tbuckley/cabot-search huggingface dataset:
Abstract 13572: The Effects of Baseline Thrombocytopenia on Post-procedural Bleeding and Thrombotic Outcomes of Left Atrial Appendage Closure With Watchman Device
Authors: Chiehju Chao, Chia-chun Chiang, Pradyumna Agasthi, Marlene Girardo, Reza Arsanjani, David R Holmes, Mohamad Adnan Alkhouli, Paul Friedman, Peter Pollak, Eric Yang
Journal: Circulation (2020)

Background: Left atrial appendage occlusion (LAAO) devices have successfully provided an alternative therapeutic option in patients with atrial fibrillation and high bleeding risk. However, patients with thrombocytopenia (TP) were underrepresented in the milestone trials, and the optimal strategy of postprocedural antithrombotic therapy in this group of patients remains unclear. Methods: Patients were identified from the National Cardiac Database Registry - LAAO database at all three Mayo Clinic sites in the period from 1/2016-10/2019. Patients were further divided into TP (platelet &amp;lt; 150 x 10^9/L) and control (platelet &amp;gt; 150 x 10^9 /L) groups for clinical outcome analysis. Outcome endpoints include composite of bleeding (GI bleeding, hemorrhagic stroke, and other non-intracranial hemorrhage) and composite thrombotic events (device thrombus, ischemic stroke, TIA and undetermined stroke). Results: A total of 249 consecutive patients were included in the final analysis. The mean age was 76.7 ± 7.2 years, and 169 (67.9%) were male; 242 (97.2%) were white. The mean CHA2DS2-VASc score was 5.3 ±1.5, and the HAS-BLED score was 3.0 ± 1.1. TP at baseline was present in 74 (29.7%) patients. The median follow-up time was 6.8 months. The use of post-procedural antithrombotic regimens was similar between the two groups (Table 1). When comparing the TP group to control, there was no significant difference in composite bleeding events (10.8% vs. 8.0%, P = 0.069) and thrombotic events (2.7% vs. 2.3%, P= 0.170). Conclusions: The presence of baseline TP does not significantly increase post-procedural bleeding risk in atrial fibrillation/atrial flutter patients who underwent an LAAO occlusion procedure with the Watchman device (Boston Scientific). This group of patients can be treated with the same antithrombotic regimen as patients with normal platelet levels. Future studies are still warranted to determine the optimal antithrombotic regimen.
Abstract 13866: Cardiovascular Event Rates After Myocardial Infarction or Ischemic Stroke in Older Medicare Patients
Authors: Suying Li, Yi Peng, Xinyue Wang, Yi Qian, Pin Xiang, Sally W Wade, Haifeng Guo, J. Antonio G Lopez, Yehuda Handelsman, Charles A Herzog
Journal: Circulation (2017)

Introduction: Older patients surviving myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular (CV) events or death. Methods: This retrospective observatio...
Abstract 13935: Steroids Wean Failures After Heart Transplantation - Does It Lead to Mortality?
Authors: Rafael Skorka, Keith Nishihara, Adriana Shen, Jignesh K Patel, David H Chang, Michelle M Kittleson, Evan P Kransdorf, Lawrence S Czer, Jon A Kobashigawa
Journal: Circulation (2020)

Introduction: It is estimated that approximately 90% of heart transplant (HTx) patients who are low risk can be weaned off steroids after 6 months post-transplant. However, for those 10% who fail weaning subsequent outcome is not known. There is concern that failure to wean off steroids may lead to subsequent greater morbidity/mortality. Methods: Between 2010 and 2014, 178 HTx patients at low rejection risk were initiated to be weaned off steroids after 6 months post-transplant. Our protocol includes decreasing prednisone by 1mg per month from a baseline of 5mg daily. Monthly heart biopsy or use of Allomap are used to exclude rejection during weaning. 15 patients failed the corticosteroid wean due to either rejection (n=8), abnormal echocardiogram (n=2) or severe corticosteroid withdrawal symptoms (n=5). Study endpoints include subsequent 5-year survival, freedom from cardiac allograft vasculopathy (CAV) and non-fatal major adverse cardiac events (NF-MACE); and 1-year freedom from any treated rejection (ATR), antibody-mediated rejection (AMR), acute cellular rejection (ACR). Results: The failed wean group compared to the successful wean group had a trend for lower subsequent 5-year survival. There was no significant difference between the two groups in subsequent 5-year freedom from CAV or NF-MACE. Subsequent 1 Year freedom all rejection (ATR, ACR, AMR) were significantly lower in the failed steroid wean group compared to the successfully weaned group. Conclusions: HTx patients who are deemed low risk who failed corticosteroid weaning may be at risk to develop more rejection with compromised 5-year outcome, including a possible lower survival rate. It is unclear whether the act of corticosteroid weaning activated a deleterious response in these patients. Caution must be given to those patients who fail corticosteroid weaning.
Abstract 13927: Advanced Age and Preferential Use of Vitamin K Antagonists in Severe Renal Impairment: First Results of the XARENO Registry in Patients With Non-valvular Atrial Fibrillation and Non-dialysis Dependent Advanced Chronic Kidney Disease
Authors: Reinhold Kreutz, Gilbert Deray, Juergen Floege, Marianne Gwechenberger, Andreas Luft, Hahn Kai, Pontus Persson, Jan Beyer-Westendorf
Journal: Circulation (2020)

Introduction: Patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) are at increased risk for both ischemic stroke and hemorrhage. In addition, treatment with vitamin K antagonists (VKA) has been associated with worsening of renal function compared to direct oral anticoagulants (DOACs). XARENO (Factor XA -inhibition in RENal patients with non-valvular atrial fibrillation Observational registry) is an ongoing prospective, non-interventional, observational study conducted in Europe. XARENO evaluates the effectiveness of rivaroxaban in preserving renal function and preventing thromboembolic events as compared to VKA in NVAF patients with CKD in clinical practice. Methods: XARENO included male and female NVAF patients ≥18 years old with an estimated glomerular filtration rate (eGFR) between 15 and 49 mL/min per 1.73 m 2 and an indication for anticoagulation. Enrolment took place from April 2016 until January 2020. Patients treated with either rivaroxaban or VKA were included, while patients in whom physicians were withholding any anticoagulation could be also enrolled. Minimal planned follow-up is one year. Primary observational outcomes include efficacy and safety outcomes (progression of CKD, stroke, other thromboembolic events, major cardiovascular events, major bleeding, and all-cause mortality). First results on outcomes in the full cohort are expected in 2021. Results: In this analysis of a first set of 1485 patients (56.1% males), 731 and 666 patients received rivaroxaban and VKA, while 88 patients did not receive any anticoagulation. Mean age at baseline was 77.3 years (67.5% older than 75 years) with a mean eGFR of 38.9 mL/min per 1.73 m 2 . Overall 74.7% of patients had eGFR values below 45 mL/min per 1.73 m 2 and 28.0% below 30 mL/min per 1.73 m 2 . In the latter group, use of a VKA was about twofold more frequent compared to rivaroxaban. Conclusions: This first analysis of XARENO patients reveals the very high age of NVAF patients with concomitant non-dialysis dependent advanced CKD and a preferential use of VKA in stage 4 CKD. XARENO aims to provide important information on the real-world effectiveness and safety of rivaroxaban compared with VKA for this vulnerable patient group.
ABNORMAL LIVER ENZYMES AT BASELINE PREDICT OUTCOMES IN COVID-19 PATIENTS WITHOUT CHRONIC LIVER DISEASE: A LARGE, MUTLI-CENTER US COHORT STUDY
Authors: D. E. Bernstein, N. C. Roth, T. P. Lee, C. Kuntzen, H. C. Bodenheimer, S. K. Satapathy
Journal: Hepatology (2020)

Background: Abnormalities in liver chemistries in COVID-19 infection are common, but their effects on outcomes are unclear Our study assessed the prevalence and prognostic value of initial liver chemistries in a large cohort of COVID-19 patients without known chronic liver disease Methods: We reviewed electronic medical records of 10,614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1 to April 30, 2020 We analyzed baseline demographics and liver chemistries The primary outcome was in-hospital mortality, and the secondary outcome was a composite of in-hospital mortality or the need for mechanical ventilation Results: Elevated levels of aspartate aminotransferase (AST) appeared in 59% of patients, alanine aminotransferase (ALT) in 54% of patients, alkaline phosphatase in 13% of patients, and bilirubin in 5% of patients The majority of patients had AST and ALT within >1 to ≤4x the ULN (49% and 54%, respectively)  The majority of patients had AST and ALT within >1 to ≤4x the ULN (49% and 54%, respectively) Extreme elevations of AST and ALT were uncommon, with 4 6% of patients having AST >4 to ≤10x ULN, 0 8% having AST >10x ULN, 4 1% of patients having ALT >4 to ≤10x ULN, and 0 8% having ALT >10x ULN  Most patients (76%) had AST higher than ALT on presentation Based on our a priori definitions of severe liver injury, there were 936 patients (8 9%) with a hepatocellular pattern, 133 patients (1 3%) with a cholestatic pattern, and 91 patients (0 9%) with a mixed pattern The prevalence of liver chemistry elevations differed based on sex, ethnicity, race, and presence of comorbidities (Table 2) Compared to females, males were more likely to have elevations in AST (64 8% vs 50 1%, p 1) had higher risks of in-patient mortality and the composite outcome of in-hospital mortality or the need for mechanical ventilation Conclusion: Liver test abnormalities are common upon initial presentation in COVID-19 infection and are associated with increased mortality and the need for mechanical ventilation in patients without underlying chronic liver disease Those with a cholestatic pattern of liver injury are at the highest risk for poor outcomes (Figure Presented)(Table Presented)
Reduced Mitochondrial Apoptotic Priming Drives Resistance to BH3 Mimetics in Acute Myeloid Leukemia
Authors: Shruti Bhatt, Marissa S. Pioso, Elyse Anne Olesinski, Binyam Yilma, Jeremy A. Ryan, Thelma Mashaka, Buon Leutz, Sophia Adamia, Haoling Zhu, Yanan Kuang, Abhishek Mogili, Abner Louissaint, Stephan R. Bohl, Annette S. Kim, Anita K. Mehta, Sneha Sanghavi, Youzhen Wang, Erick Morris, Ensar Halilovic, Cloud P. Paweletz, David M. Weinstock, Jacqueline S. Garcia, Anthony Letai
Journal: Cancer Cell (2020)
Relief of Back Pain
Authors: George Ehni
Journal: JAMA (1980)

To the Editor.—  The letter from Stanley H. Bohrer, MD (242:2845, 1979), concerning the comfort he gets from sleeping in a hammock calls for comment, lest he or others think themselves the first to make such an observation. In 1948 Van Gelderen 1 described the painful effects of the lordotic posture and the good effect of reversing lordosis in two patients with spondylotic compression of the cauda equina. In his report he used lying in a hammock supine and prone as test procedures, reporting that lying in a hammock supine relieved symptoms, whereas the opposite did not. Since about that time the lordotic posture while walking has been recognized as an important contributing factor in neurogenic intermittent claudication. Rounding the back, walking in a stooped-forward position, stooping down to reverse lordosis, sleeping with the knees up under the chin to produce reverse lordosis, and sleeping with hips flexed in a
Abstract 17187: Misinterpretation of Q-waves in Ventricular Septal Defect and Tetralogy of Fallot Patients by Non-Adult Congenital Heart Disease Specialists
Authors: Audrey Thorp, Alexander Hajduczok, Sudhanshu Bhatnagar, Ravi Shah, William R Davidson
Journal: Circulation (2020)

Introduction: Tetralogy of Fallot (TOF) and Ventricular Septal Defect (VSD) patients have non-diagnostic Q-waves within inferior (II, III, aVF) or septal (V1-V2) leads on ECG, perhaps due to incomplete conduction through septal defects. Non-diagnostic Q-waves tend to either be wide within a single lead, or deep (3-4mm) in contiguous leads, but do not meet diagnostic criteria for infarct. Hypothesis: Non-Adult Congenital Heart Disease (ACHD) physicians may inaccurately characterize non-diagnostic Q-waves as pathologic opposed to expert interpretation by ACHD-trained physicians in VSD and TOF patients. Thus, misinterpreting ECGs to suggest prior infarct and decreasing their positive predictive value (PPV). Methods: With application of pre-specified inclusion and exclusion criteria, we retrospectively reviewed 72 ECGs from TOF or VSD patients at Penn State Hershey Medical Center from 2002-2020 that were separately read by ACHD and non-ACHD specialists. Primary outcomes were ECGs with diagnosed Q-waves in two separate distributions, inferior or septal leads, by both groups using standard criteria for Q-wave infarct. Reported measures were sensitivity, specificity, PPV, and negative predictive value (NPV). Results: The 72 subjects with isolated TOF or VSD had a mean age of 39 years and 63% were male. Total disease prevalence (presence of Q-waves) was 4.6%. Q-wave infarct diagnosed by non-ACHD physicians had a sensitivity and specificity of 33% and 74% respectively. Their PPV was 5.87% and NPV was 95.85%. Conclusions: This retrospective cohort analysis of TOF and VSD patient ECGs showed the low PPV of non-ACHD physician diagnosis of Q-waves in this respective population. Misinterpretation and misdiagnosis of infarct based off ECG, has ramifications for both the patient and medical system as a whole. Sequelae include, but are not limited to, increasing patient risk for unwarranted medical treatment and affecting hospital billing and insurance coverage.
Early changes in immune cell subsets with corticosteroids in patients with solid tumors: implications for COVID-19 management
Authors: Jennifer L Marté, Nicole J Toney, Lisa Cordes, Jeffrey Schlom, Renee N Donahue, James L Gulley
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background The risk–benefit calculation for corticosteroid administration in the management of COVID-19 is complex and urgently requires data to inform the decision. The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with poor prognosis in both COVID-19 and cancer. Investigating NLR as an inflammatory marker and lymphocyte levels as a critical component of antiviral immunity may inform the dilemma of reducing toxic hyperinflammation while still maintaining effective antiviral responses. Methods We performed a retrospective analysis of NLR, absolute neutrophil counts (ANCs) and absolute lymphocyte counts (ALCs) in patients with cancer enrolled in immunotherapy trials who received moderate-dose to high-dose corticosteroids. We compared paired presteroid and available poststeroid initiation values daily during week 1 and again on day 14 using the Wilcoxon signed-rank test. Associated immune subsets by flow cytometry were included where available. Results Patients (n=48) with a variety of solid tumors received prednisone, methylprednisolone, or dexamethasone alone or in combination in doses ranging from 20 to 190 mg/24 hours (prednisone equivalent). The median NLR prior to steroid administration was elevated at 5.0 (range: 0.9–61.2). The corresponding median ANC was 5.1 K/µL (range: 2.03–22.31 K/µL) and ALC was 1.03 K/µL (0.15–2.57 K/µL). One day after steroid administration, there was a significant transient drop in median ALC to 0.54 K/µL (p=0.0243), driving an increase in NLR (median 10.8, p=0.0306). Relative lymphopenia persisted through day 14 but was no longer statistically significant. ANC increased steadily over time, becoming significant at day 4 (median: 7.31 K/µL, p=0.0171) and remaining significantly elevated through day 14. NLR was consistently elevated after steroid initiation, significantly at days 1, 7 (median: 8.2, p=0.0272), and 14 (median: 15.0, p=0.0018). Flow cytometry data from 11 patients showed significant decreases in activated CD4 cells and effector memory CD8 cells. Conclusions The early drop in ALC with persistent lymphopenia as well as the prolonged ANC elevation seen in response to corticosteroid administration are similar to trends associated with increased mortality in several coronavirus studies to include the current SARS-CoV-2 pandemic. The affected subsets are essential for effective antiviral immunity. This may have implications for glucocorticoid therapy for COVID-19.
Abstract 14699: Arterial and Venous Thromboembolism in Covid-19: A Study-level Meta-analysis
Authors: Vicky Mai, Kim Boun Tan, Sabine Mainbourg, Arnaud Frigerri, Laurent Bertoletti, Marion Douplat, Yesim Dargaud, Claire Grange, Steeve Provencher, Jean-Christophe Lega
Journal: Circulation (2020)

Introduction: The prevalence of venous (VTE) and arterial (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. Methods: In this systematic review and meta-analysis, we systematically searched Pubmed MEDLINE, Google Scholar, and Web of Science for observational studies describing the prevalence of VTE and ATE amongst patients with COVID-19 published between Jan 1, 2020 and May 20, 2020. The websites of major journals were also searched. Results: We analysed findings from 15 studies totalizing 1,755 patients, mainly in intensive care units (ICU). The weighted frequency of COVID-19-related VTE was 16.6% (95%CI 9.5-25.1%, I 2 =94%, 13 studies: 1,546 patients). The overall prevalence of PE and deep vein thrombosis (DVT) were 9.1% (95%CI 3.7-16.6%, I 2 =95%; 15 studies; 1,755 patients) and, 7.8% (95%CI 3.4-13.8%; I 2 =92%; 13 studies; 1,445 patients), respectively. Few were isolated subsegmental PE or distal DVT. The VTE prevalence was significantly higher in ICU (21.6%; 95%CI 12.6-32.2%; I2=91% versus 4.6%; 95%CI 1.0-10.7%, I 2 =87%, p interaction =0.002 in subgroup analysis). The weighted frequency of myocardial infarction/acute coronary syndrome, stroke, and other ATE (6 studies, 812 patients) was 3.2% (95%CI 2.1-4.5%, I 2 =0%), 0.7% (95%CI 0.0-2.2%, I 2 =64%), 2.0% (95%CI 1.2-3.0%, I 2 =40%), and 0.5% (95%CI 0.0-1.6%, I 2 =60%), respectively. Conclusions: Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.
Abstract 13721: Is Single Dose Interruption of Direct Oral Anticoagulants Necessary Before Atrial Fibrillation Ablation? A Systematic Review and Meta-analysis
Authors: Ali H Jafry, Khawaja H Akhtar, Amna M Chaudhary, Safi U Khan, Mohammad S Khan, Dhanunjaya R Lakkireddy, Rakesh Gopinathannair, Zain Ul Abideen Asad
Journal: Circulation (2020)

Background: In patients with atrial fibrillation taking direct oral anticoagulants (DOACS) and undergoing catheter ablation, it is unclear if interruption of a single dose of DOAC before the procedure is necessary. We assessed the peri-procedural adverse events between uninterrupted vs single-dose interrupted DOACS. Methods: A systematic review of Medline and EMBASE was conducted and all randomized controlled trials (RCTs) and observational studies that compared uninterrupted versus interrupted DOACS were included. Random effects model was used and risk ratios (RR) with 95% confidence intervals (CI) were reported using Mantel Haenszel method. All studies defined dose interruption as holding a single dose of DOAC before ablation. Separate analyses were conducted for RCTs and observational studies. Results: Eight RCTs with 2656 patients and 4 observational studies with 834 patients were included. In RCT restricted analysis, no significant difference was seen in major bleeding [RR 0.65 (CI 0.30-1.42)], minor bleeding [RR 0.98 (0.68-1.40)], stroke/transient ischemic attack/thromboembolism [RR 0.90 (CI 0.27-2.98)] and silent cerebral infarction [RR 0.51 (CI 0.14-1.89)]. In observational study restricted analysis, no significant difference was seen in major bleeding [RR 3.04 (CI 0.13-74.07)], minor bleeding [RR 0.88 (0.46-1.69)], stroke/transient ischemic attack/thromboembolism [RR 0.98 (CI 0.12-7.91)] and a statistically significant lower silent cerebral infarction [RR 0.45 (CI 0.31-0.67)]. Conclusion: Uninterrupted DOACS are safe for patients undergoing AF ablation and logistically easier for patients. Figure 1: Forest plot showing outcomes with uninterrupted vs interrupted direct oral anticoagulants in patients undergoing ablation for atrial fibrillation in randomized controlled trials.
Abstract 16699: The Mayo Cardiac Intensive Care Unit Admission Risk Score Predicts One-Year Mortality
Authors: Thomas J Breen, Mitchell Padkins, Courtney Bennett, Nandan S Anavekar, Joseph G Murphy, Malcolm R Bell, Gregory W Barsness, Jacob C Jentzer
Journal: Circulation (2020)

Introduction: The Mayo Clinic Cardiac Intensive Care Unit Admission Risk Score (M-CARS) has been shown to predict hospital mortality in the CICU population better than conventional critical care scoring models. We tested the hypothesis that M-CARS could similarly be used to predict one-year mortality. Methods: We retrospectively reviewed adult CICU patients admitted from 2007 to 2018. M-CARS was calculated using admission data. Groups were compared using Wilcoxon test for continuous variables and chi-squared test for categorical variables. Results: This study included 12428 unique patients with a mean age of 67 ± 15 years (37% females), of whom 11279 (90.8%) survived hospitalization and 2839 patients (22.8%) died within 1 year of admission. The 1-year survival decreased incrementally as a function of increasing M-CARS ( Figure 1A , p&lt;0.0001), and all components of M-CARS were significant predictors of 1-year mortality (p&lt;0.001). 1690 hospital survivors (15.0%) died within 1 year. The 1-year survival decreased incrementally as a function of increasing M-CARS for scores &lt;3 (all p&lt;0.001); however, there was no further adverse 1-year survival for patients with M-CARS ≥3 ( Figure 1B, p=0.99). M-CARS components associated with 1-year mortality among hospital survivors included blood urea nitrogen, red blood cell distribution width, Braden score, and respiratory failure (all p&lt;0.001), while cardiac arrest, cardiogenic shock, and anion gap were not. Conclusions: M-CARS accurately predicts 1-year mortality among CICU admissions, with a plateau effects at high M-CARS scores ≥3. Significant predictors of 1-year mortality among CICU survivors include frailty markers rather than admission severity.
Salvage endoscopic submucosal dissection with a small-caliber endoscope for recurrent esophageal cancer on distal side of esophageal stricture
Authors: Kyosuke Tanaka, Yuhei Umeda, Hiroki Asakawa, Hiroshi Miura, Misaki Nakamura, Masaki Katsurahara, Yasuhiko Hamada
Journal: Endoscopy (2020)

Salvage endoscopic submucosal dissection (ESD) is effective for local recurrent esophageal cancer after chemoradiotherapy [1] [2]. However, severe late toxicity, mostly in the form of esophageal strictures and ulcerations, can occur in patients who undergo chemoradiotherapy in the definitive treatment of esophageal cancer [3]. Endoscopic treatment for esophageal neoplasia in patients with esophageal stricture is challenging [4].
Pulmonary Tumor Thrombotic Microangiopathy Appearance on Dual-Energy Computed Tomography
Authors: Daisuke Yamada, Manabu Murakami, Masaki Matsusako, Tomohide Tamura, Yasuyuki Kurihara
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

"Pulmonary Tumor Thrombotic Microangiopathy Appearance on Dual-Energy Computed Tomography." American Journal of Respiratory and Critical Care Medicine, 203(6), pp. 759–760