tbuckley/cabot-search huggingface dataset:
重篤な大動脈弁狭窄症を有する症候性患者における保存的管理を選択する理由-CURRENT AS登録からの観察-
Authors: Ishii Mitsuru, Taniguchi Tomohiko, Morimoto Takeshi, Ogawa Hisashi, Masunaga Nobutoyo, Abe Mitsuru, Yoshikawa Yusuke, Shiomi Hiroki, Ando Kenji, Kanamori Norio, Murata Koichiro, Kitai Takeshi, Kawase Yuichi, Izumi Chisato, Miyake Makoto, Mitsuoka Hirokazu, Kato Masashi, Hirano Yutaka, Matsuda Shintaro, Nagao Kazuya, Inada Tsukasa, Mabuchi Hiroshi, Takeuchi Yasuyo, Yamane Keiichiro, Toyofuku Mamoru, Minamino-Muta Eri, Kato Takao, Inoko Moriaki, Ikeda Tomoyuki, Komasa Akihiro, Ishii Katsuhisa, Hotta Kozo, Higashitani Nobuya, Kato Yoshihiro, Inuzuka Yasutaka, Jinnai Toshikazu, Morikami Yuko, Akao Masaharu, Minatoya Kenji, Kimura Takeshi
Journal: Circulation (2019)
Response to Comment on Lee et al. Multicenter, Head-to-Head, Real-World Validation Study of Seven Automated Artificial Intelligence Diabetic Retinopathy Screening Systems. Diabetes Care 2021;44:1168–1175
Authors: Aaron Y. Lee, Cecilia S. Lee, Matthew S. Hunt, Ryan T. Yanagihara, Marian Blazes, Edward J. Boyko
Journal: Diabetes Care (2020)

We thank Dr. Soliz for his expedient comments (1) regarding our work evaluating seven artificial intelligence (AI) algorithms in a head-to-head fashion (2). We welcome the opportunity to clarify these points of concern.

We agree that the two U.S. Food and Drug Administration–approved diabetic retinopathy (DR) systems, one of which was tested in our study, use a threshold of moderate nonproliferative DR (NPDR) or higher for referral. We set the threshold to any DR versus no DR because that represents the clinical practice at the Veterans Affairs (VA) teleretinal system, as stated in our methods. All participating companies were aware of the study threshold prior to submitting their algorithms and were allowed to adjust their algorithms accordingly. As the VA manages one of the largest teleretinal screening systems in the U.S., …
Abstract 16436: Targeting Store Operated Calcium Entry in Vascular Smooth Muscle Cells by a Novel Small-molecule Inhibitor
Authors: Heba Shawer, Karen Hemmings, Karen Porter, Richard Foster, David J Beech, Marc A Bailey
Journal: Circulation (2020)

Vascular smooth muscle cells (VSMC) are physiologically quiescent cells optimised for vascular contractility and the modulation of vascular tone. Platelet-derived growth factor (PDGF) signalling is a critical driver of pathological remodelling of native VSMC to a proliferative synthetic state, which is a process associated with vascular pathologies. Here, we studied the role of store operated calcium entry (SOCE) through Orai1 channels in VSMC plasticity utilizing novel small molecule inhibitor of Orai1 channels. We developed small-molecule Orai1 inhibitor, 4-(2,5-dimethoxyphenyl)-N-[(pyridin-4-yl)methyl]aniline, called JPIII, evaluated its effects on SOCE, and its functional impact in human primary VSMC (hVSMC) from saphenous vein and rat thoracic aorta VSMC cell line. Our Orai1 inhibitor potently suppressed SOCE in hVSMC (IC 50 of 297 nM, n=3) and rat VSMC (IC 50 of 819.5 nM, n=3), leading to significant impairment of PDGF-induced cell migration in hVSMC by 31% (P=0.0071, n=6) and rat VSMC by 24% (P=0.04, n=3). Orai1 inhibition also reduced PDGF-induced proliferation of hVSMC by 20% (P=0.02, n=5) and of rat VSMC by 26% (P=0.003, n=4) at concentration of 30 μM JPIII relative to controls. RNA-Seq analysis of PDGF-stimulated primary human aortic VSMC (n=4/group) was performed to investigate the effects of Orai1 inhibition on the transcriptional response of cells and showed significant downregulation of genes involved in inflammation (C-X-C motif chemokine ligand (CXCL) 1, CXCL3, CXCL5, CXCL6), downregulation of matrix degrading enzymes (metalloproteinase (MMP) 12 and MMP16), and upregulation of cholesterol biosynthesis pathways by Orai1 inhibition. Consistent with the observed functional phenotype, our results revealed an inhibitory effect on transcriptional networks involved in cell proliferation and migration. The effects of Orai1 inhibition on the transcription of genes involved in inflammation, MMPs expression, cholesterol metabolism, cell proliferation, and migration powerfully associate Orai1 signalling with VSMC remodelling. Our results provide insight into the role of Orai1 in VSMC remodelling and the possible therapeutic potential of a small molecule inhibition approach in targeting pathologic remodelling.
Abstract 10373: Low Body Mass Index Independently Predicts Future Risk of Elevated Low-density Lipoprotein Cholesterol Levels in Apparently Healthy Women
Authors: Aiko Sakamoto, Shintaro Yanagimoto, Kimie Tanaka, Issei Komuro, Kazuhiko Koike
Journal: Circulation (2019)

Background: Obesity contributes to the progression of cardiovascular disorders. Although the association of lower body mass index (BMI) with increased risk of adverse metabolic outcomes, referred t...
Abstract P136: Access To Potable Water, Sugar-Sweetened Beverages, And Central Obesity In Puerto Rico
Authors: Martha Tamez, Jose Rodriguez-Orengo, Josiemer Mattei
Journal: Circulation (2021)

Introduction: To date, no studies have shown how access to potable water is related to beverage (sugar-sweetened beverages (SSB's) and water) intake, and obesity. Objective: To determine associations between access to potable water, and beverage intake, with obesity among adults residing in Puerto Rico (PR). Methods: Participants of a cross-sectional study of adults (n=248;30-75y) living in PR responded to questions about the type of water access and preference factors for choosing such type based on availability, appearance, cost, or taste. Beverage intake was assessed with a food-frequency questionnaire. Interviewers measured waist circumference; central obesity was defined as &gt;102cm in men and &gt;88cm in women. We used multivariable linear regression models to evaluate the association between type of access and preference factors for potable water and beverage intake. Multivariable logistic regression models were used to evaluate the association between beverage intake and central obesity. Substitution analysis of one serving of water for one of SSB's was also performed. Results: Most participants (57%) reported drinking bottled water, 30.7% liked its taste, and 21% thought the water was clean/safe. Participants that reported cost and taste as factors for water selection had lower water intake than their counterparts (mean ± SE cost: 2.06 ± 0.19 vs. 2.76 ± 0.22; taste: 1.19 ± 0.15 vs. 1.85 ± 0.17 servings/d). Availability, appearance, or type of water source were not associated with beverage intake. Higher odds of central obesity were noted per serving/d of all SSB's (OR=1.23; 95%CI: 1.03, 1.47), and soda only (OR=1.51; 95%CI: 1.08, 2.13) (Table 1). Substituting one serving of water for soda was marginally associated with lower odds of central obesity (OR=0.73; 95% CI: 0.51, 1.03). Conclusions: Reducing soda intake and substituting it with water may be an appropriate approach to prevent central obesity in Puerto Rican adults. Measures to provide affordable and pleasantly tasting potable water may facilitate its intake.
Frequency of Preoperative Advance Care Planning for Older Adults Undergoing High-risk Surgery
Authors: Elle Kalbfell, Anna Kata, Anne S. Buffington, Nicholas Marka, Karen J. Brasel, Anne C. Mosenthal, Zara Cooper, Emily Finlayson, Margaret L. Schwarze
Journal: JAMA Surgery (2021)

<h3>Importance</h3> For patients facing major surgery, surgeons believe preoperative advance care planning (ACP) is valuable and routinely performed. How often preoperative ACP occurs is unknown. <h3>Objective</h3> To quantify the frequency of preoperative ACP discussion and documentation for older adults undergoing major surgery. <h3>Design, Setting, and Participants</h3> This secondary analysis of data from a multisite randomized clinical trial testing the effects of a question prompt list intervention on preoperative communication for older adults considering major surgery was performed at 5 US academic medical centers. Participants included surgeons who routinely perform high-risk surgery and patients 60 years or older with at least 1 comorbidity and an oncological or vascular (cardiac, peripheral, or neurovascular) problem. Data were collected from June 1, 2016, to November 30, 2018. <h3>Interventions</h3> Patients received a question prompt list brochure with 11 questions that they might ask their surgeon. <h3>Main Outcomes and Measures</h3> For patients who had major surgery, any statement related to ACP from the surgeon, patient, or family member during the audiorecorded preoperative consultation was counted. The presence of a written advance directive (AD) in the medical record at the time of the initial consultation or added preoperatively was recorded. Open-ended interviews with patients who experienced postoperative complications and family members were conducted. <h3>Results</h3> Among preoperative consultations with 213 patients (122 men [57%]; mean [SD] age, 72 [7] years), only 13 conversations had any discussion of ACP. In this cohort of older patients with at least 1 comorbid condition, 141 (66%) did not have an AD on file before major surgery; there was no significant association between the presence of an AD and patient age (60-69 years, 26 [31%]; 70-79 years, 31 [33%]; ≥80 years, 15 [42%];<i>P</i>= .55), number of comorbidities (1, 35 [32%]; 2, 18 [33%]; ≥3, 19 [40%];<i>P</i>= .62), or type of procedure (oncological, 53 [32%]; vascular, 19 [42%];<i>P</i>= .22). There was no difference in preoperative communication about ACP or documentation of an AD for patients who were mailed a question prompt list brochure (intervention, 38 [35%]; usual care, 34 [33%];<i>P</i>= .77). Patients with complications were enthusiastic about ACP but did not think it was important to discuss their preferences for life-sustaining treatments with their surgeon preoperatively. <h3>Conclusions and Relevance</h3> Although surgeons believe that preoperative discussion of patient preferences for postoperative life-sustaining treatments is important, these preferences are infrequently explored, addressed, or documented preoperatively. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02623335
Abstract 16922: Extremely Elevated Natriuretic Peptide is Associated With Incident Dialysis in Chronic Heart Failure Patients With Acute Kidney Injury
Authors: Thanat Chaikijurajai, Sevag Demirjian, Yuping Wu, Wai Hong W Tang
Journal: Circulation (2020)

Introduction: NT-proBNP has been widely used as a diagnostic and prognostic marker for both acute and chronic HF. Previous studies suggested that impaired renal function was the major contributor of an extreme elevation of NT-proBNP levels in patients with chronic HF rather than elevated cardiac filling pressure. Therefore, extremely elevated NT-proBNP levels may provide prognostic value in patients with cardiorenal syndrome. Hypothesis: Extremely elevated NT-proBNP levels are predictive of incident dialysis and dialysis dependence in chronic HF patients developing AKI Methods: Electronic medical records of 478 adult chronic HF patients admitted to the Cleveland Clinic between 2011 and 2016, who developed AKI during the hospital stay and had baseline NT-proBNP before renal consultation were reviewed. We analyzed the association between baseline NT-proBNP and incident dialysis, and dialysis dependence. Dialysis dependence was defined as patients undergoing dialysis within 72 hours of discharge. Results: Mean age was 67.6±13.3 years, 55.9% were male, and 37.7% had CKD. There were no significant differences in baseline characteristics and serum creatinine between patients with and without incident dialysis. Median NT-proBNP was 7,994 pg/mL (IQR; 3,109-19,357 pg/mL). There were 207 (43.3%) patients required dialysis, and 138 patients (66.7%) became dialysis dependent. Higher NT-proBNP was associated with increased risk of incident dialysis (Q 4 vs 1, OR 1.85, 95% C.I. 1.10-3.09, P =0.020), and dialysis dependence (Q4 vs 1, OR 2.96, 95% C.I. 1.25-7.00, P =0.014). However, in multivariate analysis adjusting for age, gender, hypertension, and baseline creatinine, only the association between NT-proBNP and incident dialysis remained statistically significant (Q4 vs 1, OR 1.77, 95% C.I. 1.03-3.02, P =0.038, Figure). Conclusions: Extremely elevated NT-proBNP was independently associated with incident dialysis in chronic HF patients developing AKI.
Abstract 15540: Prevalence and Sociodemographic Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States
Authors: Shiwani Mahajan, Gowtham R Grandhi, Javier Valero Elizondo, Isaac Acquah, Tamer Yahya, Salim S Virani, Ron Blankstein, Michael J Blaha, Miguel Cainzos-Achirica, Khurram Nasir
Journal: Circulation (2020)

Background: High out-of-pocket healthcare expenditures among US adults with atherosclerotic cardiovascular disease (ASCVD) may expose them to food insecurity, which can lead to worse health outcomes. However, few studies have examined the prevalence and determinants of food insecurity in this population. Methods: Using data from the 2013-18 National Health Interview Survey, a nationally representative annual survey of the US, we assessed prevalence and sociodemographic determinants of food insecurity among adults (≥18 years) with ASCVD. Food insecurity was defined as 3+ affirmative responses on a validated 10-item questionnaire with a 30-day look-back period. Results: Among 190,113 adults included, 18,442 (8.2%; ~19.9 million US adults annually) had ASCVD (38.3% &lt;65 years; 47.6% women). Overall, 14.6% adults with ASCVD (~2.9 million US adults annually) reported being food insecure compared with 9.1% among those without ASCVD. Among adults with ASCVD, those who were &lt;65 years, women, Black or Hispanic, uninsured, and had low income had significantly higher odds of reporting food insecurity (Table). On assessment of the cumulative effect of these high-risk characteristics, 4.2% individuals were food insecure among those with ≤1 of these characteristics compared with 18.1%, 36.0%, and 43.7% among those with 2, 3, and ≥4 high-risk characteristics, respectively. Using multivariable analyses, individuals with 2, 3, and ≥4 high-risk characteristics had nearly 4-fold (OR 4.26, 95% CI 3.59-5.07), 10-fold (OR 9.73, 95% CI 8.15-11.62), and 15-fold (OR 15.34, 95% CI 12.07-19.49) higher odds of being food insecure compared with those with ≤1. Conclusion: Nearly 1 in 7 adults with ASCVD in the US reported food insecurity, with prevalence being as high as 50% among the most vulnerable sociodemographic subgroups. There is a critical need to address the hindrances relating to social determinants of health, including food insecurity, among adults with ASCVD in the US.
Abstract 15657: Influenza Vaccination and All-cause Mortality Among Adults With Heart Failure in an Integrated Healthcare Delivery System, 2009-2018
Authors: Matthew T Mefford, Ran Liu, Katia Bruxvoort, Lei Qian, Hung-Fu Tseng, Kristi Reynolds
Journal: Circulation (2020)

Background: Vaccinations prevent respiratory infections in heart failure (HF) patients, leading to less HF decompensation. Given a growing interest around influenza vaccination and mortality reduction, we examined the association between influenza vaccination and all-cause mortality among members with HF in Kaiser Permanente Southern California. Methods: We identified members with HF by ICD-9/10 diagnosis codes prior to September 1 each year from 2009-2017. The first flu vaccination in each season (September 1-May 31) was recorded. Vaccinated/unvaccinated members were matched 1:1 on age, sex, and ejection fraction. Matched pairs were followed from the vaccinated member’s vaccination date through the end of the season for mortality, with the last date of follow-up on May 31, 2018. Frequency of healthcare utilization in the year before each season was compared between vaccinated and unvaccinated members. We calculated unadjusted and utilization-adjusted rate ratios (RR) and 95% confidence intervals (CI) for the association between vaccination and mortality. Results: Between 2009-2018, influenza vaccination among HF members increased from 74.8% to 80.3% and the number of vaccinated and unvaccinated matched pairs increased to 4,451 through the 2017-2018 season. The proportions of vaccinated and unvaccinated members with ≥ 1 prior inpatient visit and ≥1 prior emergency department (ED) visit were similar (46.2% vs 44.6% and 34.3% vs 32.6%, respectively). More unvaccinated than vaccinated members had ≥ 5 outpatient visits (41.9% vs 28.1%). After adjustment for inpatient, outpatient and ED visits, vaccinated members had between a 16% and 36% lower mortality rate across all seasons (RR 0.64 [95% CI 0.55, 0.75] in 2013-2014 and RR 0.84 [95% CI 0.73, 0.96] in 2017-2018). (Table) Conclusion: Influenza vaccination was likely associated with a lower mortality rate among HF patients. Future work will examine the potential confounding by comorbidities and treatments.
Abstract P051: Lifestyle Change In Mid-life And Long-term Weight Gain In Women With And Without History Of Gestational Diabetes Mellitus
Authors: Jiaxi Yang, Janet Rich-Edwards, Molin Wang, Wafaie W Fawzi, Cuilin Zhang, Deirdre K Tobias
Journal: Circulation (2021)

Introduction: Identifying strategies to mitigate gradual long-term weight gain is critical for preventing obesity and its related chronic diseases, particularly for persons at high risk, such as women with a history of gestational diabetes mellitus (GDM). We prospectively examined the independent associations between lifestyle changes in mid-life with long-term weight change among women with and without a history of GDM. Hypothesis: We hypothesized that favorable improvements in lifestyle would be associated with less long-term weight gain, particularly among women with a history of GDM. Methods: We used data from the longitudinal Nurses’ Health Study II, with self-reported lifestyle, diet via food frequency questionnaire, and body weight updated every 2-4 years. We analyzed repeated 4-year changes of the following lifestyle factors among parous women after age 40: adherence to a healthy dietary pattern (Alternate Healthy Eating Index score [AHEI]), physical activity (MET-hrs/wk), moderate alcohol intake (servings/d), and non-smoking, in relation to concurrent 4-year change in body weight (lb). We used multivariable generalized estimating equation models to estimate the least-squares mean of 4-year weight change and 95% confidence interval (CI) for each lifestyle change category (e.g., decrease, remain stable, and increase). Results: Our analysis included 61,637 women, of which 3,444 (5.6%) had a history of GDM. Mean of repeated 4-year weight change after age 40 was 3.0 lb (SD=14.3). Improving diet was associated with favorable 4-year weight change, particularly among women with a history of GDM vs. without GDM (AHEI score change from low to high: -6.3 lb [CI: -9.3, -3.4] vs. -2.7 lb [CI: -3.2, -2.2], respectively; p-interaction=0.04). Increasing physical activity was associated with weight maintenance for GDM women only (MET-hrs/wk change from low to high: 0.6 lb [95% CI: -0.6, 1.7] vs. 2.0 lb [95% CI: 1.8, 2.2] for GDM vs. non-GDM, respectively; p-interaction=0.01). Reducing alcohol (decreased servings/d: 1.9 lb [95% CI: 1.2, 2.6] and 2.8 lb [95% CI: 2.6, 2.9] for GDM vs. non-GDM, respectively) and smoking cessation (recent quitter: 9.8 lb [95% CI: 7.1, 12.5] and 8.5 lb [95% CI: 8.0, 9.1] for GDM vs. non-GDM, respectively) were associated with similar patterns in weight change for women with and without prior GDM. Further, the joint association of improving both diet and physical activity from low to high was related to -12.3 lb (95% CI: -19.5, -5.0) and -6.1 lb (95% CI: -8.0, -4.2) of weight loss for GDM vs. non-GDM women, respectively. Conclusions: We observed that attainable improvements in diet quality and physical activity were associated with weight gain prevention. These findings support continued efforts to improve lifestyle as a beneficial strategy to prevent long-term weight gain, particularly among women with a history of GDM.
Abstract P199: Sleep Health Varies By Immigration Status And Acculturation Level In Women: Results From The American Heart Association Go Red For Women Strategically Focused Research Network
Authors: Ivan A Samayoa, Nour Makarem, Vivian Cao, Moorea Maguire, Huaqing Xi, Citina Liang, Elsa-grace V Giardina, Brooke A Aggarwal
Journal: Circulation (2021)

Introduction: The Healthy Immigrant Effect refers to the phenomenon that recent immigrants are on average healthier than their native-born counterparts. Greater immigrant acculturation to the US has been linked to increased risk of cardiovascular disease (CVD), frequently attributed to factors including the adoption of Western diets and decreased physical activity. While immigrants may have healthier habits than US adults, which may confer protection from CVD, there is little research on sleep health, particularly in immigrant women. Hypothesis: We hypothesized that immigrants, particularly those with greater acculturation, would have more sleep problems. Methods: Baseline data from a 1-y, community-based cohort of 506 women (61% racial/ethnic minority, mean age=37±16y) was used to evaluate cross-sectional associations between acculturation and sleep. Women self-reported their immigration status and national origin. Acculturation was measured from responses to questions regarding language preference, nativity (sorted by regions: Asia, Caribbean, Latin America, other), length of residency in the US, and age at immigration. Sleep duration, sleep quality, risk of obstructive sleep apnea (OSA) and insomnia were assessed using validated questionnaires. Logistic regression models adjusted for age, health insurance, education and BMI were used to evaluate associations between acculturation measures and sleep characteristics. Results: Women who were immigrants (n=176) reported lower mean sleep duration (6.60 ± 1.25 vs. 6.85 ± 1.22 h, p=0.02) compared to non-immigrants (n=323); non-immigrants were more likely than immigrants to sleep ≥7h/night (OR: 1.50, CI: 1.01-2.22, p=0.04). Women who immigrated to the US before vs. after age 25 y had lower odds of having sleep onset latency ≥26 min (OR:0.97, CI:0.95-1.00, p=0.03). Immigrant women living in the US &gt;10y vs. &lt;10y had more than 2-fold higher odds of having longer sleep onset latency (≥26 min) (OR:2.43, CI:1.09-5.41, p=0.03). Immigrants from the Caribbean were more likely than immigrants from other regions to be at a high risk for OSA (OR:2.65, CI:1.07-6.55, p=0.04). Conclusions: Compared to non-immigrants, immigrant women exhibit shorter habitual sleep duration. Sleep problems may vary by age of immigration, years lived in the US, and region of origin, as those who immigrated when they were older and those who had lived in the US&gt;10 y required more time to fall asleep and Caribbean immigrants had higher OSA risk.