tbuckley/cabot-search huggingface dataset:
Abstract 14820: Are Early Recurrent Relapses of Atrial Fibrillation Following Cardioversion Predictive of Late Clinical Outcome?
Authors: Ryo Nakamaru, Koichi Inoue, Koji Tanaka, Yuko Hirao, Yuichi Ninomiya, Takafumi Oka, Nobuaki Tanaka, Masato Okada, Hiroyuki Inoue, Katsuomi Iwakura, Kenshi Fujii
Journal: Circulation (2017)

Introduction: Following catheter ablation (CA) for atrial fibrillation (AF), early recurrence (ER) during the 3 month blanking period (BP) may be significant for late recurrence (LR). Recognition o...
Contraception for Women With Psychiatric Disorders
Authors: Leanne R. McCloskey, Katherine L. Wisner, Minaz Kolia Cattan, Hannah K. Betcher, Catherine S. Stika, Jessica W. Kiley
Journal: American Journal of Psychiatry (2020)

Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices.A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives.The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions.Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.
Abstract 13714: Clinical Utility of the Triglyceride-glucose Index Which is a Novel Marker of Insulin Resistance for Predicting the Neointimal Vulnerability After Everolimus-eluting Stent Implantation
Authors: Naotaka Akutsu, Riku Arai, Daisuke Fukamachi, Yasuo Okumura
Journal: Circulation (2020)

Introduction: Insulin resistance has been recognized as the cause of cardiovascular disease, but little is known about the influence of insulin resistance to neointimal characteristics after stent implantation. Hypothesis: The high triglyceride-glucose index (TyG index) has been reported to indirectly represent a high insulin resistance. It was hypothesized that in-stent neointimal characteristics in the high TyG index patients may be unstable more than the low TyG index patients. Methods: In 100 patients, we investigated the relationship between the neointimal characteristics and the TyG index using coronary angioscopy (CAS) and optical coherence tomography (OCT) during follow-up angiography after stent implantation. We divided into 2 groups according to the median value of TyG index (8.8). Results: The high TyG index group (n=48) had the higher yellow grade and the higher prevalence of yellow grade 3 by CAS than the low TyG index group (n=52). The prevalence of heterogeneous and layered patterns were more often observed by OCT in the high TyG index group than in the low TyG index group (Figure). Conclusions: The high TyG index strongly associated with neointimal vulnerability evaluating by CAS and OCT. The TyG index can be a useful predictor for the neointimal vulnerability after stent implantation.
Abstract 14354: Persistence to Oral Anticoagulation Treatment in Non-valvular Atrial Fibrillation Patients in the United States
Authors: Amol Dhamane, Manuela Di Fusco, Cynthia Gutierrez, Mauricio Ferri, Cristina Russ, Wan-Lun Tsai, Birol Emir, Allison Keshishian
Journal: Circulation (2020)

Background: Studies have shown that nonvalvular atrial fibrillation (NVAF) patients who discontinue direct oral anticoagulants (DOAC) are at higher risk of complications, such as stroke. This analysis compared the risk of non-persistence of OACs among NVAF patients. Methods: Adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin were identified using 01JAN2013-31MAR2019 data from the IQVIA commercial claims database. Non-persistence was defined as discontinuation (no evidence of index OAC use for 60 days from the last days’ of supply) or switch to another OAC. Kaplan-Meier (KM) curves were generated to illustrate time-to-non-persistence along with cumulative incidences of non-persistence. Adjusted cox proportional hazards models, including time-varying covariates (e.g., major bleeding, stroke), were used to evaluate non-persistence risk. Results: A total of 32,103 apixaban, 5,906 dabigatran, 29,385 rivaroxaban, and 21,420 warfarin patients were included; mean age: 63. Apixaban was associated with a lower risk of non-persistence compared to dabigatran (hazard ratio [HR]: 0.54; 95% confidence interval [CI]: 0.52-0.56), rivaroxaban (HR: 0.79; 95% CI: 0.78-0.81), and warfarin (HR: 0.66; 95% CI: 0.65-0.68). Dabigatran was associated with a higher risk of non-persistence compared to warfarin (HR: 1.23; 95% CI: 1.19-1.28) and rivaroxaban (HR: 1.47; 95% CI: 1.42-1.52), and rivaroxaban was associated with a lower risk compared to warfarin (HR: 0.84; 95% CI: 0.82-0.86). KM curves and cumulative incidences are presented below (Figure). Conclusions: In this group of NVAF patients, apixaban was associated with a significantly lower risk of non-persistence compared to dabigatran, rivaroxaban, and warfarin. Rivaroxaban was associated with a lower risk of non-persistence compared to warfarin and dabigatran. Such differences are critical as persistence with OACs is essential to prevent thromboembolic complications.
Abstract 14236: Cardiovascular Risk at Presentation for Gender-Affirming Care in the Transgender Population
Authors: Kara J Denby, Meghana Patil, Karlo Toljan, Leslie Cho, Cecile A Ferrando
Journal: Circulation (2020)

Introduction: Due to stigma, the transgender (TG) population experiences socioeconomic and health disparities, including decreased access to care. Use of gender affirming hormone therapy (GAHT) may place TG individuals at increased cardiovascular (CV) risk. The objective of this study is to identify the baseline CV risk of TG individuals presenting for gender affirming care. Methods: This was a retrospective study of TG patients seeking GAHT from a multi-disciplinary transgender program. Patients were included if they had not yet initiated GAHT. Once patients were identified, the EMR was queried for the following data: demographics, medical history, vitals, medications, and laboratory results. The ACC/AHA ASCVD and QRISK3 risk scores were calculated for all patients who did not have documented CV disease. Results: 427 patients met inclusion criteria. Demographics are in Table 1. Of the patients, 237 (55.4%) had a chronic medical condition. The incidence of undiagnosed hypertension and hyperlipidemia was 6.8% and11.3% respectively, and of these cases, only 64.4% and 24.1% were on appropriate therapies. Mean ASCVD risk and QRISK3 for ages 40-65 was 8.3% and 12.2%, respectively. Mean QRISK for ages 25-39 years was 4.6%. Of those patients who fell into intermediate or high risk categories, there was limited statin use (Figure 1). Conclusions: TG individuals presenting for GAHT have elevated CV risk, including high rates of undiagnosed and untreated CV risk factors with inadequate CV prevention. They appear to be at higher risk than their age matched historical cohorts regardless of gender.
The role of transposable elements in the evolution of non-mammalian vertebrates and invertebrates
Authors: Noa Sela, Eddo Kim, Gil Ast
Journal: Genome biology (2010)

Transposable elements (TEs) have played an important role in the diversification and enrichment of mammalian transcriptomes through various mechanisms such as exonization and intronization (the birth of new exons/introns from previously intronic/exonic sequences, respectively), and insertion into first and last exons. However, no extensive analysis has compared the effects of TEs on the transcriptomes of mammals, non-mammalian vertebrates and invertebrates. We analyzed the influence of TEs on the transcriptomes of five species, three invertebrates and two non-mammalian vertebrates. Compared to previously analyzed mammals, there were lower levels of TE introduction into introns, significantly lower numbers of exonizations originating from TEs and a lower percentage of TE insertion within the first and last exons. Although the transcriptomes of vertebrates exhibit significant levels of exonization of TEs, only anecdotal cases were found in invertebrates. In vertebrates, as in mammals, the exonized TEs are mostly alternatively spliced, indicating that selective pressure maintains the original mRNA product generated from such genes. Exonization of TEs is widespread in mammals, less so in non-mammalian vertebrates, and very low in invertebrates. We assume that the exonization process depends on the length of introns. Vertebrates, unlike invertebrates, are characterized by long introns and short internal exons. Our results suggest that there is a direct link between the length of introns and exonization of TEs and that this process became more prevalent following the appearance of mammals.
Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: a randomized controlled trial
Authors: Da Hyun Jung, Hee Seok Moon, Chan Hyuk Park, Jun Chul Park
Journal: Endoscopy (2020)

Abstract Background Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Several methods to prevent post-ESD bleeding (PEB) have been introduced; however, they have not been widely used because of technical difficulties. We aimed to investigate whether polysaccharide hemostatic powder (PHP), which is very easy to apply, can prevent early post-ESD bleeding, especially in patients with a high risk of post-ESD bleeding. Methods This was a prospective, multicenter, randomized, open-label, controlled trial. Patients with a high risk for post-ESD bleeding were enrolled. Patients with gastric neoplasms in whom the resected specimen size was expected to be &gt; 40 mm and those who were regularly taking antithrombotic agents were defined as high risk patients. Patients were randomly assigned to the PHP or control groups. Results Between May 2017 and September 2018, 143 patients were enrolled (PHP group, 73; control group, 70). The total post-ESD bleeding rate was 6.3 % (PHP group, 5.5 % vs. control group, 7.1 %; P = 0.74). There was no bleeding within 7 days after ESD in the PHP group. Continued antithrombotic use was an independent risk factor for post-ESD bleeding. In subgroup analysis excluding the patients who continued to take antithrombotic agents (n = 129) during ESD, the rate of post-ESD bleeding tended to be lower in the PHP group than in the control group (0 % vs. 6.3 %; P = 0.06). Conclusion PHP did not demonstrate a significant effect on the prevention of post-ESD bleeding in this study. Further larger scale, randomized controlled trials are needed to confirm this.
Abstract 13603: Utility of the 6-minute Walk Test in Coronary Artery Disease Screening Before Kidney Transplant
Authors: Xingxing Cheng, Daniel J Watford, Hiroyuki Arashi, Jane C Tan, William F Fearon
Journal: Circulation (2020)

Introduction: Coronary artery disease (CAD) screening is a cornerstone of kidney transplant (KTx) evaluation, but existing approaches result in excess testing and low intervention rate. Hypothesis: We hypothesize that aerobic performance, based on a simple office test (the 6-minute walk test, 6MWT), may help risk stratify KTx candidates. Methods: We performed 6MWT in waitlisted patients who were nearing KTx. Results were used for frailty counselling and not for cardiac evaluation. CAD screening was done according to our center protocol: invasive angiogram for patients with long-standing diabetes mellitus (DM) and non-invasive testing for other patients with risk factors and at the evaluating transplant nephrologist’s discretion. We used subdistribution Cox regression and time-dependent receiver operator curve to evaluate time to CAD event (revascularization, myocardial infarction, waitlist removal for CAD, or cardiac death), treating waitlist removal for non-CAD and non-cardiac death as competing events. Results: Of the 360 patients, 200 and 161 patients had 6MWT results &lt;400 meters and ≥400 meters (~4 metabolic equivalents), respectively. Patients with lower 6MWT results were older (59±10 vs 50±12 years) and more likely to be female (54% vs 34%), have DM (61% vs 33%) or known atherosclerotic disease (44% vs 22%), and have had prior cardiac evaluation (72% vs 61%). They were also more likely to exhibit cardiac symptom during 6MWT (36% vs 6%) and more likely to be censored due to waitlist removal for non-CAD reasons (follow-up 391±337 vs 541±277 days). 6MWT was not associated with CAD event (subdistribution hazard ratio 1.00 [0.90-1.10], 1-year area under the curve [AUC] 0.54). 196 patients had invasive (52%) or non-invasive (48%) CAD testing within 6 months of 6MWT: 6MWT did not predict the CAD test result (odds ratio 0.96 [0.81-1.14], AUC 0.54). Of the 94 patients who had concurrent non-invasive CAD testing, the 1-year AUC of 6MWT, symptom (at rest or during 6MWT), AST guidelines, or non-invasive testing for CAD event were 0.64, 0.52, 0.46 and 0.66 respectively. Conclusions: The 6MWT did not perform better in risk stratification for CAD events compared to a symptom- or risk factor-based approach.
Abstract 13481: South Asian-specific <i>MYBPC3 25bp</i> Intronic Deletion Carriers Demonstrate Hypercontractility and Impaired Diastolic Function Under Exercise Stress
Authors: Sholeh Bazrafshan Kondori, Robert Sibilia, Saavia Girgla, Shiv K Viswanathan, Megan Puckelwartz, Elizabeth M McNally, Kiranpal S Sangha, Rohit Singh, Mashhood Kakroo, Roman Jandarov, David Harris, Jack Rubinstein, Richard C BECKER, Sakthivel sadayappan
Journal: Circulation (2020)

Introduction: A 25bp intronic deletion in MYBPC3 ( Δ25bp ), present in 6% of US South Asians, is a risk allele for late onset left ventricular (LV) dysfunction and hypertrophy. Hypothesis: Asymptomatic Δ25bp carriers have detectable subclinical pathology to development of LV hypercontractility and impaired relaxation. Methods: To evaluate Δ25bp carriers for changes in cardiac function with bicycle exercise stress echocardiography and continuous cardiac monitoring, 16 Δ25bp male carriers (51±2 years) and 10 age- and sex-matched non-carrier (NCs) controls (50±3 years) participated in this pilot study. Of 16 Δ25bp carriers, six carried an additional pathogenic variant D389V in MYBPC3 . Included subjects had no uncontrolled comorbidities. Regression analysis and two-way ANOVA were performed, and 95% confidence interval (CI) and p values were reported. Results: Baseline echocardiographic parameters as well as baseline and monitored exercise heart rate and blood pressure were similar in both groups. The estimated effect of exercise stress and genotype showed that Δ25bp carriers had significantly higher ejection fraction (%) (CI: 4.03±1.64; p&lt;0.0001) and higher LV outflow tract peak velocity (m/s) (CI: 0.15±0.06; p&lt;0.0001) in comparison to NCs. Additionally, stress-induced LV end diastolic diameter did not increase in Δ25bp carriers as compared to NCs with a significant difference between the groups (CI: 0.22±0.11; p=0.0002). E/A ratio, a marker of diastolic function, significantly decreased with exercise in Δ25bp carriers (slope: -0.002; p=0.005) but showed non-significant change in the NCs (slope: -0.0006; p=0.428). Right ventricular systolic excursion velocity s' (m/s) as a marker of right ventricle function increased similarly in both groups, although tricuspid annular plane systolic excursion (cm) increased more dramatically in carriers (slope: 0.004; p=0.0002). Sub-analysis of Δ25bp vs Δ25bp + D389V did not reveal any differences. Conclusions: LV hypercontractility under exercise stress conditions with evidence of diastolic impairment at high workloads is evident among asymptomatic carriers of MYBPC3 Δ25bp allele, suggesting MYBPC3 Δ25bp as a risk allele with sub-clinical pathology prior to late onset LV dysfunction in South Asians .
Speed, Evidence, and Safety Characteristics of Vaccine Approvals by the US Food and Drug Administration
Authors: Jeremy Puthumana, Alexander C. Egilman, Audrey D. Zhang, Jason L. Schwartz, Joseph S. Ross
Journal: JAMA Internal Medicine (2020)

Viewpoint The Ethics of Continuing Placebo in SARS-CoV-2 Vaccine Trials Annette Rid, MD; Marc Lipsitch, DPhil; Franklin G. Miller, PhD
Abstract 256: Outcome Prediction of Out of Hospital Cardiac Arrest with Environmental Information Using Machine Learning
Authors: Samuel Harford, Houshang Darabi, Sara Heinert, Marina Del Rios
Journal: Circulation (2020)

Background: The lethality of out-of-hospital cardiac arrest (OHCA) among minority and low income patients in large urban centers has been extensively described. Neighborhood disparities in OHCA survival outcomes cannot be fully explained by clinical variables alone. Machine Learning (ML) is a sub-field of Artificial Intelligence where algorithms can learn and improve themselves by studying high volumes of data and evaluating interactions that affect OHCA. We sought to determine whether incorporating neighborhood variables into a ML model of OHCA can increase its predictive accuracy of survival outcomes. Methods: Using OHCA data from the Cardiac Arrest Registry to Enhance Survival (CARES) database, we geocoded Chicago incidents that occurred outside of healthcare facilities and nursing homes from 2014 - 2019 into the 77 Chicago community areas. Neighborhood characteristics (e.g., access to healthcare, educational attainment, crime rates) were assigned to OHCA cases based on community area using publicly available data from the Chicago Health Atlas (CHA). The merged CARES and CHA data were used to train, validate, test, and analyze ML models for OHCA survival outcomes, defined as a binary outcome based on Cerebral Performance Category or CPC (Good = CPC 1 or 2; Poor=CPC 3, 4, or 5). ML models including deep neural networks were developed and compared using average class sensitivity to models developed using only CARES data. Results: ML algorithms were tested on 9,595 cases of OHCA. Baseline results using only CARES data on the Embedded Fully Convolutional Network (EFCN) show an average class sensitivity of 84%. Including neighborhood variables from the CHA dataset increased the average class sensitivity of the EFCN model to 86.5-86.9%. Conclusion: The use of neighborhood variables in combination with CARES data can predict neurologic outcomes with a higher level of accuracy than using CARES registry data alone. Future studies will use this newly developed model to perform simulation experiments to identify neighborhood level interventions to improve OHCA survival outcomes.
Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancers
Authors: Anass M. Majbar, Amine Benkabbou, Amine Souadka
Journal: JAMA Surgery (2020)

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Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation
Authors: Jacob Sands, Martin C. Tammemägi, Sebastien Couraud, David R. Baldwin, Andrea Borondy-Kitts, David Yankelevitz, Jennifer Lewis, Fred Grannis, Hans-Ulrich Kauczor, Oyunbileg von Stackelberg, Lecia Sequist, Ugo Pastorino, Brady McKee
Journal: Journal of Thoracic Oncology (2020)

Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the U.S. Preventive Services Task Force, recommend annual CTLS in high-risk populations. However, fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening. In large part, this is owing to delayed implementation of CTLS in many countries throughout the world. Factors contributing to low uptake in countries with longstanding CTLS endorsement, such as the United States, include lack of patient and clinician awareness of current recommendations in favor of CTLS and clinician concerns about CTLS-related radiation exposure, false-positive results, overdiagnosis, and cost. This review of the literature serves to address these concerns by evaluating the potential risks and benefits of CTLS. Review of key components of a lung screening program, along with an updated shared decision aid, provides guidance for program development and optimization. Review of studies evaluating the population considered "high-risk" is included as this may affect future guidelines within the United States and other countries considering lung screening implementation.