tbuckley/cabot-search huggingface dataset:
Ampullary neuroendocrine tumors: A window into a rare tumor using a national database.
Authors: Samantha M Ruff, Gary B Deutsch, Matthew John Weiss, Danielle Deperalta
Journal: Journal of Clinical Oncology (2021)

373 Background: Ampullary neuroendocrine tumors (NET) make up &lt; 1% of all gastrointestinal NETs. Information about their behavior and prognosis is reliant on small case series. This study set out to describe the population of patients who are diagnosed with ampullary NETs and compare them to patients with duodenal and pancreatic head NETs. Methods: The National Cancer Database (2004 – 2016) was queried for patients with ampullary, duodenal, and pancreatic head NETs. Clinicopathologic and treatment characteristics were compared. Subset analysis was performed on patients who underwent surgery. Kaplan Meier (KM) analysis and Cox regression were used to analyze the survival of patients with ampullary NETs. Results: Overall, 872 patients were identified with ampullary NET, 9692 with duodenal NET, and 6562 with pancreatic head NET. Patients with ampullary NET had an average age of 60.9 +/- 14.5 years, were evenly split among men and women (N = 437, 50.1% vs N = 435, 49.9%, respectively), and primarily Caucasian (N = 663, 76.0%). 72.1% underwent local tumor destruction or surgery (N = 629). Most did not receive radiation (N = 832, 95.4%), chemotherapy (N = 627, 71.9%), or hormone therapy (N = 788, 90.4%). Patients with ampullary NETs had more poorly differentiated tumors (N = 119, 13.6%) than patients with duodenal (N = 159, 1.6%) or pancreatic head (N = 602, 9.2%) NETs. Patients with ampullary NETs had more positive lymph nodes (N = 288, 33%) than patients with duodenal (N = 915, 9.4%) or pancreatic head (N = 1381, 21%) NETs. At five years, the overall survival for patients with ampullary, duodenal, and pancreatic head NETs was 57%, 68%, and 46%, respectively. Within the surgical population, five-year survival for patients with ampullary (N = 367), duodenal (N = 991), and pancreatic head (N = 1961) NETs was 60%, 74%, and 72%, respectively. When compared, there was a statistically significant difference between the mean overall survival of patients with ampullary (98 +/- 4.7 months), duodenal (112 +/- 2.5 months), and pancreatic head (108 +/- 1.7 months) NETs (p &lt; 0.001). In the cox regression analysis, sex, Charlson-Deyo score, lymph node positivity, lymph-vascular invasion, mitotic rate, chromogranin A level, 5-HIAA level, and tumor size did not correlate with survival. Increasing age (HR 1.04, CI 1.01 – 1.07, p = 0.008) and worse tumor differentiation (poorly differentiated HR 3.33, CI 1.38 – 8.04, p = 0.008 and undifferentiated HR 8.31, CI 2.77 – 24.92, p &lt; 0.001 compared to well differentiated) were associated with increased mortality. Conclusions: This study sheds light on a rare tumor histology. When compared to patients who underwent surgical resection for duodenal or pancreatic head NETs, patients with ampullary NETs had a significantly worse prognosis. Identifying prognostic factors allows us to create more concrete treatment recommendations and provide patients with improved prognostic information.
PERITONEAL DRAINAGE FLUID LACTATE LEVEL IN SURGICAL PATIENITS WITH HIGH INTRAABDOMINAL PRESSURE
Authors: Natasa Kovac, Mladen Siranovic, Helena Krolo, Katarina Klican, Branka Mazul-Sunko, Mijo Kelecic, Marinko Vucic, Bojan Rode
Journal: Intensive Care Medicine (2006)
Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019
Authors: Jennifer R. Marin, Jonathan Rodean, Matt Hall, Elizabeth R. Alpern, Paul L. Aronson, Pradip P. Chaudhari, Eyal Cohen, Stephen B. Freedman, Rustin B. Morse, Alon Peltz, Margaret Samuels-Kalow, Samir S. Shah, Harold K. Simon, Mark I. Neuman
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Diagnostic imaging is frequently performed as part of the emergency department (ED) evaluation of children. Whether imaging patterns differ by race and ethnicity is unknown. <h3>Objective</h3> To evaluate racial and ethnic differences in the performance of common ED imaging studies and to examine patterns across diagnoses. <h3>Design, Setting, and Participants</h3> This cross-sectional study evaluated visits by patients younger than 18 years to 44 US children’s hospital EDs from January 1, 2016, through December 31, 2019. <h3>Exposures</h3> Non-Hispanic Black and Hispanic compared with non-Hispanic White race/ethnicity. <h3>Main Outcomes and Measures</h3> The primary outcome was the proportion of visits for each race/ethnicity group with at least 1 diagnostic imaging study, defined as plain radiography, computed tomography, ultrasonography, and magnetic resonance imaging. The major diagnostic categories classification system was used to examine race/ethnicity differences in imaging rates by diagnoses. <h3>Results</h3> A total of 13 087 522 visits by 6 230 911 children and adolescents (mean [SD] age, 5.8 [5.2] years; 52.7% male) occurred during the study period. Diagnostic imaging was performed during 3 689 163 visits (28.2%). Imaging was performed in 33.5% of visits by non-Hispanic White patients compared with 24.1% of visits by non-Hispanic Black patients (odds ratio [OR], 0.60; 95% CI, 0.60-0.60) and 26.1% of visits by Hispanic patients (OR, 0.66; 95% CI, 0.66-0.67). Adjusting for confounders, visits by non-Hispanic Black (adjusted OR, 0.82; 95% CI, 0.82-0.83) and Hispanic (adjusted OR, 0.87; 95% CI, 0.87-0.87) patients were less likely to include any imaging study compared with visits by non-Hispanic White patients. Limiting the analysis to only visits by nonhospitalized patients, the adjusted OR for imaging was 0.79 (95% CI, 0.79-0.80) for visits by non-Hispanic Black patients and 0.84 (95% CI, 0.84-0.85) for visits by Hispanic patients. Results were consistent in analyses stratified by public and private insurance groups and did not materially differ by diagnostic category. <h3>Conclusions and Relevance</h3> In this study, non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. Further investigation is needed to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
Endoscopic ultrasound-guided colo-enterostomy for relief of complete small-bowel obstruction
Authors: Belén Martínez-Moreno, José R. Aparicio
Journal: Endoscopy (2021)

A 40-year-old man with a history of rectal cancer and abdominoperineal amputation was admitted with a complete small bowel obstruction, with no ostomy output for 3 days. Computed tomographic (CT) scan of the abdomen demonstrated massively dilated small-bowel loops ([Fig. 1]) with a high-grade obstruction at the level of the preterminal ileum due to a peritoneal implant ([Fig. 2]). Pelvic recurrence and bone and liver metastases were also observed. Conservative management for 2 weeks failed to resolve the patient's symptoms. After detailed interdisciplinary discussion with the patient, we decided to attempt endoscopic ultrasound-guided colo-enterostomy using a lumen-apposing metal stent ([Video 1]).
Enhanced immune memory through a constant photothermal-metabolism regulation for cancer prevention and treatment
Authors: Lihua Luo, Xiang Li, Junlei Zhang, Chunqi Zhu, Mengshi Jiang, Zhenyu Luo, Bing Qin, Yanqing Wang, Bin Chen, Yongzhong Du, Yan Lou, Jian You
Journal: Biomaterials (2021)
COVID-19 in patients with chronic hepatitis c receiving daa therapy: Initial experience from a longitudinal survey
Authors: A. Roy, R. Kaur, T. Kaur, A. De, N. Verma, M. Premkumar, S. Taneja, A. Duseja, V. Singh
Journal: Hepatology (2020)

Background: Directly acting antiviral (DAA) agents are currently the cornerstone of hepatitis C virus (HCV) management Preliminary studies have pointed towards a potential role of certain DAAs in the management of COVID-19 Both daclatasvir and sofosbuvir have been reported to have antiviral activity against the novel coronavirus (nCoV-19) In this background, we conducted a preliminary survey among patients with HCV on DAA therapy to ascertain the incidence of COVID-19 in these patients Methods: A total of 600 HCV infected patients belonging to the Punjab region in India, enrolled in our institutional registry were contacted in the last week of March, 2020 Data was telephonically collected by audio-visual contact with the patients as a part of tele-hepatology services Those patients who were receiving or were due to receive DAA therapy were enquired about COVID-19 related symptoms These patients were again followed up telephonically after 12-weeks for re-assessment of symptoms Results: Thirty-six patients [83 3% males;median age 43 (27-63) years] were on DAA regimens Five (13 9%) patients were on sofosbuvir-daclatasvir, while rest of the patients (86 1%) were on the sofosbuvir-velpatasvir regimen None of the patients reported any COVID-19 related symptoms during this period Two (5 5%) patients died due to liver-related complications During the same time-period, the state of Punjab reported 294 69 cases per million population with a positivity rate of 1 92% Conclusion: A preliminary survey of patients with HCV undergoing DAA therapy showed no incidence of COVID-19 symptoms in these patients A preventive or curative role of DAA as postulated needs to be ascertained Further, longitudinal randomized control trials are required to establish the role of anti-HCV DAAs in the management of COVID-19
AB1040 COEXISTENCE OF DEMYELINATION DISEASE AND FAMILIAL MEDITERRANEAN FEVER
Authors: C. Korkmaz, D. Üsküdar Cansu, S. Canbaz Kabay
Journal: Annals of the Rheumatic Diseases (2020)

Background: In the course of familial Mediterranean fever (FMF), the frequency of other inflammatory diseases increases compared to the general population. Multiple sclerosis (MS) or demyelinating diseases (DD) of central nervous system (CNS) are also more common in FMF patients than in the general population. Objectives: In this study, we would like to report 5 cases with MS/DD accompanied by FMF or MEFV mutations in two families. Methods: 4 patients with FMF and 1 patient with MEFV mutation were included in this study. The patients with FMF were diagnosed according to Tell-Hashomer clinical criteria for FMF. The diagnosis of MS was made according to McDonald criteria. Results: The clinical features of the patients were shown in Table 1. Conclusion: FMF and MS/DD are characterized by repetitive attacks. Familial association can be seen in 12% of patients with MS (1). This is related to both HLA and non-HLA-related genetic tendency. The probability of developing MS increased 4 times in FMF patients (2). This seems to be related to the presence of MEFV gene creating a pro-inflammatory background. In such family samples, combining HLA and non-HLA gene related studies with MEFV gene analysis will be useful in common genetic factors investigation. References: [1]Harirchian MH, Fatehi F, Sarraf P, Honarvar NM, Bitarafan S. Worldwide prevalence of familial multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2018;20:43-47. [2]Akman-Demir G, Gül A, Gürol E, Özdoğan H, Bahar S, et al. Inflammatory/demyelinating central nervous system involvement in familial Mediterranean fever (FMF): coincidence or association? J Neurol 2006;253:928-934. Acknowledgments: None Disclosure of Interests: None declared
FRI0158 Microscopic hematuria in temporal arteritis
Authors: SM Vanderschueren, I Depoot, DC Knockaert, H Bobbaers
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Temporal arteritis (TA) is traditionally considered to spare the kidney, although an uncontrolled study reported microscopic hematuria in 10 out of 30 patients with TA.<sup>1</sup> <h3>Objectives</h3> To study the incidence and characteristics of microscopic hematuria in TA. <h3>Methods</h3> We studied retrospectively 41 patients with biopsy-proved TA (the TA-patients), 41 patients with polymyalgia rheumatica (the PMR-patients) and 43 patients over 65 years of age admitted to the general internal medicine unit (the control patients). Urinalysis and urine microscopy were performed. Microscopic hematuria was defined as the presence of more than 5 red blood cells (RBCs) per high-power field. Patients with pyuria, significant bacteriuria or known urologic or nephrologic disorders were excluded. <h3>Results</h3> Heem (trace or more) in the urine was present in 41.0% patients of the AT-patients, versus in 22.2% of the PMR-patients (p = 0.14) and in 21.4% of the control patients (p = 0.095). Microscopic hematuria was significantly more frequent in the AT-patients (Table 1). Presenting symptoms, renal function, arterial blood pressures, degree of proteinuria and of leucocyturia did not differ between AT-patients with and without microscopic hematuria. Urinary RBCs were predominantly dysmorphic in all 7 AT-patients in whom RBC-morphology was assessed. In 2 patients RBC-casts were present. Biopsy in one of them confirmed renal vasculitis. In 69.2% of the AT-patients microscopic hematuria disappeared after initiation of corticosteroid therapy. <h3>Conclusion</h3> Microscopic hematuria of renal origin in TA is frequent but generally benign. Its presence, if unassociated with blood pressure elevation or renal function deterioration, serves to rule in rather than rule out the diagnosis of TA. In the typical setting invasive urologic and nephrologic work-up is not warranted. <h3>Reference</h3> Manna R, Cristiano G, Todaro L, Latteri M, Gasbarinni G. Microscopic hematuria: a diagnostic aid in giant-cell arteritis? Lancet 1997;350:1226
Use of Circulating Cell-Free DNA to Guide Precision Medicine in Patients with Colorectal Cancer
Authors: Van K. Morris, John H. Strickler
Journal: Annual Review of Medicine (2021)

Patient-specific biomarkers form the foundation of precision medicine strategies. To realize the promise of precision medicine in patients with colorectal cancer (CRC), access to cost-effective, convenient, and safe assays is critical. Improvements in diagnostic technology have enabled ultrasensitive and specific assays to identify cell-free DNA (cfDNA) from a routine blood draw. Clinicians are already employing these minimally invasive assays to identify drivers of therapeutic resistance and measure genomic heterogeneity, particularly when tumor tissue is difficult to access or serial sampling is necessary. As cfDNA diagnostic technology continues to improve, more innovative applications are anticipated. In this review, we focus on four clinical applications for cfDNA analysis in the management of CRC: detecting minimal residual disease, monitoring treatment response in the metastatic setting, identifying drivers of treatment sensitivity and resistance, and guiding therapeutic strategies to overcome resistance.
Study reveals wide health disparity between different ethnic groups in England
Authors: Adrian O’Dowd
Journal: BMJ (2021)

Some people from minority ethnic groups appear to have much poorer health than white people—which can equate to being 20 years older than their actual age—a large observational study has suggested.1

A study published in Lancet Public Health on 28 January found evidence of stark health differences between various ethnicities in England. The findings prompted the authors to call for policy changes to improve ethnic parity for socioeconomic opportunity, service provision, and health outcomes.

Lead study author Ruth Watkinson from the University of Manchester, said, “The disproportionate number of deaths from covid-19 in minority ethnic groups has highlighted inequalities in health among older adults in England. Our study adds detail to evidence of these inequities and their …
COVID-19 Case Investigation and Contact Tracing Efforts from Health Departments — United States, June 25–July 24, 2020
Authors: Kimberly D. Spencer, Christina L. Chung, Alison Stargel, Alvin Shultz, Phoebe G. Thorpe, Marion W. Carter, Melanie M. Taylor, Mary McFarlane, Dale Rose, Margaret A. Honein, Henry Walke
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Case investigation and contact tracing are core public health tools used to interrupt transmission of pathogens, including SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19); timeliness is critical to effectiveness (1,2). In May 2020, CDC funded* 64 state, local, and territorial health departments† to support COVID-19 response activities. As part of the monitoring process, case investigation and contact tracing metrics for June 25-July 24, 2020, were submitted to CDC by 62 health departments. Descriptive analyses of case investigation and contact tracing load, timeliness, and yield (i.e., the number of contacts elicited divided by the number of patients prioritized for interview) were performed. A median of 57% of patients were interviewed within 24 hours of report of the case to a health department (interquartile range [IQR] = 27%-82%); a median of 1.15 contacts were identified per patient prioritized for interview§ (IQR = 0.62-1.76), and a median of 55% of contacts were notified within 24 hours of identification by a patient (IQR = 32%-79%). With higher caseloads, the percentage of patients interviewed within 24 hours of case report was lower (Spearman coefficient = -0.68), and the number of contacts identified per patient prioritized for interview also decreased (Spearman coefficient = -0.60). The capacity to conduct timely contact tracing varied among health departments, largely driven by investigators' caseloads. Incomplete identification of contacts affects the ability to reduce transmission of SARS-CoV-2. Enhanced staffing capacity and ability and improved community engagement could lead to more timely interviews and identification of more contacts.
Transfer of a lumen-apposing metal stent to a different fistula for endoscopic necrosectomy of walled-off pancreatic necrosis
Authors: Koichiro Mandai, Tetsuhisa Ko, Koji Uno, Kenjiro Yasuda
Journal: Endoscopy (2021)

A 54-year-old man underwent multiple rounds of endoscopic necrosectomy via a 15-mm-diameter lumen-apposing metal stent (LAMS) (Hot AXIOS; Boston Scientific, Marlborough, MA, USA) in the gastric body for a large walled-off pancreatic necrosis (WON); however, infectious WON remained ([Fig. 1]). Endoscopic ultrasound-guided transmural drainage with a plastic stent through the antrum was performed. Because of the unstable position of the echoendoscope, a LAMS was not used. Endoscopic necrosectomy was attempted 6 days later, but scope insertion through the antrum fistula was difficult. Thus, we attempted to transfer the LAMS from the gastric body to the antrum fistula.
Disparity in maternal deaths because of ethnicity is “unacceptable”
Authors: Matthew Limb
Journal: BMJ (2021)

Disparity in maternal deaths because of ethnicity is "unacceptable" Matthew LimbUrgent action is needed to tackle systemic biases contributing to unequal mortality outcomes in ethnic minority women and women facing multiple problems and deprivation, say experts.The authors of a new analysis of maternal deaths in the UK, 1 issued by Oxford University's Nuffield Department of Population Health, say that the coronavirus pandemic is likely to have worsened the disparities they have highlighted.
Trial to evaluate the immunogenicity and safety of a melanoma helper peptide vaccine plus incomplete Freund’s adjuvant, cyclophosphamide, and polyICLC (Mel63)
Authors: Craig L Slingluff, Jr., Gina R Petroni, Kimberly A Chianese-Bullock, Nolan A Wages, Walter C Olson, Kelly T Smith, Kathleen Haden, Lynn T Dengel, Anna Dickinson, Caroline Reed, Elizabeth M Gaughan, William W Grosh, Varinder Kaur, Nikole Varhegyi, Mark Smolkin, Nadejda V Galeassi, Donna Deacon, Emily H Hall
Journal: Journal for ImmunoTherapy of Cancer (2021)

Peptide vaccines designed to stimulate melanoma-reactive CD4+ T cells can induce T cell and antibody (Ab) responses, associated with enhanced overall survival. We hypothesized that adding toll-like receptor 3 agonist polyICLC to an incomplete Freund's adjuvant (IFA) would be safe and would support strong, durable CD4+ T cell and Ab responses. We also hypothesized that oral low-dose metronomic cyclophosphamide (mCy) would be safe, would reduce circulating regulatory T cells (T-regs) and would further enhance immunogenicity.An adaptive design based on toxicity and durable CD4+ T cell immune response (dRsp) was used to assign participants with resected stage IIA-IV melanoma to one of four study regimens. The regimens included a vaccine comprising six melanoma peptides restricted by Class II MHC (6MHP) in an emulsion with IFA alone (Arm A), with IFA plus systemic mCy (Arm B), with IFA+ local polyICLC (Arm C), or with IFA+ polyICLC+ mCy (Arm D). Toxicities were recorded (CTCAE V.4.03). T cell responses were measured by interferon γ ELIspot assay ex vivo. Serum Ab responses to 6MHP were measured by ELISA. Circulating T-regs were assessed by flow cytometry.Forty-eight eligible participants were enrolled and treated. Early data on safety and dRsp favored enrollment on arm D. Total enrollment on Arms A-D were 3, 7, 6, and 32, respectively. Treatment-related dose-limiting toxicities (DLTs) were observed in 1/7 (14%) participants on arm B and 2/32 (6%) on arm D. None exceeded the 25% DLT threshold for early closure to enrollment for any arm. Strong durable T cell responses to 6MHP were detected ex vivo in 0%, 29%, 67%, and 47% of participants on arms A-D, respectively. IgG Ab responses were greatest for arms C and D. Circulating T-regs frequencies were not altered by mCy.6MHP vaccines administered with IFA, polyICLC, and mCy were well tolerated. The dRsp rate for arm D of 47% (90% CI 32 to 63) exceeded the 18% (90% CI 11 to 26) rate previously observed with 6MHP in IFA alone. Vaccination with IFA+ polyICLC (arm C) also showed promise for enhancing T cell and Ab responses.