tbuckley/cabot-search huggingface dataset:
Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis
Authors: Rita Reyburn, Evelyn Tuivaga, Cattram D Nguyen, Felisita T Ratu, Devina Nand, Joe Kado, Lisi Tikoduadua, Kylie Jenkins, Margaret de Campo, Mike Kama, Rachel Devi, Eric Rafai, Daniel M Weinberger, E Kim Mulholland, Fiona M Russell
Journal: The Lancet Global Health (2020)

In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction.We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data.Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months.The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region.Department of Foreign Affairs and Trade of the Australian Government.
Abstract 13523: Self-guided Mobilization in the Cardiac ICU During the COVID Era
Authors: Koorosh Semsar-kazerooni, Michael Goldfarb
Journal: Circulation (2020)

Introduction: Measures instituted to prevent the spread of COVID may have an impact on cardiac ICU care practices, such as early mobility (EM) program delivery. A structured EM program was in place in our cardiac ICU prior to COVID. Restrictions on hallway ambulation and patient-provider interaction due to COID led us to modify our EM program to a nurse-assisted, patient-guided program. To our knowledge, there are no studies evaluating patient-guided mobilization in a critical care setting. Thus, our objective was to assess whether self-guided EM was safe and feasible in the cardiac ICU during the COVID period. Methods: We reviewed consecutive records in a tertiary care cardiac ICU over a 2-month period following initiation of the self-guided EM program. Only patients who were COVID negative or presumed negative were admitted to the cardiac ICU. Nurses assessed patients using the Level of Function Mobility Score (range 0 to 5, with higher scores indicating better mobility) and provided the current functional level to patients. Patients used their own smartphones or supplied tablets to view video modules, which guided performance of level-specific mobility activities. Patients with contraindications to mobilization based on prespecified criteria were not mobilized. There were 2 mobilization opportunities per day and 3 activities per opportunity. Results: There were 52 patients admitted to the CICU during the study period (mean age 67.4 ± 16.0 years; 38.5% female). Ten patients (19.2%) had contraindications to mobilization during unit stay; all of these patients were subsequently mobilized. Two-thirds (66.7%; 208/312) of mobilization opportunities had at least one mobility activity. 72.2% (676/936) of prescribed mobility activities were performed. The adverse event rate was 0.6% (4 events/676 activities); none of these were major or life-threatening. There were no falls or line dislodgements. Conclusions: Patient self-guided mobilization was safe and feasible during a period of limited provider-patient interaction in a cardiac ICU. Self-guided EM programs can be considered during periods of restrictions on usual mobility programs. Further studies are needed to evaluate EM in other settings, such as in COVID hospital wards.
Targeting Nestin+ hepatic stellate cells ameliorates liver fibrosis by facilitating TβRI degradation
Authors: Huaxin Chen, Jianye Cai, Jiancheng Wang, Yuan Qiu, Chenhao Jiang, Yi Wang, Yiqin Wang, Chenju Yi, None Guo lv, Lijie Pan, Yuanjun Guan, Jun Zheng, Dongbo Qiu, Cong Du, Qiuli Liu, Guihua Chen, Yang Yang, Yan Xu, Andy Peng Xiang, Qi Zhang
Journal: Journal of Hepatology (2020)
Abstract 14851: Under Pressure: Hemodynamics Bringing the Right "fix" to Heart Failure
Authors: Estefania Oliveros, Ashish A Correa, Aditya Parikh, Robert Leber, Soheila Talebi, Yevgeniy Brailovsky, Anu Lala, Johanna P Contreras
Journal: Circulation (2020)

Introduction: High-output heart failure (HF) develops in the setting of excessive cardiac output. Case Presentation: 65-year-old male with HF (EF 40%), severe right ventricular dysfunction, and emphysema presented with dyspnea and anasarca. On admission, physical examination showed a BP 97/66mmHg, heart rate 109bpm, temperature 97.2F, respiratory rate of 19rpm, 93% on 2-Liters of oxygen. Jugular venous pressure was 20 cm H20 with large V waves. The rhythm was irregular, with a loud second heart sound, audible third heart sound, parasternal heave, and left lower sternal border murmur. Lung exam demonstrated basilar crackles and prolonged expiratory phase. The abdomen was distended with a pulsatile liver and the lower extremities were cool with 3+ pitting edema. There was an audible bruit with thrill at the right groin. Laboratory testing showed sodium=123mEq/L, creatinine=1.25mg/dL, bilirubin=2.2, ALT=135U/L, AST=146u/L, troponin-I=0.097ng/mL, BNP=1528pg/mL. CT and VQ scan were negative for acute/chronic pulmonary embolism. Lower extremity Doppler ultrasound revealed a right common femoral arteriovenous (AV) fistula (Fig.1). After diuretics and milrinone, a left heart catheterization demonstrated known three vessel disease, but without limitations in instant flow reserve. Right heart catheterization demonstrated RA=15mmHg, RV=50/16mmHg, PA=50/24(34)mmHg, PCWP=11mmHg, CO=5.4L/min, PVR=4.25WU, after which the fistula was ligated. On post-op day 2, repeat hemodynamics off inotropes showed an RA=4mmHg, PA=40/18mmHg, PCWP=18 mmHg, CO=4.4L/min and normalization of end-organ function. He was maximized on GDMT. Echocardiogram 5 months later showed improvement of RV function and he was able to go back to work with minimal symptoms. Conclusion: AV fistulas can lead to high-output HF if undiagnosed. A multidisciplinary approach and comprehensive hemodynamic assessment proved essential in allowing improvement of symptoms and resulting outcomes.
Abstract 14653: Genome-wide Association Study of Peripheral Artery Disease and Critical Limb Ischemia Identifies Novel Genetic Loci and Coagulation Pathways
Authors: Chayakrit Krittanawong, Jagat Narula, Kipp W Johnson, Navneet Narula, Jeffrey S Berger, Jeffrey W Olin, Fahd Al-Mulla, Ebaa Al-Ozairi, Ron DO, Girish Nadkarni
Journal: Circulation (2020)

Introduction: The pathogenesis of peripheral artery disease (PAD) and critical limb ischemia (CLI) are poorly understood. Hypothesis: We hypothesize that genetic factors related to abnormalities in coagulation or fibrinolysis, in addition to atherosclerosis, could play an important role in PAD patients and PAD with CLI patients. Methods: A genome-wide association study (GWAS) was performed testing for associations between single-nucleotide variants (SNVs) and PAD case-control (3,190 cases and 463,495 controls) and subgroup analysis of PAD with CLI case-control (142 cases and 3,048 controls) in the UK Biobank cohort. To further validate the results, we selected SNVs with the most significant Cochrane-Armitage trend p values without evidence of strong linkage disequilibrium (r2 &gt; 0.8) for PAD with CLI case-control in the BioMe Biobank. We tested for association using BOLT-LMM with adjustment for age, sex, BMI, and the first ten principal components to control for population structure. The SNV association tests' significance level was set at P &lt; 5x10–8 after Bonferroni correction. Results: 363 SNVs from 81 genetic loci reached the threshold for statistical significance based on a Bonferroni correction (p &lt;5x10–8). (Figure) We then performed a subgroup analysis between PAD patients and PAD with CLI patients in the UK Biobank. We identified 63 SNVs with 52 genetic loci independent for PAD with CLI in the UK Biobank. We further validated those 63 SNVs with 52 genetic loci in the BioMe Biobank. In the validation cohort, 2 genetic loci ( PLG and CDKN2B ) were independent for PAD with CLI. On pathway analyses, we identify several new loci that implicate thrombotic, inflammation, glycosaminoglycan synthesis, coagulation, and fibrinolytic pathways involved in PAD along with known atherosclerosis pathways (p &lt;0.05). Conclusions: We show that PLG gene related to coagulation pathways in PAD may play an important role in coagulation-related PAD pathogenesis.
First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care
Authors: Sarah-Jo Sinnott, Ian J Douglas, Liam Smeeth, Elizabeth Williamson, Laurie A Tomlinson
Journal: BMJ (2020)

Abstract Objective To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care. Design Observational cohort study. Setting UK primary care, from 1 January 2007 to 31 December 2017. Participants New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides. Main outcome measures Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (&lt; v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations. Results During one year of follow-up, 87 440 new users of ACEI/ARB, 67 274 new users of CCB, and 22 040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval −2.52 to −0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (−0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (−6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (−1.49 to −0.47) in non-black people. Conclusions Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.
Abstract 12815: Lambda-like St-segment Elevation in Acute Myocardial Infarction: May be a New Risk Predictor for Lethal Ventricular Arrhythmia
Authors: Heng shee Kim, Gurudevan Mahadevan, Chuey Yan Lee, Hou Tee Lu
Journal: Circulation (2020)

Introduction: Ventricular arrhythmia (VA) is the frequent most cause of SCD in AMI patients. Among, early VT and VF are associated with high in-hospital mortality. Certain ECG changes during AMI was reported to be associated with lethal VA. We described a case of lethal VA in AMI patient with a specific ECG sign - the Lambda ST elevation. Case Description: A 49 year old diabetic and hypertensive man presented with worse ever angina. Examination showed bilateral lung crepitation. ECG revealed wide spread Lambda shaped ST elevation over anteroinferior lead with reciprocal changes. He was treated as anteroinferior STEMI and planned for PPCI. During preparation, he developed VF and resuscitated with CPR and defibrillations. He was then intubated and BP supported with inotropes. Coronary angiogram showed acute total occlusion of RCA and LAD. We decided PCI to both vessels. Multiple white thrombus aspirated from RCA and successfully established TIMI II flow. Just before deployment of the stent, he developed VF again and resuscitated. RCA was stented after ROSC. Similarly, multiple red and white thrombus aspirated from LAD. After balloon dilatation, TIMI II flow re-established with no obvious lesion. Unfortunately, he developed VF storm in between and succumbed despite one hour of resuscitation effort with acceptable angiographic results. Discussion: The presence of elevated J-wave followed by a steep downsloping elevated ST segment that merges with the inverted T wave, forming a Lambda or shark fin shape, was reported to be associated with fatal VA, cardiogenic shock and in-hospital mortality. It is closely related to early abnormal ventricular repolarization, which involves acute myocardial ischemia and genetic abnormality. Conclusion: This case demonstrated that the presence of Lambda-like ST elevation in AMI may be a risk predictor for lethal VA and cardiogenic shock. Early recognition of this high risk group and prompt aggressive treatment strategies can be lifesaving.
Abstract 16386: Patient Perceptions of Cardiac Electrophysiology Procedural Postponement at an Urban Center During the SARS-CoV-2 Pandemic
Authors: Anne Sophie Lacharite Roberge, Abdullah Haddad, Benjamin Khazan, Joseph Noto, Lauren Tragesser, Rebecca Garber, Chethan Gangireddy, Edmond Cronin, Anuj Basil, George Yesenosky, Richard Greenberg, Anjali Vaidya, Meredith Brisco-Bacik, Joshua M Cooper, Isaac Whitman
Journal: Circulation (2020)

Background: To curb transmission of SARS-CoV-2 and to preserve hospital resources, elective procedures were indefinitely postponed nationally, affecting many patients previously scheduled for electrophysiology (EP) procedures. Procedural wait times may affect patient satisfaction and retention, yet patient perceptions of procedural postponements during the SARS-CoV-2 pandemic are currently unknown. Methods: We performed a phone survey of consecutive patients who experienced EP procedural postponement from March – April 2020. Surveys were performed between May 1 – May 15. Sociodemographics, SARS-CoV-2 testing history, notification circumstances, and perceptions were obtained from patients. Results: Of 112 patients postponed, 77 patients consented to the survey, most of whom were minorities (black 43%, Hispanic 20%), 30% were below the poverty line, and 67% had ≤ high school education. Catheter ablation accounted for 33% of procedures and device procedure 44%. Half of patients (51%) were informed of their postponement by their electrophysiologist. In response to when patients thought their procedure would occur, 37% believed it would occur within 12 weeks of the survey. Perceptions and testing history are shown ( Figure ). Patients who had undergone SARS-CoV-2 testing were more likely to disagree with postponement than those who had not undergone testing (30% of those tested disagreed vs. 2% of those not tested, p&lt;0.001). Only 1 of 7 patients who had their procedures done in the interim had it done at another institution. Of the 11% of patients reconsidering their procedure, 22% were AF patients and 45% were heart failure patients. Conclusion: Within an urban population, most patients agreed with procedural postponement and felt their procedure would occur soon. Interim SARS-CoV-2 testing was associated with disagreement with postponement and one third of patients had high anxiety about postponement. In our experience, patient retention was high.
Defining best practices for tissue procurement in immuno-oncology clinical trials: consensus statement from the Society for Immunotherapy of Cancer Surgery Committee
Authors: Brian Gastman, Piyush K Agarwal, Adam Berger, Genevieve Boland, Stephen Broderick, Lisa H Butterfield, David Byrd, Peter E Fecci, Robert L Ferris, Yuman Fong, Stephanie L Goff, Matthew M Grabowski, Fumito Ito, Michael Lim, Michael T Lotze, Haider Mahdi, Mokenge Malafa, Carol D Morris, Pranav Murthy, Rogerio I Neves, Adekunle Odunsi, Sara I Pai, Sangeetha Prabhakaran, Steven A Rosenberg, Ragheed Saoud, Jyothi Sethuraman, Joseph Skitzki, Craig L Slingluff, Vernon K Sondak, John B Sunwoo, Simon Turcotte, Cecilia CS Yeung, Howard L Kaufman
Journal: Journal for ImmunoTherapy of Cancer (2020)

Immunotherapy is now a cornerstone for cancer treatment, and much attention has been placed on the identification of prognostic and predictive biomarkers. The success of biomarker development is dependent on accurate and timely collection of biospecimens and high-quality processing, storage and shipping. Tumors are also increasingly used as source material for the generation of therapeutic T cells. There have been few guidelines or consensus statements on how to optimally collect and manage biospecimens and source material being used for immunotherapy and related research. The Society for Immunotherapy of Cancer Surgery Committee has brought together surgical experts from multiple subspecialty disciplines to identify best practices and to provide consensus on how best to access and manage specific tissues for immuno-oncology treatments and clinical investigation. In addition, the committee recommends early integration of surgeons and other interventional physicians with expertise in biospecimen collection, especially in clinical trials, to optimize the quality of tissue and the validity of correlative clinical studies in cancer immunotherapy.
Abstract 17484: Prevalence, Prognosis and Predictors of Neurological Complications After Heart Transplantation
Authors: Camila Caraviello, Daniela Harsanyi, Sandrigo Mangini, Ligia Trevizan, Fernando Bacal
Journal: Circulation (2020)

Introduction: Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its benefits, this therapy still involves complications. Among them, neurological complications may impact significantly patient’s morbidity and mortality. The aim of this study is to identify the prevalence, prognosis and predictors of neurological complications after HT. Methods: Data from all patients who underwent orthotopic HT between 2007 and 2017 in a single center were collected and analyzed. Neurological complications were defined as seizures, ischemic and hemorrhagic stroke. Univariate and multivariate analysis were performed to identify significant predictors and ROC curves were generated to determine cutoff values that could influence the presence of neurological complications. Results: We assessed 132 patients from 15-76 years of age, mean age of 51.8 (73.5% men), who were mainly in INTERMACS profile 3 (78.8%). Cardiomyopathy etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated (24.4%) and other etiologies (22.2%). Neurological events before transplant were present in 16.7%. Neurological complications after HT occurred in 17.4% of patients (8.7% ischemic stroke, 60.9% hemorrhagic stroke and 30.4% seizures), mainly in the first 10 postoperative days (71.4%) and were not related to a higher mortality risk (p=0.159). In the multivariate analysis, pre-transplant adrenaline use (p-value=0.044; 95% CI of 1.07-179.25, OR 13.84) and the difference between mean systolic blood pressure before HT and on the 3rd postoperative day (p-value=0.011; 95% CI of 1.38-11.56, OR 3.99) were independent predictors of neurological complications. A cutoff value higher than 32 mmHg (between mean systolic blood pressure before HT and on the 3rd postoperative day) increased the risk of neurological complications (64.3% sensitivity, 63% specificity; AUROC 0.652). Conclusion: In this single center study, prevalence of neurological complications was high, however had no impact on prognosis. Pre-transplant adrenaline use and systolic blood pressure elevation in the 3rd postoperative day in comparison to the pre-transplant period were predictors of neurological complications.