tbuckley/cabot-search huggingface dataset:
Abstract 16068: Local Anesthesia Using the “Tumescent Technique” versus General Anesthesia for Subcutaneous-implantable Cardioverter Defibirllator Implantation: Description of a Novel Technique
Authors: Jorge Romero, Juan Diaz, Isabella Alviz, David Briceno, Chintan Trivedi, Sanghamitra Mohanty, Kavisha Patel, Dommenico Della Rocca, David Burkhardt, Amin Al-ahmad, G Gallinghouse, Dhanunjaya Lakkireddy, Andrea Natale, Luigi Di Biase
Journal: Circulation (2020)

Introduction: General anesthesia is routinely used during the implantation of S-ICD which dramatically prolongs total procedure time, patient recovery time and adds unnecessary potential complications. The tumescent local anesthesia (TLA) technique provides anesthesia of large areas of skin and subcutaneous tissue by means of the direct infiltration of large volumes of a dilute local anesthetic solution into subcutaneous fat. Hypothesis: TLA during S-ICD implantation is feasible and associated with a reduction in total procedure time. Methods: A retrospective analysis was conducted in two medical centers during 2019. Five patients underwent S-ICD with TLA due to baseline conditions that represented relative contraindications to general anesthesia (e.g, muscular dystrophy). A large volume of a local anesthesia solution (i.e., 1 liter of normal saline, 30 cc of 1% lidocaine, 30 cc of bupivacaine, 1 mg of epinephrine, 12.5 mEq of sodium bicarbonate) was used in each patient and injected 10 minutes prior to incisions. Five other patients who underwent S-ICD under general anesthesia served as controls. The skin-to-skin time, total length of procedure and post-procedural pain levels were compared between groups. Results: A total of 10 patients were included (male: 60%; mean age: 62 ± 16). All devices were implanted for primary prevention of sudden cardiac death. TLA was considered the best anesthetic approach in five patients who had medical conditions that represented a high risk of complications if general anesthesia was employed. In the group of TLA, an average of 260 ± 45 cc was administered. The skin-to-skin times were 44.8 ± 13.9 minutes in patients who underwent general anesthesia vs. 46.2 ± 14.3 minutes in TLA (p = 0.3). The total procedural time was 148 ± 28 min vs 64.2 ± 13.4 min (p &lt;0.001) for general anesthesia and TLA, respectively. There was a significant difference between groups in pain scale following the procedure being better pain control with TLA. Conclusions: S-ICD implantation using TLA appears to be a feasible and safe option in patients with contraindications to general anesthesia. This technique significantly decreases total procedure time with better post-procedural pain control.
Development and Validation of a Deep Learning Model for Detection of Allergic Reactions Using Safety Event Reports Across Hospitals
Authors: Jie Yang, Liqin Wang, Neelam A. Phadke, Paige G. Wickner, Christian M. Mancini, Kimberly G. Blumenthal, Li Zhou
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Although critical to patient safety, health care–related allergic reactions are challenging to identify and monitor. <h3>Objective</h3> To develop a deep learning model to identify allergic reactions in the free-text narrative of hospital safety reports and evaluate its generalizability, efficiency, productivity, and interpretability. <h3>Design, Setting, and Participants</h3> This cross-sectional study analyzed hospital safety reports filed between May 2004 and January 2019 at Brigham and Women's Hospital and between April 2006 and June 2018 at Massachusetts General Hospital in Boston. Training and validating a deep learning model involved extracting safety reports using 101 expert-curated keywords from Massachusetts General Hospital (data set I). The model was then evaluated on 3 data sets: reports without keywords (data set II), reports from a different time frame (data set III), and reports from a different hospital (Brigham and Women's Hospital; data set IV). Statistical analyses were performed between March 1, 2019, and July 18, 2020. <h3>Main Outcomes and Measures</h3> The area under the receiver operating characteristic curve and area under the precision-recall curve were used on data set I. The precision at top-k was used on data sets II to IV. <h3>Results</h3> A total of 299 028 safety reports with 172 854 patients were included. Of these patients, 86 544 were women (50.1%) and the median (interquartile range [IQR]) age was 59.7 (43.8-71.6) years. The deep learning model achieved an area under the receiver operating characteristic curve of 0.979 (95% CI, 0.973-0.985) and an area under the precision-recall curve of 0.809 (95% CI, 0.773-0.845). The model achieved precisions at the top 100 model-identified cases of 0.930 in data set II, 0.960 in data set III, and 0.990 in data set IV. Compared with the keyword-search approach, the deep learning model reduced the number of cases for manual review by 63.8% and identified 24.2% more cases of confirmed allergic reactions. The model highlighted important words (eg,<i>rash</i>,<i>hives,</i>and<i>Benadryl</i>) in prediction and extended the list of expert-curated keywords through an attention layer. <h3>Conclusions and Relevance</h3> This study showed that a deep learning model can accurately and efficiently identify allergic reactions using free-text narratives written by a variety of health care professionals. This model could be used to improve allergy care, potentially enabling real-time event surveillance and guidance for medical errors and system improvement.
Abstract 13905: Gender Differences in Cardiac Implantable Electronic Devices (cieds) Among Systolic Heart Failure Hospitalizations: Aninsight From the National Inpatient Sample 2016 to 2017
Authors: Dinesh C Voruganti, Hafeez Hassan, Aman M Amanullah, Sushma Dugyala
Journal: Circulation (2020)

Background: Gender differences in systolic heart failure (HF) patients for the implantation of various cardiac implantable electronic devices (CIEDs) using ICD-10 have not been studied. We aim to explore the gender differences for each type of procedure. Methods: The National Inpatient Sample (NIS) 2016-2017 was used to obtain the hospitalizations with Systolic HF (ICD 10 CM codes I5020, I5021, I5022, I5023). Pacemaker/Defibrillator procedures were obtained using ICD 10 procedure codes. Demographic data were obtained using the variables provided in the NIS. All analysis was performed using SAS statistical software (9.4 Cary NC). Results: We identified 2,812,603 systolic HF hospitalizations from January 2016 to December 2017. Overall, two third of patients were male (62.9%). Table 1 elaborates on the demographics of these hospitalizations. Majority of hospitalizations were ascribed to white patient population (66% males were white &amp; 63.2% females were white). Females were substantially higher Medicare beneficiaries (74.63% in females vs. 69.71% in males). Among the CIEDs, the males had a higher rates of procedure utilization compared to females (Table 2): Percutaneous insertion of defibrillator in right ventricle (1.6% in males vs. 1% in females); Insertion of defibrillator generator via sternotomy (1.1% in males vs. 0.7% in females); Percutaneous insertion of defibrillator lead in right atrium (1.1% in males vs. 0.7% in females); Cardiac resynchronization therapy-pulse generator via sternotomy (0.8% in males vs. 0.5% in females). Conclusion: Despite minimal differences in baseline characteristics, implantation of CIEDs appear to be underutilized in women. Further studies are required to confirm these findings and further explore gender differences.
Abstract 14494: Once You 1c It, You Can’t Unsee It: A Case of Flecainide Toxicity
Authors: Balint Laczay, Venu Menon
Journal: Circulation (2020)

Introduction: Flecainide is a class 1c antiarrhythmic commonly used for the treatment of atrial and ventricular arrhythmias in the absence of underlying structural heart disease. The significant proarrhythmic effects of the drug warrant familiarity with the drug and its toxicity. Flecainide overdose, whether intentional or iatrogenic, is a life threatening emergency with mortality rates as high as 22.5%. We present a case of intentional flecainide overdose and its management. Case: A 78-year-old man with a history of heart failure, paroxysmal atrial fibrillation on flecainide, presented to a local ED after a suicide attempt. He was initially hemodynamically stable and a 12-lead EKG revealed a wide-QRS bradyarrhythmia (See figure 1). Electrolyte panel showed normal potassium and pH. During transport to our tertiary cardiac intensive care unit, the patient declined and was critically ill on arrival. The diagnosis of flecainide toxicity was suspected and therapy was initiated on arrival. Despite therapy with sodium bicarbonate and fat emulsion, the patient continued to decline. Renal replacement therapy was started and the patient was evaluated for mechanical circulatory support. Ultimately, the patient’s family elected for palliative extubation. The patient’s flecainide level returned more than four times above the therapeutic range. Discussion: This case highlights the importance of a high index of suspicion when faced with a wide-QRS arrythmia in a patient with suspected antiarrhythmic overdose. The persistence of these rhythms after correction of acid-base abnormalities and electrolyte derangements should prompt aggressive, empiric treatment of potential overdose. The presence of electromechanical dyssynchrony in this context is an ominous sign and should prompt simultaneous evaluation for biventricular mechanical circulatory support concomitant with medical therapy for suspected overdose. Figure 1
Laparoscopic Port-Site Metastasis From Prostate Cancer on 18F-Fluciclovine PET/CT
Authors: Gary Tran, Daniel Parrinello, Ishani Dalal
Journal: Clinical Nuclear Medicine (2020)

Laparoscopic port-site metastasis from prostate cancer is a rare complication after radical prostatectomy and pelvic lymph node dissection. We report a case of port-site metastasis from prostate cancer identified on 18F-fluciclovine PET/CT for a patient with evidence of biochemical recurrence. Final pathology after targeted ultrasound and biopsy of the mass in the right abdominal wall revealed prostatic adenocarcinoma.
STING agonist-based treatment promotes vascular normalization and tertiary lymphoid structure formation in the therapeutic melanoma microenvironment
Authors: Manoj Chelvanambi, Ronald J Fecek, Jennifer L Taylor, Walter J Storkus
Journal: Journal for ImmunoTherapy of Cancer (2021)

Background The degree of immune infiltration in tumors, especially CD8 + T cells, greatly impacts patient disease course and response to interventional immunotherapy. Enhancement of tumor infiltrating lymphocyte (TIL) is a critical element of efficacious therapy and one that may be achieved via administration of agents that promote tumor vascular normalization (VN) and/or induce the development of tertiary lymphoid structures (TLS) within the tumor microenvironment (TME). Methods Low-dose stimulator of interferon genes (STING) agonist ADU S-100 (5 µg/mouse) was delivered intratumorally to established subcutaneous B16.F10 melanomas on days 10, 14 and 17 post-tumor inoculation. Treated and control tumors were isolated at various time points to assess transcriptional changes associated with VN and TLS formation via quantitative PCR (qPCR), with corollary immune cell composition changes in isolated tissues determined using flow cytometry and immunofluorescence microscopy. In vitro assays were performed on CD11c + BMDCs treated with 2.5 µg/mL ADU S-100 or CD11c + DCs isolated from tumor digests and associated transcriptional changes analyzed via qPCR or profiled using DNA microarrays. For T cell repertoireβ-CDR3 analyses, T cell CDR3 was sequenced from gDNA isolated from splenocytes and enzymatically digested tumors. Results We report that activation of STING within the TME leads to slowed melanoma growth in association with increased production of antiangiogenic factors including Tnfsf15 (Vegi) and Cxcl10, and TLS-inducing factors including Ccl19 , Ccl21 , Lta , Ltb and Light . Therapeutic responses resulting from intratumoral STING activation were characterized by improved VN, enhanced tumor infiltration by CD8 + T cells and CD11c + DCs and local TLS neogenesis, all of which were dependent on host expression of STING. Consistent with a central role for DC in TLS formation, ADU S-100-activated mCD11c + DCs also exhibited upregulated expression of TLS promoting factors including lymphotoxin-α (LTA), interleukin (IL)-36, inflammatory chemokines and type I interferons in vitro and in vivo. TLS formation in ADU S-100-treated mice was associated with the development of a highly oligoclonal TIL repertoire enriched in expanded T cell clonotypes unique to the TME and not detected in the periphery. Conclusions Our data support the premise that i.t. delivery of low-dose STING agonist promotes VN and a proinflammatory TME supportive of TLS formation, enrichment in the TIL repertoire and tumor growth control.
COVID-19 Antibody Tests Perform Well in Head-to-Head Comparison
Authors: Jennifer Abbasi
Journal: JAMA (2020)

Four widely used severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests had high sensitivity and specificity in what scientists said was the first large head-to-head comparison of commercial immunoassays developed during the coronavirus disease 2019 (COVID-19) pandemic.
In heart failure, adding empagliflozin to medical therapy reduced a composite of CV death or HF hospitalization
Authors: Nicolas L. Palaskas, Anita Deswal
Journal: Annals of Internal Medicine (2020)

ACP Journal Club17 November 2020In heart failure, adding empagliflozin to medical therapy reduced a composite of CV death or HF hospitalizationNicolas L. Palaskas, MD, Anita Deswal, MD, MPHNicolas L. Palaskas, MDUniversity of Texas MD Anderson Cancer Center, Houston, Texas, USA (N.L.P., A.D.)Search for more papers by this author, Anita Deswal, MD, MPHUniversity of Texas MD Anderson Cancer Center, Houston, Texas, USA (N.L.P., A.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJ202011170-051 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationPacker M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383:1413-24. https://pubmed.ncbi.nlm.nih.gov/32865377Clinical Impact RatingsGIM/FP/GP: Cardiology: Nephrology: References1 Zelniker TA, Braunwald E. Clinical benefit of cardiorenal effects of sodium–glucose cotransporter 2 inhibitors: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75:435-47. [PMID: 32000956] Google Scholar2 McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995-2008. [PMID: 31535829] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas MD Anderson Cancer Center, Houston, Texas, USA (N.L.P., A.D.)Disclosures: The commentators have disclosed no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3049. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 17 November 2020Volume 173, Issue 10Page: JC51KeywordsCardiovascular therapyEjection fractionEstimated glomerular filtration rateHazard ratioHeart failureHospitalizationsLeft ventricular ejection fractionMortalityReceptor antagonist therapySoft tissue infections ePublished: 17 November 2020 Issue Published: 17 November 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract 14604: Flecainide Induced Myalgias. A Rare but Important Adverse Reaction
Authors: Dilpat Kumar, Rehman Muhammad Ebad, Prashant Patel, Tracey Mersfelder
Journal: Circulation (2020)

Introduction: Flecainide is an anti-arrhythmic used in patients with symptomatic arrhythmias without structural heart anomalies. It is known to cause several non-cardiac adverse reactions, most commonly headaches, dizziness, fatigue and nausea. We report a case of symmetric polymyalgia, a rare side effect of flecainide. Case Report: A 62 year-old woman with history of atrial fibrillation presented with chest heaviness and generalized myalgias. Just 5 days prior to her presentation, she underwent a cardiac ablation and was started on flecainide 150 mg twice daily. Her other home medications included furosemide, carvedilol, dabigatran, losartan and aspirin, all of which were unchanged. Vital signs were stable. Pertinent exam findings included tenderness to palpation over bilateral calf muscles, muscle strength testing with 3/5 in bilateral flexor and extensor muscles of hip and knee joints, and absent bilateral knee and ankle reflexes. EKG showed normal rate and rhythm. ESR and CRP were elevated with a normal ANA and creatinine kinase. The Naranjo score of 7 suggested a probable cause for flecainide-induced myalgias. Flecainide was discontinued leading to improvement in muscle weakness and reflexes at the time of discharge, and at follow-up visits, her symptoms completely resolved. Discussion: Antiarrhythmics are commonly used medications with cardiac and non-cardiac adverse effects. Flecainide-induced adverse effects are dose dependent. In dose ranging studies, increasing flecainide dosages caused significant myalgias, especially in patient taking 300 mg/day. In the appropriate clinical context, healthcare providers should be aware of this rare, reversible adverse effect, to prevent extensive inflammatory or neuromuscular disease workup. As our case illustrates, early discontinuation of flecainide can resolve myalgias and prevent long-term sequelae.
Abstract 14124: Characteristics and Outcomes of Severe Hypercholesterolemia in Patients With St-segment Elevated Myocardial Infarction
Authors: Nicole Groth, Catherine P Benziger
Journal: Circulation (2020)

Background: Patients with severe hypercholesterolemia (SH) are at increased risk of developing cardiovascular disease. The aim of this study was to examine the characteristics and outcomes of ST-segment elevated myocardial infarction (STEMI) patients with SH. Methods: We used the Essentia Health (EH) ST-segment elevated myocardial infarction (STEMI) database including all consecutive STEMI activations between 5/01/2009-6/24/2019 (n=2,711). We excluded false-positive events non-type I myocardial infarctions that did not meet non-obstructive coronary artery criteria (N=455). The study population was divided into SH or non-SH based on having a prior LDL-c ≥ 190 mg/dL since 01/01/2000. Results: Among the study population of 2,256 STEMI patients, a total of 152 patients had SH. The mean age was similar for SH patients and the non-SH group (63.1 ± 11.1 vs 63.6 ± 12.8 years, respectively), but patients without SH were significantly more likely to be male (70.5%, p&lt;0.001). There were similar co-morbidities in both groups, but the SH group was more likely to be current smokers and less likely to be hypertensive. We identified at least one risk factor for STEMI in 99.5% of all patients and two or more in 40.6%. Of those in the SH group, 63.2% were on a high-intensity statin, 9.9% on ezetimibe and 4.6% a proprotein convertase subtilisin-kexin type 9 inhibitor. Highest ever low-density lipoprotein (LDL) was 217.0 ± 30.3 mg/dL and most recent was LDL 117.5 ± 50.6 mg/dL in the SH group. Mean percentage LDL lowering was 47.2% ± 22.1 and only 15.8% (n=24) had a most recent LDL &lt;70 mg/dL. SH patients were less likely to die in the hospital, at 30 days, and at 1 year after event, compared to patients without SH (p&lt;0.001). Conclusion: Nearly 85% of SH patients do not have their LDL treated to goal. Having SH did not predict mortality or readmission after STEMI. Further studies on secondary prevention are warranted.
Abstract 14765: Exosome Shuttled VEGFR Promotes Angiogenesis in Peripheral Vascular Disease
Authors: Ao Shi, D Kent K Arrell, Timothy E Peterson, Tyra A Witt, Mary Nagel, Jialun Li, Steven Moran, Andre Terzic, Atta Behfar
Journal: Circulation (2020)

Introduction: Counteracting the pandemic of peripheral vascular disease necessitates development of proangiogenic treatments. As stem cell benefit has increasingly been associated with paracrine influence on diseased tissue, a purified extracellular vesicle population (PEP) was established to promote tissue regeneration and neovascularization. The mechanistic basis for PEP-induced proangiogenic effects was here probed and validated in two separate in vivo models of vascular ischemia. Hypothesis: PEP drives pro-angiogenic effects though donation of VEGFR. Methods: Nanosight and immunoblotting were utilized to characterize PEP purity and identity. OMICs profiling identified VEGFR as highly prioritized, with downstream signaling was tested in human umbilical vascular endothelial cells using Matrigel assay, qPCR and immunoblotting. In vivo, blood perfusion (Fluorescent imaging - SPY) was quantified in a rodent model of hind-limb ischemia and in a rabbit model of critical ischemic ear, each treated with sham or PEP. Rabbit tissues were next examined by whole transcriptome analysis to assess PEP-induced proangiogenic signaling. Immunohistochemical staining with smooth muscle actin and von Willebrand factor probed de novo blood vessel formation. Results: PEP was characterized by size (mean: 128.6 +/-1 nm) and VEGFR expression. VEGFR knock-down diminished endothelial cell angiogenic activity in vitro, rescued with PEP (5.3x1010+/-109 vesicles/ml) was sufficient enhance total and phosphor-VEGFR expression, along with amplification of downstream VEGFR targets (MAPK, AKT, CXCL8, NOTCH4, MMP9) and enhanced tube formation. In both hind-limb (n=5) and critical ear (n=4) ischemia models, local delivery of PEP to ischemic tissue resulted in restoration of blood perfusion and prioritized proangiogenic signaling in tissue transcriptome pathway analysis, further confirmed by immunohistochemistry. Conclusions: Taken together, our study establishes a new regenerative paradigm documenting exosome-based delivery of VEGFR as a key driver for angiogenesis. This PEP-based platform broadens potential options available for treatment of peripheral vascular disease and may have therapeutic implications in restoration of microvasculature.