tbuckley/cabot-search huggingface dataset:
Abstract 12847: Left Atrial Cardiac Angiosarcoma: A Systematic Review of Case Reports
Authors: Sonali Sachdeva, Nirmit Patel, Sneha Gupta, Mimoza Isufi, TAHA SAEED, Shivani Dalal, Pritika Manaktala, VARSHA NANDWANA, Ankit Vyas, Rupak Desai
Journal: Circulation (2021)

Background: Primary cardiac angiosarcoma is a rare endothelial cell tumor, most commonly (78-93%) found in the right atrium. However, rare instances of left atrial angiosarcoma have been noted with varied clinical presentation and fatal prognosis. Methods: A systematic search using PUBMED, SCOPUS and WEB OF SCIENCE was undertaken to identify case reports on left atrial angiosarcomas through June 2021. The data on patient demographics, presentation, diagnostics imaging, management, and outcomes were analyzed using descriptive statistics. Results: Of 19 case reports (Table 1) , left atrial angiosarcoma was more prevalent among females (63%, 12/19). The mean age of cases was 59.26± 12.21 years. Progressive exertional dyspnea (11/19, 58%) and chest pain (5/19, 26%) were the most common presenting symptoms. Myocardial ischemia was the initial presentation in 11% of cases (2/19), congestive heart failure in 26%(5/19) while cerebrovascular events were reported in 11% of cases (2/19). Transesophageal echocardiography and transthoracic echocardiography were the mainstay imaging modalities used for diagnoses. Most cases were diagnosed intraoperatively (16/19, 84.2%) with one case being diagnosed through skin biopsy of a cutaneous metastatic nodule (Table 2) . Surgical excision followed by chemotherapy was the treatment of choice in most cases. With 26% (5/19) metastatic prevalence, death was reported in 58% of the patients (11/19). Conclusions: Primary left atrial cardiac angiosarcoma remains an elusive diagnosis with nonspecific constitutional symptoms. Even with advanced diagnostic modalities, the tumor is mostly detected at an advanced and incurable stage with a grave prognosis and high mortality rate. A deeper understanding of the spectrum of clinical presentation with a high index of suspicion can help clinicians in early diagnosis, which is imperative to prolonged survival.
EPID-14. EPIDEMIOLOGY OF ADULT PITUITARY TUMORS IN THE U.S. ACCORDING TO THE 2017 WHO CLASSIFICATION OF ENDOCRINOLOGY TUMOURS
Authors: Luz Castellanos, Catherine Gutierrez, Timothy Smith, Bryan Iorgulescu
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION Among adult intracranial tumors, the pituitary represents a frequent site of origin. We examine their contemporary epidemiology with a particular focus on uncommon pituitary tumor types. METHODS Adult patients presenting with pituitary or sellar tumors between 2004-2017 were identified from the U.S. National Cancer Database (comprising &amp;gt;70% of newly-diagnosed cancers). Their epidemiology was assessed in the context of the 2017 WHO Classification of Endocrine Tumours. RESULTS 12.5% of adult intracranial tumors arose in the pituitary region. 113,352 adults with pituitary tumors were identified. Histopathological diagnosis was obtained in only 59% of cases, in which 93% were pituitary adenomas and 6% were craniopharyngiomas. Among craniopharyngiomas, 71% were adamantinomatous and 29% were papillary, between which there were no differences in age, sex, or tumor size—however, papillary craniopharyngiomas were less common among Black nonHispanic patients (p&amp;lt; 0.001). Among the remaining 1% (n=680) of pituitary tumors, posterior pituitary tumors comprised 21%, chordomas 16%, meningiomas 15%, pituitary carcinomas 11%, GCTs 10%, hematolymphoid 8%, other mesenchymal and stromal 7%, neuronal/paraneuronal 6%, and schwannoma 4%. Meningiomas (84%), mesenchymal/stromal (64%), and neuronal/paraneuronal (64%) tumors displayed a female predominance, whereas GCTs (75%) and pituitary carcinomas (62%) exhibited a male predominance. Age at diagnosis, tumor size, and race/ethnicity varied widely across uncommon tumor types. We further examined the subtypes of uncommon pituitary tumors: for sellar chordomas, 19% were chordoid and none were dedifferentiated; for sellar meningiomas, 94% were grade I; for pituitary GCTs, 79% were pure germinomas; for hematolymphoid, 52% were DLBCL, 11% were plasmacytomas, and 9% were Langerhans cell histiocytosis; for neuronal/paraneuronal, 64% were gangliocytomas; and for mesenchymal tumors, 53% were vascular and 16% were SFTs/HPCs. CONCLUSIONS Using national registry data, we provide a detailed dissection of the epidemiology of adult pituitary tumors, with a particular focus on examining uncommon pituitary tumor types in the context of WHO2017.
NCMP-08. CHALLENGING DIAGNOSIS AND MANAGEMENT OF PCNSL IN AN IMMUNOSUPPRESSED PATIENT ON MYCOPHENOLATE MOFETIL FOR MYASTHENIA GRAVIS
Authors: Ornella Bricoune, Sepideh Mokhtari, Arnold Etame, Timothy Robinson, yolanda Pina, Robert Macaulay
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION Primary CNS lymphoma (PCNSL) typically presents with non-focal neurologic symptoms including disorientation, poor balance and memory and singel or multifocal periventricular MRI lesions. Deviations in characteristic findings can delay diagnosis and require additional diagnostic tests. OBSERVATION A 68-year-old man with a recent zoster infection and acetylcholine receptor antibody positive myasthenia gravis (MG) on Mycophenolate Mofetil for 22 years presented at another institution with left eye vision changes, and focal neurological deficits. A brain MRI showed an enhancing lesion within his left medulla extending to the cerebellum. Cerebrospinal fluid (CSF) analysis was positive for EBV and negative for malignancy. He was diagnosed with VZV vasculopathy and discharged home on IV Acyclovir for 14 days and a 5-day course of oral prednisone 60 mg. Three months later, a repeat brain MRI showed multiple new enhancing lesions bilaterally along the periventricular white matter with involvement of the corpus callosum with several lesions in peripheral locations of the cerebrum, cerebellum, and brainstem. He presented to local ER with intermittent encephalopathy, acute left eye vision blurriness and was started on steroids. He was transferred to our institution and had CSF analysis which was positive for EBV and negative for malignancy. Due to rapid progression of his symptoms, he underwent gross total resection of the left frontal lesion which showed EBV-induced diffuse large B-cell lymphoma (DLBCL). His Mycophenolate Mofetil was discontinued and he had a dramatic improvement in his left eye vision and cognitive deficits within 24 hours after one dose of Rituximab IV 500 mg/m2. DISCUSSION In the setting of periventricular lesions and EBV positivity on CSF, EBV-induced DLBCL should be highly considered. CONCLUSION Misdiagnosis or delay in diagnosis of PCNSL due to the presence of atypical features in disease presentation and radiographic findings could lead to progression of PCNSL.
Abstract 10400: The Role of Patient, Community, and Healthcare System Factors in Variability of Hospital Readmissions After Myocardial Infarction
Authors: Joshua Saef, Arshneel S Kochar, Jennifer Riggs, Robert A Montgomery, Michael Martyn, Grant W Reed, Paul Cremer, Yuli Y Kim, Wai Hong Tang, Venu Menon
Journal: Circulation (2021)

Introduction: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals by reducing Medicare (CMS) reimbursement for those institutions with higher rates of readmissions following hospitalizations for myocardial infarction (MI). Understanding the contributors to readmission following MI hospitalization can identify meaningful areas for intervention. We examine whether community and patient or healthcare system factors contribute more to variability in MI readmissions. Methods: We compiled CMS hospital data on MI readmissions, CMS physician reimbursement data, and 2020-21 County Health Rankings (Credit: University of Wisconsin). The outcome was the ratio of a hospital’s MI readmissions to MI discharges. Physician/healthcare system factors included total number of cardiac subspecialists, presence of all subspecialties, and the mean proportion of reimbursed charges. Patient and community factors included mean Hierarchical Condition Category (HCC) risk score (quantifies expected healthcare costs for CMS beneficiaries based on ICD-10 coding), median household income, the proportion of residents reporting no physical activity, and access to food stores. Models were created using linear regression. Model of best fit was determined using R 2 , AIC, BIC in model training data and mean absolute prediction error (MAPE) and root mean square prediction error (RMSE) in test data. Results: The linear regression model incorporating community and patient factors explained greater variability in MI readmission rates and performed with greater accuracy in the test data (R 2 0.21; AIC -40.2; BIC -5.1; MAPE 0.030; RMSE 0.042) than the model incorporating physician/healthcare system factors (R 2 0.04; AIC 170.0; BIC 195.0; MAPE 0.033; RMSE 0.045). HCC score, level of physical activity, median household income, and number of cardiac specialists were associated with significant effect sizes on the outcome. Conclusions: At a county level, community and patient factors appear to contribute more to variability in hospitals’ MI readmission rates. Further analyses should explore other community, patient, and provider factors that contribute. The HRRP does not account for community or patient factors, indicating its limitations.
Abstract 9979: Medicare Reduces Disparities in Hospital Readmission Following Percutaneous Coronary Intervention
Authors: Clay Sherrill, Christopher Chew, Michael Cowherd, Hannan Yang, Joseph Rossi
Journal: Circulation (2021)

Introduction: We examined the relationship between type of health insurance and all-cause readmission in the year following PCI among age-bracketed groups in a single large health system. Materials &amp; Methods: We retrospectively reviewed data from all patients undergoing PCI at UNC-Chapel Hill Hospitals from 2015 to 2019. Patients were divided into groups based on age (&lt;65 or 65+) and type of insurance. Multivariate logistic regression was used to assess the association between the presence of private insurance coverage and readmission rate in the year following PCI among the &lt;65 population and the 65+ Medicare population. Results: Readmission rate was 19.0% in the &lt;65 group and 27.12% in the ≥65 group. After adjusting for age, gender, procedural variables, and medical comorbidities, odds ratios (OR) were determined based upon reference groups of “Private” in the &lt;65 group and “Medicare + Private” in the ≥65 group. In the &lt;65 population, OR’s showed increased risk of readmission in all groups compared to “Private.” In the ≥65 population, OR’s showed no increase in risk of readmission between “Medicare + Private” and other groups. Conclusion: The presence of universal health care (Medicare) in the &gt;65 population significantly reduces disparities in repeat hospital admissions following PCI that are noted in patients &lt;65 without private insurance. Utilization of hospital readmission data coupled with NCDR Cath-PCI data is a useful tool to determine predictors of readmission.
Methodological framework for development of competence standards for optical diagnosis in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Authors: Britt B. S. L. Houwen, Cesare Hassan, Yark Hazewinkel, Jasper L. A. Vleugels, Mario Dinis-Ribeiro, Marjolein J. E. Greuter, Veerle M. H. Coupé, Evelien Dekker, Raf Bisschops
Journal: Endoscopy (2021)

Source and Scope This Position Statement is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). ESGE has a vision to create a thriving community of endoscopy services and endoscopists in Europe, to provide a high quality of endoscopy care. This position statement provides a methodological framework for the development of easy-to-measure competence standards that are focused on clinical consequences of optical diagnosis. The methodological framework presented has been established by a task force of experts in optical diagnosis who were involved in the ESGE Curricula Working Group for optical diagnosis training.
Evaluating Eligibility of US Black Women Under USPSTF Lung Cancer Screening Guidelines
Authors: Alexandra L. Potter, Chi-Fu Jeffrey Yang, Kirsten M. Woolpert, Thrusha Puttaraju, Kei Suzuki, Julie R. Palmer
Journal: JAMA Oncology (2021)

This quality improvement study evaluates lung cancer screening eligibility among US Black women under the 2013 and 2021 USPSTF guidelines.
Abstract 10427: Length of Stay After Atrial Fibrillation Ablation in a U.S. Ambulatory Surgical Setting Compared to a Hospital Setting
Authors: William Zagrodzky, Jason Zagrodzky, Fred Kueffer, Erik B Kulstad
Journal: Circulation (2021)

Introduction: Atrial ablation for the treatment of atrial fibrillation has traditionally been performed in the hospital setting. Recently, the Centers for Medicare and Medicaid Services (CMS) announced the Hospitals Without Walls program, allowing ambulatory surgery centers (ASCs) to conduct procedures such as atrial ablations. As a result, the first cases of ablations in an ASC have recently been completed. This study aimed to compare patient length of stay (LOS) and between the ASC setting to a traditional hospital setting. Hypothesis: LOS in the ASC setting is shorter than in the traditional hospital. Methods: Data from all patients treated with cryoballoon pulmonary vein isolation (PVI) in a single ASC were analyzed. A random sample of patients treated by the same provider during the same timeframe in the hospital setting were then acquired and compared. Procedural approaches were similar, with transeptal puncture performed under intracardiac echo, contrast venography and pressure waveform analysis performed prior to ablation to ensure good venous seal. No 3D mapping was used at either site. Intraprocedural emergency protocols were established prior to ablations. Results: A total of 13 patients received treatment in the ASC, with a mean age of 71 ± 8 years, 38% female, 9 patients had paroxysmal atrial fibrillation and 4 persistent atrial fibrillation. The mean number of cryoablation applications per pulmonary vein was 1.4 ± 0.7 with average application duration of 187 ± 37 seconds. The mean procedural duration was 52 ± 10 minutes and mean time in the ASC was 5.4 ± 1.5 hours. No acute adverse events occurred; however, one patient later presented with a sore throat and a groin hematoma without active bleeding or pseudoaneurysm. A total of 13 patients were analyzed in the hospital setting. Mean time in the hospital was longer than in the ASC (13.0 ± 13.0 hours, p&lt;0.01). This is inclusive of 2 patients staying overnight. The mean hospital length of stay was also longer than in the ASC for the 11 patients with same day discharge (8.2 ± 6.6 hours, p&lt;0.01). Conclusions: Cryoballoon PVI performed in an ASC setting resulted in a shorter overall length of stay than in the traditional hospital setting, with no acute complications occurring.
Acute Myeloid Leukemia Patients in Complete Remission with Positive Measurable Residual Disease Prior to Allogeneic Transplant Have Worse Outcomes, Similar to Active Disease Regardless of Conditioning Regimen Intensity and Post-Transplant Cyclophosphamide Administration
Authors: Pavan Tenneti, Jiaxian He, Brittany Knick Ragon, Nilay A. Shah, Jing Ai, Aleksander L. Chojecki, Thomas G. Knight, Belinda Avalos, Edward A. Copelan, Michael R. Grunwald, Srinivasa Reddy R. Sanikommu
Journal: Blood (2021)
Abstract 12211: Water Hammer Shock Causing Rupture Of Vulnerable Cap Of Culprit Lesions In Acute Coronary Syndrome: An Angiographic And Machine Learning Analysis
Authors: Thach N Nguyen, Vi N Ly, Thoa Le, Thu Q Nguyen, Minh Anh Le, Thoai Nguyen, Dat Q Ha, Trang Le, Minh H Le, Nghi V Tran, Loc Vu, Hung N Pham, Dung T Ho, Thinh Cao, Gianluca Rigatelli, Marco Zuin, Nghia T Nguyen Thuong
Journal: Circulation (2021)

Introduction: Acute coronary syndrome (ACS) is caused by rupture of coronary plaques. What triggers these ruptures? Hypothesis: In the field of hydraulics, in a setting of a tank and draining pipe, if the valve at the distal end of the pipe is open, the fluid flows normally. If the valve closes abruptly, the flow next to the valve stops. However the fluid from the tank continues to flow forward and can collide with the distal stationary fluid. This is called water hammer shock. Could the same event happen in coronary arteries? The contraction of the left ventricle (LV) is similar to the abrupt closure of a valve, stopping the myocardial capillary flow. Could the systolic LV contraction trigger water hammer shock? Methods: Angiograms with culprit lesions of ACS (recorded at 15 images/second or 0.06 second per image) were reviewed. The first image was of the artery completely filled with contrast. The subsequent images showed the blood in white color blood moving in over a background of black contrast. The normal flow was laminar. When there was retrograde on top of turbulent flow, this was evidence of a collision between antegrade and retrograde flow (or water hammer shock). The measurements by visual angiographic evaluation and by Machine Learning (ML) included (1) the duration and (2) size of coronary segment with turbulence. The ML program had 2 models (build on Python). Model 1 was built based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification of flow. The model 2 was trained based on the convolutional neural network. Results: Angiograms of 20 ACS patients showed laminar flow (90%) in diastole. The flow became turbulent during systole with retrograde flow. The area of collision or water hammer shock showed diffuse coarse mixing of black (contrast) and white (blood). The presence of turbulence matched the location of 85% of ruptured plaques. The duration of turbulence lasted 80% of systole. Special protocols were used successfully to train AI to recognize the lesions, retrograde and turbulent flow. Conclusions: With the new angiographic technique, detailed images of water hammer shock matched the location of ruptured plaques in ACS patients. These results may help to understand the genesis and offer precise prevention and treatment for ACS
Abstract 12816: Epicardial Adipose Tissue Around the Left Atrium is Associated With Atrial Fibrosis in Patients With Atrial Fibrillation
Authors: Bahareh Askari-Atapour, Kristen Kwan, Carter A Anderson, Mahbod Jafarvand, Zeinab Birjandian, Deanna Tregoning, Patrick M Boyle, Nazem W Akoum
Journal: Circulation (2021)

Background: Obesity is a risk factor for atrial fibrillation (AF) and strongly influences the response to treatment. Atrial fibrosis shows similar associations. Left atrial epicardial fat (LAEF) may be a link to these associations. Objective: We sought to assess whether LAEF is associated with atrial fibrosis and BMI (Body Mass Index). Methods: Patients with atrial fibrillation undergoing catheter ablation were assessed with cardiac MRI for overall epicardial fat, LAEF, and fibrosis quantification. Epicardial fat was imaged using a 3-dimensional Dixon sequence and quantified by contouring regions of fat on axial images (Panel A; Blue regions represent LAEF). Atrial fibrosis was quantified from the Late Gadolinium Enhancement (LGE) MRI. Image registration was used to assess the relationship between left atrial epicardial fat and left atrial fibrosis. Results: 45 patients underwent the imaging protocol (64±10 years; 76% male). BMI was 29.3±6.1 kg/m 2 , LAEF was 248±155 cm 2 , and LA fibrosis was 17.4±8.4%. LAEF was significantly correlated with both LA fibrosis (Fig B; P=0.017; R 2 =0.125) and BMI (y[BMI] = 0.093x[LAEF] + 5.37; p=0.01, R 2 =0.155). Total epicardial fat was also correlated with BMI (y[BMI] = 0.014x[total epicardial fat] + 9.01; p&lt;0.001, R 2 =0.33). The overlap of LAEF and fibrosis was moderate with a Dice coefficient ranging from 0.26 to 0.49. (Fig C). Conclusion: LAEF is associated with obesity (BMI) and LA fibrosis with a moderate degree of colocalization. These findings support a role for LAEF as a contributor to atrial fibrosis and a link between obesity and atrial fibrillation.
Abstract 12228: Metformin Use in Patients Hospitalized With COVID-19: Lower Inflammation, Oxidative Stress, and Thrombotic Risk Markers and Better Clinical Outcomes
Authors: Kevin Bliden, Udaya Tantry, Abira Usman, Alastair Cho, Naval Walia, Christophe Jerijan, Arvind Singh, Sunal Makadia, Paul A Gurbel
Journal: Circulation (2021)

Introduction: Diabetes mellitus (DM) is associated with a greater risk of COVID-19 and an increased mortality when the disease is contracted. Metformin use in patients with DM is associated with less COVID-19-related mortality, but the underlying mechanism behind this association remains unclear. Hypothesis: We hypothesize that inhibitory effect of metformin on markers of inflammation, oxidative stress, and hypercoagulability is associate with better clinical outcomes. Methods: Patients with DM on metformin (n=34) and metformin naïve (n=41), and patients without DM (n=73) were enrolled within 48 hours of hospital admission and were diagnosed with COVID-19 by reverse transcription-polymerase chain reaction assay. Laboratory assessments were conducted within 48 hours of hospital admission. The chi-squared test was used to determine whether there was a significant difference in frequencies between disease groups; p&lt; 0.05 was considered a significant difference between groups. Results: DM patients on metformin compared to naïve patients had a lower white blood cell count (p=0.02), d-dimer (p=0.04), urinary 11-dehydro thromboxane B 2 (p=0.01) and urinary liver-type fatty acid binding protein (p=0.03) levels and had lower sequential organ failure assessment score (p=0.0002), intubation rate (p=0.03), and a trend for fewer hospitalized days (p=0.13), lower in-hospital mortality (p= 0.12) and lower mortality plus nonfatal thrombotic event occurrences (p=0.10). Patients on metformin had similar clinical outcomes compared to patients without DM. Conclusion: In conclusion, metformin treatment in COVID-19 patients with DM was associated with lower markers of inflammation, renal ischemia, and thrombosis; and fewer hospitalized days and intubation requirement. Further focused studies are required to support these findings.
Elranatamab (PF-06863135), a B-Cell Maturation Antigen (BCMA) Targeted CD3-Engaging Bispecific Molecule, for Patients with Relapsed or Refractory Multiple Myeloma: Results from Magnetismm-1
Authors: Michael Sebag, Noopur S. Raje, Nizar J. Bahlis, Caitlin Costello, Bhagirathbhai Dholaria, Melhem Solh, Moshe Y. Levy, Michael H. Tomasson, Harman Dube, Michael A. Damore, Hoi Ken Lon, Cynthia Basu, Athanasia Skoura, Edward Chan, Suzanne Trudel, Andrzej Jakubowiak, Michael P. Chu, Cristina Gasparetto, Andrew P. Dalovisio, Alexander Lesokhin
Journal: Blood (2021)