartori, Christine Kretz, Pascal Kessler, Suzie Buono, Sarah Djerroud, Nadia Messaddeq, Pascale Koebel, Ivana Prokic, Yann Hérault, Norma B. Romero, Jocelyn Laporte, Belinda S. Cowling
Journal: Science Translational Medicine (2019)

Modulation of human amphiphysin 2 expression by genetic cross and viral delivery rescues all hallmarks of X-linked centronuclear myopathy in mice.
Abstract P291: Projected Heterogeneity in the Long-term Effects of Obesity Interventions Across the Life Course
Authors: Christy L Avery, Johanna K Schönbach, Priya A Palta, Stephanie B Wheeler, Stefan K Lhachimi
Journal: Circulation (2016)

Approximately 69% of U.S. adults are obese or overweight, with African Americans (AA) and Mexican Americans (MA) shouldering disproportionate burdens when compared to Caucasian Americans (CA). Despite the vast resources dedicated to testing obesity interventions, few studies have compared their effectiveness for obesity prevention across the life course or in multi-ethnic populations. We therefore leveraged race/ethnic- and sex-specific body mass index and population size estimates from the National Health and Nutrition Examination Survey (n=15,007; 2007-12; ages 18-80), mortality rates from the National Center for Health Statistics (2010), previously estimated net transition probabilities, and the Dynamic Modeling for Health Impact Assessment simulation tool to project the effects of two classes of obesity interventions by race/ethnicity (AA; CA; MA) and sex: interventions that proportionally decreased the prevalence of overweight and obesity at age 18, thereby modeling the cumulative effect of interventions throughout childhood and adolescence; and interventions that proportionally decreased the probability of transitioning to overweight or obesity in adults 18-80 years. At age 18, the prevalence of obesity ranged from 17-32%, with the lowest prevalence estimated for CA females and the highest estimated for AA females. Interventions achieving a 10% proportional decrease in the prevalence of overweight and obesity at age 18 were associated with modest decreases in the prevalence of obesity later in life, with the greatest benefits projected for MA males (e.g., an 8.8% proportional decrease in obesity at age 40) and the smallest benefits projected for AA females (e.g., a 5.5% proportional decrease in obesity at age 40). In comparison, projected effects of interventions achieving a 10% proportional decrease in the probability of transitioning to overweight and obesity in adults 18-80 years of age were smaller in magnitude, with the greatest benefits projected for CA females (e.g., a 6.2% proportional decrease in obesity at age 40) and the smallest benefits projected for MA males (e.g., a 2.8% proportional decrease in obesity at age 40). When both interventions were applied simultaneously, the largest effects were projected for CA males and females (e.g., a 12.5% proportional decrease in obesity at age 40). We conclude that both classes of interventions decrease the prevalence of obesity across the life course, but they are not equivalent and could potentially exacerbate longstanding disparities. Further work evaluating the race/ethnic- and sex-specific optimal age epochs at which to intervene is therefore warranted.
55 Patient survey to assess stool testing compliance
Authors: A Alakkari, BM Ryan
Journal: Gut (2017)

Background  Stool testing is increasingly used as a GI investigational tool. We are currently conducting a prospective study using non-invasive tests including stool testing in the initial assessment of patients referred to our gastroenterology unit. Faecal sample return rate in our study is 60% for patients 50 years.  Aim  A patient survey was conducted to identify (1) reasons for reduced faecal testing compliance, and (2) ways to improve it.  Method  The anonymous survey was randomly distributed to patients in gastroenterology clinics over 4 weeks.  Results  Of 282 surveys distributed, 226 (80%) were returned. 3 were excluded. 223 surveys were stratified into group A: age  50 years (n=103). 87 (39%) patients were previously asked to provide a stool sample by a medical professional; 48 in group A and 39 in group B. 55% were female. 81 (93%) patients returned the faecal sample, with no statistically significant difference between the two groups. 82% and 84% felt adequately informed regarding the indication and method for stool collection. Reasons for not completing stool testing in 6 patients were, uncomfortable with test or technical difficulty. The good compliance with stool testing which does not correlate with our previous clinical experience, suggests those not completing stool testing were less likely to participate in the survey.  Conclusions  Compliance may be improved by patient education, user friendly stool collection kits, and a public based strategy addressing attitudes, fears, and awareness of stool testing.
Initial Feasibility Study of a New Transcatheter Mitral Prosthesis
Authors: Paul Sorajja, Neil Moat, Vinay Badhwar, Darren Walters, Gaetano Paone, Brian Bethea, Richard Bae, Gry Dahle, Mubashir Mumtaz, Paul Grayburn, Samir Kapadia, Vasilis Babaliaros, Mayra Guerrero, Lowell Satler, Vinod Thourani, Francesco Bedogni, David Rizik, Paolo Denti, Nicolas Dumonteil, Thomas Modine, Ajay Sinhal, Michael L. Chuang, Jeffrey J. Popma, Philipp Blanke, Jonathon Leipsic, David Muller
Journal: Journal of the American College of Cardiology (2019)
QIM19-146: A Multidisciplinary Approach to Conquer Central-Line Associated Blood Stream Infections: Establishing the Continuum of Prevention
Authors: Christine Wallace, Jennifer Sullivan, Erin Supan
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Central line associated blood stream infection (CLABSI) rates have been above the benchmark for our academic medical center that includes a comprehensive cancer center. In response, a 20% CLABSI reduction rate was set by the hospital Chief Medical and Associate Chief Nursing Officers. A multidisciplinary group convened to standardize central line insertion and maintenance practices. Product review showed 20 different central line insertion kits and 6 different dressing kits throughout the system. Hospital central line policy focused solely on nursing practice and there was not a policy including provider practice regarding central line insertion. A gap analysis determined dressing and insertion site integrity was compromised in 53% of our patients, including visible blood under 38% of the dressings, with oncology patients having some of our highest rates of bleeding. Objective: The purpose of this quality improvement project was to collaborate amongst disciplines to review practice, products, and policy for central line insertion and maintenance. We aimed to systematically improve practice across the central line continuum of prevention. Methods: A multidisciplinary team evaluated and defined current and best practice for policy and product changes. Implementation of best practice checklists included a team checklist to be used during insertion of every central line in the intensive care units and checklists that detailed practice steps in accordance with the updated central line policy. Central line dressing change prototypes were designed, products were compared, and approval for a standardized kit to support practice occurred. A new antimicrobial and hemostatic dressing was selected for line care to improve site integrity. The number of central line insertion kits was reduce by half and dressing kits were reduced to just one standard kit for the hospital system. Results: CLABSI rates have decreased from 7.43 cases/month to 3.6 cases/month following. Trends post-product rollout and repeat gap analysis data will be included at time of presentation. Conclusion: Reduction of CLABSI requires a multidisciplinary approach focusing simultaneously on best practices for central line insertion and maintenance. Best evidence for provider and nursing practice needs to be bundled in a comprehensive policy with checklist and products to support the standardization. Clinician evaluation and input on choosing products is critical to positive patient outcomes.