tbuckley/cabot-search huggingface dataset:
Abstract 14357: Straight for the Jugular: Cardiomyopathy After Recent EBV Infection and Lemierre Syndrome
Authors: Robert N Dangelo, Robert E GERSZTEN, Reshad Garan, Duane S Pinto, Jason Freed, Dhruv Kazi
Journal: Circulation (2020)

A 21-year-old man presented to an outside hospital with 10 days of fever, fatigue, and malaise. On exam, temperature was 106F, blood pressure 85/50 mm Hg, and heart rate 121 bpm. He was cold and clammy, with elevated jugular venous pressure, normal heart sounds, clear lungs, and cool extremities without edema. Laboratory results were notable for elevated white blood cell count (predominantly neutrophils), serum triglycerides, ferritin, C-reactive protein, coagulation parameters, and positive Monospot test. Following blood cultures, he was initiated on broad spectrum antibiotics, fluid resuscitated, and started on norepinephrine, epinephrine, and phenylepehrine. Shortly after transfer to our institution, although asymptomatic, an electrocardiogram demonstrated diffuse 5 mm ST-elevations with elevated cardiac biomarkers. A transthoracic echocardiogram demonstrated biventricular contractile dysfunction with ejection fraction 20% and apical akinesis. The patient was diagnosed with mixed cardiogenic and distributive shock. Cardiogenic shock was attributed to myocarditis with possible vasospasm or cytokine-induced myocardial suppression. Coronary angiogram was deferred given low suspicion for thrombotic acute coronary syndrome. Cardiac MRI showed subepicardial early and late gadolinium enhancement consistent with myocarditis, but negative viral serologies. Distributive shock was thought to be due to sepsis or hemophagocytic lymphohistiocytosis (HLH). The patient received empiric dexamethasone for HLH; and the diagnosis was confirmed on bone marrow biopsy. Blood cultures grew Fusobacterium necrophorum and neck imaging revealed thrombosis of the left internal jugular vein. Lemierre syndrome, thought to be bacterial invasion in the setting of tonsillitis was diagnosed. He was treated with antibiotics and dexamethasone with rapid clinical improvement and recovery of biventricular function. We suspect EBV infection lead to Lemierre syndrome and HLH with secondary myocardial suppression from the resultant cytokine storm. This case describes the first case of HLH-related myocarditis and highlights clinical decision-making surrounding the workup and management of mixed etiologies of shock with suspected myocarditis.
Biodegradable materials for bone defect repair
Authors: Shuai Wei, Jian-Xiong Ma, Lai Xu, Xiao-Song Gu, Xin-Long Ma
Journal: Military Medical Research (2020)

Abstract Compared with non-degradable materials, biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects, and have attracted extensive attention from researchers. In the treatment of bone defects, scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role, which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue. Traditional biodegradable materials include polymers, ceramics and metals, which have been used in bone defect repairing for many years. Although these materials have more or fewer shortcomings, they are still the cornerstone of our development of a new generation of degradable materials. With the rapid development of modern science and technology, in the twenty-first century, more and more kinds of new biodegradable materials emerge in endlessly, such as new intelligent micro-nano materials and cell-based products. At the same time, there are many new fabrication technologies of improving biodegradable materials, such as modular fabrication, 3D and 4D printing, interface reinforcement and nanotechnology. This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing, especially the newly emerging materials and their fabrication technology in recent years, and look forward to the future research direction, hoping to provide researchers in the field with some inspiration and reference.
Covid-19 test and trace: localised approach urgently needed
Authors: Michael Craig Watson, Anne Coufopoulos
Journal: BMJ (2020)

Iacobucci is correct to draw our attention to some of the major problems with England's test and trace system. 1 Crucially, any testing scheme needs to be carefully thought through and be part of a test, trace, isolate, and support system.Moreover, this needs to be part of an overarching public health strategy.The emphasis should not be on just aiming for high testing numbers, as this on its own will not tackle the virus and will not improve the health of the country.A high quality testing scheme would help us to know precisely the size of the current problem and to accurately pinpoint outbreaks. 2This information would support planning by local communities and national government and would let them know whether their past work had been successful.Directors of public health and their multidisciplinary teams are pivotal to the health of their communities. 3 They have detailed knowledge of their communities and longstanding relationships with key individuals and organisations. 4 5 We recommend that local directors of public health are put in the driving seat of the test, trace, isolate, and support system.Critically, however, they need to be given the resources to enable them to make it a success.Funds need to be redirected from a national level.There is still a need for national coordination and support of local public health professionals.We need a new national body led by elite public health professionals who are qualified and have extensive experience in public health.In the current situation we are having blanket lockdowns, and many people are being restricted even though they are not ill.A locally driven well funded test, trace, isolate, and support system would gather more precise information enabling a higher proportion of people to be isolated and supported, without the need for blanket lockdowns.
Abstract 13593: Global Aortic Stiffness in Bicuspid-associated Aortopathy is Independent of Aortic Dimensions and Similar to Tricuspid Aortic Valve Control Subjects
Authors: Ethan M Johnson, Michael Scott, Kelly Jarvis, Bradley D Allen, S Malaisrie, Patrick M McCarthy, Paul W Fedak, Alexander J Barker, Michael Markl
Journal: Circulation (2020)

Introduction: Bicuspid aortic valve (BAV) carries high aortopathy risk, and debate exists about relative contributions of altered wall structure vs. BAV-mediated hemodynamics. Pulse wave velocity (PWV), a surrogate for stiffness, can be quantified from 4D flow MRI. Here we use PWV to study wall stiffness in a large cohort of BAV aortic dilatation patients and two control groups. Hypotheses: 1. abnormal thoracic aortic (Ao) wall biomechanics for BAV patients result in altered PWV compared to controls and 2. PWV correlates with Ao diameter. Methods: This retrospective IRB approved study included 483 subjects: 124 healthy (no known cardiovascular disease), 168 BAV patients with ascending Ao (AAo) dilatation—maximal-area AAo (MAA) or sinus of Valsalva (SOV) diameter ≥4cm—and 191 TAV AAo dilatation (see table). No subjects had valve stenosis or ejection fraction ≤50%. Global PWV was assessed from MRI by cross-correlating flow in 80-100 Ao cutplanes and median AAo diameter by geometric mesh analysis of 3D Ao segmentations. Results: In multivariate regression, older age was the most significant predictor of higher PWV (controls: 0.073 m/s / y; TAV: 0.072 m/s / y; BAV: 0.092 m/s / y; all p&lt;1E-4). Increased Ao diameter in controls associated with higher PWV (0.10 m/s / mm, p=0.03). Both BAV and TAV patients had no association between any Ao diameter (MAA, SOV, median) and PWV (p≥0.1 for all metrics). Between subject groups in a given age range, no significant differences of PWV existed except in some younger groups (see image; p≤0.04 in some under-40y). Conclusion: Global Ao wall stiffness from PWV in BAV Ao dilatation patients has minimal/no significant difference from non-BAV control PWV, despite genetic factors and different wall structure in BAV patients. This suggests wall tissue differences of BAV patients do not coincide with globally altered Ao stiffness. However, BAV-mediated Ao flow changes manifest regionally, and further study of localized properties would be valuable.
Abstract 14508: Development of a Risk Prediction Model for 1-year Readmission Among Younger Adults Hospitalized for Acute Myocardial Infarction
Authors: Rachel P Dreyer, Terrence E Murphy, Valeria Raparelli, Sui Tsang, Gail Onofrio, Nancy P Lorenze, Louise Pilote
Journal: Circulation (2020)

Introduction: Although readmission over the first year following hospitalization for acute myocardial infarction (AMI) is common among younger adults (18-55 yrs), there is no available risk prediction model for this age group. Existing risk models have been developed in older populations, have modest predictive ability, and exhibit methodological drawbacks. We developed a risk prediction model that considered a broad range of demographic, clinical, and psychosocial factors for readmission within 1-year of hospitalization for AMI among young adults. Methods: Young AMI adults (18-55 yrs) were enrolled from the prospective observational VIRGO study (2008-2012) of 3,572 patients. Data were obtained from medical record abstraction, interviews, and adjudicated hospitalization records. The outcome was all-cause readmission within 1-year. We used a two-stage selection process (LASSO followed by Bayesian Model Averaging) to develop a risk model. Results: The median age was 48 years (IQR: 44,52), 67.1% were women, and 20.1% were Non-white or Hispanic. Within 1-year, 906 patients (25.3%) were readmitted. Patients who were readmitted were more likely to be female, black, and had a clustering of adverse risk factors and co-morbidities. From 61 original variables considered, the final multivariable model of readmission within 1-year of discharge consisted of 14 predictors (Figure) . The model was well calibrated (Hosmer-Lemeshow P &gt;0.05) with moderate discrimination (C statistic over 33 imputations: 0.69 development cohort). Conclusion: Adverse clinical risk factors such as diabetes, hypertension and prior AMI, but also female sex, access to specialist care, and major depression were associated with a higher risk of readmission at 1-year post AMI. This information is important to inform the development of interventions to reduce readmissions in young patients with AMI.
Abstract 15413: Building New Arteriogenic Therapy for Ischemic Cardiomyopathyusing Notch-induced Mesenchymal Stem Cell Patch
Authors: Shusaku Maeda, Shigeru Miyagawa, Takuji Kawamura, Dai Chida, Takashi Shibuya, Takayoshi Ueno, Yoshiki Sawa
Journal: Circulation (2020)

Introduction: The induction of arteriogenesis is a promising approach for treatment of ischemic cardiomyopathy. Notch signaling has been reported to be a key regulator of arteriogenesis. Hypothesis: We hypothesized that Notch-induced human mesenchymal stem cell (SB623) sheet transplantation would induce arteriogenesis in ischemic lesion, leading to improvement of left ventricular function in ischemic cardiomyopathy model rats. Methods: Two weeks after the ischemic induction, SB623-patches were transplanted to myocardial infarction model rats (SB group, n=10) or shame operations were performed (Control group, n=10). We evaluated cardiac performance and histology six weeks after the treatment in vivo. In vitro, we performed RNA-sequencing of human umbilical vein endothelial cells (HUVECs) cocultured with SB623s. Results: Left ventricular ejection fraction was significantly improved 6 weeks after SB623-sheets transplantation (LVEF, 52±7% vs. 34±5%, p&lt;0.001). Similarly, the attenuation of LV remodeling was observed at 6 weeks (LV diastolic dimension, 73±7 mm vs. 85±5 mm, p&lt;0.001). Histological findings revealed that fibrosis was decreased in SB group (11±1% vs. 22±4%, p=0.02). Furthermore, vWF-positive capillary vessels (vessels, 516±110 /mm 2 vs. 248±26 /mm 2 , p&lt;0.001) and αSMA- and vWF-positive arterioles with over 20μm diameter (arterioles, 25±8 /mm 2 vs. 6±3 /mm 2 , p=0.002) were significantly increased in SB group, suggesting the induction of angiogenesis and arteriogenesis. In vitro, whole transcriptome analysis showed that Notch signaling pathway was significantly upregulated (p&lt;0.001) in HUVECs co-cultured with SB623s. Similarly, pathway analysis revealed upregulated “fluid shear stress and atherosclerosis” pathway (p&lt;0.001) in vitro, suggesting an arteriogenic response of endothelial cell. In vivo study, upregulations of ephrin-B2 (p=0.03) and EphB4 (p=0.01) gene expressions in SB group were confirmed, indicating both arterial and venous remodeling induced by Notch signaling. Conclusions: SB623 patch transplantation induces arteriogenesis with functional recovery via Notch signaling in rat myocardial infarction model, proposing a new strategy for the treatment of ischemic cardiomyopathy.
Abstract 16763: Frailty, as Measured by the Essential Frailty Toolset, is Associated With Higher Resource Utilization in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Fady K Soliman, Lindsay Volk, Rajath Kenath, Alexis K Okoh, Joshua C Chao, Jigesh Baxi, Hirohisa Ikegami, Anthony Lemaire, Mark J Russo, Leonard Y Lee
Journal: Circulation (2020)

Introduction: Frailty is an important predictor of clinical outcomes, but its contribution to resource utilization remains understudied. This study investigates the impact of frailty on high resource utilization (HRU) in patients undergoing Coronary Artery Bypass Graft Surgery (CABG). Methods: We reviewed data on patients who underwent CABG at a single center between 04/2018 and 12/2019. A Frailty score (FS) was calculated using the Essential Frailty Toolset (EFT). Patients were divided into two groups: Frail (FS ≥ 3/5) &amp; Non-Frail (FS &lt;3/5). Baseline clinical characteristics and outcomes were compared in both groups. The primary outcome was HRU (post-operative length of stay &gt; 7 days or readmission within 30-days). Secondary outcomes included operative time, prolonged ventilation, &amp; direct procedure costs. Multivariable logistic regression was used to assess the effect of frailty on HRU. Results: The study included 740 patients of whom 18% (n=132) were frail. Compared to Non-Frail patients, Frail patients were older (66 vs. 70 yrs. P&lt;0.001) and more likely to be high risk for operative mortality (1.3% vs. 14%, p&lt;0.001). The incidence of HRU was 28% vs. 53%, p&lt;0.001, in Non-Frail vs. Frail patients. Frail patients had longer operative times (272 vs. 247 mins; p&lt;0.001), and a higher incidence of prolonged ventilation (9.9% vs. 4%; p&lt;0.001). Median direct costs were also higher in Frail subjects ($33,434 vs. $22, 207; p&lt;0.001). On multivariable logistic regression analysis, independent predictors of HRU were (OR: 95% C.I.) Frailty: 2.19(1.44, 3.33; p=0.003), Sex (Female): 1.66 (1.14, 2.40; p=0.008), and history of COPD: 2.32(1.53, 3.54; p&lt;0.001). Conclusions: About one out of every five patients undergoing CABG was classified as frail by the EFT. Frailty was associated with higher direct costs and found to be an independent predictor of high resource utilization. Further attention is required to optimize outcomes and resource use in this vulnerable population.
Abstract 14591: Persistent Racial Disparities in Risks of Readmission and Mortality After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Authors: Stephanie Spehar, Milan Seth, Khaldoon Alaswad, Theodore Schreiber, Aaron Berman, John Syrjamaki, Omar Ali, Yousef Bader, Hitinder S Gurm, Devraj Sukul
Journal: Circulation (2020)

Introduction: Racial disparities in the management and outcomes following acute myocardial infarction are well-established. However, there remains conflicting data on whether such disparities exist between black and non-black patients (pts) after percutaneous coronary intervention (PCI) in contemporary practice. Hypothesis: We hypothesize that compared with non-black race, black race is associated with increased risks of post-PCI readmission and mortality. Methods: We linked clinical registry data from PCIs performed between 1/2013 and 3/2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. Patient race as recorded in the registry was dichotomized as black and non-black. The date of death was obtained from the Medicare beneficiary file. We used a logistic regression model to estimate the odds of 90-day readmission and a Cox model to estimate the association between race and post-discharge mortality after adjusting for important clinical characteristics. Results: A total of 30,206 pts (10.0% black, 59.9% men) were included. Black pts tended to be younger (68.9 vs 72.2 yrs), were more likely to smoke (27.7% vs. 19.5%), and had a higher burden of cardiovascular comorbidities. Compared with non-black pts, black pts had an increased risk of 90-day readmission (26.5% vs. 18.2%; adjusted OR 1.34; 95% CI 1.22-1.47; p&lt;0.001) and long-term mortality after PCI (HR 1.13; 95% CI 1.05-1.21; p=0.001) (Figure). Conclusions: Even after accounting for clinical comorbidities, in contemporary practice black pts are at an increased risk of readmission and long-term mortality after PCI discharge. Future studies investigating differences in care and social determinants of health are needed to elucidate the mechanisms behind these disparate outcomes and identify potential opportunities to reduce these dramatic and persistent health care disparities.
Emerging potential of cannabidiol in reversing proteinopathies
Authors: Raju Dash, Md. Chayan Ali, Israt Jahan, Yeasmin Akter Munni, Sarmistha Mitra, Md. Abdul Hannan, Binod Timalsina, Diyah Fatimah Oktaviani, Ho Jin Choi, Il Soo Moon
Journal: Ageing Research Reviews (2020)
Abstract 14141: A Contemporary Assessment of Lipid Lowering Therapies and Low-density Lipoprotein Cholesterol in Peripheral Artery Disease
Authors: Connie N Hess, Christopher P Cannon, Joshua A Beckman, Philip Goodney, Manesh R Patel, Erin Shannon, Kate K Orroth, Katherine E Mues, william R hiatt, Marc P Bonaca
Journal: Circulation (2020)

Introduction: Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with peripheral artery disease (PAD). Strategies that lower LDL-C levels reduce this risk. Hypothesis: We hypothesized that real-world PAD patients are overall undertreated with lipid lowering therapies (LLT) but that LLT use and achieved LDL-C are improved in high risk patients with ischemic events. Methods: Patients with PAD in the MarketScan database linked to PROGNOS lab data from January 1, 2014 through December 31, 2018 were examined. Outcomes included use of LLT, defined as high intensity (HI) (high intensity statin, any statin plus ezetimibe, or any use of a PCSK9 inhibitor), low intensity (LI) (any other lipid regimen), or no therapy, and follow up LDL-C level. Goal LDL-C was defined as &lt;70 mg/dl. Results: Among 18,747 PAD patients, 25% were on HI LLT, 43% were on LI LLT, and 32% were on no therapy at baseline (Figure A). The median LDL-C was 91 mg/dl (IQR 70, 118), and 25% of patients were at goal (Figure B). After a median follow up of 18 months, use of HI LLT increased by 4%, the median LDL-C decreased by 5 mg/dl, and an additional 3% of patients were at goal LDL-C. Greater use of HI LLT was observed among patients with a MACE (55%) or MALE (41%) event during follow up compared with patients without an ischemic event (26%) during follow up (Figure C). Follow up LDL-C levels remained above goal for most patients (post-MACE: median LDL-C 77 mg/dl, 42% patients at goal; post-MALE: median LDL-C 80 mg/dl, 36% patients at goal). Conclusions: In PAD patients, use of LLT is suboptimal, and LDL-C levels remain elevated. After an ischemic event, LLT use is intensified, with greater use of HI LLT observed after MACE than MALE. Despite this, LLT remains underutilized, with &gt;50% of patients not at goal LDL-C. Strategies to better implement proven therapies to reduce risk in this high risk population are needed.
Abstract 16157: Catheter Ablation Induces an Increase in Heart Rate With Discordant With a Decrease in Sympathetic Nerve Activity in Patients With Paroxysmal Atrial Fibrillation
Authors: Yusuke Mukai, Hisayoshi Murai, Tadayuki Hirai, Hiroyuki Sugimoto, Takuto Hamaoka, Yoshitaka Okabe, hideki tokuhisa, Masayuki Takamura
Journal: Circulation (2020)

Background/Introduction: Paroxysmal atrial fibrillation (PAF) is the most common arrhythmia and catheter ablation (CA) is selected with the aim of rhythm control. CA was reported to increase heart rate (HR), which explains the modulation on the cardiac autonomic nervous system. However, little is known about the relationship between heart rate, sympathetic nerve activity and parasympathetic nerve activity in patient with PAF. Purpose: The purpose of this study was to evaluate the effect of CA on direct recording of muscle sympathetic nerve activity (MSNA) and heart rate variability (HRV), and these influences on HR. Methods: This study was conducted as a prospective, observational study. Patients with PAF who were scheduled for CA were enrolled. We measured blood pressure, HR, body weight, brain natriuretic peptide (BNP), echocardiogram parameters, high frequency component as cardiac parasympathetic nerve activity and low frequency component as cardiac sympathetic nerve activity in HRV, and MSNA before and 12 weeks after CA. Results: 21 PAF patients participated in this study. After CA, E/e’ and Ln BNP were significantly reduced(10.6±2.9 to 9.2±2.6, p&lt;0.05. 3.8±1.3 to 3.3±1.6 log/pg/ml, p&lt;0.05, respectively) while no significant changes were observed in EF, SV, left atrial diameter, left ventricular end diastolic and systolic diameters. HR was significantly increased (61.3±7.8 to 71.1±7.6 beats/min, p&lt;0.05, respectively). However, the MSNA burst incidence and frequency were significantly decreased (65.4±12.6 to 41.3±13.4 bursts/100beats, p&lt;0.01, n=21. 39.8±8.8 to 28.1±9.6 bursts/min, p&lt;0.01, n=21. respectively). Also, the reduction in MSNA burst frequency was correlated with the increase in HR (r=0.57, 95%CI 0.183-0.804, p=0.00702). Ln Low frequency component in HRV was significantly decreased (5.72±1.75 to 3.85±2.13 log/ms 2 , p&lt;0.05, n=12), but Ln high frequency (HF) component was not changed . No significant relationship observed between increased HR and HF component. Conclusion: CA induced paradoxical increasing heart rate with the reduction in sympathetic nerve activity in patient with PAF. These findings suggest that CA might modulate autonomic interaction between sinus nodes and in left atrium with denervated in ganglionated plexi.