tbuckley/cabot-search huggingface dataset:
Importance of Quality-of-Life Measurement Throughout the Disease Course
Authors: Hilde M. Buiting, Gert Olthuis
Journal: JAMA Network Open (2020)

In the study by Haslam et al, 1 how often patient's quality of life (QoL) is assessed throughout the patient's disease course is described.The authors included articles from 3 high-impact oncology journals (from July 2015 to July 2018) that assessed QoL as an outcome variable in intervention trials.They included both clinical trials and other (psychological) intervention studies and reported that most studies measured QoL during the intervention period only.Moreover, QoL was rarely measured after progression of the disease and was rarely measured until the end of the patient's life.The findings of the study suggest that QoL should be measured throughout the patient's disease course.Measuring QoL is a challenge in itself. 2 The underlying reason for including QoL measures in health care was the emerging necessity to consider persons as integrated, feeling, and active beings, not just as biological organisms. 3From a philosophical perspective, QoL is increasingly considered as well-being, referring to the prudential value of life emphasizing a person's biographical and personal characteristics. 4The difficult-to-quantify and subjective question, what makes life go well for the individual whose life it is?provides the starting point for discussing QoL.Various studies 5,6 demonstrated that the interpretation of QoL can be difficult partly because a similar score could be interpreted differently throughout the disease course by a single patient.Westerman et al 5 therefore argued that a qualitative approach to evaluate quantitative questions can be worthwhile.Following
Abstract P111: Sex Differences in Rate or Rhythm Control and Outcomes Among Elderly Patients With Atrial Fibrillation
Authors: Vinita Subramanya, J'Neka S Claxton, Pamela L Lutsey, Richard MacLehose, Alanna M Chamberlain, Faye L Norby, Lin Yee Chen, Alvaro Alonso
Journal: Circulation (2020)

Introduction: Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control for the treatment of AF. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. Methods: We studied 135,850 men and 139,767 women 75 years or older diagnosed with AF in the MarketScan Medicare database between 2007-2015. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmics, catheter ablation or cardioversion. Participants on both rate and rhythm were coded under rhythm control. We used multivariable logistic and Cox regression models to estimate 1) the association of sex and treatment strategy (within 30-day post AF diagnosis and entire follow-up) and, 2) the association of treatment strategy with incident heart failure, stroke and major bleeding. Results: Men were on average (SD) 82.5 (5.2) years old and women 83.8 (5.6) years, respectively. Women were less likely to receive rhythm control treatment as compared to men in the 30-day post AF diagnosis period (22% vs 27%), (OR 0.91, 95% CI 0.88, 0.94) and over the entire duration of follow-up (28% vs 32%) (HR 0.93, 95% CI 0.90, 0.96). Rhythm (vs. rate) control was associated with a higher risk of heart failure in women [HR 1.41, 95% CI 1.34, 1.49] than in men [HR, 1.21 95% CI 1.15, 1.28] (p for multiplicative interaction &lt; 0.001, Table ). Sex did not modify associations between treatment and incident stroke or major bleeding events. Conclusion: Women aged 75 years and older were less likely to be prescribed rhythm control as compared to men, and experienced higher risk of heart failure than men when receiving rhythm (vs rate) control. Future studies will need to delve into the mechanisms underlying these differences.
Low incidence of brain metastasis as first site of relapse in patients with stage II and III non-small cell lung cancer
Authors: N. Moazzam, R. Kratzke
Journal: Journal of Clinical Oncology (2007)

18051 Background: Lung cancer remains the leading cause of cancer mortality in both women and men in the United States. Despite recent advances in treatments, many patients with stage II and III non-small cell lung cancer (NSCLC) die of recurrent disease. Methods: A retrospective review was conducted to determine the incidence of brain metastasis as first site of relapse as well as other patterns of failure in patients with stage II and III NSCLC. From 1995 to 2003, 239 patients were identified from Minneapolis Veterans Affairs Medical Center tumor registry. Data was collected on the following variables to identify prognostic factors for brain metastasis and others patterns of failure: patient’s age, tumor histology, tumor size, nodal status, use of adjuvant chemotherapy, and type of adjuvant chemotherapy. Results: Of the 239 patients, only 12 (5%) had brain metastasis as first site of relapse. Median survival for patients with brain metastasis was 0.9 year (95% CI, 0.75–1.50). Out of 12 patients, 8 (67%) developed brain metastasis between 6 and 12 months after the initial diagnosis, 3 (25%) developed brain metastasis between 12 and 18 months and 1 (8%) developed brain metastasis as first site of relapse more than 18 months after initial diagnosis. Other patterns of failure were as follows: Thorax 36%, primary site 22%, primary + thorax 14% and distant metastasis 32%. Among 88 patients who underwent surgery as a part of definitive therapy, thorax was again the most common site of relapse (23%). Multivariate analysis showed that use of non-platinum based chemotherapy is a significant risk factor for relapse (p=0.02). Conclusion: Brain metastasis as first site of relapse is uncommon in patients with stage II and III NSCLC. Due to very low incidence of brain metastasis in this cohort of patients, prophylactic cranial radiation (which is the focus of few ongoing clinical trials) may cause more harm than good. No significant financial relationships to disclose.
Abstract 15785: Significance of Complex Fractionated Electrogram Region Within the Pulmonary Vein for the Maintenance of Paroxysmal Atrial Fibrillation
Authors: Hiroshige Yamabe, Hisanori Kanazawa, Miwa Ito, Shozo Kaneko, Yusuke Kanemaru, Takuya Kiyama, Kenichi Tsujita
Journal: Circulation (2017)

Background: It has been suggested that pulmonary vein acts as the driving source of atrial fibrillation (AF). However its precise mechanism has not been clarified. We hypothesized that complex frac...
A Novel Treatment for Vascular Calcification in Patients With Dialysis-Dependent Chronic Kidney Disease
Authors: S. Susan Hedayati
Journal: Circulation (2020)

AreWe There Yet? Article, see p 728 C hronic kidney disease (CKD) affects >30 million adults in the United States. 1 Patients with CKD, including those receiving long-term dialysis, are at a disproportionately higher risk for cardiovascular disease and its associated morbidity and mortality than the general population, and this increased risk cannot be fully accounted for by traditional cardiovascular risk factors.3][4] The reason could be the excess risk conferred by nontraditional factors in the setting of derangements of metabolism present in CKD.One such risk factor proposed and investigated is a net positive calcium and phosphate balance, thought to result in hydroxyapatite formation and accelerated vascular calcification. 5,6Even in young adults with dialysis-dependent end-stage kidney disease (ESKD), in whom traditional cardiovascular risk factors are not yet apparent, vascular calcification and coronary artery calcification (CAC) are very prevalent and progressive and are associated with increased cardiovascular mortality. 6alcium-containing phosphate binders, which increase oral calcium intake, may accelerate vascular calcification.8][9] In a trial of 200 dialysis-dependent participants randomized to calcium-containing binders versus sevelamer, the median absolute calcium score in the coronary arteries and aorta increased in the calcium-treated but not in the sevelamer-treated participants (coronary arteries, 36.6 versus 0, P = 0.03; aorta, 75.1 versus 0, respectively, P=0.01). 7In addition, compared with calciumcontaining binders, sevelamer was less likely to cause hypercalcemia and low levels of parathyroid hormone level. 7Treatment with a calcimimetic agent, cinacalcet, which is used to treat secondary hyperparathyroidism in CKD but does not increase serum calcium levels, was also shown to reduce vascular calcification progression in patients with ESKD. 10 After these landmark trials, some data were obtained to suggest that the benefit of such interventions that reduce CAC, a surrogate outcome, may translate to an all-cause mortality benefit in patients with ESKD.[13]
Abstract P365: Psychosocial Factors and Subsequent Risk of Peripheral Artery Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yasuyuki Honda, Yejin Mok, Lena Mathews, Jeremy Van’t Hof, Gail Daumit, Anna Kucharska-newton, Elizabeth Selvin, Thomas Mosley, Josef Coresh, Kunihiro Matsushita
Journal: Circulation (2020)

Background and aims: Psychosocial factors such as depression, character traits, and lack of social support have been associated with increased risk of cardiovascular disease (CVD). However, data of peripheral artery disease (PAD) in this regard are sparse. Since risk factor profiles differ across atherosclerotic CVD (ASCVD) subtypes, to appreciate the contribution of psychosocial factors to overall ASCVD, we aimed to comprehensively explore the association of psychosocial factors with the risk of PAD and ASCVD in a community cohort. Methods: We included 12,090 participants from the Atherosclerosis Risk in Communities (ARIC) Study (mean age 56.7 [SD 5.7] years) free of PAD and ASCVD at baseline (1990-1992). Depressive symptom was evaluated by the Maastricht Questionnaire (MQ). Trait anger was assessed by the Spielberger Trait Anger Scale. Social support was measured by the Interpersonal Support Evaluation List, while the extent of social networks was evaluated by the Lubben Social Network Scale. PAD events were defined as hospitalizations with PAD diagnosis and procedures. ASCVD included adjudicated myocardial infarction, fatal coronary disease, and ischemic stroke events. Results: We observed 429 PAD and 2,539 ASCVD events during a median follow-up of 23.1 years. The cumulative incidence of PAD was highest in the highest quartile of MQ score. This association remained after adjusting for traditional CVD risk factors, socioeconomic status, and physical activity. A weaker association was observed for ASCVD. Social support also showed independent association with incident PAD, but not with ASCVD. Trait anger and social network were not significantly associated with either PAD or ASCVD (Table). Conclusions: Psychosocial factors demonstrated more evident associations with PAD than ASCVD. Our results suggest the importance of considering PAD when assessing the overall impact of those factors on CVD. Future studies are needed to explore potential mechanisms behind our observation.
Bright PD-1 expression by flow cytometry is a powerful tool for diagnosis and monitoring of angioimmunoblastic T-cell lymphoma
Authors: Mariko Yabe, Qi Gao, Neval Ozkaya, Sarah Huet, Natasha Lewis, Janine D. Pichardo, Alison J. Moskowitz, Steven M. Horwitz, Ahmet Dogan, Mikhail Roshal
Journal: Blood Cancer Journal (2020)

Angioimmunoblastic T-cell lymphoma (AITL) is one of the most common specific types of peripheral T-cell lymphomas (PTCL) 1 .The cell of origin for AITL is T follicular helper cells (TFH) 2,3 .AITL has an immunophenotype closely akin to that of normal TFH; CD4+, CD8-, T-cell receptor (TCR) alpha/beta, and often expressing CXCL13, CD10, BCL6, Programmed-Death-1 (PD-1), ICOS, and CD200 2,4-6 .Diagnosis of AITL is challenging especially in small needle core biopsy due to the presence of admixed abundant inflammatory cells.The differential diagnosis is broad, and a definitive diagnosis requires a use of ancillary testing, including large panels of immunohistochemistry and molecular genetic studies.Immunophenotyping by flow cytometry is a common study for the diagnosis as well as for monitoring minimal residual disease of hematologic malignancies [7][8][9][10][11][12][13] , but contribution of flow cytometry to diagnose AITL, while often reported, has been unclear due to lack of systemic studies with integrated morphologic assessment 14 .Here, we evaluated the utility of highly sensitive flow cytometry in diagnosing AITL using an antibody against PD-1 in the context of other T-cell antigen.Tissue biopsies, bone marrow biopsies, and peripheral blood samples were retrieved from pathology archives between
Peter Salama: medical epidemiologist who transformed global efforts to tackle major disease emergencies
Authors: Matt Limb
Journal: BMJ (2020)

Credit: WHO

Medical epidemiologist Peter Salama, a leading figure in the World Health Organization and Unicef, shook up global efforts to tackle major disease emergencies such as Ebola. He is credited with helping to rebuild WHO’s reputation after experts criticised its slow and disorganised response to the Ebola outbreak in west Africa (2013-16).1

As WHO’s head of health emergencies from 2016 to 2019 he oversaw reforms that analysts say transformed aspects of its approach and bore fruit in subsequent disease outbreaks.

Salama’s sudden death from a suspected heart attack, aged 51, has shocked the global health community.

Only last year, as WHO’s head of universal health coverage, he had started ambitious new work to improve health systems and health outcomes in “fragile states.”

Jeremy Farrar, director of the Wellcome Trust, says Salama’s influence can be found in a more proactive and research based approach to tackling epidemics. His “energy and drive” at WHO were important in supporting the development of an Ebola vaccine and its use “as a public health tool which has had a dramatic impact,” says Farrar. “It’s a remarkable legacy to have left. There are huge lessons to be learnt now as we start to deal with novel coronaviruses.”

More than 11 000 people died in the Ebola outbreak that wrecked economies …
Airway Oscillometry Detects Spirometric-Silent Episodes of Acute Cellular Rejection
Authors: Elizabeth Cho, Joyce K. Y. Wu, Daniella Cunha Birriel, John Matelski, Richard Nadj, Emily DeHaas, Qian Huang, Kelsey Yang, Tong Xu, Aloysius B. Cheung, Lindsay N. Woo, Lauren Day, Marcelo Cypel, Jussi Tikkanen, Clodagh Ryan, Chung-Wai Chow
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

Rationale: Acute cellular rejection (ACR) is common during the initial 3 months after lung transplant. Patients are monitored with spirometry and routine surveillance transbronchial biopsies. However, many centers monitor patients with spirometry only because of the risks and insensitivity of transbronchial biopsy for detecting ACR. Airway oscillometry is a lung function test that detects peripheral airway inhomogeneity with greater sensitivity than spirometry. Little is known about the role of oscillometry in patient monitoring after a transplant.Objectives: To characterize oscillometry measurements in biopsy-proven clinically significant (grade ≥2 ACR) in the first 3 months after a transplant.Methods: We enrolled 156 of the 209 double lung transplant recipients between December 2017 and March 2019. Weekly outpatient oscillometry and spirometry and surveillance biopsies at Weeks 6 and 12 were conducted at our center.Measurements and Main Results: Of the 138 patients followed for 3 or more months, 15 patients had 16 episodes of grade 2 ACR (AR2) and 44 patients had 64 episodes of grade 0 ACR (AR0) rejection associated with stable and/or improving spirometry. In 15/16 episodes of AR2, spirometry was stable or improving in the weeks leading to transbronchial biopsy. However, oscillometry was markedly abnormal and significantly different from AR0 (P < 0.05), particularly in integrated area of reactance and the resistance between 5 and 19 Hz, the indices of peripheral airway obstruction. By 2 weeks after biopsy, after treatment for AR2, oscillometry in the AR2 group improved and was similar to the AR0 group.Conclusions: Oscillometry identified physiological changes associated with AR2 that were not discernible by spirometry and is useful for graft monitoring after a lung transplant.
Evaluation of<i> POLE/POLD1</i> Variants as Potential Biomarkers for Immune Checkpoint Inhibitor Treatment Outcomes
Authors: Benoît Rousseau, Joana Vidal, Luis A. Diaz
Journal: JAMA Oncology (2020)

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COVID-19 and the cardiovascular system
Authors: Ying-Ying Zheng, Yi-Tong Ma, Jin-Ying Zhang, Xiang Xie
Journal: Nature Reviews Cardiology (2020)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through ACE2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia, while also causing acute myocardial injury and chronic damage to the cardiovascular system. Therefore, particular attention should be given to cardiovascular protection during treatment for COVID-19.
Abstract P6-10-11: In vitro chemo interrogation of viable circulating tumor associated cells from breast cancer patients
Authors: Timothy Crook, Dadasaheb Akolkar, Sanket Patil, Vishakha Mhase, Revati Patil, Cynthe Sims, Vineet Datta, Sachin Apurwa, Viwek Mane, Ashok Gawai, Madhavi Apastamb, Ajay Srinivasan, Rajan Datar
Journal: Cancer Research (2020)

Abstract Background: Chemoresistance in cancer cells is the underlying reason for treatment failure. Real-time monitoring of chemoresistance and response (CRR) is a fundamental but unmet prerequisite of precision oncology. Repetitive invasive biopsies to obtain tumor tissue for in-vitro CRR profiling are neither feasible nor advisable. Circulating Tumor Associated Cells (C-TACs) have been proposed for functional assessment of CRR. In this observational study, we performed CRR profiling on viable C-TACs from breast cancer patients. Methods: In this 3 arm study, viable C-TACs were harvested from 15 ml of peripheral blood obtained from 242 breast cancer patients using CellWizard™, an epigenetically active media with paradoxical cytotoxicity that selectively kills normal cells and simultaneously confers survival benefit on cells of tumorigenic origin. C-TACs were stained with EPCAM, CK, CD45 and GCDFP. Viable Tumor Derived Cells (TDCs) harvested from freshly biopsied tumor tissue (Arm 1, N=48) and concurrently obtained C-TACs were simultaneously CRR profiled irrespective of whether patient was pre-treated or otherwise. Arm 2 (N=100) included refractory (pre-treated) patients where C-TACs were evaluated for resistance to previously administered drugs. Arm 3 (N=124) included recently diagnosed therapy naïve patients where C-TACs were evaluated for innate chemoresistance. Results: In Arm 1, CRR profile of C-TACs showed 96.1% concordance with CRR profile of concurrently obtained TDCs. In Arm2, CRR profiling of C-TACs identified chemoresistance due to prior drug exposure in 91.4% of patients. In Arm 3, innate chemoresistance was observed in 42% of patient samples towards commonly used first / second line Standard of Care drugs belonging to various functional categories such as mitotic inhibitors, DNA damaging agents, topo inhibitors and antimetabolites. Conclusion: This study shows for the first time the feasibility of CRR profiling of C-TACs and its correlation to in-vitro and in-vivo CRR characteristics of the tumor. Adoption of C-TAC based CRR profiling can provide unprecedented real time treatment oversight towards treatment selection and monitoring of drug resistance for personalized treatment of breast cancer patients. Citation Format: Timothy Crook, Dadasaheb Akolkar, Sanket Patil, Vishakha Mhase, Revati Patil, Cynthe Sims, Vineet Datta, Sachin Apurwa, Viwek Mane, Ashok Gawai, Madhavi Apastamb, Ajay Srinivasan, Rajan Datar. In vitro chemo interrogation of viable circulating tumor associated cells from breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-10-11.
Abstract P340: 30-Day Readmission Risk Assessment Among Patients Who Underwent Transcatheter Aortic Valve Replacement (TAVR), ACS NSQIP, 2015-2017
Authors: Anshul Saxena, Muni Rubens, Joseph A Salami, Peter McGranaghan, Chintan B Bhatt, Sankalp Das, Venkataraghavan Ramamoorthy, Emir Veledar
Journal: Circulation (2020)

Background: In August 2019, FDA approved TAVR for low-risk patients, a paradigm shift in the field of Cardiology. This approval will pave the way for TAVR to rapidly become mainstream, and it will be a preferred procedure for patients with symptomatic aortic stenosis in the coming years. In this study, we considered creating a useful tool to assess the risk of 30-day readmission after TAVR. Methods: We utilized data from ACS National Surgical Quality Improvement Program (ACS NSQIP) between 2015 and 2017. We selected 35 past medical history (such as history of CHF, COPD, etc.) and preoperative lab (such as BUN, WBC count, etc.) variables. A binary variable for 30-day readmission was created. Elastic net, random forest, and gradient boosted classification trees machine learning models were run and best performing model was selected based on the AUROC. Variables were plotted according to the importance. We created a nomogram using logistic regression by including important variables. Methods: About 594 patients underwent TAVR between 2015 and 2017; 56% patients were 80 years or older; and 45% were females. Majority of patients (62.8%) were Non-Hispanic White, had BMI ≥ 25 (71%), and took antihypertensive medication (82%). History of CHF was reported by 26%, and COPD by 17%. There were 68 (11.4%) patients who were readmitted within 30-days for any cause. Gradient boosted classification performed best. Top 15 variables were selected for logistic regression analysis to construct a nomogram. Five of the top variables were Total hospital LOS, pre-op platelet count, pre-op serum sodium, general anesthesia, pre-op BUN. Conclusion: In the US, 1 in 6 patients with TAVR could be readmitted within 30-days due to any cause after TAVR. We presented an interpretable model based on past medical history and pre-operative variables, which can be used to identify high risk patients so that their hospital readmission risk and can be reduced. This will also lower financial burden among patients.