tbuckley/cabot-search huggingface dataset:
Abstract P2-10-07: A prospective clinical utility study of the impact of the 21-gene recurrence score (RS) assay in the treatment of estrogen receptor positive (ER+), HER2 negative (HER2-), 1-3 node positive (N+) breast cancer (BC)
Authors: J Sun, D Fenton, S Baxter, A Chan, S Roberts, X Feng, C Lohrisch, K Gelmon, T Shenkier, S Chia
Journal: Cancer Research (2018)

Abstract Background: The 21-gene RS is routinely used in node negative ER+, HER2- BC to help guide chemotherapy treatment decision making. There is emerging use of the RS in limited N+ BC, though the results from the randomized clinical trial (RxPONDER) is pending. The objective of the study is to determine whether the results of the 21-gene RS will alter physician treatment decisions in ER+ HER2- limited N+ BC. Methods: Consenting patients (pts) with ER+, HER2-, 1-3 N+ (microscopic or macroscopic) early stage BC participated in this prospective, multi-center British Columbia Cancer Agency (BCCA) study. Treating physicians completed a questionnaire after an initial visit with the patient to document their treatment recommendation before obtaining the RS assay. At a subsequent visit, the assay result and final treatment recommendations were discussed and physicians completed a second questionnaire on the final treatment plan. The statistical assumption of the study was based upon anticipating an overall treatment decision change rate (from chemo-hormonal therapy to hormone only, or vice-versa) to be at least 30%. Results: Out of 84 pts enrolled, 82 went on to have RS testing. 57% of pts had T1 tumors, 40% T2 and 2% T3 tumors. The majority of pts (77%) had N1 macroscopic disease compared to 23% that had microscopic nodal involvement. 63% of cases were grade 2, followed by 23% grade 1 and 14% grade 3. 60% of RS were low (&amp;lt;18), 33% intermediate (18-30) and 7% were high (&amp;gt;30). In 53% of cases there was an altered treatment plan (49% switched from chemo-hormonal therapy to hormone only, and 4% switched from hormone only to chemo-hormonal therapy). Of the 49% that switched to hormone only, 68% had a low RS and 33% had an intermediate RS. All 4% that switched to chemo-hormonal therapy had an intermittent RS. Conclusions: This multi-centered Canadian study showed that in 53% of cases, treatment recommendations were changed based on the RS. This suggests that there is clinical utility for the RS in 1-3 N+, ER+, and HER2- breast cancer. Citation Format: Sun J, Fenton D, Baxter S, Chan A, Roberts S, Feng X, Lohrisch C, Gelmon K, Shenkier T, Chia S. A prospective clinical utility study of the impact of the 21-gene recurrence score (RS) assay in the treatment of estrogen receptor positive (ER+), HER2 negative (HER2-), 1-3 node positive (N+) breast cancer (BC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-10-07.
Abstract P4-02-05: Diagnostic value of breast MRI in evaluating total extent of disease when non-calcified DCIS is present in stereotactic core biopsy samples
Authors: D Sheth, J Bao, H Abe, N Jaskowiak
Journal: Cancer Research (2018)

Abstract PURPOSE To compare the extent of disease as seen on mammography, breast MRI and final surgical pathology in all patients with non-calcified DCIS identified on stereotactic core biopsy. Can MRI provide useful diagnostic information to the surgeon when mammographically occult DCIS is present. METHOD AND MATERIALS All patients with stereotactic core biopsies performed at the University of Chicago from 2010 to 2017 were retrospectively reviewed. Patients with pathology demonstrating DCIS in non-calcified cores on stereotactic biopsy were further selected based on whether they had a subsequent breast MRI and definitive surgical treatment. A total of 76 patients met these criteria. All patients undergoing stereotactic core biopsy had at least six 9-gauge cores removed, all of which were radiographed and separated based on whether calcifications were present or absent. Select patients with documented DCIS in the non-calcified cores had a MRI. All patients with MRI underwent a routine diagnostic protocol consisting of one pre- and five post-contrast bilateral, fat suppressed T1 sequences along with a non-fat suppressed T2 sequence. Final surgical treatment was subsequently determined and performed by the breast surgeon. RESULTS 76 women met all criteria for this study. In 16/76 (21%) of the cases, MRI revealed greater extent of disease than was detected via mammography, and led to change in management in half of those cases (8/76 - 11%). In all 16 of these cases, final surgical pathology confirmed the MRI-detected extent of disease. In 52/76 (68%) of the cases, MRI confirmed the extent of disease detected on mammography and final surgical pathology. In 8/76 (11%) of the cases, MRI showed little to no abnormal enhancement at site of mammographically detected calcifications, even though final surgical pathology confirmed presence of residual disease. CONCLUSION The presence of non-calcified DCIS in stereotactic core biopsy samples raises the suspicion for the presence of mammographically occult disease. Breast MRI performed in this setting shows that in majority (82% -68/76) of the cases, MRI can either confirm or even advantageously reveal greater extent of disease than was initially detected on mammography. Furthermore, there can be a change in management due to the breast MRI findings. CLINICAL RELEVANCE/APPLICATION Breast MRI can be a useful diagnostic tool for the surgeon when non-calcified DCIS is present in stereotactic core biopsy samples. Citation Format: Sheth D, Bao J, Abe H, Jaskowiak N. Diagnostic value of breast MRI in evaluating total extent of disease when non-calcified DCIS is present in stereotactic core biopsy samples [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-05.
Complement levels as predictors of survival in pancreatic adenocarcinoma.
Authors: Davendra Sohal, Feng Lin, Suman Kundu, Keith McCrae, Alok A. Khorana
Journal: Journal of Clinical Oncology (2018)

315 Background: Novel biomarkers to predict outcomes in pancreatic adenocarcinoma (PDA) are urgently needed. Complement activation, an important mediator of inflammatory processes, has been reported in some solid tumors but its role in PDA is unknown. We evaluated the prognostic role of complement in a prospective cohort of PDA patients. Methods: Blood samples were collected from consenting PDA patients at study entry (prior toany new regimen) in a prospective biorepository protocol at Cleveland Clinic from 2013-2016. Samples were processed for C3a, C4a, and C5a levels using ELISA on serum samples (BD Biosciences). Data on clinical variables, treatment, and survival were collected from medical records. Resectability was defined using Intergroup criteria. Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) are presented. Results: The study population comprised 48 consecutive patients. Median age was 65 years (range, 41-84); 60% (n=29) were female; 33 (69%) had potentially curable (resectable or borderline resectable) disease. Overall, 43 (93%) received chemotherapy; 22 (46%) received radiation; 29 (60%) underwent surgery. Median follow-up was 17 months. Median OS was 10.9 (1.6-54.5) months. Baseline levels, and associations with stage and OS are shown in Table. Increasing levels of C3a, C4a and C5a were associated with worsened survival (HR 1.00-1.03 per each unit increase in baseline level) despite not being significantly associated with stage. Conclusions: Levels of C3a, C4a, and C5a are detected in nearly all patients with PDA. Increased levels correlate with OS. Complement activation has not been reported previously in PDA and may be a potential therapeutic target. Our findings suggest that complement levels may serve as novel biomarkers. [Table: see text]
Abstract 18092: Source of Galectin-3 in Human Heart Failure, Chronic Kidney Disease and Cardio-renal Failure
Authors: Imad Hussain, Mariam P Alexander, Joseph J Maleszewski, Naveen L Pereira, Margaret M Redfield
Journal: Circulation (2015)

Background: Galectin-3 (Gal-3) may promote cardiac and renal fibrosis in heart failure (HF). Plasma Gal-3 levels predict outcome in HF but are tightly correlated with renal function. The source of Gal-3 in human HF, chronic kidney disease (CKD) or cardio-renal failure (HF+CKD) is unclear. Objective: To assess Gal-3 presence and location in human heart or kidney tissue from patients with HF, CKD or HF+CKD. Methods: Plasma Gal-3 levels and LV tissue explanted at time of cardiac transplant in systolic HF (n=15) and autopsy renal sections from patients with normal kidneys (n=4), CKD (n=17) or CKD+HF (n=14) were examined (H&amp;E, Masson’s trichrome and CD-68 and Gal-3 immunohistochemistry). In the systolic HF patients, we quantified the number of Gal-3+/CD-68+ cells per HPF in LV tissue and assessed the correlation with plasma Gal-3 levels. In autopsy renal tissue, we derived a Composite Gal-3 Score (CG3S) incorporating the % of Gal-3+ tubules per HPF, % of Gal-3+ cells/tubule per HPF, and intensity of Gal-3 staining and assessed the correlation of the CG3S with ante-mortem estimated glomerular filtration rate(eGFR). Renal macrophage Gal-3 staining was also assessed. Results: In systolic HF LV tissue, Gal-3 was present in macrophages rather than myocytes but Gal-3+/CD-68+ cells per HPF was not correlated with plasma Gal-3 levels (p&gt; 0.9) which correlated inversely with eGFR (r = -0.89 for log Gal-3 vs eGFR, p&lt;0.0001). In the kidney, Gal-3 was not present in macrophages but was localized to renal tubular cells (Figure). The CG3S increased exponentially as eGFR decreased (r = - 0.88 for log CG3S versus eGFR; p&lt;0.0001) and this relationship was not different (p=0.44) in patients with or without HF (Figure). The log CG3S correlated with the degree of fibrosis (tubulointerstitial scarring) in the kidney (r=0.88; p&lt;0.0001). Conclusion: Collectively, these data suggest that plasma Gal-3 is predominantly of renal tubular epithelial origin in human HF, CKD, and CKD+HF.
Manchester hospital to publish individual consultant performance data
Authors: Helen Jaques
Journal: BMJ (2013)

A hospital trust in Manchester is to publish performance data on individual consultants, making it the first UK organisation to do so.

University Hospital of South Manchester will publish online treatment outcome data and patient feedback for all 250 consultants at the trust. The trust will start by publishing data on cardiologists and cardiothoracic surgeons and build up to publishing information for consultants across all specialties by the end of the year.

The organisation has worked with the non-profit research institute Picker Europe to determine the most appropriate performance …
Nearly three quarters of doctors put in unpaid overtime
Authors: Helen Jaques
Journal: BMJ (2012)

Nearly three quarters (73%) of doctors and dentists put in additional hours on top of their contracted working time last year, according to the NHS staff survey for 2011.

A total of 46% of the roughly 7500 doctors and dentists who responded to last year’s survey reported working up to an extra five hours a week, 19% did an additional 6-10 hours, and almost one in 10 (8%) did 11 hours or more of unpaid overtime a week. A third did paid overtime on top of their contracted work.

Around half (45%) said that …
Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia
Authors: Catia Cilloniz, Miquel Ferrer, Adamanthia Liapikou, Carolina Garcia-Vidal, Albert Gabarrus, Adrian Ceccato, Jorge Puig de La Bellacasa, Francesco Blasi, Antoni Torres
Journal: European Respiratory Journal (2018)

Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition. We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality. Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively. Streptococcus pneumoniae was the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% versus 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis. ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.
Trends of Gender-Affirming Surgery Among Transgender Patients in the United States
Authors: Marie Crandall
Journal: JAMA Surgery (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Prognostic impact of interval between diagnosis and surgery in patients with gastric cancer.
Authors: Yuta Kumazu, Tsutomu Hayashi, Kentaro Hara, Hiroaki Osakabe, Shinsuke Nagasawa, Masato Nakazono, Toru Aoyama, Takanobu Yamada, Tsutomu Sato, Yasushi Rino, Munetaka Masuda, Takashi Ogata, Takaki Yoshikawa
Journal: Journal of Clinical Oncology (2018)

24 Background: Patients with gastric cancer should receive treatment for the cure as soon as possible because cancer cells are considered to grow and metastasize quickly. However, patients sometimes have to wait for the treatment because of further examinations of comorbidity, social background, and limited medical resources. It remained unclear whether interval between diagnosis and surgery is a risk factor for the survival. Methods: This retrospective single-center study examined 801 patients who visited outpatient clinic for gastric cancer and underwent curative surgery from 2006 to 2012 at Kanagawa Cancer Center in Japan. The patients who received neoadjuvant chemotherapy were excluded. Interval was defined as the time from the date of the first visit to the date of surgery. Interval was divided by the median and was classified to the early (less than median) and the late (exceeding the median) groups. Survival was analyzed by separating clinical T1 and T2-4. Results: 461 patients had clinical T1 and 340 had clinical T2-4. Median interval was 55 days (15-269 days) in clinical T1 and 35 days (10-148 days) in clinical T2-4, respectively. In clinical T1, 5-year survival rate was 93.1% in the early group and 91.2% in the late group (p = 0.456). In clinical T2-4, 5-year survival rate was 77.8% in the early group and 78.9% in the late group (p = 0.864). In the multivariate analysis, significant independent risk factors were over 75 years of age and clinical T4, and clinical N+, over 75 years of age in clinical T1, and over 75 years of age and clinical T4 in clinical T2-4. Interval was not significant factor both in clinical T1 (HR: 1.242, 95%CI 0.641-2.407 p = 0.522) and in clinical T2-4 (HR: 1.078, 95%CI 0.672-1.729 p = 0.756). Conclusions: Interval between diagnosis and surgery did not have a negative impact on the prognosis in patients with gastric cancer. Necessary interval for the clinical practice would be acceptable.
Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR)
Authors: Désirée van der Heijde, David I Daikh, Neil Betteridge, Gerd R Burmester, Afton L Hassett, Eric L Matteson, Ronald van Vollenhoven, Sharad Lakhanpal
Journal: Annals of the Rheumatic Diseases (2018)

A European League Against Rheumatism-American College of Rheumatology working group consisting of practising and academic rheumatologists, a rheumatology researcher and a patient representative created a succinct general statement describing rheumatic and musculoskeletal diseases (RMDs) in adults and children in language that can be used in conversations with the lay public, media, healthcare providers and other stakeholders. Based on the literature review, several elements were deemed important for inclusion in the description of RMDs. First, RMDs encompass many different diseases that can affect individuals at any age, including children. Second, there are various pathophysiological pathways underlying different RMDs. Third, the impact of RMDs on individuals and society should be emphasised. The working group agreed that the language should be comprehensible to the lay public. Thus, the following description of RMDs has been developed: 'Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscles and bones. Many of these diseases are long term and worsen over time. They are typically painful and limit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.' This description can be used by rheumatology groups, researchers and those who work in advocacy and education related to RMDs.
MANAGEMENT OF PRE-TERM PERIPARTUM VENTRICULAR TACHYCARDIA DUE TO ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA COMPLICATED BY SEVERE PRE-ECLAMPSIA
Authors: Chirag Desai, Udit Bhatnagar, Maryam Sheikh, Kade Klippenstein, Scott Pham
Journal: Journal of the American College of Cardiology (2018)
Phase I study of E7046, a novel PGE<sub>2</sub> receptor type 4 inhibitor, in patients with advanced solid tumors: Clinical results and effects on myeloid- and T-lymphoid cell-mediated immunosuppression.
Authors: David S. Hong, Aparna Parikh, Geoffrey Shapiro, Andrea Varga, Aung Naing, Funda Meric-Bernstam, Larisa Reyderman, Xingfeng Bao, Terri A. Binder, Min Ren, Amy Siu, Lu Xu, Mingjie Liu, Satish Dayal, Vijay Bhagawati-Prasad, Ilian Tchakov, Takashi Owa, Chean Eng Ooi, Aurelien Marabelle
Journal: Journal of Clinical Oncology (2018)

49 Background: E7046 is a selective inhibitor of the prostaglandin E 2 (PGE 2 ) receptor EP4, which transduces potent immunosuppressive activity of PGE 2 in myeloid and T-lymphoid cells. In preclinical studies, E7046 reversed PGE 2 -mediated activities and facilitated activation of cytotoxic T-cells. Here, we present initial clinical, PK and PD results from a first-in-human study of E7046 in patients (pts) with cancers having high myeloid cell infiltration. Methods: E7046 was given orally, once-daily, in 21-day cycles in sequential dose-escalating cohorts (125, 250, 500 and 750mg). Tumor responses were evaluated by irRECIST and metabolic responses by 18 FDG-PET. Immune response modulation was assessed in tumors and peripheral blood. Results: Thirty pts were treated, with no dose-limiting toxicities observed. The most common adverse events were fatigue (37%), diarrhea (33%), and nausea (30%). Grade 3/4 AEs in &gt; 1 pt were abdominal pain (3 pts) and vomiting (2 pts). Grade 3/4 treatment-related AEs occurred in 4 pts (rash in 2 pts, and diarrhea, allergic reaction, anaphylaxis, hypersensitivity, and hyperuricemia, in 1 pt each). Four pts discontinued E7046 due to an AE (bowel obstruction, allergic reaction, abdominal pain, acute renal failure). No objective tumor responses were reported. Treatment duration of ≥20 wks with best response of stable disease (SD) was observed in 5 pts, 3 of whom had partial metabolic responses. E7046 exposure was dose-proportional up to 500 mg. Elimination half-life (12 hr) justified once-daily dosing. E7046 treatment significantly increased tumor CD3 + and CD8 + T-cell infiltration, and blood levels of the T-cell-recruiting chemokine CXCL10. E7046 also modulated blood expression of EP4 signaling genes (IDO1, EOMES, PD-L1). Longer duration of therapy with SD was associated with higher baseline tumor infiltrate of CD8 + T-cells and CD163 + macrophages. Conclusions: E7046 demonstrated favorable tolerability with preliminary evidence of anti-tumor activity and immune modulation in tumor and peripheral blood. MTD was not reached. Further studies of E7046 in combination with other agents are planned. Clinical trial information: NCT02540291.
Pension changes threaten GP locum workforce, BMA says
Authors: Helen Jaques
Journal: BMJ (2013)

The stability of the GP locum workforce is under threat after changes to how employers’ contributions to locums’ pensions are paid, the BMA has said.

From April this year general practices in England have been required to pay the 14% employer pension contribution for locum GPs. Previously this sum was paid by primary care trusts. General practices have received an extra 0.15% payment on top of the 1.32% increase to the global sum for 2013-14 to cover this cost.

The BMA is concerned that the additional …
Moving GMC registration to the point of graduation will put doctors and patients at risk, says BMA
Authors: Abi Rimmer
Journal: BMJ (2014)

The BMA has opposed plans to move full registration with the General Medical Council from the end of the first year of foundation training to the point of graduation from medical school.

The plans were first proposed in the UK-wide Shape of Training review, led by David Greenaway,1 and were also set out in the government’s mandate for Health Education England.2

Delegates at the BMA’s Annual Representative Meeting in Harrogate voted unanimously in favour of a motion that said the association “deplored” plans to give full registration to junior doctors on the completion of their medical school studies “before …
DIAGNOSTIC PERFORMANCE OF A HIGH-SENSITIVITY CARDIAC TROPONIN I FOR ACUTE MYOCARDIAL INFARCTION USING SEX-SPECIFIC 99TH PERCENTILES DERIVED FROM THE AMERICAN ASSOCIATION OF CLINICAL CHEMISTRY UNIVERSAL SAMPLE BANK
Authors: Yader Sandoval, Stephen Smith, Anne Sexter, Karen Schulz, Fred Apple
Journal: Journal of the American College of Cardiology (2018)