tbuckley/cabot-search huggingface dataset:
Abstract P003: Effectiveness And Safety Of Direct Oral Anticoagulants Compared With Warfarin In Patients With Atrial Fibrillation Across Body Mass Index Categories
Authors: Yoshihiro Tanaka, Sadiya Khan, Rachel Kaplan, Philip Greenland, Rod S Passman, Karlyn Martin
Journal: Circulation (2021)

Background: Although direct oral anticoagulants (DOACs) are preferred for most patients needing anticoagulation for atrial fibrillation (AF), uncertainty remains in the effectiveness and safety of DOACs compared with warfarin in patients with obesity. Available data from large real-word cohorts are lacking. Purpose: To examine the effectiveness and safety of DOACs compared with warfarin in patients with obesity and AF. Methods: We conducted a retrospective cohort study at an integrated, multi-site healthcare system. We included patients with AF prescribed either a DOAC or warfarin with ≥ one year of follow-up between 2010-2017. The primary effectiveness outcome was ischemic stroke or systemic embolism (S/SE) and the primary safety outcome was incident intracranial hemorrhage (ICH). Using logistic regression, we calculated propensity scores (PS) of prescription for DOAC in each body mass index (BMI) category (&lt;25 kg/m2, 25.0-29.9 kg/m2, 30.0 to 34.9 kg/m2, and BMI≥35.0 kg/m2) using the following covariates: age, sex, race, ethnicity, BMI, systolic blood pressure, and CHA 2 DS 2 -VASc score. We used inverse probability weighting (IPW) based on the PS and IPW-weighted hazard ratios with 95% confidence intervals were calculated by Cox proportional hazard model. Results: Of a total of 17,905 patients included, mean (standard deviation [SD]) age was 70 ± 12 years and mean (SD) BMI was 29.9 ± 6.7 kg/m 2 ; nearly half received a prescription for DOAC (42.7%) and 57.3% for warfarin. During median follow-up of 3.8 years (interquartile range: 2.2-6.0), a total of 159 stroke and 376 intracranial hemorrhage events were observed. Patients on DOACs had a similar or lower HRs for both S/SE and ICH events compared with warfarin across each BMI category (Figure). Conclusion: In this retrospective study, DOACs were as safe and effective compared with warfarin across BMI categories in patients with AF.
Nanoghosts: Mesenchymal Stem cells derived nanoparticles as a unique approach for cartilage regeneration
Authors: D. D'Atri, L. Zerrillo, J. Garcia, J. Oieni, Y. Lupu-Haber, T. Schomann, A. Chan, L.J. Cruz, L.B. Creemers, Marcelle Machluf
Journal: Journal of Controlled Release (2021)
Abstract 15593: In Hospital Outcomes and Prevalence of Comorbidities in Patients With Infective Endocarditis With and Without Heart Blocks - Insight From a National Inpatient Sample
Authors: Shakeel Jamal, Asim Kichloo, michael Albosta, Beth Bailey, Ronak Soni, Navya Nanda, Hafiz Waqas Khan, Ramsha Sadiq, Jagmeet SINGH, Nicholas Haddad, khalil kanjwal
Journal: Circulation (2020)

Objective: To study inpatient outcomes of infective endocarditis (IE) with concurrent heart blocks Introduction: IE complicated with heart blocks can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart blocks are lacking. Methods: Patients with a principle diagnosis of IE with or without heart blocks were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, the National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 18,733 patients were admitted with a diagnosis of IE, out of whom 867 had concurrent heart blocks. There was an increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), cost of care (282,573 vs 223,559), cardiogenic shock (8.9% vs 3.2%), placement of an ICD/CRT/PPM (30.6% vs 0.9%), acute kidney injury (40.1% vs 32.6%) and hematologic complications (19.3 vs 15.2%) in patients admitted with IE with heart blocks as compared to those with IE but without heart block. Infective endocarditis and concurrent heart block resulted in increased requirement for aortic (25.7 vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements as compared to IE without heart block. Conclusions: IE with concurrent heart block worsens in-hospital mortality, length and cost of hospital stay. Our analysis clearly demonstrates an increase in the indications for cardiac procedures, specifically aortic and/or mitral valve replacements and ICD/CRT/PPM placement. A close tele monitoring system and prompt interventions may represent a significant mitigation strategy to avoid adverse outcomes observed in this study.
Imaging the dynamics and microstructure of fibrin clot polymerization in cardiac surgical patients using spectrally encoded confocal microscopy
Authors: Diane M. Tshikudi, Olivier Simandoux, Dongkyun Kang, Elizabeth M. Van Cott, Michael N. Andrawes, Dvir Yelin, Seemantini K. Nadkarni
Journal: American Journal of Hematology (2021)

During cardiac surgery with cardiopulmonary bypass (CPB), altered hemostatic balance may disrupt fibrin assembly, predisposing patients to perioperative hemorrhage. We investigated the utility of a novel device termed spectrally-encoded confocal microscopy (SECM) for assessing fibrin clot polymerization following heparin and protamine administration in CPB patients. SECM is a novel, high-speed optical approach to visualize and quantify fibrin clot formation in three dimensions with high spatial resolution (1.0 μm) over a volumetric field-of-view (165 × 4000 × 36 μm). The measurement sensitivity of SECM was first determined using plasma samples from normal subjects spiked with heparin and protamine. Next, SECM was performed in plasma samples from patients on CPB to quantify the extent to which fibrin clot dynamics and microstructure were altered by CPB exposure. In spiked samples, prolonged fibrin time (4.4 ± 1.8 to 49.3 ± 16.8 min, p < 0.001) and diminished fibrin network density (0.079 ± 0.010 to 0.001 ± 0.002 A.U, p < 0.001) with increasing heparin concentration were reported by SECM. Furthermore, fibrin network density was not restored to baseline levels in protamine-treated samples. In CPB patients, SECM reported lower fibrin network density in protaminized samples (0.055 ± 0.01 A.U. [Arbitrary units]) vs baseline values (0.066 ± 0.009 A.U.) (p = 0.03) despite comparable fibrin time (baseline = 6.0 ± 1.3, protamine = 6.4 ± 1.6 min, p = 0.5). In these patients, additional metrics including fibrin heterogeneity, length and straightness were quantified. Note, SECM revealed that following protamine administration with CPB exposure, fibrin clots were more heterogeneous (baseline = 0.11 ± 0.02 A.U, protamine = 0.08 ± 0.01 A.U, p = 0.008) with straighter fibers (baseline = 0.918 ± 0.003A.U, protamine = 0.928 ± 0.0006A.U. p < 0.001). By providing the capability to rapidly visualize and quantify fibrin clot microstructure, SECM could furnish a new approach for assessing clot stability and hemostasis in cardiac surgical patients.
Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial
Authors: Nasser K Altorki, Timothy E McGraw, Alain C Borczuk, Ashish Saxena, Jeffrey L Port, Brendon M Stiles, Benjamin E Lee, Nicholas J Sanfilippo, Ronald J Scheff, Bradley B Pua, James F Gruden, Paul J Christos, Cathy Spinelli, Joyce Gakuria, Manik Uppal, Bhavneet Binder, Olivier Elemento, Karla V Ballman, Silvia C Formenti
Journal: The Lancet Oncology (2021)
Healthcare decision making should be democratised
Authors: Tessa Richards, Henry Scowcroft, Emma Doble, Amy Price, Kamran Abbasi
Journal: BMJ (2021)

The covid-19 pandemic has precipitated radical changes in healthcare practices and highlighted outdated ways of working that are not fit for purpose in the digital age.It also stalled progress on shared decision making and patient and public involvement in healthcare.Early in the pandemic, well embedded structures for involvement were suddenly disrupted 1 at a time when the concerns of patients and the public could scarcely have been greater.
REPLY:
Authors: Navine Nasser‐Ghodsi, Kymberly D. Watt
Journal: Hepatology (2021)

Potential conflict of interest: Nothing to report. Thank you for your letter and the attention to important risk associations between smoking and immunosuppression with malignancy. As you rightly mention, the limitations of the United Network for Organ Sharing database preclude analyzing those factors in our study and others like it. Unfortunately, these types of large databases do not provide information on many possible cofounding factors including smoking status, prior surgical history including a prior colectomy, family history, and specifics regarding a patient’s history of malignancy prior to transplant (exceptions including HCC and cholangiocarcinoma). We agree with the authors that a history of tobacco use and other known risk factors for the development of cancer is critical to further understand the patient populations at higher risk of developing a de novo malignancy following liver transplantation. Prior research showing that smoking is associated specifically with the development of both colorectal cancer and pancreatic cancer also exists (in the nontransplant population). A large meta‐analysis clarifying the association of cigarette smoking and colorectal cancer found a pooled relative risk of 1.18 (95% CI, 1.11‐1.25) for colorectal cancer in ever‐smokers versus never‐smokers.(1) A large meta‐analysis examining the risk of cigarette smoking and pancreatic cancer found an even more robust association, with a pooled risk of 1.7 (95% CI, 1.61‐1.87) for current smokers and 1.2 (95% CI, 1.11‐1.29) for former smokers.(2) The risk of de novo posttransplant malignancy may not be specific to tacrolimus but more to the general immunosuppressed state, but more granular data are certainly needed.(3) Overall, we are hopeful that as we continue to identify a liver transplant population at higher risk of developing a de novo posttransplant malignancy, we will be able to reduce modifiable risk factors to improve posttransplant mortality.
Abstract 13351: Association of Atrial Fibrillation With In-hospital Mortality Among Patients With Takotsubo Cardiomyopathy
Authors: Qiying Dai, Abhishek Bose, Pengyang Li, PENG CAI, Douglas Laidlaw
Journal: Circulation (2020)

Introduction: Takotsubo cardiomyopathy (TC), characterized by transient left ventricular dysfunction, is known to be precipitated by sudden physical or emotional stress. Atrial fibrillation (AF) is a common arrhythmia and its presence increases mortality in patients with chronic underlying diseases. Furthermore, multiple studies have suggested that in TC patients, underlying AF correlates with a higher in-hospital mortality. However, these studies were constrained by either a disproportionate percentage of AF patients or lack of risk factor matching. To systematically explore the association between TC and AF, we decided to perform a propensity score matching analysis. Methods: We performed a retrospective cohort analysis using the ICD-10 codes for a primary diagnosis of TC from the 2016 National Inpatient Sample. To adjust for underlying risk factors a multivariable logistic regression model was employed followed by a propensity score matching analysis for the AF group and the non-AF group. A similar analysis method was followed for the subset of patients with paroxysmal AF. In-hospital mortality rates were compared between the two groups. Results: Out of the total 3139 patients with a primary diagnosis of TC, 433 (13.7%) had AF and 243 (7.7%) had paroxysmal AF. In the unmatched group, patients with AF appeared to be older (74.7 vs. 65.3 years, P&lt;0.001) and more likely to have comorbidities like diabetes mellitus (24.0% vs 19.2%, P=0.024), chronic kidney disease (15.7% vs 7.6%, P&lt;0.001) and obstructive sleep apnea (8.8% vs 4.9%, P=0.002). On multivariable logistic regression, in-hospital mortality was higher in the AF group (3.9% vs 1.3%, P&lt; 0.001). However, after propensity score matching, there was no significant difference in the mortality rate between the two groups (3.7% vs 1.9%, P=0.082). Similarly, on logistic regression followed by propensity matching for patients with paroxysmal AF, no significant difference was noted for in-hospital mortality rates (3.3% vs 1.3%, P=0.112). Conclusions: In patients with TC, the presence of underlying AF had no effect on the in-hospital mortality rate.
Response to Comment on Vistisen et al. A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes. Diabetes Care 2021;44:901–907
Authors: Dorte Vistisen, Gregers S. Andersen, Adam Hulman, Stuart J. McGurnaghan, Helen M. Colhoun, Jan E. Henriksen, Reimar W. Thomsen, Frederik Persson, Peter Rossing, Marit E. Jørgensen
Journal: Diabetes Care (2021)

We would like to thank Ostergaard et al. (1) for their perspective on our article (2), which includes a suggestion for using lifetime prediction models to estimate disease-free life expectancy. The lifetime prediction models previously published are primarily based on Cox proportional hazards models including age as timescale (3). We have used Poisson models that facilitate the inclusion of multiple timescales such as age and diabetes duration. Both modeling approaches estimate a hazard function for the event of interest as well as for the competing event of death, and with both approaches these hazard functions can be used to estimate lifetime risk and disease-free life expectancy.

As pointed out by Ostergaard et al., risk prediction should ideally cover a long time horizon, and in that sense estimating lifetime risk may seem attractive. Models predicting diseases …
Abstract 15740: Concomitant Use of Dronedarone and Direct Oral Anticoagulants and Risk of Bleeding in Patients With Atrial Fibrillation: An Analysis of the U.S. Truven Health MarketScan Database
Authors: Sampada K Gandhi, Michael D Ezekowitz, James A Reiffel, Rania Boiron, Mattias Wieloch
Journal: Circulation (2020)

Introduction: Dronedarone (DR), a P-gp and CYP 3A4 inhibitor may increase exposure and the risk of bleeding when combined with direct oral anticoagulants (DOACs). Objective: To examine the association between concomitant use of DR and the DOACs, apixaban (A), dabigatran (D), and rivaroxaban (R), and risk of bleeding compared to DOAC monotherapy in patients with atrial fibrillation (AF). Methods: A retrospective cohort study using a U.S. claims database, Truven Health MarketScan identified new users of A, D, and R in patients with AF ≥18 years from Jan 1, 2007 to Sep 30, 2017. Bleeding was defined as hospitalization or emergency room visit with a primary diagnosis of gastrointestinal (GI) bleeding, intracranial hemorrhage (ICH), or bleeding at other sites. Risk of overall and by type of bleeding was examined in concomitant users of DOAC and DR compared to patients using DOAC alone after adjusting for covariates of interest and applying propensity score (PS) trimming via Cox proportional hazards modeling. Results: Among concomitant users of DR and A (1,932), D (3,117), and R (2,395), crude incidence rates of bleeding per 1,000 person-years were 17.2, 37.8, 61.8, respectively versus 26.8, 31.3, and 44.9 in users of A (51,420), D (42,312), and R (57,300) alone. Incidence rates stratified by PS showed higher bleeding incidence in concomitant users of DR with D or R, but not with A. No increased bleeding risk was associated with use of DR and A vs A alone [Adjusted Hazard ratio (aHR): 0.69 (95% CI: 0.40, 1.17), p=0.16]. A modestly increased risk of GI bleeding but not overall bleeding was associated with combined use of DR and D vs D alone [aHR bleeding: 1.18 (95% CI: 0.89, 1.56), p=0.26; aHR GI bleeding: 1.40 (95% CI: 1.01, 1.93); p=0.04]. An increased risk of overall bleeding, driven by GI bleeding, was associated with combined use of DR and R vs R alone [aHR bleeding:1.31 (95% CI: 1.01, 1.69); p=0.04; aHR GI bleeding:1.39 (95% CI: 0.98, 1.95); p=0.06]. There was no increase in the risk of ICH associated with combined use of DR and any DOAC. Conclusions: Concomitant treatment with DR and A showed no increased risk of bleeding, but DR increased the risk of GI bleeding when given with D or R, and of overall bleeding only with R. Concomitant treatment with DR and any DOAC did not increase ICH risk.
Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990–2019
Authors: Hao Zi, Shao-Hua He, Xie-Yuan Leng, Xiao-Feng Xu, Qiao Huang, Hong Weng, Cong Zhu, Lu-Yao Li, Jia-Min Gu, Xu-Hui Li, Dao-Jing Ming, Xiao-Dong Li, Shuai Yuan, Xing-Huan Wang, Da-Lin He, Xian-Tao Zeng
Journal: Military Medical Research (2021)

The burden of kidney, bladder, and prostate cancers has changed in recent decades. This study aims to investigate the global and regional burden of, and attributable risk factors for genitourinary cancers during the past 30 years.
Abstract 15166: Automated Analysis of 12-lead Electrocardiogram for Pediatric Cardiac Disease Mass Screening in School-age Children by the Combined Use of Signal Processing and Deep Learning
Authors: Shuhei Toba, Yoshihide Mitani, Yusuke Sugitani, Hiroyuki Ohashi, Hirofumi Sawada, Noriko Yodoya, Kazunobu Ohya, Naoki Tsuboya, Kentaro Umezu, Yu Shomura, Hisato Ito, Ayano Futsuki, Renta Ishikawa, Takato Yamasaki, Motoshi Takao, Masahiro Hirayama
Journal: Circulation (2020)

Introduction: Electrocardiogram (ECG) is useful for screening children at risk of sudden cardiac death. However, high resources for manual interpretation were a drawback when undertaking mass screening; the accuracy of conventional automated ECG analysis was unsatisfactory for this purpose. Hypothesis: A model consisting of signal processing and deep learning is newly developed and validated to analyze ECG in school-age children and has higher accuracy than a conventional automated model. Methods: We obtained 12-lead ECGs performed in consecutive patients at 6-18 years of age at the inpatient or outpatient clinic of a tertiary hospital in Japan during 2003-06. Patients were randomly assigned to training (83%) and test (17%) groups. Each ECG was labeled as normal or abnormal by 3 board-certified pediatric cardiologists in accordance with the JCS guideline 2016 for school ECG screening. A model to analyze several-second digital wave data of 12-lead ECG was developed by combining signal analysis and deep learning (fast Fourier transform and deep convolutional neural network) to predict abnormality. The trained model was evaluated in the test data using ROC curve and by comparing its accuracy with that of a conventional model (Minnesota code assigned by ECG-1400, Nihon kohden, Japan). Results: We included 1842 ECGs performed in 1062 patients (median age 11 years, IQR, 8-14; male 56%), in which 519 ECGs (28%) were labeled abnormal. Findings include ST-T abnormality (16%), right bundle branch block (7.8%), QRS axis abnormality (5.9%), right ventricular hypertrophy (3.6%) and left ventricular hypertrophy (3.3%). Of 310 ECGs for test (27% labeled as abnormal), 20% were considered abnormal by our model, while 73% by the conventional model. Our model showed AUC of .87 and higher accuracy than the conventional model (.85 vs .47; P &lt;.001, McNemar test). Sensitivity and specificity were .60 and .95 in our model; .86 and .33 in conventional model, respectively. Conclusions: A model combining signal processing and deep learning is newly developed and validated for analyzing 12-lead ECG in school-age children, achieving higher accuracy than a conventional model. This proof-of-concept study warrants further studies toward deep learning-based school ECG mass screening.
MODIFIED SOFA BASED ON AKI CLASSIFICATION: A PROGNOSTIC SCORING SYSTEM FOR MORTALITY IN ELDERLY PATIENTS UNDERGOING EMERGENCY SURGERY FOR COLORECTAL PERFORATION
Authors: Chisiro T, Kubo K, Matsushima S, Kubo M, Kawamura M, Fujii K, Tsujimoto T, Okamoto H
Journal: Intensive Care Medicine (2010)
慢性完全閉塞病変(CTO)に対するSeesaw wiring technique(SWT)の有用性
Authors: Yamamoto Hiroyuki, Mitsufuji Kazuaki, Inoue Katsumi, Goto Tsuyoshi, Monden Kazushige, Fujii Yoshiki, Fuku Yasushi, Ogawa Masakazu, Hirono Akitoshi
Journal: Circulation (2004)
Abstract 16880: Exosomes From Dilated Cardiomyocytes Activate Fibrosis
Authors: Xuebin Fu, Jihyun Jang, Muthukumar Gunasekaran, Sudhish Sharma, Rachana Mishra, Progyaparamita Saha, Mohamed Abdullah, Lina Wang, Mir Yasir Arfat, Deqiang Li, Sunjay Kaushal
Journal: Circulation (2020)

In dilated cardiomyopathy (DCM), exaggerated fibrosis reduces tissue compliance and accelerates the progression to heart failure. However, the mechanisms for fibrotic remodeling in DCM are not well understood. Exosomes are small extracellular vesicles that function as intercellular messengers. Our hypothesis is that exosomes from hypertrophic stimulated DCM cardiomyocytes activate fibrosis in the heart. We utilized iPSCs reprogrammed from DCM patients and healthy control individuals (CTL) to differentiate them into cardiomyocytes (iCMs). iCMs were stimulated by Angiotensin II, and conditioned media were collected to isolate exosomes thereafter. Fibroblasts were treated with CTL-exosomes and DCM-exosomes respectively in vitro. Meanwhile, we injected exosomes into the mouse hearts in vivo. Fibrotic markers and protein expression were examined by western blot and histology. Additionally, we also analyzed the microRNA profiles in the DCM-exosomes and CTL-exosomes by small RNA sequencing. The microRNAs expressions in exosomes were also confirmed by RT-PCR. We found DCM exosomes treatment significantly upregulated extracellular matrix proteins expressions in fibroblasts. Collagen I, collagen III, and CTGF were significantly upregulated in DCM exosomes treatment group compared to CTL exosomes treatment group. Intramyocardial injection of DCM exosomes into wild type mice (CD-1) caused impaired ejection fraction after 7 days compared to CTL exosomes injection (DCM = 51.5 ± 6.21%*, CTL =64.6 ± 3.99%; * = P &lt; 0.05). Picro sirius red staining for extracellular matrix showed significant increase of fibrosis in DCM exosome injection group, compared to CTL exosomes and PBS group (DCM = 3.08 ± 0.24%*, CTL = 0.087 ± 0.02%, PBS = 0.053 ± 0.01%; * = P &lt; 0.05). Next-generation sequencing of these exosomes exhibited upregulation of a group microRNAs in the DCM exosomes. microRNA-103a upregulation was confirmed in DCM exosomes. Overexpression microRNA-103a resulted in fibroblast activation and upregulation of Col I, Col III, and CTGF expression in vitro. Our findings uncovered a critical role for exosomal microRNA (microRNA-103a) mediating pathological fibrotic remodeling in DCM.
Linked transmission chains of imported SARS-CoV-2 variant B.1.351 across mainland France, January 2021
Journal: Eurosurveillance (2021)

Two cases of confirmed SARS-CoV-2 infection with the B.1.351 variant were reported in France in mid-January, 2020. These cases attended a gathering in Mozambique in mid-December 2020. Investigations led to the identification of five imported cases responsible for 14 transmission chains and a total 36 cases. Epidemiological characteristics seemed comparable to those described before the emergence of the South African variant B.1.351. The lack of tertiary transmission outside of the personal sphere suggests that distancing and barrier measures were effective.