tbuckley/cabot-search huggingface dataset:
FDG-Avid Lung Nodule Formation by the Use of Hemostatic Powder
Authors: Kevser Oksuzoglu, Tunc Ones, Emine Bozkurtlar, Korkut Bostanci, Derya Tureli
Journal: Clinical Nuclear Medicine (2020)

Abstract FDG PET/CT is used in the diagnosis and follow-up of various malignant tumors and changes patient management in routine clinical practice. However, inflammatory, infectious, physiological, and technical causes and benign pathological conditions may lead to false-positive FDG uptake. We report a case of a 59-year-old man who was considered having a false-positive FDG-PET pulmonary nodular lesion in favor of metastasis, which was formed by the use of hemostatic powder.
Abstract 15903: Pulmonary Arterial Pressure During Recovery From Exercise Predicts Outcomes in Patients Undergoing Evaluation for Dyspnea
Authors: David S Olshan, Rohan Bhat, Robyn Farrell, Mark Schoenike, Liana Brooks, Jennifer E Ho, Rajeev Malhotra, Gregory Lewis
Journal: Circulation (2020)

Introduction: The post-exercise recovery period poses advantages over the within-exercise period for acquisition of hemodynamic measurements because of attenuated respirophasic changes, ability to time measurements precisely relative to peak exercise, and increased feasibility of multi-modality data acquisition (i.e. echocardiographic imaging). While several studies have linked rest and exercise hemodynamic measurements to outcomes, the prognostic significance of recovery hemodynamics in patients with dyspnea on exertion remains unknown. Hypothesis: Impaired recovery of mean pulmonary arterial pressure (mPAP) following exercise predicts poor clinical outcomes. Methods: Upright incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring was performed in patients referred for evaluation of exertional dyspnea. mPAP was obtained at rest, peak exercise, and at two-minutes following peak exercise. In addition, maximum workload was recorded for each patient. mPAP elevation at recovery versus baseline, indexed to peak workload, was determined. Cox regression was performed using the primary outcome of heart failure event-free survival. Results: Among 272 patients with dyspnea on exertion and preserved LVEF [age 61 (IQR 49 – 70), 47% male, BMI 29 kg/m 2 (25 – 34), exercise duration 8.1 minutes (6.9 – 9.2), peak workload 91 watts (71 – 121)] we observed an increase in mPAP from 17 (14– 20) to 33 (28 – 41) mmHg with a fall in mPAP to 22 (18 – 29) at 2 minutes of recovery. Median mPAP elevation at recovery versus baseline mPAP, indexed to peak workload, was 0.057 (0.031 – 0.101) mmHg/W. Persistently elevated mPAP, indexed to peak workload, was associated with future risk of HF hospitalization or death both in unadjusted analysis (Cox hazard ratio 1.53 for every standard deviation increase, p=0.003), and when adjusted for age, sex, and BMI (HR 1.40, p=0.025). Conclusions: Among patients with dyspnea on exertion undergoing invasive hemodynamic evaluation during exercise, persistently elevated mPAP following exercise predicts future heart failure event-free survival and may be more feasible to estimate non-invasively than measures obtained at peak exercise.
Treatment of Attention-Deficit Hyperactivity Disorder
Authors: Fred A. Baughman
Journal: JAMA (1993)

<h3>To the Editor.</h3> —In a school nurse survey of medication use for hyperactive/ inattentive students in Baltimore County, Maryland, public and private schools, Safer and Krager<sup>1</sup>found a 39% decrease from 3.6% in 1987 to 2.2% in 1989 and 1991; they attribute the decline to the "apprehension of parents and involved professionals generated by the methylphenidate media blitz and the threatened lawsuit." Since they allege that scientific proofs, or the lack of them, concerning hyperactive/inattentive and methylphenidate therapy have nothing to do with the 39% drop observed, it is only appropriate to look at the possible reasons for the doubling every 4 to 7 years of the medication rate for hyperactive/inattentive students in Baltimore County that was observed from 1971 through 1987. Estimates of the frequency of hyperactivity/inattentiveness (hereafter referred to as attention-deficit hyperactivity disorder) range from a low of 1 per 1000<sup>2</sup>to a high of 33%
Abstract 318: Association Carbon Dioxide Level During Cardiopulmonary Resuscitation with Neurological Outcome After Out-of-hospital Cardiac Arrests
Authors: Tasuku Matsuyama, Tetsuhisa Kitamura, Taku Iwami, Bon Ohta
Journal: Circulation (2020)

Background: Little evidence exists to guide appropriate ventilation strategies during CPR. We aimed to investigate the association between carbon dioxide (CO2) pressure measured on hospital arrival from those who were receiving ongoing resuscitation and neurological outcome after out-of-hospital cardiac arrest (OHCA). Method: This nationwide hospital-based prospective observational study (The JAAM-OHCA registry) carried out between June, 2014 and December, 2017 in Japan. From this registry, we included adult OHCA patients aged ≥18 years with blood gas sampled on hospital arrival during CPR. The main exposure was CO2 level in blood gas analysis during CPR. Based on the CO2 level on hospital arrival, included patients were classified into four quartiles (Q1-Q4) defined as Q1 (&lt;66.0 mmHg), Q2 (66.1-87.2 mmHg), Q3 (87.3-113.5 mmHg), and Q4 (≥113.6 mmHg). The primary outcome of this study was one-month survival with favorable neurological outcome defined by cerebral performance category 1 or 2. We adjusted for potential confounders with multivariable logistic regression analysis. Results: During the study period, a total of 21,137 patients were included in our analysis. The overall proportion of favorable neurological outcome was 1.0% (207/21137). The highest proportion of favorable neurological outcome was observed in the Q1 group (2.4% [140/5244]), followed by Q2 (0.7% [37/5284]), Q3 (0.4% [21/5296]), and Q4 (0.2% [9/5313]). In the multivariable logistic regression analysis, we found that the Q4 group had the significantly lower proportion of favorable neurological outcome than the Q1 group (adjusted odds ratio 0.25; 95% confidence interval 0.16-0.55). The adjusted probability of favorable neurological outcome decreased in a stepwise fashion across increasing quartiles (P&lt;0.001). Conclusion: This study observed the association between lower CO2 level on hospital arrival and favorable neurological outcome after OHCA in a dose-dependent manner.
Abstract 17152: Artificial Intelligence ECG for the Detection of Cardiac Injury as Confirmed by High Sensitivity Cardiac Troponin T-Concentrations
Authors: Zachi I Attia, Yader Sandoval, Rickey Carter, Suraj Kapa, Francisco Lopez-jimenez, Peter A Noseworthy, Allan S Jaffe, Paul Friedman
Journal: Circulation (2020)

Background: High-sensitivity cardiac troponin (hs-cTn) assays quantify cTn in patients at very low concentrations. Myocyte injury due to ischemia or other pathologies cause blood levels to increase, which is prognostic. A noninvasive, rapid, broadly available, home-based test to detect hs-cTn increases would facilitate risk-stratification. Since myocyte injury is associated with ECG changes, we hypothesized an artificial intelligence ECG (AI-ECG) could non-invasively predict current or impending hs-cTnT elevations. Objective: To develop an AI-ECG convolutional neural network (CNN) to detect an abnormal hs-cTnT (5 th Gen cTnT, Roche Diagnostics) concentration using a 12-lead ECG, and a single lead ECG (lead I), which would enable smartphone, home-based detection. Methods: We developed single lead and 12-lead ECG CNNs to detect a) hs-cTnT concentrations that were at or above the 6ng/L limit that can be reported b) above the 99 th percentile upper limits of &gt;15ng/L for men and &gt;10ng/L for women. All ECGs were recorded within one hour of the hs-cTnT measurements. We used 73,012 ECG and hs-cTnT pairs from 47,542 unique patients to train the network, 9031 ECGs from 5,811 patients for internal validation to optimize hyperparameters, and 18,276 ECG and hs-cTnT pairs from 11,904 different patients as a holdout test set to determine the area under the receiver-operator curve (AUC). Results: The mean age was 63.9±17.5 years, and 30,348 of the 59,446 patients (51%) were male. Of the 91,288 hs-cTnT pairs 73,271 (80.2%) were above 6ng/L and 50,799 (55.6%) are above the 99 th percentile. In the test set, the AUC for the detection of a hs-cTnT level higher than 6ng/L was 0.88 using the 12 lead ECG and 0.834 with the single lead. For the detection of hs-cTnT level above of 99 th percentile, the 12 lead ECG AUC was 0.853 and the single lead was 0.806. Conclusion: The AI-ECG permits detection of levels of hs-cTnT consistent with myocardial injury. This may allow a home-based, non-invasive test that would be massively scalable and could further enhance rapid-risk stratification and patient triage with potentially significant cost reductions and enable novel triage strategies at sites without hs-cTn assays.
Emergency laparotomy: lack of geriatrician input leaves frail patients at double risk of death
Authors: Zosia Kmietowicz
Journal: BMJ (2020)

Older frail patients undergoing emergency laparotomy have double the 30 day mortality rate of younger, healthier patients because they are not getting input from geriatricians, an audit has found.1

The care of around 24 800 patients who had emergency bowel surgery in NHS hospitals in England and Wales between December 2018 and November 2019 was reviewed for the National Emergency Laparotomy Audit.

Overall, 30 day mortality reduced from 11.8% in 2013 to 9.3% in 2019, research from the Royal College of Anaesthetists shows. But among patients over 65 who were frail, 30 day mortality was 18%.

Of the patients having this type of surgery, …
Abstract 14478: Left Ventricular (LV) Determinants of Left Atrial (LA) Remodeling in Ischemic Cardiomyopathy (iCM): From the Allogeneic Heart Stem Cells to Achieve Myocardial Regeneration (ALLSTAR) Double Blind Placebo Controlled Trial
Authors: Karan Kapoor, Vinithra Varadarajan, Mohammad R Ostovaneh, Bharath Ambale-Venkatesh, Timothy D Henry, Raj Makkar, Linda Marban, Eduardo Marban, Joao Ac Lima
Journal: Circulation (2020)

Introduction: ALLSTAR, a trial of cardiosphere-derived cells in iCM, phenotyped the subjects by cardiac magnetic resonance (CMR) at baseline, and 6- and 12- months post-randomization. The overall CMR dataset provides an opportunity to study temporal remodeling of the LA in the context of iCM-related LV alterations. Hypothesis: We hypothesize that LA volumetric and functional remodeling in iCM are coupled to LV determinants. Methods: LA volumes (LAV; maximum and minimum) were obtained from 4- and 2-chamber cine CMR images. LA functional parameters included total, passive and active LA emptying fractions and global longitudinal strain (GLS). LV parameters included end-diastolic and end-systolic volumes (indexed to body surface area; LVEDVi and LVESVi), as well as LV ejection fraction (EF), infarct size, GLS and end-diastolic mass. Six- and 12-month differences from the baseline CMR study were calculated for LA and LV parameters. Linear regression models were used to evaluate univariate associations between LA and LV parameters (at baseline, 6-months, 12-months and their differences [Δ]), independent of treatment effect (which is the subject of ongoing analysis). Results: 101 participants had 6-month follow up CMR studies; 57 had 12-month studies. Baseline means(SD): age 53.9(10.9) years; 87(86.1%) male; LVEF 39.7%(7.0%); infarct size 22.7%(5.4%). In univariate analyses at 6 months, ΔLVEDVi and ΔLVESVi were both significantly associated with ΔLAVimax and ΔLAVimin, but not with LA functional parameters (Table). At 12 months, ΔLVEDVi remained significantly associated with ΔLAVimax, and ΔLVESVi with ΔLAVimin. No association with LA functional parameters was seen. LVEF, infarct size, GLS and end-diastolic mass were not associated with any volumetric or functional LA parameters (not shown). Conclusions: In conclusion, in this cohort of iCM, pathologic dilatation of the LV appears coupled to volumetric LA remodeling, but not other functional LA parameters.
Abstract 16001: Recurrent Vasospastic Angina Caused by Electronic Cigarette Usage
Authors: Samuel Wopperer, Lowell Safren, Ravi Masson, Awais Malik, Christopher Barnett
Journal: Circulation (2020)

Introduction: A 45 year old female with a past medical history significant for tobacco use disorder presented for evaluation of substernal pressure with radiation to the left shoulder, nausea, and dizziness. There was no associated shortness of breath, diaphoresis, or palpitations. Her symptoms were not associated with exertion. Hypothesis: The differential diagnosis for this atypical chest pain included unstable angina, microvascular angina, vasospastic angina, Takotsubo syndrome, and anxiety. Methods: An ECG revealed ST-segment elevations in the inferior leads, and an emergent coronary angiography demonstrated no significant atherosclerotic disease. However, her right coronary artery was found to be in vasospasm. Nitroglycerin was administered and relieved her chest pain, and her ECG changes returned to baseline after the episode. This fulfilled COVADIS criteria, and a diagnosis of vasospastic angina was made. Results: The patient was treated with nitroglycerin and a calcium channel blocker. She stopped smoking cigarettes and symptoms did not recur. Five years later, the patient again presented with similar symptoms. She reported that she had recently started smoking electronic cigarettes. The patient was counseled to stop using electronic cigarettes. One month later, the patient reported no further episodes of chest pain. Conclusions: We report a case of vasospastic angina caused by electronic cigarette use. Cardiac toxicity from electronic cigarettes is believed to result from exposure to nicotine as well as other chemicals including synthetic vitamin E, aldehydes, and metals present in electronic cigarettes. Though the concentration of nicotine in the blood of electronic cigarette users is highly variable, some reports describe levels comparable to or higher than those in patients who use paper cigarettes. In this patient, cessation of electronic cigarette smoking was effective in eliminating symptoms of vasospastic angina.
Abstract 15074: Impact of Conducting Basic Science versus Clinical Research During Training on Future Academic Productivity Among Cardiothoracic Surgeons
Authors: Hanjay Wang, Simar S Bajaj, Aravind Krishnan, Joseph C Heiler, Kiah M Williams, Joshua M Pickering, Keerthi Manjunatha, Christian T O'Donnell, Mark Sanchez, Y. Joseph Woo, Jack H Boyd
Journal: Circulation (2020)

Introduction: There is growing concern regarding the attrition of surgeon-scientists in cardiothoracic (CT) surgery. The academic impact of conducting basic science research (BSR) during training, however, remains unknown. We hypothesized that CT surgeons who publish a first-author BSR paper during training exhibit enhanced future academic productivity. Methods: CT surgeons on faculty at accredited United States CT surgery training hospitals in 2018 who published a first-author BSR paper or a first-author clinical research (CR) paper during training were identified (n=762). To normalize for environmental differences in research exposure, we specifically studied the surgeons who pursued a research fellowship and who attended a top-50 NIH-funded institution at every stage of training (n=252). Data regarding each surgeon’s professional history and publication record were obtained from publicly-available online sources. Results: As shown in Table 1, surgeons who published a first-author paper in BSR during training and those who published a first-author paper only in CR share similar characteristics and have practiced as an attending surgeon for a similar duration (11.0 years each, p=0.486). However, surgeons who published a first-author BSR paper during training ultimately published more papers per year as an attending (4.3 vs 2.8, p=0.017), resulting in more total publications (73.5 vs 47.5, p=0.003) and a greater H-index (22.0 vs 18.0, p=0.004). The surgeons who published a first-author BSR paper during training were also more likely to have published a BSR paper in the past 2 years as an attending, both as a first or last author (12.0% vs 2.0%, p=0.004), or as a co-author (34.0% vs 15.7%, p=0.001). Conclusions: Academic CT surgeons who published a first-author BSR paper during training exhibit enhanced research productivity and scholarly impact. Funding and institutional support for aspiring CT surgeon-scientists may yield career-long academic benefits.
Abstract 243: Out-of-hospital Cardiac Arrest in the Outpatient Clinical Environment
Authors: Oscar J Mitchell, Michael Wang, Stacie Neefe, Michael Lynch, William D Schweickert, Michael G Shashaty, Benjamin S Abella
Journal: Circulation (2020)

Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death in the US, affecting over 400,000 annually. Although outcomes have improved, rates of return of spontaneous circulation (ROSC) and survival are lower from OHCA than from in-hospital cardiac arrest. Clinical emergencies, including OHCA, in outpatient clinical settings are often first attended by rapid response teams (RRT), but the causes and outcomes from OHCA in these environments has not been characterized. An understanding of this population is critical both for RRT quality improvement and resource allocation. Objectives: We aimed to describe OHCA that occurred in outpatient clinical environments. We hypothesized that OHCA in ambulatory settings would be uncommon and would be concentrated in a limited number of higher-risk outpatient areas. Methods: Retrospective analysis of all RRT calls for non-hospitalized adult outpatients occurring between 2012- 2020 at the Hospital of the University of Pennsylvania. Results: There were 7336 RRT calls;25 were for OHCA. Information was available for 24 of these. Mean age was 64 +/- 16.7 y, and 38% were female. Initial rhythm was pulseless electrical activity in 79%, ventricular fibrillation in 13%, asystole in 4%, and was not recorded in 4%. CPR was initiated in all cases prior to the arrival of the RRT. ROSC was obtained in 84%, extracorporeal membrane oxygenation (ECMO) was initiated in 8%, and 8% did not survive. ROSC was obtained within 5 min in 58% of cases. Of those that attained ROSC, 75% survived to discharge, 80% with good neurological status (CPC 1-2). Most events (54%) were judged to be iatrogenic. Of these, 54% were due to anaphylaxis, 15% were during cardiac stress testing, and 31% were peri-procedural. The most common causes of anaphylaxis were chemotherapeutics and radiographic contrast agents. Conclusions: OHCA events are uncommon in the outpatient clinical setting and are frequently iatrogenic. These events are associated with high rates of ROSC and neurologically intact survival. Iatrogenic OHCA occurred during a limited number of clinical settings, including outpatient procedural, , infusion, and stress test locations.. This finding suggests the need to focus resuscitation training in these specific environments.
Abstract 16684: Risk Prediction in Chronic Heart Failure: Comparison of the PREDICT-HF and MAGGIC Risk Scores in 4744 Patients in DAPA-HF
Authors: JoAnne Simpson, Kieran Docherty, Mark Petrie, Pardeep S Jhund, John J McMurray
Journal: Circulation (2020)

Introduction: Predicting outcomes in patients with heart failure (HF) is challenging. We compared the performance of the recently developed PREDICT-HF score with the established MAGGIC risk score in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). Methods: The MAGGIC risk score is the most commonly used risk score in heart failure and was derived using data from 39,372 patients enrolled in 30 clinical trials and cohort studies and includes 13 clinical variables. PREDICT-HF (www.predict-hf.com) incorporates demographic, comorbidity and laboratory variables, including natriuretic peptides, and was developed using data from PARADIGM-HF. The performance of both models was tested in in DAPA-HF i.e. in symptomatic patients with HFrEF receiving contemporary standard care. The outcomes examined included all-cause death and cardiovascular (CV) death at 1 and 2 years. Model discrimination and calibration were assessed by Harrell’s C statistic. For the PREDICT-HF model participants with missing values, median values from the derivation cohort were imputed. Results: The mean age of the 4744 patients in DAPA-HF was 66 years and 77% were male; 68% were in NYHA functional class II and 24% in class III. During a median follow-up of 18 months, 605 patients died, and 500 experienced CV death. Using PREDICT-HF, the C statistic at 1 and 2 years was 0.71 and 0.70 for all-cause death, and 0.73 and 0.72 for CV death, respectively. The MAGGIC risk score was available for 4740 patients in DAPA-HF. The C-statistic for all cause death at 1 and 2 years was 0.63 and 0.63, respectively. Model discrimination for PREDICT-HF and MAGGIC are shown in Table 1. Conclusions: PREDICT-HF performed well, and significantly better than the MAGGIC risk score, in predicting mortality in a contemporary cohort of patients receiving evidence-based treatment.
Doctors’ polls on assisted dying are irrelevant
Authors: Sam Shuster
Journal: BMJ (2020)

We’ve had a Royal College of Physicians poll, a Royal College of General Practitioners poll, and now the BMA poll on assisted dying.1 That’s a full hand of polls, but it’s a dead hand, because the response rates were too low—29%, 15%, and 19%, respectively.

Such trivial responses relate to only small subgroups; they augment bias, as the RCP figures showed, and provide no evidence whatsoever of the …