tbuckley/cabot-search huggingface dataset:
Abstract 16084: Relationship Between Diastolic Interventricular Septal Flattening and Prognosis in Patients With Severe Tricuspid Regurgitation
Authors: Omori Taku, Goki Uno, Shunsuke Shimada, Takahiro Shiota
Journal: Circulation (2020)

Introduction: Diastolic interventricular septal flattening is one of the major findings in patients with severe tricuspid regurgitation (TR). However, the relationship between diastolic interventricular septal flattening and outcome in patients with severe TR is not fully understood. This study aimed to investigate the impact of diastolic interventricular septal flattening on cardiac events in patients with severe TR. Methods: We retrospectively reviewed patients who underwent 2 dimensional echocardiography and were diagnosed as severe TR in 2014. Eccentricity index in end-diastole (EI-ED) was measured as septal wall configuration (Figure). Cardiac events investigated as endpoints were cardiac death and heart failure (HF) admission. Results: 376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support during echocardiography and 20 with missing data of clinical information. Remaining 341 severe TR patients (75 ± 16 years, 191 (56%) female) were investigated in this study.232 (68%) patients showed abnormal EI-ED (defined as over 1.0). During a follow-up period (median, 183 days; range. 40 to 983 days), 119 (34%) patients experienced cardiac events (29 cardiac death and 90 HF admission). By the Cox proportional hazard model, the presence of abnormal EI-ED and right atrial pressure (RAP) elevation on echocardiography (defined as more than 8mmHg) were independent predictors for cardiac events with a hazard ratio of 2.71 (95% Confidential interval (CI), 1.25 to 5.86; p=0.011) and of 3.02 (95%CI, 1.08 to 8,47; p=0.036) respectively. The Kaplan-Meier curves showed that severe TR patients with abnormal EI-ED and RAP elevation were at higher risk for cardiac event (Figure). Conclusions: The presence of abnormal EI-ED is an important predictor for cardiac events in patients with severe TR. The presence of abnormal EI-ED and RAP elevation can be a potential surrogate marker of advanced therapy for severe TR.
James Alan McKinna
Authors: Fiona McKinna, Graham Layer
Journal: BMJ (2021)

James Alan McKinna was the youngest son of two GPs. He was educated at West Bridgford Grammar School, Nottinghamshire. He did his surgical training in London and was consultant surgeon at the Royal Marsden Hospitals in 1972-92 and honorary surgeon to Chelsea Hospital for Women.

His major interest was in the management of breast cancer, and he became a Hunterian professor of the Royal College of Surgeons in 1989 with his lecture “The earlier diagnosis of breast cancer—a 20 year experience at the Royal Marsden.” His private practice was in Kensington and at the Cromwell Hospital (emeritus consultant in 1995, when he retired several years after leaving the Marsden). He felt privileged to enjoy the national and international contacts and opportunities in …
Abstract 072: Being Mindful Is Associated With Being More Physically Active: A Study Of Stage B Heart Failure Patients
Authors: Maira Tristao Parra
Journal: Circulation (2021)

Background: Being mindful in daily life appears to be relevant to maintain adequate psychological and physical health. An active lifestyle is essential to maintain cardiovascular health, prevent diseases, and to delay and prevent the progression of heart failure (HF). Little is known about the relationship between being mindful and engaging in healthy behaviors such as physical activity in individuals with HF. This study aimed to explore the association between mindfulness and physical activity. Hypothesis: We hypothesized that individuals with higher mindful scores would be more physically active. Methods: A cross-sectional analysis including patients recruited from the UC San Diego and the Veteran Affairs San Diego Health Care Systems between 2011 and 2014. Asymptomatic stage B HF was diagnosed according to the ACC/AHA definition, and echocardiograms followed guidelines from the American Society of Echocardiography for functional and structural cardiac assessments. Mindfulness was assessed using the Five Facets of Mindfulness Questionnaire. Weekly leisure-time physical activity was captured by the Leisure Time Exercise Questionnaire, MET-based scores were calculated, and patients were stratified into active, moderately active, or insufficiently active. Pearson’s correlations and ANOVAs were calculated. Adjusted linear regression models assessed associations. Significance for all analyses was set at p ≤ 0.05. Results: A sample of 256 patients was analyzed. Continuous PA scores was significantly correlated with observe mindfulness domain (r = 0.148, p = 0.017), but not with describe (r = 0.087, p = 0.16), act with awareness (r = 0.021, p = 0.736), non-judgment (r = 0.043, p = 0.49), or non-reactivity (r=0.07, p = 0.22). ANOVAs revealed that patients who were active or moderately active had higher scores in the mindfulness domains of observe (p = 0.017), describe (p=0.026), and the total score (p = 0.008) than insufficiently active patients. Observe domain (independent variable) remained significantly associated with physical activity (independent variable) when adjusted for age, sex, race, and ethnicity (β = 0.152, p = 0.019). Conclusions: These cross-sectional findings suggest that certain domains of mindfulness are associated with being more physically active in individuals with HF. Broadly, being more mindful, as well as identifying internal and external experiences such as sensation, emotions, and thoughts (observe) and, labeling internal experiences with words (describing), were associated with being more physically active. The directionality of these associations merits further investigation.
Long-term effects of COVID-19 on kidney function – Authors' reply
Authors: Lixue Huang, Xiaoying Gu, Yeming Wang, Chaolin Huang, Bin Cao
Journal: The Lancet (2021)

In our study, 1 we observed a considerable number of patients presenting with low estimated glomerular filtration rate (eGFR) over time without acute kidney injury and an eGFR of 90 mL/min per 1•73 m² or more during hospitalisation.Another study has shown that the use of creatinine to diagnose acute kidney injury might underestimate the patients with acute kidney injury at acute phase. 2 We found that reduced eGFR at follow-up is possibly associated with kidney injury at acute phase, which was not recognised on the basis of serum creatinine values.Philipp Enghard and colleagues reported that other factors (eg, hydration) could lead to fluctuations of serum creatine values and further affect the calculated eGFR values.Patients categorised into the group with an eGFR of 90 mL/min per 1•73 m² or more at acute phase all had eGFR values that were 90 mL/min per 1•73 m² or more during hospitalisation.According to our data, 1366 (80•1%) of 1703 had at least two eGFR values and 956 (56•0%) of 1703 patients had at least three eGFR values, which, to some extent, excluded the possibility of misclassification resulting from fluctuations.For the eGFR value at 6 months after symptom onset, fluctuations might have existed, as the value was obtained once.However, attention should be paid to the group of people that had a lower eGFR value after discharge than at acute phase and are at risk of longterm kidney damage, and who need help from health-care providers and further follow-up to differentiate kidney damage from fluctuation or physiological decrease.Pierre Delanaye and colleagues reported that among patients without acute kidney injury during acute phase, an eGFR less than 90 mL/min per 1•73 m² during followup might be attributable to lowered eGFR before COVID-19.For patients
Abstract 16955: Contrasting Effects of Smooth Muscle TRPV4 Channels on Vascular Function
Authors: YEN LIN CHEN, Zdravka Daneva, Swapnil K. Sonkusare
Journal: Circulation (2020)

Introduction: Transient receptor potential vanilloid 4 (TRPV4) channels are a major Ca 2+ entry pathway in vascular endothelial cells. TRPV4 channels are also expressed in vascular smooth muscle cells (SMC). However, the effect of SMC TRPV4 (TRPV4 SMC ) channels on vascular resistance and blood pressure remains controversial. Hypothesis: We hypothesized that TRPV4 SMC channels are essential regulators of vascular function and blood pressure. Methods: Inducible, SMC-specific TRPV4 knockout (TRPV4 SMC -/- ) mice were used. Blood pressure was monitored using radiotelemetry catheters. SMC Ca 2+ signals were recorded with a spinning disk confocal imaging system. Pressure myography studies assessed vascular reactivity in MAs. Results: Resting diastolic blood pressure and mean arterial pressure were lower in TRPV4 SMC -/- mice when compared to control mice. Selective TRPV4 channel agonist, GSK1016790A (GSK101), induced Ca 2+ influx signals in SMCs that were inhibited by TRPV4 channel inhibitor GSK2193874 and were absent in MAs from TRPV4 SMC -/- mice. In pressure myography studies, GSK101 constricted the MAs in control mice, but not in TRPV4 SMC -/- mice. Moreover, MAs from TRPV4 SMC -/- showed lower vasoconstriction in response to phenylephrine, a α1 adrenergic receptor agonist. These results indicated that Ca 2+ influx through TRPV4 SMC channels contributes to vasoconstriction and increased vascular resistance. However, studies of pressure-induced constriction or myogenic tone indicated that MAs from TRPV4 SMC -/- mice exhibit a higher myogenic constriction at pressures ≥ 60 mm Hg. Moreover, membrane depolarization-induced vasoconstriction (KCl, 33 and 60 mM) was also increased in TRPV4 SMC -/- mice when compared to the control mice, indicating that TRPV4 SMC channels oppose pressure- or membrane depolarization-induced vasoconstriction. Conclusions: TRPV4 SMC channels are essential regulators of resting blood pressure. While TRPV4 SMC channels contribute to α1 adrenergic receptor-induced vasoconstriction, they negatively regulate pressure-induced vasoconstriction. The divergent effects of TRPV4 SMC channels on vascular function may be determined by the selective stimulus-TRPV4 SMC channel coupling and downstream signaling mechanisms.
Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study
Authors: Yejin Mok, Lena Mathews, Ron C Hoogeveen, Michael J Blaha, Christie M Ballantyne, Josef Coresh, Wayne D Rosamond, Kunihiro Matsushita
Journal: Circulation (2021)

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.
Abstract 16805: Assessing Correlation and Agreement in Activated Clotting Time (ACT) Measurement Using Hemochron Signature Elite
Authors: Ankita Aggarwal, Anubhav Jain, Arjun Bhardwaj, Nishit Choksi
Journal: Circulation (2020)

Introduction &amp; Hypothesis: ACT is the preferred mode of assessing degree of anti-coagulation during cardiac catheterization. Studies have shown significant variability in ACT measurement with different company analysers. We aimed to assess correlation and agreement between two instruments of the same company, Hemochron Signature Elite. Method: Paired samples were collected before and after heparin administration for each patient. Each paired sample was collected and entered into the two instruments tagged A &amp; B using the same syringe and at the same time. Results: A total of 46 samples were included in the study. There was a significant correlation between the two instruments (r= 0.92, p- value 0.02). However, the two devices had significant discordance with a mean bias of 11.1 , 95% CI 0.77 to 24.9 and limits of agreement -35.8 to 58.1. Mean ACT between the two devices was significantly different (231 vs 248, p-value 0.01). Inter-device reliability was 30%. There was a more than 10% difference in about 30% of the paired samples and more than 20% difference in 9% of the samples. Conclusion: Significant correlation but discordance exists in ACT measurement even between the same type of device. This may affect clinical decision making during cardiac procedures and need further investigation.
Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis
Authors: Ferenc Emil Mózes, Jenny A Lee, Emmanuel Anandraj Selvaraj, Arjun Narayan Ajmer Jayaswal, Michael Trauner, Jerome Boursier, Céline Fournier, Katharina Staufer, Rudolf E Stauber, Elisabetta Bugianesi, Ramy Younes, Silvia Gaia, Monica Lupșor-Platon, Salvatore Petta, Toshihide Shima, Takeshi Okanoue, Sanjiv Mahadeva, Wah-Kheong Chan, Peter J Eddowes, Gideon M Hirschfield, Philip Noel Newsome, Vincent Wai-Sun Wong, Victor de Ledinghen, Jiangao Fan, Feng Shen, Jeremy F Cobbold, Yoshio Sumida, Akira Okajima, Jörn M Schattenberg, Christian Labenz, Won Kim, Myoung Seok Lee, Johannes Wiegand, Thomas Karlas, Yusuf Yılmaz, Guruprasad Padur Aithal, Naaventhan Palaniyappan, Christophe Cassinotto, Sandeep Aggarwal, Harshit Garg, Geraldine J Ooi, Atsushi Nakajima, Masato Yoneda, Marianne Ziol, Nathalie Barget, Andreas Geier, Theresa Tuthill, M. Julia Brosnan, Quentin Mark Anstee, Stefan Neubauer, Stephen A. Harrison, Patrick M Bossuyt, Michael Pavlides
Journal: Gut (2021)

Objective Liver biopsy is still needed for fibrosis staging in many patients with non-alcoholic fatty liver disease. The aims of this study were to evaluate the individual diagnostic performance of liver stiffness measurement by vibration controlled transient elastography (LSM-VCTE), Fibrosis-4 Index (FIB-4) and NAFLD (non-alcoholic fatty liver disease) Fibrosis Score (NFS) and to derive diagnostic strategies that could reduce the need for liver biopsies. Design Individual patient data meta-analysis of studies evaluating LSM-VCTE against liver histology was conducted. FIB-4 and NFS were computed where possible. Sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Biomarkers were assessed individually and in sequential combinations. Results Data were included from 37 primary studies (n=5735; 45% women; median age: 54 years; median body mass index: 30 kg/m 2 ; 33% had type 2 diabetes; 30% had advanced fibrosis). AUROCs of individual LSM-VCTE, FIB-4 and NFS for advanced fibrosis were 0.85, 0.76 and 0.73. Sequential combination of FIB-4 cut-offs (&lt;1.3; ≥2.67) followed by LSM-VCTE cut-offs (&lt;8.0; ≥10.0 kPa) to rule-in or rule-out advanced fibrosis had sensitivity and specificity (95% CI) of 66% (63–68) and 86% (84–87) with 33% needing a biopsy to establish a final diagnosis. FIB-4 cut-offs (&lt;1.3; ≥3.48) followed by LSM cut-offs (&lt;8.0; ≥20.0 kPa) to rule out advanced fibrosis or rule in cirrhosis had a sensitivity of 38% (37–39) and specificity of 90% (89–91) with 19% needing biopsy. Conclusion Sequential combinations of markers with a lower cut-off to rule-out advanced fibrosis and a higher cut-off to rule-in cirrhosis can reduce the need for liver biopsies.
Abstract 16501: Intravenous Administration of Neonatal Mesenchymal Stem Cells Mediates Functional Recovery in a Renal Ischemia-reperfusion Injury Rodent Model
Authors: Aakash M Shah, Mohamed Abdullah, Lauren Davidson, Progyparamita Saha, Muthukumar Gunasekaran, Rachana Mishra, Sudhish Sharma, Sunjay Kaushal
Journal: Circulation (2020)

Introduction: The prevalence of acute kidney injury in cardiac surgery patients is up to 30%. However, treatments to facilitate kidney recovery are mainly limited to supportive care. In preclinical studies, stem cell therapy using adult Mesenchymal Stem Cells (aMSCs) has reduced kidney damage through the secretion of paracrine factors. Previously, we have established that our neonatal Mesenchymal Stem Cells (nMSCs) have a more potent anti-inflammatory and pro-angiogenic secretome profile than aMSCs. Hypothesis: Intravenous administration of nMSCs and their secretome (total conditioning media) will diminish kidney injury in a renal ischemia-reperfusion injury rodent model. Methods: Six to seven-week-old Brown-Norway rodents underwent bilateral renal clamping to induce 90-minute ischemia. After removal of the clamps and renal reperfusion, the rodents were injected with 100 uL of PlasmaLyte A (control; n=7), an nMSC suspension (10 million cells/kg; n=6), or a total conditioning media (TCM) suspension (10 mg/kg; n=6) via their lateral tail vein. Results: One day after nMSC and TCM treatment, both blood urea nitrogen (116.08 ± 12.02 vs 149.41 ± 9.26 mg/dL; *p=0.0434 and 111.34 ± 9.54 vs 149.41 ± 9.26 mg/dL; *p=0.0174, respectively) and blood creatinine (0.75 ± 0.074 vs 1.25 ± 0.18 mg/dL; **p=0.0028 and 0.76 ± 0.06 vs 1.25 ± 0.18 mg/dL; **p=0.0030, respectively) levels were significantly reduced compared to after PlasmaLyte A injection. Associated decreases in pro-apoptotic signaling molecules (CASP8, BAK, and BAD) and increases in anti-apoptotic signaling molecules (pAKT, SOD2, and BCL2) are being investigated. Conclusions: nMSC and TCM treatment via intravenous injection showed indications of a reduction in kidney injury. This therapy should be further investigated for use in select cardiac surgery patients.
On the optimistic performance evaluation of newly introduced bioinformatic methods
Authors: Stefan Buchka, Alexander Hapfelmeier, Paul P. Gardner, Rory Wilson, Anne-Laure Boulesteix
Journal: Genome biology (2021)

Abstract Most research articles presenting new data analysis methods claim that “the new method performs better than existing methods,” but the veracity of such statements is questionable. Our manuscript discusses and illustrates consequences of the optimistic bias occurring during the evaluation of novel data analysis methods, that is, all biases resulting from, for example, selection of datasets or competing methods, better ability to fix bugs in a preferred method, and selective reporting of method variants. We quantitatively investigate this bias using an example from epigenetic analysis: normalization methods for data generated by the Illumina HumanMethylation450K BeadChip microarray.
Abstract 17141: Atrial Fibrillation And Sleep Apnea: A Central Problem
Authors: Evan Harmon, Patrick Stafford, McCall Walker, Paras Patel, Jacob Blackwell, Sula Mazimba, Nishaki M Mehta, Kenneth C Bilchick, Younghoon Kwon
Journal: Circulation (2019)

Introduction: Sleep apnea is highly-prevalent in patients with atrial fibrillation (AF), and is considered an important risk factor for AF recurrence following cardioversion or catheter-based ablat...
Abstract 14797: Pediatric Arrhythmogenic Ventricular Cardiomyopathy Often Misclassified in End Stage Heart Failure Patients - A 30 Year Tertiary Care Center Experience
Authors: Swati Choudhry, Debra L Kearney, Kyle D Hope, Hari P Tunuguntla, Joseph Spinner, Jack F Price, William Dreyer, Susan W Denfield
Journal: Circulation (2020)

Introduction and Background: Arrhythmogenic ventricular cardiomyopathy (AVC) is a hereditable disorder characterized by fibro-fatty infiltration of the right ventricular myocardial wall. The purpose of this study was to describe the clinicopathologic phenotype of AVC in pediatric end-stage heart failure patients who underwent heart transplantation (HTx). Hypothesis: We hypothesized that AVC is misclassified in the young population who require heart transplant. Methods: We investigated 371 consecutive cases of primary pediatric (≤21 years) heart transplantation performed at Texas Children’s hospital between 1989 and 2018. Heart re-transplants were excluded from the study. Explanted hearts and tissue blocks were examined by a cardiac pathologist after HTx. Histological Diagnosis of AVC was based on the presence of major and minor diagnostic criteria according to the 2010 Revised Task Force Criteria. Results: Over half of the patients who underwent HTx had cardiomyopathy (212/371=57%) as the underlying primary diagnosis. After comprehensive histological evaluation of explanted hearts, 8 cases (8/212=3.8%) were diagnosed with AVC. Predominantly right ventricular disease was seen in 2/8 (25%), and biventricular involvement in 6/8 (75%) patients on pathological examination. Six out of 8 patients (6/8=75%) were misclassified, 4 as dilated cardiomyopathy, 1 as viral myocarditis, and 1 as restrictive cardiomyopathy. The median age at heart transplant (AVC cohort) was 11 years. Four of 8 (50%) were males. Six of 8 (75%) had a significant ventricular arrhythmia burden manifesting as non-sustained ventricular tachycardia requiring antiarrhythmic therapy. Genetic testing was undertaken in 3 of 8 (37.5%); all three were found to have pathogenic mutations in the PKP2 gene. Conclusion: Arrhythmogenic ventricular cardiomyopathy is often misclassified in the young population who require heart transplant. Pediatric dilated and restrictive cardiomyopathy phenotypes with end-stage heart failure waitlisted for a heart transplant (HT) who have a significant ventricular arrhythmia burden should be investigated for AVC.
Helen Salisbury: General practice on the brink
Authors: Helen Salisbury
Journal: BMJ (2021)

No sensible person setting out to build the NHS from scratch would reproduce what we have now.Like an ancient house, which each generation has altered to fit-pulling down a wing here, adding a new storey there-it's grown into something much loved, which mainly works but sometimes lacks coherence.The quality of workmanship varies, not enough has been invested in maintenance, and large cracks are visible.Right now, the bit most in danger of falling down is general practice.