tbuckley/cabot-search huggingface dataset:
Abstract 13769: Assessing the Risk for Cardiovascular Diseases According to Lipoprotein(a) Levels
Authors: Narek A Tmoyan, Marat V Ezhov, Olga I Afanasieva, Uliana V Chubykina, Elena A Klesareva, Sergei N Pokrovsky
Journal: Circulation (2020)

Introduction: There is no common opinion about threshold lipoprotein(a) [Lp(a)] concentration for atherosclerotic cardiovascular diseases (ASCVD) risk. Different clinical guidelines and consensus documents postulated cut-off Lp(a) level as 30 mg/dL or 50 mg/dL. We assessed the concentration of Lp(a) that associated with ASCVD of different locations. Methods: The study included 1224 patients with ASCVD. Lp(a) concentration was measured by enzyme-linked immunosorbent assay in serum. Patients were divided into 3 groups: group I - Lp(a)&lt;30 mg/dL, group II - 30≤Lp(a)&lt;50 mg/dL, group III - Lp(a)≥50 mg/dL (table). Results: Coronary heart disease, carotid artery disease, lower extremity artery disease, myocardial infarction and ischemic stroke were diagnosed in 61%; 34%; 23%; 42% and 11% patients, respectively. Lower extremity artery disease, carotid artery disease and myocardial infarction were more frequent in patients with Lp(a) concentration from 30 to 50 mg/dL compared to patients with Lp(a) &lt;30 mg/dL: 36%, 41%, 48% vs. 17%, 30%, 36% respectively, p&lt;0.01 for all. Subjects with Lp(a) 30-50 mg/dL (n=182, 15%) had a greater odds ratio of lower extremity artery disease, carotid artery disease and myocardial infarction compared to patients with Lp(a) &lt;30 mg/dL (table). ROC analysis demonstrated that Lp(a) cut-off levels for lower extremity artery disease, carotid artery disease, coronary heart disease and myocardial infarction were 26; 21; 37 and 36 mg/dL, respectively. Conclusions: Our results demonstrate that in case of Lp(a) cut-off level of 50 mg/dL about 15% of patients are underestimated for the risk of ASCVD. Lp(a) cut-off level for ASCVD is between 20 and 40 mg/dL regarding the atherosclerosis location.
Letter to the Editor: Evaluating Liver Function in Patients With Cirrhosis
Authors: Takashi Kokudo
Journal: Hepatology (2020)

Potential conflict of interest: Nothing to report. TO THE EDITOR: We read with great interest the article by Mahmud et al. reporting the risk model to predict postoperative mortality in patients with cirrhosis, and we congratulate the investigators for their excellent work.(1) The model substantially improved postoperative mortality predictions in patients with cirrhosis. Indocyanine green (ICG) retention rate at 15 minutes is a test that is widely used in Japan to predict liver function.(2) Although it was not included in the final model and the results are not available in the database, including the ICG retention rate in the model might have ameliorated the predictive value.
The use of human donor milk
Authors: Hoang Thi Tran, Tuan T Nguyen, Roger Mathisen
Journal: BMJ (2020)

### What you need to know

A 25 year old woman gave birth to her first child prematurely, at 27 weeks gestation, at Da Nang Hospital for Women and Children, in central Vietnam. The male infant weighed 980 grams and required continuous positive airway pressure respiratory support in the neonatal intensive care unit. Neonatal care nurses provided breastfeeding counselling and support to the mother, and the infant received mother’s own milk as well as pasteurised donor milk in the first four days of life. From the fifth day of life, the mother was able to produce enough breast milk to meet her son’s nutritional needs. During the hospital stay, the neonatal nurses encouraged the mother to breastfeed, store breast milk for her son, and donate her surplus breast milk to the human milk bank. She became a breast milk donor when her son was 45 days old and still hospitalised. The mother continued donating breast milk once she returned home, ultimately donating 62 L of breast milk over five months. The mother was proud to be a breast milk donor to newborns in need. 

In line with global recommendations from the World Health Organization (WHO), the UK National Institute for Health and Care Excellence (NICE) and …
Abstract 14738: Classification of Atrial Fibrillation by Deep Learning of Electrogram Shapes versus Rate and Regularity
Authors: Miguel Rodrigo, Albert J Rogers, Prasanth Ganesan, Mahmood Alhusseini, JUSTIN XU, Sanjiv M Narayan
Journal: Circulation (2020)

Introduction: It is unclear whether atrial fibrillation (AF) is best identified on intracardiac recordings by varying shape, rapid rate or extent of irregularity. Prioritizing these features may improve device diagnosis of AF. Hypothesis: AF can be separated from organized atrial flutter (AFL) by electrogram shape, independent of the contributions of rate or regularity. Methods: In 86 patients (25 female, age 65±11 years) we trained a convolutional neural network (CNN) to classify AF or AFL from 64 unipolar electrograms of persistent AF recorded for 60 seconds. In cases labelled as AF, we modified inputs by progressively regularizing (a) electrogram shape; (b) rate or (c) regularity in timing, to define which switched the classification to AFL. Results: The CNN provided a c-statistic of 0.95 ± 0.05 to identify AF or AFL in independent test cohorts not used for training, using 10-fold cross validation. Fig A shows AF in which progressive regularization of shape and timing from #1 to #4 flipped CNN classification into AFL in 45%. EGMs with 100% consistent shape and timing were classified by their cycle length (CL=1/rate): ~90% AF for CL &lt; 175 ms, ~80% AFL for CL from 200-280 ms. Fig. B shows sequences simulated from patient-specific EGMs of AF that were classified as AF in 91 ± 12% of cases even if regular with CL of 200-280 ms, showing AF classification based on EGM shape alone. Figure B illustrates some ‘AF pathognomic’ electrogram shapes in red. Conclusions: AF may be identified by specific EGM shape patterns independent of regularity or rate. Regularity in shape and timing contribute ~45% to AFL classification, and adding CL explains up to 80%. Studies are required to study the mechanistic basis and clinical implications of specific AF-electrogram shapes.
Abstract 359: Systemic Administration of Allogeneic Mesenchymal Stem Cells Attenuates Post-Resuscitation Left Ventricular Dysfunction in a Porcine Model of Cardiac Arrest
Authors: Dorcas Nsumbu, Kristen Kosmerl, Drew Ashbery, Shannon Allen, John M Canty, Brian R Weil
Journal: Circulation (2020)

Introduction: Advances in CPR have increased the likelihood of achieving ROSC after cardiac arrest (CA), but &gt;50% of initially resuscitated patients die before hospital discharge. Evidence that a systemic inflammatory response exacerbates post-ROSC injury supports investigation of anti-inflammatory therapies in this setting. Accordingly, we tested the efficacy of allogeneic mesenchymal stem cell (MSC) administration early after ROSC in a porcine model of CA. Methods: Swine (n=33) were subjected to 10 min CA followed by mechanical CPR with defibrillation and intravenous epinephrine (EPI; 0.015 mg/kg). Animals that achieved ROSC (n=19) were blindly randomized to intraventricular saline (n=9) or allogeneic bone marrow-derived MSCs (55±2 x 10 6 ; n=10) 30 min post-ROSC. Intravenous EPI was given during the post-ROSC period as needed to maintain MAP ≥60 mmHg. Left ventricular (LV) function and plasma cardiac troponin I (cTnI) were assessed for 4 hr post-ROSC, at which time heart tissue was collected to assess myocardial inflammation (RT-PCR). Results: Compared with saline-treated controls, MSC-treated animals exhibited improved post-ROSC LV wall thickening ( A ) and lower cTnI levels, indicative of reduced myocardial injury. By design, both groups had a similar post-ROSC MAP and cardiac output, but the saline group required significantly more EPI ( B ). Although a similar degree of monocyte infiltration (CCR2) and macrophage expansion (CD68) was observed in both groups, MSCs increased expression of the anti-inflammatory marker Arginase1 ( C ) and tended to attenuate the post-ROSC rise in circulating IL-6 ( D ). Conclusion: Early post-ROSC delivery of allogeneic MSCs attenuates LV dysfunction and reduces the need for pharmacologic hemodynamic support after CA in swine. These results indicate that systemic MSC administration may be an effective immunomodulatory strategy to reduce post-resuscitation injury, particularly if protective effects extend to the brain.
Abstract 331: Trajectories of Sequential Organ Failure Assessment (sofa) Scores After Cardiac Arrest
Authors: Kate Flickinger, Patrick J Coppler, McKenzie Brown, Jonathan Elmer
Journal: Circulation (2020)

Cardiac arrest (CA) often results in multi-system organ failure (MSOF). The Sequential Organ Failure Assessment (SOFA) Score is a tool based on the assessment of 6 physiological systems and can quantify severity of MSOF. Understanding the epidemiology, temporal dynamics and anticipated course of MSOF after CA is critical to both clinical care and prognostication. We included patients treated at a single center after CA from 2010-2019, regardless of arrest location or etiology. We electronically extracted all medication, laboratory, ventilator, intake and output data. We calculated SOFA scores daily for up to five days (or until death or discharge). We used group-based trajectory modeling (GBTM, also known as growth curve mixture modeling) to identify groups of patients with distinct trajectories of SOFA over time. We started by fitting trajectories with third order polynomials then sequentially eliminated higher order terms with non-significant coefficients. We used AIC and BIC to determine the number of groups. We included 2,740 patients, of whom most (1,633; 59%) were male, with mean (SD) age of 59 (16) years. Most arrests (2,106; 76%) occurred out-of-hospital and 837 (30%) had a shockable initial rhythm. Overall survival to discharge was 38%. Bilirubin was infrequently checked in this cohort, so we excluded the liver subscale of SOFA from total SOFA calculation making maximum SOFA 20. Mean presenting SOFA was 6 (3), and mean SOFA on day 2 was 6 (4). We identified 5 groups of patients with unique trajectories of SOFA over time. Baseline demographics and survival differed across trajectory groups. Despite showing delayed MOSF onset with rapidly rising SOFA from baseline to day 2, 26% of Group 4 still survived to discharge, while Group 3, which had an initially severe but rapidly improving MSOF had a 32% survival rate. Unique patterns of MSOF after CA can be identified using GBTM. Delayed onset of severe MSOF is less prognostically ominous than commonly believed by clinicians.
Abstract 15087: Identifying Clinical Predictors of Mortality After PCI and the Impact of Complete Revascularization in Patients With Multi-vessel Coronary Artery Disease
Authors: Zaid N Safiullah, Jianhui Zhu, Catalin Toma, Floyd W Thoma, Anson J Smith, Oscar C MARROQUIN, Jeffrey A Fowler, John T Schindler, Suresh R Mulukutla
Journal: Circulation (2020)

Coronary revascularization for multi-vessel coronary artery disease (mvCAD) can be established through PCI or CABG. The benefit of surgical intervention over PCI has been attributed, in part, to more complete revascularization. However, among patients treated with PCI in the present era of drug-eluting stents, it is important to understand whether the completeness of revascularization is associated with mortality. Further, it is important to investigate this relationship in specific patient populations to determine which patients, if any, derive a survival benefit from complete revascularization. Moreover, it is critical to identify which factors are associated with higher mortality in this population to pinpoint potential areas of intervention to mitigate risk. In this propensity-score adjusted analysis, outcomes among 1,580 mvCAD patients who underwent PCI were analyzed and stratified by complete versus incomplete revascularization. The primary outcome was all-cause mortality. Complete revascularization was achieved in 28.4% of the cohort. Complete revascularization was not independently associated with survival compared with incomplete revascularization in the overall cohort (p=0.16). The predictors of increased all-cause mortality included advanced age, chronic lung disease, cardiogenic shock, diabetes, renal insufficiency, reduced left ventricular function, and left main stenosis. Complete revascularization was associated with reduced all-cause mortality in specific patient subsets including those with congestive heart failure and chronic lung disease. Our analysis elucidated numerous clinical predictors of all-cause mortality for mvCAD patients undergoing PCI. Complete revascularization was not among the independent predictors of mortality in the overall population and was associated with reduced mortality in patients with chronic lung disease, history of congestive heart failure and those who did not have previous PCI. While this study was not designed to test whether complete revascularization was superior to incomplete revascularization, the results suggest that when PCI is pursued among patients with mvCAD, achieving complete revascularization does not contribute to increased mortality.
Testing Clinical Prediction Models—Reply
Authors: Amin Adibi, Mohsen Sadatsafavi, John P. A. Ioannidis
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
Targeting the hypoxia-HIF-1-CXCR4 pathway by arsenic trioxide
Authors: Lin-Hung Wei, Kuo-Pao Lai, Chi-An Chen, Min-Wei Chen, Min-Liang Kuo, Jen-Liang Su
Journal: Cancer Research (2008)

2041  Despite the success of arsenic trioxide in the treatment of some hematological malignancies, its therapeutic role in solid tumors remains elusive. We now report that arsenic trioxide inhibits hypoxia-induced expression of the chemokine receptor CXCR4, and suppress the ability of tumor cell to metastasize. Here we have demonstrated that the mRNA and protein production of CXCR4 on HeLa cells could be significantly reduced by arsenic trioxide at the clinical achievable levels, under both normoxic and hypoxic conditions. Luciferase reporter gene assay confirms that arsenic trioxide negatively regulates hypoxia-induced CXCR4 expression in various cancer cell lines, including breast, cervical, and ovarian cancer cells. In keeping with the above, reduction of CXCR4 is essentially responsible for the arsenic-mediated inhibition of tumor migration in vitro as well as distant metastasis in vivo. Studies to date have delineated the hypoxia-HIF (hypoxia-inducible factor)-CXCR4 signaling as a pivotal pathway tuning cancer metastasis. To substantiate our finding we investigate whether arsenic trioxide negatively regulates CXCR4 expression owing to its capacity to target HIF for degradation under hypoxic conditions. Our experimental results have demonstrated that arsenic trioxide destabilized HIF-1α protein under hypoxic condition through interrupting histone deacetylase (HDAC) 1 associating with HIF-1α, thus resulting in reduction of CXCR4 expression. Further, arsenic trioxide dephosphorylated HDAC1, a process by activating PP1 phosphatase, is critically responsible for the interruption of HDAC1 binding to HIF-1α. Collectively, these results unveil Hypoxia-HIF-1-CXCR4 pathway as a novel molecular therapeutic target for arsenic trioxide. As starving tumor cells of oxygen is the major microenvironmental factor that triggers metastasis, the data presents herein may provide insight into the rational development of chemotherapeutic combinations involving arsenic trioxide as well as into molecular mechanisms of arsenic-suppressed cancer metastasis.
Neutrophils interact with cholangiocytes to cause cholestatic changes in alcoholic hepatitis
Authors: Masahiro Takeuchi, Paula T Vidigal, Mateus T Guerra, Melanie A Hundt, Marie E Robert, Maria Olave-Martinez, Satoshi Aoki, Tanaporn Khamphaya, Remco Kersten, Emma Kruglov, Randolph de la Rosa Rodriguez, Jesus M Banales, Michael H Nathanson, Jittima Weerachayaphorn
Journal: Gut (2020)

Background &amp; objectives Alcoholic hepatitis (AH) is a common but life-threatening disease with limited treatment options. It is thought to result from hepatocellular damage, but the presence of cholestasis worsens prognosis, so we examined whether bile ducts participate in the pathogenesis of this disease. Design Cholangiocytes derived from human bile ducts were co-cultured with neutrophils from patients with AH or controls. Loss of type 3 inositol 1,4,5-trisphosphate receptor (ITPR3), an apical intracellular calcium channel necessary for cholangiocyte secretion, was used to reflect cholestatic changes. Neutrophils in contact with bile ducts were quantified in liver biopsies from patients with AH and controls and correlated with clinical and pathological findings. Results Liver biopsies from patients with AH revealed neutrophils in contact with bile ducts, which correlated with biochemical and histological parameters of cholestasis. Cholangiocytes co-cultured with neutrophils lost ITPR3, and neutrophils from patients with AH were more potent than control neutrophils. Biochemical and histological findings were recapitulated in an AH animal model. Loss of ITPR3 was attenuated by neutrophils in which surface membrane proteins were removed. RNA-seq analysis implicated integrin β1 (ITGB1) in neutrophil-cholangiocyte interactions and interference with ITGB1 on cholangiocytes blocked the ability of neutrophils to reduce cholangiocyte ITPR3 expression. Cell adhesion molecules on neutrophils interacted with ITGB1 to trigger RAC1-induced JNK activation, causing a c-Jun-mediated decrease in ITPR3 in cholangiocytes. Conclusions Neutrophils bind to ITGB1 on cholangiocytes to contribute to cholestasis in AH. This previously unrecognised role for cholangiocytes in this disease alters our understanding of its pathogenesis and identifies new therapeutic targets.
The epidemiology of stomach cancer: correlating the past with the present
Authors: D. Forman
Journal: BMJ (2000)

Papers p 1705 

Studies of geographical correlation have low status within the canons of evidence based medicine. At times, the low status is not without reason—most readers will be familiar with presentations in which the equivalent of the international variation in childbirth is attributed to the nesting patterns of storks. Every so often, however, a simple correlation synthesises a complex web of research hypotheses and findings and shows a striking relation not previously appreciated.

Leon and Davey-Smith present one such picture in this week's BMJ (p 1705). Their graph plots the mortality from stomach cancer in 1991–3 among 65–74 year old men against infant mortality in 1921–3 in 27 countries and shows a strong relation between the two. The strength of the correlation is nearly identical for mortality from stomach cancer in women and changes little when adjusted for current (1991–3) infant mortality in each country. In contrast, the correlation between …
Thermo-responsive imprinted hydrogel with switchable sialic acid recognition for selective cancer cell isolation from blood
Authors: Yue Ma, Yimei Yin, Li Ni, Haohan Miao, Yingjia Wang, Cheng Pan, Xiaohua Tian, Jianming Pan, Tianyan You, Bin Li, Guoqing Pan
Journal: Bioactive Materials (2020)

In this work, a sialic acid (SA)-imprinted thermo-responsive hydrogel layer was prepared for selective capture and release of cancer cells. The SA-imprinting process was performed at 37 °C using thermo-responsive functional monomer, thus generating switchable SA-recognition sites with potent SA binding at 37 °C and weak binding at a lower temperature (e.g., 25 °C). Since SA is often overexpressed at the glycan terminals of cell membrane proteins or lipids, the SA-imprinted hydrogel layer could be used for selective cancer cell recognition. Our results confirmed that the hydrogel layer could efficiently capture cancer cells from not only the culture medium but also the real blood samples. In addition, the captured cells could be non-invasively released by lowing the temperature. Considering the non-invasive processing mode, considerable capture efficiency, good cell selectivity, as well as the more stable and durable SA-imprinted sites compared to natural antibodies or receptors, this thermo-responsive hydrogel layer could be used as a promising and general platform for cell-based cancer diagnosis.
Abstract 16253: Temporal Trends and Outcomes of Coronary Artery Bypass Grafting After Acute St-elevation Myocardial Infarction
Authors: Ayman Elbadawi, Mohammed Elzeneini, Islam Y Elgendy, Mohamed Omer, Gbolahan O Ogunbayo, Michael S Megaly, Hani Jneid
Journal: Circulation (2020)

Introduction: There is paucity of data on the outcomes of coronary artery bypass grafting (CABG) among patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We queried the National Inpatient Sample database (2002-2016) for patients with STEMI who underwent CABG. We reported the trends in utilization of CABG for STEMI, and the associated in-hospital outcomes. Using multivariable analysis, we compared in-hospital outcomes in patients undergoing CABG on hospitalization day 1 vs. day 2 vs. day ≥3 , in the early (2002 to 2009) and contemporary cohorts (2012 to 2016). Results: Our analysis yielded 2,910,960 patients with STEMI, of whom 7.6% underwent CABG (9.6% in 2002 versus 3.9% in 2016, P trend &lt;0.001). There was an increase in in-hospital mortality (5.8% in 2002 versus 7.6% in 2016, P trend &lt;0.001) which corresponded to an increase in comorbidities burden among patients undergoing CABG. There was a rising trend in performing CABG on hospitalization day ≥ 3 corresponding to an increase in the utilization of MCS and pre-CABG PCI during the study years. CABG was more likely to be performed on admission day 1 in patients with anterior STEMI, cardiogenic shock or mechanical complications. In the early cohort, CABG on day 1 and day 2 was associated with higher in-hospital mortality, while in the contemporary cohort only CABG on day 1 was associated with higher in-hospital mortality compared with CABG on day ≥ 3. CABG on day 1 was associated with higher rate of cardiac arrest, hemorrhagic stroke, blood transfusion and cardiac tamponade in the earlier cohort, while in the more contemporary cohort it was associated with higher blood transfusion. Conclusions: There was a downtrend in performing CABG for STEMI, and an uptrend in in-hospital mortality after CABG. Patients undergoing emergent CABG on day 1 were more likely to have mechanical complications and cardiogenic shock and were associated with higher in-hospital mortality.