tbuckley/cabot-search huggingface dataset:
Let Me Ring the Bell
Authors: Mary Beth Schaeffer
Journal: Annals of Internal Medicine (2018)

On Being a Patient2 October 2018Let Me Ring the BellMary Beth Schaeffer, BAMary Beth Schaeffer, BAAmerican College of Physicians, Philadelphia, Pennsylvania (M.B.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0289 Audio Reading - “Let Me Ring the Bell” Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Let Me Ring the Bell," by M.B. Schaeffer. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I've watched it time after time. Family and friends wait outside the infusion room for their loved one to emerge. The last treatment is done, the cancer gone. Cheers and hugs! The patient rings the bell. Nurses and doctors join in. A family dinner! Toasts abound!But one third of them will be back with a recurrence. And they will join me. I was diagnosed with stage IV de novo breast cancer, never having an earlier stage of cancer. My treatment is lifelong, my race much longer, the battles more frequent. My hope resides in science, in the next new ... Author, Article, and Disclosure InformationAffiliations: American College of Physicians, Philadelphia, Pennsylvania (M.B.S.)Corresponding Author: Mary Beth Schaeffer, BA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org. PreviousarticleNextarticle Advertisement Audio Reading - “Let Me Ring the Bell” Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Let Me Ring the Bell," by M.B. Schaeffer. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byThe Cancer Bell: Too Much of a Good Thing? 2 October 2018Volume 169, Issue 7Page: 506KeywordsBrainBreast cancerCancer treatmentChemotherapyDrugsGamesIntensive care unitsNursesRacial and ethnic issuesSurgery ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Trends in aggressive inpatient care at the end-of-life for stage IV lung cancer patients.
Authors: Chebli Mrad, Marwan S Abougergi, Robert Michael Daly
Journal: Journal of Clinical Oncology (2018)

26 Background: Metastatic lung cancer patients are treated with palliative intent. Aggressive inpatient care at the end-of-life is seen as a marker of poor quality care. However, national trends and factors related to aggressive inpatient care at the end-of-life for these patients have not previously been evaluated. Methods: A total of 3,030,866 hospitalizations of metastatic lung cancer patients were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end-of-life and multivariate logistic regression was performed to determine associations with age, race, region, and hospital characteristics. Results: From 1998 to 2014, in-hospital mortality for metastatic lung cancer patients decreased from 17% to 11%. However, the proportion admitted to the intensive care unit during the terminal hospitalization increased from 12.9% to 26.4%. Reflecting this aggressive end-of-life care, mean total charges for a terminal hospitalization increased from $29,386 to $72,469, adjusted for inflation. Among patients who died in the inpatient setting, the intensive care unit stay translated into higher total costs (+$18,461 CI: $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations increased during this period from 8.7% to 53.0% and were correlated with a decrease in aggressive care at the end-of-life. A multivariable model showed variation by patient and hospital characteristics in aggressive inpatient care utilization. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in intensive care unit use during terminal hospitalizations, resulting in high cost for the health care system.
Effects of Cognitive Behavioral Therapy on Neural Processing of Agoraphobia-Specific Stimuli in Panic Disorder and Agoraphobia
Authors: André Wittmann, Florian Schlagenhauf, Anne Guhn, Ulrike Lueken, Manja Elle, Meline Stoy, Carolin Liebscher, Felix Bermpohl, Thomas Fydrich, Bettina Pfleiderer, Harald Bruhn, Alexander L. Gerlach, Benjamin Straube, Hans-Ulrich Wittchen, Volker Arolt, Andreas Heinz, Tilo Kircher, Andreas Ströhle
Journal: Psychotherapy and Psychosomatics (2018)

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Patients suffering from panic disorder and agoraphobia are significantly impaired in daily life due to anxiety about getting into a situation due to apprehension about experiencing a panic attack, especially if escape may be difficult. Dysfunctional beliefs and behavior can be changed with cognitive behavioral therapy; however, the neurobiological effects of such an intervention on the anticipation and observation of agoraphobia-specific stimuli are unknown. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We compared changes in neural activation by measuring the blood oxygen level-dependent signal of 51 patients and 51 healthy controls between scans before and those after treatment (group by time interaction) during anticipation and observation of agoraphobia-specific compared to neutral pictures using 3-T fMRI. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A significant group by time interaction was observed in the ventral striatum during anticipation and in the right amygdala during observation of agoraphobia-specific pictures; the patients displayed a decrease in ventral striatal activation during anticipation from pre- to posttreatment scans, which correlated with clinical improvement measured with the Mobility Inventory. During observation, the patients displayed decreased activation in the amygdala. These activational changes were not observed in the matched healthy controls. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; For the first time, neural effects of cognitive behavioral therapy were shown in patients suffering from panic disorder and agoraphobia using disorder-specific stimuli. The decrease in activation in the ventral striatum indicates that cognitive behavioral therapy modifies anticipatory anxiety and may ameliorate abnormally heightened salience attribution to expected threatening stimuli. The decreased amygdala activation in response to agoraphobia-specific stimuli indicates that cognitive behavioral therapy can alter the basal processing of agoraphobia-specific stimuli in a core region of the fear network.
Abstract 19828: Sleep Duration Modifies the Effect of Race on Major Adverse Cardiovascular Events in Post Acute Coronary Syndrome Patients
Authors: Linda Oyesiku, Keith M Diaz, Ellen-ge Denton, Siqin Ye, Eleanor McGlinchey, Karina W Davidson, Carmela Alcantara
Journal: Circulation (2016)

Introduction: Black–White racial disparities in cardiovascular disease (CVD) risk and sleep duration are well documented. While short sleep duration is a risk factor for incident CVD, its associati...
Developing and testing a novel hospital readmission score for patients with cancer.
Authors: Steve Power, Arif Kamal
Journal: Journal of Clinical Oncology (2018)

244 Background: Up to 50% of cancer patients experience an unplanned hospitalization. This represents opportunities for both improvements in quality of care and utilization of low value resources. Hospital readmission scores, to best target post-discharge navigation and follow-up, are needed yet not widely available. Methods: We conducted a retrospective cohort study among oncology patients admitted to Duke University Hospitals in 2015. The readmissions risk test model was built using multivariate analysis to identify and ‘weight’ four key readmission predictors. The model was subsequently analyzed in a validation data set using 2016 &amp; 2017 admission data. Results: Of the 4987 admissions in 2015, 55% were male, 73% were Caucasian, and mean age was 61 (SD 14.1 years). Common cancers were GI (31%), Thoracic (27%) and GU (24%). Factors used to build the readmission predictor model based on the relative Odds Ratios were race (1), length of stay (1), discharge disposition (2), and previous admission with &lt; 90 days (2) or 91-180 days (1). The patient cohort used to test the model had 1926 admissions and each were assigned a point value according to the model specifications, see Figure 1. We found significant differences in risk for readmission among differences in scores (p &lt; 0.05). We have subsequently launched a post-discharge navigation program, with frequency of contacts dictated by readmission risk from the model. Conclusions: Predictor models in the oncology setting can identify combinations of factors that are associated with readmission. Programs that integrate such models may identify cancer patients at high risk of readmission and thus tailor a personalized approach to preventing a subsequent admission.[Table: see text]
Abstract 14340: Intraperitoneal Administration of Low Dose 2s, Apoa-i Mimetic Peptide, Inhibits The Atherosclerotic Lesion Development in Apoe−/− Mice
Authors: Bok-Soo Lee, Seul Hee Han, YeWon Kim, Jaehoon Yu, Jeong Euy Park
Journal: Circulation (2011)

Background and aim: Not only HDL injection but also apoA-I mimetic peptide can be developed as the effective medicine in the treatment of acute coronary syndrome. We have generated apoA-I mimetic peptide named 2s, which is structurally similar to 4F but two F sites of 4 phenylalanines were replaced with two non-natural amino acid analogs and investigated its effect as therapeutic drug for atherosclerosis using apoE−/− mice. Methods: ApoE−/− mice (10 mice/group) at 6 weeks of age were fed with 0.15% high fat high cholesterol diet (HFHC) for 8 weeks and the diet was changed to normal chow diet and was continued for another 4 weeks. Mice were injected intraperitonealy with 2s and 4F peptides at doses of 1mg/kg or 20mg/kg, three times a week during the last 4 weeks. Mice receiving saline or water without peptides were used as reference group. After 12 weeks, mice were sacrificed and atherosclerotic lesions in aorta and aortic sinus were examined by oil red O staining and immunohistochemistry. Results: Lipid a...
Fibromuscular Dysplasia and Its Neurologic Manifestations
Authors: Emmanuel Touzé, Andrew M. Southerland, Marion Boulanger, Paul-Emile Labeyrie, Michel Azizi, Nabila Bouatia-Naji, Stéphanie Debette, Heather L. Gornik, Shazam M. Hussain, Xavier Jeunemaitre, Julien Joux, Adam Kirton, Claire Le Hello, Jennifer J. Majersik, J. Mocco, Alexandre Persu, Aditya Sharma, Bradford B. Worrall, Jeffrey W. Olin, Pierre-François Plouin
Journal: JAMA Neurology (2018)

Data on neurologic manifestations of fibromuscular dysplasia (FMD) are rare, and current knowledge remains limited.To present a comprehensive review of the epidemiologic characteristics, management, and prognosis of the neurologic manifestations associated with cerebrovascular FMD (ie, involving cervical or intracranial arteries) and to guide future research priorities.References were identified through searches of PubMed from inception to December 2017 using both the medical subject headings and text words. Additional sources were also identified by reviewing reference lists of relevant articles and through searches of the authors' personal files. Selected articles described at least 1 clinical or radiologic feature and/or outcome of cerebrovascular FMD. Isolated case reports could be included if they described interesting or noteworthy manifestations of FMD.A total of 84 relevant references were identified. Diagnosis of cerebrovascular FMD is based on the appearance of alternating arterial dilatation and constriction ("string of beads") or of focal narrowing, with no sign of atherosclerotic or inflammatory lesions. Although the diagnosis is easily apparent on results of radiographic imaging, making a diagnosis can be challenging in children or individuals with atypical phenotypes, such as purely intracranial FMD and arterial diaphragm. Involvement of multiple arteries is common, and there is increased incidence of cervical artery dissection and intracranial aneurysms. A variant in the PHACTR1 gene has been associated with FMD as well as cervical artery dissection and migraine, although less than 5% of cases of FMD are familial. Headaches, mainly of the migraine type, are observed in up to 70% of patients with FMD. Cerebrovascular FMD is mostly asymptomatic, but the most frequent neurologic manifestations include transient ischemic attack and ischemic stroke, notably in the presence of associated cervical artery dissection. Other conditions associated with FMD include subarachnoid hemorrhage and, rarely, intracranial hemorrhage. Management relies on observational data and expert opinion. Antiplatelet therapy is considered reasonable to prevent thromboembolic complications. Endovascular therapy is typically restricted to cases with symptomatic stenosis despite optimal medical therapy or in those with rupture of an intracranial aneurysm.Longitudinal cohort studies of individuals of multiple ethnicities with biosampling are needed to better understand the risk factors, pathophysiological features, and outcomes of FMD. Patient advocacy groups could assist researchers in answering patient-centered questions regarding FMD.
Systematic literature review of treatments used for adult immune thrombocytopenia in the second‐line setting
Authors: Lauren C. Bylsma, Jon P. Fryzek, Karynsa Cetin, Fiona Callaghan, Carla Bezold, Bhakti Mehta, Jeffrey S. Wasser
Journal: American Journal of Hematology (2018)

Abstract Immune thrombocytopenia (ITP) is a rare platelet disorder that is often persistent or chronic in adults. Patient management is dependent upon physician judgment and patient preference, given both the rarity of the condition and a paucity of high‐quality clinical trial evidence to inform practice guidelines. A systematic literature review was conducted to provide an up‐to‐date summary of studies evaluating the safety and efficacy/effectiveness of therapies used to treat adults with primary ITP in the second‐line setting. Using comprehensive search strings, several medical research databases were queried. Final abstraction was performed on 186 articles. Most (75%) studies were observational in nature; nearly half were conducted in Europe. Splenectomy was the most commonly studied (n = 83, 47%), followed by rituximab (n = 49, 26%) and the thrombopoietin‐receptor agonists (TPO‐RAs) romiplostim (n = 34, 18%) and eltrombopag (n = 24, 13%). Twelve prospective, randomized controlled trials (RCTs) with a placebo or standard‐of‐care arm evaluating the safety and efficacy of either rituximab or a TPO‐RA were identified and described in detail. These trials provide important information on the safety and efficacy of these treatments, and in the absence of head‐to‐head data, offer insights on how these therapies compare with one another in treating adult ITP in the second‐line setting. This review confirms that for most second‐line ITP treatment options, there remains a lack of rigorous evidence derived from RCTs, and for many treatments, there is limited evidence of any kind. The need for additional research to guide treatment choices in this setting and greater use of standardized ITP terminology are highlighted.
Tumor-derived microRNAs induce myeloid suppressor cells and predict immunotherapy resistance in melanoma
Authors: Veronica Huber, Viviana Vallacchi, Viktor Fleming, Xiaoying Hu, Agata Cova, Matteo Dugo, Eriomina Shahaj, Roberta Sulsenti, Elisabetta Vergani, Paola Filipazzi, Angela De Laurentiis, Luca Lalli, Lorenza Di Guardo, Roberto Patuzzo, Barbara Vergani, Elena Casiraghi, Mara Cossa, Ambra Gualeni, Valentina Bollati, Flavio Arienti, Filippo De Braud, Luigi Mariani, Antonello Villa, Peter Altevogt, Viktor Umansky, Monica Rodolfo, Licia Rivoltini
Journal: Journal of Clinical Investigation (2018)

The accrual of myeloid-derived suppressor cells (MDSCs) represents a major obstacle to effective immunotherapy in cancer patients, but the mechanisms underlying this process in the human setting remain elusive. Here, we describe a set of microRNAs (miR-146a, miR-155, miR-125b, miR-100, let-7e, miR-125a, miR-146b, miR-99b) that are associated with MDSCs and resistance to treatment with immune checkpoint inhibitors in melanoma patients. The miRs were identified by transcriptional analyses as being responsible for the conversion of monocytes into MDSCs (CD14+HLA-DRneg cells) mediated by melanoma extracellular vesicles (EVs) and were shown to recreate MDSC features upon transfection. In melanoma patients, these miRs were increased in circulating CD14+ monocytes, plasma, and tumor samples, where they correlated with the myeloid cell infiltrate. In plasma, their baseline levels clustered with the clinical efficacy of CTLA-4 or programmed cell death protein 1 (PD-1) blockade. Hence, MDSC-related miRs represent an indicator of MDSC activity in cancer patients and a potential blood marker of a poor immunotherapy outcome.
Renal transplant recipients receiving loop diuretic therapy have increased urinary tract infection rate and altered medullary macrophage polarization marker expression
Authors: Janis Casper, Jessica Schmitz, Jan Hinrich Bräsen, Abedalrazag Khalifa, Bernhard M.W. Schmidt, Gunilla Einecke, Hermann Haller, Sibylle von Vietinghoff
Journal: Kidney International (2018)
Down-regulation of dcr3 enhances TRAIL-mediated apoptosis in pancreatic cancer
Authors: Wei Wang, Weimin Sun, Hengshan Zhang, Shanmin Yang, Chaomei Liu, Mei Zhang, Bruce Fenton, Peter Keng, Ivan Ding, Chunyou Wang, Sunghee Kim, Paul Okunieff, Lurong Zhang
Journal: Cancer Research (2008)

827   Introduction: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), a critical pro-apoptotic molecule on the cell surface, has been identified as a promising anti-cancer agent. However, most human pancreatic cancer cells are resistant to TRAIL-induced apoptosis. This study is focused on revealing the underlying mechanisms by which pancreatic cancer cells utilize their extracellular molecules to counteract the pro-apoptotic signaling mediated by the TNF family. Methods: The binding of DcR3 (Decoy Receptor 3) with TRAIL was determined with several assays including Flow cytometry analysis, Western blotting and ELISA-like binding assay using recombinant DcR3 and TRAIL. The binding assays were also performed in both culture media and cell lysate from AsPC-1 and MiaPaCa-2 human pancreatic cancer cells. The biological function of this binding was studied with several indices for apoptosis including sub-G1 population, caspase 3 activity and cleaved PARP. Gemcitabine and siRNA for DcR3 were used to regulate the expression levels of DcR3 and TRAIL to confirm the function of the interaction of these two molecules. Results: In this study, we demonstrate for the first time that DcR3, a secreted decoy receptor expressed at a high level by malignant pancreatic cancer cells, acts as an extracellular anti-apoptotic molecule by binding to TRAIL, thus counteracting the death-promoting function of TRAIL. The reduction of DcR3 with siRNA unmasks TRAIL and greatly enhances TRAIL-induced apoptosis. Gemcitabine, a first line drug for pancreatic cancer, also reduces the level of DcR3. The addition of DcR3 siRNA could further enhance the apoptosis induced by Gemcitabine. Importantly, the  in vivo  studies demonstrate that the therapeutic effect of Gemcitabine is enhanced via further reduction of DcR3, suggesting that down-regulation of DcR3 in tumor cells could tip the balance from survival to death and serve as a new strategy for pancreatic cancer therapy. Conclusion: DcR3 is utilized by cancer cells for their survival upon the various stresses, including chemotherapy. The binding of DcR3 to TRAIL blocks the apoptosis induced by TRAIL. The down-regulation of DcR3 is a new strategy for enhancement of anti-cancer therapy.
Impact of technology-based access to a multidisciplinary tumor board on treatment planning for patients with cancer in developing countries.
Authors: Amit Kumar Jotwani, Rashie Jain, Spoorthi Shelometh
Journal: Journal of Clinical Oncology (2018)

271 Background: The developing countries account for 70% of cancer associated mortality in spite of significantly lesser incidence than the developed world. The main reason for poor outcomes is acute shortage of trained oncology medical professionals. We conducted a prospective study on impact of Onco.com multidisciplinary tumour board (MTB) opinion on the treatment plan for patients. Onco.com provides online access to senior experts in oncology from India and United States wherein the patients can avail unbiased, evidence based treatment opinion through technology. Methods: We prospectively evaluated the impact of treatment plan provided by multidisciplinary team of oncologists on the treatment received by patients who opted for secure online opinion on onco.com. A total of 335 patients from 13 countries received online MTB opinion from July 2017 till April 2018 were included in the study. A multidisciplinary tumour board was constituted through an automated system by matching expertise of the oncologists as per patient’s condition. The experts had access to cutting edge scientific journals and international clinical practice guidelines (NCCN, ESMO, Uptodate.com) while giving opinion for the patient. The opinion was delivered in 3 days. Results: Of the total 335 MTB reports evaluated, 68 had stage I or II disease, 104 had locally advanced disease and 163 patients had metastatic/relapsed disease at presentation. Online access to multidisciplinary team of expert oncologists lead to a better treatment plan for 81.5% patients, while significant 14.6% patients received drastic changes in their existing treatment plan. Conclusions: The results demonstrate that technology can help us bridge the gaps in access to trained expert oncologists across borders for developing countries and help them receive better treatments. A longer follow up is needed to evaluate impact of online MTB opinion on clinical outcomes for patients.[Table: see text]