tbuckley/cabot-search huggingface dataset:
Randomised controlled trial of polysomnographic titration of noninvasive ventilation
Authors: Liam M. Hannan, Linda Rautela, David J. Berlowitz, Christine F. McDonald, Jennifer M. Cori, Nicole Sheers, Caroline Chao, Fergal J. O'Donoghue, Mark E. Howard
Journal: European Respiratory Journal (2019)

Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone. Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL). In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h −1 versus control 41.0 (28–182) events·h −1 ; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h −1 versus control 14.6 (11–19) arousals·h −1 ; p=0.258). Overall adherence was not different except in those with poor early adherence (&lt;4 h·day −1 ) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day −1 versus control −23 (95% CI −86–39) min·day −1 ; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL. NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.
Does extent of resection matter in recurrent glioblastoma? Lessons from the DIRECTOR trial.
Authors: Bogdana Suchorska, Michael Weller, Ghazaleh Tabatabai, Christian Senft, Peter Hau, Michael Sabel, Ulrich Herrlinger, Ralf Ketter, Uwe S. Schlegel, Christine Marosi, Guido Reifenberger, Wolfgang Wick, Joerg Tonn, Hans-Georg Wirsching
Journal: Journal of Clinical Oncology (2015)

2041 Background: The role of surgery for recurrent glioblastoma is under debate. Tumor volume at recurrence was prognostic in single-institution retrospective studies, but no data from prospective multicenter trials for recurrent glioblastoma have been published to date. Here, we report the association with outcome of surgery for recurrent glioblastoma in a well characterized patient cohort treated in the DIRECTOR trial, which evaluated the effect of two different dose-intensified temozolomide regimens at first recurrence of glioblastoma. Methods: We analyzed prospectively collected clinical, molecular and imaging data from the DIRECTOR cohort (N = 105). Imaging data was available from 87 patients. Volumetric analysis was performed based on gadolinium (Gd) enhancement on MRI and correlated with progression-free survival (PFS) and overall survival (OS). Proportional hazard models were applied to obtain prognostic factors. Results: 71 of 105 patients received surgery at recurrence. Prognostic factors were balanced between patients who had undergone surgery and those who had not, including age (P = 0.358), O6-methylguanine DNA methyltransferase (MGMT) gene promoter methylation (P = 0.965), isocitrate dehydrogenase (IDH)-1 mutation (P = 0.724), Karnofsky performance score (P = 0.880), or steroid intake before randomization (P = 0.950). Mean tumor volumes in patients who had received surgery were smaller at study entry than in patients who had not undergone surgery (3.0 cm3 [range 0-37] versus 6.8 cm3[range 1-23], P < 0.001). The outcomes in patients who did or did not receive surgery at recurrence were similar for PFS (2.0 months [95% CI 3.5-7.1] vs. 1.9 months [95% CI 1.9-6.4], P = 0.1974) and OS (9.2 months [95% CI 8.7-12.6] vs 9.4 months [95% CI 8.3-13.5], P = 0.9538). Among patients who underwent surgery for recurrence, post-surgery imaging was available in 59 cases. In these patients, complete resection of Gd-enhancing tumor (N = 39) versus residual detection of Gd enhancement (N = 20) was associated with improved OS (11.5 months [95% CI 9.3-15.1] vs. 6.7 months [95% CI 5.2-9.5], P = 0.006). Conclusions: Surgery at first recurrence of glioblastoma may improve outcome if complete resection of Gd-enhancing tumor is feasible.
Prospective performance study of the liquid based endometrial cytology not inferior to suction endometrial tissue biopsy for the endometrial cancer screening.
Authors: Yasuo Hirai, Hideo Matsui
Journal: Journal of Clinical Oncology (2015)

e16523 Background: Since the need of the early detection and treatment of endometrial cancer continues increasing in Japan, the development of the reliable and easy practical method to detect the endometrial cancer has been urgently required. We conducted prospective performance study of the liquid based endometrial cytology(SurePath method), which is not inferior to suction endometrial tissue biopsy for the endometrial cancer screening Methods: In the period from 2011 November to now, after obtaining the informed consent, 1118 LBC specimens, 1111 conventional specimens, and 674 suction tissue biopsy specimens are collected consecutively from the selected outpatients in our clinic who have gynecologic symptoms such as genital bleedings and/or endometrial thickness in the uterine imaging technique, which suggest the risk of endometrial cancer. The slide is read by one cytotechnologist using standardized OSG(Osaki Study Group) Format and positive cases are checked by the cytopathologist. The final result is reported with descriptive endometrial reporting format presented by Yanoh el al. Results: The sensitivity of LBC to detect endometrial malignancies is 67.2%, which is hardly inferior to 69.8% that is the sensitivity of the suction tissue biopsy. The specificity of LBC is 98.4%. The specificity of suction tissue biopsy is 99.8%, which is slightly better than LBC. Thus, the performance of endometrial cytology using LBC method to detect and diagnose the endometrial cancer was totally almost same as the performance of the endometrial suction tissue biopsy. Conclusions: Our method with the liquid based endometrial cytology using BD SurePath showed a good performance to evaluate the status of the endometrium. This cytology method is useful enough for not only the initial endometrial cellular evaluation but also endometrial cancer screening together with cervical cytology.
Abstract 038: Improvements in Meeting the <i>2008 Physical Activity Guidelines for Americans</i> by Cardiovascular Disease Status — United States, 2012 and 2017
Authors: John D Omura, Eric T Hyde, Fleetwood Loustalot, Janet E Fulton, Susan A Carlson
Journal: Circulation (2019)

Introduction: Physical activity can help prevent and manage cardiovascular disease (CVD), and is one of the AHA Life’s Simple 7 metrics. Recent behavioral recommendations have specifically targeted physical activity for adults at high risk for CVD. For example, in 2014 the US Preventive Services Task Force recommended intensive behavioral counseling interventions for adults with cardiovascular risk factors. Our purpose was to examine the magnitude of differences in prevalence of meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans by CVD status over five years. Methods: Nationally representative self-reported data from the 2012 and 2017 National Health Interview Survey (N=32,568 and N=25,258 respectively) were analyzed. Prevalence of meeting the aerobic guideline was estimated overall and by CVD status (no CVD/not at risk; at risk for CVD: overweight or has obesity and ≥1 of diabetes, high cholesterol, or hypertension; or having CVD). T-tests were used to identify significant differences. Results: Similar differences in age-adjusted prevalence of meeting the aerobic guideline were observed across CVD statuses in both 2012 and 2017, with adults with no CVD and not at risk having the highest prevalence (57.7% in 2017) and those with CVD having the lowest prevalence (38.5% in 2017) (p&lt;0.05). From 2012 to 2017, prevalence increased significantly overall (7.8%), among those with no CVD and not at risk (7.8%), and among those at risk (13.0%) (p&lt;0.001). Among those with CVD, the increase (8.5%) was not significant. Conclusions: Prevalence of meeting the aerobic guideline showed significant improvement among adults with better CVD statuses; however, only about half of those at risk and 39% of those with CVD currently meet the aerobic guideline. The anticipated release of the 2 nd edition of the Physical Activity Guidelines presents an important opportunity for promoting physical activity. Efforts to identify and address the barriers those with higher CVD risk face could help prevent or manage CVD.
Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report
Authors: Vanessa M. McDonald, James Fingleton, Alvar Agusti, Sarah A. Hiles, Vanessa L. Clark, Anne E. Holland, Guy B. Marks, Philip P. Bardin, Richard Beasley, Ian D. Pavord, Peter A.B. Wark, Peter G. Gibson
Journal: European Respiratory Journal (2019)

“Treatable traits” have been proposed as a new paradigm for the management of airway diseases, particularly complex disease, which aims to apply personalised medicine to each individual to improve outcomes. Moving new treatment approaches from concepts to practice is challenging, but necessary. In an effort to accelerate progress in research and practice relating to the treatable traits approach, the Treatable Traits Down Under International Workshop was convened in Melbourne, Australia in May 2018. Here, we report the key concepts and research questions that emerged in discussions during the meeting. We propose a programme of research that involves gaining international consensus on candidate traits, recognising the prevalence of traits, and identifying a potential hierarchy of traits based on their clinical impact and responsiveness to treatment. We also reflect on research methods and designs that can generate new knowledge related to efficacy of the treatable traits approach and consider multidisciplinary models of care that may aid its implementation into practice.
CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions
Authors: H.J. Prins, Ruud Duijkers, Paul van der Valk, Marianne Schoorl, Johannes M.A. Daniels, Tjip S. van der Werf, Wim G. Boersma
Journal: European Respiratory Journal (2019)

The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription. Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L −1 ). In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted odds ratio (OR) 0.178, 95% CI 0.077–0.411, p=0.029). The 30-day treatment failure rate was nearly equal (44.5% in the CRP group versus 45.5% in the GOLD-group, p=0.881; adjusted OR 1.146, 95% CI 0.649–1.187, p=0.630), as was the time to next exacerbation (32 days in the CRP group versus 28 days in the GOLD group, p=0.713; adjusted hazard ratio 0.878, 95% CI 0.649–1.187, p=0.398). Length of stay was similar in both groups (7 days in the CRP group versus 6 days in the GOLD group, p=0.206). On day-30, no difference in symptom score, quality of life or serious adverse events was detected. Use of CRP as a biomarker to guide antibiotic treatment in severe acute exacerbations of COPD leads to a significant reduction in antibiotic treatment. In the present study, no differences in adverse events between both groups were found. Further research is needed for the generalisability of these findings.
Outcomes of patients with multiple myeloma refractory to CD38-targeted monoclonal antibody therapy
Authors: Ujjawal H. Gandhi, Robert F. Cornell, Arjun Lakshman, Zhubin J. Gahvari, Elizabeth McGehee, Megan H. Jagosky, Ridhi Gupta, William Varnado, Mark A. Fiala, Saurabh Chhabra, Ehsan Malek, Joshua Mansour, Barry Paul, Alyssa Barnstead, Saranya Kodali, Amarendra Neppalli, Michaela Liedtke, Swapna Narayana, Kelly N. Godby, Yubin Kang, Ankit Kansagra, Elvira Umyarova, Emma C. Scott, Parameswaran Hari, Ravi Vij, Saad Z. Usmani, Natalie S. Callander, Shaji K. Kumar, Luciano J. Costa
Journal: Leukemia (2019)
Abstract P127: Years of Life Lost Due to Cardiovascular Disease Among Asian American Subgroups, 2003-2012
Authors: Divya Iyer, Latha Palaniappan
Journal: Circulation (2019)

Introduction: Asian American subgroups (Asian Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display significant differences in mortality due to cardiovascular disease. It has previously been proposed that cancer is the leading cause of death for all Asian Americans. However, recent analysis of each individual subgroup reveals that heart disease is actually the leading cause of death for Asian Indian, Filipino and Japanese populations. Additionally, certain Asian American subgroups have an increased burden of risk factors and disease mortality at younger ages when compared to Non-Hispanic Whites. Years of potential life lost (YPLL) provides a measure of premature mortality due to cardiovascular disease by taking into account race-specific life expectancy and the younger age at death that is specific to Asian American populations. Hypothesis: We assessed the hypothesis that certain subgroups, such as Asian Indian and Filipino populations, lost more years of life due to cardiovascular disease when compared to other Asian American subgroups and Non-Hispanic Whites. Methods: We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003-2012. Sample size for Asian Americans was 354,256 and for Non-Hispanic Whites was 19,722,445. We calculated life expectancy, mean YPLL, and YPLL per 100,000 population for each Asian subgroup. We further characterized race-specific life expectancy using linear interpolation, and YPLL per 100,000 was standardized and age-adjusted using age categories. Results: Asian American subgroups display heterogeneity in cardiovascular disease burden. Asian Indians had a high burden of ischemic heart disease (IHD); Asian Indian men lost a mean of 17 years of life to IHD while Japanese and Non-Hispanic White men lost 14 years of life. Regarding cerebrovascular disease, Vietnamese populations lost a mean of 17 years of life, and Filipino populations lost a mean of 16 years. All Asian subgroups had higher years of life lost to cerebrovascular disease compared to Non-Hispanic Whites. Conclusion: Cardiovascular disease burden varies among Asian subgroups, and contributes to significant premature mortality in certain populations. Asian Indian and Filipino populations have the highest years of life lost due to ischemic heart disease. Filipino and Vietnamese have the highest years of life lost due to cerebrovascular disease. Mean YPLL due to cardiovascular disease was higher for Asian Indians, Korean, Vietnamese, and Filipino subgroups than mean YPLL for Non-Hispanic Whites. To address these health disparities, an analysis of risk factors is required and subgroup-specific interventions must be developed.
A deep neural network improves endoscopic detection of early gastric cancer without blind spots
Authors: Lianlian Wu, Wei Zhou, Xinyue Wan, Jun Zhang, Lei Shen, Shan Hu, Qianshan Ding, Ganggang Mu, Anning Yin, Xu Huang, Jun Liu, Xiaoda Jiang, Zhengqiang Wang, Yunchao Deng, Mei Liu, Rong Lin, Tingsheng Ling, Peng Li, Qi Wu, Peng Jin, Jie Chen, Honggang Yu
Journal: Endoscopy (2019)

Abstract Background Gastric cancer is the third most lethal malignancy worldwide. A novel deep convolution neural network (DCNN) to perform visual tasks has been recently developed. The aim of this study was to build a system using the DCNN to detect early gastric cancer (EGC) without blind spots during esophagogastroduodenoscopy (EGD). Methods 3170 gastric cancer and 5981 benign images were collected to train the DCNN to detect EGC. A total of 24549 images from different parts of stomach were collected to train the DCNN to monitor blind spots. Class activation maps were developed to automatically cover suspicious cancerous regions. A grid model for the stomach was used to indicate the existence of blind spots in unprocessed EGD videos. Results The DCNN identified EGC from non-malignancy with an accuracy of 92.5 %, a sensitivity of 94.0 %, a specificity of 91.0 %, a positive predictive value of 91.3 %, and a negative predictive value of 93.8 %, outperforming all levels of endoscopists. In the task of classifying gastric locations into 10 or 26 parts, the DCNN achieved an accuracy of 90 % or 65.9 %, on a par with the performance of experts. In real-time unprocessed EGD videos, the DCNN achieved automated performance for detecting EGC and monitoring blind spots. Conclusions We developed a system based on a DCNN to accurately detect EGC and recognize gastric locations better than endoscopists, and proactively track suspicious cancerous lesions and monitor blind spots during EGD.
Abstract P231: Sugar-Sweetened Beverage Consumption is Associated with Higher Circulating Ceramide Concentrations in the Framingham Offspring Cohort
Authors: Maura E Walker, Vanessa Xanthakis, Lynn L Moore, Vasan Ramachandran, Paul F Jacques
Journal: Circulation (2019)

Introduction: Ceramides are a class of sphingolipid that have been implicated in the pathogenesis of cardiometabolic diseases, and their circulating concentrations may be affected by foods that can alter hepatic lipid metabolism. We hypothesized that sugar-sweetened beverage (SSB) consumption may influence plasma concentrations of three ceramide species. Methods: Framingham Offspring cohort participants (N=2142; mean age, 65 years; 57% women) were categorized based on SSB consumption, as non-consumers (0 to &lt; 1 serving/month), occasional consumers (1 serving/month to &lt;1 serving/week), frequent consumers (1 serving/week to &lt;1 serving/day), and daily consumers (≥1 serving/day). Plasma ceramide concentrations were assayed using a validated LC-MS/MS protocol. Multivariable linear regression models related frequency of SSB consumption to plasma ceramide concentrations (C16:0, C22:0, and C24:0), and to ceramide ratios (C22:0/C16:0 and C24:0/C16:0). Models adjusted for age, sex, smoking status, use of lipid-lowering medication, total energy, alcohol, diet quality, physical activity, and BMI. We explored if the SSB effects were modified by use of lipid-lowering medication, BMI (&lt; 25 vs ≥ 25), or diabetes status (pre-diabetic/diabetic vs non-diabetic). Analyses were repeated using mean cumulative SSB consumption reflective of usual intake over 14 years. Results: Approximately 49% of participants were non-consumers, 20% occasional consumers, 25% frequent consumers, and 6% daily consumers, of SSBs. On average daily SSB consumers were younger, more likely to be men, more likely to smoke, had a lower diet quality, and were slightly more physically active (P trend &lt;0.05). Concentrations (LS mean [95% CI] μg/mL) of the C16:0 ceramide were 0.163 [0.161, 0.166] for non-consumers and 0.169 [0.163, 0.175] for daily consumers (P trend &lt;0.05). Concentrations of the C22:0 ceramide were 0.601 [0.599, 0.620] for non-consumers and 0.634 [0.604, 0.664] for daily consumers (P trend &lt;0.05). There were no statistically significant associations between SSB consumption and plasma concentrations of the C24:0 ceramide or with ceramide ratios (C22:0/C16:0 and C24:0/C16:0). None of the interactions evaluated were statistically significant. Results of analyses using mean cumulative SSB consumption were similar but additionally indicated a significant positive association with concentrations of the C24:0 ceramide; concentrations were 2.252 [2.193, 2.312] for non-consumers and 2.428 [2.313, 2.542] for daily consumers (P trend &lt;0.05). Conclusion: In our cross-sectional community-based sample of middle-aged adults, SSB consumption was positively associated with plasma concentrations of several ceramide species but not with ceramide ratios. This study may help to elucidate mechanisms mediating the association between SSB consumption and higher risk of cardiometabolic diseases.
Conversion of T-Effector Cells to Immunosuppressive T-Regulatory-like Cells By CRISPR/Cas9-Mediated Integration of a FOXP3 Transgene
Authors: Yuchi Honaker, Yufei Xiang, Logan Fisher, Karen Sommer, Troy R. Torgerson, Andrew M. Scharenberg, David J. Rawlings
Journal: Blood (2018)
Мини-инвазивные технологии в лечении стеноза пилоробульбарной зоны язвенного генеза
Authors: V.M. Ratchik, S.O. Tarabarov, N.V. Prolom
Journal: GASTROENTEROLOGY (2019)

Цель. Разработка тактики мини-инвазивного лечения больных с пилородуоденальным стенозом язвенной этиологии. Материалы и методы. В отделении хирургии органов пищеварения ГУ «Институт гастроэнтерологии НАМН Украины» в 2015–2018 годах проведено лечение 36 больных со стенозом пилородуоденальной зоны язвенного генеза с использованием эндоскопической, комбинированной лапароэндоскопической и лапароскопической оперативной техники; среди них изолированная эндоскопическая баллонная пилородуоденопластика выполнялась у 27 пациентов, комбинированные лапароэндоскопические вмешательства — у 9 больных. Мужчин было 24, женщин — 12. Средний возраст — (45,3 ± 5,2) года. Результаты. У 7 пациентов (19,5 %) диагностирован компенсированный стеноз, у 21 пациента (58,3 %) — субкомпенсированный стеноз, у 8 больных (22,2 %) — декомпенсированный стеноз. В ходе исследования были уточнены известные и разработаны новые показания к выполнению эндоскопической баллонной пилородуоденопластики и комбинированного лапароэндоскопического вмешательства, выполненных у всех пациентов в зависимости от степени сужения выходного отдела желудка. Осложнения в ближайшем послеоперационном периоде возникли у 1 больного (2,7 %) в виде перфорации зоны дилатации. Летальных исходов не было. Отдаленный период наблюдения составил 7–12 месяцев. Эндоскопических, рентгенологических и клинических признаков рецидива язвенной болезни и стеноза не выявлено. Выводы. Метод мини-инвазивного эндоскопического и комбинированного лапароэндоскопического вмешательства в лечении стеноза пилородуоденальной зоны язвенного генеза характеризуется минимальным числом осложнений, имеет хорошие показатели эффективности и отсутствие рецидивов заболевания в отдаленном периоде.