tbuckley/cabot-search huggingface dataset:
Racial differences in tumor biology and treatment of gastric cancer in the United States.
Authors: Joshua Tseng, James Miller, Xiaoxi Feng, Alexandra Gangi, Jun Gong, Miguel Burch
Journal: Journal of Clinical Oncology (2021)

174 Background: Racial disparities for gastric cancer are often identified in the literature. Although patients in Asia consistently demonstrate a survival benefit compared to those in the West, Asian patients in the US still retain this advantage, which suggests that tumor biology may be a major factor. The goal of our study is to identify racial differences in patient demographics, tumor biology and treatment for gastric cancer in the United States. Methods: The National Cancer Database was queried from 2006-2016 for patients with a diagnosis of gastric adenocarcinoma. Patient demographics, tumor characteristics, and treatment patterns were compared by patient ethnicity (White, Black, Hispanic, and Asian) with Kruskal-Wallis test and Pearson’s chi-squared test. Kaplan-Meier survival curves used to assess overall survival, and cox regression used to identify independent prognostic factors for survival. Results: 116,717 patients with gastric cancer identified; 78,066 were White, 17,486 were Black, 8,494 were Asian, and 12,671 were Hispanic. White patients were most likely to be older than 70 and have proximal tumors, and least likely to have diffuse type adenocarcinoma. Hispanic and Black patients were most likely to present with metastases. Asian patients were most likely to receive surgery and least likely to receive chemotherapy or radiotherapy. Stage for stage, Asians had the longest median survival, followed by Hispanic, Black, and White patients. Prognostic factors associated with a survival benefit include Asian ethnicity (HR 0.72, 95% CI 0.68-0.74), Hispanic ethnicity (HR 0.76, 95% CI 0.73-0.79), Black ethnicity (HR 0.95, 95% CI 0.93-0.98), private insurance (HR 0.91, 95% CI 0.87-0.96), higher income (HR 0.85, 95% CI 0.82-0.88), treatment at academic center (HR 0.87, 95% CI 0.83-0.91), higher-volume centers (HR 0.90, 95% CI 0.87-0.93), receiving surgery (HR 0.42, 95% CI 0.41-0.43), chemotherapy (HR 0.56, 95% CI 0.55-0.57), and radiation (HR 0.96, 95% CI 0.93-0.98). Conclusions: Treatment differences between Eastern and Western countries for gastric cancer persist between ethnic groups within the United States, with Asian patients retaining a survival benefit. Black and Hispanic patients present with aggressive disease and unfavorable socioeconomic factors that are detrimental to overall survival.
Cannabis use and lung cancer: time to stop overlooking the problem?
Authors: Léa Betser, Matthieu Glorion, Pierre Mordant, Caroline Caramella, Maria-Rosa Ghigna, Benjamin Besse, David Planchard, Jérome Le Pavec, Alain Chapelier, Sylvie Friard, Valérie Gounant, Yves Castier, Antonin Levy, Olaf Mercier, Dominique Fabre, Elie Fadel, Pauline Pradere
Journal: European Respiratory Journal (2021)

<b>Cannabis smoking is highly prevalent and largely underreported in young patients with resected nonsmall cell lung cancer. This is a major issue as co-consumption of cannabis and tobacco may lead to more severe and advanced forms of lung cancer.</b>https://bit.ly/39tvsAm
Rituximab in thrombotic primary antiphospholipid syndrome: a pilot study from a single centre in China
Authors: Yijun You, Ce Shi, Zhuochao Zhou, Fan Wang, Yue Sun, Jialin Teng, Honglei Liu, Xiaobing Cheng, Yutong Su, Hui Shi, Chengde Yang, Junna Ye
Journal: Annals of the Rheumatic Diseases (2021)

Antiphospholipid syndrome (APS) is a multisystem disorder defined by a combination of arterial and/or venous thrombosis, recurrent fetal loss in women and persistent presence of antiphospholipid (aPL) antibodies such as lupus anticoagulant (LAC), anti-β2-glycoprotein I (anti-β2GPI) and anticardiolipin antibodies (aCL).1 APS can occur either in primary condition (primary APS, PAPS) or in association with other autoimmune diseases (secondary APS).

In terms of the treatment of APS, the first-line therapy consists of low-dose aspirin or low-molecular-weight heparin2 or warfarin, usually it was highly effective, but in a few cases, APS may be refractory. So in the recent years, new emerging treatments have been used, such as hydroxychloroquine, statins, rituximab (RTX), eculizumab and intravenous immunoglobulin.3

RTX is a specific anti-CD20 antibody. Several reports showed the efficacy of RTX in APS, even in catastrophic APS,4 or in combination with SLE and diffuse alveolar haemorrhage,5 or in refractory obstetrical APS.6

In our study, we aimed to describe the efficacy of RTX in six patients with thrombotic PAPS in Department of Rheumatology …
Administrative Coding in Electronic Health Care Record‐Based Research of NAFLD: An Expert Panel Consensus Statement
Authors: Hannes Hagström, Leon A. Adams, Alina M. Allen, Christopher D. Byrne, Yoosoo Chang, Henning Grønbæk, Mona Ismail, Peter Jepsen, Fasiha Kanwal, Jennifer Kramer, Jeffrey V. Lazarus, Michelle T. Long, Rohit Loomba, Philip N. Newsome, Ian A. Rowe, Seungho Ryu, Jörn M. Schattenberg, Marina Serper, Nick Sheron, Tracey G. Simon, Elliot B. Tapper, Sarah Wild, Vincent Wai‐Sun Wong, Yusuf Yilmaz, Shira Zelber‐Sagi, Fredrik Åberg
Journal: Hepatology (2021)

Electronic health record (EHR)-based research allows the capture of large amounts of data, which is necessary in NAFLD, where the risk of clinical liver outcomes is generally low. The lack of consensus on which International Classification of Diseases (ICD) codes should be used as exposures and outcomes limits comparability and generalizability of results across studies. We aimed to establish consensus among a panel of experts on ICD codes that could become the reference standard and provide guidance around common methodological issues.Researchers with an interest in EHR-based NAFLD research were invited to collectively define which administrative codes are most appropriate for documenting exposures and outcomes. We used a modified Delphi approach to reach consensus on several commonly encountered methodological challenges in the field. After two rounds of revision, a high level of agreement (>67%) was reached on all items considered. Full consensus was achieved on a comprehensive list of administrative codes to be considered for inclusion and exclusion criteria in defining exposures and outcomes in EHR-based NAFLD research. We also provide suggestions on how to approach commonly encountered methodological issues and identify areas for future research.This expert panel consensus statement can help harmonize and improve generalizability of EHR-based NAFLD research.
Comparative efficacy of commonly used first-line chemotherapy regimens in advanced pancreatic cancer: A network meta-analysis.
Authors: Philip A. Haddad, Kevin Michael Gallagher, Dalia Hammoud
Journal: Journal of Clinical Oncology (2021)

403 Background: Pancreatic adenocarcinoma is one of the deadliest cancers, ranking fourth in mortality and accounting for up to 7% of all cancer related deaths in the United States. For many years, Gemcitabine and its combinations have been the standard first-line treatments for patients with unresectable locally advanced or metastatic pancreatic cancer (aPC). Recently, FOLFIRINOX was shown to be associated with a survival advantage as well. These chemotherapy combinations have not been compared to each other. We conducted this network meta-analysis to evaluate the relative efficacy of the commonly used chemotherapy regimens in patients with aPC. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language; diagnosis of aPC; treatment with Gemcitabine (GEM) combined with Capecitabine (CAPE), Erlotinib (ERLO), or nab-Paclitaxel (NABPAC) and treatments with FOLFIRINOX; and randomized studies reporting survival and response rates. A frequentists network meta-analysis was conducted using netmeta package and random-effects model. Results: Six studies comprising a total of 2,717 participants were included. FOLFIRINOX demonstrated a significantly better relative risk (RR) of progression and death (P&amp;D) followed by GEM+NABPAC, GEM+ERLO, GEM+CAPE, and GEM in a decreasing order. When compared to GEM-based combination as a group, FOLFIRINOX maintained its superior RR for P&amp;D. Moreover, FOLFIRINOX and GEM+NABPAC had significantly better response rates than GEM+CAPE and GEM+ERLO. Inconsistency analysis did not reveal any significant differences between direct and indirect estimates. Conclusions: This network meta-analysis is the first to compare and rank commonly used treatment regimens in aPC. It indicates that FOLFIRINOX combination seems to be superior to GEM-based combinations with respect to P&amp;D as well as response rates. Nevertheless, among GEM-based combinations, GEM+NABPAC seems to have the best profile given its lower RR for P&amp;D and higher response rates.
Response to: ‘Correspondence on ‘Interleukin 6 receptor inhibition in primary Sjögren syndrome: a multicentre double-blind randomised placebo-controlled trial’’ by de Wolff<i>et al</i>
Authors: Renaud Felten, Jacques-Eric Gottenberg
Journal: Annals of the Rheumatic Diseases (2021)

We read with interest the correspondence related to our article, ‘Interleukin 6 receptor inhibition in primary Sjogren syndrome: a multicentre double-blind randomised placebo-controlled trial’, by Wang et al 1 who discuss the disappointing results of recent trials of primary Sjogren syndrome (pSS).

To explain recent negative results of tocilizumab and abatacept, apart from the inefficacy of these biologicals in pSS, Wang et al discuss the contribution of the design of the study. First, they discuss the choice of a primary endpoint based on the EULAR Sjogren’s Syndrome Disease Activity Index (ESSDAI). As mentioned by the authors, this score captures only the systemic complications of the disease, observed in 30%–50% …
PALBI and ALBI score as a prognosis factor for liver metastasis undergoing transarterial radioembolization.
Authors: Jorge Sanchez-Garcia, Randie Riegler, Maria Jepperson, Andrew Gagnon, Diane Alonso, Shiro Fujita, Manuel Rodriguez-Davalos, Ramya Thota, George Cannon, Jake Krong, Sean Dow, Richard Gilroy, Mark Kringlen, Ivan R Zendejas-Ruiz
Journal: Journal of Clinical Oncology (2021)

345 Background: Liver metastasis is evident in many oncological patients at the time of initial presentation. Recently, platelet-albumin-bilirubin (PALBI) score was reported to be superior to Child-Pugh classification and albumin-bilirubin (ALBI) score in terms of mortality prediction, while Model for End-Stage Liver Disease (MELD) score is the most frequent used. Trans-arterial radioembolization (TARE) is a minimally invasive therapy used to treat liver tumors. The aim of this study is to assess prognostic performance of pre-TARE liver function scores. Methods: We retrospectively assessed all patients with liver metastasis that underwent TARE between February 2008 and January 2020 at a single institution. Demographic characteristics; and laboratory values were collected to calculate MELD, ALBI, PALBI, within six months before TARE administration. Results are presented as proportions and median (IQR). Multivariate Cox regression analysis was performed to identify risk factors for overall survival. Results: A total of 90 patients were included, 46.7% were females with a median age was 61 (50-69). Colorectal (CR) metastasis was found in 45.6% of cases, neuroendocrine tumors (NET) in 27.8% and the remainder a heterogenous group of metastatic disease. In 90% of cases, TARE was used as destination therapy. The median tumor size was 5.1 (3.3-7.1) cm with 81% having multifocal lesions. The median scores were: MELD 8 (7-10), ALBI -2.77 (-3.01 to -2.56), PALBI -2.58 (-2.77 to -2.32). Other metastatic disease (OR=2.3: 95%CI 1.3-4.3; p=0.02), MELD (OR=1.1: 95%CI 1.002-1.2; p=0.04), ALBI (OR=2: 95%CI 1.2-3.3; p=0.005) and PALBI (OR=2.4: 95%CI 1.2-4.7; p=0.01) were significant in univariate Cox regression. In the multivariate Cox regression, MELD score was not statistically significant when adjusted with diagnosis and PALBI or ALBI score. As expected due to similar variables to calculate score, ALBI and PALBI score were not statistically significance when these are used in the same model (Table). Conclusions: To our knowledge, this is the first report of PALBI as prognostic factor in patients undergoing TARE for metastatic liver disease. Interestingly, the multivariate cox regression showed us that MELD score is not a significant score for these patients. Further non-inferiority assessment of PALBI and ALBI over MELD score should be developed. [Table: see text]
Efficacy and safety of nab-paclitaxel plus gemcitabine-cisplatin (GemCis/nab-P) in Korean patients with advanced biliary tract cancers (aBTC): Multicenter retrospective analysis.
Authors: Jaekyung Cheon, Choong-kun Lee, Yunbeom Sang, Chan Kim, Beodeul Kang, Hongjae Chon
Journal: Journal of Clinical Oncology (2021)

274 Background: A recent phase II trial (NCT02392637) demonstrated prolonged survival by treatment with GemCis/nab-P in patients (pts) with aBTC. Further evaluation in real-world setting is necessary to measure the clinical outcomes of GemCis/nab-P in daily practice in Asian pts. Methods: This is a multicenter retrospective analysis of data from 3 institutes in Korea. Between September 2019 and August 2020, a total of 104 pts who received GemCis/nab-P for the management of aBTC were included in this analysis. Results: Median age was 64 years (range, 34-84), and 60 pts (57.7%) were male. GemCis/nab-P was used as the starting regimen in 60 pts (57.7%), 16 pts (15.4%) received GemCis/nab-P after failure of GemCis ± investigational drug (mainly immune checkpoint inhibitors), and 28 pts (26.9%) added nab-P to initial Gem/Cis without progressive disease. Baseline characteristics were as follows: Intrahepatic cholangiocarcinoma (CCC)/extrahepatic CCC/gallbladder cancer in 42 (40.4%)/33 (31.7%)/29 (27.9%); metastatic or recurred/locally advanced in 82 (78.8%)/22 (21.2%) pts. According to RECIST v 1.1, objective response rates (ORR) and disease control rate (DCR) were 30.8% and 81.8% of all pts, 33.4% and 88.4% in initial GemCis/nab-P, 28.6% and 73.8% in intrahepatic CCC, 36.3% and 96.9% in extrahepatic CCC, and 27.6% and 75.9% in gallbladder cancer groups, respectively. In nab-P addition group, while the ORR and DCR of pts without GemCis failure were 39.3% and 85.7%, those with GemCis failure were 6.3%, 50.0%, respectively. Median overall survival and progression-free survival were not reached, with a median follow-up duration of 3.3 months (95% confidence interval [CI], 2.9-6.7). The most common grade 3-4 toxicities were neutropenia (n=36, 34.6%), anemia (n=17, 16.4%), thrombocytopenia (n=10, 9.6%), and febrile neutropenia (n=9, 8.1%). In patients with locally advanced BTC (n=22), 5 patients (22.7%) were converted to resectable disease and underwent surgery. Conclusions: GemCis/nab-P showed consistent real-life efficacy and safety outcomes for Korean aBTC pts compared with those from the phase 2 trial. [Table: see text]
Defining optimal selection criteria to improve prognosis and avoid futility in surgical resection of colorectal peritoneal metastases.
Authors: Lana Bijelic, Isabel Ramos, Domenico Sabia, Oriol Crusellas, Montse Martin, Pedro Barrios
Journal: Journal of Clinical Oncology (2021)

36 Background: Surgical resection of peritoneal metastases of colorectal cancer (CRC PM) may benefit some patients similar to hepatic metastases. This approach remains controversial in part due to inconsistent selection criteria and reported outcomes. The impact of preoperative clinical characteristics and tumor molecular profiles on survival among surgically treated patients is incompletely understood. The aim of this study was to investigate the relationship between possible predictive variables and survival in a large cohort of patients treated on a standardized clinical pathway and to develop a clinically useful patient selection tool. Methods: This retrospective cohort study utilized the database of the Catalonian peritoneal metastases regional program, established in 2006. The program provides treatment for all PM patients within an autonomous region with a population of 7.5 million and includes a single dedicated high volume surgical unit. We included all adult patients with surgically resected CRC PM. The clinical pathway includes the administration of perioperative (neoadjuvant and adjuvant) systemic chemotherapy and has historically included a dose of heated intraoperative intraperitoneal chemotherapy (HIPEC) at the time of surgery. Demographic and clinical data was analyzed with descriptive statistics. Survival and the associated predictors were analyzed with the Cox proportional hazard model with HRs used to create a predictive nomogram. Results: A total of 538 patients (mean age 59) have been treated with surgery and a complete resection (CC0) was achieved in 94% of cases. Planned preoperative systemic chemotherapy was delivered in 95% of cases, consistent with the clinical pathway. Surgical morbidity was low (urgent reoperation 6.1%, postoperative return to the ICU 2.4%, 30-day readmission 4.3%) as was 30-day mortality (0.4%). After a median follow up of 27.5 months, the median overall survival (OS) was 43.1 months. It varied considerably by subgroup: patients with low peritoneal tumor burden had the highest OS (median 49 months) and those with signet ring cell subtype the lowest (median 19 months). Factors independently associated with survival were: N stage at diagnosis, histological subtype, quantified peritoneal tumor burden (PCI score) and presence of visceral involvement. A selection tool and predictive nomogram were designed incorporating the results of the multivariable analysis. Conclusions: A set of clinical variables can be identified that independently influences patient survival after surgical resection of CRC PM that should be used as selection criteria when considering surgery. With optimized patient selection and treatment within a specialized center, excellent survival and low morbidity can be anticipated following surgery for CRC PM.
Racial/Ethnic Disparities in Unintentional Fatal and Nonfatal Emergency Medical Services–Attended Opioid Overdoses During the COVID-19 Pandemic in Philadelphia
Authors: Utsha G. Khatri, Lia N. Pizzicato, Kendra Viner, Emily Bobyock, Monica Sun, Zachary F. Meisel, Eugenia C. South
Journal: JAMA Network Open (2021)

This cross-sectional study describes the differential associations of the coronavirus disease 2019 (COVID-19) pandemic with opioid-related overdoses among racial/ethnic groups in Philadelphia, Pennsylvania.
Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening
Authors: Jessie R. Baldwin, Avshalom Caspi, Alan J. Meehan, Antony Ambler, Louise Arseneault, Helen L. Fisher, HonaLee Harrington, Timothy Matthews, Candice L. Odgers, Richie Poulton, Sandhya Ramrakha, Terrie E. Moffitt, Andrea Danese
Journal: JAMA Pediatrics (2021)

Adverse childhood experiences (ACEs) are well-established risk factors for health problems in a population. However, it is not known whether screening for ACEs can accurately identify individuals who develop later health problems.To test the predictive accuracy of ACE screening for later health problems.This study comprised 2 birth cohorts: the Environmental Risk (E-Risk) Longitudinal Twin Study observed 2232 participants born during the period from 1994 to 1995 until they were aged 18 years (2012-2014); the Dunedin Multidisciplinary Health and Development Study observed 1037 participants born during the period from 1972 to 1973 until they were aged 45 years (2017-2019). Statistical analysis was performed from May 28, 2018, to July 29, 2020.ACEs were measured prospectively in childhood through repeated interviews and observations in both cohorts. ACEs were also measured retrospectively in the Dunedin cohort through interviews at 38 years.Health outcomes were assessed at 18 years in E-Risk and at 45 years in the Dunedin cohort. Mental health problems were assessed through clinical interviews using the Diagnostic Interview Schedule. Physical health problems were assessed through interviews, anthropometric measurements, and blood collection.Of 2232 E-Risk participants, 2009 (1051 girls [52%]) were included in the analysis. Of 1037 Dunedin cohort participants, 918 (460 boys [50%]) were included in the analysis. In E-Risk, children with higher ACE scores had greater risk of later health problems (any mental health problem: relative risk, 1.14 [95% CI, 1.10-1.18] per each additional ACE; any physical health problem: relative risk, 1.09 [95% CI, 1.07-1.12] per each additional ACE). ACE scores were associated with health problems independent of other information typically available to clinicians (ie, sex, socioeconomic disadvantage, and history of health problems). However, ACE scores had poor accuracy in predicting an individual's risk of later health problems (any mental health problem: area under the receiver operating characteristic curve, 0.58 [95% CI, 0.56-0.61]; any physical health problem: area under the receiver operating characteristic curve, 0.60 [95% CI, 0.58-0.63]; chance prediction: area under the receiver operating characteristic curve, 0.50). Findings were consistent in the Dunedin cohort using both prospective and retrospective ACE measures.This study suggests that, although ACE scores can forecast mean group differences in health, they have poor accuracy in predicting an individual's risk of later health problems. Therefore, targeting interventions based on ACE screening is likely to be ineffective in preventing poor health outcomes.
Covid-19: People are not being warned about pitfalls of mass testing
Authors: Elisabeth Mahase
Journal: BMJ (2021)

Only a third of local authorities that are rolling out lateral flow testing have made the test’s limitations clear to the public—including that it does not pick up all cases and that people testing negative could still be infected, an investigation by The BMJ has found.

A search of the websites of the 114 local authorities rolling out lateral flow testing1 found that 81 provided information for the public on rapid covid-19 testing. Of these, nearly half (47%; 38) did not explain the limitations of the tests or make it clear that people needed to continue following the restrictions or safety measures even if they tested negative, as they could still be infected.

Although 53% (43) did advise people to continue to follow the current measures after a negative result, only 32% (26) were clear about the …
Can the health care system be effective? - The research results
Authors: Joanna Jasińska
Journal: Clinical Cardiology and Cardiovascular Interventions (2020)

The different definitions of efficiency (in their medical meanings) are presented as the result of meta-reviews found in scientific databases. Efficacy and efficiency are often mismatched with effectiveness in the research of healthcare systems in different countries. In addition to the classic Bismarck’s and Beveridge’s models the modern concepts of health systems include personalized medicine, recognition of health as economic value. However, the basic problem in the Polish healthcare system is the low quality of overly specific and often changed legislation.