tbuckley/cabot-search huggingface dataset:
Low advance directive completion rates in hospitalized oncology patients: Room for improvement.
Authors: Manojna Konda, Aneesha Ananthula, Alan Baltz, Yadav Pandey, Arya Mariam Roy, Abhijit Godbole, Issam Makhoul, Heather Moore
Journal: Journal of Clinical Oncology (2019)

1 Background: Advance care planning (ACP), which includes advance directive (AD) completion, ensures that patients receive care that is consistent with their beliefs and preferences. ACP is particularly important to patients with cancer as they have high rates of hospitalization and mortality. However, AD completion rates for oncology patients have been reported to be as low as 10%. We sought to evaluate barriers and improve AD completion rates in hospitalized oncology patients in our institution. Methods: 63 patients with cancer admitted to our inpatient oncology unit were surveyed. A multi-disciplinary team, consisting of resident physicians and social workers, was constituted to educate patients and provide assistance with AD completion. Barriers to AD completion were identified and AD completion and filing rates on patients’ discharge were calculated. Results: Most patients were female (66.6%) with mean age of 63.8 years. Majority of patients had stage IV cancer (71.4%) and were receiving palliative treatment (80.9%). Only 9.5% (6/63) of the patients had completed AD on file. However, 92% of the patients had previously heard about AD. After intervention, the AD filing rate improved to 41.2% (26/63). Some of the patient-reported barriers were needing more time to discuss with family (28.5%), wanting to file in clinic (23.8%), too sick to make decision (6.3%) and did not think they needed it (4.7%). Conclusions: AD completion rate in hospitalized oncology patients in our institute was lower than anticipated. We identified the barriers and improved the AD filing rate, however there is room for further improvement. While AD discussion and filing should ideally be done in clinic, hospitalization is an opportunity that should not be missed to educate and assist completion of AD. [Table: see text]
Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001–2015
Authors: Ashish A Deshmukh, Ryan Suk, Meredith S Shiels, Kalyani Sonawane, Alan G Nyitray, Yuxin Liu, Michael M Gaisa, Joel M Palefsky, Keith Sigel
Journal: JNCI Journal of the National Cancer Institute (2019)

Abstract Background Squamous cell carcinoma of the anus (SCCA) incidence is rising in the United States. Study of incidence trends by stage at diagnosis, age-specific and birth cohort patterns, and trends in mortality could provide evidence for a true increase and etiological clues for the increase in incidence. Methods Using the US Cancer Statistics dataset, we examined trends in SCCA incidence (2001–2015) and mortality (2001–2016) rates. Join-point regression was used to compute annual and average annual percentage change (AAPC). Incidence patterns by 5-year age group and birth cohort were evaluated using incidence rate ratios (IRRs) and age-period-cohort modeling. Results SCCA incidence increased 2.7% per year (95% confidence interval [CI] = 2.1% to 3.3%), with pronounced increases in age groups 50 years and older. Distant-stage SCCA incidence tripled (AAPC = 8.6%, 95% CI = 5.4% to 12.0%, among men and AAPC = 7.5%, 95% CI = 4.8% to 10.2%, among women) and regional-stage SCCA incidence nearly doubled (AAPC = 4.7% for men and women) in both sexes; the AAPC for localized stage was 1.3% (95% CI = 0.6% to 2.0%) in men and 2.3% (95% CI = 1.8% to 2.8%) in women. Compared with adults born circa 1946, recently born black men (born circa 1986) had a nearly fivefold higher risk (IRR = 4.7, 95% CI = 2.1 to 10.2) of SCCA, and the risk doubled among white men (IRR = 2.0, 95% CI = 1.7 to 2.2) and white women (IRR = 2.1, 95% CI = 1.9 to 2.3) born after circa 1960. Anal cancer mortality rates increased 3.1% per year (95% CI = 2.6% to 3.5%) with statistically significant increases in age groups 50 years and older. SCCA incidence-based mortality increased 1.9% annually (95% CI = 0.5% to 3.4%), with a notable (4.9%, 95% CI = 2.4% to 7.3%, per year) rise in adults ages 60–69 years. Conclusion The increase in SCCA incidence, particularly advanced-stage disease, and a similar increase in mortality suggest a true increase in the occurrence of SCCA. Future research and improved prevention are urgently needed to mitigate the increasing disease burden.
A study in recurrent small cell lung cancer patients, comparing weekly paclitaxel, irinotecan and temozolomide in second-line: A prospective study from a south Indian tertiary cancer hospital
Authors: L. Moharana, D. Lokanatha, L.A. Jacob, M. Sureshbabu, K. Lokesh, A. Rudresha, L. Rajeev, S. Smitha
Journal: Annals of Oncology (2019)
Upconversion Nanoparticle Powered Microneedle Patches for Transdermal Delivery of siRNA
Authors: Min Wang, Yiyuan Han, Xiaojun Yu, Liangliang Liang, Hao Chang, David C. Yeo, Christian Wiraja, Mei Ling Wee, Linbo Liu, Xiaogang Liu, Chenjie Xu
Journal: Advanced Healthcare Materials (2019)

Abstract Microneedles (MNs) permit the delivery of nucleic acids like small interfering RNA (siRNA) through the stratum corneum and subsequently into the skin tissue. However, skin penetration is only the first step in successful implementation of siRNA therapy. These delivered siRNAs need to be resistant to enzymatic degradation, enter target cells, and escape the endosome–lysosome degradation axis. To address this challenge, this article introduces a nanoparticle‐embedding MN system that contains a dissolvable hyaluronic acid (HA) matrix and mesoporous silica‐coated upconversion nanoparticles (UCNPs@mSiO 2 ). The mesoporous silica (mSiO 2 ) shell is used to load and protect siRNA while the upconversion nanoparticle (UCNP) core allows the tracking of MN skin penetration and NP diffusion through upconversion luminescence imaging or optical coherence tomography (OCT) imaging. Once inserted into the skin, the HA matrix dissolves and UCNPs@mSiO 2 diffuse in the skin tissue before entering the cells for delivering the loaded genes. As a proof of concept, this system is used to deliver molecular beacons (MBs) and siRNA targeting transforming growth factor‐beta type I receptor (TGF‐βRI) that is potentially used for abnormal scar treatment.
The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study
Authors: Bertrand Guidet, Dylan W. de Lange, Ariane Boumendil, Susannah Leaver, Ximena Watson, Carol Boulanger, Wojciech Szczeklik, Antonio Artigas, Alessandro Morandi, Finn Andersen, Tilemachos Zafeiridis, Christian Jung, Rui Moreno, Sten Walther, Sandra Oeyen, Joerg C. Schefold, Maurizio Cecconi, Brian Marsh, Michael Joannidis, Yuriy Nalapko, Muhammed Elhadi, Jesper Fjølner, Hans Flaatten
Journal: Intensive Care Medicine (2019)
Management of Established Status Epilepticus
Authors: Phil E. Smith
Journal: New England Journal of Medicine (2019)

Status epilepticus is a medical emergency characterized either by continued seizures or by a lack of full recovery between seizures. It is relatively common, with a reported annual incidence of between 10 and 41 cases per 100,000 population (the variation partly reflects differing diagnostic criteria) and a mortality of approximately 20%.1 The previous definition of status epilepticus as epileptic activity persisting for more than 30 minutes has been superseded2 with the aim of limiting the irreversible neurologic damage that has been shown in animal models.3 Clinicians have long been urged instead to intervene early in the disorder, typically when seizures . . .
How to Identify and Fix Sleep Problems
Authors: John W. Winkelman
Journal: JAMA Psychiatry (2019)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Psychiatry HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Psychiatry journal
Pharmacogenetic (PGx) guided cancer pain management in an oncology palliative medicine (PM) clinic.
Authors: Jai Narendra Patel, Danielle Boselli, James Thomas Symanowski, Stephanie Wodarski, ShRhonda Turner, Courtney Slaughter, Melissa Waller, Donna Baldassare, Rebecca Edwards, Beth Susi, Rebecca Greiner, Connie Edelen
Journal: Journal of Clinical Oncology (2019)

117 Background: About 30% of cancer patients presenting with pain have symptomatic improvement using conventional strategies within one month. PGx may help personalize opioid selection and improve cancer pain management. Methods: This is a pragmatic pilot trial investigating the feasibility and application of PGx testing to improve pain management in adults with uncontrolled cancer pain referred to an oncology PM clinic. PM providers assessed patients using Edmonton Symptom Assessment Scale at baseline and opioid therapy was initiated or modified. A buccal swab was obtained for genotyping single nucleotide polymorphisms in: COMT, CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, and OPRM1. The first assessment occurred within one week of baseline and a second within another week if intervention was required. PGx results were available before the first assessment and utilized, if applicable, throughout the one-month study period. Pain improvement rate (≥ 2-point reduction on a 0-10 scale) from baseline to final visit, was compared to historical control data by a one-sided exact binomial test of proportions. Results: Of 75 undergoing PGx testing, 52 were evaluable for the primary endpoint (54% female, 81% white, 17% black, median age 63, 75% stage 3 or 4 disease, median personalized pain goal 3 [0-6]). 56% had pain improvement compared to 30% in historical controls (p &lt; 0.001). At final assessment, 35% met their personalized pain goal. Of 26 (50%) requiring opioid adjustments, 18 (69%) had an actionable genotype with a 61% pain improvement rate. The two most common genes for opioid adjustment were CYP2D6 (16/18; 89%) and COMT (8/18; 44%). The most common PGx-guided modification involved switching from a CYP2D6-metabolized drug (hydrocodone, oxycodone, tramadol) to a non-CYP2D6-metabolized drug (fentanyl, hydromorphone, methadone, morphine). Conclusions: PGx implementation in an oncology PM clinic was feasible and improved pain management. Half of those requiring opioid adjustments had an actionable genotype, with the largest impact from CYP2D6 polymorphisms. Future studies should focus on preemptive PGx testing to guide initial drug selection and confirm clinical utility in a randomized trial. Clinical trial information: NCT02542397.
Selective activation of TWIK-related acid-sensitive K <sup>+</sup> 3 subunit–containing channels is analgesic in rodent models
Authors: Ping Liao, Yunguang Qiu, Yiqing Mo, Jie Fu, Zhenpeng Song, Lu Huang, Suwen Bai, Yang Wang, Jia-Jie Zhu, Fuyun Tian, Zhuo Chen, Nanfang Pan, Er-Yi Sun, Linghui Yang, Xi Lan, Yinbin Chen, Dongping Huang, Peihua Sun, Lifen Zhao, Dehua Yang, Weiqiang Lu, Tingting Yang, Junjie Xiao, Wei-Guang Li, Zhaobing Gao, Bing Shen, Qiansen Zhang, Jin Liu, Hualiang Jiang, Ruotian Jiang, Huaiyu Yang
Journal: Science Translational Medicine (2019)

The paucity of selective agonists for TWIK-related acid-sensitive K+ 3 (TASK-3) channel, a member of two-pore domain K+ (K2P) channels, has contributed to our limited understanding of its biological functions. By targeting a druggable transmembrane cavity using a structure-based drug design approach, we discovered a biguanide compound, CHET3, as a highly selective allosteric activator for TASK-3-containing K2P channels, including TASK-3 homomers and TASK-3/TASK-1 heteromers. CHET3 displayed potent analgesic effects in vivo in a variety of acute and chronic pain models in rodents that could be abolished pharmacologically or by genetic ablation of TASK-3. We further found that TASK-3-containing channels anatomically define a unique population of small-sized, transient receptor potential cation channel subfamily M member 8 (TRPM8)-, transient receptor potential cation channel subfamily V member 1 (TRPV1)-, or tyrosine hydroxylase (TH)-positive nociceptive sensory neurons and functionally regulate their membrane excitability, supporting CHET3 analgesic effects in thermal hyperalgesia and mechanical allodynia under chronic pain. Overall, our proof-of-concept study reveals TASK-3-containing K2P channels as a druggable target for treating pain.
Skin pathologic change evaluation of the patients who had EGFR inhibitor-related skin adverse events
Authors: S.Y. Oh, J.H. Ji, Y. Kim, S. Lee, S.J. Huh, J.H. Lee, K.-H. Song, C.H. Son, J.H. Kang, M.S. Roh, J.M. Kim, J.E. Choo
Journal: Annals of Oncology (2019)
Clinical Outcomes After Left Ventricular Assist Device Implantation in Older Adults
Authors: Cesar Caraballo, Ersilia M. DeFilippis, Shunichi Nakagawa, Neal G. Ravindra, P. Elliott Miller, Catherine Mezzacappa, Megan McCullough, Jadry Gruen, Andrew Levin, Samuel Reinhardt, Clancy Mullan, Ayyaz Ali, Mathew S. Maurer, Nihar R. Desai, Tariq Ahmad, Veli K. Topkara
Journal: JACC Heart Failure (2019)
Thrombotic Profile and Oral Anticoagulation in Asian and Non-Asian Patients With Nonvalvular Atrial Fibrillation
Authors: Ying X. Gue, Nobutaka Inoue, Nikolaos Spinthakis, Asumi Takei, Hiroyuki Takahara, Kazunori Otsui, Gregory Y.H. Lip, Diana A. Gorog
Journal: Journal of the American College of Cardiology (2019)
HBsAg-specific CD8+ T cells as an indispensable trigger to induce murine hepatocellular carcinoma
Authors: Xiaolei Hao, Yongyan Chen, Lu Bai, Haiming Wei, Rui Sun, Zhigang Tian
Journal: Cellular and Molecular Immunology (2019)

Hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) is mediated by an inappropriate attack by HBV-specific T cells in patients. However, this immunopathogenic process has not been clarified because of the lack of a suitable animal model. Here, we used immunocompetent Fah-/- mice as the recipients in the adoptive transfer of HBsAg+ hepatocytes from HBs-Tg mice to replace the recipient hepatocytes (HBs-HepR). HBs-HepR mice exhibited persistent HBsAg expression with chronic hepatitis and eventually developed HCC with a prevalence of 100%. HBsAg-specific CD8+ T cells were generated and specifically and continuously induced hepatocyte apoptosis with progressive chronic inflammation, and the depletion of CD8+ T cells or their deficiency prevented HCC, which could then be reproduced by the transfer of HBsAg-specific CD8+ T cells. In summary, our results demonstrated that CD8+ T cells plays a critical role in HBsAg-driven inflammtion and HCC tumorigenesis.
Safety and efficacy of dacomitinib for EGFR+ NSCLC in the subgroup of Asian patients from ARCHER 1050
Authors: T.S.K. Mok, Y. Cheng, X. Zhou, K.H. Lee, K. Nakagawa, S. Niho, R. Rosell, R. Linke, C.H. Wong, Y. Tang, M. Singh, K.D. Wilner, Y.-L. Wu
Journal: Annals of Oncology (2019)
The wealth→life history→innovation account of the Industrial Revolution is largely inconsistent with empirical time series data
Authors: Michael E W Varnum, Igor Grossmann
Journal: Behavioral and Brain Sciences (2019)

Abstract Baumard proposes a model to explain the dramatic rise in innovation that occurred during the Industrial Revolution, whereby rising living standards led to slower life history strategies, which, in turn, fostered innovation. We test his model explicitly using time series data, finding limited support for these proposed linkages. Instead, we find evidence that rising living standards appear to have a time-lagged bidirectional relationship with increasing innovation.
Structural Basis of Protection against H7N9 Influenza Virus by Human Anti-N9 Neuraminidase Antibodies
Authors: Xueyong Zhu, Hannah L. Turner, Shanshan Lang, Ryan McBride, Sandhya Bangaru, Iuliia M. Gilchuk, Wenli Yu, James C. Paulson, James E. Crowe, Andrew B. Ward, Ian A. Wilson
Journal: Cell Host & Microbe (2019)
Expression of Concern to: Identifying and targeting cancer stem cells in leiomyosarcoma: prognostic impact and role to overcome secondary resistance to PI3K/mTOR inhibition
Authors: Benjamin Fourneaux, Aurélien Bourdon, Bérengère Dadone, Carlo Lucchesi, Scott R. Daigle, Elodie Richard, Audrey Laroche-Clary, François Le Loarer, Antoine Italiano
Journal: Journal of Hematology & Oncology (2019)

The Editor-in-Chief would like to alert readers that the ownership of some of the data presented in this article [1]
Novel concepts in the pathophysiology and treatment of functional dyspepsia
Authors: Lucas Wauters, Nicholas J Talley, Marjorie M Walker, Jan Tack, Tim Vanuytsel
Journal: Gut (2019)

Emerging data increasingly point towards the duodenum as a key region underlying the pathophysiology of functional dyspepsia (FD), one of the most prevalent functional GI disorders. The duodenum plays a major role in the control and coordination of gastroduodenal function. Impaired duodenal mucosal integrity and low-grade inflammation have been associated with altered neuronal signalling and systemic immune activation, and these alterations may ultimately lead to dyspeptic symptoms. Likely luminal candidates inducing the duodenal barrier defect include acid, bile, the microbiota and food antigens although no causal association with symptoms has been convincingly demonstrated. Recognition of duodenal pathology in FD will hopefully lead to the discovery of new biomarkers and therapeutic targets, allowing biologically targeted rather than symptom-based therapy. In this review, we summarise the recent advances in the diagnosis and treatment of FD with a focus on the duodenum.
GPs call for home visits to be removed from contract
Authors: Gareth Iacobucci
Journal: BMJ (2019)

GP leaders in England have called for an end to their contractual responsibility to carry out home visits, following a tense vote at their annual conference in London.

After a passionate and polarised debate, England’s local medical committee (LMC) representatives passed a motion which said that GPs “no longer have the capacity to offer home visits” and called on the BMA’s General Practitioners Committee (GPC) for England to negotiate changes to their contract to reflect this.

The motion was voted on in three parts, all of which were carried. The first section to “remove the anachronism of home visits from core contract work” narrowly passed, with 54% voting in favour …
Preoperative chemotherapy compared with postoperative adjuvant chemotherapy for squamous cell carcinoma of the thoracic oesophagus with the detection of circulating tumour cells randomized controlled trial
Authors: Yunpeng Zhao, Lu Han, Wenhao Zhang, Lei Shan, Yongqiang Wang, Pingping Song, Chuanliang Peng, Xiaogang Zhao
Journal: International Journal of Surgery (2019)

The role of preoperative chemotherapy in the treatment of patients with oesophageal squamous cell carcinoma (ESCC) remains controversial. Chemotherapy followed by surgery was compared with surgery ± chemotherapy, and the detection of circulating tumour cells (CTCs) was performed on all enrolled patients. We randomly assigned patients with resectable tumours to the preoperative chemotherapy group (Pre group) or surgery group (patients who were either given or not given adjuvant chemotherapy according to their postoperative lymph node status, Post group). Blood samples were collected 1–3 days before treatment (including preoperative chemotherapy and surgery) and 7 days after surgery for CTC detection. From July 2016 to October 2018, 115 patients were enrolled in the study, of whom 57 were assigned to the Pre group and 58 to the Post group. The proportion of patients with stage III ESCC was 63.16% in the Pre group and 48.28% in the Post group. No patients died during chemotherapy. One patient exhibited a complete response to preoperative chemotherapy, and 13 patients exhibited partial responses. The 2-year progression-free survival (PFS) and overall survival (OS) rates were not significantly different between the Pre and Post groups. In the subgroup analysis, patients with CTC (+) prior to treatments receiving preoperative chemotherapy had a better 2-year PFS (71.90% vs. 38.73%, P = 0.0379). In the Cox proportional hazards regression analysis, platelet count was proven to correlate significantly with disease progression (P = 0.016), and no factors were proven to correlate significantly with mortality after the factors were balanced in the present analysis. Preoperative chemotherapy improved the short-term PFS when CTC detection was positive prior to any treatment for patients with stage II or III ESCC. CTC detection may be used as an index to guide individualized strategic decisions regarding preoperative chemotherapy, but more evidence is needed.