tbuckley/cabot-search huggingface dataset:
<i>IDH</i>-wildtype lower-grade diffuse gliomas: the importance of histological grade and molecular assessment for prognostic stratification
Authors: Giulia Berzero, Anna Luisa Di Stefano, Susanna Ronchi, Franck Bielle, Chiara Villa, Erell Guillerm, Laurent Capelle, Bertrand Mathon, Alice Laurenge, Marine Giry, Yohann Schmitt, Yannick Marie, Ahmed Idbaih, Khe Hoang-Xuan, Jean-Yves Delattre, Karima Mokhtari, Marc Sanson
Journal: Neuro-Oncology (2020)

Abstract Background Isocitrate dehydrogenase (IDH) wildtype (wt) grade II gliomas are a rare and heterogeneous entity. Survival and prognostic factors are poorly defined. Methods We searched retrospectively all patients diagnosed with diffuse World Health Organization (WHO) grades II and III gliomas at our center (1989–2020). Results Out of 517 grade II gliomas, 47 were “diffuse astrocytomas, IDHwt.” Tumors frequently had fronto-temporo-insular location (28/47, 60%) and infiltrative behavior. We found telomerase reverse transcriptase (TERT) promoter mutations (23/45, 51%), whole chromosome 7 gains (10/37, 27%), whole chromosome 10 losses (10/41, 24%), and EGFR amplifications (4/43, 9%), but no TP53 mutations (0/22, 0%). Median overall survival (OS) was 59 months (vs 19 mo for IDHwt grade III gliomas) (P &amp;lt; 0.0001). Twenty-nine patients (29/43, 67%) met the definition of molecular glioblastoma according to cIMPACT-NOW update 3. Median OS in this subset was 42 months, which was shorter compared with patients with IDHwt grade II gliomas not meeting this definition (median OS: 57 mo), but substantially longer compared with IDHwt grade III gliomas meeting the definition for molecular glioblastoma (median OS: 17 mo, P &amp;lt; 0.0001). Most patients with IDHwt grade II gliomas met cIMPACT criteria because of isolated TERT promoter mutations (16/26, 62%), which were not predictive of poor outcome (median OS: 88 mo). Actionable targets, including 5 gene fusions involving FGFR3, were found in 7 patients (24%). Conclusions Our findings highlight the importance of histological grading and molecular profiling for the prognostic stratification of IDHwt gliomas and suggest some caution when assimilating IDHwt grade II gliomas to molecular glioblastomas, especially those with isolated TERT promoter mutation.
Abstract 12880: A Clinical Index of Myocardial Afterload Can Replace Wall Stress Calculations
Authors: Nathaniel Reichek, Jonathan Weber, Madhavi Kadiyala, Marie Grgas, Tazim Merchant, Meghana Jayam 2nd, Derek Knight, Liana V Haigis, Simcha Pollack, Yang Cheng
Journal: Circulation (2020)

Introduction: Afterload at the myocardial level is a principal determinant of LV chamber and myocardial wall function, generated by interplay of LV pressure, volume, and mass. Quantitation has relied on wall stress indices which require additional measurements and calculations as well as incorrect assumptions. Unfamiliar to most clinicians, they have largely fallen out of use, but the role of myocardial afterload in contemporary heart failure pathophysiology and therapy merits reevaluation given the roles of EF and myocardial strains in prognostic indices and treatment guidelines. Hypothesis: A simple clinical afterload index using variables fundamental to wall stress indices (systolic pressure(mmHg) * LV volume(ml))/LV mass(g)) or PV/M correlates closely with stress indices and relates similarly to LV EF and myocardial strains. Methods: In 277 normals (54% female, mean age 50.9±12.9 yrs) and small cohorts with dilated non-ischemic cardiomyopathy(35), aortic stenosis(12) and cancer chemotherapy(43), each with matched controls, we used CMR LV volumes, mass and brachial systolic pressure during imaging to compare end-systolic PV/M to stress indices and systolic pressure alone using correlations and correlation standard errors(SEs). Results: There were extremely close correlations (r= 0.97-0.99, all p&lt; 0.001) with minimal SEs between PV/M and Arts and Alters stress indices with similar slopes in all groups and in normal subgroups by age and gender. Negative correlations with EF, global strains and strain rates were also present and extremely similar in all groups. But Mirsky’s stress index and brachial pressure performed less well. Conclusions: A simple clinical afterload index correlates closely with wall stress indices and similarly with LV ejection fraction and strains. It can support efficient reassessment of the role of afterload at the myocardial level in research and potentially, in clinical practice.
Abstract 257: Adherence to the Termination Recommendations in the Universal Termination of Resuscitation Rule and Survival After Out-of-hospital Cardiac Arrest
Authors: Masashi Okubo, David J Wallace, Brian E Grunau, Mohamud R Daya, Clifton W Callaway
Journal: Circulation (2020)

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) varies across emergency medical services (EMS) systems, but the EMS practices that contribute to the outcome variation are unclear. We evaluated the association between EMS agency variation in adherence to the termination recommendations in the Universal Termination of Resuscitation (TOR) rule and survival after OHCA. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry, a prospective multicenter OHCA registry in North America. We included adults (≥ 18 years) with OHCA for whom EMS providers attempted resuscitation from 2011 through 2015. The main exposure was proportion of patients meeting the Universal TOR rule (not EMS-witnessed arrest, no return of spontaneous circulation prior to transport, and no shock delivery prior to transport) among those who had prehospital TOR at the level of EMS agency. We categorized EMS agencies into quartiles based on the adherence to the Universal TOR rule. Our primary outcome was survival to hospital discharge. We used multilevel modified Poisson regression model, including patient-level and EMS-level covariates with patients nested within EMS agencies. Results: We included 43,656 EMS-treated OHCAs from 112 EMS agencies. The median adherence to the Universal TOR rule was 75.6% (interquartile range [IQR] 67.5-83.7) across EMS agencies. Compared with patients resuscitated at EMS agencies in the quartile of the lowest adherence (median adherence 62.5% [IQR 58.9-65.7]), survival to hospital discharge was inversely associated with treatment at EMS agencies in the second quartile (median adherence 72.6% [IQR 70.2-74.7]) (adjusted risk ratio [aRR] 0.83, 95% confidence interval [CI] 0.71-0.96), the third quartile (median adherence 80.6% [IQR 78.5-81.9]) (aRR 0.71, 95% CI 0.60-0.85), and the fourth quartile (median adherence 90.6% [IQR 86.2-93.7]) (aRR 0.68, 95% CI 0.58-0.80). Conclusions: In this large cohort study of adult patients with OHCA, we observed variation in the adherence to the Universal TOR rule’s termination recommendations across EMS agencies, and an association between higher EMS-level adherence and worse survival to hospital discharge after OHCA.
Scalable and accurate deep learning with electronic health records
Authors: Alvin Rajkomar, Eyal Oren, Kai Chen, Andrew M. Dai, Nissan Hajaj, Michaela Hardt, Peter J. Liu, Xiaobing Liu, Jake Marcus, Mimi Sun, Patrik Sundberg, Hector Yee, Kun Zhang, Yi Zhang, Gerardo Flores, Gavin E. Duggan, Jamie Irvine, Quoc Le, Kurt Litsch, Alexander Mossin, Justin Tansuwan, De Wang, James Wexler, Jimbo Wilson, Dana Ludwig, Samuel L. Volchenboum, Katherine Chou, Michael Pearson, Srinivasan Madabushi, Nigam H. Shah, Atul J. Butte, Michael D. Howell, Claire Cui, Greg S. Corrado, Jeffrey Dean
Journal: npj Digital Medicine (2018)

Abstract Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patient’s record. We propose a representation of patients’ entire raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two US academic medical centers with 216,221 adult patients hospitalized for at least 24 h. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting: in-hospital mortality (area under the receiver operator curve [AUROC] across sites 0.93–0.94), 30-day unplanned readmission (AUROC 0.75–0.76), prolonged length of stay (AUROC 0.85–0.86), and all of a patient’s final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed traditional, clinically-used predictive models in all cases. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios. In a case study of a particular prediction, we demonstrate that neural networks can be used to identify relevant information from the patient’s chart.
Abstract 14661: High Sensitive Troponin Elevation Pattern in Covid-19 Era
Authors: Alessandro Maino, Enrico Di Stasio, Maria Chiara Grimaldi, Luigi Cappannoli, Erica Rocco, Federico Biscetti, Landolfi Raffaele, Luigi M Biasucci
Journal: Circulation (2020)

Introduction: Coronavirus disease 2019 (COVID-19) is a pandemic disease that has caused a public health emergency due to its high rapid spread, to the high mortality rate, and the high percentage of patients requiring hospitalization and intensive care . Information regarding the impact of cardiovascular complication on fatal outcome is scarce. Purpose: To compare the levels of hs-Tn between patients affected by SARS-CoV-2 admitted to our hospital in the period February 20-April 9, 2020 versus the general population COVID free. Furthermore, we studied the dependence of hs-Tn levels in SARS-CoV-2 patients on disease severity and on other epidemiological, clinical and laboratory parameters. Methods: This retrospective single-center study analyzed all patients in whom hs-TnI was determined at the Policlinico A.Gemelli (Rome, Italy) from 20 February 2020 to 09 April 2020. One hundred-seventy of these patients received SARS-CoV-2 diagnosis. Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with COVID 19. Results: In our study, the population affected by SARS-CoV-2 (n=170) showed a significant association between disease severity and troponin levels (median [range] = 4.0 [&lt;2.4-227.0], 13.5 [&lt;2.4-545.0] and 34.0 [&lt;2.4-45345.0], p&lt;0.001, for mild, severe and critical state, respectively). Moreover, 27 subjects out of 170 (16%) showed high sensitivity troponin values higher than the 99 percentile upper reference limit stratified among previously defined severity classes as follows n=2 (2.4%), n=7 (15.9%) and n=18 (45.0%), respectively. Conclusions: The distribution of the troponin values greater than the cut-off in the SARS-CoV-2 population indicates a myocardial suffering independently related to COVID19 infection. This phenomenon may partially explain the high risk of adverse outcome in COVID-19 patients with underlying CVD. Therefore, it may be reasonable to triage patients with COVID-19 according to the presence of underlying CVD and evidence of myocardial injury for prioritized and personalized treatment strategies.
Injury Incidence and Burden in a Youth Elite football (Soccer) Academy: A 4-Season Prospective Study of551 players aged from under 9 to under 19 years.: Injury and burden in elite young footballers
Authors: Lars Mcnaughton, Matt Greig, Olivier Materne, karim Chamari, Abdulaziz Farooq, Adam Weir, per Holmich, Roald Bahr
Journal: British Journal of Sports Medicine (2020)
Abstract 16271: Resolution of Left Bundle Branch Block With Sacubitril/Valsartan in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Anas Abudan, Nikhil Parimi, Farhad Sami, Uzair Mahmood, Colton Schwarz, Michael Pierpoline, Moghniuddin Mohammed, Raghuveer Dendi, Rhea C Pimentel, Loren D Berenbom, Martin Emert, Rigoberto Ramirez, Amit Noheria, Madhu Reddy, Andrew J Sauer, Bhanu Gupta, Seth H Sheldon
Journal: Circulation (2020)

Introduction: Sacubitril/valsartan is associated with structural and functional reverse remodeling. It is uncertain if a subset of patients with HFrEF and LBBB treated with sacubitril/valsartan have resolution of LBBB. We aim to assess the effect of sacubitril/valsartan on QRS duration and LVEF in patients with HFrEF and LBBB. Methods: We performed a retrospective study of HFrEF patients treated with Sacubitril/Valsartan from January 2014 to June 2019. Minimum duration of treatment and follow-up was 3 months. Electrocardiographic and echocardiographic parameters were reviewed at four time points. Patients with baseline LBBB were identified. Patients with CRT ≧3 months after sacubitril/valsartan initiation were included and censored following CRT implantation. Results: Among 368 patients that met study criteria, 56 (15%) had baseline LBBB. Mean age was 64 (± 13.5), 53.6% were male and 78.6% had nonischemic cardiomyopathy. During median (IQR) follow-up of 9.1 months (5-18 mo), five (9%) had resolution of LBBB to normal conduction and two (4%) had improvement to non-specific IVCD. Examples of ECGs illustrating LBBB resolution are shown in Figure 1. Time to resolution of LBBB ranged from 1.2-5.7 months. Long term follow-up was only available in one patient with resolution of LBBB lasting at least 25.6 months after initiation of Entresto. The majority (n=4/5, 80%) had nonischemic cardiomyopathy. There was a trend towards greater improvement in LVEF in those with LBBB resolution vs. persistence (23 ± 6% vs. 9 ± 15%, p=0.11) as well as a trend towards greater reduction in LVIDd (-1.2 ± 0.8 cm vs. -0.5 ±0.7 cm, p=0.08). Conclusion: A small subset of patients with LBBB and HFrEF have resolution of LBBB with Sacubitril/Valsartan therapy. This may have important ramifications for timing of CRT implantation and highlights the potential importance of assessing the underlying rhythm in patients that receive a CRT device.
EAACI task force logograms : Food allergy logogram to facilitate the diagnosis of food allergy in primary care
Authors: B. M. J. Flokstra-De Blok, J. Van Der Velde, E. Angier, E. Clark, P. Demoly, C. Gaudin, R. Gawlik, M. Mamodaly, L. Tanno, K. Romberg, J. W. H. Kocks, D. Ryan
Journal: Allergy (2020)
Deep Learning in Cardiology
Authors: Paschalis Bizopoulos, Dimitrios Koutsouris
Journal: IEEE Reviews in Biomedical Engineering (2018)

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.
Abstract 14377: Therapeutic Potential of Clinical Grade Human Induced Pluripotent Stem Cell-derived Cardiac Tissues for a Rat Myocardial Infarction Model: A Pre-clinical Study for a Cell Transplantation Therapy
Authors: Hiroaki Osada, Hidetoshi Masumoto, Masahide Kawatou, Tadashi Ikeda, Yasuhiko Tabata, Kenji Minatoya, Jun K Yamashita
Journal: Circulation (2020)

Introduction: Transplantation of three-dimensional bioengineered cardiac tissues composed of pluripotent stem cell-derived cardiovascular cell lineages is reported to hold potential for functional recovery on pre-clinical studies. We aimed to evaluate therapeutic and myocardial regenerative potential of clinical grade human induced pluripotent stem cell (hiPSC)-derived cardiac tissues (HiCTs) on a rat myocardial infarction (MI) model. Methods: Clinical grade hiPSC lines established from a healthy volunteer were simultaneously differentiated into cardiovascular cell lineages. We seeded the cells on temperature responsive culture dishes to form cell sheets. HiCTs were generated by stacking 5 cell sheets with insertion of gelatin hydrogel microspheres (GHMs) to promote oxygen and nutrition supply and transplanted onto an athymic rat MI model (n=6). Echocardiography and histological analysis at 12 weeks after surgery were conducted and compared to those in animals with sham surgery (n=9) and with cell sheet stacks without GHMs [GHM(-), n=6]. Some of HiCT-transplanted rats were subjected to tissue clearing and two-photon excitation microscopy (TPEM) to assess graft vascularization. Results: Flow cytometry revealed cellular components after differentiation as follows: 52.0±1.4% of cardiomyocytes (cardiac isoform of troponin-T + :cTnT), 9.9±0.7% of vascular endothelial cells (VE-cadherin + ) and 14.1±1.8% of vascular mural cells (PDGFRβ + ). Echocardiography revealed significantly lower left ventricular end diastolic volume (LVEDV) and higher left ventricular ejection fraction (LVEF) in HiCT group [sham vs GHM(-) vs HiCT: LVEDV; 1.5±0.1 vs 1.3±0.05 vs 0.9±0.03 mL, p&lt;0.0001 / LVEF; 59.7±2.2 vs 67.4±0.6 vs 82.7±0.9 %, p&lt;0.0001]. HiCT group showed significantly larger engraftment [GHM(-) vs HiCT; 12 week; 0.1 ± 0.1 vs 1.8 ± 0.6 mm 2 ; p&lt;0.05]. Engrafted graft tissues were composed of cTnT / α-Actinin-positive cardiomyocytes which exhibited obvious striated structure. TPEM revealed host to graft vascular connection at 2 weeks after HiCT transplantation. Conclusions: HiCTs derived from clinical grade hiPSC potentially serve as a stem cell-derived cellular product in cardiac regenerative therapy for foreseeable clinical applications.
Abstract 12725: Smokers Are Aware of Their Health Risk
Authors: Hisako Tsuji, Yohei Oishi, Yuzo Akita, Ichiro Shiojima
Journal: Circulation (2020)

Background: Health checkup results, even if 12-lead ECG and chest X-ray are included, usually do not reflect risk of smoking and it may lead smokers to continue smoking. Therefore, to show specific risk amount of smoking, 10-year cardiovascular (CV) risks were calculated with and without smoking at the same level of other risk factors and the information was sent to the smokers. Smoking cessation rate was compared between smokers with and without the information. Methods: In subjects who had the annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 2018, the brochure which included the 2 values of 10-year CV risks calculated by the Framingham risk score (2008) based on the results of the health checkup was sent to male smokers aged 40 between 74 with no history of CV disease and the 10-year CV risk between 10% and 40%. Male smokers with the same condition were extracted from subjects who had the annual health checkup in 2017 as the control subjects. Smoking cessation was evaluated at the health checkup next year. Results: The brochure was sent to 499 smokers in 2018 and 344 of those received the health checkup in 2019. The 10-year CV risk of smokers was 1.80±0.05 times higher than that of non-smokers at the same level of other risk factors. As the control subjects, 568 smokers were extracted from 2017 checkup and 407 of those received the health checkup in 2018. Clinical characteristics of the 2018 checkup (n=344) and the 2017 checkup (n=407) groups were similar in terms of age, clinical risk factors, duration of smoking and number of cigarettes smoked per day. Smoking cessation rate of the 2018 checkup group next year was 7.0% while that of the 2017 checkup group was 7.1%. By the logistic regression analysis adjusted for age, duration of smoking and number of cigarettes smoked per day, smoking cessation rate of the 2018 checkup group was not higher than that of the 2017 checkup group (odds ratio=0.97, 95% confidence interval=0.55 to 1.71, p=0.9131). Conclusions: Showing specific amount of risk by smoking was not helpful for smoking cessation. Most smokers seem to be aware of the risk. To promote smoking cessation, interventions such as increased price of cigarette and/or limitation of smoking area may be more practical than emphasizing health hazards of smoking.
Medical staff did have input to unit
Authors: F. Clarke
Journal: BMJ (1995)

Medical staffdid have input to unitEDrrOR,-In their paper on a midwife managed delivery unit V A Hundley and colleagues state that "there is no input to the midwives unit by medical staff."'In table IV, however, they state that 246 women received epidural or spinal anaes- thesia during their stay in the unit.This implies that the women benefited from a 24 hour obstetric anaesthesia service.A recent survey of patients' knowledge showed that at least 21% of patients are unaware that their anaesthetist is a doctor.2Surely this does not also apply to our obstetric and midwifery colleagues.
IDENTIFICATION OF A NOVEL CELL TYPE IN PERIPHERAL LYMPHOID ORGANS OF MICE
Authors: Ralph M. Steinman, Dinah S. Lustig, Zanvil A. Cohn
Journal: The Journal of Experimental Medicine (1974)

Several properties of lymphoid dendritic cells in situ have been determined, and contrasted to information previously established for lymphocytes and mononuclear phagocytes. Dendritic cells are not found in newborn mice, and their concentration in both spleen and mesenteric lymph node does not reach adult levels until 3-4 wk of age. Dendritic cells largely disappear from adherent populations following administration of steroids (2.5 mg hydrocortisone acetate s.c.) and ionizing radiation (D(o) of 100 rads for Co(60)). Splenic dendritic cells can originate from precursors located in both bone marrow and spleen itself, probably the red pulp. The mature splenic population does not actively divide (pulse labeling index with [(3)H]thymidine of 1.5-2.5%), but does turnover at substantial rate, 10+% of the total pool per day. The influx of new cells appears to be derived from a proliferating precursor compartment, but the mechanism for efflux or turnover is not known. Dendritic cells in spleen and node undergo little or moderate increase in numbers during development of a primary immune response. These in vivo characteristics, taken together, further distinguish dendritic cells as a novel cell type, distinct from mononuclear phagocytes and lymphocytes.