tbuckley/cabot-search huggingface dataset:
Prognostic significance of quality of life index in breast cancer
Authors: D. Gupta, J. F. Grutsch, J. Granick, R. Neelam, P. G. Vashi, M. Daehler, T. Wodek, C. G. Lis
Journal: Journal of Clinical Oncology (2006)

6135 Background: Quality of Life (QoL) is a multidimensional construct. There is extensive data showing that QoL tools measuring the activities of daily life provide prognostic information in cancer. However, similar information on QoL tools measuring patient satisfaction with their life is sparse. The Ferrans and Powers Quality of Life Index (QLI) is one such instrument. The goal of this study was to evaluate the statistical strength of association between QLI and survival in breast cancer patients undergoing care in a non-clinical trial setting. Methods: We examined a case series of 251 breast cancer patients treated at Cancer Treatment Centers of America between 04/01 and 11/04. QLI defines QoL in terms of satisfaction with the aspects of life that are important to the patient. QLI measures overall QoL and QoL in four major subscales: health and physical, social and economic, psychological and spiritual, and family. All scores range from 0 to 30 with higher scores indicating better QoL. Study patients were dichotomized into 2 groups based on median scores for all QoL subscales. Kaplan Meier method was used to calculate survival. Log-Rank test was used to study the equality of survival distributions. Results: Of 251 patients, 74 were newly diagnosed and 177 had prior treatment history. The median age was 48 years (range 25 - 74 years). 45 patients had stage I disease, 105 stage II, 38 stage III, and 32 stage IV. The table describes the median survival for all QLI subscales. Health and physical functioning subscale and QLI subtotal subscale were significantly associated with survival. Conclusions: This study shows that baseline levels of patient satisfaction with their QoL provide useful prognostic information in breast cancer. While these findings need to be evaluated further to ascertain which subscales of QoL have a role in predicting patients’ prognosis, they have important implications for patient stratification in clinical trials and may aid decision-making in clinical practice. [Table: see text] No significant financial relationships to disclose.
Impact of first-line chemotherapy duration in metastatic breast cancer: A systematic review.
Authors: A. Gennari, M. Sormani, O. Nanni, M. Stockler, N. Wilcken, M. Puntoni, D. Amadori, A. De Censi, P. Bruzzi
Journal: Journal of Clinical Oncology (2010)

1023 Background: Prolonging chemotherapy (CT) until disease progression is a common practice in the management of MBC. This approach is based on available evidence from randomized trials comparing longer with shorter CT duration, showing an improvement in progression-free survival (PFS) and in some cases in overall survival (OS) with longer CT duration. However, recently new studies of maintenance CT with modern regimens have been reported, with conflicting results. This systematic review was therefore undertaken to evaluate the impact of first-line chemotherapy duration in terms of PFS and OS, based on updated evidence. Methods: Randomized studies, comparing shorter with longer CT duration were identified, through literature search. Pooled estimates of the PFS HRs and OS HRs were obtained, according to standard meta-analysis procedures. Sensitivity analyses were performed to examine whether the overall effect was associated with study design (timing of randomization: ab initio or after induction CT), maintenance CT duration (until progression vs. fixed number of cycles), and co-administration of maintenance endocrine therapy. Results: Eleven eligible studies, including 2,62 patients were identified. Overall longer CT duration was associated with a 34% reduction in the hazard of progression (HR 0.66, CI 0.61-0.72; p<0.0001) and with an 8% reduction in the hazard of death (HR 0.92, CI 0.84-1.00; p=0.06). The magnitude of this effect was remarkably similar across groups of trials, both in terms of PFS and OS, suggesting its independence of study design (p for interaction 0.60/0.10), duration of maintenance CT (p for interaction 0.70/0.92) and concomitant maintenance endocrine therapy (p for interaction 0.14/0.63). Conclusions: Longer duration of first line CT in MBC is associated with a significant improvement in PFS and with a marginal improvement in OS. No significant financial relationships to disclose.
Genes of the TGFβ1 pathway in multimodally treated squamous cell carcinoma of the esophagus
Authors: B. L. Bruecher, F. Puehringer-Oppermann, N. Ott, J. T. Hartmann, A. Koenigsrainer, M. Sarbia
Journal: Journal of Clinical Oncology (2008)

22152 Background: Pretherapeutic biopsies from 97 patients with esophageal squamous cell carcinomas (ESCC) (cT3, cN0/+, cM0) who underwent neoadjuvant radiochemotherapy (RCTx: 45 Gy plus cisplatin and 5-fluorouracil) and subsequent esophagectomy in the setting of a single-center prospective treatment trial were investigated for expression of members of the TGF-β1 signaling pathway. Methods: Expression of TGF-β1 and its downstream effectors Smad4 and Smad7 was determined by means of quantitative RT-PCR from RNA prepared from pretherapeutic tumor biopsies. The presence of phosphorylated Smad2 was determined by immunohistochemistry. Results: Expression of TGF-β1, Smad4 and Smad7 varied greatly between cases. Tumors with histopathological response (according to Brücher et al. Cancer 2006) determined by histopathological examination after neoadjuvant radiochemotherapy showed significantly higher levels of Smad4 mRNA expression than tumors defined as histopathological nonresponder. TGF-β1 and Smad7 mRNA expression as well as Smad2 protein expression were of no prognostic value. Furthermore, expression of the four genes under analysis showed no impact on overall survival. In contrast, overall survival was significantly correlated with histopathological regression (p<0.0001). Conclusion: Among the parameters analyzed only Smad4 may have predictive value for esophageal squamous cell carcinoma treated with neoadjuvant radiochemotherapy. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Wilhelm Sander Foundation, Grant No. 2005.001.1
Abstract 209: The Incidence and Determinants of Brain Tissue Hypoxia in Cardiac Arrest Survivors with Severe Neurological Injury
Authors: Jonathan Elmer, Lori Shutter, David Okonkwo, Jon C Rittenberger, Clifton W Callaway, Cameron Dezfulian
Journal: Circulation (2014)

Introduction:  After cardiac arrest (CA), the American Heart Association recommends weaning inspired oxygen (FiO2) “to achieve an arterial oxygen saturation [SaO2]≥94%...to avoid potential oxygen toxicity.” This risks inadequate cerebral oxygen delivery. We hypothesized that brain tissue hypoxia (BTH) would occur commonly in severely brain injured post-CA patients and be more frequent when SaO2 was    Methods:  We monitor intracranial pressure (ICP), temperature, PbtO2 and jugular venous oxygen saturation in patients with severe neurological injury (extensor posturing or worse) after CA. We collected data hourly and defined BTH as PbtO298% vs 94-98%. We used generalized estimating equations to test the correlation of ICP, temperature, time from arrest, PaO2, MAP, arterial oxygen content and PaCO2 with PbtO2, then constructed an adjusted model using predictors with an unadjusted P98% (P   Conclusion:  In severely injured post-CA patients, BTH occurs frequently, appears to be delivery responsive, and occurs more commonly when SaO2 is 94-98%. The risk-benefit ratio between limiting BTH vs. limiting hyperoxia must be carefully considered in light of existing guidelines in these severely injured patients.
Is the timing of recommended childhood vaccines evidence based?
Authors: Kathryn M Edwards, Yvonne Maldonado, Carrie L Byington, Tom Jefferson, Vittorio Demicheli
Journal: BMJ (2016)

Vaccines undergo extensive testing and review before licensing to evaluate their immunogenicity, safety, and effectiveness in preventing disease.1 For example, prelicensing trials of pneumococcal conjugate and rotavirus vaccines are among the largest randomised controlled trials ever conducted, enrolling tens of thousands of infants.2 3 4 In addition to randomised controlled trials, which produce the highest level of evidence and provide the basis for vaccine licensure, vaccine policy also benefits from the additional supportive evidence obtained from thousands of other types of vaccine studies. Such studies generate critical data regarding age specific immunogenicity, dose and dosing intervals, interaction with other vaccines, duration of immunity, and overall vaccine safety to inform schedules.

### What evidence is needed to make the most appropriate schedule?

Data from clinical trials represent only a portion of the evidence considered in determining vaccination schedules.5 Burden of disease, immunogenicity, and efficacy studies enable countries to select vaccines and schedules appropriate for their populations, as shown by the recent infographic in The BMJ .6 Vaccine schedules are further refined by considerations such as timing and efficiency of access to the target population to optimise uptake. For childhood vaccines, integration with existing local or national well child visit schedules is a critical consideration. This concept was summarised well in the US Institute of Medicine (IoM) report on the childhood immunisation schedule: “Each new vaccine is approved on the basis of a detailed evaluation of both the vaccine itself and the immunization schedule.” The IoM further stated that randomised controlled trials in which children “would receive less than the full immunization schedule or no vaccines would not be ethical because they would be exposed to a greater risk for the development of diseases and community immunity would be compromised.”5

Once vaccines are in general use local surveillance is generally conducted to evaluate their effect on disease burden. …
Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery
Authors: Hung-Jui Tan, Debra Saliba, Lorna Kwan, Alison A. Moore, Mark S. Litwin
Journal: Journal of Clinical Oncology (2016)

Purpose Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Patients and Methods Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Results Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P &lt; .001). Adjusting for patient and hospital characteristics, those patients who experienced a geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Conclusion Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care.
Ki-1/CD30+ (anaplastic) large-cell lymphoma: maturation of a clinicopathologic entity with prospects of effective therapy.
Authors: M E Kadin
Journal: Journal of Clinical Oncology (1994)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1994.12.5.884 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 8164037 Ki-1/CD30+ (anaplastic) large-cell lymphoma: maturation of a clinicopathologic entity with prospects of effective therapy. M E KadinxM E KadinSearch for articles by this author https://doi.org/10.1200/JCO.1994.12.5.884 First Page PDF © 1994 by American Society of Clinical Oncology
Abstract 325: Early Initiation and Fast Achievement of Mild Therapeutic Hypothermia in Patients Successfully Resuscitated from Out-of-Hospital Cardiac Arrest
Authors: Christoph Testori, Peter Stratil, Heidrun Losert, Harald Herkner, Michael Holzer, Andreas Schober, Christian Wallmüller, Fritz Sterz
Journal: Circulation (2014)

AIM:  We hypothesized that a protocol with an early initiation of cooling as well as an earlier achievement of target temperature would be associated with a pronounced beneficial effect as compared to a delayed slow induction of mild therapeutic hypothermia (MTH) in patients after cardiac arrest.   MATERIALS AND METHODS:  This was a retrospective study in patients successfully resuscitated from witnessed out-of-hospital cardiac arrest with shockable cardiac rhythm. All patients were treated with MTH (32.0°C to 34.0°C) for 24 hours. For the intervention group we selected patients from our cardiac-arrest registry receiving MTH by the application of cooling pads (EMCOOLSpad, EMCOOLS AG, Austria), with or without the additive administration of cold saline. Patients from cooling-group of the “Hypothermia after Cardiac Arrest (HACA) Trial” receiving surface cooling with cold air (TheraKool, Kinetic Concepts Inc., United Kingdom) served as control group. Primary outcome measure was best neurologic function within six month with a cerebral performance category score of 1 or 2 defining good neurologic recovery.   RESULTS:  From 1996 to 2011 97 patients (51%) were treated with an early and fast cooling regimen. A total of 92 patients (49%) from the HACA-Trial served as controls. In the intervention group cooling was initiated 50 minutes after return of spontaneous circulation (IQR 19-75) as compared to 126 minutes (IQR 67-199) in the control group (p   CONCLUSION:  In this retrospective study early initiation and fast achievement of MTH was associated with better neurologic outcome in patients after cardiac arrest.
P0668 : On-treatment HBsAg kinetics to predict long-term HDV RNA response to peg-IFNa treatment of hepatitis delta
Authors: M. Wöbse, S. Hardtke, S. Ernst, H. Benjamin, B. Bremer, O. Keskin, A. Koch, M.P. Manns, H. Wedemeyer, C. Yurdaydin
Journal: Journal of Hepatology (2015)
Abstract 15119: Remote Ischemic Preconditioning Does Not Affect Skeletal Muscle Energy Metabolism Measured by 31-Phosphorus Magnetic Resonance Spectroscopy: A Randomized Crossover Trial
Authors: Emilie Jean-St-Michel, Jessica Caterini, Sara Thompson, Cedric Manlhiot, Brian W McCrindle, Andrew N Redington, Greg D Wells
Journal: Circulation (2013)

Background: Remote ischemic preconditioning (RIPC), induced by transient limb ischemia, has been demonstrated to protect organs against ischemia-reperfusion injury and to improve maximal, but not submaximal exercise performance. Nonetheless, the cellular mechanisms remain poorly understood. Phosphocreatinine concentration was recently shown to recover more rapidly during reperfusion in muscle that has undergone local ischemic preconditioning. Therefore, we used 31P-MRS and blood oxygen level dependent MRI (BOLD fMRI) to test the hypothesis that RIPC beneficially modifies muscle metabolism and perfusion during maximal but not submaximal exercise.

Method: Ten healthy subjects, 20 to 27 years, were randomised to RIPC (4 cycles of 5 minutes (min) arm ischemia/5 min reperfusion) or sham procedure, then crossed-over to the other intervention. Each subject performed ten 30 seconds (sec) bouts at 65% of the previously determined maximal work rate each separated by 15 sec of rest. Finally, six of the subjects also performed two bouts of 60 sec of maximal (100%) exercise. 31P-MRS and BOLD fMRI data were obtained before and after every testing protocol.

Results: There were no differences for ATP production (0.3±0.1 RIPC mmol/L, 0.3±0.1 SHAM, p=0.90), phosphocreatinine to inorganic phosphate ratio (0.9±0.8, 1.0±0.7, p=0.78) or in the half-time of phosphocreatinine recovery (27.1±11.8, 24.6±12.8 sec, p=0.66) during submaximal exercise. There were also no differences in BOLD signal amplitude between RIPC and SHAM (279.3 ± 169.3, 276.6 + 135.9, p=0.96) or for BOLD signal intercept (1614.0 + 373.4, 1522.7 + 332.9, p = 0.1), or for the BOLD signal recovery time constant (75.5 + 154.5, 47.3 + 23.6 sec, p=0.34). Similarly for the maximal exercise protocol, we observed no difference in pre vs. post-exercise pH (0.77±0.26, 0.93±0.14, p= 0.29), post-exercise phosphocreatinine and phosphate ratio (1.9±1.5, 2.4±2.4, p=0.70) or in the half-time of phosphocreatinine recovery (23.0±19.5, 20.2±7.3 sec, p=0.67).

Conclusion: The lack of demonstrated effect of RIPC on aerobic and anaerobic energy metabolism, and perfusion, is different than previously shown with local preconditioning and may suggest that different mechanisms play a role in the observed effects of RIPC.
Repeat hepatic resection and chemotherapy for recurrent colorectal liver metastases
Authors: D. Ferrari, E. Opocher, R. Santambrogio, A. Pisani, M. Barabino, C. Codecà, R. Scalzone, D. Marussi, A. Luciani, P. Foa
Journal: Journal of Clinical Oncology (2007)

14590 Background: An aggressive surgical approach combined with chemotherapy (CHT) is the best way to prolong survival in patients with colorectal cancer and synchronous resectable metastatic disease. Reintervention followed by systemic CHT is often a safe and effective procedure for fit patients with metastatic liver recurrence. Methods: Patients with resectable metastatic liver disease who underwent at least two surgical operations were included in the study. At diagnosis they had a median number of 6 measurable liver metastases (range 1–16), and median sum of largest diameters of lesions was 35 mm (range 10–70) from CT scan. Hepatic resection was followed each time by systemic CHT. Radiofrequency (RF) was added as needed to reach a curative intent . The aim of our study was to evaluate DFS and OS combining surgery, RF and CHT in this high-risk group. Results: Between November 2003 and July 2006 13 patients (median age 52 yrs, range 36–73; PS 0) with metastatic colorectal cancer underwent surgery on primary tumour and liver metastases followed by adjuvant CHT consisting of FOLFOX4 (oxaliplatin 85 mg/m 2 and LV5FU) or FOLFIRI (irinotecan 180 mg/m 2 and LV5FU) for 6 months. Free margins were obtained in 12 patients (92.3%). The second relapse was treated by liver surgery and systemic CHT (either FOLFIRI or FOLFIRI + Cetuximab in EGFR expressing tumours). Eight patients were offered concomitant radiofrequency (RF) for smaller lesions. Five patients (38.5%) underwent a third operation + RF followed by third-line CHT consisting of capecitabine alone or associated to oxaliplatin. After second and third hepatectomy there was no intraoperative or early postoperative mortality. With a median follow-up of 24 months (range 6–37) 6 patients are free of disease and all patients are still alive. Two-year DFS and OS are 46.2% and 100% respectively. Conclusions: Patients with metastatic colorectal cancer should be treated aggressively by surgery and CHT. In a small group of fit patients operated at least two times we obtained excellent 2-year DFS and OS. The benefit of adding adjuvant CHT as second-line or even third-line treatment seems to be justified by good long-term results. Our promising data from a single institution prompt further evaluation for aggressive surgery associated to CHT and new target molecules. No significant financial relationships to disclose.
PWE-375 A significant proportion of patients still require colonoscopy after ct colonography within the nhs bowel cancer screening programme
Authors: V Sehgal, E Harvey, J Stein, S Bloom, R Vega, S McCartney, A Obichere, K Besherdas
Journal: Gut (2015)

<h3>Introduction</h3> Patients within the Bowel Cancer Screening Programme (BCSP) who are unsuitable for or decline colonoscopy are instead usually offered CT colonography (CTC). Whereas patients with a normal CTC are either discharged or returned back to biennial screening, colonoscopy is usually indicated if CTC demonstrates a suspected colorectal cancer (CRC) or large polyp/s (&gt;10mm). Patients who have intermediate-sized polyps (6–9mm) or multiple diminutive polyps (&lt;5mm) either proceed to colonoscopy (flexible sigmoidoscopy for left-sided polyps) or interval CTC. We investigated the number of patients who required colonoscopy after CTC within the BSCP. We hypothesised that a significant proportion of patients still require colonoscopy, thus questioning the utility of CTC in patients in the BCSP. <h3>Method</h3> Patients who had a CTC within the BCSP at UCLH between September 2007–14 were identified retrospectively. All CTC examinations were performed using faecal tagging with laxatives wherever possible with or without intravenous contrast. <h3>Results</h3> of CTC were classified as normal, low-risk (1–2 polyps both &lt;10mm), intermediate-risk (3–4 polyps &lt;10mm or at least one ≥10mm), high-risk (≥5 small polyps or ≥3 intermediate-sized polyps with at least one ≥10mm) and suspected CRC. <h3>Results</h3> In total, 319 CTCs were performed in 292 patients. 39 patients (13%) had CTC after incomplete colonoscopy and were excluded. 253 patients (136 male, median age 70 years) underwent CTC as their primary investigation and their outcomes analysed. 98 patients (39%) proceeded to having a colonoscopy after their CTC. There was no significant difference in the reported study quality between those patients requiring a colonoscopy (good 44%, poor 10%) and not (good 52% poor 7%). 57 patients (92%) who had either intermediate/high-risk polyps or suspected CRC on CTC underwent colonoscopy. Of these 57 patients, 15 (26%) had either low-risk polyps (n = 9) or no abnormality at colonoscopy (n = 6). 37 patients (20%) whose CTC was either normal (n = 10) or revealed low-risk polyps (n = 27) were also referred for colonoscopy. No patient had their CTC diagnosis upstaged after colonoscopy. The median time from CTC to colonoscopy was 35 days (5–1852 days). 72 patients (74%) had their colonoscopy within 3 months of their index CTC. <h3>Conclusion</h3> A significant proportion of patients who undergo CTC within the BCSP will still require a colonoscopy. Although the sensitivity of polyp detection between CTC and colonoscopy is comparable, CTC confers a not insignificant radiation burden. It is essential that all patients be counselled with this information upon entrance into the BCSP and in doing so, may reduce the number of CTCs as the primary investigation within the BCSP. <h3>Disclosure of interest</h3> None Declared.
Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort
Authors: Guillaume Geri, Lucie Guillemet, Florence Dumas, Julien Charpentier, Marion Antona, Virginie Lemiale, Wulfran Bougouin, Lionel Lamhaut, Jean-Paul Mira, Christophe Vinsonneau, Alain Cariou
Journal: Intensive Care Medicine (2015)