tbuckley/cabot-search huggingface dataset:
P14.25 Melanoma brain metastases in the era of novel therapies: a single-center, Dutch cohort study
Authors: S H A E Derks, J L M Jongen, C Slagter, A Joosse, J W Schouten, M J van den Bent, A A M van der Veldt
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Until recently, patients with melanoma brain metastases (MBMs) had limited therapeutic options. With the arrival of immune checkpoint inhibitors (ICIs), targeted therapy (TT) and advances in stereotactic radiotherapy (SRT), treatment has improved. We evaluated treatments and patient outcome before and after the introduction of these novel therapies. MATERIAL AND METHODS In this retrospective, single-center study, patients presenting with MBMs at the Erasmus MC between November 2005 and January 2021 with sufficient follow-up were included. Overall survival (OS), measured from date of MBM diagnosis, was calculated using the Kaplan-Meier method. Patients were stratified according to MBM diagnosis before and after January 1, 2016, since novel therapies were mostly prescribed in our clinic after this date. Results were significant (p&amp;lt;0.05), unless otherwise stated. RESULTS Overall, 413 patients were included. Median [IQR] age was 56.6 years [52–71] with a 60% male predominance. A BRAF mutation was present in 46.7% of patients. A single MBM was found in 29.3% and ≥4 MBMs were found in 49.0% of patients. Before January 1, 2016, 191 patients were treated, and 222 patients after that date. Chemotherapy was more frequently used before 2016, both prior to (3.9% pre-2016 vs. 0.9% post-2016) and after (7.0% vs. 0.0%) the diagnosis of MBMs. In contrast, treatment with TT was more frequent after 2016, both prior to (3.7% vs. 16.2%) and after (7.9% vs. 41.4%) the diagnosis of MBMs. Comparable changes were observed for treatment with ICIs (prior to MBM diagnosis: 0.5% vs. 25.2%; after MBM diagnosis: 18.3% vs 39.2%). The application of SRT did not differ significantly before and after 2016 (12.0% vs. 19.4%, p=0.89), while the application of whole brain radiotherapy (WBRT) decreased (52.4% vs. 13.5%). Surgical resection was not significantly different between those periods (15.7% vs. 16.7%, p=0.90). Before 2016, median OS [IQR] was shorter than after 2016 (4.6 [1.9–10.9] vs. 6.6 [1.8–24.5] months). The effect of novel therapies on OS was further analysed in patients diagnosed after 2016; treatment vs. no treatment was compared. ICI treatment prior to MBM diagnosis was associated with worse OS (median OS 4.0 vs. 7.5 months). ICI treatment after MBM diagnosis was associated with better OS (median OS 24.5 vs. 3.0 months). In patients with a BRAF mutation, TT before MBM diagnosis was associated with worse OS (median OS 1.8 vs. 9.4 months). TT after MBM diagnosis in those patients was not significantly associated with improved OS (median OS 7.6 vs. 5.2 months, p=0.96). CONCLUSION Recent therapeutic advances for MBM replaced WBRT and chemotherapy with SRT, TT and ICIs. In that period, prognosis of MBM patients increased significantly. OS in patients treated with ICIs or TT prior to MBM diagnosis is still poor, but OS is improved in patients treated with ICIs after the diagnosis of MBM.
Post COVID 19 aplastic anemia: Case report
Authors: O. Fahmy, A. Ayad, M. Marie, E. S. Saber, M. T. Hamza, D. El Demerdash
Journal: HemaSphere (2021)

Background: The most common symptoms seen in COVID-19 patients are fever, fatigue, and dry cough, and dyspnea. Although there is comparatively few rising reports on the hematological sequelae. Hematological changes commonly described in patients with COVID-19, include reduced lymphocyte count and platelet count but normal white blood cell count. we present a case of pancytopenia and hypocellular marrow which is not a commonly known sequalae of COVID 19 infection. Aims: To describe a novel case of coronavirus disease 2019 (COVID- 19)-associated aplastic anemia in a patient known to have primary glomerulonephritis. Methods: we described a case report of hematological sequalae of a COVID 19 case including the clinical presentation, management, and response to therapy Results: A 25-year-old lady with a background of primary membranous glomerulonephritis with crescent formation required therapy with rituximab monoclonal anti CD20, presented with anemia, mucocutaneous bleeding. 25 days before her presentation she had subjective fever, cough, and dyspnea with radiological findings highly suspicious for COVID 19 and she tested positive for COVID-19 by PCR on nasopharyngeal swab. Isolation at home was recommended for her as she had mild-moderate COVID19 and her swab turned negative after 15 days of onset of the respiratory symptoms. she experienced pallor and muco-cutaneous bleeding in form of ecchymosis all over the body, wet purpura but the rest of her clinical examination was free, her CBC revealed hemoglobin: 6.9 g/dl;WBC: 2.67×103/mm3;platelets: 10×103/mm3. MCV 79 with reticulocytopenia, all immunological profiles as well as virology screening for HCV, HBV, HIV, CMV and EBV were negative. Bone marrow aspirate and biopsy revealed marked hypocellular marrow (cellularity 20%) with all bone marrow element were markedly depressed. Cyclosporine was prescribed for her as well as eltrombopag in the dose of 50 mg/day orally which titrated gradually according to platelet response to 100 mg/day PO with repeated irradiated packed RBCs and platelet transfusion during hospital stay. During her hospital stay her liver enzymes (AST & ALT) were elevated so doses of cyclosporine and eltrombopag were decreased till the normalization of her liver enzymes then reiterated again according to the hematological response. She is maintained on this protocol now for 2 months with minimal hematological response. she prepared now for HLA matching and hematopoietic stem cell transplantation. Summary/Conclusion: Further exploration of potential COVID-19- related hematological abnormalities is needed and requires extensive collaboration to collect large, organized data sets. The possibility of an immune-mediated process and its therapeutic implications also warrants greater study.
Abstract 15579: Multivessel Coronary Artery Revascularization During Index Hospitalization Has Favorable Outcomes Compared to Infarct Related Artery Only Revascularization in STEMI Patients- Meta-Analysis of Randomized Control Trials
Authors: Sainath Gaddam, Viswajit Reddy Anugu, Deepak Asti, Muhammad Raza, Bhavi Pandya, Ruben Kandov, Donald McCord, James Lafferty
Journal: Circulation (2015)

Introduction: Multivessel coronary artery disease is present in about half of the patients presenting with STEMI. Timing of revascularization for the non-culprit vessels has been a long debate, with few trials suggesting benefit at index hospitalization rather than staging them at a later time. Current ACCF/AHA 2013 STEMI guidelines do not recommend PCI of non-infarct artery at the time of primary PCI but recommend it at a later time if patients are symptomatic. We hypothesized, complete revascularization during primary PCI or index hospitalization would have favorable outcomes compared to culprit vessel only revascularization. Aim: We performed meta-analysis of randomized control trials comparing multivessel vs. infarct artery only revascularization during primary PCI or index hospitalization. Methods and Results: Pubmed, Embace and Google scholar databases were searched for randomized control trials comparing multivessel vs. culprit vessel only revascularization during primary PCI or index hospitalization. We compared deaths, non-fatal MI and repeat revascularization events for the groups. Total number of patients in our study was 1819, with 919 patients in multivessel revascularization and 900 patients in infarct artery only revascularization groups. Mean follow up period was 28 months. Pooled analysis showed significant favorability for multivessel coronary revascularization comparing events of repeat revascularization (OR= 0.39, p&lt;0.0001). There was also non-significant decrease in mortality (OR=0.92, p=0.7) and non-fatal MI (OR=0.68, p=0.09) with complete revascularization. Conclusions: In our study of STEMI patients, complete revascularization during primary PCI or index hospitalization has significantly decreased need for repeat revascularization and there was also non-significant decrease in mortality and non-fatal MI. Studies with larger sample size and longer follow up are needed for stronger evidence.
Real-world patterns of pain medication use among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC).
Authors: Ashley Ann Laursen, Andy Surinach, Shu Wang, Paul Cockrum, Ben George
Journal: Journal of Clinical Oncology (2021)

302 Background: Helping patients manage cancer-related pain is an important aspect of supportive care. 80% of patients with mPDAC suffer from abdominal and/or back pain. Pancreatic cancer-related pain is typically treated pharmaceutically using pain medicines, which include opioids or narcotics. Previous studies have found that the presence of pain was associated with impaired survival in pancreatic cancer patients. The goal of this study was to assess the treatment patterns of pain medication usage and their association with duration of therapy (DOT) among patients with mPDAC treated in the real-world setting. Methods: This retrospective observational study utilized the IBM MarketScan Commercial and Medicare supplemental claims data. Data were analyzed for adult patients who were diagnosed with mPDAC and received treatment between January 2015 and March 2020. Patient characteristics and DOT were assessed. Opioid use during treatment including the number of prescriptions filled and average daily dose in morphine equivalents were summarized. Yearly and regional trends of opioid use were assessed. Results: There were 2,841 patients (median age: 61 years, IQR: 56-66) included in the study treated with first line (1L) therapies of interest. 55.6% (n = 1,579) of patients were male and 72.0% (2,046) had commercial insurance. The overall DOT in 1L was 78 days (IQR: 38 – 157). 54.3% of patients filled at least one prescription for opioids during treatment. The mean number of prescriptions filled during treatment was 2.2 (SD: 4.0) and the mean daily dose was 39.5mg morphine equivalents (SD: 134.6) The median DOT among patients who received at least one pain prescription was 92 days (IQR: 44 – 176) while those who did not receive pain medication experienced a DOT of 64 days (IQR: 29 – 135). Among the 1,248 patients who received second line treatment the median DOT was 60.5 days (IQR: 29 – 127). 50.6% (n = 632) filled at least one opioid prescription during treatment. Median DOT among patients who received pain medication was 73.5 days (IQR: 42 – 141) and 47.5 days (IQR: 15 – 103.5) among those who did not. Across lines of therapy opioid use remained stable during the study period ranging from 54.2% among patients treated in 2015 to 51.1% among those who initiated treatment in 2019. No regional differences were observed in prescription patterns within the four US census regions (range: 50.2 – 54.4%). Conclusions: In this real-world cohort of patients with mPDAC nearly half were prescribed at least one opioid during treatment. Patients who received opioids experienced a longer duration of therapy compared to those who did not. Further studies are needed to understand the association of pain control with improved clinical outcomes among patients with mPDAC.
Arteriovenous Fistula Maturation, Functional Patency, and Intervention Rates
Authors: Thomas S. Huber, Scott A. Berceli, Salvatore T. Scali, Dan Neal, Erik M. Anderson, Michael Allon, Alfred K. Cheung, Laura M. Dember, Jonathan Himmelfarb, Prabir Roy-Chaudhury, Miguel A. Vazquez, Charles E. Alpers, Michelle L. Robbin, Peter B. Imrey, Gerald J. Beck, Alik M. Farber, James S. Kaufman, Larry W. Kraiss, Wanpen Vongpatanasin, John W. Kusek, Harold I. Feldman
Journal: JAMA Surgery (2021)

<h3>Importance</h3> National initiatives have emphasized the use of autogenous arteriovenous fistulas (AVFs) for hemodialysis, but their purported benefits have been questioned. <h3>Objective</h3> To examine AVF usability, longer-term functional patency, and remedial procedures to facilitate maturation, manage complications, or maintain patency in the Hemodialysis Fistula Maturation (HFM) Study. <h3>Design, Setting, and Participants</h3> The HFM Study was a multicenter (n = 7) prospective National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases cohort study performed to identify factors associated with AVF maturation. A total of 602 participants were enrolled (dialysis, kidney failure: 380; predialysis, chronic kidney disease [CKD]: 222) with AVF maturation ascertained for 535 (kidney failure, 353; CKD, 182) participants. <h3>Interventions</h3> All clinical decisions regarding AVF management were deferred to the individual centers, but remedial interventions were discouraged within 6 weeks of creation. <h3>Main Outcomes and Measures</h3> In this case series analysis, the primary outcome was unassisted maturation. Functional patency, freedom from intervention, and participant survival were summarized using Kaplan-Meier analysis. <h3>Results</h3> Most participants evaluated (n = 535) were men (372 [69.5%]) and had diabetes (311 [58.1%]); mean (SD) age was 54.6 (13.6) years. Almost two-thirds of the AVFs created (342 of 535 [64%]) were in the upper arm. The AVF maturation rates for the kidney failure vs CKD participants were 29% vs 10% at 3 months, 67% vs 38% at 6 months, and 76% vs 58% at 12 months. Several participants with kidney failure (133 [37.7%]) and CKD (63 [34.6%]) underwent interventions to facilitate maturation or manage complications before maturation. The median time from access creation to maturation was 115 days (interquartile range [IQR], 86-171 days) but differed by initial indication (CKD, 170 days; IQR, 113-269 days; kidney failure, 105 days; IQR, 81-137 days). The functional patency for the AVFs that matured at 1 year was 87% (95% CI, 83.2%-90.2%) and at 2 years, 75% (95% CI, 69.7%-79.7%), and there was no significant difference for those receiving interventions before maturation. Almost half (188 [47.5%]) of the AVFs that matured had further intervention to maintain patency or treat complications. <h3>Conclusions and Relevance</h3> The findings of this study suggest that AVF remains an accepted hemodialysis access option, although both its maturation and continued use require a moderate number of interventions to maintain patency and treat the associated complications.
Do Prevotella copri and Blastocystis promote euglycaemia?
Authors: Sok-Ja Janket, Harry A Conte, Eleftherios P Diamandis
Journal: The Lancet Microbe (2021)

The PREDICT 1 study reported that long-term dietary patterns were associated with serum cardiometabolic markers and faecal microbiota.1 This study corroborated our view that faecal microbiota reflect lifestyle factors such as diet, exercise, medicine intake, and other factors.2 The long-term intake of healthy plant-based foods was associated with improved cardiometabolic markers. This finding is consistent with our previous report3 that fruit and vegetable intake is predictive of risk of diabetes.
Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis
Authors: Emily J Tweed, Daniel F Mackay, Kathleen A Boyd, Ashley Brown, Thomas Byrne, Philip Conaglen, Peter Craig, Evangelia Demou, Lesley Graham, Alastair H Leyland, Nicola McMeekin, Jill P Pell, Helen Sweeting, Kate Hunt
Journal: The Lancet Public Health (2021)

Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody.We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control.A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control).Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing.National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.
Steroid pretreatment of deceased donors and liver allograft function - Ten years follow-up of a blinded randomized placebo controlled trial
Authors: Georg P. Györi, Zoltan Mathe, Kira Jelencsics, Angelika Geroldinger, Zsuzsanna Gerlei, Gabriela A. Berlakovich
Journal: International Journal of Surgery (2021)

Within the last decade numerous attempts have been reported in order to expand the donor pool and alleviate organ shortage in the setting of liver transplantation. Aim of this blinded randomized controlled trial was to evaluate the effect of donor steroid pretreatment on outcomes after liver transplantation.We performed an international, multi-center double-blinded randomized placebo controlled trial. Donors received 1000 mg methylprednisone or placebo before organ procurement. Primary endpoint were patient and graft survival. Secondary end points were rate of BPAR and liver functions trajectories after transplantation. Follow up was 10 years.There was no effect of steroid pretreatment vs. placebo on overall patient survival (50% vs. 46%, p = n.s.) as well as graft survival (47% vs. 51%, p= n.s.). Further donor steroid pretreatment did not alter the rate of biopsy proven acute rejections (34% steroid group vs. 36% placebo, p = n.s.). Evaluating short term and long term graft function, steroid pretreatment had minor effect on immediate liver function trajectories within the first 2 weeks after transplantation. This was not seen in long-term follow up.In conclusion we found no evidence that donor steroid pretreatment translates in improved outcomes after liver transplantation.
P14.20 Quality of life of patients with newly diagnosed glioblastoma during TTFields therapy in routine clinical care: first results of the TIGER study
Authors: O Bähr, G Tabatabai, R Fietkau, R Goldbrunner, M Glas
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Glioblastoma (GBM) is an aggressive primary tumor of the central nervous system. Current interdisciplinary treatment strategies outside clinical trials include maximal safe resection, followed by treatment with radiation and an alkylating chemotherapy. Based on the results of the positive phase III trial EF-14, the addition of Tumor Treating Fields (TTFields) to temozolomide (TMZ) maintenance therapy brought an additional treatment method to clinical routine. The prospective non-interventional study TIGER (TTFields In GErmany in Routine Clinical Care) documents the use of TTFields in routine clinical care with a particular focus on health-related quality of life (HRQoL) within 4 months after starting therapy, treatment compliance and duration. MATERIAL AND METHODS This multi-center prospective non-interventional study in Germany (NCT03258021) included ndGBM patients eligible for TTFields therapy. Following their consent to participate in the study, patients received a comprehensive introduction to the therapy and their baseline demographic data were collected. Information on TTFields therapy decision is evaluated based on a dedicated TTFields questionnaire at baseline in both arms, follow-up information on how patients cope with the therapy is collected two months after TTFields treatment start, if applicable. HRQoL was assessed in patients deciding for TTFields therapy at baseline as well as at 2 months and 4 months thereafter using the EORTC-QLQ-C30/BN-20 questionnaires. RESULTS Between August 2017 and November 2019, 710 patients (259 female/451 male) were enrolled at 81 participating centers. The mean age was 58.5 years (range: 19.0–85.0; Cut-off: August 31, 2020). The overall baseline characteristics of the study group reflects a typical GBM population. Of these, 582 (82%) decided to start TTFields and 128 (18%) refused TTFields treatment. Health-related QoL did not decline during TTFields therapy except for itchy skin, comparable to the results of the EF-14 phase 3 trial. A detailed analysis of the cohort as well as their reported QoL will be presented. CONCLUSION The TIGER study is the largest non-interventional trial on the use of TTFields in routine clinical care. The use of TTFields in patients with ndGBM did not impair HRQoL during the follow-up period, except for more itchy skin.
P14.74 Grade II and III pleomorfic xanthoastrocitoma: a monocentric, retrospective analysis
Authors: P Gaviani, G Simonetti, M Farinotti, V Redaelli, A Botturi, B Pollo, F Legnani, V Pinzi, A Silvani
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Pleomorphic xanthoastrocytoma (PXA) represent an astrocytic neoplasm that is typically well circumscribed and can have a relatively favorable prognosis. Tumor progression to anaplastic PXA (WHO grade III), however, is associated with a more aggressive biologic behavior and worse prognosis. The factors that drive anaplastic progression are largely unknown. The activating BRAF mutation is a genetic alteration that could be present in both PXA and anaplastic PXA; Identification of the mutation can be important as BRAF V600E mutant protein could be targeted therapeutically by small molecule inhibitors of both RAF and MEK. The low frequency of these tumors has fostered heterogeneity of therapeutic approaches, particularly in adult patients. We performed a monocentric, retrospective study on adult patients with a PXA diagnosis treated by our Institution, in order to search for markers of diagnosis and prognosis. MATERIAL AND METHODS All consecutive patients older than 18 years with a histological diagnosis of a primary grade II and III pleomorphic xanthoastrocytoma operated and treated by our Institution from 2011 to 2021 were consecutively and retrospectively included in the study. All pathological diagnoses and PXA cases were reviewed according to the WHO classification. Histological and molecular characteristics, including BRAF mutation status, as well as clinical data, treatment modalities, and patient outcome were analyzed and described. RESULTS 21 patients were included, 10 males and 11 females, with a median age of 40 years old (range 18–66). In 10 patients the histology showed an anaplastic PXA and in 11 patients a grade II tumor. Genetic features, including IDH status were available to all patients and BRAF mutation study was available in 8/10 anaplastic PXA. All patients underwent main surgery. Anaplastic features were associated with minimal PFS, whereas BRAF mutation tended to be associated with a better PFS. CONCLUSION Anaplastic features and BRAF mutation can lead to identify subgroups with distinct prognosis. These results should be validated in a larger and prospective study.