tbuckley/cabot-search huggingface dataset:
Doctor experts in family court cases should be allowed to work from their desks, says working group
Authors: Clare Dyer
Journal: BMJ (2020)

Medical experts in family court cases should be allowed to give evidence from their hospital desks, a working group of judges, medical royal colleges, and doctors’ representatives has recommended.

The suggestion is among 22 recommendations from the group, set up by the president of the High Court’s family division to help tackle a serious shortage of doctors willing to act as experts in family court cases involving children. The shortage was “likely in some cases to be harmful to children” because of the delays in finalising placements for children, the report said.1

The exercise marks “the first time a number of medical royal colleges, professional bodies, and the family court have pooled their experiences to come together to develop joint health and …
Abstract 14646: Left Ventricular Global Longitudinal Strain and CT Derived Extracellular Volume Predicts Outcomes in Patients With Low-flow, Low-gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Maulin B Shah, Suzanne Oskouie, Nir Flint, James Mirocha, Donghee Han, Louise Thompson, John Friedman, Raj Makkar, Robert Siegel, Balaji K Tamarappoo
Journal: Circulation (2020)

Introduction: Low-flow, low-gradient aortic stenosis (LFLG-AS) is associated with impaired left ventricular (LV) function and afterload mismatch. Indications and timing for transcatheter aortic valve replacement (TAVR) in LFLG-AS do not account for the presence of subclinical LV remodeling. We evaluated whether combining LV global longitudinal strain (GLS) and CT-derived extracellular volume (ECV), both markers of LV remodeling, provides incremental prediction of adverse outcomes in patients with LFLG-AS undergoing TAVR. Methods: We retrospectively evaluated patients with LFLG-AS undergoing TAVR in whom pre-TAVR CT-based ECV measurements were available. GLS was measured in pre-TAVR echocardiograms using speckle tracking. Cox regression analysis was performed with a primary outcome of heart failure hospitalization (HFH) or death. Four sub-groups were identified for analysis based on optimal cutoff points: Group 1 (n=64): ECV&lt; 33 + GLS≥
Abstract 14276: A Pediatric Cardiology Handbook for the Digital Age
Authors: Ellis Rochelson, Bradley C Clark, Kara Motonaga
Journal: Circulation (2020)

Background: Pediatric cardiology (PC) fellows, tasked with studying a large and dynamic field, may benefit from a quick-access digital resource that reflects contemporary practice. Objective: To design a PC Handbook smartphone app and evaluate its effectiveness in enhancing the accessibility of information such as guidelines and treatment recommendations for PC fellows. Methods: The PC handbook app was designed for iPhone using XCode and Swift programming. A pre-app electronic survey and instructions for download were sent to U.S. PC fellows followed by a post-app survey within 3 months of use. Fellows were asked to rate the ease of rapid access to various types of information, such as guidelines and normal values, with responses given on a 4-point scale (1 = very difficult, 4 = very easy). Responses were compared pre- and post-app using the Wilcoxon signed-rank test. Results: Two-hundred and thirty PC fellows were contacted; 23% (total n = 53) completed both the pre-app and post-app surveys and were included for analysis. Over half (57%) of fellows used the PC handbook app 1-3 times per month while 17% used it at least 1-3 times per week. After using the app, fellows found it easier to quickly access information in 8 out of 9 domains evaluated (Fig 1). All fellows found the app easy to use (100%), most felt that the app is well-organized (98%), contains reliable information (92%), and is useful for finding quick answers to clinical questions (87%). Almost all (91%) would recommend the app to a colleague. Conclusions: The Peds Cardiology Handbook iPhone app is a useful, reliable tool that provides quick access to high yield information, including various guidelines and references, in one location. Overall, PC fellows found it easier to rapidly access clinically relevant information after using the app, though future studies may be necessary to evaluate long-term use and impact on evidenced-based practice.
Small molecules combined with collagen hydrogel direct neurogenesis and migration of neural stem cells after spinal cord injury
Authors: Yaming Yang, Yongheng Fan, Haipeng Zhang, Qi Zhang, Yannan Zhao, Zhifeng Xiao, Wenbin Liu, Bing Chen, Lin Gao, Zheng Sun, Xiaoyu Xue, Muya Shu, Jianwu Dai
Journal: Biomaterials (2020)
Ticagrelor or Prasugrel in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
Authors: Christian Valina, Franz-Josef Neumann, Maurizio Menichelli, Katharina Mayer, Jochen Wöhrle, Isabell Bernlochner, Alp Aytekin, Gert Richardt, Bernhard Witzenbichler, Dirk Sibbing, Salvatore Cassese, Dominick J. Angiolillo, Sebastian Kufner, Christoph Liebetrau, Christian W. Hamm, Erion Xhepa, Alexander Hapfelmeier, Hendrik B. Sager, Isabel Wustrow, Michael Joner, Dietmar Trenk, Karl-Ludwig Laugwitz, Heribert Schunkert, Stefanie Schüpke, Adnan Kastrati
Journal: Journal of the American College of Cardiology (2020)
Association of Preexisting Interstitial Lung Abnormalities With Immune Checkpoint Inhibitor–Induced Interstitial Lung Disease Among Patients With Nonlung Cancers
Authors: Kiyofumi Shimoji, Takeshi Masuda, Kakuhiro Yamaguchi, Shinjiro Sakamoto, Yasushi Horimasu, Taku Nakashima, Shintaro Miyamoto, Hiroshi Iwamoto, Kazunori Fujitaka, Hironobu Hamada, Sachio Takeno, Michihiro Hide, Jun Teishima, Hideki Ohdan, Noboru Hattori
Journal: JAMA Network Open (2020)

Immune checkpoint inhibitor-induced interstitial lung disease (ICI-ILD) is clinically serious and life-threatening. Preexisting interstitial lung abnormalities have been shown to be risk factors for ICI-ILD in patients with lung cancer.To evaluate whether interstitial lung abnormalities are associated with ICI-ILD in patients with nonlung cancers.This cohort study was conducted between December 2015 and May 2019 at Hiroshima University Hospital. A total of 199 consecutive patients with head and neck cancer, malignant melanoma, oral cavity cancer, urological cancer, and gastrointestinal cancer who received anti-programmed cell death 1 (PD-1) antibody monotherapy were included. Data analysis was conducted from December 2015 to May 2019.The associations between potential risk factors and the development of ICI-ILD were examined. Information on patient characteristics before antibody administration, including chest computed tomography findings, was obtained. The diagnosis of ICI-ILD was defined as abnormal computed tomography shadows occurring during treatment with anti-PD-1 antibodies.A total of 199 patients were enrolled in the study. The median (range) age was 66 (20-93) years, and most patients (133 [66.8%]) were men. Nineteen patients (9.5%) developed ICI-ILD. There was no significant difference in the baseline characteristics between patients with and without ICI-ILD. The logistic regression analyses revealed that interstitial lung abnormalities were associated with increased risk of ICI-ILD (odds ratio, 6.29; 95% CI, 2.34-16.92; P < .001), and ground glass attenuation in interstitial lung abnormalities was an independently associated risk factor (odds ratio, 4.05; 95% CI, 1.29-12.71; P = .01).In this cohort study, preexisting interstitial lung abnormalities, including ground glass attenuation, were risk factors associated with ICI-ILD in patients with nonlung cancers. This observation is consistent with previously reported findings in patients with lung cancer. Therefore, we should pay more attention to the development of ICI-ILD in patients with interstitial lung abnormalities, regardless of cancer type.
Breast Implant Manufacturers Get Labeling Guidance
Authors: Mary Chris Jaklevic
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Abstract 14245: Fibroblast Growth Factor 23 and Long-term Cardiac Function: The Multi- Ethnic Study of Atherosclerosis
Authors: Ravi B Patel, Hongyan Ning, Ian H de Boer, Bryan Kestenbaum, Joao Ac Lima, Rupal Mehta, Norrina B Allen, Sanjiv J Shah, Donald M Lloyd-jones
Journal: Circulation (2020)

Background: While fibroblast growth factor 23 (FGF23) is associated with incident heart failure (HF) and atrial fibrillation (AF), the mechanisms driving these associations are unclear. FGF23 elevation leads to cardiomyocyte calcium handling abnormalities, suggesting that FGF23 may directly reduce myocardial function. Methods: In the Multi-Ethnic Study of Atherosclerosis, a cohort free of cardiovascular disease at recruitment, we evaluated the associations of serum FGF23 (2000-2002) with measures of left ventricular (LV) and left atrial (LA) mechanical function on cardiac magnetic resonance (CMR) at 10-year follow up (2010-2012). Results: Of 2,276 participants with baseline FGF23 and CMR at 10-year follow up, participants with higher FGF23 levels were more likely white race, taking anti-hypertensive medications, and had lower baseline glomerular filtration rate (GFR). After covariate adjustment, baseline FGF23 levels were independently associated with worse LV global circumferential strain, worse LV mid-wall circumferential strain, and lower LA total emptying fraction in later life ( Table ). The association of FGF23 and LV global circumferential strain was consistent across the spectrum of GFR ( Figure ). While higher FGF23 was associated with higher LV mass (β coefficient per SD higher: 1.14, 95% CI: 0.16, 2.12, P= 0.02), it was not associated with the presence of macroscopic myocardial scar (OR per SD higher: 1.12, 95% CI: 0.86-1.45, P= 0.42). Conclusions: Baseline FGF23 is independently associated with lower LV and LA systolic function in later life. These findings provide mechanistic insight driving the associations of FGF23 with development of both HF and AF.
Abstract 14614: The Automatically Assessed P-wave Notch Predicts Cardiovascular Events in Patients With Cardiovascular Risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study
Authors: Tomoyuki Kabutoya, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2020)

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and long-term cardiovascular events remains unclear. Hypothesis: We hypothesized that the notched P-wave would be associated with cardiovascular events. Methods: We enrolled 810 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). We compared two definitions: P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥20 msec or ≥40 msec in lead II. The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography. Results: The mean follow-up period was 101±34 months, and 85 cardiovascular events occurred. When we defined a notched P wave as ≥20msec in the M shape (n=92), a notched P wave was a significant predictor of cardiovascular events after adjustment for age, gender, and comorbidity (hazard ratio 1.80, 95%CI: 1.06-3.05). When we defined a notched P wave as ≥40msec in the M shape (n=25), the hazard ratio of cardiovascular events in the notched P-wave group was significantly borderline after adjustment for covariates (hazard ratio 2.23, 95%CI: 0.90-5.56). The left atrial diameter and LVMI in the patients in the notched P-wave group (≥20 msec in the M shape) were significantly higher than those in the control group (left atrial dia. 38.8±5.9 vs. 36.8±5.0 mm, p=0.001; LVMI 103.9±27.7 vs. 96.3±25.7 g/m 2 , p=0.010). Conclusion: The automatically assessed notched P wave was associated with cardiovascular events, left atrial enlargement and left ventricular hypertrophy.
Soluble Neprilysin and Corin Concentrations in Relation to Clinical Outcome in Chronic Heart Failure
Authors: D.H. Frank Gommans, Elena Revuelta-Lopez, Josep Lupon, Adriana Cserkóová, Mar Domingo, Priya Vart, Niels van Royen, Antoni Bayés-Genis, Roland R.J. van Kimmenade
Journal: JACC Heart Failure (2020)
Abstract 130: Mechanical, Team-focused, Video-Reviewed Cardiopulmonary Resuscitation Improves Trends in Survival to Discharge and Cardiac Arrest Performance Measures
Authors: Daniel Rolston, Timmy Li, Casey Owens, Ghania Haddad, Timothy Palmieri, Jennifer Wolff, Veronika Blinder, Michael Cassara, Lance B Becker
Journal: Circulation (2020)

Background: Our previous research demonstrated an improvement in ROSC after implementing a bundle including mechanical, team-focused, video-reviewed cardiopulmonary resuscitation (MTV-CPR) for cardiac arrest patients in our ED. The aims of this study are to assess trends in cardiac arrest outcomes and improvements in cardiac arrest performance measures after the implementation of our MTV-CPR intervention. Methods: In 2018, our ED began using mechanical CPR; a new team-focused strategy with nurse led ACLS; and biweekly video-review of cardiac arrests. The primary outcome of this study was to evaluate the annual trend in survival to discharge from 2017 (the year before implementing MTV-CPR) through 2019. Secondary outcomes included ROSC and survival to admission. The Cochrane-Armitage test was used to evaluate annual trends in outcomes over the 3-year study period. We also sought to determine if an improvement in cardiac arrest performance measures occurred over the two years of our MTV-CPR intervention using Wilcoxon rank sum and two-sample t-tests. Cardiac arrest performance measures are listed in the table. Results: The groups were similar at baseline over the 3-year study period. 291 patients were included in the study (96 in 2017, 96 in 2018, and 99 in 2019). Survival to discharge improved from 3.1% in 2017 to 5.2% in 2018 to 10.1% in 2019 (p= 0.043); ROSC improved from 26% to 41.7% to 40.4% (p=0.038); survival to admission went from 19.8% to 25% to 29.3% but was not significantly different (p=0.124). Results for cardiac arrest performance measures are reported in the table. There were significant reductions in time to bed transfer, rhythm determination, mechanical CPR placement, and duration of each chest compression interruption due to ultrasound. Conclusions: Implementation of our MTV-CPR intervention for cardiac arrest patients resulted in improved trends in survival to discharge and ROSC, as well as improvements in multiple cardiac arrest performance measures.
Abstract 244: Preliminary Results on Angiotensin II as a Novel Vasopressor in Modeled Out-of-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Tobias Neumann, Simon-Richard Finke, Marlen Assam, Jakob Emrich, Alexander Fuchs, Alexandra C Maul, Daniel C Schroeder, Thorsten Annecke
Journal: Circulation (2020)

Introduction: The PARAMEDIC2-trial reported a higher survival rate comparing standard epinephrine treatment with placebo, but severe neurologic impairment was found more often in patients who received epinephrine. Angiotensin II (AT2) has been recently authorized by FDA and EMA to treat distributive shock in adults. It is not approved as a vasopressor in the treatment of cardiac arrest (CA) and has not been studied in a standardized model of out-of hospital cardiac arrest with subsequent guideline-based cardiopulmonary resuscitation (CPR) before. Hypothesis: AT2 administration during CPR will 1. result in higher rates for return of spontaneous circulation (ROSC) after modeled out-of-hospital CA and 2. will achieve a greater increase in mean arterial blood pressure (MAP) compared to standard epinephrine bolus regimen. Methods: After legal approval (81-02.04.2019A072) and in conformance with the AHA position statement (Circulation 1985; 71:849A), we conducted a prospective, randomized trial in 25 swine weighing 32 to 43.5 kilogram bodyweight (kgBW) under general anesthesia. In 22 swine randomized to intervention groups i) EPI or ii) AT2, ventricular fibrillation was induced electrically and mechanical ventilation was discontinued. After 10 minutes (min) of untreated CA, ventilation was resumed and CPR was performed adapted to current guidelines for up to 56 min. After the third unsuccessful defibrillation (6 min CPR), swine received either i) boluses of epinephrine 0.01 mg/kgBW every 4 min or ii) an initial bolus of AT2 (25 μg/kgBW) followed by continuous infusion at 1 μg/kgBW/min. Three animals served as sham controls and received identical treatment but neither CA nor CPR. Results: ROSC was achieved in 7/22 swine and in 5/20 requiring vasopressors (EPI 1/10 vs. AT2 4/10, n. s.). The initial vasopressor bolus increased MAP significantly more in AT2 compared to EPI (p = 0.03). However, this could not be maintained under continuous infusion of AT2. Conclusions: For the first time, we have demonstrated the feasibility of successful guideline-based CPR using AT2 as sole vasopressor. But still, questions such as the optimal dosage remain. We strongly encourage larger trials to investigate this newly available drug also for the treatment of CA.
Abstract 16267: Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients Presenting With Acute Coronary Syndrome With Culprit Unprotected Left Main Artery
Authors: Kiro Barssoum, Ashish Kumar, Devesh Rai, Adnan Kharsa, Medhat Chowdhury, Samarthkumar J Thakkar, Mohan Rao
Journal: Circulation (2020)

Background: Outcomes of coronary artery bypass grafting (CABG) versus (vs) percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS) with unprotected left main (ULM) as culprit vessel are not well represented in major clinical trials. We performed a meta-analysis and meta-regression of studies that compared the outcomes of CABG vs PCI in ULM in ACS. Methods: Medline, EmCare, CINHAL, Cochrane database, and Google Scholar were searched for studies comparing CABG vs PCI in patients who presented with ACS and was found to have ULM as culprit vessel. Our primary outcome was mortality at longest follow up. Our secondary Outcome was repeat revascularization at longest follow up. We used PM method with HKSJ adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using I 2 statistics. Multivariable meta-regression analysis was used to account for heterogeneity. History of smoking, diabetes, hypertension and previous PCI was used for multivariable regression. R version 3.6.2 was used for all statistical analysis. Results: A total of 8 studies met our inclusion criteria. The follow up period varied from 6 months to 10 years. There was no significant difference in the risk of mortality between CABG vs PCI; RR: 1.31, CI: 0.76 - 2.27, I 2 = 71%. However, the PCI as compared to CABG was associated with higher risk repeat revascularization at longest follow up; RR: 2.64, 95% CI: 1.56 to 4.46, I 2 = 60%. Meta-regression analysis reported previous PCI to be associated with lower mortality with CABG [P value =0.01], while history of diabetes was associated with higher mortality with CABG [P value &lt;0.001]. Conclusion: CABG vs PCI in ULM in ACS is associated with similar risk of mortality. Previous PCI and non-diabetics were associated with higher mortality with PCI as compared to CABG. However PCI as compared to CABG was associated with higher risk of repeat revascularizations.
Abstract 13702: A Novel Genetic Risk Score Predicts Ischemic Stroke in Patients With Cardiometabolic Disease
Authors: Parth N Patel, Nicholas A Marston, Frederick K Kamanu, Lu Chen Weng, Marc P Bonaca, Robert P Giugliano, Benjamin M Scirica, Michelle L O'Donoghue, Christopher P Cannon, Christopher D ANDERSON, Deepak L Bhatt, Philippe G Steg, Marc Cohen, Robert F Storey, Peter S Sever, Anthony C Keech, Itamar RAZ, ofri Mosenzon, Eugene Braunwald, Patrick T Ellinor, Steven A Lubitz, Marc S Sabatine, Christian T Ruff
Journal: Circulation (2020)

Introduction: Recent genome-wide association studies have identified single nucleotide polymorphisms (SNPs) that are associated with an increased risk of stroke. We sought to determine whether a genetic risk score (GRS) could identify subjects at higher risk for first ischemic stroke after accounting for traditional risk factors in four clinical trials across the spectrum of cardiometabolic disease. Methods: Subjects who had consented for genetic testing, were of European ancestry, and had no prior history of stroke from the SOLID-TIMI 52, SAVOR-TIMI 53, PEGASUS-TIMI 54, and FOURIER trials were included in this analysis. A recently validated GRS composed of 36 SNPs associated with ischemic stroke was calculated in each patient. A Cox model was used to calculate hazard ratios for ischemic stroke across genetic risk groups, adjusted for age, sex, ancestry, hypertension, hyperlipidemia, smoking, diabetes mellitus, atrial fibrillation, coronary artery disease, and congestive heart failure. Results: In 23,089 subjects across the four trials, a total of 313 ischemic strokes occurred over a median follow-up of 3 years. Those with higher genetic risk were at significantly increased risk for ischemic stroke with an adjusted HR per 1-SD GRS of 1.12 (1.004-1.25; p=0.043). Individuals in the top 10% of genetic risk had a 42% greater hazard for ischemic stroke than those in the lower 90% of genetic risk (adjusted HR 1.42 [1.03-1.97]; p=0.034). The magnitude of risk conferred by high genetic risk was similar or greater than the risk provided by well-established clinical risk factors (Figure). Conclusions: Across four large clinical trials of subjects with cardiometabolic disease, a 36-SNP GRS was a strong, independent predictor of first ischemic stroke. The risk of stroke was particularly high in patients in the top 10% of genetic risk.