tbuckley/cabot-search huggingface dataset:
Abstract P042: Metabolic Syndrome Prevalence and Risk Factors Among Adult Asian Americans
Authors: Lin Zhu, Wenyue Lu, Minsun Lee, Grace X Ma
Journal: Circulation (2019)

Metabolic Syndrome (MetS) is a disease entity characterized by a constellation of interconnected physiological, biochemical, clinical, and metabolic factors that directly increase the risk of cardiovascular atherosclerotic diseases, and diabetes mellitus type 2. Limited evidence of MetS found excess risk in Asian Americans. Despite lower body mass index (BMI), Asian Americans have higher MetS rate than Caucasians at every BMI level. Although there is the increasing burden of diabetes, hypertension, and obesity in Asian American populations in the US, no national estimates of MetS prevalence are available. This study used the National Health and Nutrition Examination Survey (NHANES) 2015-2016 data to examine the prevalence of MetS, and identify sociodemographic and lifestyle risk factors among Asian Americans. The analysis sample consist of 281 Asian Americans over the age of 18, including 134 women (47.69%) and 147 men (52.31%). The average age was 44. About one third of the sample (24.20%, 68 out of 281) were obese, with a BMI of 27.5 or higher. Chi-square test was used to examine the bivariate relationship, while logistic regression was used to examine the multivariate relationship between MetS and risk factors. We used the International Diabetes Federation (IDF) criteria to decide MetS. Sociodemographic factors included age, gender, marital status, household income, employment status, nativity status, and years lived in the US. Lifestyle factors included smoking, alcohol use, sleep duration, and recreational physical activity.One third of the sample (31.32%, 88/281) met the IDF criteria of MetS. The rate was lower in those who were under- or normal weight (10.38%, 11/106), and higher in those who were overweight (30.84%, 33/107) or obese (64.71%, 44/68). Furthermore, a higher likelihood of having MetS was associated older age (40 or over versus 18-39), having lived in the US for over 5 years, lower household income, and low recreational physical activity. Age, household income, and physical activity reminded independent and significant predictors in multivariate regression model. To the best of our knowledge, this is the first study one to use a nationally representative sample to examine the MetS prevalence and risk factors among adult Asian Americans, a population that faces increasing cardiovascular burden yet remained understudied. The findings of this study provided critical epidemiological reference data for further investigation. Because only a subsample took part in the physical examination, biomarker data were only available for these participants, hence the limited sample size. The authors intend to conduct analyses with a combined sample from multiple release cycles of NHANES to achieve a larger sample size, and use multiple imputation to increase sample size. We will also conduct subgroup analysis by detailed Asian ethnic groups, BMI level, gender, and age group.
Errors in Analysis of Mean Deviations in Study of Photocoagulation vs Ranibizumab for Diabetic Retinopathy
Authors: Adam R. Glassman
Journal: JAMA (2019)

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David Oliver: Contentious comments from NHS England’s chair
Authors: David Oliver
Journal: BMJ (2019)

In February NHS England’s chair, David Prior, waded into the debate on the state and future of the NHS. At a meeting hosted by the Reform think tank he said that relentless edicts and targets from NHS central bodies had left local clinicians and managers feeling “learned helplessness” instead of exercising professional leadership.12

Prior also criticised the commitment and discretionary effort of staff, lamenting that they wouldn’t stay at work to help out beyond contracted hours—for instance, in the emergency department when they were ready to go home—and that some were retiring too soon.1 His comments were widely reported in print and broadcast media, as he surely knew that they would be.

One might ask, “Why shouldn’t he speak out?” Some may even find his frankness refreshing in a sea of technocratic uniformity and …
Abstract P267: Lifestyle Program Improves Sleep Quality in Participants With a History of Concussion
Authors: Francisco E Ramirez, Neil Nedley, Lance Hofer-draper
Journal: Circulation (2019)

Background: Patients with a history of concussion are susceptible to insomnia. This study documents how lifestyle changes could improve insomnia. Methods: The educational depression program is an 8-week community educational program which addresses optimal health through diet, exercise, sleep hygiene, light therapy, and mental/spiritual health. Participants met once a week for 2 hours over an 8 week period. During the first hour, participants listened to a health lecture by a health professional and then divided in small groups. The hypothesis of the program is to try to understand the causes of mental health problems and educating participants on how to apply lasting changes to their daily lives to address these problems. From n=5,861 participants who finished the program, n=275 participants had a history of concussion and their data was used. They answered an 85 question questionnaire at baseline and again at the end of the program that included participant history and measured depression and anxiety. Participants were asked about their sleeping patterns, on a scale of 0-3; 0 being excellent sleep patterns, and 3 being bad sleep patterns. Results: Mean age for those with a history of concussion (n=275) was 52.9 (SD 15.7), and 71% were females. Sleep patterns at baseline for those with concussion were: n=48 had excellent sleep, n=30 had good sleep, n=79 had below average sleep, n=118 had bad sleep, and average baseline anxiety was 9.6 (moderate) SD 5.2. At the end of the program, the same test was administered and sleep was: n=111 reported excellent, n=60 had good, n=55 had below average, n=49 had bad, and end mean anxiety was 5.5 (mild) SD 4.1 Conclusion: The program effectively improves sleep quality in most of the participants. Lifestyle seems to be an important factor in improving insomnia in these participants. Anxiety levels also decreased and may have played a role in the improvements in sleep. Long-term follow-up is planned.
How well do surrogate endpoints and overall survival endpoints in clinical trials predict real-world survival?
Authors: Jason Shafrin, Ron Brookmeyer, Desi Peneva, Jinhee Park, Jie Zhang, Robert A. Figlin, Darius N. Lakdawalla
Journal: Journal of Clinical Oncology (2015)

6574 Background: The survival of cancer patients in the real world often differs from that measured in randomized controlled trials (RCT) for reasons including differences between trial participants and real-world patients, and crossover contamination. We compare the ability of RCT overall survival (OS) and RCT surrogate endpoints -- progression-free survival (PFS) and time-to-progression (TTP) -- to predict real-world OS prognosis across five cancers. Methods: Using NCCN guidelines, we identified 30 drug treatments for breast, colorectal, lung, ovarian, or pancreatic cancer approved before 2009 with Phase III RCTs reporting both OS and either PFS or TTP. Median RCT survival (i.e., PFS or TTP, and OS) and inclusion criteria were identified within each treatment’s relevant pivotal trial publication. We measured median real-world OS for each treatment using a Kaplan-Meier estimator applied to SEER-Medicare data (1991-2010). Accuracy of trial PFS/TTP and OS in predicting real-world OS was measured using median absolute prediction error and R2from linear regressions. Results: Among the 49,827 patients qualifying for inclusion in the relevant RCT study population, median survival across the 30 treatments was 6.0 months for trial surrogates (i.e., PFS/TTP), 14.8 for trial OS, and 13.5 months for real-world OS. Median error from predictive models using trial surrogates was 3.55 months compared to 1.80 months for trial OS (p= 0.156; R2: PFS/TTP = 0.382 vs. OS = 0.613). Among all patients receiving a relevant treatment (240,852 individuals), prediction error was 5.32 months for models using trial surrogate endpoints and 5.34 months for models using trial OS (p= 0.802; R2: PFS/TTP = 0.113 vs. OS = 0.167). Conclusions: RCT OS tended to outperform PFS/TTP in predicting real-world OS prognosis for patients similar to trial participants. However, in the broader real-world population of treated patients, RCT PFS/TTP and OS performed similarly. Among the five cancer sites studied, trial PFS and trial OS may be equally valuable to payers and providers seeking to predict survival in broad real-world populations.
A whole-brain atlas of monosynaptic input targeting four different cell types in the medial prefrontal cortex of the mouse
Authors: Sofie Ährlund-Richter, Yang Xuan, Josina Anna van Lunteren, Hoseok Kim, Cantin Ortiz, Iskra Pollak Dorocic, Konstantinos Meletis, Marie Carlén
Journal: Nature Neuroscience (2019)
Clinical significance of AR amplification from CF DNA among Japanese castration-resistant prostate cancer patients.
Authors: Shinichi Sakamoto, Keisuke Ando, Nobushige Takeshita, Satoshi Yamamoto, Akira Komiya, Kazuto Nishio, Tomohiko Ichikawa, Yusuke Imamura
Journal: Journal of Clinical Oncology (2019)

314 Background: We study the prognostic ability of androgen receptor amplification (AR amp) from cf DNA in Japanese castration-resistant prostate cancer (CRPC) patients. Methods: Multiple sets of serums were obtained from 38 castration-resistant prostate cancer patient at Chiba University hospital. Serum cfDNA was purified using a cobas cfDNA Sample Preparation Kit. AR copy number was measured using the QX100 Droplet Digital PCR System. Factors associated with progression-free survival (PFS) and Overall Survival (OS) were statistically studied. Results: The number of patients received Enzalutamide (Enza)/Abiraterone (Abi)/Docetaxel (Doc) were 33/25/11. Regarding PFS, the presence of AR amplification, Bone Scan Index (BSI), PSA was significant factors on univariate analysis. On multivariate analysis, AR amplification was an independent prognostic factor (HR. 8.9, p=0.003). Regarding OS, PSA and AR amp was significant factors. On multivariate analysis, AR amp (HR 4.2, p=0.028) was an independent prognostic factor. AR amp was related to the young age, high bone metastasis, high PSA, while no association was identified related the visceral metastasis. Overall, the presence of AR amp was negatively related to the initial ADT periods (r=-0.28). In contrary, among primary resistance cases (initial treatment periods &lt;1 year), AR amp positively related to the treatment periods (r=0.31). Higher nadir testosterone (&gt;15 ng/dL) was related to the higher AR amp (p=0.0169). AR amp was related to the treatment resistance in Enza (p=0.0216), while no relation was observed in Abi or Doc. Conclusions: AR amp significantly correlated with the poor prognosis. Higher serum testosterone level may predict the presence of AR amp in cf DNA. [Table: see text]
MicroRNA-21 to predict response to preoperative chemoradiotherapy in locally advanced rectal cancer.
Authors: Cristina Carames Sanchez, Irene Moreno, Andrea Correa Noguera, Roberto Hernandez Lopez, Tatiana Hernandez Guerrero, Victor Zenzola, Manuel Domine, Jose Ignacio Martin-Valades, Ana Leon, Victoria Casado, Gustavo Rubio, Francisco Lobo, Jesus Garcia-Foncillas
Journal: Journal of Clinical Oncology (2015)

e14625 Background: The treatment of choice for locally advanced rectal cancer is preoperative chemoradiotherapy. Despite half of patients do not respond, suffer unnecessary toxicities and surgery delays, there are no biomarkers to guide preoperative CRT outcome. MicroRNA-21 has been related to acquisition of 5-fluorouracil resistance, however its potential predictive value of response to preoperative chemoradiotherapy in locally advanced rectal cancer remains unknown. Methods: Nighty-two patients diagnosed with locally advanced rectal cancer who were preoperatively treated with chemoradiotherapy were selected for this study. Moreover, microRNA-21 expression was quantified in formalin-fixed paraffin-embedded biopsies from this cohort and the results obtained were correlated with clinical and molecular characteristics, pathological response and outcome. Results: MicoRNA-21 was found overexpressed in 77.6% cases, and significantly correlated with tumor grade after preoperative chemoradiotherapy (p = 0.013) and with pathological response (p = 0.013). The Odds Ratio of having miR-21 overexpression and not getting a respond to chemoradiotherapy resulted in 9.75 CI: (2.24 to 42). Sensitivity, specificity, negative predictive values and positive predictive value were 86.6%, 60%, 42.8% and 92%, respectively. Multivariate analysis confirmed the clinical significance of miR-21 determining preoperative chemoradiotherapy response. Conclusions: MiR-21 expression efficiently predicts preoperative chemoradiotherapy pathological response in locally advanced colorectal cancer.
Clinical utility of PI3K/AKT/mTOR pathway activation in breast cancer: A study in Indian population.
Authors: Mithua Ghosh, Urvashi Bahadur, Sheela ML, Shekar Patil, Radheshyam Nayak, Nalini K Rao, Krithika Murugan, Mahesh Bandemegal, Sridhar PS, Vaijayanti Gupta, Satish Sankaran, Satheesh Chiradoni Thungappa, Naveen Krishnamoorthy, Susmitha C.S, Aarthi Ravichandran, Goutham HV, Ramesh Hariharan, Preveen Ramamoorthy, Kalyanasundaram Subramanian, Basavalinga S. Ajaikumar
Journal: Journal of Clinical Oncology (2015)

e12542 Background: Activation of PI3K/AKT/mTOR pathway is associated with growth and survival of breast cancers (BC), confer resistance to HER2 targeted and hormonal agents and response to mammalian target of mTOR inhibitors. Using next generation sequencing, we investigated the frequency of mutations in this pathway in different breast cancer subtypes. Methods:150 women aged 26-75 yrs diagnosed with breast cancer at HCG in 2014 were profiled by NGS for hotspot mutations in 48 cancer-related genes using Illumina’s TSCAP panel and the MiSeq technology in an IRB-approved prospective study. Tissue samples were also analyzed for pathological stage, histological type, hormonal status and Ki67. Results: Data available from gene profile of BC patients including 38% hormone receptor positive,21% HR+/HER2+ive, 27% HR-/HER2-ive and 24% TNBC showed an activation of PI3K/AKT/mTOR pathway in a substantial fraction (28%) of cases. In this pathway, PI3K alone was found to be mutated in 15% of BC patients. These mutations were more prevalent in hormone receptor positive invasive ductal carcinomas (36%) and in HR-/HER2-ve (40%) than in HR+/HER2+ve tumors(15%). However, PIK3CA mutations were not correlated with stage and the proliferative index (Ki67) of the tumor. Major hotspot mutations in the PI3K gene in these patients were reported to be H1047R at exon 20 (kinase domain) and E542K and E545K at exon 9 (helix domain). PIK3CA were co-mutatedwith p53 in 67% of cases. Another important finding is that 80% of breast cancer cases with PIK3CA mutations presented with liver metastasis. 4 out of 28 patients showing alterations in this pathway showed no pathological response post neoadjuvant/adjuvant chemotherapy and had a poor outcome. The response and outcome in patients who have received mutation specific therapy (matched) are being monitored. Conclusions: This study reports the prevalence of PI3K/AKT/mTOR pathway activation and in Indian breast cancer patients who could potentially benefit from PI3K inhibitors and targeted treatment. Prospective studies and randomized clinical trials are ongoing to confirm the independent prognostic and therapeutic value of this pathway in a larger cohort of Indian population.
Understanding and attitudes toward cancer clinical research (CCR) among patients with a cancer diagnosis: Prospective cohort study from a disadvantaged region in Ireland.
Authors: Ciara Marie Kelly, John McCaffrey, Catherine Margaret Kelly
Journal: Journal of Clinical Oncology (2015)

e17586 Background: Understanding of patient (pt) factors influencing cancer clinical trial (CCT) accrual is critical. The aim of this study was to evaluate 1) understanding of the terms ‘clinical research’ (CR) and ‘clinical trials’ (CT) and 2) attitudes toward participation in CCR in pts treated in a socially disadvantaged area. Methods: Pts with a cancer diagnosis (dx) attending a North Dublin hospital, able to complete a questionnaire, were eligible. The questionnaire examined 5 areas: a) demographics b) cancer dx c) understanding and attitudes towards CCR 4) discussion regarding participation and 5) experience in CCT. Results: 195 pts completed the questionnaire, (response rate = 44%). Median age was 57 yr (range: 22-82 yr), 29% were > 64 yr. 66% had (neo)-adjuvant disease, 34% had advanced cancer. Only 55% completed 2ndlevel education and 25% reported inaccurate cancer details. The majority accurately understood the term ‘CR’ (75%) but not the term ‘CT’ (30%). Most agreed with participating in CCR: donation of blood (85%), supply of medical details (94%) and participation in CCT (61%). Baseline characteristics of pts who disagreed with CCT participation include: religious (60%), low level of education (51%), (neo)-adjuvant disease (76%). Reasons included fear of side effects (42%), lack of information (19%), inappropriate candidate/age (13%) and unable to see benefit (6%). Regarding the decision to participate pts relied on family and GP for support, no pt availed of support groups and 4% used the internet. Over 90% of pts who had the option of a CCT (30%) reported a positive discussion however 79% suggested a decision aid would help introduce the CCT. 9% declined enrolment. Over 90% of CCT participants would take part in another or recommend CCT to pts. Conclusions: This cohort displayed a poor understanding of the term CT. Pts were less inclined to participate in CCT relative to other forms of CCR. Family and GPs are key figures of support in the decision making process. Understanding demographics of a cancer center catchment will help decide the type and delivery of information about CCT. We plan to widen this study to all regional cancer centers in Ireland.
Racial disparities in radium-223 treatment in a large real-world population.
Authors: Hanson Hanqing Zhao, Lauren Howard, Amanda de Hoedt, Martha K Terris, Christopher L. Amling, Christopher J. Kane, Matthew R. Cooperberg, William J. Aronson, Thomas Polascik, Stephen J. Freedland
Journal: Journal of Clinical Oncology (2019)

268 Background: Black men with prostate cancer are more likely to have unfavorable tumor characteristics and are at greater risk of prostate cancer mortality. Radium-223 is a FDA approved treatment for metastatic castration-resistant prostate cancer (mCRPC) that showed a survival benefit in the ALSYMPCA trial, where 94% of the participants were Caucasian. We aim to examine treatment patterns and outcomes of radium-223 in a large, heterogeneous population in the real world. Methods: We reviewed charts of all men with diagnosed with mCRPC in the entire Veterans Affairs (VA) system alive as of January 1 st , 2013 who received radium-223. We compared common treatment patterns and characteristics between black and nonblack men. We analyzed predictors of time from radium-223 start to overall survival and time to skeletal related event (SRE) with Cox models. Results: 318 patients with bone mCRPC who received radium-223 were identified. 27% (87/318) were black. Black men were younger (67 vs 70 years, p = 0.001) and had higher PSA and alkaline phosphatase (ALP) levels at radium start (p = 0.014 and 0.017, respectively). There were no significant differences in biopsy Gleason, number of bone metastasis, primary localized treatment (yes/no), PSA doubling time, bone pain, or number of radium injections. Black men had lower mortality risk (HR 0.75; 95% CI 0.57 to 0.98; P = 0.038) on multivariable analysis. Comparison of common treatment patterns between black and nonblack men revealed that black men were more likely to receive other therapies prior to radium, including chemotherapy. Conclusions: Using a large, heterogeneous, real world cohort, we describe differences in treatment patterns and outcomes with radium-223 between black and nonblack men with mCRPC. While black men had a lower risk of mortality in this cohort, they had higher PSA and ALP levels when receiving radium-223. They were also more likely to receive other therapies prior to radium-223, indicating a possible delay in radium use in black men.
Predictors of cervical cancer screening among patients at an international medicine clinic – Seattle, WA.
Authors: Manoj Menon, Angel Desai, Mahri Haider, Genji Terasaki
Journal: Journal of Clinical Oncology (2015)

e17632 Background: Average-risk women between the ages of 21 and 65 are recommended to receive cervical cancer screening every 3 years. The mortality secondary to cervical cancer has decreased by over 75% in the U.S. since the routine implementation of the Pap test. However, cervical cancer continues to take a toll among women with limited access to care including ethnic minorities and immigrants – likely secondary to disparities in screening. The International Medicine Clinic (IMC) at Harborview Medical Center provides adult refugees and immigrants with access to primary health care services, including age-appropriate cancer screening. Here we document cervical cancer screening rates among women at the IMC and describe predictors of screening. Methods: We extracted data from our medical record on all women between the ages of 21 and 65 who presented for care at the IMC between 2/1/11 and 1/31/12. Patient age, language, and date of most recent cervical cancer screening were collected. The gender and level of clinical training of the provider were also abstracted. We utilized bivariate analyses to identify measures with p < 0.20 for inclusion in a multivariate logistic regression model. Results: We analyzed data from 565 women; 15 women had a prior hysterectomy and were excluded from this analysis. The median age was 52 years (IQR 18). Somali was the most common language (25.3%) spoken followed by Amharic (13.5%), Vietnamese (12.5%), Khmer (10.0%), Tigrinya (9.1%), English (7.1%), and Spanish (6.4%). Cervical cancer screening was performed on 346 (62.9%) of women in the previous 3 years. The provider was female for 263 patients (47.8%). The majority of patients were seen by an attending physician (452; 82.2%). In multivariate analyses, younger patients (p < .001) and patients seen by female providers (p = .05) were more likely to have received cervical cancer screening. Patients who spoke either Somali (p = .02) or Tigrinya (p = .03) were less likely to receive cervical cancer screening (p = .03). Conclusions: The percentage of women who had not been screened for cervical cancer in our clinic is high. In order to increase utilization of cervical cancer screening, a better understanding of both patient and provider factors is necessary.