Cedars-Sinai Medical Center Research Articles

Benefits of nature-based walking for breast cancer survivors

IntroductionPhysical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits...

Trends in Ambulatory Blood Pressure Monitoring in Five High-Volume Medical Centers.

HomeHypertensionAhead of PrintTrends in Ambulatory Blood Pressure Monitoring in Five High-Volume Medical Centers No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessTrends in Ambulatory Blood Pressure Monitoring in Five High-Volume Medical Centers Stephen P. Juraschek, Natalie A. Bello, Alexander R. Chang, Jennifer L. Cluett, Karen Griffin, Alan Hinderliter, Kenneth Mukamal, Long Ngo, Ruth-Alma N. Turkson-Ocran, Raven Voora and Wanpen Vongpatanasin Stephen P. JuraschekStephen P. Juraschek Correspondence to: Stephen P. Juraschek, Beth Israel Deaconess Medical Center, Division of General Medicine, Section for Research, 330 Brookline Ave, CO-1309, 216, Boston, MA 02215. Email E-mail Address: [email protected] https://orcid.org/0000-0003-4168-2696 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., J.L.C., K.M., L.N., R.-A.N.T.O.). Search for more papers by this author , Natalie A. BelloNatalie A. Bello https://orcid.org/0000-0003-3257-3623 Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (N.A.B.). Search for more papers by this author , Alexander R. ChangAlexander R. Chang https://orcid.org/0000-0002-8114-7447 Geisinger Health, Danville, PA (A.R.C.). Search for more papers by this author , Jennifer L. CluettJennifer L. Cluett https://orcid.org/0000-0002-5744-1099 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., J.L.C., K.M., L.N., R.-A.N.T.O.). Search for more papers by this author , Karen GriffinKaren Griffin Loyola University Medical Center, Maywood, IL (K.G.). Search for more papers by this author , Alan HinderliterAlan Hinderliter University of North Carolina at Chapel Hill, NC (A.H., R.V.). Search for more papers by this author , Kenneth MukamalKenneth Mukamal https://orcid.org/0000-0001-8450-6970 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., J.L.C., K.M., L.N., R.-A.N.T.O.). Search for more papers by this author , Long NgoLong Ngo Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., J.L.C., K.M., L.N., R.-A.N.T.O.). Search for more papers by this author , Ruth-Alma N. Turkson-OcranRuth-Alma N. Turkson-Ocran https://orcid.org/0000-0001-9932-052X Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J., J.L.C., K.M., L.N., R.-A.N.T.O.). Search for more papers by this author , Raven VooraRaven Voora University of North Carolina at Chapel Hill, NC (A.H., R.V.). Search for more papers by this author and Wanpen VongpatanasinWanpen Vongpatanasin https://orcid.org/0000-0002-7531-9388 University of Texas Southwestern Medical Center, Dallas (W.V.). Search for more papers by this author Originally published25 May 2023https://doi.org/10.1161/HYPERTENSIONAHA.123.21412Hypertension. 2023;0FootnotesORCID iD for Stephen P. Juraschek: 0000-0003-4168-2696For Sources of Funding and Disclosures, see page XXX.Correspondence to: Stephen P. Juraschek, Beth Israel Deaconess Medical Center, Division of General Medicine, Section for Research, 330 Brookline Ave, CO-1309, 216, Boston, MA 02215. Email [email protected]harvard.edu Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.123.21412PMID: 37226835 Originally publishedMay 25, 2023 Keywordssyncopemasked hypertensionhypotensionambulatory blood pressure monitoringwhite coat hypertensionPDF download Advertisement SubjectsBlood PressureHypertension

(126) Long-term Functional Outcomes for Men with Priapism Secondary to Recreational Use of Intracavernosal Injectables: A Multi-center Follo- up Study

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism. Objective We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs. Methods Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5). Results A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism. Conclusions Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner. Disclosure No

Imaging Caveats to Consider When Screening for Thrombolysis in the Extended Time Window.

HomeStrokeAhead of PrintImaging Caveats to Consider When Screening for Thrombolysis in the Extended Time Window No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessImaging Caveats to Consider When Screening for Thrombolysis in the Extended Time Window Dennys Reyes, Sabrena M. Ahmadi, Stuart Kieran, Nils H. Mueller-Kronast, Scott E. Blumenthal, Shlee S. Song and Alexis N. Simpkins Dennys ReyesDennys Reyes Delray Medical Center, Delray Beach, FL (D.R., S.K., N.H.M.-K., S.E.B.). Search for more papers by this author , Sabrena M. AhmadiSabrena M. Ahmadi Department of Vascular Neurology, Cedars Sinai Medical Center, Los Angeles, CA (S.M.A., S.S.S., A.N.S.). Search for more papers by this author , Stuart KieranStuart Kieran https://orcid.org/0009-0006-8083-8584 Delray Medical Center, Delray Beach, FL (D.R., S.K., N.H.M.-K., S.E.B.). Search for more papers by this author , Nils H. Mueller-KronastNils H. Mueller-Kronast Delray Medical Center, Delray Beach, FL (D.R., S.K., N.H.M.-K., S.E.B.). Search for more papers by this author , Scott E. BlumenthalScott E. Blumenthal Delray Medical Center, Delray Beach, FL (D.R., S.K., N.H.M.-K., S.E.B.). Search for more papers by this author , Shlee S. SongShlee S. Song https://orcid.org/0000-0002-7838-0205 Department of Vascular Neurology, Cedars Sinai Medical Center, Los Angeles, CA (S.M.A., S.S.S., A.N.S.). Search for more papers by this author and Alexis N. SimpkinsAlexis N. Simpkins Correspondence to: Alexis N. Simpkins, MD, PhD, MSCR, Director of Vascular Neurology Research and the SkRIPT Research Program, Department Neurology, 127 S San Vicente Blvd, Los Angeles, CA 90048. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7529-4267 Department of Vascular Neurology, Cedars Sinai Medical Center, Los Angeles, CA (S.M.A., S.S.S., A.N.S.). Department of Neurology, University of Florida College of Medicine, Gainesville (A.N.S.). Search for more papers by this author Originally published15 May 2023https://doi.org/10.1161/STROKEAHA.122.042019Stroke. 2023;0FootnotesFor Sources of Funding and Disclosures, see page xxx.Correspondence to: Alexis N. Simpkins, MD, PhD, MSCR, Director of Vascular Neurology Research and the SkRIPT Research Program, Department Neurology, 127 S San Vicente Blvd, Los Angeles, CA 90048. Email alexis.[email protected]org Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.042019PMID: 37183685 Originally publishedMay 15, 2023 Keywordsbrain imagingthrombolytic therapyischemic strokemagnetic resonancePDF download Advertisement SubjectsCerebrovascular Disease/StrokeIschemic Stroke

Editorial introductions.

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Lawrence J. HirschLawrence J. HirschLawrence J. Hirsch, MD is Professor of Neurology, Chief of the Division of Epilepsy and EEG, and Co-Director of the Comprehensive Epilepsy Center, all at Yale University, USA. He has held leadership positions in the American Clinical Neurophysiology Society (ACNS), American Epilepsy Society, American Academy of Neurology, and the Epilepsy Foundation, and is lead author of the 2012 and 2021 ACNS guidelines on critical care EEG terminology. He is founder and former chair of the Critical Care EEG Monitoring Research Consortium, which now includes more than 50 centers, and co-chair of the medical advisory board of the NORSE Institute. He has been an active researcher throughout his career, having published more than 200 peer-reviewed manuscripts and more than 100 reviews, editorials or book chapters on topics including status epilepticus, all aspects of EEG including intracranial recordings and brain monitoring in the critically ill, brain stimulation, epilepsy surgery, seizure clusters, rescue medications, sudden death in epilepsy (SUDEP), and anti-seizure medication use. He has won multiple teaching awards and is co-author of the first-ever atlas on EEG in critical care, now in its 2nd edition. He continues to see patients in the inpatient and outpatient setting, direct fellowship programs, teach, mentor, and manage a large epilepsy division at a level IV Comprehensive Epilepsy Center. Michael F. WatersMichael F. WatersMichael F. Waters, MD, PhD, is a neurologist, director of both the Neurovascular Division and the Petznick Stroke Center, and a professor in the Department of Neurology at Barrow Neurological Institute, USA. He is board certified in neurology by the American Board of Psychiatry and Neurology with subspecialty board certification in vascular neurology. Dr Waters’ expertise is stroke and neurovascular disease, including signs, symptoms, diagnostics, and treatments. He is a fellow of both the American Academy of Neurology and American Heart Association and a member of the American Neurological Association, American Society of Human Genetics, and the Society of Vascular and Interventional Neurology. Dr Waters received his Masters in genetics from Penn State University in State College, Pennsylvania, USA, and his doctorate in biochemistry and molecular biology from The University of Florida College of Medicine in Gainesville, USA, where he also completed his MD. He completed his residency training at the University of California – Los Angeles Department of Neurology and completed his fellowship in clinical and molecular neurogenetics at Cedars Sinai Medical Center in Los Angeles, USA. Dr Waters’ research studies include genetic mechanisms of stroke, neuroprotection in stroke, stroke treatment, multiple clinical trials investigating stroke treatments, and neurogenetic mechanisms of neuroplasticity.

(1169) Outcome of Enoxaparin Bridging in Left Ventricular Assist Devices (LVAD) in an Ambulatory Setting: A Continuation Study at Cedars Sinai Medical Center (CSMC)

(1169) Outcome of Enoxaparin Bridging in Left Ventricular Assist Devices (LVAD) in an Ambulatory Setting: A Continuation Study at Cedars Sinai Medical Center (CSMC)

MP77-15 INCREASED RISK OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY IN THE ACTIVE SURVEILLANCE ERA

You have accessJournal of UrologyCME1 Apr 2023MP77-15 INCREASED RISK OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY IN THE ACTIVE SURVEILLANCE ERA Sanjay Das, Michael Luu, Stephen Freedland, and Timothy Daskivich Sanjay DasSanjay Das More articles by this author , Michael LuuMichael Luu More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , and Timothy DaskivichTimothy Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the active surveillance (AS) era, radical prostatectomy (RP) has become more often used for intermediate- and high-risk disease and less for low-risk disease. AS/conservative management became the most common treatment for low-risk disease in the VA in 2010. However, the impact of this shift on risk of biochemical recurrence (BCR) after RP is unknown. We sought to determine how risk of BCR has changed before and after 2010 and to provide contemporary projections for BCR by tumor risk. METHODS: We sampled men who underwent RP for clinically localized disease between 2000 and 2017 from the VA SEARCH database. Kaplan Meier analysis was used to calculate incidence of BCR before and after 2010 overall and across tumor risk subgroups. Multivariable Cox proportional hazard regression analysis including an interaction term between epoch and tumor risk was used to compare risk of BCR before and after 2010 overall and across tumor risk subgroups. RESULTS: Of 5,648 patients, 3,276 (58%) underwent RP in 2010 or prior and 2,372 (42%) after 2010. Of those who underwent RP in 2010 or prior, 1,266 (39%), 503 (15%), 655 (20%), and 712 (22%) had low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively, compared with 335 (14%), 488 (21%), 768 (32%), and 749 (32%) among those who underwent RP after 2010 (p<0.001). The 7-year risk of BCR in the post-2010 was 43%, compared with 33% in the pre-2010 era (HR 1.15, 95%CI 1.04–1.28). In a multivariable Cox model adjusting for tumor risk, there was a significant interaction between tumor risk and epoch in predicting BCR (p<0.001). Men with favorable intermediate risk (HR 0.71, 95%CI 0.53–0.96) and unfavorable intermediate risk disease (HR 0.74, 95%CI 0.61–0.90) had a lower risk of BCR in the post-2010 era. Men with high-risk disease (HR 1.24, 95%CI 1.06–1.45) had higher risk of BCR in the post-2010 (vs. pre-2010) era. The 5-year risk of BCR in the pre- vs. post-2010 eras were 17% vs. 15%, 23% vs. 20%, 40% vs. 33%, and 46% vs. 52% for low, favorable intermediate, unfavorable intermediate, and high-risk disease, respectively. CONCLUSIONS: Trends toward using RP for higher risk disease have increased the 7-year risk of BCR from 33% to 43% in the pre- vs. post-AS eras, primarily driven by increased risk of BCR in high-risk patients. Source of Funding: This research was supported by Cedars-Sinai Cancer at Cedars-Sinai Medical Center through the Biostatistics Core Voucher Program. Dr. Das was supported by the Patient Centered Outcomes in Urologic and Gynecologic Cancers (PCORT: UroGynCan) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1108 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjay Das More articles by this author Michael Luu More articles by this author Stephen Freedland More articles by this author Timothy Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

Meet the First Authors.

HomeCirculation ResearchVol. 132, No. 6Meet the First Authors Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBMeet the First Authors Originally published16 Mar 2023https://doi.org/10.1161/RES.0000000000000603Circulation Research. 2023;132:672–673is related toGJA1-20k Rescues Cx43 Localization and Arrhythmias in Arrhythmogenic CardiomyopathySmooth Muscle MR in Post-Preeclampsia Hypertension (p 674)Download figureDownload PowerPointDr Lauren Biwer is a postdoctoral researcher in Dr Iris Jaffe’s lab at Tufts Medical Center. She became passionate about research in Dr Taben Hale’s lab at the University of Arizona and completed her PhD in Molecular Physiology at the University of Virginia with Dr Brant Isakson. When her sister developed preeclampsia, she became interested in mitigating future cardiovascular disease in women with complicated pregnancies. Lauren received a K99 grant to pursue this work and is thrilled to start her independent laboratory in the Yale Vascular Biology and Therapeutics program in November 2023. She enjoys traveling, outdoor activities, college sports and reading non-fiction. She can be found on Twitter @DrLaurenBiwer.Endosomal PI3Kγ Regulates Hypoxia Sensing (p 690)Download figureDownload PowerPointDr Yu Sun (Cynthia) earned her MD in Pathology from Shanghai Medical College at Fudan University in 2014. Following her clinical training, Cynthia joined the lab of Dr Naga Prasad in 2017 as a postdoctoral fellow to understand the mechanisms regulating βAR function in hypoxia. Unexpectedly, she found that hypoxia regulates endosomal βAR function by inhibition of resensitization through PI3K. Her current work focuses on dissecting the agonist-independent endosomal regulation of βARs, as acute hypoxia is the initial stress following ischemia. During her free time Cynthia enjoys reading and watching movies.Download figureDownload PowerPointKate Stenson is currently Senior Laboratory Technologist in the Department of Cardiovascular and Metabolic Sciences at Lerner Research Institute, Cleveland Clinic. She earned her undergraduate degrees in Marine Biology and Psychobiology from the University of New England in Maine. She joined Cleveland Clinic to further extend her hands-on approach from her undergraduate education to the mouse models of pathology, specifically heart failure. She is passionate about unraveling scientific discoveries through the use of animal models and during her spare time, when she is not imaging mice, she likes to play with her kids and take them to musicals.Dectin-1 Mediates Ang II Action in Heart (p 707)Download figureDownload PowerPointDr Shiju Ye earned his MS in Cardiovascular Disease at the Wenzhou Medical University, China, in 2019, and is now pursing his Cardiovascular Disease PhD at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China. Dr Ye’s recent research interests include Ang II related cardiac inflammation, heart failure, and the crosstalk between the cardiomyocytes and macrophages. Outside of the laboratory, he not only maintains an active social life and studies, but also focuses on learning clinical knowledge of cardiovascular disease.GJA1-20k Reduces Arrhythmias in ACM (p 744)Download figureDownload PowerPointDr Joseph Palatinus is an Assistant Professor of Medicine at the Nora Eccles Harrison Cardiovascular Research and Training Institute at the University of Utah and Critical Care Cardiologist at Intermountain Medical Center. He completed his residency at Beth Israel Deaconess Medical Center and cardiology and critical care medicine fellowships at Cedars Sinai Medical Center. His postdoctoral work focused on gap junction trafficking in the laboratory of Dr Robin Shaw. The Palatinus Lab is focused on mechanisms contributing to disease progression in arrhythmogenic cardiomyopathy. Dr Palatinus’s clinical interests are focused on the care of patients with cardiogenic shock in the CCU. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesGJA1-20k Rescues Cx43 Localization and Arrhythmias in Arrhythmogenic CardiomyopathyJoseph A. Palatinus, et al. Circulation Research. 2023;132:744-746 March 17, 2023Vol 132, Issue 6 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/RES.0000000000000603PMID: 36927179 Originally publishedMarch 16, 2023 PDF download Advertisement

Quality of Life, Procedural Success, and Clinical Outcomes following Transcatheter Mitral Valve Repair.

Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to characterize those who had procedural success, yet reported a low Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score. We reported the experience of Cedars-Sinai Medical Center patients between 2013 and 2020. Patients were allocated into four groups according to the 30-day KCCQ: <25, 25-49, 50-74, and ≥75. Primary outcome included 1-year all-cause death or heart failure (HF) hospitalizations. We also examined the association between QoL and the primary outcome in those with procedural success. A total of 555 patients were included in our analysis, median follow-up of 650 days (IQR 243-1113). The lower KCCQ groups had a higher prevalence of functional mitral regurgitation (65%, 60%, 56%, and 43%, p = 0.001), as well as a higher Society of Thoracic Surgeon (STS) score. These groups had a significantly higher occurrence of 1-year all-cause death or HF hospitalizations in a stepwise fashion (40%, 22%, 16%, and 10%, p < 0.001). Multivariable Cox regression analysis revealed 30-day KCCQ as the strongest predictor of the 1-year primary outcome (HR 0.98, 95%CI (0.97-0.99), p = 0.006). Approximately a quarter of patients with procedural success had a low KCCQ score. These patients had a higher rate of the combined 1-year outcome regardless of procedural success or failure. QoL following TMVr is a powerful prognostic factor. KCCQ assessment is an important indicator for identifying patients prone to adverse outcomes even after procedural success.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Cleaving It All Behind: ADAMTS7 Degrades Factor H.

1Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California 2Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York Correspondence: Dr. Paolo Cravedi, Icahn School of Medicine at Mount Sinai, 1 Levy Place, New York, NY 10029. Email: [email protected] See related article, “ADAMTS7-Mediated Complement Factor H Degradation Potentiates Complement Activation to Cause Renal Injuries,” on pages 291–308.

Now is the greatest time to be in it

Daylon James is an associate professor at Weill Cornell Medicine in New York, where his work focuses on reproductive biology and cell-based approaches for treating infertility. Arun Sharma is an assistant professor at the Cedars-Sinai Medical Center Regenerative Medicine Institute, and his lab works on modelling cardiovascular diseases and developing cell-based screening platforms for drug toxicity. Many of us also know them as the hosts of the Stem Cell Podcast. Here, we ask them about the podcast and discuss their view on the stem cell field and science communication.

Discussion: Revascularization of the Nipple-Areola Complex following Nipple-Sparing Mastectomy.

Santa Monica and Los Angeles, CA From the 1Division of Plastic Surgery, David Geffen School of Medicine at the University of California, Los Angeles 2Division of Surgical Oncology, Cedars Sinai Medical Center. Received for publication March 5, 2022; accepted June 27, 2022. Disclosure: The authors have no financial interests to report. No funding was received for this Discussion. Jay Arthur Jensen, MD, Division of Plastic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, 2001 Santa Monica Boulevard, Suite 1180W, Santa Monica, CA 90404, [email protected]

Reply: Machine learning models for NAFLD/NASH and cirrhosis diagnosis and staging: accuracy and routine variables are the success keys.

1Arnold O. Beckman High School, Irvine, United States 2Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California 3Houston Research Institute, Houston Texas Correspondence Mazen Noureddin, Director, Houston Liver Institute, Director, Houston Research Institute, 1155 Dairy Ashford Suite 200, Houston, Texas, 77079. Email: [email protected]

Behavioural Economics to Improve Antihypertensive Therapy Adherence (BETA): protocol for a pilot randomised controlled trial in Los Angeles

IntroductionNon-adherence to antihypertensive therapy is one of the major barriers to reducing the risk of cardiovascular disease. Several interventions have targeted higher medication adherence, yet most do not result in...

Editorial introductions.

Editorial introductions.

Confounders mediate AI prediction of demographics in medical imaging

Deep learning has been shown to accurately assess “hidden” phenotypes from medical imaging beyond traditional clinician interpretation. Using large echocardiography datasets from two healthcare systems, we test whether it is possible to predict age, race, and sex from cardiac ultrasound images using deep learning algorithms and assess the impact of varying confounding variables. Using a total of 433,469 videos from Cedars-Sinai Medical Center and 99,909 videos from Stanford Medical Center, we trained video-based convolutional neural networks to predict age, sex, and race. We found that deep learning models were able to identify age and sex, while unable to reliably predict race. Without considering confounding differences between categories, the AI model predicted sex with an AUC of 0.85 (95% CI 0.84–0.86), age with a mean absolute error of 9.12 years (95% CI 9.00–9.25), and race with AUCs ranging from 0.63 to 0.71. When predicting race, we show that tuning the proportion of confounding variables (age or sex) in the training data significantly impacts model AUC (ranging from 0.53 to 0.85), while sex and age prediction was not particularly impacted by adjusting race proportion in the training dataset AUC of 0.81–0.83 and 0.80–0.84, respectively. This suggests significant proportion of AI’s performance on predicting race could come from confounding features being detected. Further work remains to identify the particular imaging features that associate with demographic information and to better understand the risks of demographic identification in medical AI as it pertains to potentially perpetuating bias and disparities.

Abstract C071: Keratin 17 excludes CD8-positive T cells and recruits CD163-positive macrophages in pancreatic ductal adenocarcinoma

Abstract Background: Keratin 17 (K17) is a negative prognostic biomarker, overexpressed in the biologically most aggressive forms of pancreatic ductal adenocarcinoma (PDAC). In other anatomic sites and disease processes, K17 expression also correlates with immune cell infiltrates and could block T-cell infiltration. Thus, we hypothesized that K17 expression correlates with the inflammatory microenvironment in PDAC. In this study, we aimed to determine the relationship between the stromal immune cell infiltrates and K17 expression, using multiplexed immunohistochemistry (mIHC) and our suite of deep learning tools to quantitatively evaluate the expression of four biomarkers of T-cells and macrophages in PDAC. Methods: mIHC was performed on representative sections of 201 primary PDACs from Stony Brook University Hospital, Thomas Jefferson University Hospital, Cedars Sinai Medical Center, and from a national cohort (KYT, Pancreatic Cancer Action Network, and Perthera). Antibodies for CD4 (helper T-cells), CD8 (cytotoxic T-cells), CD16 (pan-macrophage), CD163 (M2 macrophages), pancytokeratin, and K17 were provided by Roche Diagnostics Corporation through a sponsored research agreement. mIHC was performed on a Discovery Ultra Autostainer (Roche), using horseradish peroxidase (HRP) and alkaline phosphatase (AP)-based protocols with multiple chromogens (Red: CD4, Purple: CD8, Yellow: CD16, Green: CD163, Teal: pancytokeratin, and Brown: K17) to enable multispectral imaging of diverse immune cell populations within the cancer microenvironment. A deep learning analysis workflow was used to detect and classify stromal inflammatory cells, in whole slide images (WSIs), generated using an Olympus VS120 digital microscope (Olympus, Tokyo, Japan). Pixel-wise predictions from a color auto-encoder (ColorAE) union UNET anchor UNET model were combined to create multi-class masks that were further analyzed to perform detection and classification. Results: The analysis of the inflammatory microenvironment focused on defining immune cell infiltrates located within 25 microns of the closest K17-positive versus K17-negative tumor cell in each representative section. Across the sum of K17-positive and negative zones/section, CD4 cell counts ranged from 0-10,617 (mean 2,709), CD8 cell counts ranged from 63-28,596 (mean 6,745), CD16 cell counts ranged from 4-7,797 (mean 3,024), and CD163 cell counts ranged from 35-34,696 (mean 14,968). CD4 T-helper cells, CD8 cytotoxic T cells, and CD16 macrophages were more numerous (respectively, p=0.0012; p=&amp;lt;0.0001; p=&amp;lt;0.0001) in K17-negative tumor zones compared to K17-positive zones. By contrast, the number of CD163 (M2) tumor-promoting macrophages was greater in K17 positive zones (p=0.0019). Conclusion: K17 expression by tumor cells impacts the chronic inflammatory microenvironment, shielding tumor cells from immune cell mediated cytotoxic responses, while recruiting tumor-promoting M2 macrophages, indicating that K17 impacts the immune response as a fundamental hallmark of aggression in PDAC. Citation Format: Lyanne Oblein, Michael Horowitz, Mahmudul Hasan, Sruthi Babu, Mariana Torrente-Goncalves, Lucia Roa, Jaymie Oentoro, Jason Harper, Xin Yao Zheng, Wei Jiang, Andrew Hendifar, Natalie Moshayedi, Brent Larson, Veronica Placencio-Hickok, Edik Blais, Emmanuel Petricoin, Joel Saltz, Natalia D. Marchenko, Luisa F. Escobar-Hoyos, Kenneth Shroyer. Keratin 17 excludes CD8-positive T cells and recruits CD163-positive macrophages in pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C071.

Bibliometric and visual analysis of coronary microvascular dysfunction.

Coronary microvascular dysfunction (CMD) may play an important role in various cardiovascular diseases, including HFpEF and both obstructive and non-obstructive coronary artery disease (CAD). To date, there has been no bibliometric analysis to summarize this field. Here, we aim to conduct a bibliometric analysis of CMD to determine the current status and frontiers in this field. Publications about CMD were taken from the Web of Science Core Collection database (WOSCC). WOSCC's literature analysis wire, the VOSviewer 1.6.16, and CiteSpace 5.1.3 were used to conduct the analysis. A total of 785 publications containing 206 reviews and 579 articles are included in the sample. The leading authors are Iacopo Olivotto, Paolo G. Camici, and Carl J. Pepine. The most productive institutions are the University of Florence, Cedars Sinai Medical Center, and Harvard University. The most productive countries are the USA, Italy, and England. There are a total of 237 journals that contribute to this field, and the leading journals in our study were the International Journal of Cardiology, the European Heart Journal and the JACC. From 2012 to 2021, the top three most-cited articles focused on the association between HFpEF and CMD. The important keywords are heart failure, hypertrophic cardiomyopathy, chest pain, women, coronary flow reserve (CFR), endothelial dysfunction and prognostic value. "Positron emission tomography" shows the strongest burst strength, followed by "blow flow" and "artery." The keywords that started to burst from 2015 are particularly emphasized, including "heart failure," "coronary flow reserve," and "management." Studies about CMD are relatively limited, and the largest contribution comes from the USA, Italy and England. More studies are needed, and publications from other countries should be enhanced. The main research hotspots in the CMD field include CMD in patients with HFpEF, sex differences, the new methods of diagnosis for CMD, and the effective treatment of CMD. Attention should be given to CMD in patients with HFpEF, and untangling the association between CMD and HFpEF could be helpful in the development of physiology-stratified treatment for patients with CMD and HFpEF.

Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy

BackgroundAmong women with hypertensive disorders of pregnancy, biomarkers may stratify risk for developing preeclampsia with severe features (sPE).MethodsAcross 18 U.S. centers, we prospectively measured the ratio of serum soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) in pregnant women hospitalized between 23 and 35 weeks of gestation. The primary outcome was predicting sPE, and secondary outcomes included predicting adverse outcomes within 2 weeks. The prognostic performance of the sFlt-1:PlGF ratio was assessed by using a derivation/validation design.ResultsA total of 1014 pregnant women were evaluated; 299 were included in the derivation cohort and 715 in the validation cohort. In the derivation cohort, the median sFlt-1:PlGF ratio was 200 (interquartile range, 53 to 458) among women who developed sPE compared with 6 (interquartile range, 3 to 26) in those who did not (P<0.001). The discriminatory ratio of ≥40 was then tested in the validation cohort and yielded a 65% positive (95% confidence interval [CI], 59 to 71) and a 96% negative (95% CI, 93 to 98) predictive value for the primary outcome. The ratio performed better than standard clinical measures (area under the receiver-operating characteristic curve, 0.92 versus <0.75 for standard-of-care tests). Compared with women with a ratio <40, women with a ratio ≥40 were at higher risk for adverse maternal outcomes (16.1% versus 2.8%; relative risk, 5.8; 95% CI, 2.8 to 12.2).ConclusionsIn women with a hypertensive disorder of pregnancy presenting between 23 and 35 weeks of gestation, measurement of serum sFlt-1:PlGF provided stratification of the risk of progressing to sPE within the coming fortnight. (Funded by Cedars-Sinai Medical Center and Thermo Fisher Scientific; ClinicalTrials.gov NCT03815110.)