tbuckley/cabot-search huggingface dataset:
Cardiovascular disease: The rise of the genetic risk score
Authors: Joshua W. Knowles, Euan A. Ashley
Journal: PLoS Medicine (2018)

Use of risk factors for decision-making in cardiovascular disease has a long history in medicine.• Early attempts to augment traditional risk factors with genetic risk scores were hampered by too little understanding of the genetic basis of complex cardiovascular disease.• Newer studies based on hundreds of thousands of people and millions of genetic variants indicate that genetic risk scores can now outperform traditional risk factors in risk prediction.• We propose the time has come to incorporate genetic risk scores into clinical practice.• Studies should focus on the most appropriate way to do this to maximize benefit for our patients."[However,] epidemiologic information has accumulated which now allows the physician to recognize certain characteristics of increased risk in patients he [sic] sees in his practice.Some of these characteristics have been convincingly demonstrated, others are still under investigation.More precise identification will undoubtedly be possible in the future."-WilliamKannel, Director, Framingham Heart Study [1] In a classic paper [1], Kannel reported the early results of the longitudinal Framingham Heart Study, demonstrating the identification of factors (for which he coined the term "risk factors") that "precede the development of overt coronary heart disease in humans".Later, the Framingham Risk Score was formalized to include age, sex, diabetes, smoking status, total cholesterol, high-density lipoprotein (HDL) cholesterol, and blood pressure [2], providing a framework for cardiovascular disease (CVD) risk assessment to which all others are compared.Intuitively, the burden of these risk factors accumulates over time (e.g., pack years of smoking or years of hypertension), and some newer risk models allow input of risk factor data from multiple time points [3].While repeated measurement of CVD biomarkers such as total cholesterol may improve risk prediction, lifelong exposure to CVD risk factors is better captured by genetic susceptibility [4].Thus, the quest to improve risk prediction for CVD has naturally come to focus on the development of genetic risk scores [5].This has only been possible because of robust, replicable
A HIGH PROFICIENCY ON OPTICAL DIAGNOSIS WITH NARROW-BAND IMAGING (NBI) CAN BE ACHIEVED BY A NON-GUIDED SELF-LEARNING PROGRAM
Authors: M Bustamante Balén, C Satorres Paniagua, N Alonso Lazaro, MT Blazquez Martinez, A Nevarez Heredia, M Ponce Romero, C Sanchez Montes, L Argüello Viudez, V Pons Beltrán
Journal: Endoscopy (2018)

To assess the accuracy of OD in a colorectal cancer (CRC) screening program, using NBI and the NICE classification, after following a non-guided self-learning program.
Evaluation des pratiques professionnelles (EPP) référence 45a. Les professionnels identifient les actes, les processus et les pratiques à risque et évaluent leurs conditions de sécurité. Thème: la gastrostomie endoscopique percutanée (GEP)
Authors: H Dall Osto, MA Frileux, A Vidal, D Bertoli, C Decade, C Theodore
Journal: Endoscopy (2009)

Introduction: De 1989 à 2005 inclus, 1058 GEP ont été faites. Cette endoscopie interventionnelle et pluridisciplinaire nécessite une procédure rigoureuse. La iatrogénie potentielle à toutes les étapes justifie une EPP. Les précautions à prendre avant, pendant et après la pose d'une GEP ont fait l'objet de ce travail.
ENDOSCOPIC WEDGE GASTRECTOMY OF A SUBEPITHELIAL TUMOR WITH CLOSURE OF THE GASTRIC WALL DEFECT WITH OVERSTITCH ENDOSCOPIC SUTURING SYSTEM
Authors: A Granata, D Ligresti, F Cipolletta, I Tarantino, L Barresi, M Traina
Journal: Endoscopy (2018)

A 51-year-old woman affected by gastric submucosal tumors (Fig. 1) underwent an EUS. Echographic imaging showed a homogeneous, hypoechoic lesion on the front wall of the gastric body, starting at the fourth layer of the wall, of about 22 mm in diameter (Fig. 2). The histological examination of the EUS-guided fine needle aspiration biopsy found a gastrointestinal stromal tumor (GIST).
Endoscopic Submucosal Dissection
Authors: Gloria Fernández-Esparrach, Ángel Calderón, Joaquín de la Peña, José Díaz Tasende, José Esteban, Antonio Gimeno-García, Alberto Herreros de Tejada, David Martínez-Ares, David Nicolás-Pérez, Óscar Nogales, Akiko Ono, Aitor Orive-Calzada, Adolfo Parra-Blanco, Sarbelio Muñoz, Eloy Sánchez Hernández, Andrés Sánchez-Yagüe, Enrique Vázquez-Sequeiros, Juan Vila, Leopoldo López Rosés
Journal: Endoscopy (2014)

Endoscopic submucosal dissection (ESD) was developed in Japan as a treatment for early gastric cancer (EGC). This technique allows en-bloc resection of the lesions [1] which has demonstrated to be crucial because the local recurrence rate when this is not possible is of 15 % [2]. Nowadays, there is a huge experience with ESD in Eastern countries where this technique is considered the gold standard treatment for EGC [3] [4]. Indications for ESD have expanded to lesions in other locations (esophagus and colon) and other types of lesions (submucosal tumors). However, the introduction of ESD in Europe and the United States of America has been and still is very slow. The aim of this guideline is to familiarize Spanish endoscopists and gastroenterologists not only with the general indications of the procedure and possilble complications but also the dedicated tools.
Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure
Authors: Kevin Damman, Mauro Gori, Brian Claggett, Pardeep S. Jhund, Michele Senni, Martin P. Lefkowitz, Margaret F. Prescott, Victor C. Shi, Jean L. Rouleau, Karl Swedberg, Michael R. Zile, Milton Packer, Akshay S. Desai, Scott D. Solomon, John J.V. McMurray
Journal: JACC Heart Failure (2018)

The purpose of this study was to evaluate the renal effects of sacubitril/valsartan in patients with heart failure and reduced ejection fraction. Renal function is frequently impaired in patients with heart failure with reduced ejection fraction and may deteriorate further after blockade of the renin–angiotensin system. In the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibition to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, 8,399 patients with heart failure with reduced ejection fraction were randomized to treatment with sacubitril/valsartan or enalapril. The estimated glomerular filtration rate (eGFR) was available for all patients, and the urinary albumin/creatinine ratio (UACR) was available in 1872 patients, at screening, randomization, and at fixed time intervals during follow-up. We evaluated the effect of study treatment on change in eGFR and UACR, and on renal and cardiovascular outcomes, according to eGFR and UACR. At screening, the eGFR was 70 ± 20 ml/min/1.73 m2 and 2,745 patients (33%) had chronic kidney disease; the median UACR was 1.0 mg/mmol (interquartile range [IQR]: 0.4 to 3.2 mg/mmol) and 24% had an increased UACR. The decrease in eGFR during follow-up was less with sacubitril/valsartan compared with enalapril (−1.61 ml/min/1.73 m2/year; [95% confidence interval: −1.77 to −1.44 ml/min/1.73 m2/year] vs. −2.04 ml/min/1.73 m2/year [95% CI: −2.21 to −1.88 ml/min/1.73 m2/year ]; p < 0.001) despite a greater increase in UACR with sacubitril/valsartan than with enalapril (1.20 mg/mmol [95% CI: 1.04 to 1.36 mg/mmol] vs. 0.90 mg/mmol [95% CI: 0.77 to 1.03 mg/mmol]; p < 0.001). The effect of sacubitril/valsartan on cardiovascular death or heart failure hospitalization was not modified by eGFR, UACR (p interaction = 0.70 and 0.34, respectively), or by change in UACR (p interaction = 0.38). Compared with enalapril, sacubitril/valsartan led to a slower rate of decrease in the eGFR and improved cardiovascular outcomes, even in patients with chronic kidney disease, despite causing a modest increase in UACR.
Clonal Hematopoiesis after Induction Chemotherapy for Acute Myeloid Leukemia
Authors: David P. Steensma, Benjamin L. Ebert
Journal: New England Journal of Medicine (2018)

Successful intensive induction chemotherapy for acute myeloid leukemia (AML) results in at least a 2 to 4 log10 reduction in the 1 trillion malignant cells that are present at diagnosis, often with recovery of normal platelet and neutrophil levels within a month after treatment initiation — an impressive result for a short course of treatment. More than half of patients with AML achieve remission after intensive induction therapy with an anthracycline and cytarabine, but relapse is common. Predicting the likelihood of relapse for an individual patient can be helpful in tailoring the intensity of postremission treatment.1 Even when a patient . . .
What is the value of multidisciplinary care for chronic kidney disease?
Authors: Richard J. Fluck, Maarten W. Taal
Journal: PLoS Medicine (2018)

Chronic kidney disease (CKD) is associated with multiple biochemical and physiological abnormalities as well as important adverse outcomes that include increased risk of cardiovascular events (CVEs) [1], acute kidney injury (AKI) [2], and progression to end-stage kidney disease (ESKD).These factors in turn impact negatively on quality of life and increase the burden on healthcare resources.In this context, multidisciplinary care (MDC), advocating a holistic approach to treatment, has the potential to improve care and reduce the risk of adverse outcomes.Importantly, timely referral to multidisciplinary nephrology services allows effective preparation for ESKD, including evaluation for kidney transplantation, dialysis modality selection, dialysis access planning, and financial, social, and psychological support.However, the provision of MDC requires additional funding and personnel, and it is therefore vital that advocates of MDC provide evidence of benefit and value to justify the additional cost.This is particularly important because CKD consumes a disproportionate share of healthcare funding globally due to the need for long-term care, a high rate of medical complications, and the high cost of renal replacement therapy (RRT) [3].The publication this week in PLOS Medicine of a comprehensive model to assess the costeffectiveness of MDC for patients with CKD, by Eugene Lin and colleagues [4], is therefore a welcome development.The authors used data from published studies and Medicare claims in the United States to develop a novel Markov model of CKD progression and used this to assess the impact of a theoretical programme of MDC in mild to moderate CKD (estimated glomerular filtration rate [eGFR] 20-59 ml/min/1.73m 2 ), with the intention of assessing the effectiveness of MDC in slowing progression of CKD and reducing mortality.Predicted benefit was measured as quality-adjusted life years (QALYs) gained.Overall, MDC was estimated to add 0.23 QALYs (95% CI 0.08-0.42)over usual care at a cost of US$51,285 per QALY gained, within generally accepted cost-effectiveness thresholds for high-income countries.Robust sensitivity testing showed that MDC remained cost-effective at a threshold of US$150,000 per QALY gained, even when effectiveness was reduced to 25% or cost was increased 5-fold.This analysis will be very useful to providers and those responsible for commissioning and funding services seeking to implement MDC for CKD, but the paper also highlights important areas of uncertainty that require further exploration.First, what constitutes optimal MDC for CKD?In their analysis, the authors considered MDC aimed at reducing CKD progression and made reasonable assumptions to include components delivered by a nephrologist or advanced practitioner, a CKD educator, a dietician, and a social worker.It is clear, however, that additional components could have been added, including input from a pharmacist, a physiotherapist, an occupational therapist, or a
Inhibition of interleukin-1 receptor-associated kinase-1 is a therapeutic strategy for acute myeloid leukemia subtypes
Authors: Mona M. Hosseini, Stephen E. Kurtz, Sherif Abdelhamed, Shawn Mahmood, Monika A. Davare, Andy Kaempf, Johannes Elferich, Jason E. McDermott, Tao Liu, Samuel H. Payne, Ujwal Shinde, Karin D. Rodland, Motomi Mori, Brian J. Druker, Jack W. Singer, Anupriya Agarwal
Journal: Leukemia (2018)
ENDOSCOPIC PAPILLARY LARGE BALLOON DILATATION (EPLBD) FOR EXTRACTION OF COMMON BILE DUCT STONES. EARLY EXPERIENCE FROM QENA, EGYPT
Authors: M Alsenbesy, M Tag-Aldeen Said, M Abbas Sobh, H Elamien
Journal: Endoscopy (2018)

Endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option in management of difficult common bile duct (CBD) stones. Given the minor incision necessary, the short procedure time, the reduced requirement for mechanical lithotripsy (ML) and the low frequency of adverse events, EPLBD may be applied in patients who cannot tolerate wide endoscopic biliary sphincterotomy (EBS). The aim of our work was to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15 – 20 mm) in extraction of difficult CBD stones.
EFFICACY AND SAFETY OF A NEW LOW-VOLUME PEG BOWEL PREPARATION FOR COLONOSCOPY (CLENSIA®): A MULTICENTER RANDOMIZED TRIAL VS LOW VOLUME PEG WITH ASCORBIC ACID (PEG-ASC)
Authors: P Kump, C Hassan, C Spada, E Brownstone, C Datz, M Haefner, F Renner, R Schoefl, F Schreiber
Journal: Endoscopy (2018)

Quality of inspection during colonoscopy is strictly related to the level of cleansing. High-volume solutions are highly effective and safe, but high volume affects tolerability and compliance. Aim of this study was to compare a new low volume PEG with citrate and simethicone solution (PMF 104, Clensia®) with a low volume PEG with ascorbic acid solution (PEG-ASC; Moviprep®).
Efficacité, sécurité d'emploi et acceptabilité d'une solution de lavage en 2 litres à base de macrogol + électrolytes + ascorbate chez des patients à risque devant effectuer une coloscopie
Authors: AL Tarrerias, B Bour, C Boustière, P Houcke, H Hagège, C Dugué
Journal: Endoscopy (2009)

Introduction: De récentes études et revues de la littérature ont mis en avant l'importance, pour les gastroentérologues, de sélectionner une préparation colique adaptée à leurs patients à risque.
EUS-GUIDED CHOLEDOCHODUODENOSTOMY USING A LUMEN APPOSING METAL STENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A RESTROSPECTIVE ANALYSIS OF A SINGLE CENTER EXPERIENCE
Authors: A Anderloni, A Fugazza, F Auriemma, S Carrara, M Di Leo, R Maselli, E Troncone, E Ferrara, PA Galtieri, R Semeraro, F D'Amico, S Attardo, A Repici
Journal: Endoscopy (2018)

Endoscopic ultrasonography guided choledochoduodenostomy (EUS-CD) using a lumen apposing stent has been recently reported as an alternative approach in patients with malignant obstructive jaundice and failed ERCP.
Abstract 19198: Is Z-Score an Appropriate Index of Beneficial Drug Effect in Clinical Trials in Aneurysm Disease?
Authors: Sherif Elkinany, Constance Weismann, Alexander Curtis, Tanya Smith, Thomas Breen, Maryann Tranquilli, Bulat A Ziganshin, John A Rizzo, Sandip K Mukherjee, John A Elefteriades
Journal: Circulation (2016)

Introduction:  Aortic Z-score is widely used in cardiology to monitor aortic dilation in aortic diseases, including Marfan syndrome. Z-score has also been used in clinical trials to monitor the effect of medications on aortic dilation rate in Marfan patients. We found a void in information regarding the natural, non-pharmacological change in Z-score over time as children age. We studied the natural changes in aortic Z-score in normal children and children with Marfan syndrome. We also studied the effect of obesity on aortic Z-score   Methods: (1)  We compared mean aortic Z-scores in 4 pediatric age groups, for both ascending aorta and aortic root   (2)  We compared mean Z-score in adolescents of different BMI ranges   (3)  We studied the change of aortic Z-score over time (aging) in both normal children and children with Marfan syndrome (All children were on no cardiac medications). Data from our echo studies were entered into the Boston Children’s Hospital Z-score calculator   Results: (1)  We identified 361 children with normal echo studies. For the ascending aorta, the mean Z-score showed a sequential decrease as age increased. For the root there were no significant changes between the 4 age groups   (2)  We divided 168 children (Age 10-12 and 15-18) based on BMI into 3 groups. For both the ascending aorta and the root there was a decrease in the mean Z score with increasing BMI.   (3)  We observed the change in Z-score over time in 27 children without aortic disease with more than a single echo. Mean follow-up time was 24.6 months. 19 of 27 (70%) showed a decrease of root Z-score and 24 (89%) showed a decrease of ascending Z-score.  We identified 25 untreated Marfan children with multiple echo studies. Mean follow-up was 28.5 months. We used each 2 sequential studies as one observation, achieving a total of 30 observations. 12 (40%) showed a decrease in root Z-score. 10 (33%) showed a decrease in ascending Z-score   Conclusion:  Aortic Z-score is affected by other factors even in the absence of any aortic disease process or any medical intervention. Specifically, Z-score decreases spontaneously as children age. Obesity decreases the Z-score. In clinical drug trials in aneurysm disease, decreasing Z-score has been interpreted as a sign of beneficial drug effect. These data put such conclusions into doubt
Patterns of failure in a phase II trial of neoadjuvant chemotherapy and stereotactic body radiation therapy (SBRT) for resectable and borderline resectable (BLR) pancreatic cancer.
Authors: Jordan Kharofa, Michelle Lynn Mierzwa, Olugbenga Olanrele Olowokure, Jeffrey J. Sussman, Tahir Latif, Anumeha Gupta, Hope Esslinger, Sampath Poreddy, Brian Mcgill, Eric Wolf, Milton T Smith, Kyuran Ann Choe, Syed A. Ahmad
Journal: Journal of Clinical Oncology (2018)

482 Background: There is emerging interest in the role of SBRT in locally advanced pancreas cancer, however little prospective data exists examining the safety, efficacy, and optimal target volumes for SBRT in the neoadjuvant setting for resectable or BLR pancreatic cancer. Methods: Eighteen patients were enrolled from 11/2014-6/2017. SBRT was delivered to the tumor and abutting vessel with fiducials/compression and a 3 mm PTV margin to 33 Gy (6.6 Gyx5fxn) with an optional elective PTV to 25 Gy (5 Gyx5fxn) customized to the nodal space and mesenteric vessels. Patients without progression underwent surgery 4-6 weeks following SBRT. The primary endpoint is ≥ Grade 3 acute and late GI toxicity. Secondary endpoints included overall survival (OS), progression-free survival (PFS),and cumulative incidence of local failure (LF). LF is defined as recurrence within conventional RT volumes from the time of resection to local failure or last CT with no progression. Local failures were fused to planning CTs for dose quantification. Results: Thirteen patients had BLR tumors due to arterial abutment (n = 7) or SMV encasement (n = 8); 3 patients had resectable tumors. All patients received 4 months of gemcitabine/nab-paclitaxel (n = 13) or FOLFIRNOX (n = 5) prior to SBRT. There were no ≥ Grade 3 acute or late GI events. Metastases were noted in 6 patients (33%) at restaging or surgery. Surgery was performed in 12 patients (67%) with 11 (92%) R0 resections. Median OS and PFS are 21 months and 11 months, respectively. Progression occurred in 67% (8/12) of resected patients with first site of failure as distant (n = 3, 38%), local only (n = 4, 50%), and local and distant (n = 1,13%). The cumulative incidence of LF at 12 months from resection was 50%. All LF were outside to the PTV33 with median D90 of 11.5 Gy (4-25 Gy), V25 Gy of 51% (0-90%), and V33 Gy of 45% (0-52%). Conclusions: SBRT as a component of neoadjuvant therapy was well tolerated. However, local failures were predominantly observed outside the PTV33 volume within conventional RT volumes. Therefore, the durability of local control after SBRT in the neoadjuvant setting relative to chemoradiation merits close examination. Clinical trial information: NCT02208024.
Into the mediastinum and out of the papilla: minimally invasive endoscopic therapy in two body cavities with one instrument
Authors: Bernhard Magdeburg, Daniela Husarik, Thomas Greuter
Journal: Endoscopy (2017)

A 48-year-old woman with chronic ethylic pancreatitis presented with new onset of fever, dysphagia, and elevated inflammatory parameters. Computed tomography revealed a large cystic supradiaphragmatic paraesophageal structure and two small retroperitoneal cysts near the pancreatic body. Transesophageal endosonographic fine-needle aspiration showed pus and an elevated amylase level. The diagnosis of an infected pancreatic pseudocyst was made. Consequently, a 10 Fr double-pigtail catheter and a 7 Fr nasocystic tube were inserted transesophageally. Infection was treated with intravenous penicillin according to antimicrobial resistance of the detected Streptococcus anginosus.
TREATMENT OF LARGE-BOWEL OBSTRUCTION, THROUGH THE USE OF SELF EXPANDING METAL STENTS (SEMS)
Authors: A Maynard, C Emperatriz Ramirez Salazar De Vela, M Abu-Suboh Abadia, M Masachs Peracaula, J Armengol Bertoli, A Benages Curell, MD Castillo Cejas, J Guevara Cubas, D Sihuay Diburga, M Pigrau Pastor, JR Armengol Miro, J Dot Bach
Journal: Endoscopy (2018)

SEMS are a therapeutic alternative in the management of large-bowel obstruction. We describe the cases and complications that occurred with the use of SEMS in a single center tertiary hospital.
DEVELOPMENT OF NOVEL ENDOSCOPIC IRREVERSIBLE ELECTROPORATION ABLATION DEVICE
Authors: G Min, HS Choi, W Kim, SJ Choi, JM Lee, SH Kim, JM Lee, ES Kim, B Keum, YT Jeen, HS Lee, HJ Chun, CD Kim
Journal: Endoscopy (2018)

An advantage of IRE is its mechanism to remove undesired cells by affecting the cell membrane without thermally destructing blood vessels, nerves and the surrounding tissues. Several clinical trials for applying IRE to human organs such as liver, pancreas, and kidney are conducted and studies about IRE ablation for gastrointestinal tumors also have been conducted recently. Here, we developed new endoscopic IRE device, and studied about its effectiveness and feasibility in animal model.
UNUSUAL TRICK FOR CHALLENGING CANNULATION OF AN INTRADIVERTICULAR PAPILLA: A BIOPSY FORCEP-ASSISTED CANNULATION
Authors: P Soriani, C Barbera, VG Mirante, T Gabbani, L Miglioli, M Manno
Journal: Endoscopy (2018)

Peri-ampullary diverticulum (PAD) is a herniation of the mucosa and submucosa layers throught a muscolaris propria defect, which prevalence generally increases with the age. Two types of PAD are described: type I (peri-diverticular papilla, PDP) and type II (intra-diverticular papilla, IDP). In type I, the papilla is at the rim or within 2 cm of the edge of the diverticulum, while in type II it lies inside the diverticulum, making difficult successful biliary cannulation.