tbuckley/cabot-search huggingface dataset:
Innovative pilot to reimburse nurse and social work-led advance care planning.
Authors: Angela Kalisiak, Lisa Kathryn Hansen, Jamie Newell, Lydia Mills
Journal: Journal of Clinical Oncology (2017)

3 Background: Research has shown that advance care planning (ACP) leads to better patient care and outcomes. The Oregon Health Leadership Council (OHLC) identified ACP as an opportunity to improve care and offset costs. In 2014, the OHLC commissioned a workgroup to pilot a payment model to promote broader adoption of ACP. A community oncology provider and 4 health plans implemented the pilot for nurses (RNs) and licensed clinical social workers (LCSWs) to conduct ACP in an effort to elicit and honor patient preferences at end of life (EOL). Methods: Five RNs and 2 LCSWs underwent specific ACP training (by academic EOL educator or VitalTalk). They conducted one or more substantive ACP conversations (minimum 20 minutes) with 149 patients (89 female, 60 male; median age 64; range 24-92) between 12/5/14 and 5/9/16. Most patients had recurrent and/or metastatic cancer. Charts were reviewed in April 2017 for goals of care (GOC) discussion, ACP documents, preferences for EOL care, hospice enrollment, date of death, and death location. Results: Among all 149 patients, GOC discussion was documented for 126 (85%). Advance directives were in the chart for 34 (23%) and POLST for 53 (36%) patients. Among the 69 patients who died, 80% were on hospice (median days = 14; 15% on hospice &lt; 3 days); 87% preferred comfort care at time of death. Three patients (4%) requested life-prolonging treatment until death. Conclusions: This pilot demonstrated that RNs and LCSWs can provide substantive ACP within robust team-based care. Hospice enrollment, POLST completion, and EOL care consistent with preferences were high. Cost data was inadequate to draw conclusions. While physician management, patient values, disease and treatment factors may also impact EOL choices, pilot data indicates that expanding ACP through trained RNs and LCSWs serves to normalize ACP as an integral component of quality care and promote outcomes congruent with GOC. [Table: see text]
A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial
Authors: Pierre Kalfon, Karine Baumstarck, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mohamed Boucekine, Mélanie Fromentin, Martine Nyunga, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Juliette Audibert, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Karine Vie, Gwenaëlle Lannuzel, Hélène Bout, Jean-Philippe Parthiot, Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Jean-Pierre Quenot, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, Alicia Richard, Claire Boulle, Benjamin Kowalski, Elisa Klusek, Tarek Sharshar, Andrea Polito, Caroline Duvallet, Sonia Krim, Nicolas Girard, Juliette Audibert-Souhaid, Cécile Jourdain, Stéphane Techer, Corinne Chauvel, Corinne Bruchet, Johanna Temime, Stéphanie Beaussart, Fabienne Jarosz, Julien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, Valérie Cerro, Déborah Levy, Sébastien Andre, Christophe Guervilly, Laurent Papazian, Myriam Moussa, Stéphanie Renoult, Delphine Biet, Steve Novak, Jean-Christophe Orban, Aminata Diop, Carole Ichai, Antoine Tesniere, Jean-Pascal Goupil, Frédérique Laville, Nadège Rutter, Sandie Brochon, Kelly Tiercelet, Julien Amour, Nora Ait-Hamou, Marjorie Leger, Virginie Souppart, Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, Sabrina Seguin, Christophe Hart, Kathy Dernivoix, Caroline Wuiot, Karine Sanches, Stéphane Hecketsweiler, Catherine Sylvestre-Marconville, Vincent Gardan, Stéphanie Deparis-Dusautois, Yana Chaban
Journal: Intensive Care Medicine (2017)
Clusters de doença dos legionários associados com viajens para Espanha durante o período de Janeiro 2001 a Julho 2003
Authors: R Cano, N Prieto, C Martin, C Pelaz, S Mateo
Journal: Eurosurveillance (2004)

A vigilância epidemiologica e o controlo da doenca dos legionarios associada a viagens sao actividades comprovadamente necessarias em termos de saude publica e de colaboracao na area da saude entre paises. As recomendacoes europeias sobre o controlo e a prevencao da doenca dos legionarios associada a viagens foram elaboradas no quadro da rede EWGLINET. Estas recomendacoes estabelecem os criterios de notificacao e de resposta quando surgem casos isolados ou clusters. Este artigo apresenta a analise dos dados correspondentes a notificacao de 46 clusters relacionados com viagens para Espanha, entre Janeiro de 2001 e Julho de 2003.
Combined checkpoint inhibitor therapy causing diabetic ketoacidosis in metastatic melanoma
Authors: Pouyan N. Changizzadeh, Shiva Kumar R. Mukkamalla, Vincent A. Armenio
Journal: Journal for ImmunoTherapy of Cancer (2017)

There has been a significant improvement in survival of advanced malignancies with the advent of checkpoint inhibitors. These newer treatment modalities come with a wide spectrum of unique side effects, termed immune related adverse events (irAE), ranging from mild skin rash to severe colitis. Included in that spectrum is the rare side effect of autoimmune diabetes mellitus. Despite a few case reports illustrating the incidence of autoimmune diabetes associated with immunotherapy, there has not been much mentioned about exacerbation or acceleration of hyperglycemia in non-autoimmune settings leading to de novo diagnosis of type 2 diabetes mellitus.We report the case of a 42 year old man with metastatic melanoma and no prior history of diabetes mellitus, who presented with diabetic ketoacidosis (DKA) after 3 cycles of combination checkpoint inhibitor therapy using nivolumab and ipilimumab. New onset diabetes mellitus was diagnosed on the basis of elevated hemoglobin A1c, in the absence of prior personal or family history. Autoimmune or type 1 diabetes mellitus was ruled out with normal levels of anti-glutamic acid decarboxylase 65 (GAD65) antibody, zinc transporter 8 (ZnT8) antibody, and islet antigen-2 (IA-2) antibody.This case report highlights the importance of recognizing rare but serious adverse events related to immunotherapy and incorporation of appropriate tools for early identification and management in national cancer treatment guidelines.
P2.06-006 Screening Values of CEA and Cyfra 21-1 for Lung Cancer in Combination with Low Dose CT (LDCT) in High-Risk Populations
Authors: N. Triphuridet, S. Vidhyarkorn, N. Chungklay, C. Auewarakul, J. Patumanond
Journal: Journal of Thoracic Oncology (2017)
Cell-Free DNA and Circulating Tumor Cells: Comprehensive Liquid Biopsy Analysis in Advanced Breast Cancer
Authors: Giovanna Rossi, Zhaomei Mu, Alfred W. Rademaker, Laura K. Austin, Kimberly S. Strickland, Ricardo Lima Barros Costa, Rebecca J. Nagy, Vittorina Zagonel, Timothy J. Taxter, Amir Behdad, Firas H. Wehbe, Leonidas C. Platanias, William J. Gradishar, Massimo Cristofanilli
Journal: Clinical Cancer Research (2017)

Liquid biopsy provides a real-time assessment of metastatic breast cancer (MBC). We evaluated the utility of combining circulating tumor cells (CTC) and circulating tumor DNA (ctDNA) to predict prognosis in MBC.
Abstract 209: Exosomes Derived From c-kit+ Cardiac Progenitor Cells are Essential for Myocardial Repair After Acute Myocardial Function
Authors: Sudhish Sharma, Grace E Bigham, Rachana Mishra, Flaviu Gruia, Philip Z Brohawn, Sotirios Karanthasis, Sunjay Kaushal
Journal: Circulation Research (2016)

Background: Human cardiac progenitor cells (hCPCs), identified by ckit + /CD45 - , provide a promising therapeutic option following myocardial infarction (MI) as their clinical relevance has been validated in the S tem C ell I nfusion in P atients with I schemic Cardi o myopathy (SCIPIO) Phase I clinical trial. The mechanism for their functional recovery of the injured myocardium is unknown. Hypothesis: We hypothesized whether CPCs secrete biologically active exosomes and if these exosomes could provide cardioprotection after myocardial infarction (MI). Methods and results: Exosomes were isolated from cultured CPCs, generated from the biopsies of right atrial appendage (RAA) from neonatal (nCPCs) and adult (aCPCs) patients with normal functioning myocardium. TEM showed that both CPCs secrete microvesicles, which fall within the same size range as exosomes (80-170nM, diameter). FACS performed for canonical exosomal surface markers CD63, ALIX and CD9 confirmed the presence of exosomes in the secretome of CPCs. Quantification of exosomes by Nanosight NS300 showed that nCPCs produce more than twice the amount of exosomes as compared to aCPCs in 48 hours. Exosomes were internalized by cardiomyocytes, endothelial cells and fibroblasts, within the myocardium. CPCs derived exosomes enhanced angiogenesis as analyzed by HUVEC tube assay formation and proliferation of neonatal rat cardiomyocytes while inhibiting their apoptosis in the presence of oxidative stress and inflammation. Intra-myocardial injection of exosomes into rat myocardium after MI restored ejection fraction (CPCs 63.74±3.68% vs CPCs-exosomes 62 ± 2.97%), attenuated adverse left ventricular remodeling and reduced infarct size which were comparable to CSC therapy at 28 days post MI. CPC exosomes also contain distinctive cargo of miRs and proteins. Immunoblot analysis shows that CPC exosomes are enriched in the paracrine factors VEGFA, ANG1, SCF1 and HGF1, with cardioprotective roles. Conclusion: Our findings identify exosomes as the smallest functional unit and potential biomarkers of CPC therapy. CPCs derived exosomes can be utilized as an off the shelf cell-free therapy which eliminates several shortcomings of cell therapy, including cell retention, cell rejection and arrhythmia.
P2.03-056 Primary Double EGFR Mutations T790M and Mutation in Exon 19 or 21 in Slovakiab NSCLC Patients - Updated Survival Data
Authors: P. Berzinec, P. Kasan, R. Godal, L. Plank, L. Copakova, A. Alemayehu, G. Chowaniecova, A. Farkasova, P. Hlavcak, M. Kucma, L. Rotikova, M. Slavikova, P. Vasovcak
Journal: Journal of Thoracic Oncology (2017)
Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases
Authors: Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Manu Tandan, Rakesh Kalapala, Santosh Darisetty, Sundeep Lakhtakia, G. Rao, D. Reddy
Journal: Endoscopy (2017)

Abstract Background and study aim Peroral endoscopic myotomy (POEM) has emerged as an effective treatment modality for achalasia. Prior treatment may affect the outcomes of subsequent management. In this study, we aimed to compare the safety and efficacy of POEM in treatment-naïve patients vs. those with prior treatment failure (PTF). Patients and methods The data of consecutive patients with achalasia who underwent POEM at a single tertiary care center from January 2013 to November 2016 were analyzed retrospectively. A comparative analysis was performed between treatment-naïve and PTF cases. Technical and clinical success, adverse events, and operative time for POEM were compared between the two groups. Results Overall, 502 patients with achalasia underwent POEM during the study period: 260 patients (51.8 %) in the treatment-naïve group and 242 patients (48.2 %) in the PTF group. The mean operative time was significantly longer in the PTF group compared with the treatment-naïve group (74.9 ± 30.6 vs. 67.0 ± 27.1 minutes; P = 0.002). On multivariate analysis, type of achalasia, dilated esophagus ( &gt; 6 cm), disease duration, prior treatment, occurrence of adverse events, and type of knife used were significant predictors of operative time. Technical success (98.1 % vs. 97.1 %; P = 0.56) and clinical success (92.4 % vs. 92.5 %; P = 0.95) were comparable in the treatment-naïve and PTF cases, respectively. Occurrence of gas-related events and mucosotomy were similar in both groups. Elevated DeMeester score was found in 17 /53 patients (32.1 %) in the PTF group and in 11 /44 patients (25.0 %) in the treatment-naïve group (P = 0.50). Conclusion POEM is safe and equally effective for treatment-naïve patients and for those in whom prior treatment has failed. POEM should be considered the treatment of choice in patients in whom prior treatment has failed.
Does use of the POLST form implicate overall care for patients with advanced cancer syndromes?
Authors: Justin Lebenthal, David Barile, Ramy Sedhom
Journal: Journal of Clinical Oncology (2017)

15 Background: The POLST “Practitioner Orders for Life-Sustaining Treatments” form addresses patient goals, scope of therapies, artificial nutrition, and resuscitation status. In New Jersey, Section A offers a unique opportunity for patients to describe in their own words overall goals of care. We investigated if completion of Section A influences aggressiveness of care at end of life for patients with advanced cancer syndromes. Methods: All POLST forms completed in 2015 at the University Medical Center of Princeton were retrospectively reviewed. Patients 18 years or older, electing for DNAR/DNAI status, were eligible for inclusion. All other responses on the POLST form were collected. Chart review was used to collect admitting diagnosis, referral and/or admission to the intensive care unit, palliative care and hospice use, length of stay, number of readmissions and deaths in the hospital. Discharge summaries were reviewed to assess if advance care planning discussions were documented. Results: 57 charts were reviewed: 34% were female, age 41 to 99 (mean 82), and average LOS was 6 days. 19% preferred “symptom treatment only” on their POLST forms and 70% preferred “limited treatment.” Section A was completed for 34 of 57 patients (60%). Those completing section A were less likely to be referred to the ICU, had a shorten length of stay (5 vs. 9 days), and had fewer unexpected deaths in the hospital. In addition, those completing section A were more likely to utilize both palliative and hospices services. Though physicians rarely documented code status on discharge summaries (38%), all patients with a palliative care consult while hospitalized had advance care planning discussions documented at discharge. Conclusions: Use of the POLST form provides a very natural order for discussion of life sustaining treatments and end-of-life care. Patients completing section A were more likely to utilize palliative care, hospice services, and advance care planning. The benefits of the POLST form extends beyond patient outcomes and may positively impact the care patients with advanced cancer syndromes. The importance of individualized preferences seems logical, but larger studies are needed to validate our findings.
Pericardial Adipose Tissue Regulates Granulopoiesis, Fibrosis, and Cardiac Function After Myocardial Infarction
Authors: Michael Horckmans, Mariaelvy Bianchini, Donato Santovito, Remco T.A. Megens, Jean-Yves Springael, Irene Negri, Michele Vacca, Marco Di Eusanio, Antonio Moschetta, Christian Weber, Johan Duchene, Sabine Steffens
Journal: Circulation (2017)

Background: The pericardial adipose tissue (AT) contains a high density of lymphoid clusters. It is unknown whether these clusters play a role in post–myocardial infarction (MI) inflammatory responses and cardiac outcome. Methods: Lymphoid clusters were examined in epicardial AT of humans with or without coronary artery disease. Murine pericardial lymphoid clusters were visualized in mice subjected to coronary artery ligation. To study the relevance of pericardial clusters during inflammatory responses after MI, we surgically removed the pericardial AT and performed B-cell depletion and granulocyte-macrophage colony-stimulating factor blockade. Leukocytes in murine hearts, pericardial AT, spleen, mediastinal lymph nodes, and bone marrow were quantified by flow cytometry. Cannabinoid receptor CB2 (CB2 –/– ) mice were used as a model for enhanced B-cell responses. The effect of impaired dendritic cell (DC) trafficking on pericardial AT inflammatory responses was tested in CCR7 –/– mice subjected to MI. Cardiac fibrosis and ventricular function were assessed by histology and echocardiography. Results: We identified larger B-cell clusters in epicardial AT of human patients with coronary artery disease in comparison with controls without coronary artery disease. Infarcted mice also had larger pericardial clusters and 3-fold upregulated numbers of granulocyte-macrophage colony-stimulating factor–producing B cells within pericardial AT, but not spleen or lymph nodes. This was associated with higher DC and T-cell counts in pericardial AT, which outnumbered DCs and T cells in lymph nodes. Analysis of DC maturation markers, tracking experiments with fluorescently labeled cells, and use of CCR7-deficient mice suggested that activated DCs migrate from infarcts into pericardial AT via CCR7. B-cell depletion or granulocyte-macrophage colony-stimulating factor neutralization inhibited DC and T-cell expansion within pericardial AT, and translated into reduced bone marrow granulopoiesis and cardiac neutrophil infiltration 3 days after MI. The relevance of the pericardial AT in mediating all these effects was confirmed by removal of pericardial AT and ex vivo coculture with pericardial AT and granulocyte progenitors. Finally, enhanced fibrosis and worsened ejection fraction in CB2 –/– mice were limited by pericardial AT removal. Conclusions: Our findings unveil a new mechanism by which the pericardial AT coordinates immune cell activation, granulopoiesis, and outcome after MI.
Abstract 16959: Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients
Authors: Bruce J Barnhart, Eric Helfenbein, Octavio Perez, Saeed Babaeizadeh, Dawn B Jorgenson, Chengcheng Hu, Vatsal Chikani, Joshua B Gaither, Duane Sherrill, Samuel M Keim, Daniel W Spaite
Journal: Circulation (2017)

Objective: Little is known about the patterns of nasal cannula-derived end-tidal CO2 (NC-ETCO2; sensors placed in patient nares) in Traumatic Brain Injury (TBI) patients. A previous report revealed...
Effect of eradicating hepatitis C on alanine aminotransferase levels
Authors: S. Mauss, C. Boesecke, F. Berger, P. Ingiliz, K.G. Simon, D. Hueppe, T. Lutz, K. Schewe, A. Baumgarten, J. Rockstroh, S. Christensen
Journal: Journal of Hepatology (2017)
Crossmodal lifelong learning in hybrid neural embodied architectures
Authors: Stefan Wermter, Sascha Griffiths, Stefan Heinrich
Journal: Behavioral and Brain Sciences (2017)

Abstract Lake et al. point out that grounding learning in general principles of embodied perception and social cognition is the next step in advancing artificial intelligent machines. We suggest it is necessary to go further and consider lifelong learning, which includes developmental learning, focused on embodiment as applied in developmental robotics and neurorobotics, and crossmodal learning that facilitates integrating multiple senses.
Abstract 20105: Ten-Year Major Clinical Outcomes of Current Smoker With Single Vessel versus Multivessel Coronary Artery Disease underwent Percutaneous Coronary Intervention With Drug-eluting Stents
Authors: Yong Hoon Kim, Seung-Woon Rha, Ae-Young Her, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Yoonjee Park, Ahmed Mashaly, Won Young Jang, Woo Hyeun Kim, Eun Jin Park, Jah Yeon Choi, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
Journal: Circulation (2017)

Purpose:  Smoking is a well-known risk factor for coronary artery disease (CAD). But long-term (10-year) impacts of current smoking on major clinical outcomes between single vessel and multivessel CAD following successful percutaneous coronary intervention (PCI) with drug-eluting stent (DES) is not clarified yet. We compared 10-year major adverse cardiac events (MACEs) of current smoker with single vessel to multivessel CAD.   Materials and Methods:  A total of 1,392 consecutive current smokers who had CAD and underwent successful PCI with DES were enrolled since 2004. They were divided into the 2 groups such as single vessel CAD (single group) and multivessel CAD (multivessel group). We excluded ex-smokers to compare only current smoking effect on long term clinical outcomes. To adjust any potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model and 2 PSM groups (350 pairs, n = 700, C-statistic = 0.942) were generated.   Results:  During the 10-year follow-up period, after PSM, the cumulative incidence of revascularization rates were significantly higher in multivessel group (TLR: HR, 1.86; 95% CI, 1.14-3.05; p = 0.014, TVR: HR, 2.10; 95% CI, 1.33-3.32; p = 0.001) compared with single group. MACEs were significantly higher in multivessel group (20.9% vs. 15.5%, p = 0.019) before PSM, but after PSM the difference was disappeared. Also 10-year incidences of death and myocardial infarction (MI) were not significantly between the two groups (Table and Figure).   Conclusions:  Current smoking can increase revascularization rates after PCI with DES in CAD patients, especially revascularization rates were significantly higher in multivessel CAD patients compared with single vessel CAD patients.
National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands
Authors: Wieke Altorf-van der Kuil, Annelot F Schoffelen, Sabine C de Greeff, Steven FT Thijsen, H Jeroen Alblas, Daan W Notermans, Anne LM Vlek, Marianne AB van der Sande, Tjalling Leenstra
Journal: Eurosurveillance (2017)

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the scientific impact and the possibility of detecting outbreaks may be amplified by merging the AMR surveillance database with databases from selected pathogen-based surveillance programmes containing patient data and genotypic typing data.