tbuckley/cabot-search huggingface dataset:
Intercostal vessel screening prior to pleural interventions by the respiratory physician: a prospective study of real world practice
Authors: Eihab O. Bedawi, Ambika Talwar, Maged Hassan, David J. McCracken, Rachelle Asciak, Rachel M. Mercer, Nikolaos I. Kanellakis, Fergus V. Gleeson, Rob J. Hallifax, John M. Wrightson, Najib M. Rahman
Journal: European Respiratory Journal (2020)

Introduction The rising incidence of pleural disease is seeing an international growth of pleural services, with physicians performing an ever-increasing volume of pleural interventions. These are frequently conducted at sites without immediate access to thoracic surgery or interventional radiology and serious complications such as pleural bleeding are likely to be under-reported. Aim To assess whether intercostal vessel screening can be performed by respiratory physicians at the time of pleural intervention, as an additional step that could potentially enhance safe practice. Methods This was a prospective, observational study of 596 ultrasound-guided pleural procedures conducted by respiratory physicians and trainees in a tertiary centre. Operators did not have additional formal radiology training. Intercostal vessel screening was performed using a low frequency probe and the colour Doppler feature. Results The intercostal vessels were screened in 95% of procedures and the intercostal artery (ICA) was successfully identified in 53% of cases. Screening resulted in an overall site alteration rate of 16% in all procedures, which increased to 30% when the ICA was successfully identified. This resulted in procedure abandonment in 2% of cases due to absence of a suitable entry site. Intercostal vessel screening was shown to be of particular value in the context of image-guided pleural biopsy. Conclusion Intercostal vessel screening is a simple and potentially important additional step that can be performed by respiratory physicians at the time of pleural intervention without advanced ultrasound expertise. Whether the widespread use of this technique can improve safety requires further evaluation in a multi-centre setting with a robust prospective study.
Omalizumab for Aspirin Hypersensitivity and Leukotriene Overproduction in Aspirin-exacerbated Respiratory Disease. A Randomized Controlled Trial
Authors: Hiroaki Hayashi, Yuma Fukutomi, Chihiro Mitsui, Keiichi Kajiwara, Kentaro Watai, Yosuke Kamide, Yuto Nakamura, Yuto Hamada, Yasuhiro Tomita, Kiyoshi Sekiya, Takahiro Tsuburai, Kenji Izuhara, Keiko Wakahara, Naozumi Hashimoto, Yoshinori Hasegawa, Masami Taniguchi
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

Rationale: Aspirin-exacerbated respiratory disease is characterized by severe asthma, nonsteroidal antiinflammatory drug hypersensitivity, nasal polyposis, and leukotriene overproduction. Systemic corticosteroid therapy does not completely suppress lifelong aspirin hypersensitivity. Omalizumab efficacy against aspirin-exacerbated respiratory disease has not been investigated in a randomized manner.Objectives: To evaluate omalizumab efficacy against aspirin hypersensitivity, leukotriene E4 overproduction, and symptoms during an oral aspirin challenge in patients with aspirin-exacerbated respiratory disease using a randomized design.Methods: We performed a double-blind, randomized, crossover, placebo-controlled, single-center study at Sagamihara National Hospital between August 2015 and December 2016. Atopic patients (20–79 yr old) with aspirin-exacerbated respiratory disease diagnosed by systemic aspirin challenge were randomized (1:1) to a 3-month treatment with omalizumab or placebo, followed by a >18-week washout period (crossover design). The primary endpoint was the difference in area under logarithm level of urinary leukotriene E4 concentration versus time curve in the intent-to-treat population during an oral aspirin challenge.Measurements and Main Results: Sixteen patients completed the study and were included in the analysis. The area under the logarithm level of urinary leukotriene E4 concentration versus time curve during an oral aspirin challenge was significantly lower in the omalizumab phase (median [interquartile range], 51.1 [44.5–59.8]) than in the placebo phase (80.8 [interquartile range, 65.4–87.8]) (P < 0.001). Ten of 16 patients (62.5%) developed oral aspirin tolerance up to cumulative doses of 930 mg in the omalizumab phase (P < 0.001).Conclusions: Omalizumab treatment inhibited urinary leukotriene E4 overproduction and upper/lower respiratory tract symptoms during an oral aspirin challenge, resulting in aspirin tolerance in 62.5% of the patients with aspirin-exacerbated respiratory disease.
Quantitative immunohistochemical (IHC) assessment of ataxia-telangiectasia mutated (ATM) in estrogen receptor (ER) negative early breast cancer (BC).
Authors: Patricia Tang, Alexander C. Klimowicz, Gregory Russell Pond, Daniel Yick Chin Heng, Marc A. Webster, Anthony M. Magliocco, D. Gwyn Bebb
Journal: Journal of Clinical Oncology (2012)

e21083 Background: ATM plays a key role in the cellular response to DNA damage and germline mutations are associated with a predisposition to BC. We evaluated the impact of ATM expression on outcomes in Stage I-III ER negative BC patients (pts). Methods: A tissue microarray was constructed from formalin-fixed paraffin-embedded specimens of ER negative Stage I-III BC pts from the Tom Baker Cancer Centre. ATM expression was assessed by quantitative fluorescence IHC using a rabbit anti-ATM monoclonal antibody (Epitomics) and the HistoRx AQUA platform. ATM expression index (EI) was calculated by the tumor cell to stroma expression ratio. Prognostic ability of ATM EI was explored univariately, and multivariately after adjusting for clinicopathological factors selected using algorithmic methods, with Cox regression methods. Results: Of 126 eligible pts treated from 1999-2004, 44.4% were HER2-neu + and 52.4% were triple negative. ATM EI was normalized using a logarithmic transformation. Univariately, higher ATM EI was associated with worse outcomes (Table). Multivariately, higher ATM EI remained significantly prognostic for recurrence-free survival (RFS) (HR=5.46, p=0.046), local RFS (HR=5.56, p=0.052), distant RFS (HR=4.38, p=0.080), but not overall survival (p=0.48). Conclusions: High ATM EI is associated with worse RFS in ER negative BC in this hypothesis-generating study. Validation of this finding is currently ongoing. [Table: see text]
Authors’ reply to Erren and colleagues
Authors: Eva Schernhammer, Yin Zhang, Susanne Strohmaier, Elizabeth Devore, Fran Grodstein
Journal: BMJ (2020)

We appreciate Erren and colleagues’ response to our recently published paper, suggesting we examine photoperiod (hours of daylight).12

A fundamental question in health remains whether fetal adaptations in response to adverse intrauterine conditions increase the risk of childhood and adulthood disease.3 Barker and colleagues’ observation that birth weight predicts future risk of ischaemic heart disease4 has received renewed attention through the potential impact of early life environments, such as nutritional status and …
Abstract P2-02-02: Lack of screening mammography and black race are associated with late-stage breast cancer diagnosis in safety-net setting
Authors: Marissa A Mendez, An-Lin Cheng, Nasim Ahmadiyeh
Journal: Cancer Research (2020)

Abstract Importance: In our urban safety-net hospital (SNH) setting, we see approximately three times more late-stage (stage III and IV) breast cancer at diagnosis than the rest of the country. Breast cancers diagnosed at later stages have lower survival than those diagnosed at earlier stages. The aim of this study is to determine the factors associated with late-stage breast cancer diagnosis in our SNH setting. Method: This is a retrospective study of all breast cancer cases diagnosed or treated at the primary SNH in the Kansas City, MO metro area between January 2011-July 2018 (n=615). All female breast cancer patients diagnosed with early-stage (stage 0 or I, n=314) or late-stage (stage III or IV, n=98) disease were included. Those diagnosed at stage II (n=176), recurrent breast cancer (n=20) or with conflicting or unknown stage (n=27) were excluded. Variables analyzed: clinical TNM stage at diagnosis, age, race, insurance type, zip code, tumor subtype, whether patient presented with symptoms, whether a screening mammogram was obtained in the two years prior to diagnosis, and whether the patient was referred from outside our institution, or internally. Median household income and distance to treating facility were imputed from patient-level zipcode data. Multiple logistic regression was performed to determine the variables that contributed the most to the late-stage at diagnosis. Results: Three variables were significantly associated with late-stage diagnosis in the multiple regression: not having had a screening mammogram within two years (p&amp;lt;0.0001, OR 0.132, CI= 0.063, 0.277), being black (p= 0.0051, OR 2.549, CI = 1.325, 4.904), and having HER2 positive disease (p=0.0213, OR=2.695, CI= 1.159, 6.265). A race by tumor marker interaction was examined, and was not found to be significant. Conclusions: In our safety-net hospital setting, not having a screening mammogram in the two years prior to a breast cancer diagnosis was the most significant factor associated with late-stage at diagnosis, followed by being black. Screening mammography ought to be actively promoted in safety-net hospital settings with excess late-stage diagnosis. Black women may need different risk-based screening guidelines. Citation Format: Marissa A Mendez, An-Lin Cheng, Nasim Ahmadiyeh. Lack of screening mammography and black race are associated with late-stage breast cancer diagnosis in safety-net setting [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 P2-02-02.
Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures
Authors: Eduardo Guimarães Hourneaux de Moura
Journal: Endoscopy (2020)

The endoscopic evaluation of indeterminate biliary strictures in patients with and without primary sclerosing cholangitis (PSC) has evolved considerably with the improvement in duodenoscopes. Endoscopic retrograde cholangiopancreatography (ERCP) has become the basis for diagnosis and therapy in patients with this condition.
Comprehensive characterization of cell-free tumor DNA in plasma and urine of patients with renal tumors
Authors: Christopher G. Smith, Tina Moser, Florent Mouliere, Johanna Field-Rayner, Matthew Eldridge, Anja L. Riediger, Dineika Chandrananda, Katrin Heider, Jonathan C. M. Wan, Anne Y. Warren, James Morris, Irena Hudecova, Wendy N. Cooper, Thomas J. Mitchell, Davina Gale, Andrea Ruiz-Valdepenas, Tobias Klatte, Stephan Ursprung, Evis Sala, Antony C. P. Riddick, Tevita F. Aho, James N. Armitage, Samantha Perakis, Martin Pichler, Maximilian Seles, Gabriel Wcislo, Sarah J. Welsh, Athena Matakidou, Tim Eisen, Charles E. Massie, Nitzan Rosenfeld, Ellen Heitzer, Grant D. Stewart
Journal: Genome Medicine (2020)

Abstract Background Cell-free tumor-derived DNA (ctDNA) allows non-invasive monitoring of cancers, but its utility in renal cell cancer (RCC) has not been established. Methods Here, a combination of untargeted and targeted sequencing methods, applied to two independent cohorts of patients ( n = 91) with various renal tumor subtypes, were used to determine ctDNA content in plasma and urine. Results Our data revealed lower plasma ctDNA levels in RCC relative to other cancers of similar size and stage, with untargeted detection in 27.5% of patients from both cohorts. A sensitive personalized approach, applied to plasma and urine from select patients ( n = 22) improved detection to ~ 50%, including in patients with early-stage disease and even benign lesions. Detection in plasma, but not urine, was more frequent amongst patients with larger tumors and in those patients with venous tumor thrombus. With data from one extensively characterized patient, we observed that plasma and, for the first time, urine ctDNA may better represent tumor heterogeneity than a single tissue biopsy. Furthermore, in a subset of patients ( n = 16), longitudinal sampling revealed that ctDNA can track disease course and may pre-empt radiological identification of minimal residual disease or disease progression on systemic therapy. Additional datasets will be required to validate these findings. Conclusions These data highlight RCC as a ctDNA-low malignancy. The biological reasons for this are yet to be determined. Nonetheless, our findings indicate potential clinical utility in the management of patients with renal tumors, provided improvement in isolation and detection approaches.
Asbestos-related malignant mesothelioma in Japan
Authors: T. Kishimoto
Journal: Journal of Clinical Oncology (2007)

18182 Large amounts of asbestos use from 1960’s induced the increase of death caused by malignant mesothelioma in Japan. However, a national survey of the relationship between malignant mesothelioma and asbestos exposure, as well as diagnosis and treatment of malignant mesothelioma has not done up to today. One hundred and fifty-three cases of malignant mesothelioma diagnosed and treated in the Rosai Hospitals located all over Japan were studied, and 132 cases (80.4%) proved to be the definite diagnosis of malignant mesothelioma; another 21 cases were diagnosed as lung cancer, etc. As for definite 132 cases, 105 cases are male and other 27 cases are female with the ratio of 3.9:1. Ages ranges from 28 to 92 years old with the mean of 66.2 years old. One hundred and twelve cases originated from pleura, 18 cases from peritoneum, and each one case originated from pericardium and testicular tunica vaginalis. Final diagnosis of 104 cases (78.8%) was done by the tumor tissues. According to IMIG classification, stage I was 29 cases, stage II 6 cases, stage III 28 cases and stage IV was 44 cases. For the treatment, 29 cases were done extrapleurectomy, 58 cases were chemotherapy and other 39 cases were best supportive care. Median survival term of 132 cases were 9.5 months with 9.8 months of pleural origin and 5.6 months of peritoneal origin. By the clinical staging, stage I and II were 17.2 months, stage III 10.4 months and stage IV 5.4 months. By the treatment, extrapleurectomy was 18.1 months, chemotherapy 8.0 months and palliative care was 5.7 months. Seventy six percent cases were induced by occupational asbestos exposure and the mean exposuring time was 27.6 years and the mean latency was 43 years. Occupational histories were mainly shipbuilders, carpenters, electricians and piping workers. Summary: Seventy-six percent of Japanese malignant mesothelioma appeared by the occupational exposure to asbestos. Seventy-eight percent of final diagnosis were done by histological examination of tumor tissue. Extrapleurectomy was effective for the prognosis. [Table: see text] No significant financial relationships to disclose.
Helen Salisbury: Is general practice prepared for a pandemic?
Authors: Helen Salisbury
Journal: BMJ (2020)

The very short answer is no. As I write this, on 8 March, we haven’t received our personal protective equipment at our practice or any training in how to use it. We’re adapting our systems so that every patient is triaged rather than booking in directly, but we haven’t yet worked out whether, or how, to stop people with respiratory symptoms and fever from walking into our surgery.

We’re juggling the need to maintain our routine services for patients while keeping everyone safe from a virus we know is out there, but we don’t know how widespread it is. The advice we had this week …
Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology
Authors: William J. Gradishar, Benjamin O. Anderson, Jame Abraham, Rebecca Aft, Doreen Agnese, Kimberly H. Allison, Sarah L. Blair, Harold J. Burstein, Chau Dang, Anthony D. Elias, Sharon H. Giordano, Matthew P. Goetz, Lori J. Goldstein, Steven J. Isakoff, Jairam Krishnamurthy, Janice Lyons, P. Kelly Marcom, Jennifer Matro, Ingrid A. Mayer, Meena S. Moran, Joanne Mortimer, Ruth M. O'Regan, Sameer A. Patel, Lori J. Pierce, Hope S. Rugo, Amy Sitapati, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, Erica M. Stringer-Reasor, Melinda L. Telli, John H. Ward, Jessica S. Young, Jennifer L. Burns, Rashmi Kumar
Journal: Journal of the National Comprehensive Cancer Network (2020)

Several new systemic therapy options have become available for patients with metastatic breast cancer, which have led to improvements in survival. In addition to patient and clinical factors, the treatment selection primarily depends on the tumor biology (hormone-receptor status and HER2-status). The NCCN Guidelines specific to the workup and treatment of patients with recurrent/stage IV breast cancer are discussed in this article.
Gender reassignment: legal challenge over use of hormone blockers gets green light
Authors: Clare Dyer
Journal: BMJ (2020)

The High Court has given the go-ahead for a legal challenge to the provision of hormone blocking drugs by the only NHS service for children seeking gender reassignment.

The application for judicial review, which is expected to be heard before the end of July, has been brought against the Tavistock and Portman NHS Foundation Trust, which runs the Gender Identity Development Service at the Tavistock Clinic in London.1

The case is being brought by Keira Bell, 23, who now identifies as female and says that she regrets being allowed to transition to male as a 16 year …
Abstract P303: Use of Community Health Workers for Community-based Hypertension Screening in Urban Haiti
Authors: Caleigh Smith, Vanessa Rivera, Jean Joscar Victor, Lookens Pierre, Fabyola Preval, Rode Secours, Rosie Tilus, Inddy Joseph, Jean Baptiste Raynold, Serfine Exantus, Charles Benedict, Olga Tymejczyk, Denis Nash, Daniel Fitzgerald, Jean W Pape, Monika M Safford, Margaret McNairy
Journal: Circulation (2020)

Background: Cardiovascular disease is the leading cause of mortality among Haitian adults, and hypertension (HTN) is the most important CVD risk factor, as in other resource-poor countries. The majority of Haitians have never been screened for hypertension and access to clinic-based services is limited. Methods: Twenty-eight Haitian community health workers (CHW) conducted household-based HTN screening within a population-based longitudinal cohort study of 3,000 adults in metropolitan Port-au-Prince. Randomly selected GPS locations across census blocks were selected in proportion to the estimated population of each block. One household at each waypoint was selected systematically and CHW collected household information and conducted three blood pressure measurements the same day on all adult household members (≥ 18 years) present at the time of the survey using AHA guidelines. Adults with HTN were referred to the GHESKIO clinic for repeat BP measurement and treatment. Results: Between March and September 2019, 585 households provided verbal consent for surveys and BP screening (97% response rate). These households had a total of 2542 people (1777 adults) with the median number of adults per household being 3 (IQR 2-4; range 1-9). A total of 913 adults (51%) were present at the time of survey, and all agreed to blood pressure screening. The majority were women (70%) with a median age of 36 years (IQR 27-52). Hypertension prevalence (SBP &gt; 140 and/or DBP &gt; 90) was 25.3% (15.5% Stage I, 9.8% Stage II). Figure 1 reports HTN prevalence by age group (18-30, 31-45, 46-60, &gt;60) and by sex, with HTN increasing by age group but without significant variation by sex. Conclusion: Community blood pressure screening is feasible and highly acceptable in Port-au-Prince, Haiti. Preliminary results show high rates of HTN among a population with limited access to screening, diagnosis and treatment. Further research is urgently needed to design linkage to care strategies and effective treatment interventions to curb the HTN epidemic in Haiti.
Physician Suicide—A Personal and Community Tragedy
Authors: Katherine J. Gold, Thomas L. Schwenk
Journal: JAMA Psychiatry (2020)

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Antioxidants and toxicity of cancer chemotherapy: A systematic review of the evidence from randomized controlled trials
Authors: K. I. Block, A. C. Koch, M. N. Mead, P. Tothy, R. A. Newman, C. Gyllenhaal
Journal: Journal of Clinical Oncology (2007)

9130 Background: Much debate has focused on whether or not antioxidants interfere with the efficacy of cancer chemotherapy. The objective of this study is to systematically review the medical literature to compile results from randomized, controlled clinical trials evaluating the effects of concurrent use of antioxidants with chemotherapy on toxic side effects. Methods: We performed a search of literature from 1966-December 2006 using MEDLINE, Cochrane, CinAhl, AMED, AltHealthWatch and EMBASE databases. Randomized, controlled clinical trials reporting mitigation of chemotherapy toxicity were included in the final tally. The searches were performed in duplicate following a standardized protocol. No meta-analysis was performed due to heterogeneity of cancers and chemotherapy regimens. Results: Of 848 articles considered, 32 trials met the inclusion criteria. Antioxidants evaluated were: glutathione (9), melatonin (6), vitamin A (1), an antioxidant mixture (3), N-acetylcysteine (3), vitamin E (5), selenium (1), L-carnitine (1), Co-Q10 (2) and ellagic acid (1). Subjects of most studies had advanced or relapsed disease. Conclusions: One of the 32 studies included reported evidence of significant increase in toxicity from the concurrent use of antioxidants with chemotherapy. In 18 studies, antioxidant groups experienced significantly lower toxicity than control groups. Statistical power and poor study quality were concerns with some of the studies. We have reported elsewhere that randomized trials of various antioxidants given with chemotherapy did not demonstrate an adverse effect on treatment response or survival. Well-designed studies evaluating larger populations of patients given antioxidants concurrently with chemotherapy are thus warranted. No significant financial relationships to disclose.