tbuckley/cabot-search huggingface dataset:
68Ga PET Imaging in Patients With Neuroendocrine Tumors
Authors: Simron Singh, Raymond Poon, Rebecca Wong, Ur Metser
Journal: Clinical Nuclear Medicine (2018)

The aim of this study was to systematically review the literature to assess the role of Ga PET imaging in neuroendocrine tumors (NETs).The literature was searched using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews databases through OVID. Studies comparing PET or PET/CT with conventional imaging in the initial diagnosis, staging and restaging, assessment of treatment response, and routine surveillance of NETs were deemed eligible for inclusion. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.Twenty-two studies met the inclusion criteria. For the initial diagnosis of NETs, PET or PET/CT had a pooled sensitivity of 91% (95% confidence interval [CI], 85%-94%) and a pooled specificity of 94% (95% CI, 86%-98%). In the setting of staging and restaging, the sensitivity of PET or PET/CT for detecting primary and/or metastatic lesions ranged from 78.3% to 100%, whereas specificity ranged from 83% to 100%. Change in management occurred in 45% (95% CI, 36%-55%) of the cases, with majority of the changes involving surgical planning and patient selection for peptide receptor radionuclide therapy.Ga PET or PET/CT is recommended for initial diagnosis where conventional testing remained equivocal, for staging of patients with localized primary and/or limited metastasis where definitive surgery is planned, to determine somatostatin receptor status and suitability for peptide receptor radionuclide therapy, and for staging of patients where detection of occult disease will alter treatment options and decision making.
Cancer survival outcomes in Ontario, Canada: Significant unexplained variation.
Authors: Michael Donald Brundage, Patti Groome, Timothy Hanna, Christopher M. Booth, Weidong Kong, Tina Dyer, Brenda Carter, William J. Mackillop
Journal: Journal of Clinical Oncology (2018)

36 Background: Cancer-specific outcomes are critical for assessing quality of care, and are key quality indicators for cancer control programs. Previous analyses of Ontario (Canada) data show that regional survival differences at the Local Health Integrated Network (LHIN) level exist for relative survival, overall survival, cancer-specific survival (CSS), and mortality rates.We sought to describe: 5-year cancer-specific survival (5Y-CSS) rates among Ontario LHINs; the impact of adjusting for known patient factors; and 5Y-CSS rates among patients diagnosed at Ontario's 50 largest cancer diagnosing hospitals. Methods: Newly diagnosed cases (colorectal, lung, breast, or prostate cancer) were identified in the Ontario Cancer Registry. Records were linked to data from CIHI and Statistics Canada, to identify date of diagnosis, cause-specific vital status, diagnosing hospital, and other reported variables. Cox regression models were used, and all models were adjusted for age and sex. Results: N = 498,382 incident cases (2007-2013) were included. 5Y-CSS varied across LHINs for all patients combined (range 62%-72%; p &lt; 0.0001). Considering colorectal cancer cases as illustrative (N = 57,927), 5Y-CSS varied among LHINs from 58.4%-66.4% (p &lt; 0.0001). Further adjusting for socioeconomic and urban-rural status minimally reduced that variation. Limiting the analysis cohort to patients diagnosed in one of Ontario's 50 largest hospitals (N = 43,245), 5Y-CSS ranged from 52% to 72% (p &lt; 0.0001) among hospitals, and from 55% to 63% (p &lt; 0.0001) among the hospitals affiliated with regional cancer centres. Comparable findings were seen for patients diagnosed with lung, breast, or prostate cancer. Collaborative staging data were available for a subset of patients; 5Y-CSS within all stage III patients (N = 5,360) ranged from 72% to 87%. Conclusions: Important, highly significant differences in cancer survival outcomes exist across Ontario. These are of great interest to patients, health-care providers, system administrators, and policy makers, and are not explained by adjusting for the variables included in these analyses.
Abstract 18346: Transcriptional Characterization of Glo1 Knockdown and Transgenic Mouse Models Implies a Role in Cardiometabolic Diseases
Authors: Le Shu, Richard C Davis, Xiuju Wu, Aldons J Lusis, Abraham A Palmer, Xia Yang
Journal: Circulation (2015)

Accumulation of advanced glycation end-products (AGEs) has been associated with atherosclerosis and diabetes. As the major detoxifying enzyme for AGE precursors, Glyoxalase 1 (Glo1) has been implicated in diabetic complications and more recently in coronary artery disease (CAD). We have recently identified Glo1 as a potential key regulator for an antigen-related gene network that is causal for CAD through an integrative genomics analysis. However, whether Glo1 plays a protective role against cardiometabolic disorders remains controversial. To systematically investigate the impact of Glo1, we performed genome-wide transcriptional profiling of two genetically modified animal models with either Glo1 overexpression in a transgenic (TG) model or Glo1 knockdown (KD), both on C57BL/6J background. For each mouse model, we examined the liver, aorta, adipose and kidney tissues. We found that the Glo1 KD mice which had ~50% reduced Glo1 expression showed much stronger perturbation at transcriptomic level, as compared to Glo1 TG mice. For Glo1 KD mice, significant differential expression was observed across tissues for multiple known cardiometabolic risk genes, including Ide, Cdkn2b and Col4a1, as well as perturbations of lipid metabolic pathways such as PPAR signaling and fatty acid metabolism. We also identified iron transport and collagen formation pathways as specifically enriched in the differentially expressed genes in aorta. When intersected with human GWAS, the Glo1 KD signature genes were found to be enriched for candidate genes associated with lipid levels, type 2 diabetes and coronary heart disease. Lastly, genes perturbed in the Glo1 KD animals had significant overlap with our predicted CAD-antigen gene network in both aorta (p = 0.005) and liver (p = 0.03). This study suggests a functional role of Glo1 in regulating multiple processes relevant to cardiometabolic diseases. Future investigation of these animal models in atherogenesis under diabetic conditions is warranted.
Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States.
Authors: Jingxuan Zhao, Zhiyuan Zheng, Xuesong Han, Amy J. Davidoff, Matthew P. Banegas, Ashish Rai, Ahmedin Jemal, K Robin Yabroff
Journal: Journal of Clinical Oncology (2018)

68 Background: Policy makers, health care providers and patients are increasingly concerned about rising costs for prescription drugs and cost-related medication non-adherence (CRN). This study aims to evaluate the relationship between cancer history and CRN as well as cost-coping strategies, by health insurance coverage. Methods: We used the National Health Interview Survey data from 2013-2016 to identify adults age 18-64 with (n = 3 599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included a) CRN (skipping, taking less or delaying medication because of cost), and b) cost-coping strategies (requesting lower cost medication or using alternative therapies to save money). Separate multivariable logistic regressions were used to calculate the adjusted percentages of CRN and cost-coping strategies associated with cancer history, stratified by health insurance. Results: Cancer survivors reported higher percentages of CRN (14.5% vs. 12.1%, P &lt; .001) and were slightly more likely to report using cost-coping strategies (24.4% vs. 22.8%, P = .060) compared with adults without a cancer history. The magnitude of differences in CRN by cancer history varied by insurance type (any private 10.2% vs. 8.6%, P = .034; public only 17.9% vs. 14.2%, P = .010; uninsured 41.0% vs. 33.2%, P = .064). Among the privately insured, the difference in CRN by cancer history was greatest among those enrolled in high deductible health plans (HDHP) without health saving accounts (HSA) (16.9% vs. 10.9%, P = .002). Regardless of cancer history, CRN and use of cost-coping strategies were highest for those uninsured, enrolled in HDHP and without HSA, and without prescription drugs coverage under their health plan (all P &lt; .001). Conclusions: Cancer survivors are prone to CRN and more likely to use cost-coping strategies to minimize financial hardship. Expanding options for health insurance coverage and use of HSA, and prescription drug coverage may be effective strategies to address CRN.
Abstract 11843: Comparison of Prognostic Value Between Carotid Plaque Score and Intima-Media Thickness in Patients With Acute Coronary Syndrome
Authors: Takuya Nakahashi, Hayato Tada, Kenji Sakata, Mika Mori, Kenshi Hayashi, Masayuki Takamura, Masa-aki Kawashiri, Maasakazu Yamagishi
Journal: Circulation (2016)

Introduction: Although both carotid plaque score (cPS) and intima-media thickness (cIMT) determined by carotid ultrasounds have been shown to reflect the severity of coronary atherosclerosis, few data exist regarding the direct comparison of their prognostic values in patients with established atherosclerotic vascular disease. Hypothesis: Calculation of cPS which is the reflection of the cumulative atherosclerotic burden of carotid artery is superior in predicting future cardiovascular events compared with only measurement cIMT in common carotid artery. Methods: We examined 263 patients (195 male; mean age, 68±11 years) with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. The cPS was computed by summing the maximal thickness of plaques in each segment on both side (a + b + c + thickness of the contralateral plaques in each segment on both sides; Figure A). The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCE) defined as all-cause death, myocardial infarction, stoke, target vessel revascularization, and coronary artery bypass grafting. Renal function was determined by estimated glomerular filtration rate (eGFR). Results: During follow-up duration (median 3.8 years, interquartile range: 1.2 to 6.1 years), 95 MACCE were occurred. Multivariate Cox proportional hazard regression analysis revealed that eGFR (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.99) and cPS (HR, 1.33; 95% CI, 1.05-1.69) with a 1-SD increase were significantly associated with MACCE, whereas, cIMT was not. Stratification of patients based on the tertiles of cPS was shown in Figure B. Addition of either cPS or cIMT over the eGFR changes C-statistic with nonsignificant. However, the addition of cPS to eGFR significantly improved net reclassification index (0.28, p &lt;0.05), but not cIMT. Conclusions: The cPS provides superior risk stratification in patients with ACS compared with cIMT.
Implementing prehabilitation as part of enhanced recovery after surgery (ERAS) efforts at a comprehensive cancer center: A team-based approach.
Authors: An Ngo-Huang, Rhodora C. Fontillas, Ekta Gupta, Sunil Kumar Sahai, Shannon Popovich, Tayab Andrabi, Katy E. French
Journal: Journal of Clinical Oncology (2018)

137 Background: ERAS efforts across surgical specialties have been evolving since 2012. At MD Anderson Cancer Center (MDACC), surgical and anesthesia services have been participating in this movement. In 2017, anesthesia, surgical, internal medicine, physical medicine and rehabilitation (PM&amp;R), and nutrition teams collaborated to pilot a prehabilitation clinical pathway. Our goal was to develop a preoperative pathway using validated screening tools to incorporate prehabilitation for patients preparing for cancer surgery. Methods: This pilot included patients with thoracic and gynecological cancers who were at least 3 weeks prior to surgery. They were screened using the validated FRAIL index (Morley) and the Centers for Disease Control and Prevention fall risk screening tool. (Questions below) All patients who scored &gt; / = 2 were referred to the PM&amp;R clinic. Each patient received an individualized prehabilitation program including exercise, nutrition, and underwent screening for mood impairments: Fatigue: Are you fatigued at rest or with activities of daily living?; Resistance: Do you have any difficulty walking up one flight of steps without stopping for rest?; Aerobic: Are you unable to walk at least one block at a brisk pace and without stopping for rest?; Illness: Do you have more than five illnesses?; Loss of weight: Have you had unintended weight loss of more than 5% of your weight in the past 6 months?; Have you fallen in the past year?; Do you feel unsteady when standing or walking?; Do you worry about falling? Results: 27 referrals were received. 21 patients seen by PM&amp;R (six were not seen due to scheduling conflicts). Average age was 70 years, 38% male. Baseline functional status was below aged-related normal values. Mean values for functional tests include: 6 minute walk test distance was 301 meters, five-times sit-to-stand was 12.4 seconds, and dynamic gait index score was 20.1. Conclusions: Prehabilitation as part of the team-based approach in cancer care is becoming an important part of ERAS pathways. Screening surgical patients for functional issues and fall risk is vital as these patients require prehabilitation to optimize them prior to surgery.
NHS launches tool for hospitals to assess sepsis risk
Authors: Susan Mayor
Journal: BMJ (2018)

The NHS in England has launched a tool that will enable hospitals to more accurately measure numbers of patients admitted as emergencies with severe bacterial infection who are at risk of sepsis, as part of efforts to improve sepsis prevention and reduce deaths.

The Suspicion of Sepsis (SOS) Insight Dashboard (https://www.sos-insights.co.uk) measures the number of emergency admissions of patients recorded as having a severe bacterial infection and categorised as having “suspicion of sepsis,” rather than just those coded as having sepsis. It collects data on around 200 common bacterial infection and sepsis diagnostic codes documented at the end of …
Use of Multispectral Optoacoustic Tomography to Diagnose Vascular Malformations
Authors: Max Masthoff, Anne Helfen, Jing Claussen, Angelos Karlas, Niklas A. Markwardt, Vasilis Ntziachristos, Michel Eisenblätter, Moritz Wildgruber
Journal: JAMA Dermatology (2018)

Differential diagnosis of congenital vascular anomalies is challenging, and misdiagnosis is frequent. Vascular malformations are considered one of the most difficult vascular diseases to treat. A new imaging approach that visualizes anatomical features and quantitatively assesses molecular biomarkers noninvasively would aid diagnosis and monitoring of treatment response of vascular malformations.To evaluate multispectral optoacoustic tomography (MSOT) for noninvasive assessment of molecular biomarkers for diagnosis and therapeutic monitoring of vascular malformations.This pilot study examined 6 patients with arteriovenous malformation (AVM) and 6 patients with venous malformation (VM) diagnosed according to the classification system of the International Society for the Study of Vascular Anomalies. All patients underwent clinical hybrid MSOT/ultrasonographic (US) imaging before and after treatment at an interdisciplinary vascular malformations clinic by trained MSOT and US examiners. Examiners were blinded to the patient history and stage of disease. Data were collected from April 11 to 25, 2017, and analyzed from May 1 to October 31, 2017.Clinical hybrid MSOT/US imaging was performed before or within 1 week after endovascular embolization (for AVM) or percutaneous sclerotherapy (for VM).Region-of-interest analysis of the lesion and contralateral healthy tissue revealed quantitative values for oxygenated (HbO2) and deoxygenated (HbR) hemoglobin by spectral unmixing of optoacoustic data acquired at multiple wavelengths. The HbO2:HbR ratio was calculated for healthy tissue and for AVM and VM before and after treatment.Twelve patients (9 female and 3 male; mean [SD] age, 23 [18] years; age range, 6-59 years) with vascular malformations (6 with AVMs and 6 with VMs) were included. Significantly higher HbO2:HbR ratios for AVMs (mean [SEM], 1.82 [0.08] vs 0.89 [0.03]; P < .001) and for VMs (mean [SEM], 1.12 [0.04] vs 0.89 [0.03]; P = .001) were found on MSOT tissue compared with healthy tissue. Significantly higher HbO2:HbR ratios for AVMs compared with VMs (mean [SEM], 1.82 [0.08] vs 1.12 [0.04]; P < .001) were also found. Therefore, MSOT provided intrinsic biomarker patterns to distinguish both vascular malformations. After therapy, the HbO2:HbR ratio dropped in correlation to treatment success validated by magnetic resonance imaging or angiography.This study suggests that different types of vascular malformations are clearly distinguished by MSOT-based, noninvasive assessment of hemoglobin levels in vascular malformations. The therapy effects found in this study could be instantly visualized, and this may offer a new tool for noninvasive diagnosis and monitoring of vascular malformations.
Assessment of Outcomes of Treatment With Oral Anticoagulants in Patients With Atrial Fibrillation and Multiple Chronic Conditions
Authors: Amgad Mentias, Ghanshyam Shantha, Pulkit Chaudhury, Mary S. Vaughan Sarrazin
Journal: JAMA Network Open (2018)

<h3>Importance</h3> Comparative effectiveness and safety of oral anticoagulants in patients with atrial fibrillation (AF) and multiple chronic conditions (MCC) are unknown. <h3>Objective</h3> To determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with AF with MCC. <h3>Design, Setting, and Participants</h3> This retrospective comparative effectiveness analysis included data from the population-based Medicare beneficiaries database, evaluating patients with new AF diagnosed from January 1, 2010, to December 31, 2013, who initiated an oral anticoagulant within 90 days of diagnosis. Patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc scores of 1 to 3, 4 to 5, and 6 or higher; HAS-BLED scores of 0 to 1, 2, and 3 or higher; and Gagne comorbidity scores of 0 to 2, 3 to 4, and 5 or higher were categorized as having low, moderate, or high morbidity, respectively. Within morbidity categories, patients receiving dabigatran, rivaroxaban, or warfarin were matched using a 3-way propensity matching, and the relative hazards of stroke, major hemorrhage (MH), and death were evaluated. Data analysis included follow-up from the date of initial anticoagulant use through December 31, 2013. <h3>Exposures</h3> Rivaroxaban (20 mg once daily), dabigatran (150 mg twice daily), or warfarin therapy. <h3>Main Outcomes and Measures</h3> Ischemic stroke, MH, and death. <h3>Results</h3> The study cohort included 21 979 patients using dabigatran (mean [SD] age, 75.8 [6.4] years; 51.1% female), 23 177 using rivaroxaban (mean [SD] age, 75.8 [6.4] years; 49.9% female), and 101 715 using warfarin (mean [SD] age, 78.5 [7.2] years; 57.3% female). In the propensity-matched cohorts, there were no differences in stroke rates between the 3 oral anticoagulant groups. Dabigatran users had lower hazard of MH compared with warfarin users among patients with low MCC (hazard ratio [HR], 0.62; 95% CI, 0.47-0.83;<i>P</i> &lt; .001; for MCC defined as low CHA<sub>2</sub>DS<sub>2</sub>-VASc score), and similar risk in patients with moderate to high MCC. While there was no difference in MH between rivaroxaban and warfarin users, rivaroxaban users had significantly higher MH risk compared with dabigatran users in the medium and high comorbidity groups (HR, 1.24; 95% CI, 1.04-1.48;<i>P</i> = .02 and HR, 1.28; 95% CI, 1.05-1.56;<i>P</i> = .01, respectively). Dabigatran and rivaroxaban users had lower rates of death compared with warfarin users (HR ranged from 0.52-0.84), across comorbidity levels. <h3>Conclusions and Relevance</h3> Oral anticoagulants are similarly effective in stroke prevention among patients with AF with MCC. However, dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
Extraskeletal myxoid chondrosarcoma: A retrospective analysis of 69 patients with localized disease and molecularly confirmed diagnosis.
Authors: Anna Paioli, Alessandro Gronchi, Emanuela Palmerini, Chiara Colombo, Alberto Righi, Marco Fiore, Stefania Benini, Silvana Pilotti, Marilena Cesari, Tiziana Negri, Giuseppe Bianchi, Paolo Giovanni Casali, Stefano Ferrari, Piero Picci, Silvia Stacchiotti
Journal: Journal of Clinical Oncology (2014)

10589 Background: Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain origin, marked by specific chromosomal translocations: t(9;22)(q22.3;q12.2), t(9;17)(q22.3;q12) and t(9;15)(q22.3;q21.3), and usually characterized by indolent course. Surgery +/- radiotherapy is the mainstay of treatment. In order to better evaluate prognostic factors and outcome, a retrospective pooled analysis of all patients surgically treated for localized EMC in two referral institutions for treatment of sarcoma (Istituto Ortopedico Rizzoli, Bologna, Italy; Istituto Nazionale Tumori, Milano, Italy) was carried out. Diagnosis was centrally reviewed in all cases. Methods: All patients (pts) with molecularly confirmed diagnosis of localized EMC, surgically treated between period 1994-2012 at either institution, were included. Results: 69 pts were identified (22 female; 47 male); median age: 55 years (range: 15-81). Tumor location was: extremities 49 (71%), limb girdles or trunk 20 (29%), with a median size of 8 cm (range: 2-38). 56 (81%) pts had primary disease and 13 (19%) recurrent. Median overall survival (OS) was 47 months (range 1-284).OS at 5- and 10-year was 88% and 82% respectively. 35 (51%) pts relapsed [12 local recurrence (3 with lung metastasis) and 26 distant recurrence (20 lung and 6 locoregional lymphnodes)], with a 5-year post-relapse survival of 76%. Event free survival (EFS) at 5- and 10- year was 51% and 26%. Size influenced EFS (5 year EFS was 75%, 47% and 39% for size <5 cm, 5-9 cm and >9 cm, respectively; p 0.001), while sex, tumor location and radiotherapy did not. EFS did not significantly differ by type of translocation but the median time to recurrence was 60 months in pts with t(9:22) and 25 months with t(9:17). 13 pts received systemic treatment for metastatic disease with 3 PR. Conclusions: A prolonged survival can be expected in patients with EMC, despite a high rate of local and distance recurrence. Size is significantly associated with outcome. The use of radiotherapy does not increase the EFS. Patients bearing t(9:22) recur later than those with t(9:17). Some PR were reported after chemotherapy treatment.