tbuckley/cabot-search huggingface dataset:
Abstract 16955: Training EP Fellows to Use Low Fluoroscopy Techniques for Atrial Fibrillation Ablation
Authors: Michele Murphy, Augustus Mealor, Will Camnitz, Andrew Darby, Rohit Malhotra, Kenneth Bilchick, Pamela Mason, John Ferguson, Michael Mangrum
Journal: Circulation (2016)

Introduction:  Despite the use of 3D electroanatomic mapping (EAM) systems, atrial fibrillation (AF) ablation still requires high radiation exposure and fluoroscopy (FL) times. Using CARTO UnivU (CU), FL images are imported to create a background over which virtual catheters are displayed and then fused with EAM of the left atrium, thus simulating FL without further radiation. We report techniques to train EP fellows in low FL left atrial ablation (LA) using CU, phased-array intracardiac ultrasound (ICE) and force-sensing (FS) catheters.   Methods:  We performed 52 ablations for AF and left atrial flutter (LAF) from Feb to Nov 2015 in which the EP fellow was primary operator. AP and LAO CU images were obtained and ICE was advanced from the left femoral vein to the right atrium, to image the SVC. The guidewire and transseptal long sheath were positioned in the SVC under ICE guidance. We then performed pullback to the fossa under ICE guidance until tenting of the fossa was observed. Transseptal puncture was performed using ICE and FL in the LAO projection. A second transseptal sheath was placed using the same technique. EAM of the left atrium was performed using a multipolar mapping catheter (Pentarray or LassoNav). A coronary sinus catheter was advanced without FL, using both CU and ICE. Following transseptal puncture, all catheter manipulation was done with CU, ICE and the force vector of the FS catheter. At this point, lead protective wear was no longer needed.   Results:  We performed 52 ablations: 47 for AF (30 persistent) and 5 for LAF. The mean age was 66 yrs., 64% were male, and 12% had implanted devices. Mean procedure time was 225 (120 - 390) min with 40 (14 - 68) min of RF ablation. Mean FL time was 4.2 (0.5 - 8.4) min and mean dose of 22 (9-124) cGy. Pulmonary vein isolation was performed in all patients. Additional LA ablation was performed in 16 patients; 4 had CTI ablation. There was 1 major complication of cardiac tamponade requiring pericardiocentesis.   Conclusions:  CU is an intuitive mapping system that together with FS catheters and ICE imaging facilitates catheter manipulation during LA ablation, allowing very low fluoroscopy exposure, even during training of EP fellows.
Using Siglec-engaging Tolerance-inducing Antigenic Liposomes (STALs) to reduce memory B cell responses to the major peanut allergen Ara h 2
Authors: LaKeya C. Hardy, Kelly Orgel, Shiteng Duan, Soheila J. Maleki, A. Wesley Burks, James C. Paulson, Matthew Macauley, Michael D. Kulis
Journal: Journal of Allergy and Clinical Immunology (2018)
OC-008 Stratification of patients with alcoholic hepatitis by analysis of trajectory of serum bilirubin concentration
Authors: R Parker, J Cabezas, J Altamirano, A Sinha, A Dhanda, M Arrese, JP Abad, V Vargas, CA McCune, R Bataller, A Holt
Journal: Gut (2017)

Introduction  Acute alcoholic hepatitis (AAH) has a poor prognosis. We analysed the trajectory of serum bilirubin concentration to stratify patients in terms of risk of morbidity and mortality, and to identify patients who might benefit from corticosteroid treatment.  Method  Bilirubin concentration up to 28 days from admission was evaluated in 262 patients with AAH who did not receive steroids at Queen Elizabeth Hospital, Birmingham and Bristol Royal Infirmary, Bristol. Traj software was used to identify distinct bilirubin trajectories. Survival was evaluated with Kaplan Meier and Cox proportional analyses. Findings were validated in a cohort of 74 patients drawn from the UK, USA, Spain and Chile. Finally the utility of using bilirubin trajectory to identify patients who benefited from corticosteroid therapy was evaluated.  Results  Three discrete trajectories of bilirubin concentration were identified over 28 days: group 1 ‘fast fallers’, group 2 ‘static’ and group 3 ‘rapid risers’ (figure 1). The course of bilirubin trajectory could be discerned accurately in the first 7 days of admission (Kappa 0.83), allowing for stratification of patients early in their illness. Group 3 had an increased risk of death at 90 days after admission (log rank p  Conclusion  Identification of types of bilirubin trajectory in alcoholic hepatitis stratifies patients into distinct groups with differing clinical outcomes. This allows accurate identification of a subgroup of patients who benefit from corticosteroid therapy.  Disclosure of Interest  None Declared
Seven in 10 complaints reviewed under new GMC scheme are thrown out
Authors: Abi Rimmer
Journal: BMJ (2017)

The General Medical Council carried out over 700 fewer fitness to practise investigations into complaints about doctors over the past two years, following a change to its processes.

The regulator investigated 18% of the complaints it received in 2016 (1436 out of 8197), compared with 31% in 2014 (2726 out of 8851).1

In its State of Medical Education and Practice in the UK …
The effect of loneliness on cancer mortality.
Authors: Simona D'ippolito, Ettore Ambrosini, Malihe Shams, Giuseppe Calì, Davide Pastorelli
Journal: Journal of Clinical Oncology (2017)

10070 Background: Convergent findings indicate the need of broadening the vision of cancer beyond known prognostic factors, as many variables of different nature equally affect the course of disease. Loneliness has been found to be associated with various health outcomes, but its relationship with cancer remains unclear. Here we aimed to investigate the specific effect of loneliness and other demographic, psychological, and clinical variables on cancer mortality and to validate the Italian UCLA Loneliness Scale in cancer patients. Methods: This descriptive and correlational study was conducted at the Veneto Institute of Oncology in Padua. 400 patients undergoing chemotherapy from 01/2014 to 06/2015 were enrolled. The sample was stratified by sex and age (4 groups, 40-80 y). We collected demographic, clinical (site and stage of cancer, type of chemotherapy, death date), and psychosocial [self-esteem (RSE), perceived social support (MSPSS), social interaction anxiety (SIAS), personality (EPQR), and depression (BDI)] data. Results: GLM analyses: loneliness was higher in women than men (F(1,398) = 7.5, p = .006) and it linearly increased with age (F(1,398) = 10.9, p = .001). Loneliness was also influenced by marital status (F(3,396) = 2.9, p = .037), cohabitant offspring (F(1,398) = 7, p = .008), and educational level (F(3,396) = 4.7, p = .003), but not by clinical variables (all ps &gt; .05). Correlation analyses: loneliness was inversely related to RSE (r = -.51), MSPSS (r = -.52), and extroversion (r = -.32), and directly related to SIAS (r = .46), neuroticism (r = .43), and BDI (r = .44). More importantly, a hierarchical binomial logistic regression revealed that patients’ mortality was reliably predicted by gender, stage of cancer at diagnosis, time from diagnosis to UCLA collection, BDI, and UCLA (HL χ 2 (8) = 3.53, p = .90). In particular, high BDI predicted higher mortality (Wald = 11.6, p &lt; .001); surprisingly, after controlling for BDI and other effects, high loneliness predicted lower mortality (Wald = 7, p = .008). Conclusions: Our results replicate prior research and reveal a surprising association between loneliness and mortality risk after partialling out the impact of, especially, depression. This suggests the role of loneliness on cancer course as an important health concern.
Impact of neoadjuvant chemoradiotherapy on health-related quality of life in long-term survivors of esophageal or junctional cancer: results from the randomized CROSS trial
Authors: B J Noordman, M G E Verdam, S M Lagarde, J Shapiro, M C C M Hulshof, M I van Berge Henegouwen, B P L Wijnhoven, G A P Nieuwenhuijzen, J J Bonenkamp, M A Cuesta, J Th M Plukker, E J Spillenaar Bilgen, E W Steyerberg, A van der Gaast, M A G Sprangers, J J B van Lanschot
Journal: Annals of Oncology (2017)

Neoadjuvant chemoradiotherapy (nCRT) plus surgery is a standard of care for patients with esophageal or junctional cancer, but the long-term impact of nCRT on health-related quality of life (HRQOL) is unknown. The purpose of this study is to compare very long-term HRQOL in long-term survivors of esophageal cancer who received nCRT plus surgery or surgery alone.Patients were randomly assigned to receive nCRT (carboplatin/paclitaxel with 41.4-Gy radiotherapy) plus surgery or surgery alone. HRQOL was measured using EORTC-QLQ-C30, EORTC-QLQ-OES24 and K-BILD questionnaires after a minimum follow-up of 6 years. To allow for examination over time, EORTC-QLQ-C30 and QLQ-OES24 questionnaire scores were compared with pretreatment and 12 months postoperative questionnaire scores. Physical functioning (QLQ-C30), eating problems (QLQ-OES24) and respiratory problems (K-BILD) were predefined primary end points. Predefined secondary end points were global quality of life and fatigue (both QLQ-C30).After a median follow-up of 105 months, 123/368 included patients (33%) were still alive (70 nCRT plus surgery, 53 surgery alone). No statistically significant or clinically relevant differential effects in HRQOL end points were found between both groups. Compared with 1-year postoperative levels, eating problems, physical functioning, global quality of life and fatigue remained at the same level in both groups. Compared with pretreatment levels, eating problems had improved (Cohen's d -0.37, P = 0.011) during long-term follow-up, whereas physical functioning and fatigue were not restored to pretreatment levels in both groups (Cohen's d -0.56 and 0.51, respectively, both P < 0.001).Although physical functioning and fatigue remain reduced after long-term follow-up, no adverse impact of nCRT is apparent on long-term HRQOL compared with patients who were treated with surgery alone. In addition to the earlier reported improvement in survival and the absence of impact on short-term HRQOL, these results support the view that nCRT according to CROSS can be considered as a standard of care.Netherlands Trial Register NTR487.
Prospective, Cluster-Randomized Trial to Implement the Ottawa Model for Smoking Cessation in Diabetes Education Programs in Ontario, Canada
Authors: Robert D. Reid, Janine Malcolm, Evyanne Wooding, Amy Geertsma, Debbie Aitken, David Arbeau, Chris Blanchard, Jo-Anne Gagnier, Anil Gupta, Kerri-Anne Mullen, Paul Oh, Sophia Papadakis, Heather Tulloch, Allana G. LeBlanc, George A. Wells, Andrew L. Pipe
Journal: Diabetes Care (2017)

OBJECTIVE To test whether a practice-level intervention to promote the systematic identification, treatment, and follow-up of smokers (the Ottawa Model for Smoking Cessation [OMSC]) would improve long-term abstinence rates among smoker-patients with type 2 diabetes or prediabetes receiving care from diabetes education programs in Ontario, Canada. RESEARCH DESIGN AND METHODS The Tobacco Intervention in Diabetes Education study was a matched-pair, cluster-randomized clinical trial. Within each pair, sites were randomly allocated to either an OMSC intervention (n = 7) or a wait-list control (WLC) condition (n = 7). Diabetes education programs in the OMSC group introduced standardized processes to identify smokers and routinely provided smoking cessation interventions and follow-up. Smokers in the OMSC group received counseling, a discount card to partially cover the cost of smoking cessation medication, and follow-up telephone calls over a 6-month period. Diabetes education programs in the WLC condition were offered the OMSC intervention after a 1-year waiting period. Smokers in the WLC group received usual care for smoking cessation from their diabetes educator. The primary end point was carbon monoxide (CO)–confirmed 7-day point prevalence abstinence from smoking at 6-month follow-up. RESULTS A total of 313 smokers (OMSC group n = 199, WLC group n = 114) with diabetes or prediabetes were enrolled. The CO-confirmed abstinence rate at 6 months was 11.1% in the OMSC group versus 2.6% in the WLC group (odds ratio 3.73 [95% CI 1.20, 11.58]; P = 0.02). CONCLUSIONS Implementation of the OMSC in diabetes education programs resulted in clinically and statistically significant improvements in long-term abstinence among smokers with diabetes or prediabetes.
A phase 2 study of intralesional PV-10 followed by radiotherapy for localized in transit or recurrent metastatic melanoma.
Authors: Matthew C Foote, Bryan H Burmeister, Janine Thomas, Tavis Read, Bernard Mark Smithers
Journal: Journal of Clinical Oncology (2016)

e21072 Background: Intralesional rose bengal (IL PV-10) can elicit ablation of injected tumors and a T-cell mediated abscopal effect in untreated lesions. Phase 2 testing in patients with Stage III-IV melanoma yielded a 51% objective response rate (ORR) with 50% complete response (CR) when all disease was injected. Three patients who progressed received external beam radiotherapy (XRT) to their recurrent lesions with an impressive response without an increased radiation reaction. Methods: An open-label, single-arm phase 2 study was performed to assess efficacy and safety of IL PV-10 followed by XRT. Eligibility included recurrent localized dermal, subcutaneous, in-transit or metastatic malignant melanoma (stage IIIb / IIIc) suitable for intralesional therapy and XRT. Patients received a single course of PV-10 into lesions treatable within a localized radiotherapy field. If CR was not achieved patients received 30 Gy (6 fractions of 5 Gy twice weekly over 3 weeks) 3D conformal radiotherapy (photons or electrons) commencing 6-10 weeks after PV-10. Outcome assessments included ORR and clinical benefit (CR+PR+SD) of in-field target lesions by RECIST criteria, toxicity using CTCAE V3.0, and progression free survival (PFS). Results: There were 15 patients enrolled with 13 completing the radiotherapy component. Two patients had rapidly progressive distant disease following PV-10 injection. The mean age of patients was 69 years. With a median follow up duration of 19.3 months the overall response rate was 87% (CR 33%, PR 53%) with 93% clinical benefit on an intent-to-treat basis. The mean time to best response was 3.8 months, mean duration of complete response (PFS) 12.2 months, overall loco regional progression rate 80% and melanoma specific survival 65.5 months. Size of metastases ( < 10mm) predicted potential for lesion complete response. Treatments were well tolerated with no treatment associated grade 4 or 5 adverse events. Conclusions: The combination of IL PV-10 and radiotherapy resulted in lesion specific, normal tissue sparing, ablation of melanoma tumors with minimal local or systemic adverse effects. The study results justify expanded evaluation in a randomized trial.
Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest
Authors: Krishna K. Patel, John A. Spertus, Yevgeniy Khariton, Yuanyuan Tang, Lesley H. Curtis, Paul S. Chan, Paul S. Chan, Anne Grossestreuer, Ari Moskowitz, Dana P. Edelson, Joseph P. Ornato, Mary Ann Peberdy, Matthew M. Churpek, Michael C. Kurz, Monique Anderson Starks, Patricia Kunz Howard, Saket Girotra, Sarah M. Perman, Zachary D. Goldberger
Journal: Circulation (2017)

Background: Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients with in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown. Methods: We linked data from a national IHCA registry with Medicare files and identified 36 961 patients ≥65 years of age with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA caused by pulseless ventricular tachycardia or ventricular fibrillation were stratified by prompt (≤2 minutes) versus delayed (&gt;2 minutes) defibrillation, whereas patients with IHCA caused by asystole or pulseless electric activity were stratified by prompt (≤5 minutes) versus delayed (&gt;5 minutes) epinephrine treatment. The association between prompt treatment and long-term survival for each rhythm type was assessed with multivariable hierarchical modified Poisson regression models. Results: Of 8119 patients with an IHCA caused by ventricular tachycardia or ventricular fibrillation, the rate of 1-year survival was higher in those treated with prompt defibrillation than with delayed defibrillation (25.7% [1466 of 5714] versus 15.5% [373 of 2405]; adjusted relative risk [RR], 1.49; 95% confidence interval [CI] 1.32–1.69; P &lt;0.0001). This survival advantage persisted at 3 years (19.1% versus 11.0%; adjusted RR, 1.45; 95% CI, 1.23–1.69; P &lt;0.0001) and at 5 years (14.7% versus 7.9%; adjusted RR, 1.50; 95% CI, 1.22–1.83; P &lt;0.0001). Of 28 842 patients with an IHCA caused by asystole/pulseless electric activity, the rate of 1-year survival with prompt epinephrine treatment was higher than with delayed treatment (5.4% [1341 of 24 885] versus 4.3% [168 of 3957]; adjusted RR, 1.20; 95% CI, 1.02–1.41; P =0.02), but this survival benefit was no longer present at 3 years (3.5% versus 2.9%; adjusted RR, 1.17; 95% CI, 0.95–1.45; P =0.15) and at 5 years (2.3% versus 1.9%; adjusted RR, 1.18; 95% CI, 0.88–1.58; P =0.27). Conclusions: Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years. By quantifying the greater survival associated with timely defibrillation and epinephrine administration, these findings provide important insights into the durability of survival benefits for 2 process-of-care measures in current resuscitation guidelines.
A model for predicting effect of treatment on progression-free survival using MRD as a surrogate end point in CLL
Authors: Natalie Dimier, Paul Delmar, Carol Ward, Rodica Morariu-Zamfir, Günter Fingerle-Rowson, Jasmin Bahlo, Kirsten Fischer, Barbara Eichhorst, Valentin Goede, Jacques J. M. van Dongen, Matthias Ritgen, Sebastian Böttcher, Anton W. Langerak, Michael Kneba, Michael Hallek
Journal: Blood (2017)
Epidemiology of liver cancer in South Korea
Authors: Bo Hyun Kim, Joong-Won Park
Journal: Clinical and Molecular Hepatology (2017)

Liver cancer is the sixth most common cancer (fourth in men and sixth in women) and the second largest cause of cancer mortality in South Korea. The crude incidence rate of liver cancer was 31.9/100,000 (47.5/100,000 in men and 16.2/100,000 in women) and the age-standardized incidence rate was 19.9/100,000 (32.4/100,000 in men and 8.8/100,000 in women) in 2014. The crude incidence rate increased from 1999 to 2011 and thereafter showed a subtle decreasing tendency. The crude prevalence rate was 113.6/100,000 (170.2/100,000 in men and 57.1/100,000 in women) and the age-standardized prevalence rate was 72.6/100,000 (115.7/100,000 in men and 33.7/100,000 in women) in 2014, which increased from 2010 to 2014. Survival from liver cancer has improved over the last two decades. The 5-year relative survival rate was markedly increased from 10.7% in those diagnosed with liver cancer between 1993 and 1995 to 32.8% in those diagnosed between 2010 and 2014. The epidemiology of liver cancer is influenced by that of underlying liver diseases such as viral hepatitis. Substantial progress has been made in the prevention and treatment of viral hepatitis; however, uncontrolled alcoholic liver disease, obesity and diabetes appears to have the potential to emerge as major causes for liver cancer. Depending on the success of the control of risk factors, the epidemiology of liver cancer in Korea may change. Keywords: Epidemiology; Hepatocellular carcinoma; Incidence; Liver cancer; Prevalence
Successful outcome following allogeneic hematopoietic stem cell transplantation in adults with primary immunodeficiency
Authors: Thomas A. Fox, Ronjon Chakraverty, Siobhan Burns, Benjamin Carpenter, Kirsty Thomson, David Lowe, Adele Fielding, Karl Peggs, Panagiotis Kottaridis, Benjamin Uttenthal, Venetia Bigley, Matthew Buckland, Victoria Grandage, Shari Denovan, Sarah Grace, Julia Dahlstrom, Sarita Workman, Andrew Symes, Stephen Mackinnon, Rachael Hough, Emma Morris
Journal: Blood (2017)
A pilot study of an autologous tumor-derived autophagosome vaccine with docetaxel in patients with stage IV non-small cell lung cancer
Authors: Rachel E. Sanborn, Helen J. Ross, Sandra Aung, Anupama Acheson, Tarsem Moudgil, Sachin Puri, Traci Hilton, Brenda Fisher, Todd Coffey, Christopher Paustian, Michael Neuberger, Edwin Walker, Hong-Ming Hu, Walter J. Urba, Bernard A. Fox
Journal: Journal for ImmunoTherapy of Cancer (2017)

<h3>Background</h3> Tumor-derived autophagosome vaccines (DRibbles) have the potential to broaden immune response to poorly immunogenic tumors. <h3>Methods</h3> Autologous vaccine generated from tumor cells harvested from pleural effusions was administered to patients with advanced NSCLC with the objectives of assessing safety and immune response. Four patients were vaccinated and evaluable for immune response; each received two to four doses of vaccine. Study therapy included two cycles of docetaxel 75&nbsp;mg/m<sup>2</sup> on days 1 and 29 to treat the tumor, release hidden antigens and produce lymphopenia. DRibbles were to be administered intradermally on days 14, 43, 57, 71, and 85, together with GM-CSF (50 μg/d x 6d, administered via SQ mini pump). Peripheral blood was tested for immune parameters at baseline and at each vaccination. <h3>Results</h3> Three of four patients had tumor cells available for testing. Autologous tumor-specific immune response was seen in two of the three, manifested by IL-5 (1 patient after 3 doses), and IFN-γ, TNF-α, IL-5, IL-10 (after 4 doses in one patient). All 4 patients had evidence of specific antibody responses against potential tumor antigens. All patients came off study after 4 or fewer vaccine treatments due to progression of disease. No significant immune toxicities were seen during the course of the study. <h3>Conclusions</h3> DRibble vaccine given with GM-CSF appeared safe and capable of inducing an immune response against tumor cells in this small, pilot study. There was no evidence of efficacy in this small poor-prognosis patient population, with treatment not feasible. Trial registration NCT00850785, initial registration date February 23, 2009.
A possible association between BP230-type bullous pemphigoid and dementia: a report of two cases in elderly patients
Authors: M. Zheng, H. Ujiie, K. Muramatsu, K.C. Sato-Matsumura, T. Maeda, I. Ujiie, H. Iwata, K. Izumi, W. Nishie, H. Shimizu
Journal: British Journal of Dermatology (2017)
Case 39-2017
Authors: Sarah V. Tsiaras, Lucy M. Safi, Brian B. Ghoshhajra, Mark E. Lindsay, Malissa J. Wood
Journal: New England Journal of Medicine (2017)

A 41-year-old woman presented with recurrent episodes of chest pain. She had an elevated troponin level, anterior ST-segment depressions on electrocardiography, and focal left ventricular hypokinesis on echocardiography. A diagnosis was made.