tbuckley/cabot-search huggingface dataset:
Insurance status and survival of multiple myeloma (MM) patients.
Authors: Kamal Chamoun, Marcos J.G. De Lima, Paolo Fabrizio Caimi, Pingfu Fu, Shufen Cao, Folashade Otegbeye, Seema Patel, Naveed Ali, Stanton L. Gerson, Kirsten M Boughan, Ravi Kumar Kyasaram, Ehsan Malek
Journal: Journal of Clinical Oncology (2019)

LBA107 Background: MM is often treated with oral antineoplastic medications (OAM). OAM prices have been rapidly escalating and there are well-described issues with affordability (Shih et al. JCO 2017). We therefore hypothesized that insurance status influences MM patients (pts) survival and interrogated the National Cancer Database (NCDB) to test this hypothesis. Methods: NCDB houses data on 70% of cancer pts in the USA. Data from 117,926 MM pts diagnosed between year 2005 and 2014 was analyzed. Primary outcome was overall survival (OS) which was analyzed using Kaplan-Meier method and Cox model. Results: Median age at diagnosis was 67 years (19-90); 55% were males. 57% of pts lived in areas where the median income was &lt; $46k/year (individual income data was not available); Primary insurance was Medicare (52%), private insurance (35%) or Medicaid (5%), and 3% were uninsured. 40% were treated in academic institutions. Median follow up was 30 months (0-145). By univariate analysis, better OS was observed in pts with primary MM, lower Charlson Comorbidity Index (CCI), treatment in academic institutions, higher median regional income, or private insurance ( p&lt;0.0001 for all). Median age of pts on Medicare, private insurance, Medicaid, or those without insurance was 74, 57, 58, and 57 years, respectively. When restricting the analysis to pts ≥ 65 years old, pts with private insurance had longer OS compared to Medicare pts (p&lt;0.0001). The table shows the results of MV analysis. Conclusions: Insurance type and regional income are associated with MM survival. This may be related to affordability of OAM and merits further investigation. [Table: see text]
Abstract 1979: Association of Renal Dysfunction, Myocardial Fibrosis and Survival in Patients with Severe Left Ventricular Dysfunction: A Delayed Hyperenhancement MRI Study
Authors: Carmel M Halley, Deborah H Kwon, Thomas P Carrigan, Randolph Setser, Paul Schoenhagen, Randall Starling, Scott D Flamm, Milind Y Desai
Journal: Circulation (2007)

Background: Both renal dysfunction and severe left ventricular (LV) systolic dysfunction lead to reduced survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately detects myocardial fibrosis (scar), seen commonly in patients with severe left ventricular (LV) dysfunction. We sought to determine the association of myocardial scar and renal dysfunction on survival in patients with severe LV dysfunction. Methods: We studied 176 consecutive patients (61 ± 13 years, 73 % men) with severe LV systolic dysfunction (mean ejection fraction (24 ± 8 %) who underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2005–6. Myocardial scar was determined visually on DHE-MR images, using custom software (Siemens Research), and defined as intensity &gt;2 standard deviation above viable myocardium. Clinical and laboratory information, along with all-cause mortality, were recorded. Glomerular filtration rate (GFR, ml/min/1.73 m 2 ) was calculated using the following formula: 186 × (serum creatinine −1.154 ) × (age −0.203 ) × 1.212 (if black) × 0.742 (if female). We divided patients into 4 groups: GFR &gt; 60, no scar (n = 28) GFR &gt; 60 with scar (n = 85) GFR ≤ 60, no scar (n = 9) and GFR ≤ 60 with scar (n = 53). Results: There were 24 deaths in the group and 14 patients (65 %) had myocardial scar. Mean GFR was 70 ± 29 and 62 (35 %) patients had at-least moderate renal dysfunction (GFR &lt; 60). Frequency of myocardial scar was higher in patients with GFR ≤ 60 vs. those with GFR &gt; 60 (92 % vs. 79 %, p = 0.02). On multiple regression (including GFR, myocardial scar, coronary artery disease, hypertension, diabetes and coronary bypass), GFR and myocardial scar were associated with mortality (both p value &lt; 0.05, overall model p value &lt; 0.001). There were no deaths in group 1, 7 in group 2, 3 in group 3 and 14 in group 4 (p &lt; 0.001). One year survival was significantly worse for groups 2, 3 and 4, compared to group 1 (log rank p value &lt; 0.001). Conclusion: Renal dysfunction is associated with a higher frequency of myocardial fibrosis in patients with severe LV dysfunction. Presence of renal dysfunction, myocardial fibrosis or both is associated with worse survival in such patients. The mechanistic association between renal dysfunction and myocardial fibrosis needs to be further defined.
Abstract 1480: A Cullin 4a E3 Ligase Complex Mediates Rapid Degradation of the Calcineurin Regulatory Protein MCIP1.4 In Cardiac Myocytes.
Authors: Asim Dey, Joseph A Hill, Beverly A Rothermel
Journal: Circulation (2007)

Background: Activation of the protein phosphatase calcineurin is a fundamental signaling event promoting hypertrophic growth and pathological remodeling of the heart. The modulatory calcineurin-int...
Abstract 17530: Under-Recognized Acute Cerebral Infarction Occurring After the Cardiac Catheterization for the Pre-Op Testing of Cardiothoracic Surgery
Authors: Yoshihiro Takeda, Michishige Ozeki, Tomohiro Fujisaka, Kenichi Shibata, Hideaki Morita, Koichi Sohmiya, Masaaki Hoshiga, Nobukazu Ishizaka
Journal: Circulation (2017)

Background and Methods: Diffusion-weighted imaging of MRI enables us to detect ischemic lesions in its hyperacute phase. In this retrospective study, we have analyzed the frequency of acute cerebra...
Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients With Localized Muscle-Invasive Bladder Cancer
Authors: Stephen B. Williams, Yong Shan, Mohamed D. Ray-Zack, Hogan K. Hudgins, Usama Jazzar, Douglas S. Tyler, Stephen J. Freedland, Todd A. Swanson, Jacques G. Baillargeon, Jim C. Hu, Sapna Kaul, Ashish M. Kamat, John L. Gore, Hemalkumar B. Mehta
Journal: JAMA Surgery (2019)

<h3>Importance</h3> Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. <h3>Objective</h3> To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. <h3>Design, Setting, and Participants</h3> This population-based cohort study used the US Surveillance, Epidemiology, and End Results–Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2011. The data analysis was performed from March 5, 2018, through December 4, 2018. <h3>Main Outcomes and Measures</h3> Total Medicare costs within 1 year of diagnosis following radical cystectomy vs trimodal therapy were compared using inverse probability of treatment–weighted propensity score models that included a 2-part estimator to account for intrinsic selection bias. <h3>Results</h3> Of 2963 participants, 1030 (34.8%) were women, 2591 (87.4%) were white, 129 (4.4%) were African American, and 98 (3.3%) were Hispanic. Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83 754 vs $68 692; median difference, $11 805; 95% CI, $7745-$15 864), 180 days ($187 162 vs $109 078; median difference, $62 370; 95% CI, $55 581-$69 160), and 365 days ($289 142 vs $148 757; median difference, $109 027; 95% CI, $98 692-$119 363), respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On inverse probability of treatment–weighted adjusted analyses, patients undergoing trimodal therapy had $136 935 (95% CI, $122 131-$152 115) higher mean costs compared with radical cystectomy 1 year after diagnosis. <h3>Conclusions and Relevance</h3> Compared with radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. The differences in costs were largely attributed to medication and radiology expenses associated with trimodal therapy. Extrapolating cost figures resulted in a nationwide excess spending of $468 million for trimodal therapy compared with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.
Evaluation of Differences in Individual Treatment Response in Schizophrenia Spectrum Disorders
Authors: Stephanie Winkelbeiner, Stefan Leucht, John M. Kane, Philipp Homan
Journal: JAMA Psychiatry (2019)

An assumption among clinicians and researchers is that patients with schizophrenia vary considerably in their response to antipsychotic drugs in randomized clinical trials (RCTs).To evaluate the overall variation in individual treatment response from random variation by comparing the variability between treatment and control groups.Cochrane Schizophrenia, MEDLINE/PubMed, Embase, PsycINFO, Cochrane CENTRAL, BIOSIS Previews, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform from January 1, 1955, to December 31, 2016.Double-blind, placebo-controlled, RCTs of adults with a diagnosis of schizophrenia spectrum disorders and prescription for licensed antipsychotic drugs.Means and SDs of the Positive and Negative Syndrome Scale pretreatment and posttreatment outcome difference scores were extracted. Data quality and validity were ensured by following the PRISMA guidelines.The outcome measure was the overall variability ratio of treatment to control in a meta-analysis across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model. A personal element of response was hypothesized to be reflected by a substantial overall increase in variability in the treatment group compared with the control group.An RCT was simulated, comprising 30 patients with schizophrenia randomized to either the treatment or the control group. The different components of variation in RCTs were illustrated with simulated data. In addition, we assessed the variability ratio in 52 RCTs involving 15 360 patients with a schizophrenia or schizoaffective diagnosis. The variability was slightly lower in the treatment compared with the control group (variability ratio = 0.97; 95% CI, 0.95-0.99; P = .01).In this study, no evidence was found in RCTs that antipsychotic drugs increased the outcome variance, suggesting no personal element of response to treatment but instead indicating that the variance was slightly lower in the treatment group than in the control group; although the study cannot rule out that subsets of patients respond differently to treatment, it suggests that the average treatment effect is a reasonable assumption for the individual patient.
Undetected Dysglycemia Is an Important Risk Factor for Two Common Diseases, Myocardial Infarction and Periodontitis: A Report From the PAROKRANK Study
Authors: Anna Norhammar, Barbro Kjellström, Natalie Habib, Anders Gustafsson, Björn Klinge, Åke Nygren, Per Näsman, Elisabet Svenungsson, Lars Rydén
Journal: Diabetes Care (2019)

Information on the relationship among dysglycemia (prediabetes or diabetes), myocardial infarction (MI), and periodontitis (PD) is limited. This study tests the hypothesis that undetected dysglycemia is associated with both conditions.The PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study included 805 patients with a first MI and 805 matched control subjects. All participants without diabetes (91%) were examined with an oral glucose tolerance test. Abnormal glucose tolerance (AGT) (impaired glucose tolerance or diabetes) was categorized according to the World Health Organization. Periodontal status was categorized from dental X-rays as healthy (≥80% remaining alveolar bone height), moderate (79-66%), or severe (<66%) PD. Odds ratios (ORs) and 95% CIs were calculated by logistic regression and were adjusted for age, sex, smoking, education, marital status, and explored associated risks of dysglycemia to PD and MI, respectively.AGT was more common in patients than in control subjects (32% vs. 19%; P < 0.001) and was associated with MI (OR 2.03; 95% CI 1.58-2.60). Undetected diabetes was associated with severe PD (2.50; 1.36-4.63) and more strongly in patients (2.35; 1.15-4.80) than in control subjects (1.80; 0.48-6.78), but not when categorized as AGT (total cohort: 1.07; 0.67-1.72). Severe PD was most frequent in subjects with undetected diabetes, and reversely undetected diabetes was most frequent in patients with severe PD.In this large case-control study previously undetected dysglycemia was independently associated to both MI and severe PD. In principal, it doubled the risk of a first MI and of severe PD. This supports the hypothesis that dysglycemia drives two common diseases, MI and PD.
Genomic Evolutionary Patterns of Leiomyosarcoma and Liposarcoma
Authors: Ali Amin-Mansour, Suzanne George, Stefano Sioletic, Scott L. Carter, Mara Rosenberg, Amaro Taylor-Weiner, Chip Stewart, Aaron Chevalier, Sara Seepo, Adam Tracy, Gad Getz, Jason L. Hornick, Marisa R. Nucci, Bradley Quade, George D. Demetri, Chandrajit P. Raut, Levi A. Garraway, Eliezer M. Van Allen, Andrew J. Wagner
Journal: Clinical Cancer Research (2019)

Abstract Purpose: Leiomyosarcoma and liposarcoma are common subtypes of soft tissue sarcoma (STS). Patients with metastatic leiomyosarcoma or dedifferentiated liposarcoma (DDLPS) typically have worse outcomes compared with localized leiomyosarcoma or well-differentiated liposarcoma (WDLPS). A better understanding of genetic changes between primary/metastatic leiomyosarcoma and between WDLPS/DDLPS may provide insight into their genetic evolution. Experimental Design: We interrogated whole-exome sequencing (WES) from “trios” of normal tissue, primary tumor, and metastatic tumor from individual patients with leiomyosarcoma (n = 9), and trios of normal tissue, well-differentiated tumor, and dedifferentiated tumor from individual patients with liposarcoma (n = 19). Specifically, we performed mutational, copy number, and tumor evolution analyses on these cohorts and compared patterns among leiomyosarcoma and liposarcoma trios. Results: Leiomyosarcoma cases harbored shared drivers through a typical parent/child relationship where the metastatic tumor was derived from the primary tumor. In contrast, while all liposarcoma cases shared the characteristic focal chromosome 12 amplicon, most paired liposarcoma cases did not share additional mutations, suggesting a divergent evolutionary pattern from a common precursor. No highly recurrent genomic alterations from WES were identified that could be implicated as driving the progression of disease in either sarcoma subtype. Conclusions: From a genomic perspective, leiomyosarcoma metastases contain genetic alterations that are also found in primary tumors. WDLPS and DDLPS, however, appear to divergently evolve from a common precursor harboring 12q amplification, rather than as a transformation to a higher-grade tumor. Further efforts to identify specific drivers of these distinct evolutionary patterns may inform future translational and clinical research in STS.
Reduced Spending With Mandatory Bundled Payments for Joint Replacements
Authors: Prakash Jayakumar, Kevin J. Bozic
Journal: JAMA Internal Medicine (2019)

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Resumption of Immune Checkpoint Inhibitor Therapy After Immune-Mediated Colitis
Authors: Hamzah Abu-Sbeih, Faisal S. Ali, Abdul Rafeh Naqash, Dwight H. Owen, Sandipkumar Patel, Gregory A. Otterson, Kari Kendra, Biagio Ricciuti, Rita Chiari, Andrea De Giglio, Joseph Sleiman, Pauline Funchain, Beatriz Wills, Jiajia Zhang, Jarushka Naidoo, Jessica Philpott, Jianjun Gao, Sumit K. Subudhi, Yinghong Wang
Journal: Journal of Clinical Oncology (2019)

Immune checkpoint inhibitor (ICI) therapy often is suspended because of immune-mediated diarrhea and colitis (IMDC). We examined the rate of and risk factors for IMDC recurrence after ICI resumption.This retrospective multicenter study examined patients who resumed ICI therapy after improvement of IMDC between January 2010 and November 2018. Univariable and multivariable logistic regression analyses assessed the association of clinical covariates and IMDC recurrence.Of the 167 patients in our analysis, 32 resumed an anti-cytotoxic T-cell lymphocyte-4 (CTLA-4) agent, and 135 an anti-programmed cell death 1 or ligand 1 (PD-1/L1) agent. The median age was 60 years (interquartile range [IQR], 50-69 years). The median duration from IMDC to restart of ICI treatment was 49 days (IQR, 23-136 days). IMDC recurred in 57 patients (34%) overall (44% of those receiving an anti-CTLA-4 and 32% of those receiving an anti-PD-1/L1); 47 of these patients (82%) required immunosuppressive therapy for recurrent IMDC, and all required permanent discontinuation of ICI therapy. The median duration from ICI resumption to IMDC recurrence was 53 days (IQR, 22-138 days). On multivariable logistic regression, patients who received anti-PD-1/L1 therapy at initial IMDC had a higher risk of IMDC recurrence (odds ratio [OR], 3.45; 95% CI, 1.59 to 7.69; P = .002). Risk of IMDC recurrence was higher for patients who required immunosuppression for initial IMDC (OR, 3.22; 95% CI, 1.08 to 9.62; P = .019) or had a longer duration of IMDC symptoms in the initial episode (OR, 1.01; 95% CI, 1.00 to 1.03; P = .031). Risk of IMDC recurrence was lower after resumption of anti-PD-1/L1 therapy than after resumption of anti-CTLA-4 therapy (OR, 0.30; 95% CI, 0.11 to 0.81; P = .019).One third of patients who resumed ICI treatment after IMDC experienced recurrent IMDC. Recurrence of IMDC was less frequent after resumption of anti-PD-1/L1 than after resumption of anti-CTLA-4.
Gastrointestinal anastomosis using a new lumen-apposing metal stent for biliary drainage is a good option in the palliative setting
Authors: N. Soukaïna Chawki, Bertrand Leroy, Bachir Hag, Xavier Roblin, Jean-Marc Phelip, Nicolas Williet
Journal: Endoscopy (2019)

A 74-year-old woman was hospitalized in August 2017 for altered performance status and obstructive cholangitis due to the recurrence of an adenocarcinoma involving the head of the pancreas that had been resected 2 year previously. Disease recurrence was locoregional and causing complete stenosis of the afferent loop, which prevented access to the biliary–digestive anastomosis using an endoscope. This stenosis was responsible for the accumulation of bilirubin in the afferent loop and distension of the biliary ducts ([Fig. 1 a, b]). Antibiotics were started and a percutaneous drain was placed with technical success; however, the patient’s bilirubin level remained high (200 µmol/L) despite a second attempt at drainage on day 3.
Differential lung tissue gene expression in males and females: implications for the susceptibility to develop COPD
Authors: Maarten van den Berge, Corry-Anke Brandsma, Alen Faiz, Maaike de Vries, Senani N.H. Rathnayake, Peter D. Paré, Don D. Sin, Yohan Bossé, Michel Laviolette, David C. Nickle, Ke Hao, Ma'en Obeidat, Tommaso A. Dragani, Francesca Colombo, Wim Timens, Dirkje S. Postma
Journal: European Respiratory Journal (2019)

<b>Sex strongly affects the gene expression profile in lung tissue, and overall reflects the activity of different biological pathways that probably play a role in the susceptibility to develop COPD with smoking</b>http://bit.ly/31drVkX
Qualitative study of bereaved carers’ experiences in advanced melanoma
Authors: J.A. Fox, D. Langbecker, J. Rosenberg, S. Ekberg
Journal: British Journal of Dermatology (2019)

Melanoma is the deadliest form of skin cancer. In Australia, where this study was conducted, there were 1,281 deaths from melanoma in 2016. Treatments for melanoma have changed rapidly in recent years with the introduction of immune and targeted therapies. These have resulted in longer term survival for some, but it is not clear which patients these treatments will work for, and for how long. This study aimed to understand the impact of melanoma treatments, as they relate to diagnosis and prognosis, on the experiences of family carers. Interviews were conducted with twenty carers of patients who were treated at three melanoma centres in Australia and who subsequently died. The study found that diagnosis of advanced melanoma was a time of uncertainty as carers struggled to understand the implications of the diagnosis. Treatment options in the form of relatively new immune and targeted therapies added to uncertainty around prognosis (i.e. the likely outcome, such as chance of survival). Carers reported unclear communication of prognosis by medical specialists. Some carers reported that medical specialists did not want or were not able to give a prognosis. Many carers expected that treatments would have positive outcomes. The study findings indicate that medical specialists should recognise and address carer understanding of and need for information about prognosis as early as possible following diagnosis. Communication of the uncertain benefit of these new therapies can help patients and carers make decisions about treatment preference and care planning.
Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada
Authors: Eyal Cohen, Jonathan Rodean, Christina Diong, Matt Hall, Stephen B. Freedman, Paul L. Aronson, Harold K. Simon, Jennifer R. Marin, Margaret Samuels-Kalow, Elizabeth R. Alpern, Rustin B. Morse, Samir S. Shah, Alon Peltz, Mark I. Neuman
Journal: JAMA Pediatrics (2019)

Diagnostic imaging overuse in children evaluated in emergency departments (EDs) is a potential target for reducing low-value care. Variation in practice patterns across Canada and the United States stemming from organization of care, payment structures, and medicolegal environments may lead to differences in imaging overuse between countries.