tbuckley/cabot-search huggingface dataset:
Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced Gastric Cancer
Authors: Jing Guo, Aman Xu, Xiaowei Sun, Xuhui Zhao, Yabin Xia, Huamin Rao, Yaming Zhang, Rupeng Zhang, Li Chen, Tao Zhang, Gang Li, Hongtao Xu, Dazhi Xu
Journal: JAMA Surgery (2019)

<h3>Importance</h3> Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a new prophylactic strategy for treatment of peritoneal metastasis of locally advanced gastric cancer; however, the safety and efficacy of EIPL is currently unknown. <h3>Objective</h3> To evaluate short-term outcomes of patients with advanced gastric cancer who received combined surgery and EIPL or surgery alone. <h3>Design, Setting, and Participants</h3> From March 2016 to November 2017, 662 patients with advanced gastric cancer receiving D2 gastrectomy were enrolled in a large, multicenter, randomized clinical trial from 11 centers across China. In total, 329 patients were randomly assigned to receive surgery alone, and 333 patients were randomly assigned to receive surgery plus EIPL. Clinical characteristics, operative findings, and postoperative short-term outcomes were compared between the 2 groups in the intent-to-treat population. <h3>Main Outcomes and Measures</h3> Short-term postoperative complications and mortality. <h3>Results</h3> The present analysis included data from 550 patients, 390 men and 160 women, with a mean (SD) age of 60.8 (10.7) years in the surgery alone group and 60.6 (10.8) in the surgery plus EIPL group. Patients assigned to the surgery plus EIPL group exhibited reduced mortality (0 of 279 patients) compared with those assigned to surgery alone (5 of 271 patients [1.9%]) (difference, 1.9%; 95% CI, 0.3%-3.4%;<i>P</i> = .02). A significant difference in the overall postoperative complication rate was observed between patients receiving surgery alone (46 patients [17.0%]) and those receiving surgery plus EIPL (31 patients [11.1%]) (difference, 5.9%; 95% CI, 0.1%-11.6%;<i>P</i> = .04). Postoperative pain occurred more often following surgery alone (48 patients [17.7%]) than following surgery plus EIPL (30 patients [10.8%]) (difference, 7.0%; 95% CI, 0.8%-13.1%;<i>P</i> = .02). <h3>Conclusions and Relevance</h3> Inclusion of EIPL can increase the safety of D2 gastrectomy and decrease postoperative short-term complications and wound pain. As a new, safe, and simple procedure, EIPL therapy is easily performed anywhere and does not require any special devices or techniques. Our study suggests that patients with advanced gastric cancer appear to be candidates for the EIPL approach. <h3>Trial Registration</h3> ClinicalTrials.gov identifier:NCT02745509
Prognostic Significance of Early Immune Reconstitution in Newly Diagnosed Multiple Myeloma
Authors: Moritz Binder, S. Vincent Rajkumar, Martha Q. Lacy, Morie A. Gertz, Francis K. Buadi, Angela Dispenzieri, Lisa Hwa, Amie Fonder, Miriam Hobbs, Suzanne R. Hayman, Steven Zeldenrust, John A. Lust, Stephen J. Russell, Nelson Leung, Prashant Kapoor, Ronald S. Go, Wilson I Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Robert A. Kyle, Shaji K. Kumar
Journal: Blood (2018)
Automatically Charting Symptoms From Patient-Physician Conversations Using Machine Learning
Authors: Alvin Rajkomar, Anjuli Kannan, Kai Chen, Laura Vardoulakis, Katherine Chou, Claire Cui, Jeffrey Dean
Journal: JAMA Internal Medicine (2019)

Automating clerical aspects of medical record keeping through speech recognition during a patient's visit 1 could allow physicians to dedicate more time directly with patients.We considered the feasibility of using machine learning to automatically populate a review of systems (ROS) of all symptoms discussed in an encounter.
FATTY ACIDS INDUCE HEPATOCYTE SENESCENCE IN VITRO: IMPLICATIONS FOR PATHOGENESIS IN NON-ALCOHOLIC STEATOHEPATITIS
Authors: Richard Skoien, Elizabeth E. Powell, Michelle Melino, Andrew D. Clouston, Brian Gabrielli, Julie R. Jonsson
Journal: Hepatology (2010)

Introduction Hereditary iron overload associated with mutations in theFerroportin gene produce a dichotomy of phenotypes resulting from eitheran increase or decrease in iron effl ux capacity. In this study we examinedthe molecular basis of iron overload in an Australian family of Vietnameseorigin, characterised the molecular and cellular defect, and correlated thiswith the clinical and pathological phenotype.Methods We analysed the Ferroportin gene by DNA sequencing. Liverbiopsy was performed on two members of the family. Molecular characterisationwas performed by immunofl uorescence microscopy analysis oftransfected liver, kidney and intestinal cell lines. We analysed the ferritinlevels of cells expressing wild-type and mutant ferroportin to defi ne thenature of the molecular defect on iron transport.Results We identifi ed a G to A nucleotide change at position 238 in theFerroportin gene leading to the G80S substitution in family members fromthree different generations. These patients presented with hyperferritinemiain the presence of normal transferrin saturation. Perls’ staining ofliver sections showed a marked presence of iron throughout the parenchyma.Stainable iron was present in Kupffer cells with signifi cant stainingin the periportal hepatocytes. Cellular analysis of the mutant protein indicatesthat this amino acid change does not affect the localisation of theprotein but does affect its ability to transport iron.Conclusions This is the fi rst clinical report of ferroportin disease in afamily of Vietnamese origin and the fi rst report of the G80S ferroportinmutation outside of Southern Europe. We also show that in in vitro studiesthe G80S mutant ferroportin fails to export iron. This is in agreement withthe phenotypic characteristics of patients carrying this mutation which areindicative of the classical form of ferroportin disease which is characterisedby hyperferritinemia with normal transferrin saturation, and ironaccumulation preferentially in macrophages.
Abstract P171: Potential Mortality Reduction with Optimal Usage of sacubitril/valsartan Therapy for the Treatment of Heart Failure in Canada
Authors: Robert McKelvie, Michel White, Marc Vaillancourt, Paola Haddad, Nancy Zaour
Journal: Circulation (2017)

Background: Despite well-recognized standard of care therapies, heart failure (HF) continues to be characterized by high mortality rates. Sacubitril/valsartan, a first-in-class treatment for HF with reduced ejection fraction (HFrEF) provided incremental cardiovascular and overall survival benefit in PARADIGM-HF, the largest clinical trial ever conducted in HF patients. We hypothesized that optimal use of sacubitril/valsartan in the treatment of HFrEF in Canada would be associated with potential benefits in terms of deaths avoided. Objective: The objective of this analysis was to quantify the number of potential deaths avoided with optimal usage of sacubitril/valsartan in the treatment of HFrEF in Canada. Methods: Data from Statistics Canada was used to quantify the population above 18 years of age. A literature search was then conducted to determine the prevalence of HF in Canada, the proportion of these with NYHA class II and III, and finally the proportion of patients with HFrEF. The number needed to treat (NNT) to avoid one death, standardized to 12 months was derived from the PARADIGM-HF trial. The NNT using product limit survival rates and actual follow-up times from the PARADIGM-HF trial was also derived. The potential number of deaths prevented as a result of optimal usage of sacubitril/valsartan as per current approved usage in Canada (HFrEF patients with NYHA class II or III) were estimated along with multiple-way sensitivity analysis using the analysis-of-extremes method. The main outcome and measure was all-cause mortality. Results: A Canadian prevalence of 2.31% was applied to determine the number of HF patients. From those, 64% were classified as NYHA Class II and III of which 56% were considered as rEF. It was estimated that in Canada, approximately 242,200 patients are affected with HFrEF with NYHA class II and III. Based on a NNT of 80, optimal usage of sacubitril/valsartan therapy was estimated to prevent 3,014 deaths per year (range, 1,930 – 4,331 per year). Based on the alternate NNT (71.3) using the product limit survival rates and actual follow-up times from PARADIGM-HF, a total of 3,397 patient deaths could be potentially prevented each year (range, 2,718 – 4,076 per year). Conclusion: Standard of care treatment for HF is well-established and has shown important mortality reduction but there is still a need for additional therapies to further improve survival rates for patients living with HFrEF. The findings from this analysis suggest that a substantial number of deaths in Canada could potentially be avoided by optimal usage of sacubitril/valsartan therapy. This analysis supports the importance of rapidly implementing evidence-based therapy, in this case sacubitril/valsartan, into routine clinical practice to improve clinical outcomes for HFrEF patients in Canada.
Abstract 20398: Residual and/or Progression of Tricuspid Regurgitation; An Important Determinant of Long-Term Outcome Post-Aortic Valve Replacement for Severe Aortic Valve Stenosis
Authors: Shin Yajima, Koichi Toda, Satsuki Fukushima, Teruya Nakamura, Shigeru Miyagawa, Yasushi Yoshikawa, Shunsuke Saito, Keitaro Domae, Takayoshi Ueno, Toru Kuratani, Yoshiki Sawa
Journal: Circulation (2016)

Introduction: Although residual tricuspid regurgitation (TR) is known to be associated with poor outcome post-mitral valve surgery, impact of residual TR on outcome post-aortic valve surgery is poo...
Cholesterol Granuloma Masquerading as Gallbladder Carcinoma on 18F-FDG PET/CT
Authors: Zhanli Fu, Xueqi Chen, Xing Yang, Qian Li
Journal: Clinical Nuclear Medicine (2019)

F-FDG PET/CT was performed on a 70-year-old man to stage the newly diagnosed multiple myeloma. A hypermetabolic lesion in the gallbladder fundus was revealed incidentally and suspected for gallbladder carcinoma, but was finally proven to be a cholesterol granuloma by the pathology of cholecystectomy.
GWAS of smoking behaviour in 165,436 Japanese people reveals seven new loci and shared genetic architecture
Authors: Nana Matoba, Masato Akiyama, Kazuyoshi Ishigaki, Masahiro Kanai, Atsushi Takahashi, Yukihide Momozawa, Shiro Ikegawa, Masashi Ikeda, Nakao Iwata, Makoto Hirata, Koichi Matsuda, Michiaki Kubo, Yukinori Okada, Yoichiro Kamatani
Journal: Nature Human Behaviour (2019)
QIM19-130: Quality Improvement Project to Standardize a Prehabilitation Pathway for Patients With Esophageal Cancer Receiving Neoadjuvant Chemoradiation
Authors: Ashley E. Glode, S. Lindsey Davis, Supriya K. Jain, Megan D. Marsh, Lisa J. Wingrove, Tracey E. Schefter, Karyn Goodman, Lindel C.K. Dewberry, Martin D. McCarter, Laura Melton, Michelle Bunch, William T. Purcell, Stephen Leong
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: At our institution, the standard treatment recommendation for esophageal cancer patients with stage IB–IIIB disease is for neoadjuvant chemoradiation per the CROSS regimen prior to surgery. This regimen can be difficult for patients to tolerate, and they may be unable to receive full dose therapy without treatment dose reductions and delays. Methods: We conducted a quality improvement (QI) project, STRENGTH (Seeking to Reactivate Esophageal and Gastric Treatment Health), to implement supportive care interventions in the prehabilitation phase of neoadjuvant treatment. Our QI program included a standardized chemotherapy order template with supportive care interventions implemented at specific time points. Following implementation of the STRENGTH pathway, a retrospective QI analysis assessed an equal number of patients in the pre-STRENGTH and STRENGTH group for chemotherapy and radiation therapy dose intensities, as well as treatment outcomes. Results: During the pre-STRENGTH period, patients received an average of 5 chemotherapy treatments (range, 2–6), with an average relative dose intensity of 91.8% for carboplatin and 86.7% for paclitaxel. During the STRENGTH period, patients received an average of 6 (range, 5–8) chemotherapy treatments, with an average relative dose intensity of 111.4% for carboplatin and 112.9% for paclitaxel. In the pre-STRENGTH group, one patient did not complete their planned radiation dose due to nausea, vomiting, and dehydration. All patients in the STRENGTH group received their planned radiation dose. In the STRENGTH group, there is a trend of improved pathologic response, longer progression-free survival, and shortened time to surgery. Conclusion: Implementation of the STRENGTH pathway improved chemotherapy dose intensity, with potentially improved oncologic outcomes in the STRENGTH group. We plan to further optimize the STRENGTH program with implementation of standardized dose reduction and delay protocols for both chemotherapy and radiation, and assess the effects of STRENGTH interventions on patient quality of life.
EPR19-075: Geographic Region and Race/Ethnicity Are Associated With Treatment and Survival for Gastric Cancer
Authors: Mark Ulanja, Mohit Rishi, Bryce Beutler, Santhosh Ambika
Journal: Journal of the National Comprehensive Cancer Network (2019)

Introduction: Gastric adenocarcinoma (GAC) remains a lethal disease. Evidence suggests that there is increased incidence of gastric cancer among ethnic minorities as compared to whites. In addition, survival and treatment recommendations may vary based on geographic regions. Objectives: We sought to assess the impact of geographic region and race/ethnicity on treatment and survival for GAC. Methods: Data from SEER registry was used to identify patients with potentially resectable gastric adenocarcinoma (AJCC I–III) diagnosed 2004 to 2015. Exposures of interest were geographic region of diagnosis: Western (West), Midwestern (MW), Southern (SO) or North Eastern (NE), and race. The endpoints were: (1) recommendation of no surgery by the provider, (2) utilization of surgery, and (3) gastric cancer-specific survival (GCS). Multivariable logistic and Cox regression models were used to identify associations. Results: 15,991 patients were included in the analysis (West, 56.3%; NE, 16.3%; MW, 7.8%; and SO, 19.7%). On univariate analysis, the likelihood of no recommendation for surgery was highest in SO (OR: 1.35; P &lt;.001;] West, referent). In adjusted analysis, it was lowest in NE and MW (NE aOR: 0.78; P &lt;.001; MW aOR: 0.78; P =.002). The likelihood of no recommendation for surgery was lowest in Asians (AS) on univariate analysis (OR: AS, 0.47; P &lt;.001); American Indian (AI) 0.59 ( P =.027); Hispanic (HS) 0.85 ( P =.018); whites (W) 1.01 ( P =.884); Black (B) ref]. The adjusted analysis for W is (aOR: 0.86; P =.029; B-ref) and persisted for the rest of ethnicity. Patients diagnosed in NE were independently more likely to undergo surgery as compared to those in other regions (aOR: 1.25; P &lt;.001); black individuals were less likely to undergo surgery as compared to whites, Asians, and Hispanics ( P &lt;.05 for all). Overall, a diagnosis of gastric cancer in the NE region was independently associated with superior GCS (HR=0.85; P &lt;.001) (Table 1). Among patients who underwent surgery, those in the NE (HR=0.85; P =.001) exhibited superior GCS, but poor GCS in SO (HR=1.17; P =.001; West-ref). AS who underwent surgical intervention demonstrated superior GCS as compared to all other ethnic groups (HR=0.76; P &lt;.001). Conclusion: There is significant difference in treatment and survival for GAC based on geographic region and race/ethnicity. Adherence to treatment guidelines and recommendations is essential to optimize outcomes for all patients.
A transgenic mouse model reproduces human hereditary systemic amyloidosis
Authors: Michèle Chabert, Xavier Rousset, Magali Colombat, Michel Lacasa, Hermine Kakanakou, Mathilde Bourderioux, Pierre Brousset, Odile Burlet-Schiltz, Juris J. Liepnieks, Barbara Kluve-Beckerman, Gilles Lambert, François P. Châtelet, Merrill D. Benson, Athina D. Kalopissis
Journal: Kidney International (2019)
Management of Kaposi sarcoma after solid organ transplantation: A European retrospective study
Authors: Julie Delyon, Clementine Rabate, Sylvie Euvrard, Catherine A. Harwood, Charlotte Proby, A.Tülin Güleç, Deniz Seçkin, Veronique Del Marmol, Jan Nico Bouwes-Bavinck, Carla Ferrándiz-Pulido, Maria Andrea Ocampo, Stephane Barete, Christophe Legendre, Camille Francès, Raphael Porcher, Celeste Lebbe
Journal: Journal of the American Academy of Dermatology (2019)
Language Development of Young Children Is Not Linked to Phthalate Exposure
Authors: Rainer Otter, Angelika Langsch, Gerard Swaen
Journal: JAMA Pediatrics (2019)

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Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology
Authors: John A. Thompson, Bryan J. Schneider, Julie Brahmer, Stephanie Andrews, Philippe Armand, Shailender Bhatia, Lihua E. Budde, Luciano Costa, Marianne Davies, David Dunnington, Marc S. Ernstoff, Matthew Frigault, Brianna Hoffner, Christopher J. Hoimes, Mario Lacouture, Frederick Locke, Matthew Lunning, Nisha A. Mohindra, Jarushka Naidoo, Anthony J. Olszanski, Olalekan Oluwole, Sandip P. Patel, Sunil Reddy, Mabel Ryder, Bianca Santomasso, Scott Shofer, Jeffrey A. Sosman, Momen Wahidi, Yinghong Wang, Alyse Johnson-Chilla, Jillian L. Scavone
Journal: Journal of the National Comprehensive Cancer Network (2019)

The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visit NCCN.org .
In vivo development of amoxicillin and ceftriaxone resistance in Salmonella enterica serovar Typhi
Authors: G.S.E. Tan, S. Octavia, J.W.P. Teo, M.L.T. Ang, M.-V. La, R.T.P. Lin, S. Choudhury, B.S.P. Ang
Journal: Clinical Microbiology and Infection (2019)
CLO19-028: Incidence and Management of Toxicities Associated With Anti-PD1 and Anti-PD-L1 Treatment Among Patients Enrolled in Medicare Advantage
Authors: Victoria T. Brown, Dana Drzayich Antol, Patrick N. Racsa, Melea A. Ward, Jarushka Naidoo
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Anti-PD1/PD-L1 therapy is standard-of-care for patients with a variety of advanced malignancies. Although clinical trials report a lower incidence of grade 3-4 toxicities than observed with cytotoxic agents, it is imperative that clinicians identify and manage the unique toxicities of these agents. We aimed to identify real-world incidence of immune-related toxicities and management for patients treated with anti-PD1/PD-L1 agents prior to publication of clinical practice guidelines. Methods: Patients enrolled in a Humana Medicare Advantage plan who initiated any anti-PD1/PD-L1 therapy September 1, 2014–February 28, 2018 were identified. NCCN Guidelines for immune-related toxicity were used to determine appropriate pharmacy and medical codes from administrative claims data for toxicity identification and management. ICD-10 codes were examined for patients requiring hospital or ED visits, and HCPCS and NDC codes were used for patients requiring toxicity treatment (eg, corticosteroids, anti-TNFα). Results: 6,005 patients were identified; 39.1% were female, median (IQR) age was 72 years (67–77). The majority (64.7%) had thoracic cancers; 16.3% genitourinary cancers; and 12.8% skin cancers. The median number of anti-PD1/PD-L1 doses received was 4 (2–8). Overall, 62.5% (n=3,751) of patients experienced &gt; 1 toxicity with half (n=1,913) requiring an inpatient stay or ED visit, and the other half (n=1,838) receiving outpatient toxicity medication. A similar proportion of patients developed &gt; 1 toxicity, regardless of age: &lt;75 years, 62.4% (n=2,416); and 62.5% (n=1,335) &gt; 75 years. Systemic corticosteroids were used by 61.3% (n=2,300) of patients that experienced toxicity. The most frequently observed toxicity in this dataset by organ system was cardiovascular (18.5%, n=1,108), which was comprised largely of arrhythmias (13.7%; n=823), and endocrine toxicities (15.8%; n=950), mostly type 2 diabetes (11.9%; n=714). Conclusion: Real-world data from a large Medicare Advantage plan indicate that half of patients receiving anti-PD1/anti-PD-L1 may experience a toxicity resulting in an inpatient stay or ED visit with no difference by age. While attribution of toxicity may be challenging using claims data, the spectrum of immune-related toxicities in the real world may differ from those reported in clinical trials. Future research should evaluate incidence and management of toxicities post-guideline release and monitor changes in site of care for management.
Abstract 19568: African-American Ethnicity, Risk Variables, Coronary Artery Disease, and Long-Term Prognosis in Women: The National Heart, Lung, and Blood Institute Sponsored Women's Ischemia Syndrome Evaluation Study
Authors: Pankaj Malhotra, Galen Cook-Wiens, Carl J Pepine, Eileen M Handberg, Steven E Reis, Nathaniel Reichek, Vera Bittner, Sheryl F Kelsey, ReddySailaja Marpuri, George Sopko, C Noel Bairey Merz
Journal: Circulation (2017)

Introduction: African American (AA) women have a higher incidence of major adverse cardiac events (MACE), including all-cause death, nonfatal myocardial infarction, nonfatal stroke, and angina/hear...