tbuckley/cabot-search huggingface dataset:
Abstract 17141: Pulmonary Artery Pulsatility Index is Associated With Greater Mortality Across a Broad Hospital-Based Cohort
Authors: Emily K Zern, Paula Rambarat, Samantha Paniagua, Elizabeth Liu, Jenna McNeill, Carl T Andrews, Eugene V Pomerantsev, Michael Picard, Jennifer E Ho
Journal: Circulation (2020)

Introduction: The pulmonary artery pulsatility index (PAPi), calculated from the ratio of pulmonary artery pulse pressure to right atrial pressure, was initially described as a novel predictor of right ventricular failure after inferior myocardial infarction or left ventricular assist device implantation. Whether PAPi is associated with adverse outcomes in broader samples is unknown. Hypothesis: A lower PAPi is associated with mortality in a broad population referred for right heart catheterization. Methods: We examined consecutive patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. The following exclusion criteria were applied: shock or cardiac arrest within 24 hours of catheterization, presence of mechanical circulatory support, prior cardiac transplant, prior valvular surgery, or those with missing key clinical covariates. Multivariable Cox models were utilized to examine the association between PAPi and mortality. Analyses were adjusted for age, sex, BMI, hypertension, diabetes, prior myocardial infarction, and prior heart failure. Results: We studied 8559 patients with mean age 63 years and 40% women. We found that patients in the lowest quartile of PAPi were younger, with greater proportion of men, and higher BMI, yet similar NT-proBNP compared with other quartiles ( Table 1 ). Over 12.5 years of follow-up, there were 2441 death events. Patients in the lowest PAPi quartile had a 31% greater risk of death compared with the highest quartile (multivariable adjusted HR 1.31, 95% CI 1.15-1.48, p&lt;0.001), whereas no differences in survival were seen among individuals in quartile 2 or 3 (p&gt;0.05 vs quartile 4 for both). Conclusions: Patients in the lowest PAPi quartile had a 31% increased risk of all-cause mortality in a broad population referred for right heart catheterization. These findings highlight a potential role for PAPi in identifying high-risk individuals across a spectrum of disease.
Single-cell lineage mapping of a diverse virus-specific naive CD4 T cell repertoire
Authors: Achia Khatun, Moujtaba Y. Kasmani, Ryan Zander, David M. Schauder, Jeremy P. Snook, Jian Shen, Xiaopeng Wu, Robert Burns, Yi-Guang Chen, Chien-Wei Lin, Matthew A. Williams, Weiguo Cui
Journal: The Journal of Experimental Medicine (2020)

Tracking how individual naive T cells from a natural TCR repertoire clonally expand, differentiate, and make lineage choices in response to an infection has not previously been possible. Here, using single-cell sequencing technology to identify clones by their unique TCR sequences, we were able to trace the clonal expansion, differentiation trajectory, and lineage commitment of individual virus-specific CD4 T cells during an acute lymphocytic choriomeningitis virus (LCMV) infection. Notably, we found previously unappreciated clonal diversity and cellular heterogeneity among virus-specific helper T cells. Interestingly, although most naive CD4 T cells gave rise to multiple lineages at the clonal level, ∼28% of naive cells exhibited a preferred lineage choice toward either Th1 or TFH cells. Mechanistically, we found that TCR structure, in particular the CDR3 motif of the TCR α chain, skewed lineage decisions toward the TFH cell fate.
Abstract 15802: Association Between Tidal Volume and Outcomes in Patients Undergoing Mechanical Ventilation in the Cardiac Intensive Care Unit: Insights From the Medical Information Mart for Intensive Care (MIMIC-III) Database
Authors: Carlos L Alviar, Albert Y Lui, Leonid Garber, Christopher Cosgriff, Jordan Poles, Vincent J Major, Marie Charpignon, Leo A Celi, Sean Van Diepen, Nathaniel Smilowitz
Journal: Circulation (2019)

Background: The use of low tidal volume (TV) ventilation has been associated with lower mortality in patients with acute respiratory distress syndrome. Limited data suggest potential benefit in pat...
Sinus Tarsi Syndrome on Bone Scintigraphy With SPECT/CT
Authors: Patrick Martineau, Matthieu Pelletier-Galarneau
Journal: Clinical Nuclear Medicine (2020)

Sinus tarsi syndrome is a common cause of hindfoot pain in adults; however, diagnosis on planar bone scintigraphy can be challenging. We present 3 cases of sinus tarsi syndrome, review the spectrum of imaging findings associated with sinus tarsi syndrome, and show the key role that SPECT/CT can play in its diagnosis.
Inflammatory heterogeneity in aspirin-exacerbated respiratory disease
Authors: William C. Scott, Katherine N. Cahill, Ginger L. Milne, Ping Li, Quanhu Sheng, Li Ching Huang, Spencer Dennis, Jacob Snyder, Ashley M. Bauer, Rakesh K. Chandra, Naweed I. Chowdhury, Justin H. Turner
Journal: Journal of Allergy and Clinical Immunology (2020)
Abstract 13686: Increased Right Superior Pulmonary Vein Ovality is Associated With Phrenic Nerve Injury in Patients Undergoing Cryoablation for Atrial Fibrillation
Authors: Aditi S Vaishnav, Kristie M Coleman, Parth Makker, Moussa Saleh, Kabir Bhasin, Neil Bernstein, Nicholas T Skipitaris, Stavros E Mountantonakis
Journal: Circulation (2020)

Introduction: Success of cryoablation for atrial fibrillation (AF) requires creation of continuous, circumferential lesions around the pulmonary veins (PVs). The depth of these cryo-lesions depends on tissue contact, balloon location, ablation duration and nadir temperature. An optimum lesion depth must be achieved such that effective isolation occurs without collateral cryothermal damage to surrounding structures eg, phrenic nerve injury (PNI). Hypothesis: Increased RSPV ovality results in poor pairing between the balloon and PV, which may cause deeper freezing at the lateral circumference of the PV antrum, near the course of the phrenic nerve, resulting in PNI. Methods: Consecutive patients undergoing cryoablation for paroxysmal/persistent AF were included. Pre-procedural cardiac CT scans were analyzed to evaluate PV size (diameters, cross-sectional area, circumference) and ovality (ratio of maximum:minimum diameter (d max :d min ), shape). Effects of these anatomic characteristics on rates of complications were analyzed. Results: RSPVs from 310 patients (age 65.2 years, 38.1% female, 43.2% persAF) were studied. RSPVs were the largest of the 4 normal PVs (d max 21.5±4 mm; d min 17.8±3.8 mm; area 309±113 mm 2 ; circumference 124.2±22.8 mm). A majority of RSPVs were round (57.3% round, 26.9% oval and 15.9% flat), with median d max :d min = 1.18 [1.1-1.32]. PNI was the 2nd most common complication (after access-site complications). Transient diaphragmatic palsy occurred in 2.9% of patients; there were no cases of complete or persistent diaphragmatic paralysis. Patients in whom diaphragmatic palsy occurred had more oval veins (median d max :d min 1.35 [1.23-1.5] vs 1.18 [1.1-1.31]; p=0.015). Additionally, there was a significant difference in the proportion of patients with round RSPVs who had diaphragmatic palsy (1.1%) compared to those with oval or flat RSPVs (5.3%) (p=0.029) (Fig). Conclusion: Increased RSPV ovality is associated with phrenic nerve injury.
Abstract 13417: Impact of Sex on the Prognostic Value of Galectin-3 in Patients With Suspected or Known Coronary Artery Disease: The ANOX Study
Authors: Hiromichi Wada, Kazuhiko Kotani, masahiro suzuki, Morihiro Matsuda, Yoichi Ajiro, Tsuyoshi Shinozaki, Satoru Sakagami, Kazuya Yonezawa, masatoshi shimizu, JUNICHI FUNADA, Takashi Takenaka, Yukiko Morita, Toshihiro Nakamura, Kazuteru Fujimoto, Hiromi Matsubara, Toru Kato, Takashi Unoki, Daisuke Takagi, Kyohma Wada, Miyaka Wada, Moritake Iguchi, Nobutoyo Masunaga, MITSURU ISHII, Mitsuru Abe, Masaharu Akao, Koji Hasegawa
Journal: Circulation (2020)

Background: High circulating levels of galectin-3 are associated with all-cause mortality, cardiovascular (CV) mortality, and/or major adverse CV events (MACE) in patients with CV diseases such as heart failure and coronary artery disease (CAD). However, the impact of sex on the prognostic value of galectin-3 in patients with suspected or known CAD remains unclear. Methods: Using data from a multicenter, prospective cohort of 2418 patients with suspected or known CAD, we assessed the impact of sex on the association between galectin-3 levels and the risks of all-cause death, CV death, and MACE defined as a composite of CV death, nonfetal myocardial infarction, and nonfetal stroke. Galectin-3 was measured in 1624 men and 794 women enrolled in the ANOX Study. Patients were followed up over 3 years. Results: The mean ages (standard deviations) were 69.8 (10.6) years in men and 72.2 (9.9) years in women ( P &lt;0.001). Men exhibited significantly lower levels of galectin-3 compared to women (median [interquartile range], 9.0 [6.9-11.9] versus 9.6 [7.3-12.4] ng/mL, respectively; P =0.004). In the entire patient cohort, the galectin-3 level was significantly associated with all-cause death (hazard ratio per 1 standard deviation increase [HR], 1.28; 95% confidence interval [CI], 1.16-1.42), CV death (HR, 1.24; 95% CI, 1.04-1.46), and MACE (HR, 1.24; 95% CI, 1.09-1.41) after adjusting for potential clinical confounders. These associations were still significant in women (HR for all-cause death, 1.59; 95% CI, 1.26-1.98; HR for CV death, 1.53; 95% CI, 1.06-2.21; HR for MACE, 1.61; 95% CI, 1.21-2.09), whereas in men, galectin-3 was significantly associated with all-cause death (HR, 1.23; 95% CI, 1.08-1.39), but not with CV death (HR, 1.14; 95% CI, 0.93-1.40) or MACE (HR, 1.15; 95% CI, 0.99-1.35). Furthermore, galectin-3 provided incremental prognostic information for all-cause death, but not for CV death or MACE, to the model with potential clinical confounders and the established CV biomarkers in the entire cohort and in women, but not in men. Conclusions: We identified a significantly stronger prognostic value of galectin-3 in women than in men among patients with suspected or known CAD.
<i>Vital Signs:</i> Deaths Among Persons with Diagnosed HIV Infection, United States, 2010–2018
Authors: Karin A. Bosh, Anna Satcher Johnson, Angela L. Hernandez, Joseph Prejean, Jocelyn Taylor, Rachel Wingard, Linda A. Valleroy, H. Irene Hall
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population, yet HIV remains among the 10 leading causes of death among certain populations. Using surveillance data, CDC assessed progress toward reducing deaths among persons with diagnosed HIV (PWDH).CDC analyzed National HIV Surveillance System data for persons aged ≥13 years to determine age-adjusted death rates per 1,000 PWDH during 2010-2018. Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non-HIV-related. Temporal changes in total deaths during 2010-2018 and deaths by cause during 2010-2017 (2018 excluded because of delays in reporting), by demographic characteristics, transmission category, and U.S. Census region of residence at time of death were calculated.During 2010-2018, rates of death decreased by 36.6% overall (from 19.4 to 12.3 per 1,000 PWDH). During 2010-2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7), whereas non-HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2).Early diagnosis, prompt treatment, and maintaining access to high-quality care and treatment have been successful in reducing HIV-related deaths and remain necessary for continuing reductions in HIV-related deaths.
Abstract 16907: Relationship Between 3 <sup>rd</sup> Trimester Umbilical Arterial Blood Flow and Neurodevelopmental Outcomes at 2 Years in Major Fetal Heart Disease
Authors: AMOL MORAY, charlene robertson, Gwen Bond, Jayani Abeysekera, Parsa Mohammadian, Irina Dinu, Joseph Atallah, Lisa K Hornberger
Journal: Circulation (2020)

Introduction: Congenital heart disease (CHD) requiring surgical intervention in infancy is associated with impaired neurodevelopmental (ND) outcomes which may be due in part to prenatal insults. Supporting this, we recently found an inverse relationship between 3 rd trimester umbilical artery Doppler-based (UA) pulsatility index (PI=systolic velocity-diastolic velocity/mean velocity) and growth and ND outcomes at 2 years in hypoplastic left heart syndrome and d-transposition of great arteries. In the present study we explore associations between 2 nd and 3 rd trimester UA-PI in all major fetal CHD and 2-year ND outcomes. Methods: We identified all patients with major structural CHD and fetal echocardiography who underwent cardiac surgery and 2-year ND and biometric assessments (Western Canadian Complex Pediatric Therapies Follow-up Program) from 2007-2017 in our program. Eligible surgeries were: bypass &lt; 6 weeks, shunts at &lt; 6 months or isomerisms with surgery at &lt; 12 months. Patients with genetic syndromes were excluded. 2 nd and 3 rd trimester UA-PI z scores were examined for relationships with 2 year Bayley III ND scales. Data is presented as mean (SD). Results: Data from 147 children was analysed (see Table). 2 nd and 3 rd trimester fetal echo was performed at 22.4(3.7) and 34.7(2.9) weeks, with UA-PI z scores of 0.18 (0.3), and 0.51(1.4) and respectively. The Bayley III cognitive, language and motor scores were 93(13), 89(15) and 89(14) for the entire group. Multivariable regression analysis of the entire group and specific subgroups showed an inverse relationship between 3 rd trimester UA-PI and ND domains (see Table). No association was found for 2 nd trimester UA-PI and ND for the whole group and subgroups. Conclusions: Increased 3 rd trimester UA-PI, which could reflect an altered late gestation placental circulation, inversely relates to abnormal 2 year ND. These relationships are most notably observed in SVs and in CHD associated with AOTO.
Short-term and long-term outcomes in living donors for liver transplantation: Cohort study
Authors: Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Nobuyuki Watanabe, Takashi Kuise, Kazuhiro Yoshida, Kazuya Yasui, Tatsuo Matsuda, Toshiyoshi Fujiwara, Takahito Yagi
Journal: International Journal of Surgery (2020)
Oleic acid restores suppressive defects in tissue-resident FOXP3 Tregs from patients with multiple sclerosis
Authors: Saige L. Pompura, Allon Wagner, Alexandra Kitz, Jacob LaPerche, Nir Yosef, Margarita Dominguez-Villar, David A. Hafler
Journal: Journal of Clinical Investigation (2020)

FOXP3+ Tregs rely on fatty acid β-oxidation-driven (FAO-driven) oxidative phosphorylation (OXPHOS) for differentiation and function. Recent data demonstrate a role for Tregs in the maintenance of tissue homeostasis, with tissue-resident Tregs possessing tissue-specific transcriptomes. However, specific signals that establish tissue-resident Treg programs remain largely unknown. Tregs metabolically rely on FAO, and considering the lipid-rich environments of tissues, we hypothesized that environmental lipids drive Treg homeostasis. First, using human adipose tissue to model tissue residency, we identified oleic acid as the most prevalent free fatty acid. Mechanistically, oleic acid amplified Treg FAO-driven OXPHOS metabolism, creating a positive feedback mechanism that increased the expression of FOXP3 and phosphorylation of STAT5, which enhanced Treg-suppressive function. Comparing the transcriptomic program induced by oleic acid with proinflammatory arachidonic acid, we found that Tregs sorted from peripheral blood and adipose tissue of healthy donors transcriptomically resembled the Tregs treated in vitro with oleic acid, whereas Tregs from patients with multiple sclerosis (MS) more closely resembled an arachidonic acid transcriptomic profile. Finally, we found that oleic acid concentrations were reduced in patients with MS and that exposure of MS Tregs to oleic acid restored defects in their suppressive function. These data demonstrate the importance of fatty acids in regulating tissue inflammatory signals.
Abstract 13501: Patent Ductus Arteriosus Catheterization Closure in Preterm Infants: A Descriptive Study of an Institutional Experience
Authors: Heidi Kim, Sushmita Yallapragada, Rashmin C Savani, Vedanta Dariya, Sana Ullah, Kate Mangona, Timothy Pirolli, Larry Brown, Surendranath V Reddy
Journal: Circulation (2020)

Introduction: A patent ductus arteriosus (PDA) in a preterm infant can lead to respiratory insufficiency and chronic lung disease as well as necrotizing enterocolitis due to systemic hypoperfusion. Recently, catheter-based PDA closure has emerged as an appealing alternative to invasive surgical ligation in preterm infants; however, evidence to support this procedure in infancy, particularly in the premature population, is still evolving. Methods: A retrospective chart review was conducted to collect information regarding demographics, neonatal and maternal clinical characteristics, and procedural and post-catheterization data. Inclusion criteria included infants born at &lt;32 weeks gestational age whose PDAs were closed via catheterization at our institution between January 2017 and August 2019. Infants with critical congenital heart disease and/or lethal congenital anomalies were excluded from this study. Results: Twenty-seven patients were included in our study. Indications for PDA closure in our patient population included hemodynamically significant PDA on echocardiogram, difficulty weaning respiratory support, poor feeding and weight gain, and development of NEC. Median gestational age and weight were 26 weeks and 820 g (ranging from 23 to 30 weeks and 400 to 1540 g, respectively). Most infants tolerated the procedure well and without serious adverse outcomes. One infant developed an intimal flap post-catheterization that resolved without invasive intervention, and 1 infant developed a PAH crisis after PDA closure with resolution of PAH prior to discharge. Statistically significant associations were found between PDA plug closures and decreased oxygen requirements, decreased pulmonary artery hypertension, decreased diuretic requirements, and decreased vasodilator requirements by time of discharge. Conclusions: Successful device closures of PDAs are feasible and safe, and preliminary findings show promising outcomes without mortality or long-term morbidity following transcatheter PDA closure.
Serially Transplantable Patient-Derived Xenograft Model of Chronic Myelomonocytic Leukemia (CMML)
Authors: Arnold Kloos, Felicitas Thol, Lina Winckler, Razif Gabdoulline, Konstantinos Mintzas, Nidhi Jyotsana, Renate Schottmann, Felix F. Adams, Adrian Schwarzer, Dirk Heckl, Suzan Imren, R. Keith Humphries, Arnold Ganser, Michael Heuser
Journal: Blood (2017)
A dangerous onychodystrophy
Authors: Nicola Martinelli, Oliviero Olivieri
Journal: American Journal of Hematology (2020)

A 65-year-old Caucasian man reported 15 months of asymptomatic but persistent nail changes (Image 1, panels A,B), for which many dermatological examinations had been performed. Onychomycosis was often suspected, but direct microscopy examinations and cultures from nail scrapings were negative. Empirical antifungal medications did not lead to any improvement. In the last 4 months, a progressive loss of axillary hair was also reported (Image 1, panels C,D). No signs of dermatitis were detected, nor history of psoriasis was present. Routine laboratory analysis did not show relevant alterations. Serum protein electrophoresis revealed the presence of monoclonal immunoglobulin (lambda light-chain 3.5 g/L). Bone marrow biopsy was diagnostic for multiple myeloma and Congo red staining of subcutaneous fat showed amyloid deposits. Monoclonal immunoglobulin light chain amyloidosis (AL amyloidosis) is the most common form of acquired systemic amyloidosis.1, 2 The involvement of skin is relatively frequent and can be an early indicator of AL amyloidosis. Petechia, purpura, and ecchymosis represent the most common cutaneous findings. Macular, papular, nodular, and bullous lesions are also observed, while alopecia has been only rarely described. Onychodystrophy has been seldom reported in AL amyloidosis with nail changes like brittleness, crumbling, onycholysis, and longitudinal ridging.3 Few previous reports indicated that nail changes may represent the sole sign of amyloidosis.4, 5 In our case, strikingly, onychodystrophy appeared to precede the diagnosis of multiple myeloma with an anticipation of several months. Nail changes may be a clue to systemic diseases. Onychodystrophy is a rare but diagnostically helpful manifestation of AL amyloidosis. The authors declare no potential conflict of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Abstract 140: Effects of ω-3 Polyunsaturated Fatty Acids on Systemic Inflammation and Post-resuscitation Myocardial Function in a Rat Model of Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Cheng Cheng, Hui Li, Tao Jin, Lian Liang, Guozhen Zhang, Jennifer Bradley, Mary Ann A Peberdy, Joseph P Ornato, Dayanjan Wijesinghe, Wanchun Tang
Journal: Circulation (2020)

Introduction: Massive systemic inflammation is a primary cause of myocardial dysfunction following cardiac arrest (CA) and resuscitation (CPR). We investigated the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on systemic inflammation and myocardial function after CA and CPR. Hypothesis: Administration of ω-3 PUFA at the start of CPR will alleviate post CPR inflammation and improve cardiac function in a rat model of CA and CPR. Methods: 18 male Sprague-Dawley rats weighing between 450g-550g were randomized into three groups: Sham, Control, and ω-3 PUFA. Ventricular fibrillation (VF) was induced and untreated for 6 min. 4J defibrillation was attempted after 8 min of CPR. Saline placebo or ω-3 PUFA (5mL/kg) was infused at the start of CPR and continued for 4h. Ejection fraction (EF), cardiac output (CO) and myocardial performance index (MPI) were measured by echocardiography at baseline, 1, 3 and 6h after return of spontaneous circulation (ROSC). Inflammatory cytokines (IL-6 and TNF-α) and cardiac biomarker (cTnI) levels in plasma were detected at baseline and 6 hrs after ROSC. Results: A decrease in EF and CO and an increase in MPI occurred after resuscitation. Significant improvement was noted in ω-3 PUFA compared to control animals (p&lt;0.05) (Fig. 1). ELISA analysis showed increased plasma IL-6, TNF-α, and cTnI in post-resuscitated rats. Administration of ω-3 PUFA attenuated the rise in these plasma biomarkers (p&lt;0.05) (Fig. 2). Conclusion: Administration of ω-3 PUFA attenuates post-resuscitation systemic inflammation and improves myocardial function in a rat model of CA and CPR.
Nearly half of advertised consultant physician posts left unfilled, census finds
Authors: Clara Munro
Journal: BMJ (2020)

A lack of applicants has left almost half of advertised consultant physician posts in the UK unfilled, research conducted by the Royal College of Physicians has found.

The college sent a census to 16 053 consultant physicians in the UK between 30 September 2019 and 31 December 2019 and received 4668 responses (a 29% response rate).1 The work, conducted on behalf of the Federation of the …