tbuckley/cabot-search huggingface dataset:
Abstract 14400: Prevalence of Arrhythmias and Conduction Disease in Patients Hospitalised With Cardiac Amyloidosis
Authors: Sreeram Yalamanchili, Ramtej Atluri, Meghana Vallabhaneni, Mouna Kodali, Satyam Krishan
Journal: Circulation (2021)

Introduction: Cardiac Amyloidosis (CA) is an infiltrative cardiomyopathy that results in deposition of misfolded amyloid fibrils into the myocardium, and is thought to disrupt the conduction system. As there is limited data regarding the prevalence of arrhythmias and conduction disease in patients with cardiac amyloidosis, we sought to determine their prevalence in patients hospitalized with CA using the National Inpatient Sample (NIS) from 2017. Methods: A retrospective study was done using the Nationwide Inpatient Sample from 2017. 18,380 patients with cardiac amyloidosis were identified using ICD-10 codes. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables for the adjusted odds ratio. Results: Among 18,380 total patients, the average age was 74 and 56% were male. Atrial fibrillation (AF) was the most prevalent (34%) atrial arrhythmia followed by atrial flutter (AFL) (5.2%) and supraventricular tachycardia (SVT) (3.0%). Ventricular tachycardia (VT) was the most common ventricular arrhythmia (4.9%) and less than one percent of the cohort had reported episodes of ventricular fibrillation/flutter (&lt; 1%). In terms of conduction disease, 3.5% had either first-degree (1AVB) or second-degree AV block (2AVB), and 3.2% had either right (RBBB) or left bundle branch block(LBBB). When adjusted to patient demographics, comorbidities, and hospital characteristics, patients with CA had higher risk of AF (aOR= 1.69, p&lt;0.0001), AFL (aOR=2.3, p&lt;0.0001), SVT (aOR=1.78, p&lt;0.0001), VT (aOR=2.3, p&lt;0.0001), ICD (aOR=1.5, p &lt;0.0001), RBBB (aOR=1.32, p=0.048), 1AVB (aOR=1.82, p&lt;0.0001), and 2AVB (aOR=2.24, p&lt;0.0001) as compared to those without. Conclusions: Patients with cardiac amyloidosis are more likely to develop atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, RBBB, 1AVB, and 2AVB. Atrial fibrillation was the most common arrhythmia found in our cohort, and this is consistent with trends seen in prior observational studies.
Risk of <i>N</i>-Nitrosodimethylamine (NMDA) Formation With Ranitidine
Authors: David G. Strauss, Jeffry Florian, David Keire
Journal: JAMA (2021)

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Immunogenicity of Covid-19 Vaccination in Subjects with Myelodysplastic Syndromes
Authors: Jennifer Vidler, Thanussuyah Alaguthurai, Sultan Abdul-Jawad, Sivalekha Viramuthu, Richard Beatson, Rosalind Graham, Sheeba Irshad, Austin G. Kulasekararaj, Piers EM Patten
Journal: Blood (2021)
Abstract 14335: Abnormal Left Atrial Conduit Function in Obstructive Hypertrophic Cardiomyopathy is Mediated Through Elevated Left Ventricular Filling Pressure
Authors: Raymond B Fohtung, Rohit Mital, Dai-yin Lu, Ramsis Ramsis, Dwight Bibby, Nelson B Schiller, Katherine Beutner, Maria R Abraham, Theodore Abraham
Journal: Circulation (2021)

Introduction: Elevated left ventricular outflow tract (LVOT) gradient occurs in a majority of HCM patients and is associated with diastolic dysfunction, heart failure, atrial fibrillation and death. These adverse outcomes are also commonly associated with Left atrial (LA) dysfunction. Yet, the nature and extent of the relationship between LVOT gradient and LA function remains ill-understood. Methods: HCM patients were classified as obstructive (rest gradient ≥ 30 mmHg), labile (rest gradient &lt; 30 mmHg, provoked gradient ≥ 30 mmHg) and non-obstructive (rest and provoked gradient &lt; 30 mmHg). In addition to conventional analysis, LA reservoir, conduit and contractile strain were measured (TomTec Imaging Systems). Results: Of 135 patients, 34 (44% male) were obstructive, 36 (75% male) labile and 65 (63% male) non-obstructive HCM. Large LA volume index and elevated E/e’ was associated with elevated LVOT gradient at rest (r 0.17; p 0.04 and r 0.40; p&lt;0.001, respectively) and with Valsalva (r 0.19; p 0.03 and r 0.33; p&lt;0.001, respectively). Low LV strain was associated with elevated LVOT gradient with exercise (r -0.22, p 0.04). LA conduit strain (but not reservoir or contractile strain) was lower in patients with obstructive HCM compared to patients with non-obstructive HCM (13.1 ± 5.4 vs 11.0 ± 3.9%, p = 0.03, Figure 1). There was no significant difference in all LA strain parameters across all the other HCM types. Conclusions: Measures of elevated LV filling pressure (large LA volume index, elevated E/e’ and low LV strain) were associated with elevated LVOT gradient. LA conduit strain was lower in obstructive compared to non-obstructive HCM. Our data suggest that elevated LVOT gradient is associated with abnormal LA conduit function most likely mediated via elevated LV filling pressure.
EXTH-07. TEMPORAL ASSESSMENT OF ALTERED PERI-ABLATION BLOOD-BRAIN BARRIER PERMEABILITY FOLLOWING TUMOR CYTOREDUCTION BY THERMAL THERAPY IN A RAT ORTHOTOPIC GLIOBLASTOMA MODEL
Authors: Tavarekere Nagaraja, Seamus Bartlett, Glauber Cabral, Katelynn Farmer, Robert Knight, Olivia Grahm Valadie, Stephen Brown, James Ewing, Ian Lee
Journal: Neuro-Oncology (2021)

Abstract Laser interstitial thermal therapy (LITT) is a minimally invasive tumor cytoreductive treatment for recurrent gliomas, brain tumors in eloquent regions and/or otherwise inaccessible. Following reports of persistent peri-ablation blood-brain barrier (BBB) opening in humans, we examined this phenomenon using a rat glioblastoma model. Athymic female rats were implanted with U251 tumor cells in one brain hemisphere. Tumor growth was monitored using magnetic resonance imaging (MRI) and dynamic contrast enhanced (DCE)-MRI. When tumors reached about 4 mm in diameter, they were ablated under supervision of diffusion-weighted MRI using Visualase®, a clinical LITT system. Four rats were used as controls. Longitudinal MRI data were obtained before LITT, and at post-LITT 2 (n=9), 3 (n=3) and 4 (n=9) weeks. After the terminal MRI at each time point, rats were injected intravenously with fluorescent isothiocyanate dextran (FITC-dextran; 2000 kDa) and Evans Blue (68 kDa after binding to plasma albumin) and the brains immersion fixed in 10% paraformaldehyde. The brains were cut into 100 μM thick slices in a vibratome and examined for the distribution of the two fluorophores. All rats survived the LITT procedure. The sham controls showed increased tumor burden by 2 weeks and were sacrificed. DCE-MRI data and fluorescent data showed elevated BBB permeability in peri-ablation regions, with leakage of a gadolinium contrast on DCE-MRI and of Evans Blue, but not of FITC-dextran. Histology showed little tumor tissue at 2 weeks, but evidence of recurrence at ablation margins at later times. These data demonstrate that LITT is adaptable to rat glioma models and can be performed under MRI monitoring. Peri-ablation regions showed selective increase in BBB permeability acutely due to sublethal heating, but later increases in permeability may be due to tumor recurrence. We suggest this model is useful for examining the temporal and spatial development of peri-ablation BBB opening following LITT.
State-Level Economic Costs of Fatal Injuries — United States, 2019
Authors: Cora Peterson, Feijun Luo, Curtis Florence
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Unintentional and violence-related injury fatalities, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the 10 leading causes of death for all age groups in the United States in 2019.* There were 246,041 injury deaths in 2019 (unintentional injury was the most frequent cause of death after heart disease and cancer) with an economic cost of $2.2 trillion (1). Extending a national analysis (1), CDC examined state-level economic costs of fatal injuries based on medical care costs and the value of statistical life assigned to 2019 injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).† West Virginia had the highest per capita cost ($11,274) from fatal injury, more than twice that of New York, the state with the lowest cost ($4,538). The five areas with the highest per capita total fatal injury costs were West Virginia, New Mexico, Alaska, District of Columbia (DC), and Louisiana; costs were lowest in New York, California, Minnesota, Nebraska, and Texas. All U.S. states face substantial avoidable costs from injury deaths. Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from the CDC's National Center for Injury Prevention and Control.§.
Abstract 12037: Neighborhood Environmental Correlates of Physical Activity Maintenance Among Healthy People in the Seoul Metropolitan City
Authors: Songwhi Noh, Jina Choo
Journal: Circulation (2021)

Introduction: Neighborhood environmental policy development to support physical activity (PA) maintenance are keys to the implementation of city-wide health promotion initiatives. These efforts may make citizens’ PA more maintainable and sustainable than any other efforts. However, there is lack of information on the identification of neighborhood environmental correlates of PA maintenance. We aimed to identify its neighborhood environmental correlates and to investigate whether the correlates would differ by PA mode, i.e., walking versus aerobic sports. Methods: Participants were 1,449 healthy citizens of the Seoul Metropolitan city. Neighborhood environment variable was perceived by respondents, as measured by the Physical Activity Neighborhood Environmental Scale (PANES). PANES can be evaluated by full- and sub-scale scores. Walking maintenance was defined as daily &gt; 30 minutes on 5 days or more in a behavioral maintenance stage of 6 months or greater. Aerobic sports included leisure-time physical sports (e.g., hiking, bicycling, or other sports) and its maintenance was defined as either &gt; 150 minutes of moderate-intensity exercises or &gt; 75 minutes of vigorous-intensity exercises in a behavioral maintenance stage of 6 months or greater. Results: Both walking maintenance (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.09 - 1.21) and the maintenance of aerobic sports (OR = 1.05, 95% CI = 1.01 - 1.10) were significantly associated with the PANES full score. Specifically, walking maintenance was significantly associated with the sub-scale scores of land use mix (OR = 1.42), recreation facilities (OR = 1.56), and aesthetics (OR = 1.42). The maintenance of aerobic sports was significantly associated with bicycling infrastructures (OR = 1.22), recreation facilities (OR = 1.50) and traffic safety (OR = 0.78). Conclusions: Neighborhood environmental correlates of PA maintenance differed by walking vs. aerobic sports. Overall, city-wide neighborhood environmental policy makers should consider these differences, and prioritize the increases and improvements in availability and accessibility of public recreation exercise facilities (that is a common correlate) for PA maintenance in Seoul Metropolitan city.
Abstract 10652: Epidemiology and Outcomes of Pulmonary Hypertension in the Cardiac Intensive Care Unit
Authors: Jacob C Jentzer, Brandon Wiley, Yogesh Reddy, Christopher F Barnett, Barry A Borlaug, Michael A Solomon
Journal: Circulation (2021)

Introduction: Pulmonary hypertension (PH), defined as an elevated mean pulmonary artery pressure, has been consistently associated with adverse outcomes in hospitalized patients. Limited epidemiologic data exist regarding PH in the cardiac intensive care unit (CICU) population. We used transthoracic echocardiography (TTE) to describe the prevalence, etiology, and outcomes of PH in the CICU. Hypothesis: PH will be associated with higher in-hospital mortality in CICU patients. Methods: CICU patients admitted from 2007 to 2018 who had right ventricular systolic pressure (RVSP) measured via TTE within 1 day of CICU admission were included. PH was defined as an estimated RVSP &gt;35 mmHg. Predictors of in-hospital mortality were determined using multivariable logistic regression. Results: We included 5042 patients with a mean age of 69.4±14.8 (41% females); 81.1% had an admission diagnosis of acute coronary syndrome or heart failure. PH was present in 3085 (61%); the majority (68%) of patients with PH had left heart failure, and 29% had lung disease. In-hospital mortality occurred in 8% and was higher in patients with PH (11% vs. 4%, adjusted OR 1.40, 95% CI 1.03-1.92, p =0.03). PH was associated with higher in-hospital mortality in patients with acute coronary syndrome, heart failure or cardiac arrest (all p &lt;0.01), but not in patients with cardiogenic shock, respiratory failure or sepsis ( Figure ). In-hospital mortality increased as a function of higher RVSP in each admission diagnosis group (adjusted 1.18 per 10 mmHg higher in the entire cohort, 95% CI 1.09-1.28, p &lt;0.001). Conclusions: PH by TTE is very common in the CICU population and remains associated with a higher risk of death during hospitalization even after adjustment. TTE assessment of right heart hemodynamics can predict mortality in CICU patients, with variability across common admission diagnoses. This highlights the importance of PH determined by TTE in hospitalized patients with cardiac critical illness.
DPYD c.1905 + 1G &gt; A and c.2846A &gt; T and UGT1A1*28 allelic variants as predictors of toxicity: Pharmacogenetic translational analysis from the phase III TRIBE study in metastatic colorectal cancer
Authors: C. Cremolini, M. Del Re, F. Loupakis, F. Marmorino, V. Citi, M. Palombi, F. Bergamo, M. Schirripa, D. Rossini, E. Cortesi, G. Tomasello, R. Spadi, A. Buonadonna, D. Amoroso, S. Vitello, S. Di Donato, C. Granetto, M. D'Amico, A. Falcone, R. Danesi
Journal: Annals of Oncology (2015)
NCOG-10. RADIATION THERAPY CAN BE SAFELY DEFERRED IN OLIGODENDROGLIOMAS
Authors: Alexis Demopoulos, Jonathan Knisely
Journal: Neuro-Oncology (2021)

Abstract Deferring multimodal aggressive therapies in young patients to delay treatment-induced toxicity without jeopardizing long-term outcome would be of great benefit to our patients. After IRB approval, we retrospectively reviewed 80 confirmed IDH mutant and 1p19q codeleted oligodendrogliomas treated at one institution between 2005 and 2020. Median follow-up was 5 (range 1-26) years. All patients underwent maximal safe resection, followed by observation with routine imaging (n=28), chemotherapy alone (n=27), or radiation with chemotherapy (n=25) as initial upfront therapy. Median progression free survival was 36 (range 1-203), 54 (range 1-306), and 57 (range 4-281) months, respectively. Median overall survival was not reached, with 85% (67/80) alive, 8 on treatment and 59 stable off therapy. Among 35 patients who died or were followed for 10 years, median PFS was 12, 15, and 10 years for observation (n=9), chemotherapy (n=11) and chemoradiotherapy (n=15), with deaths or KPS below 50 in 3, 6, and 8, respectively. Three deaths in the observation group occurred 12, 12 and 17 years after diagnosis; one at 95 years old and another tumor-unrelated. Among 44 patients eventually receiving radiation, 15 suffered toxicity, including pathologically proven necrosis (n=6), cognitive decline with KPS&amp;lt; 50 (n=5), memory loss with KPS &amp;gt; 50 (n=3), and optic neuropathy (n=1). Myelosuppression from PCV was more pronounced after chemoradiation than in the upfront setting. Temozolomide after PCV chemotherapy was well tolerated. Long term follow-up of oligodendroglioma patients is challenging, but essential in determining late toxicities and treatment efficacy. Long-term results of European and North American multicenter cooperative group trials contradicted earlier publications reporting no benefit from early chemotherapy. Some management practice guidelines established a half-century ago persist (i.e., administer radiation therapy early), despite potentially crippling late effects. Deferring upfront radiation therapy is safe, less toxic, and equally efficacious in codeleted oligodendrogliomas.
Health and Care Bill fails to tackle workforce problems and risks outsourcing to private providers, BMA warns
Authors: Elisabeth Mahase
Journal: BMJ (2021)

The BMA has written to MPs highlighting concerns over the proposed NHS restructure set out in the Health and Care Bill which it says would loosen competition rules and include private providers on commissioning boards.

In the letter BMA North East regional council chair George Rae warned that the bill “fails to address dangerous workforce shortages, risks unnecessary and destabilising outsourcing to private providers, fails to empower and engage with local clinical leadership, and gives politicians greater powers to interfere in operational NHS decision making.”

He …
Abstract 14188: Medication Opportunities Among Patients Admitted for Heart Failure With Reduced Ejection Fraction
Authors: Stanley Swat, Larry A Allen, Stephen J Greene, Adam D Devore, Haolin Xu, Roland Matsouaka, Parag Goyal, Pamela Peterson, Adrian F Hernandez, Harlan M Krumholz, Clyde W Yancy, Gregg C Fonarow, Paul Hess
Journal: Circulation (2021)

Introduction: Patients hospitalized with heart failure with reduced ejection fraction (HFrEF) are eligible for multiple medical therapies prior to discharge. The number of new medication opportunities for HFrEF patients by the time of hospital discharge has not been recently characterized. Methods: We identified 47,277 patients hospitalized for HFrEF between 2017 and 2020 across 160 sites in the Get With The Guidelines-Heart Failure Registry and eligible for medical therapy. Accounting for collected contraindications for each medication class, we calculated the differences between both admission and discharge medications based on professional guideline eligibility. Results: The mean number of guideline-eligible medications for HFrEF patients was 3.51 ± 0.96 while the number of medications used on admission was lower at 2.06 ± 1.33. Among those eligible for each medication class, the proportion of use before admission to discharge increased for all classes: ACEi/ARB/ARNI from 60% to 93%, beta blocker from 70% to 98%, MRA from 26% to 56%, hydralazine/isosorbide among African Americans from 15% to 27%, anticoagulation for atrial fibrillation from 69% to 89%, and diuretics for signs/symptoms of congestion from 63% to 86%. Cumulatively, 29% of patients were eligible for 1 new medication, 30% for 2-3 new medications, and 10% for ≥ 4 new medications. The proportion of patients on all guideline eligible medications increased from 29% on admission to 60% on discharge. Of all new medication opportunities (mean, 1.44 ± 1.32), 66% were addressed by discharge ( Figure 1 ). Conclusions: Among patients hospitalized for HFrEF in the US, two-thirds of all new guideline indicated medication opportunities are addressed by discharge. Nonetheless, continued efforts toward initiating guideline medications for HFrEF are needed, integrating inpatient with post discharge opportunities for medication use.
Abstract 9769: Bicarbonate Treatment Before Reperfusion Attenuates Myocardial Ischemia/Reperfusion Injury by Inhibition of Spleen-Mediated Inflammatory Response
Authors: Aimee Zhang, Katherine Marsh, Radhika Rastogi, Irving L Kron, Zequan Yang
Journal: Circulation (2021)

Introduction: The spleen plays an important role in mediating myocardial ischemia/reperfusion injury (IRI). Sodium bicarbonate (NaHCO 3 ) administration is reported to inhibit spleen-mediated inflammatory responses via vagus nerve activation. Hypothesis: NaHCO 3 treatment attenuates myocardial IRI in a spleen dependent-manner. Methods: C57BL/6 mice underwent 40 minutes of LCA occlusion followed by 60 minutes of reperfusion. PBS (control), NaHCO 3 (1 mEq/ml), or 5.8% NaCl of equivalent osmolality were administered intravenously (IV) 10 minutes before reperfusion at a dose of 1 μl/g. Intraperitoneal (IP) NaHCO 3 was administered 10 minutes before reperfusion at low dose (0.25 mEq/ml, 20 μl/g), high dose (0.5 mEq/ml, 20 μl/g), or as a localized topical rinse of the spleen or liver (1 mEq/ml, 1μl/g). Infarct size (IF), denoted as percentage of risk region (RR, % of LV), was measured by TTC-Phthalo blue staining. Additional groups (n=4) without IRI received IV PBS, IV NaHCO 3 , or IP NaHCO 3 splenic rinse and underwent plasma and spleen harvest 10 minutes after treatment. Results: RR was comparable among all groups with IRI. Among IV-treated groups (Figure A), IF was similar with PBS and 5.8% NaCl (51±4% and 46±3%), while IV NaHCO 3 significantly reduced IF to 25±3% (p&lt;0.05 vs. PBS &amp; 5.8% NaCl). Among IP-treated groups (Figure B), low-dose NaCO3, high-dose NaHCO 3 , and topical NaHCO 3 spleen rinse equally attenuated IF compared to control (p&lt;0.05), while topical NaHCO 3 liver rinse did not reduce IF (51±2%, p = NS vs. control). IV NaHCO 3 administration elevated base excess and HCO 3 - without changing pH, pO 2 or pCO 2 . IV and topical splenic NaHCO 3 elevated plasma GLP-1 and enhanced splenic monocyte M2 polarization. Conclusions: Both IV and IP NaHCO 3 treatment attenuated IF via inhibiting spleen-mediated inflammatory responses. Sodium bicarbonate administered prior to reperfusion may a potential therapeutic adjunct for ischemia/reperfusion injury in acute coronary syndrome.