tbuckley/cabot-search huggingface dataset:
Abstract 13097: Feasibility and Safety of Trans-nasal Transesophageal Echocardiography Guiding Left Atrial Appendage Closure Without General Anesthesia
Authors: Mingxing XIE, Sun Wei, Wang Bin, He Liin, Lv Qing, Zhang Li
Journal: Circulation (2020)

Background: Percutaneous left atrial appendage closure (LAAO), may be an alternative therapy to non-valvular atrial fibrillation (AF) patients. And the transesophageal echocardiography (TEE) is the mainstay of the imaging technology to guide LAAO procedures. However, in the local anesthesia state, LAAO cannot be accomplished under the real-time guidance of conventional TEE with the standard adult TEE probe. The aim of the study was to explore the feasibility and safety of trans-nasal TEE with the microprobe to guide LAAO without general anesthesia. Methods: A total of 30 non-valvular AF participants were enrolled in the study. All participants both underwent conventional TEE examination with the standard adult TEE probe before LAAO, and the real-time guidance of trans-nasal TEE with the microprobe intraoperatively under local anesthesia. Results: There weren’t significant difficulties to insert the microprobe into the esophagus through the nares. All patients tolerated the trans-nasal approach well. Image quality by the microprobe was reviewed as good (67.3%) and acceptable (36.7%) by two different echocardiographers. The devices were successfully implanted in all participants. No observed significant residual peri-device leaks by the microprobe at the time of the procedure and by the standard TEE on a median of 55 days (interquartile range: 48 to 66 days) postoperatively. 2(7%) patients had mild epistaxis after the procedure, and there were no other severe complications. Conclusion: The present study preliminarily showed the feasibility and safety of the trans-nasal micro-TEE and suggested it may become an alternative to conventional TEE to guide LAAO procedure without general anesthesia.
AB0235 Factors Associated with the Intensification of Treatment in Rheumatoid Arthritis in Clinical Practice:
Authors: A. Naranjo, L. Caceres, J.A. Hernández-Beriaín, F. Francisco, S. Ojeda, S. Talaverano, J. Nόvoa-Medina, J.A. Martín, E. Delgado, E. Trujillo, F. Άlvarez, L. Magdalena, B. Rodriguez-Lozano, J.C. Quevedo, S. Machin, C. Rodríguez-Lozano
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The decision to intensify treatment when arthritis is active is more complex in practice than make management guidelines and treat to target (T2T) <h3>Objectives</h3> To analyze the habits of intensified treatment of rheumatoid arthritis (RA) in patients with active disease in routine clinical care. <h3>Methods</h3> Cross-sectional study conducted in five hospitals in consecutive patients with RA. Inclusion criteria were patients over 18 years treated at rheumatology clinic with a diagnosis of RA (criteria 1997 and/or 2010). In the current visit the following data were collected: parameters to calculate the DAS28-ESR, active treatments (including glucocorticoids, DMARDs and biological), performed ultrasonography, therapeutic decision in the visit and the time of the next visit. The therapeutic decision was divided into three options: 1) maintenance of treatment; 2) reduction of treatment; and 3) increased treatment. Any change of DMARD or biologic was considered increased treatment. <h3>Results</h3> 343 patients were included, 77% female, mean age 57 years and mean duration of RA 10 years. 44% of patients were in remission by DAS28. After the current visit the same treatment was recommended in 60% of patients, was reduced in 16%, and was intensified in 24%. Of the 117 patients with active RA (DAS28≥3.2) treatment was intensified in 52%; 61% if we exclude active RA in biological therapy with no difference between hospitals. In patients with active RA and biological, treatment was intensified in 16 of 44 cases (36%). Factors associated with treatment intensification were patient and physician VAS, DAS28 and performing ultrasonography. The next visit was scheduled at an average of 4.3 months. 64% of patients with active RA had a scheduled visit between 1 and 3 months. Factors associated with the time for next visit were patient VAS, physician VAS and DAS28 in this order. <h3>Conclusions</h3> In clinical practice half of patients with active RA the treatment is maintained or reduced. Factors associated with treatment intensification were disease activity and performing ultrasonography. The decision to intensify treatment in active RA as T2T recommend is complex in practice. <h3>Acknowledgements</h3> This study was supported by a grant from AbbVie (ACA-SPAI-12-17). AbbVie had no role in the writing of the abstract or the decision to submit it <h3>Disclosure of Interest</h3> None declared
Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial
Authors: Alexander Supady, Enya Weber, Marina Rieder, Achim Lother, Tim Niklaus, Timm Zahn, Franziska Frech, Sissi Müller, Moritz Kuhl, Christoph Benk, Sven Maier, Georg Trummer, Annabelle Flügler, Kirsten Krüger, Asieb Sekandarzad, Peter Stachon, Viviane Zotzmann, Christoph Bode, Paul M Biever, Dawid Staudacher, Tobias Wengenmayer, Erika Graf, Daniel Duerschmied
Journal: The Lancet Respiratory Medicine (2021)

We sought to clarify the benefit of cytokine adsorption in patients with COVID-19 supported with venovenous extracorporeal membrane oxygenation (ECMO).We did a single-centre, open-label, randomised, controlled trial to investigate cytokine adsorption in adult patients with severe COVID-19 pneumonia requiring ECMO. Patients with COVID-19 selected for ECMO at the Freiburg University Medical Center (Freiburg, Germany) were randomly assigned (1:1) to receive cytokine adsorption using the CytoSorb device or not. Randomisation was computer-generated, allocation was concealed by opaque, sequentially numbered sealed envelopes. The CytoSorb device was incorporated into the ECMO circuit before connection to the patient circuit, replaced every 24 h, and removed after 72 h. The primary endpoint was serum interleukin-6 (IL-6) concentration 72 h after initiation of ECMO analysed by intention to treat. Secondary endpoints included 30-day survival. The trial is registered with ClinicalTrials.gov (NCT04324528) and the German Clinical Trials Register (DRKS00021300) and is closed.From March 29, 2020, to Dec 29, 2020, of 34 patients assessed for eligibility, 17 (50%) were treated with cytokine adsorption and 17 (50%) without. Median IL-6 decreased from 357·0 pg/mL to 98·6 pg/mL in patients randomly assigned to cytokine adsorption and from 289·0 pg/mL to 112·0 pg/mL in the control group after 72 h. One patient in each group died before 72 h. Adjusted mean log IL-6 concentrations after 72 h were 0·30 higher in the cytokine adsorption group (95% CI -0·70 to 1·30, p=0·54). Survival after 30 days was three (18%) of 17 with cytokine adsorption and 13 (76%) of 17 without cytokine adsorption (p=0·0016).Early initiation of cytokine adsorption in patients with severe COVID-19 and venovenous ECMO did not reduce serum IL-6 and had a negative effect on survival. Cytokine adsorption should not be used during the first days of ECMO support in COVID-19.None.
Disseminated coccidioidomycosis in bone marrow
Authors: Anupama Narla, Jyothsna Narla
Journal: American Journal of Hematology (2021)

IMAGE Bone marrow (x10 on left and x100 on right) with coccidioidomycosis spherules (red rectangles) A 29 year old previously healthy Chinese-American man presented with progressive respiratory failure and hepatosplenomegaly. Initial white count was 21.9 × 109/L, hemoglobin 9.3 g/dL, and platelets 60 × 109/L. On automated differential, 21% eosinophils were noted. The working diagnosis was hypereosinophilic syndrome. On evaluation of his bone marrow (×10 on left and ×100 on right, Image left and right), coccidioidomycosis spherules (refractile double-walled bodies that contain endospores) were clearly visible (red rectangles). (Image left and right) There was no evidence for an increased blast population and no evidence for a B-cell or T-cell lymphoproliferative disorder by flow cytometry. Although eosinophilia is typically mild in coccidial infections, marked eosinophilia can be seen in disseminated disease. The fungus is endemic to the Southwest US, Central and South America. Clinical manifestations of coccidiomycosis can range from asymptomatic disease to mild respiratory disease and in some cases to fulminant disseminated disease. The present case highlights the importance of considering coccidiomycosis in the differential diagnosis of eosinophilia even in the absence of relevant travel or clinical patient history given that specific therapy is needed if the diagnosis is confirmed (see IDSA guidelines). The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Exposure to Type 2 Diabetes Provokes Mitochondrial Impairment in Apparently Healthy Human Hearts
Authors: Elric Zweck, Daniel Scheiber, Tomas Jelenik, Florian Bönner, Patrick Horn, Dominik Pesta, Heinz-Peter Schultheiss, Udo Boeken, Payam Akhyari, Artur Lichtenberg, Malte Kelm, Michael Roden, Ralf Westenfeld, Julia Szendroedi
Journal: Diabetes Care (2020)

Cardiac mitochondrial alterations are suspected to play a key role in the development of diabetes-related heart failure as reported in some animal and few human studies in type 2 diabetes (1). It is yet unclear whether these alterations are induced by diabetes-related metabolic changes or develop secondary to other factors underlying heart failure including micro- and macrovascular disease. We hypothesized that 1 ) exposure to type 2 diabetes provokes myocardial mitochondrial impairment prior to apparent left ventricular heart failure in humans and 2 ) these mitochondrial alterations are accompanied by increased oxidative stress, edema, and intracellular inflammation.

The cohort of this cross-sectional clinical study (study number 5263R; ClinicalTrials.gov NCT03386864) comprised adult heart transplant recipients undergoing routine transcatheter ventricular endomyocardial biopsies (EMB) post-transplantation, who received heart transplants of donors without type 2 diabetes. Thus, time between transplantation and EMB (2.9 ± 2.4 years) corresponded to the exposure of the hearts to type 2 diabetes. The first post-transplantation visit was included; exclusion criteria comprised allograft rejection (>0R according to International Society for Heart and Lung Transplantation criteria) and coronary artery disease (assessed via coronary angiography). Participants underwent oral glucose tolerance tests to assess glucose tolerance and insulin sensitivity (oral glucose insulin sensitivity [OGIS]). Cardiac magnetic resonance imaging was conducted at 1.5T to determine ventricular volumes and function, left ventricular T2 relaxation time, global left ventricular longitudinal strain (GLS), and diastolic strain rate. EMBs were attained for assessment of allograft rejection, mRNA expression of nuclear factor κ-light-chain-enhancer of activated B cells p105 subunit (NF-κB1), Toll-like receptor 9 (TLR9), and mitochondrially encoded cytochrome c oxidase I (CO1) and mitochondrial function using high-resolution respirometry in permeabilized …
27P MiR-221/222 may enhance epithelial-mesenchymal transition and tamoxifen resistance by down-regulating GATA3
Authors: Y-K. Liang, Q. Xie, Z-H. Wang, W. Wang, Z-M. Xie, X-F. Xiao, D. Zeng, H. Lin
Journal: Annals of Oncology (2021)
Abstract 15148: The Impact of the Covid-19 Pandemic on the Mental Distress of Health Care Providers Working in the Coronary Care Unit
Authors: Sayaka Tamano, Yumi Tashiro, Shiho Moriyama, Megumi Takahashi, Takeshi Yamada, Akihiko Takahashi
Journal: Circulation (2020)

Introduction: Medical workers fighting current COVID-19 pandemic are considered facing a mental health crisis. However, there is a paucity of data regarding mental distress in those who caring non-COVIT patients. To assess the mental distress of health care provider working in a coronary care unit during the COVID-19 pandemic, we evaluated the changes in occupational stress before and during the pandemic based on Stress Check Program, which was conducted by Japanese government to screen for workers with high psychosocial stress in the workplace. Methods: Between January 2019 and March 2020, a total of 115 healthcare providers working in our hospital participated in the routine Stress Check Program. Of those, 30 participants working in the coronary care unit underwent a follow-up stress check between May and June 2020. The mean age of the participants was 36.3 ± 9.23 years, and 24 of them (80%) were women. We used the Brief Job Stress Questionnaire, which comprises four components with a total of 57 items: psychological stressors (17 items), psychological and physiological stress reactions (29 items), social support in the workplace (9 items), and personal satisfaction (2 items). Each item was rated on a 4-point scale ranging from 1 to 4. Scores were expressed as mean ± SD for analysis. The changes in scores from before to during the pandemic in terms of the four components and 57 items were analyzed. Results: The mean scores before and during the pandemic for 4 components; psychological stressors, psychological and physiological stress reaction, social support in the workplace, and personal satisfaction were 2.67 ± 0.93 vs. 2.76 ± 0.95 ( p = 0.14); 1.99 ± 0.94 vs. 2.23 ± 1.01 ( p &amp;lt; 0.001); 2.18 ± 0.89 vs. 2.18 ± 0.83 ( p = 0.92); and 2.05 ± 0.65 vs. 2.20 ± 0.78 ( p = 0.09), respectively. Conclusion: Significant worsening during the pandemic was observed for psychological and physiological reactions without no significant change in psychological stressors, social support in the workplace, or personal satisfaction. These results may indicate that the current COVID-19 pandemic was the sole factor contributing to the worsened stress reactions in healthcare providers.
증례 : Pneumobilia 가 동반된 간세포암종에서 간동맥 화학색전술 후 비암성 간 내에 발생한 간농양 1 예
Authors: 김용균(Yong Kyun Kim), 유수은(Su Eun Yu), 홍창균(Chang Kyun Hong), 이성구(Sung Ku Lee), 이소영(So Young Lee), 김영철(Young Chul Kim), 신제현(Je Hyun Shin), 배시현(Si Hyun Bae), 변병훈(Byung Hun Byun), 최종영(Jong Young Choi), 박영민(Young Min Park), 정규원(Kyu Won Chung), 선희식(Hee Sik Sun), 박두호(Doo Ho Pa)
Journal: Clinical and Molecular Hepatology (2001)

Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from O% to 3.3%. Moreover, liver abscess formation in non - tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo - enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non - tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia
Abstract 17072: Acetylcholine Signaling and Endothelial to Mesenchymal Transition in Pulmonary Arterial Hypertension
Authors: Ana Fernandez Nicolas, Alexander Vang, Thomas Mancini, Denielli da Silva Goncalves Bos, Richard T Clements, Peng Zhang, Gaurav Choudhary
Journal: Circulation (2020)

Introduction: Pulmonary arterial hypertension (PAH) is characterized by severe pulmonary vascular remodeling. Transition of endothelial cells (EC) to mesenchymal cells (EndMT) contributes to vascular remodeling; however, the role of EndMT and underlying mechanisms in PAH remain unclear. While nicotinic acetylcholine (Ach) receptor (nAChR)-mediated pathway regulates epithelial to mesenchymal transition and promotes mesenchymal cell proliferation, its role in EndMT is unknown. In this study, we investigate EndMT in PAH and delineate the mechanisms. Methods: PAH was induced in Sprague Dawley rats by SU5416 (20 mg/kg; s.c.), followed by 3 wks of hypoxia (3 wk PAH) or 3wks of hypoxia with additional 4 wks of normoxia (7 wk PAH). Rats without SU5416 and kept at normoxia served as controls. At the end of experiments, hemodynamic measurements were performed. Lung EC were then isolated and purified using CD31 antibody conjugated beads and passage 3-4 were used. EndMT was assessed by dual staining of EC markers (von Willebrand factor and Griffonia simplicifolia) and α-smooth muscle actin (α-SMA) and by the mRNA expression of EC and mesenchymal genes. Lung ACh was measured by ELISA. Results: PAH rats had elevated PA pressures at both 3 wk (PAH vs. CON in mm Hg: 77.3 vs. 24.8, p&lt;0.05, n=4-5) and 7 wk (65.5 vs. 28.6, p&lt;0.05, n=10-12). EndMT was evidenced in PAH (% of cells positive with both EC markers and α- SMA: 3 wks: PAH 4.2% vs. CON 1.6%, p&lt;0.05; 7 wks: PAH 38.5% vs. CON 4.5%, p&lt;0.05), which was associated with significantly increased expression of mesenchymal gene (CD44, PAI1, and α-SMA) and decreased expression of vascular endothelial cadherin at 7 wk. The lungs of PAH rats had higher levels of ACh (PAH vs. CON in pg/mL, 3wk: 78.7 vs. 47.3, p&lt;0.05, n=7; 7wk: 85.1 vs. 45.6, p&lt;0.05, n=7). A significant increase in α7 nAChR expression was found in 7wk PAH EC. In vitro , treatment with ACh markedly induced EndMT in lung EC from normal rats, which was assessed by increased dual staining of EC markers and α-SMA and increased expression of mesenchymal genes (α-SMA, PAI1, and pro-collagen 1, p&lt;0.05 for all). Conclusions: EndMT in PAH is associated with increased lung ACh levels and α7nAChR expression in lung ECs. ACh/nAChR-mediated EndMT may contribute to the vascular remodeling in PAH.
Abstract MP26: Silent Small-vessel Cerebrovascular Disease In Individuals With A Family History Of Coronary Heart Disease: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Michelle C Johansen, Paul A Nyquist, Kevin Sullivan, Myriam Fornage, Rebecca F Gottesman, Diane Becker
Journal: Circulation (2021)

Background: It is established that a family history of coronary heart disease (FHCHD) is associated with coronary atherosclerosis in healthy first-degree relatives, but the extent to which FHCHD is associated with silent cerebrovascular disease (cSVD) is unknown. We hypothesized a higher prevalence of cSVD in healthy persons with FHCHD, independent of traditional risk factors, compared to those without FHCHD. Methods: ARIC is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (visit 5; 2011-13). The association between binary markers of cSVD (lacunar infarcts and/or cerebral microbleeds), or log-transformed white matter hyperintensity volume (WMH), and FHCHD (parent and/or sibling), or number of relatives was examined using separate adjusted multivariable logistic or linear regression models respectively. Sensitivity analysis (N=183) excluded prevalent CHD. Race interaction terms were included. Results: Of 1828 participants (76±5yo, 60% female, 28% black), 787 had FHCHD (699 parental, 209 sibling FHCHD). There were increased adjusted odds of lacunar infarct among those with parental FHCHD (Table). An increased odds of cerebral microbleeds were seen among those with sibling history but not parental. Effect estimates were similar when excluding those with prevalent CHD (Table). Greater number of siblings affected was associated with higher odds of lacunar infarct (OR 1.35, CI 1.04-1.74), lobar (OR 1.53, CI 1.12-2.09) and subcortical microbleeds (OR 1.30, CI 1.01-1.66). Odds of a lacunar infarct being present were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) compared to whites (OR 1.17, CI 0.87-1.56). Neither FHCHD nor number of affected relatives was associated with WMH. Conclusions: Our results suggest that some cSVD manifestations are associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.
Abstract 16062: Hypoglycemia and Risk of Atherosclerotic Cardiovascular Disease (ascvd) in Patients With Diabetes
Authors: Jamal S Rana, Jennifer Y Liu, Howard H Moffet, Andrew Karter
Journal: Circulation (2020)

Introduction: Studies evaluating the relationship of severe hypoglycemia (SH) with the risk of atherosclerotic cardiovascular disease (ASCVD) events are limited by size, confounding and inconsistent outcome definitions. The aim of this study was to assess the association of SH, as defined by hypoglycemia-related hospital utilization, with risk of ASCVD. Methods: We conducted an observational cohort study of adults with diabetes with or without established ASCVD (as of 1/1/2014). All subjects were members of Kaiser Permanente Northern California, an integrated health care delivery system. Baseline was determined by the date of the first hypoglycemia-related utilization (primary diagnosis of hypoglycemia in the emergency department or principal diagnosis in the hospital) during 1/1/2013 - 12/31/2013. Baseline for those without SH, was a randomly assigned date in 2013. Multivariate Cox proportional hazard models were specified to estimate hazard ratios (HRs) for SH in adjusted models of time to incident ASCVD events. This outcome was defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through 12/31/2017. Results: Among 233,696 eligible individuals, mean age was 63.6 years, 47.6% were women, and mean follow-up was 3.8 years. There were 2,179 episodes of SH. Age-sex-race adjusted risk of ASCVD among those with SH versus those without was HR 2.59 (95% CI 2.3-2.9). When additionally adjusted for prior ASCVD, the HR was still more than double, HR 2.32 (95% CI 2.1-2.6). In a fully saturated model with additional adjustments for diabetes type, diabetes duration, HbA1c, GFR, Charlson score, insulin use, sulfonylureas, and quartiles of neighborhood deprivation, SH was associated with a 30% increased risk (HR 1.31, 95% CI 1.16-1.5). The substantial attenuation in risk after more comprehensive adjustment suggests that patients at higher risk of SH are likely at higher risk of ASCVD. Conclusions: In a large, diverse and contemporary cohort of patients with diabetes, SH as defined by hypoglycemia-related hospital utilization is associated with greater risk of ASCVD. Increased awareness in recognizing this risk and vigilance in care for this higher risk population is warranted.