tbuckley/cabot-search huggingface dataset:
Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study
Authors: David Jiménez, Behnood Bikdeli, Andrés Quezada, Alfonso Muriel, José Luis Lobo, Javier de Miguel-Diez, Luis Jara-Palomares, Pedro Ruiz-Artacho, Roger D Yusen, Manuel Monreal
Journal: BMJ (2019)

To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality.Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018.353 hospitals in 16 countries.39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism.Pulmonary embolism related mortality within 30 days after diagnosis of the condition.Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals.In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.
Assessment of Preoperative Liver Function for Surgical Decision Making in Patients with Hepatocellular Carcinoma
Authors: Takashi Kokudo, Kiyoshi Hasegawa, Chikara Shirata, Meguri Tanimoto, Takeaki Ishizawa, Junichi Kaneko, Nobuhisa Akamatsu, Junichi Arita, Nicolas Demartines, Emilie Uldry, Norihiro Kokudo, Nermin Halkic
Journal: Liver Cancer (2019)

Most patients with hepatocellular carcinoma (HCC) have underlying liver disease and a preoperative liver function evaluation is important to avoid postoperative liver failure and death. In Western guidelines, portal hypertension (PH) is listed as a contraindication for liver resection. On the other hand, the indocyanine green retention rate at 15 min (ICG R15) has been widely used in Asian countries for surgical decision making. However, these criteria are based on reports published in the 20th century that included only a small number of patients and were developed empirically.The number of published case series concerning liver resection in HCC patients with PH has been rapidly increasing since 2011, indicating that liver resection in HCC patients with PH is now routinely performed in specialized centers worldwide. Although PH certainly has an impact and should be considered as a contraindication for major liver resection, it is no longer considered to be a contraindication for minor liver resection, especially laparoscopic liver resection. In addition, new biomarkers and imaging tools to assess preoperative liver function have been extensively reported. The combination of these new factors to well-known risk factors, such as PH and ICG R15, might strengthen the ability to stratify the risk of postoperative liver failure.The present review covers recent topics regarding the assessment of preoperative liver function for surgical decision making in patients with HCC.
Longitudinal analysis of quality of life (QoL) within a randomized phase III trial in patients (pts) with metastatic pancreatic adenocarcinoma (MPA)
Authors: F. Bonnetain, E. Maillard, J. Seitz, E. Mitry, M. Ychou, M. Gasmi, J. Raoul, C. Mariette, L. Bedenne, L. Dahan
Journal: Journal of Clinical Oncology (2009)

e17544 Background: The FFCD phase III trial in pts with MPA comparing LV5FU2-P followed by gemcitabine (arm A) versus the opposite sequence (arm B) had failed to demonstrate a significant difference in median OS. To longitudinally compare QoL according to treatment sequence we have explore definitions of time until definitive deterioration (TUDD) of QoL scores according to minimal clinically important difference (MCID) cut off. Methods: From August 2003 to May 2006, 202 pts with measurable MPA, PS 0–2, non prior CT were included in 33 centers, 102 in arm A and 100 in arm B. QoL was evaluated using EORTC QLQ-C30 every 8 wks up to death. We focused analyses on the following scores: global health (GH), emotional functioning (EF), physical functioning (PF), fatigue (FA), and pain (PA). TUDD were estimated using Kaplan Meier, and compared using log-rank tests. They were defined as the time interval between randomization and the first occurrence of a decrease in QLQ-C30 score ≥ 5 points without any further improvement in QoL score ≥ 5 points or any further available QoL data. These analyses were repeated using a 10 points MCID, and by including deaths as event. Results: Amongst the 202 pts, 179 had completed at least one QoL questionnaire (89%) and the mean number of available QoL data was 3 (SD: 2.14). Using a 5 points MCID as well as 10 points, TUDD of the 5 scores did not differ according to treatment arm. About 25% of patients reported definitive score deteriorations≥ 5 points and 15%≥ 10 points. Including death as event for a 5 points MCID, median TUDD of GH score was 5.2 months (4.3–6.2) in Arm A and 6.1 months (5.1–6.1) in Arm B (log rank p = 0.50). Median TUDD of FA score was 4.8 months (3.5–6.3) in Arm A and 5.6 months (4.2–7.7) in Arm B (log rank p = 0.76). Median TUDD of scores was reached after median PFS and at median time of second-line PFS. While treatment had no impact, multivariate Cox model showed that tumor localization and progression were independently associated with TTDU (p &lt; 0.05). Conclusions: We have investigated QoL analyses modalities using survival techniques dealing with binding drop out missing data and with an easier clinical interpretation of results. Progression seems to negatively impact QoL. No significant financial relationships to disclose.
Acceptability of the NCI patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE) in women with metastatic breast cancer (MBC).
Authors: Christine Nichols, Sandra A. Mitchell, Kathy Lang, Victoria Federico, Kathleen M. Castro, Lauren J. Rogak, Deepa Lalla, Steven B. Clauser, Bryce B. Reeve, Andrea Denicoff, Alice P. Chen, Richard Piekarz, Thomas Michael Atkinson, Musa Mayer, Melissa G. Brammer, Laura Sit, Ann M. O'Mara, Lori M. Minasian, Ethan M. Basch
Journal: Journal of Clinical Oncology (2012)

e19633 Background: NCI PRO-CTCAE is a new patient-reported outcome measure designed to enhance adverse event (AE) reporting in clinical trials by integrating the patient experience. The PRO-CTCAE item bank includes items representing the frequency (F), severity (S) and interference (I) with usual activities of 78 symptomatic AEs. The aim of this study was to examine the acceptability of a subset of PRO-CTCAE items to women receiving treatment for HER2+ MBC. Methods: 207 women on active treatment for HER2+ MBC (median 47 months since MBC diagnosis) were recruited from 6 U.S. breast cancer support groups and completed a web survey that included 18 PRO-CTCAE symptoms. Respondents were aged 45-64 years (71%), white (94%), college-educated (72%), with health-related quality of life rated good to excellent (61%) and median EQ5D utility score of 0.8. To explore PRO-CTCAE acceptability and data quality, we examined item level missingness, endorsement frequencies and binary and free-text responses about the comprehensibility of PRO-CTCAE items. Results: Item level missingness across all symptoms for each PRO-CTCAE dimension (F, S and I) ranged from 1.0% to 5.3%, with a median of 2.9%; interference associated with decreased appetite had the greatest missingness (5.3%). Excluding this outlier, maximum missingness was 3.9%. Endorsement frequencies of response choices for S of insomnia, constipation, fatigue, pain, anxiety/worry and sad/unhappy feelings support acceptable instrument sensitivity (all adjacent response points endorsed by &gt;7% of respondents). Most respondents (92%) thought the items were easy to understand; a few were uncertain about how to rate symptoms such as anxiety, depression, insomnia and nausea if they were present but partially controlled with medication. Conclusions: These findings confirm and extend those of other studies demonstrating the acceptability of PRO-CTCAE. Evaluation in a more heterogeneous sample, particularly with respect to education and cancer site, is underway.
Extent of neutrophil (NTP) infiltration in benign lymph nodes (LNs) to predict survival in patients with muscle-invasive bladder cancer (MIBC).
Authors: Wei Liang, Richard Jove, Bertram E. Yuh, Kevin Chan, Timothy G. Wilson, David James McConkey, Seth P. Lerner, Sumanta Kumar Pal
Journal: Journal of Clinical Oncology (2013)

e15522 Background: In preclinical models, NTPs appear to establish a pre-metastatic niche that fosters the invasion of metastases (Kowanetz et al. PNAS 2010). This observation still requires clinical validation in MIBC. Methods: Benign LN tissue was obtained from patients (pts) who had undergone cystectomy and LN dissection for documented MIBC. Immunohistochemical (IHC) staining for CD15 (a NTP marker) was performed. Interleukin-17 (IL-17) and phosphorylated signal transducer and activator of transcription 3 (pSTAT3), putative mediators of NTP recruitment, were assessed through the same method (Laan et al. J Immunol 1999; Fielding et al. J Immunol 2008). Positively staining cells were counted and averaged over 8 high power fields. Pts were stratified by the median cell count for each biomarker. Analyses of overall survival (OS) were performed using the Kaplan-Meier method and log-rank test. Results: Of 55 pts with MIBC, 19 pts received no neoadjuvant chemotherapy (NAC), while 36 pts had received NAC with either GC (n=17) or MVAC (n=19). CD15 and IL-17 expression was significantly lower in pts with prior NAC (P&lt;0.001 for both), while expression of pSTAT3 was similar in both groups. Furthermore, across the whole cohort, a strong association was seen between expression of CD15 and IL-17 (r=0.73, P&lt;0.001). Amongst patients with no prior NAC, median OS was higher in those pts with low CD15 v high CD15 (158.7 mos v 36.9 mos, P=0.02), and low pSTAT3 v high pSTAT3 (NR v 106.4 mos, P=0.04). Median OS was numerically higher in pts with low IL-17 v high IL-17 (114.5 v 36.9 mos; P=0.14). Patients with both low CD15/IL-17 had a particularly favorable outcome. Amongst pts with prior exposure to NAC, no difference in survival was noted based on CD15, pSTAT3 or IL-17. Conclusions: NTP recruitment to benign LNs (potentially mediated by IL-17) may be prognostic of OS in pts with MIBC who have not received NAC. Bolstered by these findings, the prognostic value of NTP recruitment will be examined prospectively in SWOG 1011, a trial comparing limited v extended LN dissection in pts with MIBC.
Epidemiology of chronic liver diseases in the USA in the past three decades
Authors: Zobair M Younossi, Maria Stepanova, Youssef Younossi, Pegah Golabi, Alita Mishra, Nila Rafiq, Linda Henry
Journal: Gut (2019)

Given significant advances in treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of liver diseases in the USA may be changing. Our aim was to assess the shift in the prevalence of different liver disease aetiologies in the USA over the past three decades.National Health and Nutrition Examination Surveys (NHANES; cross-sectional 1988-1994 and 1999-2016) were used.A total of 58 731 adults from NHANES (1988-2016) were included. Over the study period, the prevalence of chronic hepatitis B and alcoholic liver disease remained stable: 0.3%-0.4% and 0.8%-1.0%, respectively (p>0.05). The prevalence of chronic hepatitis C decreased nearly twofold: 1.6% in 1988-1994 to 0.9% in 2013-2016 (p=0.03). In contrast, the prevalence of non-alcoholic fatty liver disease (NAFLD; by US-Fatty Liver Index) increased from 20.0% (1988-1994) to 28.3% (1999-2004) to 33.2% (2009-2012) and 31.9% (2013-2016) (p<0.0001). Furthermore, steady increases were observed in the rates of obesity (22.2% in 1988-1994 to 31.0% in 1999-2004 to 38.9% in 2013-2016), type 2 diabetes mellitus (T2DM) (from 7.2% to 8.2% to 13.5% same years), insulin resistance and hypertension (all p<0.0001). Yearly trend analyses showed that the only LD with consistently increasing prevalence was NAFLD (trend p=0.01). Multivariable regression analysis showed that obesity (OR 10.4; 95% CI 9.5 to 11.3) and T2DM (OR 3.7; 95% CI 3.2 to 4.2) were the major independent predictors of NAFLD.Over the past 30 years in the USA, NAFLD is the only liver disease with growing prevalence, synchronous with the increasing rates of obesity and T2DM.
Long telomeres and cancer risk: the price of cellular immortality
Authors: Emily J. McNally, Paz J. Luncsford, Mary Armanios
Journal: Journal of Clinical Investigation (2019)

The distribution of telomere length in humans is broad, but it has finite upper and lower boundaries. Growing evidence shows that there are disease processes that are caused by both short and long telomere length extremes. The genetic basis of these short and long telomere syndromes may be linked to mutations in the same genes, such as the telomerase reverse transcriptase (TERT), but through differential effects on telomere length. Short telomere syndromes have a predominant degenerative phenotype marked by organ failure that most commonly manifests as pulmonary fibrosis and are associated with a relatively low cancer incidence. In contrast, insights from studies of cancer-prone families as well as genome-wide association studies (GWAS) have identified both rare and common variants that lengthen telomeres as being strongly associated with cancer risk. We have hypothesized that these cancers represent a long telomere syndrome that is associated with a high penetrance of cutaneous melanoma and chronic lymphocytic leukemia. In this Review, we will synthesize the clinical and human genetic observations with data from mouse models to define the role of telomeres in cancer etiology and biology.
Breast cancer in a patient with multiple endocrine neoplasia type 1 (MEN 1): A case report and review of the literature.
Authors: Zorka Momcilo Inic, Momcilo Inic, Radan Dzodic, Gordana Pupic, Svetozar Damjanovic
Journal: Journal of Clinical Oncology (2012)

e21136 Background: We treated a patient with breast cancer associated with multiple endocrine neoplasia type 1 (MEN 1). There are only few studies of the development of breast cancer in patients diagnosed with MEN1 syndrome. Methods: We found that patient had a pituitary macroadenoma that secretes prolactin (prolactinomas), increased serum concentration of calcium, 4.09 mmol/l and increased serum concentration of PTH, 212 pg/ml. Neck ultrasound and scintigrafy showed suspicious adenoma in lower left parathyroid gland. A computed tomography scan of the abdomen revealed a tumor mass in the body of the pancreas and adenoma in the left suprarenal gland. We diagnosed multiple endocrine neoplasia type 1 (MEN 1). Results: MEN1 occurs as a result of inactivating mutations of the MEN1 gene (MEN1), located on chromosome11q13. Results indicate that menin is a direct activator of ERalpha function. In a clinical study, in Kagawa, with 65 ER-positive breast cancer samples-all of which had been treated with tamoxifen for 2-5 years as adjuvant therapies-menin-positive tumors had a worse outcome than menin-negative ones. This indicated that menin can function as a transcriptional regulator of ERalpha and is a possible predictive factor for tamoxifen resistance.These results demonstrate that allelic deletions of the 13q12-14 region occur in some pituitary adenomas and 16% of parathyroid adenomas. Conclusions: As recent molecular studies have suggested genetic mutations in multiple endocrine neoplasia type 1, this syndrome may possibly predispose patients to breast cancer.This possibility cannot be evaluated definitively on the basis of a single case report; additional observations and studies are necessary to investigate this hypothesis further.
Hodgkin’s disease and HIV infection (HD-HIV): Prognostic factors in 596 patients (pts) within the group of European Cooperation on AIDS and Tumors (GECAT).
Authors: Michele Spina, Josep-Maria Ribera, Jean Gabarre, Christoph Wyen, Silvia Montoto, Ulrich Jaeger, Renato Talamini, Alessandro Re, Andres J. Ferreri, Umberto Tirelli
Journal: Journal of Clinical Oncology (2012)

8058 Background: Hodgkin’s disease (HD) is the most common non-AIDS defining tumour diagnosed in HIV setting. The introduction of highly active antiretroviral therapy (HAART) has opened a new prospective in the treatment of pts with HD-HIV as the better control of the underlying HIV infection allows the use of more aggressive chemotherapy regimens, including high dose chemotherapy. However, up to now prognostic factors on overall survival (OS) or time to treatment failure (TTF) have not yet been identified. Methods: In order to identify prognostic factors, we analyzed data on 596 pts with HD-HIV diagnosed and treated in 90 different Institution of 6 European countries from October 1983 to March 2010. All factors were analyzed for OS and TTF. Results: 86% of pts were male and the median CD4 cell count was 224/dl (range 3-1274); 52% of pts had mixed cellularity subtype, stages III-IV were diagnosed in 72% of cases and 55% of pts had extranodal involvement (bone marrow 35%, spleen 21%, liver 14%). The table summarizes the results of multivariate analysis. Conclusions: We identified a new “European Score” for HD-HIV able to predict different outcomes in these patients. This score should be considered for future prospective studies. [Table: see text]
More on Intralymphatic Injection of Autoantigen in Type 1 Diabetes
Authors: Johnny Ludvigsson, Beatriz Tavira, Rosaura Casas
Journal: New England Journal of Medicine (2017)

To the Editor: Ludvigsson et al. (Feb.16 issue) 1 report the results of the DIAGNODE-1 (GAD-Alum [Diamyd] Administered into Lymph Nodes in Combination with Vitamin D in Type 1 Diabetes) trial.They found that injection of alum-formulated glutamic acid decarboxylase (GAD-alum) into the inguinal lymph node plus administration of oral vitamin D was "associated with preservation of residual beta-cell function" and changes to immunologic markers in patients with type 1 diabetes.Although the authors introduce an interesting new approach, their data, as presented, do not support their conclusions adequately.In brief, the authors do not provide statistical data to support assertions regarding the stable C-peptide level in the patients.They also do not provide raw data to support their accounts of changes in immunologic markers, and they do not adequately discuss how the "historical agematched patients" from specific trials 2-4 were chosen as a comparison group.Finally, they do not show the standard-error bars that are necessary to understand this small descriptive data set (see Fig. 1 of their article, available at NEJM.org).Conclusive statements based on the results of small pilot studies are inherently tenuous, but they are particularly problematic when inadequate information is provided to support the findings.
In Low-Value Care, Less Is (Not Always) More
Authors: Thomas L. Forbes
Journal: JAMA Internal Medicine (2019)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Primary adrenocortical carcinoma: A retrospective review of The Cleveland Clinic Foundation experience between 1995 to 2002
Authors: N. J. Tirgan, A. H. Hamrahian
Journal: Journal of Clinical Oncology (2006)

18614 Background: Primary adrenocortical carcinoma (PAC) is a rare disease with a incidence of 1 per million. PAC’s are highly malignant tumors with guarded prognosis. Radical surgery is the treatment of choice. Methods: The pathology database and medical charts of these patients were retrospectively reviewed. Results: There were 14 females, 8 males, and 95% were caucasion. The mean age was 49.2 ± 11.8 years (females 51.6 years, males 45 years). The mean size of the tumor was 12.6 ± 5.1 cm (range of 3.6 to 25 cm). Thirteen patients (59.1%) presented with left and nine (40.9%) with right sided PAC. Seventy- two percent of the patients had abdominal, back, and/or flank pain. Forty five percent of patients had symptoms related to hypercortisolism and/or hyperandrogenism. Twelve patients (55%) had functional tumors (hypercortisolism 67%, hyperandrogenism 42%, and DHEA-S hypersecretion 42%) and ten were non-functional. Five percent of the tumors were classified as stage I, 33% were stage II, 38% were stage III, and 24% were stage IV. Twelve patients (55%) had distant metastases (liver 75%, lung 67%, retroperitoneum 33%, kidney 17%, contra-lateral adrenal gland 17%). All 22 patients had adrenalectomies (open 91%; laparoscopic 9%). The microscopic margin of resection were negative in 14 and positive in 6 patients. The information for 18 patients were evaluable for treatment. Eight patients received post-op therapy. Four patients received Mitotane (o,p’-DDD) alone (three died at 2, 29, and 213 months; and one is alive at 38 months after diagnosis). Three patients received both Mitotane and chemotherapy (two died at 3 and 43 months, one is alive at 140 months). One patient received only chemotherapy and died at 8 months. Ten patients received no post-op therapy. The estimated 5-year survival for the entire group was 48% (Kaplan-Meier survival estimate, 95% confidence interval). The estimated 5-year survival for stage III was 33%, and for stage IV was 30%. There were no deaths in patients with stage II group. The estimated 5-year survival for the treated group (8 patients) was 33% and 58% for the untreated group (10 patients). Conclusions: In PACs, surgery remains the main method of therapy. In our experience, Mitotane with or without chemotherapy did not improve survival. No significant financial relationships to disclose.
Mitochondria-localized β-actin is essential for priming innate antiviral immune signaling by regulating IRF3 protein stability
Authors: Xin Xie, Martin Endara-Coll, Raza Mahmood, Robertas Jankauskas, Tamara Gjorgjieva, Piergiorgio Percipalle
Journal: Cellular and Molecular Immunology (2019)