tbuckley/cabot-search huggingface dataset:
A single-center, real-world experience of atezolizumab plus bevacizumab as first-line therapy in patients with unresectable hepatocellular carcinoma, including patients with advanced cirrhosis.
Authors: Jay Parekh, Soniya Abraham, Haripriya Andanamala, Asad Rehman, Paul Ahearn, Yaw Adjepong, Gregory Buller, Stacey Stein
Journal: Journal of Clinical Oncology (2024)

445 Background: Atezolizumab plus bevacizumab (A+B) is approved by the Food and Drug Administration (FDA) for treatment of advanced stage hepatocellular carcinoma (HCC) as first line systemic therapy following results of the IMBRAVE150 trial. Since its approval, limited real-world data is available. The benefit of this treatment in patients with advanced cirrhosis is still unclear, especially in patients with Child Pugh (CP) B cirrhosis. We aim to supplement the trial data with real world outcomes of individuals with unresectable HCC treated with (A+B) in the first line setting including patients with advanced cirrhosis. Methods: This was a single-center, retrospective analysis of patients with advanced HCC treated with A+B as first line systemic therapy between May 2020-January 2023. Patient characteristics, HCC stage, treatment information, adverse events and survival data were collected. Outcomes evaluated included progression free survival (PFS), overall survival (OS), overall response rate (ORR) using RECIST 1.1 and adverse events (AE) rate according to CTCAE v5. R v4.2.1 was used for analysis. Results: We identified a total of 41 patients with advanced stage HCC who received A+B as first line systemic therapy. The median age at diagnosis was 69 years (range 42 – 85). 34(83%) of the patients were males. 8(20%) of the patients were African American. 7(17%) patients had CP B cirrhosis. Median PFS on A+B among all patients was 10.82 months (95% CI: 5.38 – 16.26). Median OS from time of A+B initiation was 14.01 months (95% CI: 10.67 – 17.34). Median OS and PFS were significantly shorter among CP B patients, 6.84(95% CI: NE – 19.36, p = 0.003) and 6.8(95% CI: NE -19.33, p = 0.016) respectively. Hazard ratio (HR) for death from any cause among CP B patients was 4.87(95% CI: 1.35 – 17.48, p &lt;0.01) compared to others. ORR was 31.42%. 10/23(39.13%) patients with CP A had overall response, while 1/7(14.28%) patients with CP B had overall response. AE of any grade was observed in 30(73.2%) patients.10(24.4%) patients had grade 3 or more events, 2(28.5%) among CP B patients. 1(14.2%) had GI bleed among CP B patients, while 4(9.7) patients had GI bleed overall. Common adverse events included fatigue (26.8%), anorexia (26.8%), aspartate aminotransferase (AST) elevation (14.6%), proteinuria (17%), rash (21.9%). Conclusions: Efficacy profile of A+B appears to be sustained in the real world. While the efficacy is inferior in CP B liver disease, A+B remains a viable option for these patients with limited treatment options and acceptable tolerability. Our study adds to the body of evidence for real world data with A+B.
Application of GPT-4 foundation model for risk prediction and stratification in colorectal cancer.
Authors: Antonio Rueda-Lara, David Viñal, Maria Alameda, Gema Martin-Montalvo, Jesus Peña-Lopez, Diego Jiménez-Bou, Iciar Ruiz-Gutierrez, Nuria Rodriguez Salas, Jaime Feliu
Journal: Journal of Clinical Oncology (2024)

219 Background: Deep Learning Language Models (LLMs) show significant potential in analyzing complex data, particularly in oncology, where they can predict and stratify patient risks, detect non-linear interactions, and weigh multiple variables. This study applies LLMs to stage II/III localized colon cancer patients to assess their effectiveness in identifying risk subgroups. Methods: In this retrospective study, we examined a cohort of stage II and III localized colorectal cancer patients diagnosed from September 2016 to December 2022 at La Paz University Hospital. Utilizing the GPT-4 API beta version, patients were stratified into high and low-risk groups for relapse based on various risk parameters outlined in the table. Notably, adjuvant treatment data was excluded from the input. The model was prompted with the question, "Given the following risk parameters for localized colorectal cancer {param}, guess whether the patient is in low risk or high risk for relapse," and the model provided dichotomic responses categorized as either 1 (high risk) or 0 (low risk). Results: Patient characteristics are depicted in the table. During a median follow-up of 23.68 months, 63 recurrence events and 73 deaths were observed. The GPT-4 model stratified patients into low (37.9%) and high-risk (62.1%) groups, with the survival curves showing a significant difference in outcomes between the groups. Low-risk patients had a relapse-free rate of 93% at 36 months vs 63% in the high-risk group. In univariate analysis, the high-risk variable had a hazard ratio (HR) of 4.26 (95% CI: 2.03-8.95; p &lt; 0.005). When stratified by adjuvant treatment, no significant difference in relapse probability was observed for those receiving therapy. However, without adjuvant therapy, high-risk patients had an HR of 12.41 (95% CI: 3.72-41.97; p &lt; 0.005) for relapse. Conclusions: GPT-4 demonstrated its potential in predicting oncology outcomes by accurately understanding colorectal cancer risk factors. To fully harness the benefits of LLMs in the future of oncology, they must be fine-tuned on extensive oncological datasets to improve patient risk stratification and treatment selection, ultimately leading to better patient outcomes.[Table: see text]
Glucagon-like peptide-1 receptor agonists and risk of major adverse liver outcomes in patients with chronic liver disease and type 2 diabetes
Authors: Axel Wester, Ying Shang, Emilie Toresson Grip, Anthony A Matthews, Hannes Hagström
Journal: Gut (2024)

Objective Phase II trials suggest glucagon-like peptide-1 receptor (GLP1) agonists resolve metabolic dysfunction-associated steatohepatitis but do not affect fibrosis regression. We aimed to determine the long-term causal effect of GLP1 agonists on the risk of major adverse liver outcomes (MALO) in patients with any chronic liver disease and type 2 diabetes. Design We used observational data from Swedish healthcare registers 2010–2020 to emulate a target trial of GLP1 agonists in eligible patients with chronic liver disease and type 2 diabetes. We used an inverse-probability weighted marginal structural model to compare parametric estimates of 10-year MALO risk (decompensated cirrhosis, hepatocellular carcinoma, liver transplantation or MALO-related death) in initiators of GLP1 agonists with non-initiators. We randomly sampled 5% of the non-initiators to increase computational efficiency. Results GLP1 agonist initiators had a 10-year risk of MALO at 13.3% (42/1026) vs 14.6% in non-initiators (1079/15 633) in intention-to-treat analysis (risk ratio (RR)=0.91, 95% CI=0.50 to 1.32). The corresponding 10-year per-protocol risk estimates were 7.4% (22/1026) and 14.4% (1079/15 633), respectively (RR=0.51, 95% CI=0.14 to 0.88). The per-protocol risk estimates at 6 years were 5.4% (21/1026) vs 9.0% (933/15 633) (RR=0.60, 95% CI=0.29 to 0.90) and at 8 years 7.2% (22/1026) vs 11.7% (1036/15 633) (RR=0.61, 95% CI=0.21 to 1.01). Conclusion In patients with chronic liver disease and type 2 diabetes who adhered to therapy over time, GLP1 agonists may result in lower risk of MALO. This suggests that GLP1 agonists are promising agents to reduce risk of chronic liver disease progression in patients with concurrent type 2 diabetes, although this needs to be corroborated in randomised trials.
Effect of a coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years: a cluster randomised controlled trial
Authors: Juliana S Oliveira, Catherine Sherrington, Chris Rissel, Kirsten Howard, Allison Tong, Dafna Merom, James Wickham, Adrian E Bauman, Stephen R Lord, Richard I Lindley, Judy M Simpson, Margaret Allman-Farinelli, Catherine Kirkham, Elisabeth Ramsay, Sandra O’Rourke, Anne Tiedemann
Journal: British Journal of Sports Medicine (2024)

Objectives To evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years. Design Cluster randomised controlled trial. Setting Community-dwelling older people. Participants 72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control. Intervention Intervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months. Outcomes The co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability. Results The mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI −21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes. Conclusion A physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. Trial registration number ACTRN12615001190594.
Predictors of Repeated Septal Reduction After Alcohol Septal Ablation in Patients With Hypertrophic Cardiomyopathy
Authors: Takashi Hiruma, Mitsunobu Kitamura, Itaru Takamisawa, Yuki Izumi, Ryosuke Higuchi, Mamoru Nanasato, Tomoki Shimokawa, Shuichiro Takanashi, Mitsuaki Isobe, Morimasa Takayama
Journal: Journal of the American College of Cardiology (2024)
Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients With Functional Mitral Regurgitation
Authors: Adnan K. Chhatriwalla, David J. Cohen, Sreekanth Vemulapalli, Andrew Vekstein, Chetan P. Huded, Dianne Gallup, Andrzej S. Kosinski, Leo Brothers, JoAnn Lindenfeld, Gregg W. Stone, Paul Sorajja
Journal: Journal of the American College of Cardiology (2024)
Prognostic Implications of Initial Focal Contrast Enhancement in Acute Type B Intramural Hematoma
Authors: Xiaolang Jiang, Tianyue Pan, Yifan Liu, Bin Chen, Junhao Jiang, Daqiao Guo, Xin Xu, Kai Hou, Jiang Lin, Shuai Ju, Weiguo Fu, Zhihui Dong
Journal: Journal of the American College of Cardiology (2024)
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study)
Authors: Iain Robert Louis Kean, John A Clark, Zhenguang Zhang, Esther Daubney, Deborah White, Paloma Ferrando-Vivas, Gema Milla, Brian Cuthbertson, John Pappachan, Nigel Klein, Paul Mouncey, Kathy Rowan, John Myburgh, Theodore Gouliouris, Stephen Baker, Julian Parkhill, Nazima Pathan, None ARCTIC research team
Journal: Gut (2024)

Objective Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control. Design We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care. Results SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment. Conclusion Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy.
Randomized Trial of Macitentan/Tadalafil Single-Tablet Combination Therapy for Pulmonary Arterial Hypertension
Authors: Ekkehard Grünig, Pavel Jansa, Fenling Fan, Jakob A. Hauser, Matthieu Pannaux, Adele Morganti, Hany Rofael, Kelly M. Chin
Journal: Journal of the American College of Cardiology (2024)

Endothelin receptor antagonist (ERA) and phosphodiesterase 5 inhibitor (PDE5i) combination therapy is recommended for low-/intermediate-risk pulmonary arterial hypertension (PAH) patients. A fixed-dose combination of the ERA macitentan and PDE5i tadalafil (M/T FDC) in a once-daily, single tablet would simplify treatment. The multicenter, double-blind, adaptive phase 3 A DUE study investigated the efficacy and safety of M/T FDC vs macitentan 10 mg and vs tadalafil 40 mg monotherapies in PAH patients, including treatment-naïve and prior ERA or PDE5i monotherapy-treated patients. World Health Organization functional class II-III patients were randomized to M/T FDC, macitentan, or tadalafil depending on their PAH treatment (treatment-naïve, ERA, or PDE5i monotherapy) at baseline. The primary endpoint was change in pulmonary vascular resistance (PVR) at week 16. In total, 187 patients were randomized to single-tablet M/T FDC (n = 108), macitentan (n = 35), or tadalafil (n = 44). PVR reduction with M/T FDC was significantly greater vs macitentan (29%; geometric mean ratio 0.71; 95% CL: 0.61-0.82; P < 0.0001) and vs tadalafil (28%; geometric mean ratio 0.72; 95% CL: 0.64-0.80; P < 0.0001). Three patients died in the M/T FDC arm (judged unrelated to treatment). Adverse events (AEs) leading to discontinuation, serious AEs, and those of special interest (anemia, hypotension, and edema) were more frequent with M/T FDC. Macitentan and tadalafil FDC significantly improved PVR vs monotherapies in PAH patients, with a safety and tolerability profile consistent with the individual components. The A DUE study supports M/T FDC as a once-daily, single-tablet combination for initial therapy and escalation to double combination therapy in patients with PAH. (Clinical Study to Compare the Efficacy and Safety of Macitentan and Tadalafil Monotherapies With the Corresponding Fixed-dose Combination Therapy in Subjects With Pulmonary Arterial Hypertension [PAH]) [A DUE]; NCT03904693)
Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery
Authors: Adam J. Milam, Modele O. Ogunniyi, Abimbola O. Faloye, Luis R. Castellanos, Ricardo E. Verdiner, James W. Stewart, Merije Chukumerije, Alexis K. Okoh, Steven Bradley, Robert O. Roswell, Paul L. Douglass, Shakirat O. Oyetunji, Alexander Iribarne, Debra Furr-Holden, Harish Ramakrishna, Sharonne N. Hayes
Journal: Journal of the American College of Cardiology (2024)
Food sensitization and cardiovascular mortality: An intriguing association in need of further study
Authors: Marcus Shaker, Elissa M. Abrams, John Oppenheimer, Aikaterini Anagnostou, Christopher D. Codispoti, David B.K. Golden, Matthew Greenhawt, David Stukus, Melissa Moore- Clingenpeel, Sarah W. Hughes, Douglas P. Mack, S. Shahzad Mustafa, David M. Lang
Journal: Journal of Allergy and Clinical Immunology (2024)
One-year effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a secondary analysis from a randomised controlled trial
Authors: Behnam Liaghat, Birgit Juul-Kristensen, Daniel A Faber, Emil O Christensen, Karen Søgaard, Søren T Skou, Jens Søndergaard, Carsten B Juhl
Journal: British Journal of Sports Medicine (2024)

Objectives To investigate the long-term effectiveness of high-load versus low-load strengthening exercise on self-reported function in patients with hypermobility spectrum disorder (HSD) and shoulder symptoms. Methods A secondary analysis of a superiority, parallel-group, randomised trial (balanced block randomisation 1:1, electronic concealment) including adult patients (n=100) from primary care with HSD and shoulder pain and/or instability ≥3 months. Patients received 16 weeks of shoulder exercises (three sessions/week): HEAVY (n=50, full-range, high-load, supervised twice/week) or LIGHT (n=50, neutral/mid-range, low-load, supervised three times in total). The 1-year between-group difference in change in self-reported function was measured using the Western Ontario Shoulder Instability Index (WOSI, scale 0–2100, 0=best). Secondary outcomes were self-reported measures including changes in shoulder-related symptoms, function, emotions and lifestyle, quality of life, patient-perceived effect, treatment utility and adverse events. A blinded analyst conducted the analyses using linear mixed model repeated measurements analysis. Results One-year data were available in 86 out of 100 participants (79% women, mean age 37.8 years) (LIGHT 84%, HEAVY 88%). The mean WOSI score between-group difference favoured HEAVY (−92.9, 95% CI −257.4 to 71.5, p=0.268) but was not statistically significant. The secondary outcomes were mostly inconclusive, but patients in HEAVY had larger improvement in the WOSI emotions subdomain (−36.3; 95% CI −65.4 to −7.3, p=0.014). Patient-perceived effect favoured HEAVY anchored in WOSI-emotions (55% vs 31%, p=0.027) and WOSI-lifestyle (50% vs 29%, p=0.042). Conclusion High-load shoulder strengthening exercise was not superior to low-load strengthening exercise in improving self-reported function at 1 year. High-load strengthening exercise may be more effective in improving patient emotions about shoulder pain and function, but more robust data are needed to support these findings. Trial registration number NCT03869307 .
Year-round injury and illness surveillance in UK summer paralympic sport athletes: 2016–2019
Authors: Michael Brownlow, Moses Wootten, Steve McCaig, Abbie Taylor, Nick Webborn, Pippa Bennett, Josh Wass, Dawn Ibrahim, Craig Ranson
Journal: British Journal of Sports Medicine (2024)

Objective To identify the priority injuries and illnesses across UK summer Paralympic World Class Programmes (WCP). Methods Four years (2016–2019) of electronic medical records from 360 athletes across 17 Paralympic WCP sports were analysed. Methods were based on the 2021 International Paralympic Committee translation of the original 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. This included reporting incidence (count of injury per athlete year) and burden (time loss days per athlete year) of injuries by impairment category. Results 836 injuries and 453 illnesses were recorded during the surveillance period, accounting for 34 638 and 10 032 time-loss days, respectively. 216 (60%) athletes reported at least one injury, while 171 (47.5%) reported at least one illness. There were 0.9 injuries per athlete year, resulting in a mean injury burden of 38.1 days per athlete year. The lumbar/pelvis, shoulder and thoracic/ribs body region had the greatest incidence whereas the shoulder, lumbar/pelvis and wrist had the greatest injury burden. All impairment categories had shoulder or lumbar/pelvis as the body region with the greatest incidence, however the burden of body areas did not always reflect the incidence. Athletes reported 0.5 illnesses per athlete year, resulting in an average illness burden of 11.3 days per athlete year. The respiratory, gastrointestinal, dermatological and genitourinary organ systems had the greatest illness incidence. Conclusions To optimise health and performance in Paralympic sport athletes, system-wide mitigation initiatives should target priority injury problems occurring in the lumbar/pelvis, shoulder, thoracic spine/ribs and wrist. Illness types causing the greatest burden vary with impairment group, and illness mitigation initiatives should consider athlete impairment types in their design, while continuing to note the high incidence of respiratory and gastrointestinal illness across all impairments. Further research should examine associated risk factors and the influence of impairment categorisation.
DRG-LLaMA : tuning LLaMA model to predict diagnosis-related group for hospitalized patients
Authors: Hanyin Wang, Chufan Gao, Christopher Dantona, Bryan Hull, Jimeng Sun
Journal: npj Digital Medicine (2024)

In the U.S. inpatient payment system, the Diagnosis-Related Group (DRG) is pivotal, but its assignment process is inefficient. The study introduces DRG-LLaMA, an advanced large language model (LLM) fine-tuned on clinical notes to enhance DRGs assignment. Utilizing LLaMA as the foundational model and optimizing it through Low-Rank Adaptation (LoRA) on 236,192 MIMIC-IV discharge summaries, our DRG-LLaMA -7B model exhibited a noteworthy macro-averaged F1 score of 0.327, a top-1 prediction accuracy of 52.0%, and a macro-averaged Area Under the Curve (AUC) of 0.986, with a maximum input token length of 512. This model surpassed the performance of prior leading models in DRG prediction, showing a relative improvement of 40.3% and 35.7% in macro-averaged F1 score compared to ClinicalBERT and CAML, respectively. Applied to base DRG and complication or comorbidity (CC)/major complication or comorbidity (MCC) prediction, DRG-LLaMA achieved a top-1 prediction accuracy of 67.8% and 67.5%, respectively. Additionally, our findings indicate that DRG-LLaMA 's performance correlates with increased model parameters and input context lengths.
Severe Fever with Thrombocytopenia Syndrome Complicated by Haemophagocytic Lymphohistiocytosis: A Retrospective Cohort Study
Authors: Gang Wang, Hong-Han Ge, Lifen Hu, Pei-Jun Guo, Ning Cui, Chuan-Long Zhu, Ling Lin, Wei Liu
Journal: Clinical Microbiology and Infection (2024)