tbuckley/cabot-search huggingface dataset:
QIM19-126: NCCN Member Institution Patient Education and Teaching for Biliary Stents and Drains
Authors: Lorraine C. Drapek, Karen Driskill, Natasha Pinheiro, Ronald Harris, Renuka Iyer, Susan Acquisto
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Biliary obstruction often occurs with hepatobiliary cancers. Treatment consists of internal biliary stents or external biliary drains. Patient education regarding signs and symptoms of cholangitis, change of stents, or care of biliary drains is both critical and challenging. The Nursing Advisory Board of the Cholangiocarcinoma Foundation (CCF) found patient questions regarding stents and drains posted on the CCF website. Quality of life is impacted by treatment complications as well as lack of knowledge regarding living with stents or drains. Aim: To compare stent and biliary drain patient education practices of NCCN Member Institutions across the United States. Methods: A 40 item information survey was sent to the NCCN Member Institutions by email. Intended respondents were nursing or health professionals who provided patient instruction regarding biliary stents drains. The survey was sent to interventional radiology and endoscopy departments. It included questions regarding demographics of respondents, patient education and instructions, supplies provided, signs and symptoms to be reported, and follow-up appointments. Results: There were 26 survey responses. Of the 26 responses, 23 responses were complete. Patient education regarding stents or drains was predominantly completed by registered nurses (74%), or nurse practitioners (26%). The largest number of respondents practiced in interventional radiology (52%), endoscopy (13%), and other (30%), which included gastroenterology, or surgery. Verbal and written instructions were provided by 87% of NCCN centers. There was variation in survey responses regarding biliary drains. Survey responses regarding biliary stents were more cohesive. A schedule for stent change was provided by 75% of NCCN Member Institutions, although there was variation on length of time between stent exchanges. The majority of patients at these institutions receive education regarding signs and symptoms to report (95%). Conclusion: Discharge instructions to patients with external drains are inconsistent. Although there is some agreement among NCCN Member Institutions, the schedules for stent change vary. Patient education and instruction is predominantly provided by nurses and NPs. The importance of teaching signs and symptoms to report is evident in this sample. Standardized patient instructions post stents or external biliary drains may enable patients to care for drains and will help nurses and NPs reinforce consistent education.
Acidic Microenvironment Up-Regulates Exosomal miR-21 and miR-10b in Early-Stage Hepatocellular Carcinoma to Promote Cancer Cell Proliferation and Metastasis
Authors: Xiao-Peng Tian, Chen-Yuan Wang, Xiao-Han Jin, Mei Li, Feng-Wei Wang, Wei-Juan Huang, Jing-Ping Yun, Rui-Hua Xu, Qing-Qing Cai, Dan Xie
Journal: Theranostics (2019)

Rationale: The incidence of hepatocellular carcinoma is rising worldwide. It is predicted that nearly half of the early-stage hepatocellular carcinoma (E-HCC) patients will develop recurrence. Dysregulated pH, a hallmark of E-HCC, is correlated with poor prognosis. The acidic microenvironment has been shown to promote the release of exosomes, the membrane vesicles recognized as intercellular communicators associated with tumor progression, recurrence, and metastasis. We, therefore, aimed to identify exosomes induced by acidic microenvironment that may regulate E-HCC progression and to explore their mechanisms and clinical significance in E-HCCs. Methods: miRNA microarray analysis and LASSO logistic statistic model were used to identify the main functional exosomal miRNAs. Invasion and scratch assays were performed to examine the migration and invasion of HCC cells. Immunoblotting and immunofluorescence were employed to detect the epithelial-to-mesenchymal transition (EMT) in HCC cells. Chromatin immunoprecipitation (ChIP) was used to analyze the binding of HIF-1α and HIF-2α to promoter regions of miR-21 and miR-10b. Results: The acidic microenvironment in HCC was correlated with poor prognosis of patients. Exosomes from HCC cells cultured in the acidic medium could promote cell proliferation, migration, and invasion of recipient HCC cells. We identified miR-21 and miR-10b as the most important functional miRNAs in acidic HCC-derived exosomes. Also, the acidic microenvironment triggered the activation of HIF-1α and HIF-2α and stimulated exosomal miR-21 and miR-10b expression substantially promoting HCC cell proliferation, migration, and invasion both in vivo and in vitro. In E-HCC patients, serum exosomal miR-21 and miR-10b levels were associated with advanced tumor stage and HIF-1α and HIF-2α expression and were independent prognostic factors for disease-free survival of E-HCC patients. Most importantly, we developed a nano-drug to target exosomal miR-21 and/or miR-10b and examined its therapeutic effects against HCC in vivo. Conclusion: Our findings suggested that the exosomal miR-21 and miR-10b induced by acidic microenvironment in HCC promote cancer cell proliferation and metastasis and may serve as prognostic molecular markers and therapeutic targets for HCC.
QIM19-127: Novel Admission Checklist for Malignant Bowel Obstruction
Authors: Gabrielle Gauvin, Leigh Selesner, Marcin Chwistek, Molly Collins, Crystal Denlinger, Mark Itzen, Kenneth Patrick, Jeffrey Farma
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Malignant bowel obstruction (MBO) is a frequent presentation of advanced abdominal malignancy. Despite the frequency of MBO and the availability of NCCN Guidelines for its management, clinicians struggle to create a personalized care plan accounting for a patient’s current condition, prognosis, and goals of care. The aim of this project is to develop a discussion tool to implement on admission to ensure realistic prognostication and appropriate involvement of the patient, caregivers, and multidisciplinary team in treatment decisions. Methods: At our tertiary care center, a multidisciplinary team composed of surgical oncologists, medical oncologists, palliative care specialists, hospitalists, social workers, and nutritionists developed an algorithm to implement when a patient is admitted with MBO. The algorithm was influenced by the NCCN Guidelines for palliative care but was designed as a single-page checklist that could be easily executed by all team members. Results: The MBO admission checklist is divided into 4 sections. The general assessment section includes information about the etiology, severity, and reversibility of the current and past MBO. Also, the patient’s resuscitation and functional status are reviewed. The cancer care coordination/communication section covers the patient’s oncological history and estimated lifespan, as well as the need for further coordination of care and a goals of care discussion. The subsequent portion covers the management plan, with specific decisions resulting from a goals of care discussion as well as the need for specialized consults. The medical, procedural, and operative interventions the team and patient discussed as options are also documented. A key portion is the risks and benefits discussion for each treatment modality. Lastly, the discussion about future considerations section explores the patient’s wishes for the next episode of MBO. Conclusions: The goal of this checklist is to ensure that a comprehensive discussion is held between the different services involved in a patient’s care at every admission for MBO in order to provide a personalized management plan and improve communication. The next step in our study is to assess the effectiveness of implementation of the checklist as well as its impact on patient satisfaction, quality of life, early hospice referral, and outcomes.
Jean Eva Shorland
Authors: Tim Brook
Journal: BMJ (2019)

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Strategies for Image-Guided Therapy, Surgery, and Drug Delivery Using Photoacoustic Imaging
Authors: Colman Moore, Jesse V. Jokerst
Journal: Theranostics (2019)

Photoacoustic imaging is a rapidly maturing imaging modality in biological research and medicine.This modality uses the photoacoustic effect ("light in, sound out") to combine the contrast and specificity of optical imaging with the high temporal resolution of ultrasound.The primary goal of image-guided therapy, and theranostics in general, is to transition from conventional medicine to precision strategies that combine diagnosis with therapy.Photoacoustic imaging is well-suited for noninvasive guidance of many therapies and applications currently being pursued in three broad areas.These include the image-guided resection of diseased tissue, monitoring of disease states, and drug delivery.In this review, we examine the progress and strategies for development of photoacoustics in these three key areas with an emphasis on the value photoacoustics has for image-guided therapy.
Abstract P196: Cardiovascular Health Across the Lifespan: The Development and Validation of a Synthetic Cardiovascular Cohort
Authors: Norrina B Allen, Hongyan Ning, Donald Lloyd Jones, Lihui Zhao, Juned Siddique
Journal: Circulation (2017)

Introduction: The burden of cardiovascular (CV) risk factors accumulates over the lifespan: however, little information on CV risk across the full lifespan is available. Synthetic cohorts offer the opportunity to understand CV health across the lifespan. In this study we developed and validated a synthetic cohort approach to examine CV risk factors from age 18-90 years of age. Methods: This study included African American and Caucasian participants from 7 cohorts in the Lifetime Risk Pooling Project. Individuals’ demographics (age, birth year, sex, race, SES), CV risk factors (smoking, total cholesterol, SBP, DBP, glucose, diabetes, lipid-lowering and antihypertensive meds) and outcomes (incident CVD and death) at each exam were included. To generate a complete set of values from age 18 to 90 for each participant, we multiply imputed the participant’s CV risk profile and outcome using the available exam records based on a joint multi-level imputation model. To validate our imputed values, we removed the observed CARDIA data with exam ages 18-30, MESA data with exam ages 50-59 and CHS data with exam ages 80-90. We then imputed the CV risk profile of these deleted values and compared imputed and observed values. Results: We included 41,387 participants (55% female, 30% African American, mean age 51 at baseline, avg follow-up time 20 yrs). In our validation sample, imputed CV risk factor levels were consistent with observed values at both younger and older ages (table) for BMI, SBP, DBP, glucose and total cholesterol. The prevalence of antihypertensive meds was 14.6% in the observed and 14.9% in the imputed data. Similar findings were shown for the prevalence of diabetes, current smoking, CVD events and death. Imputed prevalence of lipid-lowering meds was lower than observed rates (5% vs 12%). Conclusions: This synthetic cohort approach provides valid and unbiased estimates of CV risk factors across the lifespan. Future studies using this synthetic cohort can provide novel insights into the origins and accumulation of CVD.
The AGITG ICECREAM STUDY: The Irinotecan Cetuximab Evaluation and Cetuximab Response Evaluation Amongst Patients with a G13D Mutation- analysis of outcomes in patients with “Quad WT”. J Clin Oncol 35 (15) 3572.
Authors: Eva Segelov, Jeremy Shapiro, Subotheni Thavaneswaran, Paul Waring, Jayesh Desai, Kirsty Mann, Maria Elena Elez, Lorraine A Chantrill, Nick Pavlakis, Louise Nott, C Underhill, Mustafa Khasraw, Harpreet Wasan, Fortunato Ciardiello, Michael J Jefford, Warren Joubert, Andrew Mark Meurisse Haydon, Christos Karapetis, Tim J. Price, Kate Wilson
Journal: Journal of Clinical Oncology (2017)
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
Authors: Giovanni Landoni, Vladimir V. Lomivorotov, Caetano Nigro Neto, Fabrizio Monaco, Vadim V. Pasyuga, Nikola Bradic, Rosalba Lembo, Gordana Gazivoda, Valery V. Likhvantsev, Chong Lei, Andrey Lozovskiy, Nora Di Tomasso, Nazar A.R. Bukamal, Fernanda S. Silva, Andrey E. Bautin, Jun Ma, Martina Crivellari, Ahmed M.G.A. Farag, Nikolay S. Uvaliev, Cristiana Carollo, Marina Pieri, Jan Kunstýř, Chew Yin Wang, Alessandro Belletti, Ludhmila A. Hajjar, Evgeny V. Grigoryev, Felice E. Agrò, Hynek Riha, Mohamed R. El-Tahan, A. Mara Scandroglio, Abeer M. Elnakera, Massimo Baiocchi, Paolo Navalesi, Vladimir A. Shmyrev, Luca Severi, Mohammed A. Hegazy, Giuseppe Crescenzi, Dmitry N. Ponomarev, Luca Brazzi, Renato Arnoni, Dmitry G. Tarasov, Miomir Jovic, Maria G. Calabrò, Tiziana Bove, Rinaldo Bellomo, Alberto Zangrillo
Journal: New England Journal of Medicine (2019)

Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).
Duke University pays $112m to settle claims that it knowingly used falsified data to obtain research grants
Authors: Owen Dyer
Journal: BMJ (2019)

Duke University in North Carolina will pay $112.5m (£85.2m; €100m) to settle allegations from the US government and a whistleblowing employee that it allowed fraudulent data to be used in federal research grant claims.

The case dates back to 2013, when Erin Potts-Kant, a clinical research coordinator at the university’s Foster Lab, was arrested for spending the laboratory’s research budget on internet purchases, which triggered an investigation by Duke into her research.

Analysis of her data and attempts to reproduce her results found that none of her work dating back to 2006 could be relied on. Because the Foster Lab was a “core” laboratory—conducting mouse lung tissue experiments for many Duke departments and external institutes—the fraudulent data contaminated research throughout the university. The findings have since led to 17 retractions. Grants for the research came from the National Institutes of Health and the Environmental Protection Agency.

As Duke scrambled …
HSR19-103: Burden of Self-Reported Mental Health Among Women With Cervical Cancer (CC) in the United States
Authors: Chizoba Nwankwo, Michael J. Doane
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Globally, CC is the fourth most common cancer in women, with 569,847 new cases and 311,365 deaths from CC reported in 2018. Little is known about the burden of living with CC, especially related to mental health. This study examined patient-reported outcomes, including symptoms of depression and anxiety, amongst women with and without a diagnosis of CC. Methods: Data were aggregated from the 2016–2018 U.S. National Health and Wellness Surveys, a nationally representative, self-administered, internet-based survey of adults (N=247,484). Women who reported a physician-diagnosis of CC were matched 1:1 by propensity scores to a sample of women who did not report any cancer diagnoses. Propensity score matching was conducted using the following sociodemographic characteristics: age, race, possession of health insurance, smoking status, comorbidity status, body mass index, income, and year of survey completion. Bivariate analyses (ie, chi-square and t-tests) assessed differences in mental health outcomes between these 2 matched groups of female respondents. Outcomes included the following: (1) depressive severity via the Patient Health Questionnaire (PHQ-9), (2) suicidal ideation via the PHQ-9 (ie, thoughts of being better off dead on several days or more during the past 2 weeks), (3) anxiety severity via the Generalized Anxiety Disorder 7-Item Scale (GAD-7), and (4) healthcare resource use for mental health services (ie, visits to psychologists and psychiatrists during past 6 months). Results: Analyses of the propensity score matched sample of 1,044 women with a CC diagnosis versus 1,044 without a CC diagnosis showed that CC respondents reported significantly more severe scores of both depression (7.3 vs 6.0; P &lt;.001) and anxiety (5.7 vs 4.7; P &lt;.001). Although not statistically significant, a numerically greater proportion of CC respondents reported suicidal ideation during the past 2 weeks (19.0% vs 16.0%; P =.158). Respondents with CC were marginally more likely to visit a psychologist (8.6% vs 6.4%; P =.056) and were significantly more likely to visit a psychiatrist (8.6% vs 6.2%; P =.037) at least once during the prior 6 months than respondents without CC. Conclusions: CC is associated with mental health burden, including more severe symptoms of depression and anxiety as well as greater use of mental health services. This study highlights the likely impact of CC for both patients as well as the healthcare system
Sex Hormones and Anticancer Immunity
Authors: Berna C. Özdemir, Gian-Paolo Dotto
Journal: Clinical Cancer Research (2019)

The impact of sex hormones on anticancer immunity deserves attention due to the importance of the immune system in cancer therapy and the recognition of sex differences in immunity. Cancer is ultimately the result of failed immune surveillance, and the diverging effects of male and female sex hormones on anticancer immunity could contribute to the higher cancer incidence and poorer outcome in men. Estrogens and androgens affect the number and function of immune cells, an effect that depends on cell type, tumor microenvironment, and the age and reproductive status of the individual. Despite the recent progress in immuno-oncology, our current understanding of the interplay between sex hormones and anticancer immune responses is in its infancy. In this review, we will focus on the impact of sex hormones on anticancer immunity and immunotherapy. We will discuss the potential role of the changing hormone levels in anticancer immunity during aging and in the context of menopausal hormone therapies and oral contraception. We will review emerging data on sex differences in PD-L1 expression and potential biomarkers predictive for the efficacy of immune checkpoint inhibitors such as the microbiome and consider ongoing clinical trials evaluating the potential impact of hormone deprivation therapies to increase response to immune checkpoint inhibitors in breast and prostate cancer. Finally, we will point to areas of future research.
Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study
Authors: Arnon Elizur, Michael Y Appel, Liat Nachshon, Michael B Levy, Na'ama Epstein-Rigbi, Bo Pontoppidan, Jonas Lidholm, Michael R Goldberg
Journal: The Lancet Child & Adolescent Health (2019)
CGE19-065: Number of Somatic Mutations Is an Independent Predictor of Overall Survival in Acute Myeloid Leukemia
Authors: Zin W. Myint, Rani Jayswal, Ranjana Arora, Gregory P. Monohan, Amit Goldberg, Roger Fleischman, Roger Herzig, Hayder Saeed, Gerhard C. Hildebrandt, Reshma Ramlal
Journal: Journal of the National Comprehensive Cancer Network (2019)

Purpose: Acute myeloid leukemia (AML) is characterized by multiple somatically acquired mutations that affect genes of different functional categories. It has been well established in myelodysplastic syndrome (MDS) that the cumulative number of somatic mutations has an impact on overall survival. However, no such data exist for AML. In this study, we sought to determine the number of clinically significant somatic mutations for each cytogenetically defined risk group of AML and to determine whether this had an impact on overall survival (OS). Methods: In this retrospective, single-center study, all adult patients diagnosed with AML from August 2016–December 2017 were reviewed. Baseline characteristics, somatic mutations in the diagnostic bone marrow as detected by Next Generation Sequencing (NGS), and survival outcomes were analyzed. NGS panel was done in-house and could identify 94 genes. Patients were divided into favorable, intermediate, and poor risk groups based on cytogenetics, and molecular abnormalities using NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AML, version 1.2018. Kaplan-Meier plots and Cox regression analyses were utilized. Results: A total of 105 AML patients were included; baseline characteristics and frequency of identified clinically significant (CS) mutations are described in the presentation. The FLT3 mutation occurred in the highest frequency (22%) followed by DNMT3A &amp; ASXL1 (15%). 17 (16%) patients were favorable risk, 33 (31%) intermediate risk, and 55 (52%) were poor risk. 67.6% of patients were male, and the median age was 64 (20–79) years. There was a difference in the number of CS mutations between the intermediate risk group and favorable risk group ( P =.007), but not between the favorable risk and poor risk groups ( P =.221) or between the intermediate risk group and poor risk group ( P =.093). Increased number of CS mutations (≥ 5) was seen with equal frequency across risk groups and predicted for shorter overall survival in both univariate (HR=2.80; P =.039) and by multivariate Cox regression analysis ( P =.001) independently from assigned risk group. There were no differences in age, gender, smoke, geographic, and different risk groups by multivariate analyses. Conclusion: Our study shows that ≥ 5clinically significant somatic mutations were associated with adverse outcomes and decreased survival, independent of risk groups and induction regimen. Thus, it may be a useful prognostic factor. This finding needs to be validated using a larger sample size.