tbuckley/cabot-search huggingface dataset:
Abstract 14068: One-year Outcomes of Dpp-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching From Data of Multicenter Registry -
Authors: Takehiro Hata, Kentaro Jujo
Journal: Circulation (2020)

Introduction: Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i). Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Results: Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B). Conclusion: Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.
Abstract 14159: Variation in Post-Acute Care Use and Spending After Cardiac Surgery
Authors: Michael P Thompson, Sudipta Dasmunshi, John D Syrjamaki, Scott E Regenbogen, James M Dupree, Francis D Pagani, Donald S Likosky
Journal: Circulation (2018)

Introduction: The use of post-acute care (PAC) after cardiac surgery, such as rehabilitation, skilled nursing facilities (SNFs), and home health care, is common and expensive. Understanding variati...
Association of Highly Restrictive State Abortion Policies With Abortion Rates, 2000-2014
Authors: Benjamin P. Brown, Luciana E. Hebert, Melissa Gilliam, Robert Kaestner
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Although abortion is common in the United States, patients face substantial barriers to obtaining an abortion. Recently enacted abortion restrictions pose such barriers. <h3>Objectives</h3> To assess the association between a state legislative climate that is highly restrictive toward abortion provision and the abortion rate and to evaluate whether distance to a facility providing abortion care mediates the association between legislative climate and the abortion rate. <h3>Design, Setting, and Participants</h3> This cohort study examined county-of-residence abortion rates from all states that publicly provided them and used data on abortion restrictions, facility locations, and county demographic characteristics for the years 2000 to 2014. The association between legislative climate and abortion rates was evaluated using propensity score–weighted, linear regression difference-in-difference analysis. All models included state and year fixed effects and standard errors adjusted for state-level clustering. <h3>Exposures</h3> Highly restrictive legislative climate, defined as having at least 3 of 4 types of abortion restrictions; distance to a high-volume facility providing abortion care (ie, performing ≥395 abortions per year) in miles. <h3>Main Outcomes and Measures</h3> County-level abortion rate, defined as abortions per 1000 women per year. <h3>Results</h3> Abortion rate data were obtained from 1178 counties in 18 states for a median of 12.5 years (range, 5-14). The median abortion rate was 2.89 per 1000 women (interquartile range, 1.71-4.46 per 1000 women). A highly restrictive legislative climate, when compared with a less restrictive one, was associated with 0.48 fewer abortions per 1000 women (95% CI, −0.92 to −0.04 abortions per 1000 women;<i>P</i> = .03). Adjusted for distance to a facility providing abortion care, a highly restrictive legislative climate was associated with 0.44 fewer abortions per 1000 women (95% CI, −0.85 to −0.03;<i>P</i> = .04). Each mile to a facility was associated with 0.02 fewer abortions per 1000 women (95% CI, −0.03 to −0.01 abortions per 1000 women;<i>P</i> = .003). Legislative climate was not significantly associated with distance to a facility providing abortion care (change in distance associated with highly restrictive climate, −2.73 [95% CI, −6.02 to 0.57] miles;<i>P</i> = .10). <h3>Conclusions and Relevance</h3> This study provides evidence that a state legislative climate that is highly restrictive toward abortion provision is associated with a lower abortion rate. The cumulative effect of restrictive policies may pose a barrier to abortion access.
Abstract 13804: Clinical Profile and Outcomes of Myocardial Infarction With Non-obstructive Coronary Arteries in Older Adults
Authors: Ara H Rostomian, Derek Q Phan, Mingsum Lee, Ray X Zadegan
Journal: Circulation (2020)

Introduction: Myocardial Infarction with non-obstructive coronary artery disease (MINOCA) is found in 5%-6% of patients with acute myocardial infarction (AMI). As such, the diagnosis and management of AMI patients with non-obstructive coronary artery disease (NOCAD) poses a challenge as compared to patients with MI with coronary artery disease (MICAD). Hypothesis: To evaluate the characteristics and outcomes of MINOCA in older patients as compared with MICAD patients, with and without revascularization. Methods: This was a retrospective observational study of patients ≥80 years old who underwent invasive coronary angiography (ICA) for AMI between 2009-2019 at Kaiser Permanente Los Angeles Medical Center. MINOCA was defied as &lt;50% stenosis of coronary arteries on angiography with a troponin level ≥0.05 ng/ml. Patients with MINOCA vs MICAD were compared. Multivariate logistic regression was used to identify independent predictors of MINOCA and Kaplan-Meier survival analysis was used to analyze all-cause mortality between cohorts. Results: A total of 259 patients with MINOCA (mean ± SD age 83.8±2.7 years, 68% female) and 687 patients with MICAD (84.7±3.4 years, 40% female) were analyzed. Younger age (odds ratio [OR]=1.11; 95% confidence interval [CI]=1.05-1.18), female sex (OR=3.14; CI=2.20-4.48), black race (OR=2.53; CI=1.61-3.98), no history of prior stroke (OR=1.56; CI=1.06-2.33), atrial fibrillation or flutter (OR=2.04; CI:1.38-3.02), lower troponin levels (OR=1.08; CI:1.03-1.11), and lower triglyceride levels per 10 mg/dl increments (OR=1.06; CI:1.03-1.11) increased the odds of having MINCOA as compared to MICAD. At median follow-up of 2.4 years, MINOCA was associated with a lower rate of death (44.8% vs 55.2%, p&lt;0.01) compared to un-revascularized MICAD, but no difference (31.3% vs 40.4%, p=0.68) when compared to re-vascularized MICAD. Conclusions: Patients age ≥80 years with MINOCA have fewer traditional risk factors compared to their counterparts with MICAD and fewer deaths compared to un-revascularized MICAD, but similar mortality compared to revascularized MICAD
Cooperative group for fogo selvagem research - endemic pemphigus foliaceus in western parana, brazil (1976-1988)
Authors: J C Empinotti, L A Diaz, Ciro Roberto Martins, Evandro Ararigbóia Rivitti, S. A. P. Sampaio, C Lombardi, J A Sanches
Journal: British Journal of Dermatology (1990)
Abstract 13276: Dyad Gender and Relationship Quality Are Related to Heart Failure Self-care Maintenance
Authors: Michael A Stawnychy, Ercole Vellone, Valentina Zeffiro, Barbara J Riegel
Journal: Circulation (2020)

Background: Self-care, a process of health maintenance, monitoring and symptom management, improves morbidity and mortality in adults with HF. Caregivers are important in promoting patient self-care but little is known about the effect of relationship quality (RQ) on HF patient self-care, especially in same and mixed gender dyads. Aim: Quantify the contribution of dyadic gender and RQ on HF patient self-care maintenance. Methods: Secondary analysis of baseline data from a study of Italian adults with HF and their caregivers ( n =503). Dyads were enrolled to assess effectiveness of motivational interviewing on HF self-care maintenance measured with the Self-Care of Heart Failure Index v.6.2, validated in an Italian population. RQ was assessed with the Mutuality Scale, validated for HF patients and caregivers. Dyadic gender was categorized as Male-Male (M-M), Female-Male (Fpt-Mcg), Female-Female (F-F), and Male-Female (Mpt-Fcg; reference group). Univariate linear regression with backward elimination ( p &lt;.05) was used to identify determinants of HF patient self-care maintenance. Results: The sample was 48% Mpt-Fcg, 27% F-F, 15% Fpt-Mcg, 10% M-M. Mpt-Fcg dyad patients were married (86%); with older (59±15 years), less educated (46% secondary or lower) spousal caregivers (66%). More F-F vs M-M patients lived alone (32% vs 4%). Determinants of better patient self-care were: living alone, receiving assistance for HF, better mental quality of life, patient and caregiver employment, caregiver married status, higher caregiver perceived social support, and more months caring for the patient. Dyad gender, RQ, and these covariates explained 23% of variance in patient self-care maintenance. Dyad gender independently contributed to self-care, but only for same gender dyads. Being in a M-M dyad was associated with higher patient self-care (ß=.52, p &lt;.026). Better caregiver perception of RQ in both M-M and F-F dyads was associated with lower patient self-care (M-M: ß=-.97, p &lt;.001; F-F: ß=-.55, p &lt;.026). There were no significant interactions for patient RQ or mixed gender dyads. Conclusion: Dyadic relationship quality appears to be important for self-care, particularly in M-M dyads and should to be considered when working with HF patients and their caregivers.
Exploration of Factors Associated With Surgeon Deviation From Practice Guidelines for Management of Inguinal Hernias
Authors: Anne P. Ehlers, C. Ann Vitous, Anne Sales, Dana A. Telem
Journal: JAMA Network Open (2020)

Despite availability of evidence-based guidelines for surgery, many patients receive guideline-discordant care. Reasons for this are largely unknown. For example, evidence-based guidelines recommend a minimally invasive approach for persons with bilateral or recurrent unilateral inguinal hernias. Benefits are also noted for primary unilateral inguinal hernia. However, findings from previous quantitative research indicate that only 26% of patients receive this treatment and only 42% of surgeons offer a minimally invasive approach, even for recurrent or bilateral hernias.To explore factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care.Qualitative study performed as part of a larger explanatory sequential mixed methods design. Purposive sampling was used to recruit 21 practicing surgeons from a large statewide quality collaborative who were diverse with regard to practice type, geographic location, and surgical specialty. Qualitative interviews consisted of a clinical vignette, followed by semi-structured interview questions. Through thematic analysis using qualitive data analysis software, patterns within the data were located, analyzed, and identified. All data were collected between April 24 and July 31, 2018.Clinical vignette as part of the qualitative interviews.Capture of surgical approaches and factors motivating decision-making for inguinal hernia repair.Of the 21 participating surgeons, 17 (81%) were men, 18 (86%) were White, and all were 35 years of age or older. Data revealed 3 dominant themes: surgeon preference and autonomy (eg, favoring one approach over the other), access and resources (eg, availability of robot), and patient characteristics (eg, age, comorbidities).Decision-making for the approach to inguinal hernia repair is largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. Addressing surgeon preference and available resources with a clinician-facing decision aid may provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
Unanticipated buried endoscopic ultrasound-guided lumen-apposing metal stent for gastroenterostomy concerning for potential dehiscence
Authors: Irving Waxman, Christopher G. Chapman, Uzma D. Siddiqui, Jeffrey B. Matthews
Journal: Endoscopy (2020)

A 55-year old man presented with a gastric outlet obstruction from metastatic duodenal cancer. Given his poor performance status from malnutrition, we decided to perform an endoscopic ultrasound (EUS)-guided gastroenterostomy with a lumen-apposing metal stent (LAMS). The procedure was performed successfully utilizing nasojejunal water irrigation and free-hand deployment of a 15-mm cautery-enhanced LAMS through the antrum ([Fig. 1]). The patient was discharged the following day tolerating oral intake. He developed a biliary obstruction 1 month later and EUS-guided choledochoduodenostomy was performed. During this endoscopy, the previously placed LAMS was noted to be completely buried within the gastric wall with purulent material oozing from the embedded margin ([Video 1], [Fig. 2], [Fig. 3]). Given the concern for separation between lumens, a through-the-scope 18 mm × 6 cm long, fully covered metal stent was placed through the LAMS and oriented along the jejunal lumen. Three months later, the patient remains asymptomatic, maintaining weight and undergoing chemotherapy.
Inflammatory bowel disease in developing tropical countries: abdominal pain caused by Ascaris lumbricoides diagnosed with single-balloon enteroscopy
Authors: Alejandra Tepox-Padrón, Melanie Figueroa, Norberto Sánchez-Fernández, Félix I. Tellez-Avila
Journal: Endoscopy (2020)

A 36-year-old woman with no significant medical history presented with abdominal pain. She was admitted to emergency. An upper endoscopy was performed showing erosive gastritis and duodenitis. She was discharged with a proton pump inhibitor (PPI) without improvement. A computed tomograph (CT) and magnetic resonance imaging (MRI) cholangiopancreatography were performed; enlargement of the pancreas suggestive of autoimmune pancreatitis was observed ([Fig. 1]) but serum IgG4 levels were normal. She was referred to our hospital. Biochemical analysis showed blood eosinophilia. An expert radiologist reviewed the previous imaging studies and confirmed the suspicion of autoimmune pancreatitis, but segmental jejunal wall thickening was observed. Endoscopic ultrasound (EUS) was done, ruling out autoimmune pancreatitis. Because of previous findings in MRI, MRI enterography was indicated and multiple focal small bowel-wall thickening areas were observed ([Fig. 2]) with a presumptive diagnosis of Crohn’s disease. A single-balloon enteroscopy (SBE) was carried out for tissue samples. During SBE, a roundworm was identified ([Video 1]) and extracted ([Fig. 3]). It was finally identified as Ascaris lumbricoides. Oral albendazole therapy was prescribed. The abdominal pain resolved after treatment.
Abstract 13311: Cyclocreatine Phosphate: A Novel Mechanism for Preventing Development of Heart Failure
Authors: Salwa A Elgebaly, Charles Van Buren, Robert Todd, Robert Poston, Mostafa A Rabie, Ahmed F Mohamed, Lamiaa A Ahmed, Nesrine S El Sayed
Journal: Circulation (2020)

Introduction: Demand ischemia causes irreversible myocardial injury (MI) through exhaustion of cellular adenosine triphosphate (ATP). We demonstrated that enhancing myocardial ATP stores during ischemia using Cyclocreatine Phosphate (CCrP), prevents myocardial injury and maintains cardiac contractility in a variety of models. The FDA has granted CCrP Orphan Drug Status with the designation of “ Prevention of Ischemic Injury to Enhance Cardiac Graft Recovery and Survival in Heart Transplantation ” . Hypothesis: CCrP administration will prevent ischemic injury and the subsequent development of heart failure in standard isoproterenol (ISO) rat model. Methods: 20 male Wistar rats (180-220 g) were used: ISO/saline (n=6), ISO/CCrP 0.8 gm/kg/day (n=5), control/saline (n=5), control/CCrP 0.8 gm/kg/day (n=4). Rats were injected S.C. with ISO for two consecutive days at doses of 85 and 170 mg/kg/day, respectively, then left for 2 weeks. CCrP and saline were injected IP (1 ml) 24 hours and 1 hour before ISO administration, then daily for 2 weeks. Serum CK-MB (U/L) measured 24 hours after last ISO injection. After 14 days, ECHO analysis for Ejection Fraction (EF%) was conducted, as well as heart weight (mg), fibrosis and deposition of collagen. Mean ± S.E.M and one-way ANOVA analysis were used. Results: Table I shows evidence of MI after 24 hours by high elevation of CK-MB in ISO rats, while significant protection was seen in ISO/CCrP rats. After 14 days, ISO/CCrP rats showed normal EF% and heart weight, while ISO/saline rats showed significant drop in EF% and an increase in heart weight. Blinded pathology indicated marked increase of fibrin and collagen deposition in ISO/saline rats, which were not seen in ISO/CCrP rats. Healthy rats treated with CCrP for 14 days, showed no toxicity in liver and renal function. Conclusions: The bioenergetic Cyclocreatine Phosphate is a promising first-in-class cardio-protective drug that prevents the development of heart failure due to ischemia.
Abstract 17385: Soluble CD163 Predicts Myocardial Fibrosis in People Living With Human Immunodeficiency Virus Infection: Myocardial and Coronary Abnormalities in HIV Infection (MACHIN) Study
Authors: April Banayan, Pavan Reddy, Arazin Minasian, Ahsan Javed, Samuel Valencerina, Krishna Nayak, Michael P Dube, Hossein Bahrami
Journal: Circulation (2020)

Background: Soluble CD163 (sCD163) is a scavenger receptor that is shed during inflammation and monocyte/macrophage activation and appears to be useful in resolution of the inflammation. This marker has been associated with increased mortality and morbidity in several inflammatory conditions. Hypothesis: sCD163 levels are related to myocardial fibrosis (MF) in people living with HIV infection (PLWH) and controls. Methods: sCD163 levels were measured in serum samples of 92 participants (54 PLWH and 38 HIV- controls, mean age 47±14 years, 28% female).. Myocardial structure and function were assessed using CMR (GE 3.0T; acquisition: RT-Hawk, Heart Vista Inc; analysis: cvi42, Circle Inc, v5.10). Our protocol included cine, pre-contrast, 12-minute post contrast T1 mapping and LGE after infusion of 0.1mmol/kg of gadolinium (Multihance). 12-minute ECV (extra cellular volume) maps were generated from T1 maps. Results: We studied 40 PLWH and 28 HIV- controls (mean age 45±14 years, 46% men). HIV-positive individuals had significantly higher levels of sCD163, compared to controls ( mean±SD: 78±6 versus 54±5 ng/dL, p-value&lt;0.01). The association of sCD163 with diffuse fibrosis detected by ECV was modified by HIV infection (p-value for interaction term: 0.05). log-sCD163 levels were significantly associated with ECV in PLWH (regression coefficient: 9, 95% CI:2-15, p:0.01), but not in controls (p:0.74). The significant association of sCD163 with ECV remained significant even after adjusting for age, gender, race, and LVEF (p:0.02) and even after adding history of protease inhibitor and abacavir use to the models (p:0.02). But after adding both nadir CD4 and highest viral load to the above model, the association was not significant (p:0.08). LGE was not significantly associated with sCD163 levels. Conclusions: Soluble CD163, as a marker of monocyte/macrophage activation, is associated with increased diffuse subclinical MF, estimated by postcontrast ECV, in virologically-suppressed PLWH. Importantly, this association is independent of demographic factors, LV function, and ART medication use. These findings highlight the importance of chronic sustained inflammation in development of MF in PLWH.
Abstract 365: The Minnesota Mobile Extracorporeal Cardiopulmonary Resuscitation Consortium for Treatment of Out-of-hospital Refractory Ventricular Fibrillation: Program Description and Outcomes
Authors: Jason Bartos, Rj Frascone, Marc Conterato, Keith Wesley, Charles Lick, Kevin Sipprell, Nik Vuljaj, Nicholas S Simpson, Kealy Ham, Charles Bruen, Kim Harkins, Marinos Kosmopoulos, Tom P Aufderheide, Demetris Yannopoulos
Journal: Circulation (2020)

Background: Extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation has been shown to improve the survival rate for patients with refractory VF/VT cardiac arrest. However, survival decreases as CPR duration increases and metabolic derangement progresses. We describe here a first of its kind multi-healthcare system consortium to rapid deploy ECMO-facilitated resuscitation to patients across a metropolitan area. Methods: This retrospective cohort study analyzed 58 consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium’s ECMO-facilitated resuscitation program. Inclusion criteria included: 1) age 18 to 75 years, 2) VF/VT as presenting rhythm, 3) refractory cardiac arrest despite 3 shocks, 4) body habitus accommodating a LUCAS mechanical CPR device, 5) estimated transfer time of &lt; 30 min from a cannulating center. The consortium included multiple healthcare systems, dispatch services, and emergency medical services. Essential components included EMS, selection of 3 ECMO cannulation sites in geographically favorable emergency departments, a centralized ECMO center for post-arrest care, and a 24/7 mobile ECMO cannulation team. The cannulation team provided ECMO cannulation and medical care until the patient reached the ECMO center. Results: From December 1, 2019 to April 1, 2020, 58 consecutive patients were treated by the mobile ECMO team. Mean age was 57 ± 1.8 years. Of these, 25/58 (43%) were discharged from the hospital with neurologically favorable survival. Patients were cannulated at all three cannulation sites with transport to the nearest site leading to mean professional CPR time of 52 min. Conclusions: This represents the first community-wide ECMO-facilitated resuscitation program in the United States. A consortium including multiple healthcare systems and emergency medical services coordinated efforts to rapidly deliver patients with refractory VF/VT cardiac arrest to a highly trained and equipped mobile ECMO cannulation team resulting in improved neurologically favorable survival.
Pembrolizumab Antitumor Activity in Relapsed/Refractory Classical Hodgkin Lymphoma in Keynote-087: Revised Response Criteria for Malignant Lymphoma 2007 Criteria Versus Lugano 2014 Classification
Authors: Craig H. Moskowitz, Robert W. Chen, Philippe Armand, Pier Luigi Zinzani, Theodoros P. Vassilakopoulos, Gregory V. Goldmacher, Jianxin Lin, Akash Nahar, Arun Balakumaran, Gilles Salles
Journal: Blood (2017)
Preprint Servers’ Policies, Submission Requirements, and Transparency in Reporting and Research Integrity Recommendations
Authors: Mario Malicki, Ana Jeroncic, Gerben ter Riet, Lex M. Bouter, John P. A. Ioannidis, Steven N. Goodman, IJsbrand Jan Aalbersberg
Journal: JAMA (2020)

Harlan M. Krumholz, MD, SM; Theodora Bloom, PhD; Richard Sever, PhD; Claire Rawlinson, BSc; John R. Inglis, PhD; Joseph S. Ross, MD, MHS