tbuckley/cabot-search huggingface dataset:
Abstract 16568: New Algorithms and Tailored Programming of Insertable Cardiac Monitors Reduce Alerts and Time Required to Follow Patients
Authors: Kevin T Ousdigian, Sarah Rosemas, Jodi L Koehler, Ya-Jian Cheng, Esteban M Kloosterman
Journal: Circulation (2020)

Introduction: Insertable Cardiac Monitors (ICM) aid in the diagnosis and monitoring of arrhythmias, however, reviewing the data is labor intensive and time consuming. Hypothesis: We hypothesized that new algorithms (ALG) and indication tailored programming (ITP) could reduce device-based alerts and clinician review time. Methods: Baseline data was obtained from a real-world de-identified Reveal LINQ TruRhythm ICMs database. The arrhythmia alerts and manual transmissions per patient/month was queried in this Control Group of patients with ≥3 months of follow-up. The effect of ALG and ITP was computed and applied to the Control Group. For practical purposes, the results were extrapolated to a 200 ICM clinic. Annualized clinic review time was estimated by assuming the staff time per transmission was 12.9 min., based on prior study. ALG improvements included: 1) Reject noise, loss of contact, and small R-waves for Pauses, 2) Require rapid onset for Tachy, 3) Limit nighttime episodes for Brady, and 4) Eliminate manual patient transmissions. ITP changes included: 1) Patients without Syncope: Pause ≥ 5 sec., Brady ≥ 12 beats and not during night, 2) Patients for AF Monitoring: AF ≥ 6 min. Results: The dataset consisted of 248,603 ICMs inserted for Syncope (36%), AF Diagnosis (35%), AF Monitoring (17%), and Other (12%) with an avg. of 1.1 years of follow-up (total 265,938 yrs). Applied to a 200 ICM clinic size, ALG and ITP reduced arrhythmia alerts by 32% (Control: 2,445 to ALG and ITP: 1,655 per clinic/yr). Using the new data transmission scheme eliminated 360 manual transmissions per clinic/yr.(Panel A) In total, the projected annual transmission volume (alerts + manuals in Panel A) and corresponding clinic review time (Panel B) dropped by 41% (247 hrs/yr = 13.1% full-time employee). Conclusion: Improved ALG and ITP can significantly reduce the volume of ICM alerts and consequently clinician review time impacting the management efficiency of this patient population.
Abstract 17099: Implementation of a High Sensitivity Troponin-I Assay in an Academic Medical Center: A Qualitative and Quantitative Assessment
Authors: David Winchester, Omkar Betageri, Patrick Perche, Brandon Allen, Ryan Theis
Journal: Circulation (2020)

Background: High sensitivity troponin assays (hsTn) have received regulatory approval for use in the United States and health care facilities are beginning to adopt these new assays. Questions remain about how to implement these assays and what affect they may have on demand for cardiovascular services. Methods and Results: We conducted a mixed-methods implementation science-based investigation of hsTn adoption at a single academic medical center. We designed the investigation based on the Consolidated Framework for Implementation Research, exploring clinicians’ perspectives on intervention characteristics, inner setting, individual characteristics, and process of implementation domains. Focus groups were conducted with clinicians from multiple service lines. Participants reported that the new hsTn assay did not fundamentally change processes of care such as cardiology consultations or inpatient admissions. Implementation was facilitated by leveraging the electronic medical record to provide useful suggestions for hsTn management at the point-of-care. Participants expressed satisfaction with the multidisciplinary and collaborative approach taken to educating clinicians prior to implementation. The use of case-based teaching was considered most effective. Emergency department clinicians expressed greater confidence about decisions to discharge to home with the hsTn assay, compared to the older assay. Areas of ongoing concern included management of high risk patients, outpatient follow-up, and feasibility of accelerated diagnostic protocols for early discharge from the emergency department. Deidentified quantitative data on cardiovascular service use were gathered from administrative sources and analyzed on runcharts. A decrease in the number of hsTn assays ordered was observed; no change was noted for admissions, cardiology consultations, or noninvasive cardiac imaging. Conclusions: A comprehensive educational campaign, based on multidisciplinary collaboration can effectively prepare clinicians for implementation of hsTn. New hsTn assays may not have any substantial effect of acute management of patients with cardiac complaints. Many questions remain about best clinical practices for hsTn assays.
Abstract P160: Associations Between Metabolic Syndrome Severity And Race/ethnicity, Socioeconomic, And Lifestyle Factors
Authors: Christopher C Imes, Jacob Kariuki, Eileen Chasens, Paul Scott, Kyeongra Yang
Journal: Circulation (2021)

Introduction/Purpose: Metabolic syndrome (MetS) is a disorder characterized by a cluster of cardiometabolic conditions that increase the risk of cardiovascular disease and diabetes. While MetS is treatable through lifestyle changes and medication, factors of race/ethnicity, socioeconomic, and lifestyle may influence MetS severity. Methods: The National Health and Nutrition Examination Survey (NHANES) 2015-2016 dataset was used for this secondary data analysis. Weighted data from individuals aged ≥ 20, not pregnant during the time of the assessment, with self-reported Non-Hispanic (NH) white, NH black, or Hispanic race/ethnicity, and with the variables needed to calculate MetS severity were included in the analysis (N=1850). Severity of MetS was determined using the formula developed by Gurika and DeBoer (2014) and expressed as a Z-score adjusted for sex and race. The severity score includes systolic blood pressure, triglycerides, HDL cholesterol, glucose, and body mass index. Socioeconomic variables included education level and the ratio between annual household income and poverty level. Lifestyle factors included sleep duration, dietary quality, sedentary time, and meeting the physical activity (PA) recommendation of 500 MET-mins/week (yes/no). Z-scores were converted to percentiles, which were categorized into quartiles. Regression analysis was used to examine the associations between MetS severity and race/ethnicity, socioeconomic, and lifestyle factors. Results: Based on weighted data, prevalence of MetS severity &gt;75 th percentile differed across age (20% for 20-40 y/o, 36.4% for 41-60 y/o, 33.0% for 61-80 y/o) and across racial/ethnic (29.4% for NH white, 29.1% for NH black, and 34.9% for Hispanic) groups. Mean MetS severity scores were significantly different between the age and race/ethnicity groups (p &lt;. 001 and p = .014, respectively). While MetS severity scores were not significantly different among the four income to poverty-index ratio groups, the difference between the lowest (≤ 133%) and highest (≥ 500%) group was significantly different (p = .02). In the regression model, a higher quality diet (p &lt;.001), meeting the PA recommendations (p = .008), and higher education level (p = .027) were associated with lower mean MetS severity score. After adjusting for socioeconomic and lifestyle factors, being in the Hispanic race/ethnicity group was associated with higher MetS severity scores (p = .020) compare to being in the NH white group. Conclusions: Diet, physical activity, and educational level were associated with MetS severity score. After adjusting for socioeconomic and lifestyle factors, being in the Hispanic group was associated with the highest MetS severity scores. Research and preventive efforts should focus on groups at increased risk for MetS and severity. Culturally appropriate education and interventions are needed to address this health inequity.
Abstract P147: Association Of Rosuvastatin Use With Risk Of Rhabdomyolysis Across Chronic Kidney Disease Status
Authors: Jung-Im Shin, Yao Qiao, Aditya Surapaneni, Lesley Inker, Derek Fine, Thomas Nolin, Alex R Chang, Morgan Grams
Journal: Circulation (2021)

Introduction: Statin-induced rhabdomyolysis is a rare, but potentially life-threatening condition. It is unknown whether specific statins carry a greater risk of rhabdomyolysis and whether the risk differs between patients with and without chronic kidney disease (CKD). The objective of this study was to investigate the association of rosuvastatin use vs. atorvastatin use with the risk of rhabdomyolysis across CKD status. Hypothesis: Rosuvastatin use is associated with a higher risk of rhabdomyolysis as compared to atorvastatin use and the risk is greater among those with CKD than those without CKD. Methods: We identified adult patients who initiated rosuvastatin or atorvastatin between January 1, 2004 and December 31, 2018 and were free of end-stage kidney disease at the time of prescription in the Geisinger Health System. The association between rosuvastatin use and rhabdomyolysis was assessed using Cox proportional hazards regression models with an interaction between rosuvastatin use and CKD (i.e., estimated glomerular filtration rate &lt;60 ml/min/1.73 m 2 ) in an inverse probability of treatment weighted (IPTW) sample. Results: Of 8,748 rosuvastatin users (mean [SD] age, 59.7 [12.6] years; 49.8% female; 11.8% CKD) and 31,770 atorvastatin users (mean [SD] age, 59.1 [12.6] years; 48.2% female; 11.9% CKD), 0.7% and 0.4% patients developed rhabdomyolysis, respectively, during a median follow-up of 5.1 years. Rosuvastatin use was associated with a higher risk of rhabdomyolysis in patients with CKD (hazard ratio [HR], 3.29; 95% CI, 1.53-7.09), but not in those without CKD (HR, 1.29; 95% CI, 0.82-2.03; p-interaction=0.04). A higher risk of rhabdomyolysis associated with rosuvastatin use in lower eGFR was also observed in the analysis with continuous eGFR ( Figure ). Conclusions: The findings suggest that rosuvastatin use in patients with CKD may be associated with excess risk of rhabdomyolysis as compared to atorvastatin.
Risk factors for atrophic chronic gastritis in a European population: results of the Eurohepygast study
Journal: Gut (2002)

The development of atrophic chronic gastritis (ACG) is multifactorial, involving environment as well as host responses to Helicobacter pylori infection. The aim of this study was to determine factors involved in ACG in a European dyspeptic population.Data concerning sociodemographics, social behaviour, biological aspects, diet, and virulence factors of H pylori strains were collected in a cross sectional study from 19 European centres in 14 countries. Dyspeptic H pylori positive patients with ACG or non-ACG (NACG) at histology were included. Anti-CagA antibodies were evaluated by two immunoblot tests and anti-VacA antibodies by one. Logistic regression models were constructed, and estimated odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated from the coefficients.Of the 451 patients included in the study, 267 were analysed: 202 had NACG and 65 ACG. Mean age was 44.4 years and 63% were women. Risk factors for atrophy identified by multivariate analysis were: age over 60 years (OR 4.14, 95% CI 1.79-9.58), coffee consumption (OR 2.35, 95% CI 1.07-5.16), sedative consumption (OR 2.17, 95% CI 1.04-4.52), and harbouring anti-CagA and anti-VacA antibodies simultaneously (OR 3.09, 95% CI 1.26-7.56), while the odds were significantly reduced for those with an anxiety score of 6 or more (OR 0.45, 95% CI 0.21-0.99).The simultaneous presence of anti-CagA and anti-VacA antibodies enhanced the risk of ACG in European dyspeptic patients. Failure to discern diet and family history as risk factors for ACG may suggest that diet is homogeneous in Europe and that most of the risk factors for ACG identified so far are identical to risk factors for H. pylori infection.
Transcranial color‐coded duplex sonography reliably identifies intracranial vasculopathy in adult patients with sickle cell disease
Authors: Myriam Edjlali, Marie‐Pierre Gobin‐Metteil, Nicolas Mélé, Benjamin Maïer, Anoosha Habibi, Paul Kauv, Hassan Hosseini, Jean‐Louis Mas, Catherine Oppenheim, Frédéric Galactéros, Pablo Bartolucci, David Calvet
Journal: American Journal of Hematology (2021)

Abstract In order to prevent stroke, screening for disease‐related intracranial vasculopathy using Doppler ultrasound is recommended in sickle‐cell disease (SCD) children. How to screen such vasculopathy in adults remains largely unknown. The objective of this study was to assess whether transcranial color‐coded duplex sonography (TCCD) is sensitive and specific enough to identify SCD adult patients with vasculopathy, compared with magnetic resonance angiography (MRA). Sickle cell disease adults followed in referral centers at high risk of vasculopathy were included in this study. Transcranial color‐coded duplex sonography examination and 3‐D time‐of‐flight MRA were performed on the same day. On MRA, vasculopathy was defined by the presence of at least one ≥50% arterial stenosis. On TCCD, vasculopathy was defined by a time‐averaged mean of the maximum velocity (TAMx) stenotic/prestenotic ratio ≥ 3, an occlusion, or a Moyamoya pattern. Vasculopathy was also considered as present when TAMx ratio could not be calculated because of the presence of severe cervical lesions. Among 80 included patients, quality of MRA was insufficient in three patients. Among the 38 patients with vasculopathy on MRA, 37 had a vasculopathy according to TCCD criteria: TAMx ratio ≥ 3 or intracranial occlusion in 33 patients and cervical lesion in four patients. A Moyamoya pattern was identified with TCCD in all 17 patients with Moyamoya on MRA. Sensitivity and specificity of TCCD to identify patients with ≥50% vasculopathy on MRA were (n = 37/38) 97% and (n = 28/34) 82%, respectively. Positive and negative predictive values were (n = 37/43) 86% and (n = 28/29) 97%, respectively. Note, TCCD may be used to identify SCD adult patients with vasculopathy.
Abstract 13174: Peripheral Arterial Stiffness Assessment Using Pulse Wave Doppler by Echocardiography in Healthy Children
Authors: Yozo Teramachi, Lisa K Hornberger, Sachie Shigemitsu, Nee K Khoo, Timothy Colen
Journal: Circulation (2019)

Background: Increased peripheral arterial stiffness (PAS) is a predictor of cardiovascular mortality in adults, and in some pediatric populations increases the risk of adult cardiovascular disease....
Abstract 15505: Aortic Stiffening in L-NAME Treated C57bl6 Mice Precedes Peripheral Hypertension and Cardiac Hypertrophy: Early Endothelial Dysfunction Shifts to Late-term Vascular Smooth Muscle Cell Disease
Authors: Sofie De Moudt, Jhana O Hendrickx, Dorien G De Munck, Arthur Leloup, Wim Martinet, Guido De Meyer, Paul Fransen
Journal: Circulation (2020)

Introduction: Endothelial dysfunction (ED) acts as a common player in most cardiovascular (CV) risk factors (e.g. hypertension, smoking) underlining its importance in CV ageing. Therefore, this study aims to characterize ex vivo aortic function changes in Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME) treated mice. Methods: C57Bl6 mice (male, n=10) received 0.5 mg/mL L-NAME through the drinking water for 1, 2, 4, 8, and 16 weeks, followed by in-depth ex vivo thoracic aorta isometric reactivity studies and arterial stiffness (Peterson modulus, Ep) measurements in the Rodent Oscillatory Tension set-up for Arterial Compliance (ROTSAC). In addition, peripheral blood pressure (BP, Coda), aortic pulse wave velocity (aPWV, Vevo2100), and echocardiography (Vevo2100) were measured in vivo . (Data are represented as mean±SEM) Results: L-NAME treated mice display fast-onset aortic stiffening after 1-week L-NAME (Fig. A, B), followed by the development of peripheral hypertension (Fig. C) and cardiac disease (Fig. D-F) after 4-weeks L-NAME. Ex vivo aorta studies reveal different stages of disease. Early on (1-4 weeks), mice show elevated phenylephrine (PE) contractions (Fig. G) and impaired acetylcholine (ACh) relaxations (Fig. H), consistent with L-NAME related ED. After 8 weeks, endothelial function and PE contractions normalize. Relaxations to exogenous NO remain unaltered (Fig. I). In contrast to the recovery of ACh relaxations, stiffness analysis in the ROTSAC reveals constantly reduced basal NO levels (Fig. J), and a late-term shift (16 weeks) towards vascular smooth muscle cell (VSMC) disease. This involves basal cytoplasmic calcium loading (Fig. K) and a sharply increasing contribution of voltage-gated calcium channels (Fig. L). Conclusions: NOS inhibition by L-NAME treatment causes a distinct time-dependent aortic disease phenotype, underlying fast-onset arterial stiffening which precedes peripheral hypertension and cardiac disease.
Abstract 13357: Dhtkd1 Knock-out Alters Cellular Respiration by Preventing Electron Transport Chain Related Proteins From Entering Into Mitochondria
Authors: Chuan Wang, Holly Smith, Jane Ferguson
Journal: Circulation (2020)

The metabolite α-aminoadipic acid (2-AAA) has been identified as a predictor of diabetes and atherosclerosis in large human prospective studies. However, the mechanisms linking this metabolite to disease pathophysiology remain unknown. DHTKD1 is a central gene in the 2-AAA pathway, and has been linked to variation in 2-AAA levels in humans and animals. However, little is known about the role of DHTKD1 in cellular metabolism. We hypothesized that DHTKD1 is an important regulator of mitochondrial energy metabolism, with potential involvement in cardiometablic disease. Methods and Results: We investigated the consequences of loss of DHTKD1 function in a human HAP-1 cell line. Treatment with 2-AAA increased mitochondrial respiration in wild-type (WT) cells, but had no effect in DHTKD1 knock-out (KO) cells. DHTKD1 KO cells had significantly lower mitochondrial respiration (Mito Stress Test, Seahorse Analyzer), with no differences in glycolytic function, supporting an important role for DHTKD1 in mitochondrial metabolism. Membrane potential and mitochondrial content were up-regulated in KO compared to WT cells, suggesting a potential compensatory mechanism. We investigated the mechanisms underlying impaired mitochondrial function, and found TOM40 and TIM23, the pivotal proteins required for the movement of proteins into mitochondria, were decreased in DHTKD1 KO cells. Further, DHTKD1 KO resulted in reduced expression of electron transport chain related proteins (NDUF88, SDHB, MTCO1, UQCRC2, ATP5A) in mitochondria, but increased expression in the cytosol, suggesting impaired ability to cross the mitochondrial membrane. Conclusions: Our data suggest that the absence of DHTKD1 leads to less TOM40 and TIM23 expression, preventing key proteins in the electron transport chain from entering into mitochondria, resulting in impaired mitochondrial respiration. These findings highlight the vital role of DHTKD1 in cellular metabolism, and establish DHTKD1-mediated mitochondrial dysfunction as a potential novel pathway in cardiometabolic disease. Elevated 2-AAA observed in individuals prior to onset of diabetes and atherosclerosis may be an early biomarker of dysfunction in this pathway.
Liver Pathology : Composite Liver tumors: A radiologic-pathologic
Authors: Megha Nayyar, David K Imagawa, Temel Tirkes, Aram N Demirjian, Roozbeh Houshyar, Kumar Sandrasegaran, Chaitali S Nangia, Tara Seery, P Bhargava, Joon Ii Choi, Chandana Lall
Journal: Clinical and Molecular Hepatology (2014)

Bi-phenotypic neoplasm refers to tumors derived from a common cancer stem cell with unique capability to differentiate histologically into two distinct tumor types. Bi-phenotypic hepatocellular carcinoma-cholangiocarcinoma (HCC-CC), although a rare tumor, is important for clinicians to recognize, since treatment options targeting both elements of the tumor are crucial. Imaging findings of bi-phenotypic HCC-CC are not specific and include features of both HCC and CC. A combination of imaging and immuno-histochemical analysis is usually needed to make the diagnosis. (Clin Mol Hepatol 2014;20:406-410)
Food colorants metabolized by commensal bacteria promote colitis in mice with dysregulated expression of interleukin-23
Authors: Zhengxiang He, Lili Chen, Jovani Catalan-Dibene, Gerold Bongers, Jeremiah J. Faith, Chalada Suebsuwong, Robert J. DeVita, Zeli Shen, James G. Fox, Juan J. Lafaille, Glaucia C. Furtado, Sergio A. Lira
Journal: Cell Metabolism (2021)
Nasal ciliated cells are primary targets for SARS-CoV-2 replication in the early stage of COVID-19
Authors: Ji Hoon Ahn, JungMo Kim, Seon Pyo Hong, Sung Yong Choi, Myung Jin Yang, Young Seok Ju, Young Tae Kim, Ho Min Kim, MD Tazikur Rahman, Man Ki Chung, Sang Duk Hong, Hosung Bae, Chang-Seop Lee, Gou Young Koh
Journal: Journal of Clinical Investigation (2021)

The upper respiratory tract is compromised in the early period of COVID-19, but SARS-CoV-2 tropism at the cellular level is not fully defined. Unlike recent single-cell RNA-Seq analyses indicating uniformly low mRNA expression of SARS-CoV-2 entry–related host molecules in all nasal epithelial cells, we show that the protein levels are relatively high and that their localizations are restricted to the apical side of multiciliated epithelial cells. In addition, we provide evidence in patients with COVID-19 that SARS-CoV-2 is massively detected and replicated within the multiciliated cells. We observed these findings during the early stage of COVID-19, when infected ciliated cells were rapidly replaced by differentiating precursor cells. Moreover, our analyses revealed that SARS-CoV-2 cellular tropism was restricted to the nasal ciliated versus oral squamous epithelium. These results imply that targeting ciliated cells of the nasal epithelium during the early stage of COVID-19 could be an ideal strategy to prevent SARS-CoV-2 propagation.
Abstract 15527: Association Between Adrenergic Receptor Modulation and the Risk of Heart Failure: A Two-sample Mendelian Randomization Study
Authors: Claire Baudier, Françoise Fougerousse, Amand F Schmidt, Folkert W Asselbergs, Mickael Guedj, Michel Komajda, Dipak Kotecha, Tom Lumbers, Benoit Tyl
Journal: Circulation (2020)

Introduction: The impact of the sympathetic nervous system (SNS) modulation on the risk of heart failure (HF) outside of ß1 receptor blockade remains controversial. Methods: We performed a two-sample Mendelian randomization (MR) study using common independent genetic variants located in the cis region of genes encoding the 9 SNS receptors (α1 A, B, D, α2 A, B, C and ß 1, 2 and 3) that were associated at genome-wide significance (P-value ≤ 5х10 –8 ) with blood pressure (BP) and/or heart rate (HR) in published genome-wide association studies (GWAS) available for BP and HR. Variants were filtered out by Linkage Disequilibrium clumping (LD R 2 &gt; 0.1) and based on their minor allele frequency (MAF &lt; 0.01). The effects of selected variants on the genetic risk of HF were extracted from a GWAS of HF from the HERMES consortium, based on a non-overlapping sample population. MR estimates were obtained using the Wald estimator for a single variant or the inverse variance weighted method for multiple variants. Results: 542,362 controls and 40,805 HF cases were evaluated. Independent variants in genes encoding 4 SNS receptors associated with BP or HR were identified as follows: α1A (diastolic BP), α2B (diastolic BP and HR), ß1 and ß2 (diastolic and systolic BP). MR analysis of α1A and ß1, weighted by their effects on diastolic BP, estimated an association with a higher risk of HF, while α2B variants were associated with a lower risk. We found no evidence for an effect of ß2. A similar relationship with systolic BP was found for ß1 and ß2. HR increasing effect of α2B variants was associated with a decreased odd of HF. Conclusions: Mindful of pleiotropic effects, these findings are consistent with the known benefits of ß1 blockade in HF and support a similar role for α1A blockade; conversely, they suggest a detrimental lowering effect of BP and HR through α2B modulation that deserves further studies. No evidence for a role of ß2 in HF was found.