tbuckley/cabot-search huggingface dataset:
Abstract 11816: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Reduces Myocardial Damage and Mortality in Lethal Cardiogenic Shock Patients Due to Acute Coronary Syndrome
Authors: Takashi Unoki, Motoko Kametani, Takaaki Toyofuku, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, eiji horio, Tetsuo Yufu, Kazuhisa Kodama, Megumi Yamamuro, Eiji Taguchi, Tadashi Sawamura, KOICHI NAKAO, Tomohiro Sakamoto
Journal: Circulation (2021)

Background: Short-term mortality of lethal cardiogenic shock (CS) patients due to acute coronary syndrome (ACS) remains to be improved. The veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been applied as the effective lifesaving modality for CS patients. While VA-ECMO maintains end-organ perfusion, it increases the damaged left ventricular (LV) afterload. Combined treatment of VA-ECMO and a micro-axial Impella pump, ECPELLA, simultaneously provides the systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect by ECPELLA can reduce the myocardial damage and the mortality. Purpose: This study was to assess whether ECPELLA reduces myocardial damage and improves the mortality of CS patients due to ACS. Methods: From January 2012 to May 2021, 66 consecutive patients with lethal CS (SCAI stage-E) due to ACS were enrolled. All patients received VA-ECMO support prior to or after the percutaneous coronary intervention. Among them, 34 patients received ECPELLA and 32 patients received VA-ECMO + IABP. We assessed serum CK-MB levels and the cumulative 30-day mortality. Results: There were no significant difference in age, rate of male sex, coronary risk factors, ST elevated ACS, left main trunk (LMT) lesion, and the time from onset to reperfusion between two treatment groups. The ECPELLA group had significantly lower peak CK-MB and lower 30-day all-cause mortality compared to the VA-ECMO + IABP group [Peak CPK level: median (IQR); 295 (92-507) vs.580 (219-1090): p=0.002, the 30-day mortality rate: 50% vs. 76%: p=0.02, respectively]. Multivariate Cox proportional hazard analysis including age, the time form onset to reperfusion, LMT lesion, E-CPR, and ECPELLA revealed that the ECPELLA (HR: 0.30 95% confidence interval:0.13-0.64; p=0.002) was independently associated with the 30-day all-cause mortality. Conclusion: Results suggest that the ECPELLA reduces the myocardial damage shown by peak CK-MB and improves the 30-day mortality.
Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England
Authors: Eric P Budgell, Timothy J Davies, Tjibbe Donker, Susan Hopkins, David H Wyllie, Tim E A Peto, Martin J Gill, Martin J Llewelyn, A Sarah Walker
Journal: Journal of Infection (2021)

Objectives: Initiatives to curb hospital antibiotic use might be associated with harm from under-treatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. Methods: This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (≥16y) to 135 acute hospitals in England, 01/April/2010–31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics. Results: Hospital-level antibiotic DDDs/1,000 bed-days varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk. Conclusions: We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.
Association of Intravenous Acetaminophen Administration With the Duration of Intravenous Opioid Use Among Hospitalized Pediatric Patients
Authors: Anita K. Patel, Jiaxiang Gai, Eduardo Trujillo-Rivera, Farhana Faruqe, Dongkyu Kim, James E. Bost, Murray M. Pollack
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Adoption of multimodal pain regimens that incorporate nonopioid analgesic medications to reduce inpatient opioid administration can prevent serious opioid-related adverse effects in children, including tolerance, withdrawal, delirium, and respiratory depression. Intravenous (IV) acetaminophen is in widespread pediatric use; however, its effectiveness as an opioid-sparing agent has not been evaluated in general pediatric inpatients. <h3>Objective</h3> To determine if IV acetaminophen administered prior to IV opioids is associated with a reduction in the total duration of IV opioids administered compared with IV opioids administered without IV acetaminophen in general pediatric inpatients. <h3>Design, Setting, and Participants</h3> This comparative effectiveness research study included data on pediatric inpatients from 274 US hospitals between January 2011 and June 2016 collected from a national database. Outcomes were compared with a propensity score–matched analysis of pediatric inpatients administered IV opioids without IV acetaminophen (control) and those administered IV acetaminophen prior to IV opioids (intervention). Data were analyzed from January 2020 through October 2021. <h3>Exposures</h3> Patients in the intervention group received IV acetaminophen prior to IV opioids. Patients in the control group received IV opioids without IV acetaminophen. <h3>Main Outcomes and Measures</h3> Total duration of all IV opioids administered during a patient's hospitalization. <h3>Results</h3> Of 893 293 pediatric inpatients, a total of 104 579 were included in analysis (median [IQR] age, 1.3 [0-14.7] years; 59 806 [57.2%] female; 21 485 [21.5%] African American, 56 309 [53.8%] White), of whom 18 197 (2.0%) received IV acetaminophen, and 287 504 (34.0%) received IV opioids. After applying exclusion criteria, among patients who received IV acetaminophen, 1739 (10.8%) received IV acetaminophen prior to IV opioids within a median (IQR) treatment time of 1.5 (0.02-7.3) hours. After propensity score matching produced comparable groups in the control and intervention groups (with 839 patients in each group), the multivariable model estimated a 15.5% shorter duration of IV opioid use in the intervention group, with an absolute IV opioid reduction of 7.5 hours (95% CI, 0.7-15.8 hours). <h3>Conclusions and Relevance</h3> In this comparative effectiveness study, IV acetaminophen administered prior to IV opioids was associated with a reduction in IV opioid duration by 15.5%. Multimodal pain regimens that use IV acetaminophen prior to IV opioids could reduce IV opioid duration.
NASHFit: A randomized controlled trial of an exercise training program to reduce clotting risk in patients with NASH
Authors: Jonathan G. Stine, Ian R. Schreibman, Alison J. Faust, Jessica Dahmus, Benjamin Stern, Christopher Soriano, Gloriany Rivas, Breianna Hummer, Scot R. Kimball, Nate R. Geyer, Vernon M. Chinchilli, Rohit Loomba, Kathryn Schmitz, Christopher Sciamanna
Journal: Hepatology (2021)

Abstract Background and Aims NASH is a common disease associated with increased rates of thromboembolism (TE). Although exercise training can lessen thrombotic risk in patients with vascular disease, whether similar findings are observed in patients with NASH is open for study. Approach and Results We conducted a 20‐week randomized controlled clinical trial involving patients with biopsy‐confirmed NASH. Patients were randomly assigned (2:1 ratio) to receive either an exercise training program or standard clinical care. The primary endpoint was change in plasminogen activator inhibitor 1 (PAI‐1) level, an established thrombotic biomarker. Twenty‐eight patients were randomly assigned (18 exercise training and 10 standard clinical care). PAI‐1 level was significantly decreased by exercise training when compared to standard clinical care (−40 ± 100 vs. +70 ± 63 ng/ml; p = 0.02). Exercise training decreased MRI proton density fat fraction (MRI‐PDFF; −4.7 ± 5.6 vs. 1.2 ± 2.8% absolute liver fat; p = 0.01); 40% of exercise subjects had a ≥30% relative reduction in MRI‐PDFF (histological response threshold) compared to 13% for standard of care ( p &lt; 0.01). Exercise training improved fitness (VO 2 peak, +3.0 ± 5.6 vs. −1.8 ± 5.1 ml/kg/min; p = 0.05) in comparison to standard clinical care. Conclusions This clinical trial showed that, independent of weight loss or dietary change, exercise training resulted in a significantly greater decrease in thrombotic risk than standard clinical care in patients with NASH, in parallel with MRI‐PDFF reduction and improvement in fitness. Future studies are required to determine whether exercise training can directly impact patient outcomes and lower rates of TE.
Should Ki-67 be adopted to select breast cancer patients for treatment with adjuvant abemaciclib?
Authors: P. Tarantino, H.J. Burstein, N.U. Lin, I.E. Krop, E.P. Winer, S.J. Schnitt, E.P. Hamilton, S.A. Hurvitz, H.S. Rugo, G. Curigliano, S.M. Tolaney
Journal: Annals of Oncology (2021)
Place of Birth of Extremely Preterm Infants in Sweden
Authors: Mikael Norman, Christian Gadsbøll, Lars J. Björklund, Aijaz Farooqi, Stellan Håkansson, David Ley
Journal: JAMA (2021)

Place of Birth of Extremely Preterm Infants in SwedenMany studies on outcomes after extremely preterm birth have been restricted to infants born alive or admitted for neonatal care in regional centers. 1,2Less is known about extremely preterm births outside such centers.This is an important gap in knowledge because some hospitals may not have optimal capacity to manage delivery and immediate life support of such infants.
15. Management of Diabetes in Pregnancy: <i>Standards of Medical Care in Diabetes—2022</i>
Journal: Diabetes Care (2021)

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Chitosan: A versatile bio-platform for breast cancer theranostics
Authors: Vijay Sagar Madamsetty, Shima Tavakol, Saeid Moghassemi, Arezoo Dadashzadeh, John D. Schneible, Iman Fatemi, Abdolsamad Shirvani, Ali Zarrabi, Fereshteh Azedi, Ali Dehshahri, Abbas Aghaei Afshar, Kian Aghaabbasi, Abbas Pardakhty, Reza Mohammadinejad, Prashant Kesharwani
Journal: Journal of Controlled Release (2021)
Quantitative SARS-CoV-2 antigen test as a tool able to predict the stage of the infection
Authors: Luana Coltella, Stefania Ranno, Livia Piccioni, Giulia Linardos, Luna Colagrossi, Marilena Agosta, Cristina Russo, Carlo Concato, Andrea Campana, Andrea Onetti Muda, Alberto Villani, Carlo Federico Perno
Journal: Journal of Infection (2021)
“Real-life” data of the efficacy and safety of belantamab mafodotin in relapsed multiple myeloma—the Mayo Clinic experience
Authors: I. Vaxman, J. Abeykoon, A. Dispenzieri, S. K. Kumar, F. Buadi, M. Q. Lacy, D. Dingli, Y. Hwa, A. Fonder, M. Hobbs, C. Reeder, T. Sher, S. Hayman, T. Kourelis, R. Warsame, E. Muchtar, N. Leung, R. Go, W. Gonsalves, M. Siddiqui, R. A. Kyle, S. V. Rajkumar, McCullough Kristen, P. Kapoor, M. A. Gertz
Journal: Blood Cancer Journal (2021)

Belantamab mafodotin is a highly selective targeted therapy for multiple myeloma. It targets the B cell maturation antigen (BCMA) on plasma cells and showed promising results in several randomized clinical trials. We report the outcomes of 36 patients treated at Mayo Clinic. Our cohort received a median of eight prior lines of therapy. Six patients received belantamab in combination with other medications (pomalidomide, cyclophosphamide, thalidomide), 13 patients (36%) were 70 years or older, two patients had a creatinine of >2.5 mg/dL, and one patient was on dialysis. All three patients with renal failure received full dose belantamab. Chimeric antigen receptor (CAR-T) therapy was used prior to belantamab in seven patients and none of them responded to belantamab therapy. The overall response rate (ORR) was 33% (CR 6%, VGPR 8%, PR 19%), like the ORR reported in the DREAMM-2 trial. Keratopathy developed in 16 patients (43%), grade 1 in six patients, grade 2 in seven patients, and grade 3 in three patients. Eight percent discontinued therapy due to keratopathy. The median PFS and OS was 2 months and 6.5 months, respectively.
Abstract 12580: An Interprofessional Approach to Standardizing Family Care During Code Blue Events
Authors: Carolina Tennyson, John Oliver, Karen Jooste
Journal: Circulation (2021)

Introduction: The development of a standardized practice for family care during resuscitation (FPDR) events was identified as an area for quality improvement at a large academic hospital. Healthcare Chaplains were identified as ideal Family Facilitators for FPDR due to their professional training in therapeutic communication and existential crisis management as well as their current practice of responding to all Code Blue events. An interprofessional workgroup developed guidelines to delineate the role of Chaplain as Family Facilitator in Code Blue events and created an interprofessional education simulation (IPE-sim) training curriculum for their dissemination. Methods: The workgroup, which included an acute care nurse practitioner in the nursing faculty, a palliative care physician, and the director of Chaplain Services, conducted a thorough review of FPDR literature, analyzed data on Chaplain care provided at Code Blue events over the past 9 years, and entered into dialogue with stakeholders regarding FPDR. The group authored guidelines which were adopted as an addendum to the institution’s existing Code Blue policy. The workgroup collaborated with the Code Blue team to develop simulation training events to ensure proper application of the new guidelines. Results: This work resulted in the addition of FPDR guidelines to the Code Blue policy and the creation of a FPDR flowchart that standardized the Chaplain role in Code Blue events by delineating a communication process as well as FPDR inclusion and exclusion criteria. The implementation of this work was facilitated through three 4-hour IPE-sim training sessions. Conclusions: Standardized FPDR guidelines pertaining to the role of Chaplain as Family Facilitator improve patient- and family-centered care. Institutional FPDR guidelines should be created by an interprofessional team and vetted by multidisciplinary stakeholders. Simulation-enhanced IPE prepares Chaplains and teams for FPDR and can improve interprofessional collaboration during Code Blue events.
Characterization of Changes and Driver Microbes in Gut Microbiota During Healthy Aging Using a Captive Monkey Model
Authors: Zhi-Yuan Wei, Jun-Hua Rao, Ming-Tian Tang, Guo-An Zhao, Qi-Chun Li, Li-Ming Wu, Shao-Qiang Liu, Bi-Hai Li, Bai-Quan Xiao, Xing-Yin Liu, Jian-Huan Chen
Journal: Genomics Proteomics & Bioinformatics (2021)

Abstract Recent population studies have significantly advanced our understanding of how age shapes the gut microbiota. However, the actual role of age could be inevitably confounded due to the complex and variable environmental factors in human populations. A well-controlled environment is thus necessary to reduce undesirable confounding effects, and recapitulate age-dependent changes in the gut microbiota of healthy primates. Herein we performed 16S rRNA gene sequencing, characterized the age-associated gut microbial profiles from infant to elderly crab-eating macaques reared in captivity, and systemically revealed the lifelong dynamic changes of the primate gut microbiota. While the most significant age-associated taxa were mainly found as commensals such as Faecalibacterium, the abundance of a group of suspicious pathogens such as Helicobacter was exclusively increased in infants, underlining their potential role in host development. Importantly, topology analysis indicated that the network connectivity of gut microbiota was even more age-dependent than taxonomic diversity, and its tremendous decline with age could probably be linked to healthy aging. Moreover, we identified key driver microbes responsible for such age-dependent network changes, which were further linked to altered metabolic functions of lipids, carbohydrates, and amino acids, as well as phenotypes in the microbial community. The current study thus demonstrates the lifelong age-dependent changes and their driver microbes in the primate gut microbiota, and provides new insights into their roles in the development and healthy aging of their hosts.
International Bladder Cancer Group Consensus Statement on Clinical Trial Design for Patients with Bacillus Calmette-Guérin–exposed High-risk Non–muscle-invasive Bladder Cancer
Authors: Mathieu Roumiguié, Ashish M Kamat, Trinity J Bivalacqua, Seth P Lerner, Wassim Kassouf, Andreas Böhle, Maurizio Brausi, Roger Buckley, Raj Persad, Marc Colombel, Donald Lamm, Juan Palou-Redorta, Mark Soloway, Ken Brothers, Gary Steinberg, Yair Lotan, Richard Sylvester, J Alfred Witjes, Peter C Black
Journal: European Urology (2021)
<i>QuickStats:</i> Infant Mortality Rates for Metropolitan and Nonmetropolitan Counties,* by Single Race and Hispanic Origin — National Vital Statistics System, United States, 2019
Authors: Danielle Ely
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Metro NonmetroInfant deaths per 1,000 live births White, non-Hispanic Black, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian, non-Hispanic HispanicRace/Ethnicity * Urbanization level is based on maternal county of residence.Counties were classified according to their metropolitan status using the National Center for Health Statistics Urban-Rural Classification Scheme.https://www.cdc.gov/nchs/data_access/urban_rural.htmIn metropolitan counties, infant mortality rates were highest for infants of non-Hispanic Black mothers (10.60 infant deaths per 1,000 live births), followed by infants of non-Hispanic American Indian or Alaska Native (5.95), Hispanic (4.96), non-Hispanic White (4.22), and non-Hispanic Asian (3.34) mothers.In nonmetropolitan counties, the mortality rate was also highest for infants of non-Hispanic Black mothers (10.85), followed by infants of non-Hispanic American Indian or Alaska Native (9.78), Hispanic (5.97), non-Hispanic White (5.63), and non-Hispanic Asian (4.85) mothers.The infant mortality rate was significantly lower for infants of non-Hispanic White, non-Hispanic American Indian or Alaska Native, and Hispanic mothers in metropolitan counties compared with nonmetropolitan counties; differences in rates between metropolitan and nonmetropolitan counties for infants of non-Hispanic Black and non-Hispanic Asian mothers were not statistically significant.
3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: <i>Standards of Medical Care in Diabetes—2022</i>
Journal: Diabetes Care (2021)

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
<scp>CD163</scp>+ <scp>M2</scp> Macrophages Promote Fibrosis in <scp>IgG4‐Related</scp> Disease Via <scp>Toll‐like</scp> Receptor 7/Interleukin‐1 Receptor–Associated Kinase 4/<scp>NF‐κB</scp> Signaling
Authors: Akira Chinju, Masafumi Moriyama, Noriko Kakizoe‐Ishiguro, Hu Chen, Yuka Miyahara, A. S. M. Rafiul Haque, Katsuhiro Furusho, Mizuki Sakamoto, Kazuki Kai, Kotono Kibe, Sachiko Hatakeyama‐Furukawa, Miho Ito‐Ohta, Takashi Maehara, Seiji Nakamura
Journal: Arthritis & Rheumatology (2021)

IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect multiple organs. We previously demonstrated that TLR7-transgenic C57BL/6 mice showed elevated serum IgG1 levels and inflammation with fibrosis in the salivary glands (SGs), lungs, and pancreas. Moreover, we observed extensive Toll-like receptor 7 (TLR-7)-positive CD163+ M2 macrophage infiltration in SGs from IgG4-RD patients. We undertook this study to examine the fibrotic mechanism via the TLR-7 pathway.Gene expression in SGs from human TLR7-transgenic mice and IgG4-RD patients was analyzed using DNA microarrays. We extracted the common up-regulated TLR-7-related genes in SGs from TLR7-transgenic mice and IgG4-RD patients. Finally, we investigated the interaction between CD163+ M2 macrophages and fibroblasts before and after stimulation with the TLR-7 agonist loxoribine.In TLR7-transgenic mice and IgG4-RD patients, IRAK3 and IRAK4 were significantly overexpressed. Real-time polymerase chain reaction validated the up-regulation of only IRAK4 in IgG4-RD patients compared with the other groups (P < 0.05). Interleukin-1 receptor-associated kinase 4 (IRAK4) was strongly detected in and around germinal centers in SGs from patients with IgG4-related dacryoadenitis and sialadenitis alone. Double immunofluorescence staining showed that IRAK4-positive cells were mainly colocalized with CD163+ M2 macrophages in SGs (P < 0.05). After stimulation with loxoribine, CD163+ M2 macrophages exhibited significantly enhanced expression of IRAK4 and NF-κB and increased supernatant concentrations of fibrotic cytokines. Finally, we confirmed that the number of fibroblasts was increased by culture with the supernatant of CD163+ M2 macrophages following stimulation with loxoribine (P < 0.05).CD163+ M2 macrophages promote fibrosis in IgG4-RD by increasing the production of fibrotic cytokines via TLR-7/IRAK4/NF-κB signaling.
Omission of Funding Information in Article Information
Journal: JAMA Surgery (2021)

Catherine Y. Zhu, MD; Max A. Schumm, MD; Theodore X. Hu, MPhil; Dalena T. Nguyen, MPH; Jiyoon Kim, MS; Chi-Hong Tseng, PhD; Anne Y. Lin, MD; Michael W. Yeh, MD; Masha J. Livhits, MD; James X. Wu, MD