tbuckley/cabot-search huggingface dataset:
CARDIOVASCULAR SAFETY PROFILE OF TAXANES AND VINCA ALKALOIDS: 30-YEARS FDA REGISTRY EXPERIENCE
Authors: Akshee Batra, Brijesh Patel, Daniel Addison, Lauren Baldassarre, Nihar Desai, Neal Weintraub, Anita Deswal, Zeeshan Hussain, Sherry-Ann Brown, Sarju Ganatra, Vivek Agarwala, Purvish Parikh, Michael Fradley, Arjun Ghosh, Avirup Guha
Journal: Journal of the American College of Cardiology (2021)
COVID-19 PANDEMIC IS ASSOCIATED WITH REDUCED ADMISSIONS FOR STEMI, INCREASED ISCHAEMIA TIME, MORTALITY REMAINS THE SAME: DATA FROM A LOW COVID-19 MORBIDITY COUNTRY
Authors: Povilas Budrys, Greta Rodevic, Aurelija Martinonyte, Laurynas Dieckus, Ignas Badaras, Kamile Cerlinskaite, Mindaugas Lizaitis, Vilhelmas Bajoras, Jelena Celutkiene, Pranas Serpytis, Aleksandr Volodko, Egle Urbonaite, Giedrius Davidavicius
Journal: Journal of the American College of Cardiology (2021)
The Prognostic Value of Monosomal Karyotype (MK) in High-Risk Patients with Myelodysplastic Syndromes Treated with 5-Azacitidine
Authors: Sotirios Papageorgiou, Christos K. Kontos, Thomas Tsiambalis, Athina Vyniou, Argiris Symeonidis, Athanasios Galanopoulos, Ioannis Kotsianidis, Vassiliki Pappa
Journal: Blood (2017)
Cocktail strategy for ‘cold’ tumors therapy via active recruitment of CD8+ T cells and enhancing their function
Authors: Xiang Li, Lihua Luo, Mengshi Jiang, Chunqi Zhu, Yingying Shi, Junlei Zhang, Bing Qin, Zhenyu Luo, Xuemeng Guo, Yichao Lu, Xinyu Shan, Yu Liu, Yongzhong Du, Peng Ling, Jian You
Journal: Journal of Controlled Release (2021)
CRYO-BALLOON PULMONARY VEIN AND LEFT ATRIAL POSTERIOR WALL ISOLATION FOR THE TREATMENT OF ATRIAL FIBRILLATION. COMPARABLE OUTCOMES FOR ADULT CONGENITAL HEART DISEASE
Authors: Jeremy P. Moore, Roberto Gallotti, Heajung Nguyen, Jonathan Su, Arash Bedayat, Ashley Prosper, Eric Buch
Journal: Journal of the American College of Cardiology (2021)
ACUTE CORONARY SYNDROME MANAGEMENT AND OUTCOMES IN VERY ELDERLY PATIENTS - A REAL WORLD EXPERIENCE
Authors: Matteo Bianco, Filiberto Fausto Mottola, Enrico Cerrato, De Benedetto Fabrizi Mauro, Giorgio Baralis, Sebastian Cinconze, Rolfo Fabrizio, Francesca Giordana, Alessandro Locatelli, Alison Verra, Giuseppe Musumeci, Roberta Rossini
Journal: Journal of the American College of Cardiology (2021)
Re: Svetlana Avulova, John C. Cheville, Christine M. Lohse, et al. Grading Chromophobe Renal Cell Carcinoma: Evidence for a Four-tiered Classification Incorporating Coagulative Tumor Necrosis. Eur Urol 2021;79:225–31
Authors: Riuko Ohashi, Arndt Hartmann, Guido Martignoni, Holger Moch
Journal: European Urology (2021)
Correction: microRNA 31 functions as an endometrial cancer oncogene by suppressing Hippo tumor suppressor pathway
Authors: Takashi Mitamura, Hidemichi Watari, Lei Wang, Hiromi Kanno, Masaya Miyazaki, Makiko Kitagawa, Mohamed Hassan, Peixin Dong, Taichi Kimura, Mishie Tanino, Hiroshi Nishihara, Shinya Tanaka, Noriaki Sakuragi
Journal: Molecular Cancer (2014)
Infant gut microbiota modulation by human milk disaccharides in humanized microbiome mice
Authors: Antonio Rubio-Del-Campo, Roberto Gozalbo-Rovira, Eva M. Moya-Gonzálvez, Juan Alberola, Jesús Rodríguez-Díaz, María J. Yebra
Journal: Gut Microbes (2021)

Human milk glycans present a unique diversity of structures that suggest different mechanisms by which they may affect the infant microbiome development. A humanized mouse model generated by infant fecal transplantation was utilized here to evaluate the impact of fucosyl-α1,3-GlcNAc (3FN), fucosyl-α1,6-GlcNAc, lacto-N-biose (LNB) and galacto-N-biose on the fecal microbiota and host–microbiota interactions. 16S rRNA amplicon sequencing showed that certain bacterial genera significantly increased (Ruminococcus and Oscillospira) or decreased (Eubacterium and Clostridium) in all disaccharide-supplemented groups. Interestingly, cluster analysis differentiates the consumption of fucosyl-oligosaccharides from galactosyl-oligosaccharides, highlighting the disappearance of Akkermansia genus in both fucosyl-oligosaccharides. An increment of the relative abundance of Coprococcus genus was only observed with 3FN. As well, LNB significantly increased the relative abundance of Bifidobacterium, whereas the absolute levels of this genus, as measured by quantitative real-time PCR, did not significantly increase. OTUs corresponding to the species Bifidobacterium longum, Bifidobacterium adolescentis and Ruminococcus gnavus were not present in the control after the 3-week intervention, but were shared among the donor and specific disaccharide groups, indicating that their survival is dependent on disaccharide supplementation. The 3FN-feeding group showed increased levels of butyrate and acetate in the colon, and decreased levels of serum HDL-cholesterol. 3FN also down-regulated the pro-inflammatory cytokine TNF-α and up-regulated the anti-inflammatory cytokines IL-10 and IL-13, and the Toll-like receptor 2 in the large intestine tissue. The present study revealed that the four disaccharides show efficacy in producing beneficial compositional shifts of the gut microbiota and in addition, the 3FN demonstrated physiological and immunomodulatory roles.
Molecular characterization of fosfomycin-resistant Escherichia coli urinary tract infection isolates from Australia
Authors: Shakeel Mowlaboccus, Denise A. Daley, Jacob Birdsall, Thomas Gottlieb, John Merlino, Graeme R. Nimmo, Narelle George, Tony Korman, Richard Streitberg, Jenny Robson, Georgia Peachey, Peter Collignon, Susan Bradbury, Benjamin A. Rogers, Geoffrey W. Coombs
Journal: Clinical Microbiology and Infection (2021)
CHARACTERISTICS AND OUTCOMES OF PATIENTS ADMITTED WITH TYPE 2 MYOCARDIAL INFARCTION IN UNITED STATES
Authors: Purnima Sharma, Sangeeta Bhat, Rohi Mishra, Byomesh Tripathi, Smit Patel, Radha Gopalan, Abhishek Deshmukh, Jason Klein
Journal: Journal of the American College of Cardiology (2021)
Abstract 14000: Endothelial-Specific Deficiency of Thrombospondin-1 Attenuates Abdominal Aortic Aneurysm Through Modulating Vascular Remodeling
Authors: Ting Zhou, Carmel Assa, Amelia Stranz, Binkai Liu, Huan Yang, Christine M Sorenson, Nader Sheibani, Bo Liu
Journal: Circulation (2019)

Rationale: Thrombospondin-1 (TSP1) is a matricellular protein with TGFβ dependent and independent functions that has been implicated in various vascular diseases. Our previous work demonstrates tha...
Successful Management With Dual Therapy of Lenvatinib and Macitentan for HCC With Portopulmonary Hypertension
Authors: Tsuyoshi Ishikawa, Ryo Sasaki, Takashi Matsuda, Issei Saeki, Taro Takami, Yasuaki Wada, Masafumi Yano, Isao Sakaida
Journal: Hepatology (2021)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
PREVALENCE AND OUTCOMES OF GASTROINTESTINAL ANGIODYSPLASIA IN AORTIC STENOSIS PATIENTS: AN ANALYSIS OF NATIONAL READMISSION DATABASE
Authors: Yasar Sattar, Summer Aldrugh, Waseem Amjad, Lara Kovell, Abhishek Dutta, Abdul-Rahman M. Suleiman, Nikolaos Kakouros, M. Chadi Alraies, Waqas T. Qureshi
Journal: Journal of the American College of Cardiology (2021)
Chilblain lesions after COVID‐19 mRNA vaccine
Authors: A. Pileri, A. Guglielmo, B. Raone, A. Patrizi
Journal: British Journal of Dermatology (2021)

DEAR EDITOR, A 42-year-old man developed nonpainful erythematous-to-purplish patches located on his distal phalanges and nail beds (Figure ) after the first dose of the anti-COVID-19 vaccine (+ 12 days, Pfizer-BioNTech COVID-19, BNT162b2) along with an acrocyanosis of the hands.Although negative antibodies do not preclude a previous exposure to the virus, blood and swab tests were negative for COVID-19 infection and thrombophilic/autoimmune conditions.After the second jab (+ 21 days) no worsening of the lesions or other onset of symptoms were observed.A diagnosis of possible severe adverse event due to vaccine administration was made. 1 Chilblain lesions have been described in patients with COVID-19 and may be due to an abnormal inflammatory response.Although not reported in clinical trials, 2 vaccination may have promoted an immunological reaction leading to vascular swelling and perniosis similar to what has been observed after COVID-19 infection.
IMPLEMENTATION OF A PROTOCOL-DRIVEN, PHARMACIST-LED, MEDICATION ADJUST AND TITRATE CLINIC TO IMPROVE UPTAKE OF GUIDELINE-DIRECTED MEDICAL THERAPY FOR PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Authors: Anthony Pensa, Michelle Fine, Tingqing Wu, Rebecca Harap, Faraz Ahmad, Raja Mutharasan, Jane Wilcox
Journal: Journal of the American College of Cardiology (2021)
Monitored needle acceleration in endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses improves sample quality and diagnostic accuracy: a randomized trial
Authors: Mihai Ciocîrlan, Anca Gheorghiu, Dana Bilous, Miruna Cruceru, Georgiana Mănăilă, Elena Tianu, Cătălina Vlăduţ
Journal: Endoscopy (2021)

Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is recommended for the diagnosis of solid pancreatic masses. We aimed to evaluate whether a high needle movement acceleration value during puncture increases diagnostic accuracy. Methods EUS-FNA needle acceleration was measured using a PocketLab accelerometer connected by Bluetooth to a smartphone. Two passes (fast and slow, with higher and lower than 1g [9.8 m/s2] needle acceleration values, respectively) were performed in a random order. The sample cellularity and quality were measured using semiquantitative scales. Results 51 patients were included (32 women; mean age 63). The mean (standard deviation [SD]) acceleration values were 1.59g (0.66g) for the fast pass and 0.32g (0.19g) for the slow pass (P &lt; 0.001). The fast pass yielded significantly higher levels of EUS-FNA accuracy (84.3 % vs. 68.6 %; P = 0.02) and adequate quality scores (94.1 % vs. 76.5 %; P = 0.007). High cellularity scores were seen with similar frequencies (15.7 % vs. 11.8 %; P = 0.32). Conclusions A higher than 1g EUS-FNA needle acceleration may increase the diagnostic accuracy and specimen quality from solid pancreatic lesions.
ASSESSMENT OF SUB-CLINICAL LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS USING SPECKLE-TRACKING ECHOCARDIOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Raahat Bansal, Vinay Thallapally, Abhishek Thandra, Sarah Aurit, Joseph Nahas, Venkata Alla
Journal: Journal of the American College of Cardiology (2021)
ORTHOTOPIC LIVER TRANSPLANT COMPLICATED BY ANTERIOR STEMI AND CARDIOGENIC SHOCK DUE TO THROMBOEMBOLISM
Authors: Kris Kumar, Ryle Przybylowicz, Nalini Colaco, Castigliano Bhamidipati, Erin Maynard, Hind Rahmouni, Harsh Golwala, Firas Zahr
Journal: Journal of the American College of Cardiology (2021)
Application of a framework to guide genetic testing communication across clinical indications
Authors: Miranda L. G. Hallquist, Eric P. Tricou, Kelly E. Ormond, Juliann M. Savatt, Curtis R. Coughlin, W. Andrew Faucett, Laura Hercher, Howard P. Levy, Julianne M. O’Daniel, Holly L. Peay, Melissa Stosic, Maureen Smith, Wendy R. Uhlmann, Hannah Wand, Karen E. Wain, Adam H. Buchanan
Journal: Genome Medicine (2021)

Genetic information is increasingly relevant across healthcare. Traditional genetic counseling (GC) may limit access to genetic information and may be more information and support than some individuals need. We report on the application and clinical implications of a framework to consistently integrate genetics expertise where it is most useful to patients.The Clinical Genome Resource's (ClinGen) Consent and Disclosure Recommendations (CADRe) workgroup designed rubrics to guide pre- and post-genetic test communication. Using a standard set of testing indications, pre- and post-test rubrics were applied to 40 genetic conditions or testing modalities with diverse features, including variability in levels of penetrance, clinical actionability, and evidence supporting a gene-disease relationship. Final communication recommendations were reached by group consensus.Communication recommendations were determined for 478 unique condition-indication or testing-indication pairs. For half of the conditions and indications (238/478), targeted discussions (moderate communication depth) were the recommended starting communication level for pre- and post-test conversations. Traditional GC was recommended pre-test for adult-onset neurodegenerative conditions for individuals with no personal history and post-test for most conditions when genetic testing revealed a molecular diagnosis as these situations are likely higher in complexity and uncertainty. A brief communication approach was recommended for more straightforward conditions and indications (e.g., familial hypercholesterolemia; familial variant testing).The CADRe recommendations provide guidance for clinicians in determining the depth of pre- and post-test communication, strategically aligning the anticipated needs of patients with the starting communication approach. Shorter targeted discussions or brief communications are suggested for many tests and indications. Longer traditional GC consultations would be reserved for patients with more complex and uncertain situations where detailed information, education, and psychological support can be most beneficial. Future studies of the CADRe communication framework will be essential for determining if CADRe-informed care supports quality patient experience while improving access to genetic information across healthcare.
Influence of the clindamycin administration route on the magnitude of clindamycin–rifampicin interaction: a prospective pharmacokinetic study
Authors: Valérie Zeller, Sophie Magreault, Beate Heym, Dominique Salmon, Marie-Dominique Kitzis, Eliane Billaud, Simon Marmor, Anne-Sophie Jannot, Laurence Salomon, Vincent Jullien
Journal: Clinical Microbiology and Infection (2021)
Abstract 234: Physiological Toxicity Assessment of Tyrosine Kinase Inhibitors with Human Induced Pluripotent Stem Cell Cardiomyocytes
Authors: Jayna Stohlman, Derek Schocken, Jose Vicente, Dulciana Chan, Lars Johannesen, Xiaoyu Zhang, Yama Abassi, David Strauss, Ksenia Blinova
Journal: Circulation Research (2016)

Tyrosine kinase inhibitors (TKIs) have improved targeted therapeutics for cancer management despite possible cardiac side effects, including decreased contractility. A combination microelectrode and impedance platform was used to assess field potential (FP) electrical activity and contractility, respectively, after acute and chronic exposure of six TKIs on human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs). Four non-TKI drugs were tested to confirm assay sensitivity. hERG current inhibitors dofetilide and pentamidine increased beat rate (BR) corrected FP duration (FPDc). Dofetilide (6μM) induced transient early afterdepolarizations (EADs), characterized as ectopic beats/notching in the FP signal, and decreased impedance amplitude (BAmp) at 48hrs. Multi-channel blocker amiodarone (2μM) acutely decreased FPDc, with quiescence up to 1hr, and increased BAmp after 24hrs. Doxorubicin decreased BAmp, inducing quiescence starting at 48hrs (5μM and 10μM). Nilotinib, sorafenib and sunitinib, which have varying documented risks of clinical QT prolongation and/or cardiotoxicity, increased FPDc. With highest tested doses, nilotinib (6μM) generated persistent EADs and increased BR, sunitinib (2.5μM) produced tachyarrhythmias with minimal impedance-evident contractions that recovered by 24hrs, and sorafenib (10μM) induced quiescence that recovered by 3hrs. Imatinib, erlotinib and lapatinib, which have fewer clinical cardtiotoxic effects, did not cause rhythm disturbances. Erlotinib and lapatinib had no significant effect on FPDc, lapatinib (2.5μM and 5μM) decreased BR, while imatinib (15μM) acutely increased FPDc and increased BR after 48hrs. Tandem electrical and impedance screening in hiPSC-CMs for drug cardiotoxicity was consistent with the clinical experience for TKIs, suggesting its potential utility for preclinical cardiotoxicity assessment for proarrhythmia and decreased contractility.
IMPACT OF HIV INFECTION ON INPATIENT MORTALITY, TREATMENT STRATEGIES AND COMPLICATIONS IN PATIENTS ADMITTED FOR ACUTE CORONARY SYNDROME: ANALYSIS OF NATIONAL INPATIENT SAMPLE
Authors: Muhammad Usman Almani, Muhammad Usman, Cyra-Yoonsun Kang, Emmanuel Akuna, Iriagbonse Rotimi Asemota, Mahmoud Elbermawy, Raquel Soon-Shiong, Dimeji Williams, Smriti Khanal, Bharosa Sharma
Journal: Journal of the American College of Cardiology (2021)
Autoregulation of Coronary Blood Supply in Response to Demand
Authors: Nils P. Johnson, K. Lance Gould, Bernard De Bruyne
Journal: Journal of the American College of Cardiology (2021)

Although our coronary circulation evolved to meet demands during marked physical exertion for "fight or flight" survival, complex and multilayered control mechanisms reduce flow during other periods. Understanding homeostasis of resting flow provides essential insights into clinical pathophysiology. Several homeostatic mechanisms (myogenic, metabolic, endothelial, and neural) maintain sufficient baseline flow regardless of driving pressure (in aggregate, "autoregulation"). As a result, ventricular dysfunction does not arise until coronary perfusion pressure decreases to ∼40 mm Hg. Straightforward clinical parameters explain approximately one-half of observed absolute resting perfusion but with wide imprecision. Resting perfusion does not associate with clinical outcomes and remains unaffected by revascularization, recovery after myocardial infarction, and treating severe aortic stenosis, thereby supporting the notion that the heart was designed for peak performance.
SAT0689 A NOVEL METHODOLOGY FOR TEACHING RHEUMATOLOGY TO NEW GENERATIONS
Authors: Daniel Gallardo, Alejandra Herrera, Carolina Llanos, Pamela Diaz
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Teaching rheumatology to undergraduate students is every day more challenging. In order to motivate new generations and use time more efficiently, we explored new methods to incorporate active learning in our rheumatology course. Therefore, we developed a video library and turned the classical lectures into flipped classrooms. <h3>Objectives:</h3> To evaluate the impact of this new teaching method of rheumatology in a cohort of medical students at Pontificia Universidad Catolica de Chile School of Medicine. <h3>Methods:</h3> Fundamental lectures of rheumatology were recorded, edited and uploaded to YouTube, so the students were able to easily access the lessons from different electronic devices. A total of 10 videos were created, with an average duration of 6 minutes. A cohort of 120 fourth-year medical students took the rheumatology course between May 28th and June 11th of 2018. They were asked to watch the videos before the class, and during the classroom time the teacher could work on clinical classes, complement the information about the topic and answer questions. At the end of the course, the students evaluated this new methodology with a final online and anonymous survey. Performance analysis of each video was obtained from YouTube Analytics. <h3>Results:</h3> Seventy-two students completed the survey at the end of the course (60%). One hundred percent thought that watching the videos before the class was useful for their learning. Moreover, 70 students (97%) would like to continue using flipped classrooms in the future, and 1/3 of them would even use them to replace traditional lectures. Overall, the rheumatology was evaluated with a 6.8 score in a 1 – 7 scale. A 100% of this cohort approved the course. Average view duration of all videos was 4:37 minutes. Twenty-two students added positive comments about the use of flipped classroom in this course, and appreciated the videos were short enough to watch them before attending lectures. <h3>Conclusion:</h3> Advances in technology have allowed developing innovating ways to teach. Flipped classroom encourages students to adopt a more active role in the learning process. This new methodology seems to be well accepted by students and shows a promising way to motivate new generations to learn rheumatology. <h3>Acknowledgement:</h3> Supported by FONDEDOC Grant, Pontificia Universidad Catolica de Chile <h3>Disclosure of Interests:</h3> None declared
PREDICTORS OF TAKOTSUBO CARDIOMYOPATHY IN LIVER TRANSPLANT RECIPIENTS - A COHORT STUDY USING MULTI-CENTER POOLED ELECTRONIC HEALTH RECORD DATA
Authors: Mohammad Zmaili, Jafar Alzubi, Motasem Alkhayyat, Mariam Rana, Paulino Alvarez, Emad Mansoor, Bo Xu
Journal: Journal of the American College of Cardiology (2021)
Selecting β-thalassemia Patients for Gene Therapy: A Decision-making Algorithm
Authors: Donatella Baronciani, Maddalena Casale, Lucia De Franceschi, Giovanna Graziadei, Filomena Longo, Raffaella Origa, Paolo Rigano, Valeria Pinto, Monia Marchetti, Antonia Gigante, Achille Iolascon, Gian Luca Forni
Journal: HemaSphere (2021)

This expert opinion originally developed by a panel of the Italian Society of Thalassemias and Hemoglobinopathies (SITE), reviewed and adopted by the European Hematology Association (EHA) through the EHA Scientific Working Group on Red Cells and Iron, has been developed as priority decision-making algorithm on evidence and consensus with the aim to identify which patients with transfusion-dependent beta-thalassemia (TDT) could benefit from a gene therapy (GT) approach. Even if the wide utilized and high successful allogeneic hematopoietic stem-cell transplantation provides the possibility to cure several patients a new scenario has been opened by GT. Therefore, it is important to establish the patients setting for whom it is priority indicated, particularly in the early phase of the diffuse use outside experimental trials conducted in high selected centers. Moreover, actual price, limited availability, and resources disposal constitute a further indication to a rational and progressive approach to this innovative treatment. To elaborate this algorithm, the experience with allogeneic transplantation has been used has a predictive model. In this large worldwide experience, it has been clearly demonstrated that key for the optimal transplant outcome is optimal transfusion and chelation therapy in the years before the procedure and consequently optimal patient's clinical condition. In the document, different clinical scenarios have been considered and analyzed for the possible impact on treatment outcome. According to the European Medicine Agency (EMA) for the GT product, this expert opinion must be considered as a dynamic, updatable, priority-based indications for physicians taking care of TDT patients.
TELEHEALTH CARE BEFORE AND DURING COVID-19: TRENDS AND QUALITY IN A LARGE HEALTH SYSTEM
Authors: Paulina Luna, Megan Lee, Nikki DeLucia, Yollanda London, Pamela Hoffman, Matthew Burg, Kristie Harris, Erica Spatz, Carlos Mena Hurtado, Kim Smolderen
Journal: Journal of the American College of Cardiology (2021)
VESSEL FRACTIONAL FLOW RESERVE DETECT FUNCTIONALLY SIGNIFICANT NONCULPRIT CORONARY LESIONS IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION
Authors: Chun Chin Chang, Ming-Ju Chuang, Yin-Hao Lee, Chien-Hung Hsueh, Ya-Wen Lu, I-Lin Tsai, Ruey-Hsing Chou, Po-Hsun Huang, Shing-Jong Lin
Journal: Journal of the American College of Cardiology (2021)
Cholangiocarcinoma Risk Factors Open the Floodgates for Gut Microbes and Immunosuppressive Myeloid Cells
Authors: Sharmeen Chagani, Lawrence N. Kwong
Journal: Cancer Discovery (2021)

Abstract Summary: Primary sclerosing cholangitis and colitis are known predisposing factors for bile duct cancer, but their exact pro-oncogenic mechanisms are unclear. In this issue of Cancer Discovery, Zhang and colleagues identify intestinal barrier impairment as a key mechanism, resulting in gut microbes spilling into the portal vein, in turn recruiting immunosuppressive myeloid-derived suppressor cells and promoting cholangiocarcinoma. See related article by Zhang et al. p. 1248.