tbuckley/cabot-search huggingface dataset:
Abstract 13193: Hispanics/Latinos Lack Access to Hospitals With Therapeutic Hypothermia Programs Following Out-of-Hospital Cardiac Arrest
Authors: Nicholas Morris, Michael Mazzeffi, Patrick McArdle, Teresa May, Greer Waldrop, Sarah A Perman, James F Burke, Steven M Bradley, Sachin Agarwal, Jose F Figueroa, Neeraj Badjatia
Journal: Circulation (2021)

Introduction: Variation exists in outcomes following out-of-hospital cardiac arrest (OHCA), but whether racial/ethnic disparities exist in post-arrest provision of therapeutic hypothermia (TH) is unknown. Hypothesis: Racial/ethnic disparities exist in the utilization of guideline-recommended TH following OHCA. Methods: We performed a retrospective analysis of a cohort of 96,695 patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~40% of the United States, from 2013 through 2019. Our primary exposure was race/ethnicity, and the primary outcome was utilization of TH. We performed a secondary analysis to assess for racial/ethnic disparities in the reasons why TH was not used (supplemental data element data available since 2016). Results: Among 96,695 patients [mean (SD) age 61.4 (16.3) years, 24.6% Black, 8.0% Hispanic/Latino, 63.4% White] that survived to hospital admission following OHCA, 54,687 (56.6%) did not receive TH. Using a mixed-effects model that adjusted for patient, arrest, neighborhood, and hospital factors with state of arrest modeled as a random intercept to account for clustering, we found that Hispanics/Latinos were less likely to receive TH than Whites (Odds Ratio [OR] 0.79, 95 % Confidence Interval [CI] 0.75-0.83). When the clustering variable was changed from the state of arrest to the admitting hospital, Hispanics/Latinos were more likely to receive TH (OR 1.07, 95% CI 1.00 to 1.14). In the 22,896 patients with data regarding why they did not receive TH, a higher percentage of Hispanics/Latinos compared to Blacks and Whites did not receive TH due to lack of a TH program at the hospital (4.0% vs. 2.5 % vs 1.8%, p &lt; .001). No disparity in TH utilization was found for Black patients. Conclusion: We found disparities in access to TH for Hispanics/Latinos following OHCA. Reassuringly, we did not find any disparity in TH utilization for Black patients.
Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study
Authors: Stephanie R. Johnson, Deborah J. Holmes-Walker, Melissa Chee, Arul Earnest, Timothy W. Jones
Journal: Diabetes Care (2021)

OBJECTIVE Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management; however, funding models vary. This study determined the uptake rate and glycemic outcomes following a change in national health policy to introduce universal subsidized CGM funding for people with type 1 diabetes aged &amp;lt;21 years. RESEARCH DESIGN AND METHODS Longitudinal data from 12 months before the subsidy until 24 months after were analyzed. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycemia, insulin regimen, CGM uptake, and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Service Scheme (NDSS) registry that includes almost all individuals with type 1 diabetes nationally. RESULTS CGM uptake increased from 5% presubsidy to 79% after 2 years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of &amp;lt;7.0% improved at 12 months (OR 2.5, P &amp;lt; 0.001) and was maintained at 24 months (OR 2.3, P &amp;lt; 0.001). The OR for suboptimal glycemic control (HbA1c ≥9.0%) decreased to 0.34 (P &amp;lt; 0.001) at 24 months. Of CGM users, 65% used CGM &amp;gt;75% of time, and had a lower HbA1c at 24 months compared with those with usage &amp;lt;25% (7.8 ± 1.3% vs. 8.6 ± 1.8%, respectively, P &amp;lt; 0.001). Diabetic ketoacidosis was also reduced in this group (incidence rate ratio 0.49, 95% CI 0.33–0.74, P &amp;lt; 0.001). CONCLUSIONS Following the national subsidy, CGM use was high and associated with sustained improvement in glycemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.
Impact of extending direct antiviral agents (DAA) availability in France: an observational cohort study (2015-2019) of data from French administrative healthcare databases (SNDS).
Authors: Stanislas Pol, Fayssoil Fouad, Magali Lemaitre, Ingrid Rodriguez, Olivier Lada, Pascaline Rabiega, Elias Benabadji, Françoise Roudot-Thoraval
Journal: The Lancet Regional Health - Europe (2021)

Direct antiviral agents (DAAs) became available in France in 2014 for the treatment of chronic hepatitis C (CHC) in patients with severe fibrosis (prioritized access); in 2017, DAAs became available to all CHC patients (universal access). We evaluated the impact of extending DAA availability on CHC patient care, especially on screening and time to treatment.
Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’
Authors: Oliver J Price, Nicola Sewry, Martin Schwellnus, Vibeke Backer, Tonje Reier-Nilsen, Valerie Bougault, Lars Pedersen, Bruno Chenuel, Kjell Larsson, James H Hull
Journal: British Journal of Sports Medicine (2021)

Objective To report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups. Design Systematic review and meta-analysis. Data sources PubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020). Eligibility criteria Original full-text studies, including male or female athletes/physically active individuals/military personnel (aged 15–65 years) who had a prior asthma diagnosis and/or underwent screening for lower airway dysfunction via self-report (ie, patient recall or questionnaires) or objective testing (ie, direct or indirect bronchial provocation challenge). Results In total, 1284 studies were identified. Of these, 64 studies (n=37 643 athletes) from over 21 countries (81.3% European and North America) were included. The prevalence of lower airway dysfunction was 21.8% (95% CI 18.8% to 25.0%) and has remained stable over the past 30 years. The highest prevalence was observed in elite endurance athletes at 25.1% (95% CI 20.0% to 30.5%) (Q=293, I 2 =91%), those participating in aquatic (39.9%) (95% CI 23.4% to 57.1%) and winter-based sports (29.5%) (95% CI 22.5% to 36.8%). In studies that employed objective testing, the highest prevalence was observed in studies using direct bronchial provocation (32.8%) (95% CI 19.3% to 47.2%). A high degree of heterogeneity was observed between studies (I 2 =98%). Conclusion Lower airway dysfunction affects approximately one in five athletes, with the highest prevalence observed in those participating in elite endurance, aquatic and winter-based sporting disciplines. Further longitudinal, multicentre studies addressing causality (ie, training status/dose–response relationship) and evaluating preventative strategies to mitigate against the development of lower airway dysfunction remain an important priority for future research.
Long-Term Follow-Up of DANISH (The Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality)
Authors: Adelina Yafasova, Jawad H. Butt, Marie B. Elming, Jens C. Nielsen, Jens Haarbo, Lars Videbæk, Line L. Olesen, Flemming H. Steffensen, Niels E. Bruun, Hans Eiskjær, Axel Brandes, Anna M. Thøgersen, Kenneth Egstrup, Finn Gustafsson, Christian Hassager, Jesper H. Svendsen, Dan E. Høfsten, Christian Torp-Pedersen, Steen Pehrson, Jens J. Thune, Lars Køber
Journal: Circulation (2021)

DANISH (The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators [ICDs] in Patients With Nonischemic Systolic Heart Failure on Mortality) found that primary-prevention ICD implantation was not associated with an overall survival benefit in patients with nonischemic systolic heart failure during a median follow-up of 5.6 years, although there was a beneficial effect on all-cause mortality in patients ≤70 years. This study presents an additional 4 years of follow-up data from DANISH.In DANISH, 556 patients with nonischemic systolic heart failure were randomized to receive an ICD and 560 to receive usual clinical care and followed until June 30, 2016. In this long-term follow-up study, patients were followed until May 18, 2020. Analyses were conducted for the overall population and according to age (≤70 and >70 years).During a median follow-up of 9.5 years (25th-75th percentile, 7.9-10.9 years), 208/556 patients (37%) in the ICD group and 226/560 patients (40%) in the control group died. Compared with the control group, the ICD group did not have significantly lower all-cause mortality (hazard ratio [HR] 0.89, [95% CI, 0.74-1.08]; P = 0.24). In patients ≤70 years (n = 829), all-cause mortality was lower in the ICD group than the control group (117/389 [30%] versus 158/440 [36%]; HR, 0.78 [95% CI, 0.61-0.99]; P = 0.04), whereas in patients >70 years (n = 287), all-cause mortality was not significantly different between the ICD and control group (91/167 [54%] versus 68/120 [57%]; HR, 0.92 [95% CI, 0.67-1.28]; P = 0.75). Cardiovascular death showed similar trends (overall, 147/556 [26%] versus 164/560 [29%]; HR, 0.87 [95% CI, 0.70-1.09]; P = 0.20; ≤70 years, 87/389 [22%] versus 122/440 [28%]; HR, 0.75 [95% CI, 0.57-0.98]; P = 0.04; >70 years, 60/167 [36%] versus 42/120 [35%]; HR, 0.97 [95% CI, 0.65-1.45]; P = 0.91). The ICD group had a significantly lower incidence of sudden cardiovascular death in the overall population (35/556 [6%] versus 57/560 [10%]; HR, 0.60 [95% CI, 0.40-0.92]; P = 0.02) and in patients ≤70 years (19/389 [5%] versus 49/440 [11%]; HR, 0.42 [95% CI, 0.24-0.71]; P = 0.0008), but not in patients >70 years (16/167 [10%] versus 8/120 [7%]; HR, 1.34 [95% CI, 0.56-3.19]; P = 0.39).During a median follow-up of 9.5 years, ICD implantation did not provide an overall survival benefit in patients with nonischemic systolic heart failure. In patients ≤70 years, ICD implantation was associated with a lower incidence of all-cause mortality, cardiovascular death, and sudden cardiovascular death. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00542945.
Abstract 11710: Poloxamer 188 Protects Coronary Artery Endothelial Cells After Extended Hypoxia and Reoxygenation in an in vitro Model of Simulated Ischemia/Reperfusion Injury
Authors: zhu li, Matthew J Hampton, Matthew B Barajas, Matthias L Riess
Journal: Circulation (2021)

Reperfusion restores blood flow after myocardial ischemia but can cause additional cellular injury by the sudden reintroduction of oxygen and nutrients. There is still no effective remedy for myocardial ischemia/reperfusion (IR) injury. Our previous study using cardiomyocytes (CMs) found that, after 3 hrs hypoxia followed by 2 hrs reoxygenation, viability decreased, and release of lactate dehydrogenase (LDH), calcium influx, membrane leakage (insertion of fluorescent probe FM1-43) significantly increased, indicating that cell membrane function was negatively affected. This was attenuated by the triblock copolymer Poloxamer (P)188. Here, we first hypothesized that endothelial cells are also susceptible to simulated IR injury, albeit requiring longer hypoxia times. We further hypothesized that P188 can also attenuate simulated IR injury in endothelial cells when given upon reoxygenation. Mouse coronary artery endothelial cells (MCAECs) were exposed to different durations of hypoxia (2, 3, 12 and 24 hrs) in serum- and glucose-free media +/- reoxygenation for 2 hrs in regular media. P188 was administered upon reoxygenation at 0, 100, 300 or 1,000 μM in experiments of 24 hrs hypoxia / 2 hrs reoxygenation. LDH release was measured and compared to appropriately timed normoxic control experiments. Reoxygenation and hypoxia times significantly longer than 3 hrs were required to elicit sufficient injury (panel A). When P188 was given upon reoxygenation after 24 hrs hypoxia, it dose-dependently attenuated LDH release (panel B). These findings contrast to the higher susceptibility of CMs to IR injury that only allowed shorter hypoxia durations. They also confirm a protective effect of P188 on the endothelium, not just on CMs. These findings have important implications for co-culture models with MCAECs and CMs to elucidate the interplay of both cell types on each other when studying mechanisms of cardioprotective strategies and compounds like P188.
Abstract 13076: Refractory Out-of-Hospital Cardiac Arrest in Patients With Pulmonary Embolism and Use of Extracorporeal Membrane Oxygenation: Prague OHCA Study Subanalysis
Authors: Jan Pudil, Jana Smalcova, Ondrej Smid, Daniel Rob, Michaela Hronova, Michal Huptych, Ondrej Franek, Petra Kavalkova, Dusík Milan, Jan Belohlavek
Journal: Circulation (2021)

Introduction: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) has poor outcome. Data about use of extracorporeal membrane oxygenation (ECMO) in PE are heterogenous and there is minimal evidence for its use in patients presenting with r-OHCA. Hypothesis: To describe in detail profile, initial settings of cardiac arrest (CA) and clinical course of patients with PE presenting with r-OHCA and its specifics in comparison to patients with r-OHCA of other cause. The special attention was paid to the use of ECMO and its potential benefit for patient prognosis. Methods: We reanalyzed subgroup of patients with PE from Prague OHCA study - a randomized control trial evaluating the effect of hyperinvasive approach including the use of ECMO in r-OHCA. Patients characteristics, the specifics of CA settings and the outcome were compared to the patients with other cause of r-OHCA. The neurologically favorable survival was then compared between PE patients randomized to Hyperinvasive and Standard arm of the study. Results: The PE was identified as a cause of CA in 24 (9.4 %) patients in Prague OHCA study. PE patients were more likely women (12 [50 %] vs 32 [13.8 %]) with non-shockable initial rhythm (23 [95.8 %] vs 77 [33.2 %]; P &lt; 0.0001). The CA occurs more frequently after arrival of emergency medical service (14 [58.3 %], vs 22 [9.5 %]; P &lt; 0.0001), had shorter time to hospital admission (median in minutes [IQR], 40 [34.5-57.8] vs 54 [46-64]; P = 0.01) with more severe acidosis at admission (median pH [IQR]; 6.83 [6.75-6.88] vs 6.98 [6.82-7.14] P = 0.0008). The primary outcome of patients with PE - CPC 1 or 2 at 180 days - was significantly worse (2 [8.3 %] vs 66 [28.4 %]; P = 0.049). There was non-significant difference in primary outcome - CPC 1 or 2 at 180 days - between PE patients in Hyperinvasive (12 [50%]) and Standard arm of the study (2 [16.7 %] vs 0; P = 0.24). Conclusion: The initial profile of patients and the settings of CA in patients with r-OHCA and PE differs from patients with other CA cause and their prognosis is significantly worse. The Hyperinvasive approach did not improved outcome in this subgroup of patients.
BiTE secretion from in situ-programmed myeloid cells results in tumor-retained pharmacology
Authors: S. Hao, V.V. Inamdar, E.C. Sigmund, F. Zhang, S.B. Stephan, C. Watson, S.J. Weaver, U.B. Nielsen, M.T. Stephan
Journal: Journal of Controlled Release (2021)

Bispecific T-Cell Engagers (BiTEs) are effective at inducing remission in hematologic cancers, but their use in solid tumors has been challenging due to their extreme potency and on-target, off-tumor toxicities in healthy tissue. Their deployment against solid tumors is further complicated by insufficient drug penetration, a hostile tumor microenvironment, and immune escape. To address these challenges, we developed targeted nanocarriers that can deliver in vitro-transcribed mRNA encoding BiTEs to host myeloid cells - a cell type that is actively recruited into the tumor microenvironment. We demonstrate in an immunocompetent mouse model of ovarian cancer, that infusion of these nanoparticles directs BiTE expression to tumor sites, which reshapes the microenvironment from suppressive to permissive and triggers disease regression without systemic toxicity. In contrast, conventional injections of recombinant BiTE protein at doses required to achieve anti-tumor activity, induced systemic inflammatory responses and severe tissue damage in all treated animals. Implemented in the clinic, this in situ gene therapy could enable physicians - with a single therapeutic - to safely target tumor antigen that would otherwise not be druggable due to the risks of on-target toxicity and, at the same time, reset the tumor milieu to boost key mediators of antitumor immune responses.
Factors Threatening Central Visual Function of Patients with Advanced Glaucoma
Authors: Kenji Sugisaki, Toshihiro Inoue, Keiji Yoshikawa, Akiyasu Kanamori, Yoshio Yamazaki, Shinichiro Ishikawa, Kenichi Uchida, Aiko Iwase, Makoto Araie, Makoto Araie, Atsuo Tomidokoro, Kenji Sugisaki, Asaoka Ryo, Hiroshi Murata, Hidenobu Tanihara, Masaru Inatani, Toshihiro Inoue, Keiji Yoshikawa, Akira Negi, Hidetaka Maeda, Akiuasu Kanamori, Yuko Nakanish, Yoshio Yamazaki, Kenji Mizuki, Satoshi Okinami, Ryo Iwakiri, Shinichirou Ishikawa, Shun Matsumoto, Kenichi Uchida, Koichi Mishima, Hodaka Nemoto, Aiko Iwase
Journal: Ophthalmology (2021)
COVID-19 vaccine equity and booster doses
Authors: None The Lancet Infectious Diseases
Journal: The Lancet Infectious Diseases (2021)

The debate on COVID-19 vaccine equity has been long-running, and we have previously weighed in on the topic. However, the facts that (1) by Aug 9, only 12·6 million of the 4·46 billion doses administered globally were in low-income countries, (2) 3·65 billion have been administered in high-income (HICs) and upper-middle-income countries, and (3) WHO Director-General Tedros Adhanom Ghebreyesus actually had to issue a plea for a moratorium on third-dose boosters in HICs on Aug 4, mean that we, again, need to add our voice to the demand for equitable access to vaccines.
Abstract 17074: Primary Cardiac Sarcoma In Elderly Patient And Need For High Index Of Suspicion
Authors: Mohammad Ahmed, Carly Maucione, Nathaniel Long, Ryan Wilson
Journal: Circulation (2021)

Case Presentation: Primary cardiac tumors are rare with an incidence between 0.0017 and 0.2%. Most cardiac tumors are benign such as myxomas, lipomas, and papillary fibroelastomas. Primary malignant cardiac tumors are even more uncommon, with cardiac sarcomas being the most common. We present a case of an 87-year old female who presented initially for progressive shortness of breath and concern for potential endocarditis vs intra-cardiac thrombus noted on outside hospital transthoracic echocardiogram. Blood cultures were negative, no leukocytosis or sequelae of infection were noted. Transesophageal echocardiogram (TEE) noted a large lesion attached to the anterior mitral leaflet, with additional lesions noted on the left atrial free wall just medial to the right sided pulmonary veins. Obstruction of mitral inflow was noted with a mean gradient through the mitral valve of 5mmHg. Cardiac MRI was performed for further delineation of lesions and based on tissue characteristics were felt to be thrombus (Figure 1). Hypercoagulability workup was negative, and there was no improvement in lesion size with systemic anticoagulation. Cardiothoracic surgery was consulted for surgical removal of the mass. Pre-operative cardiac catheterization showed multi-vessel obstructive coronary artery disease. It was also noted that the left circumflex artery appeared to supply blood into a discrete area in the left atrium. The patient was ultimately taken for surgical removal. Surgical pathology demonstrated primary high grade cardiac sarcoma. Discussion: The rarity and heterogeneity of primary cardiac tumors, along with many potential mimickers pose a diagnostic and therapeutic challenge. This, combined with the location and aggressive nature of the tumors, make them difficult to treat and incur a high mortality rate. This highlights the importance of maintaining a high index of suspicion and keeping a broad differential when evaluating intra-cardiac masses.
Abstract 12921: One Hand Open Palm Technique for Infant Cardiopulmonary Resuscitation: A Randomized Crossover Study
Authors: Shruti Patel, Shilpa Balikai, Timothy G Elgin, Elizabeth A Newell, Tarah T Colaizy, Madhavan L Raghavan, Dianne L Atkins, Sarah E Haskell
Journal: Circulation (2021)

Introduction: The American Heart Association (AHA) CPR guidelines states that effective chest compression depth, rate and recoil are essential factors for establishment of return of spontaneous circulation. A recent survey from an international pediatric resuscitation collaborative showed that healthcare providers failed to meet the metrics of the AHA guidelines, with the greatest difficulty in achieving targeted chest compression depth in infants. The recommended techniques for infant compression include two finger (TFT) or two-thumb technique (TTT). We hypothesized using the heel of one palm (open palm technique, OPT) in infants will result in improved chest compression depth with decreased provider fatigue. Methods: Each participant performed three techniques including TFT, TTT, and novel open-palm technique (OPT) with randomization for sequence of techniques for each participant. Each technique was performed for 2 minutes followed by a 5-minute rest period on an infant manikin. Data were collected through Zoll R series defibrillators on chest compression depth, rate, and fraction. At the end of the study, each participant filled out a survey for difficulty level, finger fatigue, and rescuer fatigue. Results: Thirty pediatric critical care providers participated in the study consisting of 16 nurses, 9 respiratory therapists, 3 fellows, 2 nurse practitioners. The mean chest compression depth for OPT was significantly deeper (2.61 ± 0.63 cm) in comparison to TFT (2.25 ± 0.54 cm, p= 0.0004) but not significantly deeper in comparison to TTT (2.43 ± 0.46 cm, p= 0.0820). There were no significant differences between the three techniques in chest compression rate or chest compression fraction. The finger fatigue and rescuer fatigue surveys were graded from 0-10 with 10 being the most fatigue. OPT showed significantly less finger and rescuer fatigue in comparison to TTT and TFT (p&lt;0.05). Conclusion: This study demonstrated that OPT generated improved chest compression depth with considerably less rescuer and finger fatigue. However, chest compression depth with all three techniques failed to meet the AHA infant goal of 4 cm. Further research is needed to optimize CPR performance to achieve the targeted chest compression depth in infants.
IGF1R-IRS1/2 Pharmacological Inhibitors Act By Distinct Cellular and Molecular Mechanisms and Reveals Vulnerabilities for Treatment of Acute Myeloid Leukemia
Authors: Juan L Coelho-Silva, Diego A Pereira-Martins, Virginia Campos Silvestrini, João Agostinho Machado-Neto, Eduardo M Rego, Marcus Smolka, Vitor Marcel Faca, Fabiola Traina
Journal: Blood (2021)
2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Authors: Jennifer S. Lawton, Jacqueline E. Tamis-Holland, Sripal Bangalore, Eric R. Bates, Theresa M. Beckie, James M. Bischoff, John A. Bittl, Mauricio G. Cohen, J. Michael DiMaio, Creighton W. Don, Stephen E. Fremes, Mario F. Gaudino, Zachary D. Goldberger, Michael C. Grant, Jang B. Jaswal, Paul A. Kurlansky, Roxana Mehran, Thomas S. Metkus, Lorraine C. Nnacheta, Sunil V. Rao, Frank W. Sellke, Garima Sharma, Celina M. Yong, Brittany A. Zwischenberger
Journal: Circulation (2021)