tbuckley/cabot-search huggingface dataset:
Abstract 15474: New Onset Left Bundle Branch Block Secondary to Severe Hyperkalemia
Authors: Ahmed H Qavi, Abdul M Minhas, Fariha Ilyas
Journal: Circulation (2020)

Case presentation: A 79-year-old female with history of renal failure on hemodialysis (HD) presented with generalized weakness. Her last HD was 3 days ago. On examination, she was vitally stable. Blood tests demonstrated a potassium (K+) of 8.3 mmol/L, confirmed on repeat testing. ECG revealed wide QRS, tall T waves and a new left bundle branch block (Figure 1). She was immediately treated with calcium chloride, insulin, dextrose and polystyrene sulfonate. The patient was admitted to the ICU and underwent emergent HD. Repeat K+ post HD reversed to 4.0 mmol/L and ECG reflected normal sinus rhythm with resolution of ST-T wave changes (Figure 2). Discussion: Hyperkalemia can lead to cardiac arrhythmias and sudden death. The ECG changes are dependent on severity of hyperkalemia. It can vary from narrow based, peaked T waves to ventricular fibrillation. Hyperkalemia can also lead to interventricular conduction delays, which, with severity, can take the form of right or left bundle branch block (LLLB). The conduction delay from hyperkalemia usually lasts only in initial or terminal portions as opposed to throughout the QRS complex as seen in bundle branch block disease. Association of LLLB with hyperkalemia is an uncommon but important occurrence and has only scarcely been reported in literature. Its prevalence remains unknown. With the growing use of renin-angiotensin aldosterone system inhibitors, more patients are prone to experience life threatening electrolyte disturbances. A thorough knowledge of the ECG manifestations related to hyperkalemia is crucial to ensure emergent treatment. This may result in improved outcomes in such patients with cardiovascular and renal diseases.
Let us up our game and make conference participation enrich our clinical skill set
Authors: Karen Kotila, Thomas Bandholm, Michael Skovdal Rathleff, Julie Sandell Jacobsen, Heidi Klakk, Kristian Thorborg
Journal: British Journal of Sports Medicine (2020)

Come join us at the 4th World Congress of Sports Physical Therapy (WCSPT2022) in Denmark! The key value of the congress is translating science into clinical practice, and we invite you to take an active part. Let us up our game and make conference participation enrich our clinical skill set.

Traditionally when planning a conference, we load up the programme and offer a platform where a massive amount of information is delivered in a short time. We overload with numerous exciting topics, leaving the attendants practically incapable of processing all the information and with little time to reflect on how …
Abstract 4089: Unique Epicardial Substrate in Non-Ischemic CM: Echo Signature, Electrogram Correlates and Outcome with Substrate Based Ablation
Authors: Rupa Bala, Oscar Cano, Mathew D Hutchinson, Fermin C Garcia, Michael P Riley, Edward P Gerstenfeld, Joshua M Cooper, David Lin, Sanjay Dixit, David J Callans, Francis E Marchlinski
Journal: Circulation (2008)

We present a unique series of patients (pts) with non-ischemic cardiomyopathy (NICM) and unmappable ventricular tachycardia (VT) who demonstrated predominantly normal left ventricular (LV) endocardial (ENDO) voltage and abnormal epicardial (EPI) substrate defined by intracardiac echo (ICE) and fractionated electrograms (EGMS). This substrate served as an appropriate ablation target for VT. All patients underwent ICE imaging and detailed ENDO and EPI voltage mapping to further characterize the substrate and define the EGM correlates. 5 pts with NICM had increased echogenicity in the lateral epicardium by ICE imaging. Detailed LV ENDO mapping (199 ± 94.5 points) identified no voltage abnormalities in 4 pts. In one pt, a 16.2cm2 low voltage area in the LV ENDO was present and adjacent to the EPI abnormality. In all pts, detailed EPI mapping (477 ± 158 points) revealed a distinct area (20.6 ± 3.6 cm2) of low voltage (&lt;1.0mV) that correlated with the echogenic area. These areas displayed low amplitude EGMS that were wide (&gt;80msec), split, and late (beyond QRS). (Figure 1 ). After excluding coronary branch vessels and the course of the phrenic nerve, all pts underwent substrate based ablation based on pace-mapping and targeting of abnormal EGMS to eliminate the targeted VT. No VT has recurred during mean follow-up of 20mo (range 1–30 mo). Unique EPI substrate in NICM, defined by echo imaging and confirmed by EGM correlates, can be successfully targeted for RF ablation to provide effective VT control.
Abstract 14925: Mechanical Tension in Syndecan-1 is Regulated by Extracellular Mechanical Cues and Fluidic Shear Stress
Authors: Lei Mei, Victoria Le, Peter Voyvodic, Chi Zhao, David Busch, Jeanne Stachowiak, Aaron Baker
Journal: Circulation (2020)

Syndecan-1 (SDC1) is a transmembrane proteoglycan that mediates the shear stress-induced signaling and inflammatory phenotypes of endothelial cells. While SDC1 is known to be involved mechanically in regulating the behavior of cells, it remains unknown how SDC1 responds to extracellular mechanical cues on the molecular level. We designed a set of FRET-based SDC1 tension sensors including full-length SDC1 (SDC1TS), SDC1 with deleted ectodomain (ΔEcto), SDC1 with deleted glycosylation sites (ΔGAG) and SDC1 with a deleted cytoplasmic tail (ΔCyto). We transduced these constructs into ECs and validated the constructs by WB and confocal imaging. When cultured on glass-bottom coverslips, we found that the baseline tension in SDC1TS was significantly higher than that in Ecto and GAG mutants. When cultured on engineered substrates, we demonstrated that tension in SDC1 is modulated by micropatterned surfaces and nanotopographical cues. To study if SDC1 directly responds to substrate stiffness, transduced ECs were cultured on 0.2 kPa and 25 kPa substrates. We found that there was significantly decreased tension in the Ecto construct compared to the full-length SDC1TS construct on 0.2 kPa substrates but no significant changes were observed on the 25 kPa substrates. To examine the effect of substrate stiffness on the association of SDC1 with adhesion-related proteins, we performed IP and WB on ECs expressing HA-tagged SDC1 cultured on 0.2 kPa or 25 kPa substrates. We found there were increases in SDC1 binding to action and myosin IIb, while there were decreased in SDC1 binding to Src, PKA, and FAK in cells grown on stiff substrates versus on soft substrate. To study the effect of shear stress on the tension of SDC1, ECs expressing the constructs were cultured on static or under 12dyn/cm 2 fluidic shear stress. We found that a gradient developed in the tension of SDC1 in all four constructs. There was higher tension of SDC1 in the upstream region in comparison to the downstream region. IP and WB results showed that shear stress-induced SDC1 association with actin, Src, myosin IIb, cortactin, calmodulin, and integrin beta3. In summary, our results demonstrate that SDC1 is mechanically responsive to substrate mediated biophysical cues and shear stress.
Abstract 13143: Safety Evaluation of Therapeutic Angiogenesis With Adipose-derived Regenerative Cells for Ischemic Limb in a Tumor Bearing Model
Authors: Junya Suzuki, Yuuki Shimizu, Kazuhito Tsuzuki, Zhongyue Pu, Shukuro Yamaguchi, Rei Shibata, Toyoaki Murohara
Journal: Circulation (2020)

Introduction: Implantation of adipose-derived regenerative cells (ADRC) is a promising novel strategy to augment angiogenesis and blood perfusion recovery in ischemic diseases with no other therapeutic option. However, there is a clinical concern underlying therapeutic angiogenesis that implantation of ADRC may promote tumor growth and metastasis via remote angiogenesis. Accordingly, we tested whether therapeutic angiogenesis with ADRC against hindlimb ischemia (HLI) would affect remote tumor growth and angiogenesis in a tumor-bearing mouse ischemic hindlimb model. Methods and results: B16F10-Luc (murine melanoma cells expressing luciferase, 1x106 cells/animal) were implanted to C57BL/6J mice’s (male, 8-10 weeks old, n=10) back. Mice were subjected to unilateral HLI surgery one day after tumor implantation. Then, mice were randomly assigned to the control group or the ADRC group (n=5 for each). ADRC (1x106 cells/animal) or PBS were implanted/injected into ischemic hindlimb muscles one day after the surgery. Blood perfusion recovery in HLI by laser Doppler perfusion imaging system and tumor size by a caliper were measured every week up to 21 days after surgery. At POD 21, tumor weight and luciferase activity in primary tumors obtained by in vivo bioluminescence imaging system were also evaluated. Immunohistochemistry by CD31 or LYVE1 staining was performed to detect feeder arteries or outflow lymphatic vessels in tumors. The results demonstrated that better blood perfusion recovery and more capillary density in HLI was observed in the ADRC group than in the control group (p&lt;0.05, respectively). However, there were no significant differences in terms of tumor volume (p=0.95), tumor weight (p=0.88) and luciferase activity of primary tumor (p=0.92) between those two groups. No sign of distant metastasis was detected by macroscopic and pathological examination, and by in vivo bioluminescence imaging system in both groups. Further study also revealed that capillary density of peritumoral blood vessels or lymphatic vessels was not augmented by ADRC implantation into remote HLI. Conclusions: Our data indicated that therapeutic angiogenesis with ADRC implantation against HLI did not promote remote tumor growth, angiogenesis and metastasis.
Integrative Imaging Reveals SARS-CoV-2-Induced Reshaping of Subcellular Morphologies
Authors: Mirko Cortese, Ji-Young Lee, Berati Cerikan, Christopher J. Neufeldt, Viola M.J. Oorschot, Sebastian Köhrer, Julian Hennies, Nicole L. Schieber, Paolo Ronchi, Giulia Mizzon, Inés Romero-Brey, Rachel Santarella-Mellwig, Martin Schorb, Mandy Boermel, Karel Mocaer, Marianne S. Beckwith, Rachel M. Templin, Viktoriia Gross, Constantin Pape, Christian Tischer, Jamie Frankish, Natalie K. Horvat, Vibor Laketa, Megan Stanifer, Steeve Boulant, Alessia Ruggieri, Laurent Chatel-Chaix, Yannick Schwab, Ralf Bartenschlager
Journal: Cell Host & Microbe (2020)
Changes in Health Care Use and Outcomes After Turnover in Primary Care
Authors: Adrienne H. Sabety, Anupam B. Jena, Michael L. Barnett
Journal: JAMA Internal Medicine (2020)

<h3>Importance</h3> Disruptions of continuity of care may harm patient outcomes, but existing studies of continuity disruption are limited by an inability to separate the association of continuity disruption from that of other physician-related factors. <h3>Objectives</h3> To examine changes in health care use and outcomes among patients whose primary care physician (PCP) exited the workforce and to directly measure the association of this primary care turnover with patients' health care use and outcomes. <h3>Design, Setting, and Participants</h3> This cohort study used nationally representative Medicare billing claims for a random sample of 359 470 Medicare fee-for-service beneficiaries with at least 1 PCP evaluation and management visit from January 1, 2008, to December 31, 2017. Primary care physicians who stopped practicing were identified and matched with PCPs who remained in practice. A difference-in-differences analysis compared health care use and clinical outcomes for patients who did lose PCPs with those who did not lose PCPs using subgroup analyses by practice size. Subgroup analyses were done on visits from January 1, 2008, to December 31, 2017. <h3>Exposure</h3> Patients' loss of a PCP. <h3>Main Outcomes and Measures</h3> Primary care, specialty care, urgent care, emergency department, and inpatient visits, as well as overall spending for patients, were the primary outcomes. Receipt of appropriate preventive care and prescription fills were also examined. <h3>Results</h3> During the study period, 9491 of 90 953 PCPs (10.4%) exited Medicare. We matched 169 870 beneficiaries whose PCP exited (37.2% women; mean [SD] age, 71.4 [6.1] years) with 189 600 beneficiaries whose PCP did not exit (36.9% women; mean [SD] age, 72.0 [5.0] years). The year after PCP exit, beneficiaries whose PCP exited had 18.4% (95% CI, −19.8% to −16.9%) fewer primary care visits and 6.2% (95% CI, 5.4%-7.0%) more specialty care visits compared with beneficiaries who did not lose a PCP. This outcome persisted 2 years after PCP exit. Beneficiaries whose PCP exited also had 17.8% (95% CI, 6.0%-29.7%) more urgent care visits, 3.1% (95% CI, 1.6%-4.6%) more emergency department visits, and greater spending ($189 [95% CI, $30-$347]) per beneficiary-year after PCP exit. These shifts were most pronounced for patients of exiting PCPs in solo practice, whose beneficiaries had 21.5% (95% CI, −23.8% to −19.3%) fewer primary care visits, 8.8% (95% CI, 7.6%-10.0%) more specialty care visits, 4.4% more emergency department visits (95% CI, 2.1%-6.7%), and $260 (95% CI, $12-$509) in increased spending. <h3>Conclusions and Relevance</h3> Loss of a PCP was associated with lower use of primary care and increased use of specialty, urgent, and emergency care among Medicare beneficiaries. Interrupting primary care relationships may negatively impact health outcomes and future engagement with primary care.
Abstract 13332: Platelet Distribution Width is Associated With Adverse Prognosis in Patients With Heart Failure
Authors: Koichiro Watanabe, Yu Sato, Akiomi YOSHIHISA, Yasuhiro Ichijo, Yu Hotsuki, Yusuke KIMISHIMA, Tetsuro Yokokawa, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, ATSUSHI KOBAYASHI, Yasuchika Takeishi
Journal: Circulation (2020)

Backgrounds: The associations between red blood cell distribution width and prognosis in patients with heart failure (HF) have been reported. However, the prognostic impact of platelet distribution width (PDW) has been unclear in HF patients. Methods: We conducted a prospective observational study. We analyzed data on 1,746 hospitalized patients with HF who discharged alive and measured PDW at stable condition in prior to discharge. Patients were divided into tertiles based on levels of PDW: 1 st (PDW &lt; 15.9 fL, n = 586), 2 nd (PDW 15.9-16.8 fL, n = 617), and 3 rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and their post-discharge prognosis such as all-cause death, cardiac death, and cardiac events including cardiac death and re-hospitalization due to worsening HF. Results: Prevalence of diabetes mellitus, anemia, and chronic kidney disease was highest in the 3 rd tertile than in the 1 st and 2 nd tertiles (diabetes mellitus, 42.7% vs. 40.3% and 30.5%, P &lt; 0.001; anemia, 52.5% vs. 48.3% and 41.2%, P &lt; 0.001; chronic kidney disease, 57.5% vs. 49.0% and 49.3%, P = 0.005). Age was oldest and B-type natriuretic peptide levels were highest in the 3 rd tertile compared to the 1 st and 2 nd tertiles (age, 70.0, vs. 69.0 and 68.0 years old, P = 0.038; B-type natriuretic peptide, 241.0 vs. 235.2 and 171.9 pg/mL, P &lt; 0.001). In contrast, sex and left ventricular ejection fraction did not differ among the groups. The Kaplan-Meier analysis ( Figure ) demonstrated that rates of all endpoints were the highest in the 3 rd tertile among the groups (log-rank P &lt; 0.001, respectively). The Cox proportional hazard analysis adjusted for potential confounding factors revealed that the 3 rd tertile was independently associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.312, P = 0.042; cardiac death, HR 1.422, P = 0.046; cardiac event, HR 1.283, P = 0.041). Conclusion: PDW is a novel independent predictor of adverse prognosis in patients with HF.
Abstract 13453: Estrogen Regulates Expression of Fibrotic Markers in Ips-derived Cardiac Fibroblasts and Cardiomyocytes
Authors: Mariana A Argenziano, Mariana Burgos Angulo, jiajia yang, Alexander Bertalovitz, Thomas McDonald
Journal: Circulation (2020)

Introduction: Cardiovascular disease (CVD) is the leading cause of death among women. Epidemiologic studies indicate that pre-menopausal women are protected against the development of CVD when compared to age-matched men. Women show less cardiac remodeling, with downregulation in fibrosis and inflammation pathways. Remodeling is manifested by morphology and electrophysiological changes including hypertrophy, apoptosis, fibroblast proliferation, fibrosis and accumulation of fibrillar collagens. Hypothesis: We hypothesize that female protection against CVD is associated with estrogen levels as the incidence and severity of CVD increases after menopause. Methods: Induced pluripotent stem cells (IPSC) from male (M) and female (F) controls were differentiated to cardiomyocytes (IPSC-CMs) and cardiac fibroblasts (IPSC-CFs). Samples were cultured for 30 days and collected for analysis before and after 48 hs incubation with 1uM of 17-b-estradiol (EST). In IPSC-CMs we analyzed gene expression, morphology and beating frequency. Gene expression, morphology and wound healing were analyzed in IPSC-CFs. Results: Expression of ESR1 , and MYH7 was higher in female IPSC-CMs with upregulation after EST treatment in females but not males. Male IPSC-CMs showed higher expression of COL1A1 , CX43 , MYH6 and RYR2 ; MYH6 , RYR2 and COL1A1 were downregulated after EST treatment. No differences were observed in morphology or beating frequency before or after EST treatment (F:27.5±4.5 bpm vs M:22±2.5 bpm). In IPSC-CFs, males showed higher expression of the fibrotic markers COL1A1 , POSTN, SMAD2 and CCL2 ; EST treatment decreased the expression of POSTN and SMAD2 . Wound healing assays showed a decrease of the wound healing % in women after EST treatment (CT F:86.4±19.7% vs EST F:57.43±10.1%, at 8 hs, *p&lt;0.05). Male wound healing rate was slower than women in control and treated groups, with no changes after EST treatment (CT F: 86.4±19.7% vs CT M: 51.65±18.4%, at 8 hs, *p&lt;0.05). Conclusions: Estrogen treatment exerts an effect on gene expression in female and male IPSC-CMs and IPSC-CFs with men showing higher expression of fibrotic markers, which are down-regulated by EST. Further functional studies will shed light on the phenotypic effects of gene expression changes.
Abstract 13942: Down-titration of Renin-angiotensin System Inhibitors After Hospitalization for Heart Failure With Reduced Ejection Fraction
Authors: Parag Goyal, Ligong Chen, Robert S Rosenson, John Umejiego, Alessandro Pontes-Arruda, Emily B Levitan
Journal: Circulation (2020)

Introduction: While there are data demonstrating poor outcomes associated with discontinuation of renin-angiotensin system inhibitors (RASI) after hospitalization for heart failure with reduced ejection fraction (HFrEF), less is known about the prevalence and outcomes of RASI dose reduction. Objective: To determine the proportion of older US adults with HFrEF who had RASI down-titration after hospitalization and identify characteristics associated with RASI down-titration. Methods: This study included US Medicare beneficiaries age &gt; 65 years with fee-for-service coverage hospitalized with HFrEF in 2007-2017 who filled a prescription for a RASI in the 90 days prior to hospitalization. We compared dosages of RASI prescription fills prior to and up to 1 year after hospitalization. Diagnoses of conditions that can reduce RASI tolerance (hypotension, acute kidney injury, hyperkalemia, angioedema, syncope, fall-related injuries) were identified during the hospitalization. We used modified Poisson models to calculate prevalence ratios and 95% CIs. Results: Among 35,047 Medicare beneficiaries hospitalized with HFrEF, the average age was 78.5 (SD 8.0) years, 82.3% were white, and 50.8% were women. After hospitalization, 61.9% filled a prescription for the same or higher dose, 15.6% filled a lower dose, and 22.6% did not fill a prescription for a RASI. Among the beneficiaries who filled a prescription for a RASI after hospitalization, hypotension, acute kidney injury, and hyperkalemia were associated with a higher prevalence of RASI down-titration (Table). Conclusion: Down-titration of RASIs is common among older adults with HFrEF following hospitalization and is more frequent among individuals with hypotension, acute kidney injury, or hyperkalemia during hospitalization. Down-titration may reduce risks of adverse events during periods of reduced medication tolerance after hospitalization, but could also lead to sustained suboptimal treatment.
Abstract 219: Characterizing Covid-19 Pandemic Related Anxiety and Its Impact on Cardioprotective Health Behaviors Among Racially and Ethnically Diverse Cardiac Arrest Survivors
Authors: Sachin Agarwal, Edmund Shen, Jeffrey L. Birk, Ari Shechter, Keith Diaz, David Roh, Soojin Park, Jan Claassen, Mitchell S Elkind, Donald Edmondson
Journal: Circulation (2020)

Introduction: Cardiac arrest (CA) patients’ fear of contracting Coronavirus disease 2019 (COVID-19) may limit their ability or willingness to perform cardio-protective health behaviors. We assessed the association of COVID-19 anxiety with physical activity (PA), sleep, and the likelihood of seeking medical care. Methods: Between May 15-28, 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; range 1-42). PA in 7 days both pre- and during COVID-19 was categorized into International Physical Activity Questionnaire-based low, moderate, or high activity levels. Self-reported poor sleep quality and hours of sleep per night in the previous month were assessed via the Pittsburgh Sleep Quality Index. Self-reported likelihood of delay in seeking care for non-COVID related conditions was assessed. Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). The majority (84%) were COVID-19 tests and/or symptoms negative. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37)- indicating substantial fear. Black and Latinx participants reported greater COVID-19 anxiety than White (33±6 vs 32±8 vs 23±10 respectively, p=0.03). Compared to pre-COVID, CA survivors had reduced their days per week engagement in any PA by an average of 2±3.6 days. COVID-19 anxiety was highest in those who were previously high PA and now were low PA (high-high:25±9, low-low:28±9, and high-low:32±4, ANOVA p=0.06). For every 1 SD increase in COVID-19 anxiety, participants reported 45 min less sleep per night (B= -0.05, p =.06) and poorer sleep quality (OR = 1.07, 95% CI [1.0, 1.1], p=0.017). Participants (48%) who said they were “moderately” to “extremely” likely to delay seeking care for non-COVID related conditions had greater levels of COVID-19 anxiety (32±9 vs 26±10, p=0.02) compared to other responses. Conclusions: COVID-19 anxiety is more frequent in Black and Latinx participants and is associated with poorer health behaviors.