Miracle-dz/UniFAR-FTUs huggingface dataset:
Ovarian Cancer Rates After Hysterectomy With and Without Salpingo-Oophorectomy

OBJECTIVE: To estimate ovarian and peritoneal cancer rates after hysterectomy with and without salpingo-oophorectomy for benign conditions. METHODS: All patients after hysterectomy for benign disease from 1988 to 2006 in Kaiser Permanente Northern California, an integrated health organization. Incidence rates per 100,000 person-years were calculated. RESULTS: Of 56,692 patients, the majority (54%) underwent hysterectomy with bilateral salpingo-oophorectomy; 7% had hysterectomy with unilateral salpingo-oophorectomy, and 39% had hysterectomy alone. There were 40 ovarian and eight peritoneal cancers diagnosed during follow-up. Median age at ovarian and peritoneal cancer diagnosis was 50 and 64 years, respectively. Age-standardized rates (per 100,000 person-years) of ovarian or peritoneal cancer were 26.7 (95% confidence interval [CI] 16–37.5) for those with hysterectomy alone, 22.8 (95% CI 0.0–46.8) for hysterectomy and unilateral salpingo-oophorectomy, and 3.9 (95% CI 1.5–6.4) for hysterectomy and bilateral salpingo-oophorectomy. Rates of ovarian cancer were 26.2 (95% CI 15.5–37) for those with hysterectomy alone, 17.5 (95% CI 0.0–39.1) for hysterectomy and unilateral salpingo-oophorectomy, and 1.7 (95% CI 0.4–3) for those with hysterectomy and bilateral salpingo-oophorectomy. Compared with women undergoing hysterectomy alone, those receiving an unilateral salpingo-oophorectomy had a hazard ratio (HR) for ovarian cancer of 0.58 (95% CI 0.18–1.9) and those undergoing bilateral salpingo-oophorectomy had an HR of 0.12 (95% CI 0.05–0.28). CONCLUSIONS: The removal of both ovaries decreases the incidence of ovarian and peritoneal cancers. Removal of one ovary might also decrease the incidence of ovarian cancer but warrants further investigation. LEVEL OF EVIDENCE: II
The Handbook of Research Synthesis

Ed Harris Cooper, Larry V Hedges, Russell Sage Foundation, $49.95, pp 573 ISBN 0-87154-226-9 Methods for combining results across different studies have existed since the early ‘thirties, but the use of quantitative techniques for synthesising research results was rare until about 15 years ago. Meta- analysis, as the statistical analysis of a large collection of results from individual studies is called, has now achieved a status of respectability in medicine. This respectability, when combined with the slight hint of mystique …
Effect of cysteine mutagenesis on human IgE reactivity of recombinant forms of the major rye grass pollen allergen Lol p 1

ABSTRACT Background Hypersensitivity to the group 1 grass pollen allergens is a significant causative factor in the onset of symptoms for hay fever sufferers. To better understand the IgE reactivity of the group 1 allergen from rye grass pollen, we sought to disrupt potential conformational IgE epitopes on recombinant (r) Lol p 1 by the specific replacement of the seven cysteine residues in the protein sequence. Methods Site-directed mutagenesis on the Lol p 1 coding sequence was used to replace all seven cysteine residues with serine residues. rLol p 1 and the seven cysteine variants generated by this method were tested for comparative human IgE reactivity via western blot immunoscreening and densitometry. Results Alteration of the cysteine residues at amino acid positions 72, 77, 83 and 139 of rLol p 1 was found to reduce the human IgE binding potential of the molecule. However, the most consistent reduction in human IgE reactivity was demonstrated by replacement of C 77 ; human IgE antibodies showed an average 62.7% reduction in reactivity to this molecule. Conclusions The present investigation has shown that at least one of the cysteine residues within the Lol p 1 protein contributes to the IgE binding properties of this allergen.
Association Between the New Hampshire Parental Notification Law and Minors Undergoing Abortions in Northern New England

OBJECTIVE: To assess the association of the 2012 New Hampshire parental notification law with patterns of abortion in northern New England minors. METHODS: This was a retrospective cohort study examining all minors undergoing abortions at Planned Parenthood clinics in Vermont, New Hampshire, and Maine from 2011 to 2012. RESULTS: The number of abortions among minors in New Hampshire decreased from 95 to 50 (47%, 95% confidence interval [CI] 37.03–57.88; P=.015) from 2011 to 2012. Minors residing in Massachusetts, which has a parental consent law, accounted for 62% of this change. Abortions among New Hampshire minors decreased by 19% (from 57 to 46, 95% CI 10.05–31.91; P=.707), and minors did not seek more abortions at Planned Parenthood clinics in Vermont or Maine. The average age, gestational age, and number of second-trimester cases did not change. Parental awareness of the abortion increased from 2011 to 2012 in New Hampshire (54%, 95% CI 44.21–63.96 to 92%, 95% CI 80.65–97.36; P<.001); however, there was no difference in the overall rate of adult involvement during the study period. Four (8%) minors in New Hampshire used the judicial bypass option. CONCLUSION: Implementation of the New Hampshire parental notification law correlated with a decrease in minors undergoing abortions at Planned Parenthood clinics in the state, largely as a result of a decrease in the number of minors coming from Massachusetts. There was an increase in parental involvement but no change in overall adult involvement, and use of the judicial bypass option or minors crossing state lines was uncommon.
Aberrant expression of epidermal growth factor receptor and its interaction with protein kinase C δ in inflammation associated neoplastic transformation of human esophageal epithelium in high risk populations

Background and Aim: Esophageal cancer is the second most common cancer among Indian males and is mostly associated with tobacco smoking and alcohol consumption. Epidermal growth factor receptor (EGFR) is a member of Type I tyrosine kinases. Its activation causes the docking of various proteins in its cytosolic tail. In the present study we have analyzed the expression pattern of EGFR, protein kinase C δ (PKCδ), tumor necrosis factor‐α (TNF‐α), nuclear factor κB (NFκB) and the interactions between EGFR and PKCδ in various pathological conditions.
Basics in microbiology for the patient requiring intensive care

Abstract The major aim of the article is to clearly define the basic concepts of carriage, colonization and infection. The individuals defence system consisting of three potent lines of defence against carriage, colonization and infection is described in detail. Surveillance samples of throat and rectum are required to measure carriage defence and are distinguished from diagnostic samples including lower airway secretions and blood for the evaluation of the quality of the last two defence barriers against colonization and infection. Microbes and infections are classified using the concept of the carrier state. Low level pathogens are distinguished from high level pathogens and potentially pathogenic microorganisms. Low level pathogens including viridans streptococci, enterococci and coagulase negative staphylococci only cause morbidity. High level pathogens including Salmonella and potential pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella, Acinetobacter baumannii and Pseudomonas aeruginosa causing pneumonia and/or septicaemia, cause attributable mortality. The concept of the carrier state allows the distinction of primary endogenous from secondary endogenous and exogenous infections. Seven recent studies demonstrate that the major infection problem is primary endogenous due to potential pathogens imported into the unit, varying between 50% and 75% in adult and paediatric units respectively. Nosocomial infections due to intensive care unit (ICU) microbes only include secondary endogenous and exogenous infections. Infection control targets the three types of infection mainly due to potential pathogens. To control primary endogenous infections parenteral antibiotics are administered immediately on admission. Eradication of digestive tract overgrowth by abnormal flora using enteral non-absorbable antibiotics controls secondary endogenous infections besides restoring systemic immunity. A high level of hygiene is required to prevent exogenous infection. Surveillance cultures are indispensable for the evaluation of the efficacy and compliance of this protocol, termed selective decontamination of the digestive tract (SDD) which has been shown to reduce morbidity and mortality by 65% and 20%, respectively.
Effects of weak mobile phone—Electromagnetic fields (GSM, UMTS) on event related potentials and cognitive functions

Modern mobile phones emit electromagnetic fields (EMF) ranging from 900 to 2000 MHz which are suggested to have an influence on well‐being, attention and neurological parameters in mobile phone users. Until now most studies have investigated Global System for Mobile Communications (GSM)‐EMF and only very few studies have focused on Universal Mobile Telecommunications System (UMTS)‐EMF. Therefore, we tested the effects of both types of unilaterally presented EMF, 1950 UMTS (0.1 and 1 W/kg) and pulsed 900 MHz GSM (1 W/kg), on visually evoked occipital P100, the P300 of a continuous performance test, auditory evoked central N100 and the P300 during an oddball task as well as on the respective behavioral parameters, reaction time and false reactions, in 15 healthy, right handed subjects. A double‐blind, randomized, crossover application of the test procedure was used. Neither the UMTS‐ nor the GSM‐EMF produced any significant changes in the measured parameters compared to sham exposure. The results do not give any evidence for a deleterious effect of the EMF on normal healthy mobile phone users. Bioelectromagnetics 29:488–497, 2008. © 2008 Wiley‐Liss, Inc.
The Most Commonly Dispensed Prescription Medications Among Pregnant Women Enrolled in the U.S. Medicaid Program

OBJECTIVE: To characterize the 20 most common prescription medications and the 10 most common prescription medications classified in the former U.S. Food and Drug Administration categories D or X dispensed to pregnant women enrolled in the U.S. Medicaid program. METHODS: We conducted a cohort study of 1,106,757 pregnant women with live births using 2000–2007 Medicaid Analytic eXtract data. We used outpatient pharmacy records to identify medication dispensings and reported the proportion of pregnancies that were dispensed at least one prescription medication. Maternal age and race and ethnicity-stratified estimates were compared using prevalence ratios and 95% confidence intervals (CIs). RESULTS: During pregnancy, 82.5% of the cohort had a dispensing for one or more prescription medication. The most commonly dispensed medications during pregnancy included nitrofurantoin (21.6%), metronidazole (19.4%), amoxicillin (18.0%), azithromycin (16.9%), and promethazine (13.5%). Proportions were highest among younger women for several medications; eg, nitrofurantoin (23.9% compared with 15.4%; prevalence ratio 1.55, CI 1.52–1.58), metronidazole (20.7% compared with 12.0%; prevalence ratio 1.73, CI 1.69–1.77), and azithromycin (21.1% compared with 11.0%; prevalence ratio 1.93, CI 1.89–1.97) were more common among women younger than 20 years than among women aged 35 years or older. Proportions were highest among white women with some exceptions; eg, compared with white women, metronidazole was more common among black women (29.8% compared with 14.4%; prevalence ratio 2.07, CI 2.05–2.09). Excluding fertility treatments, 42.0% had at least one dispensing for a D or X medication during pregnancy. Codeine (11.9%) and hydrocodone (10.2%) were the most common D medications. CONCLUSION: Medications used to treat infections were the most commonly dispensed prescription medications. Dispensing of commonly used prescription medications during pregnancy varied by maternal age and race–ethnicity. LEVEL OF EVIDENCE: II
A Cost–Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States

OBJECTIVE: To develop a decision model to evaluate the risks, benefits, and costs of different approaches to aspirin prophylaxis for the approximately 4 million pregnant women in the United States annually. METHODS: We created a decision model to evaluate four approaches to aspirin prophylaxis in the United States: no prophylaxis, prophylaxis per American College of Obstetricians and Gynecologists (the College) recommendations, prophylaxis per U.S. Preventive Services Task Force recommendations, and universal prophylaxis. We included the costs associated with aspirin, preeclampsia, preterm birth, and potential aspirin-associated adverse effects. TreeAge Pro 2011 was used to perform the analysis. RESULTS: The estimated rate of preeclampsia would be 4.18% without prophylaxis compared with 4.17% with the College approach in which 0.35% (n=14,000) of women receive aspirin, 3.83% with the U.S. Preventive Services Task Force approach in which 23.5% (n=940,800) receive aspirin, and 3.81% with universal prophylaxis. Compared with no prophylaxis, the U.S. Preventive Services Task Force approach would save $377.4 million in direct medical care costs annually, and universal prophylaxis would save $365 million assuming 4 million births each year. The U.S. Preventive Services Task Force approach is the most cost-beneficial in 79% of probabilistic simulations. Assuming a willingness to pay of $100,000 per neonatal quality-adjusted life-year gained, the universal approach is the most cost-effective in more than 99% of simulations. CONCLUSION: Both the U.S. Preventive Services Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower health care costs in the United States to a much greater degree than the approach currently recommended by the College.
Association of Preoperative Thrombocytosis and Leukocytosis With Postoperative Morbidity and Mortality Among Patients With Ovarian Cancer

OBJECTIVE: To examine whether preoperative thrombocytosis or leukocytosis is associated with increased postoperative morbidity or mortality. METHODS: Patients with ovarian cancer undergoing primary surgery from 2005 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Project. Thrombocytosis was defined as platelets greater than 450,000/mm3 and leukocytosis as white blood cells greater than 10,000/mm3. We examined 30-day postoperative complications and mortality. Descriptive statistics and adjusted multivariable logistic regression were used for analysis. RESULTS: We identified 1,072 patients. The incidence of thrombocytosis was 9.6%, leukocytosis was 18.7%, and 4.9% had both. Leukocytosis was associated with major complication (16.5% compared with 10.3%, P=.01) but not postoperative death (3.0% compared with 1.3%, P=.08). Thrombocytosis was also associated with major complication (19.4% compared with 10.7%, P<.01) but not postoperative death (2.9% compared with 1.5%, P=.30). Patients with both thrombocytosis and leukocytosis had increased rates of both major complication (22.6% compared with 10.9%, P<.001) and mortality (5.7% compared with 1.4%, P=.02). In logistic regression adjusting for age, comorbidities, and surgical complexity, major complication remained associated with thrombocytosis (adjusted odds ratio [OR] 2.16, 95% confidence interval [CI], 1.25–3.74, P<.01) and leukocytosis (adjusted OR 1.78, 95% CI, 1.13–2.80, P=.01). Additionally, thrombocytosis and leukocytosis together were associated with postoperative death (adjusted OR 5.4, 95% CI, 1.4–22.3, P=.02). CONCLUSION: Preoperative thrombocytosis or leukocytosis is associated with an increased risk of major postoperative complication. Patients with both thrombocytosis and leukocytosis experienced twice the rate of major complication and a fourfold increase in postoperative death. LEVEL OF EVIDENCE: II
INV 33 Targeting cellular proliferation and angiogenesis: a multitargeted approach to cancer treatment

Recent progress in molecular oncology has led to the discovery of novel intracellular targets and the development of several new selective agents for cancer treatment. Angiogenesis plays a key role in the progression of most solid tumours, is essential from the initiation of tumour growth until metastasis and is vital for tumour survival. Hence, molecules critical in the regulation of angiogenesis are potential targets for cancer treatment. VEGFRs, located on vascular endothelial cells, are key players in the angiogenic process and are well recognized targets for antiangiogenic strategies. However, tumour growth and survival requires both proliferative and angiogenic signals. It was recently shown that vascular endothelial cells and pericytes work together to promote angiogenesis, and PDGFRs (particularly, PDGFR-b) located on pericytes have emerged as additional important targets for anti-angiogenic treatments. Preclinical studies suggest that simultaneous targeting of VEGFR and PDGFR produces greater and more long-lasting antiangiogenic effects than treatments focused on either alone. PDGFR signaling may also play a role in direct regulation of cellular proliferation and migration in some tumours. Sunitinib is a multitargeted receptor tyrosine kinase (RTK) inhibitor with both antiangiogenic and direct antitumour activities that selectively targets all subtypes of VEGFR and PDGFR, KIT, and various other RTKs implicated in various cancers. VEGF and PDGF, the respective ligands for VEGFR and PDGFR, are both overexpressed in melanoma, and angiogenic serum factors have been reported to serve as prediction markers for overall survival and PFS in patients with melanoma. In addition, some melanomas are associated with mutated KIT receptors. Overexpression of KIT, VEGFR, and PDGFR have also been reported in patients with melanoma. Therefore, sunitinib could exhibit activity in melanoma when used as a single-agent or in combination with other anticancer agents. A phase I/II study has been designed and is currently recruiting patients to study sunitinib in combination with temozolomide for patients with malignant melanoma. Angiogenesis is recognized as a hallmark of melanoma progression and tumour microenvironment is increasingly important. However, while angiogenesis is an important therapeutic target for cancer, the value of angiogenesis as a target for melanoma therapy is still unclear. Angiogenesis inhibitors in melanoma will probably be more effective in combination with other signal transduction inhibitors or with chemotherapy.
Utilization and Toxicity of Alternative Delivery Methods of Adjuvant Chemotherapy for Ovarian Cancer

OBJECTIVE: Compared with conventional intravenous platinum and taxane-based chemotherapy for ovarian cancer, both intraperitoneal chemotherapy and more frequent dose-dense intravenous chemotherapy have been associated with improved survival in some studies. We examined the utilization and toxicity of these three methods of chemotherapy delivery in women with ovarian cancer. METHODS: We performed a population-based study and analyzed data on women with ovarian cancer who underwent primary surgery followed by platinum and taxane-based chemotherapy from 2009 to 2013 who were recorded in the MarketScan database. Adjuvant chemotherapy was classified as: intraperitoneal chemotherapy, dose-dense chemotherapy (weekly administration of chemotherapy), or standard chemotherapy (every 3 weeks). Hospitalizations and emergency department visits for chemotherapy-associated complications and costs were recorded and compared using &khgr;2 tests. RESULTS: A total of 5,892 patients, including 4,135 (70.2%) who received standard chemotherapy, 859 (14.6%) who received intraperitoneal chemotherapy, and 898 (15.2%) treated with dose-dense chemotherapy, were identified. From 2009 to 2013, use of intraperitoneal chemotherapy remained constant (16.3–16.3%), whereas use of dose-dense therapy increased (8.7–18.1%) (P<.001). Hospitalizations for chemotherapy-associated complications occurred in 21.3% of women receiving standard chemotherapy, 34.7% of patients treated with intraperitoneal therapy, and in 25.2% of those receiving dose-dense treatment (P<.001); emergency department visits occurred in 18.3%, 26.3%, and 20.3%, respectively (P<.001). The largest differences in hospitalizations and emergency department visits were seen for gastrointestinal toxicities and electrolyte disorders. The per-patient costs of hospitalization were higher for intraperitoneal chemotherapy than other treatment modalities. CONCLUSION: Intraperitoneal chemotherapy was used in less than 15% of women with ovarian cancer, whereas use of dose-dense chemotherapy is increasing. Although we did not examine survival, intraperitoneal chemotherapy is significantly more toxic than the other methods of treatment.
Association of Sexual Debut in Adolescents With Microbiota and Inflammatory Markers

OBJECTIVE: To investigate the association of sexual debut and vaginal, anorectal, and oral microbiota and vaginal inflammatory markers in female adolescents. METHODS: We conducted a school-based study in adolescents in Antwerp, Belgium. During three visits over 8 months, participants answered questionnaires and self-collected vaginal, anorectal, and oral swabs. Five Lactobacillus species, Lactobacillus genus, Gardnerella vaginalis, and Atopobium vaginae were quantified; and seven inflammatory markers were measured in the vaginal specimens. In the oral and anorectal specimens, Lactobacillus genus, G vaginalis, and A vaginae were ascertained. RESULTS: Of the 93 adolescents (mean age 16.2 years) at the first visit, 41 (44.1%) had passed sexual debut (penile–vaginal intercourse) and five (5.4%) had sexual experience without passing sexual debut. Having sexual experience at the first visit was not found to be associated with species presence or concentrations (acknowledging an underpowered study because the required sample size was not attained). Modeling the longitudinal data on all girls showed that sexual debut was associated with increased odds of vaginal and anorectal G vaginalis (P=.021; P=.030) and A vaginae (P=.041; P=.012) with increments of interleukins (interleukin [IL]-1&agr; P<.001, IL-1&bgr; P=.046, IL-8 P=.033) and chemokines (regulated on activation, normal T cell expressed and secreted P<.001; macrophage inflammatory protein-1&bgr; P=.040), whereas no difference was seen when modeling (before–after) the girls initiating and girls staying without sexual intercourse. The association of sexual intercourse with IL-1&agr; (P<.001), IL-1&bgr; (P=.030), and IL-8 (P=.002) at the first visit was (greater than 70%) mediated by vaginal G vaginalis and A vaginae concentrations. CONCLUSION: Sexual debut in adolescents is associated with an inflammatory vaginal reaction and with the presence of bacterial vaginosis–related species. Strategies preventing the colonization of bacterial vaginosis–related organisms during early sexual debut are urgently needed and may prevent acquisition of sexually transmitted infections including human immunodeficiency virus in early life.