tbuckley/cabot-search huggingface dataset:
Abstract MP02: Association Between Acculturation and Ideal Cardiovascular Health Among Adults From the Multi-Ethnic Study of Atherosclerosis
Authors: Olatokunbo Osibogun, Oluseye Ogunmoroti, Lena Mathews, Victor Okunrintemi, Martin Tibuakuu, Roger S Blumenthal, Erin D Michos
Journal: Circulation (2020)

Background: Greater acculturation is associated with increased risk of cardiovascular disease (CVD). However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association’s Life’s Simple 7 (LS7) metric. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of United States (US) adults free of clinical CVD at baseline. Methods: This is a cross-sectional analysis of 6,506 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. The independent variables were measures of acculturation [birthplace, language spoken at home and years lived in the US (foreign-born participants)]. The primary dependent variable was the CVH score derived from the LS7 metrics and the total CVH score ranged from 0-14 points. Scores of 0-8 indicate inadequate, 9-10 average and 11-14 optimal CVH. We used multivariable logistic and multiple linear regression models to examine the association between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. Results: The mean age (SD) was 62 (10) years and 53% were women. US-born participants had lower odds of having optimal CVH scores [prevalence odds ratio (POR) 0.63 (0.50-0.79), Table ] compared to foreign-born participants. Participants who spoke Chinese and other foreign languages at home had higher odds of having optimal CVH compared to those who spoke English [POR 1.91 (1.08-3.36) &amp; 1.65 (1.04-2.63), respectively]. Among foreign-born participants, years lived in the US was associated with a decrease in CVH score [β coefficient -0.01 (-0.02, -0.01)]. Conclusion: Greater US acculturation was associated with poorer CVH. This finding suggests that promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the US is associated with a decline in CVH score.
British GPs are more stressed and time pressured than international colleagues, survey shows
Authors: Gareth Iacobucci
Journal: BMJ (2020)

GPs in the UK are more stressed and less satisfied with the time they have to see patients than colleagues in other high income countries, a survey has suggested.

A report by the Health Foundation analysed results from a 2019 Commonwealth Fund survey of 13 200 GPs from 11 high income countries, including 1001 from the UK.1 Only France reported lower levels of overall satisfaction with practising medicine than the UK, and only Sweden reported higher levels of stress.

GPs in the UK were the least satisfied with the amount of time they were able to spend with patients, as …
Ending the HIV epidemic in the USA: an economic modelling study in six cities
Authors: Bohdan Nosyk, Xiao Zang, Emanuel Krebs, Benjamin Enns, Jeong E Min, Czarina N Behrends, Carlos del Rio, Julia C Dombrowski, Daniel J Feaster, Matthew Golden, Brandon D L Marshall, Shruti H Mehta, Lisa R Metsch, Ankur Pandya, Bruce R Schackman, Steven Shoptaw, Steffanie A Strathdee, Czarina N Behrends, Carlos del Rio, Julia C Dombrowski, Daniel J Feaster, Kelly A Gebo, Matthew Golden, Gregory Kirk, Brandon D L Marshall, Shruti H Mehta, Lisa R Metsch, Julio Montaner, Bohdan Nosyk, Ankur Pandya, Bruce R Schackman, Steven Shoptaw, Steffanie A Strathdee
Journal: The Lancet HIV (2020)
Long‐Term Study of Hepatitis Delta Virus Infection at Secondary Care Centers: The Impact of Viremia on Liver‐Related Outcomes
Authors: Habiba Kamal, Gabriel Westman, Karolin Falconer, Ann‐Sofi Duberg, Ola Weiland, Susanna Haverinen, Rune Wejstål, Tony Carlsson, Christian Kampmann, Simon B. Larsson, Per Björkman, Anders Nystedt, Kristina Cardell, Stefan Svensson, Stephan Stenmark, Heiner Wedemeyer, Soo Aleman
Journal: Hepatology (2020)

Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have, however, been mainly from tertiary care centers, with risk for referral bias toward patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside the human immunodeficiency virus co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of patients with hepatitis B and D co-infection, cared for at secondary care centers in Sweden.In total, 337 patients with anti-HDV positivity, including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline, were retrospectively studied, with a mean follow-up of 6.5 years (range, 0.5-33.1). The long-term risks for liver-related events (i.e., hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8-fold and 2.6-fold higher, respectively, in patients with HDV viremia compared with those without viremia, although the latter was not statistically significant. Among patients with HDV viremia with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0% after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 cases per person-year.HDV RNA viremia is associated with a 3.8-fold higher risk for liver-related outcomes. The prognosis was rather poor for patients with HDV viremia without cirrhosis at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings may be of importance when making decisions about treatment and evaluating potential outcomes of upcoming antivirals against HDV.
Abstract 12: Skeletal Muscle Density, Not Size, is Beneficially Associated With Incident Coronary Heart Events: The Multi-Ethnic Study of Atherosclerosis
Authors: Jonathan Unkart, John Bellettiere, Britta A Larsen, Michael H Criqui, Chantal A Vella, Iva Miljkovic, Robyn McClelland, Pamela Ouyang, Matthew A Allison
Journal: Circulation (2020)

Introduction: Fat infiltration into muscle reduces muscle density and increases the risk for metabolic dysfunction, mobility disability and mortality. We assessed abdominal muscle density and muscle area in relation to incident coronary heart disease (CHD) events. Methods: Adults (mean age 64.6 ± 9.6) from the Multi-Ethnic Study of Atherosclerosis body composition ancillary study had computed tomography (CT)-derived measures of muscle density, muscle area and visceral fat at the L2-L4 spinal column levels between 2002-05 and were followed for incident events. Using sex-stratified Cox proportional hazards regression, associations of muscle density and muscle area (in the same model) with CHD events were assessed using restricted cubic splines with adjustment for confounders including visceral adiposity and BMI. Results: After 10.3±2.9 years of follow up, 924 males had 70 CHD (7.6%) events and 945 females had 44 CHD (4.7%) events. Muscle density was higher in males (44.5±4.9 HU) than females (40.1±5.2 HU), as was muscle area (116.7±23.9 vs. 80.4±23.9 cm 2 , respectively). Among males, and in mutually adjusted models, each incremental SD of muscle density was inversely associated with CHD (HR=0.67; 95%CI=0.49-0.92), while each SD of muscle area was associated with higher risk of CHD (HR=1.75; 95%CI=1.34-2.28; Figure). Overall patterns were similar but less strong among females for density (HR=0.79; 95%CI=0.50-1.22) and area (HR=1.17; 95%CI=0.79-1.73). Conclusions: Greater muscle density is associated with lower CHD risk, while greater muscle size is associated with increased CHD risk. These associations were independent of traditional CHD risk factors and measures of visceral and total body adiposity. Quantity and quality of skeletal muscle may represent distinct aspects of aging and physical functioning that are important in heart health.
Abstract 21051: The Incidence of Common Post-Procedural Complications After ICD and Crt-d Placement Using the Nationwide Inpatient Sample 2009-2013
Authors: Anusha G Shanbhag, Kshitij Chatterjee, Abhinav Goyal, Naga venkata K Pothineni, Bashar Alzghoul, Ayoub Innabi, Hakan Paydak
Journal: Circulation (2017)

Introduction: With the increasing burden of patients undergoing ICD and CRT-D placement, we attempted to determine the incidence of common in-hospital post-procedural complications (cx) after ICD and CRT-D placement and independent predictors of post-procedural mortality. Post-procedural cx after placement of ICD and CRT-D devices have been sparsely studied. Methods: Using the Nationwide Inpatient Sample, hospitalizations with placement of new ICD (ICD-9 procedure code 37.94) or CRT-D (ICD-9 procedure code 00.51) devices were identified between 2009 and 2013. Hospitalizations involving generator or lead changes or those with additional procedures like cardiac cath, cardiac surgery, pacemaker or catheter ablation during the same hospital stay were excluded. Only adults (age≥18 years) were included and cases with missing data on age or gender were excluded. A multivariate regression model was created with demographics, post-procedural cx (cardiac, vascular, neurologic, respiratory) and Elixhauser co-morbidities as covariates. Results: There were a total of 280,144 hospitalizations for placement of ICD or CRT-D between 2009-2013 with a mean age of patients being 66.6 (SD=13.4) years; 71.5% were males and 71% were Caucasians. Post-procedure, around 9.1% patients had cardiac cx like pericardial effusion, tamponade, hematoma, post-op MI; 5.9% had vascular cx like hemorrhage and injury to blood vessels. Respiratory cx like pneumothorax, hemothorax and respiratory failure were reported in 1.2% and neurological cx in 1.9% patients. In-hospital death was reported in 1,526 (0.5%) patients. The independent predictors of post-procedural mortality were cardiac cx (OR 2.38, p&lt;0.001), respiratory cx (OR 3.01,p&lt;0.001) and history of chronic kidney disease (OR 2.09,p&lt;0.001). There was no association of age or gender with mortality after adjusting for other variables. The mean charge for all hospitalizations was $141792 (SD $92866). Conclusions: Post-procedural complications have been reported to increase costs by 20% over an uncomplicated hospitalization. Closer monitoring of patients with above stated cx and initiatives like QI projects to curb the load of cx may be beneficial.
Screening for Hepatitis B Virus Infection in Adolescents and Adults
Authors: Alex H. Krist, Karina W. Davidson, Carol M. Mangione, Michael J. Barry, Michael Cabana, Aaron B. Caughey, Katrina Donahue, Chyke A. Doubeni, John W. Epling, Martha Kubik, Gbenga Ogedegbe, Douglas K. Owens, Lori Pbert, Michael Silverstein, Melissa A. Simon, Chien-Wen Tseng, John B. Wong
Journal: JAMA (2020)

<h3>Importance</h3> An estimated 862 000 persons in the US are living with chronic infection with hepatitis B virus (HBV). Persons born in regions with a prevalence of HBV infection of 2% or greater, such as countries in Africa and Asia, the Pacific Islands, and parts of South America, often become infected at birth and account for up to 95% of newly reported chronic infections in the US. Other high-prevalence populations include persons who inject drugs; men who have sex with men; persons with HIV infection; and sex partners, needle-sharing contacts, and household contacts of persons with chronic HBV infection. Up to 60% of HBV-infected persons are unaware of their infection, and many remain asymptomatic until onset of cirrhosis or end-stage liver disease. <h3>Objective</h3> To update its 2014 recommendation, the USPSTF commissioned a review of new randomized clinical trials and cohort studies published from 2014 to August 2019 that evaluated the benefits and harms of screening and antiviral therapy for preventing intermediate outcomes or health outcomes and the association between improvements in intermediate outcomes and health outcomes. New key questions focused on the yield of alternative HBV screening strategies and the accuracy of tools to identify persons at increased risk. <h3>Population</h3> This recommendation statement applies to asymptomatic, nonpregnant adolescents and adults at increased risk for HBV infection, including those who were vaccinated before being screened for HBV infection. <h3>Evidence Assessment</h3> The USPSTF concludes with moderate certainty that screening for HBV infection in adolescents and adults at increased risk for infection has moderate net benefit. <h3>Recommendation</h3> The USPSTF recommends screening for HBV infection in adolescents and adults at increased risk for infection. (B recommendation)
Reasons for initial PSA (iPSA) and biochemical failure (BF) being poor predictors of prostate cancer (PC) mortality
Authors: J. W. Denham
Journal: Journal of Clinical Oncology (2007)

5153 Background: iPSA and BF are often poor predictors of mortality in men treated for locally advanced PC. We sought to find out why from prospective randomised trial data. Methods: In the TROG 96.01 trial men with T2b,c, 3, 4 N0 PC were randomised to 0, 3 or 6 months maximal androgen deprivation (AD) (goserelin 3.6 mg sc monthly and flutamide 250 mg po tid) prior to 66 Gy to the prostate and seminal vesicles. Failure site was diagnosed prior to salvage hormone therapy (ST) where possible, and type, timing and duration of response to ST recorded. Proportional hazards modeling was used to identify predictors of cause specific and overall survival (CSS, OS) at follow-up landmark points (where p&gt;0.05= NS , &lt;0.01= S , &lt;0.001= H ). Results: Between 1996 and 2000, 802 eligible men were randomised. Higher iPSA was found to be a potent predictor of BF (Houston [HF]) H but a poor one for of CSS NS and OS NS . Patients having HF and/or clinical failure had unfavourable initial prognostic factors (high iPSA H , stage H , Gleason score H or risk group H ) compared to patients who did not fail. However in this cohort poor initial prognostic features did not predict PC death when the relapse characteristics (failure site H and PSA doubling time H [PSA DT]) were accounted for. Instead lower iPSA levels were predictive of worse outcome in these models S , a finding supported by univariate analyses. PSA DT was found to correlate positively with interval between HF and ST H and the likelihood S and duration of response to ST H , and survival H . Thus lower PSA DTs were associated with earlier intervention but poorer responses and outcomes. Conclusions: Prognosis after BF is related more to tumour biology at relapse than to initial prognostic factors. ST alone is an unsatisfactory treatment for rapid PSA DT relapses. No significant financial relationships to disclose.
Bisphosphonate-induced osteonecrosis of the jaw: Risk factors and diagnostic utility of bone scans
Authors: T. L. O'Connor, A. Padmanabhan, G. Wilding, M. Sullivan, L. Solomon, D. Lamonica
Journal: Journal of Clinical Oncology (2007)

9052 Background: Osteonecrosis of the jaw (ONJ) is a serious long-term effect of intravenous bisphosphonates. We report characteristics of patients with ONJ at Roswell Park Cancer Institute (RPCI) and utility of bone scans in its diagnosis. Methods: Patients were identified using RPCI database. ONJ diagnosed was staged using the system used for jaw osteoradionecrosis (Schwartz et al, Am J Clin Oncol, 2002). Controls included patients receiving bisphosphonates between July 2002 and 2006. Routine whole body bone scans were reviewed for jaw uptake. Statistical analysis was done using SAS 9.1. Results: Three hundred and fifty-four patients received intravenous bisphosphonates between July 2002 and 2006. Twenty-four (7%) were diagnosed with ONJ. Among patients with ONJ, fifteen (63%) had breast cancer, eight (33%) had multiple myeloma and one (4%) had lung cancer. Mean age was 56.8 years. (SD= 9.1) Thirteen patients (54%) had tobacco use, five (21%) had diabetes, nine (37.5%) had hypertension and twenty-three patients (96%) received chemotherapy. Five patients (21%) had caries, three (12.5%) had dental surgery, nine (37.5%) had periodontal disease, thirteen (54%) had extractions and one (4%) had prior dental trauma. Twenty-two patients (92%) presented with pain. Twelve patients (50%) had ONJ Stage 1, eight (33%) Stage 2 and four (17%) Stage 3. Median duration of exposure to bisphosphonates was 39 months. The difference between the average number of infusions in the ONJ group (11.2, CI: 11.3, 20.3) and control group (7.2, CI: 6.2, 8.2) was found to be significant (p&lt;0.0009). Three patients (12.5%) had progressive ONJ. Thirteen patients with ONJ had bone scans and twelve (92%) showed jaw uptake. Among controls, one hundred and eighty-three had bone scans and one hundred and twenty-eight (70%) showed jaw uptake. This difference was not significant. (p=0.114, two-tailed Fisher's exact test). Conclusions: In our study, chemotherapy, smoking, prior dental extractions and the number of bisphosphonate infusions appear to be risk factors for ONJ. It has been recently reported (Chiandussi et al., Dentomaxillofacial Radiol. 2006) that bone scans can be used as a screening tool for ONJ, however, in our series jaw uptake on bone scan was not a reliable predictor for the development of ONJ. No significant financial relationships to disclose.
Abstract P270: Prediction of Telomere Shortening Using a Genetic Risk Score: The Multi-ethnic Study of Atherosclerosis (mesa)
Authors: Cecilia Castro-Diehl, Jennifer Smith, Wei Zhao, Xu Wang, Elissa Epel, Bhramar Mukherjee, Brisa Sanchez, Teresa Seeman, Belinda Needham
Journal: Circulation (2020)

In epidemiological studies, telomere shortening has been associated with age-related diseases and mortality. We assessed whether a genetic risk score (GRS) combining seven telomere length (TL)-associated genetic variants identified in a European-American genome-wide association study (GWAS) predicts TL and change in TL over 10 years in a multi-ethnic sample. Research Hypotheses: 1. In cross-sectional analysis, the GRS will be inversely associated with TL. 2. In longitudinal analysis, the GRS will be associated with change in TL over a 10-year period. Methods: TL was assessed on a sample of 1198 white, African-American and Hispanic participants, who attended both, MESA Exam 1 and 5, 10 years apart. Participants were 45-84 years at Exam 1. We used MESA measured or imputed genotype data to create the TL GRS and constructed the GRS using weighted estimates from the prior GWAS. Our main exposure was TL GRS. For hypothesis 1, we used linear mixed-effects model (LMEM) including all valid observations from both exams and adjusted for an exam indicator, age, sex and specific genetic principal components (PC). For hypothesis 2, we used LMEM with time-varying covariates and adjusted for follow-up time since Exam 1, age, sex and PC. We stratified our analysis by race/ethnic group and used the top three race/ethnic-specific genetic PC to account for population stratification. Results: In cross-sectional analysis, we observed a significant inverse association between GRS and TL (estimates= -0.18 (S.E.=0.08), P =0.02 for white; -0.18 (0.07), P &lt;0.01 for black; and -0.13 (0.05), P =0.01 for Hispanic) after full adjustment. In the longitudinal analysis, only among Hispanics, higher TL GRS predicted a reduction in TL over a 10-year period (-0.22 (0.06, P &lt;0.001)), but after adjustment for PC, the association became not statistically significant. Conclusion: In the cross-sectional analysis, higher TL GRS was associated with shorter TL in the three race/ethnic groups studied. TL GRS did not predict telomere attrition in any of the race/ethnic groups.
Phase I trial of imatinib mesylate, hydroxyurea and vatalanib for patients with recurrent glioblastoma multiforme (GBM)
Authors: S. Sathornsumetee, J. N. Rich, J. J. Vredenburgh, A. Desjardins, J. A. Quinn, S. Gururangan, M. J. Egorin, A. J. Salvado, H. S. Friedman, D. A. Reardon
Journal: Journal of Clinical Oncology (2007)

2027 Background: Recent studies have demonstrated promising anti-glioma activity of imatinib mesylate (IM) and hydroxyurea (H). Angiogenesis is one of the hallmarks of GBM with VEGF as a key regulator. This study attempts to extend the efficacy of IM and H by adding a VEGF receptor inhibitor, vatalanib (V; PTK787/ZK22584). Methods: We employ a ‘3+3‘ dose escalation design to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of IM and V when administered with fixed dose of H in adult recurrent GBM patients with &lt; 3 prior recurrences, KPS = 70% and adequate organ function. Patients are stratified based on concurrent enzyme-inducing anticonvulsant (EIAC) administration, and both strata (A- not on EIAC and B- on EIAC) are independently dose-escalated. Initial dose levels for stratum A: IM - 400 mg/day; H - 500 mg bid; V- 250 mg bid and for stratum B: IM- 500 bid; H-500 mg bid; V- 500 mg bid. Patients are given only V on day 1–7 of cycle 1 and then IM+H+V daily thereafter. Only cycle 1 is 35 days with subsequent cycles of 28 days. Response is evaluated every other cycle. Pharmacokinetic (PK) studies are performed on days 7 and 35 of cycle 1. Results: Thirty-five recurrent GBM patients have enrolled. The median age is 51.5 (range 31 to 75), 66% are male, and 51% are on EIAC. One DLT (grade 3 thrombocytopenia) occurred in a stratum A patient on dose level three . For stratum B, two DLTs (grade 3 hypertension and ALT elevation) occurred in a patient on dose level two and one DLT (grade 3 fatigue) occurred in a patient on dose level three. MTDs for each stratum have not been reached and accrual is ongoing. PK results are pending. Ten partial responses (29%) have been observed and nine patients remain on study including three who have received more than 6 cycles of therapy. Conclusions: Combination of imatinib, hydroxyurea and vatalanib is safe and well-tolerated with an encouraging rate of radiographic response. Further accrual is in progress to define the MTD. No significant financial relationships to disclose.
Pilot study of selective internal radiation therapy (SIRT) for patients with unresectable neuroendocrine liver metastases (NETLM)
Authors: J. King, R. Quinn, D. Glenn, W. Liauw, J. Janssen, D. Morris
Journal: Journal of Clinical Oncology (2007)

15096 Background: Few effective treatment options exist for inoperable NETLM. A prospective single-unit study assessed safety and efficacy of radioactive yttrium 90 resin (SIR) in 34 patients with unresectable (NETLM). Method: Microspheres were administered via temporary percutaneous hepatic artery catheter with concomitant 7day 5-flurouracil infusion. Patients were monitored prospectively and treatment response measured by CT imaging and chromogranin A (CgA). Results: 34 patients (22 male), mean age 61 years (range 32–79) were treated with SIRT from December 2003 to December 2005. Mean follow-up 28.9 months, (95% CI 23.4 to 32.3). Complications were: post-embolitic pain and lethargy 1 week-1 month; 3 radiation gastritis, 2 of whom developed a duodenal ulcer. RECIST response on CT scan of 34 patients at 1 month: PR 9 (26%); SD 22 (65%); PD 3 (9%); 32 at 6 months, PR 7 (22%); SD 19 (59%); PD 6 (19%); 29 at 12 months CR 2 (7%); PR 3 (10%); SD 16 (55%); PD 8 (28%); 16 at 18 months, CR 4(25%); PR 1 (6%); SD 8 (50%); PD =3 (19%); 8 at 24 months, CR 4 (50%);SD 2 (25%),PD 2 (25%); 6 at 30 months, CR 2 (33%); SD 2 (33%); PD 2 (33%). CgA U/L fall from entry was: 19 (26%) at one month; 15 (43%) at 6 months; 15 (52%) at 9 months; 11 (57%) at 12 months; 8 (38%) at 24 months and 4 (80%) at 30 months. At 36 months from entry 11 (32%) have died; 8 (24%) have PD; 9 (26%) have SD and 6 (18%), (15 to 30 months) have CR on CT scan. Conclusion: SIRT is a promising treatment option for patients with in-operable NETLM. No significant financial relationships to disclose.