tbuckley/cabot-search huggingface dataset:
Abstract 12639: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island
Authors: Rahaf Al Assil
Journal: Circulation (2021)

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). Hypothesis: Gender-based disparities in the modifiable and non-modifiable OHCA characteristics and outcomes are significant between rural and urban settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value&lt;.001). Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.
Non-pharmaceutical interventions during the roll out of covid-19 vaccines
Authors: Yi Zhang, Ashley Quigley, Quanyi Wang, C Raina MacIntyre
Journal: BMJ (2021)

Non-pharmaceutical interventions during the roll out of covid-19 vaccinesYi Zhang and colleagues call for continued use of non-pharmaceutical interventions to control covid-19 during and after vaccine roll outs affect people's lives, such as universal mask wearing, should continue, while NPIs that impose greater societal restrictions should be implemented on a regional basis as required
Properties and Distribution of IDH-1/2 Mutations in Acute Myeloid Leukemia By the Comprehensive Genomic Analysis
Authors: Satoshi Uchiyama, Nakamura Hirotaka, SungGi Chi, Kentaro Fukushima, Hirohiko Shibayama, Naoko Hosono, Takahiro Yamauchi, Seiichiro Katagiri, Akihiko Gotoh, Motoki Eguchi, Takanobu Morishita, Reiki Ogasawara, Takeshi Kondo, Masamitsu Yanada, Kazuhito Yamamoto, Tsutomu Kobayashi, Junya Kuroda, Kensuke Usuki, Nobuyuki Aotsuka, Makoto Yoshimitsu, Kenji Ishitsuka, Takaaki Ono, Naoto Takahashi, Satoshi Iyama, Makoto Nakamura, Yukinori Nakamura, Suguru Fukuhara, Koji Izutsu, Nobuhiko Yamauchi, Junichiro Yuda, Yosuke Minami
Journal: Blood (2021)
Abstract 11095: Three Year After Acute Coronary Syndrome, 6/10 of the Patients Are Treated in Accordance with International Guidelines in Middle East and North Africa: The Touraco Study
Authors: Mohamed Shoby, Mohammed Arafah, Mohamed Alsayed, Jassim M Al suwaidi, Fahad Baslaib, Viraj Rajadhyaksha, Djamaleddine Nibouche, Ragy Hany, Adel Rhouati, Nooshin Bazargani, Ramez Guindy
Journal: Circulation (2021)

Introduction: The TOURACO study aimed to describe the short- and long-term (i.e., up to 3 years following the index event) management in patients hospitalized for an ACS, and the compliance with ESC and AHA/ACC guidelines in a ‘real-life’ setting in the Middle East and North Africa (MENA) area. Methods: TOURACO is an observational prospective study on adults hospitalized within 24 hours of ACS onset between December 2015 and February 2017 and having given written informed consent, in Algeria, Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Initial care, hospitalization and follow-up (1, 6, 12, 24 and 36 months after hospital discharge) data were recorded. Patients were followed-up until April 2020. Results: 1,131 eligible patients (mean age: 56 [49; 64] years; 927 (82.0%) males; median BMI: 28.1 [25.1; 31.6] kg/m2) were included; 602 (53.2%) patients had a STEMI, 306 (27.1%) patients a NSTEMI and 223 (19.7%) patients an UA. The most common risk factor was hypercholesterolemia, affecting more than half of the patients, and 43% of the patients were current smokers. However, during the 3 months preceding ACS, only 191 (17.1%) patients received an anti-thrombotic agent, 14 (1.3%) at least 2 anti-platelet agents, 151 (13.5%) patients a cholesterol lowering agent, 135 (12.1%) patients an anti-diabetic agent and 233 (20.9%) an anti-hypertensive agent. Compliance with guidelines 1 month after discharge was high (79.2%). At 1 year, compliance was available for 614 (55%) and remained high (77%). Compliance decreased overtime and reached 65% at 3 years. Cumulative mortality rate was relatively low with a rate of 1.7 ±0.4% at 1 month, 3.8±0.6% at 1 year, 5.1±0.7% at 2-year and 6.2±0.7% at 3-years. Conclusions: TOURACO is the first study assessing compliance of treatments with international guidelines in the MENA region. Compliance was good 1 month after the ACS episode and remained high for the next 3 years likely responsible for the low mortality. However, patient’s baseline characteristics at arrival were not optimum: a high proportion of patients were not treated for their diabetes and their hypertension , and smoking cessation. This study highlights the importance of preventive therapies.
BIOM-06. MOLECULAR SIGNATURES UNDERLIE THE DISTINCT FAILURE PATTERNS OF MALIGNANT GLIOMAS
Authors: Seung Won Choi
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Malignant gliomas exhibit varied failure patterns upon recurrence; however, genomic backgrounds of these distinct phenotypes have not been evaluated. We aimed to explore the genomic traits associated with distinct failure patterns in malignant glioma patients. METHODS This study involved 272 malignant glioma patients. Failure pattern was defined for the spatial relationship between recurrent tumor and the original tumor as follows: local recurrence (LR), remote recurrence, leptomeningeal seeding (LMC), and combined failure pattern. Molecular characteristics underlying different failure patterns were investigated for the mutation profile, copy number variation (CNV), and transcriptomic signatures. RESULTS Local recurrence was the most prominent failure pattern (62.9%), followed by combined recurrence (22.8%). Multivariate Cox regression analysis confirmed failure pattern as one of the independent prognostic factors. Patients with combined failure patterns exhibited the worst prognoses, whereas patients with remote recurrence exhibited the most favorable outcomes (median overall survival = 11.4 and 25.2 months, respectively). In IDH1-wild type glioblastoma (GBM) patients, TERT and PIK3CA mutation were significantly associated with the development of combined failure pattern and leptomeningeal seeding, respectively (p-value=0.015 &amp; p-value=0.004, respectively). Transcriptomic analysis exhibited that inter-neuronal synaptic transmission was enriched in GBMs with combined failure pattern and this finding was further validated in proteomic analysis; neuronal myelination and synaptic transmission-related pathways were upregulated in GBMs which exhibited combined failure pattern. CONCLUSIONS Collectively, we demonstrated that the inherent molecular characteristics of the tumors might contribute to the eventual relapse patterns; tracking their evolutionary pathways may unravel novel therapeutic vulnerabilities of these tumors.
Abstract 10148: Prevalence, Clinical Characteristics and Cardiovascular Outcomes of Acute Coronary Syndrome Attributable to Coronary Subclavian Steal Syndrome in Patients with a History of Coronary Artery Bypass Grafting
Authors: Nobunari Tomura, Yu Kataoka, Nobuhito Yagi, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Satoshi Honda, Masashi Fujino, Kensuke Takagi, Shuichi Yoneda, Fumiyuki Otsuka, Yoshio Tahara, Yasuhide Asaumi, Tetsu Satow, Hiroharu Kataoka, Satsuki Fukushima, Tomoyuki Fujita, Teruo Noguchi
Journal: Circulation (2021)

Introduction: Coronary subclavian steal syndrome (CSSS) is coronary steal phenomenon due to subclavian artery stenosis (SAS) in patients with a history of CABG using internal mammary artery (IMA). While CSSS could cause acute coronary syndrome (ACS), its frequency, clinical characteristics and cardiovascular outcomes remain unknown. Methods: The current study was a retrospective multi-center analysis of 142 ACS patients who previously received CABG from January 2007 to October 2020. CSSS was defined as myocardial ischemia due to SAS. Clinical characteristics and cardiovascular events (=cardiac-cause death + myocardial infarction + stroke) were compared in subjects with and without CSSS. Results: CSSS was identified in 7.0% (=10/142) of study subjects. Of these, 1, 6 and 3 CSSS cases had SAS at right, left and both subclavian arteries, respectively. The averaged pressure gradient at SAS site was 31±13mmHg. ACS subjects attributable to CSSS were more likely to exhibit NSTEMI (90% vs. 52%, p=0.02), a history of hemodialysis (40% vs. 14%, p=0.03) and peripheral artery disease (70% vs. 20%, p&lt;0.001). Of note, all of 4 CSSS subjects receiving hemodialysis had their arterial-venous fistula at the same side of SAS. With regard to revascularization procedure in CSSS subjects, primary endovascular treatment for SAS was performed in only 2 cases. Furthermore, despite SAS as a culprit lesion of ACS, primary PCI for native coronary lesion was conducted in other 6 cases. As a consequence, most of them (=5/6) required additional revascularization of SAS after primary PCI due to unresolved myocardial ischemia or chest pain. During 50-month observational period, CSSS was associated with a greater likelihood of cardiovascular (p=0.003) and stroke events (p&lt;0.001, Figure). Conclusions: A substantially elevated cardiovascular risk was observed in ACS patients attributable to CSSS. This finding suggests clinical needs to meticulously evaluate SAS before and after CABG using IMA.
Validity and reliability of the one-minute sit-to-stand test for the measurement of cardio-respiratory responses in children with cystic fibrosis
Authors: Yann Combret, Guillaume Prieur, Fairuz Boujibar, Francis-Edouard Gravier, Pauline Smondack, Pascal Le Roux, Tristan Bonnevie, Clément Medrinal, Grégory Reychler
Journal: Pulmonology (2021)
Abstract 14078: Diabetes Attenuates Leukocyte Inflammatory Transcription Following Sleeve Gastrectomy
Authors: Brenda Dorcely, Julie DeBermont, Dimitrios Nasias, Akash Gujral, MIGDALIA REID, Michael Verano, Melanie Jay, Michael Bergman, Ira J Goldberg, Jose O Aleman, Sally Vanegas
Journal: Circulation (2021)

Introduction: Individuals with obesity and diabetes have increased risk for atherosclerosis; contributed by chronic systemic inflammation and elevated glycemic variability (GV). Bariatric surgery reduces circulating inflammatory markers. We aimed to determine the differences in GV and the expression of inflammatory genes from circulating white blood cells (WBC) after sleeve gastrectomy (SG) in those with and without non-insulin dependent diabetes. Methods: We conducted a prospective cohort study in subjects with obesity and type 2 diabetes (n=10) and subjects with obesity and no diabetes (n=11). Research visits occurred before SG and 6 months postoperatively. Elevated GV was defined by oral glucose tolerance test derived 1-h plasma glucose ≥155 mg/dL and elevated continuous glucose monitor derived GV index-MAGE (reference range 0-2.8 mmol/l). Bulk RNA-sequencing was performed on total WBCs, isolated neutrophils, monocytes, and lymphocytes to analyze genetic expression changes in chronic 6-month weight loss from baseline. Results: At 6 months, SG caused equivalent weight loss from baseline in both groups (22%). However, HbA1c, 1-h plasma glucose, and MAGE levels were different after SG between both groups. HbA1c decreased by 3.0±1.3% in the diabetes group (p&lt;0.01) but was in the prediabetes range at 6 months. The mean 1-h plasma glucose levels was 228.7± 74.6 mg/dL in the diabetes group versus 137.8 ± 30.5 mg/dL in the no diabetes group, and MAGE remained elevated (4.9 ±1.5 mmol/l) only in the diabetes group at 6 months. Also, total WBC counts decreased significantly at 6 months in both groups (p&lt;0.05). RNA sequencing analysis of these WBCs revealed that SG induced weight loss changed the expression of fewer total and WBCs subset genes in the diabetes group, and the majority of these gene expression changes (&gt;94% of total genes) were different between both groups. Furthermore, our gene set analysis showed downregulated expression of WBC genes enriched in inflammatory pathways primarily in subjects without diabetes. Conclusion: Diabetes dampens the weight-loss induced changes to transcriptomes from WBC subsets that contribute to cardiovascular disease. Elevated GV after SG may contribute to these attenuated changes.
Primary plasma cell leukemia: consensus definition by the International Myeloma Working Group according to peripheral blood plasma cell percentage
Authors: Carlos Fernández de Larrea, Robert Kyle, Laura Rosiñol, Bruno Paiva, Monika Engelhardt, Saad Usmani, Jo Caers, Wilson Gonsalves, Fredrik Schjesvold, Giampaolo Merlini, Suzanne Lentzch, Enrique Ocio, Laurent Garderet, Philippe Moreau, Pieter Sonneveld, Ashraf Badros, Gösta Gahrton, Hartmut Goldschmidt, Sascha Tuchman, Hermann Einsele, Brian Durie, Baldeep Wirk, Pellegrino Musto, Patrick Hayden, Martin Kaiser, Jesús San Miguel, Joan Bladé, S. Vincent Rajkumar, Maria Victoria Mateos
Journal: Blood Cancer Journal (2021)

Abstract Primary plasma cell leukemia (PCL) has a consistently ominous prognosis, even after progress in the last decades. PCL deserves a prompt identification to start the most effective treatment for this ultra-high-risk disease. The aim of this position paper is to revisit the diagnosis of PCL according to the presence of circulating plasma cells in patients otherwise meeting diagnostic criteria of multiple myeloma. We could identify two retrospective series where the question about what number of circulating plasma cells in peripheral blood should be used for defining PCL. The presence of ≥5% circulating plasma cells in patients with MM had a similar adverse prognostic impact as the previously defined PCL. Therefore, PCL should be defined by the presence of 5% or more circulating plasma cells in peripheral blood smears in patients otherwise diagnosed with symptomatic multiple myeloma.
Loss-of-function mutation in <i>IKZF2</i> leads to immunodeficiency with dysregulated germinal center reactions and reduction of MAIT cells
Authors: Iivo Hetemäki, Meri Kaustio, Matias Kinnunen, Nelli Heikkilä, Salla Keskitalo, Kirsten Nowlan, Simo Miettinen, Joona Sarkkinen, Virpi Glumoff, Noora Andersson, Kaisa Kettunen, Reetta Vanhanen, Katariina Nurmi, Kari K. Eklund, Johannes Dunkel, Mikko I. Mäyränpää, Heinrich Schlums, T. Petteri Arstila, Kai Kisand, Yenan T. Bryceson, Pärt Peterson, Ulla Otava, Jaana Syrjänen, Janna Saarela, Markku Varjosalo, Eliisa Kekäläinen
Journal: Science Immunology (2021)

A truncated variant of Helios causes a human immunodeficiency disease with signs of immune overactivation.
Abstract 13948: Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States
Authors: Veer Sangha, Kasia Lipska, Zhenqiu Lin, Silvio E Inzucchi, Darren K McGuire, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2021)

Background: Evidence from large randomized clinical trials supports the benefit of SGLT2is to improve cardiovascular and kidney outcomes in patients with type 2 diabetes mellitus (T2DM). In light of this evidence, prescription patterns of SGLT2i among US Medicare beneficiaries were evaluated. Methods: Antihyperglycemic medication prescribers were based on metformin prescribing in national Medicare part D prescriber data. The proportion of clinicians prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. The relative use of SGLT2i was compared with other second-line antihyperglycemic medication classes, sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP4is), without known CV benefits. Results: Among the 232,523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018, 45,255 (19.5%) prescribed SGLT2i - varying from 72% of endocrinologists to 14% of cardiologists. Among clinicians who prescribed both sulfonylureas and SGLT2i, SGLT2i were prescribed to 33% (IQR 18%, 67%) the number prescribed sulfonylureas. Of 118,091 metformin-prescribing clinicians who also prescribed DPP4i, 39,511 (33.5%) used SGLT2i, with a median 50% SGLT2i prescription volume relative to DPP4i (IQR 33, 100). Between 2014-2018, the number of unique clinicians prescribing SGLT2i increased from 5-fold, from 9,048 in 2014 to 45,255 in 2018, and proportionate utilization of SGLT2i per prescriber relative to sulfonylureas also increased from 19% in 2014 to 33% in 2018 (P-trend &lt;0.001). Conclusions: A vast majority of diabetes-treating clinicians did not prescribe SGLT2i to Medicare beneficiaries as recently as 2018. Moreover, prescriptions of sulfonylureas and DPP4is, which have no known cardiac or kidney benefits, were 3 and 2 times more frequent, respectively, than those of SGLT2is. These findings highlight opportunities to improve care and outcomes for patients with T2DM.
Abstract 10794: Adenosine Induced Dormant Pulmonary Vein Reconnection Predicts Recurrent Atrial Fibrillation After Pulmonary Vein Isolation: Systematic Review and Meta-Analysis
Authors: Kuldeep Shah, Siddharth Shah, Mohit K Turagam, Rahul Bhardwaj, Tahmeed Contractor, Ravi Mandapati, Andrea Natale, Dhanunjaya Lakkireddy, Jalaj Garg
Journal: Circulation (2021)

Introduction: Adenosine can be used to reveal dormant pulmonary vein (PV) conduction following pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). Hypothesis: We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF. Methods: We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies that reported freedom from AF during follow-up compared between those without reconnection and those with reconnection (requiring further targeted ablation). Statistical analysis was performed using meta-package for R version 4.0 and Rstudio version 1.2. Results: A total of 20 eligible studies (14 prospective, 3 retrospective, 3 randomized) consisting of 3,595 patients (Reconnection group - 1,228 and No Reconnection group - 2,367) were included in the meta-analysis. The follow-up period ranged from 6.1 months to 36 months. The freedom from AF in patients with PV reconnection was 62.45% compared to 68.10% of patients without PV reconnection. There was significant heterogeneity between studies (I2 = 68%; p &lt; 0.001). Random-effects meta-analysis showed significantly higher freedom from AF in patients with no identified reconnection than those with identified reconnection (RR 0.89; 95% CI 0.80 - 0.99; p = 0.03). Conclusions: Adenosine-guided dormant conduction was associated with higher AF recurrence despite further ablation, but there was substantial heterogeneity between trials. Future research should be directed to improved techniques, and optimal methodology, including adenosine dosage and wait time between PVI and adenosine administration.
Abstract 12310: Metabolic Gain Index is Associated With Adverse Clinical Outcomes Independently of Peak VO <sub>2</sub> in Patients With Heart Failure With Reduced Ejection Fraction Undergoing Cardiopulmonary Exercise Stress Testing
Authors: Thanat Chaikijurajai, Timothy Engelman, J. Emanuel Finet, Wai Hong W Tang
Journal: Circulation (2021)

Introduction: Cardiopulmonary exercise stress test (CPET) is an essential prognostic tool in patients with heart failure with reduced ejection fraction (HFrEF) for advanced therapy evaluation. We studied the predictive utility of the metabolic gain index (MGI), which reflects the relative gain of the CPET-estimated stroke volume by the relative change in the product of VO 2 and heart rate (HR) from resting to peak exercise. This novel MGI aims to reflect cardiac reserve function, and, overall prognosis in HFrEF patients. Hypothesis: The MGI is an independent predictor of adverse outcomes in patients with HFrEF. Methods: We reviewed electronic medical records of 843 HFrEF patients (LVEF ≤40%) undergoing CPET from 12/2012 to 9/2020. The MGI was calculated using the formula, [(Peak VO 2 x Peak HR)-(Resting VO 2 x Resting HR)]/(Resting VO 2 x Resting HR). Patients with hypotensive or bradycardia response during exercise were excluded. Primary outcome was the composite of all-cause mortality, LVAD implantation, and heart transplantation. Multivariable Cox proportional hazard models and log rank test were used. For subgroup analysis, patients were stratified by the RER, age, sex, BMI, and beta-blocker use. Results: In our study cohort (mean age 56.2±12.2 years, 73% men, 85% with beta-blockers, mean LVEF 24.8±8.0 %, 16% with BMI ≥35 kg/m 2 , and 75% with RER &gt;1.05), there were 279 (33.1%) patients developed adverse events during median follow up time of 897 days. Lower MGI was independently associated with increased risk of the adverse outcomes with adjustment for age, sex, comorbidities, LVEF, and peak VO 2 (quartile 1 vs 4, hazard ratio 1.83, 95% CI 1.03-3.25, p =0.040, Figure 1A ), especially in patients with RER &gt; 1.05, BMI &lt; 35 kg/m 2 , and without beta-blocker use ( Figure 1B ). Conclusions: Lower MGI is associated with poor prognosis independently of peak VO 2 . The prognostic value of MGI needs to be further corroborated in other multicenter HFrEF cohorts.