tbuckley/cabot-search huggingface dataset:
Outpatient Management of Liver Function Test Abnormalities in Patients With a Liver Transplant
Authors: Danielle S. Graham, Ronald W. Busuttil, Fady M. Kaldas
Journal: JAMA (2020)

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Tyrosine Kinase Inhibitor Discontinuation in Patients With Chronic Myeloid Leukemia
Authors: Theodore P. Braun, Brian J. Druker
Journal: JAMA Oncology (2020)

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 Oncology 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 Oncology journal
健康な男女日本人における無症候性頚動脈アテローム硬化症:無症候性アテローム硬化症の滋賀疫学研究(SESSA)
Authors: Kadota Aya, Miura Katsuyuki, Okamura Tomonori, Fujiyoshi Akira, Nakamura Yasuyuki, Ohkubo Takayoshi, Mitsunami Kenichi, Maegawa Hiroshi, Kimura Takeshi, Kashiwagi Atsunori, Ueshima Hirotsugu
Journal: Circulation (2012)
Abstract 17163: Prolonged Increase in Endothelium-Specific NOX2-Derived Cytosolic Oxidants Exacerbates Maladaptive Cardiac Remodeling in Ischemic Myocardium
Authors: Rayane Brinck Teixeira, Melissa Pfeiffer, Catherine Karbasiafshar, Frank W Sellke, Ruhul Abid
Journal: Circulation (2020)

Introduction: Global increase in reactive oxygen species (ROS) in endothelial cells (EC) plays major roles in cardiovascular disease (CVD). However, the precise role of ROS within specific compartments of ECs are not yet known. This study aims to address the role of endothelium-derived cytosolic ROS in myocardial infarction (MI). Hypothesis: We hypothesized that an extended exposure to increased NADPH oxidase 2 (NOX2)-derived cytosolic ROS in EC would result in a worse post-MI outcome. Methods: Binary conditional transgenic mice expressing NOX2 in an EC-specific manner (NOX2VE) were studied. NOX2VE mice were assigned to tetracycline (Tet)-ON (control) to turn off transgene, or without Tet as Tet-OFF, i.e. NOX2- O ver E xpressing (NOX2VE-OE) groups. After 15 weeks of Tet-ON/OFF treatment, all mice were subjected to left anterior descending (LAD) coronary artery ligation that mimics acute MI (n=10/group). Left ventricle function was assessed by echocardiography 28 days post LAD. Ejection fraction (EF), fractional shortening (FS), left ventricle mass, wall thickness, heart rate, chamber diameter and volume at systole and diastole were analyzed by Student’s t-test. Results: Echocardiographic data showed that mice subjected to an increased NOX2-derived ROS in EC (NOX2VE-OE) presented with 19.3 ± 7.7% and 20.8 ± 7.9% decrease in EF and FS, respectively (p&lt;0.05) compared to control (NOX2VE, Tet-ON). NOX2VE-OE mice showed an increase (by 14.1 ± 3.4%, p&lt;0.01) in diastolic posterior wall thickness (DPWT) suggesting ventricular stiffness. NOX2VE-OE group also showed increased cardiac mass (by 14.0 ± 5.4%, p&lt;0.05), which, along with DPWT indicates hypertrophy with a likelihood to develop heart failure. Interestingly, heart rate, systolic and diastolic chamber volume and diameters, stroke volume, and cardiac output showed no differences between the groups (p&gt;0.05). Conclusions: Together, these results suggest that prolonged exposure to increased cytosolic ROS in coronary EC results in worse cardiac performance and myocardial stiffness, leading to a higher propensity to heart failure after MI. Currently, in vivo signaling studies are being carried out to understand molecular mechanisms by which NOX2-derived ROS in ECs result in impaired cardiac function.
Sustainable Development Goals relevant to kidney health: an update on progress
Authors: Valerie A. Luyckx, Ziyad Al-Aly, Aminu K. Bello, Ezequiel Bellorin-Font, Raul G. Carlini, June Fabian, Guillermo Garcia-Garcia, Arpana Iyengar, Mohammed Sekkarie, Wim van Biesen, Ifeoma Ulasi, Karen Yeates, John Stanifer
Journal: Nature Reviews Nephrology (2020)
Abstract 13797: Enabling Advanced Real-world Evidence in Heart Failure: A Pilot Study Defining Preferred Approaches to Electronic Health Record Data Use
Authors: Dan Riskin, Keri L Monda, Ricardo Dent, A. Reshad Garan
Journal: Circulation (2020)

Introduction: Real world evidence (RWE) is increasingly used for regulatory and market access decision-making. In heart failure (HF), typical structured datasets have limitations in data accuracy and identifying relevant patient characteristics. Understanding which characteristics require enhancement from unstructured data and how to validly apply extraction methods will improve the definition of complex patient cohorts. Hypothesis: Augmenting structured with unstructured electronic health record (EHR) data may overcome challenges in accurately identifying relevant HF patient characteristics. Methods: Using EHR data from 4,288 primary care encounters, 20 clinical concepts were defined a priori by 3 HF experts. A reference standard was generated through chart abstraction, with each record reviewed by at least two annotators. Inter-rater reliability (IRR) was measured by Cohen’s kappa. EHR structured data (EHR-S) extracted with traditional query techniques and EHR unstructured (EHR-U) data extracted with artificial intelligence (AI) technologies were tested for accuracy against the reference standard. Results: In EHR-S, recall ranged from 0-95.1% and precision from 52.9-100%. In EHR-U data processed using AI, recall ranged from 80.4-99.7% and precision from 82.3-100%. Results demonstrated a 45.1% absolute difference and 98.1% relative increase in F1-score (Table). Reference standard IRR was 95.3%. Conclusions: RWE credibility and applicability relies on accurate identification of a patient cohort. This study suggests that readily available data sources may not accurately identify patient phenotypes in HF. Novel means of using AI with EHR-U may improve such efforts, particularly for conditions and symptoms. This approach offers a pathway for defining highly accurate HF cohorts that may be useful in studies with narrowly defined or complex phenotypes, such as those where inclusion and exclusion criteria are specific and outcomes require validity.
Abstract 17222: MRSA Infection is Associated With Worse Outcomes After Device Infection
Authors: MUHAMMAD ZUBAIR KHAN, Kay Khine, Heath Saltzman, Steven P Kutalek, Ashwani Gupta
Journal: Circulation (2020)

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is more virulent compared with other bacteria. Data regarding outcomes after transvenous lead extraction (TLE) for device infection with various staphylococcal and non-staphylococcal species are lacking Hypothesis: We hypothesized that MRSA infection is associated with worse outcomes after TLE for device infection compared with other infections Methods: We collected data for all patients undergoing TLE for infectious indication between April 2004 and June 2015. Patients were divided into 5 groups- group 1 had MRSA infection, group 2 had methicillin-sensitive Staphylococcous aureus (MSSA), group 3 had coagulase-negative Staphylococcus (CoNS), group 4 had non-staphylococcal infection and group 5 were culture negative. Results: Out of total 700 TLE procedures for infectious indication, 134 (19.1%) had MRSA, 143 (20.4%) had MSSA, 229 (32.7%) had CoNS, 109 (15.6%) had other bacterial infections and 59 (8.4%) were culture negative. Pocket infection was more commonly associated with CoNS (40.3%) and negative cultures (18.2%). Systemic infection was unlikely to be associated with negative cultures (2.9%) and equally distributed among other 4 groups.There was no difference in procedural outcomes between the groups. Complications during hospital stay were equally common with MRSA, MSSA and CoNS infections (22.5%, 27.2%, 24.9%, respectively) and less common with other infections (16.2%) and culture negative group (9.2%). Kaplan-Meier survival curves showed worse mortality with MRSA, compared with other infections. MRSA and MSSA have similar worse mortality up to 9 months, after which curves diverge and continue to diverge up to 4 years follow up. Conclusions: MRSA and MSSA infections are associated with worse mortality up to 9 months after TLE for device infection. After 9 months, MRSA infection is associated with worse mortality and curve continues to diverge up to 4 years follow-up.
Abstract 16541: Clinical and Imaging Phenotypes From a Registry of Segmental Arterial Mediolysis
Authors: Arvind K Pandey, Marie Gerhard-Herman
Journal: Circulation (2020)

Background: Segmental arterial mediolsyis (SAM) is a non-inflammatory arteriopathy that is increasingly being recognized; however, its clinical characteristics and natural history remain poorly defined. Methods: A retrospective, single-institution review of 20 patients presenting with arterial dissection, intramural hematoma, aneurysm, or occlusion between 2015 and 2020 was performed. To establish a non-invasive diagnosis of SAM, patients with FMD, inflammatory, or genetic arteriopathy were excluded by clinical, laboratory, and imaging criteria according to multidisciplinary guidelines. Patient demographics, clinical features, imaging findings, and management were assessed. Results: The average age of patients was 56 years; 75% were male. CAD was present in 15% of patients and 45% had hypertension; 55% were current or prior smokers. In patients without diagnosed CAD, the 10-year ASCVD risk score was 8.7% and the Framingham risk score was 6.8%. The average hemoglobin A1c was 5.6%. Acute onset abdominal pain (70%) was the most frequent presenting symptom. On average, two different arterial beds were affected at the time of diagnosis, most often in the abdomen. Arterial dissection was present in 75% of patients, and intramural hematoma was seen in 35% of cases. The most affected vessel was the superior mesenteric artery (50%), followed by the celiac, renal, and iliac arteries (35% each). Over a mean follow-up period of 20 months, all patients survived; two patients required intervention due to worsening clinical symptoms. Anticoagulation (AC) was utilized in 50% of cases, most commonly for one month. Long-term follow-up imaging was available in 11 patients; 3 patients (27%) had progression in lesion size over the first month. By 1 year, only 1 patient continued to show enlargement, with all others showing regression. Conclusions: This cohort provides longitudinal follow-up on both clinical and imaging characteristics of non-invasively diagnosed SAM. The condition shows a male predominance, typically manifesting in middle-aged patients with low to intermediate cardiovascular risk. While a subset of patients shows growth in size of the affected vascular segment over the first month, longer follow-up imaging demonstrates regression.
Abstract 16333: Racial Differences in Pressure-volume Relationships in Val122Ile Associated Cardiac Amyloidosis
Authors: Jaya Batra, iacopo olivotto, Mathew S Maurer
Journal: Circulation (2020)

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is the leading cause of restrictive cardiomyopathy in older adults. The valine-to-isoleucine substitution (Val122Ile) is the most common inherited variant in the U.S., primarily affecting patients of Afro-Caribbean descent. This variant has also been identified in white individuals in Northern Italy who present with a similar disease phenotype. It is unknown whether there are between-race differences in cardiac chamber function at diagnosis of Val122Ile associated ATTR-CA. Methods: In this retrospective study of 70 patients from two amyloid centers with Val122Ile associated ATTR-CA diagnosed over two decades, clinical and echocardiographic features at diagnosis were compared between races. Cardiac chamber performance was compared using noninvasive, single beat pressure-volume analysis. Results: Average age at diagnosis was 72 years. Compared to white patients (n=17), black individuals (n=53) had lower systolic blood pressure (110 vs. 131 mmHg , p&lt;0.001), reduced pulse pressure (41 vs. 58 mmHg, p&lt;0.001), and impaired renal function (eGFR 46 vs. 67 mL/min/1.73m 2 , p&lt;0.001) at the time of diagnosis. End-systolic pressure-volume relationship (2.3 vs. 1.9 mmHg/mL, p = 0.88), and arterial elastance (3.0 vs. 3.0 mmHg/mL, p = 1.0) were similar between groups (Panel A). Black patients had an end-diastolic pressure-volume relationship shifted upward and leftward relative to white patients, indicating reduced left ventricular capacity. Accordingly, pressure-volume area at a left ventricular end-diastolic pressure of 30 mmHg was lower in black compared to white individuals (8,415 vs. 11,538 mmHg*mL, p = 0.012, Panel B). Conclusion: Despite presenting at a similar age to white patients, black individuals with Val122Ile associated ATTR-CA have a greater degree of cardiac remodeling which drives reduced overall chamber function. These findings suggest a more aggressive disease phenotype.
Network medicine in <i>Cardiovascular Research</i>
Authors: Laurel Y Lee, Arvind K Pandey, Bradley A Maron, Joseph Loscalzo
Journal: Cardiovascular Research (2020)

Abstract The ability to generate multi-omics data coupled with deeply characterizing the clinical phenotype of individual patients promises to improve understanding of complex cardiovascular pathobiology. There remains an important disconnection between the magnitude and granularity of these data and our ability to improve phenotype–genotype correlations for complex cardiovascular diseases. This shortcoming may be due to limitations associated with traditional reductionist analytical methods, which tend to emphasize a single molecular event in the pathogenesis of diseases more aptly characterized by crosstalk between overlapping molecular pathways. Network medicine is a rapidly growing discipline that considers diseases as the consequences of perturbed interactions between multiple interconnected biological components. This powerful integrative approach has enabled a number of important discoveries in complex disease mechanisms. In this review, we introduce the basic concepts of network medicine and highlight specific examples by which this approach has accelerated cardiovascular research. We also review how network medicine is well-positioned to promote rational drug design for patients with cardiovascular diseases, with particular emphasis on advancing precision medicine.
Abstract 16677: Real World Screen Failure Rates for Transcatheter Mitral Valve Repair and Replacement for Mitral Regurgitation
Authors: Lowell Safren, Nayeem Nasher, Gemma Reddin, Brian Forrestal, Jaffar Khan, Brian C Case, Erin Collins, itsik ben-dor, Christian Shults, Lowell F Satler, Toby Rogers, Ron Waksman
Journal: Circulation (2020)

Background: Despite an expanding armamentarium of devices, many patients with mitral regurgitation referred for transcatheter mitral valve repair or replacement are not eligible to participate in the clinical trials or receive a commercially available device. We sought to understand the reasons why patients were excluded from receiving therapy. Methods: We retrospectively analyzed the medical charts, and correspondence related to patients referred to our tertiary valve center for transcatheter mitral valve replacement (TMVR) or transcatheter mitral valve repair (TMVr) between June 2016 to September 2019. Patients were screened for eligibility by our structural Heart Team for either TMVR or TMVr. If TMVR or TMVr was not offered the reason for screen failure was recorded and categorized. Results: Over the 3-year period, 564 patients were referred for TMVR/TMVr. Of these, 15.9% were determined to be eligible for and underwent surgical repair or replacement. 440 patients (78.0%) were considered for TMVR/TMVr. 92 patients (16.3%) underwent TMVR/TMVr. The majority of patients (348/564, 61.7%) ultimately did not undergo intervention (Panel A). The reasons for exclusion were clinical in 78%, issues related to patient preference of care delivery in 49% of patients, anatomical in 37% and futility in 25% of patients (Panel B). Conclusions: The majority of patients with mitral regurgitation referred for transcatheter mitral therapy are excluded for a variety of reasons. Clinical trials testing new transcatheter mitral valve devices should be encouraged to follow patients who are excluded to better understand optimal timing of intervention, address challenging anatomies, and ultimately improve penetrance of these novel therapies.
Abstract 14331: Patient Outcomes Enhanced by Partner Involvement in Social Cognitive Interventions After an Initial Implantable Cardioverter Defibrillator
Authors: Jon AULD, Frances Elaine Thompson, Cynthia M Dougherty
Journal: Circulation (2020)

Background: Research points to reciprocal influences that patients and partners may have on one another’s recovery in cardiac illness, yet interventions to enhance recovery after an implantable cardioverter defibrillator (ICD) are usually directed only toward the patient. Purpose: To compare 2 social cognitive (SC) intervention conditions (patient only or P-only, and patient + partner or P+P) from the Patient + Partner RCT. Patient physical symptoms and depression were compared with partner caregiver burden over 12 months post initial ICD. Methods: The study included 301 patient-partner dyads (151=P-only; 150=P+P) who participated in 1 of 2 nurse-led SC interventions delivered by telephone in the first 3 months after the patient received an ICD. Patient symptoms were measured with the PCA, depression with the PHQ-9, and partner caregiver burden with the OCBS, at baseline, 3, 6, and 12 months. Parallel process growth modeling and mixed effects models were used to compare intervention outcomes. Results: Patients were on average 64±12 years old, male (74%), white (91%), and most received an ICD for primary prevention (60%). Partners were on average 62±12 years, female (74%), and white (88%). In the first 3 months, decline in patient depression was significantly associated with decline in partner caregiver burden in P+P (β=0.93; p&lt;0.001), but not in P-only (β= -0.14; p=0.54). Decline in physical symptoms was more strongly associated with decline in partner caregiver burden in P+P (β=0.93, p&lt;0.001) than P-only (β=0.58, p=0.02). At 3 months, there were no significant differences in patient physical (p=0.59) and depressive symptoms (p=0.27) for P+P vs P-only. Partner caregiver burden was significantly lower in P+P vs P-only (p=0.01). At 12 months, patient physical and depressive symptoms and partner caregiver burden were significantly lower in P+P vs P-only (p=0.043, p=0.008, p=0.001, respectively). Conclusion: A SC intervention that included intimate partners (P+P) showed greater reductions in patient physical and depressive symptoms and partner caregiver burden and reflected greater reciprocal influence than the P-only intervention. Dyadic SC interventions can provide added support for patients after an ICD and may improve partner caregiver burden.
Abstract 16745: Effect of the Baseline Use of Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin-Receptor Blockers (ARBs) on Outcomes of Patients With Suspected or Positive COVID-19 Infection
Authors: Joseph B Muhlestein, Kirk U Knowlton, Heidi T May, Stacey Knight, Tami L Bair, Viet T Le, Benjamin D Horne, Jeffrey L Anderson
Journal: Circulation (2020)

Introduction: SARS-CoV-2 requires the ACE-2 receptor to gain cellular entry, leading to concerns as to whether the use of ACEIs/ARBs may adversely affect patients (pts) exposed to the virus. Because of the potential for multiple confounding variables, determining their real impact through observational study may require the use of a carefully adjusted dataset. Methods: We collected data, including baseline characteristics and medication use, on 104,018 pts tested at Intermountain Healthcare for SARS-CoV-2 up to June 8, 2020, and determined their hospitalization and intensive care unit (ICU) admission status. We used multivariable regression analysis to ascertain the independent effect of the baseline use of ACEIs or ARBs on the risk of each outcome. Results: Tables 1 and 2 show baseline characteristics, including the use of ACEIs/ARBS, of test-positive versus -negative pts and, among test-positive pts, who did or did not require hospitalization and ICU care, respectively. In the entire cohort, test-negative pts were more likely to have multiple comorbidities and on ACEIs/ARBs. In the test-positive group, hospitalized patients were more likely to have comorbidities and to be taking ACEIs/ARBs. However, after multivariable adjustment, the baseline use of ACEIs/ARBs was associated with a reduced likelihood of being test-positive (OR=0.87, p=0.04), a reduced need for hospitalization (OR = 0.58, p=0.004), and a numerically reduced need for ICU placement (OR = 0.74, p=0.32). Conclusions: Selection bias regarding viral testing likely influenced the baseline characteristics of the entire tested population. Test-positive patients requiring hospitalization also had more comorbidities and used more ACEIs/ARBs. However, after multivariable adjustment, because of a strong correlation with comorbidities, the use of ACEIs/ARBs became associated with a reduced need for hospitalization and ICU admission. These findings provide further evidence of ACEI/ARB safety.