tbuckley/cabot-search huggingface dataset:
Abstract 13800: Using Different Scoring Systems to Differentiate In-hospital Mortality in Patients With Extracorporeal Membrane Oxygenation
Authors: Jou W Lin, Nian-Ze Hu, Jiun Hsu, Hsun-Mao Cheng, Yih-Sharng CHEN
Journal: Circulation (2020)

Introduction: The objective of this study was to evaluate the performance of different scoring systems in discriminating in-hospital mortality among patients receiving extracorporeal membrane oxygenation (ECMO). Methods: This observation registry involved adult patients who received ECMO from 2006 to 2016 in a medical center in Taiwan. Clinical variables collected when ECMO was instituted were used to generate the following scores: Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE), sequential organ failure assessment (SOFA) score, the logistic organ dysfunction score (LODS), the multiple organ dysfunction score (MODS), The Simplified Acute Physiology Score III (SAPS3), and the survival after venoarterial ECMO (SAVE) score. A logistic regression model incorporating statistically significant variables was applied to find the predicted probability of in-hospital death, which was then used as a new model-based estimator. Receiver-operating characteristic (ROC) curves were drawn and area under curves (AUC) was used as the marker for discriminatory power. Results: A total of 1342 patients (71.5% men) were included with mean age of 53.5 (15.7) years and in-hospital mortality rate 62.3%. Based on the valid observations, the AUCs were 0.590 (95% CI: 0.553~0.627, n = 929) for CCI, 0.672 (95% CI: 0.638~0.706, n = 998) for APACHE, 0.691 (95% CI: 0.655~0.727, n = 841) for SOFA, 0.696 (95% CI: 0.660~0.732, n = 820) for LODS, 0.657 (95% CI: 0.619~0.695, n = 974) for MODS, 0.660 (95% CI: 0.623~0.696, n = 840) for SAPS3, 0.649 (95% CI: 0.596~0.701, n = 429) for SAVE (all p &lt; 0.001), and 0.766 for the model-based estimator (95% CI: 0.740~0.791, n = 1342). When the cases were restricted to the 247 patients in whom all scores could be successfully calculated, the model-based estimator still resulted in the highest discriminatory power (AUC 0.747, 95% CI: 0.686~0.807), with other systems ranging from 0.590 (CCI) to 0.684 (SAPS3). Conclusions: The model-based algorithm incorporated mathematically optimized coefficients to produce a new estimator that outperformed different types of clinical risk scores, and could be used for future clinical prediction.
Anesthesiologist to Patient Communication
Authors: Michael J. Tylee, Gordon D. Rubenfeld, Duminda Wijeysundera, Michael C. Sklar, Sajid Hussain, Neill K. J. Adhikari
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Many patients are admitted to the intensive care unit following surgery, and some of them will experience incomplete recovery. For patients in this situation, preoperative discussions regarding patient values and preferences may direct care decisions. Existing literature shows that it is uncommon for surgeons to have these conversations preoperatively; it is unclear whether anesthesia professionals engage with patients on this topic prior to surgery. <h3>Objective</h3> To review the literature on communication between patients and anesthesia professionals, with a focus on discussions related to postoperative critical care. <h3>Evidence Review</h3> MEDLINE and Web of Science were searched using specific search criteria from January 1980 to April 2020. Studies describing encounters between patients and anesthesia professionals were selected, and data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting were extracted and collated. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. <h3>Findings</h3> A total of 12 studies including 1284 individual patient encounters were eligible for inclusion in the review. These studies demonstrated that communication between patients and anesthesia professionals related to postoperative care is rare: only 2 studies reported communication regarding adverse postoperative events, and this communication behavior was reported in only 46 of 1284 consultations (3.6%) across all studies. Additional findings were that communication during these encounters is dominated by anesthetic planning and perioperative logistics, with variable discussion of perioperative risks vs benefits and infrequent elicitation of patient values and preferences. Some data suggest that patients wish to be involved in perioperative decision-making but are often limited by an incomplete understanding of risks and benefits. <h3>Conclusions and Relevance</h3> This systematic review found that communication in anesthesia is dominated by anesthetic planning and discussion of preoperative logistics, whereas postoperative critical care is rarely discussed. Most patients who are admitted to an intensive care unit after a major operation will not have had a discussion regarding goals of care specific to protracted recovery or prolonged intensive care with their anesthesiologist.
Abstract 13612: Association of Tracheobronchial Calcification With Cardiovascular Events and All-cause Mortality in Multi-Ethnic Study of Atherosclerosis (MESA); the MESArthritis Ancillary Study
Authors: Mahsima Shabani, Farhad Pishgar, Ali Rashidi, Thiago Q Silva, Matthew J Budoff, Wendy S Post, Graham Barr, Colin Wu, David A Bluemke, Shadpour demehri, João A.C. Lima
Journal: Circulation (2020)

Introduction: Tracheobronchial calcification (TBC), is a readily available potential biomarker in non-contrast chest CT scans, including cardiac calcium scan CTs. However, there is a paucity in literature investigating how this measure contributes to CVD risk prediction. Hypothesis: TBC is associated with CVD and mortality events independent from CAC score. Methods: Available non-contrast chest CT images from Johns Hopkins Hospital field center within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The calcifications observed in the wall of tracheobronchial tree were measured from aortic arch to carina, by calcium scoring package (VScore, Vitrea 7.11, Vital Images). Outlier values were excluded using the Interquartile range-based outlier fence estimates. Association of TBC with cardiovascular risk factors was investigated by linear regression models. Cox proportional hazard models were applied for CVD and mortality event prediction by TBC with and without adjustment for age, gender, race, CAC, and Framingham global CVD risk score (FRS). Results: After exclusion of 39 outliers, a total of 382 participants (51.2% female) with a mean age of 69.9 (±8.82) were included. TBC was associated with age (β=3.26, p:.002), gender (β=96.30, p&lt;.001), race (β=-28.96, p:.002), and FRS (β=3.57, p&lt;.001). In time-to-event analysis, risk of CHD, CVD, and mortality increased by 1.34, 1.28, and 1.15-fold respectively, by every 100 increase in TBC score adjusted for age, gender, and race. Compared with CAC score (C-index: 0.78) and FRS (0.71) individually, the model with TBC addition to both scores had higher C-index (0.82) for CHD event prediction. Conclusions: Quantification of calcifications in tracheobronchial area can be used to predict CHD, CVD and all-cause mortality and augment the predictive power of the highly validated CAC and FRS for CHD events.
Abstract 14622: Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Li Zhao, Brian Claggett, Kunihiro Matsushita, Dalane W Kitzman, Aaron R Folsom, Suma H Konety, Thomas Mosley, Hicham Skali, Amil M Shah
Journal: Circulation (2020)

Introduction: Diastolic dysfunction is a potent risk factor for heart failure (HF). However, there is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for HF. Methods: We studied 2,559 community-based elderly participants in the prospective ARIC study who underwent protocol echocardiography, were in sinus rhythm at study Visits 5 (2011-2013) and 7 (2018-2019), and did not have an interval myocardial infarction. The primary diastolic measures were Tissue Doppler e’, E/e’ ratio, and left atrial volume index (LAVi). Results: Mean age at Visit 5 was 74±4 years, 59% were women, and 25% black. At Visit 5, mean e’ was 5.8±1.4 cm/s, E/e’ 11.8±3.6, and LAVi 24.3±6.7 ml/m 2 . Over a mean of 6.5±3.1 years, e’ decreased by 0.6±1.4 cm/s, E/e’ increased by 3.1±4.5, and LAVi increased by 1.4±7.7 ml/m 2 . Using validated ARIC-based cut-points, there was significant increase in the proportion of participants with abnormal e’ (18% at Visit 5 to 34 % at Visit 7), E/e’ (20% vs 46%), LAVi (17% vs 25%; all p&lt;0.01), and in the number of abnormal diastolic measures ( Figure ). Compared to participants free of cardiovascular (CV) risk factors or CV diseases (n=237), those with CV risk factors or diseases at Visit 5 (n=2,210) demonstrated greater increases in E/e’ (2.3±3.9 vs 3.1±4.5 respectively; p=0.006) and LAVi (0.0±7.0 vs 1.5±7.7 ml/m 2 ; p=0.008) while increases in E/e’ (5.0±5.1; p&lt;0.001) and LAVi (4.6±8.7 ml/m 2 ; p&lt;0.001) were the most prominent in those who developed HF between Visits 5 and 7 (n=60). Conclusions: Diastolic function progressively worsens over 6.5 years in late life, particularly among persons with CV risk factors. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.
Abstract 13886: Colchicine for Secondary Prevention of Adverse Outcomes From Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Ninad Zaman, Simran Grewal, Louis Borgatta, Matthew Nudy, Brandon Peterson
Journal: Circulation (2020)

Introduction: Recent evidence suggests colchicine may prevent adverse outcomes from cardiovascular disease (CVD). The objective of this study is to perform a meta-analysis of randomized controlled trials (RCTs) testing colchicine’s effect on CVD adverse events and mortality among participants with known CVD. Methods: All RCTs testing colchicine versus control were identified and included in the analysis. The endpoints of interest included CVD adverse events (a composite of acute coronary syndrome, cardiac arrest, acute heart failure and hospitalization, stroke, revascularization, and recurrent myocardial infarction), mortality, and gastrointestinal (GI) adverse events. The primary analysis calculated the summary odds ratio (OR) and 95% confidence intervals (CI) for each endpoint. A secondary analysis tested CVD adverse events for heterogeneity of treatment effect (HTE) using Chi 2 and I 2 tests. Results: 9 RCTs (N = 7,031, mean follow-up 9 months) were identified comparing colchicine to control. Colchicine decreased the risk of CVD adverse events [OR 0.64, 95% CI 0.45-0.91]. Colchicine did not reduce all-cause mortality [OR 0.84, 95% CI 0.61-1.15]. GI adverse events were more likely in the colchicine group [OR 3.03, 95% CI 1.60-5.75, p = 0.0007; I 2 = 83%] but with significant HTE. When performing the test for subgroup differences, there was significant HTE between placebo and open-label trial for CVD events [Chi 2 = 10.55, p = 0.001, I 2 = 90.5%]. After excluding two open-label trials, colchicine reduced the risk of CVD events [OR 0.77, 95% CI 0.63-0.93]. Conclusion: Colchicine was associated with reduced CVD adverse events, but not with reduced mortality, among patients with underlying CVD. Colchicine use was associated with increased GI adverse events. Further studies with longer follow-up times are needed to better understand colchicine’s role in the long-term prevention of CVD adverse events.
Abstract 15409: The Need for Lesion-specific Stent Optimization Criteria in Intravascular Ultrasound-guided Intervention for Diffuse Long Coronary Lesions: An Individual Patient-level Pooled Analysis of Four Randomized Controlled Trials
Authors: Daehoon Kim, Byeong-Keuk Kim, Seung-Jun Lee, Sung-jin Hong, Chul-min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
Journal: Circulation (2020)

Introduction: Achieving stent optimization on intravascular ultrasound (IVUS) is associated with favorable clinical outcomes in new-generation drug-eluting stents (DESs) implantation. Little is known about the stent optimization criteria in lesion subsets assorted according to vessel size and lesion length. Hypothesis: We hypothesized lesion-specific IVUS criteria could provide a better prediction for the outcomes after DES implantation for diffuse coronary lesions. Methods: From four randomized trials comparing IVUS and angiography guidance in long coronary lesions, a total of 1,194 patients who underwent IVUS-guided intervention with DESs ≥26 mm in length were included. Primary endpoint was a major adverse cardiac event (MACE), defined as a composite of cardiovascular death, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year following intervention. Results: MACE occurred in 41 (3.4%) patients. Among possible combinations of absolute and relative expansion criteria, the combination best predicting MACE was minimal stent area (MSA) ≥5.4 mm 2 or 80% of mean lumen area (MLA) (Youden index=0.250) in overall patients. In 2x2 factorial subgroup analyses, the MSA cutoff was 4.9 mm 2 or 85% of MLA for shorter (&lt;30 mm) lesions with a smaller vessel diameter (reference vessel diameter [RVD] &lt;3.0 mm) (Index=0.616) and 5.6 mm 2 or 85% for shorter lesions with a larger vessel diameter (RVD ≥3.0 mm) (Index=0.211). In longer lesions (≥30 mm), the MSA cutoff was 5.5 mm 2 or 70% of MLA for smaller vessels (RVD &lt;3.0 mm) (Index=0.469), and 6.2 mm 2 or 70% for larger vessels (RVD ≥3.0 mm) (Index=0.578). Conclusions: When IVUS is used to optimize DES implantations for long coronary stenoses, applying different criteria according to angiographic parameters might improve the outcomes. In relatively longer lesions with a larger vessel diameter, pursuing to achieve a higher absolute MSA value rather than relative expansion might be more important.
Abstract 12963: The Prevalence and Predictors of Transthyretin Amyloidosis in Patients Underwent Transcatheter Aortic Valve Implantation
Authors: Yuki Muto, Akiomi YOSHIHISA, Masayoshi Oikawa, ATSUSHI KOBAYASHI, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato, Tsuyoshi Fujimiya, Shinya Takase, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2020)

Background: Several studies have recently reported that transthyretin (ATTR) amyloidosis is present in patients with aortic stenosis (AS). We aimed to 1) examine the prevalence of ATTR amyloidosis in AS patients undergoing transcatheter aortic valve implantation (TAVI), 2) compare clinical characteristics between AS patients with and without ATTR, and 3) identify predictors of ATTR amyloidosis in AS patients. Methods and Results: We prospectively analyzed consecutive 32 patients with severe AS who underwent screening tests for ATTR in prior to TAVI. To detect ATTR, we performed cardiac technetium-99m pyrophosphate ( 99m Tc-PYP) scintigraphy in 24 patients and biopsies of fat tissue from the puncture site in 24 patients. Of 32 AS patients who were screened for ATTR, 6 (18.8%) patients were diagnosed as ATTR by cardiac 99m Tc-PYP scintigraphy (n=2) and fat biopsy (n=5). Compared with non-ATTR patients, ATTR patients presented higher levels of B-type natriuretic peptide (BNP, 242.3 vs. 1101.4 ng/ml, P=0.004), lower left ventricular ejection fraction (LVEF, 62.3 vs. 45.5%, P=0.002) and lower mean pressure gradient of AS (50.2 vs. 32.0 mmHg, P=0.016). In contrast, age, sex, STS score, clinical frailty scale, prevalence of chronic kidney disease and atrial fibrillation, and levels of hemoglobin, albumin, estimated glomerular filtration rate and troponin I were comparable between the two groups. Other echocardiographic parameters including interventricular septal wall thickness, posterior wall thickness and aortic valve area did not differ between the two groups. To detect ATTR among AS patients, receiver operating characteristic (ROC) analysis demonstrated that area under the curve of BNP, LVEF, and mean pressure gradient was 0.814, 0.766 and 0.846, respectively. Although TAVI was successfully completed in all patients, and there was no procedural complication in both groups, one of ATTR patients re-hospitalized due to decompensated heart failure 3 weeks after TAVI. Conclusion: In AS patients undergoing TAVI, especially in cases of low-flow low-gradient pattern and high BNP levels, screening of ATTR should be considered. In this population, cardiac 99m Tc-PYP scintigraphy and fat biopsy are useful to detect latent ATTR non-invasively.
Genomics in the era of COVID-19: ethical implications for clinical practice and public health
Authors: Gail Geller, Priya Duggal, Chloe L. Thio, Debra Mathews, Jeffrey P. Kahn, Lisa L. Maragakis, Brian T. Garibaldi
Journal: Genome Medicine (2020)

Abstract Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications—both potential benefits and harms—of genomics for clinical practice and public health in the era of COVID-19.
PTU-089 Follow-up of patients with primary sclerosing cholangitis – do we meet international standards?
Authors: S Lin, N Smith, T Valliani, M Lockett
Journal: Gut (2017)

Introduction  Primary Sclerosing Cholangitis (PSC) is a chronic progressive cholestatic liver disease associated with significant complications such as cirrhosis, fat-soluble vitamin deficiency, metabolic bone disease, cholangiocarcinoma and colorectal carcinoma (CRC). We reviewed our current practice against the American Clinical Gastroenterology (ACG) guidelines on PSC, with the aim of developing trust guidelines to standardise follow-up in both hepatology and Inflammatory Bowel Disease (IBD) clinics.  Method  42 patients with a diagnosis of PSC were identified on retrospective review of clinic letters between 2012–2016. Demographic data, presence of IBD, investigations at diagnosis and investigations at follow-up were collected by interrogating clinic letters, pathology results and endoscopy reports.  Results  37 patients were seen in a mixed hepatology and gastroenterology clinic, 5 in IBD clinics. 5 patients died during follow-up, 2 from causes directly related to PSC. Of the remaining 37 patients, 60% were male, median age 61 (23 – 91). 84% of patients were diagnosed prior to 2015 when this guideline was published. 80% of patients had concurrent IBD, pan-colitis ulcerative colitis (UC) being predominant. 5 patients had undergone a liver transplant. Of the recommended tests at diagnosis, 56% of patients without IBD had screening colonoscopy, 32% had IgG4 levels measured and 27% underwent a Fibroscan. Investigations undertaken at follow-up are shown in Table 1. Only 2 patients failed to have annual colonoscopy, 1 due to appointment delay and the other declined surveillance. Comparing surveillance standards, 75% of patients in IBD clinics had chromoendoscopy versus 43% in hepatology clinics. Poor bowel prep and a lack of request were noted as reasons for this. Similarly, 50% of hepatology clinic patients had regular biliary imaging, compared to 25% in IBD clinics.  Conclusion  PSC patients require multiple investigations at diagnosis and follow-up, some of which may have an important impact on the risk of malignancy. This study demonstrates a need to improve and standardise management in both hepatology and IBD clinics in this group of patients. At present, there are no established UK guidelines, although we have since developed trust guidelines and changes implemented in the form of PSC patient proformas and investigation “order-sets” to improve the care of patients with PSC, which will be re-audited.  Disclosure of Interest  None Declared
Comment on Gan et al. Efficacy of Modern Diabetes Treatments DPP-4i, SGLT-2i, and GLP-1RA in White and Asian Patients With Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2020;43:1948–1957
Authors: Awadhesh Kumar Singh, Ritu Singh, Kamlesh Khunti
Journal: Diabetes Care (2020)

We read the article by Gan et al. (1) with great interest and appreciate their exemplary work. The authors have concluded that among the newer antidiabetes drugs of 24 weeks’ duration, sodium–glucose cotransporter 2 inhibitors (SGLT-2i) lower HbA1c better in studies predominantly of Asian ethnicity (∆ −0.32%, P = 0.0003) compared with White ethnicities, but dipeptidyl peptidase 4 inhibitors (DPP-4i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) do not. Moreover, this meta-analysis also finds that both SGLT-2i (∆ −0.28%, P = 0.02) and DPP-4i (∆ −0.24%, P = 0.01) lower HbA1c further in studies predominantly of Asians ethnicities at 12 weeks but the GLP-RA do not, when compared with White participants. These findings would likely encourage clinicians to use more SGLT-2i and perhaps less GLP-1RA for patients of Asian ethnicity, in addition to other inherent reasons such as oral versus injectable route …
DNA‐Based Nanocarriers to Enhance the Optoacoustic Contrast of Tumors In Vivo
Authors: James Joseph, Kevin N. Baumann, Alejandro Postigo, Laura Bollepalli, Sarah E. Bohndiek, Silvia Hernández‐Ainsa
Journal: Advanced Healthcare Materials (2020)

Abstract Optoacoustic tomography (OT) enables non‐invasive deep tissue imaging of optical contrast at high spatio‐temporal resolution. The applications of OT in cancer imaging often rely on the use of molecular imaging contrast agents based on near‐infrared (NIR) dyes to enhance contrast at the tumor site. While these agents afford excellent biocompatibility and minimal toxicity, they present limited optoacoustic signal generation capability and rapid renal clearance, which can impede their tumor imaging efficacy. In this work, a synthetic strategy to overcome these limitations utilizing biodegradable DNA‐based nanocarrier (DNA‐NC) platforms is introduced. DNA‐NCs enable the incorporation of NIR dyes (in this case, IRDye 800CW) at precise positions to enable fluorescence quenching and maximize optoacoustic signal generation. Furthermore, these DNA‐NCs show a prolonged blood circulation compared to the native fluorophores, facilitating tumor accumulation by the enhanced permeability and retention (EPR) effect. In vivo imaging of tumor xenografts in mice following intravenous administration of DNA‐NCs reveals enhanced OT signals at 24 h when compared to free fluorophores, indicating promise for this method to enhance the optoacoustic signal generation capability and tumor uptake of clinically relevant NIR dyes.