tbuckley/cabot-search huggingface dataset:
Diagnostic Performance of High-Sensitivity Cardiac Troponin T Strategies and Clinical Variables in a Multisite US Cohort
Authors: Brandon R. Allen, Robert H. Christenson, Scott A. Cohen, Richard Nowak, R. Gentry Wilkerson, Bryn Mumma, Troy Madsen, James McCord, Maite Huis in’t Veld, Michael Massoomi, Jason P. Stopyra, Cindy Montero, Michael T. Weaver, Kai Yang, Simon A. Mahler
Journal: Circulation (2021)

Background: European data support the use of low high-sensitivity troponin (hs-cTn) measurements or a 0/1-hour (0/1-h) algorithm for myocardial infarction to exclude major adverse cardiac events (MACEs) among patients in the emergency department with possible acute coronary syndrome. However, modest US data exist to validate these strategies. This study evaluated the diagnostic performance of an initial hs-cTnT measure below the limit of quantification (LOQ: 6 ng/L), a 0/1-h algorithm, and their combination with history, ECG, age, risk factors, and initial troponin (HEART) scores for excluding MACE in a multisite US cohort. Methods: A prospective cohort study was conducted at 8 US sites, enrolling adult patients in the emergency department with symptoms suggestive of acute coronary syndrome and without ST-elevation on ECG. Baseline and 1-hour blood samples were collected, and hs-cTnT (Roche; Basel, Switzerland) was measured. Treating providers blinded to hs-cTnT results prospectively calculated HEART scores. MACE (cardiac death, myocardial infarction, and coronary revascularization) at 30 days was adjudicated. The proportion of patients with initial hs-cTnT measures below the LOQ and risk according to a 0/1-h algorithm was determined. The negative predictive value (NPV) was calculated for both strategies when used alone or with a HEART score. Results: Among 1462 participants with initial hs-cTnT measures, 46.4% (678 of 1462) were women and 37.1% (542 of 1462) were Black with an age of 57.6±12.9 (mean±SD) years. MACEs at 30 days occurred in 14.4% (210 of 1462) of participants. Initial hs-cTnT measures below the LOQ occurred in 32.8% (479 of 1462), yielding an NPV of 98.3% (95% CI, 96.7–99.3) for 30-day MACEs. A low-risk HEART score with an initial hs-cTnT below the LOQ occurred in 20.1% (294 of 1462), yielding an NPV of 99.0% (95% CI, 97.0–99.8) for 30-day MACEs. A 0/1-h algorithm was complete in 1430 patients, ruling out 57.8% (826 of 1430) with an NPV of 97.2% (95% CI, 95.9–98.2) for 30-day MACEs. Adding a low HEART score to the 0/1-h algorithm ruled out 30.8% (441 of 1430) with an NPV of 98.4% (95% CI, 96.8–99.4) for 30-day MACEs. Conclusions: In a prospective multisite US cohort, an initial hs-cTnT below the LOQ combined with a low-risk HEART score has a 99% NPV for 30-day MACEs. The 0/1-h hs-cTnT algorithm did not achieve an NPV &gt;99% for 30-day MACEs when used alone or with a HEART score. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02984436.
Impact of adjuvant chemotherapy and patient age on patterns of metastatic recurrence in stage III colorectal cancer.
Authors: Grace Gard, Yat Hang To, Lucy Gately, Matthew Croxford, Ian Jones, Ian Faragher, Malcolm Steel, Wei Hong, Rachel Wong, Margaret Lee, Jeanne Tie, Suzanne Kosmider, Vanessa Wong, Sumitra Ananda, Azim Jalali, Peter Gibbs
Journal: Journal of Clinical Oncology (2021)

122 Background: The patterns of metastatic relapse for Stage III colorectal cancer (CRC) are known to be influenced by the primary site and mutation status. Whether the use of adjuvant therapy also influences recurrence patterns, due to a variable chemotherapy impact by metastatic site, has yet to be explored. Patient age 70 years has consistently been associated with a lack of benefit from the addition of oxaliplatin to a fluoropyrimidine (FP) chemotherapy. Methods: Data from a multi-site CRC database that prospectively captures, patient, tumour, treatment and outcome data was examined. Patients with de novo metastatic or multiple primary tumours were excluded. Patterns of recurrence were analysed by receipt of surgery and adjuvant chemotherapy (S + AC) or surgery alone (S alone) and by age 70 years and &lt;70 years old. Results: Of 701 patients with stage III colon cancer 397 were male, median age was 68 years (range 33-83) and 574 (81%) were ECOG 0-1. S + AC was administered in 555 (79%), including 228 treated with a FP alone and 324 treated with an oxaliplatin doublet. Metastatic relapse was delayed in S + AC patients, occurring at a median of 17.81 vs 9.43 months (p&lt; 001). Liver metastases were the most common site of relapse overall (40%) and numerically less common in the S + AC group (38% vs 46%, p = 0.06). Brain metastases were less common in S + AC patients (1% vs 3.5%, p = 0.04). When analysed by primary tumour side the only significant finding was that for patients with a right-side primary (n= 208, 76% had S + AC), S+ AC was associated with a lower rate of lung metastases (28% vs 41% p = 0.046). 318 of the 701 (45%) of this relapsed cohort were 70 years old, 220 (69%) of these patients had S + AC. In both the older and younger cohort metastatic relapse was delayed with S + AC (18.7 vs 11.3 months, p &lt; 0.001, 17.08 vs. 6.01 months, p &lt; 0.001) and liver metastases were the most common site of relapse (41% vs 38%, p=0.56). Similar rates of lung metastases (40% vs 34%, p=0.1), peritoneal disease (20% vs 22%, p=0.57) and brain metastases (2.2% vs 0.8%, p=0.13) were seen in the 70 years old and &lt;70 years old patients, with no evident interaction between chemotherapy use and age with respect to recurrence sites. Conclusions: S + AC for stage III colon cancer in this community series delayed time to recurrence and resulted in numerically lower recurrence rates at all disease sites. Brain metastases although uncommon were less frequent in S + AC patients. Patients with a right sided primary had a lower incidence of lung metastases following S + AC patient cohort. There was no significant impact of age on recurrence patterns.
FRI0183 Anticardiolipin antibodies in women with unexplained pregnancy loss
Authors: RR Petrovic, Z Mikovic, M Petrovic, LJ Srejic, M Roganovic
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Recurrent pregnancy loss is one of the major clinical features of antiphospholipid syndrome (APS). Although pregnancy losses in patients with antiphospholipid antibodies typically occur after the 10th week of gestation, early losses and premature birth also take place. Preliminary classification criteria for APS precisely define pregnancy morbidity associated with anticardiolipin antibodies (aCL) and/or with lupus anticoagulant (LA) as follows: 1) one or more unexplained fetal deaths; 2) one or more premature births; 3) three or more unexplained consecutive spontaneous abortions before the 10th week of gestation, when other causes (endocrine, genetic, and morphological) have been excluded.<sup>1</sup> <h3>Objectives</h3> To assess the prevalence of elevated levels of anticardiolipin antibodies in otherwise healthy women with history of unexplained pregnancy losses and to investigate prevalence of APS among them. <h3>Methods</h3> 29,8 ± 5,3 A cross-sectional study comprised fifty women (mean age 29,8 ± 5,3 years) with a history of unexplained pregnancy losses (median 3; range 1–6). None of these women had anatomical, endocrine, genetic or infective cause for miscarriage. Anticardiolipin antibodies of IgG and IgM isotype were measured by a standardised ELISA for beta2-GPI- dependent aCL. <h3>Results</h3> 14 out of 50 (28%) women had elevated levels of aCL IgG (5) or IgM (6) or both (3) isotypes. Comparing aCL positive and aCL negative women, we found statistically significant difference in women age (32,3 ± 5,85 vs. 28,8 ± 4,8 years; p &lt; 0,02) and fetal age at the time of miscarriage (median 18 vs. 10 weeks; p &lt; 0,0001). Ten out of these 14 women fulfilled criteria for APS. During the follow-up of these patients that has lasted several years (3–5), 2 patients have developed full-blown of primary APS that includes thromboembolic events, and the other 3 were diagnosed as systemic lupus erythematosus (2) and overlap syndrome (1) with secondary APS. <h3>Conclusion</h3> Elevated levels of anticardiolipin antibodies in women with unexplained pregnancy losses imply the presence of antiphospholipid syndrome. In fifty percent of these patients, full development of primary APS or secondary APS associated with systemic lupus erythematosus can be expected. <h3>Reference</h3> Wilson WA, Gharavi AE, Koike T, <i>et al</i>. International consensus statement on preliminary classification criteria for antiphospholipid syndrome: report of an international workshop. Artritis Rheum. 1999;42:1309–11
THU0211 Adult onset still’s disease: a rare association with autoimmune thyroiditis
Authors: A Cossu, LA Congiu, P Capelli, F Solinas, A Carcassi
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Adult onset Still's disease (AOSD) was first described by Bywaters in 1971. Subsequently more than 300 cases have been reported. AOSD is a systemic inflammatory disease with high spiking fever, a typical rash and arthritis or arthralgia as major clinical features. The disease is accompanied by a neutrophylic leukocytosis. Other common features are sore throat, intensive myalgias, lymphoadenopathy, hepatosplenomegaly, pericarditis and pleuritis. A 48 years old white woman recently presented to our observation. She had been in her usual state of good health until 7 years before, when she developed fever, arthralgias, sore throat and euthyroid non-toxic goitre. Thyroid antibodies (Thyreoglobulin, microsomal, peroxidase) were elevated. She was diagnosed to have autoimmune thyroiditis and was treated with l-thyroxine and prednisone 25 mg daily. She has done well until eight months ago when she developed fever, arthralgias, sore throat and myalgias. One month later she was admitted to her local hospital with spyking fever of 39,0°C, pleuritic chest pain, dyspnea, hepatomegaly, palpitations, fatigue and weight loss. Chest radiograph revealed bilateral pleural effusion and echocardiogram demonstrated pericardial effusion. A thoracentesis removed 30 ml of pleuric fluid, wich had the characteristic of an exudate. Ultrasound abdominal investigation revealed mild hepstomegaly. Once with the fever spike (40°C) a mildly pruritic maculopapular evanescent rash located on the extremities was observed and interpreted as drug induced. Laboratory examination revealed haemoglobin 10,2 g/dl, Erythrocyte mean corpuscolar volume 71,2 fl, platelet count 628'000/mmc, White blood cell count 30'640/mmc with 96% neutrophils, ESR 76 mm/h, CRP 32,7 mg/dl, Rheumatoid Factor 121,0 UI/ml. ANA, ENA, ANCA, ACA and anti-DNA were normal. There was no serological evidence for active o recent infection and blood coltures were negative. Malignancies were excluded. There was no response to empiric antibiotics. Therapy with NSAIDs failed. Treatment with 3,5‑4,0 mg/Kg daily Cyclosporine for three months was ineffective. Prednisone 50 mg daily resulted in resolution of fever, systemic manifestations, sore throat and normalisation of her laboratory tests, including Rheumatoid Factor. Rheumatic diseases are, more frequently than suspected, associated with autoimmune thyroiditis. To our knowledge this is the second reported case of association between AOSD and autoimmune thyroiditis. Test for Rheumatoid Factor, ANA and other autoantibodies are generally negative in AOSD. Some criteria for the diagnosis of AOSD consider a positive Rheumatoid Factor as an exclusion criteria. But it may be positive in a transient manner in up to 4 to 6% of those patients. <h3>Objectives</h3> <h3>Methods</h3> <h3>Results</h3> <h3>Conclusion</h3>
National Clinical Trials Networkbiobanking during the COVID-19 pandemic
Authors: H. A. Lankes, M. A. Watson, R. C. Jordan, N. C. Ramirez, I. I. Wistuba, L. Shepherd, I. A. Lubensky, H. Makhlouf
Journal: Clinical Cancer Research (2020)

The National Cancer Institute (NCI) has a large portfolio of ongoing cancer clinical trials that involve biospecimencollection and are supported by the NCI-funded National Clinical Trials Network (NCTN) Biospecimen Banks locatedacross the United States and Canada  At the start of the COVID-19 pandemic, NCTN biobanks rapidly responded tostaffing consequences of state- and institution-issued stay-at-home orders  Many of the NCTN biobanks weredeemed essential by their institutions, allowing for limited and/or socially distanced operations  NCTN biobanksquickly worked with NCI and their respective groups to advise participating sites of changes to usual biospecimencollection procedures in order to accommodate limited staffing at the biobanks  In many instances, participating sites were navigating their own institutional process change due to the pandemic  NCTN cancer clinical trials experiencedan approximate 40% decrease in enrollment from March 11 to May 19, 2020, compared to the same time frame in2019  Likewise, NCTN biobanks saw an approximate 40% and 60% decrease in biospecimen receipt anddistribution, respectively  The decrease in biospecimen receipt was likely due to two factors: (1) participating siteCOVID-19 policies limiting patient enrollment on NCI cancer clinical trials and/or biospecimen collection for thosetrials, and (2) NCTN biobank requests for participating sites to hold nonurgent and/or nonmandatory biospecimensduring the initial phase of the pandemic  Decrease in biospecimen distributions was mainly due to receivinglaboratory closures as dictated by their institutional COVID-19 policies  On May 20, 2020, all states had begun initialreopening phases to some extent  At this time, several, but not all, NCTN biobanks had begun measured return tofull operations, following institutional guidance  NCTN biobanks are making numerous considerations towardreturning to full operations and will continue to work with NCI and their respective groups to responsibly collect anddistribute biospecimens collected during the COVID-19 pandemic  Likely, some patients enrolled on NCTN cancerclinical trials may have had clinical or subclinical COVID-19 at the time of biospecimen collection  Additionally, biospecimens will be collected on two recently activated NCI COVID-19 studies: (1) the NCI COVID-19 in CancerPatients Study (NCCAPS): A Longitudinal Natural History Study ( NCT04387656 ), and (2) a tocilizumab treatmenttrial for COVID-19-related acute respiratory distress syndrome in cancer patients ( NCT04370834 )  Retrospectiveannotation of these biospecimens may provide a unique resource for translational research efforts and will also be aneeded caveat for interpreting biomarker studies conducted using these biospecimens, as the impact of COVID-19on various biomarkers is currently unknown
Alternative Site Pacing to Promote Cardiac Synchrony: Has Conventional Pacing Become Unconventional?⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.
Authors: Mark H. Schoenfeld
Journal: Journal of the American College of Cardiology (2006)
Assessment of Knowledge of HIV/AIDS and Association With Socioeconomic Disparities Among Young Women in Low- and Middle-Income Countries, 2003 to 2018
Authors: Fan Yang, Zhihui Li, S. V. Subramanian, Chunling Lu
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Knowledge of HIV/AIDS among the younger population is crucial for long-term control. Little research has been done on which groups of young women (aged 15-24 years) in low- and middle-income countries (LMICs) have been left behind with respect to obtaining this knowledge. <h3>Objective</h3> To provide an up-to-date assessment of the levels of and changes in knowledge of HIV/AIDS and its associations with socioeconomic disparity among young women in LMICs. <h3>Design, Setting, and Participants</h3> This cross-sectional study used nationally representative Demographic and Health Surveys with available data on HIV/AIDS knowledge in 51 LMICs between 2003 and 2018. The final data set contained 282 757 young women. For 40 LMICs with multiple surveys available, we examined changes in knowledge and socioeconomic disparities. Analyses of the survey data were conducted between December 1, 2019, and July 31, 2020. <h3>Main Outcomes and Measures</h3> The percentage of young women who were able to (1) correctly identify the 2 major ways of preventing the sexual transmission of HIV, (2) reject the 2 most common local misconceptions about HIV transmission and (3) know that a healthy-looking person can transmit HIV. The level of and changes in young women's knowledge of HIV/AIDS as well as knowledge disparities by residential area, wealth status, and level of education on the aggregate and country levels were assessed. <h3>Results</h3> Of a total of 282 757 young women from 51 LMICs, 29.3% (95% CI, 24.1% to 34.5%) reported having knowledge of HIV/AIDS in the latest years, ranging from 1.0% (95% CI, 0.7% to 1.3%) in Afghanistan in 2015 to 64.9% (95% CI, 63.3% to 66.5%) in Rwanda in 2014 to 2015. Those living in rural areas, living in households in the lowest income quintile, or with low levels of education reported less knowledge about HIV/AIDS than their counterparts (−12.8 [95% CI, −10.6 to −14.9] percentage points; −21.8 [95% CI, −18.3 to −25.3] percentage points; and −19.4 [95% CI, −16.6 to −22.2] percentage points, respectively). Among the 40 countries that had undertaken at least 2 surveys during the period, the surveys indicated that there was a significant increase in knowledge of HIV/AIDS among young women in 24 countries (60.0%), but a significant decrease in 10 countries (25.0%). Less than half of countries experienced significant reductions in disparities associated with residential area (8 countries [20.0%]), wealth (5 countries [12.5%]), or education (17 countries [42.5%]). <h3>Conclusions and Relevance</h3> This cross-sectional study of women in 51 LMICs found low levels and large gaps in knowledge of HIV/AIDS between groups, suggesting that future HIV-prevention campaigns should emphasize providing easily accessible information to socioeconomically disadvantaged groups.
THU0111 Fc gamma receptor i and iii expression by macrophages of collagen type ii susceptible mice is higher and differently regulated compared to other strains
Authors: AB Blom, PL Van Lent, AE Holthuysen, C Jacobs, I Tchetverikov, LB Van de Putte, WB Van den Berg
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> In a previous study we found that knee joints of mice, susceptible for collagen type II arthritis (DBA/1, B10. RIII) display enhanced sensitivity to immune complexes (ICs) compared to other strains (C57BL/6, BALB/c). Higher and prolonged inflammation and more severe cartilage damage was observed. Murine synovial macrophages as well as IL-1 determine IC mediated arthritis and these cells communicate with ICs using three classes of Fcγ receptors mediating intracellular signalling: FcγRI and III are activating and FcγRII is an inhibitory receptor. <h3>Objectives</h3> To investigate whether macrophages of mice that are prone to develop collagen type II arthritis are hypersensitive to ICs by differential FcγR expression and regulation. <h3>Methods</h3> Basal expression of FcγR on macrophages of all strains was determined by immunohistochemistry on naïve whole knee joint sections and FACS-analysis using 2.4G2 antibody. Peritoneal macrophages were stimulated with ICs and cells were processed for RT-PCR. Using primers specific for FcγRI, II or III semiquantitative RT-PCR was performed. In addition, peritoneal macrophages of all strains and of mice lacking functional FcγRI and III (FcR γ-chain<sup>-/-</sup>) were stimulated and tested for the production of IL-1 and stromelysin. <h3>Results</h3> Basal expression of FcγR was significantly higher on synovial and peritoneal macrophages of DBA/1 and B10. RIII mice (mean fluorescence resp 440 ± 50 and 360 ± 30) if compared to C57BL/6 and BALB/c (mean fluorescence resp 240 ± 30 and 280 ± 30). After stimulation with ICs, mRNA levels of FcγRI and III were significantly higher in DBA/1 and B10. RIII mice. At day 2, FcγRI expression was 50× higher and FcγRIII was 10× higher. At day 3, FcγRI and III expression were both 10× higher. In contrast, FcγRII mRNA levels were down regulated 50× for DBA/1 and 10× for B10. RIII if compared to C57BL/6 and BALB/c. When DBA/1 and B10RIII peritoneal macrophages were stimulated with ICs (100 μg/ml), a twofold higher and prolonged production of IL-1 was measured if compared to other strains. Macrophages of FcR γ-chain<sup>-/-</sup> mice showed no detectable amounts of IL-1 after IC stimulation, indicating the role of FcγR in stimulation of cells using ICs. In addition, also stromelysin production was significantly increased in DBA/1 macrophages. <h3>Conclusion</h3> Collagen type II arthritis sensitive mice are hyper reactive to IC through higher basal expression of FcγR on macrophages of these strains and stronger up regulation of stimulatory as well as down regulation of inhibitory FcγReceptors, resulting in higher and prolonged expression of IL-1 and stromelysin.
Modality alignment contrastive learning for severity assessment of COVID-19 from lung ultrasound and clinical information
Authors: Wufeng Xue, Chunyan Cao, Jie Liu, Yilian Duan, Haiyan Cao, Jian Wang, Xumin Tao, Zejian Chen, Meng Wu, Jinxiang Zhang, Hui Sun, Yang Jin, Xin Yang, Ruobing Huang, Feixiang Xiang, Yue Song, Manjie You, Wen Zhang, Lili Jiang, Ziming Zhang, Shuangshuang Kong, Ying Tian, Li Zhang, Dong Ni, Mingxing Xie
Journal: Medical Image Analysis (2021)
Abstract 16900: Exertional Hemodynamics Among Patients With HFrEF Based on Resting HF Profile
Authors: Cole Buchanan, Ashley Pratt-Cordova, Gregory Coe, Larry A Allen, Eugene E Wolfel, William K Cornwell
Journal: Circulation (2020)

Introduction: HFrEF can be classified by profiles A, B, C or L based on resting pulmonary capillary wedge pressure (PCWP) and cardiac output (Qc). We characterized exertional hemodynamics by HF profile. Methods: HFrEF patients (N=34) completed invasive exercise testing with Swan-Ganz and radial arterial catheterization on upright bicycle. Oxygen uptake was monitored by indirect calorimetry. Data were recorded at supine and upright rest, two exercise stages below ventilatory threshold (steady states 1 and 2), and peak exercise. Participants were stratified into HF profiles based on supine resting hemodynamics including PCWP and cardiac index (CI): Profile A (warm-dry) PCWP≤16mmHg, CI≥2.5L/min/m 2 ; Profile B (warm-wet) PCWP&gt;16mmHg; CI≥2.5L/min/m 2 ; Profile C (cold-wet) PCWP&gt;16mmHg; CI&lt;2.5L/min/m 2 ; Profile L (cold-dry) PCWP≤16mmHg, CI&lt;2.5L/min/m 2 . Results: Demographics are displayed in the table . Peak oxygen uptake (VO 2 ) was severely reduced in all participants ( figure 1 ). Throughout exercise, profile C and L patients had lower stroke volume and Qc, but higher (A-V)O2 difference than profiles A and B ( figure 2 ). Profile B and C patients had higher resting and exertional pulmonary arterial and PCWP filling pressures compared to profiles A and L. Conclusion: Exercise performance among HFrEF patients is not uniform. Exertional hemodynamics vary substantially based on HF profile.