tbuckley/cabot-search huggingface dataset:
Identification of keratinocyte subpopulations in transcriptome to evaluate drug effects in atopic dermatitis
Authors: T. Miyano, R.J. Tanaka
Journal: British Journal of Dermatology (2020)

Publicly available transcriptome data has been widely used to achieve a systems-level understanding of the complex pathogenesis of atopic dermatitis (AD) 1 .The transcriptome data is interpreted not only by individual gene-level analysis to identify differentially expressed genes between two sample sets (e.g.before and after drug administration), but also by gene-set analysis 2 (GSA) to extract information on biological functions.GSA evaluates associations between the expression profiles and pre-defined gene sets with known biological functions using different statistical methods (e.g.gene set enrichment analysis 3 and gene set variation analysis 4 ).A new computational approach, Cell-type Identification By Estimating Relative Subsets Of RNA Transcripts (CIBERSORT), was developed in 2015 by Newman et al. to estimate the relative fractions of pre-chosen cell types in tissue samples using their transcriptome data 5 .CIBERSORT applies linear support vector regression to
Abstract 321: Illness Perceptions and Readiness for Discharge Are Associated with Psychological Symptoms in Cardiac Arrest Survivors with Good Neurologic Recovery
Authors: Alex Presciutti, Sarah M Perman, Mary M Newman, Jonathan Shaffer
Journal: Circulation (2020)

Introduction: Understanding the development of psychological symptoms post-arrest is a major research gap. In qualitative studies, cardiac arrest survivors report being poorly equipped to face the numerous sequelae upon returning home, which could in turn exacerbate acute psychological symptoms from the initial cardiac arrest event. In this study, we examined associations between illness perceptions (i.e. cognitive and emotional appraisals of illness and recovery), readiness for discharge, and provider-patient communication with psychological symptoms in cardiac arrest survivors with good neurologic recovery. Methods: We distributed an online survey to cardiac arrest survivors who were members of the Sudden Cardiac Arrest Foundation. Survivors completed the Brief Illness Perception Questionnaire (B-IPQ), Readiness for Hospital Discharge Scale (RHDS), Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), PTSD Checklist-5 (PCL-5), and Patient Health Questionnaire-4 (PHQ-4) which has anxiety and depression subscales. Three multiple regression models examined associations between B-IPQ, RHDS, and QQPPI scores with PCL-5 and PHQ-4 anxiety and depression sores, adjusted for age, sex, time since arrest, self-reported understanding of cardiac arrest and post-arrest symptoms at discharge, self-reported memory at discharge, functional status via the Lawton Instrumental Activities of Daily Living scale, pre-arrest Charlson Comorbidity Index, and income. Results: We obtained full data from 163 survivors (mean age: 50.1 years, 50.3% women, 95.5% white, mean time since arrest: 63.9 months). More threatening illness perceptions (β: .57, p &lt; .01) and lower readiness for discharge (β: -.22, p = .01) were associated with greater posttraumatic stress symptoms. More threatening illness perceptions was associated with greater anxiety (β: .53, p &lt; .01) and depression (β: .5, p &lt; .01) symptoms. Conclusions: Illness perceptions and readiness for discharge were associated with psychological symptoms in cardiac arrest survivors. Future studies should examine the feasibility of in-hospital assessment of survivors’ illness perceptions, readiness for discharge, and psychological symptoms.
Abstract 14980: Describing Atrioventricular Conduction in Patients With Chronic Atrial Fibrillation During Hospitalization for COVID-19 - Less RR Interval Variation is Associated With Worse Outcomes
Authors: Joey Junarta, Joshua M Riley, Behzad B Pavri
Journal: Circulation (2020)

Introduction: Myriad cardiovascular manifestations have been reported with COVID-19. We previously reported that failure of PR interval shortening with increasing heart rate (HR) in COVID-19 patients (pts) is associated with adverse outcomes. Here we report on atrioventricular (AV) conduction and clinical outcomes in pts with chronic atrial fibrillation (cAF) while hospitalized for COVID-19. Methods: A retrospective review of all admitted (Feb 01 - Jun 01) COVID-19 pts with cAF was performed. Clinical and ECG characteristics were collected. The ventricular response in cAF was compared during pre-COVID-19 to COVID-19 admissions. Mean HR, shortest RR, and longest RR intervals were recorded. Regularization of ventricular rate was assessed by difference between the longest and shortest RR intervals (ΔRR), with a smaller ΔRR indicating greater regularization. The cohort was divided into tertiles based on ΔRR. Clinical outcomes during COVID-19 were correlated to AV conduction based on the ventricular response. Results: A total of 189 ECGs (106 pre-COVID-19, 83 COVID-19) from 34 patients were included. Mean age 78.6 ± 11.4 years, male 48.6%. Comparing pre-COVID-19 vs. COVID-19 ECGs of all patients showed: mean HR (95.0 ± 24.3 vs. 99.5 ± 23.5 BPM; p=0.20), shortest conducted RR interval (514.9 ± 133.3 vs. 502.5 ± 141.6 ms; p=0.53), longest conducted RR interval (932.2 ± 250.0 vs. 794.7 ± 168.0 ms; p&lt;0.01 ), and ΔRR range (417.3 ± 165.7 vs. 292.2 ± 104.2 ms; p&lt;0.01 ). Pts who showed a more regularized ventricular response (smaller ΔRR) during a COVID-19 admission had longer ICU length of stay and numerically greater need for intubation (Table 1). Conclusion: In pts with cAF, the average ventricular rates were more regularized during COVID-19 compared to prior illnesses with comparable HRs. Importantly, pts with the most regularized ventricular response were more likely to have a longer ICU stay compared to pts whose ventricular rate was more irregular.
Abstract 13716: Racial Differences in Patients With Cryptogenic Stroke With Insertable Cardiac Monitors
Authors: mark heckle, Eva Ingram, Issa Pour-Ghaz, Andrei V Alexandrov, Sunil K Jha, Rohini Bhole, Yehoshua Levine, Rajesh Kabra
Journal: Circulation (2020)

Introduction: African American (AA) patients have a higher incidence of stroke but lower prevalence of atrial fibrillation (AF). Studies involving long term monitoring with implantable cardiac monitors (ICM) for AF after cryptogenic stroke are limited by the under-representation of the AA population. Objective: We sought to assess racial differences in the diagnosis of AF by implantable cardiac monitors in patients with cryptogenic stroke. Methods: We performed a retrospective chart review study at Methodist University Hospital, University of Tennessee Health Science Center, Memphis TN. We included patients with cryptogenic stroke who received an ICM from September 2014 to June 2019 to assess for AF. Race and additional demographic characteristics were obtained from the electronic medical records. Interrogation reports from the ICMs were obtained by remote monitoring as well as clinic visits. Fisher exact and student t test were used to compare demographic data as well as the incidence of AF in these patients. Results: A total of 219 patients with cryptogenic stroke who underwent ICM implantation were included, of which 129 (58.9%) were AA. In the AA cohort, the patients were significantly younger than (62.3 versus 65.8 years; p =0.04) and had a significantly higher prevalence of hypertension (92.2% versus 68.5%; p &lt;0.01) and diabetes mellitus (40.3% versus 27.3%; p =0.04). Upon a mean follow up of 10.6 months, a total of 39 patients (17.8%) were diagnosed with AF on ICM monitoring. The mean time to the incidence of AF was 7.4 months. There was no significant difference in the incidence of AF in the AA population (17.8%) as compared to the rest of the population (17.8%) ( p =1.00). Conclusion: In this single center study of patients with cryptogenic stroke who underwent long term monitoring with ICM, there was no significant difference in the incidence of AF between AA and the rest of the population. We conclude that ICM’s have an equally important role in AF detection in AA patients as in the general population with cryptogenic stroke.
The US Preventive Services Task Force Recommendation on Screening for Blood Pressure in Children
Authors: Priya Verghese, Debora Matossian
Journal: JAMA (2020)

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Abstract 248: When Does Expiration End? Comparison of Two Criteria for Measuring End-tidal Co <sub>2</sub>
Authors: Jose Julio Gutierrez, Sofia Ruiz De Gauna, Jesus Ruiz, Izaskun Azkarate, Camilo L Sandoval, Luis A Leturiondo, James K Russell, Mohamud R Daya
Journal: Circulation (2020)

Aim: End-tidal CO2 is defined as the partial pressure of carbon dioxide in exhaled air at the end of expiration. During CPR with manual ventilation, end-tidal CO2 is generally measured as the maximum CO2 value during the expiratory plateau of the capnogram. Transthoracic impedance (TTI) acquired through defibrillation pads also allows for tracking inspiratory and expiratory phases during CPR. Our aim was to compare the CO2 value measured at the end of the TTI expiration with the maximum CO2 value in the capnogram plateau. Materials and methods: Fifteen out-of-hospital cardiac arrest defibrillation recordings (Tualatin Valley Fire &amp; Rescue, Oregon, USA) containing concurrent TTI and capnogram were analyzed. TTI signal was filtered to isolate the fluctuations caused by ventilations from those caused by chest compressions or spontaneous circulation. Inspiratory and expiratory intervals per ventilation were marked in the TTI. Values of CO2 at the end of the TTI expiratory interval and the maximum value in the capnogram expiratory plateau were annotated. Results: A total of 3559 ventilations were analyzed. Median (IQR) ventilation rate was 17.1 (11.2, 22.9) min-1. Median ventilation duration was 2.4 (2.1, 2.9) s, and inspiration represented the 45.5 (40.2, 49.9) % of the ventilation duration. CO2 value at the end of TTI expiration was 24.5 (14.7, 34.1) mmHg. Difference with respect to the maximum capnogram CO2 was 2.1 (0.7, 4.4) mmHg. More importantly, we found differences higher than 7.5 mmHg (29.1%) in 10% of the annotated ventilations. In the figure, both values match in the first ventilation but not in the second, where the difference between CO2 values is 15.4%. Conclusion: Median differences between CO2 concentration at the end of the TTI expiratory phase and the maximum tidal value in the capnogram were small. However, the observed important differences require further exploration.
Abstract 17168: Myocardial Natriuretic Peptide Expression in Heart Failure With Preserved Ejection Fraction
Authors: Virginia S Hahn, Hildur Knutsdottir, Kenneth C Bedi, Kenneth B Margulies, Saptarsi M Haldar, Marina Stolina, Joel S Bader, David A Kass, Kavita Sharma
Journal: Circulation (2020)

Introduction: Serum natriuretic peptides (NP) are reduced in heart failure with preserved ejection fraction (HFpEF) compared to HFrEF; however, myocardial NP expression in HFpEF is unknown. We analyzed serum NTproBNP and myocardial RNAseq data to test the hypothesis that 1) lower myocardial NP expression in HFpEF drives the difference in serum levels, and 2) HFpEF with higher NP expression have transcriptomic signatures more similar to HFrEF. Methods: HFpEF patients (n=41) with clinical HF, LVEF≥50%, and meeting current consensus criteria for HFpEF underwent right heart catheterization and right ventricular (RV) endomyocardial biopsy. We performed differential gene expression analysis of RV septal tissue from HFpEF and compared to explanted HFrEF (n=30) and unused donor hearts (n=24, Control). Results: Myocardial NPPB expression was 5-fold higher in HFrEF vs Control (p&lt;0.001) and unchanged in HFpEF vs Control, while NPPA expression was 9-fold higher in HFrEF and 5-fold higher in HFpEF vs Control (p&lt;0.0001 for both comparisons). After adjustment for renal function and BMI, myocardial NPPB expression was significantly associated with serum NTproBNP in HFpEF (R 2 0.68; p&lt;0.0001 for renal function, NPPB expression; p=0.03 for BMI). Pulmonary artery (PA) systolic pressure and PA wedge pressure correlated with myocardial NPPB expression (PASP R 2 0.45, p&lt;0.0001; PAWP R 2 0.25, p=0.01), even after adjustment for comorbidities. HFpEF patients with high (≥ median NPPB expression in HFpEF) vs low NPPB expression had transcriptomic signatures more similar to HFrEF using ~13,000 genes in a Principal Component Analysis (Figure), quantified by vector distance from HFrEF (p=0.017). Conclusions: HFpEF patients have reduced serum NTproBNP due to lower myocardial NPPB gene expression. HFpEF patients with higher NPPB expression have transcriptomic signatures more similar to HFrEF, highlighting a HFpEF subgroup that may benefit from targeted therapies.
Abstract 13596: Identifying the Most Important Ecg Predictors of Reduced Ejection Fraction in Patients With Suspected Acute Coronary Syndrome
Authors: Abdullah Ahmad, Mohammad Alhamaydeh, Ziad Faramand, Richard Gregg, Samir Saba, Salah S Al-Zaiti
Journal: Circulation (2020)

Background: Non-invasive screening tools of cardiac function can play a significant role in the initial triage of patients with suspected acute coronary syndrome. Numerous ECG features have been previously linked with cardiac contractility in the general population. We sought to identify ECG features that are most predictive for real-time screening of reduced left ventricular ejection fraction (LVEF) in the acute care setting. Methods: We performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. The parent study recruited consecutive patients evaluated at the emergency department of three UPMC-affiliated tertiary care hospitals. We included consecutive patients in whom an echocardiogram was performed during indexed encounter. Baseline ECGs were preprocessed using manufacturer specific algorithms. We evaluated 554 automated 12-lead ECG features in multivariate linear regression for predicting LVEF. We then used regression trees to identify the most important predictive ECG features. Results: Our final sample included 297 patients (aged 63 ± 15, 45% females). The mean LVEF was 57% ± 13 (IQR 50%-65%). In multivariate analysis, depolarization dispersion in the horizontal plane; global repolarization dispersion; and abnormal temporal indices in inferolateral leads were all independent predictors of LVEF (R 2 = 0.452, F = 6.679, p &lt; 0.001). Horizontal QRS axis deviation and prolonged ventricular activation (VAT) time in left ventricular apex were the most important determinants of reduced LVEF (Figure), while global QRS duration was of less importance. Conclusions: Poor R wave progression in precordial leads with dominant QS pattern in V3 is the most predictive feature of reduced LVEF in suspected ACS. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function.
Sleep laboratories reopening and COVID-19: a European perspective
Authors: Sophia Schiza, Anita Simonds, Winfried Randerath, Francesco Fanfulla, Dries Testelmans, Ludger Grote, Joseph M. Montserrat, Jean-Louis Pepin, Johan Verbraecken, Refika Ersu, Maria R. Bonsignore
Journal: European Respiratory Journal (2020)

Clinical activities regarding sleep disordered breathing (SDB) have been sharply interrupted during the initial phase of the coronavirus disease 2019 (COVID-19) epidemic throughout Europe. In the past months, activities have gradually restarted, according to epidemiological phase of COVID-19 and national recommendations. The recent increase in cases throughout Europe demands a reconsideration of management strategies of SDB accordingly. Diagnosis of SDB and initiation of treatment pose some specific problems to be addressed to preserve the safety of patients and health personnel. This perspective document by a group of European sleep experts aims to summarise some different approaches followed in Europe and United States, which reflect national recommendations according to the epidemiological phase of the COVID-19 infection. Respiratory sleep medicine is likely to change in the near future, and use of telemedicine will grow to avoid unnecessary risks and continue to provide optimal care to patients. In addition, the document covers paediatric sleep studies and indications for titration of noninvasive ventilation, as well as precautions to be followed by patients who are already on positive airway pressure treatment. A single consensus document developed by the European Respiratory Society and national societies would be desirable to harmonise SDB management throughout Europe.
Abstract 14298: Right Ventricular Strain Before and After Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension
Authors: Darrin Wong, Averie Tigges, Lawrence Ang, MITUL PATEL, Hyong Kim, David Poch, Ajit Raisinghani, Michael M Madani, Anthony N Demaria, Ehtisham Mahmud, Daniel G Blanchard
Journal: Circulation (2020)

Background: Right ventricular (RV) function is impaired in chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) may be an alternative treatment for patients (pts) who are not candidates for pulmonary thromboendarterectomy (PTE). We assessed the RV global and segmental strain patterns in pts who underwent BPA. Methods: Between 12/2016 and 5/2019, 22 pts had completed BPA treatment and had transthoracic echocardiograms (echos) before and after treatment. Of those 22 pts, 14 had echos with adequate imaging of the RV. Epsilon EchoInsight® was used to measure global and segmental RV strain. Tricuspid annular plane excursion (TAPSE) was also measured. Paired t-tests were used to determine mean differences for pre &amp; post BPA, and Pearson correlation coefficient was used to determine association with hemodynamics. Results: RV global longitudinal strain (GLS) significantly improved after BPA (-11.1±3.4 to -16.2±2.9 % p&lt;0.05). The apical and mid segmental strain also significantly improved after BPA (-5.0±9.1 to -12.5±7.5%, p=0.03; -13.3±6.2 to -17.5±5.4%, p&lt;0.01 respectively). Basal strain did not significantly change (-15.2±6.3 to -18.5±9.2%, p=0.22). Furthermore, TAPSE did not change significantly (1.87±0.5 to 1.95±0.5 cm, p=0.55). Hemodynamically, mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) significantly decreased (40.3±10.5 to 34.0±10.3 mmHg, p=0.001 and 5.9±3.1 to 3.9±1.8 WU, p=0.01) while cardiac output remained unchanged (5.6±2.0 to 5.7±1.1 L/min, p=0.86). There was no correlation between improvement in RV GLS and decrease in mPAP and PVR. Conclusion: RV function as measured by RV GLS significantly improved after BPA, though only the mid and apical segments improved. TAPSE and RV basal strain did not change after BPA. Previous studies have shown that GLS did not improve significantly after PTE. Furthermore, TAPSE significantly decreases after PTE. The reasons for the difference in RV function after PTE vs BPA are not entirely clear, but may be due to operability and location of disease, as well as immediate post-operative RV stunning after PTE.
Abstract 13788: Acute Administration of Nicotine Induces Transient Elevation of Blood Pressure and Increases Myocardial Infarct Size in an Acute Myocardial Ischemia/reperfusion Rat Model
Authors: Lifu Zhao, Wangde Dai, Juan Carreno, jianru shi, Michael Kleinman, Robert A Kloner
Journal: Circulation (2020)

Introduction: Nicotine is a major bioactive component in tobacco cigarettes and electronic cigarettes. Despite the fact that smokers are at higher risk of experiencing an acute myocardial infarction (AMI), there are few studies that have examined the acute effects of nicotine on AMI.To address this issue, our present study was to examine the acute effects of nicotine on myocardial infarct size, no reflow, cardiac hemodynamics and cardiac function in a rat myocardial infarct model. Methods: Forty-six female Sprague-Dawley rats were randomly divided into nicotine group and control group (n=23/group) and received an intravenous loading dose of nicotine at 2.0 μg/kg/min or saline for 30 minutes before starting coronary artery occlusion, then followed by a maintenance dose 0.35 μg/kg/min of nicotine to the end of 3.5 hours of occlusion (30 minutes) and reperfusion (3 hours). Results: At baseline, there were no difference between the two study groups, in systolic blood pressure (BP in mmHg) (nicotine, 69.0±2.7; control, 69.3±4.4; p &gt; 0.05), or diastolic BP (nicotine, 45.7±3.2; control, 48.2±4.2; p &gt; 0.05). Nicotine initially increased systolic BP (nicotine, 97.0±8.6; control, 69.2±3.3, p &lt;0.05) and diastolic BP (nicotine, 65.6±6.4; control, 47.4±3.1, p &lt; 0.01) at 10 minutes after starting injection of the loading dose; pressures dropped to control levels in both groups at 30 minutes. During occlusion/reperfusion, the BP and heart rate were not altered by nicotine. Nicotine significantly increased myocardial infarct size as a percentage of the ischemic risk zone compared to the controls (nicotine, 54.9 ± 1.9 %; control, 48.6 ± 2.7 %, p &lt; 0.05), but nicotine did not affect the no-reflow size (nicotine, 34.8 ± 3.10 %; control, 33.7 ± 3.0%, p &gt; 0.05). Nicotine did not alter fractional shortening assessed by echocardiography. Conclusions: Nicotine infusion can transiently increase blood pressure in anesthetized rats. During coronary occlusion and reperfusion, nicotine increased myocardial infarct size, but did not affect hemodynamics or fractional shortening, suggesting that the increase in infarct size was not simply due to an increase in oxygen demand due to altered afterload, heart rate or contractility, but may reflect a more direct effect on the myocardium.