tbuckley/cabot-search huggingface dataset:
Using a patient-reported outcomes tool as a gateway to identifying patients who would benefit from palliative care.
Authors: Kathleen Dunn, Morgan Hannaford, Scott Hartman, Diane Denny, DBA
Journal: Journal of Clinical Oncology (2018)

306 Background: Palliative care provides a wide range of supportive care services that aim to enhance the patient’s quality of life, reduce complications, address supportive care needs earlier, and avoid unnecessary resource consumption. A national network of five hospitals providing comprehensive cancer care noted barriers in identification of patients that may benefit from these services. Technology and objective criteria can circumvent human barriers such as, prognostic uncertainty and psychology of decision making. Referred to as the SIT (symptom inventory tool) process, an externally validated assessment tool that captures patients’ perceived symptom burden from baseline and every 21 days was used as means of identifying patients who might benefit from referral. Methods: A three-month pilot was initiated at two centers using a report run on a weekly basis, generated from the SIT process utilizing the following criteria: six or &gt; symptoms from 27 increasing in severity by two points or &gt; since their last assessment. This subset of patients identified by this filter was reviewed by the palliative care nurse to determine if they meet the following criteria: any stage with metastatic disease, stage 3 not in remission, and stage 4 not already enrolled in palliative care. Results: During the pilot timeframe, 1,127 SIT self-assessments were completed by patients at Site 1 with 168 patients flagged for review by the palliative care RN. Of these 168 patients 75 (or 44.6%) met the criteria for palliative care services. At Site 2, 802 self-assessments were completed, with 82 identified for review of which 46 (or 56.1%) met the criteria. Conclusions: Patients with overwhelming symptoms were identified for intervention that might otherwise have been missed by relying solely on referral. This patient population resulted in a request for practice integration across centers recognizing the clinical and financial benefits outlined below. [Table: see text]
<i>Aspergillus</i> and progression of lung disease in children with cystic fibrosis
Authors: Sabariah Noor Harun, Claire E Wainwright, Keith Grimwood, Stefanie Hennig
Journal: Thorax (2018)

Background The impact of Aspergillus on lung disease in young children with cystic fibrosis is uncertain. Aims To determine if positive respiratory cultures of Aspergillus species are associated with: (1) increased structural lung injury at age 5 years; (2) accelerated lung function decline between ages 5 years and 14 years and (3) to identify explanatory variables. Methods A cross-sectional analysis of association between Aspergillus positive bronchoalveolar lavage (BAL) cultures and chest high-resolution CT (HRCT) scan findings at age 5 years in subjects from the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) study was performed. A non-linear mixed-effects disease progression model was developed using FEV 1 % predicted measurements at age 5 years from the ACFBAL study and at ages 6–14 years for these subjects from the Australian Cystic Fibrosis Data Registry. Results Positive Aspergillus BAL cultures at age 5 years were significantly associated with increased HRCT scores for air trapping (OR 5.53, 95% CI 2.35 to 10.82). However, positive Aspergillus cultures were not associated with either FEV 1 % predicted at age 5 years or FEV 1 % predicted by age following adjustment for body mass index z-score and hospitalisation secondary to pulmonary exacerbations. Lung function demonstrated a non-linear decline in this population. Conclusion In children with cystic fibrosis, positive Aspergillus BAL cultures at age 5 years were associated contemporaneously with air trapping but not bronchiectasis. However, no association was observed between positive Aspergillus BAL cultures on FEV 1 % predicted at age 5 years or with lung function decline between ages 5 years and 14 years.
Safety of lumen-apposing stent with or without coaxial plastic stent for endosonography-guided drainage of pancreatic fluid collections: Time to randomize!
Authors: Michel Kahaleh
Journal: Endoscopy (2018)

See also: Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective studyEndoscopy eFirstDOI: 10.1055/a-0582-9127
Evaluation of the host immune response to decellularized lung scaffolds derived from α-Gal knockout pigs in a non-human primate model
Authors: Elizabeth C. Stahl, Ryan W. Bonvillain, Clint D. Skillen, Brandon L. Burger, Hidetaka Hara, Whayoung Lee, Cynthia B. Trygg, Peter J. Didier, Brooke F. Grasperge, Nicholas C. Pashos, Bruce A. Bunnell, John Bianchi, David L. Ayares, Kelly I. Guthrie, Bryan N. Brown, Thomas H. Petersen
Journal: Biomaterials (2018)
Decisional preferences and satisfaction with short-course radiation for breast cancer.
Authors: Matthew Culbert, Gregory Bidermann, Audrey S. Wallace
Journal: Journal of Clinical Oncology (2018)

193 Background: Limited literature exists regarding preferences and decisional satisfaction for women who choose accelerated partial breast irradiation (APBI) in lieu of 6-7 weeks of radiation. This analysis provides long-term patient reported outcomes in women treated with APBI at one institution. Methods: Records of women treated primarily with balloon-based APBI (2005-2013) were reviewed after IRB approval. Women with recurrent disease or poor prognosis second primary cancer were excluded. Assessment of decisional factors important to the patient, as well as satisfaction and regret with treatment choices (Decisional Regret and Satisfaction Scales) were captured via mail or telephone. Results: In 141 women who met inclusion criteria, 83 participated. Median age at diagnosis was 62 years (SD = 9), and median time from RT to survey completion was 102 months (SD = 8). Histology was pre-invasive, (25%), invasive (52%), and combined invasive/pre-invasive (23%). The majority had estrogen/progesterone receptor positive disease. Factors that were important in decision making included convenience, physician recommendation, financial considerations, novelty of treatment, desire to avoid mastectomy, and recovery time. The majority (48%) reported convenience to be the single most important factor. Provider recommendation was the primary factor in decision making for 20% of women. Most women agreed that their choice was the right decision (96%) and most felt adequately informed (90%). The majority (92% and 90% respectively) of women agreed that their decision was consistent with their personal values and was the best decision for them personally. Decisional satisfaction was high (95%). Overall satisfaction with treatment choices was high: 84% and 10% reported being totally and somewhat satisfied respectively. The majority (90%) of women stated they would make the same treatment choice again. Conclusions: Decisional satisfaction remains high almost a decade after completion of short course radiation. Practitioners should consider patient values and preferences as part of shared decision making when determining type and duration of radiation as part of breast conservation therapy.
Telomere Length and All-Cause Mortality: A Meta-analysis
Authors: Qi Wang, Yiqiang Zhan, Nancy L. Pedersen, Fang Fang, Sara Hägg
Journal: Ageing Research Reviews (2018)

Telomere attrition is associated with increased morbidity and mortality of various age-related diseases. Reports of association between telomere length (TL) and all-cause mortality remain inconsistent. In the present study, a meta-analysis was performed using published cohort studies and un-published data from the Swedish Twin Registry (STR). Twenty-five studies were included: four STR cohorts (12,083 individuals with 2517 deaths) and 21 published studies. In the STR studies, one standard deviation (SD) decrement of leukocyte TL corresponded to 13% increased all-cause mortality risk (95% confidence interval [CI]: 7%-19%); individuals in the shortest TL quarter had 44% higher hazard (95% CI: 27%-63%) than those in the longest quarter. Meta-analysis of all eligible studies (121,749 individuals with 21,763 deaths) revealed one SD TL decrement-associated hazard ratio of 1.09 (95% CI: 1.06-1.13); those in the shortest TL quarter had 26% higher hazard (95% CI: 15%-38%) compared to the longest quarter, although between-study heterogeneity was observed. Analyses stratified by age indicated that the hazard ratio was smaller in individuals over 80 years old. In summary, short telomeres are associated with increased all-cause mortality risk in the general population. However, TL measurement techniques and age at measurement contribute to the heterogeneity of effect estimation.
Abstract 9969: Genotype-phenotype Correlations According to Clinical and Echocardiographic Characteristics in Hypertrophic Cardiomyopathy
Authors: Christine Henri, Patrick Garceau, Laura Robb, Joël Lavoie, Lise-Andrée Mercier, Philippe Romeo, Michael S Phillips, Yannick Renaud, Catherine Barahona-Dussault, Isabelle Fillion, Philippe L'Allier, FranÇois Marcotte, Mario Talajic
Journal: Circulation (2012)

Background: Many mutations among genes encoding sarcomeric proteins have been identified in hypertrophic cardiomyopathy (HCM). Data on specific genotype-phenotype correlations are limited and highly variable. Methods: Identified mutations in genes TNNI3 (troponin I), TNNT2 (troponin T), MYBPC3 (myosin-binding protein C) and MYH7 (myosin heavy chain) were screened in 284 patients at the Cardiovascular Genetic Clinic of the Montreal Heart Institute. Mutations were identified in 113 patients (40%) and 84 patients (74%) were included for analysis. Five cardiac transplant recipients without previous echocardiographic images available were analysed according to clinical characteristics only. We excluded 16 patients without HCM phenotype and 13 patients with follow-up outside of our center. Results: MYH7 (40%) and MYBPC3 (40%) mutations were the most common. Only one patient was identified with a TNNI3 (1%) mutation and was excluded. Patients with MYH7 mutations were younger at diagnosis and presented more often with a familial history of sudden cardiac death (76%) and defibrillator implantation (59%). Patients with MYH7 mutations were also more likely to progress to “burn-out” HCM (27%) and cardiac transplantation (18%). Significant mitral insufficiency was more prevalent in patients with MYBPC3 mutations (33%). Patients with TNNT2 (18%) mutations showed an increased probability of having a significant resting and provocable left outflow tract obstruction (47%) with systolic anterior movement of the mitral valve (53%) leading to septal myomectomy (27%). Genotype did not affect septal morphology with an overall predominance of the midseptal form (73% overall). Conclusion: This retrospective study suggests that TNNT2 mutations are associated with obstructive HCM while MYH7 mutations are related with arrhythmic complications. Moreover, septal morphologies do not appear to be influenced by any specific gene mutation.
Vago-Splenic Axis in Signal Transduction of Remote Ischemic Preconditioning in Pigs and Rats
Authors: Helmut Raphael Lieder, Petra Kleinbongard, Andreas Skyschally, Helene Hagelschuer, William M. Chilian, Gerd Heusch
Journal: Circulation Research (2018)

The signal transduction of remote ischemic conditioning is still largely unknown.Characterization of neurohumoral signal transfer and vago-splenic axis in remote ischemic preconditioning (RIPC).Anesthetized pigs were subjected to 60 minutes of coronary occlusion and 180 minutes of reperfusion (placebo+ischemia/reperfusion [PLA+I/R]). RIPC was induced by 4×5/5 minutes of hindlimb I/R 90 minutes before coronary occlusion (RIPC+I/R). Arterial blood samples were taken after placebo or RIPC before I/R. In subgroups of pigs, bilateral cervical vagotomy, splenectomy, or splenic denervation were performed before PLA+I/R or RIPC+I/R, respectively. In pigs with RIPC+I/R, infarct size (percentage of area at risk) was less than in those with PLA+I/R (23±12% versus 45±8%); splenectomy or splenic denervation abrogated (splenectomy+RIPC+I/R: 38±15%; splenic denervation+RIPC+I/R: 43±5%), and vagotomy attenuated (vagotomy+RIPC+I/R: 36±11%) RIPC protection. RIPC increased phosphorylation of STAT3 (signal transducer and activator of transcription 3) in left ventricular biopsies taken at early reperfusion. Splenectomy or splenic denervation, but not vagotomy, abolished this increased phosphorylation. In rats with vagotomy, splenectomy, or splenic denervation, RIPC (3×5/5 minutes of hindlimb occlusion/reperfusion) or placebo was performed, respectively. Hearts were isolated, saline perfused, and subjected to 30/120-minute global I/R. With RIPC, infarct size (percentage of ventricular mass) was less (20±7%) than with placebo (37±6%), and vagotomy, splenectomy, or splenic denervation abrogated RIPC protection (38±12%, 36±9%, and 36±7%), respectively. Rat spleens were isolated, saline perfused, and splenic effluate (SEff) was sampled after infusion with carbachol (SEffcarbachol) or saline (SEffsaline). Pig plasma or SEff was infused into isolated perfused rat hearts subjected to global I/R. Infarct size was less with infusion of RIPC+I/Rplasma+ (24±6%) than with PLA+I/Rplasma (40±8%), vagotomy+PLA+I/Rplasma (39±11%), splenectomy+PLA+I/Rplasma (35±8%), vagotomy+RIPC+I/Rplasma (40±9%), splenectomy+RIPC+I/Rplasma (33±9%), or splenic denervation+RIPC+I/Rplasma (39±8%), respectively. With infusion of SEffcarbachol, infarct size was less than with infusion of SEffsaline (24 [19-27]% versus 35 [32-38]%).Activation of a vago-splenic axis is causally involved in RIPC cardioprotection.
Real-world adherence in patients with metastatic colorectal cancer (mCRC) treated with trifluridine/tipiracil (FTD/TPI) or regorafenib (REG).
Authors: Anuj K. Patel, Victoria Barghout, Mihran Ara Yenikomshian, Guillaume Germain, Philippe Jacques, François Laliberté, Mei Sheng Duh
Journal: Journal of Clinical Oncology (2018)

11 Background: Adherence to oral chemotherapies is a critical but difficult to measure factor in the care of patients with advanced cancer. FTD/TPI and REG have both demonstrated prolonged survival in patients with refractory mCRC, but with notably different side effect profiles. This study utilizes real-world data to assess adherence and discontinuation of patients treated with FTD/TPI or REG and explore the effect of sequencing on adherence. Methods: Adults diagnosed with mCRC were identified using the nationally representative IQVIA Real-World Data Adjudicated Claims – US database (10/2014–07/2017). The first dispensing date of FTD/TPI or REG (if after FTD/TPI approval [10/2015]) was defined as the index date and the 3 months before as the baseline period. The observation period spanned from the index to the earliest date of a switch to another mCRC agent, end of continuous enrollment, or end of data availability. Medication possession ratio (MPR), proportion of days covered (PDC) at 3 months, and discontinuation (i.e., allowable gap≥45 days) were compared. Logistic (odds ratio [OR]) and Cox proportional hazards (hazard ratio [HR]) regressions, adjusting for baseline characteristics, were used to compare adherence and discontinuation, respectively. A subgroup analysis was conducted among switchers (FTD/TPI to REG vs REG to FTD/TPI). Results: A total of 469 FTD/TPI and 311 REG users were identified. FTD/TPI users had higher compliance with an MPR ≥ 80% (OR = 2.47; p &lt; 0.001) and PDC ≥ 80% (OR = 2.77; p &lt; 0.001). FTD/TPI users had lower risk of discontinuation (HR = 0.76; p = 0.006). Among switchers (96 FTD/TPI to REG; 83 REG to FTD/TPI), those switching from FTD/TPI to REG were more likely to have an MPR ≥ 80% (OR = 2.91; p &lt; 0.001) and PDC ≥ 80% (OR = 4.60; p &lt; 0.001) compared to REG to FTD/TPI switchers. Additionally, FTD/TPI to REG switchers had a lower risk of first treatment discontinuation (HR = 0.66; p = 0.009). Conclusions: In this study, FTD/TPI users had significantly higher compliance, lower discontinuation rate, and switchers treated first with FTD/TPI had better compliance, demonstrating that claims data can provide insight into oral chemotherapy adherence patterns in mCRC.
Abstract 16708: Valvular Disease in Hispanics
Authors: Jonathan Rubin, Shivani A Aggarwal, Katrina Swett, Ajay K Kirtane, Susheel K Kodali, Tamim Nazif, Min Pu, Robert Kaplan, Carlos J Rodriguez
Journal: Circulation (2016)

Introduction: Hispanics represent the largest racial/ethnic minority group in the United States. There are studies characterizing valvular heart disease in Caucasians and African Americans, but not among Hispanics. Methods: As part of Echocardiographic Study of Latinos (ECHO-SOL) 1,818 participants ≥45 years of age underwent a comprehensive echocardiographic exam. We assessed prevalence of mitral (MR), tricuspid (TR), pulmonic (PR) and aortic (AR) regurgitation as well as bicuspid aortic valve (BAV), mitral valve prolapse (MVP), mitral (MS) and aortic (AS) stenosis. Logistic regression analysis using survey statistics and sampling weights was employed to examine the associations of clinical and sociodemographic variables with valvular lesions. Results: Study population mean age 55.2 (SE 0.17); 57.4% were female. The prevalence of each valvular lesion is described in the Table. The overall prevalence of AVHD was 3.1% with no significant difference across gender; however, the prevalence of valvular lesions ...
Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries
Authors: Fan Yang, Xueyi Liu, Panpan Zha
Journal: JAMA Network Open (2018)

<h3>Importance</h3> Anemia remains a major challenge for women's and children's health in low- and middle-income countries (LMICs). <h3>Objective</h3> To assess the socioeconomic inequalities and prevalence of anemia among children and nonpregnant girls and women in LMICs over time. <h3>Design, Setting, and Participants</h3> This cross-sectional and repeated cross-sectional analysis used data from the Demographic and Health Surveys collected from January 1, 2000, through December 31, 2014. Initial cross-sectional data sets constructed from the most recent surveys included 163 419 children aged 6 to 59 months and 304 202 nonpregnant girls and women aged 15 to 49 years (hereinafter referred to as nonpregnant women) from 45 LMICs. Repeated cross-sectional data sets from the most recent and the earliest surveys consisted of 322 088 nonpregnant women from 25 LMICs and 182 273 children from 24 LMICs. Analyses were conducted from June 1, 2016, through July 3, 2018. <h3>Main Outcomes and Measures</h3> Total and severe anemia for children aged 6 to 59 months (hemoglobin level, &lt;11 and &lt;7 g/dL, respectively) and nonpregnant women aged 15 to 49 years (&lt;12 and &lt;8 g/dL, respectively) were defined according to the World Health Organization hemoglobin cutoff levels. The slope index of inequality (SII) and the relative index of inequality (RII) were calculated to determine anemia inequalities. <h3>Results</h3> Among the 163 419 children aged 6 to 59 months and the 304 202 nonpregnant women aged 15 to 49 years in the initial cross-sectional data sets, 34 of 45 countries had anemia prevalence levels for children greater than 40% and 37 of 45 had anemia prevalence levels greater than 20% for nonpregnant women. Among the 182 273 children from 24 LMICs and 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.67 to 3.98 percentage points in 16 of the 24 LMICs; for cases of severe anemia, the decrease was 0.03 to 0.82 percentage points in 15 LMICs. Among 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.49 to 2.59 percentage points in 17 of 25 LMICs; for severe anemia, the decrease was 0.03 to 0.29 percentage points in 15 LMICs. The SII was significantly negative and the RII was significantly less than 1 in 37 of the 45 LMICs among children and in 26 of the 45 LMICs for nonpregnant women. The annualized changes in the SII approached 0 in 16 of the 24 LMICs among children and in 11 of 25 LMICs among nonpregnant women. <h3>Conclusions and Relevance</h3> Most LMICs continue to exhibit a high prevalence of anemia among children and nonpregnant women, although the prevalence of total and severe anemia have decreased in many LMICs. Anemia inequalities among children and nonpregnant women persist in most LMICs.
Retrospective Analysis of Safety of Vedolizumab in Patients With Inflammatory Bowel Diseases
Authors: Joseph Meserve, Satimai Aniwan, Jenna L. Koliani-Pace, Preeti Shashi, Aaron Weiss, David Faleck, Adam Winters, Shreva Chablaney, Gursimran Kochhar, Brigid S. Boland, Siddharth Singh, Robert Hirten, Eugenia Shmidt, Justin G. Hartke, Prianka Chilukuri, Matthew Bohm, Sashidhar Varma Sagi, Monika Fischer, Dana Lukin, David Hudesman, Shannon Chang, Youran Gao, Keith Sultan, Arun Swaminath, Nitin Gupta, Sunanda Kane, Edward V. Loftus, Bo Shen, Bruce E. Sands, Jean-Frederic Colombel, Corey A. Siegel, William J. Sandborn, Parambir S. Dulai
Journal: Clinical Gastroenterology and Hepatology (2018)

There are few real-world data on the safety of vedolizumab for treatment of Crohn's disease (CD) or ulcerative colitis (UC). We quantified rates and identified factors significantly associated with infectious and non-infectious adverse events in clinical practice.We performed a retrospective review of data from a multicenter consortium database (from May 2014 through June 2017). Infectious and non-infectious adverse events were defined as those requiring antibiotics, hospitalization, vedolizumab discontinuation, or resulting in death. Rates were quantified as proportions and events per 100 patient years of exposure (PYE) or follow up (PYF). We performed multivariable logistic regression analyses to identify factors significantly associated with events and reported as odds ratios (OR) with 95% CIs.Our analysis comprised 1087 patients (650 with CD and 437 with UC; 55% female; median age, 37 years) with 861 PYE and 955 PYF. Infections were observed in 68 patients (6.3%; 7.9 per 100 PYE, 7.1 per 100 PYF); gastrointestinal infections (n = 31, 2.4 per 100 PYE, 2.2 per 100 PYF) and respiratory infections (n = 14, 1.6 per 100 PYE, 1.5 per 100 PYF) were the most common. Arthralgias were the most common non-infectious adverse events (n = 31, 2.9%; 3.6 per 100 PYE). Two patients developed malignancies (squamous cell skin cancer and colorectal cancer; 0.23 per 100 PYE, 0.21 per 100 PYF). Active smoker status (OR, 3.39) and number of concomitant immunosuppressive agents (corticosteroids or immunomodulators; OR, 1.72 per agent) used were independently associated with infections.In a retrospective cohort study of patients with IBD, we found vedolizumab to be well tolerated with an overall favorable safety profile. Active smoking and concomitant use of immunosuppressive agents were independently associated with infections.
Male sex and the pattern of recurrent myeloid mutations are strong independent predictors of blood transfusion intensity in patients with myelodysplastic syndromes
Authors: Jenny Rydén, Gustaf Edgren, Mohsen Karimi, Gunilla Walldin, Magnus Tobiasson, Agneta Wikman, Eva Hellström-Lindberg, Petter Höglund
Journal: Leukemia (2018)