tbuckley/cabot-search huggingface dataset:
Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population
Authors: Philip E. Rosenbaum, Christopher Locandro, Sara P. D. Chrisman, Meeryo C. Choe, Rachel Richards, Christina Pacchia, Lawrence J. Cook, Frederick P. Rivara, Gerard A. Gioia, Christopher C. Giza
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Pediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment. <h3>Objective</h3> To describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery. <h3>Design, Setting, and Participants</h3> This prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020. <h3>Exposures</h3> Diagnosis of mild TBI or concussion. <h3>Main Outcomes and Measures</h3> This study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment. <h3>Results</h3> A total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (<i>P</i> = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%];<i>P</i> = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%];<i>P</i> = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%];<i>P</i> = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex. <h3>Conclusions and Relevance</h3> These findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions.
Abstract 14727: Meteorin-like Glial Cell Differentiation Regulator is a Novel Protein Biomarker of Cardiovascular Outcomes in Patients With Diabetes and Vascular Disease: A TECOS Substudy
Authors: Lauren K Truby, Jessica A Regan, Maggie Nguyen, Stephani Giamberardino, Robert J Mentz, Robert W McGarrah, Yinggan Zheng, Darren K McGuire, John B Buse, Paul W Armstrong, Jennifer Green, eberhard standl, Eric D Peterson, Svati H Shah, Rury Holman
Journal: Circulation (2020)

Introduction: To date, there are limited data on the potential role of proteomic biomarkers to predict future cardiovascular (CV) events among patients with type 2 diabetes mellitus (DM). Hypothesis: Specific protein biomarkers will be predictive of major adverse CV events (MACE) and incident heart failure hospitalization (HFH) among patients with DM. Methods: Using the Olink aptamer-based platform, we performed proteomic profiling (&gt;700 proteins) on 440 paired cases and matched controls from placebo-assigned participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Cases were defined as having met the primary composite outcome of MACE or incident HFH and matched to controls on baseline prevalent heart failure, coronary artery disease, BMI, hemoglobin A1C, creatinine, low-density lipoprotein cholesterol, fasting status and ejection fraction. Conditional logistic regression was used to determine the association between log-transformed relative protein expression and incident MACE or HFH. False-discovery-rate (FDR) was used to adjust for multiple comparisons. Results: We identified three specific proteins that were significantly associated with prevalent MACE or HFH: METRNL, Notch 3, and ROR1 (OR 2.1, 1.6, 1.7 and q-value 0.01, 0.02, and 0.05 respectively) (Figure 1). METRNL, in particular, performed similarly to the established biomarker NT-proBNP (Figure 1). When MACE and HFH were analyzed separately, METRNL, in particular, remained strongly associated with both outcomes (OR 2.0, p&lt;0.001 and OR 2.7, p=0.05). Conclusions: Three novel protein biomarkers, in particular METRNL (a circulating adipokine that regulates insulin-sensitivity), may identify diabetic patients at high risk for subsequent HF and MACE. Additional studies are needed to replicate these findings and uncover the biologic mechanism linking adipokine signaling and heart failure.
Abstract 13676: Association of Plant-centered Diet Intake With Cardiovascular Disease and All-cause Mortality: Findings From the Coronary Artery Risk Development in Young Adults Study
Authors: Yuni Choi, Nicole Larson, Lyn M Steffen, Pamela J SCHREINER, Daniel D Gallaher, Daniel A Duprez, James M Shikany, Jamal S Rana, David R Jacobs
Journal: Circulation (2020)

Introduction: There is growing data regarding the potential for plant-centered diets to reduce risk for cardiovascular disease (CVD) and mortality. However, additional investigation is needed to strengthen and address inconsistencies in the existing evidence base. We examined the association between cumulative consumption of a plant-centered diet and a shift toward a more plant-centered diet and onset of CVD and all-cause mortality. Hypothesis: Nutritionally-rich plant-centered diets will be related to decreased risk of CVD and mortality. Methods: We included 4,926 black and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, ages 18-30 years and free of CVD at baseline (1985-1986, exam year [Y0]) and followed until 2018. Diet was assessed through an interviewer-administered diet history at Y0, Y7, and Y20. A Priori Diet Quality Score (APDQS) was used to assess plant-centered diet quality, and high index scores were characterized by higher consumption of nutritionally-rich plant foods with limited consumption of meats and less healthful plant foods. Proportional hazards regression estimated the association of time-varying APDQS, which were cumulatively averaged over follow-up and 13-year change in APDQS (Y7-Y20) with CVD and all-cause mortality. The model was adjusted for sociodemographic factors, energy intake, parental history of CVD, smoking, and physical activity. Results: We documented 289 new CVD cases and 445 all-cause deaths during the median 32-years of follow up. In multivariable analysis, the highest quintile of cumulative APDQS was associated with a 52% lower risk of CVD (hazard ratio [HR]: 0.48, 95% CI: 0.28-0.81) compared with the lowest quintile of cumulative APDQS. Increased APDQS over 13 years was related to a 62% lower subsequent 12-year risk of CVD (95% CI: 0.18-0.78) when comparing extreme quintiles. The association for all-cause mortality was only apparent among high educational groups. Conclusions: Following a plant-centered, high-quality diet staring from young adulthood was associated with a lower risk of developing CVD and death by middle age. Our findings support the concept that a plant-centered diet may help prevent early CVD and death.
Tumor-derived exosomal miR-934 induces macrophage M2 polarization to promote liver metastasis of colorectal cancer
Authors: Senlin Zhao, Yushuai Mi, Bingjie Guan, Binbin Zheng, Ping Wei, Yanzi Gu, Zhengxiang Zhang, Sanjun Cai, Ye Xu, Xinxiang Li, Xuefeng He, Xinyang Zhong, Guichao Li, Zhiyu Chen, Dawei Li
Journal: Journal of Hematology & Oncology (2020)

Abstract Background Mounting evidence has demonstrated the vital importance of tumor-associated macrophages (TAMs) and exosomes in the formation of the premetastatic niche. However, the molecular mechanisms by which tumor-derived exosomal miRNAs interact with TAMs underlying premetastatic niche formation and colorectal cancer liver metastasis (CRLM) remain largely unknown. Methods Transmission electron microscopy and differential ultracentrifugation were used to verify the existence of exosomes. In vivo and in vitro assays were used to identify roles of exosomal miR-934. RNA pull-down assay, dual-luciferase reporter assay, etc. were applied to clarify the mechanism of exosomal miR-934 regulated the crosstalk between CRC cells and M2 macrophages. Results In the present study, we first demonstrated the aberrant overexpression of miR-934 in colorectal cancer (CRC), especially in CRLM, and its correlation with the poor prognosis of CRC patients. Then, we verified that CRC cell-derived exosomal miR-934 induced M2 macrophage polarization by downregulating PTEN expression and activating the PI3K/AKT signaling pathway. Moreover, we revealed that hnRNPA2B1 mediated miR-934 packaging into exosomes of CRC cells and then transferred exosomal miR-934 into macrophages. Interestingly, polarized M2 macrophages could induce premetastatic niche formation and promote CRLM by secreting CXCL13, which activated a CXCL13/CXCR5/NFκB/p65/miR-934 positive feedback loop in CRC cells. Conclusions These findings indicate that tumor-derived exosomal miR-934 can promote CRLM by regulating the crosstalk between CRC cells and TAMs. These findings reveal a tumor and TAM interaction in the metastatic microenvironment mediated by tumor-derived exosomes that affects CRLM. The present study also provides a theoretical basis for secondary liver cancer.
Abstract 235: The Covid-19 Pandemic in Dallas: Increased Out-of-hospital Cardiac Arrest and Death
Authors: Lin Guo, Pamela Owens, Marshal Isaacs, Tami Kayea, Lu Ann McKee, Purav Mody, Ahamed H Idris
Journal: Circulation (2020)

Introduction: Since March, the CDC has reported weekly excess deaths of up to 40% in the US. Spikes in excess deaths were associated with spikes in COVID-19 cases. In Texas, 55% of excess deaths from March 1 to May 30, 2020 were unattributed to COVID-19. One possible source of this unaccounted excess death is out-of-hospital cardiac arrest, which corresponds to a notable decline in hospitalizations for acute cardiovascular events. Objective: To compare the number of out-of-hospital cardiac arrest (OOHCA) and dead-on-scene cases in Dallas, Texas in years prior to and during the COVID-19 pandemic. Methods: The Dallas-Fort Worth Center for Resuscitation Research Cardiac Arrest Registry provided data for this IRB-approved study. Eligible cases were non-traumatic OOHCAs who received cardiopulmonary resuscitation (CPR) from emergency medical services (EMS) providers. We compared monthly case numbers in 2017, 2018, and 2019 with case numbers in 2020 at the time of the COVID-19 pandemic in Dallas, TX. Additionally, we compared the numbers of non-traumatic deaths (declared dead on scene without receiving CPR from EMS providers) in the same timeframes. Results: While total counts of out-of-hospital cardiac arrest during the months of March to June decreased from 2017 to 2019 by 9.2% and 1.2% respectively, the number of cardiac arrest cases rose dramatically by 47.9% in 2020 (p &lt; 0.05).(Table) The percentage of OOHCAs with an initial rhythm of asystole increased as well, from 50.1% in 2018 and 2019 to 60.4% in 2020. The total number of dead-on-scene cases was also higher in March to June 2020 than in 2017 to 2019 (NS). Conclusion: Increased out-of-hospital cardiac arrest is likely contributing to the unattributed excess deaths noted during the months of the COVID-19 pandemic in Dallas, TX. The rise in cases may be indirectly attributable to COVID-19 as cardiovascular events go untreated or treated too late.
Treatment of Hidradenitis Suppurativa
Authors: S. Gerald Gever
Journal: JAMA (1968)

To the Editor:—  I read with interest the article by Knaysi et al on hidradenitis suppurativa ( 203: 19, 1968). While I completely agree that surgical treatment is needed for the chronic recurrent case of hidradenitis, I should like to point out another surgical approach not mentioned by the authors which is simpler, less likely to produce complications, and just as effective. This consists of probing and unroofing all communicating sinus tracts, cutting away all overhanging scar tissue, and curetting away necrotic tissue found in the opened tracts with or without subsequent cautery of the epithelial linings. The resultant defect is then allowed to granulate in. No graft is required, nor is immobilization necessary, so there is little chance for complications. Very little surgical talent is required as evidenced by the fact that I can ably perform the operation.  I do not have the extensive series to match the authors' since
Real-time, interactive website for US-county-level COVID-19 event risk assessment
Authors: Aroon Chande, Seolha Lee, Mallory Harris, Quan Nguyen, Stephen J. Beckett, Troy Hilley, Clio Andris, Joshua S. Weitz
Journal: Nature Human Behaviour (2020)

Large events and gatherings, particularly those taking place indoors, have been linked to multitransmission events that have accelerated the pandemic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To provide real-time, geolocalized risk information, we developed an interactive online dashboard that estimates the risk that at least one individual with SARS-CoV-2 is present in gatherings of different sizes in the United States. The website combines documented case reports at the county level with ascertainment bias information obtained via population-wide serological surveys to estimate real-time circulating, per-capita infection rates. These rates are updated daily as a means to visualize the risk associated with gatherings, including county maps and state-level plots. The website provides data-driven information to help individuals and policy makers make prudent decisions (for example, increasing mask-wearing compliance and avoiding larger gatherings) that could help control the spread of SARS-CoV-2, particularly in hard-hit regions.
Abstract 16334: An Artificial Intelligence Derived Method for Instantaneous Detection of Elevated Left Ventricular End Diastolic Pressure
Authors: Niema M Pahlevan, Rashid Alavi, Melissa Ramos, Antreas Hindoyan, Ray V Matthews
Journal: Circulation (2020)

Introduction: Instantaneous, non-invasive detection of an elevated left ventricular end-diastolic pressure (LVEDP) offers a significant benefit in diagnosis and treatment of heart failure. We recently proposed a systems approach, called cardiac triangle mapping (CTM), that uses intrinsic frequencies (IFs) of the arterial waveform and pre-ejection period (PEP) to map the global ventricular function (Pahlevan et al. Fluids 4.1 (2019): 16). Here, we tested the hypothesis that an elevated LVEDP can be detected using ECG and arterial pressure waveform by applying an artificial neural network (ANN) combined with CTM approach. Methods: This study included 46 patients (12 females, age 39-90 (66.4±9.9), BMI 20.2-36.8 (27.6±4.1)) who were scheduled for a clinical left heart catheterization or coronary angiogram at the Keck Medical Center of USC. Exclusion criteria were valvular heart disease, atrial fibrillation, or left bundle branch block. Invasive LVEDP and aortic pressure waveforms were measured using a 3F Millar transducer tipped catheter with simultaneous 3 channel ECG. The IFs were computed from pressure waveforms. PEPs were calculated as the time difference between the beginning of QRS and the uprising of the pressure waveform. A 3-layer network consisted of 6 input, 6 hidden and one output nodes was developed. LVEDP=18 mmHg was used as the cut-off for a binary outcome. Data from 34 patients were used to design the ANN (27 for training, 7 for validation). The model was tested on 12 additional patients. Results: Our results showed a specificity of 87% and a sensitivity of 96% in detecting an elevated LVEDP (Fig.1). Conclusions: Here, we demonstrated the proof-of-concept that an AI model based on reduced-order parameters (extracted from arterial waveform and ECG) can instantaneously detect an elevated LVEDP. Although our hemodynamic measurements were done invasively, all variables that are required for this AI-LVEDP calculation can be collected noninvasively.
Abstract 15069: Long Term Heart Failure Risk in Zika Myocarditis
Authors: ivan mendoza, Karina Gonzalez, Jose I Medina, Igor Morr, Yolimar Meza, Elias Urbaez, Terzic Carmen, Vicente Finizola, Francisco Lopez-jimenez, Nahir Martinez, Ivan Mendoza
Journal: Circulation (2020)

Introduction: It has been estimated that up to a billion people worldwide could be exposed to Zika re-emergence including North America. Zika was considered the worst outbreak of the century before COVID-19. There are only few reports of cardiac complications and the long-term risk of heart failure (HF) is unknown. This is the objective of this study. Methods: We included 19 patients who developed acute myocarditis within one week of symptomatic Zika, in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation including Zika confirmation, ECG, echocardiogram, Holter, cardiac MRI, coronary arteriography (2). Patient follow-up examinations were performed at 2, 6,12, 24, 36 and 48 months. Results: Of the 19 patients, 12 (63%) were female with a mean age of 49 ± 17 years with a median follow-up of 3 years. Nine patients (47%) developed acute HF; 8 (42%) with reduced ejection fraction (HFrEF) and one with preserved EF (HFrEF) and moderate to severe pericardial effusion. Two cases died suddenly in the first week of Zika onset, both with HFrEF. Treatment included sacubitril /valsartan, or ace-inhibitors, SGLT2 inhibitors, beta-blockers, aldosterone-blockers, cardiovascular rehabilitation, and in one case cardiac resynchronization therapy plus implanted defibrillator. There was no new HF onset after the acute phase of the disease. Myocarditis resolved in 10 (56%) patients. Persistent atrial and ventricular arrhythmia with normal EF observed in 5 (26%) of cases. Altogether, characteristic features of dilated cardiomyopathy that developed in 7 patients (36, 8%); 2 (11%) of them died. Conclusion: Almost half of the patients with Zika myocarditis developed acute HF during the first week of disease onset, none of the patients developed HF after the acute phase. A 3-year mortality rate of 10,5 % was observed.
Herpes Zoster (Japanese Version)
Authors: Kenneth Schmader
Journal: Annals of Internal Medicine (2018)

In the Clinic7 August 2018Herpes Zoster (Japanese Version)Correction(s) for this article:CorrectionsNov 2022Correction: Japanese Translations of In the ClinicFREEKenneth Schmader, MDKenneth Schmader, MDFrom Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina. (K.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/IsTranslatedFrom_AITC201808070_Japanese SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note: This article (available in PDF format) is the translated Japanese version of In the Clinic: Herpes Zoster (Schmader K. Herpes Zoster. Ann Intern Med. 2018;169:ITC17-ITC32. doi:10.7326/AITC201808070). Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina. (K.S.)Correction: This article was updated on 1 November 2022 to remove the glossary of terms, which was not present on the original publication, and to indicate the translators of the article.Acknowledgment: The author thanks Jennifer F. Wilson, author of the previous version of this In the Clinic.Funding Source: American College of Physicians.Disclosures: Dr. Schmader, ACP Contributing Author, reports grants from Merck & Co. and GlaxoSmithKline outside the submitted work. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0998.With the assistance of additional physician writers, the editors of Annals of Internal Medicine develop In the Clinic using MKSAP and other resources of the American College of Physicians.In the Clinic does not necessarily represent official ACP clinical policy. For ACP clinical guidelines, please go to https://www.acponline.org/clinical_information/guidelines/. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHerpes Zoster Kenneth Schmader Correction: Japanese Translations of In the Clinic Metrics Cited byCorrection: Japanese Translations of In the Clinic 7 August 2018Volume 169, Issue 3Page: JITC17-JITC32 ePublished: 17 November 2020 Issue Published: 7 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract 16365: A New Left Atrial Assist Device for Heart Failure With Preserved Ejection Fraction: <i>In Vitro</i> Test
Authors: Kiyotaka FUKAMACHI, Barry D Kuban, Christine Flick, Jamshid Karimov, David Horvath, Takuma Miyamoto, Randall Starling
Journal: Circulation (2020)

Introduction: The effective treatment for patients with heart failure with preserved ejection fraction is not yet established. We previously reported the concept of the left atrial assist device (LAAD) that pumps blood from the left atrium to the left ventricle to treat diastolic heart failure (DHF). We have now developed the first working prototype of the LAAD that can be implanted at the mitral valve level (Fig. 1). The purpose of the study was to demonstrate that the LAAD can reduce left atrial pressure (LAP) and increase cardiac output (CO) while maintaining arterial pulsatility and normal aortic valve function in the in vitro DHF model. Methods: The LAAD was tested at three pump speeds (3,600, 4,400 and 5,200 rpm) on a pulsatile mock loop with a pneumatic pump that simulated the normal function of the native ventricle, as well as mild, moderate, and severe DHF conditions, by adjusting the diastolic drive pressure to limit diastolic filling of the ventricle. Results: Without the LAAD, CO and aortic pressure (AoP) decreased dramatically: from 3.9 L/min and 102 mm Hg at normal heart condition to 1.0 L/min and 33 mm Hg at severe DHF, respectively (Fig. 2A, 2B). With LAAD support, both CO and AoP recovered to normal heart values at 4,200 rpm and surpassed normal heart values at 5,200 rpm (Fig. 2A, 2B). With LAAD support, LAP recovered to that of the normal heart condition at 5,200 rpm (Fig. 2C). The pulsatility was maintained (Fig. 2D), as all the CO went through the aortic valve. Conclusions: These initial in vitro results support our hypothesis that use of the LAAD increases CO and AoP and decreases LAP under DHF conditions, while maintaining arterial pulsatility and full function of the aortic valve.