tbuckley/cabot-search huggingface dataset:
Abstract 291: Interaction Between Diabetes and Hypothermia on Outcomes After Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study
Authors: Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Eui Jung Lee
Journal: Circulation (2014)

Objective: To determine whether diabetes mellitus (DM) has an interaction effect with the mild therapeutic hypothermia (MTH) on brain recovery after emergency medical services (EMS) assessed out-of-hospital cardiac arrest (OHCA) survivors. Methods: We included all OHCA patients survived to admission with presumed cardiac etiology (Jan. 2009 to Dec. 2012) from Korean national OHCA registry, excluding cases without available outcome data. The primary exposure was MTH which included all kinds of cooling methods. The endpoints were hospital discharge and discharge with brain recovery (cerebral performance category 1 or 2). DM was defined as PDM-positive when the patient has clinical treatment history or positive at blood laboratory test, NDM- negative in history and test, and UDM- if there is no available laboratory test and history. We compared outcomes between MTH versus non-MTH group using multivariable logistic regression with interaction term between MTH and DM for calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for individual, Utstein, post-resuscitation factors, and comorbidities. Results: We included 7,516 OHCAs survived to admission. MTH was performed in 14.6% and showed better outcomes than non-MTH group; 54.1% vs. 36.4% in survival discharge and 22.6% vs. 14.1% in good brain recovery (Ps&lt;0.001). Survival to discharge with good brain recovery of all and DM group was 15.3% of all (n=7,516), 17.7% of NDM (n=4,129), 9.7% of PDM (n=1,952), and 16.1% of UDM (n=2,382), respectively. MTH performed has increased by year; 8.6% (2009), 9.9% (2010), 16.1% (2011), and 21.1% (2012). Adjusted OR (95% CI) by MTH for survival to discharge was 1.66 (1.42-1.95) in non-interaction model and 2.08 (1.55-2.81) in NDM, 1.24 (0.88-1.75) in PDM, 1.84 (1.23-2.61) in UDM in interaction model, respectively. Adjusted OR (95% CI) by MTH for discharge with brain recovery was 1.29 (1.04-1.56) in non-interaction model and 1.33 (0.87-2.02) in NDM, 0.59 (0.34-1.04) in PDM, and 0.62 (0.36-1.03) in UDM in interaction model, respectively. Conclusions: The MTH was associated with better outcomes and is significantly associated with survival to discharge in non-diabetes group, not in diabetes group.
Comparative study of NOTES alone vs. NOTES guided by a new image registration system for navigation in the mediastinum: A study in a porcine model
Authors: H Córdova, R San José Estépar, A Rodríguez-D'Jesús, G Martínez-Pallí, P Arguis, C Rodríguez de Miguel, R Navarro-Ripoll, JM Perdomo, M Cuatrecasas, J Llach, KG Vosburgh, G Fernández-Esparrach
Journal: Endoscopy (2012)

Background and study aims: Natural Orifice Transluminal Endoscopic Surgery (NOTES) mediastinoscopy through the esophagus has proven to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent complication when using a blind access. The aim of the current study was to assess the utility and safety of a CT-based Image Registered (IR) navigation system to identify mediastinal structures.
Annals Story Slam - Lessons From Crying
Authors: Karen Alexander
Journal: Annals of Internal Medicine (2018)

Web Exclusives3 April 2018Annals Story Slam - Lessons From CryingFREEKaren Alexander, MDKaren Alexander, MDThomas Jefferson University, Philadelphia, Pennsylvania (K.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W18-0005 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Video. Annals Story Slam - Lessons From Crying "Lessons From Crying," by Dr. Karen Alexander (Duration 5:59)Building on the popular Annals feature “On Being a Doctor,” storytellers share stories about the experience of doctoring on video.For more videos from and information on Annals Story Slam, visit go.annals.org/StorySlam. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (K.A.)Corresponding Author: Karen Alexander, MD; e-mail, karen.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 3 April 2018Volume 168, Issue 7Page: SS1 ePublished: 3 April 2018 Issue Published: 3 April 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...
RISK FACTORS FOR DUODENAL PERFORATION CAUSED BY BILIARY PLASTIC STENT MIGRATION
Authors: JK Ryu, JY Cho, YT Kim, YB Yoon, WH Paik
Journal: Endoscopy (2018)

Migration of biliary plastic stent (PS) inserted by endoscopic retrograde cholangio- pancreatography can cause duodenal perforation and become a life-threatening condition, yet there is no study revealing its risk factors. We aim to report the incidence of duodenal perforation caused by biliary plastic stent migration and seek the risk factors.
A HOME-MADE BILIARY SENGSTAKEN TUBE AS A TEMPORIZING STRATEGY FOR MASSIVE BLEEDING SECONDARY TO ARTERIO-BILIARY FISTULA (ABF)
Authors: M Cimavilla-Roman, R Torres-Yuste, A Carbajo-Lopez, R Sanchez-Ocana, M de Benito-Sanz, S Sevilla-Ribota, P Diez-Redondo, H Nuñez-Rodriguez, C De la Serna-Higuera, M Perez-Miranda
Journal: Endoscopy (2018)

ABF are an infrequent complication of EUS-guided biliary drainage. Angiography with embolization is the treatment of choice, but it is not always immediately available. A novel endoscopic method to temporize severe bleeding from ABF is reported here.
Postoperative proton therapy for pancreatic cancer patients enrolled on the Proton Collaborative Group (PCG) registry.
Authors: Romaine Charles Nichols, Christopher G. Morris, Kiran Prabhu, William F. Hartsell, Oren Cahlon, Smith Apisarnthanarax, Lisa McGee, Carlos E. Vargas
Journal: Journal of Clinical Oncology (2018)

513 Background: The PCG registry is a multicenter registry for patients receiving proton therapy for various malignancies. The current abstract reviews the outcomes for patients receiving postoperative proton therapy for resected pancreatic cancer. Methods: From March, 2013 to August,2016 18 patients with resected pancreatic adenocarcinoma received postoperative proton therapy. The current study reviews the pretreatment characteristics and outcomes of these patients. Results: Median age -70 years (range 52 to 79); Males 12, Females 6; pT Stage -T2–4, T3–13, T4–1; N Stage -N1–12, N0–6; Margin Status -Close-8, Positive-4, Negative-6; Surgical approach -open-16, laparoscopic 2; Operations performed: standard pancreaticoduodenectomy-11, pylorus sparing pancreaticoduodenectomy-4, total pancreatectomy-1; Pancreaticoduodenectomy with portal vein reconstruction –1; Pancreaticoduodenectomy with irreversible electroporation. Median lymph nodes taken-16.50 (range 3 to 72); Median lymph nodes positive-1.5 (range 0 to 7); PNI positive-9, PNI negative-2, PNI unknown-4; LVI positive-7, LVI negative-6, LVI unknown-5; Median tumor size –3.1cm (range 2.2 to 6.2); Median dose delivered –50.51Gy(RBE) (range 27.88 to 54.00); Median treatment duration –38 calendar days (range 25 to 48); One patient died during treatment. One additional patient demonstrated grade 3 toxicity (anorexia, nausea, diarrhea). Only one patient’s treatment was protracted by more than 5 days. Median available follow up is 1.1 years (range 0.07 to 3.4 years); 2 year survival 37%. Conclusions: Postoperative proton therapy after pancreatectomy was well tolerated without treatment interruption or severe toxicity.
Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act
Authors: Ryan D. Nipp, Amy M. Shui, Giselle K. Perez, Anne C. Kirchhoff, Jeffrey M. Peppercorn, Beverly Moy, Karen Kuhlthau, Elyse R. Park
Journal: JAMA Oncology (2018)

Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking.To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act.We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers.We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties.Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not getting medical care also decreased each year (B = 0.35; P = .04). In addition, the proportion of cancer survivors who reported being unable to afford prescription medication decreased each year (B=0.66; P = .004) and the proportion of those unable to afford at least 1 of 6 services decreased each year (B = 0.51; P = .01).Despite higher rates of insurance coverage, cancer survivors reported greater difficulties accessing and affording health care compared with adults without cancer. Importantly, the proportion of survivors reporting these issues continued a downward trend throughout our observation period in the years following the implementation of the Affordable Care Act. Our findings suggest incremental improvement in health care access and affordability after recent health care reform and provide an important benchmark as additional changes are likely to occur in the coming years.
Ibrutinib plus Venetoclax for the Treatment of Mantle-Cell Lymphoma
Authors: Constantine S. Tam, Mary Ann Anderson, Christiane Pott, Rishu Agarwal, Sasanka Handunnetti, Rodney J. Hicks, Kate Burbury, Gillian Turner, Juliana Di Iulio, Mathias Bressel, David Westerman, Stephen Lade, Martin Dreyling, Sarah-Jane Dawson, Mark A. Dawson, John F. Seymour, Andrew W. Roberts
Journal: New England Journal of Medicine (2018)

Both the BTK inhibitor ibrutinib and the BCL2 inhibitor venetoclax are active as monotherapy in the treatment of mantle-cell lymphoma. Complete response rates of 21% have been observed for each agent when administered as long-term continuous therapy. Preclinical models predict synergy in combination.We conducted a single-group, phase 2 study of daily oral ibrutinib and venetoclax in patients, as compared with historical controls. Patients commenced ibrutinib monotherapy at a dose of 560 mg per day. After 4 weeks, venetoclax was added in stepwise, weekly increasing doses to 400 mg per day. Both drugs were continued until progression or an unacceptable level of adverse events. The primary end point was the rate of complete response at week 16. Minimal residual disease (MRD) was assessed by flow cytometry in bone marrow and by allele-specific oligonucleotide-polymerase chain reaction (ASO-PCR) in blood.The study included 24 patients with relapsed or refractory mantle-cell lymphoma (23 patients) or previously untreated mantle-cell lymphoma (1 patient). Patients were 47 to 81 years of age, and the number of previous treatments ranged from none to six. Half the patients had aberrations of TP53, and 75% had a high-risk prognostic score. The complete response rate according to computed tomography at week 16 was 42%, which was higher than the historical result of 9% at this time point with ibrutinib monotherapy (P<0.001). The rate of complete response as assessed by positron-emission tomography was 62% at week 16 and 71% overall. MRD clearance was confirmed by flow cytometry in 67% of the patients and by ASO-PCR in 38%. In a time-to-event analysis, 78% of the patients with a response were estimated to have an ongoing response at 15 months. The tumor lysis syndrome occurred in 2 patients. Common side effects were generally low grade and included diarrhea (in 83% of the patients), fatigue (in 75%), and nausea or vomiting (in 71%).In this study involving historical controls, dual targeting of BTK and BCL2 with ibrutinib and venetoclax was consistent with improved outcomes in patients with mantle-cell lymphoma who had been predicted to have poor outcomes with current therapy. (Funded by Janssen and others; AIM ClinicalTrials.gov number, NCT02471391 .).
The role of RICTOR downstream of receptor tyrosine kinase in cancers
Authors: Ahlem Jebali, Nicolas Dumaz
Journal: Molecular Cancer (2018)

The importance of the network defined by phosphatidylinositol-3-kinase (PI3K), AKT and mammalian target of rapamycin (mTOR) downstream of Receptor Tyrosine Kinase (RTK) has been known for many years but the central role of RICTOR (rapamycin-insensitive companion of mTOR) in this pathway is only starting to emerge. RICTOR is critical for mTORC2 (the mammalian target of rapamycin complex 2) kinase activity and as such plays a key role downstream of RTK. Alterations of RICTOR have been identified in a number of cancer cell types and its involvement in tumorigenesis has begun to be unraveled recently. Here, we summarize new research into the biology of RICTOR signaling in cancers focusing on tumors with altered RTK. We show that, as a key signaling node and critical effector of RTKs, RICTOR is becoming a valuable therapeutic target in cancer with altered RTK.
An Engineered Complement Factor H Construct for Treatment of C3 Glomerulopathy
Authors: Yi Yang, Harriet Denton, Owen R. Davies, Kate Smith-Jackson, Heather Kerr, Andrew P. Herbert, Paul N. Barlow, Matthew C. Pickering, Kevin J. Marchbank
Journal: Journal of the American Society of Nephrology (2018)

Background C3 glomerulopathy (C3G) is associated with dysregulation of the alternative pathway of complement activation, and treatment options for C3G remain limited. Complement factor H (FH) is a potent regulator of the alternative pathway and might offer a solution, but the mass and complexity of FH makes generation of full-length FH far from trivial. We previously generated a mini-FH construct, with FH short consensus repeats 1-5 linked to repeats 18-20 (FH1-5^18-20), that was effective in experimental C3G. However, the serum t1/2 of FH1-5^18-20 was significantly shorter than that of serum-purified FH.Methods We introduced the oligomerization domain of human FH-related protein 1 (denoted by R1-2) at the carboxy or amino terminus of human FH1-5^18-20 to generate two homodimeric mini-FH constructs (FHR1-2^1-5^18-20 and FH1-5^18-20^R1-2, respectively) in Chinese hamster ovary cells and tested these constructs using binding, fluid-phase, and erythrocyte lysis assays, followed by experiments in FH-deficient Cfh-/- mice.Results FHR1-2^1-5^18-20 and FH1-5^18-20^R1-2 homodimerized in solution and displayed avid binding profiles on clustered C3b surfaces, particularly FHR1-2^1-5^18-20 Each construct was >10-fold more effective than FH at inhibiting cell surface complement activity in vitro and restricted glomerular basement membrane C3 deposition in vivo significantly better than FH or FH1-5^18-20 FH1-5^18-20^R1-2 had a C3 breakdown fragment binding profile similar to that of FH, a >5-fold increase in serum t1/2 compared with that of FH1-5^18-20, and significantly better retention in the kidney than FH or FH1-5^18-20Conclusions FH1-5^18-20^R1-2 may have utility as a treatment option for C3G or other complement-mediated diseases.
RESECTION OF GIANT PEDUNCULATED POLYPS USING SCISSOR FORCEPS; A RESCUE POLYPECTOMY
Authors: S Budihal, S Sansone, K Ragunath, A Parra-Blanco
Journal: Endoscopy (2018)

Lumen filling giant pedunculated polyps can be challenging to resect and in some instances can be impossible leading patients to have surgery. Difficulties in polypectomy include an unstable position, large polyp head, unclear views and thick stalks. Here we describe an endoscopic technique which salvaged a challenging polypectomy.
HIGH-QUALITY CLEANSING IMPROVES LESION DETECTION DURING COLONOSCOPY COMPARED TO ADEQUATE CLEANSING: POST HOC ANALYSIS OF 1170 CENTRAL-READER ASSESSED PATIENTS IN THREE RANDOMISED PHASE 3 TRIALS
Authors: C Hassan, J Manning, J Halonen, B Amlani, M Epstein
Journal: Endoscopy (2018)

Effective colonoscopy requires successful bowel preparation. ‘Adequate’ preparation allows detection of lesions > 5 mm and has been defined as a Boston Bowel Preparation Scale (BBPS) score of ≥2 per segment. This post hoc analysis determined the relationship between BBPS scores and adenoma and polyp detection rates in patients who had identical scores in each of the three colon segments, using pooled data from three identically designed Phase 3, multicentre, randomised trials.
SEQUENTIAL BIODEGRADABLE STENTING IS EFFECTIVE AND SAFE FOR REFRACTORY BENIGN OESOPHAGEAL PEPTIC STRICTURES
Authors: T El-Menabawey, A Alisa, S Musa, KH Tang
Journal: Endoscopy (2018)

Refractory benign oesophageal strictures (RBES) unresponsive to potent acid-suppression are challenging to manage. Serial balloon dilation, self-expanding metal (SEMS)/plastic stents offer dysphagia-free success rates between 21 – 52%. Self-expanding biodegradable stents (BDS-SX-ELLA) have comparable efficacy with added benefit of not requiring removal. To date, 1 study has evaluated sequential stenting up to 3 stents with BDS for RBES. We assessed efficacy of serial BDS stenting for recurrent peptic strictures at District General Hospital setting.
Regorafenib dose optimization study (ReDOS): Randomized phase II trial to evaluate dosing strategies for regorafenib in refractory metastatic colorectal cancer (mCRC)â€“An ACCRU Network study.
Authors: Tanios S. Bekaii-Saab, Fang-Shu Ou, Daniel M. Anderson, Daniel H. Ahn, Patrick McKay Boland, Kristen Keon Ciombor, Nisha Lassi Jacobs, Rodwige J. Desnoyers, James M. Cleary, Jeffrey P. Meyers, E. Gabriela Chiorean, Katrina Pedersen, Afsaneh Barzi, Jeffrey Sloan, Jeannine S. McCune, Mario E. Lacouture, Heinz Josef Lenz, Axel Grothey
Journal: Journal of Clinical Oncology (2018)

611 Background: Regorafenib is an oral multikinase inhibitor with survival benefit in refractory mCRC patients (pts). Toxicities such as Palmar-plantar erythrodysesthesia syndrome (PPES), fatigue and hypertension (HTN) have limited its use. Despite absence of supportive data, various dosing or interval scheduling have been implemented into clinical practice. Methods: A randomized phase II study of regorafenib dose-escalation (Arm A: 80 mg/day, weekly dose escalation if no significant drug-related toxicities, up to 160 mg/day) vs. standard dose (Arm B: 160 mg/day) in pts with mCRC for 21 days of a 28-day cycle. Pts were randomized 1:1:1:1 to arms A1 and B1 (Pre-emptive Clobetasol for PPES); A2 and B2 (Reactive Clobetasol). The primary endpoint was the proportion of patients who completed 2 cycles of treatment and initiated the 3rd in Arm A (Pooled A1 + A2) vs. Arm B (Pooled B1 + B2). Superiority for Arm A was to be declared if the one-sided p-value calculated using Fisher’s exact method was less than 0.2. Results: From June 2015 to June 2017, 123 pts were randomized with 116 (A = 54, B = 62) evaluable for the primary endpoint. Demographic data were well balanced with overall median age of 61yrs (range: 29-81), M/F (61/39%) and ECOG PS 0/1 (37/63%) and KRAS MT/WT/UNK (47/44/9%).The study met its primary endpoint with 43% of pts on Arm A initiating the 3rd vs. only 25% of pts Arm B [one-sided p-value 0.028]. Median Overall Survival (OS) was improved in Arm A vs. Arm B (9.0 mos vs. 5.9 mos; p = 0.094). Median Progression Free Survival (PFS) was 2.5 mos for Arm A vs. 2.0 mos for Arm B (p=0.553). Overall rates of grade 3/4 toxicity were more favorable for Arm A vs. Arm B (% PPES 15 vs. 16, HTN 7 vs. 15 and fatigue 13 vs. 18, respectively). Multiple QOL parameters were improved in A vs. B primarily at week 2 of the first cycle. Conclusion: A strategy with weekly dose escalation of regorafenib from 80 mg to 160 mg/day was found to be superior to a starting dose of 160 mg/day. These results establish a new standard for optimizing regorafenib dosing. Further data on outcomes of preemptive vs. reactive clobetasol strategies are undergoing analysis and will be presented later. Clinical trial information: NCT02368886.
THE DIAGNOSTIC ACCURACY OF CARCINOEMBRYONIC ANTIGEN IN DIFFERENTIATING MUCINOUS AND NON-MUCINOUS PANCREATIC CYSTIC NEOPLASMS – A SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS
Authors: NCM van Huijgevoort, SA Hoogenboom, SJ Lekkerkerker, MD Topazian, V Chandrasekhara, G Morris-Stiff, MA Al-Haddad, KW Oppong, A Khalid, M del Chiaro, MG Besselink, JE van Hooft
Journal: Endoscopy (2018)

Distinction between the different types of pancreatic cystic neoplasms (PCNs) is essential, since non-mucinous cysts are benign without need for surveillance, whereas mucinous cysts are considered premalignant and require either surveillance or surgical resection. We aimed to systematically review the diagnostic accuracy of CEA> 192 ng/mL in differentiating mucinous and non-mucinous PCNs and to determine the optimal cut-off value of CEA using individual patient data meta-analysis.
Facteurs et motifs de participation au dépistage du cancer colorectal par recto-sigmoïdoscopie en France
Authors: B Denis, EA Sauleau, P Strentz, D Gras, MF Bacqué, I Gendre, P Perrin
Journal: Endoscopy (2009)

Objectif: Nous avons montré que le dépistage du cancer colorectal (CCR) par recto-sigmoïdoscopie (RS) était faisable en France et offrait un meilleur rendement que le dépistage par Hemoccult (H). But: évaluer les facteurs socio-démographiques et médicaux et les motifs de participation au dépistage par RS.
Digital biomarkers of cognitive function
Authors: Paul Dagum
Journal: npj Digital Medicine (2018)

To identify digital biomarkers associated with cognitive function, we analyzed human-computer interaction from 7 days of smartphone use in 27 subjects (ages 18-34) who received a gold standard neuropsychological assessment. For several neuropsychological constructs (working memory, memory, executive function, language, and intelligence), we found a family of digital biomarkers that predicted test scores with high correlations (p < 10-4). These preliminary results suggest that passive measures from smartphone use could be a continuous ecological surrogate for laboratory-based neuropsychological assessment.