tbuckley/cabot-search huggingface dataset:
Hypomethylating agents as first-line therapy in acute myeloid leukemia (AML).
Authors: Samuel D Bailey, Zartash Gul, Stacey A. Slone, Emily Marie Van Meter, Amber Lawson, Ali Raufi, John W. Hayslip, Gregory Monohan, Dianna S. Howard, Kevin T. McDonagh, Zaid Alkadhimi
Journal: Journal of Clinical Oncology (2013)

7084 Background: Hypomethylating agents are used in older AML patients (pts) who are not considered candidates for standard induction therapy. However, data regarding their efficacy remains unclear. Methods: We retrospectively evaluated a cohort of 24 consecutive AML pts who were placed on hypomethylation therapy at diagnosis between October 2010 and June 2012 at Markey Cancer Center. Results: Baseline characteristics of the patients are described in table 1. Response rate (CR+PR) was 45.8%. Median number of infections were 1 (8 pts), 2 (5 pts), 3 (4 pts).Median hospital admissions required were 1 (10 pts), 2 (4 pts), 3 (5 pts), 4 or greater (2 pts). Average length of hospital stay was 10.3 days (0-37 days). Median units of packed red cell and platelet transfusions were 10 and 11 units (Range=0-64 and 0-78) respectively. After a median follow up of 145.5 days, 13 pts had died. Cause of death was AML (6 pts), infection and end organ failure (7pts).Median overall survival (OS) was 9.7 months (95%CI: 3.2-16.5 months). On multivariate analysis, blast count less than 30% was borderline significantly associated with better OS (P=0.05). However after addition of average hospital stay in the model only age (HR=1.3, CI=1.06- 1.67), gender (HR=11.5, CI=1.2, 110.5), and average hospital stay were significantly associated with OS (HR=1.2, CI = 1.04- 1.32). Conclusions: In this cohort of pts the median OS was 9.7 months. Older pts and those with longer average hospital stay had a higher mortality. Better selection of pts in a larger cohort who are likely to gain more benefit from these agents may impact outcomes. [Table: see text]
Subpopulations of cells from bronchoalveolar lavage can predict prognosis in sarcoidosis
Authors: Pernilla Darlington, Susanna Kullberg, Anders Eklund, Johan Grunewald
Journal: European Respiratory Journal (2019)

<b>The higher the proportion of a T-cell subset (CD4<sup>+</sup>Vα2.3<sup>+</sup> T-cells) in bronchoalveolar lavage fluid of sarcoidosis patients, the better the prognosis and therefore it may be used as an additional prognostic tool</b>http://bit.ly/2Mta0Cs
The development of an instrument to identify cancer caregivers at risk for metabolic syndrome.
Authors: Reyna Jones, Debra Moore, David A. Geller, Jessica Miceli, Carol Lynn Hecht, Michael Spring, Ritambhara Pathak, Qi Chen, Jennifer Lynne Steel
Journal: Journal of Clinical Oncology (2019)

e23174 Background: Cancer caregivers are at increased risk for cardiovascular disease. The aims of the present study were to develop an instrument to identify cancer caregivers at risk for the development of cardiovascular disease. Methods: Cancer caregivers were enrolled in a prospective study examining predictors of metabolic syndrome. Predictors included perceived stress, caregiver stress, depression, hostility, physical activity, diet, alcohol and tobacco use, social support and relationship with the patient. Regression analyses and factor analyses was performed to reduce the number of items to develop an instrument that would identify cancer caregivers at risk for cardiovascular disease. Internal consistency and Area Under the Receiver Operator Curve was also performed to test the new instrument. Results: A total of 111 caregivers were included in the analyses. The mean age of caregivers was 59.6 ( SD= 12.7) and the majority of caregivers were female (74.8%), Caucasian (94.6%), and were the spouse of the cancer patient (65.8%).Using regression analyses, the items from the caregiver stress, hostility, and social support questionnaires were most likely to predict metabolic syndrome. Preliminary findings suggest that a 35-item instrument was predictive of metabolic syndrome [B = 0.067, HR = 1.07, p = 0.001]. The reliability of the instrument was good with a Cronbach Alpha = 0.83. The Area Under the Receiver Operator Curve was also fair (AUROC = 0.703; 95% CI = 0.597-0.808, p = 0.001). Based on the AUROC, the best cut point to detect metabolic syndrome would be a score of 24 (Sensitivity = 0.75 and Specificity = 0.55). Conclusions: Preliminary findings suggest that this 35-item questionnaire may be useful in identifying cancer caregivers at risk for metabolic syndrome, an intermediate endpoint for cardiovascular disease. The questionnaire may be used to screen cancer caregivers for interventions to reduce metabolic syndrome.
Development and Implementation of a Hands-on Surgical Pipeline Program for Low-Income High School Students
Authors: Serena S. Bidwell, Miquell O. Miller, Edmund W. Lee, Kirbi Yelorda, Sonia Koshy, Mary Hawn, Arden M. Morris
Journal: JAMA Network Open (2019)

Students belonging to racial/ethnic minority groups continue to be underrepresented among medical school applicants, matriculates, and graduates.1 While existing pipeline programs for students who are underrepresented in medicine engage them in biomedicine at the undergraduate level, efforts to promote diversity in the medical workforce may be more effective during the years from kindergarten through 12th grade.2 We created a summer pipeline program focused on surgery, invited participation by students from low-income high schools, and queried students’ self-efficacy, interest, and perceived barriers in this convergent mixed-methods study. Our emphasis on surgery was intended to address the lower percentage of physicians from underrepresented groups in medical subspecialties.3,4,5
ELAN-ONCOVAL (Elderly Head and Neck Cancer-Oncology Evaluation) study: Evaluation of the G8 screening tool and the ELAN geriatric evaluation (EGE) for elderly patients (pts) with head and neck squamous cell carcinomas (HNSCC).
Authors: Cécile Mertens, Hervé Le Caer, Cécile Ortholan, Emmanuel Blot, Caroline Even, Hubert Rousselot, Frederic Peyrade, Christian Sire, Didier Cupissol, Yoann Pointreau, Philippe Debourdeau, Frederic Rolland, Jerome Fayette, Olivier Capitain, Xu Shan Sun, Moufida Debbah, Rabia Boulahssass, Dominique Schwob, Anne Auperin, Joel Guigay
Journal: Journal of Clinical Oncology (2019)

11541 Background: About 47% and 10% of HNSCC occur in pts aged ≥65 or ≥80 respectively. This population being heterogeneous, balancing efficacy with toxicity is challenging. As the G8 screening tool includes 3 nutritional items, we need to evaluate its usefulness in HNSCC pts and to establish an adapted tool for HNSCC pts. Methods: ONCOVAL is the first step of the ELAN program for pts ≥70 with HNSCC not amenable to surgery. Pts were assessed for geriatric frailties before inclusion in appropriate trials (ELAN-RT, FIT, UNFIT) depending on curative or palliative setting and fit or unfit status. The aim was to evaluate the G8 tool and EGE usable by oncologists to classify pts as fit or unfit. The EGE was elaborated by the French GERICO group for HNSCC pts, evaluating functional status, comorbidity, cognition/mood, social status. To estimate sensitivity and specificity of G8 and EGE, we used comprehensive geriatric assessment (CGA) performed by geriatricians as gold standard. Results: From 06/2013 to 08/2018, 633 pts were included in 44 centers. Data are available for 613 pts. Median age 79 years (70-97) with 45% ≥ 80. 75% males. G8 score was ≤14, i.e. at risk of geriatric frailty, in 82% pts. Assessment by EGE was done by physicians (64%), nurses (11%), ELAN staff (21%) in 20 minutes of median time. After EGE, oncologists classified 71% pts as unfit. 49% of pts were assessed by CGA. The G8 score with cut-off ≤ 14 has sensitivity 91% and specificity 30%. Lowering cut-off to 12 increased specificity to 56% but decreased sensitivity to 75%. Sensitivity of EGE was 95% and specificity 60%. Multidisciplinary interventions were more frequently implemented in pts assessed by geriatricians than in others (71% vs 47%), even after adjusting for frailty. 58% of pts included in ONCOVAL were further included in ELAN therapeutic trials. Assessment by geriatricians did not modify the rate of inclusion in trials. Conclusions: The G8 screening tool is not appropriate for HNSCC pts. The EGE was feasible and had better sensitivity and specificity. Oncologists and geriatricians must continue such collaboration to propose tailored treatments. Clinical trial information: NCT03614936.
Comment on Elliott et al. Prevalence and Prognosis of Unrecognized Myocardial Infarction in Asymptomatic Patients With Diabetes: A Two-Center Study With Up to 5 Years of Follow-up. Diabetes Care 2019;42:1290–1296
Authors: José Milei, Francisco Azzato, Gastón A. Rodriguez-Granillo
Journal: Diabetes Care (2019)

In a recently published article, Elliott et al. (1) determined the prevalence and prognostic significance of unrecognized myocardial infarction (MI) by delayed-enhancement MRI in asymptomatic patients with diabetes without known cardiac disease. Data from the cohort were collected under rigid methodological conditions with very low loss to follow-up and appropriate statistical data analysis. The authors concluded that unnoticeable MI is prevalent in asymptomatic patients with diabetes and confers a markedly increased risk of death and clinical MI, providing significant incremental prognostic value over traditional variables.

These data are welcome given the need for improvements in risk prediction models for patients …
Features of clinical course of vulva cancer in reproductive patients.
Authors: Ekaterina Nerodo, Galina A. Nerodo
Journal: Journal of Clinical Oncology (2012)

e15519 Background: The significant increase of vulva cancer patients in young and middle age is observed during the last ten years. Methods: To compare the clinical course of vulva cancer in reproductive patients (under 50 years of age) with the one in elderly agewe performed the comparative analysis of clinical characteristics of 839 vulva cancer patients, aged 20-90, with stages I-IV carcinoma who underwent standard complex antitumour treatment. Results: The reproductive group included 64 patients (7.6%), 775 patients (92.4%) were over 50 years. These included prevailed groups of 61-70 years of age – 38% and 71-80 years of age – 34%. Early stages of the disease were observed in 48% of all cases, st. III-IV – in 52%. In the reproductive group st. I was observed in 18.75%, st. II – 51.56%, st. III – 23.43%, st. IV – 6.25%. 70.03% patients of reproductive age had early stages of the disease, that is significantly higher than in the group of elderly patients: 51-70 years of age – 55%, 71-80 years of age – 40%, more than 80 years of age – only 25%(p&lt;0.05). Age characteristics of vulva cancer patients in reproductive group were the following: 20-30 years of age – 10.9%, 31-40 years of age – 32.8%, 41-50 years of age – 56.25%. Organ-preserving operations carried out according to strict individual indications were performed to 35 sexually active patients in early stages. Relapses of the disease were revealed in 11 patients out of 64 (17%) in the reproductive group, and in 180 out of 775 (23.2%) patients in the elderly group(p&lt;0,05) Relapses occurred in 8% of reproductive patients with st. I of the disease, st. II – 9%, st. III – 46%. Med locoregional free-survival was in st.I-72,3 mon. ,in st. II-61,3 mon., in st III-17,3 mon. All patients with inoperable tumour relapse underwent chemotherapy with subsequent tumour removal. Conclusions: Vulva cancer in patients of reproductive age is revealed in early stages more often that in elderly patients. There is a possibility to perform organ-preserving operations in young patients, which doesn't lead to relapse increase.
Shared epitope defines distinct associations of cigarette smoking with levels of anticitrullinated protein antibody and rheumatoid factor
Authors: Yuki Ishikawa, Katsunori Ikari, Motomu Hashimoto, Koichiro Ohmura, Masao Tanaka, Hiromu Ito, Atsuo Taniguchi, Hisashi Yamanaka, Tsuneyo Mimori, Chikashi Terao
Journal: Annals of the Rheumatic Diseases (2019)

Although the association of cigarette smoking (CS) with susceptibility to rheumatoid arthritis (RA) has been established, the impact of CS on anticitrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) levels in RA has yet been clear, especially in relation to shared epitope (SE) alleles.A total of 6239 subjects, the largest Asian study ever, from two independent Japanese cohorts were enrolled. Precise smoking histories, levels of ACPA and RF, and HLA-DRB1 allele status were withdrawn from databases. Associations between CS and high ACPA or RF levels, defined by the top quartiles, were evaluated. The effect of HLA-DRB1 alleles on the association was further investigated.CS at RA onset conferred the risks of high levels of both antibodies, especially RF (OR 2.06, p=7.4×10-14; ACPA, OR 1.29, p=0.012), suggesting that RF level is more sensitive to CS than ACPA level. The patients who had quitted CS before RA onset showed a trend of decreased risks of developing high levels of ACPA or RF, and the risks steadily decreased according to the cessation years. The association of CS with high ACPA level was observed only in subjects carrying SE alleles, while the association of high RF level was observed regardless of SE.CS confers the risks of high autoantibody levels in RA in different manners; CS interacts with SE alleles on ACPA level, while CS impacts on RF level despite SE allele. These data suggest novel distinct production mechanisms of RF and ACPA.
DNR patterns in cancer patients (pts) 16 years after the Patient Self Determination Act (PSDA)
Authors: P. R. Helft, R. Qi, B. P. Brown, K. Drabiak, E. D. Morrell
Journal: Journal of Clinical Oncology (2007)

6582 Background: In 1991, the PSDA required institutions receiving federal funding to inform pts about the right to refuse life prolonging treatments such as CPR. Studies conducted around 1991 suggest that most DNR orders are written by oncologists less than 3 days prior to death in hospitalized pts, raising ethical concerns. 16 years later, are oncology clinicians writing DNR orders earlier in cancer pts’ hospital course compared to non-cancer pts? Methods: We conducted a chart review of 284 of the 296 total adult deaths during 2005 at Indiana University Hospital. Demographic, diagnostic, and attending service info was collected from hospital billing records. Pts’ DNR status, timing of DNR orders, and presence of a written advanced directive (AD) were assessed through chart review. Results: 76 of 284 (26.8%) patients had cancer diagnoses. Of these, 59 had documented DNR orders. There was no difference in presence or absence of DNR orders at the time of death for cancer vs. non-cancer pts (77.6 vs 72.7%, p=0.35). Mean time from writing of the DNR order to death was 3.51 ± 4.61 days for cancer pts compared to 3.26 ±3.81 days for non-cancer pts (p=0.40), however, the majority of DNR orders written by oncologists were written less than 2 days prior to death. We calculated a ratio of the time between DNR order writing and death to the overall length of stay for cancer and non-cancer pts, excluding pts with very short lengths of stay ( = 5 days). In univariate analyses, this ratio trended toward statistical significance (p=0.08). In multivariate analyses, cancer pts had a higher ratio of the time between DNR order and death to LOS (0.30 vs 0.21, p=0.05). Existence of an AD had no significant impact on this ratio. Surgical specialists wrote DNR orders less frequently (64.2 vs 77.3%, p=0.02) and later than non-surgical specialists (mean 21 vs 10 days from admission, p=0.0008). Conclusions: In this study, DNR ordering patterns among hospitalized cancer and non-cancer pts have changed little since the PSDA. Although cancer pts on average had DNR orders written relatively earlier in their terminal hospital stay than non-cancer pts, the timing varied little from pts in prior studies. Although the majority of hospitalized pts in this sample died with DNR orders, these orders were written very late in their hospital stay. No significant financial relationships to disclose.
Adjuvant Whole-Brain Radiation Therapy Compared With Observation After Local Treatment of Melanoma Brain Metastases: A Multicenter, Randomized Phase III Trial
Authors: Angela M. Hong, Gerald B. Fogarty, Kari Dolven-Jacobsen, Bryan H. Burmeister, Serigne N. Lo, Lauren E. Haydu, Janette L. Vardy, Anna K. Nowak, Haryana M. Dhillon, Tasnia Ahmed, Brindha Shivalingam, Georgina V. Long, Alexander M. Menzies, George Hruby, Katharine J. Drummond, Catherine Mandel, Mark R. Middleton, Claudius H. Reisse, Elizabeth J. Paton, Victoria Steel, Narelle C. Williams, Richard A. Scolyer, Rachael L. Morton, John F. Thompson
Journal: Journal of Clinical Oncology (2019)

The brain is a common site of metastasis for patients with high-risk melanoma. Although surgery or stereotactic radiosurgery are highly effective local treatments for a small number of metastases, there is a high risk of developing additional brain metastases. The role of adjuvant whole-brain radiotherapy (WBRT) in reducing new metastases is controversial, with a lack of high-level evidence specifically for melanoma.In this randomized phase III trial, patients who had local treatment of one to three melanoma brain metastases were randomly assigned to WBRT or observation. The primary end point was distant intracranial failure within 12 months, and secondary end points included time to intracranial failure, survival, and time to deterioration in performance status.Between April 2009 and September 2017, 215 patients were randomly assigned from 24 centers. Median follow-up was 48.1 months (range, 39.6 to 68 months). Forty-two percent of patients in the WBRT group and 50.5% of those in the observation developed distant intracranial failure within 12 months (odds ratio, 0.71; 95% CI, 0.41 to 1.23; P = .22) and the rates over the entire follow-up period were 52.0% and 57.9%, respectively (odds ratio, 0.79; 95% CI, 0.45 to 1.36; P = .39). Local failure rate was lower after WBRT (20.0% v 33.6%; P = .03). At 12 months, 41.5% of patients in the WBRT group and 51.4% of patients in the observation group had died (P = .28), with no difference in the rate of neurologic death. Median time to deterioration in performance status was 3.8 months after WBRT and 4.4 months with observation (P = .32). WBRT was associated with more grade 1 to 2 acute toxicity.After local treatment of one to three melanoma brain metastases, adjuvant WBRT does not provide clinical benefit in terms of distant intracranial control, survival, or preservation of performance status.
Pancreas–Microbiota Cross Talk in Health and Disease
Authors: Timon E. Adolph, Lisa Mayr, Felix Grabherr, Julian Schwärzler, Herbert Tilg
Journal: Annual Review of Nutrition (2019)

The pancreas controls metabolism through endocrine and exocrine functions. Pancreatic diseases comprise a spectrum of mild to life-threatening conditions, including acute and chronic pancreatitis, diabetes, and pancreatic cancer, which affect endocrine and exocrine pancreatic function and impose a substantial disease burden on individuals. Increasing experimental evidence demonstrates that the intestinal microbiota has an important impact on pancreatic function and diseases. This influence may be conferred by bacterial metabolites, such as short-chain fatty acids, or the modulation of immune responses. In turn, pancreatic factors, such as the excretion of antimicrobials, might have a substantial impact on the composition and functional properties of the gut microbiota. Here, we summarize experimental and clinical approaches used to untie the intricate pancreas–microbiota cross talk. Future advances will allow clinicians to manipulate the intestinal microbiota and guide patient management in pancreatic diseases.
Disclosure of Interests and Management of Conflicts of Interest in Clinical Guidelines and Guidance Statements: Methods From the Clinical Guidelines Committee of the American College of Physicians
Authors: Amir Qaseem, Timothy J. Wilt
Journal: Annals of Internal Medicine (2019)

One of the hallmarks of a trustworthy clinical guideline or guidance statement is a comprehensive process for disclosure of interests (DOI) and management of conflicts of interest (COIs). The American College of Physicians (ACP) Clinical Guidelines Committee (CGC) aims to disclose all health care–related interests and manage conflicts in a manner that is transparent, proportional, and consistent. Any person involved in the development of an ACP clinical guideline or guidance statement must disclose all financial and intellectual interests related to health care from the previous 3 years. Persons complete disclosures at the start of their participation and are required to update them over the course of their involvement with the CGC, including before each CGC meeting. A DOI-COI Review and Management Panel reviews the disclosures; flags potential conflicts; grades the COI as low-, moderate-, or high-level; and manages the person's participation accordingly. A high-level COI results in recusal from authorship, voting, and all committee discussions. Participants with a moderate-level COI are recused from authorship and voting for clinically relevant topics but may participate in all discussions. A low-level COI results in no role restrictions. All disclosures and COI management decisions are publicly reported.