tbuckley/cabot-search huggingface dataset:
Abstract 15209: <i>LPA</i> Variants Are Associated With Aortic Valve Stenosis, Heart Failure and Chronic Kidney Disease
Authors: Ozan Dikilitas, Benjamin A Satterfield, Maya Safarova, Shoa L Clarke, Catherine Tcheandjieu, Xiang Zhu, Lisa Bastarache, eric B LARSON, Anne E Justice, Ning Shang, Elisabeth Rosenthal, Amy S Shah, Bahram Namjou-Khales, Elaine M Urbina, Wei-Qi Wei, Qiping Feng, Scott J Hebbring, Gail P Jarvik, Mariza de Andrade, Teri A Manolio, Themistocles L Assimes, Iftikhar J Kullo
Journal: Circulation (2020)

Background: The pathophysiology of lipoprotein (a) [Lp(a)] remains obscure. We conducted a phenome wide analysis study (PheWAS) to identify pleiotropic effects of LPA variants. Methods: Among 51,843 European-ancestry participants (age 58±16 years, 54% female) of the electronic MEdical Records and Genomics (eMERGE) network we assessed whether LPA variants exhibited pleiotropic affects through an electronic health record-based PheWAS. We adjusted significant associations by presence of atherosclerotic cardiovascular disease (ASCVD; defined as a composite of coronary heart disease, cerebrovascular disease, and peripheral artery disease) to determine whether those associations were independent of ASCVD. Results: In PheWAS analysis, we tested 864 phecodes with 36 independent LPA variants. We identified 21 significant associations with non-ASCVD phenotypes including heart failure, aortic valve stenosis, and chronic kidney disease of which 14 were replicated across independent cohorts. The strength of associations between the LPA variant rs10455872 and both heart failure and aortic valve stenosis related phecodes were significantly attenuated after adjustment for ASCVD. However, the association with chronic kidney disease phecode remained independent following adjustment for ASCVD without any attenuation in the estimated odds ratio (Table). Conclusions: LPA genetic variants were associated with aortic valve stenosis, heart failure and chronic kidney disease. The observed association of LPA variant rs10455872 with aortic stenosis and heart failure appear to be partially mediated by ASCVD, while the association with chronic kidney disease appears to be independent of ASCVD. Additional studies are needed to elucidate potential mechanisms by which Lp(a) may contribute to the pathogenesis of non-ASCVD disease phenotypes.
HCC : Clinical utility of gadoxetic acid-enhanced MRI versus multiphase multidetector row computed tomography for predicting recurrence of hepatocellular carcinoma treated with radiofrequency ablation (초)
Authors: Jung Im Jung, Heo Jung, Young Hwa Jo, Yong Wan Sung, Hyun Young Woo, Ki Tae Yoon, Gwang Ha Kim, Dae Hwan Kang, Geun Am Song, Mong Cho
Journal: Clinical and Molecular Hepatology (2011)
Abstract 15537: An Electronic Health Record Intervention to Optimize Utilization of Transthoracic Echocardiography: Opportunity for Cost Savings in the Era of Value Based-care
Authors: Jason Castaneda, corey rearick, Joseph Weber, Eve Edstrom, Kimisha Cassidy, Vineet Arora, R Ward
Journal: Circulation (2020)

Introduction: In the current value-based era, targeting diagnostic resources and minimizing unnecessary testing is of paramount importance. Transthoracic echocardiography (TTE) is a common and costly test, and available Appropriate Use Criteria (AUC) guide optimal utilization. Limited TTE (L-TTE) shortens sonographer time, lowers cost and may be ideal for repeat TTEs (R-TTE) with a focused indication. However, many clinicians are unfamiliar with the AUC and opportunities for L-TTE. We prospectively tested an Electronic Health Record (EHR)-based intervention aimed at optimizing TTE utilization in a large academic medical center. Methods: TTE utilization at the University of Chicago Medicine was assessed over a 6-month period and complete TTE (C-TTE), L-TTE and R-TTE (TTE repeated within 6 months) were recorded. An EHR-based intervention was then implemented and TTE utilization was assessed over the ensuing 8 weeks. The intervention included presenting new descriptive L-TTE options (i.e. “Limited TTE: EF or Effusion Only”) when any “echo” was searched in the EHR order panel, an alert to prior TTEs (i.e. date &amp; LVEF) and a link to AUC-based guidance for TTE ordering. Educational materials were also distributed to frequent TTE ordering providers. Results: Among 9121 TTEs (53% inpatient) pre-intervention , 11% (n=1002) were L-TTEs and 25% (n=2320) were R-TTEs. There were more L-TTEs and R-TTEs in pre-intervention inpatients compared to outpatients (L-TTE 14% vs 7%, p&lt;0.0001, R-TTE 33% vs 17%, p&lt;0.0001). Post-intervention (2879 TTEs, 53% inpatient), R-TTEs significantly decreased (22.6% vs 25.4%, p=0.0019) and L-TTEs significantly increased (14% vs 11%, p&lt;0.0001) compared to pre-intervention, with inpatient TTEs most impacted (R-TTE 28% vs 33%, p=0.0016, L-TTE 19% vs 14%, p&lt;0.001). The intervention’s greatest impact was to markedly increase L-TTEs among inpatient R-TTEs (44% vs 35%, p=0.0002). Conclusions: Despite AUC discouraging frequent repeat TTEs, R-TTEs are common in an academic medical center and utilization of L-TTE is rare. An EHR-based intervention with prior TTE alerts and descriptive L-TTE options increases L-TTEs and reduces R-TTEs. Further study is warranted to describe the full clinical and financial impact of this intervention.
Cruciferous vegetables (<i>Brassica oleracea</i>) confer cytoprotective effects in <i>Drosophila</i> intestines
Authors: James T. Lyles, Liping Luo, Ken Liu, Dean P. Jones, Rheinallt M. Jones, Cassandra L. Quave
Journal: Gut Microbes (2021)

Varieties and cultivars of the cruciferous vegetable Brassica oleracea are widely presumed to elicit positive influences on mammalian health and disease, particularly related to their indole and sulforaphane content. However, there is a considerable gap in knowledge regarding the mechanisms whereby these plant-derived molecules elicit their beneficial effects on the host. In this study, we examined the chemical variation between B. oleracea varieties and evaluated their capacity to both activate Nrf2 in the Drosophila intestine and elicit cytoprotection. Ten types of edible B. oleracea were purchased and B. macrocarpa was wild collected. Fresh material was dried, extracted by double maceration and green kale was also subjected to anaerobic fermentation before processing. Untargeted metabolomics was used to perform Principal Component Analysis. Targeted mass spectral analysis determined the presence of six indole species and quantified indole. Extracts were tested for their capacity to activate Nrf2 in the Drosophila intestine in third instar Drosophila larvae. Cytoprotective effects were evaluated using a paraquat-induced oxidative stress gut injury model. A "Smurf" assay was used to determine protective capacity against a chemically induced leaky gut. Extracts of Brussels sprouts and broccoli activated Nrf2 and protected against paraquat-induced damage and leaky gut. Lacto-fermented kale showed a cytoprotective effect, increasing survival by 20% over the non-fermented extract, but did not protect against leaky gut. The protective effects observed do not directly correlate with indole content, suggesting involvement of multiple compounds and a synergistic mechanism.
Association Between Bariatric Surgery and All-Cause Mortality
Authors: Shuo-Yan Gau
Journal: Annals of Internal Medicine (2021)

LettersMay 2021Association Between Bariatric Surgery and All-Cause MortalityShuo-Yan GauShuo-Yan GauSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1242 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: I read with interest Doumouras and colleagues' article (1) reporting decreased mortality in patients after bariatric surgery. Using a robust database, the authors also conducted several subgroup analyses to evaluate the association between bariatric surgery and death from different causes to strengthen their results. They stated that bariatric surgery was associated with lower all-cause, cardiovascular, and cancer mortality. However, I am concerned that their interpretation of the results for decreased cancer mortality may be misleading.According to Figure 2, panel C, and Supplement Table 2 of their article, the adjusted hazard ratio for subsequent cancer death in ...Reference1. Doumouras AG, Hong D, Lee Y, et al. Association between bariatric surgery and all-cause mortality: a population-based matched cohort study in a universal health care system. Ann Intern Med. 2020;173:694-703. [PMID: 32805135]. doi:10.7326/M19-3925 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Disclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1242. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation Between Bariatric Surgery and All-Cause Mortality: A Population-Based Matched Cohort Study in a Universal Health Care System Aristithes G. Doumouras , Dennis Hong , Yung Lee , Jean-Eric Tarride , J. Michael Paterson , and Mehran Anvari Metrics May 2021Volume 174, Issue 5Page: 730 ePublished: 18 May 2021 Issue Published: May 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults
Authors: Afifah Mohamed, Maciej Marciniak, Wilby Williamson, Odaro J. Huckstep, Winok Lapidaire, Angus McCance, Stefan Neubauer, Paul Leeson, Adam J. Lewandowski
Journal: JAMA Cardiology (2021)

Preterm-born individuals have higher blood pressure with an increased risk of hypertension by young adulthood, as well as potentially adverse cardiac remodeling even when normotensive. To what extent blood pressure elevation affects left ventricular (LV) structure and function in adults born preterm is currently unknown.To investigate whether changes observed in LV structure and function in preterm-born adults make them more susceptible to cardiac remodeling in association with blood pressure elevation.This cross-sectional cohort study, conducted at the Oxford Cardiovascular Clinical Research Facility and Oxford Centre for Clinical Magnetic Resonance Research, included 468 adults aged 18 to 40 years. Of these, 200 were born preterm (<37 weeks' gestation) and 268 were born at term (≥37 weeks' gestation). Cardiac magnetic resonance imaging was used to characterize LV structure and function, with clinical blood pressure readings measured to assess hypertension status. Demographic and anthropometric data, as well as birth history and family medical history information, were collected. Data were analyzed between January 2012 and February 2021.Cardiac magnetic resonance measures of LV structure and function in response to systolic blood pressure elevation.The cohort was primarily White (>95%) with a balanced sex distribution (51.5% women and 48.5% men). Preterm-born adults with and without hypertension had higher LV mass index, reduced LV function, and smaller LV volumes compared with term-born individuals both with and without hypertension. In regression analyses of systolic blood pressure with LV mass index and LV mass to end-diastolic volume ratio, there was a leftward shift in the slopes in preterm-born compared with term-born adults. Compared with term-born adults, there was a 2.5-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in very and extremely preterm-born adults (<32 weeks' gestation) (0.394 g/m2 vs 0.157 g/m2 per 1 mm Hg; P < .001) and a 1.6-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in moderately preterm-born adults (32 to 36 weeks' gestation) (0.250 g/m2 vs 0.157 g/m2 per 1 mm Hg; P < .001). The LV mass to end-diastolic volume ratio per 1-mm Hg elevation in systolic blood pressure in the very and extremely preterm-born adults was 3.4-fold greater compared with those born moderately preterm (3.56 × 10-3 vs 1.04 × 10-3 g/mL per 1 mm Hg; P < .001) and 3.3-fold greater compared with those born at term (3.56 × 10-3 vs 1.08 × 10-3 g/mL per 1 mm Hg; P < .001).Preterm-born adults have a unique LV structure and function that worsens with systolic blood pressure elevation. Additional primary prevention strategies specifically targeting cardiovascular risk reduction in this population may be warranted.
Activity of PD-1 blockade with nivolumab among patients with recurrent atypical/anaplastic meningioma: phase II trial results
Authors: Wenya Linda Bi, Lakshmi Nayak, David M Meredith, Joseph Driver, Ziming Du, Samantha Hoffman, Yvonne Li, Eudocia Quant Lee, Rameen Beroukhim, Mikael Rinne, Ricardo McFaline-Figueroa, Ugonma Chukwueke, Christine McCluskey, Sarah Gaffey, Andrew D Cherniack, Jennifer Stefanik, Lisa Doherty, Christina Taubert, Meghan Cifrino, Deborah LaFrankie, Thomas Graillon, Patrick Y Wen, Keith L Ligon, Ossama Al-Mefty, Raymond Y Huang, Alona Muzikansky, E Antonio Chiocca, Sandro Santagata, Ian F Dunn, David A Reardon
Journal: Neuro-Oncology (2021)

Abstract Background Programmed death ligand 1 (PD-L1) contributes to tumor immunosuppression and is upregulated in aggressive meningiomas. We performed a phase II study of nivolumab, a programmed death 1 (PD-1) blocking antibody among patients with grade ≥2 meningioma that recurred after surgery and radiation therapy. Methods Twenty-five patients received nivolumab (240 mg biweekly) until progression, voluntary withdrawal, unacceptable toxicity, or death. Tumor mutational burden (TMB) and quantification of tumor-infiltrating lymphocytes (TIL) were evaluated as potential immunocorrelative biomarkers. Change in neurologic function was prospectively assessed using the Neurologic Assessment in Neuro-Oncology (NANO) scale. Results Enrolled patients had multiple recurrences including ≥3 prior surgeries and ≥2 prior courses of radiation in 60% and 72%, respectively. Nivolumab was well tolerated with no unexpected adverse events. Six-month progression-free survival (PFS-6) rate was 42.4% (95% CI: 22.8, 60.7) and the median OS was 30.9 months (95% CI: 17.6, NA). One patient achieved radiographic response (ongoing at 4.5 years). TMB was &amp;gt;10/Mb in 2 of 15 profiled tumors (13.3%). Baseline TIL density was low but increased posttreatment in 3 patients including both patients with elevated TMB. Most patients who achieved PFS-6 maintained neurologic function prior to progression as assessed by NANO. Conclusion Nivolumab was well tolerated but failed to improve PFS-6, although a subset of patients appeared to derive benefit. Low levels of TMB and TIL density were typically observed. NANO assessment of neurologic function contributed to outcome assessment. Future studies may consider rationally designed combinatorial regimens.
David Oliver: Consulting on uniform while ignoring PPE failings insults NHS staff
Authors: David Oliver
Journal: BMJ (2021)

On 12 April, NHS Supply Chain (NHSSC) launched a seven week consultation with NHS staff on a “potential standardised national uniform for NHS staff working in clinical roles in England.”1 NHSSC is responsible for managing the sourcing, delivery, and supply of healthcare products, services, and food for NHS trusts in England and Wales. It’s been criticised by opponents of NHS privatisation for awarding numerous contracts and subcontracts to private sector organisations, all taking a slice of profit as part of their business model.2

NHSSC also attracted considerable criticism during the covid pandemic, not least from the National Audit Office3 and the Public Accounts Committee,4 for conspicuous failings over stocks, timely supply, availability, and quality of personal protective equipment (PPE) for the very same NHS clinical staff it now wants …
Hepatitis B during chemotherapy
Authors: 장정원
Journal: Clinical and Molecular Hepatology (2011)

Reactivation of hepatitis B virus (HBV) has been well documented as a complication in cancer patients who receive cytotoxic or immunosuppressive therapy. The frequency of HBV reactivation in chronic HBV carriers receiving chemotherapy varies according to clinical situations. The risk of reactivation is highest in hematopoietic stem cell or solid organ transplant recipients and in those undergoing chemotherapy for hematological malignancies; however, it has been described following almost any form of immunosuppressive treatment. With the recent introduction of newer agents with a high level of immunosuppression effect, this unfavorable event often occurs in patients with HBsAg-negative and/or occult HBV infection. The first step in HBV reactivation management is the identification of the patients at risk of viral reactivation by testing for HBV serology prior to commencing immunosuppressive treatment or chemotherapy. Multiple publications have consistently indicated the benefit of prophylactic or preemptive antiviral therapy in this setting, and justified such approach before the start of cytotoxic therapy. Unresolved issues concerning such prophylactic approach remain in the situations of HBsAg-negative/anti-HBc-positive or negative status, which presumably consists of a large number of occult HBV infection cases. This topic review will summarize clinical issues related to HBV reactivation, focusing clinical manifestations, risk factors associated with HBV reactivation, and a growing body of evidence supporting preventive antiviral therapy in high-risk patients.
Isolated ST-Elevation Myocardial Infarction of the Diagonal
Authors: Venkatakrishnan Ramakumar, Ram Manohar Talupula, Satyavir Yadav
Journal: JAMA Internal Medicine (2021)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Decay of Fc-dependent antibody functions after mild to moderate COVID-19
Authors: Wen Shi Lee, Kevin John Selva, Samantha K. Davis, Bruce D. Wines, Arnold Reynaldi, Robyn Esterbauer, Hannah G. Kelly, Ebene R. Haycroft, Hyon-Xhi Tan, Jennifer A. Juno, Adam K. Wheatley, P. Mark Hogarth, Deborah Cromer, Miles P. Davenport, Amy W. Chung, Stephen J. Kent
Journal: Cell Reports Medicine (2021)
Abstract 16037: Hybrid Convergent Ablation for Atrial Fibrillation: Updated Systematic Review and Meta-analysis
Authors: suvash shrestha, David DeLurgio, Andy Kiser, Saumil Oza, Yisachar Greenberg, Felix Yang
Journal: Circulation (2020)

Introduction: Hybrid convergent epicardial/endocardial ablation was developed in response to the limited effectiveness of endocardial catheter ablation for persistent (PersAF) and longstanding PersAF (LSPAF). The objective of this study was to perform a systematic review and meta-analysis of reported safety and efficacy outcomes with convergent procedures. Methods: Predefined search terms were used in PubMed; the initial search was performed in June 2019 and updated in May 2020. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test. Results: The updated search yielded 325 unique results. Two articles from meta-analyses were added. Nineteen articles met inclusion with safety and/or efficacy data. Three overlapping studies were excluded. Results from the randomized CONVERGE trial were added, for a total of 1084 patients in 17 studies; 94% had PersAF or LSPAF. The 30-day major adverse event rate was 3.1% (95% CI 1.9% - 4.3%; n=1084; 17 studies), excluding pericardial effusions (PE) (non-emergent inflammatory response) and 5.1% (95% CI 3.6% - 6.6%) overall. The PEs may be mitigated by anti-inflammatory prophylaxis, pericardial drainage and appropriate patient monitoring. Freedom from AF/atrial arrhythmia at one year or later was 75.0% (95% CI 66.0%-83.9%; n=805; 14 studies) regardless of anti-arrhythmic drugs (AAD) and 64.9% (95% CI 54.7%-75.1%; n=494; 8 studies) off AADs/ absent increased dosage of failed AADs. Heterogeneity across studies was detected for effectiveness (p&lt;0.0001), but not for safety (p=0.12). Conclusions: This meta-analysis shows high efficacy of hybrid convergent ablation at one year, even off AADs, and a reasonable safety in mostly persistent or long-standing persistent AF.
Abstract 15966: Abnormal Left Ventricular Strain Correlates With Left Ventricular Dysfunction but Not Aortic Pathology in Marfan Syndrome in Children
Authors: Patrick S CONNELL, Shaine A Morris, Tam Doan, Justin Weigand
Journal: Circulation (2020)

Introduction: Cardiomyopathy has been described in some adults with Marfan syndrome (MFS), as demonstrated by low ejection fraction (EF) and abnormal left ventricular (LV) strain. Recent studies from our group show that LV dilation and decreased EF are common in children with MFS. However, LV strain remains understudied in children. Hypothesis: Abnormal strain is associated with lower EF, higher aortic root z-score and higher height-adjusted vertebral artery tortuosity index (VTI-h). In addition, abnormal strain with normal EF is associated with a subsequent decline in EF. Methods: Patients with MFS, defined as meeting Ghent 2010 criteria and a pathogenic FBN1 variant or ectopia lentis, &lt;19 years of age at first cardiac magnetic resonance imaging study (CMR) from 2003-2018 were included. CMR LV circumferential and longitudinal strain were measured using feature tracking software. CMR aortic root Z-scores were calculated using both pediatric echocardiographic formulas and MRI reference data. VTI-h was measured using previously described methods. We evaluated initial CMR for associations between strain, EF, root z-scores, and VTI using Spearman correlation. A secondary analysis was performed limiting to patients with a normal EF on initial CMR, evaluating for associations between initial strain values and the outcomes of sustained normal EF versus development of low EF (&lt;55%). Results: Of 31 included patients, median age at first CMR was 13.5 y (IQR 10.7-16.2 y). Worse circumferential strain was associated with lower EF (basal: rho = -0.586, p = 0.001; mid: rho = -0.573, p = 0.001; apical: rho = -0.406, p = 0.026), while longitudinal strain was not associated with EF (p = 0.063, 0.257, 0.260). Neither circumferential nor longitudinal strain were associated with aortic root z-score or VTI-h. Among patients with normal EF, initial circumferential strain was not different between patients who maintained normal EF or developed low EF. Conclusions: Worse LV circumferential strain was associated with lower EF in children with MFS, while longitudinal strain was not. Abnormal strain was not associated with aortic pathology or later development of reduced EF. This suggests that the cardiomyopathy seen in children with MFS is likely independent of aortic pathology.