tbuckley/cabot-search huggingface dataset:
Abstract 300: Detection of Hemodynamic Status Using a Novel Analytic Based Solely on a Single Ecg Waveform
Authors: Benjamin S Bassin, Catherine Spino, Richard Medlin
Journal: Circulation (2020)

Introduction: Delayed identification of hemodynamic deterioration remains a persistent issue for in-hospital patient care. Unfortunately, no continuously measured non-invasive method of detecting hemodynamic deterioration currently exists. Clinicians rely on vital signs associated with tachycardia and hypotension to identify hemodynamically unstable patients. However, the collection of non-invasive vital signs remains labor-intensive, inconsistent, and error-prone in practice. In contrast, the Analytic for Hemodynamic Instability (AHI) depends only on the continuous ECG signal from a typical bedside monitor. Hypothesis: Continuous real-time hemodynamic status obtained from the analysis of existing ECG monitor data can accurately detect the combination of hypotension and tachycardia without the need for continuous direct measurement of blood pressure. Methods: 28,348 5-minute windows of the analytic output were analyzed from 222 consecutive adult patients receiving continuous ECG and arterial line monitoring at an academic medical center. AHI outputs were compared to vital sign indication of tachycardia and hypotension in the same window. Results: The observed sensitivity and specificity of AHI compared to vital signs measurement were 95.6% and 84.9%, respectively, with an area under the curve (AUC) of 0.90 and an accuracy of 85.6%. The false-negative rate was 4.4%. The false-positive rate was 15.1%. Conclusions: The AHI derived hemodynamic status correlated well with vital sign derived hemodynamic status for both invasive and non-invasive methods. In patients who had their blood pressure monitored non-invasively, AHI provided continuous hemodynamic monitoring in patients who usually have vitals measured only every few hours. Footnote: The Analytic for Hemodynamic Instability is currently pending US FDA review and is not yet for sale in the US.
Aqueous outflow regulation – 21st century concepts
Authors: Murray Johnstone, Chen Xin, James Tan, Elizabeth Martin, Joanne Wen, Ruikang K. Wang
Journal: Progress in Retinal and Eye Research (2020)

We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory mechanisms such as those of the arterial, venous, and lymphatic systems. Here, we also provide a framework for developing novel diagnostic and therapeutic strategies to improve glaucoma patient care. In the model, the trabecular meshwork distends and recoils in response to continuous physiologic IOP transients like the ocular pulse, blinking, and eye movement. The elasticity of the trabecular meshwork determines cyclic volume changes in Schlemm's canal (SC). Tube-like SC inlet valves provide aqueous entry into the canal, and outlet valve leaflets at collector channels control aqueous exit from SC. Connections between the pressure-sensing trabecular meshwork and the outlet valve leaflets dynamically control flow from SC. Normal function requires regulation of the trabecular meshwork properties that determine distention and recoil. The aqueous pump-conduit provides short-term pressure control by varying stroke volume in response to pressure changes. Modulating TM constituents that regulate stroke volume provides long-term control. The aqueous outflow pump fails in glaucoma due to the loss of trabecular tissue elastance, as well as alterations in ciliary body tension. These processes lead to SC wall apposition and loss of motion. Visible evidence of pump failure includes a lack of pulsatile aqueous discharge into aqueous veins and reduced ability to reflux blood into SC. These alterations in the functional properties are challenging to monitor clinically. Phase-sensitive OCT now permits noninvasive, quantitative measurement of pulse-dependent TM motion in humans. This proposed conceptual model and related techniques offer a novel framework for understanding mechanisms, improving management, and development of therapeutic options for glaucoma.
Development of thermosensitive resiquimod-loaded liposomes for enhanced cancer immunotherapy
Authors: Hua Zhang, Wei-Lun Tang, Azadeh Kheirolomoom, Brett Z. Fite, Bo Wu, Kenneth Lau, Mo Baikoghli, Marina Nura Raie, Spencer K. Tumbale, Josquin Foiret, Elizabeth S. Ingham, Lisa M. Mahakian, Sarah M. Tam, R. Holland Cheng, Alexander D. Borowsky, Katherine W. Ferrara
Journal: Journal of Controlled Release (2020)
Abstract 17230: Transcatheter Leak Occlusion With Endovascular Coils Following Left Atrial Appendage Closure
Authors: Domenico G Della Rocca, Rodney Horton, Luigi Di Biase, Nicola Tarantino, Jorge Romero, Carola Gianni, CHINTAN G TRIVEDI, Sanghamitra Mohanty, G Joseph Gallinghouse, Mohamed Bassiouny, Amin Al-ahmad, Javier Sanchez, Andrea Natale
Journal: Circulation (2020)

Introduction: The Transcatheter Leak Closure With Detachable Coils Following Incomplete Left Atrial Appendage Closure Procedures (TREASURE) is a prospective, nonrandomized, single-center study. This study was undertaken to investigate the efficacy of transcatheter leak closure with endovascular coils in patient with incomplete percutaneous/epicardial left atrial appendage (LAA) closure procedures and high thromboembolic (TE)- and bleeding-risk. Hypothesis: We report the efficacy of transcatheter leak closure with endovascular coils in patients with incomplete LAA closure. Methods: Sixty-five consecutive patients with a clinically relevant residual leak (mean age: 72±8 years; 73.8% males; CHA 2 DS 2 -VASc: 4.7±1.1; HAS-BLED: 3.7±0.7) underwent percutaneous closure of the LAA patency via embolization coils. Trans-esophageal echocardiography (TEE) was performed at 60±15 days post-procedure. Results: LAA closure had been previously attempted with a Watchman device in 62 patients, and a LARIAT in 3. Baseline TEE documented a moderate or severe leak in 14 (21.5%) and 51 (78.5%) patients, respectively. Procedure and fluoroscopy times were 69±37min and 22±15min, respectively; the mean volume of iodinated contrast medium used was 82±43mL. Coil deployment was successful in all cases [median n. of coils attempted: 3 (IQR:2-5); median n. of coils deployed: 3 (IQR: 2-4)]. The overall complication rate was 3.1% (1 pericardial tamponade, 1 pericardial effusion). Peri-procedural angiographic and TEE outcomes demonstrated complete obliteration or a negligible residual opacification with a trivial residual jet in 62 cases (95.4%), and a partial occlusion with moderate residual jet in 3 (6.4%). Follow-up TEE after 67±12 days revealed complete LAA sealing or a negligible residual leak in 63 cases (96.9%). Coil deployment led to an average reduction of 90.1% in leak size (p&lt;0.001). After an overall follow-up of 17±4 months, no TE events were documented; 3 patients died from non-cardiovascular and one from cardiovascular causes (heart failure). Conclusions: Transcatheter LAA leak occlusion via endovascular coils appears to be a safe, effective, and promising approach in high TE-risk patients with incomplete LAA closure.
Abstract 16390: Cost-effectiveness of a CYP2C19 Genotype-guided Antiplatelet Strategy in ST-elevation Myocardial Infarction Patients
Authors: Danny M Claassens, Gerrit J Vos, Cornelis Boersma, Thomas Bergmeijer, Rik Hermanides, Arnoud van t Hof, Pim Van Der Harst, Emanuele Barbato, Carmine Morisco, Richard M Tjon Joe Gin, Folkert W Asselbergs, Arend Mosterd, Jean-Paul Herrman, Willem Dewilde, Maarten J Postma, Vera H Deneer, jurrien m ten berg
Journal: Circulation (2020)

Introduction: The POPular Genetics trial demonstrated that a genotype-guided strategy to select antiplatelet therapy in patients with ST-elevation myocardial infarction (STEMI) compared to universal treatment with ticagrelor or prasugrel, resulted in a reduction in bleedings without an increase in the thrombotic risk. The objective of this analysis was to assess the cost-effectiveness of the genotype-guided strategy. Methods: In the POPular Genetics trial, STEMI patients who underwent primary percutaneous coronary intervention were randomized to an intervention or a control arm. In the intervention arm CYP2C19 genetic testing for the *2 and *3 loss-of-function alleles took place. Carriers of a loss-of-function allele were treated with ticagrelor or prasugrel, while noncarriers were treated with clopidogrel. In the control arm patients were treated with ticagrelor or prasugrel. An alongside clinical-trial cost-effectiveness analysis was conducted based on a decision-model with 1000 patients in both groups. A hybrid model, consisting of a 1-year decision tree combined with a 25-years Markov model was developed, to estimate the life-time cost-effectiveness from a societal perspective. Outcome measures were costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to account for the uncertainty around the key parameters. In an exploratory analysis the price for ticagrelor and prasugrel was the same as clopidogrel, to simulate the effect of generic ticagrelor and prasugrel in the future. Results: The genotype-guided strategy resulted in 26.87 QALY gained with cost-savings of є601,807 indicating that the genotype-guided strategy is a cost-saving intervention. The exploratory analysis - keeping the price of antithrombotic therapies at the same price level - resulted in cost-savings of є137,980. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the base-case analysis. Conclusion: Based on the POPular Genetics trial, a genotype-guided strategy compared to universal ticagrelor or prasugrel treatment resulted in favorable cost-effectiveness with QALYs gained and cost-savings.
Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years
Authors: Olivier Materne, Karim Chamari, Abdulaziz Farooq, Adam Weir, Per Hölmich, Roald Bahr, Matt Greig, Lars R McNaughton
Journal: British Journal of Sports Medicine (2020)

Objective Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons. Methods All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups. Results A total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures. Summary At this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.
Abstract 317: Outcome Predictors in Substance - Related Cardiac Arrests
Authors: Annelise Kulpanowski, Brandon Hancock, Eric Rosenthal, Brian L Edlow, William Kimberly, Michael B Westover, Edilberto Amorim, Mingming Ning, William A Copen, Pamela Schaefer, Rajeev Malhotra, Joseph T Giacino, David M Greer, Ona Wu
Journal: Circulation (2020)

Introduction: The incidence of substance-related cardiac arrests (SRCA) has increased due to the opioid epidemic. Previous studies have shown that SRCA present differently than non-SRCA. Weinvestigated differences in the clinical courses between the two groups for patients who were initially comatose post-resuscitation. Methods: Data from out-of-hospital arrest patients seen between 2007-2019 were retrospectively analyzed. Arrests were classified as SRCA if the patient had a positive toxicology screen, witnesses testified to substance use, or drug paraphernalia was present at the scene. Arrest types were categorized as shockable or non-shockable. Cerebral edema classifications were based on MRI or CT radiology reports. Poor outcomes were defined as Cerebral Performance Category (CPC) &gt; 3 at discharge. Differences in demographics, presentation and outcomes were compared (Fisher’s Exact Test or Exact Wilcoxon-Mann-Whitney). Multivariable backward stepwise logistic regression was performed. Results: SRCA patients (N=90) were younger (p&lt;.001), more likely to be non-shockable (p&lt;.001) and have worse Glasgow Coma Scale (GCS) scores (p=.041) and higher Incidence (p&lt;.001) and earlier development of cerebral edema (p=.04) than non-SRCA patients (N=339) (see Table). Adjusting for age and sex, SRCA was a significant predictor of GCS (p=0.02), shockable rhythm (p&lt;.001), edema (p=.004) and poor outcomes (p=.016). SRCA (p&lt;.001) remained an independent predictor of shockable rhythm in multivariable regression including sex (p&lt;.001) and GCS (p=.006). Multivariable analyses showed younger age (p=.001) and non-shockable rhythm (p=.002) to be predictors of edema development. Older age (p=.002) and edema (p&lt;.001) remained significant predictors of poor outcomes. Discussion: SRCA patients are more likely to have non-shockable arrests which in turn leads to cerebral edema development and potentially worse outcomes.
Abstract 14147: Vascular Complication of Distal Transradial Approach in Patients With Acute Myocardial Infarction
Authors: Takeshi Yamada, Yuki Matsubara, Soichiro Washimi, Sho Hashimoto, Norimasa Taniguchi, Shunsuke Nakajima, Tetsuya Hata, Akihiko Takahashi
Journal: Circulation (2020)

Background: The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This study investigated the incidence of vascular complication of the dTRA in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods: Consecutive 131 patients with AMI who underwent primary PCI between April 2018 and October 2019 were investigated. The dTRA was used as the primary approach whenever feasible in this study period. The bleeding complication after dTRA and the patency of the radial artery were investigated. The patency of the radial artery was examined using Doppler ultrasound in follow-up period. Results: Among the 131 AMI patients, 116 patients (88.5%) underwent successful primary PCI using the dTRA. The patients included 83 men (71.6%), and the mean age was 70.4 ± 12.9 years. A 5- or 6-French sheath (conventional or slender) was used in the primary procedure. The average time to achieving hemostasis was 5.0 ± 4.1 hours; TIMI minor bleeding was observed in 2 patients (1.5%) and there were no TIMI major bleeding. Color Doppler sonography of the radial artery was performed in 94 patients with the mean follow-up period of 273 ± 183 days, and the incidence of radial artery occlusion (RAO) was 1.1% (n=1). Conclusions: The application of dTRA is considered to have low incidences of bleeding complication and radial artery occlusion in the patients with AMI.
A commentary on “The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: A systematic review and meta-analysis based on 23 randomized studies” [Int. J. Surg. 84 (2020 Dec) 69–77, doi:10.1016/j.ijsu.2020.10.012]
Authors: Jie Deng, Hongchen He, Lin Shui
Journal: International Journal of Surgery (2020)
Group 3 Innate Lymphoid Cells Program a Distinct Subset of IL-22BP-Producing Dendritic Cells Demarcating Solitary Intestinal Lymphoid Tissues
Authors: Fabian Guendel, Michael Kofoed-Branzk, Konrad Gronke, Caroline Tizian, Mario Witkowski, Hung-Wei Cheng, Gitta Anne Heinz, Frederik Heinrich, Pawel Durek, Paula S. Norris, Carl F. Ware, Christiane Ruedl, Susanne Herold, Klaus Pfeffer, Thomas Hehlgans, Ari Waisman, Burkhard Becher, Anastasios D. Giannou, Sebastian Brachs, Karolina Ebert, Yakup Tanriver, Burkhard Ludewig, Mir-Farzin Mashreghi, Andrey A. Kruglov, Andreas Diefenbach
Journal: Immunity (2020)

Solitary intestinal lymphoid tissues such as cryptopatches (CPs) and isolated lymphoid follicles (ILFs) constitute steady-state activation hubs containing group 3 innate lymphoid cells (ILC3) that continuously produce interleukin (IL)-22. The outer surface of CPs and ILFs is demarcated by a poorly characterized population of CD11c+ cells. Using genome-wide single-cell transcriptional profiling of intestinal mononuclear phagocytes and multidimensional flow cytometry, we found that CP- and ILF-associated CD11c+ cells were a transcriptionally distinct subset of intestinal cDCs, which we term CIA-DCs. CIA-DCs required programming by CP- and ILF-resident CCR6+ ILC3 via lymphotoxin-β receptor signaling in cDCs. CIA-DCs differentially expressed genes associated with immunoregulation and were the major cellular source of IL-22 binding protein (IL-22BP) at steady state. Mice lacking CIA-DC-derived IL-22BP exhibited diminished expression of epithelial lipid transporters, reduced lipid resorption, and changes in body fat homeostasis. Our findings provide insight into the design principles of an immunoregulatory checkpoint controlling nutrient absorption.
Abstract 13455: Predicting Emergency Department Disposition at Triage for Suspected Patients With Acute Coronary Syndrome Using Machine Learning Algorithms
Authors: Stephanie O Frisch, Zeineb Bouzid, Jessica Zègre-Hemsey, Clifton W CALLAWAY, Holli A Devon, Ervin Sejdic
Journal: Circulation (2020)

Introduction: Overcrowded emergency departments (ED) and undifferentiated patients make the provision of care and resources challenging. We examined whether machine learning algorithms could identify ED patients’ disposition (hospitalization and critical care admission) using readily available objective triage data among patients with symptoms suggestive of acute coronary syndrome (ACS). Methods: This was a retrospective observational cohort study of adult patients who were triaged at the ED for a suspected coronary event. A total of 162 input variables (k) were extracted from the electronic health record: demographics (k=3), mode of transportation (k=1), past medical/surgical history (k=57), first ED vital signs (k=7), home medications (k=31), symptomology (k=40), and the computer generated automatic interpretation of 12-lead electrocardiogram (k=23). The primary outcomes were hospitalization and critical care admission (i.e., admission to intensive or step-down care unit). We used 10-fold stratified cross validation to evaluate the performance of five machine learning algorithms to predict the study outcomes: logistic regression, naïve Bayes, random forest, gradient boosting and artificial neural network classifiers. We determined the best model by comparing the area under the receiver operating characteristic curve (AUC) of all models. Results: Included were 1201 patients (age 64±14, 39% female; 10% Black) with a total of 956 hospitalizations, and 169 critical care admissions. The best performing machine learning classifier for the outcome of hospitalization was gradient boosting machine with an AUC of 0.85 (95% CI, 0.82–0.89), 89% sensitivity, and F-score of 0.83; random forest classifier performed the best for the outcome of critical care admission with an AUC of 0.73 (95% CI, 0.70–0.77), 76% sensitivity, and F-score of 0.56. Conclusion: Predictive machine learning algorithms demonstrate excellent to good discriminative power to predict hospitalization and critical care admission, respectively. Administrators and clinicians could benefit from machine learning approaches to predict hospitalization and critical care admission, to optimize and allocate scarce ED and hospital resources and provide optimal care.
Refining Assumptions About Specialty Compensation Rates—Reply
Authors: Christopher P. Childers, Melinda Maggard-Gibbons
Journal: JAMA Surgery (2020)

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