tbuckley/cabot-search huggingface dataset:
Vaccinating children against SARS-CoV-2
Authors: Jennie S Lavine, Ottar Bjornstad, Rustom Antia
Journal: BMJ (2021)

<b>Purpose:</b> The purpose of this study was to assess the knowledge, opinions and practice behaviors of nurse practitioners (NP) and certified nurse midwives (CNM) regarding periodontal disease and adverse pregnancy outcomes. <b>Methods:</b> A 45 item survey was developed, approved, pretested, revised and mailed to 404 North Carolina NPs and CNMs who provide prenatal care. Data was entered into an excel database and transferred to SPSS for Windows for complete analysis. Linear regression modeling was used to determine statistical significance. <b>Results:</b> A total of 219 NPs and CNMs responded to the mailed survey, achieving a response rate of 54%. NPs and CNMs reported having limited knowledge regarding oral health. The majority felt they should collaborate with oral health care professionals to screen patients for periodontal disease. Most agreed they needed more information about periodontal disease and adverse pregnancy outcomes. <b>Conclusion:</b> NPs and CNMs who frequently examine women could serve an important role in screening for oral health problems and making appropriate dental health referrals. Increased basic and continuing education could prepare these professionals for collaborative care with oral health care professionals. This study suggests that collaboration between NPs and CNMs with dental professionals could lead to improved oral health care for pregnant patients. This study supports the NDHRA priority area, <b>Health Promotion/Disease Prevention:</b> Validate and test assessment instruments/strategies/mechanisms that increase health promotion and disease prevention among diverse populations.
Abstract 16430: Risk Factors Associated With Worsening Left Ventricular Function Post-bone Marrow Transplant in Multiple Myeloma Patients
Authors: Jim Chen, Tanya Sharma, Fuad Habash, Emily Sanders, Abdullah Malkawi, Husam Salah, Malek Alaiwah, Marina Joseph, Angel Lopez-Candales
Journal: Circulation (2020)

Background: New onset or worsening congestive heart failure (CHF) poses a significant challenge in multiple myeloma (MM) patients post bone marrow transplant (BMT). The aim of this study was to determine co-morbidies that increased the risk of worsening left ventricular (LV) function post-BMT. Methods: Retrospective study looking at MM patients between 2013 to 2019 with at least 1 bone marrow transplant. The primary end point was the time from BMT to &gt;10% worsening ejection fraction (EF) noted on echocardiogram, compared to baseline values. A Cox proportional hazards regression model was used to create hazard ratios. Results: A total of 524 patients with diagnosis of MM were included who had at least 1 BMT with an average follow up time of 309.3 days. Prior hospitalizations of heart failure prior to BMT significantly increased the risk of developing reduced systolic function post transplant (HR 6.38 [95% CI 2.07 - 19.63]). Other contributing factors for reduced EF include: elevated BMI, history of hypertension, liver disease, peripheral vascular disease, stroke, and lenalidomide prior to BMT. Conclusion: This study was able to identify prognostic factors contributing to worsening heart failure.
2020 list of human papillomavirus assays suitable for primary cervical cancer screening
Authors: Marc Arbyn, Marie Simon, Eliana Peeters, Lan Xu, Chris J.L.M. Meijer, Johannes Berkhof, Kate Cuschieri, Jesper Bonde, Anja Ostrbenk Vanlencak, Fang-Hui Zhao, Remila Rezhake, Murat Gultekin, Joakim Dillner, Silvia de Sanjosé, Karen Canfell, Peter Hillemanns, Maribel Almonte, Nicolas Wentzensen, Mario Poljak
Journal: Clinical Microbiology and Infection (2021)

Only clinically validated HPV assays can be accepted in cervical cancer screening.
Abstract 15661: Clinical Predictors and Financial Implications of Permanent Pacemaker Implantation in Patients Undergoing TAVR: A Nationwide study
Authors: Abhishek Deshmukh, Samir V Patel, Sadip Pant, Nileshkumar J Patel, Chirag Savani, Shilpkumar Arora, Nilay Patel, Maheshkumar Desai, Ronak Bhimani, Apurva O Badheka, Deepak Padmanabhan, Paul Friedman, Minang Turakhia, Yong Mei Cha, Samuel Asirvatham, Charanjit Rihal, Peter Noseworthy
Journal: Circulation (2015)

Introduction: The treatment options for high and extreme-risk patients with severe symptomatic aortic stenosis have changed significantly over the past decade because of advances in transcatheter aortic valve replacement (TAVR). However new permanent pacemaker implant (PPI) remains an impending concern after TAVR. Hypothesis: We sought to determine the frequency, predictors and outcomes of patients requiring PPI after TAVR. Methods: We queried the National Inpatient Sample (NIS) database using the ICD-9-CM procedure code of 35.05 for transfemoral/transaortic and 35.06 for transapical replacement of aortic valve .We identified TAVR procedures associated with new permanent pacemaker implants using appropriate validated ICD-9-CM codes. Using multivariate analysis we further identified predictors of PPM implants Results: An estimated 8828 TAVR procedures were performed in United States between 2011-2012. 773 (8.7%) TAVR procedures were associated with PPIs. PPI were higher in older (age&gt;80 years), White race, diabetics, left bundle branch block (LBBB), right bundle branch block (RBBB), transfemoral approach. The inhospital mortality ( 5.2% vs.4.6% ) , mean length of stay ( 9.8 vs. 8.3 days ) disposition to short term nursing facility was higher (38.2% vs. 32.1%) and mean total costs (82217$ vs. 52283$) was higher in TAVR + PPI group . On multivariate analysis, Age in 5 year increment [Odds ratio (OR) 1.11; Confidence interval (CI) 1.05-1.17, p&lt;0.001], diabetes [OR 1.26; CI 1.07-1.49, p&lt;0.001], LBBB [OR 1.99; CI 1.55-2.56, p&lt;0.001], RBBB [OR 5.36; CI 3.80-7.55, p&lt;0.001] were independent predictors of PPI. Transfemoral approach was associated with more PPI implants [OR 1.41; CI 1.12 -1.78, p&lt;0.001] Conclusion: Age, baseline conduction system disturbances, diabetes, transfemoral approach emerged as independent predictors of PPI after TAVR. This study provides useful tools to identify high-risk patients for PPI after TAVR.
Quantification of Myocardial Strain of Left Ventricle Using Myocardial Tagging at 3.0T
Authors: Inoue Yuma, Saito Makoto, Hosokawa Kouhei, Kido Teruhito, Kurata Akira, Nagao Michinobu, Honda Toshio, Okayama Hideki, Higashino Hiroshi, Higaki Jitsuo, Mochizuki Teruhito
Journal: Circulation (2009)
Abstract 16023: Network Meta-analysis of Randomized Controlled Trials for Graft Patency of a Second Conduit for Coronary Artery Bypass Surgery
Authors: Yujiro Yokoyama, Hisato Takagi, Toshiki Kuno
Journal: Circulation (2020)

Background: It has been well documented that the use of the left internal thoracic artery (LITA) to graft the left anterior descending (LAD) artery has a significant benefit in coronary artery bypass graft (CABG) surgery. However, what graft is the best as a second conduit to complement LITA-LAD anastomosis remains uncertain. We thus conducted a network meta-analysis of RCTs to compare graft patency of the radial artery (RA), the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), and saphenous vein (SVG) as a second conduit in CABG. Methods: MEDLINE and EMBASE were searched through February 8th, 2020 to identify randomized controlled trials (RCTs) that investigated graft patency of a second conduit in CABG. From each study, we extracted the incidence rate ratios (IRR) of the outcome. Results: A total of 11 RCTs were identified, including 3,434 patients and 2,171 angiographic results. There was no significant difference of IRR in graft failure among the 4 groups (vs. SVG: RA, IRR [95%CI] =0.66 [0.41-1.07]; RGEA, IRR [95% CI] =2.12 [0.54-8.38]; RITA, IRR [95% CI] =0.71 [0.32-1.60]). (Figure) Sensitivity analyses restricting trials with ≥3 years angiographic follow-up time or ≥5 years angiographic follow-up time showed no significant differences of IRR in graft failure among the four groups in both analyses. Conclusion: In a network meta-analysis of the updated outcomes from RCTs, no significant differences were observed in graft patency with the use of RA, RITA, RGEA or SVG as a second conduit in CABG.
Antibiotics armed neutrophils as a potential therapy for brain fungal infection caused by chemotherapy-induced neutropenia
Authors: Yi Han, Yanchao Liu, Xiaoyi Ma, Aijun Shen, Yiqiong Liu, Nopphon Weeranoppanant, Haiqing Dong, Yan Li, Tianbin Ren, Le Kuai, Bin Li, Maomao An, Yongyong Li
Journal: Biomaterials (2021)
Abstract 13588: Cardiovascular Outcomes in Patients With Established Atherosclerosis and LDLR Loss of Function: Results From the FOURIER Trial
Authors: Nicholas A Marston, James Pirruccello, Giorgio Melloni, Frederick Kamanu, Seung Hoan Choi, Anthony A Philippakis, Peter S Sever, Anthony C Keech, Armando Lira Pineda, Huei Wang, Robert Giugliano, Steven A Lubitz, Patrick T Ellinor, Marc S Sabatine, Christian T Ruff
Journal: Circulation (2020)

Introduction: Patients with loss of function (LoF) mutations of the LDL receptor gene (LDLR) have lifelong elevations in LDL-C. We investigated their risk of cardiovascular (CV) events compared with patients with intact LDLR function. Methods: We performed a prospective genetic cohort analysis from the FOURIER trial including all 14,297 patients who consented for genetic testing, passed QC, and were of European ancestry. All patients had established ASCVD and were on moderate or high intensity statin therapy. Whole exome sequencing was performed and LoF mutations in LDLR were identified using LOFTEE, a tool for detecting protein-truncating variants. Polygenic risk for CAD was also calculated for each patient using a previously validated 27-SNP genetic risk score, with high and low risk defined as above and below the median. The primary endpoint was a composite of CV death, myocardial infarction, stroke, unstable angina, or coronary revascularization. Results: There were 111 (0.8%) patients identified with an LDLR LoF mutation, representing an approximately 4-fold enrichment compared to the general population. These patients had mean baseline LDL-C levels 62 mg/dl higher than those without an identified LDLR LoF mutation (160 vs. 98 mg/dl, p&lt;0.0001) and a 70% increased risk of CV events (HR 1.70 [1.04-2.79], p=0.03) ( Figure, a ). When polygenic risk for CAD was combined with LDLR mutation status there was a significant gradient of risk identified (p-trend=0.001). Patients without a monogenic LDLR mutation or high polygenic risk had a 2.5-year KM event rate of 8.6%; those with either one had a 10.0-12.9% event rate; those with both had a 17.1% event rate ( Figure, b ). Conclusion: ASCVD patients with LDLR LoF mutations have persistently elevated LDL-C and increased CV risk despite intensive statin therapy. The combination of a monogenic LDLR mutation with high polygenic risk for CAD appears additive in this secondary prevention cohort.
Abstract 13427: Extracellular Vesicles Improve Heart Function Without Inducing the Generation of New Cardiomyocytes
Authors: Bruna Lima Correa, Nadia El harane, Maria Perotto, Manon Desgres, Chloe Guillas, Paul Alayrac, LAETITIA PIDIAL, VALERIE BELLAMY, noemie tence, Emilie Baron, Gwennhael Autret, Keirththana Kamaleswaran, Jose Vilar, Antonio Alberdi, Nisa Renault, Massimiliano Gnecchi, Philippe Menasche, Jean-Sebastien Silvestre
Journal: Circulation (2020)

Introduction: Extracellular Vesicles (EV) recapitulate the benefits of cell therapy for heart repair. Their mechanism of action remains unsettled. Hypothesis: EV may contribute to heart repair by de novo cardiogenesis. Methods: To answer this question, we used 2 bi-transgenic mouse models: the fate-mapping MerCreMer/ZEG and the Mosaic Analysis With Double Markers (MADM). Myocardial infarction was induced by permanent coronary artery ligation. Those with a LVEF ≤ 45% were treated 3 weeks later with EV (from human iPS-derived cardiovascular progenitor cells; 10x10 9 particles) or PBS, injected under echo guidance in the peri-infarcted area (MerCreMer/ZEG: n=15/group and MADM: n=6/group). To track endogenous cardiomyocyte (CM) proliferation, we used EdU labeling in MerCreMer/ZEG delivered by osmotic pumps implanted for 7-10 days post-injection and biphoton microscopy in MADM models. Cardiac function was assessed 4-6 weeks after injection by echocardiography and MRI, blinded to treatment group. Hearts were then subjected to histological and transcriptomic analyses (qPCR and genome-wide microarray). Results: In PBS controls, EF remained stable over time in MerCreMer/ZEG mice and decreased from 34.5% ± 6.0% to 30.7% ± 7.5% in MADM mice by the end of the study. Conversely, EV injections increased EF from 32.1% ± 9.5% to 36.1% ± 7.45 % in MerCreMer/ZEG and from 36.2 %± 8.7% to 40.5% ± 8.9% in MADM mice. A significant difference in the change from baseline was found between EV and controls: 20.7% ± 10.5 % (p=0.048) and 28.0% ± 11.0 %, (p=0.045) for MerCreMer/ZEG and MADM groups, respectively. This improvement was confirmed by MRI in MerCreMer/ZEG mice (p=0.05). Improvement in EF was unrelated to the appearance of new CM, as shown by the absence of difference in TnT+/EdU+/GFP+ cell numbers and the lack of activation of the YAP/TAZ pathway between control and EV groups. However, EV reduced infarct size by 11.9% ± 5.75% (p=0.04), which was accompanied by decreased expression of 4 pro-fibrotic genes (Col1a2, Col3a1, Lox, Col1a2 by qPCR) in heart tissue and a 2.13X overexpression of the anti-fibrotic miRNA 133a-1 compared to controls (n=3/group; p=0.001). Conclusions: EV likely improve cardiac function by modulation of fibrosis rather than by de novo cardiogenesis.
Abstract 12586: Assessing Valvuloarterial Impedance in Aortic Stenosis: A Comparison of Echocardiographic- and Cardiac Magnetic Resonance-derived Methods
Authors: Sara L Hungerford, Audrey Adji, Nicole K Bart, Linda Lin, Andrew Jabbour, Christopher S Hayward, David W Muller, Natasha Gorrie
Journal: Circulation (2020)

Introduction: Valvuloarterial impedance (Z VA ) represents the valvular and arterial factors that oppose Left Ventricular (LV) ejection and is recognised as an important index to assess global LV load in patients with Aortic Stenosis (AS). Z VA is traditionally determined by Transthoracic Echocardiogram (TTE) and brachial cuff pressure. Hypothesis: Our study sought to compare Z VA-TTE with Z VA calculated using a simultaneous Cardiac Magnetic Resonance (CMR) and Applanation Tonometry (AT) (Z VA-CMR ) technique to determine whether TTE measurement of aortic flow velocity resulted in an underestimation of Z VA. Methods: Twenty AS patients underwent a protocol of CMR/AT followed by TTE. Z VA-CMR was determined as the relationship of derived aortic pressure (radial) to CMR aortic flow velocity in the frequency domain. Z VA-TTE was determined from digitised flow velocity within the left ventricular outflow tract (LVOT) on pulsed-wave Doppler and derived central pressure waveforms. Systemic vascular resistance (SVR) was calculated from mean pressure and flow. Values from both methods were compared. Results: Our study found that Z VA-TTE values (mean±SD, 638±381 dyne.s.cm -3 ) were consistently lower (p=0.07) than Z VA-CMR values (946±318 dyne.s.cm -3 ), and attribute this to an overestimation of LVOT flow velocity on TTE. SVR calculated by CMR/AT (2215±616 dyne.s.cm -5 ) was almost four times higher than TTE (618±245 dyne.s.cm -5 ) (p&lt;0.001). This is due to more robust axi-symmetrical sampling of aortic flow across the entire cross-section of the ascending aorta (well above the stenotic jet) during CMR, than using operator-dependent TTE. Conclusions: Whilst Z VA -TTE is commonly performed in patients with AS to assess global LV load, newer methods to assess Z VA using simultaneous CMR/AT likely represent a more accurate non-invasive assessment.
Abstract 16685: Shared Genetic Pathways Contribute to Risk of Hypertrophic and Dilated Cardiomyopathies With Opposite Directions of Effect
Authors: Rafik Tadros, Catherine Francis, Xiao Xu, Alexa M Vermeer, Andrew R Harper, Roy Huurman, Ken Kelu Bisabu, Roddy Walsh, Benjamin Meder, Philippe Charron, Rudolf A De Boer, Imke Christiaans, Michelle Michels, Arthur A Wilde, Hugh Watkins, Paul Matthews, James S Ware, Connie R Bezzina
Journal: Circulation (2020)

Introduction: Hypertrophic (HCM) and dilated (DCM) cardiomyopathies are leading causes of sudden death and heart failure requiring transplantation in young individuals. While some cases have a monogenic underlying cause, the majority remain unexplained. Objective: To better understand the contribution of common genetic variants in susceptibility and severity of cardiomyopathy. Methods: We conducted three genome-wide association studies (GWAS) and multi-trait analyses in European-ancestry individuals, including a HCM (1,733 cases) and DCM meta-analyses (5,521 cases), and a GWAS of 9 left ventricular (LV) traits in 19,260 healthy participants from the UK Biobank that underwent cardiac magnetic resonance imaging. We investigated genetic correlations between LV traits, HCM and DCM using LD score regression. We used two-sample mendelian randomization (MR) to assess the causal relationship of increased LV contractility with HCM risk. Lastly, we derived a polygenic risk score and assessed whether it modulates maximal LV wall thickness (maxLVWT) and clinical events in 368 sarcomeric mutation carriers, using linear and Cox mixed effects models, respectively. Results: We identified 16 genetic loci (15 novel) associated with HCM, 13 loci (7 novel) associated with DCM, and 23 loci associated with LV traits. We showed strong genetic correlations between LV volumes and contractility traits in the general population and cardiomyopathies, with opposing effects in HCM and DCM. Using MR, we demonstrated a causal association linking increased LV contractility with HCM risk and estimated that each unit (1%) increase in LV ejection fraction increases the risk of HCM by 37% (95% CI 10%-69%, P=0.004). Lastly, a polygenic risk score (PRS HCM ) derived from the HCM GWAS was associated with maxLVWT (P=0.0001) and clinical events (P=0.009) in carriers of HCM-causing rare variants. Conclusion: Our findings highlight the contribution of common genetic variants in susceptibility for HCM and DCM, and in severity in sarcomeric mutation carriers. Our data also point to increased LV contractility as an important mechanism of HCM independently of sarcomere activating rare variants, and highlight the potential clinical relevance of PRS for risk stratification in HCM.
Rammya Mathew: Digital access has opened the floodgates to patient demand
Authors: Rammya Mathew
Journal: BMJ (2021)

For years the cost of healthcare has increased at a rate that has outpaced general inflation.1 It’s nothing short of a miracle that, despite this, the UK has managed to keep healthcare free at the point of access. With staff costs accounting for around half of all NHS spending,2 this has been possible only because the true cost of healthcare has been heavily subsidised by the people working in the health service—people who aren’t watching the clock or invoicing for all of their hours but are simply staying until the work is done.

In general practice, where over 80% of patient …
Abstract 15281: Triglyceride Levels and Cardiovascular Outcomes After Acute Coronary Syndrome: Insights From the Odyssey Outcomes Trial
Authors: Doron Zahger, Michael Szarek, Deepak L Bhatt, Vera A Bittner, Andrzej Budaj, Rafael Diaz, Shaun G Goodman, J Wouter W Jukema, Robert G Kiss, Jennifer McGinniss, Robert A Harrington, Patrick M Moriarty, Robert Pordy, Zelijko Reiner, Megan Loy, Margus Viigimaa, Harvey D White, Andreas M Zeiher, Gregory G Schwartz, Philippe G Steg
Journal: Circulation (2020)

Introduction: It is controversial whether triglyceride (TG) levels are independently associated with post-acute coronary syndrome (ACS) major adverse cardiovascular events (MACE) in patients treated with statins. PCSK9 inhibitors such as alirocumab (ALI) produce substantial reductions in LDL-C, modest reductions in lipoprotein(a) and TG-rich lipoproteins, and reduce MACE. Objective: Using data from the ODYSSEY OUTCOMES trial that compared ALI with placebo in 18,924 patients with recent ACS on optimized statin treatment, we performed a prespecified analysis to determine if MACE (death from coronary heart disease, myocardial infarction, ischemic stroke, or unstable angina) was associated with baseline TG levels in patients treated with placebo, and if MACE reduction with ALI was influenced by baseline TG or the change in TG under treatment. Methods and Results: Proportional hazards models relating continuous baseline TG or the change in TG from baseline to Month 4 with MACE were adjusted for baseline variables: age, region, LDL-C, lipoprotein(a), diabetes, hypertension, BMI, heart failure, peripheral artery disease and cerebrovascular disease. At baseline, median TG level was 130 mg/dL. Median absolute change from baseline to month 4 in the ALI group was -17 (-49, 12) mg/dL. Within the placebo group, baseline TG was associated with MACE (HR per 10 mg/dL increment 1.007, 95% CI 1.001–1.014, p=0.03), although spline analysis suggested non-linearity ( Figure ; spline effect p=0.01) with higher risk above approximately 190 mg/dL. MACE reduction by ALI (HR 0.85, 95% CI 0.78–0.93) did not depend on baseline TG (interaction p=0.99). In the ALI group, change in TG from baseline to Month 4 did not predict MACE after Month 4 (p=0.47). Conclusions: Among patients with recent ACS on optimized statin treatment, baseline TG levels are an independent predictor of MACE. The beneficial effect of ALI on MACE did not depend on either baseline or on treatment TG levels .
Abstract 17501: Splenic CD169 <sup>+</sup> Tim4 <sup>+</sup> Marginal Zone Metallophilic Macrophages Are Essential for Wound Healing and Resolution of Inflammation After Myocardial Infarction
Authors: Mohamed Ameen Ismahil, Zhou Guihua, Shyam Bansal, Bindiya Patel, Nita A Limdi, Min Xie, Sergey Antipenko, Gregg Rokosh, Tariq Hamid, Sumanth D Prabhu
Journal: Circulation (2020)

Fidelity of wound healing after myocardial infarction (MI) is an important determinant of subsequent adverse cardiac remodeling and failure. Infiltrating Ly6C hi blood monocytes are a key component of this healing response; however, the importance of other monocyte/macrophage populations is unclear. Here, we demonstrate in mice an essential role for splenic CD169 + Tim4 + marginal zone metallophilic macrophages (MMMs) in post-MI wound healing. CD169 + Tim4 + MMMs circulate as Ly6C low monocytes, and dynamically populate the naïve heart. After acute MI, mobilization robustly increases to the heart, where these macrophages are obligatory for apoptotic neutrophil clearance and the induction of pro-resolving and reparative tissue macrophages. Splenic MMMs are both necessary and sufficient forpost-MI wound healing, and limit late pathological remodeling.Pharmacological expansion of the splenic marginal zone during acute MI alleviates inflammation and cardiac remodeling. Finally, humans with acute MI also exhibit expansion of blood CD169 + monocytes. Hence, splenic CD169 + Tim4 + MMMs are required for pro-resolving and reparative responses after MI, and can be manipulated for therapeutic benefit to limit long-term heart failure.