tbuckley/cabot-search huggingface dataset:
Abstract 16324: The Overall Haemostatic Potential: A Novel Coagulation Measure Associated With Sex-specific Differences in Early Atherosclerosis and Metabolic Dysfunction
Authors: Katharine A Kott, Marie-Christine Morel-Kopp, Stephen T Vernon, Yuki Takagi, Christopher Ward, Gemma A Figtree
Journal: Circulation (2020)

Introduction &amp; Aim: Plaque micro-ruptures and associated thrombosis are a contributor to the progression of coronary artery disease (CAD). We sought to determine if disorders of haemostasis detectable by a global coagulation assay was a novel risk factor for CAD, or if hypercoagulation was associated with any of the traditional cardiac risk factors. Methods: Using the BioHEART biobank of clinical data, imaging data and pathology specimens, a cohort of patients (mean age 62.9 +/- 9.9 years, n=103 female, 103 male) had platelet poor plasma assessed by the overall haemostatic potential (OHP) assay. This assay measures the integrated effect of procoagulant, anticoagulant and fibrinolytic factors via calculation of area under a fibrin time curve. All patients had CT coronary angiograms scored; calcified plaque was identified by the coronary artery calcium score, and non-calcified plaque burden by a soft plaque score (SPS). Analysis was segregated by sex because of baseline differences in coagulation between males and females. Results: The OHP was found to be elevated in male patients who had non-calcified CAD [SPS&gt;0 - 10.4 +/- 0.6 (n=62) vs SPS=0 - 8.78 +/- 0.5 (n=41), p=0.04], male patients with obesity [BMI &gt;= 30 - 12.6 +/- 1.1 (n=26) vs BMI &lt; 30 - 8.8 +/- 0.4 (n=77), p&lt;0.01] and in female patients with hyperlipidaemia [hyperlipidaemic 11.8 +/- 0.6 (n=63) vs normolipidaemic 9.2 +/- 0.6 (n=40), p&lt;0.01]. No differences were seen in OHP with calcified CAD, hypertension, diabetes mellitus, current or previous smoking history, or significant family history of CAD. Conclusions: These results indicate that hypercoagulation is associated with more biologically active non-calcified plaque, and that disordered coagulation is associated with two significant cardiac risk factors in a sex-discrepant manner. These findings underscore the importance of global coagulation assessments as potential novel, sex-specific biomarker for subclinical atherosclerosis.
Abstract 355: Using Low-Fidelity Simulation with Hospital Specific Equipment to Improve Front Line Nursing Staff Knowledge, Skill, and Confidence in a Code Blue
Authors: Shauna R McCullough-Leewright
Journal: Circulation (2020)

Introduction: At this facility, staff response to unresponsive victims prior to arrival of Rapid Response Team is unreliable. The gaps in care reported by debrief forms include unable to find and use equipment on the crash cart, unable to appropriately document Code Blue in EHR, and not performing adequate CPR. Currently, the nursing staff is required to maintain Basic Life Support (BLS) and Advanced Life Support (ALS) (per their job description) via the Resuscitation Quality Improvement (RQI) program. RQI delivers quarterly training via computer scenarios and mannequin simulations. There is no consideration in RQI for hospital specific equipment or processes. The recommendation for improving staff response to code situations is to incorporate an annual Mock Code Event for all nursing staff to improve performance during code situations, in addition to RQI quarterly activities. Hypothesis: Participating in an instructor led Mock Code Event annually to review hospital specific equipment and processes, along with the quarterly RQI simulations, will improve staff response to code blue situations. Methods: The Mock Code Event included stations to review items in crash cart, use of defibrillator, documenting in EHR, and review of BLS. After completing the stations, the staff participated in a low-fidelity code blue simulation with a debrief. At end of activity, participants voluntarily completed a survey regarding Mock Code Event. Results: The participants scored 6 items on a Likert scale (from 1 disagree to 5 agree). 457 RNs and PCTs attended Mock Code Events in 2019. 189 completed survey after event. Conclusion: The survey findings demonstrate the Mock Code Event was an effective method to improve knowledge, skill, and confidence of front-line staff during Code Blue situations. The survey findings support that the educational techniques used were helpful and easy to understand.
Abstract 15083: Exercise Left Ventricular Ejection Fraction Predicts Long-term Brain Natriuretic Peptide Levels in Patients Undergoing Surgery for Severe Secondary Ischemic Mitral Regurgitation
Authors: Carlo Fino, Isabelle Piazza, Bruno Vito Domenico, Philippe Pibarot, Attilio Iacovoni, Maurizio Merlo, Julien Magne, Amedeo Terzi, Andrea Pozzi, Massimo Caputo, Michele Senni, Caterina Simon, Paolo Ferrero
Journal: Circulation (2020)

Background and Objective: Surgical treatment of severe secondary ischemic mitral regurgitation (IMR) may improve symptoms and functional capacity, however there are few data on its effect on long-on the evolution of heart failure. Time-course changes in brain natriuretic peptide (BNP) are a good marker of the heart failure status and outcomes. We investigated the association between the exercise stress echocardiographic (ESE) parameters and the changes in brain natriuretic peptide (BNP) following surgery for secondary IMR. Methods: We prospectively analyzed data on 50 patients (median age: 67, 61-64 y; EF: 35, 34-40%), undergoing mitral valve annuloplasty or replacement and coronary artery bypass graft (CABG). A valve annuloplasty with undersized ring was performed in 20 patients (40%) and a replacement in 30 (60%). A six minute walking test (6-MWT), BNP levels and ESE were performed at 1 year and at median follow-up (FU) of 6 years (4-7). Results: BNP level was: 388 (329-441) pg/ml before surgery, 175 (142-743) pg/ml at 1 y, and 123 (100-979) pg/ml at last FU (p=0.2). The relative changes of BNP from baseline to last FU significantly correlated with exercise tricuspid annulus plane systolic excursion (TAPSE) at last FU (r= -0.7, p&lt;0.001), with preoperative and FU exercise LVEF, respectively ( r=-0.7 p= 0.01) (r=-0.93, p&lt;0.001).On multivariable analysis, preoperative exercise EF was strongly and independently associated with independent BNP levels at last FU and with the changes in BNP from baseline to last FU. Conclusions: Despite surgical treatment of severe secondary IMR, BNP levels progressively increased over time in nearly 50% of the patients. Lower preoperative and 1-year FU exercise-stress EF was associated with increased levels of BNP during FU..
A Multicentre Randomised Trial of First Line Treatment Pathways for Newly Diagnosed Immune Thrombocytopenia: Standard Steroid Treatment Versus Combined Steroid and Mycophenolate. the Flight Trial
Authors: Charlotte A Bradbury, Rosemary Greenwood, Julie Pell, Katie Breheny, Rebecca Kandiyali, Jenny Ingram, Ian Thomas, Catherine Bagot, Quentin Hill, HaemSTAR Collaborators, Nichola Cooper
Journal: Blood (2020)
Abstract 15939: Neither Moderate Consumption of Sugarcane Liquor (“Cachaca”) Nor of Red Wine Affect Cardiovascular Risk Biomarkers in Healthy Individuals
Authors: Pedro H Cellia, Eduardo G Lima, Eduardo Moreira, Livia B Barbosa, fabio g pitta, Fabiana H Rached, Celia M Strunz, Desiderio Favarato, Cibele L Garzillo, Carlos V Serrano
Journal: Circulation (2020)

Introduction: It is well established that moderate consumption of red wine is associated with reduced risk of cardiovascular (CV) events. Many observational studies have shown that this same benefit could be seen with other alcohol beverages different from wine. However, the correlation between the Brazilian sugarcane liquor (“cachaca”) and CV benefit has not been demonstrated in human trials. Hypothesis: Cachaca causes changes in biomarkers of CV risk in the same proportion as wine. Methods: In this crossover randomized study, healthy individuals were initially designated to have daily moderate alcohol consumption (MAC) of either cachaca or red wine for a period of 4 weeks. MAC, for both drinks, was denoted as a daily dose equivalent of 28g of alcohol for men and 14g for women. Then, after an abstinence period of 7 days, drink types were switched for more 4 weeks. Analysis of CV risk biomarkers were determined before and after each intervention, and consisted of C-reactive protein, lipid profile, platelet aggregability and glycid profile. (This research was funded by FAPESP 2018/09675-4). Results: Of the 37 individuals originally enrolled, 2 refused to continue the study. The average age of the individuals was 41.7 (±15.3 years) and 43.2% were men. Adherence to the protocol was considered essentially ideal, with 100% of regular use in both interventions and only 3 individuals reporting abuse during the study period. There was no significant variation in anthropometric measurements during the study, except for a weight gain (0.6kg) with red wine (p = 0.011). As seen in the table, no significant changes were noted in the inflammatory markers, lipid profile, platelet aggregability nor glycid profile before and after each intervention. Conclusions: This study shows that in healthy individuals, neither red wine nor cachaca changed CV biomarkers related to atherosclerotic progression after 4 weeks of MAC. However, there was a marked weight gain with daily wine consumption.
Injury incidence, severity and profile in Olympic combat sports: a comparative analysis of 7712 athlete exposures from three consecutive Olympic Games
Authors: Reidar P Lystad, Alexander Alevras, Iris Rudy, Torbjørn Soligard, Lars Engebretsen
Journal: British Journal of Sports Medicine (2020)

To describe and compare the epidemiology of competition injuries in unarmed combat sports (ie, boxing, judo, taekwondo and wrestling) in three consecutive Olympic Games.Prospective cohort study using injury data from the IOC injury surveillance system and exposure data from official tournament records at three consecutive Olympic Games (ie, Beijing 2008, London 2012 and Rio de Janeiro 2016). Competition injury incidence rates per 1000 min of exposure (IIRME) were calculated with 95% CIs using standard formulae for Poisson rates.The overall IIRME was 7.8 (95% CI 7.0 to 8.7). The IIRME in judo (9.6 (95% CI 7.8 to 11.7)), boxing (9.2 (95% CI 7.6 to 10.9)) and taekwondo (7.7 (95% CI 5.6 to 10.5)) were significantly higher than in wrestling (4.8 (95% CI 3.6 to 6.2)). The proportion of injuries resulting in >7 days absence from competition or training was higher in wrestling (39.6%), judo (35.9%) and taekwondo (32.5%) than in boxing (21.0%). There was no difference in injury risk by sex, weight category or tournament round, but athletes that lost had significantly higher IIRME compared with their winning opponents (rate ratio 3.59 (95% CI 2.68 to 4.79)).Olympic combat sport athletes sustained, on average, one injury every 2.1 hours of competition. The risk of injury was significantly higher in boxing, judo and taekwondo than in wrestling. About 30% of injuries sustained during competition resulted in >7 days absence from competition or training. There is a need for identifying modifiable risk factors for injury in Olympic combat sports, which in turn can be targeted by injury prevention initiatives to reduce the burden of injury among combat sport athletes.
A Randomized Controlled Trial to Evaluate the Effects of a Smartphone Application–Based Lifestyle Coaching Program on Gestational Weight Gain, Glycemic Control, and Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus: The SMART-GDM Study
Authors: Tong Wei Yew, Claudia Chi, Shiao-Yng Chan, Rob M. van Dam, Clare Whitton, Chang Siang Lim, Pin Sym Foong, Winni Fransisca, Chieu Leng Teoh, Jeannie Chen, Su Tin Ho-Lim, Su Lin Lim, Kai Wen Ong, Peck-Hoon Ong, Bee Choo Tai, E Shyong Tai
Journal: Diabetes Care (2020)

OBJECTIVE SMART-GDM examined whether Habits-GDM, a smartphone application (app) coaching program, can prevent excessive gestational weight gain (EGWG) and improve glycemic control and maternal and neonatal outcomes in gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS In this randomized controlled trial, women diagnosed with GDM between 12 and 30 weeks were randomly assigned to usual care (control) or to additional support from Habits-GDM that integrated dietary, physical activity, weight, and glucose monitoring (intervention). The primary outcome was the proportion of participants with EGWG. Secondary outcomes included absolute gestational weight gain (GWG), glycemic control, and maternal, delivery, and neonatal outcomes. RESULTS In total, 340 women were randomized (170 intervention, 170 control; mean ± SD age 32.0 ± 4.2 years; mean BMI 25.6 ± 5.6 kg/m2). There were no statistically significant differences in the proportions of women with EGWG, absolute GWG, or maternal and delivery outcomes between experimental groups. Average glucose readings were lower in the intervention group (mean difference −0.15 mmol/L [95% CI −0.26; −0.03], P = 0.011) as were the proportions of glucose above targets (premeal: 17.9% vs. 23.3%, odds ratio 0.68 [95% CI 0.53; 0.87], P = 0.003; 2-h postmeal: 19.9% vs. 50%, 0.54 [0.42; 0.70], P &amp;lt; 0.001). When regarded as a composite (although not prespecified), the overall neonatal complications (including birth trauma, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress, neonatal intensive care unit admission, and perinatal death) were significantly lower in the intervention group (38.1% vs. 53.7%, 0.53 [0.34; 0.84], P = 0.006). CONCLUSIONS When added to usual care, Habits-GDM resulted in better maternal glycemic control and composite neonatal outcomes (nonprespecified) but did not reduce EGWG among women with GDM.
Nucleic acid amplification tests on respiratory samples for the diagnosis of coronavirus infections: a systematic review and meta-analysis
Authors: Mona Mustafa Hellou, Anna Górska, Fulvia Mazzaferri, Eleonora Cremonini, Elisa Gentilotti, Pasquale De Nardo, Itamar Poran, Mariska M. Leeflang, Evelina Tacconelli, Mical Paul
Journal: Clinical Microbiology and Infection (2020)
Abstract 15889: The Role of Physical Deconditioning in Distinguishing Hypertrophic Cardiomyopathy From Athlete's Heart
Authors: munim A khan, Ethan J Rowin, Aadhavi Sridharan, Martin S Maron
Journal: Circulation (2020)

Background: Vigorous systematic physical training can result in increased left ventricular wall thickness (LVWT) (i.e., “athlete’s heart”) which can be challenging to differentiate diagnostically from mild non-obstructive hypertrophic cardiomyopathy (HCM). The efficacy of a deconditioning strategy to observe changes in LVWT using cardiovascular magnetic resonance (CMR) that would support a diagnosis of athlete’s heart vs. HCM is not well established. Methods: We identified 9 highly trained patients involved in various organized sports who were referred to the Tufts Medical Center HCM center with a maximal LVWT in a diagnostic “gray area” of 13-15 mm. Maximal LVWT and other clinical and imaging variables were compared at baseline and following &gt; 3 months of deconditioning from athletic training. A clinically relevant change in maximal LVWT at the end of athletic deconditioning was defined as a decrease of ≥2 mm, consistent with “athlete’s heart”. Imaging studies were interpreted blinded to study time period. Results: Among the 9 patients (23.1 ± 12.3 years old; 100% male), 4 demonstrated a ≥ 2 mm decrease in maximal LVWT (range: 2 mm to 3 mm) to ≤ 12 mm in 3 patients and 13 mm in one patient, with an average decrease of 2.3 mm. Among these 4 patients, LV and LA size also decreased (217.3 ± 31.5 ml to 208.9 ± 16.8 ml; and 55.4 ± 10.0 mm to 51.7 ± 9.1 mm, respectively), and there was no late gadolinium enhancement, pathogenic sarcomere mutation, or family history of HCM. Parameters of diastolic function were normal prior to deconditioning. After deconditioning evaluation and significant change in LVWT, these 4 patients were judged to not have a clinical diagnosis of HCM. The remaining 5 patients had a non-significant change in maximal LVWT after deconditioning of 0.2 mm, with maximal LVWT remaining ≥ 13 mm, and no change in LV or LA cavity size (p&gt;0.2 for each). After deconditioning, these 5 patients were judged to have a clinical diagnosis of HCM. In the 9 patients that underwent a period of deconditioning, there was an average heart rate increase of 6.33. Conclusion: In athletes with maximal LVWT within the “gray zone” (13-15 mm) of overlap with HCM, athletic deconditioning using CMR to detect changes in maximal LVWT can aid in the differential diagnosis and inform management decisions.
Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children
Authors: Tarek Alsaied, Adriana H. Tremoulet, Jane C. Burns, Arwa Saidi, Audrey Dionne, Sean M. Lang, Jane W. Newburger, Sarah de Ferranti, Kevin G. Friedman
Journal: Circulation (2020)

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with substantial cardiovascular implications. Although infection with SARS-CoV-2 is usually mild in children, some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease. This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children. Although the prevalence is unknown, &gt;600 cases have been reported in the literature. Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States. Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS-CoV-2 infection. Persistent fever and gastrointestinal symptoms are the most common symptoms. Cardiac manifestations are common, including ventricular dysfunction, coronary artery dilation and aneurysms, arrhythmia, and conduction abnormalities. Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation, inotropic support, and in the most severe cases, mechanical ventilation and extracorporeal membrane oxygenation. Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications. Intravenous immunoglobulin, steroids, and other immunomodulatory agents have been used frequently. Most patients recover within days to a couple of weeks and mortality is rare, although the medium- and long-term sequelae, particularly cardiovascular complications, are not yet known. This review describes the published data on multisystem inflammatory syndrome in children, focusing on cardiac complications, and provides clinical considerations for cardiac evaluation and follow-up.
Abstract 259: Outcomes of Targeted Temperature Management in Patients with Out-of-hospital Refractory Ventricular Fibrillation/ventricular Tachycardia Cardiac Arrest
Authors: Kellen Albrecht, Jason Bartos, Demetris Yannopoulos
Journal: Circulation (2020)

Background: Current guidelines recommend use of targeted temperature management (TTM) with goal between 32 and 36°C for all comatose adult patients with ROSC after cardiac arrest. However, refractory cardiac arrest with prolonged hypoperfusion, may cause passive cooling below goal temperature. The impact of this passive cooling and subsequent cooling strategies remains unknown. This study aims to describe the association between passive intra-arrest cooling and survival in patients suffering refractory VF/VT cardiac arrest treated with the University of Minnesota extracorporeal cardiopulmonary resuscitation (ECPR) protocol. Methods: Between December 2015 and October 2019, consecutive adult patients with refractory VF/VT arrest requiring ongoing CPR were transported by EMS to the CCL where ECPR, coronary angiography, and PCI were performed, as appropriate. TTM was initiated with goal temperature of 34°C unless clinically significant bleeding occurred, where a goal of 36°C was used. Patient and arrest characteristics, temperature data, and survival were collected retrospectively. Results: Data was gathered for 153 consecutive patients transferred for ECPR; 12 were excluded due to death in CCL prior to TTM. Of the remaining patients, 63 (41%) survived to discharge, where 55 (36%) had CPC scores of 1-2. Among deceased patients, 25 died from acute brain death while 47 died from other causes. Patients with CPC 1-2 had an initial temperature of 34.1°C versus 32.7°C in patients developing acute brain death (p=0.002). Survivors had shorter (p=0.0001) CPR time (52 minutes) versus deceased patients (65 minutes). If the initial temperature was below goal, patients were actively warmed to goal due to bleeding risk with ECPR. Survival to hospital discharge with CPC 1-2 was associated with lower peak warming rate compared with acute brain death (0.37°C/hr vs 0.69°C/hr; p=0.014) Conclusions: Survivors with CPC 1-2 after refractory VF/VT cardiac arrest and ECPR have preserved initial temperatures compared to more severe passive cooling in patients with acute brain death. This may be due to shorter duration of CPR. However, patients with acute brain death were noted to have higher peak rate of rewarming during TTM.
Abstract 13051: Nourin-dependent <i>Mirna-137</i> : A Novel Early Diagnostic Biomarker for Unstable Angina Patients
Authors: Salwa A Elgebaly, Robert H Christenson, Hossam Kandil, Nashwa El-Khazragy, Laila Rashed, Beshoy Yacoub, Roshanak Sharafieh, Ulrike Klueh, Donald L Kreutzer
Journal: Circulation (2020)

Introduction: No blood biomarker exits that can diagnose Unstable Angina (UA) patients. Nourin is ischemia-dependent inflammatory mediator rapidly released by reversible ischemic myocardium “before” necrosis, and by necrotic cells. Using Nourin amino acid sequence, Bioinformatics analysis indicated that Nourin is likely regulated by miR-137; a marker of cell damage and a hypoxiaresponsive autophagy-signaling pathway linked to myocardial ischemia and coronary artery disease. Hypothesis: That the Nourin-dependent miR-137, is an early biomarker for UA patients when Troponin levels are below the decision limit. The underlying regulatory mechanism involves lncRCTB89H12.4 and mRNA-FTLH-17; also associated with ischemia. Methods: We measured serum gene expression profile of lnc-CTB89H12.4/miR-137 and mRNAFTHL- 17 in UA (n=30 - confirmed by invasive coronary angiography and negative Troponin) and STEMI (n=16) patients at presentation, and healthy volunteers (n=16). Results: Gene expression of miR-137 was up-regulated by 1,185-fold in UA (median=1,244.41) compared to healthy (1.05), and by 2.5-fold in STEMI (3,162.72) compared to UA (Fig. 1). Receiving Operator Characteristics (ROC) analysis revealed a statistically significant difference in miR-137 that discriminated UA from healthy controls with a test sensitivity &amp; specificity of 96% &amp; 93%, respectively. Diagnostic sensitivity was 75% &amp; specificity was 83% for discriminating UA from STEMI. Additionally, Spearman’s correlation analysis revealed a significant association of miR-137 with lncRCTB89H12.4and mRNA-FTHL-17. The down-regulation of lncR-CTB89H12.4 after ischemia resulted in the up-regulation of miR-137 and activation of mRNA-FTLH-17. Conclusions: As a marker of cell damage, the Nourin-dependent miR-137 is a promising early diagnostic biomarker indicating UA patients and discriminating between UA and STEMI. Regulations appears to be from lncR-CTB89H12.4 and mRNA-FTLH-17.