tbuckley/cabot-search huggingface dataset:
Abstract 17943: Clinical Factors That Determine the Superiority of Femoropopliteal Stenting Compared With Balloon Angioplasty
Authors: Seiichi Hiramori, Yoshimitsu Soga, Yohei Kobayashi, Yusuke Tomoi, Shinichi Shirai, Kenji Ando
Journal: Circulation (2015)

Background: It has reported that femoropopliteal stenting is superior to balloon angioplasty. However, it remains unclear that what factors affect the superiority of stent compared with balloon angioplasty. Purpose: To investigate the efficacy of stent in femoropopliteal lesions and clinical factors that affect the superiority of femoropopliteal stenting compared with balloon angiography. Methods: We analyzed consecutive 1523 de novo femoropopliteal lesions performing endovascular therapy between January 2004 and December 2013 by means of propensity score matching. We assessed the efficacy of stent for femoropopliteal lesion on primary patency and assisted-primary patency, and clinical factors that determine the superiority of stent compared with balloon angioplasty. Results: 265 lesions in each group were selected by propensity score matching model for comparison. No difference was found in primary patency at 3 year between stent group and non-stent group (58.7% vs 49.3%, p=.06) and in assisted- primary patency at 3 year (63.8% vs 61.6%, p=.89). For the subgroup analysis, hazard ratio for primary patency in non-hemodialytic (hazard ratio [HR], 0.69; 95% confidential interval [CI], 0.50-0.96; p=.03) or ambulatory patients (HR, 0.69; 95% CI, 0.52-0.92; p=.01), or occlusive (HR, 0.58; 95% CI, 0.37-0.91; p=.02), non-calcified (HR, 0.63; 95% CI, 0.39-0.99; p=.04), TASCII non type A (HR, 0.65; 95% CI, 0.46-0.91; adjusted p=.01), or long (&gt;100mm) (HR, 0.57; 95% CI, 0.32-0.98; p=.04) lesions showed the superiority of stent compared with balloon angioplasty. Conclusions: Our data suggests that femoropopliteal stenting is not necessarily recommended for all femoropopliteal lesions. However, it seems that femoropopliteal stenting is effective in non-hemodialytic or ambulatory patients, or lesions such as occlusive, non-calcified, TASC II non type A, or lesion length &gt; 100mm compared with balloon angioplasty.
#ThisIsOurLane — Firearm Safety as Health Care’s Highway
Authors: Megan L. Ranney, Marian E. Betz, Cedric Dark
Journal: New England Journal of Medicine (2018)

#ThisIsOurLane The broad and rapid response to a tweet from the National Rifle Association admonishing “self-important anti-gun doctors to stay in their lane” reflects the convergence of multiple paths on which physicians had already embarked. So where do we go from here?
Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014
Authors: Jae Heon Kim, Shufeng Li, Yash Khandwala, Kyung Jin Chung, Hyung Keun Park, Benjamin I. Chung
Journal: JAMA Surgery (2018)

<h3>Importance</h3> Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). <h3>Objective</h3> To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence. <h3>Design, Setting, and Participants</h3> A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with<i>International Classification of Diseases, Ninth Revision, Clinical Modification </i>code of 55.4 were identified from 2007 to 2015. <h3>Main Outcomes and Measures</h3> The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy. <h3>Results</h3> Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (<i>P</i> = .02 and<i>P</i> &lt; .001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66;<i>P</i> &lt; .001), older age (&gt;65 years) (OR, 0.99; 95% CI, 0.99-0.99;<i>P</i> &lt; .001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28;<i>P</i> = .004) were associated with benign pathologic findings after PNx. <h3>Conclusions and Relevance</h3> We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (&gt;65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.
99mTc-MIBI Uptake in a Benign Thymic Cyst
Authors: Hwan Lee, Christopher R. Gault, Gang Cheng, Jagruti C. Shah, Austin R. Pantel
Journal: Clinical Nuclear Medicine (2018)

A 34-year-old man with end-stage renal failure status post rejection of a deceased donor kidney transplant presented with bone pain in the setting of elevated serum parathyroid hormone and calcium levels. A Tc-MIBI SPECT/CT was performed before planned subtotal parathyroidectomy. SPECT/CT imaging revealed a 1.9-cm anterior mediastinal lesion with radiotracer uptake on both the immediate and delayed images. Surgical pathology of the lesion showed a benign thymic cyst with no parathyroid component.
Effects of short-term continuous positive airway pressure withdrawal on cerebral vascular reactivity measured by blood oxygen level-dependent magnetic resonance imaging in obstructive sleep apnoea: a randomised controlled trial
Authors: Sira Thiel, Franziska Lettau, Protazy Rejmer, Cristina Rossi, Sarah R. Haile, Esther I. Schwarz, Anna S. Stöberl, Noriane A. Sievi, Andreas Boss, Anton S. Becker, Sebastian Winklhofer, John R. Stradling, Malcolm Kohler
Journal: European Respiratory Journal (2018)

Impaired cerebral vascular reactivity (CVR) increases long-term stroke risk. Obstructive sleep apnoea (OSA) is associated with peripheral vascular dysfunction and vascular events. The aim of this trial was to evaluate the effect of continuous positive airway pressure (CPAP) withdrawal on CVR. 41 OSA patients (88% male, mean age 57±10 years) were randomised to either subtherapeutic or continuation of therapeutic CPAP. At baseline and after 2 weeks, patients underwent a sleep study and magnetic resonance imaging (MRI). CVR was estimated by quantifying the blood oxygen level-dependent (BOLD) MRI response to breathing stimuli. OSA did recur in the subtherapeutic CPAP group (mean treatment effect apnoea–hypopnoea index +38.0 events·h −1 , 95% CI 24.2–52.0; p&lt;0.001) but remained controlled in the therapeutic group. Although there was a significant increase in blood pressure upon CPAP withdrawal (mean treatment effect +9.37 mmHg, 95% CI 1.36–17.39; p=0.023), there was no significant effect of CPAP withdrawal on CVR assessed via BOLD MRI under either hyperoxic or hypercapnic conditions. Short-term CPAP withdrawal did not result in statistically significant changes in CVR as assessed by functional MRI, despite the recurrence of OSA. We thus conclude that, unlike peripheral endothelial function, CVR is not affected by short-term CPAP withdrawal.
TLR Signaling Is Activated in Lymph Node–Resident CLL Cells and Is Only Partially Inhibited by Ibrutinib
Authors: Eman L. Dadashian, Erin M. McAuley, Delong Liu, Arthur L. Shaffer, Ryan M. Young, Jessica R. Iyer, Michael J. Kruhlak, Louis M. Staudt, Adrian Wiestner, Sarah E. M. Herman
Journal: Cancer Research (2018)

Abstract Chronic lymphocytic leukemia (CLL) is a malignancy of mature B cells driven by B-cell receptor (BCR) signaling and activated primarily in the lymph node. The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib effectively inhibits BCR-dependent proliferation and survival signals and has emerged as a breakthrough therapy for CLL. However, complete remissions are uncommon and are achieved only after years of continuous therapy. We hypothesized that other signaling pathways that sustain CLL cell survival are only partially inhibited by ibrutinib. In normal B cells, Toll-like receptor (TLR) signaling cooperates with BCR signaling to activate prosurvival NF-κB. Here, we show that an experimentally validated gene signature of TLR activation is overexpressed in lymph node–resident CLL cells compared with cells in the blood. Consistent with TLR activation, we detected phosphorylation of NF-κB, STAT1, and STAT3 in lymph node–resident CLL cells and in cells stimulated with CpG oligonucleotides in vitro. CpG promoted IRAK1 degradation, secretion of IL10, and extended survival of CLL cells in culture. CpG-induced TLR signaling was significantly inhibited by both an IRAK1/4 inhibitor and ibrutinib. Although inhibition of TLR signaling was incomplete with either drug, the combination achieved superior results, including more effective inhibition of TLR-mediated survival signaling. Our data suggest an important role for TLR signaling in CLL pathogenesis and in sustaining the viability of CLL cells during ibrutinib therapy. The combination of ibrutinib with a TLR pathway inhibitor could provide superior antitumor activity and should be investigated in clinical studies. Significance: CLL relies on the concomitant cooperation of B-cell receptor and Toll-like receptor signaling; inhibition of both pathways is superior to inhibition of either pathway alone.
Preventing Maltreatment of Children
Authors: Desmond K. Runyan
Journal: JAMA (2018)

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Oncology fellows' current practice regarding concurrent outpatient oncology and palliative care.
Authors: Amy Johnson, Lyle Fettig, Erin V. Newton, Amber Comer
Journal: Journal of Clinical Oncology (2018)

122 Background: It is accepted that Palliative Care provides additional support and improves overall care to oncology patients. Literature supports early referral and integration of Palliative Care with standard oncology care and is a guideline from the American Society of Clinical Oncology. In order to make palliative care integration a standard of care, Oncology Fellows should be learning to integrate during their fellowship years. There is little information regarding the Palliative Care experience in the outpatient setting for Oncology Fellows in the United States. This study looked at the current practice model in regards to concurrent Oncology and Palliative Care in the outpatient setting. Methods: An electronic nationwide survey of medical Oncology Fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5% Fellows contacted at 17 institutions responded. 98% of the fellows’ hospital systems offered ambulatory palliative care with 79% having a palliative care specialist available during their ambulatory Oncology clinic. 55% of the Fellows’ patient referrals are occurring when they still have multiple lines of cancer directed treatment planned, and the most common initial referral reason is for symptom management. 97% of fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. Although no participants stated their initial consult request was for psychosocial and/or spiritual support, 95% strongly agreed or agreed that Palliative Care helps ensure these issues are addressed. Conclusions: Early integration of Palliative Care is occurring in the 17 responding institutions around the country as 97% of Fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% of oncology fellows indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics.
A randomized, double-blind, phase III trial of personalized peptide vaccination for recurrent glioblastoma
Authors: Yoshitaka Narita, Yoshiki Arakawa, Fumiyuki Yamasaki, Ryo Nishikawa, Tomokazu Aoki, Masayuki Kanamori, Motoo Nagane, Toshihiro Kumabe, Yuichi Hirose, Tomotsugu Ichikawa, Hiroyuki Kobayashi, Takamitsu Fujimaki, Hisaharu Goto, Hideo Takeshima, Tetsuya Ueba, Hiroshi Abe, Takashi Tamiya, Yukihiko Sonoda, Atsushi Natsume, Tatsuyuki Kakuma, Yasuo Sugita, Nobukazu Komatsu, Akira Yamada, Tetsuro Sasada, Satoko Matsueda, Shigeki Shichijo, Kyogo Itoh, Mizuhiko Terasaki
Journal: Neuro-Oncology (2018)

We conducted a phase III trial of personalized peptide vaccination (PPV) for human leukocyte antigen (HLA)-A24+ recurrent glioblastoma to develop a new treatment modality.We randomly assigned 88 recurrent glioblastoma patients to receive PPV (n = 58) or the placebo (n = 30) at a 2-to-1 ratio. Four of 12 warehouse peptides selected based on preexisting peptide-specific immunoglobulin G levels or the corresponding placebos were injected 1×/week for 12 weeks.Our trial met neither the primary (overall survival [OS]) nor secondary endpoints. Unfavorable factors for OS of 58 PPV patients compared with 30 placebo patients were SART2-93 peptide selection (n = 13 vs 8, hazard ratio [HR]: 15.9), ≥70 years old (4 vs 4, 7.87), >70 kg body weight (10 vs 7, 4.11), and performance status (PS)3 (8 vs 2, 2.82), respectively. Consequently, the median OS for PPV patients without SART2-93 selection plus one of these 3 favorable factors (<70 y old, ≤70 kg, or PS0-2) was significantly longer than that for the corresponding placebo patients (HR: 0.49, 0.44, and 0.51), respectively. Preexisting immunity against both all 12 warehouse peptides besides SART2-93 and the other cytotoxic T lymphocyte epitope peptides was significantly depressed in the patients with SART2-93 selection (n = 21) compared with that of the patients without SART2-93 selection (n = 67). Biomarkers correlative for favorable OS of the PPV patients were a lower percentage of CD11b+CD14+HLA-DRlow immunosuppressive monocytes and a higher percentage of CD4+CD45RA- activated T cells, the intermediate levels of chemokine C-C ligand 2 (CCL2), vascular endothelial growth factor, interleukin (IL)-6, IL-17, or haptoglobin, respectively.This phase III trial met neither the primary nor secondary endpoints.
Abstract 11394: Decrease of Senescence Marker Protein-30 in Aging Impairs Collateral Growth Under Ischemia
Authors: Shu-Ichi Saitoh, Hiroyuki Yamauchi, Takashi Owada, Shunuke Miura, Tomoki Kokubun, Yasuchika Takeishi
Journal: Circulation (2016)

Aging decreases collateral-dependent flow recovery following ischemic arterial obstruction. However, the critical management has been lacked in clinical setting. Senescence marker protein-30 (SMP30) is a novel aging marker, which is assumed to act as an anti-aging factor in various organs. Therefore, we studied the effect of SMP30 on ischemia-induced collateral growth in C57BL/6 mice with young [8 weeks old (W)] and old (92 W), and SMP30 knockout (KO) mice (8 W). The SMP30 expression in gastrocnemius tissue was decreased in old mice compared to that of young mice. The recoveries of cutaneous blood flow in hindlimb after femoral artery ligation and tissue capillary density were suppressed in old and SMP30 KO mice compared to those in young mice. Nitric oxide generation induced by L-arginine was lower in old and SMP30 KO mice than that in young mice. The levels of NADPH oxidase activity and superoxide production in the ischemic tissue were higher in old and SMP30 KO mice than in young mice. The phosphorylated eNOS and Akt levels and VEGF levels in ischemic muscle were lower in old and SMP30 KO mice than in young mice (VEGF: Old mice 266±32, SMP30 KO 238±34, Young 414±48 pg/mg, P&lt;0.01 ). Decrease of SMP30 exacerbates oxidative stress related to NADPH oxidase activity enhancement and impairs Akt-eNOS pathway, which leads to rarefaction of vasculogenesis induced by ischemia. These results suggest that SMP30 plays a key role in disrupting collateral growth under ischemia in aging.
Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy
Authors: Courtney Benjamin Wolk, Amelia E. Van Pelt, Shari Jager-Hyman, Brian K. Ahmedani, John E. Zeber, Joel A. Fein, Gregory K. Brown, Courtney A. Gregor, Adina Lieberman, Rinad S. Beidas
Journal: JAMA Network Open (2018)

<h3>Importance</h3> The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide. <h3>Objective</h3> To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion—Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing–informed counseling regarding safe firearm storage, and provision of free firearm locks—in pediatric primary care settings. <h3>Design, Setting, and Participants</h3> In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018. <h3>Main Outcomes and Measures</h3> Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged. <h3>Results</h3> A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement. <h3>Conclusions and Relevance</h3> By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.
Abstract 17318: Nationwide Survival After Inhospital Cardiac Arrest Before and After 2010 Cardiopulmonary Resuscitation Guidelines: 2007-2014
Authors: Sagar Mallikethi-Reddy, Arshad Javed, Emmanuel Akintoye, Melvyn Rubenfire, Cindy Grines, Luis Afonso
Journal: Circulation (2017)

Background: American Heart Association has been revising the cardiopulmonary resuscitation (CPR) guidelines quinquennially. We sought to study the influence of 2010 CPR guidelines on nationwide survival after inhospital cardiac arrest. Methods: Healthcare Utilization Project’s National Inpatient Sample 20007-2014, was used to identify 799,741 adults aged ≥15 years, who underwent inhospital CPR. We compared inhospital survival trends during period before (2007-2010) and after (2011-2014) American Heart Association 2010 CPR guidelines. Results: Mean age of the study population was 66.5 years. Females constituted 44% of the study cohort. There was a significant improvement in survival after inhospital CPR from 24.1% in 2007 to 31.1% in 2014 (Ptrend <0.001). However, we did not find any statistically significant improvement in inhospital survival after CPR, in the study period after 2010 AHA CPR guidelines in comparison to study period before the guidelines. Conclusions: We noted a significant improvement in ...