tbuckley/cabot-search huggingface dataset:
Abstract 12817: Experimental Analysis of Bicuspid Aortic Valve Hemodynamics: Effect of Mild Aortic Dilatation on Systolic Flow Characteristics
Authors: Kaoru Hattori, Natsuki Nakama, Takada Jumpei, Eita Kawasaki, Kohei Hamada, Michinobu Nagao, Yasuhiro Goto, Hiroshi Niinami, Kiyotaka Iwasaki
Journal: Circulation (2021)

Introduction: Aortic diameter is a determinant index in deciding surgical intervention for aortic aneurysm with bicuspid aortic valve (BAV). However, the treatment of a mildly dilated ascending aorta remains controversial. We experimentally investigated influence of mild dilatation of the ascending aorta on BAV-related hemodynamics in 3 BAV morphologies. Methods: An MRI-compatible pulsatile flow circulation system incorporating an aortic valve model and aortic arch model was developed. Tricuspid aortic valve (TAV) and 3 asymmetric BAV models including RL-, RN-, and LN-BAV were constructed by suturing bovine pericardium as cusps to aorta. The aortic arch models with the ascending diameters of 30 mm (non-dilatation) and 40 mm (mildly dilatation) were compared. Streamlines and the circulations (m 2 /s) of peak systolic flow in non- and mildly dilated ascending aorta were assessed using 4D-flow MRI in each BAV morphology (Fig). Results: Streamlines showed eccentric aortic valvular outflow jets impinging on the outer curvature of the ascending aorta, proximal arch, and left-anterior supra-valvular aortic wall in RL-, RN-, and LN-BAV, respectively. Regardless of the non-dilated or mildly dilated aorta, the circulations of peak systolic flow were larger in the BAVs than the TAV model (non-dilated aorta, TAV 0.005; RL- 0.016; RN- 0.026; LN-BAV 0.011 m 2 /s, mildly dilated aorta, TAV 0.009; RL- 0.017; RN- 0.028; LN-BAV 0.025 m 2 /s). Right-handed rotation was observed in RL- and RN-BAV, whereas LN-BAV presented left-handed rotation. In LN-BAV, the circulation markedly increased in the mildly dilated ascending aorta. Conclusions: Asymmetric BAV morphology was associated with highly eccentric aortic valvular outflow jet that directly impinged on the aortic wall, and the large circulation of peak systolic flow. The dilatation of the ascending aorta, even mild dilatation, might induce further increase in the circulation of systolic flow, especially in LN-BAV morphology.
Abstract 12609: Contemporary Trends of Outcomes in Left Ventricular Assist Device: Insight From Nationwide Readmission Database
Authors: Ankur Kalra, Monil Majmundar, Ashish Kumar, Rajkumar Doshi, Mariam Shariff, Zachary J Il’Giovine, Varinder Randhawa, Wai Hong W Tang, Randall Starling, Jerry Estep
Journal: Circulation (2021)

Hypothesis: We aimed to analyze trends of 30-day readmission and find high-risk patients associated with increased risk of mortality, resource utilization, and readmission after primary left ventricular assist device (LVAD) implantation. Introduction: Limited data exist on the contemporary trends of readmission rates and patients at a higher risk of worse outcomes post-LVAD. Methods: This is a retrospective study of adults from the NRD who received primary durable LVAD implantation from 2010-2018. The main outcomes were 30-day readmission rates and their trends in patients with primary durable LVAD implantation from 2010-2018. This study also sought to identify the patients at the highest risk for readmission, in-hospital mortality, and resource utilization. Results: A total of 31,002 adults with primary durable LVAD implantation were included in the present analysis. Overall, 3808 (12.3%) died, and 27168 (87.6%) were discharged alive. Of those discharged alive, 8303 (30.6%) patients were readmitted within 30 days. The trend of 30-day all-cause readmission among LVAD implantation patients remained similar from 2010-2018 (p=0.809). The in-hospital mortality during index hospitalization significantly decreased (p=0.014), and the mean cost of index hospitalization increased (p=0.031) during the study period. The patients with post-LVAD in-hospital cardiac, vascular, and thromboembolic complications (i.e., high-risk patients) had the highest mortality, resource utilization, and readmission rates as compared with patients without major complications. Conclusions: This study found that the readmission rates associated with LVAD implantation did not change from 2010-2018 and identified high-risk patients who may benefit from closer monitoring after primary LVAD implantation.
Evolution under Spatially Heterogeneous Selection in Solid Tumors
Authors: Guanghao Li, Zuyu Yang, Dafei Wu, Sixue Liu, Xuening Li, Tao Li, Yawei Li, Liji Liang, Weilong Zou, Chung-I Wu, Hurng-Yi Wang, Xuemei Lu
Journal: Molecular Biology and Evolution (2021)

Spatial genetic and phenotypic diversity within solid tumors has been well documented. Nevertheless, how this heterogeneity affects temporal dynamics of tumorigenesis has not been rigorously examined because solid tumors do not evolve as the standard population genetic model due to the spatial constraint. We therefore, propose a neutral spatial (NS) model whereby the mutation accumulation increases toward the periphery; the genealogical relationship is spatially determined and the selection efficacy is blunted (due to kin competition). In this model, neutral mutations are accrued and spatially distributed in manners different from those of advantageous mutations. Importantly, the distinctions could be blurred in the conventional model. To test the NS model, we performed a three-dimensional multiple microsampling of two hepatocellular carcinomas. Whole-genome sequencing (WGS) revealed a 2-fold increase in mutations going from the center to the periphery. The operation of natural selection can then be tested by examining the spatially determined clonal relationships and the clonal sizes. Due to limited migration, only the expansion of highly advantageous clones can sweep through a large part of the tumor to reveal the selective advantages. Hence, even multiregional sampling can only reveal a fraction of fitness differences in solid tumors. Our results suggest that the NS patterns are crucial for testing the influence of natural selection during tumorigenesis, especially for small solid tumors.
NCOG-46. WHITE MATTER TRACT INVOLVEMENT BY INTRA-AXIAL BRAIN TUMORS; DIAGNOSTIC &amp; THERAPEUTIC IMPLICATIONS
Authors: Saqib Kamran Bakhshi, Ayesha Quddusi, Danish Mahmood, Muhammad Waqas, Muhammad Shahzad Shamim, Fatima Mubarak, Syed Ather Enam
Journal: Neuro-Oncology (2021)

Abstract Diffusion tensor imaging (DTI) is a relatively recent modality which aids in visualization of WMT and their relation to intracranial lesions. Despite almost two decades since the beginning of its use in tumor resection, there is still dearth of data on its diagnostic and prognostic value from low- and middle-income countries. We aimed to assess the pattern of involvement of white matter tracts (WMT) by intra-axial brain tumors on DTI. Secondary objectives were to evaluate implications of involvement of WMT on surgical resection, and post-operative functional outcome. This was a retrospective study of 77 consecutive patients, who underwent DTI guided surgery for brain tumors. The involvement of WMT by tumors on DTI was assessed by a radiologist (who was blind to the pathology) using the Witwer classification. The pathology was reported by histopathologists using WHO brain tumor classification. Karnofsky Performance Scale (KPS) was used for assessing patients’ neurological status at admission, and at follow-up. Forty-five (58.4%) out of 77 tumors reviewed, caused infiltration of WMT, whereas only 22 (28.6%) tumors caused displacement of WMT (p = 0.040). Among 32 cases of astrocytoma, involvement of WMTs was influenced by the grade of tumor (p = 0.012), as high-grade tumors caused infiltration (19; 59.4%), unlike low grade tumors which commonly caused displacement (2; 50%). Oligodendroglioma caused infiltration/disruption of WMTs in most cases, irrespective of the grade (19 out of 25 cases; 76%). At last follow-up, 27 (35.1%) patients showed improvement in KPS and 14 (18.2%) reported deterioration, while there was no change observed in 36 (46.8%) patients. Infiltration of WMTs was associated with poor functional outcome. We conclude that intra-axial brain tumors mostly cause infiltration of WMTs, particularly high-grade astrocytoma, and oligodendroglioma of any grade. Infiltration of WMTs is associated with poor functional outcome at follow-up.
Abstract 14397: Severity of Sleep Apnea in Patients Receiving Catheter Ablation of Atrial Fibrillation: A Comparison of Home Sleep Apnea Test and Polysomnography
Authors: Nobuaki Tanaka, Masato Okada, Koji Tanaka, Yuko Hirao, Shinichi Harada, Katsuomi Iwakura, Kenshi Fujii, ATSUNORI OKAMURA
Journal: Circulation (2021)

Introduction: Sleep apnea is highly prevalent in patients referred for catheter ablation (CA) of atrial fibrillation (AF). A watch-type peripheral arterial tonometry (WP) as a home sleep apnea test demonstrates a high degree correlation of the apnea-hypopnea index (AHI) with Polysomnography (PSG), but the evidence of the accuracy in patients with AF is not adequate. Methods: This was a single-center, retrospective, observational study. The data were derived from screening tests using WP for sleep apnea, which was routinely performed in patients scheduled to receive CA of AF in our institution. After excluding patients already diagnosed with sleep apnea, we enrolled 464 consecutive patients (age 65±11 years, 76.5% male, and 54.9% of non-paroxysmal AF) who underwent both WP and PSG. PSG was performed after the CA during hospitalization. We compared the AHI using WP with that using PSG in patients receiving CA of AF. The severity of the sleep apnea was stratified as follows: normal (AHI&lt;5), mild (5≤AHI&lt;15), moderate (15≤AHI&lt;30), and severe (30≤AHI). Results: The AHI using WP (WP-AHI) was 25.9±12.7, and that using PSG was 31.4±18.9. There was a moderate correlation between the WP-AHI and AHI (r=0.48). According to the WP-AHI, the number of patients with normal, mild, moderate, and severe sleep apnea were 4 (0.9%), 85 (18.3%), 236 (50.9%), and 139 (30.0%), respectively. According to the AHI, there were 20 (4.3%), 70 (15.1%), 162 (34.9%), and 212 (45.7%) patients with normal, mild, moderate, and severe sleep apnea, respectively. In 85 patients with mild sleep apnea evaluated by WP, 38 (44.7%) and 15 (17.7%) patients were classified as moderate and severe using PSG. In 236 patients with moderate sleep apnea evaluated by WP, 100 (42.4%) were classified as severe using PSG. Conclusions: The AHI using WP was smaller than that using PSG. Further, a certain proportion of patients with mild or moderate sleep apnea using WP were diagnosed with severe sleep apnea evaluated by PSG.
Abstract 10672: Long-Term Need for Heart Transplantation and Post-Transplantation Survival After Fontan Palliation
Authors: Lydia K Wright, Amanda S Thomas, J'Neka S Claxton, Divya Suthar, Fawwaz R Shaw, William T Mahle, Lazaros Kochilas, Shriprasad R Desphande
Journal: Circulation (2021)

Introduction: Fontan palliation for single ventricle frequently leads to heart failure and need for transplant; timing and factors associated with post-Fontan transplant, as well as post-transplant outcomes are not well understood. Methods: This is a retrospective cohort study of patients undergoing Fontan in the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry of pediatric cardiac interventions. Deaths and transplants were captured in the PCCC and by linkage with the National Death Index and the Organ Procurement Transplant Network through 2019. Results: Between 1982 and 2003, 2,071 patients were enrolled in the PCCC and had their Fontan between 1988 and 2011. During Fontan hospitalization 151 deaths and 6 transplant listings occurred; 201 additional deaths and 148 listings occurred after discharge (Figure A). Cumulative incidence of transplant listing was 7.1% (95% CI 6.0-8.3) with the median time post Fontan being 11.1 years (IQR 5.3 - 13.8). After adjustment for risk factors, systemic right ventricle (HR 2.69; 95% CI 1.87 - 3.88) and &gt;30-day length of stay after Fontan (HR 2.29; 95% 1.51 - 3.48) were associated with transplant listing. Among listed patients, 112 (73%) underwent isolated heart transplant, 2 (1%) underwent heart-liver transplant, 20 (13%) died on the waitlist, and 20 (13%) are alive without transplant. One-year post-transplant survival was 70% for transplants before 2010 and 95% after 2010 (Figure B). Graft failure was associated with transplant before 2010 (HR 6.34; 95% CI 2.21-18.2), diagnosis of hypoplastic left heart syndrome (HR 3.71; 95% CI 1.38 - 9.92), and bilirubin &gt;2mg/dl at time of transplant (HR 2.79; 95% CI 1.03 - 7.58). Conclusion: Need for heart transplant is frequent post Fontan, but many die without listing. With significant improvements in post-transplant outcomes in recent years, timely transplant evaluation before significant end-organ dysfunction may improve survival for patients with single ventricle.
Molecular characterization of the histone acetyltransferase CREBBP/EP300 genes in myeloid neoplasia
Authors: Sunisa Kongkiatkamon, Simona Pagliuca, Vera Adema, Yasunobu Nagata, Cassandra M. Kerr, Wencke Walter, Hassan Awada, Stephan Hutter, Carmelo Gurnari, Heesun J. Rogers, Manja Meggendorfer, Yogen Saunthararajah, Torsten Haferlach, Valeria Visconte, Jaroslaw P. Maciejewski
Journal: Leukemia (2021)
Efficient cellular annotation of histopathology slides with real-time AI augmentation
Authors: James A. Diao, Richard J. Chen, Joseph C. Kvedar
Journal: npj Digital Medicine (2021)

In recent years, a steady swell of biological image data has driven rapid progress in healthcare applications of computer vision and machine learning. To make sense of this data, scientists often rely on detailed annotations from domain experts for training artificial intelligence (AI) algorithms. The time-consuming and costly process of collecting annotations presents a sizable bottleneck for AI research and development. HALS (Human-Augmenting Labeling System) is a collaborative human-AI labeling workflow that uses an iterative "review-and-revise" model to improve the efficiency of this critical process in computational pathology.
Abstract 12574: Syndromic Neonates With Symptomatic Tetralogy of Fallot Have Lower Early Mortality With Staged Repair Compared to Primary Repair
Authors: Teresa M Lee, Andrew C Glatz, Christopher J Petit, Bryan H Goldstein, Athar M Qureshi, George Nicholson, Mark A Law, Jeffrey Meadows, Jeffrey Zampi, Jennifer Romano, Christopher Mascio, Shabana Shahanavaz, Asaad Beshish, Shiraz A Maskatia, Sarosh P Batlivala, Joelle Pettus, Michael Kelleman, Courtney McCracken, Wendy Chung
Journal: Circulation (2021)

Introduction: Neonates with symptomatic tetralogy of Fallot (sTOF) require early intervention with staged repair (SR) or primary repair (PR). As sTOF is commonly associated with genetic syndromes, we examined outcomes of SR vs. PR for syndromic sTOF neonates. Hypothesis: We hypothesized that syndromic neonates with sTOF who underwent SR will have lower early mortality compared to PR. Methods: Syndromic neonates with sTOF who underwent initial intervention (initial palliation followed by later SR, or PR) from 2005-2017 were reviewed. The primary outcome was death. Secondary outcomes included complications, and hospital and intensive care unit (ICU) lengths of stay (LOS). Unadjusted and propensity score adjusted outcomes were compared. Results: The 176 syndromic sTOF neonates consisted mostly of DiGeorge (35%), trisomy 21 (16%), and VACTERL (10%). There were 110 and 66 neonates in the SR and PR groups, respectively. DiGeorge syndrome, pulmonary atresia, prematurity, and pre-procedural ventilation were more common in the SR group. The adjusted overall hazard of death was similar between groups, but early mortality favored SR (Figure). Procedural complications were lower in the SR group at the index procedure, but SR is associated with longer cumulative hospital and ICU LOS (Table). Conclusions: In syndromic neonates with sTOF, there was an early survival benefit to SR compared to PR, although there was no overall survival difference. The cumulative cost of the SR strategy was longer hospital and ICU LOS. These findings do not suggest a single superior management strategy in the syndromic sTOF population.
Audio Interview: The Omicron Variant of SARS-CoV-2
Authors: Eric J. Rubin, Lindsey R. Baden, Salim S. Abdool Karim, Stephen Morrissey
Journal: New England Journal of Medicine (2021)

The Omicron Variant of SARS-CoV-2 In this audio interview conducted on November 29, 2021, the editors are joined by South African researcher Salim Abdool Karim to discuss the omicron variant recent...
Extending the Child Tax Credit to Break the Cycle of Poverty
Authors: Catherine G. Coughlin, Allison Bovell-Ammon, Megan Sandel
Journal: JAMA Pediatrics (2021)

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Abstract 12031: Out of Pocket Expenditure for In-Patient Care of Cardiovascular Disease in India: A Gender-Based Analysis Using National Sample Survey Data
Authors: Bhanu Duggal, SUPARNA PAL, Mona Duggal
Journal: Circulation (2021)

Introduction: This study aims to examine the out-of-pocket expenditure (OOPE) pattern for hospitalisation in cardiovascular diseases (CVD) from a gender perspective. Methods: This study is based on 75 th round National Sample Survey (NSS) data (2017-2018), conducted by Government of India, covering the sample of 1,13,823 households from all States and Union Territories of India. NSS data considers CVD as Hypertension (HTN) and Heart Disease (HD). The sample size of hospitalisation cases in HTN and HD are 1418 and 4726 respectively based on 365 days recall period from the date of survey. Here, average OOPE per hospitalisation is estimated as μ Medical expenditure includes costs on doctor’s fee, medicine, diagnostic tests, bed charges, and other medical expenses. To analyse the data statistical and econometric tools like, multivariate regression, t test, χ2 test, ANOVA are used. Results: Multivariate analysis confirms that average OOPE per hospitalisation of CVD is significantly lower for female than male (β = -0.233, p = 0.000, CI: -0.348, -0.118) even after controlling socio-economic and demographic factors including place of residence, age, education, income status (Monthly Per capita Consumption Expenditure ,MPCE), social groups, occupation of the household, zones, marital status, household size, and, possession of health insurance. The average OOPE for male is significantly higher than the female, 1.6 and 1.7 times for HD and HTN respectively. For HD, this gap increases with the increase in education level. Across the six zones, average OOPE in both HTN and HD is higher for male than the female except Eastern zone. This gender gap in OOPE is more common among married and widow/divorced as compared to the single. Conclusion: Gender disparity prevails in OOPE for cardiovascular disease, which needs attention at the policy level go achieve the development goals. Fig:Distribution of OOPE per hospitalisation between Male and Female across Socio-economic strata ( in INR '000.)
SURG-01. CYSTIC BRAIN METASTASES MANAGED WITH RESERVOIR PLACEMENT AND STEREOTACTIC RADIOSURGERY
Authors: David Park, Prashin Unadkat, Anuj Goenka, Michael Schulder
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Stereotactic radiosurgery (SRS) has become a mainstay of treatment for patients with metastatic brain tumors. However, metastatic tumors with a large cystic component often exceed the size limit for safe and effective SRS. In such cases, surgical resection may not be the preferred first method of treatment, due to tumor location, patient co-morbidities, and patient preference. In such cases volume reduction by cyst aspiration followed by SRS may be a preferred option. OBJECTIVE To present the treatment of patients with cystic metastases using reservoir placement followed by SRS. METHODS Seven patients were treated with this method. We performed reservoir insertion for the aspiration of cystic component in each patient and followed that with outpatient SRS. RESULTS Mean overall volume reduction from this treatment method was 80% (range 46.5-94.9). Mean volume reduction from the cyst aspiration alone was 60.7% (range 3.5-90.9), and after SRS a further 71.6% (range 34.6-94.4), accounting for some cyst reaccumulation between the time of surgery and SRS. The interval between those two procedures were 24 days on average (range 11-58 days). Repeat reservoir aspiration was done a total of 10 times in 5 patients. CONCLUSION Cyst aspiration with reservoir placement followed by SRS is a good option for patients with large cystic brain metastases. The reservoir allows for repeat aspiration if needed. Catheter placement at the center of the cyst, and SRS within 2-3 weeks of surgery, can maximize the likelihood of a successful outcome.
Abstract 13192: Local Delivery of Thrombin Inhibiting Nanoparticles Preserves Cardiac Function and Modulates NLRP3 Inflammasome Processes in Acute Myocardial Infarction
Authors: Ian Vargas, Qingyu Zhou, Ryan Grabau, Junjie Chen, Carla J Weinheimer, Attila Kovacs, William Dominguez-Viqueira, Hua Pan, Samuel Wickline
Journal: Circulation (2021)

Introduction: The role of thrombin in acute myocardial infarction (AMI) has been well described, with recent attention having turned to its effect on NLRP3 inflammasome activation and the role that plays in the pathogenesis of AMI. Perfluorocarbon nanoparticles conjugated to phenylalanine-proline-arginine-chloromethylketone (PPACK NPs) are extremely potent local inhibitors of thrombin, but their role in therapy for AMI remains unclear. We hypothesize that pre-treatment with sustained locally acting PPACK NPs preserves cardiac function by attenuating thrombin-induced inflammatory processes, including those driven by the NLRP3 inflammasome. Methods: Nine mice underwent left anterior descending (LAD) occlusion for 45 minutes. At 30 minutes before LAD occlusion, mice were injected with PPACK (n=5) or control NPs (n=4). 24 hours post-reperfusion, hearts were excised and perfused. LAD was re-occluded and Lectin-488 perfused through the excised heart. Echo was performed pre- and post-reperfusion to assess cardiac function. Hearts were sectioned for follow up histological and protein analysis. Results: PPACK NP treated mice exhibited evidence of preserved cardiac function 24 hours post-reperfusion (Figure 1, A-B), reduced nuclear translocation of p65 in infarcted myocardium (Figure 1, C-D), and reduced inflammatory markers with better vessel preservation in the area adjacent to uninjured myocardium (Figure 1, E-F). The PPACK NP group also demonstrated suppression of NLRP3 inflammasome activation (Figure 2). Conclusion: Local inhibition of thrombin with anti-inflammatory PPACK NPs preserves cardiac function when administered systemically as pre-treatment.