tbuckley/cabot-search huggingface dataset:
The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States
Authors: Adam Gaffney, Danny McCormick, David H. Bor, Anna Goldman, Steffie Woolhandler, David U. Himmelstein
Journal: Annals of Internal Medicine (2019)

Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth.To determine how the implementations of Medicare and Medicaid (1966) and the Patient Protection and Affordable Care Act (ACA) (2014) affected hospital use.Repeated cross-sectional study.Nationally representative surveys.Respondents to the National Health Interview Survey (1962 to 1970) and Medical Expenditure Panel Survey (2008 to 2015).Mean hospital discharges and days were measured, both society-wide and among subgroups defined by income, age, and health status. Changes between preexpansion and postexpansion periods were analyzed using multivariable negative binomial regression.Overall hospital discharges averaged 12.8 per 100 persons in the 3 years before implementation of Medicare and Medicaid and 12.7 per 100 persons in the 4 years after (adjusted difference, 0.2 discharges [95% CI, -0.1 to 0.4 discharges] per 100 persons; P = 0.26). Hospital days did not change in the first 2 years after implementation but increased later. Effects differed by subpopulation: Adjusted discharges increased by 2.4 (CI, 1.7 to 3.1) per 100 persons among elderly compared with nonelderly persons (P < 0.001) and also increased among those with low incomes compared with high-income populations. For younger and higher-income persons, use decreased. Similarly, after the ACA's implementation, overall hospital use did not change: Society-wide rates of discharge were 9.4 per 100 persons before the ACA and 9.0 per 100 persons after the ACA (adjusted difference, -0.6 discharges [CI, -1.3 to 0.2 discharges] per 100 persons; P = 0.133), and hospital days were also stable. Trends differed for some subgroups, and rates decreased significantly in unadjusted (but not adjusted) analyses among persons reporting good or better health status and increased nonsignificantly among those in worse health.Data sources relied on participant recall, surveys excluded institutionalized persons, and follow-up after the ACA was limited.Past coverage expansions were associated with little or no change in society-wide hospital use; increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use. Reducing coverage may merely shift care toward wealthier and healthier persons. Conversely, universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained.None.
A bronchoalveolar lavage‐driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group
Authors: Francesco Marchesi, Chiara Cattaneo, Marianna Criscuolo, Mario Delia, Michelina Dargenio, Maria Ilaria Del Principe, Antonio Spadea, Nicola Stefano Fracchiolla, Lorella Melillo, Katia Perruccio, Caterina Alati, Domenico Russo, Mariagrazia Garzia, Marco Brociner, Mariagiovanna Cefalo, Daniele Armiento, Simone Cesaro, Nunzia Decembrino, Andrea Mengarelli, Mario Tumbarello, Alessandro Busca, Livio Pagano
Journal: American Journal of Hematology (2019)

Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.
Abstract 17172: GDF11 Worsens Myocardial Infarction Outcome in Ischemia and Reperfusion Mouse Model
Authors: Alexander Akhmedov, Fabrizio Montecucco, Giovanni G Camici, Ariane Schaub Clerigue, Daria Vdovenko, Sarah Costantino, Nicole Bonetti, Candela Diaz Canestro, Francesco Paneni, François Mach, Thomas F Luescher
Journal: Circulation (2017)

Introduction: Recent studies have implicated a role of TGFβ family members in aging and cardiovascular diseases. Growth Differentiation Factor 11 (GDF11) is a member of TGFβ superfamily with high h...
Triple balloon enteroscopy: a combined method
Authors: Gerardo Blanco-Velasco, Raúl Antonio Zamarripa-Mottu, Omar Michel Solórzano-Pineda, Oscar Víctor Hernández-Mondragón, Juan Manuel Blancas-Valencia
Journal: Endoscopy (2019)

Double-balloon enteroscopy (DBE) has high diagnostic and therapeutic yield (70 % – 85 %) [1], but low completion rates (18 % – 66 %) [2] [3]. The NaviAid device (SMART Medical Systems Ltd., Ra’anana, Israel) consists in a through-the-scope (TTS) balloon for deep enteroscopy using a colonoscope [4]. In this case, we combined both types of enteroscopy to achieve deeper insertion.
Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy
Authors: Elise De Bleser, Barbara Alicja Jereczek-Fossa, David Pasquier, Thomas Zilli, Nicholas Van As, Shankar Siva, Andrei Fodor, Piet Dirix, Alfonso Gomez-Iturriaga, Fabio Trippa, Beatrice Detti, Gianluca Ingrosso, Luca Triggiani, Alessio Bruni, Filippo Alongi, Dries Reynders, Gert De Meerleer, Alessia Surgo, Kaoutar Loukili, Raymond Miralbell, Pedro Silva, Sarat Chander, Nadia Gisella Di Muzio, Ernesto Maranzano, Giulio Francolini, Andrea Lancia, Alison Tree, Chiara Lucrezia Deantoni, Elisabetta Ponti, Giulia Marvaso, Els Goetghebeur, Piet Ost
Journal: European Urology (2019)
Retrospective analysis of 178 patients with stage I rectum cancer.
Authors: Sener Cihan, Nuriye Ozdemir, Zuhat Urakci, Mehmet Kucukoner, Faysal Dane, Dogan Yazilitas, Ayse Durnali, Sinemis Yuksel, Dilsen Colak, Metin Seker, Burcu Taskoylu, Arzu Aksahin, Banu Ozturk, Umut Demirci, Nedim Turan, Sercan Aksoy, Ajlan Atasoy
Journal: Journal of Clinical Oncology (2013)

e14662 Background: There is no strong evidence to suggest that type of adjuvant therapy has any role in the management of stage I rectum cancer. The risks of local relapse and distant metastasis are higher in rectal cancer than colon cancer. Due to the more aggressive nature of rectal cancers, we explored the clinical and pathologic factors that could predict the risk of relapse in stage I disease. Methods: This multicenter study was carried out by Anatolian Society of Medical Oncology. 178 patients with rectal cancers who underwent curative surgery between 1994 and 2012 were included. Retrospective analyses were made using data collected from medical records. Results: The median age was 58 years (26-85). Low anterior resection (LAR) was the most preferred surgical method. Most tumors were well or moderately differentiated. After surgery, 13 patients (7.3%) received radiotherapy alone, 12 patients (6.7%) received chemotherapy alone and 15 patients (8.4%) were given chemoradiotherapy. Median follow-up was 29 months (3-225). 41 patients (23%) had relapse; relapses were local in 18 patients (10.1%) and distant in 12 patients (6.7%). 11 patients (6.2%) who had no relapse data were considered to be disease free. The 3-year disease free survival (DFS) was 74% and the overall survival (OS) was 94%. Mucinous histology and adjuvant therapy were found to have statistically insignificant correlations with relapse and survival. Conclusions: There is no strong evidence to support the role of any type of adjuvant therapy after resection in stage I rectal cancer. Approximately ¼ of patients had local or systemic relapse. This is a high rate for stage I tumors. The rates of relapse were slightly higher in the patients who had no adjuvant therapy and those who had mucinous tumors. There may be a role for adjuvant therapy in high-risk stage I rectal tumors. However, there is still a need for prospective studies in this regard. [Table: see text]
Sensing of apoptotic cells through Axl causes lung basal cell proliferation in inflammatory diseases
Authors: Naoya Fujino, Oliver J. Brand, David J. Morgan, Toshifumi Fujimori, Aleksander M. Grabiec, Christopher P. Jagger, Rose A. Maciewicz, Mitsuhiro Yamada, Koji Itakura, Hisatoshi Sugiura, Masakazu Ichinose, Tracy Hussell
Journal: The Journal of Experimental Medicine (2019)

Epithelial cell proliferation, division, and differentiation are critical for barrier repair following inflammation, but the initial trigger for this process is unknown. Here we define that sensing of apoptotic cells by the TAM receptor tyrosine kinase Axl is a critical indicator for tracheal basal cell expansion, cell cycle reentry, and symmetrical cell division. Furthermore, once the pool of tracheal basal cells has expanded, silencing of Axl is required for their differentiation. Genetic depletion of Axl triggers asymmetrical cell division, leading to epithelial differentiation and ciliated cell regeneration. This discovery has implications for conditions associated with epithelial barrier dysfunction, basal cell hyperplasia, and continued turnover of dying cells in patients with chronic inflammatory pulmonary diseases.
Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study
Authors: Annieke C G van Baar, Frits Holleman, Laurent Crenier, Rehan Haidry, Cormac Magee, David Hopkins, Leonardo Rodriguez Grunert, Manoel Galvao Neto, Paulina Vignolo, Bu’Hussain Hayee, Ann Mertens, Raf Bisschops, Jan Tijssen, Max Nieuwdorp, Caterina Guidone, Guido Costamagna, Jacques Devière, Jacques J G H M Bergman
Journal: Gut (2019)

The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months.International multicentre, open-label study. Patients (BMI 24-40) with T2D (HbA1c 59-86 mmol/mol (7.5%-10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction.Forty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (-10±2 mmol/mol (-0.9%±0.2%), p<0.001), FPG (-1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (-2.9±1.1, p<0.001), weight was modestly reduced (-2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly.In this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further.NCT02413567.
Imatinib plus hydroxyurea in pretreated nonprogressive glioblastoma (GBM): Long-term follow up of a single-center phase II study.
Authors: Gregor Paul Dresemann
Journal: Journal of Clinical Oncology (2013)

e13004 Background: GBM is malignant brain tumour with a median survival of 15.6 months. Dysregulated signalling of platelet derived growth factor receptors is suggested to play a role in pathogenesis. The combination of imatinib (I) plus hydroxyurea (HU) is known to be well tolerated and to show moderate efficacy in patients (pts) with recurrent GBM. Despite the aggressive course of GBM once starting progression, short periods of disease stabilisation after primary treatment or effective treatment of relapse can be observed. This Phase II study was initiated to analyse the efficacy of I plus HU as maintenance treatment (MT) in GBM pts. Methods: From December 2003 up to June 2005 30 pts were included. No enzyme-inducing anticonvulsive drugs were allowed. I (600 mg/day) and HU (1000 mg/day) were given as a continuous treatment. Blood cell counts were taken weekly and magnetic resonance imaging every 6 weeks. Primary endpoint (PE) was 6 and 12 months progression free survival (PFS), secondary endpoints (SE) were 5 years PFS and overall survival (OS). Results: All pts were eligible for PE and SE. 25 pts were male, 5 pts female, median age was 44 years (32 to 71). All pts had prior irradiation, 21 pts had prior temozolomide (T) containing therapy and 9 pts non-temozolomide containing therapy. 8 pts had none, 17 pts one and 5 pts two prior relapses. 25 pts had measurable disease, 4 of these pts achieved a partial response (PR), there was no complete remission, 5 pts had no evidence of disease. Median follow up is 90 months. Hematotoxicity grade 2 and 3 occurred in 11 out of 30 pts and required dose reduction of HU in 8 pts, dose reduction of I in 1 patient and G-CSF in 8 pts. PFS rate at 6, 12, 24 and 60 months were 60% (18/30), 40% (12/30), 17% (5/30) and 17% (5/30 ) respectively, OS rate at 6, 12, 24 and 60 months were 90% (27/30), 67% (20/30), 37% (11/30) and 17% (5/30). 4 pts are still alive without progression. Conclusions: Although I and HU did not demonstrate relevant efficacy in GBM and never reached admission status the reported study indicates impressive long-term survival data for I and HU as a continuous oral MT. Further studies should analyse more effective drugs like temozolomide as MT (proof of principle). Clinical trial information: STI571DE21.
Association of Methionine to Homocysteine Status With Brain Magnetic Resonance Imaging Measures and Risk of Dementia
Authors: Babak Hooshmand, Helga Refsum, A. David Smith, Grégoria Kalpouzos, Francesca Mangialasche, Christine A. F. von Arnim, Ingemar Kåreholt, Miia Kivipelto, Laura Fratiglioni
Journal: JAMA Psychiatry (2019)

Impairment of methylation status (ie, methionine to homocysteine ratio) may be a modifiable risk factor for structural brain changes and incident dementia.To investigate the association of serum markers of methylation status and sulfur amino acids with risk of incident dementia, Alzheimer disease (AD), and the rate of total brain tissue volume loss during 6 years.This population-based longitudinal study was performed from March 21, 2001, to October 10, 2010, in a sample of 2570 individuals aged 60 to 102 years from the Swedish Study on Aging and Care in Kungsholmen who were dementia free at baseline and underwent comprehensive examinations and structural brain magnetic resonance imaging (MRI) on 2 to 3 occasions during 6 years. Data analysis was performed from March 1, 2018, to October 1, 2018.Incident dementia, AD, and the rate of total brain volume loss.This study included 2570 individuals (mean [SD] age, 73.1 [10.4] years; 1331 [56.5%] female). The methionine to homocysteine ratio was higher in individuals who consumed vitamin supplements (median, 1.9; interquartile range [IQR], 1.5-2.6) compared with those who did not (median, 1.8; IQR, 1.3-2.3; P < .001) and increased per each quartile increase of vitamin B12 or folate. In the multiadjusted model, an elevated baseline serum total homocysteine level was associated with an increased risk of dementia and AD during 6 years: for the highest homocysteine quartile compared with the lowest, the hazard ratios (HRs) were 1.60 (95% CI, 1.01-2.55) for dementia and 2.33 (95% CI, 1.26-4.30) for AD. In contrast, elevated concentrations of methionine were associated with a decreased risk of dementia (HR, 0.54; 95% CI, 0.36-0.81) for the highest quartile compared with the lowest. Higher values of the methionine to homocysteine ratio were significantly associated with lower risk of dementia and AD: for the fourth methionine-homocysteine quartile compared with the first quartile, the HR was 0.44 (95% CI, 0.27-0.71) for incident dementia and 0.43 (95% CI, 0.23-0.80) for AD. In the multiadjusted linear mixed models, a higher methionine to homocysteine ratio was associated with a decreased rate of total brain tissue volume loss during the study period (β [SE] per 1-SD increase, 0.038 [0.014]; P = .007).The methionine to homocysteine status was associated with dementia development and structural brain changes during the 6-year study period, suggesting that a higher methionine to homocysteine ratio may be important in reducing the rate of brain atrophy and decreasing the risk of dementia in older adults.
Public Approval of Exception From Informed Consent in Emergency Clinical Trials
Authors: William B. Feldman, Spencer P. Hey, Jessica M. Franklin, Aaron S. Kesselheim
Journal: JAMA Network Open (2019)

<h3>Importance</h3> The US Food and Drug Administration (FDA) created the exception from informed consent (EFIC) pathway in 1996 to allow some emergency trials to enroll patients without informed consent. To protect individual autonomy and preserve public trust, the FDA requires that EFIC trial investigators consult with community members before a trial may begin. <h3>Objectives</h3> To analyze data from surveys conducted as part of community consultation ahead of EFIC trials and assess levels of public approval. <h3>Data Sources</h3> All trials granted an EFIC must submit documentation of compliance with EFIC regulations to a publicly available docket at the FDA. Submissions between November 1, 1996, and October 23, 2017, were reviewed. <h3>Study Selection</h3> Trials with survey data were included. <h3>Data Extraction and Synthesis</h3> Data were extracted between January 2018 and June 2018 and were analyzed between June 2018 and August 2018. The quality and validity of data were assessed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A random-effects metaregression was used to assess the association of demographic characteristics with EFIC approval. <h3>Main Outcomes and Measures</h3> The primary study outcome was EFIC approval. <h3>Results</h3> The FDA docket contained 15 958 pages of material with survey data for 42 448 individuals submitted by 27 trials. Public approval of EFIC varied by question type, with more people willing to approve initiation of EFIC trials in their community (86.5%) than personal enrollment (73.0%), enrollment of a family member (68.6%), or the principle of enrollment without consent (58.4%) (<i>P</i> &lt; .001 for all comparisons). In the United States, African American individuals made up 29.3% of those enrolled in EFIC trials that reported data on race (5064 of 17 302) but only 16.7% of those surveyed as part of community consultation. In the United States and Canada, men made up 42.9% of the surveyed population but 65.6% of those eventually enrolled in EFIC trials (29 961 of 45 694). Groups surveyed with higher proportions of African American and male respondents had lower rates of EFIC approval. <h3>Conclusions and Relevance</h3> Public approval of EFIC trials varied by question type and by the respondents' reported race and sex. The demographic characteristics of those surveyed did not match the demographic characteristics of EFIC enrollees. The FDA could strengthen community consultation by standardizing survey instruments and reporting, requiring broader inclusion of African American and male respondents, clarifying the function of surveys in the development and modification of trial protocols, and building more public consensus around the acceptable use of EFIC.
Biomedical Citizen Science or Something Else? Reflections on Terms and Definitions
Authors: Christi J. Guerrini, Anna Wexler, Patricia J. Zettler, Amy L. McGuire
Journal: The American Journal of Bioethics (2019)

In their article “The Rise of Citizen Science in Health and Biomedical Research,” Wiggins and Wilbanks (2019) present a new typology for understanding the complex landscape of health and biomedical...
Multinutrient Supplementation for Prevention of Major Depressive Disorder in Overweight Adults
Authors: Julia J. Rucklidge, Alexandra J. Richardson
Journal: JAMA (2019)

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