tbuckley/cabot-search huggingface dataset:
Abstract P482: Long-term Health and Cost Impact of the 2017 American College of Cardiology/American Heart Association (2017 Acc/aha) Hypertension Guidelines for Low-risk Adults
Authors: Pengxiao C Wei, Joanne Penko, Pamela Coxson, Brandon Bellows, Leah Machen, Andrew E Moran, Kirsten Bibbins-Domingo
Journal: Circulation (2020)

Introduction: The 2017 ACC/AHA guidelines redefined stage 1 hypertension to include blood pressure 130-139 mmHg/80-89 mmHg and recommended non-pharmacologic interventions (e.g., DASH diet, physical activity) for those with stage 1 hypertension and a low 10-year risk of cardiovascular disease (CVD). The cost-effectiveness of achieving target blood pressure in this low risk population in the clinical setting (via identification, diagnosis, and counseling on diet and exercise) has not been assessed. Methods: We used the Cardiovascular Disease Policy Model (CVDPM), a dynamic state-transition model of CVD in US adults to simulate achieving blood pressure control in low-risk adults aged 35-64 years with untreated stage 1 hypertension based on the 2017 ACC/AHA guidelines. Outcomes included incident CVD (coronary heart disease and stroke), CVD healthcare costs (2018 dollars), and quality-adjusted life years (QALYs) over 10 years. We projected outcomes assuming all low-risk young adults achieve control. We then varied the degree to which patients would change behaviors following diagnosis, using low uptake (20%) and high uptake (70%) estimates sourced from literature. We tested the sensitivity of health gains to decrements in QALYs associated with receiving a diagnosis using estimates from the Global Burden of Disease. Results: An estimated 7.0 million men and 6.6 million women age 35-64 years would be newly diagnosed with stage 1 hypertension and indicated for non-pharmacologic interventions according to 2017 ACC/AHA. Achieving targets of &lt;130/80 mmHg is projected to prevent 63,200 incident CVD events and 4,800 CVD deaths and lower CVD related healthcare costs by $3.6 billion (2018 USD) over 10 years compared to no BP change. Assuming less than complete control (because of variable uptake of non-pharmacologic interventions) resulted in lower rates of CVD prevention (low uptake - 13,900 events prevented and $0.8 billion lower costs; high uptake 41,000 events prevented and $2.3 billion lower costs). In all scenarios, the magnitude of QALYs gained from preventing CVD was highly sensitive to decrements associated with anxiety from receiving a diagnosis. Conclusions: Achieving 2017 ACC/AHA stage 1 hypertension goals in newly diagnosed low-risk adults would result in substantial CVD benefit and reductions in CVD-related healthcare costs. . If these goals are to be achieved in the clinical setting, gains are likely to be offset by degree of uptake of counseling regarding non-pharmacologic interventions and anxiety related to a new diagnosis of hypertension.
Abstract 16619: Acute Aortic Dissection With No Ascending Involvement: Is Entry Tear Location in the Arch Different From Entry Tear Location in the Descending?
Authors: Hector de Beaufort, Mark D Peterson, Patrick O’Gara, Jean Bismuth, Sherene Shalhub, Valerio Tolva, Bradley S Taylor, Hans-Henning Eckstein, Toru Suzuki, Stuart Hutchison, Daniel G Montgomery, Joseph S Coselli, Arturo Evangelista, Christoph A Nienaber, Kim A Eagle, Eric M Isselbacher, Santi Trimarchi
Journal: Circulation (2018)

Introduction: Optimal management of acute aortic dissections (AD) with entry tear in the arch without ascending involvement (arch B AD) is not discussed in clinical guidelines. This study aims to better define this type of AD. Methods: Presentation, management, and in-hospital mortality of patients with arch B AD enrolled in the International Registry of Acute Aortic Dissection were analyzed and compared to a control group of Stanford type B AD (TBAD) with entry tear in the descending aorta. Results: Patients with arch B AD (n=156) and TBAD (n=222) were not significantly different concerning demographics, except age, which was higher in TBAD patients (60±14 vs 64±14 years; p=0.024). Medical history, including hypertension, diabetes, bicuspid aortic valve, Marfan disease, renal insufficiency and COPD, was similar for both groups. On preoperative imaging, arch B AD patients had a larger median arch diameter (3.7 vs 3.5 cm; p=0.007) and smaller descending diameter (3.6 vs. 4.4 cm; p&lt;0.001). The two groups were not different concerning preoperative complications such as shock, aortic rupture or neurological complications, except descending diameter &gt;5.5 cm, which was less frequently seen for arch B AD (2.6% vs 13.5%; p&lt;0.001). Arch B AD was more frequently treated with open surgery (19.9% vs. 10.8%; p=0.013) and less frequently managed medically (47.4% vs. 61.4%; p=0.007), while the frequency of endovascular treatment was similar (26.3% vs. 26.0%; P=0.953). The overall in-hospital mortality was higher for arch B AD (17.3% vs. 12.6%; p=0.196). This difference was driven primarily by those receiving open surgery (32.3% mortality for arch B AD vs. 16.7%; p=0.226), while mortality was similar after endovascular treatment (9.8% vs. 8.6%; p=1.0), and medical management (13.5% vs. 14.1%; p=1.0). Conclusions: Arch B AD is more frequently treated aggressively with open surgery, but associated mortality rates are high. A more conservative approach with either endovascular treatment or medical management may be preferable. In this respect, arch B AD may be comparable to TBAD.
Depression and Anxiety in Adults With Hidradenitis Suppurativa
Authors: Myrela O. Machado, Vicky Stergiopoulos, Michael Maes
Journal: JAMA Dermatology (2019)

Importance Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors’ knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric comorbidities in this population.  
Objective To assess the prevalence and odds for depression and anxiety in patients with HS.  
Data Sources From July 25 to September 30, 2018, observational studies investigating the prevalence and odds for depression and anxiety in adults with HS were systematically searched without language restriction from the inception of each database to July 25, 2018, in PubMed/MEDLINE, Embase, and PsycINFO databases. Searches used various configurations of the terms hidradenitis suppurativa; acne inversa; depressive disorder; depression; anxiety; anxiety disorders; phobia, social; suicide; and suicide, attempted. In addition, the reference lists of included references were screened manually.  
Study Selection Two investigators independently screened references that measured prevalence rates and odds for depressive and anxiety symptoms in patients with HS. Of 136 unique references, 10 ultimately met inclusion criteria.  
Data Extraction and Synthesis Relevant data were extracted from eligible references. Authors were contacted to provide further information when necessary. Methodological quality of included studies was assessed through a modified version of the Newcastle-Ottawa Scale. Random-effects models were used to synthesize available evidence.  
Main Outcomes and Measures Prevalence rates and ORs for depression and anxiety in adults with HS were the primary outcome measures. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses.  
Results Ten studies comprising 40 307 participants with HS met inclusion criteria. The overall prevalence of depression was 16.9% (95% CI, 9.9%-27.2%). Heterogeneity was large. In the subgroup of studies that considered a clinical criteria–based diagnosis of depression, the prevalence of depression was 11.9% (95% CI, 4.9%-26.2%), compared with 26.8% (95% CI, 20.4%-34.5%) in studies that used a screening instrument. The methodological quality of included studies moderated those findings. The OR for depression in individuals with HS compared with individuals without HS was 1.84 (95% CI, 1.57-2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%-13.2%); there were insufficient data to determine an odds ratio for anxiety in persons with HS because 2 studies included a comparison group.  
Conclusions and Relevance This systematic review and meta-analysis indicates that depression and anxiety are common comorbid conditions in patients with HS. Results suggest that the development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted.
Cytokine gene polymorphisms and cancer-related symptoms in lung cancer patients
Authors: C. C. Reyes-Gibby, M. Spitz, X. Wu, S. Shete
Journal: Journal of Clinical Oncology (2007)

9012 Background: Cytokines, aberrantly produced by cancer cells, have recently been implicated in the severity of cancer-related symptoms. We hypothesize that functional variations in cytokine genes could explain variability in self-reported pain and depressed mood in lung cancer patients of all stages. Methods: Pain, depressed mood, clinical and demographic variables were assessed at presentation, and prior to initiating any cancer treatment in 514 white patients with non-small cell lung cancer (NSCLC). Using the TaqMan method, we genotyped single nucleotide polymorphisms in interleukin (IL) −6 (−174 G&gt;C), IL-8 (−251 T&gt; A), and tumor necrosis factor-alpha (TNF-; −308 G&gt; A), and determined their associations with pain and depressed mood. Results: Sixteen and 7% of respondents reported severe levels of pain (≥ 7, on a 0–10 scale) and depressed mood most/all of the time, respectively. The severity of pain and depressed mood predictably varied by clinical, sociodemographic, and genotype variables in the univariate analyses. Multivariable logistic regression analyses showed that variant allele in IL8 (OR=2.05;95%CI=1.04–4.06), early age of onset (≤ 50 years) (OR=1.80;95%CI=1.02–3.14), and depressed mood (OR=4.55;95%CI=2.105–9.81) were significant predictors for severe pain. For depressed mood, results showed that variant allele in IL6 (OR=0.49;95%CI=0.24–0.49), severe pain (OR= 3.77;95%CI=1.79–7.95) and a history of stroke (OR=3.50;95%CI=1.03–11.82) as significant predictors. Classification and Regression Tree analyses revealed potential higher order gene-gene interaction for pain (IL1 and IL6) and depressed mood (IL8 and IL6). Conclusions: Variations in individual inflammatory responses could partly explain variability in pain and depressed mood in patients with lung cancer. No significant financial relationships to disclose.
Informed Consent for Stem Cell–Based Interventions—Reply
Authors: R. Alta Charo, Roger A. Barker, Jeremy Sugarman
Journal: JAMA (2020)

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Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children
Authors: Huanhuan Liu, Fang Liu, Jinning Li, Tingting Zhang, Dengbin Wang, Weishun Lan
Journal: Journal of Infection (2020)

BackgroundThe ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.MethodsClinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.FindingsCompared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6–9 days after initial CT scans.InterpretationAtypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.
Regulating Medicines in a Globalized World With Increased Recognition and Reliance Among Regulators
Authors: Lawrence O. Gostin, Alastair J. Wood, Patricia A. Cuff
Journal: JAMA (2020)

This Viewpoint summarizes recommendations from a 2020 National Academies of Sciences, Engineering, and Medicine (NASEM) committee report on ways to improve regulatory oversight of drugs in an era of global pharmaceutical research and development.
Abstract P158: USING CHA <sub>2</sub> DS <sub>2</sub> - VASC SCORE TO PREDICT CLINICAL OUTCOMES IN PATIENTS WITH INFECTIVE ENDOCARDITIS
Authors: Temidayo Abe, Paul J Mather, Banjo Olowu
Journal: Circulation (2020)

Background: The CHA 2 DS 2 - VASC score is a well-validated stroke risk stratification tool in patients with non-valvular atrial fibrillation. Most of the clinical variables used have been associated with poor outcomes in patients with infective endocarditis (IE). We aim to determine its usefulness in predicting outcomes in patients with IE. Methods: We included 35,570 patients with IE from the national inpatient sample (2009 - 2012). CHA 2 DS 2 - VASC score was calculated for each patient. Hierarchical two-level logistic and linear models were used to estimate outcomes for CHA 2 DS 2 - VASC scores 1 to 8, using score 0 as the referent score. Outcomes of interest were overall in-hospital mortality, cardiogenic shock, atrioventricular block (AVB) and valve replacement. All clinical characteristics were defined per the ICD-9-CM codes. Results: The mean age of the sample was 59.81 +/- 18 years. Of the 35570 patients with IE, overall mortality rate was 11.4% (n= 4038/35570), cardiogenic shock 2.6 % (n=912/35570), AVB 4% (n=1426/35570) and 10.3% (n=3652/35570) required valve replacement. Higher CHA2DS2-VASc score were associated with increased mortality from 8.1 % for a score of 0 to 21.7 % for score of 8. Cardiogenic shock increased from 5.2% for a score of 0 to 24 % for a score of 3. AVB increased from 5.5% for score of 0 to 17.5% for score of 4. While valve replacement surgery increased from 1.3% for score of 0 to 3.8% for score of 5. Figure, 1 revealed the adjusted odds ratios for outcomes per CHA 2 DS 2 - VASC score 1 to 8, using 0 as the referent score, a higher score was significantly associated with increased odds for overall mortality, cardiogenic shock, AVB, and valve replacement. Conclusion: In patients with infective endocarditis, CHA2DS2-VASc score can serve as a risk assessment tool to predict outcomes. &lt;!--EndFragment--&gt;
Interim results from a first-in-human study with AMG102, a fully human monoclonal antibody that neutralizes hepatocyte growth factor (HGF), the ligand to c-Met receptor, in patients (pts) with advanced solid tumors
Authors: M. S. Gordon, D. S. Mendelson, C. Sweeney, N. Erbeck, R. Patel, T. Kakkar, L. Yan, S. G. Eckhardt, L. Gore
Journal: Journal of Clinical Oncology (2007)

3551 Background: AMG102 is a fully human IgG 2 monoclonal antibody against HGF that prevents tumorigenesis in preclinical models through blockade of the HGF/c-Met receptor tyrosine kinase pathway. We describe interim results from the first-in-human study of AMG102. Methods: This ongoing phase 1, open-label, dose-escalation study is evaluating safety, pharmacokinetics (PK), and preliminary pharmacodynamics (PD) of AMG102 after single and multiple intravenous doses in pts with advanced solid tumors. Sequential dose cohorts of 4–6 pts were administered AMG102 at 0.5, 1, 3, 5, 10, or 20 mg/kg. Pts received a single dose, followed by a 4-wk treatment- free period during which safety and PK were assessed. If no dose-limiting toxicity (DLT) was observed, treatment was resumed every 2 wks at the same dose until pts exhibited drug intolerance or disease progression. Results: As of 10 August 2006, 31 pts have been treated with AMG102 at doses up to 20 mg/kg ( Table ). AMG102 appears to be well tolerated. One pt with non-small cell lung cancer had a grade 3 DLT of dyspnea/hypoxia after the first dose (0.5 mg/kg); a second pt with pancreatic cancer had a grade 3 DLT/serious adverse event of gastrointestinal hemorrhage after the first dose (1 mg/kg). The most frequently reported, treatment-related adverse events (AEs) have been fatigue (13%), constipation (10%), anorexia (6%), nausea (6%), and vomiting (6%). No anti-AMG102 antibodies have been detected. Initial PK analysis indicates approximately linear PK in the dose range of 0.5 to 20 mg/kg. The overall mean (SD) [median] clearance and half-life estimates based on day-1 dosing were 12.1 (5.21) [10.7] mL/hr and 15.4 (5.84) [15.5] days, respectively. Tumor response is described ( Table ). Conclusions: In this study, interim results suggest that AMG102 at doses up to 20 mg/kg appears to be well-tolerated, with preliminary PK data supporting every-2-wk administration. [Table: see text] No significant financial relationships to disclose.
Abstract P397: Social Determinants of Hypertension and Diabetes Among African Immigrants: The African Immigrant Health Study
Authors: Oluwabunmi Ogungbe, Ruth-alma N Turkson-ocran, Diana Baptiste, Binu Koirala, Cheryl R Dennison Himmelfarb, Patricia Davidson, Yvonne Commodore-Mensah
Journal: Circulation (2020)

Introduction: The differences in the risk of cardiovascular disease (CVD) among Black ethnic groups in the U.S. remain largely unexplained. African immigrants are particularly likely to have high rates of hypertension and diabetes, and less likely to be screened, diagnosed or receive treatment. Objective: To examine the association between social determinants of health (SDoH) and hypertension and diabetes among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of 465 African immigrants living in the Baltimore-Washington metropolitan area. Data collection was performed through a combination of physical examinations and questionnaires. The outcomes were self-reported hypertension and diabetes. Elements of SDoH collected were education, income, health insurance, employment and marital status. Logistic regression analyses were used to assess the association between SDoH and hypertension/diabetes. Results: The mean age of participants was 46.8(±11.5) years and 60% were women; 64% had ≥ college degree, 83% were employed, 67% had health insurance, and 70% were married/co-habiting. Mean body mass index was 30.7 (±18.3) kg/m 2 . The prevalence of hypertension and diabetes was 32%, and 13% respectively. The odds of diabetes were higher amongst those who were unemployed [aOR: 2.86 (1.39-5.56)] ( Table ). Education, health insurance, income and marital status were not associated with hypertension or diabetes after accounting for age and sex. Conclusion: Among African immigrants, we observed that those who were unemployed had a higher likelihood of self-reported diabetes than those who were employed. Additional studies are needed to further study the contributions of social determinants of hypertension and diabetes as well as and developing health policy and interventions to improve cardiovascular health.
Abstract MP31: Blood DNA Methylation Signatures of Incident Coronary Heart Disease: An Epigenome-wide Analysis in the Strong Heart Study
Authors: Ana Navas-Acien, Arce Domingo-Relloso, Maria Tellez-Plaza, Lizbeth Gomez, Miguel Herreros, Richard B Devereux, Andrea Baccarelli, Jason G Umans, Barbara Howard, Jinying Zhao, Wan-Yee Tang, Karin Haack, M. Daniele Fallin, Shelley Cole
Journal: Circulation (2020)

Background: In the US, American Indians suffer a disproportionate burden of CHD compared to other racial/ethnic groups. Additional strategies are needed to identify individuals at risk. Objectives: Investigate the association of blood DNA methylation (DNAm) with incident CHD in the Strong Heart Study and the prediction ability of DNAm beyond traditional risk factors. We maximized prediction ability using Bayesian Hierarchical Cox (BHCox) and Survival Random Forest models, which allow large numbers of CpGs in a single model, instead of considering them individually. Methods: Among 2325 men and women 45-74 years old in 1989-1991, 557 CHD events were identified over 20 years of follow-up. DNAm was measured in 790,026 CpGs, pre-processed and corrected for batch effects. We ran adjusted BHCox models for subsets of CpGs selected from similarly adjusted Cox models for individual CpGs. Prediction ability of CpGs in BHCox was further evaluated with Survival Random Forest, which is robust to overfitting. We also conducted a targeted analysis using Cox regression. Results: 26 CpGs associated with CVD in previous studies were nominally associated with incident CHD in a targeted analysis. The cross-validated C index for the model with traditional risk factors was 0.703. In BHCox, further entering 30K CpGs in a single model, resulted in 231 CpGs being significantly associated with incident CHD, with a cross-validation C statistic of 0.855. In Survival Random Forest, further entering the 231 CpGs from the BHCox model resulted in a cross-validation C statistic of 0.771 and 182 CpGs with variable importance (VIMP) greater than zero. The top CpGs in BHCox were also VIMP&gt;0 in random forest models and were located in SLC24A1 (calcium exchanger), SHBG (sex hormone binding globulin), and LINC00346 (non-protein coding RNA 346). Conclusions: We found novel CpG sites prospectively associated with incident CHD and confirmed signals from previous studies. DNAm might help to identify individuals at high risk of developing CHD.