tbuckley/cabot-search huggingface dataset:
SAT0564 BONE TEXTURE ANALYSIS WITH DEEP LEARNING IN HAND RADIOGRAPHS FOR ASSESSING THE RISK OF RHEUMATOID ARTHRITIS
Authors: C. F. Kuo, S. Miao, K. Zheng, L. Lu, C. I. Hsieh, C. Lin
Journal: Annals of the Rheumatic Diseases (2020)

Background: Conventional x-rays are essential to identify radiographic changes of rheumatoid arthritis (RA) in structure and bone texture. Limited evidence suggests that the bone texture analysis may quantify the radiographic changes in RA; 1 however, current techniques such as the fractal dimension characterize fixed texture features. Deep learning offers novel methods to ‘learn’ radiographic texture features relevant to RA. Objectives: To develop a deep learning model to assess the radiographic bone texture in the distal metacarpal bone relevant to RA. Methods: We collected 3,738 conventional hand radiographs from 2,128 individuals (RA, n = 908; non-RA, n = 1220). The second, third, and fourth metacarpal bone images were segmented using a curve Graph Convolutional Network (GCN), and the distal third was used as the input to train a texture model to classify RA. The texture model was based on the Deep Texture Encoding Network (Deep-TEN) architecture (figure 1), 2 which put an encoding layer on top of a pre-trained 18-layered residual network (ResNet18). The vectors produced by the model represent the orderless texture features that were used to generate a texture score for RA. Five texture models are trained using 5-fold cross-validation and are ensembled during inference by averaging the model outputs to produce the final score. We then validate the model using hand radiographs of 166 RA patients and 166 non-RA patients. Overall model performance was measured by area under the curve of the receiver operator curve (AUROC). Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of RA. Figure 1. Schematic representation of deep learning models to extract and encode texture features for RA classification. Results: We included 140 women and 26 men with RA (mean age, 55.9±1.8 years) and 166 non-RA individuals (F: M, 140:26; mean age, 55.5 ± 1.8 years). The mean texture score was 0.49 (95% CI, 0.48–0.50) in RA patients, which is significantly higher than non-RA patients (0.42, 95% CI, 0.40–0.43; p&lt;0.01). The AUROC of the model was 0.68. In the multivariate logistic regression model, a high texture score (&gt;0.43) is associated with an OR (95% CI) of 3.42 (2.48–4.72) for RA, adjusted by age and sex. Conclusion: This study indicates that the texture model can delineate radiographic changes in texture relevant to RA and, coupled with automatic joint detection and segmentation, it has the potential to aid early RA diagnosis and monitor radiographic progression. References: [1]Zandieh S, Haller J, Bernt R, et al. Fractal analysis of subchondral bone changes of the hand in rheumatoid arthritis. Medicine (Baltimore) 2017;96(11):e6344. [2]Zhang H, Xue J, Dana K. Deep TEN: Texture Encoding Network. The IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017:708-17. Disclosure of Interests: None declared
Bone tissue regeneration: The role of finely tuned pore architecture of bioactive scaffolds before clinical translation
Authors: Ronghuan Wu, Yifan Li, Miaoda Shen, Xianyan Yang, Lei Zhang, Xiurong Ke, Guojing Yang, Changyou Gao, Zhongru Gou, Sanzhong Xu
Journal: Bioactive Materials (2020)

Spatial dimension of pores and interconnection in macroporous scaffolds is of particular importance in facilitating endogenous cell migration and bone tissue ingrowth. However, it is still a challenge to widely tune structure parameters of scaffolds by conventional methods because of inevitable pore geometrical deformation and poor pore interconnectivity. Here, the long-term in vivo biological performances of nonstoichiometric bioceramic scaffolds with different pore dimensions were assessed in critical-size femoral bone defect model. The 6% Mg-substituted wollastonite (CSi-Mg6) powders were prepared via wet-chemical precipitation and the scaffolds elaborately printed by ceramic stereolithography, displaying designed constant pore strut and tailorable pore height (200, 320, 450, 600 μm), were investigated thoroughly in the bone regeneration process. Together with detailed structural stability and mechanical properties were collaboratively outlined. Both μCT and histological analyses indicated that bone tissue ingrowth was retarded in 200 μm scaffolds in the whole stage (2–16 weeks) but the 320 μm scaffolds showed appreciable bone tissue in the center of porous constructs at 6–10 weeks and matured bone tissue were uniformly invaded in the whole pore networks at 16 weeks. Interestingly, the neo-tissue ingrowth was facilitated in the 450 μm and 600 μm scaffolds after 2 weeks and higher extent of bone regeneration and remodeling at the later stage. These new findings provide critical information on how engineered porous architecture impact bone regeneration in vivo. Simultaneously, this study shows important implications for optimizing the porous scaffolds design by advanced additive manufacture technique to match the clinical translation with high performance.
Abstract 13939: Optimizing Telemetry Usage in Non-intensive Care Unit Patients Based on American Heart Association Guidelines: A Quality Improvement Initiative
Authors: Tikal Kansara, Kuldeep Ghosh, Monil Majmundar, Hansang Park, Joanna Lenik, Fernando Quesada, Abdullah Zoheb Azhar, Ahmed Elmaaz, julio valencia, Noella Boma, Ferdinand Visco, Shobhana Chaudhari
Journal: Circulation (2020)

Introduction: The overuse of hospital resources is a pervasive issue. Out of the $3.5 trillion, the United States spent on health care in 2017, 30 % was considered excess cost in complications and ancillary orders. Even with established guidelines and revisions over the past few years, overzealous use of telemetry is rampant. Methods: The study included observation and admitted patients in September and October of 2018 and 2019. Patients in 2018 constituted baseline cohort (BC) and patients in 2019 were intervention cohort (IC). Both observation and inpatient admissions were analyzed separately. In August 2019, a series of presentations regarding AHA telemetry guidelines and group training for the use of telemetry monitor and software was undertaken. A template was used to document telemetry which consisted of reason for telemetry and day of telemetry in daily progress notes. Daily report of telemetry was shared on secured messaging group for residents. A comparison was made between the cohorts. Results: 516 patients were included in the study, 335 observation patients and 181 admitted patients. The number of patients on telemetry in combined IC (2019 patients) reduced by 31 % (34.32 % in observation group &amp; 24.86 % in admission group). Taking an average of $ 272 per patient on telemetry (based on hospital billing data), the burden of cost reduced by $ 43,520 in the two months of 2019. “To rule out ACS” and “monitor for arrythmias” were the most common reason for telemetry use in observation and admitted inpatients in both cohorts. There was an increase of 14.59 % patients exceeding 48 hours on telemetry in inpatient admissions of IC. Telemetry triggers in notes (reasoning and justification) increased from 4.04 % to 37.08 %. All changes in IC occurred without any adverse outcome. The comparison is shown in Figure 1. Conclusions: Strict adherence to AHA guidelines improves the quality of care and is an effective means to reduce cost for hospitals without significant adverse events.
Abstract 270: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Can Improve Outcomes in Patients Who Underwent E-CPR
Authors: Takashi Unoki, Tomoko Nakayama, Yudai Tamura, Eiji Horio, Motoko Kametani, Daisuke Takagi, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, Tetsuo Yufu, Kazuhisa Kodama, Megumi Yamamuro, Eiji Taguchi, Tadashi Sawamura, Koichi Nakao, Tomohiro Sakamoto
Journal: Circulation (2020)

Background: Extracorporeal CPR (E-CPR) using a veno-arterial ECMO (VA-ECMO) is effective for patients with refractory cardiac arrest. Intra-aortic balloon pumping (IABP) is often combined with VA-ECMO to increase coronary perfusion. However, this combination significantly increases left ventricular afterload. Recent studies showed VA-ECMO combined with IMPELLA pump (ECPELLA) had beneficial effect on refractory cardiogenic shock. Objective: Evaluate outcome of ECPELLA patients who underwent E-CPR as compared to ECMO with IABP. Method: We retrospectively reviewed 140 consecutive patients who underwent E-CPR from January 2012 through May 2020 in our institute. Thirty-eight patients who received ECMO alone were excluded, and 102 patients were recruited. Twenty-four patients underwent ECPELLA (ECPELLA group) and 78 patients underwent ECMO with IABP (IABP group). The 30-day survival rate and the rate of grades 1 and 2 Cerebral Performance Categories (CPC) as the neurological prognosis were assessed. Result: ECPELLA group showed significantly shorter time from cardiac arrest to ECMO placement compared to IABP group (24 min [IQR; 13-41] vs. 49 min [IQR; 28-75]; P=0.0003). The rate of favorable neurological prognosis were significantly higher in the ECPELLA group (38% vs. 13% ; P=0.01). The 30-day all-cause mortality of ECPELLA was significantly lower than IABP (P=0.005 by log-rank test). Multivariate cox proportional hazard analysis including the age, Out of hospital cardiac arrest, shockable rhythm, Acute coronary syndrome, Collaapse-to-ECMO under 60min, and ECPELLA revealed that the age (hazard ratio [HR], 1.34 (10 years increase), 95%CI, 1.11-1.63, P=0.002), Collapse-to-ECMO under 60 min (HR, 0.45, 95%CI, 0.23-0.87, P=0.02) and ECPELLA (HR, 0.48, 95%CI, 0.22-0.95, P=0.035) were significantly associated with 30-day mortality. Conclusion: ECPELLA improves mortality and favorable neurological outcome in patients who underwent E-CPR.
Sustained Intensive Treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in People With Type 1 Diabetes Treated With MDI
Authors: Marcus Lind, Arndís F. Ólafsdóttir, Irl B. Hirsch, Jan Bolinder, Sofia Dahlqvist, Aldina Pivodic, Jarl Hellman, Magnus Wijkman, Erik Schwarcz, Henrik Albrektsson, Tim Heise, William Polonsky
Journal: Diabetes Care (2020)

OBJECTIVE Continuous glucose monitoring (CGM) reduces HbA1c and time spent in hypoglycemia in people with type 1 diabetes (T1D) treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns, and overall well-being over longer periods of time. RESEARCH DESIGN AND METHODS The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in people with T1D treated with MDI. People completing the trial (n = 141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. RESULTS The primary end point of the change in HbA1c over 1.0–1.5 years of CGM use compared with previous self-monitoring of blood glucose during GOLD showed a decrease in HbA1c of 0.35% (95% CI 0.19–0.50, P &amp;lt; 0.001). Time spent in hypoglycemia &amp;lt;3.0 mmol/L (54 mg/dL) and &amp;lt;4.0 mmol/L (72 mg/dL) decreased from 2.1% to 0.6% (P &amp;lt; 0.001) and from 5.4% to 2.9% (P &amp;lt; 0.001), respectively. Overall well-being (World Health Organization 5-item well-being index, P = 0.009), treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire, P &amp;lt; 0.001), and hypoglycemic confidence (P &amp;lt; 0.001) increased, while hypoglycemic fear (Hypoglycemia Fear Survey–Worry, P = 0.016) decreased and diabetes distress tended to decrease (Problem Areas in Diabetes Scale, P = 0.06). From randomization and screening in GOLD, HbA1c was lowered by 0.45% (P &amp;lt; 0.001) and 0.68% (P &amp;lt; 0.001) after 2.3 and 2.5 years, respectively. CONCLUSIONS The SILVER study supports beneficial long-term effects from CGM on HbA1c, hypoglycemia, treatment satisfaction, well-being, and hypoglycemic confidence in people with T1D managed with MDI.
Assessment of Discordance Among Smoldering Multiple Myeloma Risk Models
Authors: Elizabeth Hill, Alexander Dew, Candis Morrison, Constance Yuan, Maryalice Stetler-Stevenson, Ola Landgren, Dickran Kazandjian
Journal: JAMA Oncology (2020)

This cohort study assesses the concordance of 3 models to stratify risk for progression to multiple myeloma in an independent cohort of patients with smoldering multiple myeloma.
Abstract 371: Using Defibrillator Bioimpedance Waveforms to Measure Ventilation During Continuous Chest Compression CPR
Authors: Teresa R Gordon, Enrique Rueda, Elisabete Aramendi, Unai Irusta, Pamela Owens, Ahamed H Idris
Journal: Circulation (2020)

Introduction: For patients with out of hospital cardiac arrest, prompt return of circulation and ventilation is vitally important for survival. Techniques and devices have been developed to ensure emergency responders are providing high quality chest compression, but there has been little progress in the area of ventilation. Until an advanced airway is placed, there has been no practical way to measure ventilation. The aim of this study is to develop a method to measure ventilation during continuous chest compressions cardiopulmonary resuscitation (CPR) that can be used to monitor and improve quality of ventilation during out of hospital CPR. Hypothesis: Defibrillator transthoracic bioimpedance can be used to identify ventilation waveforms prior to placement of an advanced airway during continuous chest compressions CPR. Methods: We examined 391 patients’ defibrillator files from four Resuscitation Outcomes Consortium sites for the presence of waveforms that met previously developed criteria and were manually annotated. Criteria for an acceptable ventilation waveform were: waveform amplitude ≥0.5 Ohm and waveform duration ≥1 sec. We recorded the number of ventilations, return of spontaneous circulation, initial heart rhythm, and ventilation rates. Following annotation, 333 of the 391 patients’ files had the necessary intubation time recorded and an automated program precisely measured the amplitude and duration of each ventilation. We determined mean (±SD) waveform amplitude and duration of inflation and deflation pre and post airway placement. Significance was determined using Wilcoxon ranked sum test. Results: Comparing the pre and post airway measurements did not result in any significant differences, except in duration of inflation, which was 1.06 ± 0.41 sec and 1.11 ± 0.52 sec, respectively, (p &lt;0.001). Ventilation waveforms had significantly lower amplitude and shorter duration during chest compressions than during pauses in compressions. Conclusion: Defibrillator transthoracic bioimpedance can be used to identify and monitor ventilations during continuous chest compressions CPR. Ventilation waveforms have lower amplitudes and shorter durations during chest compressions than during pauses in compressions.
Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis
Authors: Desana Kocevska, Thom S. Lysen, Aafje Dotinga, M. Elisabeth Koopman-Verhoeff, Maartje P. C. M. Luijk, Niki Antypa, Nienke R. Biermasz, Anneke Blokstra, Johannes Brug, Wiliam J. Burk, Hannie C. Comijs, Eva Corpeleijn, Hassan S. Dashti, Eduard J. de Bruin, Ron de Graaf, Ivonne P. M. Derks, Julia F. Dewald-Kaufmann, Petra J. M. Elders, Reinoldus J. B. J. Gemke, Linda Grievink, Lauren Hale, Catharina A. Hartman, Cobi J. Heijnen, Martijn Huisman, Anke Huss, M. Arfan Ikram, Samuel E. Jones, Mariska Klein Velderman, Maaike Koning, Anne Marie Meijer, Kim Meijer, Raymond Noordam, Albertine J. Oldehinkel, Joost Oude Groeniger, Brenda W. J. H. Penninx, H. Susan J. Picavet, Sara Pieters, Sijmen A. Reijneveld, Ellen Reitz, Carry M. Renders, Gerda Rodenburg, Femke Rutters, Matt C. Smith, Amika S. Singh, Marieke B. Snijder, Karien Stronks, Margreet ten Have, Jos W. R. Twisk, Dike Van de Mheen, Jan van der Ende, Kristiaan B. van der Heijden, Peter G. van der Velden, Frank J. van Lenthe, Raphaële R. L. van Litsenburg, Sandra H. van Oostrom, Frank J. van Schalkwijk, Connor M. Sheehan, Robert A. Verheij, Frank C. Verhulst, Marije C. M. Vermeulen, Roel C. H. Vermeulen, W. M. Monique Verschuren, Tanja G. M. Vrijkotte, Alet H. Wijga, Agnes M. Willemen, Maike ter Wolbeek, Andrew R. Wood, Yllza Xerxa, Wichor M. Bramer, Oscar H. Franco, Annemarie I. Luik, Eus J. W. Van Someren, Henning Tiemeier
Journal: Nature Human Behaviour (2020)
Abstract 15507: Trajectories of Point of Care B-type Natriuretic Peptide (bnp) and Its Role as a Predictor of All-cause Mortality Among Hiv and Non-hiv Heart Failure Patients in Uganda
Authors: Samson Okello, Fardous C Abeya
Journal: Circulation (2020)

Introduction: The usefulness of serial measurement of BNP to reduce hospitalization or mortality in patients with HIV and heartfailure is unknown. Hypothesis: We sought to describe changes in B-type natriuretic peptide (BNP) and estimate the effect of HIV on BNP over a week of observation in an acute heart failure cohort of 40 HIV-infected adults (≥18 years) on antiretroviral therapy (ART) and 175 HIV-uninfected hospitalized patients in Uganda. Methods: We measured BNP using i-STAT BNP (Abbott point of care, Princeton, New Jersey) and compared changes by HIV serostatus, and evaluated BNP as a predictor of all-cause mortality at 30 days from hospitalization using multilevel mixed and competitive risk regression models respectively. Results: Overall HIV-infected participants had a higher mean BNP than HIV-uninfected counterparts. After initial declines in BNP in both groups between day 0 and day 3, BNP moderately increased among the HIV-infected on day 7 and continued to decline in the HIV-uninfected group. Each 1 pg/mL increase in baseline BNP from 400 pg/mL increased the risk of all-cause mortality within 30 days by 1% (adjusted standardized hazard ratio (aSHR) 1.01, 95%CI 1.01, 1.01). Other predictors of increased 30-day all-cause mortality included smoking (aSHR 1.99, 95%CI 1.04, 3.84), hypotension (aSHR 1.69, 95%CI 1.26, 2.26) and renal failure stage 3 (aSHR 2.06, 95%CI 1.34, 3.18), and renal failure stage 5 (aSHR 2.02, 95%CI 1.30, 3.13). We found a lower risk of 30-day all-cause mortality of 38% (95%CI 20%, 73%) for those receiving loop diuretics and 74% (95%CI 56%, 99%) for antiplatelet agents. Conclusions: Over a week of observation, HIV-infected people hospitalized with acute heart failure in Uganda have higher BNP levels than HIV-uninfected counterparts. Increases in BNP above the upper bound of the normal predicted heightened risk of all-cause mortality within 30 days of hospitalization.
Abstract 307: Epidemiology, Outcomes and Factors Associated with Survival Following Out of Hospital Cardiac Arrests in Vietnam
Authors: Son N Do, Chinh Q Luong, Dung T Pham, Chi V Nguyen, Tra T Ton, Thao T Pham, Quoc T Hoang, Hanh T Hoang, Dat T Nguyen, Dai Q Khuong, Quan H Nguyen, Tuan A Nguyen, Hanh T Pham, My H Nguyen, Bryan F McNally, Marcus E Ong, Anh D Nguyen
Journal: Circulation (2020)

Introduction: Pre-hospital capabilities are minimally developed in Vietnam; therefore, the prognosis of OHCA might differ from that of other countries. The aim of this study was to investigate survival rate from OHCA and potential determinants of the chain of survival following an OHCA in a developing country. Hypothesis: Understanding the country-specific etiologies and the disease risk and prognosis of OHCA are crucial for reducing mortality in Vietnam, as well as in other countries that face challenges in clinical practice owing to limited medical resources. Methods: This is a multi-center prospective observational study of OHCA patients (age&gt;18 years) presenting to the ED of three tertiary hospitals from February 2014 to December 2018. Factors associated with survival following OHCA were collected and compared among types of pre-hospital care transportation and between survival and non-survival to admission. Factors for survival to admission were assessed using logistic regression analysis. Results: Among 590 OHCA patients (male, 74.6%; age, 56.1±17.2 years), we observed low rates of survival to admission (24.2%) and discharge (14.1%). Of total patients, 67.8% occurred at home, 79.4% witnessed by bystanders, 124/555 (22.3%) received bystander CPR, a minority of patients (8.64%) was conveyed by EMS, and 49/152 (32.2%) received pre-hospital defibrillation. Multivariate analysis revealed that past medical history (PMH) of respiratory disease (OR, 3.128; 95% CI, 1.197-8.173), pre-hospital defibrillation (OR, 3.904; 95% CI, 1.540-9.898), pre-hospital advanced airway (OR, 3.441; 95% CI, 1.203-9.844) and ROSC at ED (OR, 2.891; 95% CI, 1.030-8.115) were independent factors for survival to admission. Following OHCA with cardiac etiology, EMS use (OR, 0.203; 95% CI, 0.044-0.935) was also an independent factor for survival to admission. Conclusions: This was a highly selected cohort of OHCA patients presenting to the ED. Many OHCA victims in Vietnam do not come to the ED. PMH of respiratory disease, pre-hospital defibrillation and advanced airway, and ROSC at ED were independent factors predicting survival to admission. EMS use was also an inverse and independent predictor of survival to admission among patients following OHCA with cardiac etiology.
Rapid Response to an Outbreak in Qingdao, China
Authors: Yuhan Xing, Gary W.K. Wong, Wei Ni, Xiaowen Hu, Quansheng Xing
Journal: New England Journal of Medicine (2020)

Rapid Response to Covid-19 Outbreak in Qingdao, China After a cluster of cases was linked to a hospital in a coastal city in China, nearly 11 million residents were tested for Covid-19 in less than...
Radiographic Screening Reveals High Burden of Silicosis among Workers at an Engineered Stone Countertop Fabrication Facility in California
Authors: Amy Heinzerling, Kristin J. Cummings, Jennifer Flattery, Justine Lew Weinberg, Barbara Materna, Robert Harrison
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

"Radiographic Screening Reveals High Burden of Silicosis among Workers at an Engineered Stone Countertop Fabrication Facility in California." American Journal of Respiratory and Critical Care Medicine, 203(6), pp. 764–766