tbuckley/cabot-search huggingface dataset:
Abstract 13919: Race and Gender Specific High Sensitivity Troponin-t Cutoff Values Improve Detection in Patients’ With Ischemic Heart Disease
Authors: Nathan Kong, Rhys Chua, Stephanie Besser, Louise Heelan, Sandeep Nathan, Thomas Spiegel, Xander van Wijk, Corey E Tabit
Journal: Circulation (2020)

Introduction: Death rates from acute coronary syndrome events (ASCE) are 30% higher in African Americans than in Caucasians. A potential reason for this disparity is the underdiagnosis of ACSE due to race-specific differences in blood levels of cardiac troponin-T (cTnT), the biomarker of choice for the exclusion of myocardial injury. Hypothesis: Race- and gender-specific high-sensitivity cTnT (hs-cTnT) cutoff values will improve the detection of myocardial injury. Methods: Emergency Department encounters at the University of Chicago from June 2018 through April 2019 with at least 1 hs-cTnT value were included. Race- and gender-specific 99 th percentiles for hs-cTnT were determined for patients without a history of hypertension, heart failure, coronary artery disease, diabetes, or chronic kidney disease, and used as the threshold for a positive result. These threshold values were compared against manufacturer’s recommended gender-only values (male ≥ 22 ng/dL, female ≥ 14 ng/dL). Confusion matrices were used to calculate test characteristics. The presence of ischemic heart disease was determined by the corresponding International Statistical Classification of Diseases. Results: Among 10,934 included encounters, 89.9% were African American. The 99 th percentile values for African American were lower than for matched white counterparts. Race and gender specific cutoffs had higher specificity (83.1% vs 75.2%), greater positive predictive value (91.9% vs 90.7%), and lower false negative rates (16.9% vs. 24.8%) compared with traditional gender-only cutoff values. During the 10 months of data collection, race- and gender-specific cutoffs would have correctly identified 215 additional encounters as having ischemic heart disease, all of them African Americans. The net reclassification rate was +7.91%. Conclusions: Using race-specific, in addition to traditional gender-specific, hs-cTnT cutoff values resulted in higher specificity, greater positive predictive value, and lower false negative rates. Nearly 8% of patients with eventual diagnosis of ischemic heart disease would have been correctly reclassified using race- and gender-specific cutoffs. These findings suggest that race- and gender-specific cutoffs should be further explored.
Kit ligand/mast cell growth factor-independent differentiation of mast cells in myelodysplasia and chronic myeloid leukemic blast crisis
Authors: P Valent, E Spanblochl, HC Bankl, WR Sperr, C Marosi, H Pirc-Danoewinata, I Virgolini, HG Eichler, H Agis, C Sillaber
Journal: Blood (1994)
Abstract 14401: Elevated Levels of Angiotensin II Type 1 Receptor Autoantibodies Are Associated With Abnormal Echocardiogram Parameters in Women With Preeclampsia
Authors: Anum S Minhas, Sammy Zakaria, Monica Mukherjee, Theresa Boyer, Neal Fedarko, Arthur J Vaught
Journal: Circulation (2020)

Introduction: Preeclampsia (PEC) increases the long-term risk for heart failure with preserved ejection fraction (HFpEF). While the underlying pathogenesis is unknown, angiotensin II type 1 receptor autoantibodies (AT1-AA) have been implicated. AT1-AA bind agonistically to the AT1 receptor and may result in clinical manifestations of preeclampsia. We aimed to determine whether women with PEC have elevated AT1-AA levels compared to normotensive women (controls) during pregnancy and at 4 years postpartum, and whether AT1-AA levels correlate with abnormal echocardiographic parameters. Methods: We performed a prospective longitudinal cohort study comparing women with PEC (n=21) to controls (n=20). AT1-AA and echocardiographic measurements were obtained during pregnancy and 4 years postpartum. Linear regression analyses were performed to evaluate the association between AT1-AA levels and important echocardiographic parameters. Results: Mean AT1-AA level during pregnancy differed significantly between women with PEC versus healthy pregnant controls (10.21±3.20 vs 6.33±3.40 μg/ml, p&lt;0.001). Women with PEC were more likely to be black and deliver at an earlier gestational age. Higher AT1-AA was associated with increased systolic/diastolic blood pressure, echocardiographic markers of biventricular systolic function (tricuspid annular systolic plane excursion and left ventricular (LV) ejection fraction), concentric LV hypertrophy and worsened diastolic function. AT1-AA remained persistently elevated at 4 years in women with PEC at baseline compared to controls (12.76±5.13 vs 4.47±1.49 μg/ml, p&lt;0.001) (Figure 1). Conclusions: Women with PEC have elevated AT1-AA compared to controls, both during pregnancy and 4 years postpartum. Higher AT1-AA is associated with abnormal diastolic parameters, LV remodeling, and hyperdynamic biventricular function. These findings suggest that AT1-AA plays an important role in the risk of HFpEF in PEC.
Audio Interview: Covid-19 in Europe and New Information on Vaccines
Authors: Eric J. Rubin, Lindsey R. Baden, Charlotte J. Haug, Stephen Morrissey
Journal: New England Journal of Medicine (2020)

Covid-19 in Europe and New Information on Vaccines In this audio interview conducted on November 18, 2020, the editors are joined by Dr. Charlotte Haug, international correspondent of the Journal, ...
Open-label, multicenter phase 1/2 dose escalation and expansion study of THOR-707 as a single agent and in combination with a PD-1 inhibitor in adult subjects with advanced or metastatic solid tumors
Authors: David Luo, Raghad Abdul-Karim, Arun Azad, Joanna Bendell, Hui Gan, Filip Janku, Shiraj Sen, Tira Tan, Judy Wang, Lisa Schechet, Lauren Baker, Joseph Leveque, Tarek Meniawy
Journal: Journal for ImmunoTherapy of Cancer (2019)
Abstract 15043: Assessment of Cardiovascular Events Among Symptomatic Outpatients With Suspected Coronary Artery Disease Who Presented During COVID-19 Pandemic
Authors: Steve M Mason, Nishant Sekaran, Jon-David Ethington, Stephanie Nay, Viet T Le, Kirk U Knowlton, Kent G Meredith, David B Min
Journal: Circulation (2020)

Background: Infection mitigation efforts during the SARS-CoV-2 pandemic highlights a need to optimize evaluation of symptomatic outpatients (pts) with suspected coronary artery disease (CAD). Successful paradigms must have a low incidence of major adverse cardiovascular (CV) events (MACE) and be efficient and scalable across a large population. We describe a strategy implemented during peak interruption of usual clinical services across an integrated healthcare system looking at short-term clinical outcomes. Methods: We evaluated consecutive pts presenting to emergency departments (ED) from March to April 2020 within Intermountain Healthcare. Symptomatic pts were risk stratified using the HEART Score (HS). Those with HS of ≤3 were discharged to “active surveillance”comprised of weekly telephone calls to assess for symptom progression, prompting urgent stress testing. All pts with a HS of ≥4 received cardiac stress PET/SPECT imaging. Physician interpretation guided subsequent pt management. Short-term (minimum 30-day follow-up) clinical outcomes were incident MACE (all-cause mortality, acute MI, stroke, and return ED visits for suspected angina). Results: Those with a HS ≥4 (n=212) had an increased burden of CV risk factors compared to HS ≤3 (n=90) (Table 1). Three of the HS ≤3 group had progressive symptoms leading to urgent stress testing (resulting in low-risk findings and no intervention) and one had a MACE event (NSTE-ACS 10 days post index ED visit). In the HS ≥4 group, 123 tests were read as intermediate or high-risk, of which 59 proceeded to coronary angiography and 43 resulted in revascularization. Two pts with HS ≥4 died from complications related to preexisting heart failure. No additional MACE events occurred in the HS ≥4 group. Conclusion: Among symptomatic pts with suspected CAD who presented for ED evaluation during the SARS-CoV-2 pandemic, the HS combined with active clinical surveillance appears to be a safe and effective management strategy.
Abstract 16602: Cardiac Testing For Coronary Artery Disease In Potential Liver Transplant Recipients: A Systematic Review Of Test Accuracy Studies Comparing Dobutamine Stress Echocardiogram And Myocardial Perfusion Imaging
Authors: Jyothi Margapuri, Sandeep Jubbal, Nidhi Madan, Adarsh Katamreddy, Nidhish Tiwari
Journal: Circulation (2019)

Background: Incidence of coronary artery disease (CAD) is high in liver transplant patients and it leads to significant morbidity and mortality in these patients. Coronary angiography is the gold s...
Abstract 16928: Discordant Mechanisms in Heart Failure and Hypertrophy
Authors: Aleksandra Binek, Justyna P Fert-bober, Simion Kreimer, Alejandro Rivas, Pyzel Anna, Amy BRADSHAW, Michael R Zile, Jennifer E Van Eyk
Journal: Circulation (2020)

Introduction: Patients with heart failure and a preserved ejection fraction (HFpEF) present heart function abnormalities that remain poorly understood. Defining proteomic signature of HF that is independent of left ventricular hypertrophy (LVH) should allow for stratification of its subtypes and potential mechanism that contributes to the disease. Hypothesis: We hypothesized that HFpEF proteomic signature would be comprised of the hypertrophy and contractile protein phenotype. Methods: Intraoperative left ventricular (LV) myocardial biopsies were obtained from patients (n=21) recruited to undergo coronary artery bypass grafting (CABG). Patients were categorized to: control non-hypertensive (n=9), LVH (n=5), and HFpEF (n=7). Myocardial tissue was subfractionated: cytoplasmic- (neutral pH), myofilament- (acidic pH), and membrane-enriched extract (SDS-soluble). All fractions were assessed for protein quantity and Lys/Arg modifications using liquid chromatography mass spectrometry (LC-MS). Results: In HFpEF, 13% of the cardiac LV proteome changed compared to control heart, with a substantial proportion (77%) decreasing in quantity across all three cardiac fractions, while with LVH, 61% of the proteomic LV changes were increased. Although glycolysis and gluconeogenesis increased in both cardiopathies with respect to control, in HFpEF more subtly than in LVH. Modified proteome of the HFpEF was dominated by decreases in protein succinylation (e.g. ATP5L, THIM, IDHP, APOB, GSH1, KNTC1) and to a lesser degree in methylation (ROA3, HSP7C) or acetylation compared to control. This general trend of down-regulation of succinylation can be attributed to depletion in the levels of succinyl-CoA, the cofactor of enzymatic Lys succinylation. Importantly, there was a striking discordant activation/inhibition of cell death and proliferation pathways between the HFpEF and LVH. Two major upstream regulator clusters linked the proteome changes in cell growth and proliferation to RICTOR and Myc that showed completely opposite trends in LVH and HFpEF groups. Conclusions: HFpEF has a unique proteome signature compared to LV hypertrophy profile which does not arise from sub-proteome involved in contraction but rather is involved in overall cell death.
Abstract 16747: The Artificial Pulse of the HeartMate3 LVAD Alters Mean Arterial Pressure Calculation, and the Relationship Between Arterial Pulse Pressure and Pulsatility Index
Authors: Lorenzo Braghieri, Alberto Pinsino, Giulio Mondellini, Antonia Gaudig, Azka Javaid, Yu-Chiang Wang, Hatice D Onat, Koji Takeda, Yoshifumi Naka, Gabriel T Sayer, Nir Uriel, Ryan Demmer, Melana Yuzefpolskaya, Paolo C Colombo
Journal: Circulation (2020)

Introduction: The HeartMate (HM3) left ventricular assist device (LVAD) uniquely features an artificial pulse (AP) (designed to reduce blood stasis and simulate physiologic pulsatility) that alters arterial blood pressure (BP) tracings ( Fig. 1A ). Pulsatility Index (PI) corresponds to the magnitude of flow pulse through the LVAD and is used as a surrogate measure of arterial pulse pressure (PP). The effect of the AP on: i) relative contribution of systolic BP (SBP) and diastolic BP (DBP) to mean arterial pressure (MAP) calculation; and ii) association between PP and PI is presently unknown. Thus, we aimed to compare: i) MAP calculations; and ii) relation of PI with PP in HM3 vs HM II (LVAD with no AP) pts with arterial line (A-line) monitoring. Methods: A-line BP and LVAD PI data were prospectively collected in 48 HM3 and 29 HMII pts. MAP was calculated with the formula conventionally used in non LVAD pts (MAP = 2/3 DBP + 1/3 SBP) and compared to A-line MAP. Among HM3 pts, a multiple linear regression model was fit with A-line SBP and DBP as predictor variables, and A-line MAP as the dependent variable to derive the HM3 MAP Formula . The relation between arterial PP and PI in HM3 and HMII pts was assessed using Pearson’s correlation. Results: MAP calculated using the conventional formula accurately estimated A-line MAP in HMII pts, but overestimated A-line MAP in HM3 pts. The HM3 MAP Formula more closely approximated A-line MAP. Mean observed difference (MOD) and mean absolute difference (MAD) between calculated MAPs and A-line MAPs are reported in Fig. 1B . While median PP was similar in HM3 and HMII pts (16 vs 20 mmHg, p=0.11), median PI was significantly higher in HMII pts (3.45 vs 5.6, p&lt;0.001). PI correlated with PP in HMII pts ( r 0.47, p=0.01). However, no significant correlation was found between PI and PP in HM3 pts ( r 0.24, p=0.1; Fig. 1C ). Conclusions: In HM3 pts, the AP significantly alters the relative contribution of SBP and DBP to MAP. Unlike in HM2 pts, PI does not relate to arterial PP in HM3 pts.
Learning About Safety: Conditioned Inhibition as a Novel Approach to Fear Reduction Targeting the Developing Brain
Authors: Paola Odriozola, Dylan G. Gee
Journal: American Journal of Psychiatry (2020)

Adolescence is a peak time for the onset of psychiatric disorders, with anxiety disorders being the most common and affecting as many as 30% of youths. A core feature of anxiety disorders is difficulty regulating fear, with evidence suggesting deficits in extinction learning and corresponding alterations in frontolimbic circuitry. Despite marked changes in this neural circuitry and extinction learning throughout development, interventions for anxious youths are largely based on principles of extinction learning studied in adulthood. Safety signal learning, based on conditioned inhibition of fear in the presence of a cue that indicates safety, has been shown to effectively reduce anxiety-like behavior in animal models and attenuate fear responses in healthy adults. Cross-species evidence suggests that safety signal learning involves connections between the ventral hippocampus and the prelimbic cortex in rodents or the dorsal anterior cingulate cortex in humans. Particularly because this pathway follows a different developmental trajectory than fronto-amygdala circuitry involved in traditional extinction learning, safety cues may provide a novel approach to reducing fear in youths. In this review, the authors leverage a translational framework to bring together findings from studies in animal models and humans and to bridge the gap between research on basic neuroscience and clinical treatment. The authors consider the potential application of safety signal learning for optimizing interventions for anxious youths by targeting the biological state of the developing brain. Based on the existing cross-species literature on safety signal learning, they propose that the judicious use of safety cues may be an effective and neurodevelopmentally optimized approach to enhancing treatment outcomes for youths with anxiety disorders.
Abstract 17189: Explaining the Deep Learning Black Box by Identifying Segments of the Single-Lead ECG Signal Used for Detection of Atrial Fibrillation
Authors: Praharsh Ivaturi, Matteo Gadaleta, Amitabh C Pandey, Michael Pazzani, Steven R Steinhubl, Giorgio Quer
Journal: Circulation (2020)

Introduction: Deep learning (DL) has proved effective for automatic identification of atrial fibrillation (AF) using single-lead ECG. Adoption and trust of DL by clinicians is limited by its black box nature. Hypothesis: Post hoc explanations can elucidate what part of ECG signal is used by the black box DL algorithm, quantifying the importance of clinically relevant features in the classification decision. Making DL decision process transparent will help its integration into clinical practice. Methods: 8,528 single-lead ECG recordings collected using AliveCor devices (PhysioNet) were used. Each signal was labeled as normal sinus rhythm, AF, other arrhythmia or noise. DL automatic classification involves a lightweight convolutional neural network architecture - MobileNet - whose performance is analyzed with an explanation method for DL. Results: Each RR interval is divided into 8 equal segments, where segment 1 follows each R peak, 4 and 5 correspond to the isoelectric baseline, and 7 to the P wave. The explanation method substitutes one of these segments with a straight line, and the corresponding change in sensitivity highlights its importance for the DL algorithm decision. MobileNet achieved a sensitivity of 92.5% to identify AF (9.4% of ECGs were in AF). Sensitivity increases by 2.5% when Segment 7 is removed, indicating that the absence of P wave leads the network to classify more frequently samples as AF.(Figure) When Segments 4 and 5 are removed, the sensitivity decreases by 2.5% and 5.0%, and by 26.7% when removed together. When all RR intervals are normalized to the same value (RR in the Figure), sensitivity for AF drops by 78.3%, showing that RR intervals are key for AF detection by DL algorithm. Conclusions: Post hoc explanations for AF detection by DL from single-lead ECG show the importance of common morphological features used for classifying AF. These methods can be used to understand the decision-making process of DL and motivate its clinical adoption.
Abstract 14302: Adoption of Sacubitril/Valsartan to Treat Acute Decompensated Heart Failure Improves Health System Finances Under Value-based Alternative Payment Models
Authors: Jason Shafrin, Elmar R Aliyev, Michelle Brauer, Siyeon Park, Xian Shen
Journal: Circulation (2020)

Introduction: The PIONEER-HF trial demonstrated superior efficacy of sacubitril/valsartan over the angiotensin-converting-enzyme inhibitor (ACEi) enalapril in treating patients with acute decompensated heart failure (ADHF) after stabilization in the inpatient setting, but how medication choice affects health system finances is unknown. Measuring the financial impact is complicated as health systems are increasingly reimbursed through value-based alternative payment models (APM). Methods: A decision tree model was used to assess the financial impact of health system adoption of sacubitril/valsartan to treat ADHF under APM reimbursement. The model estimated differences in health care utilization and cost when treating hospitalized ADHF patients with ACEi or angiotensin-receptor blockers compared to sacubitril/valsartan using efficacy results from PIONEER-HF. The financial impact on health systems was assessed across three common APMs: Medicare Shared Savings Program (MSSP), Bundled Payments for Care Improvement (BPCI), and fee-for-service payments adjusted via the Hospital Readmission Reduction Program (HRRP). Results: Sacubitril/valsartan reduced re-hospitalizations after an ADHF admission by 46.3% for individuals aged 18-64 years and 23.4% for individuals aged ≥65 years. Health system financial benefit from adopting sacubitril/valsartan was $740 per ADHF case per year (PCPY). Savings were larger for patients aged ≥65 years ($803 PCPY) compared to those &lt;65 years ($653 PCPY). Adoption of sacubitril/valsartan improved health system finances under value-based APMs with the largest financial benefits under the HRRP ($1,190 financial gain PCPY), followed by BPCI ($645 financial gain PCPY) and MSSP ($253 financial gain PCPY). Conclusions: Adoption of sacubitril/valsartan to treat ADHF is expected to decrease hospitalizations and lead to a positive net financial impact on health systems under the commonly implemented APMs.
Variceal Ligator Cap Dislodgment, and Retrieval Techniques
Authors: W. Syn, M. Skander, M. Ahmed
Journal: Endoscopy (2004)

We read with interest the recent article by Wai et al. entitled ”Esophageal dislodgment of a variceal ligator cap due to size mismatch between the ligator cap and the endoscope” [1].
Traumatic Pneumothorax Presenting as a Subcutaneous “Airball”
Authors: Jai Madhok, Mohammad H. Madani, Ann N. Leung, Frederick Mihm
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

"Traumatic Pneumothorax Presenting as a Subcutaneous “Airball”." American Journal of Respiratory and Critical Care Medicine, 203(6), pp. e25–e26
A new pre-emptive TKIs strategy for preventing relapse based on BCR/ABL monitoring for Ph+ALL undergoing allo-HCT: a prospective clinical cohort study
Authors: Hui Liu, Li Xuan, Ren Lin, Lan Deng, Zhiping Fan, Danian Nie, Xudong Li, Xinquan Liang, Dan Xu, Yu Zhang, Na Xu, Jieyu Ye, Hua Jin, Dongjun Lin, Liping Ma, Jing Sun, Fen Huang, Qifa Liu
Journal: Leukemia (2020)
Weight-Focused Public Health Interventions—No Benefit, Some Harm
Authors: Tracy K. Richmond, Idia B. Thurston, Kendrin R. Sonneville
Journal: JAMA Pediatrics (2020)

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