tbuckley/cabot-search huggingface dataset:
Abstract 16107: Electrocardiographic Findings and Their Associations With Adverse Outcomes in Hospitalized Patients With COVID-19
Authors: Mariya Fatakdawala, Jason Pang, Ritesh Patel, Tariq Thannoun, Cullen Grable, Sarita Damaraju, Shamim B Mawji, Messan Folivi, Siddharth Chauhan, Christopher Powell, Muhammad A Shabbir, Radmila Lyubarova, Srikanth Damaraju, Nicolas L Palaskas, Anita M Deswal, Heinrich Taegtmeyer, Enrique Garcia-Sayan, Efstratios Koutroumpakis
Journal: Circulation (2020)

Introduction: Although primarily a respiratory illness, COVID-19 frequently involves the cardiovascular system. Hypothesis: Accordingly, we assessed whether abnormal electrocardiographic findings, including cardiac dysrhythmias, ST/T wave changes, and QTc interval prolongation, predict adverse outcomes in patients with COVID-19. Methods: A multi-center retrospective study of hospitalized patients with COVID-19 was performed across 4 hospitals in Texas and 1 in New York. Initial and subsequent ECG findings among patients with uncomplicated disease course, patients with adverse clinical outcomes (need for vasopressors, mechanical ventilation or renal replacement therapy) and patients who died were analyzed. Univariable and multivariable Cox analyses were performed. Results: We identified 297 consecutive patients with COVID-19. Of these patients, 91% had available ECGs. Median heart rate on initial ECG was 92 bpm (IQR: 27), and median QTc interval was 442 msec (IQR: 40). Longer QTc interval on initial ECG was associated with adverse clinical outcomes (443 msec, IQR: 43) and death (457 msec, IQR: 52, vs 441.5 msec, IQR: 36; p=0.033). Cardiac dysrhythmias or ST/T wave changes were noted in subsequent ECGs of 46% of patients and were associated with adverse clinical outcomes (58%) or death (68% vs 33%; HR: 2.2, 95% CI: 1.3-3.6; p=0.002). Sixty-four patients (23%) developed a QTc interval &gt;500msec during their hospitalization. In multivariable Cox analysis, history of coronary artery disease was independently associated with development of QTc&gt;500msec (HR 2.1, 95% CI 1.0-4.4; p=0.047) while other baseline comorbidities were not. Patients with QTc&gt;500msec were more commonly treated with azithromycin (91% vs 77%; p=0.048); no other differences in COVID-19 treatment were identified. In-hospital mortality among patients with QTc&gt;500msec was 37% versus 13% among patients with shorter QTc intervals (HR: 2.6, 95% CI 1.5-4.5; p=0.001). Conclusions: Prolonged QTc interval on initial ECG of COVID-19 patients predicted adverse outcomes and death. Azithromycin was associated with development of QTc&gt;500msec. Patients with a QTc interval &gt;500msec had a 2.6 times higher risk for in-hospital mortality compared to patients with shorter QTc intervals.
Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI
Authors: Giuseppe De Luca, Monica Verdoia, Miha Cercek, Lisette Okkels Jensen, Marija Vavlukis, Lucian Calmac, Tom Johnson, Gerard Rourai Ferrer, Vladimir Ganyukov, Wojtek Wojakowski, Tim Kinnaird, Clemens van Birgelen, Yves Cottin, Alexander IJsselmuiden, Bernardo Tuccillo, Francesco Versaci, Kees-Jan Royaards, Jurrien Ten Berg, Mika Laine, Maurits Dirksen, Massimo Siviglia, Gianni Casella, Petr Kala, José Luis Díez Gil, Adrian Banning, Victor Becerra, Ciro De Simone, Andrea Santucci, Xavier Carrillo, Alessandra Scoccia, Giovanni Amoroso, Arpad Lux, Tomas Kovarnik, Periklis Davlouros, Julinda Mehilli, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sébastien Levesque, Giuseppe Cirrincione, Vincenzo Guiducci, Michał Kidawa, Leonardo Spedicato, Lucia Marinucci, Peter Ludman, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Arturo Garcia-Touchard, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Forés, Luca Donazzan, Luigi Vignali, Rui Teles, Edouard Benit, Pierfrancesco Agostoni, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Marco Boccalatte, Pierre Deharo, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Dimitrios Alexopoulos, Raul Moreno, Elvin Kedhi, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Fortunato Scotto Di Uccio, Bor Wilbert, Pieter Smits, Giuliana Cortese, Guido Parodi, Dariusz Dudek
Journal: Journal of the American College of Cardiology (2020)
Abstract 15410: Post-operative Outcomes After Fontan Procedure in Patients With Heterotaxy and Other Situs Anomalies
Authors: Son Q Duong, Isabella Zaniletti, Leo Lopez, Scott M Sutherland, Andrew Y Shin, Ronnie T Collins
Journal: Circulation (2020)

Background: Heterotaxy is a multisystem disorder of situs often associated with cardiac, immune, and gastrointestinal abnormalities. Heterotaxy and other situs abnormalities (H/SA) may share ciliary dysfunction as an embryologic origin. Extracardiac manifestations of H/SA may contribute to increased morbidity and mortality after total cavopulmonary connection (Fontan) procedure. We hypothesized that patients with H/SA have worse postoperative outcomes after Fontan than patients without H/SA. Methods: We queried the Pediatric Health Information System (PHIS) database for hospitalizations with ICD-9/10 codes for Fontan procedure in patients aged 1 to 12 years from 2004 to 2019. Those coded for dextrocardia, situs inversus, asplenia/polysplenia, and atrial isomerism were defined as H/SA. Outcomes were in-hospital all-cause mortality or heart transplantation, post-operative ECMO, dialysis, postsurgical length of stay (LOS), and mechanical ventilation &gt;4 days. Outcomes were compared between H/SA and non-H/SA controls with chi-squared or rank-sum test (reported as median (IQR)), and statistically adjusted for surgical center, age, sex, race, genetic anomaly, and pre-operative support with multivariate logistic regression (reported as adjusted odds-ratio (95% CI)). Results: Of 7,897 patients who underwent Fontan at 50 PHIS centers, 1,366 (17%) met criteria for H/SA. Patients with H/SA versus non-H/SA were older (3.7 (2.9-4.8) vs 3.4 (2.7-4.2) years; p&lt;0.001), more female (44 vs 40%, p=0.005), and Asian or Hispanic (35% vs 24%, p&lt;0.001). H/SA had higher rates of discharge death/transplantation (1.9 vs 1.1%, aOR 1.76 (1.02-3.04); p=0.042), post-operative ECMO (3.7 vs 2.3%, aOR 1.73 (1.28-2.33); p&lt;0.001), dialysis (2.1 vs 1.2%, aOR 1.66 (1.06-2.59); p=0.026), prolonged intubation (13.2% vs 7.6%, aOR 1.86 (1.53-2.25); p&lt;0.001), and longer LOS (11 (8-17) vs 9 (7-13) days; p&lt;0.001). Conclusions: We observed increased mortality and postoperative complications in this largest report to date on patients with H/SA after Fontan. We postulate that ciliary dysfunction may contribute to increased lung and renal morbidity, and should be explored further. Adjustment for anatomic complexity and hemodynamics are required for further study .
Abstract 16566: Presentation and Outcome of Pediatric Multisystem Inflammatory Syndrome Temporally Associated With Sars-cov-2 Pandemic: An International Survey
Authors: Carles Bautista, Joan Sanchez-de-Toledo, Clark C Bradley, Jetrho Herberg, Fanny Bajolle, Paula C Randanne, Diana Salas-Mera, sandrine foldvari, Devyani Chowdhury, Francesco Bianco, Yogen Singh, Michael Levin, Damien Bonnet, alain fraisse
Journal: Circulation (2020)

Introduction: Following the SARS-CoV-2 pandemic peak, children suffering from a multiorgan inflammatory disease that often leads to shock have been reported. This condition shares features with Kawasaki disease, but its etiopathogenesis is unknown. Hypothesis: We aimed to describe presentation and hospital course for this pediatric inflammatory multisystemic syndrome associated with COVID-19 (PIMS-TS). Methods: Data were collected from a retrospective review of children from 33 participating European, Asian and American sites. Results: We included 183 patients (109 males, 59·6%) with PIMS-TS, at a mean age of 7·0 (±4·7) years. Fifty-six (30·6%) had black ethnicity and obesity was present in 48 (26·2%) cases. Overall, 114/183 (62·3%) had biological evidence of current or recent SARS-CoV-2 infection. At admission, all presented with fever, 117/183 (63·9%) with gastrointestinal symptoms and 79/183 (43·2%) with shock, that was associated with more frequent black ethnicity, higher inflammatory markers and more cardiac involvement. Twenty-seven patients (14·7%) fulfilled criteria for Kawasaki disease. They were younger with no shock, fewer gastrointestinal, cardio-respiratory and neurological symptoms. Among the remaining PIMS-TS patients, 77 (49·3%) had mainly fever and inflammation with less cardiac involvement. For the entire cohort of 183 patients, the mean duration of admission was 8·6 (±5·6) days. Inotropic support, mechanical ventilation and ECMO were indicated in 72 (39·3%), 43 (23·5%) and 4 (2·2%) patients, respectively. Three patients (1·6%) died. A shorter duration of symptoms before admission was a risk factor for worse outcome and for ECMO/death, with 63% increased risk per day reduction (95%CI 0·39-0·93, p=0·03) and with 51·4% increased risk per day reduction (95%CI 0·36-0·9, p=0·03), respectively. Conclusions: We describe the first largest international series of children with PIMS-TS. Life-threatening shock is a common presentation. A shorter duration of symptoms prior to admission characterizes the fulminant form of the disease with potentially worse outcome.
Self-reported sports injuries and later-life health status in 3357 retired Olympians from 131 countries: a cross-sectional survey among those competing in the games between London 1948 and PyeongChang 2018
Authors: Debbie Palmer, Dale J Cooper, Carolyn Emery, Mark E Batt, Lars Engebretsen, Brigitte E Scammell, Patrick Schamasch, Malav Shroff, Torbjørn Soligard, Kathrin Steffen, Jackie L Whittaker, Richard Budgett
Journal: British Journal of Sports Medicine (2020)

Objective Describe the self-reported prevalence and nature of Olympic-career injury and general health and current residual symptoms in a self-selected sample of retired Olympians. Methods 3357 retired Olympians from 131 countries completed a cross-sectional online survey, distributed by direct email through World Olympians Association and National Olympian Associations databases. The survey captured Olympic sport exposure, significant training and competition injury history (lasting &gt; 1 month), general health (eg, depression) during the athlete’s career, and current musculoskeletal pain and functional limitations. Results 55% were men (44% women, 1% unknown), representing 57 sports (42 Summer, 15 Winter), aged 44.7 years (range 16–97). A total of 3746 injuries were self-reported by 2116 Olympians. This equated, 63.0% (women 68.1%, men 59.2%) reporting at least one significant injury during their Olympic career. Injury prevalence was highest in handball (82.2%) and lowest in shooting (40.0%) for Summer Olympians; and highest in alpine skiing (82.4%) and lowest in biathlon (40.0%) for Winter Olympians. The knee was the most frequently injured anatomical region (20.6%, 120 median days severity), followed by the lumbar spine (13.1%, 100 days) and shoulder/clavicle (12.9%, 92 days). 6.6% of Olympians said they had experienced depression during their career. One-third of retired Olympians reported current pain (32.4%) and functional limitations (35.9%). Conclusions Almost two-thirds of Olympians who completed the survey reported at least one Olympic-career significant injury. The knee, lumbar spine and shoulder/clavicle were the most commonly injured anatomical locations. One-third of this sample of Olympians attributed current pain and functional limitations to Olympic-career injury.
Non-binary reproduction: Stories of conception, pregnancy, and birth
Authors: Olivia J. Fischer
Journal: International Journal of Transgender Health (2020)

Background: Many non-binary individuals AFAB (assigned female at birth) seek gestational parenthood. However, the limited available literature is often focused on trans men and overlooks the conception, pregnancy, and birth experiences of non-binary parents.Aims: The study aimed to capture the unique reproduction narratives of non-binary people AFAB.Methods: Five non-binary individuals volunteered to participate in this study. Data were collected using largely unstructured, in-depth, tape-recorded interviews. Thematic analysis of the verbatim transcripts and tape recordings yielded a chronological, cohesive narrative for each participant. Four participants reviewed their narrative and confirmed that their story was accurately represented. The individual narratives were then woven into one collective narrative, and common themes across the participants' stories were identified.Results: Before conception, most participants considered how to balance their medical and social transitions with their reproductive goals. Conception was relatively easy and straightforward for the four participants who used their partner's sperm. The gendered nature of, and language surrounding, pregnancy greatly impacted participant's reproductive experiences, leading to feelings of isolation and loneliness, difficulties finding maternity clothes and gender dysphoria. Participants desired gender-affirming care and reported mostly positive experiences with their healthcare providers. Their gender identity influenced their experiences of parenthood, as well as the decisions they made regarding the disclosure of their gender identity to others, their gender presentation, chestfeeding, and parental designations.Discussion: The cisnormative and heteronormative scripts that surround pregnancy shaped the reproductive narratives of those who participated in this research. The findings reinforce the importance of inclusive, gender-affirming healthcare and social support services.
Abstract 14203: Secondary Sarcopenia Assessed by Computed Tomography Can Predict Hospitalization for Heart Failure in Adults With Fontan Circulation
Authors: Yumi Shiina, Michinobu Nagao, Kei Inai
Journal: Circulation (2020)

Introduction: Sarcopenia is one of the important predictors of heart failure (HF) in patients with cardiac problems. Hypothesis: Skeletal muscle pump is very important to maintain Fontan circulation. We aimed to quantify the volume of the psoas major muscle (PMM) and investigate whether it is relevant to HF hospitalization in adults with Fontan circulation. Methods: A total of 154 adults with Fontan circulation, and 30 age-matched adults were studied retrospectively. We identified secondary sarcopenia by measuring the PMM volume, using non-contrast abdominal computed tomography (CT). Results: PMM indexed volume in Fontan patients was lower than controls (206.4+/-18.0 cc/m2 vs 288.0+/-61.1 cc/m2, P&lt;0.0001). In Fontan men, PMM indexed volume correlated with New York Heart Association functional class (NYHA FC). PMM indexed volume in Fontan women correlated with age, NYHA FC, and serum creatinine. Using a multivariate Cox hazards analysis, NYHA FC ≧3 was an important prediction of hospitalization due to HF in Fontan men. In Fontan women, NYHA FC ≧3, brain natriuretic peptide (BNP), PMM indexed volume, and protein losing enteropathy (PLE) were important predictions of hospitalization due to HF. Among all Fontan patients, those with low PMM volumes had a poorer prognosis in HF (Log rank P=0.012 [men] and 0.0009 [women]). Conclusions: PMM volume reduction has an adjunctive prediction of HF hospitalization in adults with Fontan circulation, particularly in Fontan females. Secondary sarcopenia may have a negative impact on the prognosis of HF in this population. The assessment of skeletal muscle mass also may be a comprehensive screening tool for multi-organ dysfunction in Fontan circulation.
CILP1 as a biomarker for right ventricular maladaptation in pulmonary hypertension
Authors: Stanislav Keranov, Oliver Dörr, Leili Jafari, Christian Troidl, Christoph Liebetrau, Steffen Kriechbaum, Till Keller, Sandra Voss, Timm Bauer, Jakob Lorenz, Manuel J. Richter, Khodr Tello, Henning Gall, Hossein A. Ghofrani, Eckhard Mayer, Christoph B. Wiedenroth, Stefan Guth, Holger Lörchner, Jochen Pöling, Prakash Chelladurai, Soni Savai Pullamsetti, Thomas Braun, Werner Seeger, Christian W. Hamm, Holger Nef
Journal: European Respiratory Journal (2020)

The aim of our study was to analyse the protein expression of cartilage intermediate layer protein (CILP)1 in a mouse model of right ventricular (RV) pressure overload and to evaluate CILP1 as a biomarker of cardiac remodelling and maladaptive RV function in patients with pulmonary hypertension (PH). Pulmonary artery banding was performed in 14 mice; another nine mice underwent sham surgery. CILP1 protein expression was analysed in all hearts using Western blotting and immunostaining. CILP1 serum concentrations were measured in 161 patients (97 with adaptive and maladaptive RV pressure overload caused by PH; 25 with left ventricular (LV) hypertrophy; 20 with dilative cardiomyopathy (DCM); 19 controls without LV or RV abnormalities) In mice, the amount of RV CILP1 was markedly higher after banding than after sham. Control patients had lower CILP1 serum levels than all other groups (p&lt;0.001). CILP1 concentrations were higher in PH patients with maladaptive RV function than those with adaptive RV function (p&lt;0.001), LV pressure overload (p&lt;0.001) and DCM (p=0.003). CILP1 showed good predictive power for maladaptive RV in receiver operating characteristic analysis (area under the curve (AUC) 0.79). There was no significant difference between the AUCs of CILP1 and N-terminal pro-brain natriuretic peptide (NT-proBNP) (AUC 0.82). High CILP1 (cut-off value for maladaptive RV of ≥4373 pg·mL −1 ) was associated with lower tricuspid annular plane excursion/pulmonary artery systolic pressure ratios (p&lt;0.001) and higher NT-proBNP levels (p&lt;0.001). CILP1 is a novel biomarker of RV and LV pathological remodelling that is associated with RV maladaptation and ventriculoarterial uncoupling in patients with PH.
Covid-19: Government has spent billions on contracts with little transparency, watchdog says
Authors: Gareth Iacobucci
Journal: BMJ (2020)

The government failed to provide transparency when hastily awarding billions of pounds worth of contracts during the covid-19 pandemic, the UK’s public spending watchdog has concluded.

The National Audit Office (NAO) said that the government had failed to provide adequate documentation showing how some key decisions were reached, including why particular suppliers were chosen or how potential conflicts of interest were handled.

Some contracts were awarded after work had already begun, many were not published in the timeframe they should have been, and some conflicts of interest were not disclosed, a report1 by the auditors found.

The investigation into government procurement during the pandemic found that the government awarded over 8600 contracts worth £18bn (€20bn; $24bn) by 31 …
Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation
Authors: Jonathan H Chung, Gordon Ho, Andrew Schluchter, Francisco Contijoch, Jonathan C Hsu, Gregory K Feld, David E Krummen, Elliot R McVeigh
Journal: Circulation (2020)

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p&lt;0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.
Characterization and Clinical Outcomes of DNA Mismatch Repair–deficient Small Bowel Adenocarcinoma
Authors: Alicia Latham, Jinru Shia, Zalak Patel, Diane L. Reidy-Lagunes, Neil H. Segal, Rona Yaeger, Karuna Ganesh, Louise Connell, Nancy E. Kemeny, David P. Kelsen, Jaclyn F. Hechtman, Garrett M. Nash, Philip B. Paty, Ahmet Zehir, Kaitlin A. Tkachuk, Rania Sheikh, Arnold J. Markowitz, Diana Mandelker, Kenneth Offit, Michael F. Berger, Andrea Cercek, Julio Garcia-Aguilar, Leonard B. Saltz, Martin R. Weiser, Zsofia K. Stadler
Journal: Clinical Cancer Research (2020)

Abstract Purpose: The prevalence and clinical characteristics of small bowel adenocarcinomas (SBA) in the setting of Lynch syndrome have not been well studied. We characterized SBA according to DNA mismatch repair and/or microsatellite instability (MMR/MSI) and germline mutation status and compared clinical outcomes. Experimental Design: A single-institution review identified 100 SBAs. Tumors were evaluated for MSI via MSIsensor and/or corresponding MMR protein expression via IHC staining. Germline DNA was analyzed for mutations in known cancer predisposition genes, including MMR (MLH1, MSH2, MSH6, PMS2, and EPCAM). Clinical variables were correlated with MMR/MSI status. Results: Twenty-six percent (26/100; 95% confidence interval, 18.4–35.4) of SBAs exhibited MMR deficiency (MMR-D). Lynch syndrome prevalence was 10% overall and 38.5% among MMR-D SBAs. Median age at SBA diagnosis was similar in non-Lynch syndrome MMR-D versus MMR-proficient (MMR-P) SBAs (65 vs. 61; P = 0.75), but significantly younger in Lynch syndrome (47.5 vs. 61; P = 0.03). The prevalence of synchronous/metachronous cancers was 9% (6/67) in MMR-P versus 34.6% (9/26) in MMR-D SBA, with 66.7% (6/9) of these in Lynch syndrome (P = 0.0002). In the MMR-P group, 52.2% (35/67) of patients presented with metastatic disease, compared with 23.1% (6/26) in the MMR-D group (P = 0.008). In MMR-P stage I/II patients, 88.2% (15/17) recurred, compared with 18.2% (2/11) in the MMR-D group (P = 0.0002). Conclusions: When compared with MMR-P SBA, MMR-D SBA was associated with earlier stage disease and lower recurrence rates, similar to observations in colorectal cancer. With a 38.5% prevalence in MMR-D SBA, germline Lynch syndrome testing in MMR-D SBA is warranted.