tbuckley/cabot-search huggingface dataset:
The cost of obesity in radical cystectomy.
Authors: Melissa Huynh, Ye Wang, Daniel Pucheril, Dimitar V. Zlatev, Steven Lee Chang, Matthew Mossanen, Alice Yu
Journal: Journal of Clinical Oncology (2019)

434 Background: The Centers for Disease Control and Prevention estimates that nearly 40% of the U.S. population meets the criteria for obesity classification. Several studies have shown that obesity is associated with increased medical morbidity and costs. In this study, we investigated the impact of obesity on the financial burden of radical cystectomy. We hypothesize that the cost of radical cystectomy is greater in obese and morbidly obese patients compared to overweight patients. Methods: We performed a retrospective observational study within the Premier Healthcare Database (Premier Inc., Charlotte, NC), a large, U.S. hospital-based, all-payer database representing approximately 20% of annual inpatient discharges. ICD-9 procedure codes were used to identify all patients who had undergone elective radical cystectomy (57.71, 57.79) from 2003 to 2015, and administrative data was used to extract the costs associated with the index hospitalization. Patients were stratified into three body mass index (BMI) categories: overweight (25 BMI &lt;30), obese (30 ≤ BMI &lt; 40) and morbidly obese (BMI ≥ 40). Quantile regression analysis was performed to examine the effect of BMI category on cost. Results: We identified 12,056 patients who underwent radical cystectomy, 1,406 of whom had data available regarding BMI category. The crude cost of the index hospitalization for radical cystectomy was $24,596 for overweight patients. The costs associated with patients in the obese and morbidly obese categories were $2,158 ( p=0.059) and $5,308 ( p&lt;0.001) higher compared to overweight patients, respectively. Median operative time for overweight, obese, and morbidly obese patients was 346, 391, and 420 minutes, respectively (p=0.0001). Multivariable models were constructed controlling for clinicodemographic, and surgical factors. After adjustment for operative time, there were no longer any statistically significant differences in cost between the BMI categories. Conclusions: The cost of radical cystectomy is significantly greater for obese and morbidly obese patients compared to overweight patients. This increased financial cost associated with obesity difference is driven by increased operative times encountered in obese patients.
Developing and Testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument
Authors: J. Jane Jue, Sarah Cunningham, Kathleen Lohr, Paul Shekelle, Richard Shiffman, Craig Robbins, Mary Nix, Vivian Coates, Karen Schoelles
Journal: Annals of Internal Medicine (2019)

In 2011, the Institute of Medicine (IOM) (now the National Academy of Medicine) published standards for trustworthy guidelines and recommended that the National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and Quality clearly indicate the extent to which guidelines adhere to these standards. To accomplish this, the authors developed and tested the NGC Extent of Adherence to Trustworthy Standards (NEATS) instrument. The standards were operationalized as an instrument containing 15 items that cover disclosure of the funding source; disclosure and management of conflicts of interest; multidisciplinary input; incorporation of patient perspectives; rigorous systematic review; recommendations accompanied by rationale, assessment of benefits and harms, clear linkage to the evidence, and assessment of strength of evidence and strength of recommendation; clear articulation of recommendations; external review by diverse stakeholders; and plans for updating. After multiple rounds of feedback from experts on clinical practice guideline development, the external validity and interrater reliability of the instrument were evaluated. For each item, 80% to 100% of survey respondents judged it to be a good measure of the IOM standards. All external stakeholders stated that NEATS was suitable for its intended goal. Interrater reliability for the final NEATS instrument had a weighted κ of 0.73. The NEATS instrument is a focused tool that provides a concise evaluation of a guideline's adherence to the IOM standards for trustworthy guidelines. It has good external validity among guideline developers and good interrater reliability across trained reviewers.
Expression of some molecular biological markers in different histological subtypes of gastric cancer.
Authors: Evgeniya M. Nepomnyashchaya, Inna Arnoldovna Novikova, Elena Petrovna Ulianova, Yuri Gevorkyan, Andrey Dashkov
Journal: Journal of Clinical Oncology (2015)

e15057 Background: The purpose of the study was to determine the expression of some molecular biological markers in different histological subtypes of gastric cancer. Methods: Data on 30 patients (15 men, 15 women) aged 49-73 years, mean age 55.5 years, with different histological subtypes of gastric cancer (adenocarcinoma of varying degrees of differentiation, mucus-producing adenocarcinoma, mucus-producing adenocarcinoma+signet ring cell carcinoma, signet ring cell carcinoma, undifferentiated carcinoma) were studied. All patients received surgery: stomach resection (10%) and gastrectomy with lymphadenectomy (90%). The Ki-67 proliferation activity index was defined and antibodies to p53, bcl-2, TGF, CD34 and a-fetoprotein (DAKO) were used. Results: Ki-67 proliferation activity in G1-G2 adenocarcinomas was 50-70% of tumor cell nuclei, in mucus-producing adenocarcinoma+signet ring cell carcinoma, signet ring cell carcinoma and undifferentiated carcinoma – up to 80%. TGF expression was positive in 100% of the cases, a-fetoprotein expression – negative. p53 and bcl-2 expression was positive mainly in poorly differentiated adenocarcinoma, signet ring cell carcinoma and undifferentiated carcinoma. CD34 expression was positive in all the cases. Conclusions: Ki-67 and TGF expression indices in gastric cancer do not depend on the degree of differentiation and histological type and can be used as prognostic factors.
Abstract 031: County Poverty Disproportionately Effects Mortality in Heart Failure Compared to Coronary Heart Disease
Authors: Khansa Ahmad, Edward Chen, Umair Nazir, Amal Trivedi, Sebhat Erqou, Wen-chih Wu
Journal: Circulation (2019)

Background: Regional poverty has been associated with worse outcomes in stroke, myocardial infarction and overall cardiovascular mortality. There is paucity of data regarding regional socioeconomic (SE) factors and outcomes in heart failure (HF). We studied the association between SE factors and HF mortality and compared it with CHD mortality at a regional level. Methods: This is a cross sectional analysis of all US counties (n=3141) from 2010-2015. County level data for SE factors, risk factor prevalence and demographics were collected from CDC and Census Bureau. Counties (n=6) with insufficient mortality data were excluded. In 2014, poverty threshold was $11,670 for 1-person household. Mortality data was derived from death certificates, published by National Center for Health Statistics. Random sampling (n=50) was used to compare the strength of correlation for the strongest SE factor (poverty, employment, education and uninsured %) with HF and CHD mortality. Population weighted multivariate linear regression analyses were used to relate the strongest SE factor and HF mortality, adjusted for risk factor prevalence and demographics. Results: We studied 3,135 counties with median(IQR) of poverty (15.8% (12.4% - 20.1%)), male (49.5% (48.9% -50.4%)), white (84.6% (63.4% -93.1%), ≥ 65 yrs. (17.2% (14.7%-19.9%)), number of HF hospitalizations/1000 Medicare beneficiaries (13.9 (9.2-17.6)) and HF deaths/100,000 (189.5 (164.7-219.1)). Of all SE factors, poverty% has the strongest association with HF mortality, disproportionately higher for HF than CHD (p=0.000). Our final model explains 61.7% of variation in regional HF mortality. Poverty remains an independent risk factor despite adjusting for demographics, other SE factors and risk factor prevalence. Conclusion: County poverty disproportionately effects HF mortality as compared to CHD mortality, independent of demographics and risk factor prevalence. Future studies examining additional mechanism of this association are needed to reform health policy.
The influence of body mass index and albumin on perioperative morbidity and Clinical outcomes in resected pancreatic adenocarcinoma.
Authors: Arsen Osipov, Jasleen Khanuja, Quanlin Li, Jason Naziri, Andrew Eugene Hendifar, Richard Tuli
Journal: Journal of Clinical Oncology (2015)

e15210 Background: Pancreatic adenocarcinoma (PDA) patients with higher pretreatment body-mass-index (BMI) are thought to have significantly worse clinical outcomes. A recent meta-analysis has also shown that pretreatment serum albumin (SA) is prognostic of outcome. We assessed the impact of BMI and SA on perioperative and long-term clinical outcomes in patients with resected PDA. Methods: With IRB approval, we evaluated 1,545 patients with PDA treated at a single institution from 2008 – 2013 and identified 106 patients who underwent upfront resection with curative intent. BMI and SA were calculated preoperatively and at the time of last clinical evaluation. The impact of BMI and SA on perioperative clinical outcomes including: length of hospital stay, transfusion requirements, intraoperative blood loss and operating time were analyzed. Influence of preoperative BMI, SA, and change in both variables on disease-free survival (DFS) and overall survival (OS) was assessed with cox regression modeling and ANOVA. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Results: Patients with preoperative BMI ≥ 30 and serum albumin < 3.5 had significantly worse OS rates compared to those with BMI < 30 and SA ≥ 3.5, respectively (p = .04, p = .03). A decrease in BMI ≥ 1.6 from the time of surgery to last clinical evaluation also resulted in significantly worse OS (p = 0.007). Similarly, reduction in SA ≥ 0.4 had a trend towards worse OS, although this was not statistically significant (p = 0.18). Evaluation of perioperative outcomes found a significant (p < 0.05) association between length of post-operative hospital stay and change in BMI, preoperative SA and preoperative BMI (correlation co-efficients -0.30, -0.29, and 0.23, respectively). Conclusions: We found that a higher preoperative SA was associated with greater OS and obesity was associated decreased OS. Our study is the first to describe how post-operative changes in BMI and SA impact clinical and perioperative outcomes. This data supports nutritional status and weight loss as being predictors of outcome in resected pancreatic cancer patients and warrants further prospective investigation.
Correction to: Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force
Authors: Maurizio Cecconi, Glenn Hernandez, Martin Dunser, Massimo Antonelli, Tim Baker, Jan Bakker, Jacques Duranteau, Sharon Einav, A. B. Johan Groeneveld, Tim Harris, Sameer Jog, Flavia R. Machado, Mervyn Mer, M. Ignacio Monge García, Sheila Nainan Myatra, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, Daniel De Backer
Journal: Intensive Care Medicine (2018)
Abstract P066: A Meta-Analysis of Protective Effect of Allopurinol in Preventing Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention
Authors: Kanaan Mansoor, Ahmad Amro, Mehiar El-Hamdani, Iheanyichukwu Ogu
Journal: Circulation (2019)

Background: Contrast- induced nephropathy (CIN) is an a major adverse outcome of both diagnostic and therapeutic cardiac catheterization procedures. It has been assoicated with prolonged hospitalization, morbidity and mortality. Aim of this study was to understand the protective effect on Allopurinol on CIN. Methods: Search for the literature was done of Science Direct, Pubmed/Medline, and Cochrane library. A total of 385 papers were reviewed according to the PRISMA protocol by two investigators, out of which 5 manuscripts were inculded in this study. Manuscripts which studied effect of allopurinol on CIN in patient undergoing PCI were included in the meta-analysis. In all studies CIN was diagnosed if there was &gt;25% elevation in serum creatinine. Results: A total of 5 studies met the inclusion criteria. Risk difference was calculated for each study and was tabulated in a forest plot. Heterogeneity was 83.81% with P &lt; 0.001 hence a random effect model was used. Overall Risk difference was -0.140 (CI 95% -0.257, -0.022). Conclusion: Our study demonstrates that Allopurinol potentially has a protective in preventing contrast induced nephropathy in patients undergoing percutaneous coronary intervention. Further large clinical trails are warranted to better understand this effect.
Examination of circulating DNA by using next generation sequence technology in colorectal cancer.
Authors: Fang Xie, Xiaowei Yan, Anup Madan, Edward H. Lin, Leroy Hood, Qiang Tian
Journal: Journal of Clinical Oncology (2015)

e14507 Background: Cancer is characterized by multiple somatic genetic alterations that could be useful as molecular markers for detecting tumor DNA in plasma. In healthy subjects and cancer patients, circulating plasma carry small amounts of cell free DNA. The goal of this study is to apply next generation sequencing (NGS) technology to detect circulating cell free DNA and examine whether tumor-specific oncogene mutations can be detected in colorectal cancer patients. Methods: Plasma samples were collected from 16 colorectal cancer patients including chemo-sensitive, radiation-sensitive and therapeutic-resistant patients, as well as 16 non-cancer individual controls. Circulating DNA concentration and DNA fragment size distribution were examined. Following library construction, three patient samples were subjected to NGS analysis and compared with their tissue onco-plex results. Results: Levels of circulating cell free DNA were significantly elevated in CRC patients and presented with highly fragmented DNA distribution compared with non-cancer controls. Through initially targeted analysis of oncogenes and tumor suppressor genes, more single nucleotide variations (SNV) were detected in circulating cell free DNA compared with the same individual tissue Onco-plex report at the same genes. Furthermore, two patients were identified to possess the same APC single nucleotide polymorphism (SNP) in circulating DNA. This APC SNV (NM_000038.5: c.730-1909 T > C) has been previously reported in familial colorectal cancer patients. Conclusion: Our data suggest that NGS analysis of cell-free DNA can detect oncogene variations in colorectal cancer patients. Increasing coverage by preforming whole exon sequencing may help identify actionable gene targets which will facilitate personalized cancer therapy.
Abstract P144: The Effect of a Community-Based Healthy Lifestyle Behavior Change Program on Simple 7 Score Among Rural Women
Authors: Rebecca Seguin, Sara Folta, Grace Marshall, Meredith Graham, David S Strogatz
Journal: Circulation (2019)

Objective: The objective of this study was to evaluate the effects of a multilevel healthy lifestyle behavior change program for women living in rural areas where higher rates of cardiovascular disease are influenced by poverty, reduced access to health care and unique social and built environment challenges. Methods: In eleven medically underserved rural towns in New York, 182 overweight and obese sedentary women 40 years and older enrolled in a community-randomized trial. Communities randomized to Group 1 (intervention) participated in six months of hour-long, twice weekly experiential learning classes that included progressive strength training, aerobic exercise and skill-based nutrition education (individual level), and a civic engagement curriculum focused on healthy food and physical activity environments (social, community and policy levels); classes were facilitated by local health educators trained by the research team. Communities randomized to Group 2 (delayed intervention control) received the intervention immediately following the completion of intervention activities for Group 1. All components of the Simple 7 score were recorded at baseline (prior to randomization) and at six months (post-intervention for Group 1, pre-intervention for Group 2). Weight, height, blood pressure, blood cholesterol and blood glucose were measured directly and smoking status, diet and physical activity were self-reported. Multivariate regression analyses were used to examine change in Simple 7 score from baseline to outcome. Initial models controlled for study site, baseline Simple 7 score, education and age, and were based on the 107 participants with complete data. Results: Simple 7 scores were similar for both groups prior to randomization (7.91 for Group 1, 7.83 for Group 2). At the end of the six month intervention period for Group 1, the Simple 7 score for Group 2 was unchanged (7.85) but increased to 8.98 for Group 1 participants (p=0.02 for the difference between groups in Simple 7 change). The percentage of Group 1 participants in the optimal range of scores (10-14) rose from 14.8% to 37.0%. The Simple 7 components showing the greatest improvement were BMI, physical activity and healthy diet score. Additional analyses will assess potential bias associated with incomplete data and will examine evidence for the validity of self-reports on physical activity and diet. Conclusion: The multilevel healthy lifestyle program is feasible for implementation in rural settings with limited resources and showed promise for reducing cardiovascular disease risk in midlife and older rural overweight and obese women.
Comparison of investigator-initiated and industry-initiated trials in Canada and other countries.
Authors: Bryan Wong, Scott A. North, Ben Tran, Srikala S. Sridhar
Journal: Journal of Clinical Oncology (2019)

464 Background: Investigator-initiated trials (IITs) developed by academic investigators without inherent commercial interests have contributed significantly to oncology. However, costs and regulatory complexity may negatively impact IITs. Little is published about current trends in cancer IITs. We focused on IITs in genitourinary cancers (GU IITs) in Canada and other countries and compared these to industry-initiated trials conducted over the same time period. Methods: We collected data using searches of the ClinicalTrials.gov registry for bladder, kidney, and prostate cancer trials conducted in Canada, US, and France from 2007 to 2017. IITs were defined as trials funded by individuals, universities, or organizations. We then characterized trials based on type, purpose, phase, participants, masking, assignment, and allocation. Results: Of the 498 GU trials conducted in Canada from 2007 to 2017, 201 (40%) were IITs, and 254 (51%) were industry-initiated. On average, GU IITs in Canada increased by 88% from 2007 to 2017, while industry-initiated trials increased by 30%. Although the increase of GU IITs in Canada was greater than industry-initiated trials, the growth was larger in US and France. In US, 746 (29%) of the 2537 GU cancer trials were IITs and increased by an average of 106% from 2007 to 2017, while industry-initiated trials increased by 61%. In France, 164 (41%) of the 405 GU cancer trials were IITs and increased by an average of 125% from 2007 to 2017, while industry-initiated trials increased by 83%. For GU IITs in Canada, most studies were interventional (85%) with purpose of treatment (47%). Phase 2 trials (23%) and trials with 20 to 49 participants (29%) accounted for the majority. Most trials were randomized (41%), open-label (70%), and used single group assignment (43%). GU IITs in US and France shared these same patterns in their characteristics. Conclusions: The increase in GU IITs from 2007 to 2017 was lower in Canada than US and France. In all three countries, more GU trials were industry-initiated than IITs. More emphasis must be placed on IITs in Canada through increased commitment and funding by institutions to promote development of IITs and maintain their distinctive, academically driven intentions.
Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study
Authors: Dirkje S Postma, Chris Brightling, Simonetta Baldi, Maarten Van den Berge, Leonardo M Fabbri, Alessandra Gagnatelli, Alberto Papi, Thys Van der Molen, Klaus F Rabe, Salman Siddiqui, Dave Singh, Gabriele Nicolini, Monica Kraft, Emilio Pizzichini, Alberto Cukier, Rafael Stelmach, Ronald Olivenstein, Qingling Zhang, Philipp Badorrek, Christian Gessner, Nicola Scichilone, Alfredo Chetta, Pierluigi Paggiaro, Stefano Milleri, Mariella D'Amato, Antonio Spanevello, Maria Pia Foschino, Willem Germen Boersma, Marielle Broeders, J Sebastiaan Vroegop, Vicente Plaza Moral, Ratko Djukanovic, Omar Usmani, Robert Schilz, Richard Martin, Nicola Hanania
Journal: The Lancet Respiratory Medicine (2019)
MiR expression in ovarian cancer (OvCa) and benign ovarian cystic masses (BOM) point to divergent molecular pathways of proliferation and metastasis.
Authors: Ahmad Bassam Shaker, Alejandro Recio Boiles, Devika Prasanna, Michaela Oswald, Cathleen Mason, Mary Keogh, Annette Lee, Iuliana Shapira
Journal: Journal of Clinical Oncology (2015)

e16557 Background: It is estimated that over 20,000 new cases of ovarian cancer are diagnosed annually. The workup of ovarian mass and diagnosis of cancer present a significant challenge on both patients and providers emotionally and technically. Specific tissue miRNAs play an important role in tissue identity, differentiation and function. We performed tissue and plasma analysis in patients with ovarian masses suspicious for cancer. Methods: Ovarian tissue miRNA profiles were generated from 32 women with serous type epithelial OvCa and 13 women with BOM. Taqman OpenArray panel was used to simultaneously run 745 microRNA using Biosystems Openarray RtPCR; 2-tailes t-test was used for all 2-sample comparison and ANOVA followed by Benjamin-Hochberg method for multiple testing to limit the false discovery rate (FDR) at the 5% level. Target scan context+scores identified mRNAs regulated by miR17-92a. Reactome constructed deregulated pathways. Results: OvCa patients had 4-20 fold higher expression of miR-720 not detected in tissues of BOM. Target scan was used to select the mRNAs most commonly regulated by miRNA-720. The following genes have conserved seed targets for miR-720: DCUN1D4; DNMT3A; ACVR1B; SAMD4B; FOXG1; QKI; HNRNPA2B1; FGF14; SPOCK2; AGAP2. Genes impacted by the miR-720 (total and context+score) decrease at least 29% protein level. Reactome delineated pathways repressed by OvCa overexpressed miR-720. Reactome analysis showed downregulation in chromatin modifying enzymes FDR 2.3E-1; signaling by activin FDR 1.03E-1; processing of CAP intron containing pre-mRNA FDR 1.39E-1, signaling by NODAL/ACVR1B FDR 1.03E-1; PRC2 histone methylation FDR 1.34E-1; DNMT3a DNA methylation FDR 1.03E-1. Conclusions: TGF-beta signaling via activin, epigenetic chromatin modification genes and genes involved in pre-mRNA processing appear to be important for malignant transformation. These signaling pathways were not present in BOM.
Implications of identifying the recently defined members of the Staphylococcus aureus complex S. argenteus and S. schweitzeri: a position paper of members of the ESCMID Study Group for Staphylococci and Staphylococcal Diseases (ESGS)
Authors: K. Becker, F. Schaumburg, A. Kearns, A.R. Larsen, J.A. Lindsay, R.L. Skov, H. Westh
Journal: Clinical Microbiology and Infection (2019)