tbuckley/cabot-search huggingface dataset:
The FODMAP diet: more than just a symptomatic therapy?
Authors: Peter R Gibson, Emma P Halmos
Journal: Gut (2021)

The introduction and adoption of the FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) diet has been a major change in the management of patients with irritable bowel syndrome (IBS) towards integrated care.1 The diet has been seen as an effective symptomatic therapy, but one that carries risks associated with exacerbating disordered eating, challenging nutritional adequacy and putatively inducing dysbiotic gut microbiota. The concept that FODMAPs are involved in pathogenic mechanisms that underlie visceral hypersensitivity2 might explain ongoing symptom control in patients after reintroducing dietary FODMAPs up to a level taken before FODMAP restriction.3 The report by Vervier et al in Gut goes one step further.4 Their study has suggested that initial FODMAP restriction might actually correct dysbiosis in a proportion of patients with IBS with consequent durable symptomatic benefit without the need for major FODMAP restriction. Furthermore, they may have provided another mechanism by which we can explain the wide variation of responses to FODMAP restriction from complete symptom resolution to worsening in a very small minority.

Reasons behind such heterogeneity of outcomes need to be defined so that the diet can be directed to the candidates more likely to respond or, more importantly, away from those highly likely not to respond. Dietary non-adherence, poor food selection, sometimes directed by misinformation on websites,5 or …
PREDICTORS OF ABNORMAL FRACTIONAL FLOW RESERVE AFTER PERCUTANEOUS CORONARY INTERVENTION
Authors: Tetsumin Lee, Gary Mintz, Mitsuaki Matsumura, Masahiro Hoshino, Eisuke Usui, Yoshihisa Kanaji, Tadashi Murai, Taishi Yonetsu, Tsunekazu Kakuta, Akiko Maehara
Journal: Journal of the American College of Cardiology (2018)
Abstract 10112: Who is Leading the Code? Assessing Team Dynamics and Communication Skills During Mock Codes
Authors: Theresa Anderson, Brad Trumpower, Lee Kamphuis, Lars Johnson, Joseph McEvoy, Nathan Houchens, T. Jack iwashyna, Brahmajee K Nallamothu
Journal: Circulation (2021)

Background: The Resuscitation Education Initiative (REdI) is a national mock code program for the Veteran Health Administration. We used the REdI rollout to study team dynamics for participants in mock codes. Methods: Mock code evaluation data was obtained from 8 Veterans Affairs Medical Centers across the nation in 2019-2020. Sites utilized a standardized templated evaluation sheet, which was modifiable to meet the needs of each mock code session (i.e., using a BLS score system rather than ACLS for a BLS code). Facilitators scored participants with a binary system of inclusion, reflecting successful or unsuccessful completion of a task. Eight categories assessed team dynamics: designating responsibilities, closed loop communication, clear messaging, knowing one’s limitations, knowledge sharing, constructive intervention, mutual respect, and summarizing. Results: Forty-four surveys representing unique mock codes were used in analysis. BLS was more often implemented during mock codes (34 vs 12 for ACLS); two codes used both ACLS and BLS, (n=44). In half of the mock code evaluations, participants did not clearly identify responsibilities or engage in closed loop communication (22/44, 50%). Notably mutual respect, which was described as speaking in a professional tone to others, was successfully met by 86.4% of participants (38/44). Participants performed poorly in the remaining categories, not meeting standards by 25% or more on evaluation (see Table). Conclusion: Mock codes are used for teaching skills involved in cardiac resuscitation. Participants did not perform well in areas involving team dynamics, and this could be an area for future attention when designing effective mock code programs.
Abstract 12046: Can We Better Predict Type a Aortic Dissection?
Authors: Varun Sharma, Miae Kang, Minesh Prakash, Jegatheesan Ganesh, Nishith Patel, Adam El Gamel
Journal: Circulation (2021)

Introduction: Type A aortic dissection is seen as a progression of aneurysmal dilation, but 60% of patients in the iRAD registry had a maximum aortic diameter (MAD) &amp;lt 55mm. Hypothesis: We theorized that a simplified marker for vessel instability (aortic ratios) and shear stress may improve predictability of dissection compared to maximal aortic diameter (MAD) alone. Methods: Retrospective cohort analysis of all patients who underwent open ascending aortic intervention at Waikato Hospital, New Zealand between 2014-2019, comparing dissection and non-dissection patients. MAD measured in mm; vessel instability as a ratio of MAD to 9 standardized points using ACCF/AHA guidelines; shear stress using MAD to height ratio. Reciever-operator-curve analysis to determine cut-off values for all markers; correlation with dissection assessed using logistic regression for propensity matched cohorts. Results: An entire cohort of 215 patients, 78 (36.3%) dissection patients, the median age at intervention 63.3 years, 52 (24.2%) females, with dissection and non-dissection patients well matched for size (Figure 1a). A diameter of &gt;55mm was only seen in the 33.3% of dissections (n=26/78, Figure 1b), and was not a predictor of dissection (OR 1.88, 95%CI 0.64-5.51). Sinus of Valsalva (SoV) to MAD ratio above 1.06 (cut-off value) was associated with OR 4.49 of dissection (95%CI 1.46-13.81); other vessel instability and shear stress ratios weren’t significant (Figure 1c). Compared to MAD, SoV:MAD ratio had greater sensitivity (0.33 vs. 0.73), lower number-needed-to-treat (17.9 vs. 2.7) and superior area-under-curve in ROC analysis (0.54 vs. 0.71) (Figure 1d). Conclusions: Aortic diameter remains poorly correlated to aortic dissection; SoV:MAD ratio has greater sensitivity, discrimination, and is better correlated with dissection.
Factors Associated With Nonattendance in a Nationwide Screening Program for Diabetic Retinopathy: A Register-Based Cohort Study
Authors: Gabriela B. Petersen, Stine Byberg, Dorte Vistisen, Mia V. Fangel, Henrik Vorum, Lene E. Joensen, Jette K. Kristensen
Journal: Diabetes Care (2021)

OBJECTIVE The aim of the study was to identify factors associated with nonattendance in a Danish nationwide screening program for diabetic retinopathy among people with type 2 diabetes. RESEARCH DESIGN AND METHODS A retrospective observational study linking individual-level register data was performed. First, we compared characteristics of 156,878 people with type 2 diabetes divided into attenders and never-attenders on the basis of their screening history over a 6-year period. Second, we assessed 230,173 screening intervals within the same 6-year period. Mixed-effects models were used to investigate the effect of sociodemographic and health-related factors on the likelihood of having a nonattender interval (i.e., failing to attend screening within the recommended interval). RESULTS A total of 42,068 (26.8%) people were identified as never-attenders, having no registered eye screening over a 6-year period. Compared with attenders, never-attenders were more frequently divorced/widowed, lived in the Capital Region of Denmark, and had poorer health. A total of 62,381 (27.1%) screening intervals were identified as nonattender intervals. Both sociodemographic and health-related factors were significantly associated with the likelihood of having a nonattender interval. The largest odds ratios for nonattendance were seen for mental illness, nonwestern descent, divorce, comorbidity, and place of residence. CONCLUSIONS Our findings suggest that never- and nonattendance of screening for diabetic retinopathy are more common among people who are divorced/widowed and of poorer health. Additionally, nonattendance is more frequent among people of nonwestern decent. These population subgroups may benefit from targeted interventions aimed at increasing participation in diabetic retinopathy screening.
Abstract 8914: Selective Phosphodiesterase-9 Inhibition With IMR-687 Mitigates Cardiac Hypertrophy and Renal Injury in Preclinical Mouse Models of Heart Failure With Preserved Ejection Fraction
Authors: Deepak K Gupta, Thiago T Maciel, Caroline Carvalho, Sheila Collins, Anna R Hemnes, Joseph A Hill, Joann Lindenfeld, Margaret M Redfield, Sanjiv J Shah, Kenneth Attie, Lynette Hopkinson, Thomas J Wang, Rahul Ballal
Journal: Circulation (2021)

Introduction: Through degradation of the cardio- and renal-protective second messenger cyclic GMP, phosphodiesterase-9 (PDE9) excess may contribute to cardiomyocyte hypertrophy, fibrosis, and renal dysfunction, common features in heart failure with preserved ejection fraction (HFpEF) development and progression. Hypothesis: Selective PDE9 inhibition with IMR-687 mitigates an adverse cardiac and renal phenotype in mouse models of HFpEF. Methods: Cardiac and renal responses to IMR-687 (60 mg/kg, 100 mg/kg) compared with vehicle were examined over 6-8 weeks in 3 adult male mouse models of HFpEF (1.5 mg/kg/d angiotensin-II infusion [ang-II]; uninephrectomy + 0.30 ug/h d-aldosterone infusion + 1% NaCl drinking water [neph-aldo]; and db/db [db]). Phenotyping included wheat germ agglutinin staining for cardiomyocyte cross-sectional area (CSA); RT-PCR for myocardial PDE9, natriuretic peptide, inflammatory and fibrosis marker transcript abundances; ELISA for plasma natriuretic peptides; and urinary albumin to creatinine ratio (UACR). Results: IMR-687 reduced median cardiomyocyte size (CSA) by 54, 58, and 35% compared with vehicle in the ang-II, neph-aldo, and db models, respectively; p &lt; 0.003 for all. Myocardial PDE9, NPPA, NPPB, COL3A1, and IL-1β expression were decreased by IMR-687 in all models (Table). Median plasma BNP levels (pg/mL) were lower in IMR-687 vs. vehicle treated mice in all models (ang-II: 2376 vs. 5757; neph-aldo: 1216 vs. 1860; db: 830 vs. 1216); p &lt; 0.007 for all, with similar findings for ANP (Table). UACR was lower in IMR-687 compared with vehicle treated mice in all models (Table). Heart rate and blood pressure did not differ between IMR-687 and vehicle treated mice. Conclusion: Selective PDE9 inhibition with IMR-687 was effective for prevention and treatment of cardiac hypertrophy and renal dysfunction in 3 different preclinical models of HFpEF. IMR-687 may be a promising candidate therapy for testing in clinical trials of human HFpEF.
Abstract 10585: Racial Differences in Arterial Stiffness Following Acute Bouts of Anaerobic Exercise
Authors: Huimin Yan, Noelle Merchant, Nicole Bajdek
Journal: Circulation (2021)

African Americans (AA) experience an exaggerated hemodynamic response during recovery from aerobic exercise compared to Caucasian Americans (CA). There is also evidence that local arterial stiffness increases and systemic vasculature stiffness decreases following aerobic exercise. Despite the growing popularity of high-intensity anaerobic exercise, no study has examined racial differences in arterial stiffness following maximal anaerobic exercise between AA and CA women. Purpose: To compare local and systemic arterial stiffness during recovery from repeated bouts of maximal anaerobic exercise in young, healthy AA and CA women. Methods: Twenty (AA: n=8, age = 22±1yrs, BMI = 24.7±0.8 kg/m 2 ; CA: n=12, age = 22±1 yrs, BMI = 22.9 ±0.7 kg/m 2 ) healthy women without hypertension completed two bouts of maximal anaerobic exercise on a cycle ergometer with 30 minutes of recovery between bouts. Hemodynamic measurements were taken at resting, and 5 (P5-post-EX1), 15 (P15 post-EX1), and 30 minutes (P30 post-EX1) following a maximal anaerobic exercise test on cycle ergometer, and 5 (P5 post-EX2), 15 (P15 post-EX2), and 30 (P30 post-EX2) minutes following the second maximal anaerobic exercise test. Local carotid arterial compliance (AC) was assessed using ultrasonography and systemic arterial stiffness was assessed by augmentation index (AIx@75) and segmental arterial stiffness assessed by central Pulse Wave Velocity (cPWV) using SphygmoCor. Data were analyzed by 2 by 7 (race *time) repeated measures ANOVA. Results: See Table 1. Conclusion: There is less variation in local carotid arterial compliance in AA women compared to CA women following repeated bouts of maximal anaerobic exercise despite similar systemic or segmental arterial stiffness. Racial differences in arterial distensibility between AA and CA women in response to maximal anaerobic exercise may be limited to localized changes in the predominantly elastic carotid artery.
<i>Pax5</i> Heterozygosity Delays BCR Expression in Preb-II Cells and Generates a Preleukemic Population
Authors: Franziska Auer, Juha Mehtonen, Mikko Sipola, Mina Morcos, Aleksandra Pandyra, Arndt Borkhardt, Merja Heinäniemi, Julia Hauer
Journal: Blood (2021)
NIMG-69. FREQUENCY OF TUMOR-RELATED VASCULATURE IN PRIMARY CNS LYMPHOMA ON ROUTINE MRI
Authors: Trusha Shah, Alipi Bonm, Jerome Graber
Journal: Neuro-Oncology (2021)

Abstract Primary central nervous system lymphoma (PCNSL) is known to express angiogenic factors and can have spontaneous or biopsy-related hemorrhage. Radiographically, PCNSL is characterized by homogenous enhancement and diffusion restriction, as well as T2/FLAIR abnormalities. A higher frequency of tumor-related vessels has been reported in gliomas compared to brain metastases, but this has not been assessed in PCNSL. We used a clinical database of patients with PCNSL treated at the University of Washington and reviewed pretreatment MRIs for 48 patients treated between 2014-2021 for whom susceptibility sequences were available. Median age at diagnosis was 64 years (range 35-90 years). Patients were 27.1% male and 72.9% female. Each lesion was scored by at least two independent reviewers for the presence of a prominent vessel located either centrally or eccentrically, and for the presence of hemorrhage. Lesions that were scored differently by the two reviewers (n=26) were then scored by a third independent reviewer. In several cases the findings were felt to be indeterminate. Lesions were considered measurable if they were greater than 5 mm in two perpendicular planes, and a total of 93 measurable lesions were categorized. Prominent vessels were seen in 56/93 (60.2%) lesions, with 26/56 (46.4%) being central and 30/56 (55.4%) being eccentric. An additional 7/93 (7.5%) lesions were indeterminate. Hemorrhage was seen in 11/93 (11.8%) lesions. We conclude that prominent vessels can be seen in a majority of PCNSL lesions on standard MRI.
Abstract 12343: A Real-World Disproportionality Analysis of Atrial Fibrillation Adverse Events for Glucagon Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors
Authors: Sahith Reddy Thotamgari, Aakash Sheth, Udhayvir Grewal, Paari Dominic
Journal: Circulation (2021)

Introduction: Diabetes mellitus (DM) is a known risk factor for atrial fibrillation (AF). Anti-diabetic agents such as metformin and sodium glucose co-transporter-2 inhibitors have been proven to have a protective role against AF. Recent data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RA) do not increase the risk of AF whereas evidence regarding dipeptidyl peptidase-4 inhibitors (DPP-4i) is limited. We sought to examine the association between AF and GLP-1 RA, DPP-4i using the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database. Hypothesis: We hypothesized that GLP-1 RA and DPP-4i may have a protective role against AF. Methods: We interrogated the FAERS database for reports of AF in patients on linagliptin, sitagliptin, saxagliptin, and alogliptin in the DPP-4i group and exenatide, liraglutide, dulaglutide, albiglutide, and semaglutide in the GLP-1 RA group. Number of AF events reported for each drug were collected and compared with all the other drugs in the FAERS database. Disproportionality analysis was performed using the reporting odds ratio (ROR). Results: We identified a total of 159,901 and 44,071 adverse event reports in the GLP-1 RA and DPP-4i groups, respectively. The reporting of AF was significantly lower for GLP-1 RA compared to all other drugs in FAERS (ROR 0.56; 95% CI 0.49-0.63). The reporting of AF was significantly higher in DPP-4i (ROR 2.02; 95% CI 1.76-2.33). Saxagliptin demonstrated the highest reporting of AF (ROR 2.67; 95% CI 2.00-3.57) followed by linagliptin (ROR 1.87; 95% CI 1.41-2.47) in DPP-4i group. Conclusions: The reporting frequency of AF was significantly lower in GLP-1 RA group. This complements the existing evidence and alludes to the protective role of GLP-1 RA against AF. In contrast, the reporting frequency of AF was significantly higher in DPP-4i group, especially with saxagliptin and linagliptin. Validation with larger prospective clinical data is needed to confirm these findings.
Abstract 13832: Perioperative Physician Care Model in Cardiothoracic Surgery: A Pilot Study
Authors: Rosie Freer, Sophie Tanner, Jo Hardwick, Alex Pitcher
Journal: Circulation (2021)

Background and Methods: Perioperative Medicine is an emerging discipline which seeks to optimise the care of patients during the preoperative and postoperative stages. This is particularly pertinent for older patients who are at an increased risk of a poor postoperative outcome. Evidence from other surgical disciplines demonstrates that Comprehensive Geriatric Assessment (CGA) is a valuable tool for optimising perioperative care. We describe the deployment of a single perioperative physician fellow, supported by consultant perioperative geriatricians, cardiologists and surgeons for a pilot 3-month period. We estimate the upper bounds of the impact that such a deployment could have on capacity and length of stay. Results: The perioperative fellow working 60% whole time equivalent undertook 80 CGAs during the 3 month pilot phase. Mean patient age was 75 ± 10 years, the ratio of female to male was 39:41. We therefore estimate that a perioperative physician could review and follow up 240 new patients per year, representing approximately 10% of the patients treated in our unit per year. However, when the perioperative fellow is directed to those patients with the longest stay lengths, there is substantial amplification of the effect size, as the top decile of patients occupy 34% of all bed-days within the cardiothoracic ward (Figure). Bed occupancy as a function of length of stay is described by non-normal distribution, and this fat-tailed distribution explains the large benefit likely to be accrued from relatively modest input costs in perioperative physicians (Figure b, Shapiro-Wilks p &lt; 0.05). Conclusion: Perioperative fellowship models are likely to be a cost-effective solution to the challenge of escalating demand for complex cardiac care in the setting of constrained supply. Future work will focus on the refinement of a neural network which will seek to allow identification of patient variables which best predict prolonged length of stay.
Abstract 9584: Familial Hypercholesterolemia Patient Perspectives and their Alignment With the FH Global Call to Action
Authors: Laney K Jones, Amanda Sheldon, Nicole Walters, Andrew Brangan, Katherine A Wilemon, Gemme Salome-Campbell, Alanna Kulchak Rahm, Sam Gidding, Amy C Sturm
Journal: Circulation (2021)

Introduction: Familial hypercholesterolemia (FH) is an inherited disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. The 2020 FH Global Call to Action, produced by international FH global advocacy organizations, individuals with FH, and scientific experts, provides nine recommendations to reduce premature death and the public health burden of FH. We explored alignment of patient and family member perspectives with these recommendations. Methods: Interviews and focus groups were conducted with individuals with FH and their family members from multiple U.S. health systems and members of the FH Foundation community to identify barriers to identification, cascade testing, and treatment. Patient-centered perspectives were sought to develop solutions that can be implemented. These perspectives were then examined and classified, according to their alignment to recommendations within the FH Global Call to Action. Results: Stories from 75 individuals with FH and family members, who participated in at least one of the qualitative assessments, were analyzed. The table lists the FH Global Call to Action recommendations with patient-centric perspectives abstracted from individuals’ stories. The most common stories and perspectives linked to the recommendations for awareness, screening, diagnosis, testing, and treatment, and family-based care. Conclusions: The Global Call to Action recommendations resonate highly with U.S. FH individuals and their family members. Patient-centric perspectives further address the need to prioritize FH as a global public health concern and support FH education and advocacy efforts.
NIMG-61. CLINICAL UTILITY OF SOMATOSTATIN RECEPTOR PET IMAGING BIOMARKERS FOR CHARACTERIZATION OF MENINGIOMA AMONG INCIDENTAL CNS LESIONS
Authors: Shannon Fortin Ensign, Muskan Argarwal, Mohamed Badawy, Thorvardur Halfdanarson, Derek Johnson, Mohamad (Bassam) Sonbol, Ayse Kendi
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Somatostatin receptor (SSTR) PET/CT is utilized with increasing frequency in the clinical treatment of neuroendocrine tumors. Incidental CNS lesions are commonly noted and presumed to be meningiomas, however 68Gallium (Ga-68)-DOTATATE radionuclide use lacks specificity for meningioma identification. Currently there is no established SSTR-based imaging criteria for classification of incidental CNS lesions. METHODS We retrospectively analyzed patients across clinical and radiological databases at Mayo Clinic who had undergone both Ga-68-DOTATATE PET/CT and brain MR imaging who had an incidental CNS lesion identified with clinical or radiographic prediction of meningioma. Known meningioma diagnoses prior to imaging were excluded. Imaging indication, semi-quantitative measures, and corresponding clinical history were analyzed to identify metrics impacting both the predictive and descriptive utility of SSTR-based imaging as compared to corresponding MRI prediction in incidental CNS lesions. RESULTS Among 59 patients with a CNS lesion identified on both imaging modalities, most scans were performed for a history of neuroendocrine tumor (71%). Cases with concordant lesion type prediction of meningioma between imaging modalities (N = 25) displayed a higher median SUV max and Krenning score on Ga-68-DOTATATE PET compared to cases with concordant prediction of other lesions (N=10) or discordant prediction of meningioma (N=24). Ga-68-DOTATATE was more likely to discordantly predict meningioma as compared to the corresponding patient MRI in cases with lower SUV max values. The addition of Qclear technology was significantly associated with diagnostic clarification in cases of imaging discordant tumor type prediction. Prior cranial radiation or use of a somatostatin mimetic did not affect quantitative radiographic measures in lesion characterization, and MRI-based tumor size was similar across groups. CONCLUSION The continued development of SSTR-based imaging biomarker signatures across incidental CNS lesion subtypes will further define the role of this imaging modality in the clinical diagnosis and management of presumed meningiomas.