tbuckley/cabot-search huggingface dataset:
Abstract P407: Stroke Dispatch, Provider Impression and Critical Pre-Hospital Time Intervals: NEMSIS, 2016
Authors: Erika Odom, Amena Abbas, Isaac Nwaise
Journal: Circulation (2019)

Introduction: Stroke management guidelines have established several recommendations to ensure a proper response by Emergency Medical Services (EMS), including EMS arrival at the scene in ≤8 minutes (response time, RT), and an on-scene time (OST) of ≤15 minutes. Understanding factors associated with achieving these time intervals may help to focus EMS interventions. Hypothesis: We assessed the hypothesis that RT and OST for suspected patients with a dispatch of stroke are more likely to fall within guideline recommendations than those with a dispatch for non-stroke related events. Methods: Using the 2016 National Emergency Medical Services Information System (NEMSIS), a database of patient care reports resulting from 911 calls, we extracted cases with a primary or secondary provider impression of stroke, their EMS arrival to the scene (RT) ≤8 minutes and OST of ≤15 minutes. The sample included persons aged ≥18 years with non-missing sociodemographic data on sex, race/ethnicity, rurality and dispatch calls of events. The percentages of 911 cases, stroke events, and time intervals of interest were calculated. Chi-square tests was used to assess associations. Results: There were 153,730 events (1.4% of all 911 transports) with a primary or secondary provider impression of stroke. Within these events, 69.5% had a RT ≤8 minutes, and 49.2% had an OST ≤15 minutes: differences varied within all sociodemographic groups. A significant difference was found between those dispatched as stroke and those dispatched as other, with a greater proportion of dispatched strokes having both a RT ≤8 minutes (70.2% vs 68.8%) and OST ≤15 minutes (53.0% vs 45.6%). Conclusion: In conclusion, we found a significantly higher proportion of patients dispatched as stroke falling within the critical time intervals of response time and on-scene time. Future EMS stroke education should place more focus on dispatcher knowledge of stroke signs and symptoms, as an integral pre-hospital partner in improving the stroke system of care.
A study of mature alpha-DC-1 vaccine to induce immune responses in ovarian cancer.
Authors: Cheryl M. Czerlanis, Maureen Drakes, Amira Elmishad, Margaret Liotta, Mala Parthasarathy, Lori Pease, Karen Pilman, Ronald Potkul, Zheng Yu, Patrick J. Stiff
Journal: Journal of Clinical Oncology (2015)

e14033 Background: Ovarian cancer (OvCa) is usually diagnosed at an advanced stage and relapse is common despite current treatments. The number of circulating CD4+ T regulatory cells (Tregs) correlates inversely with outcome in advanced OvCa. Novel immunotherapy is needed to stimulate anti-tumor host immune responses. Patients were treated with a mature dendritic cell (DC) vaccine (α-DC-1), to determine if this strategy reduces circulating Tregs and augments IFN-γ immune responses. Methods: Patients with relapsed/refractory or suboptimally debulked ovarian or primary peritoneal carcinoma were eligible. IL-12p70 secretion is an indicator of DC potency and primer of tumor-specific cytotoxic T cell responses. Vaccines consisted of 1-28 x 106 mature α-DC-1 cells, loaded with autologous tumor lysate and KLH (195-3195 pg/ml IL-12p70), harvested day 7. The cells were injected intranodally every other week for 3 doses per cycle, up to 3 cycles. CD4+CD25highFoxP3+CD127low Tregs were monitored weekly by monoclonal antibody labeling of PBMC and flow cytometry. Levels of IFN-γ secreted by PBMC were studied with ELISpot at leukapheresis and 2 points after cycle 1. Standard methods were used to assess disease. Results: Eight women, 6 of whom had minimal residual disease, received ≥ 1 cycle (median 2.3). No grade 3-4 toxicities were seen. Median progression free survival was 5.6 months (range 2.2-15.0), and median overall survival has not been reached. PBMC from all subjects were positive for IFN-γ secretion on 48-hr stimulation with positive control PMA/ionomycin and with KLH, and 2/8 (25%) on tumor lysate challenge. PBMC analysis at baseline and 2 or 3 weeks post cycle 1 showed that 4 of 7 evaluable patients (57%) had ≥ 20% Treg reduction. Mean Tregs/CD3+ T cells for controls were .92% (range .69-1.29). Mean Tregs/CD3+ T cells for vaccine subjects were 1.68% (range 1.22-2.13) at baseline. For 6 patients who received ≥ 2 vaccine cycles, mean Tregs/CD3+ T cells were 1.55% (range 1.13-2.08) after cycle 2, and 1.36% (n = 3) after cycle 3 (range .81-2.26). Conclusions: Administration of mature α-DC-1 vaccine resulted in anti-tumor IFN-γ immunity to tumor lysate antigens in 25% of subjects. Overall there was a modest reduction in CD4+ Tregs with DC vaccine therapy. Clinical trial information: NCT00703105.
Audit of doctors and patients' views may help
Authors: G. Batstone, M. Edwards, P. Jeffrey, D. Freire, P. Morris, F. Sheldon
Journal: BMJ (1995)

EDITOR,—D J Weatherall's comments on the interpersonal skills of clinical staff highlight how good communication enhances clinical effectiveness.1 This has been shown by several studies.2 3 While communication skills are increasingly being included in undergraduate courses and postgraduate training in general practice and psychiatry, for example, there remain the questions of how communication between a clinician and a patient may be assessed and improved for established health care professionals and how the patient might have a direct …
Prescribed analgesics in pregnancy and risk of childhood asthma
Authors: Seif O. Shaheen, Cecilia Lundholm, Bronwyn K. Brew, Catarina Almqvist
Journal: European Respiratory Journal (2019)

Many epidemiological studies have reported a positive association between prenatal exposure to paracetamol and childhood wheezing and asthma. We investigated whether the link between prenatal analgesic exposure and asthma/wheeze is specific to paracetamol, and whether it is causal or confounded. Using linked Swedish health register data we investigated the relation between various prescribed analgesics in pregnancy and the risk of childhood asthma/wheeze in a population of 492 999, and used negative paternal control and sibling comparison approaches to explore unmeasured confounding. After controlling for potential confounders, prescribed opioids, antimigraine drugs and paracetamol were all positively associated with childhood asthma/wheeze risk at all ages ( e.g. for asthma/wheeze at age 4 years: adjusted OR 1.39 (95% CI 1.30–1.49), 1.19 (95% CI 1.01–1.40) and 1.47 (95% CI 1.36–1.59) for opioids, antimigraine drugs and paracetamol, respectively). The results of the paternal control analysis did not suggest the presence of unmeasured confounding by genetics or shared environment. However, the sibling control analysis broadly suggested that associations between prenatal exposure to the analgesics and asthma/wheeze were confounded by specific maternal factors ( e.g. for asthma/wheeze at age 4 years: adjusted OR 0.91 (95% CI 0.62–1.31), 0.50 (95% CI 0.17–1.45) and 0.80 (95% CI 0.50–1.29) for opioids, antimigraine drugs and paracetamol, respectively). We propose that analgesic use in pregnancy does not cause childhood asthma/wheeze and that the association is confounded by unmeasured factors that are intrinsic to the mother, such as chronic pain or anxiety.
Baseline neutrophil-lymphocyte ratio as a prognostic factor for patients with resectable gastric cancer undergoing adjuvant chemotherapy.
Authors: Maria Maddalena Laterza, Angelica Petrillo, Jole Ventriglia, Alessio Fabozzi, Beatrice Savastano, Giuseppe Tirino, Anna Diana, Erika Martinelli, Floriana Morgillo, Michele Orditura, Fortunato Ciardiello, Ferdinando De Vita
Journal: Journal of Clinical Oncology (2015)

e15018 Background: A high neutrophil/lymphocyte ratio (NLR) in peripheral blood has been shown to be a strong negative prognostic factor in several types of tumors, such as colorectal, breast, pancreatic and lung cancers, while the results in gastric cancer are still controversial. The aim of our study was to define the prognostic value of pre-surgery NLR in an Italian population of resectable patients (pts.) with gastric adenocarcinoma (GC). Methods: We retrospectively collected the data for 139 pts with histologically confirmed GC who underwent curative resection between April 2006 and December 2014. All pts had a complete blood count record prior the surgery and the NLR was calculated from neutrophil and lymphocyte on this routine test. The survival was calculated by Kaplan-Meyer analysis and Cox regression was used to evaluate the prognostic value of NLR. Software SPSS 16.0 was used for statistical analysis. Results: From April 2006 to December 2014, we analyzed NLR in 139 pts with GC who had undergone curative surgery followed by adjuvant chemotherapy with Folfox-4 regimen. Pts characteristics were: median age was 62 years (range 22 - 87), the male/female ratio was 88/44, ECOG PS was 0 in 94.7% pts and 1 in 5.3% pts; the stage at diagnosis was Ib: 6.7%, IIa: 14.4%, IIb: 30.3%, IIIa: 23.5%, IIIb: 18.2%, IIIc: 6.8%. The median preoperative NLR was 1.81 (range 0.29-12.68) and pts were divided into two groups according to this cut-off value. In the whole group of 132 pts, 42 pts died, while 90 pts are still alive; in this group the 1-, 3-,5-year survival rate was 94.7%, 73.5% and 68.9% respectively. In the 65pts with low NLR the 1-, 3-, 5-year survival was 98.5%, 76.9% and 72.3% respectively, while in the 67 pts with high NLR was 89.5%, 70.1% and 65.7%. On multivariate analysis, no statistically significant differences were observed between OS in pts with low and high NLR (p = 0.069). Conclusions: Based on this study carried out in a caucasian population, we can affirm that NLR isn’t a prognostic factor in resectable gastric cancer patients underegoing adjuvant chemotherapy. Further studies in larger reports are required to evaluate the prognostic meaning of NLR in gastric cancer.
Association of the commensal urinary microbiome with response to Bacillus Calmette-Guérin (BCG) immunotherapy in nonmuscle invasive bladder cancer.
Authors: Randy F. Sweis, Shay Golan, Nimrod Barashi, Elle Hill, Ciro Andolfi, Ryan P. Werntz, Jeffrey Bloodworth, Gary D. Steinberg
Journal: Journal of Clinical Oncology (2019)

423 Background: Standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC) is intravesical BCG. Despite its established efficacy, up to 50% of patients may recur. The development of predictive biomarkers for BCG immunotherapy would enhance treatment algorithms and potentially uncover mechanisms of resistance. Recent data have characterized the presence of a commensal urine microbiome, but its role in BCG-treated NMIBC patients remains unexplored. We assessed the composition of the urine microbiome in NMIBC patients and evaluated associations with response to therapy. Methods: Patients with a newly diagnosed bladder tumor were enrolled prior to TURBT on an institutional review board-approved study at a single institution. Adjuvant BCG instillation was administrated to high-risk patients according to the surgical histology. Urine samples for microbiome assessment were collected by catheterization to eliminate urethral contamination before the TURBT and up to 8 additional timepoints. 16S sequencing and analysis was performed on baseline specimens prior to BCG. Results: Among 31 patients enrolled, 10 (32%) recurred and 21 (68%) had no recurrence with a median follow up of 6 months. Median age was 69 years (range 46-87), and 9 (29%) patients were female and 22 patients (71%) were male. The most abundant phyla observed were Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria, and Tenericutes. Together these accounted for &gt; 99% of the phyla detected in the cohort. Global analysis of distances by operational taxonomic units (OTUs) indicated a significant difference between patients with and without recurrence (Bonferroni-corrected P = 0.017). The abundance of Proteobacteria was higher in patients with recurrence (P = 0.035), with stronger differences observed for specific classes such as Gammaproteobacteria (P = 0.0025). Firmicutes such as Lactobacillales were more abundant in patients without recurrence (P = 0.049). Conclusions: In this study we detected variation in the composition of the urine microbiome in NMIBC patients, which may predict response to BCG immunotherapy. Further studies to confirm these results are ongoing.
Distribution of subsets of blood monocytic cells throughout life
Authors: Daniela Damasceno, Cristina Teodosio, Wouter B.L. van den Bossche, Martín Perez-Andres, Sonia Arriba-Méndez, Luis Muñoz-Bellvis, Alfonso Romero, Juan F. Blanco, Ana Remesal, Noemi Puig, Sergio Matarraz, José Luis Vicente-Villardón, Jacques J.M. van Dongen, Julia Almeida, Alberto Orfao
Journal: Journal of Allergy and Clinical Immunology (2019)

Currently, it is well established that monocytes are a heterogeneous type of cell consisting of phenotypically and functionally distinct subpopulations found to be numerically altered in blood in patients with a wide variety of disease conditions, such as infection, autoimmunity, respiratory and cardiovascular diseases, and inflammatory disorders.1,2 Thus, 3 subpopulations of circulating monocytic cells have been identified based on expression of the CD14 LPS receptor and the CD16 low-affinity Fc IgG receptor: (1) CD14hiCD16− classical monocytes (cMos), (2) CD14hiCD16+ intermediate monocytes (iMos), and (3) CD14−/loCD16+ nonclassical monocytes (ncMos).
Precision medicine and phenotypes, endotypes, genotypes, regiotypes, and theratypes of allergic diseases
Authors: Ioana Agache, Cezmi A. Akdis
Journal: Journal of Clinical Investigation (2019)

A rapidly developing paradigm for modern health care is a proactive and individualized response to patients’ symptoms, combining precision diagnosis and personalized treatment. Precision medicine is becoming an overarching medical discipline that will require a better understanding of biomarkers, phenotypes, endotypes, genotypes, regiotypes, and theratypes of diseases. The 100-year-old personalized allergen-specific management of allergic diseases has particularly contributed to early awareness in precision medicine. Polyomics, big data, and systems biology have demonstrated a profound complexity and dynamic variability in allergic disease between individuals, as well as between regions. Escalating health care costs together with questionable efficacy of the current management of allergic diseases facilitated the emergence of the endotype-driven approach. We describe here a precision medicine approach that stratifies patients based on disease mechanisms to optimize management of allergic diseases.
Young adult cancer survivors’ expectations of physicians for follow-up and general health care: Implications for health services delivery.
Authors: Pierre Camateros, Ying Wang, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2015)

6564 Background: As patients transition from cancer treatment to survivorship, the involvement of multiple physicians may lead to confusion as to who is primarily responsible for the patients’ ongoing care. This is particularly concerning for young adult cancer survivors who may have specific survivorship care needs. In this study, we examined survivors’ expectations of their physicians regarding cancer follow-up and general healthcare, and identified factors associated with these expectations. Methods: We surveyed patients aged 20 to 39 years who were diagnosed with solid tumors, evaluated at any 1 of 5 regional cancer centers in British Columbia, and alive at 2 or more years after their original diagnosis. Using multivariate regression models, we explored the relationships between patient expectations of their care and the factors associated with these expectations, while controlling for potential confounders. Results: With a survey response rate of 57%, a total of 447 patients were analyzed: median age was 35 years (IQR 31-38), 30% were men, 89% had ECOG 0. Tumor sites included breast (222; 50%), testicular (126; 28%), gynecological (76; 17%), and colorectal (23; 5%). For the entire cohort, the majority (67%) viewed their cancer specialist (CS) as being chiefly responsible for their care during the first 10 years of their diagnosis, but most (64%) shifted this expectation towards their primary care provider (PCP) after 10 years of follow-up (p < 0.001). PCPs were also viewed as more responsible for providing preventive care than CS (85% vs. 35%, p < 0.001). Active contact with the CS in the past year was significantly associated with higher expectations of their CS being engaged in the ongoing care of their most recent malignancy (p < 0.001), treatment of side effects (p = 0.03), and screening of future cancers (p < 0.001). Conclusions: Young patients expect involvement from their CS even years after their original cancer diagnosis. Early integration of PCPs in the cancer care trajectory may better foster a shared-care model of health services delivery and facilitate the transition of many young cancer survivors as they complete cancer treatment and enter follow-up care.
Timelines for multidsiciplinary limb soft tissue sarcoma management.
Authors: Shailendra Verma, Sharon McGee, Lisa Simmonds, Tamir Streiner, Lise Paquet, Joel Werier
Journal: Journal of Clinical Oncology (2015)

e17549 Background: Treatment timelines are an important metric in health services delivery. In rare tumors such as limb soft tissue sarcomas (STS’s) expert multidisciplinary management is very individualized but there are no apparent standards for the timing or sequencing of various therapies. In this study, we review the management of limb STS’s at our institution, specifically with respect to timelines to treatment. Methods: Records of all limb STS patients bewteen 2004-2014 were reviewed. Data on patient and tumour characteristics and therapeutic interventions was collected . Descriptive analyses was performed to determine the timelines to various treatment modalities. Further statistical analysis was performed to investigate the impact of tumour characteristics and treatment modalities on outcomes including time to relapse and survival. Results: 134 patients with limb STS were identified with a median age of 64 yrs, 58% male and 67% high grade (2-3) tumors. The majority (91%) were treated surgically with a median time from diagnosis to resection of 6 weeks. Radiation therapy was given , either neoadjuvantly (39%) or adjuvantly (29%), with a median time to treatment (TT) of 2 weeks post diagnosis and 9 weeks post resection, respectively. Adjuvant chemotherapy was given to 20% with a median TT of 7 weeks post resection. Surgical complcations in patients receiving neoadjuvant radiation was the main cause of delays for chemotherapy initiation. Relapses (local or distant) occurred in 32% with a median time to relapse of 13 months. Significant factors included high-grade (p = 0.022),lower extremity and chemotherapy treatment (p = 0.01). An analysis of treament delays > 4 weeks and impact on outcomes will be presented. Conclusions: Analysis of timelines to treatment showed variability between individual cases and were generally longer than expected, specifically for chemotherapy. Published data on this subject is scarce and we present our data as a reference for STS treatment timelines, to promote and inform further discussion to define the optimum management of this heterogenous disease.
Weekly administration of bevacizumab, eribulin, and oxalilplatin in patients with platinum-resistant ovarian carcinomas: A phase II study with biomarker analysis.
Authors: Yuji Ikeda, Masashi Takano, Hiroko Kouta, Kazuya Kudoh, Tsunekazu Kita, Ryoko Kikuchi, Morikazu Miyamoto, Tomoyuki Yoshikawa, Tomoko Goto, Kenichi Furuya, Yutaka Tamada, Arata Suga, Yoshihiro Kikuchi
Journal: Journal of Clinical Oncology (2015)

5603 Background: Eribulin, inhibiting a protein component of tubulin, is a candidate for paclitaxel-refractory breast cancers, and Bevacizumab (B) is known to enhance efficacy of anti-cancer agents in ovarian cancers. A phase II study to evaluate weekly administration of B with eribulin and oxaliplatin (EriOX) in patients with platinum-resistant and refractory ovarian carcinomas (PR-ROC) was performed. Methods: Eligible patients were as follows: (a) ECOG PS = 0~2 (b) histologically confirmed epithelial ovarian cancer (c) diagnosed as platinum-resistant ovarian cancer (d) written informed consent. Patients were treated with weekly-B-EriOX consisting of B (2mg/kg), eribulin (1mg/m2) and oxaliplatin (30mg/m2), three weeks on and on week off, q4weeks. Response was evaluated with RECIST 1.1, and adverse effects were assessed by CTCAE v4.0. Biomarker analyses including serum VEGF and BNP were also conducted. Results: A total of 30 patients were enrolled in the present study. There were no cases that discontinued the therapy due to toxicities. Median age of the patient was 60 years (range: 35-71). Median number of previous regimen was 5 (range: 2-9). Two patients (7%) had a complete response (CR), 5 patients (17%) had a partial remission (PR) and 15 patients (50%) had a stable disease (SD). The response rate and clinical benefit rate (CR+PR+SD) were 23% and 73%, respectively. Median progression-free survival was 3 months (range: 1-10+). Hematological adverse effects (AE) with grade 3/4 were observed in 4 patients (13%). Hypo albuminemia and edema with grade 3 were in 1 patient (3%), respectively. However, all AE were manageable and tolerable. There was no significant difference of serum level of VEGF according to the response evaluation. Conclusions: Weekly B and EriOX administration had significant activity with mild AE in patients with PR-ROC. These results warrant further prospective study with biomarker analyses.