tbuckley/cabot-search huggingface dataset:
Abstract 17969: Annual Trends in the Utilization of Nuclear Myocardial Perfusion Imaging Modalities: A Large Health System Experience
Authors: Preetham R Muskula, Faraz Kureshi, Krishna K Patel, Staci Courter, Kevin F Kennedy, Timothy M Bateman
Journal: Circulation (2017)

Background: Patient-centered nuclear myocardial perfusion imaging (MPI) emphasizing preferred modalities and protocols for select populations has been proposed for minimizing radiation and increasing efficiency and accuracy. As part of a quality improvement initiative, we compared modalities and protocols employed against patient complexity within our large health system. Methods: Patients who received an MPI study between 2012 and 2016 were analyzed along with co-morbidities: Age > 50 years, BMI> 30, known CAD, diabetes mellitus, prior PCI or CABG, hypertension, and CKD. We assessed trends in annual volumes of rest/stress (R/S) Rb-82 PET and pharmacologic and exercise SPECT and the average number of co-morbidities for each modality/protocol using one way analysis of variance and for continuous and categorical variables, respectively. Results: A total of 35,749 MPI studies were performed, averaging about 7,000 studies per year. There was a significant increase in PET utilization over time, from 31% of stu...
Why Mobility Matters in the Hospital
Authors: David M. Mitchell
Journal: Annals of Internal Medicine (2019)

Letters19 March 2019Why Mobility Matters in the HospitalDavid M. Mitchell, MD, PhDDavid M. Mitchell, MD, PhDBallad Health, Russell County Medical Center, Lebanon, Virginia (D.M.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0696 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In an age of hospital medicine racked with quality measures that have little or no effect on actual patient outcomes, I found Greysen and Patel's brief, commonsense commentary (1) reassuring. I have worked as a hospitalist for more than 15 years and have found it frustrating to be chased down by quality officers to do such things as document skin color in a septic patient, perform the zillionth echocardiography in a patient with congestive heart failure, or order a lipid panel in a patient with atypical chest pain. Is this what we call quality of care these ...Reference1. Greysen SR, Patel MS. Web exclusive. Annals for Hospitalists Inpatient Notes—bedrest is toxic—why mobility matters in the hospital. Ann Intern Med. 2018;169:HO2-3. [PMID: 30014112] doi:10.7326/M18-1427 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Ballad Health, Russell County Medical Center, Lebanon, Virginia (D.M.M.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0696. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Bedrest Is Toxic—Why Mobility Matters in the Hospital S. Ryan Greysen and Mitesh S. Patel Why Mobility Matters in the Hospital S. Ryan Greysen and Mitesh S. Patel Metrics 19 March 2019Volume 170, Issue 6Page: 429KeywordsDisclosureEchocardiographyEmotionsHealth care qualityHeart failureHospital medicineHospitalistsIschemiaLipidsShoulders ePublished: 19 March 2019 Issue Published: 19 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Endoscopic evaluation of acute intestinal GVHD after allogeneic hematopoietic cell transplantation?
Authors: Ibrahim Tek, Reskan Altun, Ayla Gokmen, Ender Soydan, Meltem Kurt Yuksel
Journal: Journal of Clinical Oncology (2015)

e18009 Background: The gastrointestinal tract (GIT) is one of the main target organs in patients with acute GVHD.The aim was to determine the endoscopic and histological findings in acute GVHD with GIS symptoms. Methods: 111 patients who received an alloHCT were reviewed. The NIH criteria were used to diagnose acute GVHD. The IBMTR system was used for grading the severity of acute GVHD. Biopsies were taken from duodenum, antrum and gastric body in upper GIS endoscopy (EGDs) and from ileum, ascending, transvers, descending colon and recto-sigmoid in lower GIS EGDs. Biopsies were stained using hematoxylin-eosin and evaluated by the same experienced pathologist. The presence of apoptotic bodies, crypt/glandular abscesses and crypt/glandular destruction was considered confirming findings in histologic specimen for the diagnosis of GVHD. The Washington criteria were used for histological grading of acute intestinal GVHD . Endoscopic findings have been staged according to the classification proposed by Cruz-Correa for upper GIS endoscopy and Freiburg criteria for lower GIS endoscopy.Results: Allogeneic HCT was performed in 111 patients, of whom 27 (24.3%) developed acute GVHD as diagnosed by NIH criteria with skin and/or liver biopsy. Among 27 patients, 55.6% (n = 15) were men and 44.4% (n = 12) were women. Mean age of the patients were 45±13.8 years. Median time to diagnosis was 55 (22-110) days. The underlying diseases were AML(33.3%), ALL(22.2%), MDS(18.5%), lymphoma(14.8%), KML(7.4%) and KLL(3.7%).Organ involvement were as follows; GIT only 26%, GIT and skin 14.8%, GIT and liver 7.4%, skin only 29.6%, liver only 7.4% and all 14.8%.Conclusions: Acute GVHD frequently involves GIT so that clinicians should be aware of GIS symptoms after SCT even if they are not specific. It is also important to decide on fastest and safest way going to diagnosis in suspected patients. In conclusion, endoscopic findings are non-spesific in acute intestinal GVHD and there is little or no concordance between endoscopic findings and histopathology. We have to focus on noninvasive procures or alternative methods in histopathology such as enumeration of duodenal Paneth cells to provide more information regarding GVHD prognosis in future.
Atypical and secondary hemolytic uremic syndromes have a distinct presentation and no common genetic risk factors
Authors: Alice Le Clech, Noémie Simon-Tillaux, François Provôt, Yahsou Delmas, Paula Vieira-Martins, Sophie Limou, Jean-Michel Halimi, Moglie Le Quintrec, Ludivine Lebourg, Steven Grangé, Alexandre Karras, David Ribes, Noémie Jourde-Chiche, Eric Rondeau, Véronique Frémeaux-Bacchi, Fadi Fakhouri
Journal: Kidney International (2019)
Correlation of Breast Cancer Index HOXB13/IL17BR (H/I), ER, PR and HER2 and prediction of relative endocrine benefit from tamoxifen and anastrozole in HR+ breast cancer: A TransATAC study.
Authors: Yi Zhang, Ivana Sestak, Jack M. Cuzick, Mitchell Dowsett, Catherine A. Schnabel, Dennis Sgroi
Journal: Journal of Clinical Oncology (2015)

526 Background: Estrogen receptor (ER) expression is a critical determinant of endocrine response, however additional biomarkers are needed to complete the molecular picture of treatment benefit, response and resistance to better individualize care. Previous studies have demonstrated that H/I expression ratio predicts benefit for ER+ breast cancer patients from tamoxifen in the Stockholm adjuvant trial and from letrozole in the MA.17 extended adjuvant trial. In this correlative study, H/I was compared with ER, PR, and HER2 expression in assessing relative benefit from adjuvant anastrozole (ANA) vs tamoxifen (TAM) in HR+, LN- patients from the prospective randomized ATAC trial. Methods: Tumor samples from 742 HR+, LN- patients treated with 5 y of TAM or ANA were examined. Expression levels for H/I, ER, PR and HER2 were determined by RT-PCR. Cox proportional hazards models assessed the significance of the interaction between treatment and each biomarker as continuous variables, with 10-year risk of distant recurrence estimated within the 2 treatment arms separately. No adjustment for multiple testing was made. Results: The interaction between H/I and treatment was statistically significant (p = 0.024) whereas the interaction for all other biomarkers was non-significant (ER, p = 0.17; PR, p = 0.054; HER2, p = 0.72). Consistent with this finding, the 10-year distant recurrence rate as a function of continuous H/I indicated that the endocrine benefit with ANA compared to TAM correlated with increasing H/I. H/I expression was not highly correlated with ER, PR or HER2. Conclusions: In this retrospective study, H/I was the only factor that predicted differential benefit of ANA vs TAM in the adjuvant setting. Consistent with previous IHC results in TransATAC, molecular ER, PR, and HER2 were not predictive of relative treatment benefit. Taken together with previous data, these results suggest that H/I may be a useful indicator of absolute or differential endocrine benefit depending on the clinical setting. Data on utility of H/I for prediction of relative benefit require further validation.
Abstract P270: Neighborhood Socioeconomic Status and Sleep Duration Among U.S. Adolescents: Does the Association Differ by Race?
Authors: Ryan Saelee, Julie A Gazmararian, Dayna A Johnson, Shakira Suglia
Journal: Circulation (2019)

Background: Short sleep duration is linked to adverse cardiovascular risk factors among adolescents and racial disparities in sleep among this group is well documented. Thus, identifying determinants and its differential impact on sleep duration by race may be important for informing sleep interventions and reducing sleep disparities. Evidence suggests neighborhood socioeconomic status (NSES) may play a role in shorter sleep duration among adolescents, but few studies have examined whether this relationship differs by race. Furthermore, previous studies were limited by sample size, geographic representation to specific U.S. cities and racial/ethnic diversity with mostly non-Hispanic White samples. The purpose of our study was to investigate the association between NSES and short sleep duration and determine if this relationship varies by race among a diverse sample of adolescents. Methods: Participants (n=17,746) are from Wave I of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative multi-ethnic study of health behaviors during adolescence and outcomes during adulthood. Sleep duration was self-reported as total hours of sleep at night, and categorized as short (6-13 years: &lt;9 hours, 14-17 years: &lt;8 hours, 18-25 years: &lt;7 hours) vs. normal (6-13 years: 9-11 hours, 14-17 years: 8-10 hours, 18-25 years: 7-9 hours ). NSES was a summary z-score consisting of three census-block measures: unemployment rate, proportion of households with income below poverty level, and public assistance. Participants were categorized as living in low (&gt;median z-score) or high (≤ median z-score) NSES. Log-binomial regression models examined the association between NSES (low vs. high) and short sleep duration and tested for racial differences. Models adjusted for race, sex, age, and highest parental education. Results: The study population was 51% female, 66% White, 15% African-American, 12% Hispanic, 4% Asian, 3% other racial group, and mean age was 15.4 years (Standard Error=0.11). The prevalence of short sleep duration was 41% and 48% for low NSES. There was no significant association between NSES and short sleep duration before (Prevalence Ratio (PR):1.02; 95% Confidence Interval (CI): 0.96-1.09) and after adjusting for individual sociodemographic characteristics (PR: 1.00; 95% CI: 0.93-1.06). There was also no significant race-by-NSES interaction (p=0.21). Conclusion: Findings suggests NSES is not associated with short sleep duration regardless of race and that other factors may play a larger role in sleep among this sample of adolescents. The inconsistency with findings from prior studies could be due to our inclusion of a larger, racially diverse, and nationally representative sample. Future studies should explore whether other neighborhood and contextual factors influence sleep and if racial differences exist in these relationships.
The SMART strategy: Subdividing M1 stage and aiming remission for target nasopharyngeal carcinoma patients with metachronous metastasis.
Authors: Lujun Shen, Peihong Wu, Yunfei Xia, Wang Li, Chen Chen
Journal: Journal of Clinical Oncology (2015)

6034 Background: Metastatic nasopharyngeal carcinoma (mNPC) varied greatly from potentially curable to incurable. This study set out to identify the target patients with chance of cure through extensive M1 stage subdivision and treatment response assessment. Methods: 1172 NPC patients with metachronous metastasis from three medical centers in Southern China were retrospectively analyzed (916 pts in derivation dataset; 256 pts in validation dataset). Various metastatic features were assessed, including involvement of specific locations, n of metastatic locations and n of metastatic lesions. A new nomenclature system for precise M staging was designed based on the independent prognostic factors. The best treatment response was assessed based on RECIST 1.1 or the modified RECIST criteria. Results: Multivariate analysis in derivation cohort showed that n of metastatic lesions, n of metastatic locations, liver involvement, bone involvement, together with age, UICC N stage, local recurrence, were independent prognostic factors for overall survival (OS). Subdividing the population by n of metastatic lesions and n of metastatic locations could result in subgroups with highly significant differences in OS. The external validation by two independent datasets showed congruent results. A new nomenclature system (M [n of locations]-Location [n of lesions in location]; B, bone; L, lung, H, liver, N, node) was designed, our data showed that mNPC patients with isolate metastatic lesion (M1-B1, M1-L1, M1-H1, M1-N1), and those with two lesions in liver only (M1-H2) had high rates of complete remission (CR) or complete surgical resection (cSR), and 3-year OS after treatment (CR+cSR, > 30%; 3-yr OS, > 50%); for patients with more than three metastatic lesions in specific location (M1-Bm, M1-Hm) or multiple-location metastasis, the treatment response was generally poor, and the rates of cSR and 3-yr OS were low (CR, < 4%; cSR, 0%; 3-yr OS, < 30%). Conclusions: The SMART strategy could serve as a powerful tool in identifying the mNPC patients with chance of cure. More trials are needed to evaluate the feasibility and significance of achieving complete remission among the target patients.
Involvement of PFKFB3 in Pulmonary Arterial Hypertension Pathogenesis. Is It All about Glycolysis?
Authors: Sebastien Bonnet, Roxane Paulin
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

maneuver on cardiac output, pulmonary blood flow, or hemodynamics-issues of obvious relevance in future clinical trials.One should always exercise caution when extrapolating data from animal research to the clinical setting.Indeed, the story of the journey of SI from animal research to widespread clinical use, and now perhaps a pullback after the report of sobering data from a major clinical trial, is a case in point.Nonetheless, the findings of the present study are important and clearly suggest the need for clinical investigations of different approaches to lung recruitment during stabilization of low-gestational-age neonates, with an emphasis on dynamic PEEP strategies that transiently use levels that may be well beyond the comfort level of many practitioners.
Early <sup>18</sup>F-FDHT PET/CT as a predictor of treatment response in mCRPC treated with enzalutamide.
Authors: Hilde Hoving, Selma Palthe, Marleen Vallinga, Rutger Dost, Jourik A. Gietema, Inez Antunes, Erik F. J. De Vries, Andor Glaudemans, Igle Jan de Jong
Journal: Journal of Clinical Oncology (2019)

232 Background: Androgen deprivation is the mainstay in the treatment of metastatic prostate cancer. During treatment, the majority of patients will develop progressive disease despite castrate levels of testosterone; castration-resistant prostate cancer (CRPC). In vivo determination of androgen receptor status by 18 F-FDHT PET/CT could be of use to predict treatment response timely and objectively. The objective of this study is to assess the value of early 18 F-FDHT PET/CT to predict treatment response of enzalutamide in mCRPC. Methods: This pilot study was performed in 18 chemotherapy naïve men with mCRPC. 18 F-FDHT PET/CT was performed at baseline and after 4 weeks of treatment with enzalutamide. Standard Uptake Value (SUV)max and SUVpeak of the 5 most intense and/or all bone, pleura and lymph node metastases were determined per patient. Area under the curve (AUC), sensitivity (Se) and specificity (Sp) of different characteristics of 18 F-FDHT PET/CT were performed by ROC analysis. Response was determined at 12 weeks of treatment according to PCCTWG. Results: A total of 477 lesions (411 bone, 3 pleura and 63 lymph node) were found. At 12 weeks, response was seen in 16 patients, whereas 2 patients showed no response. The characteristics of 18 F-FDHT PET/CT are shown in table 1. Baseline median SUVpeak of all metastatic lesions showed an AUC of 0.79 to predict response. AUC values using the 5 most intense lesions only or using the delta between baseline and 5 weeks were less accurate. Clinical trial information: NTR4086. Conclusions: Baseline 18 F-FDHT PET/CT using SUVpeak of all metastatic lesions predicts treatment response in mCRPC treated with enzalutamide with an AUC of 0.79.[Table: see text]
Treatment efficacy of abiraterone (abi), enzalutamide (enza) or cabazitaxel (caba) in metastasic castration-resistant prostate cancer patients (mCRPC) after progression to docetaxel plus androgen deprivation therapy (ADT) in hormone sensible disease.
Authors: Miguel Angel Climent Duran, M Isabel Sáez, Josep M. Piulats, A. Montesa, Isabel Chirivella, Alejandro gonzalez Forastero, Cristina Caballero Diaz, Lucia Heras, Begona Mellado, Sergio Vazquez-Estevez, David Olmos, Ignacio Duran, María José Juan Fita
Journal: Journal of Clinical Oncology (2019)

198 Background: Different treatments efficacy for mCRPC when progression after docetaxel x 6 cycles + ADT (as CHAARTED scheme) are unknown as all pivotal trials where performed in patients who progressed to mCPRC after ADT. Methods: A retrospective analysis of 175 mCRPC patients of 10 spanish hospitals who were treated with docetaxel + ADT as first line treatment was performed. Patients characteristics at diagnosis (age, gleason) and at progression to mCRPC were analyzed (PSA, presence of visceral mets, type of progression). As efficacy endpoints, clinical and objective response, and survival from progression to mCRPC were analyzed. Results: Median age at diagnosis 65.2 years old (range 44-84). Metastatic at diagnosis 173. Bone metastasis 155 (88,5%), visceral 31 (17.7%), gleason &gt;7 130 (74,3%), number docetaxel cycles: 6 (80%), 5 (5,7%), &lt;5 (14,3 %). Median survival from diagnosis: 35 months. Progression to CRPC 78pts (44.5%) Type of progression: PSA 74/78 (94,9%), clinical 45/78 (57.7%), radiological 59/78 (75.6%). Median survival from progression to CRPC: 10.3 months. Treatments frequency, clinical benefit (RP/EE) and median survival: abi 30 (38.4%)/ 7(23.3%)/ 15.7 m; enza 12 (15.4%)/ 4 (33.3%)/ 10.4 m, caba 14(17.9%)/ 3(21.4%)/ 6.4m; Other treatments frequency: Ra223 4 (5.1%), docetaxel 4 (5.1%), others/no treatment/BSC 14 (17.8%). Clinical and radiological progression before treatment was 36.7%/63.3% in abi patients, 58.3%/63.7% in enza and 93.9%/93.9% in caba pts. Visceral (mostly hepatic) metastasis were more frequent in caba (57.1%) than in abi (11.8%) or enza (0%) pts. Median PSA value abi 375/ caba 1633. Conclusions: Although AA seems be more effective than cabazitaxel in mCRPC progressed after docetaxel + ADT in HSPC, patients treated with caba are of worse prognosis.
Effect of early cross-over on survival curves in clinical trials.
Authors: Achuta Kumar Guddati
Journal: Journal of Clinical Oncology (2015)

e17616 Background: Cross-over of patients from the best supportive care (BSC) arm to treatment arm is common in clinical trials when the treatment arm shows efficacy. Estimation of overall survival in clinical trials involving cross-over is challenging as conventional analysis by intention to treat (ITT) method confounds the treatment effect. This study examines the effect of early and late cross-overs utilizing rank-preserving structural failure time (RPSFT) analysis. Methods: A set of 100 patients divided into 50 each for the treatment and best supportive care arm was simulated at various time points of cross-over for a study period of 3 years. The acceleration factor, psi was calculated using the ‘strbee’ program in STATA package. Patient accrual was assumed to be at time zero and all deaths were simulated within the study time to remove aberrations related to censoring. Treatment effect was fixed and the difference in significance levels between the Kaplan-Meir curves was studied by log-rank method. Results: The BSC arm was adjusted for cross-over by applying RPSFT analysis. The extent of adjustment corresponds to the psi values shown below. Comparison between the survival curves of the treatment arm and unadjusted control arm shows no statistically significant difference. However, there is a statistically significant difference between the treatment arm and the adjusted BSC arm at all studied time points. The level of significance increase when the cross-over occurs at earlier time points. Conclusions: Clinical trials with a significant amount of cross-over between arms pose a unique challenge to analysis of overall survival. Applying RPSFT analysis to such data sets may show statistically significant differences in survival curves which otherwise may not be detected by conventional analysis (ITT). Serial No Time of cross-over (years) Psi p value between treatment arm vs. unadjusted BSC arm p value between treatment arm vs. adjusted BSC arm 1 0.5 0.426 0.1 0.0008 2 1 0.315 0.1 0.0008 3 1.5 0.238 0.1 0.001 4 2 0.187 0.1 0.001 5 2.5 0.164 0.1 0.007