tbuckley/cabot-search huggingface dataset:
Abstract 16100: Incidence and Morphologic Characteristics of Plaque Erosion in Patients With Acute Myocardial Infarction: A Combined Optical Coherence Tomography and Intravascular Ultrasound Study
Authors: Takumi Higuma, Soeda Tsunenari, Naoki Abe, Masahiro Yamada, Hiroaki Yokoyama, Shuji Shibutani, Haibo Jia, Yoshiyasu Minami, Rocco Vergallo, Hang Lee, Ken Okumura, IK-Kyung Jang
Journal: Circulation (2014)

Background: The underlying mechanisms for acute myocardial infarction (AMI) include plaque rupture (PR), plaque erosion (PE), and calcific nodule (CN). Recently, in vivo diagnosis of PE was reported in patients with acute coronary syndromes (ACS) using optical coherence tomography (OCT). However, the true incidence of erosion in patients with AMI remains unknown. Aim: The aims of this study were (1) to evaluate the incidence of PR, PE, and CN in patients with AMI during the acute phase and (2) to compare the detailed plaque morphology in all 3 groups using both OCT and intravascular ultrasound (IVUS). Methods and Results: In 77 patients with AMI, both OCT and IVUS were performed following manual aspiration thrombectomy. Culprit plaques were classified into PR, PE, and CN using the established OCT criteria. The frequency of PR, PE, and CN were 62.3%, 27.2%, and 6.5%, respectively. PE had significantly lower prevalence of thin-cap fibroatheroma (TCFA), thicker fibrous cap and smaller lipid arc. Compared to PR and PE, CN had greater calcification (Table). On IVUS, plaque eccentricity index was significantly greater in PE compared to the others. PR and PE showed greater plaque burden. The remodeling index was different among these 3 groups. 75.0% of PR had positive remodeling but none in CN. In contrast, CN had higher prevalence of negative remodeling. The prevalence of superficial spotty calcification was higher in PR than the other 2 groups. Conclusion: This combined OCT and IVUS study demonstrates that erosion was the underlying mechanism in 27.2% of patients with AMI. In eroded plaques, TCFA was rare and eccentricity index was significantly greater.
Comparison of operative to monitoring and endocrine therapy for low-risk DCIS (COMET study).
Authors: Thomas Lynch, Elizabeth S. Frank, Deborah E. Collyar, Desiree Basila, Donna Pinto, Ann Partridge, Alastair Mark Thompson, Eun-Sil Shelley Hwang
Journal: Journal of Clinical Oncology (2018)

TPS599 Background: Approximately 50,000 women in the U.S. are diagnosed with ductal carcinoma in situ (DCIS) each year. Without treatment, it is estimated that only 20-30% of DCIS will lead to invasive breast cancer. However, over 97% of women are currently treated with guideline-concordant care (GCC) including surgery and/or radiation. An alternative to GCC is active surveillance (AS) which focuses on early detection of invasion rather than “treatment” of DCIS. The COMET study will compare risks and benefits of AS versus GCC in the setting of a Phase III pragmatic prospective randomized clinical trial. The study is funded by the Patient-Centered Outcomes Research Institute (PCORI). Methods: The primary objective is to assess whether the 2-, 5-, and 7-year ipsilateral invasive breast cancer rate for AS is non-inferior to that for GCC. Secondary objectives include determining whether AS is non-inferior to GCC for 2-year mastectomy rate; breast conservation rate; contralateral breast cancer rate; overall and breast cancer-specific survival. Patient reported outcomes (PROs) will enable comparison of health-related quality of life and psychosocial outcomes between GCC and AS groups at baseline, 6-months and years 1-5. Eligibility criteria include: age > 40 at diagnosis; pathologic confirmation of grade I/II DCIS without invasion by two pathologists; ER and/or PR ≥ 10%; HER2-negative (0, 1+, or 2+ if testing performed). Following randomization to either GCC or AS, patients who decline participation will still be eligible to participate in the non-randomized cohort of the study. The planned accrual goal is 1200 randomized patients across 100 Alliance for Clinical Trials in Oncology sites, with a projected drop-out rate of 30%, for a total of approximately 900 patients treated according to randomized arm, analyzed in an intent-to-treat analysis. Sample size of n = 446 per group will have 80% power to detect the specified non-inferiority margin. The COMET trial opened in the U.S. in June 2017. To date, 50 sites have activated the trial. Comparable studies are taking place in UK (LORIS Trial) and Europe (EORTC LORD Trial); data from all three trials will be analyzed in a planned combined analysis. Clinical trial information: NCT02926911.
Ethics and the Legalization of Physician-Assisted Suicide
Authors: E. Wesley Ely
Journal: Annals of Internal Medicine (2018)

Letters5 June 2018Ethics and the Legalization of Physician-Assisted SuicideE. Wesley Ely, MD, MPHE. Wesley Ely, MD, MPHTennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC) and Vanderbilt University, Nashville, Tennessee (E.W.E.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0078 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Because some states have legalized PAS, we as physicians must be careful to uphold the principles of medicine (to cure sometimes, provide healing always, and harm never) while at the same time balance these unchangeable truths with regional laws. Sulmasy and colleagues' position paper (1) achieves this balance. That the ACP continues to oppose a physician playing an active part in ending human life is encouraging and wholly appropriate, because doing so would not be consistent with the mission of medicine that I have stated. At the same time, penalizing physicians who participate in PAS if the ...Reference1. Snyder L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the legalization of physician-assisted suicide: an American College of Physicians position paper. Ann Intern Med. 2017;167:576-8. [PMID: 28975242]. doi:10.7326/M17-0938 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC) and Vanderbilt University, Nashville, Tennessee (E.W.E.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0078. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEthics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper Lois Snyder Sulmasy , Paul S. Mueller , and Ethics and the Legalization of Physician-Assisted Suicide Christie Reimer Ethics and the Legalization of Physician-Assisted Suicide Banu E. Symington Ethics and the Legalization of Physician-Assisted Suicide Allen H. Roberts II Ethics and the Legalization of Physician-Assisted Suicide Timothy L. Gieseke Ethics and the Legalization of Physician-Assisted Suicide Lois Snyder Sulmasy and Paul S. Mueller Metrics 5 June 2018Volume 168, Issue 11Page: 834KeywordsConflicts of interestDisclosurePeriodic acid SchiffSuicide ePublished: 5 June 2018 Issue Published: 5 June 2018 PDF downloadLoading ...
Abstract 17619: A Validated, Modifiable, and Actionable Pathway-Specific Aggregate Biomarker Risk Score Predicts Risk of Cardiovascular Outcomes in Patients with Coronary Artery Disease: Findings from the BARI 2D Trial
Authors: Nima Ghasemzadeh, Maria M Brooks, Helen E Vlachos, Sergey Sikora, Laurence Sperling, Arshed A Quyyumi, Stephen E Epstein
Journal: Circulation (2014)

Background: A biomarker risk score (BRS) comprised of C-reactive protein, Fibrin-Degradation products, and Heat Shock Protein-70 predicted MI and death in patients with CAD. Here, we sought to: a) ...
Home secretary announces review of visa cap
Authors: Gareth Iacobucci
Journal: BMJ (2018)

The home secretary, Sajid Javid, has pledged to review the UK’s current restrictions on the number of foreign doctors coming to work under a tier 2 visa, marking the first victory for The BMJ ’s Scrap the Cap campaign (bmj.com/scrap-the-cap).

The intervention came as The BMJ continued to lobby the government to change current immigration policy so that doctors from countries outside the European Economic Area who have been offered jobs in the NHS can take up their posts.

More than 1500 visa applications from doctors with job offers in the UK were refused between December 2017 and March 2018 as a result of the Home Office’s cap on the number of tier 2 visas it issues to workers from outside the EEA.1

On the evening …
Prevalence of angiomyolipoma among patients with tuberous sclerosis complex: A U.S. Healthcare Claims Database study.
Authors: Zhimei Liu, Peter Sun, Michael Kohrman, John Bissler
Journal: Journal of Clinical Oncology (2012)

e12042 Background: Angiomyolipoma (AML) are common benign neoplasm in the kidney, and are associated with tuberous sclerosis complex (TSC). The objectives of this study were to examine AML prevalence among TSC patients in a real world setting, and to explore the relationship between AML prevalence and ages, genders, or residential regions. Methods: A retrospective cohort study was conducted based on a large US commercial healthcare claims database. Patients with a TSC claim between 2000 and 2009 and with continuous 12-month enrollment after their first TSC claim were selected for the study. AML patients were identified based on ICD-9CM code (223.0X). Patients’ genders, residential regions, and age on their first TSC/or AML claim (if they had AML) were derived respectively from enrollment files and healthcare claims. Two-sample t tests and Chi-square tests were used to explore the relationships between AML prevalence, genders, residential regions and the age groups. Results: The study included 2,767 TSC patients with a mean age of 28.5 years on their first TSC claims, and 55.3% were female. AML prevalence among TSC patients was 7.8% in their first observed post-TSC year, and could be 78% at the end of the 10 th observed post-TSC year if AML incidence rate (701.1 per 10,000 TSC patient years) remains constant. Associations between AML prevalence and age groups, genders, or residential regions were statistically significant (all p&lt;0.05); and variations of AML prevalence by genders (Male: 5.6 vs. Female: 9.7%), residential regions (6.2-9.4%) and age groups at the first TSC claim (3.9% for age&lt;1 year, 5.2% for age 1-5 years, 10.6% for 6-10 years, 8.4% for age 11-18 years, 13.6% for age 19-25 years, and 6.9% for age 26 years or more) were observed. Conclusions: In a real world setting AML occurred in 7.8% TSC patients in the first post-TSC year, and could increase to 78% within 10 years if the incidence rate remained at 701.1 per 10,000 TSC patient years. AML prevalence was associated with age, gender and residential regions, and varied significantly by ages, genders and residential regions. Further research is needed to explore the factors that resulted into these associations.
Effectiveness and safety of local anesthetic, semi-flexible pleuroscopy – experience from a peripheral hospital
Authors: L.V. Rodrigues, G. Samouco, R. Gomes, C. Santos, L. Ferreira
Journal: Pulmonology (2018)

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.
Randomized, phase I/II study of gemcitabine plus IGF-1R antagonist (MK-0646) versus gemcitabine plus erlotinib with and without MK-0646 for advanced pancreatic adenocarcinoma
Authors: Reham Abdel-Wahab, Gauri R. Varadhachary, Priya R. Bhosale, Xuemei Wang, David R. Fogelman, Rachna T. Shroff, Michael J. Overman, Robert A. Wolff, Milind Javle
Journal: Journal of Hematology & Oncology (2018)

Binding of insulin-like growth factor-I (IGF-1) to its receptor (IGF-1R) initiates downstream signals that activate PI3K/Akt/mTOR and MEK/Erk pathways, which stimulate cancer cell proliferation and induce drug resistance. Cross talk between IGF-1R and epidermal growth factor receptor (EGFR) mediates resistance to anti-EGFR agents. We studied safety, tolerability, and outcomes of MK-0646, IGF-1 monoclonal antibody, in combination with gemcitabine (G) ± erlotinib (E) in metastatic pancreatic cancer.Our study included a phase I dose escalation and phase II randomization and expansion cohorts. A 3 + 3 dose escalation protocol was used to determine MK-0646 maximum tolerable dose (MTD) in combination with G ± E standard doses. For phase II, patients were randomized to arm A (G + MK), arm B (G + MK + E), or arm C (G + E). Primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), disease control rate, toxicity, and correlation between OS and IGF-1 in patients treated with MK-0646.MK-0646 MTD was 10 mg/kg in combination with G and 5 mg/kg in combination with G + E. In randomization cohort, 15 patients were treated in each arm. Disease control rates were 50, 60, and 40% respectively. PFS was not different between the three arms. OS was significantly different between arm A (10.4 months) and C (5.7 months) (P = 0.02). However, addition of erlotinib in arm B yielded no OS benefit compared to arm A (P = 0.6). Plasma and tissue IGF-1 levels did not correlate with OS (P = 0.64, 0.87). Grade 3-4 toxicity during phase II cohorts were neutropenia (10/arm A, 14/arm B, 5/arm C), leukopenia (5/A, 5/B, 7/C), thrombocytopenia (8/A, 9/B, 2/C), hyponatremia (1/A, 3/B), and hyperglycemia (8/A, 1/B).MK-0646 was tolerable in combination with G and associated with improvement in OS but not PFS as compared with G + E. Tissue and serum IGF-1 did not correlate with clinical outcome.This trial is registered in ClinicalTrial.gov under the Identifier NCT00769483 and registration date was October 9, 2008.
Association of immune-related thyroid disorders with pembrolizumab (pembro, MK-3475) in patients (pts) with advanced melanoma treated in KEYNOTE-001.
Authors: Caroline Robert, Anthony M Joshua, Richard Kefford, Richard Wayne Joseph, Jedd D. Wolchok, F. Stephen Hodi, Omid Hamid, Jeffrey S. Weber, Tara C. Gangadhar, Roxana Stefania Dronca, Amita Patnaik, Hassane M. Zarour, Wen-Jen Hwu, Peter Hersey, Adil Daud, Maxine Giannotti, Xiaoyun Nicole Li, Scot Ebbinghaus, Soonmo Peter Kang, Antoni Ribas
Journal: Journal of Clinical Oncology (2015)

9050 Background: The anti–PD-1 antibody pembro is approved in the US for treating advanced MEL that progressed following IPI and, if BRAFV600 mutant, a BRAF inhibitor. Immune-related AEs (irAEs) are of interest for immunotherapies such as pembro. Among the first 411 MEL pts treated with pembro in the phase 1 KEYNOTE-001 study (NCT01295827), 18% experienced irAEs (4% gr 3/4). We describe the incidence and treatment of thyroid disorders, the most common irAEs observed in KEYNOTE-001. Methods: AEs were monitored throughout treatment and for 30 d thereafter (serious AEs and potential irAEs for up to 90 d). AEs were graded per CTCAE v4.0. Thyroid disorders included hypothyroidism, hyperthyroidism, thyroiditis, and related terms. TSH and free T4 (FT4) levels were measured at baseline and once per treatment cycle. Results: Thyroid disorders occurred in 39 (9.5%) pts: hypothyroidism in 33 (8.0%), hyperthyroidism in 6 (1.5%), and thyroiditis in 3 (0.7%); 2 pts experienced both hypo- and hyperthyroidism, and 1 pt experienced hypothyroidism and thyroiditis. 2 events were of gr 3 severity: 1 hypo- and 1 hyperthyroidism. Hypothyroidism was managed with long-term hormone replacement therapy, with no permanent discontinuation required; only 4 pts required temporary pembro interruption. 2 pts with hyperthyroidism required corticosteroids, and 2 permanently discontinued pembro. Hyperthyroidism resolved in 83% of pts. Thyroiditis resolved in 67% of pts; no cases required treatment interruption, discontinuation, or corticosteroid use. Median time to onset and duration are shown in the Table. 111 (33.9%) pts had ≥1 abnormal postbaseline TSH or FT4 value, with subclinical hypo- and hyperthyroidism most common (20.5% and 19.3%, respectively). Conclusions: Thyroid disorders are the most frequent irAEs associated with pembro. Most events are of gr 1 or 2 severity and can be managed with supportive care and temporary treatment interruption. These findings support regular assessment of thyroid function in pembro recipients. Clinical trial information: NCT01295827. Median (range), d Time to Onset Duration Hypothyroidism 106 (5-576) 385 (14-740) Hyperthyroidism 47 (15-665) 84 (29-201) Thyroiditis 29 (20-64) 57 (43-108)
Temporal and volumetric denoising via quantile sparse image prior
Authors: Franziska Schirrmacher, Thomas Köhler, Jürgen Endres, Tobias Lindenberger, Lennart Husvogt, James G. Fujimoto, Joachim Hornegger, Arnd Dörfler, Philip Hoelter, Andreas K. Maier
Journal: Medical Image Analysis (2018)
A centralized, primary care medical home survivorship model at the GW Cancer Center.
Authors: Elizabeth Hatcher, Farzana L. Walcott, Cam Ha, April Barbour
Journal: Journal of Clinical Oncology (2018)

45 Background: Models for survivorship care are often oncology-based. George Washington (GW) Adult Cancer Survivorship Clinic (ACS) has developed a unique, centralized model for survivorship care delivery staffed by internal medicine providers. The objective is to provide care to survivors that encompass the broad array of chronic issues they face, in addition to guidance on cancer surveillance and prevention. Methods: We implemented a centralized, primary care, consultative model of survivorship care, emphasizing care coordination. A personalized, evidence based survivorship care plan (SCP) is provided to each patient. Patients with complex needs may be seen for follow-up. A copy of the SCP is sent to the patient’s primary care provider (PCP). Referrals are made to our network of specialists within the GW system including: cardiology, neurology, weight management, genetic counseling, dermatology, physical therapy, integrative medicine, psycho-oncology, sexual health, and oncofertility. Referrals are tracked to specialty services using the electronic medical record (EMR). Results: Based on preliminary data, from January 2016 to October 2017, 261 cancer survivors were seen in the survivorship clinic. The majority were breast cancer survivors (166). Referral records were available for 225 patients. Most common were dermatology for baseline skin cancer screening (28%), physical therapy (16%), social work and psycho-oncology (15%), and weight management (15%). Conclusions: Our clinic is based on a primary care medical home model for each survivor, which includes care coordination and referral to specialty services. Limitations include inconsistent referral tracking methods with our EMR and incomplete data for all survivorship patients. Future research plans include assessing the impact of referrals on patient-reported outcomes and morbidity.
A survey of colorectal cancer (CRC) survivorship practices in Ireland, and implementation of a survivorship care plan (SCP) pilot program.
Authors: Fergus Keane, Megan Greally, Derek Gerard Power, Gregory D. Leonard
Journal: Journal of Clinical Oncology (2018)

60 Background: Due to rising incidence and improved outcomes the number of CRC survivors in Ireland is approaching 20,000, and this figure is climbing. It is now recognized by leading organizations such as ASCO and NCCN, that survivorship is a distinct phase along the cancer care continuum and that supporting patients throughout their survivorship is vital. We aimed to assess the variability in surveillance practices in Ireland, and pilot the use of SCPs in CRC patients. Methods: A two phase approach was taken to complete this study. Firstly an online survey was issued to medical oncologists treating CRC in the 8 designated regional cancer centres in Ireland. This comprised 10 questions addressing surveillance practices and use of guidelines. We subsequently piloted the SCP in a cohort of our CRC patients, and followed up with a questionnaire assessing patient views. Results: The online survey was completed by 13 medical oncologists, comprising the lead treating physicians for the Irish regional cancer centres and their satellite centres. Routine surveillance of CRC is practiced by 77% (n = 10). Of those who practice follow up, 90% (n = 9) do so for 5 years. Guidelines for follow up are utilized by 77% (n = 10). The most commonly used guideline is NCCN, by 60% (n = 6). 91.6% think that the SCP is useful in enabling alternative methods of follow up and 69.2% think that nurse-led surveillance clinics should be introduced. 16 patients responded to the follow up survey. 81% (n = 13) felt the SCP was useful, and 81% (n = 13) also believed it reduced anxiety around their diagnosis. 88% (n = 14) reported that the SCP helped them feel in control of their follow up. 69% of patients (n = 11) felt the SCP aided communication and coordination of their care. Conclusions: Surveillance practices in Ireland are heterogeneous. Which guidelines are used to follow patients is physician and hospital dependent. The SCP is a useful tool for streamlining follow up practices so that they are more uniform. Physicians and patients both feel that SCPs are beneficial. Widespread use of SCPs may provide a mechanism to move CRC surveillance out of busy oncology clinics to a more appropriate setting, such as nurse-led clinics and primary care.