tbuckley/cabot-search huggingface dataset:
Oral decitabine–cedazuridine versus intravenous decitabine for myelodysplastic syndromes and chronic myelomonocytic leukaemia (ASCERTAIN): a registrational, randomised, crossover, pharmacokinetics, phase 3 study
Authors: Guillermo Garcia-Manero, James McCloskey, Elizabeth A Griffiths, Karen W L Yee, Amer M Zeidan, Aref Al-Kali, H Joachim Deeg, Prapti A Patel, Mitchell Sabloff, Mary-Margaret Keating, Nancy Zhu, Nashat Y Gabrail, Salman Fazal, Joseph Maly, Olatoyosi Odenike, Hagop Kantarjian, Amy E DeZern, Casey L O’Connell, Gail J Roboz, Lambert Busque, Rena Buckstein, Harshad Amin, Jasleen Randhawa, Brian Leber, Aditi Shastri, Kim-Hien Dao, Aram Oganesian, Yong Hao, Harold N Keer, Mohammad Azab, Michael R Savona
Journal: The Lancet Haematology (2023)
Retail demand for emergency contraception in United States following New Year holiday: time series study
Authors: Brandon Wagner, Kelly Cleland
Journal: BMJ (2023)

Abstract Objective To estimate the increase in sales of emergency contraception following the New Year’s Eve/New Year’s Day holiday. Design Time series analysis using autoregressive integrated moving average (ARIMA) model. Setting Traditional (that is, “bricks and mortar”) retail outlets—grocery stores, drug stores, mass merchandisers, club stores, dollar stores, and military outlets—in the United States from 2016 to 2022. Data source Marketing data on weekly aggregated sales of items classified as emergency contraception gathered between 2016 and 2022 (n=362). On the basis of dates, weeks were classified as following the New Year holiday (n=6) or not (n=356). Main outcome measure Weekly sales of levonorgestrel emergency contraception per 1000 women of reproductive age in the US population. Results Sales of levonorgestrel emergency contraception significantly increased after the New Year holiday (0.63 (95% confidence interval 0.58 to 0.69) unit increase per 1000 women aged 15-44). Holidays that share some aspects of the elevated risks of unprotected sexual intercourse with the New Year holiday (Valentine’s Day, St Patrick’s Day, US Independence Day) were associated with increased sales, albeit to a lesser degree, with respective sales increases per 1000 women aged 15-44 of 0.31 (0.25 to 0.38), 0.14 (0.06 to 0.23), and 0.20 (0.11 to 0.29). Holidays without these expectations (Easter, Mother’s Day, Father’s Day) were not significantly associated with sales of levonorgestrel emergency contraception. Conclusions Increased sales of emergency contraception following the New Year’s holiday suggest that this period is associated with increased risks of unprotected vaginal intercourse compared with other holidays. Targeting behavioral risks, prevention strategies to mitigate sexual violence, and improving access to contraception around holidays may limit the risks associated with unprotected vaginal intercourse.
Real world impact of Christmas BMJ research
Authors: Stuart Spicer, Graham Johnson, Andrew Tabner, Jill Matthews, Kerryn Husk
Journal: BMJ (2023)

Regular readers of The BMJ's Christmas issue may have seen our 2022 article, "Taking the biscuit: defining excessive quantities of free refreshments in a healthcare library," investigating staff attitudes towards free refreshments and what constitutes "excessive consumption." 1 This work identified that most people, when faced with the potential for unlimited free hot drinks and biscuits, would take no more than three free hot drinks and two packets of biscuits over the course of a working day.Free refreshments are usually intended to be a "work perk" to improve morale, and "back-of-a-biscuit-wrapper" calculations suggested that the cost to provide all NHS staff members with unlimited refreshments daily would be 0.084% of the total NHS budget.As such, the article concluded that any such initiative should be without restriction of "excessive consumption," with staff allowed to exercise their own judgment about equitable intake.
Abstract 14246: Impact of Coronavirus Disease 2019 Infection on Non-ST Elevation Myocardial Infarction Outcomes
Authors: Ahmad Gill, Omar Al-Taweel, Blaine Massey, Chowdhury H Ahsan
Journal: Circulation (2023)

Introduction: In this study, we explore the in-hospital outcomes of non-ST elevation myocardial infarction (NSTEMI) patients with and without concurrent coronavirus disease 2019 (COVID-19) infection. Methods: We utilized the National Inpatient Sample database (2016-2020) to identify patients who were admitted with a principal diagnosis of NSTEMI and a secondary diagnosis of COVID-19 infection. We conducted propensity score matching. Multivariable logistic regression, adjusted for age, sex and comorbidities, was used to compare mortality. Results: 1340 patients met our inclusion criteria. NSTEMI patients with concomitant COVID-19 infection had 3.24 times higher odds of suffering in-hospital mortality compared to NSTEMI admissions without COVID-19 (aOR 3.24, 95% CI: 1.93-5.43; p &lt; 0.001). When separated by race, NSTEMI patients with COVID-19 had higher mortality rates amongst White (8.2% vs 4.7%, p = 0.04) and Black patients (14.2% vs 0.9%, p &lt; 0.001, Figure 1). NSTEMI patients with COVID-19 infection were more likely to have acute respiratory distress syndrome (1.6% vs 0.1%, p = 0.004), myocarditis (1.3% vs 0%, p = 0.003) and severe sepsis (2.8% vs 0.9%, p = 0.01, Table 1). These patients were less likely to undergo percutaneous coronary intervention (PCI) (22.7% vs 28.4%, p = 0.02), but there was no significant difference in mean time to PCI (1.7 days vs 1.3 days, p = 0.12). Conclusion: Patients with NSTEMI and concurrent COVID-19 infection had higher odds of suffering in-hospital mortality compared to NSTEMI patients without COVID-19 infection. Further research should examine the impact of COVID-19 vaccination on the outcomes of this high-risk patient population.
Abstract 11516: Micra vs Transvenous Pacemaker: A Comparative Systematic Review and Meta-Analysis
Authors: Shahan Haseeb, Umair A Ansari, Ahmed T. Masoud, Chandra Chhetri, Shaheryar Usman, Muhammad Zulqarnain, Rajat Goyal
Journal: Circulation (2023)

Background: Leadless pacemakers (LP) represent an emerging modality for treating bradyarrhythmias. We performed a meta-analysis and systematic review comparing safety and efficacy outcomes of Micra LP and transvenous pacemakers (TVP). Methods: A literature search was performed. The primary efficacy endpoints were successful implantation rate and acceptable capture threshold of &lt;2V at 1 year. Primary safety outcomes were vascular injury, tamponade, device or lead dislodgement, pneumothorax, and major complications (needing intervention, prolonged hospital stay, readmission or death). A double-arm analysis was performed comparing LP and TVP. Data was pooled as mean differences (MD) or risk ratio (RR) including the 95% CI. Results: A total of 60 studies were included. There was no significant difference between the LP and TVP groups in terms of the rate of successful implantation (RR=1.02, P=0.95) and acceptable capture threshold (RR=0.90, P=0.11). LP was associated with a significantly lower incidence of major complications (RR = 0.54, [0.44, 0.67], P &lt; 0.001) and dislodgment (RR= 0.31, [0.21, 0.46], P &lt; 0.001). TVP had a significantly lower incidence of vascular injury (RR= 2.62, P=0.001) and a lower incidence of cardiac tamponade (RR= 2.29, P=0.001). There was no statistically significant difference regarding the incidence of infection (RR=0.76, P=0.6) and pneumothorax (RR= 0.58, P = 0.37). Conclusion: LP and TVP have equivalent implant success and long-term efficacy. LP had lower rates of major complications and dislodgement. TVP had lower rates of vascular injury and tamponade. Infection and pneumothorax rates were the same in both groups.
Abstract 286: Assessing the Needs of Caregivers of Cardiac Arrest Survivors: A Qualitative Study
Authors: Isabella M Tincher, Mary Holderness, Sabine Abukhadra, Danielle Rojas, Lizbeth Cespedes, Sachin Agarwal
Journal: Circulation (2023)

Background: Interventions addressing highly prevalent psychological distress in caregivers of cardiac arrest (CA) survivors are lacking.We conducted a prospective study to confirm our previous findings of information-based needs as the highest priority in a cross-sectionalsurvey of caregivers of CA survivors. Methods: Adult caregivers of CA survivors hospitalized at Columbia University Medical Center were eligible for recruitment.Caregivers completed an interview after transfer from the intensive care unit (ICU) to inpatient floors and a follow-up interview 1-monthpost-discharge. Interviews allowed for initial free response, followed by prompts for opinions on eight potential interventions addressingpatient-centered needs (i.e., CA education, information on neurological recovery or rehabilitation, having a designated member of thecare team) and caregiver-centered needs (i.e., peer-to-peer support, hospital-based resources, formal psychotherapy, self-care). Interviewtranscripts were used to identify top-ranked needs and temporal changes between post-ICU and 1-month post-discharge. Results: Of 33 caregivers who participated in post-ICU interviews between August 2021-July 2022, 22 who also completed 1-monthinterviews were analyzed. The highest ranked need during acute care (n=10; 45.5%) and 1-month post-discharge (n=8; 36.4%) wasaccess to a designated member of the patient’s medical care team to answer the caregiver’s questions throughout hospitalization and thetransition home. Patient-centered needs accounted for 81.8% (n=18) of caregiver desire for interventions at both time points. 37% (n=8)of caregivers shifted focus between patient- and caregiver-centered needs, observed in both directions, between the two interviews. Conclusions: Caregivers of CA survivors self-reported their greatest need during hospitalization and a month after hospital dischargeas access to trusted resources about their loved one’s medical condition. Studies with a longer follow-up to understand caregivers’journeys and timing of the switch from patient-to caregiver-centered needs are warranted.
The effect of carbohydrate intake on glycaemic control in individuals with type 1 diabetes: a randomised, open-label, crossover trial
Authors: Sofia Sterner Isaksson, Arndís F. Ólafsdóttir, Simon Ivarsson, Henrik Imberg, Eva Toft, Sara Hallström, Ulf Rosenqvist, Marie Ekström, Marcus Lind
Journal: The Lancet Regional Health - Europe (2023)

Few studies have examined the effects of lower carbohydrate diets on glucose control in persons with type 1 diabetes (T1D). The objective of the study was to investigate whether a moderate carbohydrate diet improves glucose control in persons with T1D.
Abstract 15472: The IRIS™ Valve: A Growth Accommodating Transcatheter Pulmonary Valve for Pediatric Patients
Authors: Nnaoma Agwu, Daryl Nguyen, Gregory S Kelley, Tanya Burney, Ekaterina Perminov, Christopher Alcantara, michael recto, Arash Kheradvar
Journal: Circulation (2023)

Introduction: It is estimated that at least 1 million children are living with a congenital heart defect (CHD) in the U.S. Most of these patients are born with some degree of right ventricular outflow tract (RVOT) abnormalities that at some point require pulmonary valve replacement to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). Due to their size, available solutions, e.g., the Melody™ valve (Medtronic Inc., Minneapolis, MN) cannot be implanted in small children under 20 Kg. Those must wait until they grow to a suitable weight to receive the valve, which may lead to RV dysfunction. Hypothesis: To mitiagte the detrminental effects to the RV, the IRIS™ valve is implantable at 12 mm with a 12-Fr delivery catheter. As the valve annulus grows, the valve would be balloon expanded up to 20 mm. Methods: The IRIS™ valve has been designed according to origami concepts such that its three leaflets would retain a fully-coapted form as it is expanded to a larger size. Here we report our methods and results of implantation in 9-17Kg Yucatan pigs. Results: The IRIS™ valve is made of thin porcine pericardial leaflets sewn into a laser-cut stainless-steel stent. The stented valve is covered with an ePTFE skirt to mitigate paravalvular leak. The IRIS™ valve is fully crimped over a 12-Fr delivery catheter for transfemoral implantation. We have successfully implanted the valve at the native pulmonary valve position with minimal regurgitation in three pigs ranging from 9 to 17kg with varying pulmonary annulus sizes. Conclusions: The IRIS™ transcatheter pulmonary valve has been successfully developed according to proprietary origami concepts. Using the 12Fr delivery catheter, the smallest delivery profile reported, we successfully implanted the IRIS™ valve within the pulmonary annulus of mini pigs with encouraging results.
Abstract 11577: Malnutrition Stratified by Marasmus and Kwashiorkor in Patients With Heart Failure
Authors: Yu Sato, Akiomi Yoshihisa, Yukiko Sugawara, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2023)

Introduction: Malnutrition is characterized by marasmus and kwashiorkor in children. However, the clinical significance of these aspects has been unclear in adult patients with heart failure (HF). Methods and Results: We divided a total of 1,888 patients with HF (median age 70.0, interquartile range 59.0-78.0) into four groups according to the presence/absence of marasmus type malnutrition (body mass index &lt; 18.5 kg/m 2 ) and kwashiorkor type malnutrition (serum albumin &lt; 3.4 g/dL): Group C (patients without malnutrition, n = 1,302, 69.0%), Group M (those with only marasmus, n = 117, 6.2%), Group K (those with only kwashiorkor, n = 390, 20.7%) and Group MK (those with both marasmus and kwashiorkor, n = 79, 4.2%). Group M showed lowest systolic blood pressure (Groups C, M, K, and MK; 122.0, 111.0, 125.0 and 122.0 mmHg, respectively, P &lt; 0.001). Groups K and MK showed higher levels of B-type natriuretic peptide (171.2, 375.4, 532.6 and 598.9 pg/mL, P &lt; 0.001). Mean right atrial pressure was lowest in Group M and highest in Group K (6.0, 5.0, 8.0 and 6.0 mmHg, P &lt; 0.001). Kaplan-Meir analysis demonstrated that Group MK had the lowest event-free rate of all-cause death compared to Group C, while Groups M and K had intermediate prognosis ( Figure ). In the multivariable Cox proportional hazard analysis, Groups M, K, MK were associated with all-cause death compared to Group C as a reference (adjusted hazard ratio 1.820, 1.623 and 2.248, respectively). Conclusions: Marasmus type malnutrition indicated wasting, kwashiorkor type malnutrition was characterized by congestion, and both types of malnutrition were independently associated with all-cause death in patients with HF.
Abstract 11578: Predicting 30- and 90-day Hospital Admission Rates Using 3-Dimensional Echocardiography Volume-Curve Parameters
Authors: Rick J Moro, Jianbin Zhu, Kapil Kapoor
Journal: Circulation (2023)

Introduction: This study compares impact of 3D echocardiography-derived novel volume-time parameters to established diastolic dysfunction grades with the aim to improve diagnostic and prognostic prediction of hospital admissions. Methods: Subjects (100 heart-failure (HF) and 11 controls) completed 3D-echocardiograms. Under 2016 ASE Guidelines ‘normal’ and ‘grade 1’ were classified as ‘lower-grade’ (n=64), while ‘grade 2’ and ‘grade 3’ as ‘higher-grade’ (n=38). Early passive filling rate to late passive filling rate ratio was calculated, with early-filling and atrial contraction volumes normalized to total filling volume and body surface area. VC based analysis was classified into ‘normal’ (n=37; atrial contraction enhanced, normal, early enhanced) and ‘abnormal’ (n=74; mid-filling enhanced, delayed filling and restrictive-constrictive). Both methods were compared for 30- and 90-day hospital admissions. Results: The mean age is 67.4 years (SD: 11.1) with 51.4% male. Overall, 9.0% (n=10) and 16.2% (n=18) of the subjects were admitted within 30-days and 90- days, respectively. For 30-day admission, 60% and 40% were lower-grade and higher-grade groups by ASE, respectively, (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.26 to 3.23, p-value = 0.89); For admission within 90-days, 50% were in lower-grade and 50% in higher-grade groups of ASE, respectively, (HR 1.37; 95% CI, 0.54 to 3.45, p-value = 0.51). Kaplan-Meier curves and log rank test showed significant differences between VC groups with (p-value =0.021 and p-value&lt;0.001) in at risk of admission within 30- and 90-days, respectively. Conclusions: Volume curve analysis provides a better diagnostic and prognostic tool for predicting near term hospital admissions in HF patients. Kaplan-Meier Curves depicting admission within 30- and 90- days by VC and ASE Group
Abstract 102: Early Bolus Epinephrine Administration During Pediatric Cardiopulmonary Resuscitation for Bradycardia With Poor Perfusion
Authors: Amanda J O'Halloran, Ron Reeder, Robert Berg, Kellimarie Cooper, Kathryn Graham, Martha Kienzle, Todd Kilbaugh, Kathleen Meert, Vinay M Nadkarni, Alexis A Topjian, Heather A Wolfe, Andrew R Yates, Robert M Sutton, Ryan W Morgan
Journal: Circulation (2023)

Introduction: Though epinephrine is recommended during CPR for children with bradycardia with poor perfusion, a registry study identified an association between epinephrine administration and worse outcomes. Our objective was to use granular data from the ICU-RESUScitation (ICU-RESUS) trial, including markers of illness severity not available in registries, to further investigate epinephrine use in this population. We hypothesized that when controlling for patient characteristics, early epinephrine administration would be associated with superior outcomes in children receiving CPR for bradycardia with poor perfusion. Methods: Prespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of pediatric (&lt;19 years) IHCA in 18 PICUs. Index events (October 2016 to March 2021) lasting 2 minutes with an initial rhythm of bradycardia with poor perfusion were included. Early administration of bolus epinephrine (first 2 minutes of CPR) was chosen as the exposure since pulselessness during CPR for bradycardia with poor perfusion develops at a median of 3 minutes. The association between early epinephrine and outcomes was evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics including Pediatric Risk of Mortality (PRISM) score and vasoactive inotropic score (VIS). Results: Of 452 patients, 322 (71.2%) received early epinephrine. The early epinephrine group had higher PRISM and VIS and more frequently received calcium and sodium bicarbonate. On univariate analysis, the early epinephrine group had lower, but not statistically significantly, rates of survival to discharge (174/322 [54%] vs 82/130 [63%], p=0.093) and survival with favorable neurologic outcome (164/322 [51%] vs 75/130 [58%], p=0.212). In multivariable analysis, early epinephrine was not associated with survival to discharge (RR 0.97, 95% CI 0.82, 1.14) or survival with favorable neurologic outcome (RR 0.99, 95% CI 0.82, 1.18). Conclusion: In this cohort of pediatric IHCA with an initial rhythm of bradycardia with poor perfusion, early bolus epinephrine was not associated with outcomes when controlling for illness severity. Further work should focus on which patients with this rhythm benefit from epinephrine.
Abstract 103: Quantitative Analysis of Apparent Diffusion Coefficients to Predict Neurological Prognosis in Cardiac Arrest Survivors: An Observational Derivation and Internal-External Validation Study
Authors: Jung A A Yoon, Jung Soo Park, You Yeonho, Kang Changshin, Min Jin Hong, Yong Nam In, Byungkook Lee, Hong Joon Ahn, Won Joon Jeong, Yong Hwan Kim, Hye Seon Jeong
Journal: Circulation (2023)

Aim: Our study aimed to develop apparent diffusion coefficient (ADC) values and thresholds to predict poor outcomes in out-of-hospital cardiac arrest (OHCA) survivors by quantitatively analyzing ADC values in brain MRI. Methods: This observational study utilized prospectively collected data two tertiary academic hospitals. The derivation cohort comprised 70% of patients randomly selected from one hospital, whereas the internal validation cohort comprised the remaining 30%. The external validation cohort used data from the other hospital. MRI data were restricted to scans conducted at 3T within 72-96 h after OHCA. We analyzed the % voxels of ADC thresholds (percentage of voxels below ADC thresholds per total voxel [PV]) at 50-step intervals ranging from 200 to 1200 х 10 -6 mm/s. Poor neurological outcomes were defined as cerebral performance categories 3-5 at 6 months after OHCA. Results: In total, 448 brain MRI scans were evaluated, including a derivation cohort (n=224) and internal/external validation cohorts (n=96 and 128, respectively). The PV values of 500, 550, 600, 650 and 700 х 10 -6 mm/s were determined using the area under the curve (AUC) and demonstrated better performance than higher values in predicting poor neurological outcomes across the derivation (AUC 0.90-0.91), internal validation (AUC 0.87-0.91), and external validation cohorts (AUC 0.91-0.92), showing similar performance levels. A PV of 600х10 -6 mm/s predicted a poor outcome with 100% specificity at a threshold of &gt;13.2% in the derivation cohort, with a sensitivity of 74% (95% CI 66-81) at 100% specificity. In both the internal and external validation cohorts, when using the same threshold, a specificity of 100% corresponded to sensitivities of 75% (95% CI 63-85) and 78% (95% CI 66-87), respectively (Figure). Conclusions: Quantitative analysis of ADC values in brain MRI is a promising tool for predicting poor neurological outcomes in OHCA survivors, with high sensitivity at a specificity of 100%.
Abstract 15401: Artificial Intelligence-Enabled Exercise-CMR for Evaluation of Cardiac Functional Reserve in Heart Failure
Authors: Fahime Ghanbari, Jordan A Street, Siyeop Yoon, Manuel A Morales, Jennifer Rodriguez, Jennifer Yue, Salah Assana, Shiro Nakamori, Jeremy M Robbins, Connie W Tsao, Deepa M Gopal, David Systrom, Aaron B Waxman, Warren J Manning, Reza Nezafat
Journal: Circulation (2023)

Introduction: Exercise unmasks pathophysiological markers in heart failure (HF), not evident at rest. Exercise CMR (Ex-CMR) has the potential to offer an accurate and reproducible assessment of cardiac functional reserve in HF. Objective: To study the cardiac functional reserve in HF using an artificial intelligence (AI) enabled exercise CMR imaging protocol. Method: We prospectively recruited patients with an established clinical diagnosis of HF and healthy adults. Subjects were imaged at rest and immediately post-exercise using a supine ergometer positioned on the CMR scan. The imaging protocol included free-breathing, real-time, highly accelerated cine short-axis images covering the entire LV. Cine images were collected with a spatial resolution of 1.9 х 1.9 mm 2 and temporal resolution of 38.8 ms using a 14.8-fold acceleration using an in-house inline deep learning reconstruction. Pre- and post-exercise biventricular volumetric and functional parameters and their corresponding percentage changes were calculated. Results: The study included 77 subjects, consisting of 37 HF patients (24 males; 60 ± 12 years) [HFpEF, n=13; HFmrEF, n=5; HFimpEF, n=13; and HFrEF, n=6], and 40 healthy adult (20 males; 45 ± 16 years). Changes in LV end-diastolic and end-systolic volume among subgroups revealed distinct clusters (Fig 1). These findings corresponded to a blunted to a modest rise in stroke volume (SV) observed in HFpEF and HFmrEF patients, respectively, while HFimpEF and HFrEF patients exhibited a mildly to excessively higher SV rise compared to other subgroups (Fig 1). HFpEF and HFmrEF showed no improvement in SV index beyond 10 ml/m 2 . Patients with known post capillary pulmonary hypertension demonstrated an inadequate right ventricle response in preload recruitment, contributing to a blunted increase in RV SV (Fig 1). Conclusion: Our AI-enabled, high-accelerated Ex-CMR imaging protocol reveals a distinctive biventricular functional reserve response in HF.