tbuckley/cabot-search huggingface dataset:
Abstract 13115: Risk Markers for Minimal Coronary Artery Calcification in Persons With Significant Aortic Valve Calcium: The Multi-Ethnic Study of Atherosclerosis
Authors: Alexander C Razavi, Rhanderson Cardoso, Omar Dzaye, Matthew J Budoff, George Thanassoulis, Wendy S Post, Sanjiv J Shah, Daniel S Berman, Khurram Nasir, Michael J Blaha, Seamus P Whelton
Journal: Circulation (2020)

Introduction: Calcific aortic valve disease is the most common valve disorder affecting &gt;5 million US adults. The underlying pathobiology for the early stages of aortic valve calcification (AVC) and coronary artery calcium (CAC) includes many shared ASCVD risk factors, but a considerable proportion of individuals with significant AVC have little to no CAC. Hypothesis: Among persons with significant AVC (&gt;100 AU), those with a low CAC burden (CAC &lt;100 AU) would be younger and have a lower prevalence of both traditional and novel ASCVD risk factors compared to persons with CAC ≥100. Methods: After excluding 2 persons with bicuspid aortic valve, 325 participants from the Multi-Ethnic Study of Atherosclerosis without clinical ASCVD and with AVC &gt;100 at Visit 1 (2000-02) were included (34% women, 23% African American). We used Poisson regression to calculate adjusted prevalence ratios for CAC &lt;100 versus CAC &gt;100, using traditional and novel ASCVD risk markers. Results: Participants had a mean age of 72.1 years and 133 (41%) had CAC &lt;100 of whom 46/133 had CAC=0. Those with CAC &lt;100 were younger (70 vs. 74 years), had a lower prevalence of both hypertension (74% vs. 87%) and statin use (16% vs. 29%), but otherwise similar risk factor profiles compared to those with CAC ≥100. There were no significant differences in median Lp(a) (19.1 vs. 19.7 mg/dL) or hsCRP values (2.3 vs. 1.9 mg/L). A higher likelihood of CAC &lt;100 was observed per 10 years younger age (PR=1.41, 95% CI: 1.22-1.62), female sex (PR=1.68, 95% CI: 1.28-2.20), and a total cholesterol-HDL cholesterol ratio &lt;3.5 (PR=1.37, 95% CI: 1.02-1.85). There was no significant association between other individual risk factors and CAC &lt;100, but an ASCVD risk of &lt;7.5% had a prevalence ratio of 2.30 (95% CI: 1.85-2.85). Among nontraditional risk factors, only the absence of thoracic calcification was associated with a higher prevalence of CAC &lt;100 (PR=1.71, 95% CI: 1.28-2.28). Conclusions: More than 40% of persons with significant AVC had a low burden of CAC, which is incompletely explained through traditional and novel ASCVD risk markers. These results suggest that unmeasured risk markers, genetics, and/or the non-ASCVD pathways of later stage AVC may be more important in understanding the observed discordance between AVC and CAC.
Fighting Prejudice and Absorbing Refugees From Nazism: The National Committee for the Resettlement of Foreign Physicians, 1939–1945
Authors: Laurel Leff, Robert E. Schoen
Journal: Annals of Internal Medicine (2021)

In the 1930s and 1940s, the medical profession reacted with hostility and erected formidable barriers to refugee physicians from Nazi-dominated Europe who sought to practice medicine in the United States. Yet, refugee physicians ultimately succeeded, with 77% of them working as doctors by 1945 and 98.6% by 1947. Although physician skills are readily transferable, and the United States had a genuine need for doctors after World War II drew 55 000 physicians into the military, refugee physicians' success can be attributed to the courageous physician leaders who lobbied on their behalf and the creation of the National Committee for the Resettlement of Foreign Physicians—an organization that helped immigrant physicians pass licensing examinations, identify locations for employment, and overcome barriers to integration into American society.
Abstract 17062: Atherosclerotic Cardiovascular Disease Risk in South Asians by Statin Use: Insights From a Large Integrated Healthcare Delivery System
Authors: Neha M Mantri, Maqdooda Merchant, Jamal S Rana, Rishi Parikh, Alan S Go, Seema Pursnani
Journal: Circulation (2020)

Introduction: South Asian ethnicity is associated with increased atherosclerotic cardiovascular disease (ASCVD) risk and has been identified as a “risk enhancer” in the 2018 ACC/AHA Guideline on the Management of Blood Cholesterol. Hypothesis: An increased use of statins has been recommended since implementation of the 2013 ACC/ AHA Pooled Cohort Equation (PCE); however, the impact of statins on ASCVD outcomes in South Asians is not well understood. We aim to identify the accuracy of 10-year ASCVD risk prediction by the PCE, based on statin use, in a South Asian cohort. Methods: This is a retrospective cohort study of members within Kaiser Permanente Northern California without existing ASCVD, age range 30-70, for whom lipid panel, ethnic data, and 10-year follow up were available. ASCVD events were defined as acute myocardial infarction, ischemic stroke, and cardiovascular death. The cohort was stratified by statin use: never, at baseline and follow-up and only during follow-up. Predicted probability of ASCVD, using the PCE were calculated and compared to the observed for each ASCVD risk category: low &lt;5.0%, borderline 5.0-7.5%, intermediate 7.5-&lt;20.0%, and high &gt;=20.0%. Results: A total of 1,835 South Asian patients were included. ASCVD risk was underestimated by the PCE across all risk categories and statin groups. The greatest disparity was seen in the low-risk ASCVD risk group; entire cohort: 1.8 vs 4.9%, p&lt;0.0001; on statin at baseline and follow-up: 2.58 vs 8.43%, p&lt;0.0001; on statin during follow-up only: 2.18 vs 7.77%, p&lt;0.0001; and never on statin: 1.37 vs 2.09%, p=0.1175 (Figure 1). The absolute risk difference in ASCVD outcomes between the cohort never on statins to those on statins during follow up was 0.73%, 3.31%, and 6.67% in the borderline, intermediate, and high-risk groups, respectively. Conclusions: In a large, community-based South Asian cohort, the PCE underestimated risk in South Asians, who were taking statins, in the low ASCVD risk category.
Abstract P219: Association Of Age At Menopause And Reproductive Years With Arterial Stiffness And Its 5-year Change: The Atherosclerosis Risk In Communities - Neurocognitive Study (ARIC-NCS)
Authors: Shantal Jayawickreme, Alison N Bonner, Angela M Malek, Catherine J Vladutiu, Clare Oliver-Williams, Yamnia I Cortes, Hirofumi Tanaka, Michelle L Meyer
Journal: Circulation (2021)

Introduction: Early age at menopause is posited to increase cardiovascular disease (CVD) risk. However, studies examining the association with arterial stiffness, a predictor of CVD, are inconsistent and cross-sectional. Hypothesis: Earlier age at menopause and shorter reproductive years in women are associated with higher arterial stiffness and greater 5-year change at later life. Methods: We included 1,084 women in ARIC-NCS (mean 74 years at visit 5) with measures of arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)) at visit 5 (2011-13) and visit 6 or 7 (2016-19). At visits 1-4, women self-reported age at first menses, age at menopause, and hysterectomy with and without bilateral oophorectomy. We defined menopause type as natural, surgical, and unknown, which included women with a hysterectomy, but unknown ovarian status. Multivariable linear regression was used to evaluate associations of age at menopause, early age at menopause (&lt;45 years vs. ≥45 years), and reproductive years (age at menopause - age at first menses) with visit 5 cfPWV and cfPWV change between visit 5 and 6 or 7, adjusting for demographics and cardiometabolic risk factors. Results: The average age at menopause was 46.2 years, and 319 (29.4%) women had early age at menopause. No statistically significant associations were observed for age at menopause and reproductive years with either visit 5 cfPWV or cfPWV change. However, the associations with cfPWV change differed by menopause type (Table). Age at menopause and reproductive years were inversely associated with cfPWV change in women with natural menopause but were positively associated with cfPWV change in women with surgical menopause. Conclusion: At later life, age at menopause and reproductive years are not strongly associated with arterial stiffness, although the change in arterial stiffness differs by menopause type. Longitudinal arterial stiffness measures among women at mid-life is needed to understand the effect of natural versus surgical menopause on arterial stiffness.
Abstract 16911: Socioeconomic Status as a Predictor of Post-Operative Mortality and Outcomes in Carotid Artery Stenting vs Carotid Endarterectomy
Authors: Jigesh Baxi, Xiaoyan Deng, Fady K Soliman, Alexis K Okoh, Joshua C Chao, Lindsay Volk, Amy Suhotliv, Justin Ady, Saum A Rahimi, Mark J Russo, Leonard Y Lee
Journal: Circulation (2020)

Introduction: The association between socioeconomic status (SES) and adverse surgical outcomes represents an emerging area of concern. Furthermore, with regard to carotid stenosis, Carotid Artery Stenting (CAS) has been demonstrated to pose a greater risk of postoperative complications, such as stroke, than Carotid Endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing Carotid Artery Stenting (CAS) versus Carotid Endarterectomy (CEA). Methods: The National Inpatient Sample (NIS) was queried from 2010 to 2015. Patients who underwent CAS and CEA were identified. Patients of the highest and lowest median income quartiles by zip code were selected and compared based on demographics, hospital characteristics, and comorbidities (Charleston Comorbidity Index: CCI). Primary and secondary outcomes were in-hospital mortality and postoperative stroke, respectively. Multivariable analysis was used to determine the effect of SES on in-hospital mortality. Results: 3,516 and 1,909 underwent CAS; 22,852 and 15,547 patients underwent CEA in the low and high SES groups, respectively. Low SES was a significant independent predictor of mortality (OR = 2.07 [1.25-3.53], p = 0.005) for patients who underwent a CEA, but not for those undergoing CAS. CCI and age were strong predictors of mortality for both procedures (CAS odds ratio (OR)(age) 1.05[1.00-1.10] p = 0.05, OR(CCI) 1.45[1.17-1.80] p &lt; 0.001; CEA: OR(age) 1.03[1.01-1.06] p = 0.01, OR(CCI) 1.60[1.45-1.77] p &lt; 0.001). Of secondary outcomes, stroke was strongly associated with CEA, while bleeding was with CAS. [Figure 1]. Conclusions: Low SES is a significant independent predictor of postoperative mortality in patients who underwent CEA, but not CAS. CEA is also associated with a higher incidence of stroke in these patients. These findings suggest that there may be a benefit to a minimally invasive approach (CAS) rather than the present standard of care (CEA), in selected low SES patients.
Effect of community-led delivery of HIV self-testing on HIV testing and antiretroviral therapy initiation in Malawi: A cluster-randomised trial
Authors: Pitchaya P. Indravudh, Katherine Fielding, Moses K. Kumwenda, Rebecca Nzawa, Richard Chilongosi, Nicola Desmond, Rose Nyirenda, Melissa Neuman, Cheryl C. Johnson, Rachel Baggaley, Karin Hatzold, Fern Terris-Prestholt, Elizabeth L. Corbett
Journal: PLoS Medicine (2021)

Undiagnosed HIV infection remains substantial in key population subgroups including adolescents, older adults, and men, driving ongoing transmission in sub-Saharan Africa. We evaluated the impact, safety, and costs of community-led delivery of HIV self-testing (HIVST), aiming to increase HIV testing in underserved subgroups and stimulate demand for antiretroviral therapy (ART).
Neuroscientific therapies for atrial fibrillation
Authors: Peter Hanna, Eric Buch, Stavros Stavrakis, Christian Meyer, John D Tompkins, Jeffrey L Ardell, Kalyanam Shivkumar
Journal: Cardiovascular Research (2021)

The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.
Abstract P086: Metabolic Risk, Galectin-3 And Heart Failure: The Atherosclerosis Risk In Communities (aric) Study
Authors: Justin B Echouffo Tcheugui, Sui Zhang, Roberta Florido, Erin Michos, VIJAY NAMBI, Ronald B Goldberg, Gary Gerstenblith, Wendy S Post, Roger S Blumenthal, Ron C Hoogeveen, Josef Coresh, Aaron R Folsom, Christie M Ballantyne, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2021)

Introduction: Diabetes and metabolic syndrome (MetS) confer an increased risk of heart failure (HF) through poorly understood mechanisms. Galectin-3 (Gal-3) is a marker of fibrosis linked to greater HF risk. The inter-relationships among diabetes, MetS and Gal-3, and related implications for HF risk, are not well understood. Hypothesis: Diabetes and MetS are associated with elevated Gal-3, and high Gal-3 indicates greater HF risk among those with diabetes or MetS. Methods: We included 8,445 participants (mean age 63, 59% male, 21% Black) at ARIC Visit 4 (1996-1999) without baseline HF. We categorized participants by metabolic risk (no diabetes/no MetS; MetS only; diabetes with or without MetS), and Gal-3 levels (gender-specific quartiles). We assessed the associations of metabolic risk categories with high Gal-3 (≥75 th percentile) using logistic regression. We used Cox regression to evaluate associations of cross-categories of metabolic risk group and Gal-3 quartiles with incident HF. Results: In cross-sectional analyses, those with MetS were more likely to have elevated Gal-3 levels than those with no diabetes or MetS (OR 1.29, 95%CI 1.13-1.47). The additional presence of diabetes did not change the likelihood of elevated Gal-3 (OR 1.29, 95%CI 1.08-1.55). Over 20.5 years of follow-up, there were 1,611 HF events. Higher Gal-3 was associated with higher HF risk in each metabolic risk group, and higher metabolic risk group was associated with greater HF risk in each Gal-3 quartile. There was no interaction between Gal-3 and metabolic risk group on HF risk ( P =0.15). The combination of diabetes &amp;MetS and high Gal-3 was associated with an almost 5-fold higher risk of incident HF (HR 4.93; 95% CI: 3.77 - 6.44) than the combination of no diabetes/MetS and low Gal-3 (first quartile) ( Table ). Conclusions: MetS was associated with higher levels of Gal-3. Metabolic risk group and Gal-3 provided powerful complementary prognostic information regarding HF risk. Fibrosis likely plays a role in the development of HF linked to metabolic risk.
Bioresponsive micro-to-nano albumin-based systems for targeted drug delivery against complex fungal infections
Authors: Liting Cheng, Miao-Miao Niu, Tong Yan, Zhongyi Ma, Kexin Huang, Ling Yang, Xin Zhong, Chong Li
Journal: Acta Pharmaceutica Sinica B (2021)

As a typical human pathogenic fungus, Cryptococcus neoformans is a life-threatening invasive fungal pathogen with a worldwide distribution causing ∼700,000 deaths annually. Cryptococcosis is not just an infection with multi-organ involvement, intracellular survival and extracellular multiplication of the fungus also play important roles in the pathogenesis of C. neoformans infections. Because adequate accumulation of drugs at target organs and cells is still difficult to achieve, an effective delivery strategy is desperately required to treat these infections. Here, we report a bioresponsive micro-to-nano (MTN) system that effectively clears the C. neoformans in vivo. This strategy is based on our in-depth study of the overexpression of matrix metalloproteinase 3 (MMP-3) in infectious microenvironments (IMEs) and secreted protein acidic and rich in cysteine (SPARC) in several associated target cells. In this MTN system, bovine serum albumin (BSA, a natural ligand of SPARC) was used for the preparation of nanoparticles (NPs), and then microspheres were constructed by conjugation with a special linker, which mainly consisted of a BSA-binding peptide and an MMP-3-responsive peptide. This MTN system was mechanically captured by the smallest capillaries of the lungs after intravenous injection, and then hydrolyzed into BSA NPs by MMP-3 in the IMEs. The NPs further targeted the lung tissue, brain and infected macrophages based on the overexpression of SPARC, reaching multiple targets and achieving efficient treatment. We have developed a size-tunable strategy where microspheres "shrink" to NPs in IMEs, which effectively combines active and passive targeting and may be especially powerful in the fight against complex fungal infections.
춘계학술대회 : 포스터전시 ; PET-CT9 (Positron Emission Tomography-Computed Tomography)에서 FDG (Fluorodeoxyglucose) 흡착과 간내 종괴 양상을 보인 지방간 1예
Authors: 이종찬, 김영석, 김상균, 장재영, 박정미, 이혜경, 고봉민, 홍수진, 유창범, 문종호, 이준성, 이문성, 심찬섭, 김부성
Journal: Clinical and Molecular Hepatology (2007)
Community Factors Associated With Telemedicine Use During the COVID-19 Pandemic
Authors: Sadiq Y. Patel, Sherri Rose, Michael L. Barnett, Haiden A. Huskamp, Lori Uscher-Pines, Ateev Mehrotra
Journal: JAMA Network Open (2021)

While telemedicine use grew rapidly during the COVID-19 pandemic, there was substantial geographic variation in uptake. 1,2What drives this variation is unclear.To understand drivers of telemedicine use, we examined the association of county-level telemedicine use with community factors among individuals with commercial or Medicare Advantage insurance. MethodsUsing OptumLabs Data Warehouse deidentified medical claims, we captured all outpatient visits, in person and telemedicine, from January 1 to July 14, 2020.We defined outpatient visits using Medicare's list of Current Procedural Terminology (CPT) codes eligible for telemedicine. 3Telemedicine visits were those with modifier codes GT, GQ, or 95, or CPT codes 99441 to 99443 with the remainder defined as in-person visits.After excluding counties with fewer than 100 members enrolled from July 2019 through July 2020, we assessed county-level telemedicine use during the pandemic (defined as March 18 to July 14, 2020) using the percentage of total visits delivered via telemedicine.We measured county-level population density (number of people per square mile) as a proxy for rurality, race, income, broadband availability, and per capita number of hospital beds, community health centers, physicians, and advanced practice registered nurses using data from the US Census and Area Health Resource Files. 4 County-level prepandemic telemedicine use was measured as the percentage of total visits delivered via telemedicine from January 1 to March 17, 2020, and cumulative COVID-19 cases per capita were measured over 2 periods, March 18 to April 16, 2020, and March 18 to July 14, 2020.To measure the association between these county characteristics and percentage point differences in telemedicine use, we used targeted maximum likelihood estimation, a machine learning procedure used in prior clinical literature. 5We divided county characteristic measures into tertiles for meaningful interpretation except for those where there were positivity violations.We addressed violations by dichotomizing variables (see eAppendix in the Supplement).The Harvard Medical School institutional review board exempted this study from review because it involved the study of data recorded such that participants cannot be reasonably identified.This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cross-sectional studies.Data analyses were performed using R statistical software version 3.6.3(R Project for Statistical Computing) with the SuperLearner and tmle packages. 5These analyses were performed on September 17, 2020. ResultsAcross 2800 counties with at least 100 enrollees, the mean (SD) and median (interquartile range [IQR]) percentage of total visits delivered via telemedicine were 19.6% (8.3%) and 18.6%
Regulation of intercellular biomolecule transfer–driven tumor angiogenesis and responses to anticancer therapies
Authors: Zhen Lu, Angelica Ortiz, Ioannis I. Verginadis, Amy R. Peck, Farima Zahedi, Christina Cho, Pengfei Yu, Rachel M. DeRita, Hongru Zhang, Ryan Kubanoff, Yunguang Sun, Andrew T. Yaspan, Elise Krespan, Daniel P. Beiting, Enrico Radaelli, Sandra W. Ryeom, J. Alan Diehl, Hallgeir Rui, Constantinos Koumenis, Serge Y. Fuchs
Journal: Journal of Clinical Investigation (2021)

Intercellular biomolecule transfer (ICBT) between malignant and benign cells is a major driver of tumor growth, resistance to anticancer therapies, and therapy-triggered metastatic disease. Here we characterized cholesterol 25-hydroxylase (CH25H) as a key genetic suppressor of ICBT between malignant and endothelial cells (ECs) and of ICBT-driven angiopoietin-2–dependent activation of ECs, stimulation of intratumoral angiogenesis, and tumor growth. Human CH25H was downregulated in the ECs from patients with colorectal cancer and the low levels of stromal CH25H were associated with a poor disease outcome. Knockout of endothelial CH25H stimulated angiogenesis and tumor growth in mice. Pharmacologic inhibition of ICBT by reserpine compensated for CH25H loss, elicited angiostatic effects (alone or combined with sunitinib), augmented the therapeutic effect of radio-/chemotherapy, and prevented metastatic disease induced by these regimens. We propose inhibiting ICBT to improve the overall efficacy of anticancer therapies and limit their prometastatic side effects.