tbuckley/cabot-search huggingface dataset:
Deep margin involvement after shave biopsy for melanoma and requirement for sentinel lymph node biopsy (SLNB).
Authors: A. Page, M. C. Lowe, N. Hill, D. R. Murray, G. W. Carlson, P. Bonaccorsi, S. Chen, K. A. Delman
Journal: Journal of Clinical Oncology (2010)

e19029 Background: One indication for SLNB in thin melanomas is an involved deep margin. While shave biopsy is discouraged as a method of diagnosing pigmented lesions, it is frequently used by dermatologists, particularly in the community. This approach can lead to a positive deep margin, which would result in unnecessary SLNBs. Patients undergoing SLNB for melanoma were analyzed to determine how frequently shave biopsy with positive margins alone led to a recommendation for SLNB. Methods: Patients who underwent SLNB for primary cutaneous melanoma with Breslow thickness less than 1 mm between 2000 and 2006 were identified from the Emory Prospective Melanoma Database. Charts were reviewed for patient, diagnostic and therapeutic data to determine how frequently a shave biopsy with a positive deep margin was the only indication for SLNB. Results: Of 250 melanomas with Breslow thickness less than 1 mm that underwent SLNB, 156 (62%) were shave biopsies of which 85 (34%) were transected with positive deep margins. Sixty-one (72%) of these were Clark's Level IV and 1 (1.1%) was ulcerated. Thus 27% (n = 23) of patients with positive deep margins from shave biopsy underwent SLNB with no other indication. Of the 85 transected shave biopsies, 3 (3.5%) had a positive SLNB compared with 2 (2.8%) of the remaining 71 nontransected shave biopsies. Conclusions: For patients at high risk for general anesthesia the increased rate of SLNBs due to shave biopsy warrants careful consideration of the use of this biopsy technique. However, shave biopsy may be a reasonable diagnostic method for patients at low risk for general anesthesia. Shave biopsy does not appear to impact incidence of positive SLNBs. No significant financial relationships to disclose.
Folinic acid + 5-Fluorouracil (5-FU) versus equidose 5-FU in advanced colorectal cancer. Phase III study of ‘GISCAD’ (Italian Group for the Study of Digestive Tract Cancer)
Authors: R. Labianca, G. Pancera, E. Aitini, S. Barni, A. Beretta, G.D. Beretta, B. Cesana, G. Comella, L. Cozzaglio, M. Cristoni, P. Spagnolli, L. Frontini, O. Gottardi, G. Martignoni, R. Scapaticci, F. Smerieri, M. Vinci, A. Zadro, A. Zaniboni, G. Luporini
Journal: Annals of Oncology (1991)
Delivering thrombectomy for acute stroke using cardiology services
Authors: Andrew Apps, Soroosh Firoozan, Tito Kabir
Journal: BMJ (2015)

Why should the location of an acutely occluded artery affect who gets treated?

Evidence is mounting for the supplementary benefit over thrombolysis of endovascular therapy in selected patients with acute stroke. Mechanical percutaneous removal of intracerebral clot using an aspiration catheter ensures that the artery is recanalised. Like thrombolysis, the benefits are greater with early treatment, and we need to think about how to achieve this. Evidence on the benefits of rapid primary percutaneous coronary intervention in patients presenting with ST segment elevation myocardial infarction (STEMI) led to a network being set up in the United Kingdom to provide 24 hour care.1 Teams staffing these networks, skilled in opening arteries quickly, could also provide endovascular therapy to selected patients with acute stroke.

Patients with acute stroke should have thrombolysis within 4.5 hours of the onset of symptoms, after bleeding has been excluded.2 The most recent meta-analysis comparing thrombolysis with conservative management3 found that, if administered within three hours, the number needed to treat (NNT) to achieve one further independent patient (modified Rankin score of 0-2) is 11.3 Delay diminishes benefit; if thrombolysis is given …
Does lung function predict response to therapy in PAH associated with connective tissue disease
Authors: Christopher Valerio, Benjamin Schreiber, Clive Handler, Christopher Denton, John Coghlan
Journal: European Respiratory Journal (2012)

Introduction  PAH specific therapies have been trialled in several lung diseases without success. It has also been shown that a low FVC is associated with a poor prognosis in CTD-PAH.  Methods  From the Royal Free Hospital pulmonary hypertension associated with connective tissue disease database we identified patients with lung function tests within 6 months of right heart catheterisation performed to confirm pulmonary hypertenson. Patients who had repeat haemodynamic studies within a year of diagnosis on first line therapy (bosentan) were included.  Results  There were no significant haemodynamic differences between groups at baseline (ANOVA). Follow up catheter studies demonstrated a good haemodynamic response with improvements in mean PA pressure (FVC >94%) and pulmonary vascular resistance (FVC >70%).  The changes seen in the FVC   Conclusion  A low FVC does not preclude a good treatment response, suggesting that PAH can co-exist with lung fibrosis in connective tissue diseases. Treatment of both pathologies may be needed to improve outcomes in this difficult group.
Disseminating good practice in clinical information
Authors: D. Carnall
Journal: BMJ (2000)

Information in practice p 160 

Doctors and other health professionals are increasingly engaged in projects that attempt to harness better management of information for the good of their patients. At the BMJ we know this because we are often sent papers that describe such efforts in the hope that we will publish them.

As editors we face a dilemma: these papers are not generally of high quality in a scientific sense, yet if we ignore them we miss the chance to …
Immunophenotypic parameters and RBC alloimmunization in children with sickle cell disease on chronic transfusion
Authors: Robert S. Nickel, John T. Horan, Ross M. Fasano, Erin Meyer, Cassandra D. Josephson, Anne M. Winkler, Marianne E.M. Yee, Leslie S. Kean, Jeanne E. Hendrickson
Journal: American Journal of Hematology (2015)

Alloimmunization against red blood cell (RBC) antigens is a cause of morbidity and mortality in transfused patients with sickle cell disease (SCD). To investigate distinguishing characteristics of patients who develop RBC alloantibodies after transfusion (responders) versus those who do not (non-responders), a cross-sectional study of 90 children with SCD on chronic RBC transfusion therapy at a single institution was conducted in which 18 immune parameters (including T and B cell subsets) were tested via flow cytometry, and medical records were reviewed. RBC alloimmunization was present in 26/90 (29%) patients, with anti-E, K, and C among the most commonly detected alloantibodies despite prophylactic matching for these antigens at the study institution. In addition, RBC autoantibodies had been detected in 18/26 (69%) of alloimmunized versus 7/64 (11%) of non-alloimmunized patients (P < 0.0001). Alloimmunized patients were significantly older (median 13.0 years vs. 10.7 years, P = 0.010) and had more RBC unit exposures (median 148 U vs. 82 U, P = 0.020) than non-alloimmunized patients. Sex, age at initiation of chronic transfusion, splenectomy, stroke, and transfusion outside of the study institution were not significantly associated with RBC alloimmunization. Alloimmunized patients had a significantly increased percentage of CD4+ T memory cells compared to non-alloimmunized patients (57% vs. 49%, P = 0.0047), with no other significant differences in immune cell subsets or laboratory values detected between these groups. Additional research of RBC alloimmunization is needed to optimize transfusion therapy and to develop strategies to prevent alloimmunization.
AQP5 role in ovalbumin-induced airway inflammation and secretion of MUC5AC in mice
Authors: Chunling Dong, Guifang Wang, Meiling Jin, Bo Li, Diane Wang, Zhihong Chen, Zhongsen Ma, Xiangdong Wang, Chunxue Bai
Journal: European Respiratory Journal (2011)

Background:  Airway inflammation and mucus hypersecretion are two important characteristic features of the pathogenesis of asthma. Aquaporin5 (AQP5) is known to be a water channel protein expressed widely in lung epithelium and submucosal glands.   Objective:  The present study aimed at investigating the involvement of AQP5 in asthma.   Methods:  The ovalbumin (OVA)-induced allergic pulmonary inflammation and MUC5AC production were examined in AQP5 +/+  or AQP5 –/–  mice. The expression of AQPs in lung tissue and their regulation were detected. In addition, epidermal growth factor receptor (EGFR) expression and osmotic water permeability in lung were evaluated.   Results:  Lower expression of AQP1, 4, 5 while higher AQP3 was significant in lung tissue from AQP5 +/+  model mice. Only AQP1 and AQP5 were up-regulated by anti-asthmatic agents (dexamethasone, ambroxol and terbutaline) significantly. However, AQP5 knockout had significantly low airway inflammation and less lung edema induced by OVA, as compared with those in AQP5 +/+  mice. In addition, lower expression of MUC5AC in airway epithelium, less secretion of MUC5AC were found in AQP5 –/–  model mice. Moreover, the expression of EGFR on airway epithelium was prevented by AQP5 knockout in asthmatic model.   Conclusion:  Our data indicate that AQP5 is involved in the development of allergic airway inflammation and mucus hypersecretion by regulating osmotic water permeability and expression of EGFR.
Abstract 1615: Is Plasma B-type Natriuretic Peptide Measurement Valid for Prediction of Cardiovascular Events and Death in Obese Subjects?
Authors: Yorihiko Koeda, Toshie Segawa, Fumitaka Tanaka, Tomohiro Takahashi, Toshiaki Sakai, Yoshinori Kanaya, Toshiyuki Onoda, Kazuyoshi Itai, Masaki Ohsawa, Kozo Tanno, Kiyomi Sakata, Yuki Yoshida, Shinji Makita, Kazuko Kawamura, Akira Okayama, Motoyuki Nakamura
Journal: Circulation (2009)

BACKGROUND: Circulating levels of B-type natriuretic peptide (BNP) have been reported to be relatively low in obese individuals, and this humoral dysfunction may be a mechanism linking obesity to t...
Response to Cyclophosphamide, Methotrexate, and Fluorouracil in Lymph Node–Positive Breast Cancer According to <i>HER2</i> Overexpression and Other Tumor Biologic Variables
Authors: Sylvie Ménard, Pinuccia Valagussa, Silvana Pilotti, Luca Gianni, Elia Biganzoli, Patrizia Boracchi, Gorana Tomasic, Patrizia Casalini, Ettore Marubini, Maria I. Colnaghi, Natale Cascinelli, Gianni Bonadonna
Journal: Journal of Clinical Oncology (2001)

PURPOSE: There is considerable interest in biologic markers able to predict the response of cancer patients to therapy. HER2 overexpression is a potential indicator of responsiveness to doxorubicin and paclitaxel and of unresponsiveness to tamoxifen in breast carcinoma patients. However, the significance of HER2 overexpression in responsiveness to cyclophosphamide, methotrexate, and fluorouracil (CMF) has remained unclear. In this study, we investigated this issue in the 386 breast cancer patients in the first CMF controlled clinical trial with a 20-year follow-up. PATIENTS AND METHODS: Node-positive breast carcinoma patients were randomly assigned to receive either no further treatment after radical mastectomy (179 women) or 12 monthly cycles of adjuvant CMF chemotherapy (207 women). Overexpression of HER2 and the status of other tumor variables was assessed by immunohistochemistry in at least 324 (84%) of the 386 patients. Statistical analyses were performed to assess the efficacy of CMF treatment for the subgroups defined by HER2 and the status of other variables using a Bayesian approach. The end points considered were relapse-free survival (RFS) and cause-specific survival (CSS). RESULTS: Bayesian analysis of the treatment effect for HER2 and other variables indicated a clinical benefit from CMF treatment in all subgroups defined according to variables status. In particular regarding HER2 status, Bayesian estimates of RFS hazard ratios were equal to 0.484 and 0.641 and estimates of CSS hazard ratios were equal to 0.495 and 0.730 for HER2-positive and -negative tumors, respectively. CONCLUSION: CMF treatment showed a clinical benefit in the considered subgroups, defined according to HER2 and other tumor variables status. Patients with HER2-positive or HER2-negative tumors benefit from CMF treatment, and the poor prognosis associated with the HER2 overexpression in the untreated group could be completely overcome by the chemotherapy treatment.
Organization, teamwork, and advocacy: Important skills needed by hospice family caregivers who manage medications.
Authors: Jennifer Tjia, Maija Reblin, Celeste Lemay, Margaret Clayton, Lee Ellington
Journal: Journal of Clinical Oncology (2014)

121 Background: In the home hospice setting, family caregivers (CGs) often assume medication administration responsibilities traditionally performed by licensed nurses. Little is known about how to assess and support CG medication management skills. As part of an ongoing study of nurse-caregiver interactions in home hospice, we gathered data on CG medication management needs. Methods: A longitudinal, multicenter study of home hospice nurse visits captured audiorecorded communication between nurses and CGs. Participants included patients with cancer and their self-identified CGs who were recruited upon home hospice enrollment. The current sub-study included participants aged ≥65 and their family CGs from 7 hospice agencies. Two investigators independently coded transcriptions of the first audio recorded nurse home visit using a directive content analytic approach to map conversations to a previously published, interview-derived, framework for hospice medication management by CGs. Results: A total of 18 patients (mean age 76.5 [SD 10.7], 56% female) and their CGs (mean age 59.6 [SD13.4], 78% female) were included. Content analysis revealed that CG skills needed for medication management are not limited to drug knowledge. Complicated organizational skills are needed to track medication acquisition and dosing, record the use of short- and long-acting drugs with similar modes of action, and coordinate medication administration by multiple CGs. Teamwork skills are needed to help coordinate medication prescribing between specialist, primary, and hospice physicians. CGs also need symptom management skills regarding the proper selection of medications, as well as skills to manage side effects, inadvertent errors, and possible medication related-emergencies. CGs play a vital role in patient advocacy, alerting providers to the burden and quality of life issues related to medication use, including whether medications have intended or unintended effects, or are potentially unnecessary or causing harm. Conclusions: CGs must have multiple skills to effectively manage medications in home hospice. A systematic approach and intervention is needed to support CGs’ medication management skills.
NHS in Scotland needs urgent change for it to survive, say colleges
Authors: B. Christie
Journal: BMJ (2015)

The royal nursing and medical colleges in Scotland have come together to issue a warning on the future sustainability of the health service. They have said that new ways must be found to deliver the service, because funding would not keep pace with rising demand from patients, especially from an increasing population of elderly people, and with cost pressures such as expensive new treatments.

A statement issued by the Academy of Royal Medical Colleges and Faculties in Scotland, the Royal College …
Spontaneous rupture of the liver.
Authors: B Arnesjö, S Bengmark, I Ihse, B G Petersson, H Tornqvist, J Vang
Journal: BMJ (1976)

Four cases of spontaneous rupture of the liver are reported. In all these cases, pathological processes in the liver caused the rupture, i.e. primary hepatoma in 3 cases and a benign angiomatous tumour in one case. In one case, the diagnosis was not established until autopsy and in 3 cases at operation. In one of these latter cases, however, the bleeding source was not found until at a secondary surgical exploration. In none of the patients was the diagnosis suspected preoperatively. Four-quadrant puncture is highly recommended even in patients with only a slight suspicion of intra-abdominal hemorrhage. In cases with a ruptured solitary primary liver tumour, an acute liver resection might be performed. If there are multiple tumours--primary or secondary--simple hemostasis seems to be the treatment of choice. In patients with intra-abdominal hemorrhage, thorough palpation of the whole liver is an obligatory manovre during surgery.
BILATERAL INTERNAL JUGULAR BLOOD
Authors: E. L. GIBBS, W. G. LENNOX, F. A. GIBBS
Journal: American Journal of Psychiatry (1945)

Blood was drawn simultaneously from an artery and the two internal jugular veins in 25 subjects. The oxygen A-V difference was approximately the same on the two sides, except in 4 patients with psychosis, and in 4 epileptics with left-sided cerebral pathology. In the latter the oxygen A-V difference on the affected side was relatively great, suggesting a diminished blood flow. In all but 3 of the 25 cases the respiratory quotient approached unity, the average in these 22 being .995 on the right side and .994 on the left side. Variations in the A-V differences in oxygen, as between both individuals and the two sides, did not cause a shift in the value of the respiratory quotient. The average ratio of the A-V difference of oxygen (in volumes percent) to the A-V difference of glucose (in milligrams percent) was equal, 1.63 on the right side and 1.62 on the left. In 7 cases hyperpnea produced the usual increase in the oxygen A-V difference, with-out consistent differences on the two sides, even in the presence of unilateral brain pathology. Simultaneous puncture of the jugulars and artery is not necessary if A-V differences in the oxygen content of the blood are being measured, but it is necessary if the carbon dioxide content, the respiratory quotient, or the oxygen-glucose ratios are being measured.
Variations in MHC Class II Antigen Processing and Presentation in Health and Disease
Authors: Emil R. Unanue, Vito Turk, Jacques Neefjes
Journal: Annual Review of Immunology (2016)

MHC class II (MHC-II) molecules are critical in the control of many immune responses. They are also involved in most autoimmune diseases and other pathologies. Here, we describe the biology of MHC-II and MHC-II variations that affect immune responses. We discuss the classic cell biology of MHC-II and various perturbations. Proteolysis is a major process in the biology of MHC-II, and we describe the various components forming and controlling this endosomal proteolytic machinery. This process ultimately determines the MHC-II-presented peptidome, including cryptic peptides, modified peptides, and other peptides that are relevant in autoimmune responses. MHC-II also variable in expression, glycosylation, and turnover. We illustrate that MHC-II is variable not only in amino acids (polymorphic) but also in its biology, with consequences for both health and disease.
The past: ‘the good old days’
Authors: David Innes Williams
Journal: Journal of the Royal Society of Medicine (1998)

Sir David Innes Williams was educated at Cambridge and University College Hospital, he qualified in 1942 and took resident posts at UCH before joining the Army. In 1944 he gained FRCS and served in India as a surgical specialist (Major RAMC). Returning to London he chose a specialist career and, after junior experience at St Peter's Hospital and the Hospital for Sick Children Great Ormond Street, was appointed urological surgeon at both those hospitals. He soon concentrated on paediatric urology and children's work gradually excluded adult practice. He was elected President of the British Association of Urological Surgeons in 1976. Two years later he resigned from his hospitals to become Director of the British Postgraduate Medical Federation, and later Pro-Vice-Chancellor of the University of London. He served on the GMC, was Vice President of the Royal College of Surgeons, Chairman of the Imperial Cancer Research Fund, President of the BMA 1988–1989 and of The Royal Society of Medicine, 1990–1992.
Health-Related Quality of Life 1 Year After Allogeneic or Autologous Stem-Cell Transplantation: A Prospective Study
Authors: Marianne J. Hjermstad, Stein A. Evensen, Stein O. Kvaløy, Peter M. Fayers, Stein Kaasa
Journal: Journal of Clinical Oncology (1999)

PURPOSE: To evaluate health-related quality of life (HRQOL) in adults treated with high-dose chemotherapy followed by allogeneic (SCT) and autologous (ASCT) stem-cell transplantation 1 year after transplantation, using data from concurrent lymphoma patients receiving combination chemotherapy (CT) as a reference. MATERIALS AND METHODS: Forty-one leukemia patients (SCT group), 51 lymphoma patients (ASCT group), and 85 CT patients completed the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire at baseline and after 1 year. RESULTS: The SCT group (median age, 36 years) had better functioning scores and less symptomatology at baseline compared with the ASCT (median age, 41 years) and CT (median age, 37 years) groups. Statistically significant differences of 10 or more points on the 0 to 100 scales were found for 10 of 15 scales and items (P ≤ .01) between the SCT and ASCT groups. Global quality of life (79 v 58, P &lt; .0001), role function (83 v 65, P = .001), sleep disturbances (6 v 28, P &lt; .0001), and fatigue (25 v 44, P = .0001) deviated most. The differences were 10 or more points for seven of 15 scales and items comparing the SCT and CT groups, with sleep disturbances (6 v 35, P &lt; .0001) and pain (11 v 29, P &lt; .01) deviating most. Differences across groups were smaller after 1 year; cognitive function was the only scale with a statistically significant difference (ASCT 80 v CT 89; P = .002). Patterns of change in HRQOL scores were different between groups during follow-up. A great improvement was found in the ASCT group (P &lt; .01 for emotional and role function, fatigue, appetite, and constipation), whereas no significant changes were observed for the SCT group. CONCLUSION: Prospective studies with extended follow-up periods are necessary to separate a slow recovery process from more permanently reduced HRQOL after transplantation and to examine the late side effects from previous treatment.