tbuckley/cabot-search huggingface dataset:
Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery
Authors: Katy Winckworth-Prejsnar, James McCanney, Alyssa A. Schatz, Warren Smedley, Leonidas C. Platanias, Cecil M. Benitez, Lee N. Newcomer, C. Lyn Fitzgerald, Robert W. Carlson
Journal: Journal of the National Comprehensive Cancer Network (2019)

Multiple factors are forcing the healthcare delivery system to change. A movement toward value-based payment models is shifting these systems to team-based integration and coordination of care for better efficiencies and outcomes. Workforce shortages are stressing access and quality of care for patients with cancer and survivors, and their families and caregivers. Innovative therapies are expensive, forcing payers and employers to prioritize resources. Patients are advocating for care models centered on their needs rather than those of providers. In response, payment policies have recently focused on the promotion of alternative payment models that incentivize coordinated, high-quality care with consideration for value and controlling the increasing overall costs associated with cancer and its treatment. Given the multitude of factors confounding cancer care, NCCN convened a multistakeholder working group to examine the challenges and opportunities presented by changing paradigms in cancer care delivery. The group identified key challenges and developed policy recommendations to address 4 high-visibility topics in cancer care delivery. The findings and recommendations were then presented at the NCCN Policy Summit: Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery in September 2018, and multistakeholder roundtable panel discussions explored these findings and recommendations along with additional items. This article encapsulates the discussion from the NCCN Working Group meetings and the NCCN Policy Summit, including multistakeholder policy recommendations on delivery issues in cancer care designed to help inform national policies moving forward.
Is cranial computed tomography unnecessary in children with a head injury and isolated vomiting?
Authors: Simon Hardman, Ola Rominiyi, David King, Edward Snelson
Journal: BMJ (2019)

### What you need to know

Nearly 35 000 children in the United Kingdom present to emergency departments with head injuries each year.1 These are largely minor injuries with normal or minimally impaired consciousness level. Around 5% have intracranial complications with approximately 1% having clinically important traumatic brain injuries (box 1).12

Box 1 
### Definitions

#### TBI-CT—Traumatic brain injury on CT2

Head injury with any of the following signs on CT:

#### ci-TBI — Clinically important traumatic brain injury2

Traumatic brain injury resulting in any of the following:RETURN TO TEXT

The use of cranial computed tomography (CT) scans to identify intracranial complications in children with head trauma has increased in developed countries. A third of children with head injuries presenting to emergency departments in the United States receive imaging.3 The associated radiation risk for an individual child is low, but it becomes important at a population level. For …
Evaluation de la conformité pré-analytique des biopsies digestives et de leurs qualités diagnostiques: expérience d'un centre hospitalier général
Authors: VJ Razafimahefa, SH Razafimahefa, SA Mioramalala, J Fenomanana, TF Andriamampionona
Journal: Endoscopy (2019)

L'optimisation de la qualité du diagnostic constitue un enjeu important dans la stratégie thérapeutique des pathologies digestives afin de réduire au maximum le risque d'erreur des analyses histologiques et des examens de biologie moléculaire. Elle requiert le contrôle en amont, allant du prélèvement du spécimen jusqu'à l'obtention de blocs pour analyses immunohistologique et moléculaire. La qualité de ces étapes dites «pré-analytiques», peu fréquemment soulevée, s'avère primordiale pour la fiabilité diagnostique. Elle repose sur des normes bien définies, relatives à des recommandations consensuelles dont la plupart restent peu connues. L'objectif de ce travail est d'évaluer la conformité préanalytique des biopsies digestives communiquées par les cliniciens et la qualité des résultats histologiques correspondants.
Group 1 innate lymphoid cells are involved in the progression of experimental anti-glomerular basement membrane glomerulonephritis and are regulated by peroxisome proliferator-activated receptor α
Authors: Yusuke Okabayashi, Shinya Nagasaka, Go Kanzaki, Nobuo Tsuboi, Takashi Yokoo, Akira Shimizu
Journal: Kidney International (2019)
SPYGLASS PANCREATOSCOPY FOR DIAGNOSIS, EVALUATION AND STAGING OF MAIN DUCT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM
Authors: R Morais, F Vilas-Boas, J Antunes, F Moreira, J Lopes, P Pereira, G Macedo
Journal: Endoscopy (2019)

An 84 year-old man, with priors of arterial hypertension and aortic stenosis underwent an abdominal computed tomography due to occasional symptoms of abdominal pain. This exam revealed a hypodense non-enhanced lesion in the head and neck of the pancreas, with 65 × 37 × 46 mm. This lesion was in continuity with the ampulla of Vater and conditioned a diffuse main pancreatic duct (MPD) dilation (12 mm in the body), in probable relation with a main duct intraductal papillary mucinous neoplasm (MD-IPMN). An endoscopic ultrasonography was performed and confirmed the presence of a multiseptated predominantly cystic mass in the head/neck of the pancreas, with hyperechoic material in the center compatible with mucin. After multidisciplinary the patient was proposed for surgery with prior pancreatoscopy to evaluate directly the MPD to help guide the type of surgery. Pancreatoscopy was performed using a peroral digital single-operator pancreatoscopy system (SpyGlass DS; Boston Scientific, Marlborough, Massachusetts, USA). On inspection a “fish mouth” ampulla was observed. After MPD cannulation with sphincterotome, contrast instillation revealed marked MPD dilation. Pancreatoscopy revealed a scarring appearance with friability in the pancreatic tail and body. In the neck and head we observed presence of mucin, papillary fronds and protusions with “fish-egg” appearance. Biopsies were performed in all MPD segments and revealed in the head and neck lesion with papillary architecture and intestinal phenotype, compatible with intraductal papillary mucinous neoplasm with low-grade dysplasia. No lesions were observed in the biopsies performed in the body and tail. The patient was submitted to a subtotal duodenopancreatectomy. Histopathological specimen examination confirmed the findings previously reported and the associated presence of ductal adenocarcinoma (pT1bN0R0).
Mortality Not Correlated With Paclitaxel Exposure
Authors: Peter A. Schneider, John R. Laird, Gheorghe Doros, Qi Gao, Gary Ansel, Marianne Brodmann, Antonio Micari, Mehdi H. Shishehbor, Gunnar Tepe, Thomas Zeller
Journal: Journal of the American College of Cardiology (2019)

Five years of prospective clinical trials confirm that the paclitaxel drug-coated balloon (DCB) (IN.PACT Admiral, Medtronic, Dublin, Ireland) is safe and effective to treat femoropopliteal artery disease. A recent meta-analysis of heterogeneous trials of paclitaxel-based balloons and stents reported that they are associated with increased mortality and that higher doses are linked to higher mortality from 2 to 5 years. The purpose of this study was to determine if there is a correlation between paclitaxel exposure and mortality by conducting an independent patient-level meta-analysis of 1,980 patients with up to 5-year follow-up. Data from 2 single-arm and 2 randomized independently adjudicated prospective studies of a paclitaxel DCB (n = 1,837) and uncoated percutaneous transluminal angioplasty (PTA) (n = 143) were included. Analyses of baseline, procedure, and follow-up data of individual patients were performed to explore correlations of paclitaxel dose with long-term mortality. Survival time by paclitaxel dose tercile was analyzed with adjustment of inverse probability weighting to correct baseline imbalances and study as random effect. A standard cohort was defined to compare DCB- and PTA-treated patients with similar characteristics by applying criteria from pivotal studies (n = 712 DCB, n = 143 PTA). A survival analysis stratified nominal paclitaxel dose by low, mid, and upper terciles; mean doses were 5,019.0, 10,007.5, and 19,978.2 μg, respectively. Rates of freedom from all-cause mortality between the 3 groups through 5 years were 85.8%, 84.2%, and 88.2%, respectively (p = 0.731). There was no significant difference in all-cause mortality between DCB and PTA through 5 years comparing all patients (unadjusted p = 0.092) or patients with similar characteristics (adjusted p = 0.188). This independent patient-level meta-analysis demonstrates that this paclitaxel DCB is safe. Within DCB patients, there was no correlation between level of paclitaxel exposure and mortality. (Randomized Trial of IN.PACT Admiral® Drug Coated Balloon vs Standard PTA for the Treatment of SFA and Proximal Popliteal Arterial Disease [INPACT SFA I], NCT01175850; IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery [SFA] and Proximal Popliteal Artery [PPA] [INPACT SFA II], NCT01566461; MDT-2113 Drug-Eluting Balloon vs. Standard PTA for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery and/or Proximal Popliteal Artery [MDT-2113 SFA], NCT01947478; The IN.PACT SFA Clinical Study for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery and/or Proximal Popliteal Artery Using the IN.PACT Admiral™ Drug-Eluting Balloon in a Chinese Patient Population, NCT02118532; and IN.PACT Global Clinical Study, NCT01609296)
Pruritus in ordinary scabies: IL‐31 from macrophages induced by overexpression of thymic stromal lymphopoietin and periostin
Authors: Takashi Hashimoto, Takahiro Satoh, Hiroo Yokozeki
Journal: Allergy (2019)

Scabies is a common contagious skin disease caused by an infestation of the skin by Sarcoptes scabiei var. hominis. A hallmark symptom of scabies is severe itch.We sought to determine the generation of a pruritogenic cytokine, interleukin (IL)-31, together with immune profiles in skin lesions of ordinary scabies through immunohistochemical and immunofluorescent studies. To elucidate the pathological mechanisms of IL-31 generation, murine peritoneal macrophages were stimulated with various T helper 2 (Th2) cytokines and proteins ex vivo.A large number of CCR4(+) Th2 cells, eosinophils, and basophils infiltrated in scabies lesions. Increased generation of IL-31, thymic stromal lymphopoietin (TSLP), and periostin was also observed. A major population of IL-31(+) cells were Arginase-1(+)/CD163(+) M2 macrophages. Murine peritoneal macrophages showed an M2 phenotype and generated IL-31 when stimulated with TSLP and periostin.IL-31 appeared to be largely generated by M2 macrophages in ordinary scabies lesions. This IL-31 induction was mediated by TSLP and periostin.
Quantitative High-Speed Video Profiling Discriminates between <i>DNAH11</i> and <i>HYDIN</i> Variants of Primary Ciliary Dyskinesia
Authors: Maurizio Chioccioli, Luigi Feriani, Quynh Nguyen, Jurij Kotar, Sharon D. Dell, Vito Mennella, Israel Amirav, Pietro Cicuta
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

Primary ciliary dyskinesia (PCD) is a genetically heterogeneous condition. The number of genes associated with primary ciliary dyskinesia is rising, and the link between genotype and clinical phenotype is largely unknown (1). Recent advances in molecular genotyping have helped establish the association between genetic defects and aberrant cilia ultrastructure in PCD, as detected by transmission electron microscopy. However, up to 30% of PCD cases do not show any specific ultrastructural defects and thus cannot be detected using this method. A classic example of this occurs in PCD cases caused by mutations in the DNAH11 (dynein axonemal heavy chain 1) protein, where aberrant ciliary beating can be detected via high-speed video microscopy (HSVM) analysis, but no ultrastructural defect is observed (2, 3). Even in cases where ultrastructural defects do exist, they can be difficult to detect using standard transmission electron microscopy techniques, and therefore patients who harbor such subtle defects are at risk of being misdiagnosed. PCD caused by mutations in the protein HYDIN, for example, display normal ciliary beat frequency and rarely exhibit abnormal ciliary transmission electron microscopy, yet mucociliary clearance is compromised.
DNA Damage Response and Repair Pathway Alteration and Its Association With Tumor Mutation Burden and Platinum-Based Chemotherapy in SCLC
Authors: Sehhoon Park, Hayoon Lee, Boram Lee, Se-Hoon Lee, Jong-Mu Sun, Woong-Yang Park, Jin Seok Ahn, Myung-Ju Ahn, Keunchil Park
Journal: Journal of Thoracic Oncology (2019)
Determination of the minimally important difference in a nasal symptom score in house dust mite allergy
Authors: Philippe Devillier, Harald Brüning, Karl‐Christian Bergmann
Journal: Allergy (2019)

House dust mite (HDM) allergens are responsible for the most prevalent persistent respiratory allergies. Clinical trials in this field often use a four-component nasal symptom score (T4NSS) as a measure of efficacy.The present observational, prospective, multinational, multicenter study determined the minimal important difference (MID) for a T4NSS in children, adolescents, and adults with physician-diagnosed HDM-induced allergic rhinoconjunctivitis (AR). Patients rated the T4NSS daily, a 15-point global rating of change scale (GRCS) and the Rhinoconjunctivitis Quality of Life Questionnaire weekly. The MID was determined primarily by using a regression method with a GRCS threshold of 2.A total of 546 patients (210 adults, 133 adolescents, and 203 children) were included; 92.6% of the patients had moderate-to-severe AR, and 30.1% had concomitant mild asthma. During the first week, the mean ± standard deviation T4NSS was 5.68 ± 2.76 in adults, 5.34 ± 2.66 in adolescents, and 5.07 ± 2.48 in children. In a GRCS regression analysis, the MID [95% confidence interval] for the T4NSS was -0.90 [-1.06;-0.75] overall (n = 509), -0.94 [-1.19;-0.69] in children (n = 187), -0.74 [-1.07;-0.41] in adolescents (n = 125), and -1.04 [-1.29;-0.79] in adults (n = 197). The MID did not differ greatly from one disease severity tertile to another. Confirmatory distribution-based analyses yielded overall MID values of -0.87 for the first week of the study and -0.93 for the week 2-week 1 difference.The MID for improvement in the T4NSS is at least -0.90 units in children, adolescents, and adults suffering from HDM-induced AR This value could be rounded up to -1 unit for convenience.
Comment on Davis et al. Effects of Severe Hypoglycemia on Cardiovascular Outcomes and Death in the Veterans Affairs Diabetes Trial. Diabetes Care 2019;42:157–163
Authors: Eberhard Standl, Jennifer B. Green, Rury R. Holman
Journal: Diabetes Care (2019)

The recent article by Davis et al. (1) reports on the relationship between severe hypoglycemic events (SHEs) and the subsequent risk of cardiovascular (CV) events or death observed in the Veterans Affairs Diabetes Trial (VADT). Unfortunately, the authors did not acknowledge our article published earlier this year in Diabetes Care , “Increased Risk of Severe Hypoglycemic Events Before and After Cardiovascular Outcomes in TECOS Suggests an At-Risk Type 2 Diabetes Frail Patient Phenotype” (2). Accordingly, they missed an opportunity to potentially confirm the intriguing reverse scenario we identified, i.e., a relationship between nonfatal CV events and the subsequent risk of SHEs. Given that there appear to be common traits for …
Abstract 19470: Sustained Improvement in Clinical Outcomes with MYDICAR® Compared to Optimal Therapy 1-year after Initial Gene Therapy in Patients with Advanced Heart Failure-The CUPID Trial
Authors: Donna Mancini, Cupid Trial Investigators
Journal: Circulation (2010)

Background: CUPID (Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease) is a phase 2 study which compared AAV1/SERCA2a (MYDICAR®) to placebo (optimal medical the...
ECTOPIC VARICEAL BLEEDING TREATED WITH HEMOSPRAY AS SALVAGE THERAPY: 2 CASE STUDIES
Authors: J Masegosa Ataz, J Doyle, E Henry, S Padol, M Barron
Journal: Endoscopy (2019)

Ectopic varices are portosystemic shunts out of the common gastro-oesophageal varices alongside the gastrointestinal tract, and although rare the rate of bleeding is 4 fold higher comparing to common varices. Likewise, treatment strategies have shown poorer outcomes than gastro-oesophageal. No cases have been reported in literature of the use of haemospray in ectopic varices.
Prediction of IDH genotype in gliomas with dynamic susceptibility contrast perfusion MR imaging using an explainable recurrent neural network
Authors: Kyu Sung Choi, Seung Hong Choi, Bumseok Jeong
Journal: Neuro-Oncology (2019)

The aim of this study was to predict isocitrate dehydrogenase (IDH) genotypes of gliomas using an interpretable deep learning application for dynamic susceptibility contrast (DSC) perfusion MRI.Four hundred sixty-three patients with gliomas who underwent preoperative MRI were enrolled in the study. All the patients had immunohistopathologic diagnoses of either IDH-wildtype or IDH-mutant gliomas. Tumor subregions were segmented using a convolutional neural network followed by manual correction. DSC perfusion MRI was performed to obtain T2* susceptibility signal intensity-time curves from each subregion of the tumors: enhancing tumor, non-enhancing tumor, peritumoral edema, and whole tumor. These, with arterial input functions, were fed into a neural network as multidimensional inputs. A convolutional long short-term memory model with an attention mechanism was developed to predict IDH genotypes. Receiver operating characteristics analysis was performed to evaluate the model.The IDH genotype predictions had an accuracy, sensitivity, and specificity of 92.8%, 92.6%, and 93.1%, respectively, in the validation set (area under the curve [AUC], 0.98; 95% confidence interval [CI], 0.969-0.991) and 91.7%, 92.1%, and 91.5%, respectively, in the test set (AUC, 0.95; 95% CI, 0.898-0.982). In temporal feature analysis, T2* susceptibility signal intensity-time curves obtained from DSC perfusion MRI with attention weights demonstrated high attention on the combination of the end of the pre-contrast baseline, up/downslopes of signal drops, and/or post-bolus plateaus for the curves used to predict IDH genotype.We developed an explainable recurrent neural network model based on DSC perfusion MRI to predict IDH genotypes in gliomas.
Abstract P148: Median American Intake of Fructose Does Not Increase Cardiovascular Disease Risk Factors
Authors: Joshua Lowndes, Stephanie Sinnett, James M Rippe
Journal: Circulation (2016)

Introduction: Studies in animals have shown that fructose can promote weight gain and the development of associated metabolic diseases when consumed in very high doses. The applicability of these findings to human consumption is unclear because they do not represent how fructose is consumed in the human diet, which is virtually always in combination with glucose and at much lower levels. Methods: 156 subjects were studied. All were apparently healthy and weight stable (no change in weight greater than 3% over the past three months) at enrollment (M=69, F=87, mean age 35.7 ± 11.4). Participants were randomly assigned to one of five groups - four that contained low fat milk with added sugar and one unsweetened low-fat milk control group. Milk was consumed in amounts so that the added sugar contributed a target percentage of the calories required for weight maintenance. The groups were as follows: Fructose 9% (50 th percentile of fructose consumption in the US), Glucose 9%, High fructose corn syrup 18%, sucrose 18% and an unsweetened milk control consumed so milk contributed 18% of the weight-maintenance calories. The energy intake required for weight maintenance was estimated using the Miflin St Joer equation and using an appropriate activity factor determined by responses to a physical activity questionnaire. The intervention lasted ten weeks. Results: There was a small change in weight (162.0 ± 28.5 vs 163.8 ± 29.3 lbs), BMI (26.0 ± 3.5 vs 26.3 ± 3.7) and waist circumference (81.0 ± 10.1 vs 81.6 ± 10.4 cm) in the entire study population (p&lt;0.01), but no effect of group (interaction p&gt;0.05). In contrast there were no changes (p&gt;0.05) in blood pressure (SBP: 106.7 ± 9.7 vs 105.5 ± 10.1, DBP: 68.7 ± 7.9 vs 68.6 ± 7.6 mmHg), cholesterol 178.3 ± 34.9 vs 179.4 ± 35.4 mg/dl), triglycerides (105.5 ± 79.9 vs 106.3 ± 76.3 mg/dl), LDL (104.4 ± 29.2 vs 105.7 ± 28.7 mg/dl), or glucose (88.9 ± 6.9 vs 90.4 ± 9.5 mg/dl). Although there was a statistically small decrease in HDL (54.2 ± 15.6 vs 52.8 ± 13.3 mg/dl, p&lt;0.05), it was not clinically important. In all cases, the treatment group did not affect the response (p&gt;0.05). Conclusion: These data suggest that the majority factors are unaffected by the consumption of the U.S. population average intake of fructose, whether consumed as fructose or as other types of sugar.
Helen Salisbury: Why be a doctor?
Authors: Helen Salisbury
Journal: BMJ (2019)

Doctors spend a lot of time complaining. There’s a socially acceptable, almost obligatory, level of moaning; but, if you dig a little deeper, only a minority regret joining the profession. Some onlookers find this incomprehensible: we work ridiculous hours, for less pay than our city colleagues. We spend our time in physically and emotionally unpleasant places, surrounded by body fluids and bad smells, grief, pain, and distress. How can that be considered a good job?

Medicine is rarely boring, although it helps to be naturally curious. In a GP consultation little …
Dose escalation using carbamylated monomeric tree pollen drops is well tolerated in patients with allergic rhinoconjunctivitis and points towards clinical effects
Authors: Esther Raskopf, Silke Allekotte, Enrico Compalati, Jaswinder Singh, Cengiz Han Acikel, Ralph Mösges
Journal: Allergy (2019)

ER, JS and CA have nothing to disclose. RM reports personal fees from ALK, grants from ASIT biotech, personal fees from allergopharma, personal fees from Allergy Therapeutics, grants and personal fees from Bencard, grants from Leti, grants, personal fees and nonfinancial support from Lofarma, nonfinancial support from Roxall, grants and personal fees from Stallergenes, grants from Optima, personal fees from Friulchem, personal fees from Hexal, personal fees from Servier, personal fees from Klosterfrau, nonfinancial support from Atmos, personal fees from Bayer, nonfinancial support from Bionorica, personal fees from FAES, personal fees from GSK, personal fees from MSD, personal fees from Johnson&Johnson, personal fees from Meda, personal fees and nonfinancial support from Novartis, nonfinancial support from Otonomy, personal fees from Stada, personal fees from UCB, nonfinancial support from Ferrero, grants from BitopAG, grants from Hulka, personal fees from Nuvo and grants from Ursapharm, outside the submitted work. SA reports grants and personal fees from Lofarma, personal fees from Servier, personal fees from Hexal and personal fees from Friulchem, outside the submitted work. EC is an employee of Lofarma SpA Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.