tbuckley/cabot-search huggingface dataset:
Adherence to Guidelines for the Administration of Intraoperative Antibiotics in a Nationwide US Sample
Authors: Amit Bardia, Miriam M. Treggiari, George Michel, Feng Dai, Mayanka Tickoo, Mabel Wai, Kevin Schuster, Michael Mathis, Nirav Shah, Sachin Kheterpal, Robert B. Schonberger
Journal: JAMA Network Open (2021)

Despite widespread adherence to Surgical Care Improvement Project antibiotic measures, prevention of surgical site infections (SSIs) remains a clinical challenge. Several components of perioperative antibiotic prophylaxis guidelines are incompletely monitored and reported within the Surgical Care Improvement Project program.To describe adherence to each component of perioperative antibiotic prophylaxis guidelines in regard to procedure-specific antibiotic choice, weight-adjusted dosing, and timing of first and subsequent administrations in a nationwide, multicenter cohort of patients undergoing noncardiac surgery.This cohort study included adult patients undergoing general, urological, orthopedic, and gynecological surgical procedures involving skin incision between January 1, 2014, and December 31, 2018, across 31 academic and community hospitals identified within the Multicenter Perioperative Outcomes Group registry. Data were analyzed between April 2 and April 21, 2021.The primary end point was overall adherence to Infectious Diseases Society of America guidelines, including (1) appropriateness of antibiotic choice, (2) weight-based dose adjustment, (3) timing of administration with respect to surgical incision, and (4) timing of redosing when indicated. Data were analyzed using mixed-effects regression to investigate patient, clinician, and institutional factors associated with guideline adherence.In the final cohort of 414 851 encounters across 31 institutions, 51.8% of patients were women, the mean (SD) age was 57.5 (15.7) years, 1.2% of patients were of Hispanic ethnicity, and 10.2% were Black. In this cohort, 148 804 encounters (35.9%) did not adhere to guidelines: 19.7% for antibiotic choice, 17.1% for weight-adjusted dosing, 0.6% for timing of first dose, and 26.8% for redosing. In adjusted analyses, overall nonadherence was associated with emergency surgery (odds ratio [OR], 1.35; 95% CI, 1.29-1.41; P < .001), surgery requiring blood transfusions (OR, 1.30; 95% CI, 1.25-1.36; P < .001), off-hours procedures (OR, 1.08; 95% CI, 1.04-1.13; P < .001), and procedures staffed by a certified registered nurse anesthetist (OR, 1.14; 95% CI, 1.11-1.17; P < .001). Overall adherence to guidelines for antibiotic administration improved over the study period from 53.1% (95% CI, 52.7%-53.5%) in 2014 to 70.2% (95% CI, 69.8%-70.6%) in 2018 (P < .001).In this cohort study, although adherence to perioperative antibiotic administration guidelines improved over the study period, more than one-third of surgical encounters remained discordant with Infectious Diseases Society of America recommendations. Future quality improvement efforts targeting gaps in practice in relation to guidelines may lead to improved adherence and possibly decreased SSIs.
Abstract 9056: The Association Between Thoracic Injuries Due to Chest Compression and Short-Term Prognosis in Patients With Non-traumatic Out-of-Hospital Cardiac Arrest
Authors: Aya Katasako, Shoji Kawakami, Hidenobu Koga, Kenichi Kitahara, Keiichiro Komiya, Komei Mizokami, Tetsuhisa Yamada, Nobutoshi Miura, Shujiro Inoue
Journal: Circulation (2021)

Background: The current guidelines emphasize that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to thoracic injuries which is a potential factor of poor prognosis. Method: Between June 2017 to July 2019, we collected Utstein-style data on 384 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital. Full-body CT scan was performed and thoracic injuries were defined as rib fracture, sternum fracture, hemorrhagic pleural effusion, pneumothorax, sternum posterior bleeding, mediastinal hematoma, or mediastinal emphysema. We identified the predictors for thoracic injuries and evaluated the relationship between thoracic injuries and prognosis. Results: Patients with thoracic injuries (Group-T) were 234 (76%). The duration of chest compression in Group-T was 43 min, which was significantly longer than that in patients without thoracic injuries (Group-N, 32 min, p&lt;0.001). ROC curve analysis identified a duration of chest compression of 35 minutes as the optimal cut off for predicting thoracic injuries (area under the curve 0.73). Multivariate analysis revealed that age (OR: 1.03, 95%CI: 1.01-1.05, p=0.005) and duration of chest compression (OR: 1.07, 95%CI: 1.04-1.09, p&lt;0.001) were independent predictors of thoracic injuries. The rate of obtaining return of spontaneous circulation (ROSC), 30-day survival and favorable neurologic outcome were larger in Group-N than Group-T. In patients with achieving ROSC, Kaplan-Meier curves showed a significantly higher cumulative survival rates in Group-N compared to that in Group-T during follow-up of 30 days (Log-rank test p=0.009). Conclusion: Age and duration of chest compression were independent predictors for thoracic injuries due to chest compression in non-traumatic OHCA patients. Moreover, the presence of thoracic injuries was associated with poor short-term prognosis.
Bah humbug! Association between sending Christmas cards to trial participants and trial retention: randomised study within a trial conducted simultaneously across eight host trials
Authors: Elizabeth Coleman, Catherine Arundel, Laura Clark, Laura Doherty, Katie Gillies, Catherine Hewitt, Karen Innes, Adwoa Parker, David Torgerson, Shaun Treweek
Journal: BMJ (2021)

Abstract Objectives To determine the effectiveness of sending Christmas cards to participants in randomised controlled trials to increase retention rate at follow-ups, and to explore the feasibility of doing a study within a trial (SWAT) across multiple host trials simultaneously. Design Randomised SWAT conducted simultaneously across eight host trials. Setting Eight randomised controlled trials researching various areas including surgery and smoking cessation. Participants 3223 trial participants who were still due at least one follow-up from their host randomised controlled trial. Intervention Participants were randomised (1:1, separately by each host trial) to either received a Christmas card in mid-December 2019 or to not receive a card. Main outcome measure Proportion of participants completing their next follow-up (retention rate) within their host randomised controlled trial. Results 1469 participants (age 16-94 years; 70% (n=1033) female; 96% (813/847) white ethnicity) across the eight host randomised controlled trials were involved in the analysis (cut short owing to covid-19). No evidence was found of a difference in retention rate between the two arms for any of the host trials when analysed separately or when the results were combined (85.3% (639/749) for cards versus 85.4% (615/720) for no card; odds ratio 0.96, 95% confidence interval 0.71 to 1.29; P=0.77). No difference was observed when comparing just participants who were due a follow-up in the 30 days after receiving the card (odds ratio 0.96, 0.42 to 2.21). No evidence of a difference in time to complete the questionnaire was found (hazard ratio 1.01, 95% confidence interval 0.91 to 1.13; P=0.80). These results were robust to post hoc sensitivity analyses. The cost of this intervention was £0.76 (€0.91; $1.02) per participant, and it will have a carbon footprint of approximately 140 g CO 2 equivalent per card. One benefit of this approach was the need to only submit one ethics application. Conclusions Sending Christmas cards to participants in randomised controlled trials does not increase retention. Undertaking a SWAT within multiple randomised controlled trials at the same time is, however, possible. This approach should be used more often to build an evidence base to support selection of recruitment and retention strategies. Although no evidence of a boost to retention was found, embedding a SWAT in multiple host trials simultaneously has been shown to be possible. Study registration SWAT repository https://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,846275,en.pdf#search=SWAT%2082 .
NCCN News
Authors: D Schmults, Rachel Blitzblau
Journal: Journal of the National Comprehensive Cancer Network (2021)

Every YearNCCN has published new NCCN Guidelines for Patients Basal Cell Skin Cancer (also known as basal cell carcinoma, or BCC), the most common form of skin cancer.This highly curable type of cancer is diagnosed in more than 2 million people in the United States every year-which is more than all other cancers combined. 1BCC primarily impacts lighter-skinned, sun-exposed people aged .60 years, due to the buildup of sun exposure over the years.However, skin cancer has recently become more common in younger people, likely as a result of them spending more time in the sun.In very rare instances untreated BCC can progress significantly and be life-threatening.This new resource provides trustworthy information based on the latest evidence, available free online at NCCN.org/patientguidelines thanks to funding from the NCCN Foundation."I am grateful to see these new and comprehensive guidelines for BCC," said Kathy Barnard, Founder of the Save Your Skin Foundation."Last year, when I was diagnosed with advanced BCC, I did not know where to turn.I got very little information from my doctor and did not understand the procedures they prescribed and the painful surgeries I received.Thankfully, patients going forward will be able to rely on the information in this book to help them understand and navigate their diagnosis and treatment options."The treatment recommendations explained in the NCCN Guidelines for Patients are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), which are updated frequently by multidisciplinary teams of experts from across NCCN Member Institutions.The patient versions present unbiased expert guidance in an easy-to-read format-with clear language, charts, images, and a glossary of medical terms."Most patients with BCC can be cured with a simple surgical excision, and some tumors can even be treated with topical creams.However, a very small subset of cases can spread.These patient guidelines help people know the difference," explained Chrysalyne
Baveno VII – Renewing consensus in portal hypertension
Authors: Roberto de Franchis, Jaime Bosch, Guadalupe Garcia-Tsao, Thomas Reiberger, Cristina Ripoll, Juan G. Abraldes, Agustin Albillos, Anna Baiges, Jasmohan Bajaj, Rafael Bañares, Marta Barrufet, Lina Benajiba, Annalisa Berzigotti, Christophe Bureau, Vincenza Calvaruso, Andres Cardenas, Gennaro D’Amico, Andrea De Gottardi, Alessandra Dell’Era, Angels Escorsell, Jonathan Fallowfield, Hector Ferral, Sven Francque, Ron Gaba, Juan Carlos Garcia-Pagàn, Joan Genescà, Susana Gomes Rodrigues, Jordi Gracia-Sancho, Guogong Han, Virginia Hernandez-Gea, Jidong Jia, Jean Jacques Kiladjian, Aleksander Krag, Wim Laleman, Vincenzo La Mura, Sabela Lens, Xuefeng Luo, Mattias Mandorfer, Sarwa Darwish Murad, Valerie Paradis, David Patch, Salvatore Piano, Massimo Pinzani, Aurelie Plessier, Massimo Primignani, Bogdan Procopet, Pierre Emmanuel Rautou, Marika Rudler, Shiv K. Sarin, Filippo Schepis, Marco Senzolo, Vijay Shah, Akash Shukla, Puneeta Tandon, Luis Tellez, Dominique Thabut, Maja Thiele, Jonel Trebicka, Dhiraj Tripathi, Emmanouil Tsochatzis, Laura Turco, Fanny Turon, Dominique Valla, Candid Villanueva, Ian Wanless, Hitoshi Yoshiji
Journal: Journal of Hepatology (2021)
Focus on organoids: cooperation and interconnection with extracellular vesicles – Is this the future of in vitro modeling?
Authors: Ancuta Jurj, Sergiu Pasca, Cornelia Braicu, Ioana Rusu, Schuyler S. Korban, Ioana Berindan-Neagoe
Journal: Seminars in Cancer Biology (2021)

Organoids are simplified in vitro model systems of organs that are used for modeling tissue development and disease, drug screening, cell therapy, and personalized medicine. Despite considerable success in the design of organoids, challenges remain in achieving real-life applications. Organoids serve as unique and organized groups of micro physiological systems that are capable of self-renewal and self-organization. Moreover, they exhibit similar organ functionality(ies) as that of tissue(s) of origin. Organoids can be designed from adult stem cells, induced pluripotent stem cells, or embryonic stem cells. They consist of most of the important cell types of the desired tissue/organ along with the topology and cell-cell interactions that are highly similar to those of an in vivo tissue/organ. Organoids have gained interest in human biomedical research, as they demonstrate high promise for use in basic, translational, and applied research. As in vitro models, organoids offer significant opportunities for reducing the reliance and use of experimental animals. In this review, we will provide an overview of organoids, as well as those intercellular communications mediated by extracellular vesicles (EVs), and discuss the importance of organoids in modeling a tumor immune microenvironment (TIME). Organoids can also be exploited to develop a better understanding of intercellular communications mediated by EVs. Also, organoids are useful in mimicking TIME, thereby offering a better-controlled environment for studying various associated biological processes and immune cell types involved in tumor immunity, such as T-cells, macrophages, dendritic cells, and myeloid-derived suppressor cells, among others.
Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation
Authors: Shahrzad Salmasi, Mary A. De Vera, Abdollah Safari, Larry D. Lynd, Mieke Koehoorn, Arden R. Barry, Jason G. Andrade, Marc W. Deyell, Kathy Rush, Yinshan Zhao, Peter Loewen
Journal: Journal of the American College of Cardiology (2021)
98P Camrelizumab as neoadjuvant, first- or later-line treatment for non-small cell lung cancer (NSCLC): A retrospective real-world study (CTONG2004)
Authors: C. Xu, Q. Chen, C. Zhou, L. Wu, W. Li, H. Zhang, Y. Li, F. Xu, J. Xiong, Q. Wang, H. Zhang, Y. Jiang, H. Yin, Q. Wu, Q. Dai, J. Hu, J. Chen, J. Zhang, G. Wu, Y-L. Wu
Journal: Annals of Oncology (2021)
Abstract 16928: Amiodarone For Atrial Fibrillation In The Setting Of Cardiogenic Shock And Thyroid Storm
Authors: Ashish Patel, Sae Jang, Samir Saba
Journal: Circulation (2021)

Case Presentation: A 29-year-old man with a history of hyperthyroidism presented to an outside hospital with altered mentation and palpitations in the setting of non-adherence to thyroid medications. He was found to be in atrial fibrillation with rapid ventricular response. Initial vital signs included a heart rate of 165 beats/min, respiratory rate of 43 breaths/min, blood pressure of 134/115 mmHg, and O2 saturation of 94% on 2L of oxygen. Point of care ultrasound showed an EF of 10% and a dilated IVC. Labs showed a creatinine of 0.7 mg/dL, total bilirubin of 3.9 mg/dL, ALT of 39 IU/L, AST of 62 IU/L, ALP of 181 IU/L, lactate of 7.6 mMol/L, TSH of &lt; 0.01 uIU/mL, free T4 of &gt; 5.00 ng/dL, and a T3 of &gt; 30.00 pg/mL. He was treated with methimazole and then switched to propylthiouracil (PTU). Esmolol and diltiazem resulted in worsening cardiogenic shock and PEA arrest twice requiring VA ECMO cannulation. Upon transfer to our facility, he was started on potassium iodide (SSKI). He had electrical cardioversion twice with reversion back to atrial fibrillation. He was then started on amiodarone and digoxin. He remained in atrial fibrillation but achieved rate control with heart rates in the 100s. Discussion: Amiodarone is typically avoided in atrial fibrillation in the setting of thyrotoxicosis due to its high iodine content which can precipitate further thyroid hormone synthesis. However, in the setting of cardiogenic shock, treatment options are limited. We learned from our endocrinology colleagues that amiodarone can be beneficial when patients are treated with PTU and SSKI as amiodarone blocks the conversion of T4 to T3. Amiodarone should be started after PTU as PTU prevents thyroid hormone synthesis and blunts the effect of the iodine load of amiodarone. In conclusion, amiodarone can be considered earlier for the treatment of atrial fibrillation in the setting of thyrotoxicosis especially if treatment options are limited by cardiac dysfunction granted the patient has been started on PTU.
Being Present After Pediatric Critical Illness—Home and Hospital, School and Work
Authors: Christopher S. Parshuram, Todd Cunningham
Journal: JAMA Network Open (2021)

Erin F. Carlton, MD, MSc; John P. Donnelly, PhD; Hallie C. Prescott, MD, MSc; Lisa A. Asaro, MS; Ryan P. Barbaro, MD, MSc; R. Scott Watson, MD, MPH; Martha A. Q. Curley, RN, PhD; RESTORE Study Investigators; Martha A.Q. Curley; David Wypij; Geoffrey L. Allen; Derek C. Angus; Lisa A. Asaro; Judy A. Ascenzi; Scot T. Bateman; Santiago Borasino; Cindy Darnell Bowens; G. Kris Bysani; Ira M. Cheifetz; Allison S. Cowl; Brenda L. Dodson; E. Vincent S. Faustino; Lori D. Fineman; Heidi R. Flori; Linda S. Franck; Rainer G. Gedeit; Mary Jo C. Grant; Andrea L. Harabin; Catherine Haskins-Kiefer; James H. Hertzog; Larissa Hutchins; Aileen L. Kirby; Ruth M. Lebet; Michael A. Matthay; Gwenn E. McLaughlin; JoAnne E. Natale; Phineas P. Oren; Nagendra Polavarapu; James B. Schneider; Adam J. Schwarz; Thomas P. Shanley; Shari Simone; Lewis P. Singer; Lauren R. Sorce; Edward J. Truemper; Michele A. Vander Heyden; R. Scott Watson; Claire R. Wells
Reply
Authors: Fien A. von Meijenfeldt, R. Todd Stravitz, William M. Lee, Ton Lisman
Journal: Hepatology (2021)

We thank Dr. Liu and colleagues for their interest in our manuscript. We agree that the lower plasma levels of the neutrophil extracellular trap (NET)‐marker, myeloperoxidase (MPO)‐DNA complex, in patients with acetaminophen‐induced acute liver failure (ALF) might be explained by the shorter duration of disease at blood sampling compared with non‐acetaminophen‐induced ALF. We disagree, however, that it has been established at what stage in human acetaminophen‐induced ALF neutrophil influx in the liver takes place and would like to emphasize that the data referred to by Dr. Liu and colleagues are derived from studies in mice. It would be of interest to assess NET formation in serial blood samples to document NET formation over time and its possible contribution to progression of disease. We agree that subsets of neutrophils are involved in tissue repair after liver injury, but when neutrophils are activated to form NETs, these beneficial features are likely lost.[1] Our study suggests that in ALF, NET formation primarily causes damage, as high plasma levels of MPO‐DNA complexes were associated with poor outcome. Notably, the vast majority of studies on the role of neutrophils in liver injury and repair have used mouse models of liver injury. Whether these results are relevant for ALF in humans should be further explored. The second comment raised on the activation of coagulation by NETs in liver disease is important and has been the subject of studies in our group. There is convincing evidence from experimental studies that NETs activate coagulation, but there is limited evidence that NETs are involved in activation of coagulation in patients with liver disease. We previously showed that MPO‐DNA complex levels were not associated with markers of coagulation activation in patients with acute‐on‐chronic liver failure[2] and in patients undergoing liver transplantation.[3] It has also been demonstrated that NETs inhibit the fibrinolytic system in vitro, but it is unclear whether this mechanism plays a role in fibrinolysis regulation in vivo. We recently demonstrated that coagulation or fibrinolytic potential in patients with ALF were not associated with outcome.[4] Thus, it may be that the mechanism by which NETs contribute to progression of ALF is not through activation of coagulation. We agree that additional (histological) studies to explore the role of NETs in progression of liver disease and their link to coagulation are of interest. CONFLICT OF INTEREST Dr. Lee consults for SeaGen, Forma, Karuna, Pfizer, Genentech, and Cortexyme. He received grants from Bristol‐Myers Squibb, Intercept, Aurora, Gilead, Ocera, Cumberland, Eiger, and Alexion.
Multiple stimuli-responsive nanosystem for potent, ROS-amplifying, chemo-sonodynamic antitumor therapy
Authors: JunJie Tang, Xiaoge Zhang, Lili Cheng, Yadong Liu, You Chen, Zhaozhong Jiang, Jie Liu
Journal: Bioactive Materials (2021)

Although sonodynamic therapy (SDT) is a promising non-invasive tumor treatment strategy due to its safety, tissue penetration depth and low cost, the hypoxic tumor microenvironment limits its therapeutic effects. Herein, we have designed and developed an oxygen-independent, ROS-amplifying chemo-sonodynamic antitumor therapy based on novel pH/GSH/ROS triple-responsive PEG-PPMDT nanoparticles. The formulated artemether (ART)/Fe3O4-loaded PEG-PPMDT NPs can rapidly release drug under the synergistic effect of acidic endoplasmic pH and high intracellular GSH/ROS levels to inhibit cancer cell growth. Besides, the ROS level in the NPs-treated tumor cells is magnified by ART via interactions with both Fe2+ ions formed in situ at acidic pH and external ultrasound irradiation, which is not affected by hypoxia tumor microenvironment. Consequently, the enriched intracellular ROS level can cause direct necrosis of ROS-stressed tumor cells and further accelerate the drug release from the ROS-responsive PEG-PPMDT NPs, achieving an incredible antitumor potency. Specifically, upon the chemo-sonodynamic therapy by ART/Fe3O4-loaded PEG-PPMDT NPs, all xenotransplants of human hepatocellular carcinoma (HepG2) in nude mice shrank significantly, and 40% of the tumors were completely eliminated. Importantly, the Fe3O4 encapsulated in the NPs is an efficient MRI contrast agent and can be used to guide the therapeutic procedures. Further, biosafety analyses show that the PEG-PPMDT NPs possess minimal toxicity to main organs. Thus, our combined chemo-sonodynamic therapeutic method is promising for potent antitumor treatment by controlled release of drug and facile exogenous generation of abundant ROS at target tumor sites.