tbuckley/cabot-search huggingface dataset:
Outcomes of patients receiving chemotherapy at the end of life.
Authors: Laura Jennifer Van Metre, Bethann Scarborough, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2017)

70 Background: Chemotherapy within 14 days of death indicates poor quality end-of-life (EOL) care. Despite this, approximately 25% of patients receive EOL chemotherapy. This study identifies determinants of EOL chemotherapy. Methods: We identified patients who died in the hospital within 2 weeks of receipt of chemotherapy in 2012 and conducted a detailed chart review to identify demographic and clinical factors, clinical intent, and cause of death. Provider reasoning and assessments were collected. We identified and grouped cause of death into: treatment related, progression of disease, and sudden/unexpected. We used descriptive statistics to document factors associated with receipt of EOL chemotherapy. Results: Of 41 patients, 73% were male; mean age was 63 years; 71% had a hematological malignancy. Whereas solid tumor patients overwhelmingly died of progression of disease (83%), the majority of hematologic patients died of treatment related causes (62%) such as neutropenic sepsis and graft versus host disease. Furthermore, 41% of hematologic malignancy decedents were undergoing induction therapy. Similarly, though all solid tumor chemotherapy was palliative, 33% was for a new diagnosis. All solid tumor patients had a palliative care consultation, whereas 28% of hematologic malignancy patients did. Only 17% of induction chemotherapy patients received a palliative care consult. 76% of hematologic patients were DNR at time of death, while all solid tumor patients were DNR. Site of death varied with 52% of hematologic patients dying in ICU and 10% on the inpatient hospice unit. No solid tumor patients died in the ICU; 67% died on inpatient hospice. Only 10% of all patients had performance status documented. Clinical reasoning for chemotherapy included: disease modification, bridge to clinical trial or transplant, and palliation of symptoms. Conclusions: Patients with hematologic malignancies who received EOL chemotherapy had high ICU utilization and were less likely to have a palliative care consultation. Clinical intent, including early line therapy, may foster unrealistic clinician expectations. An improved understanding of avoidable causes of receipt of chemotherapy at EOL is important in addressing this gap in quality of care.
P3.02a-007 Monitoring for and Characteristics of Crizotinib Progression: A Chart Review of ALK+ Non-Small Cell Lung Cancer Patients
Authors: Edmond Bendaly, Anand Dalal, Kenneth Culver, Philip Galebach, Iryna Bocharova, Rebekah Foster, Gero Struebbe, Annie Guerin
Journal: Journal of Thoracic Oncology (2017)
Abstract 12141: Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults
Authors: Ian J. Neeland, Aslan T. Turer, Colby R. Ayers, Jarett D. Berry, Anand Rohatgi, Sandeep R. Das, Amit Khera, Gloria L. Vega, Darren K. McGuire, Scott M. Grundy, James A. de Lemos
Journal: Circulation (2013)

Ian J. Neeland, 2013 Finalist and Presenting Author
Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation
Authors: Sung-Han Yoon, Tobias Schmidt, Sabine Bleiziffer, Niklas Schofer, Claudia Fiorina, Antonio J. Munoz-Garcia, Ermela Yzeiraj, Ignacio J. Amat-Santos, Didier Tchetche, Christian Jung, Buntaro Fujita, Antonio Mangieri, Marcus-Andre Deutsch, Timm Ubben, Florian Deuschl, Shingo Kuwata, Chiara De Biase, Timothy Williams, Abhijeet Dhoble, Won-Keun Kim, Enrico Ferrari, Marco Barbanti, E. Mara Vollema, Antonio Miceli, Cristina Giannini, Guiherme F. Attizzani, William K.F. Kong, Enrique Gutierrez-Ibanes, Victor Alfonso Jimenez Diaz, Harindra C. Wijeysundera, Hidehiro Kaneko, Tarun Chakravarty, Moody Makar, Horst Sievert, Christian Hengstenberg, Bernard D. Prendergast, Flavien Vincent, Mohamed Abdel-Wahab, Luis Nombela-Franco, Miriam Silaschi, Giuseppe Tarantini, Christian Butter, Stephan M. Ensminger, David Hildick-Smith, Anna Sonia Petronio, Wei-Hsian Yin, Federico De Marco, Luca Testa, Nicolas M. Van Mieghem, Brian K. Whisenant, Karl-Heinz Kuck, Antonio Colombo, Saibal Kar, Cesar Moris, Victoria Delgado, Francesco Maisano, Fabian Nietlispach, Michael J. Mack, Joachim Schofer, Ulrich Schaefer, Jeroen J. Bax, Christian Frerker, Azeem Latib, Raj R. Makkar
Journal: Journal of the American College of Cardiology (2017)
Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States
Authors: Rohan Khera, Jonathan C. Hong, Anshul Saxena, Alejandro Arrieta, Salim S. Virani, Ron Blankstein, James A. de Lemos, Harlan M. Krumholz, Khurram Nasir
Journal: Circulation (2017)
Divergent life histories and other ecological adaptations: Examples of social-class differences in attention, cognition, and attunement to others
Authors: Igor Grossmann, Michael E W Varnum
Journal: Behavioral and Brain Sciences (2017)

Many behavioral and psychological effects of socioeconomic status (SES), beyond those presented by Pepper & Nettle cannot be adequately explained by life-history theory. We review such effects and reflect on the corresponding ecological affordances and constraints of low- versus high-SES environments, suggesting that several ecology-specific adaptations, apart from life-history strategies, are responsible for the behavioral and psychological effects of SES.
Methicillin-resistant Staphylococcus aureus sequence type 45 with high rates of ciprofloxacin and tetracycline resistance in the residents and environments of long-term care facilities in Taiwan
Authors: Chih-Cheng Lai, Chun-Ming Lee, Hsiu-Tzy Chiang, Min-Chi Lu, Ling-Fang Wang, Tsai-Ling Tsai, Mei-Yu Kang, Yi-Ni Jan, Yi-Ting Lo, Wen-Chien Ko, Shu-Hui Tseng, Po-Ren Hsueh
Journal: Journal of Infection (2017)
PTH-081 Incidence and long term implications of pre pouch ileitis
Authors: J Segal, S Mclaughlin, S Clark, O Faiz, A Hart
Journal: Gut (2017)

Introduction  Restorative proctocolectomy (RPC) is considered the procedure of choice in patients with ulcerative colitis (UC) refractory to medical therapy. Pre-pouch ileitis (PPI) has no standard definition but is characterised by the presence of mucosal inflammation of the ileum immediately proximal to the pouch. This pattern of inflammation can extend into the afferent limb up to 50 cm. The estimated incidence of PPI is 6% and long-term follow-up data is lacking.  Method  We followed up our original cohort of patients who were diagnosed with PPI that was published in 2009. Patients were followed up until last available clinic or at the point of pouch failure defined as permanent ileostomy, revision of pouch or refashioning of pouch. Demographics were collected including biological use, smoking status, stool frequency, presence of terminal ileal (TI) inflammation prior to colectomy and previous obstructive symptoms. Baseline endoscopic findings at diagnosis, treatment at diagnosis and symptoms at diagnosis were collected. Follow-up data collected was stool frequency, endoscopic findings, treatment at follow-up and overall pouch function.  Results  The median length of follow-up from the index pouchoscopy of the 31 patients with PPI was 98 (range 27–143) months. Seven (23%) patients who had an index pouchoscopy with PPI had an end ileostomy; five (71%) of these were due to chronic pouchitis symptoms and two (29%) were due to small bowel obstruction secondary to pre-pouch strictures. The median time from RPC to end ileostomy was 132 (range 24–276) months in these patients.  The initial presence of PPI was associated with persistent use of antibiotics to treat co-existing pouchitis at long term follow-up. Of the 24 patients who retained their pouch, 22 (92%) of these required antibiotics at some point with 16 (73%) patients requiring chronic antibiotic use to help alleviate their symptoms. All 31 patients had co-existing pouchitis. One patient was reclassified as having Crohn’s disease.  The median time from RPC to end ileostomy was 132 (range 24–276) months in these patients. All 31 patients had co-existing pouchitis. One patient was reclassified as having Crohn’s disease.  Conclusion  In our cohort PPI is almost exclusively found in patients with pre-existing pouchitis. The presence of PPI is associated with a high chance of pouch failure. PPI does not appear to be a feature of Crohn’s disease at long term follow-up.  References  . McLaughlin SD. et al. Incidence and short-term implications of prepouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Dis. Colon Rectum2009;52:879–83.  . Bell, A J. et al. Pre-pouch ileitis: a disease of the ileum in ulcerative colitis after restorative proctocolectomy. Colorectal Dis 2006;8:402–10.  Disclosure of Interest  None Declared
Neuroimaging and outcome of patients with altered mental status in the emergency department of a comprehensive cancer center.
Authors: Patricia A Brock, Andrew J Hall, Valda D Page, Kelly W. Merriman, Cielito C. Reyes-Gibby, Sai-ching J. Yeung, Knox H. Todd, Ahmed F. Elsayem
Journal: Journal of Clinical Oncology (2014)

e20659 Background: Most cancer patients who present to the Emergency Department (ED) with symptoms of altered mental status (AMS) undergo neurological imaging (CT, MRI, or both). The purpose of this study is to compare the rate of hospital and intensive care unit (ICU) admission and mortality in patients with AMS who undergo these studies. Methods: We examined the medical records of patients presenting to the ED of the M. D. Anderson Cancer Center during calendar year 2012. Patients who presented with any symptoms of altered mental status, or were assigned ICD-9 diagnosis codes for AMS, delirium, transient mental disorders or other disorders of consciousness were identified. Patients with AMS who had acute findings on neuroimaging were compared to those with negative findings regarding the rates of admission to the hospital and ICU, length of stay, and mortality. Results: In 2012, 12,320 unique patients made 23,016 visits to the ED. AMS was found in 905 patients and 630 (70%) underwent diagnostic neuroimaging. Positive findings were found in 158 (25%) patients. These include: 95 (56.5%) with new or changed mass; 35 (20.8%) with hemorrhage, 16 (9.5%) had edema, 16 (9.5%) had infarction, 5 (3.0%) had hydrocephalus and 6 (3.6%) had other pathologies. One hundred forty-five (91%) of 158 patients who had positive findings were admitted to the hospital as compared to 393 (83%) of 472 patients who had no acute findings (P=0.01). The median LOS was 5 days (range 1-47) in both groups. Thirty-four (23%) patients with positive scans were admitted to ICU as compared to 52 (13%) patients with negative scans (P=0.005). Of the admitted patients with positive scans 20 (14%) died in the hospital as compared to 46 (12%) with negative scans (P=0.51). Of all the patients with positive imaging 57 (36%) died within 30 days of ED visit as compared to 150 (32%) patients (36%) with negative imaging (P=0.32). Conclusions: Of patients with AMS who undergo neuroimaging in the ED, 25% have positive findings and are more likely to be admitted to the hospital and ICU. However, there is no difference in hospital or 30-day mortality between the two groups. Further research is needed to evaluate the utility of neuroimaging in cancer patients with AMS.
Quality of life without toxicity or symptoms analysis of a randomized controlled clinical trial comparing efficacy of Cabazitaxel versus docetaxel in recurrent Head and Neck Cancer
Authors: V.T. Talreja, V. Patil, A. Joshi, V. Noronha, A. Chandrasekharan, S. Dhumal, N. Pande, S. Turkar, S. Shrirangwar, A. Mahajan, S. Juvrekar, A. Bhattacharjee, K. Prabhash
Journal: Annals of Oncology (2017)
Submucosal tunneling endoscopic myotomy of esophageal epiphrenic diverticulum
Authors: Antônio Conrado, Luiz Miranda, Ana Miranda, Diego Lima
Journal: Endoscopy (2017)

Esophageal epiphrenic diverticulum (EED) is an uncommon disease of the distal 10 cm of the thoracic esophagus. This motility disorder is associated with achalasia in over 60 % of cases [1]. Large diverticula or those with significant symptoms are cured through diverticulectomy, myotomy, and fundoplication by open or minimally invasive surgical techniques [2]. Recently, Cai et al. reported four patients with EED who were treated by submucosal tunneling endoscopic septum division (STESD) [3]. This video case describes the treatment of EED using this novel technique ([Video 1]).
Local Intratracheal Delivery of Perfluorocarbon Nanoparticles to Lung Cancer Demonstrated with Magnetic Resonance Multimodal Imaging
Authors: Lina Wu, Xiaofei Wen, Xiance Wang, Chunan Wang, Xilin Sun, Kai Wang, Huiying Zhang, Todd Williams, Allen J. Stacy, Junjie Chen, Anne H. Schmieder, Gregory M. Lanza, Baozhong Shen
Journal: Theranostics (2017)

Eighty percent of lung cancers originate as subtle premalignant changes in the airway mucosal epithelial layer of bronchi and alveoli, which evolve and penetrate deeper into the parenchyma. Liquid-ventilation, with perfluorocarbons (PFC) was first demonstrated in rodents in 1966 then subsequently applied as lipid-encapsulated PFC emulsions to improve pulmonary function in neonatal infants suffering with respiratory distress syndrome in 1996. Subsequently, PFC nanoparticles (NP) were extensively studied as intravenous (IV) vascular-constrained nanotechnologies for diagnostic imaging and targeted drug delivery applications. Methods: This proof-of-concept study compared intratumoral localization of fluorescent paramagnetic (M) PFC NP in the Vx2 rabbit model using proton (1H) and fluorine (19F) magnetic resonance (MR) imaging (3T) following intratracheal (IT) or IV administration. MRI results were corroborated by fluorescence microscopy. Results: Dynamic 1H-MR and 19F-MR images (3T) obtained over 72 h demonstrated marked and progressive accumulation of M-PFC NP within primary lung Vx2 tumors during the first 12 h post IT administration. Marked 1H and 19F MR signal persisted for over 72 h. In contradistinction, IV M-PFC NP produced a modest transient signal during the initial 2 h post-injection that was consistent circumferential blood pool tumor enhancement. Fluorescence microscopy of excised tumors corroborated the MR results and revealed enormous intratumor NP deposition on day 3 after IT but not IV treatment. Rhodamine-phospholipid incorporated into the PFC nanoparticle surfactant was distributed widely within the tumor on day 3, which is consistent with a hemifusion-based contact drug delivery mechanism previously reported. Fluorescence microscopy also revealed similar high concentrations of M-PFC NP given IT for metastatic Vx2 lung tumors. Biodistribution studies in mice revealed that M-PFC NP given IV distributed into the reticuloendothelial organs, whereas, the same dosage given IT was basically not detected beyond the lung itself. PFC NP given IT did not impact rabbit behavior or impair respiratory function. PFC NP effects on cells in culture were negligible and when given IV or IT no changes in rabbit hematology nor serum clinical chemistry parameters were measured. Conclusion: IT delivery of PFC NP offered unique opportunity to locally deliver PFC NP in high concentrations into lung cancers with minimal extratumor systemic exposure.
Book Review: A History of Surgery
Authors: K S Hindle, S J Hindle
Journal: Journal of the Royal Society of Medicine (2001)

Professor Ellis is renowned for his lucid prose, and in A History of Surgery he is on top form. The book is well set up to educate and amuse medical readers, particularly those from a surgical background; many non-medical readers, too, will enjoy the gruesome vignettes and be grateful for modern-day treatments.

The author describes in detail the progression of surgical procedures from prehistoric times to the present day, and in the last chapter he glances at the future; parallel accounts of key events in world civilizations offer history lessons in their own right. Selected operations are used to illustrate the advance of surgery from what today seems inconceivable—e.g. limb amputation without anaesthesia—to the modern techniques informed by warfare and science. Some procedures such as tracheostomy, described in detail by Paul of Aegina (625-690 AD), remain pertinent today while others which contributed to the demise of many patients (e.g. bloodletting) were surprisingly slow to disappear. Professor Ellis predicts that, in the 21st century, cancer surgery will be replaced by tablets and that surgeons will revert to being bone-setters, who may well regard present-day surgery as barbaric.

The brilliant amalgamation of detailed historical facts with anecdotes of famous surgeons results not only in a useful reference tool but also in an easily digestible read. Furthermore the author cleverly links famous surgeons by heritage (for example, Hugh Owen Thomas, who invented the eponymous splint that is still in use today, was the uncle of Sir Robert Jones) or by marriage (Joseph Lister, was James Syme's son-in-law), to remind us how the art of surgery was often passed from one generation to another and learnt as an apprenticeship. Professor Ellis was himself taught by some of the great surgeons of the day and his enthusiasm for passing on knowledge leaps from the pages. The book is illustrated with many classical and original pictures from different sources, including the author's own collection. Particularly eye-watering are the seventeenth century figures depicting a breast amputation followed by the use of a hot-iron cautery on a bloody wound. (Unfortunately a few of the pictures have been accidentally transposed.) This masterly compilation would be an ornament to any collection of books on surgical history.
First referral to an integrated onco-palliative care program: A retrospective analysis of its timing.
Authors: Claire Barth, Isabelle Colombet, Pascale Vinant
Journal: Journal of Clinical Oncology (2017)

167 Background: Despite being recommended early in the course of advanced cancer, palliative care (PC) referral remains often late. Taking into account limited PC resources, disease-specific referral criteria and models of care need to be explored. In a previous work, we showed that a weekly onco-palliative meeting (OPM) allowed earlier introduction of the PC team (PCT) and decreased aggressiveness of end-of-life (EOL) care1. We describe patient’s profile when first referred to this Integrated Onco-Palliative Care program (IOPC), the timing of the referral relatively to the course of his/her disease and the impact on the trajectory of EOL care. Methods: The IOPC of our University Hospital combined a weekly OPM, dedicated to patients with incurable diseases for whom goals and organization of care need to be discussed, and/or clinical evaluation with possible follow-up by the PCT. We retrospectively analysed all patients reported for the first time at OPM between 2011 and 2013. We calculated an index of precocity, defined as the ratio of time from the first referral to death and the time from the diagnosis of incurability to death, with values ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung cancer, urinary carcinoma and sarcoma. At first referral to IOPC program, 76% were receiving chemotherapy, 63% were outpatients, 56% had a PS ≤ 2 and 46% had a serum albumin level &gt; 35g/l. The median (1 st -3 rd quartile) index of precocity was 0.39 (0.16-0.72), ranging between 0.53 (0.20-0.79) (earliest, for lung cancer) to 0.16 (0.07-0.56) (latest, for prostate cancer). Among 367 decedents, 42 (13%) received chemotherapy within 14 days before death, 157 (43%) died in hospice care setting. Conclusions: Most patients first referred to IOPC were still under antitumoral treatment and had intermediate prognostic markers. However the time of referral between diagnosis of incurability and death is highly variable according to cancer type, and should probably be adapted while therapies progress. 1 Colombet I, et al. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care. 2012;2(3):239–47
Favorable effect of corticosteroids in treating acute-on-chronic liver failure underlying chronic hepatitis B
Authors: Hyeji Kim, Jung Hyun Kwon, Yong Hee Kim, Soon Woo Nam, Jong Yul Lee, Jeong Won Jang
Journal: Clinical and Molecular Hepatology (2017)

Acute-on-chronic liver failure (ACLF) occurs in the presence of a chronic liver disease or cirrhosis, and often results from exacerbation of chronic hepatitis B (CHB). The efficacy of corticosteroid treatment in ACLF patients with underlying CHB remains unclear. We report the case of a 50-year-old woman who experienced ACLF due to CHB exacerbation and was treated with a combination of corticosteroids and nucleot(s)ide analogue (NUC). The patient showed rapid decompensation due to CHB exacerbation. Three months of antiviral therapy produced no improvement in liver function. Combination therapy with corticosteroids and NUC was started, which did result in improvement of liver function. This case shows that the combined therapy of corticosteroids and NUC can be effective in treating ACLF due to CHB exacerbation.
International Bullous Diseases Group: consensus on diagnostic criteria for epidermolysis bullosa acquisita
Authors: C. Prost-Squarcioni, F. Caux, E. Schmidt, M.F. Jonkman, S. Vassileva, S.C. Kim, P. Iranzo, M. Daneshpazhooh, J. Terra, J. Bauer, J. Fairley, R. Hall, M. Hertl, J.S. Lehman, B. Marinovic, A. Patsatsi, D. Zillikens, V. Werth, D.T. Woodley, D.F. Murrell
Journal: British Journal of Dermatology (2017)

Epidermolysis bullosa acquisita (EBA) is a complex autoimmune bullous disease disease with variable clinical presentations and multiple possible diagnostic tests, making an international consensus on the diagnosis of EBA essential. To obtain an international consensus on the clinical and diagnostic criteria for EBA. The International Bullous Diseases Group (IBDG) met three times to discuss the clinical and diagnostic criteria for EBA. For the final voting exercise, 22 experts from 14 different countries voted on 50 different items. When > 30% disagreed with a proposal, a discussion was held and re‐voting carried out. In total, 48 of 50 proposals achieved consensus after discussion. This included nine diagnostic criteria, which are summarized in a flow chart. The IBDG was unable to determine one procedure that would be applicable worldwide. A limitation of the study is that differential diagnosis of bullous systemic lupus erythematosus has not been addressed. This first international consensus conference established generally agreed‐upon clinical and laboratory criteria defining the clinical classification of and diagnostic testing for EBA. Holding these voting exercises in person with the possibility of discussion prior to voting has advantages in reaching consensus over Delphi exercises with remote voting.