tbuckley/cabot-search huggingface dataset:
Covid:19: Italy has wasted the sacrifices of the first wave, say experts
Authors: Marta Paterlini
Journal: BMJ (2020)

In October, Giulia Chiarcossi, 80, called her doctor's office to arrange her flu vaccination, as she has done every year for the past 15 years, usually getting it done straightaway."My family doctor told me to call back in November," she says, a little surprised.There were no flu vaccinations available.Mindful of the dangers of winter and a potential twin epidemic of covid-19 and influenza, the Italian Ministry of Health has for months urged regions to start administering flu vaccinations early and extend free coverage to people over 60.Chiarcossi lives in Brescia in the northern region of Lombardy, one of the epicentres of the first coronavirus wave, which began in February.Italy's most wealthy and populous region, Lombardy was until May the hardest hit region in the whole of Europe. 1 Yet despite this, and the ministry's plea, Lombardy's regional government did not place its vaccine orders until September and started vaccinating only in mid-October.Some people have received flu vaccinations, but Chiarcossi is one of many who must wait until an unspecified date in November.More than one million Italians have been infected with covid-19 to date."Now, again, it seems that Italy is trying to chase the virus instead of containing [it]," says Alberto Mantovani, scientific director of the Humanitas Research Hospital in Milan."We are paying for a structural failure of our primary care.
Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids
Authors: Wei Gu, Xianding Deng, Marco Lee, Yasemin D. Sucu, Shaun Arevalo, Doug Stryke, Scot Federman, Allan Gopez, Kevin Reyes, Kelsey Zorn, Hannah Sample, Guixia Yu, Gurpreet Ishpuniani, Benjamin Briggs, Eric D. Chow, Amy Berger, Michael R. Wilson, Candace Wang, Elaine Hsu, Steve Miller, Joseph L. DeRisi, Charles Y. Chiu
Journal: Nature Medicine (2020)
Metabolic Network Analysis Reveals Altered Bile Acid Synthesis and Metabolism in Alzheimer’s Disease
Authors: Priyanka Baloni, Cory C. Funk, Jingwen Yan, James T. Yurkovich, Alexandra Kueider-Paisley, Kwangsik Nho, Almut Heinken, Wei Jia, Siamak Mahmoudiandehkordi, Gregory Louie, Andrew J. Saykin, Matthias Arnold, Gabi Kastenmüller, William J. Griffiths, Ines Thiele, Rima Kaddurah-Daouk, Nathan D. Price, Rima Kaddurah-Daouk, Alexandra Kueider-Paisley, Gregory Louie, P. Murali Doraiswamy, Colette Blach, Arthur Moseley, J. Will Thompson, Siamak Mahmoudiandehkhordi, Kathleen Welsh-Balmer, Brenda Plassman, Andrew Saykin, Kwangsik Nho, Gabi Kastenmüller, Matthias Arnold, Sudeepa Bhattacharyya, Xianlin Han, Rebecca Baillie, Oliver Fiehn, Dinesh Barupal, Peter Meikle, Sarkis Mazmanian, Mitchel Kling, Leslie Shaw, John Trojanowski, Jon Toledo, Cornelia van Duijin, Thomas Hankemier, Ines Thiele, Almut Heinken, Nathan Price, Cory Funk, Priyanka Baloni, Wei Jia, David Wishart, Roberta Brinton, Rui Chang, Lindsay Farrer, Rhoda Au, Wendy Qiu, Peter Würtz, Lara Mangravite, Jan Krumsiek, John Newman, Bin Zhang, Herman Moreno
Journal: Cell Reports Medicine (2020)

Increasing evidence suggests Alzheimer's disease (AD) pathophysiology is influenced by primary and secondary bile acids, the end product of cholesterol metabolism. We analyze 2,114 post-mortem brain transcriptomes and identify genes in the alternative bile acid synthesis pathway to be expressed in the brain. A targeted metabolomic analysis of primary and secondary bile acids measured from post-mortem brain samples of 111 individuals supports these results. Our metabolic network analysis suggests that taurine transport, bile acid synthesis, and cholesterol metabolism differ in AD and cognitively normal individuals. We also identify putative transcription factors regulating metabolic genes and influencing altered metabolism in AD. Intriguingly, some bile acids measured in brain tissue cannot be explained by the presence of enzymes responsible for their synthesis, suggesting that they may originate from the gut microbiome and are transported to the brain. These findings motivate further research into bile acid metabolism in AD to elucidate their possible connection to cognitive decline.
Abstract 15755: Differences in Patient Characteristics of Peripartum Spontaneous Coronary Artery Dissection
Authors: Nowrin Haque, Esther S Kim
Journal: Circulation (2020)

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction in women. The peripartum period, defined as the last month of pregnancy to three months post-delivery, is known to be associated with SCAD. However, differences in patient characteristics between those with non-peripartum SCAD (npSCAD) and peripartum SCAD (pSCAD) are ill-defined. It is also unknown if the prevalence of extracoronary vascular abnormalities (EVAs) or SCAD recurrence differ between patients with npSCAD and pSCAD. Methods: Patients presenting to a dedicated SCAD clinic were enrolled in a single-center registry. Baseline characteristics, SCAD presentation, lab and imaging results, and recurrent SCAD events were assessed. All patients were screened for EVAs, defined as fibromuscular dysplasia (FMD), aneurysm, pseudoaneurysm, and dissection with cross-sectional imaging. Patient characteristics, clinical presentation, presence of EVAs, and recurrent SCAD events were stratified by peripartum status. Results: 125 SCAD patients were identified from June 2016 to March 2020. Mean age (SD) at 1st SCAD event was 45.8 (10.1) years, 94.4% were female, and 15.2% (19/125) of patients were peripartum. Differences in patient characteristics between npSCAD and pSCAD are outlined in the table. npSCAD patients were older (47.5 (9.76) vs 35.6 (0.93), p= 0.0001) at the time of their 1st SCAD event and had increased rates of hypertension (35.6% (37/105) vs 11.1% (2/18), p=0.04). Those with pSCAD had higher rates of SCAD in the left anterior descending artery (LAD) (64.8% (64/125) vs 89.5% (17/19), p=0.03). There was no significant difference in the prevalence of EVAs or SCAD recurrence between npSCAD and pSCAD. Conclusion: Peripartum SCAD is associated with higher rates of dissection in the LAD compared to non-peripartum SCAD. There is no difference in prevalence of EVAs or recurrent SCAD in patients presenting with pSCAD.
Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers
Authors: Henning Bundgaard, Johan Skov Bundgaard, Daniel Emil Tadeusz Raaschou-Pedersen, Christian von Buchwald, Tobias Todsen, Jakob Boesgaard Norsk, Mia M. Pries-Heje, Christoffer Rasmus Vissing, Pernille B. Nielsen, Ulrik C. Winsløw, Kamille Fogh, Rasmus Hasselbalch, Jonas H. Kristensen, Anna Ringgaard, Mikkel Porsborg Andersen, Nicole Bakkegård Goecke, Ramona Trebbien, Kerstin Skovgaard, Thomas Benfield, Henrik Ullum, Christian Torp-Pedersen, Kasper Iversen
Journal: Annals of Internal Medicine (2020)

Observational evidence suggests that mask wearing mitigates transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is uncertain if this observed association arises through protection of uninfected wearers (protective effect), via reduced transmission from infected mask wearers (source control), or both.
Abstract 14955: Machine Learning Predicts Hemodynamic Instability in Children After Cardiac Surgery in Pediatric Intensive Care Unit (PICU)
Authors: Koichi Sughimoto, Jacob Levman, Fazleem Baig, Derek Berger, Yoshihiro Oshima, Hiroshi Kurosawa, Kazunori Aoki, Yusuke Seino, Tetsuya Ueda, Hao Liu, Kagami Miyaji
Journal: Circulation (2020)

Introduction: Despite improvements in management for children after cardiac surgery, a non-negligible proportion of patients suffer from cardiac arrest, having a poor prognosis. Although serum lactate levels are widely accepted markers of hemodynamic instability, measuring lactate requires discrete blood sampling. An alternative method to evaluate hemodynamic stability/instability continuously and non-invasively may assist in improving the standard of patient care. Hypothesis: We hypothesize that blood lactate in PICU patients can be predicted using machine learning applied to arterial waveforms and perioperative characteristics. Methods: Forty-eight children, who underwent heart surgery, were included. Patient characteristics and physiological measurements were acquired and analyzed using specialized software/hardware, including heart rate, lactate level, arterial waveform sharpness, and area under the curve. Predicting a patient’s blood lactate levels was accomplished using regression-based supervised learning algorithms, including regression decision trees, tuned decision trees, random forest regressor, tuned random forest, AdaBoost regressor, and hypertuned AdaBoost. All algorithms were compared with hold-out cross validation. Two approaches were considered: basing prediction on the currently acquired physiological measurements along with those acquired at admission, as well as adding the most recent lactate measurement and the time since that measurement as prediction parameters. The second approach supports updating the learning system’s predictive capacity whenever a patient has a new ground truth blood lactate reading acquired. Results: In both approaches, the best performing machine learning method was the tuned random forest, which yielded a mean absolute error of 5.60 mg/dL in the first approach, and 4.62 mg/dL when predicting blood lactate with updated ground truth. Conclusions: In conclusion, the tuned random forest is capable of predicting the level of serum lactate by analyzing perioperative variables, including the arterial pressure waveform. Machine learning can predict the patient’s hemodynamics non-invasively, continuously, and with accuracy that may demonstrate clinical utility.
Abstract 15154: Objectively Measured Physical Activity in Patients With Heart Failure
Authors: Leonie Klompstra, Maria Back, Anna Stromberg, Massimo Piepoli, Tiny JAARSMA
Journal: Circulation (2020)

Introduction: Novel interventions, such as exergaming, might be promising to increase physical activity (PA). We aim to explore the difference in PA in patients with heart failure (HF) who have access to exergaming compared to patients who received motivational support and to explore predictors of PA increase. Methods: This study is part of the HF-Wii study (patients randomized to exergaming or to motivational support) in which a group of HF patients (n=64, mean age 69±9, 27% female, 80% NYHA I/II) wore an accelerometer (Actigraph GT9X). Ten minutes change in daily non-sedentary PA was defined as clinically relevant change. Potential predictors of PA change were, i.e. demographic and clinical variables, self-efficacy (ESS), exercise motivation (EMI), depression (HADs) and Health-related Quality of Life (MLHFQ) analyzed by independent sample t-tests and chi-square. Factors with a significance of 0.15 in the univariate analysis were tested in a logistic regression analysis, corrected for randomization, age, gender and NYHA-class and baseline values for light PA and moderate- to vigorous physical activity (MVPA). Results: No differences were found between the exergame group and the control group at 3 months in activity counts (p=0.27), sedentary time (p=0.16), light PA (p=0.69) or MVPA (p=0.17). At baseline, patients had a mean of 173718 (±100545) PA counts/day; 9 hours and 43 minutes a day (±1h 23min) were spent sedentary, 3 hours and 29 minutes a day (±1h 6min) on light PA and 43 minutes a day (±1h 5min) on MVPA ) and 28 patients increased their PA. History of stroke (p=0.05), having grandchildren (p=0.04), recently diagnosed HF (p=0.04), total motivation (p=0.12) and social motivation (p=0.05) were included for the multivariate analysis. Only recently diagnosed HF (p=0.01), a higher social motivation (p=0.02) and a lower amount of light PA at baseline were independent predictors of increasing PA. Conclusions: Exergaming did not significantly change PA. A recently diagnosed HF, higher social motivation and lower baseline light PA are factors that need to be considered when developing PA interventions and when motivating patients to become more physically active.
Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa
Authors: Gamal Shiha, Khalid Alswat, Maryam Al Khatry, Ala I Sharara, Necati Örmeci, Imam Waked, Mustapha Benazzouz, Fuad Al-Ali, Abd Elkhalek Hamed, Waseem Hamoudi, Dina Attia, Moutaz Derbala, Mohamed Sharaf-Eldin, Said A Al-Busafi, Samy Zaky, Khaled Bamakhrama, Nazir Ibrahim, Yousef Ajlouni, Meriam Sabbah, Mohsen Salama, Amir Anushiravani, Nawel Afredj, Salma Barakat, Almoutaz Hashim, Yasser Fouad, Reham Soliman
Journal: The Lancet. Gastroenterology & hepatology (2020)
Abstract 13628: Absence of Coronary Artery Calcium in Ruling Out Obstructive Cad on Coronary Computed Tomography Angiography (ccta) Among Patients With Stable and Acute Chest Pain: A Systematic Review
Authors: Ali M Agha, Reed Mszar, Justin Pacor, Gowtham R Grandhi, Roosha Parikh, Tanushree Agrawal, Jeremy Burt, Ron Blankstein, Michael J Blaha, Leslee J Shaw, Mouaz H Al-mallah, Miguel Cainzos Achirica, Khurram Nasir
Journal: Circulation (2020)

Introduction: Coronary computed tomography angiography (CCTA) is a class IIA recommendation in low-intermediate risk patients with suspected acute coronary syndrome (ACS) and a normal or nondiagnostic cardiac biomarker and ECG. However, there is little consensus on whether absence of coronary artery calcium (CAC) can safely identify patients with stable and acute chest pain (CP) who can avoid more advanced downstream testing. In this study, we conducted a systematic analysis investigating utility of CAC zero in ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP undergoing coronary CT angiography (CCTA). Methods: We searched online databases (PubMed, MEDLINE) for original research articles published between 2005 and 2020 examining the relationship between CAC and significant stenosis on CCTA (defined as &gt;50% coronary luminal narrowing) among patients with stable and acute chest pain. Results: A systematic review of published articles revealed 18 studies including 27,719 patients with stable CP and 12 studies including 7,184 patients with acute CP undergoing simultaneous CCTA and CAC scoring. Overall, 12,664 (45%, 95% CI: 39%-50%) patients with stable CP and 4,327 (56%, 95% CI: 48%-64%) patients with acute CP had CAC zero. The pooled prevalence of obstructive CAD among those with CAC=0 was 3% (95% CI: 2%-4%) among stable CP patients and 2% (95% CI: 1%-3%) among acute CP patients. The negative predictive values for any CAC ruling out obstructive disease were 97% (95% CI: 96-98%) and 98% (95% CI: 96-100%), respectively (Figure). Conclusions: Among over 34,000 patients with stable and acute CP patients undergoing CCTA, the absence of CAC was associated with a very low likelihood of obstructive CAD. These findings support role of CAC zero in a value-based healthcare delivery model as a gatekeeper for more advanced testing.
Abstract 13619: Major Electrocardiographic Abnormalities in Brazilian Adults: Prognostic Value and Potential Use in Primary Prevention (from the Elsa-Brasil Cohort Study)
Authors: Marcelo M Pinto Filho, Luisa C Brant, Sandhi M Barreto, JOSE GERALDO MILL, Paulo A Andrade Lotufo, Sheila Alvim, Rosane Griep, Bruce Duncan, Renan B Pereira, SCHEINE CANHADA, Rodrigo P Reis, Antonio L Ribeiro
Journal: Circulation (2020)

Introduction: Cardiovascular diseases (CVD) are the most preventable noncommunicable diseases. Accurate risk stratification is paramount for identifying patients for whom interventions should be offered. The electrocardiogram (ECG) is a potential tool for CVD primary prevention. Our aim is to evaluate the ECG role as an independent predictor of all-cause and cardiovascular mortality Methods: Participants from the Longitudinal Study of Adult Health (ELSA-Brasil), who were free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010).Participants were followed up to 2018 by annual interviews.Deaths and hospitalizations were independently reviewed. Cox and Fine and Gray competitive risk regressions were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA) at baseline, defined according to de Minnesota Code system (MC), would predict total and cardiovascular deaths in multivariable models Results: The 13,437 participants (mean age 51.8 years, 55% women) were followed for 8±1 years. Baseline prevalence of MEA was 7.2% for men, 5.8% for women. All-cause and cardiovascular mortality occurred in 5.7% and 1.2% of men, and 3.1% and 1.2% of women, respectively. Prevalent MEA was an independent predictor of overall mortality after adjustments for age, race, education and traditional cardiovascular risk factors (HR:2.2; 95%CI 1.6-2.9 for men and HR:2.3; 95%CI 1.6-3.4 for women). [LB1] In the competitive risk model for cardiovascular death, the increased risk attributable to MEA was even higher (HR4.1, 95%CI 2.47-6.81 in men and 5.37, 95%CI 2.54-11.36 in women). Conclusions: Presence of MEA was a strong and independent predictor of overall and cardiovascular death for both sexes. ECG may have a role in improving risk assessment for death in primary care
Abstract 14758: Contrasting Effects of Phospholipid Linked Eicosapentaenoic Acid and Arachidonic Acid on Membrane Structure and Stability
Authors: Samuel Sherratt, Deepak L Bhatt, Preston Mason
Journal: Circulation (2020)

Background: Treatment with prescription, high dose, stable icosapent ethyl (IPE), which is metabolized to eicosapentaenoic acid (EPA), significantly reduced clinical events in high-risk patients with either cardiovascular disease or diabetes plus other risk factors (REDUCE-IT). Previous studies suggest that the benefits of EPA, an omega-3 fatty acid (O3FA), correlate positively with its levels and ratio to arachidonic acid (AA) in circulation and cellular membranes. Unlike EPA, AA is an omega-6 fatty acid (O6FA) that, along with its metabolites, contributes to inflammation and diabetes. Objective: The purpose of this study was to compare the separate and combined effects of phospholipid-linked EPA and AA on membrane structure. Methods: Small angle x-ray diffraction approaches compared the effects of 1-palmitoyl-2-eicosapentaenoyl-sn-glycero-3-phosphocholine (PL-EPA) and 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (PL-AA) at a 1:20 ratio in membranes composed of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) and cholesterol (C) at a 0.3:1 C:PL ratio. As a control, we also evaluated membranes consisting of POPC and C only at the same C:PL ratio. Electron density profiles (electrons/Å 3 vs Å) generated from the diffraction data served to determine membrane structure, including its width or d -space, at 1 Å resolution. Results: Addition of PL-EPA increased membrane hydrocarbon core electron density over a broad area ± 0-10 Å from the membrane center, indicating a stabilizing effect on surrounding phospholipid acyl chains. By contrast, PL-AA caused a smaller, bimodal increase in electron density centered at ± 7 Å from the center of the membrane corresponding to its terminal double bonds. The membrane widths of the PL-EPA and PL-AA containing membranes were similar at 58 ± 0.7 Å and 57 ± 0.5 Å, respectively. The combination of PL-EPA with PL-AA highly attenuated the stabilizing effects of EPA on the membrane. Conclusion: PL-EPA causes membrane stability in a manner that is disrupted by the presence of PL-AA. The contrasting effects of PL-EPA and PL-AA on membrane structure may contribute to differences in biological activity.
Abstract 15436: Left Ventricular Ejection Fraction and MACE in Women With Signs and Symptoms of Ischemia: Data From the WISE (Women's Ischemia Syndrome Evaluation)
Authors: Stephanie Wu, Marie Lauzon, Jenna Maughan, Leslee J Shaw, Sheryl F Kelsey, R David D Anderson, Carl Pepine, C Noel Bairey Merz
Journal: Circulation (2020)

Background: Relatively high left ventricular ejection fraction (EF) (&gt;65%) in women was recently associated with higher all-cause mortality over 6 years follow-up in the CONFIRM study. We sought to evaluate high EF and major adverse cardiovascular events (MACE) in the Women’s Ischemia Syndrome Evaluation (WISE) study. Methods: The WISE original cohort (enrolled 1996-2000) is a multicenter prospective study of women with suspected ischemic heart disease undergoing clinically indicated invasive coronary angiography. We investigated the relationship between high (&gt;65%) and normal (55-65%) EF and MACE, defined as all-cause death, nonfatal myocardial infarction (MI), stroke and heart failure (HF) hospitalization using Kaplan Meier (KM) and regression analyses. Results: A total of 653 women were included (298 high and 355 normal EF). Mean age was 58±11 years and mean EF was 68±7%. There was no significant difference in MACE by EF group over a 10-year follow-up period (log rank p=0.54, Figure ). When patients were stratified by the presence of obstructive CAD, MACE rates remained similar between high and normal EF. High EF was not associated with stroke or HF but had a lower MI risk (log rank p=0.03, Table ). EF was not associated with MACE in a multivariable regression model. Conclusions: Among women presenting with evidence of ischemia, there was no significant difference in MACE between high and normal EF groups. High EF was associated with a lower risk of myocardial infarction as an individual component of MACE.