tbuckley/cabot-search huggingface dataset:
Abstract 12666: Role of a Comprehensive ST-Elevation Myocardial Infarction Protocol in Improving Outcomes among Elderly Patients With ST-Elevation Myocardial Infarction
Authors: Nicholas Kassis, Raunak Nair, Anirudh Kumar, Chetan Huded, Michael Johnson, Kathleen A Kravitz, Grant W Reed, Amar Krishnaswamy, Venu Menon, Wael A Jaber, A M Lincoff, Samir R Kapadia, Umesh N Khot
Journal: Circulation (2021)

Introduction: Increasing age is a harbinger of poor outcomes from ST-elevation myocardial infarction (STEMI). It is uncertain whether measures can be implemented to improve care delivery and outcomes in this high-risk cohort. We assessed the impact of a comprehensive STEMI protocol (CSP) in elderly patients presenting with STEMI. Methods: A 4-step CSP was implemented, including: (1) Emergency Department catheterization lab activation; (2) STEMI Safe Handoff Checklist; (3) immediate catheterization lab transfer; and (4) radial-first percutaneous coronary intervention (PCI). Baseline characteristics, complications, procedural features, and outcomes were compared between consecutive STEMI patients &gt;65 years of age who underwent PCI at the Cleveland Clinic pre- (01/01/2011-07/14/2014) and post-CSP (07/15/2014-07/15/2019) implementation. Results: Among 265 and 445 elderly patients in the pre- and post-CSP cohorts, respectively, overall the mean age was 74 years and 58% were males. More active smoking and obesity and less prior myocardial infarction and coronary artery bypass graft were observed in the post-CSP group. Relative to pre-CSP, post-CSP patients experienced significantly less cardiogenic shock (19% vs 9%, p&lt;0.001) and cardiac arrest (16% vs 9%, p=0.009). Significant improvements were observed post-CSP implementation in median door-to-balloon time [111 (84-146) vs 89 (67-109) minutes, p&lt;0.001] and trans-radial access (16% vs 72%, p&lt;0.001), translating to significant reductions in major adverse cardiovascular events (14% vs 8%, p=0.02), major bleeding (16% vs 11%, p=0.05), and in-hospital mortality (12% vs 5%, p=0.001). Conclusion: The implementation of a CSP was associated with marked reductions in complications and improvements in in-hospital outcomes including mortality among elderly patients presenting with STEMI. Our findings highlight the opportunity to improve outcomes in high-risk elderly STEMI patients through a CSP.
Abstract P490: Vascular Rarefaction And Decreased Angiogenic Potential In The Development Of Left Ventricular Diastolic Dysfunction In Heart Failure With Preserved Ejection Fraction
Authors: Katie Anne Fopiano, Yanna Tian, Vadym Buncha, Liwei Lang, Zsolt Bagi
Journal: Circulation Research (2021)

Coronary microvascular dysfunction (CMD) develops in patients with heart failure with preserved ejection fraction (HFpEF, also known as diastolic heart failure), but the nature of the underlying pathomechanisms behind this prevalent disease remain poorly understood. The hypothesis tested was that coronary microvascular rarefaction contributes to left ventricle (LV) diastolic function in HFpEF. The obese ZSF1 rat model of human HFpEF was employed and using transthoracic echocardiography it was found that 18-week-old male obese ZSF1 rats exhibited a significantly reduced E/A ratio (E=early, A=late mitral inflow peak velocities) and increased DT (E wave deceleration time) with no change in ejection fraction, indicating diastolic dysfunction. Coronary arteriolar and capillary trees were labeled using Tomato Lectin (Lycopersicon esculentum) DyLight®594 and were imaged by fluorescent confocal microscopy to generate image stacks for 3D reconstruction. Unbiased automated tracing of the microvasculature was done using VesselLucida360 software (MBF) followed by a morphometric analysis (VesselLucida Explorer). It was found that total vessel length and the number of vessel’s branching nodes were reduced in the obese ZSF1 rats, whereas the total vessel’s volumes remained consistent, when compared to the lean ZSF1 controls. These changes in the microvasculature were accompanied by decreased angiogenesis in the coronary arteries in the obese ZSF1 rats when compared to the lean ZSF1 rats using an ex vivo endothelial sprouting assay. From these results, it was concluded that vascular rarefaction and decreased angiogenesis both play a role in the development of LV diastolic dysfunction in the obese ZSF1 rat model of human HFpEF.
Abstract 12093: Tafamidis Use and New Onset Atrial Fibrillation in Patients With Cardiac Amyloidosis
Authors: Austin O Sweat, Zachary P Girvin, Brian C Boursiquot, Gabriel Redel-traub, Stephanie Jou, Stephanie Kochav, Mathew Maurer, Jose Dizon, Angelo B Biviano, Hasan Garan, Hirad Yarmohammadi
Journal: Circulation (2021)

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia seen in patients with cardiac amyloidosis (CA). Tafamidis, a transthyretin stabilizer, has been associated with reductions in all-cause mortality and other promising outcomes in patients with CA. However, its effect on incidence of AF still remains unknown. Hypothesis: Tafamidis therapy in patients with CA is associated with lower incidence of AF. Methods: A group of 200 patients with transthyretin CA following at our institution between 2003 and 2019 were retrospectively reviewed. Baseline characteristics, onset of AF (determined by ECG, device interrogation, or ambulatory monitoring) and tafamidis use data were collected. Patients with diagnosis of AF at baseline were excluded. Patients were matched based on age, sex, BMI, DM, HTN, ischemic heart disease, and stage of amyloid disease. Time to event analysis was performed to assess the incidence of new-onset AF in patients who had received tafamidis versus those who had not. Results: In total, 36 patients met inclusion criteria. Of these 36 patients diagnosed with incident AF, 10 received tafamidis therapy prior to AF diagnosis and 26 did not. Median time to Tafamidis initiation after diagnosis of cardiac amyloidosis was 243 [64, 776] days [IQR]. Average follow-up time was 21.8 ± 24.4 months. There were no significant differences between baseline characteristics, however there were more African Americans (27% vs. 0%) and Val122Ile mutations (23% vs. 10%) in the control group. Overall, tafamidis initiation was associated with lower incidence of new-onset AF compared to those who had not received the therapy (p=0.026). Persistent AF was the most common type of AF, no matter being on tafamidis or not. Conclusions: Tafamidis therapy in patients with CA might be associated with lower incidence of AF. The mechanism however is not clear and further studies are needed to re-examine this finding and elucidate the potential mechanism.
INNV-30. USE OF MULTIDISCIPLINARY TEAMS AND MULTIMEDIA APPROACHES TO DEVELOP AND DISSEMINATE SYMPTOM AND DISEASE EDUCATIONAL MATERIALS FOR RARE CENTRAL NERVOUS SYSTEM (CNS) TUMOR PATIENTS
Authors: Molly Maher, Kristin Odom, Alvina Acquaye, Orieta Celiku, Brittany Cordeiro, Mark Gilbert, Terri Armstrong
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Primary CNS tumors represent less than 2% of all cancers, with the majority of patients receiving care outside of specialty centers. Patients are highly symptomatic while trying to navigate care for their rare disease and evidence-based tumor and symptom education is limited. Our primary objective was to create and disseminate patient-centered content utilizing multidisciplinary teams and health communication to improve access to content. METHODS The multidisciplinary team of neuro-oncology scientists and health care providers developed content from evidence-based sources. The team partnered with communication specialists to ensure health literacy and established outreach strategies for use on social media, e-newsletters, and web- and app-based programs. Web analytic tools assessed outreach and efficacy. RESULTS Educational content for 12 rare tumors and 6 self-care topics was created using evidence-based sources and multidisciplinary team review. Content was published on the National Cancer Institute Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) website and disseminated via multimedia platforms, including e-newsletters and social media (private Facebook group and Twitter). Since launching the website in September 2018, visits have increased 2,384%. The content was also shared directly to 6,156 newsletter subscribers, 4,897 Twitter followers with greater than 1 million impressions per year, 407 Facebook members, 9 non-profit advocacy partners, and thousands of attendees at more than 10 patient-focused neuro-oncology events. This outreach approach is now being replicated for symptom management content on the NCI-CONNECT website and a symptom tracking and self-care mobile application launching in 2021. CONCLUSIONS By marrying patient-centered health communication, education, and outreach, our team successfully created highly sought content that reflects the unique needs of CNS tumor patients and their families. This material can educate neuro-oncology patients on their specific tumor, promote self-care, facilitate symptom management, and empower families to advocate for their unique needs, reaching outside traditional health care systems.
Low-Dose Nivolumab Plus Brentuximab Vedotin As a Bridge to Stem Cell Transplantation in Relapsed/Refractory Classical Hodgkin Lymphoma
Authors: Perla R. R. Colunga-Pedraza, Edgar Ulises Coronado-Alejandro, Fernando De La Garza, Eliezer Tomas Gomez Gomez, Andres Gomez-De Leon, Julia Esther Colunga Pedraza, Cesar Homero Gutierrez-Aguirre, Olga Graciela Cantu Rodriguez, David Gomez-Almaguer
Journal: Blood (2021)
Abstract 9988: Racial/Ethnic Disparities in the Patients Undergoing Heart Transplantation: Insights from National Inpatient Sample 2016-2018
Authors: Abdul Minhas, Ahmed H Qavi, SALIK NAZIR, Muhammmad Khan, Hibaa Hasan, Marat Fudim, Khurram Nasir
Journal: Circulation (2021)

Background: There is a paucity of data on in-hospital outcomes of Heart Transplant (HT) recipients among different races. This study aimed to evaluate the impact of race on the clinical outcomes in the patients undergoing HT. Methods: We conducted a retrospective analysis of adult hospitalizations from the National Inpatient Sample (NIS) between 2016 and 2018. ICD codes were used to identify those who underwent HT. Prevalence estimates were weighted using NIS-provided discharge-level weights to reflect national estimates. Weighted multivariable logistic regression was used to assess the association of race and various clinical outcomes in those who underwent HT. Caucasians were kept as the reference category. These models were adjusted for several patient-level and hospital-level characteristics. Results: Among 7945 HT hospitalizations, 4835 (43.2%) were Caucasian, 1730 (41.7%) were African American, 814 (10.1%) were Hispanics and 565 (10.1%) were Others. After adjustment of variables, there was no significant difference in all-cause mortality, cardiac arrest, invasive mechanical ventilation, use of pressors, tracheostomy, gastrostomy, vascular complications, bleeding requiring transfusion, stroke or acute kidney injury in African-Americans, Hispanics and others when compared to Caucasians (Table 2). Conclusions: We did not find a significant difference in various hospital outcomes of HT recipients among different races.
The UK government’s migration policy plans will only cause more suffering and death
Authors: Sophie McCann
Journal: BMJ (2021)

On Wednesday 24 November 2021, at least 27 people, including three children and a pregnant woman, lost their lives attempting to cross the English Channel. Their deaths are a tragedy and my heart goes out to their families, friends, and loved ones. As well as sorrow I also feel immense anger and outrage that they lost their lives. It did not have to be this way.

I am horrified to see the UK government react by doubling down on their new plan for immigration: to implement punitive policies aimed at deterring people from reaching UK shores, instead of urgently providing assistance and protection to vulnerable people by opening up safe and legal routes for them to reach the UK.1

Over the last eight months, Priti Patel, the home secretary, and the Home Office have laid out these policies to be implemented through the new proposed Nationality and Borders Bill.

In its current form, this bill will open the door for this government to send refugees and asylum seekers to detention centres in another country to process …
IMMU-24. IMPROVING OUTCOMES IN OLDER ADULTS WITH GLIOBLASTOMA BY REVERSING AGE-RELATED CHANGES
Authors: Erik Ladomersky, Lijie Zhai, Lakshmi Bollu, April Bell, Kristen Lauing, Rimas Lukas, Derek Wainwright
Journal: Neuro-Oncology (2021)

Abstract Wild-type IDH glioblastoma (wtGBM) represents ≥90% of human GBM patient diagnoses with a median age of onset at 68-70 years of age. We previously found a decline of GBM patient survival with progressive age and that subjects ≥65 years of age had the poorest prognosis. We also showed an age-dependent enhancement of immune suppression in the brain that negatively affected immunotherapeutic efficacy in older adult mice with syngeneic brain tumors. Here, we extended those observations while studying C57BL/6 mice with intracranial CT-2A or GL261 between 80-110 weeks old - analogous to the age of a wtIDH GBM patient diagnosis. Overall survival of older adult mice with CT-2A or GL261 was significantly decreased when subjects were lymphopenic for CD4+ T cells as compared to an IgG Ab treatment group (n=12/group; p&amp;lt; 0.01). CD8+ T cell or NK cell leukopenia had no effect on survival outcomes. The negative effect of CD4+ T cell lymphopenia in older adults was not observed in younger mice with brain tumors. We also investigated the increased immunosuppression in the brain and its relationship to the accumulation of senescent cells and the treatment with standard of care radiation/temozolomide (RT/TMZ). p16INK4A, a marker for senescent cells, was increased in non-tumor cells of the brain during advanced age and its expression was increased after treatment with RT/TMZ. Older adult mice with brain tumors and treated with senolytics showed decreased p16INK4A levels after treatment with RT/TMZ. Senolytic treatment also improved the efficacy of combination therapy with RT, anti-PD-1 mAb, and IDO enzyme inhibitor in older adults as compared to senolytics alone or the triple immunotherapeutic cocktail alone (n=12-15/group; p&amp;lt; 0.01). Collectively, the results suggest that strategies aimed at reversing the effects of the aging combined with tumor eradication therapies may be particularly beneficial for older adult human patients with GBM.
Abstract 9985: Comprehensive Cardiac Magnetic Resonance Imaging Study for Characterising Remote Myocardial Zone Contractile Function, Perfusion and Fibrosis in Type 2 Diabetes Patients with Prior Myocardial Infarction
Authors: Sharmaine Thirunavukarasu, Amrit Chowdhary, Nicholas Jex, Henry Procter, Lauren Coles, Hui Xue, Peter Kellman, John GREENWOOD, Sven Plein, Eylem Levelt
Journal: Circulation (2021)

Background: Type 2 diabetes (T2D) is associated with accelerated increased risk of myocardial infarction (MI). However, ventricular dysfunction has been identified also in T2D patients without prior MI. Objectives: Using cardiac magnetic resonance (CMR), we assessed the effect of established MI on the non-infarcted myocardium’s contractile function, rest and stress myocardial blood flow (MBF) and extra cellular volume fraction (ECV) by comparing remote zone assessments in T2D patients with prior MI (priorMI-DM) to the global assessments in T2D patients with no MI (noMI-DM) and in controls. We also aimed to extrapolate the contributions of infarct size and glycemic control (HBA1c) to cardiac functional changes (global longitudinal strain [GLS] and left ventricular ejection fraction [LVEF]) in T2D. Methods: Age and sex matched 42 priorMI-DM, 47 noMI-DM, and 22 controls underwent CMR (3T). Results: Table-1 shows clinical and CMR data. Both T2D groups showed significant reductions in LVEF and GLS. PriorMI-DM remote zone stress MBF was decreased compared to stress MBF in noMI-DM and controls (remote zone priorMI-DM 1.6±0.6ml/g/min vs global noMI-DM 1.8±0.4ml/g/min vs global control 1.9±0.4ml/g/min, p=0.01). Remote ECV and global ECV were similar in priorMI-DM and were increased compared to noMI-DM and controls. Remote ECV correlated with infarct size (r=0.66, p=0.001). In priorMI-DM, infarct size correlated with GLS (r=0.4, p=0.005) and with LVEF (r=0.2, p=0.03) but not HBA1c. In noMI-DM, there was a significant correlation between HBA1c and GLS (r=0.3, p=0.03). Conclusions: T2D patients exhibit reductions in LVEF and GLS even in the absence of prior MI, suggesting that metabolic factors beyond high prevalence of MI contribute to the cardiac dysfunction in T2D. T2D patients with prior MI show significant increases in ECV in the remote zone, accompanied by reductions in stress MBF, while remote zone contractile function remains preserved.
NIMG-03. TUMOR HABITAT ANALYSIS BY MAGNETIC RESONANCE IMAGING DISTINGUISHES TUMOR PROGRESSION FROM RADIATION NECROSIS IN BRAIN METASTASES AFTER STEREOTACTIC RADIOSURGERY
Authors: Da Hyun Lee, Ji Eun Park, Ho Sung Kim
Journal: Neuro-Oncology (2021)

Abstract OBJECTIVES Identification of viable tumor after stereotactic radiosurgery (SRS) is important for future targeted therapy. This study aimed to determine whether tumor habitat on structural and physiologic MRI can distinguish viable tumor from radiation necrosis of brain metastases after SRS. METHOD Multiparametric contrast-enhanced T1-and T2-weighted imaging, apparent diffusion coefficient (ADC), and cerebral blood volume (CBV) were obtained from 52 patients with 69 metastases, showing enlarging enhancing masses after SRS. Voxel-wise clustering identified three structural MRI habitats (enhancing, solid low-enhancing, and nonviable) and three physiologic MRI habitats (hypervascular cellular, hypovascular cellular, and nonviable). Habitat-based predictors for viable tumor or radiation necrosis were identified by logistic regression. Performance was validated using the area under the curve (AUC) of the receiver-operating-characteristics curve in an independent dataset with 24 patients. RESULTS None of the physiologic MRI habitats were indicative of viable tumor. Viable tumor was predicted by a high-volume fraction of solid low-enhancing habitat (low T2-weighted and low CE-T1-weighted values; odds ratio [OR] 1.74, P&amp;lt; .001) and a low-volume fraction of nonviable tissue habitat (high T2-weighted and low CE-T1-weighted values; OR, 0.55, P&amp;lt; .001). Combined structural MRI habitats yielded good discriminatory ability in both development (AUC 0.85, 95% confidence interval [CI]: 0.77–0.94) and validation sets (AUC 0.86, 95% CI:0.70–0.99), outperforming single ADC (AUC 0.64) and CBV (AUC 0.58) values. The site of progression matched with the solid low-enhancing habitat (72%, 8/11). CONCLUSION Solid low-enhancing and nonviable tissue habitats on structural MRI can help to localize viable tumor in patients with brain metastases after SRS.
Cerebral aspergillosis in the era of new antifungals: The CEREALS national cohort study Nationwide CEREbral Aspergillosis Lesional study (CEREALS)
Authors: A. Serris, J. Benzakoun, F. Danion, R. Porcher, R. Sonneville, M. Wolff, S. Kremer, V Letscher-Bru, A Fekkar, G. Hekimian, V. Pourcher, M-E. Bougnoux, S. Poirée, F. Ader, F. Persat, Francois Cotton, Pierre Tattevin, J.-P. Gangneux, L. Lelièvre, S. Cassaing, Fabrice Bonneville, S. Houze, Stephane Bretagne, R. Herbrecht, O. Lortholary, O. Naggara, F. Lanternier
Journal: Journal of Infection (2021)
Abstract 12530: Impact of Multiple Lifestyle Intervention on Body Weight, Insulin Sensitivity and Remission of Type 2 Diabetes: A Single-Center Experience
Authors: Josep Iglesies-Grau, Valérie Dionne, Véronique Pelletier, Marc Bisaillon, Louis Bherer, Nadia Bouabdallaoui, Anil Nigam, Martin Juneau, Philippe L L'Allier
Journal: Circulation (2021)

Introduction: Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Hypothesis: The Montreal Heart Institute Cardiovascular Prevention EPIC Center started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. Methods: Between January and December 2019, 105 with T2D (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0,3,6 and 12 months. All patients received regular nutritional counselling and personalized physical exercise prescription. Glucose-lowering therapies were not modified, unless necessary. Partial and complete remission of diabetes were defined by HbA1c &lt;6.5% and HbA1c &lt;5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. Results: 96 patients completed the intervention (91%), mean age was 67.5±10.5 years, 72% male, 37% with coronary heart disease, 23% without glucose-lowering therapies. Mean baseline HbA1c was 7.3±0.8 %. At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p&lt;0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Adjusted by age, sex, treatment, baselineHbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost &gt;3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. Conclusions: Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention.
Abstract 11912: Risk Stratification of Life Threatening Ventricular Tachyarrhythmias in Patients With Non-Ischemic Cardiomyopathy
Authors: Ido Goldenberg, Valentina Kutyifa, Wojciech Zareba, Arwa Younis, Ilan Goldenberg, Mehmet Aktas
Journal: Circulation (2021)

Background: The implantable cardioverter defibrillator is effective in reducing mortality among patients with heart failure (HF) due to ischemic heart disease. More recent clinical trial data have called into question the benefit of an ICD in patients with HF due to non-ischemic cardiomyopathy (NICM). Objective: The purpose of this study was to identify a risk stratification score among patients with NICM receiving a primary prevention ICD. Methods: The study population comprised 1842 patients with NICM who were enrolled in the MADIT and RAID trials. We used Fine and Gray analysis to develop a model for the occurrence of ventricular tachycardia/fibrillation (VT/VF), while accounting for the competing risk of death. Patients were grouped into 3 strata based on their risk score. Results: Five factors associated with increased risk of VT/VF were identified: ICD vs cardiac resynchronization therapy with a defibrillator (CRT-D), prior history of non-sustained VT, male gender, ejection fraction ≤ 25%, and Black Race. A score was generated based on this model and the patients were stratified into three risk groups. The four-year cumulative incidences of VT/VF in the low-, intermediate-, and high-risk groups were 19%, 37%, 52%, respectively (p&lt;0.001 for the overall difference; Figure). Internal validation using a bootstrapping yielded a median c-statistic of 0.69 (95% CI 0.66-0.74). Conclusions: Our findings suggest that patients with NICM can be risk stratified for VT/VF using a combination of clinical and echocardiographic findings.