tbuckley/cabot-search huggingface dataset:
Abstract 15223: Comparison of Net Clinical Benefit Between Clopidogrel-based and Ticagrelor-based Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention in China
Authors: yundai chen, Daowen Wang, Dandan Li, Yang Sun, Xiaoran Ye, Lanting Li
Journal: Circulation (2020)

Introduction: Dual antiplatelet therapy (DAPT) increases the bleeding risk, which might outweigh the benefits of reduction in ischemic events in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). This study aimed to evaluate the difference in net clinical benefits of clopidogrel-based DAPT compared with ticagrelor-based DAPT in ACS patients undergoing PCI in a real-world setting in China. Method: This study was conducted on three pre-existing PCI patient databases, two were from nation-wide studies with similar prospective designs and time-span: the BRIC-ACS(I) study and the COSTIC study, and other was from a tertiary hospital-maintained PCI patient database. The primary endpoint was net adverse clinical and cerebral event (NACCE), which was a composite of all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke and BARC ≥ 2 (excluding BARC 4) bleeding within 12 months after discharge. The efficacy outcome, major adverse cardiovascular events (MACE), was defined as a composite of all-cause death, non-fatal MI, and non-fatal stroke. The safety outcome was defined as BARC ≥ 2 (excluding BARC 4) bleeding. Kaplan-Meier survival curves, and Cox regression were applied to analyze the difference between the two groups after propensity score matching (PSM). Results: A total of 7,236 adult ACS patients who underwent PCI in the period of Jan 2014 to Oct 2017 were analyzed. Of them, 4,330 patients were included in post-PSM analyses. Patients prescribed clopidogrel and aspirin had a significant lower risk of NACCE within 12 months after discharge relative to those prescribed ticagrelor and aspirin [5.4% vs. 8.3%, hazard ratio (HR) = 0.63, 95% CI: 0.50 - 0.80]. While the two groups did not vary significantly in the risk of MACE (2.9% vs. 3.1%, HR = 0.91, 95% CI: 0.64 - 1.28), clopidogrel-based DAPT was associated with a significant lower risk of BARC ≥ 2 (excluding BARC 4) bleeding (2.9% vs. 5.5%, HR = 0.50, 95% CI: 0.37 - 0.68) compared to ticagrelor-based DAPT. Conclusion: In this real-world study, post-PCI ACS patients prescribed clopidogrel-based DAPT were associated with a reduction in NACCE and bleeding events without significant difference in MACE, compared to patients treated with ticagrelor-based DAPT.
Abstract 15291: ‘Heart Rate Deficit’ From Dysautonomia in a Bariatric Surgery Patient - An Unusual Cause of Recurrent Syncope
Authors: Krishna Akella, Ghulam Murtaza, iftekhar Ahmed, LUIS Couchonnal, Yoaav Krauthammer, Brian Olshansky, Donita Atkins, Dhanunjaya Lakkireddy, Rakesh Gopinathannair
Journal: Circulation (2020)

Background: Patients undergoing bariatric surgery are prone to develop symptomatic dysautonomia but the mechanisms remain unclear. Methods: N/A Results: A 61-year-old female with hyperlipidemia, fibromyalgia, morbid obesity status post gastric sleeve 2 years prior, was transferred to our institution after an unremarkable initial cardiac workup for recurrent syncope and bradycardia. Patient had significant weight loss (180 lbs) post-surgery over this 2-year period but began noticing increasing fatigue, and exercise intolerance in the last four months preceding recent syncopal episodes. Syncopal spells happened while trying to lift her head &gt;60 degrees/sit up from a recumbent position. Baseline heart rate (HR) was 36-42 bpm (Figure lower Panel) while it was 75-90 bpm immediately following bariatric surgery (Figure upper panel). Blood pressure was normal. During witnessed syncopal episodes, HR remained in the 35-40 bpm range with no asystolic pauses and normal blood pressure. Video EEG showed loss of brain electrical activity during syncope; no seizure activity was noted. Progressive decline in HR and baseline bradycardia was suspected as the cause and she underwent permanent pacemaker implantation, which resulted in complete resolution of symptoms and no recurrence of syncope at 6-mo follow-up. Conclusion: We describe a unique case where marked decline in resting HR occurred in association with significant weight loss following bariatric surgery. This ‘HR deficit’ and resting bradycardia, likely due to dysautonomia, resulted in recurrent syncope without asystole or vasodepression, and completely resolved with permanent pacemaker implantation.
Abstract 14490: Sarcopenia Defined by Computed Tomography Psoas Muscle Area Predicts Morbidity and Mortality in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Yojiro Koda, Hidefumi Nishida, Ann Nguyen, Bow Chung, Gene H Kim, Bryan Smith, Sara Kalantari, Nitasha Sarswat, Jonathan Grinstein, David Onsager, Tae Song, Valluvan Jeevanandam, Takeyoshi Ota
Journal: Circulation (2020)

Objective: This study aimed to assess the correlation between psoas-muscle sarcopenia and clinical outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Methods: Patients who underwent a LVAD implantation and had a perioperative CT available were included. Bilateral psoas muscle cross-sectional areas at the level of L3 were measured, and a total psoas muscle area was divided by a body surface area (BSA) to calculate total psoas muscle area index (TPAI). Sarcopenia was defined as TPAI&lt;7.5 cm 2 /m 2 , and the cohort was divided into Sarcopenia group (S group) and Non-sarcopenia group (NS group). Postoperative complications, in-hospital mortality, and overall survival were retrospectively assessed. Results: Between 7.2008-1.2020, a total of 513 patients underwent a LVAD implantation. Among them, 244 patients with a qualified CT study were identified. The S group was 127 patients (52%), and the NS group was 117 patients (48%). There were no differences in patient characteristics including age, comorbidity, INTERMACS classification, except BSA (S group vs. NS group: 1.99±0.27 vs. 2.07±0.28, p=0.0372) and female gender (S group vs. NS group: 39% vs. 20%, p=0.0011). Postoperative acute kidney injury (AKI) (22% vs. 9%, p=0.0030), newly required dialysis (16% vs. 5%, p=0.0058), and in-hospital mortality (13% vs. 4%, p=0.0174) were higher in the S group compared with the NS group. The causes of in-hospital mortality in the S group included right ventricular failure (RVF) (N=4), stroke (N=4; cerebral hemorrhage 3, subarachnoid hemorrhage 1), sepsis (N=3), respiratory failure (N=2) , bowel ischemia (N=2), bowel perforation (N=1). Those in the NS group were RVF (N=3), sepsis (N=1), and liver failure (N=1). Overall long-term survival was similar with both groups (S group vs. NS group: 72±4 vs. 75±4% at 1 year, 53±5 vs. 53±6% at 3 years, 40±6 vs. 34±9% at 5 years, Log-Rank P=0.6356). The Youden index identified the cut-off value of TPAI of 7.2cm 2 /m 2 for in-hospital mortality (area under curve, 0.699; sensitivity, 76.2%; specificity, 54.3%). Conclusions: Sarcopenia (TPAI&lt;7.5 cm 2 /m 2 ) was a predictor for postoperative AKI and in-hospital mortality in patients undergoing a LVAD implantation.
Abstract 13595: Association of Costal Cartilage Calcification With Cardiovascular Events and Risk Factors in Multi-Ethnic Study of Atherosclerosis (MESA); The MESArthritis Study
Authors: Mahsima Shabani, Farhad Pishgar, Sepehr Akhtarkhavari, Thiago Q Silva, Matthew J Budoff, Wendy S Post, Graham Barr, Colin Wu, David A Bluemke, Shadpour demehri, João A.C. Lima
Journal: Circulation (2020)

Introduction: Costal cartilage calcification (CCC) is an evident yet usually neglected finding in calcium scoring CT scans. Although CAC score is a well-known predictive marker for CVD, little is known about the potential association between CCC and CVD risk factors (RFs) and events. Hypothesis: CCC is associated with CVD RFs and is predictive of CVD events independent from CAC score. Methods: Cardiac CAC score images from Johns Hopkins Hospital field center acquired within the fifth exam of the MESA cohort (2010-2012) were re-analyzed as part of the MESArthritis ancillary study. The CCC was measured bilaterally for the first pair of cartilages at the superior end of image FOVs using calcium scoring package (VScore, Vitrea 7.11, Vital Images) with a 180 HU cut-off. Outlier values were excluded using the IQR-based outlier fence estimates. Association of CCC with CVD RFs, and CVD and mortality time-to-event was investigated by multivariable linear regression and Cox proportional hazard models, respectively. Results: After exclusion of 3 outliers, 329 participants (53% female) with a mean age of 70.1 (±8.75) were included. In cross-sectional analysis, in addition to age (β=8.86, p:.003) and gender (376.0, p&lt;.001), CCC was associated with diabetes (141.42, p:.019) and glucose level (2.85, p:.006). CCC was correlated with Framingham global CVD risk score (FRS) (coefficient:0.39, p&lt;.001), but not with CAC when adjusted for age and gender. In time-to-event analysis, adjusted CCC was positively associated with CHD (HR:1.17, p:.039) and CVD (1.14, p:.012) risk. Compared with CAC score (C-index: 0.76) and FRS (0.74) individually, models with CCC addition to FRS (0.85) and both CAC and FRS (0.84) had higher C-index for CHD prediction. Conclusions: CCC is associated with diabetes and can be used to predict CHD and CVD events and augment the predictive power of the highly validated CAC and FRS for CHD events. However, this scoring should be validated in other larger cohorts.
The “Yin and Yang” of Immunomodulatory Magnesium‐Enriched Graphene Oxide Nanoscrolls Decorated Biomimetic Scaffolds in Promoting Bone Regeneration
Authors: Zhiwei Zheng, Yahong Chen, Hao Hong, Yi Shen, Yun Wang, Jian Sun, Xiansong Wang
Journal: Advanced Healthcare Materials (2020)

Abstract Tissue regeneration driven by immunomodulatory agents has emerged as a potential solution for repairing bone defects. However, the therapeutic benefits are compromised by disturbances in the pro‐ and anti‐inflammatory balance. Here, using magnesium nanoparticles (MgNPs) as a template, magnesium‐enriched graphene oxide nanoscrolls (MgNPs@GNSs) designed for combinational modulation of the inflammatory response are reported. First, the different effects of graphene oxide (GO) and magnesium ions (Mg 2+ ) on Raw264.7 macrophage phenotype transformation are screened. The results reveal that GO activates inflammatory M1 macrophages, and that Mg 2+ facilitates repolarization of M1 macrophages to the pro‐healing M2 phenotype. With sustained release of Mg 2+ , the MgNPs@GNS nanoplatform can orchestrate harmonious type 1 and type 2 inflammatory responses. Mg 2+ decrease the internalization of GO and downregulate the nuclear factor kappa‐B pathway, which is profoundly involved in the inflammatory process. A series of experiments show that the ordered inflammatory response induced by MgNPs@GNSs stimulates in vitro angiogenesis and osteogenesis through chemotactic, mitogenic, and morphogenic actions. Obvious vascularized bone regeneration is achieved in a rat cranial bone defect model via MgNPs@GNS deposited decellularized bone matrix scaffold. Therefore, the potential of using inherently therapeutic nanomedicine to modulate biomaterial‐induced immune responses and thus enhance bone regeneration is demonstrated.
Abstract 13819: Is an Adult Familial Hypercholesterolemia, Swine Model Suited to Test Safety and Efficacy of Drug-eluting Coronary Stents?
Authors: Francesca Razzi, Evelyn Regar, Jouke Dijkstra, Karen Witberg, Jurgen Ligthart, sharad A ramlal, Mathijs Stam, Ilona Krabbendam-Peters, Ayla Hoogendoorn, Jolanda J Wentzel, Gijs van Soest, Jan Van Esch, Dirk J Duncker, Volkert van Steijn, Heleen M Van Beusekom
Journal: Circulation (2020)

Introduction: Safety and efficacy of novel drug-eluting coronary stents (DES) are often preclinically tested using healthy swine coronary models. These only show fibrotic neointima (NI) response, while in humans we also observe uncovered struts and minimal NI thickening. Therefore, healthy swine models only allow limited conclusions. Hypothesis: In an adult familial hypercholesterolemia (FH) swine model, NI healing after coronary DES implantation mimics the range of human NI responses to DES. Methods: Adult FH swine (n=6 French Bretoncelles-Meishan) were given a high fat diet for 12 months to develop coronary atherosclerosis. DES (n=14) were implanted under guidance of OCT at sites of confirmed atherosclerotic plaque. Swine were sacrificed at 28 days follow-up (FU). Serial OCT imaging was performed before, after and 28 days FU. Lumen area, stent area, plaque burden (PB) and NI burden were evaluated for each time point and frame and averaged per stent. PB prior to stenting was evaluated using coronary side branches as references. The percentage uncovered struts at FU was assessed on a strut-by-strut basis. Results: The NI response showed uncovered struts, minimal coverage and fibrotic NI thickening. We found an association between baseline lesion PB and FU findings (Figure). Low PB (&lt;40%) prior to stenting resulted in a thick NI at FU, reminiscent of healthy coronary models. In contrast, high PB (&gt;40%) resulted in thin NI coverage and more uncovered struts at FU, uniquely showing similarities to human responses. Conclusions: In this adult FH swine model, the NI response presents the whole spectrum that is seen in humans, from uncovered struts, to minimal, to fibrotic intimal thickening. Interestingly, pre-existing coronary atherosclerotic PB is negatively associated with NI thickness and strut coverage after DES implantation. This underscores the importance of advanced disease, versus healthy, animal models for safety and efficacy testing of DES.
Erratum. Effects of Sustained Treatment With Lixisenatide on Gastric Emptying and Postprandial Glucose Metabolism in Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care 2020;43:1813–1821
Authors: Christopher K. Rayner, Linda E. Watson, Liza K. Phillips, Kylie Lange, Michelle J. Bound, Jacqueline Grivell, Tongzhi Wu, Karen L. Jones, Michael Horowitz, Ele Ferrannini, Domenico Tricò, Silvia Frascerra, Andrea Mari, Andrea Natali
Journal: Diabetes Care (2020)

The authors wish to correct some minor errors in this article:

1.  The fasting insulin secretion rate was correctly shown in Table 1 to be slightly increased after lixisenatide treatment, whereas the text of the Results and Conclusions sections incorrectly reported that it was decreased.

2.  Change …
Abstract 14254: Pharmacodynamic Effects of a Single Dose of CK-3773274 in Cats With Hypertrophic Cardiomyopathy
Authors: Maureen Oldach, Darren T Hwee, Eric S Ontiveros, Samantha L Fousse, Carina E Gonzalez, Bradley P Morgan, Fady I Malik, Samantha P Harris, Joshua A Stern
Journal: Circulation (2020)

Introduction: Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy in the absence of known causes. HCM can be due to genetic mutations that affect sarcomeric proteins, leading to myocardial hypercontractility. HCM is often complicated by left ventricular outflow tract obstruction (LVOTO) and patients may be at greater risk of cardiovascular death. Medications targeted to address the pathophysiology of HCM and ameliorate LVOTO are needed. CK-3773274 (CK-274) is a novel small molecule cardiac myosin inhibitor that reduces myocardial contractility in vitro and in vivo . Cats have naturally occurring HCM commonly complicated by LVOTO and are an excellent large animal model for investigation of HCM therapeutics. In this study, we aim to characterize the pharmacodynamic effect of a single oral dose of CK-274 on cardiac function in cats with hypertrophic cardiomyopathy and LVOTO. Methods: Eight purpose-bred cats with naturally occurring HCM and LVOTO due to the A31P mutation in cardiac myosin binding protein C (cMyBP-C) were included in a randomized, controlled, crossover study. Cats were randomized to receive vehicle, 0.3 mg/kg, or 1 mg/kg CK-274 treatment, and received echocardiograms at baseline, 6, 24, and 48 hours post-treatment. All cats were crossed over to all treatment groups. Results: CK-274 (1 mg/kg) reduced mean LV fractional shortening at 6, 24 and 48 hours post-treatment (mean reduction 13.6%, p=0.03; 15.4%, p=0.01; 11.6% p=0.02, respectively). CK-274 (1 mg/kg) increased LV systolic internal dimension at 6 and 24-hours post-treatment (mean increase 0.21 cm, p=0.046; 0.25 cm, p=0.03), and did not affect LV diastolic internal dimension. LVOT peak pressure gradient was reduced with CK-274 (0.3 mg/kg) treatment [median pressure gradient at baseline 27.1 mmHg (IQR 18.3-33.3) vs 24 hours post-drug, 7.3 mmHg (IQR 14.2-19.7) p=0.01]. Heart rate did not change for any treatment group over time. No differences were noted following vehicle administration at any time point. Conclusion: In HCM affected cats with the cMyBP-C A31P mutation, the cardiac myosin inhibitor CK-274 is well tolerated at the studied doses and caused dose-related changes in LV systolic function and reductions in LVOT peak pressure gradient.
Effect of Sodium Benzoate vs Placebo Among Individuals With Early Psychosis
Authors: James G. Scott, Andrea Baker, Carmen C. W. Lim, Sharon Foley, Frances Dark, Anne Gordon, David Ward, Drew Richardson, George Bruxner, K. Martin Beckmann, Sean Hatherill, Stephen Stathis, Krystal Dixon, Alexander E. Ryan, Brett C. McWhinney, Jacobus P. J. Ungerer, Michael Berk, Olivia M. Dean, Sukanta Saha, John McGrath
Journal: JAMA Network Open (2020)

<h3>Importance</h3> There is evidence that sodium benzoate (BZ) may be an effective adjunctive treatment for schizophrenia. The clinical efficacy of BZ has been investigated in chronic schizophrenia; however, the efficacy of this agent has not been studied in individuals with early psychosis. <h3>Objective</h3> To examine the clinical efficacy of the adjunctive use of BZ for symptoms in people with early psychosis. <h3>Design, Setting, and Participants</h3> Using a placebo-controlled double-masked parallel-group design, this randomized clinical trial was conducted from August 2015 to July 2018. Participants aged between 15 and 45 years experiencing early psychosis were enrolled from 5 major clinical sites in Queensland, Australia. Data analysis was conducted from October 2018 to February 2020. <h3>Interventions</h3> Participants were randomized 1:1 (50 participants in each group) to receive 500 mg of sodium benzoate twice daily or placebo for 12 weeks. <h3>Main Outcomes and Measures</h3> The primary efficacy outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 12 weeks. The key secondary efficacy measures were (1) the Clinical Global Impression score, (2) the Hamilton Depression Rating Scale for depression, (3) functioning as assessed by the clinician-rated Global Assessment of Function, and (4) the Assessment of Quality of Life Scale. The PANSS subscale scores and impact on selected amino acid concentrations were also assessed. <h3>Results</h3> The study comprised 100 participants with a mean (SD) age of 21.4 (4.1) years, of whom 73 (73%) were male individuals. The mean (SD) baseline PANSS score was 75.3 (15.4). We found no improvement in total PANSS score in the BZ group compared with the placebo group. The end result of least-squares mean difference (SE) for total PANSS was −1.2 (2.4) (<i>P</i> = .63). There were no differences in any subscales of the PANSS, any secondary measures, nor any amino acid concentrations. The dose of BZ was well tolerated without any clinically significant treatment-emergent adverse event differences between BZ and placebo groups. <h3>Conclusions and Relevance</h3> In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis. <h3>Trial Registration</h3> anzctr.org.au Identifier:ACTRN12615000187549
Abstract 16318: Care Dyadic Types in Patients With Multiple Chronic Conditions and Their Caregivers
Authors: Federico Ferro, MADDALENA DE MARIA, Ercole Vellone, Davide Ausili, Maria Matarese
Journal: Circulation (2020)

Introduction: Multiple Chronic Conditions (MCC) are highly prevalent in patients with cardiovascular diseases. Patients’ informal caregivers play an essential role to achieve both patient and caregiver health outcomes. Four Care Dyadic Types (DTs) of caregiver-patient relationships were previously described in heart failure depending on who is responsible for most of the care: patient-oriented, caregiver-oriented, collaborative, and incongruent (i.e., disagreement on who is responsible for the care). Since DTs in MCC were not described yet, this study aimed to describe the DTs in MCC management, and to identify the patient and caregiver characteristics associated with each type of DT. Methods: We conducted a cross-sectional study enrolling 541 dyads in outpatient settings in Italy. Patients were included in the study if they were ≥65 years old, affected by at least two chronic conditions, and had an informal caregiver ≥18 years old. The Dyadic Symptom Management Type scale was used to assess DTs. Logistic regression analysis was used to identify the characteristics associated with each DT. Results: Most patients and caregivers were female with a mean age of 76.54 (SD 7.23) years and 52.71 (SD 15.06) years, respectively. One third of the patients had heart failure. Younger patients with better cognitive status, fewer comorbidities, better relationship with their caregivers and male caregivers with a lower burden were associated with patient-oriented DT (14.2%, R 2 0.407). Older patients and caregivers with a higher burden were associated with caregiver-oriented DT (11.6%, R 2 0.388). Patients with more comorbidities, better relationship with their caregivers, and female caregivers with lower burden, perceiving strong social support, were associated with collaborative DT (58.8%, R 2 0.097). Caregivers with lower income, more frequently employed, providing more caregiving hours, and having a lower burden were associated with incongruent DT (15.4%, R 2 0.075). Conclusion: Different DTs were described in MCCs identifying specific patients and caregivers’ associated characteristics. This is helpful to classify the dyads and to tailor interventions aimed to empower patients and caregivers in MCCs.