tbuckley/cabot-search huggingface dataset:
The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)
Authors: Ezra E. W. Cohen, R. Bryan Bell, Carlo B. Bifulco, Barbara Burtness, Maura L. Gillison, Kevin J. Harrington, Quynh-Thu Le, Nancy Y. Lee, Rom Leidner, Rebecca L. Lewis, Lisa Licitra, Hisham Mehanna, Loren K. Mell, Adam Raben, Andrew G. Sikora, Ravindra Uppaluri, Fernanda Whitworth, Dan P. Zandberg, Robert L. Ferris
Journal: Journal for ImmunoTherapy of Cancer (2019)

Head and neck cancers, including those of the lip and oral cavity, nasal cavity, paranasal sinuses, oropharynx, larynx and nasopharynx represent nearly 700,000 new cases and 380,000 deaths worldwide per annum, and account for over 10,000 annual deaths in the United States alone. Improvement in outcomes are needed for patients with recurrent and or metastatic squamous cell carcinoma of the head and neck (HNSCC). In 2016, the US Food and Drug Administration (FDA) granted the first immunotherapeutic approvals - the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab - for the treatment of patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) that is refractory to platinum-based regimens. The European Commission followed in 2017 with approval of nivolumab for treatment of the same patient population, and shortly thereafter with approval of pembrolizumab monotherapy for the treatment of recurrent or metastatic HNSCC in adults whose tumors express PD-L1 with a ≥ 50% tumor proportion score and have progressed on or after platinum-containing chemotherapy. Then in 2019, the FDA granted approval for PD-1 inhibition as first-line treatment for patients with metastatic or unresectable, recurrent HNSCC, approving pembrolizumab in combination with platinum and fluorouracil for all patients with HNSCC and pembrolizumab as a single agent for patients with HNSCC whose tumors express a PD-L1 combined positive score ≥ 1. These approvals marked the first new therapies for these patients since 2006, as well as the first immunotherapeutic approvals in this disease. In light of the introduction of these novel therapies for the treatment of patients with head and neck cancer, The Society for Immunotherapy of Cancer (SITC) formed an expert committee tasked with generating consensus recommendations for emerging immunotherapies, including appropriate patient selection, therapy sequence, response monitoring, adverse event management, and biomarker testing. These consensus guidelines serve as a foundation to assist clinicians' understanding of the role of immunotherapies in this disease setting, and to standardize utilization across the field for patient benefit. Due to country-specific variances in approvals, availability and regulations regarding the discussed agents, this panel focused solely on FDA-approved drugs for the treatment of patients in the U.S.
Abstract 16915: Extracorporeal Membrane Oxygenation for Pulmonary Embolism With Acute Right Ventricular Failure and Shock: National Trends of Use, Demographics and In-Patient Mortality in the United States 2011-2014
Authors: Ayush Arora, Adamantios Tsangaris, Akhtar Amin, Kumar Satya
Journal: Circulation (2018)

Background: Extracorporeal membrane oxygenation (ECMO) is an emerging option for cardio-pulmonary support for patients with massive pulmonary emboli (PE) as a bridge to definitive treatments. Goal of this study is to assess the national trends of use, demographics and in-patient mortality of patients managed with ECMO for PE associated with acute right ventricular failure and shock. Methods: The National Inpatient Sample database was queried for patients above 18 years of age hospitalized between 2011-2014 with pulmonary emboli (ICD diagnoses codes 415.1, 415.11, 415.19). Patients with acute right ventricular failure and shock with hemodynamic instability were identified (ICD diagnoses codes 415.0, 785.59, 785.51, 785.50). Patients treated with ECMO were identified using the procedure code 39.65. SPSS version 24 was used for statistical analysis. Results: During the study period, there were 1,262,542 admissions with pulmonary emboli, out of which 32,978 had acute right ventricular failure and shock. ECMO was used in 450 patients and that showed an increasing trend over the years (figure 1), with an in-patient mortality rate of 59.2%. Mean length of stay was 23 days. More than 90% of these patients were managed in large urban teaching hospitals with bed-size more than 500. Around half (43%) of these were in the Southern US hospitals. Factors associated with higher mortality were male sex (68.8%), age &gt;80 years (100%), Hispanic race (65%), lack of insurance (71.4%) and low socio-economic strata (income quartile 1st, 74.4%), p&lt;0.05. Conclusion: Use of ECMO for cardio-pulmonary support in patients hospitalized for PE with acute right ventricular failure and shock is increasing over the years. Among these patients, male sex, age &gt;80 years, Hispanic race, lack of insurance and lower socio-economic strata are associated with higher mortality.
Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study
Authors: Corinna Hackmann, Yatan Pal Singh Balhara, Kelsey Clayman, Patricia B Nemec, Caitlin Notley, Kathleen Pike, Geoffrey M Reed, Pratap Sharan, Mona Sharma Rana, Jody Silver, Margaret Swarbrick, Jon Wilson, Hannah Zeilig, Tom Shakespeare
Journal: The Lancet Psychiatry (2019)
Abstract 17154: Machine Learning Outperforms ACC/AHA CVD Risk Calculator in MESA Offering new opportunities for Short-Term Risk Prediction and Early Detection of the Vulnerable Patient
Authors: Ioannis A Kakadiaris, Michail Vrigkas, Albert Yen, Tatiana Kuznetsova, Matthew Budoff, Morteza Naghavi
Journal: Circulation (2018)

Introduction: Machine learning (ML) is poised to revolutionize healthcare. Current national guidelines for prediction and prevention of atherosclerotic cardiovascular disease (ASCVD) use ACC/AHA Pooled Cohort Equation Risk Calculator which relies on traditional risk factors and linear statistical models. Unfortunately, this approach yields a low level of sensitivity and specificity. The low sensitivity results in missing high-risk individuals who need intensive therapy and the low specificity results in millions of people unnecessarily recommended drugs such as statin. We aimed to utilize Machine Learning (ML) to create a more accurate predictor of ASCVD events and whom to recommend statin. Methods: We developed and validated a ML Risk Calculator based on Support Vector Machines (SVMs) using the latest 13-year follow up dataset from MESA (Multi-Ethnic Study of Atherosclerosis) of 6,459 participants who were free of cardiovascular disease at baseline. We provided identical input to the ACC/AHA and ML risk calculators and compared their accuracy. We also validated the ML model in another longitudinal cohort: the Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO). Results: According to the ACC/AHA Risk Calculator and a 7.5% 10-year risk threshold, 46.0% would be recommended statin. Despite this high proportion, 23.8% of the 480 “Hard CVD” events occurred in those not recommended statin, resulting in sensitivity (Sn) 0.76, specificity (Sp) 0.56, and AUC 0.71. In contrast, ML Risk Calculator recommended statin to 11.4%, and only 14.4% of “Hard CVD” events occurred in those not recommended statin, resulting in Sn 0.86, Sp 0.95, and AUC 0.92. Similar results were seen in prediction of “All CVD” events. Conclusions: The ML Risk Calculator outperformed the ACC/AHA Risk Calculator by recommending less drug therapy, yet missing fewer events. Additional studies are underway to validate the ML model in other cohorts and to explore its ability in predicting short-term (1-5 years) events with additional biomarkers including imaging. Machine learning is paving the way for early detection of asymptomatic high-risk individuals destined to a CVD event in the near future, the Vulnerable Patient.
Modeling of prognostication based on genomic expression in the tumor microenvironment of muscle invasive urothelial carcinoma via machine learning.
Authors: Sunyoung S. Lee, Dong Eun Lee, Andrew Baird, Seongwon Lee, Shinyoung Park, Jillian Dolan, Saby George
Journal: Journal of Clinical Oncology (2019)

64 Background: Stroma in the tumor microenvironment (TME) influences prognosis and response to therapy. Few mathematical models exist to prognosticate patients (pts), based on mRNA expressivity in the TME. Methods: Clinical outcomes data and mRNA-seq of 401 pts with muscle invasive urothelial carcinoma were obtained from TCGA. Expressivity of 191 genes enriched in cellular and structural elements of TME and clinical data were analyzed by Kaplan-Meier (KM) analysis, correlation analysis, and multivariate nonlinear regression assisted by machine learning to achieve confined optimization with model-data minimization among multiple distribution functions. Results: Prognostication was modeled with higher risk score (RS) representing worse prognosis in stage 2-4 (Table, stage 1 data not available from TCGA). P/G is the ratio of genes associated with poor (19 genes) to good (11) prognosis (refer to presentation). Based on RS, pts in each stage were clustered into 2 groups (high and low RS), showing 2 KM curves with p &lt; 0.01 in each stage, confirming the validity of RS modeling. Analysis of immune profiles in these 2 groups shows that regardless of stage, expression of genes associated with Desmoplasia, Angiogenesis, and Epithelial-mesenchymal transition (DAE) is higher in high RS groups. Furthermore, expression of DEA genes in stage 4 correlated more strongly with poor prognosis than observed in stage 2-3 as evidenced by smaller p-value. Among stage 4 tumors, expression of genes related to IFN response, NK cells, and T1 helper cells is higher in low RS groups. In stage 2 and 3, genes related to immune activation and inhibition have no association with prognosis (p &gt; 0.05). Conclusions: Machine learning-assisted mathematical modeling of RS and gene analysis show that genes related to immune activation are associated with better prognosis, while DAE genes correlate with poorer prognosis among advanced stages. RS enables prognostication of pts encountered in the clinic, given genomic profiles. [Table: see text]
A study on position variation of liver cancer and interested structures during respiration by 4DCT and 3DCT.
Authors: Yingjie Zhang, Jianbin Li, Jun Xing
Journal: Journal of Clinical Oncology (2012)

e13529 Background: The movement of liver cancer targets could be infected by respiration.The aim of this study was to investigate the position difference of liver cancer in free-breathing condition between 3DCT and 4DCT simulation, and to investigate the correlation of position movement of primary tumor with normal tissues and skin markers. Methods: 12 patients with liver cancer after TACE were scanned at free breath condition by simulation 4DCT and 3DCT. A coordinate system was created based on image of T20 (maximum intensity projection) reconstructed from 4DCT, gross tumor volume (GTV), normal tissues and skin markers of end expiration, end inspiration and T20 of 4DCT and 3DCT were contoured. The three dimensional position variation of them were measured and their correlation were analyzed. Results: Corresponding to target position of T20, the targets position of end expiration and end inspiration were different from 3DCT in x-axis(χ 2 =2.552, p=0.579), y-axis(χ 2 =6.938, p=0.031), z-axis(χ 2 =10.606, p=0.005). The target movement range of liver cancer in three dimensional direction was different, that was 8.44±6.52mm in z-axis, 3.78±3.07mm in y-axis, 1.11±1.27mm in x-axis,. 9.88±6.43mm in three dimensional vector. There was statistical significant correlation for movement range of GTV with that of liver, gallbladder, right diaphragmatic dome and right skin marker(r=0.738-0.922, p=0.037-0.001), but there was no significant correlation for movement range of GTV with that of kidney, pancreas, spleen, and middle skin marker. Conclusions: Corresponding to target position of T20, there was great difference between individual GTV position of 3DCT and 4DCT. What's more, it was not all of the movement of abdominal normal tissues correlated to the movement of GTV. These uncertain factors may infer dose mapping of GTV and abdominal risk organs.
A Hungry Bone Syndrome Predicted by 18F-Fluorocholine PET/CT
Authors: Anne-Cécile Paepegaey, Fritz-Line Velayoudom, Selma Housni, Mathieu Gauthé, Lionel Groussin
Journal: Clinical Nuclear Medicine (2019)

Abstract Predicting hungry bone syndrome (HBS) after surgical cure of primary hyperparathyroidism (PHPT) can be challenging. A 57-year-old man diagnosed with PHPT was assessed preoperatively by 18 F-fluorocholine PET/CT. An intense and diffuse tracer uptake of the axial and peripheral skeleton was visualized, in addition to a pathologic uptake suggestive of hyperfunctioning parathyroid gland. After the removal of a parathyroid adenoma, a severe and prolonged HBS requiring high doses of calcium and active metabolites of vitamin D was observed. This observation suggests that intense and diffuse bone uptake on 18 F-fluorocholine PET/CT could be a predictive factor for HBS in patients with PHPT.
Medicaid Work Requirements in Kentucky
Authors: Sumit D. Agarwal
Journal: JAMA Network Open (2019)

Atheendar S. Venkataramani, MD, PhD; Elizabeth F. Bair, MS; Erica Dixon, PhD; Kristin A. Linn, PhD; Will Ferrell, MPH; Margrethe Montgomery, MA; Michelle K. Strollo, DrPH; Kevin G. Volpp, MD, PhD; Kristen Underhill, JD, DPhil
Metastatic and unresectable biliary tract tumors: A single-center retrospective review.
Authors: Maria Vieito, Nieves Martinez Lago, Santiago Aguin Losada, Rafael Lopez, Sonia Candamio, Elena Maria Brozos Vazquez, Elena Gallardo, Rafael Varela Ponte, Urbano Anido, Francisca Vazquez, Yolanda Vidal, Juan Fernando Cueva Banuelos, Marta Carmona Campos, Carmela Rodriguez Lopez
Journal: Journal of Clinical Oncology (2012)

e14733 Background: Biliary tract tumours are rare and often poor prognosis cancers that comprise cholangiocarcinomas, ampullary tumours and gallbladder cancers. Methods: Medical Electronic Records for patients diagnosed between January 2008 and December 2010 and treated at a medical oncology unit were reviewed, and clinical and epidemiological data for patients were retrieved. Results: We have found 28 patients with a distribution with a clear majority of men (60%), with a median age of 66 years (range 45-80).Patients were mostly metastatic (85%) at diagnosis and the majority of patients had intrahepatic cholangiocarcinoma (60%) as diagnosis and debuted with large intrahepatic masses and metastatic disease.Those with tumours arising outside the liver (40%) had obstructive jaundice (28%) or cholangitis (26%) at diagnosis and needed in most cases biliary stenting (33%).Six patients had PS2 at diagnosis and received gemcitabine monotherapy. Only one patient remaining progression free at 6 months and none of them received treatment at progression, the mean PFS was of 5.3 months and the OS was of 8.3 months.Of 22 patients with good performance status, 12 of them with a mean age of 60 years received polychemotherapy with GEMOX or CDDP-gem with PFS of 7. 3 months and OS of 12. 3 months.The other 10 patients (with a mean age of 65 years) received gemcitabine as monotherapy with a PFS of 7. 9 months and a OS of 11. 4 months.Eight patients were treated with second line therapy with no responses and a mean of PFS of 2 months, OS was not superior to patients who did not receive second line treatment. Conclusion: Our patients with biliary tract tumours had a mean progression free survival of 8.2 months and a mean overall survival of 12.3 months with 5 patients remaining progression free more than 20 months after beginning treatment. This survival data are compatible with those reported in recent clinical trials although we did not find improvements in survival with polychemotherapy and second line therapies. Conclusions: Taken as a whole our patients with biliary tract tumours had a mean progression free survival of 8.2 months and a mean overall survival of 12.3 months with 5 patients remaining progression free more than 20 months after beginning treatment.
Early mortality following diagnosis of multiple myeloma from 2011 to 2016 in Alberta, Canada: Initial results from the population-based Identifying Outcomes in Real-World Multiple Myeloma (INFORMM) study.
Authors: Jason Tay, Guanmin Chen, Tara Cowling, Eileen Shaw, Megan Farris, Fei Fei Liu, Victor H. Jimenez-Zepeda
Journal: Journal of Clinical Oncology (2019)

e19509 Background: The clinical outcomes of patients with newly diagnosed multiple myeloma (NDMM) have improved. However, early mortality (EM) post-diagnosis remains a concern, with incidence ranging from 13% at 2 months to 29% at 1 year after diagnosis. EM can be influenced by patient age, comorbidities, performance status, therapy, and disease biology. Our aim is to examine EM incidence in patients with NDMM and to describe variables that may influence EM in the era of novel chemotherapeutic agents using the INFORMM Study, an ongoing, province-wide real-world evidence study in Alberta, Canada. Methods: Using administrative health data in Alberta (population 4.32 million in 2018), we identified our study population from a validated algorithm of International Classification of Diseases-9 and -10 diagnostic codes. Additionally, the NDMM cohort was confirmed using bone marrow biopsy records, and patients who received therapy for myeloma were derived from the province-wide Pharmaceutical Information Network database. EM was defined as death by any cause within 90 days of diagnosis. Further analyses will be performed to explore potential risk factors associated with EM using regression modeling. Results: We identified 1,729 patients diagnosed with NDMM between 2011 and 2016. EM occurred in 185 patients (10.7%). Of the 185 patients who experienced EM, 156 (84.3%) were aged ≥ 65 years, 174 (94.1%) had a Charlson Comorbidity Index score ≥ 3, and 48 (25.9%) had infectious complications within 90 days of diagnosis. In addition, 99 (53.5%) patients received ≥ 1 anti-myeloma therapy regimen (lenalidomide-based = 5, bortezomib-based = 22, other = 72), whereas 86 (46.5%) did not receive any anti-myeloma therapy. Conclusions: Despite advances in chemotherapeutics and supportive care, patients with NDMM still have a high risk of EM. The higher EM incidence observed in older patients could be attributable to treatment toxicity, comorbidities, or issues surrounding delivery of suitable treatments. Clinicians should consider potential factors associated with EM in their care plan, including in serious illness conversations.
What's hot that the other lot got
Authors: Mairi MacLeod
Journal: Thorax (2019)

PE presents a particular diagnostic challenge in pregnancy with no validated algorithm and lower utility of d-dimer testing. Furthermore, imaging modalities hold increased risk in terms of radiation exposure for mother and fetus. The YEARS algorithm for risk stratification in PE has been validated in non-pregnant patients and successfully reduces diagnostic imaging. Pol et al (NEJM 2019;380:1139) evaluated whether a pregnancy adapted version of this algorithm was safe and effective. Pregnant woman presenting with symptoms suggestive of PE to units across Europe were included in the study (n=498). Patients were evaluated using d-dimer and three clinical features (clinical signs of deep vein thrombosis (DVT), haemoptysis and clinician assessment that thrombosis was the most likely diagnosis). Those with clinical signs of a DVT went immediately for lower limb ultrasonography. Those without were stratified. If d-dimer was >1000 ng/mL, or if d-dimer was >500 ng/mL and one of the three clinical criteria were met, a CT pulmonary angiogram was performed; otherwise, DVT/PE was considered ruled out. Participants were followed up for 3 months. Using this algorithm, 20 patients (4%, 95% CI 2.6% to 6.1%) were diagnosed with DVT/PE at presentation. Of the patients stratified as low risk, one patient was diagnosed with a DVT during follow-up but none with PE. Use of the …
Adenocarcinoma of the Stomach Leading to Recurrent Regurgitation and Muscular Hypermetabolism on 18F-FDG PET/CT
Authors: Ashwin Singh Parihar, Shelvin Kumar Vadi, Rajender Kumar, Bhagwant Rai Mittal, Harmandeep Singh, Rakesh Kapoor
Journal: Clinical Nuclear Medicine (2019)

Abstract Skeletal muscle uptake of 18 F-FDG can result from a variety of physiologic and pathologic conditions. It is important for the physician to interpret these uptake patterns in the correct context to avoid a misdiagnosis. We present a case of a 36-year-old man with progressive, repeated episodes of regurgitation who was diagnosed with adenocarcinoma of the stomach. 18 F-FDG PET/CT showed increased tracer uptake in the primary tumor and in the intercostal and sternocleidomastoid muscles. The pattern of tracer uptake along with the clinical history and examination of the patient helped differentiate a physiologic variant from a pathologic cause.
Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System
Authors: Colleen P. Judge-Golden, Kenneth J. Smith, Maria K. Mor, Sonya Borrero
Journal: JAMA Internal Medicine (2019)

The Veterans Affairs (VA) health care system is the largest integrated health care system in the United States. Like most US health plans, the VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). However, 12-month OCP dispensing has been shown to improve continuation of use, decrease coverage gaps, and reduce unintended pregnancy in other practice settings.To estimate the financial and reproductive health implications for the VA of implementing a 12-month OCP dispensing option, with the goal of informing policy change.A decision model from the VA payer perspective was developed to estimate incremental costs to the health care system of allowing the option to receive a 12-month supply of OCPs up front, compared with the standard 3-month maximum, during a 1-year time horizon. A model cohort of 24 309 reproductive-aged, heterosexually active, female VA enrollees who wish to avoid pregnancy for at least 1 year was assumed. Probabilities of continuation of OCP use, coverage gaps, pregnancy, and pregnancy outcomes were drawn from published data. Costs of OCP provision and pregnancy-related care and the number of women using OCPs were drawn from VA administrative data. One-way and probabilistic sensitivity analyses were performed to assess model robustness.Incremental per-woman and total costs to the VA of allowing for 12-month dispensing of OCPs compared with standard 3-month dispensing.The 12-month OCP dispensing option, modeled from the VA health system perspective using a cohort of 24 309 women, resulted in anticipated VA annual cost savings of $87.12 per woman compared with the cost of 3-month dispensing, or an estimated total savings of $2 117 800 annually. Cost savings resulted from an absolute reduction of 24 unintended pregnancies per 1000 women per year with 12-month dispensing, or 583 unintended pregnancies averted annually. Expected cost savings with 12-month dispensing were sensitive to changes in the probability of OCP coverage gaps with 3-month dispensing, the probability of pregnancy during coverage gaps, and the proportion of pregnancies paid for by the VA. When simultaneously varying all variables across plausible ranges, the 12-month strategy was cost saving in 95.4% of model iterations.Adoption of a 12-month OCP dispensing option is expected to produce substantial cost savings for the VA while better supporting reproductive autonomy and reducing unintended pregnancy among women veterans.