tbuckley/cabot-search huggingface dataset:
Local practice and outcome of staging investigations in asymptomatic patients with early breast cancer.
Authors: Dalia Kamel, Wilma M Hopman, Mihaela Mates
Journal: Journal of Clinical Oncology (2016)

e18144 Background: In 2012 the American Society for Clinical Oncology identified five key opportunities in Oncology to improve patient care recommending against imaging tests for staging in patients with early breast cancer (EBC) at low risk for metastases. Similarly the European Society of Medical Oncology guideline does not support radiological staging in asymptomatic EBC (aEBC). The purpose of this study was to assess local practice and outcome of staging investigations (SI) in aEBC at our institution. Methods: A retrospective electronic and paper chart review was undertaken to identify all aEBC patients treated at our institution between January 2012 and December 2014. Patients with pathological staging of T1-T2 and N0-1 were included. We collected patient demographics, treatment and pathologic tumor characteristics. The use and outcomes of initial and follow-up SI were recorded. Data were analyzed to determine associations between the use of SI and clinical characteristics (chi-square tests, independent samples t-tests and Mann-Whitney U). Results: We identified 295 eligible aEBC patients. Mean age was 64, 81% were postmenopausal and 76% had breast conserving surgery. Pathology: T1 48%; N0 73%; grade 3 – 33%; ER+ 84%, HER2+ 13%, triple negative 12%. Adjuvant therapy: chemotherapy 36%, Trastuzumab 10%, endocrine therapy 76%, radiotherapy 79%. 168 patients (57%) had 332 SI: chest x-ray 4%; abdominal ultrasound 4%; bone scan 53%; CT scan 52%. Overt metastatic disease was found in 1 bone scan and 4 CT scans. 71 patients (24%) underwent 138 follow-up imaging tests none of which were diagnostic for metastases. Of 9 biopsies 4 were malignant (1 metastatic and 3 new primaries). Factors significantly associated with staging: younger age (p 0.001), premenopausal status (p 0.01), T2 stage (p < 0.001), N1 stage (p < 0.001), HER2 positive (p < 0.001) and triple negative status (p 0.007), use of adjuvant chemotherapy (p < 0.001). Conclusions: Over a 3 year period at our institution more than 50% of aEBC patients underwent a total of 470 imaging tests and 9 biopsies with low diagnostic value, supporting current guidelines that recommend against routine use of SI in this population.
Abstract 12009: A Prospective Randomized Placebo-Controlled Crossover Trial of Flecainide for Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Prince J Kannankeril, Jeremy P Moore, Marina Cerrone, Silvia G Priori, Naomi J Kertesz, Pam Ro, Anjan S Batra, Elizabeth S Kaufman, David L Fairbrother, Elizabeth V Saarel, Susan P Etherdige, Ronald J Kanter, Michael P Carboni, Matthew V Dzurik, Darlene Fountain, Heidi Chen, E W Ely, Dan M Roden, Bjorn C Knollmann
Journal: Circulation (2016)

Introduction: Randomized clinical trials (RCTs), the gold standard to evaluate new therapies, have not been performed in Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). Up to 30% of CPVT patients have recurrent symptoms or cardiac events despite standard therapy with beta-blockers. In a mouse model flecainide was found to directly target the molecular defect in CPVT and in retrospective clinical studies patients had improved ventricular ectopy during exercise with flecainide added to beta-blockers. Hypothesis: Flecainide + beta-blocker is superior to beta-blocker alone in CPVT. Methods: CPVT patients were enrolled in a single blind placebo-controlled crossover RCT of flecainide added to beta-blocker. Subjects underwent a baseline exercise (Ex) test on maximally-tolerated beta-blocker dose which continued throughout the trial, then were randomized to flecainide or placebo for 3 months, followed by Ex testing. After a 1 week washout, subjects crossed over to placebo or flecainide for 3 months, followed by Ex testing. The primary endpoint of ventricular ectopy during Ex was compared between beta-blocker + flecainide vs. beta-blocker + placebo. Ex tests were scored on an ordinal scale of worst ventricular arrhythmia observed (0 = no ectopy, 1 = isolated PVC’s, 2 = bigeminy, 3 = couplets, 4 = nonsustained VT). Results: A total of 13 subjects (7 males) at 10 centers were randomized. Median age was 16 years and baseline Ex test score was 3 (IQR 1-3.5). Ventricular ectopy during Ex was significantly reduced by flecainide (P&lt;0.01, see Figure); there was no difference between baseline and placebo Ex score (P=0.7). Overall adverse events and serious adverse events did not differ between flecainide and placebo. Conclusions: This placebo-controlled RCT demonstrates that flecainide + beta-blocker is superior to beta-blocker alone in reducing exercise-induced ventricular arrhythmias in CPVT.
The prognostic significance of survivin expression in gallbladder carcinoma.
Authors: Tarik Salman, Asuman Argon, Tulu Kebat, Enver Vardar, Nazif Erkan, Ahmet Alacacioglu
Journal: Journal of Clinical Oncology (2016)

e15589 Background: Gallbladder cancers (GBC) have poor prognosis and the molecular mechanisms of GBC should be elucidated to develop effective therapies.Survivin, an apoptosis inhibitor protein, plays a role in the cell division and affects the survival. This study aims to examine the relationship between the expression of survivin in (GBC) patients and clinicopathological features as well as prognosis Methods: We have evaluated demographic characteristics (age, sex), tumor characteristics (histopathological type, differentiation, perineural and lymphovascular invasion; serosal invasion, surgical margin positivity and lymphocytic response) as well as Survivin expression immunohistochemically, and analyzed the relationship between these characteristics and prognosis in 47 gallbladder carcinoma cases from 2000 to 2011. Results: Immunohistochemically, while survivin was observed positively in 36 cases, it was absent in 11 cases. Follow-up information was obtained from 32 patients. 2 (8.7%) of 23 cases with Survivin-positive tumor were alive whereas this figure was 5 (%55.6) among 9 cases with Survivin-negative tumor. Statistically, Survivin expression was correlated with short survival (p = 0.043), and the univariate analysis indicates that reduced OS was associated with age (p = 0.043), male sex (p = 0.038), infiltrative pattern (p = 0.019), lymphovascular invasion (p = 0.004), perineural invasion (p = 0.009), serosal invasion (p = 0.027), ulcer (p = 0.033) and surgical margin positivity (p = 0.022). Conclusions: Despite the low number patients in our study, the analysis results suggest that Survivin positivity might actually be a significant prognostic factor. This finding could prove to be a reference point for the targeted treatment studies. However, further studies involving broader series and longer follow-ups are still required.
The effect of bundle of warmth care for patients with advanced colorectal cancer undergoing chemotherapy on reduction of oxaliplatin-related peripheral sensory neuropathy.
Authors: Jin-Xiang Lin, Zhan-hong Chen, Xiang-Wei Chen, Zu-Yan Fan, Xiu-Yan Huang, Xing Li
Journal: Journal of Clinical Oncology (2017)

e15031 Background: FOLFOX is the one of the most selected chemotherapy regimens for advanced colorectal carcinoma (aCC) patients, which includes oxaliplatin, 5-fu and leucovorin. However, oxaliplatin often causes chemotherapy-induced peripheral sensory neuropathy (CIPN) which is a common treatment-related adverse effect and affects long- term quality of life. The aim of the study is to observe the effect of warmth intervention on patients with advanced colorectal cancer undergoing chemotherapy. Methods: A total of 60 aCC patients were recruited. They were randomized into an intervention group (30 patients) and a control group (30 patients). The intervention group accepted the bundle of warmth care which included wearing cotton gloves and socks, washing hands and taking a bath with warm water, soaking hands and feet before sleep with warm water, reducing exposure to cold and avoiding cold food. The control group was treated with conventional health education which including how to reduce exposure to cold. CTCAE-4.0 was used to evaluate patient , s peripheral sensory neuropathy at baseline, 3 months, 6 months and 6 months after chemotherapy terminate. Results: At baseline, there was no peripheral sensory neuropathy in two groups. In 3 months, incidence of peripheral sensory neuropathy of intervention group and control group were 26.67%(Ⅰ:20.00%,Ⅱ:6.67%) VS 83.34% (Ⅰ:46.67%,Ⅱ:30.00%,Ⅲ:6.67%)(χ 2 = 22.289,p = 0.000). In 6 months, incidence of peripheral sensory neuropathy of two group were 36.67% (Ⅰ: 26.67%,Ⅱ: 10.00%) VS 93.34%(Ⅰ:46.67%,Ⅱ:30.00%,Ⅲ:16.67%) (χ 2 = 23.398,p = 0.000). 6 months after chemotherapy terminate, incidence of peripheral sensory nerve damage of two group were 13.33%(Ⅰ:10.00%,Ⅱ:3.33%) VS 33.34%(Ⅰ:6.67%,Ⅱ:10.00%,Ⅲ:6.67%) (χ 2 = 4.283,p = 0.233). Conclusions: Bundle of warmth care reduced oxaliplatin-related peripheral sensory neuropathy on patients with advanced colorectal cancer undergoing chemotherapy.
Six-month patient-reported outcome (PRO) results from AQUARiUS, a prospective, observational, multicenter phase 4 study in patients (Pts) with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone acetate + prednisone (AAP) or enzalutamide (ENZ).
Authors: Antoine Thiery Vuillemin, Mads Hvid Poulsen, Louis-Marie Dourthe, Redas Trepiakas, Edouard Lagneau, Elias Pasquale Pintus, Dominique Beal-Ardisson, Alison Jane Birtle, Guillaume Ploussard, Hervé Besson, Martin Lukac, Paul Robinson, Alison Helen Reid
Journal: Journal of Clinical Oncology (2018)

5058 Background: AQUARiUS is an ongoing study of PROs and medical resource use in chemotherapy-naïve pts with mCRPC newly initiated on AAP or ENZ in a real-world setting. Initial 3-month (mo) subset analyses suggested favorable outcomes for AAP vs ENZ in cognition and fatigue. We report 6-mo results. Methods: AQUARiUS prospectively collects PROs on quality of life, cognition, fatigue, and pain using EORTC QLQ-C30, FACT-Cog, BFI-SF, and BPI-SF questionnaires, over 12 mos. PROs were collected at baseline (BL) and during visits based on real-world practice schedules. Incidence of clinically meaningful worsening (CMW) and change from BL scores were determined, adjusting for BL characteristics. Results: All 211 pts were analyzed (AAP, n = 105; ENZ, n = 106). BL characteristics were well balanced (no significant differences). A significantly lower proportion of pts on AAP vs ENZ experienced CMW for cognition and fatigue during the first 6 mos of treatment (TABLE). Clinical trial information: NCT02813408. PRO scales with consistent significant differences (p < 0.05 for ≥ 3 consecutive time points) in change from BL scores were “perceived cognitive impairments” and “comments from others” (FACT-Cog); “fatigue right now,” “usual level of fatigue,” and “worst level of fatigue” (BFI-SF); and “cognitive functioning” and “fatigue” (EORTC QLQ-C30); all favored AAP over ENZ. Where significant differences for these scales were not maintained through the full 6-mo period, nonsignificant trends in favor of AAP were observed. Conclusions: These 6-mo results continue to suggest that AAP provides favorable outcomes vs ENZ for certain measures of cognition and fatigue in pts with mCRPC. Pts with ≥ 1 episode of CMW during first 6 mos of treatment AAP, % ENZ, % Odds ratioa (95% CI) p FACT-Cog Perceived cognitive impairments Comments from others 27 56 0.27 (0.13-0.56) 0.0004 20 39 0.38 (0.17-0.85) 0.0191 BFI Fatigue right now Usual level of fatigue 42 55 0.46 (0.22-0.95) 0.0365 40 55 0.42 (0.20-0.86) 0.0174 EORTC QLQ-C30 Fatigue Appetite loss 31 53 0.36 (0.18-0.73) 0.0047 20 46 0.28 (0.13-0.61) 0.0013 aAAP vs ENZ.
Abstract 17679: A Randomized Pilot Trial of Intra-arrest Cyclosporine and Methylprednisolone for Attenuation of Post-arrest Myocardial Dysfunction
Authors: Meshe Chonde, Katharyn L Flickinger, Matthew Sundermann, Allison Koller, David Salcido, Cameron Dezfulian, James Menegazzi, Jonathan Elmer
Journal: Circulation (2016)

Introduction: Myocardial dysfunction is common after cardiac arrest and may result from the systemic inflammatory response syndrome. It is unknown if immunosuppressants can prevent myocardial dysfu...
Prognostic impact of neo-adjuvant vs adjuvant vs neo-adjuvant plus adjuvant chemotherapy in advanced ovarian cancer: Analysis of National Cancer Database.
Authors: Suresh Mukkamala, Sukamal Saha, Sabarina Ramanathan, David Livert, Rajen Oza, Hayman S. Salib, Vinay Bajaj, Jeen Lee, David Wiese, Madan L. Arora
Journal: Journal of Clinical Oncology (2017)

5552 Background: Patients (Pts) with advanced ovarian cancer (OvCa) are usually treated with primary debulking (deb) surgery (Sx) followed by adjuvant (adj) chemotherapy (CRx). Recently neo-adjuvant (neo-adj) CRx is increasingly being used to reduce the bulk of the tumor. Hence, we analyzed for any prognostic impact of neo-adj vs adj vs neo-adj plus adj CRx along with deb Sx in the management of advanced OvCa. Methods: Only Stage III and IV Pts in National Cancer Data Base (NCDB) from 2006-2014, who underwent deb Sx without bowel resection (1), with bowel resection (2) and with bowel and bladder resection (3) were analyzed. Group (gp) A Pts had neo-adj CRx, gp B had adj CRx and gp C Pts had neo-adj plus adj CRx. The Pearson Chi square testing was used to evaluate the survival between gp A vs B vs C. Results: A total of 20910 Pts in stage III and 7483 Pts in stage 4 were included. Stage III Pts had a better 5 year (yr) survival in gp B compared to gp A and C, in all Pts who underwent Sx 1, 2 and 3 (Table 1). Stage IV Pts had a better 5 yr survival in gp C compared to gp A and B who underwent Sx 1 and 2, and gp B had a better 5 yr survival in Pts who underwent Sx 3 (Table 1). Overall survival was worse for all stages in Pts with neo-adj ( gp A) than gp Band C. Conclusions: Deb Sx followed by adj CRx had better survival than in gp A or C. This may be secondary to less bulkier disease in the beginning in gp B than those in gp A or C requiring neo-adj CRx for the later. Pts survival also improved after addition of adj CRx following deb Sx compared to no adj CRx. A prospective multicenter randomized trial between each group may further validate the true benefits of neo-adj CRx in advanced OvCa. [Table: see text]
The impact of a national cervical cancer screening initiative in Nicaragua.
Authors: Jordan Baeker Bispo, Omar Picado, Sandra Algaze, Orlando B. Martínez-Granera, Juan Almendarez Peralta, Gilberto Lopes
Journal: Journal of Clinical Oncology (2018)

e18657 Background: Cervical cancer is the most common cancer among women in Nicaragua, where the annual incidence of 36 and mortality of 18 per 100,000 exceeds that of any other country in Central America. Because the disease is largely preventable with HPV vaccination and early screening, national initiatives within Nicaragua have focused on improving access to screening and increasing early detection of the disease. In order to improve the effectiveness of such initiatives, more research is needed to understand variability in screening results by age and region. Methods: Data was derived from the Nicaraguan Surveillance Program for the Prevention of Gynecological Cancer. Cross-sectional analysis of women who underwent screening with cytology between January 1- May 31, 2013 was performed. Demographic, behavioral characteristics, clinical, and pathologic information were compared using t-tests, Wilcoxon rank-sum tests, and chi-square tests. Results: A total of 29,852 women underwent cytologic screening resulting in 19,449 evaluable samples. The median age was 28 years (IQR: 22-37); 35.9% of women were < 25 years, 57.0% were between 25 and 50 years, and 7.1% were > 50 years old. The sample was primarily from the Pacific (40.7%) and Central (44.0%) regions, followed by the Atlantic (15.3%). Most cytologic results were negative (94.3%), but 2.8% and 2.9% had low and high-risk lesions, respectively. Results varied significantly across age and geographic strata. Specifically, high risk lesions were most prevalent among women > 50 (3.4%) and women in the Pacific region (6.6%). Women with abnormal results were recommended surveillance in 3 months (22.3%), 4 to 6 months (30.7%), 12 months (4.7%), or colposcopy and cervical biopsy (41.9%). Conclusions: The Ministry of Health and Movicancer have collaborated to create a robust national cervical cancer screening program. Further efforts to improve sample quality and target women > 50 years old are essential. Next steps may involve continued surveillance of screening practices and outcomes, incorporation of an HPV vaccination program, HPV testing and screen and treat techniques, public education and integration of community healthcare workers.
SAT0739-HPR Occupational exposure to pesticides increases the risk of rheumatoid arthritis: results from the malaysian population-based case-control study
Authors: C.L. Too, L.K. Tan, A.F. Nurul Aain, I.S. Lau, M.L. Nor Asiah, S. Salsabil, H. Heselynn, S. Nor Shuhaila, S. Wahinuddin, S.C. Gun, B. Eashwary, M.S. Mohd Shahrir, M. Ainon, R. Azmillah, O. Muhaini, B. Camilla, L. Padyukov, L. Alfredsson, L. Klareskog, M.L. Shahnaz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Several studies have suggested farming occupation with exposure to pesticides as risk factor for rheumatoid arthritis (RA). <h3>Objectives</h3> We investigated the association between pesticides exposure and risk of RA subsets in the Malaysian population. <h3>Methods</h3> Data from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA) population-based case-control study involving 1055 early RA cases and 1057 age, sex and residential area matched controls were analysed. All study subjects answered a structured questionnaire on a broad range of issues including occupational exposures to pesticides. The self-reported information on ever/never occupationally exposed to pesticides was used to estimate the risk of developing ACPA-positive and ACPA-negative RA. Association between pesticides exposure and the HLA-DRB1 shared epitope (SE) was evaluated. <h3>Results</h3> The proportion of ACPA positivity in the RA patients was 64.4% and 1.9% in the normal controls. The presence of HLA-DRB1 SE alleles in RA patients was 40.2% and 15.8% in the normal controls. Our data demonstrated that occupational exposure to pesticides was significantly associated with an increased risk of developing RA in the Malaysian population (OR 2.31, 95% CI 1.12–4.73, p=0.03). The association between occupational exposure to pesticides and risk of RA was observed with ACPA-positive RA (OR 3.10 95% CI 1.49–6.47, p=0.003), but not with ACPA-negative RA. A dramatically increased risk for ACPA-positive RA was seen in individuals who both exposed to pesticides occupationally and carried SE alleles (OR 28.06, 95% CI 3.58–220.09, p&lt;0.0001). <h3>Conclusions</h3> This study demonstrates that occupational exposure to pesticides is associated with an increased risk of ACPA-positive RA in Malaysian population. <h3>References</h3> [1] Sverdrup B, Källberg H, Bengtsson C, Lundberg I, Padyukov L, Alfredsson L, Klareskog L and the Epidemiological Investigation of Rheumatoid Arthritis study group. Association between occupational exposure to mineral oil and rheumatoid arthritis: results from the Swedish EIRA case–control study-Arthritis Research &amp; Therapy2005;7:R1296-R1303. [2] Meyer A, Sandler DP, Beane Freeman LE, Hofmann JN, Parks CG. Pesticide Exposure and Risk of Rheumatoid Arthritis among Licensed Male Pesticide Applicators in the Agricultural Health Study. Environ Health Perspect2017;14;125(7):077010. <h3>Disclosure of Interest</h3> None declared
Recanalization of postoperative biliary disconnection with intraductal cholangioscopy-assisted forceps retrieval of rendezvous guidewire
Authors: Michihiro Yoshida, Mamoru Morimoto, Akihisa Kato, Kazuki Hayashi, Itaru Naitoh, Katsuyuki Miyabe, Yoichi Matsuo
Journal: Endoscopy (2018)

Biliary recanalization is a vital procedure to restore postoperative bile duct obstruction. However, selective guidewire negotiation across the disconnected sites under fluorescence imaging is challenging. We present a case of formidable biliary disconnection after hepatectomy that was recanalized by rendezvous technique using digital cholangioscopy.
The reduction of the expression of B-catenin and c-Myc is related to a better outcome in patients with AML
Authors: A. Cardona, J. Prada-Arismendy, E. Castillo, J.C. Arroyave
Journal: Annals of Oncology (2018)

Background: Acute myeloid leukemia (AML) is a malignant clonal disorder characterized by mutations affecting myeloid differentiation, gene expression, and epigenetic profiles. Although treatment strategy depends on a genetic profile-based risk, the accuracy of this stratification system is highly variable. Changes in gene expression profiles of signaling pathways involved in hematopoietic development, such as Wnt/B-catenin, may contribute to the transformation, development, and maintenance of leukemic cells, and could be related to the clinical outcome. Methods: qRT-PCR assays were designed to quantify mRNA levels of c-Myc, and B-catenin in blood samples from nine newly diagnosed AML patients before and after treatment. 18S ribosomal RNA was used to normalize gene expression. Statistical analysis was conducted in R statistical software. Relative expression rates (rERs) were implemented to quantify relative changes in gene expression levels after induction. Results: c-Myc and B-catenin expression decreased after induction treatment. Additionally, the rERs of both genes were linearly correlated (r = 0.937, p = 0.0002), and patients who has persistence of the disease after treatment have a higher rER -in both c-Myc and B-catenin-, compared to those who achieve complete remission (c-Myc: p = 0.0066; B-catenin: p = 0.04). However, c-Myc and B-catenin rERs were greatly variable in patients who partially responded to induction. Conclusions: c-Myc and B-catenin are molecules from Wnt signaling pathway, related to activation of the molecular pathway. Patients who have a decrease in the expression of this genes are more likely to achieve complete remission than those who don't change the expression of this molecules. Further analyses are needed to determine the precise role of Wnt/B-catenin in AML therapy response. Legal entity responsible for the study: Instituto Tecnológico Metropolitano. Funding: Colciencias, grant 669-2014. Disclosure: All authors have declared no conflicts of interest.