tbuckley/cabot-search huggingface dataset:
Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes
Authors: Brendan M. Everett, Maria Mori Brooks, Helen E.A. Vlachos, Bernard R. Chaitman, Robert L. Frye, Deepak L. Bhatt
Journal: New England Journal of Medicine (2015)

Cardiac troponin concentrations are used to identify patients who would benefit from urgent revascularization for acute coronary syndromes. We hypothesized that they might be used in patients with stable ischemic heart disease to identify those at high risk for cardiovascular events who might also benefit from prompt coronary revascularization.We measured the cardiac troponin T concentration at baseline with a high-sensitivity assay in 2285 patients who had both type 2 diabetes and stable ischemic heart disease and were enrolled in the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes trial. We tested for an association between the troponin T concentration and a composite end point of death from cardiovascular causes, myocardial infarction, or stroke; we then evaluated whether random assignment to prompt revascularization reduced the rate of the composite end point in patients with an abnormal troponin T concentration (≥14 ng per liter) as compared with those with a normal troponin T concentration (<14 ng per liter).Of the 2285 patients, 2277 (99.6%) had detectable (≥3 ng per liter) troponin T concentrations and 897 (39.3%) had abnormal troponin T concentrations at baseline. The 5-year rate of the composite end point was 27.1% among the patients who had had abnormal troponin T concentrations at baseline, as compared with 12.9% among those who had had normal baseline troponin T concentrations. In models that were adjusted for cardiovascular risk factors, severity of diabetes, electrocardiographic abnormalities, and coronary anatomy, the hazard ratio for the composite end point among patients with abnormal troponin T concentrations was 1.85 (95% confidence interval [CI], 1.48 to 2.32; P<0.001). Among patients with abnormal troponin T concentrations, random assignment to prompt revascularization, as compared with medical therapy alone, did not result in a significant reduction in the rate of the composite end point (hazard ratio, 0.96; 95% CI, 0.74 to 1.25).The cardiac troponin T concentration was an independent predictor of death from cardiovascular causes, myocardial infarction, or stroke in patients who had both type 2 diabetes and stable ischemic heart disease. An abnormal troponin T value of 14 ng per liter or higher did not identify a subgroup of patients who benefited from random assignment to prompt coronary revascularization. (Funded by the National Institutes of Health and Roche Diagnostics; BARI 2D ClinicalTrials.gov number, NCT00006305.).
Hematopoietic responses in patients with advanced malignancy treated with recombinant human granulocyte-macrophage colony-stimulating factor.
Authors: F Herrmann, G Schulz, A Lindemann, W Meyenburg, W Oster, D Krumwieh, R Mertelsmann
Journal: Journal of Clinical Oncology (1989)

The in vivo effect of yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor (rh GM-CSF) was investigated in 30 patients with advanced malignancy in a phase Ib trial. Patients were treated at four different dose levels (120 to 1,000 micrograms/m2/d) by either daily intravenous (IV) bolus injection or 24-hour continuous infusion. Administration of rh GM-CSF resulted in a broad spectrum of dose- and schedule-dependent hematopoietic effects. Sustained infusion of rh GM-CSF elicited a maximum 17-fold average peak increase of the total WBC count with mainly neutrophils, eosinophils, and monocytes accounting for this rise, and increases in bone marrow cellularity with a shift to immature myeloid elements. Elevation of lymphocytes, platelets, and reticulocytes was not induced. Within five days after discontinuation of treatment the leukocytosis had disappeared. Adverse reactions encountered with rh GM-CSF seen in 65% of the patients studied were never life-threatening and always rapidly reversible. They included mild myalgias, facial flushing, low-grade fever, headache, bone discomfort, nausea, dyspnea, and transient decline of platelet counts. These results suggest that rh GM-CSF can be safely administered at the doses and schedules used and that it can induce in vivo some of the biological effects reported in in vitro studies. Although no objective antitumour responses have been seen, the ability of rh GM-CSF to increase number and function of leukocytes in vivo may prevent neutropenia and infections when GM-CSF is added to cytotoxic cancer therapy.
Muldisciplinary conference (MDC), oncological program (OP) and practice guidelines (GL): The experience of the lung cancer (LC) clinic of a cancer hospital
Authors: Jean-Paul Sculier, Leclercq Nathalie, Anne-Pascale Meert, Ingrid C.S. Toth, Marianne Paesmans, Thierry Berghmans
Journal: European Respiratory Journal (2014)

Introduction : the ERS taskforce for quality management in LC care has shown the existence of a lot of European GL but with very few studies about their practical application.   Aims:  to assess in a LC population the application of an OP based on specific GL and to determine the non application (NA) causes.   Methods : the charts of all non-pretreated patients managed between 01-2009 and 12-2012 were reviewed (protocol approved by local ethical committee). The procedure for each new treatment consists in presentation in MDC. Proposed treatment is based on OP performed according to European Lung Cancer Working Party GL.   Results : At time of analysis, 624 MDC were performed in 354 patients, including 332, 174, 81 and 47 for 1 st , 2 nd , 3 rd  and further lines respectively. Main characteristics were: male in 197; adenocarcinoma, squamous and small cell cancer in 187, 79 & 50; median age 62; stages I & II, III and IV in 48, 75 and 228. In 1 st  line, the rate of MDC was 94% including 88% performed as recommended by OP and 77% of treatments in agreement with GL. For 2 nd  and 3 rd  lines, the rates were respectively 93 and 91% (MDC), 90 and 89% (OP), 55 and 63% (GL). In 1 st  line, main causes for NA of OP treatments were patient refusal or physician choice and for NA of GL lack of appropriate recommendations for specific situations like comorbidities or availability of new therapies not yet addressed by GL. In subsequent lines, NA of GL was mainly due to new drugs.   Conclusion : MDC is performed for the huge majority of the patients with a high rate of application of the OP. GL need to be more frequently updated according to new therapies availability.
Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA(pN2) non-small cell lung cancer (NSCLC): Outcomes update of North American Intergroup 0139 (RTOG 9309)
Authors: K. S. Albain, R. S. Swann, V. R. Rusch, A. T. Turrisi, F. A. Shepherd, C. J. Smith, D. R. Gandara, D. H. Johnson, M. R. Green, R. C. Miller
Journal: Journal of Clinical Oncology (2005)

7014 Background: Surgery after CT/RT remains controversial for patients (pts) with stage IIIA(pN2) NSCLC. Initial analyses of INT 0139 showed significantly better progression-free survival (PFS), but not overall survival (OS), in the trimodality arm. (PASCO 2003) With longer follow-up (≥2.5 yrs per pt), new analyses of primary endpoints PFS and OS were conducted. Methods: Pts with PS 0–1 and T1–3, pN2, M0 NSCLC were randomized if resection was technically feasible. All received cisplatin 50 mg/m2 d1, 8, 29, 36 and etoposide 50 mg/m2 d1–5, d29–33 (PE) and RT to 45 Gy starting day 1. Arm 1 had resection if no progression (PD), then PE X2; Arm 2 completed RT to 61 Gy with PE X2. Intent to treat analyses used Kaplan-Meier estimates, log-rank tests and Cox multivariate models; exploratory analyses used logistic regression. All CI are 95% and p-values, 2-sided. Results: 396 eligible pts were enrolled (Arm 1, 202; Arm 2, 194; well-balanced on all factors). Treatment-related deaths: Arm 1, 16 (7.9%), of which 10 (5.0%) were within 30 days postop; Arm 2, 4 (2.1%). Deaths by type of surgery: 5/23 (22%) simple and 9/31 (29%) complex pneumonectomies, 1/98 (1%) lobectomies. Arm 1 pathology (n=164): T0N0, 29 (18%); TanyN0, 76 (46%). Arm 1 PFS is superior: median 12.8 vs 10.5 mos, p=0.017, HR 0.77 (0.62, 0.96); 5-yr 22.4% vs 11.1%. More pts on Arm 1 are alive without PD (p=0.008), but more died without PD (p=0.021). OS curves overlap for 2 yrs, but separate late favoring Arm 1: median 23.6 vs 22.2 mos, p=0.24, HR 0.87 (0.70,1.10); 5-yr 27.2% vs 20.3%, odds ratio for 5-yr survival 0.63 (0.36, 1.10, p=0.10). 96 pts are alive/censored. Independent favorable OS predictors: female, no weight loss. Arm 1 5-yr OS if pN0 at surgery was 41%; pN1–3, 24%; no surgery, 8% (p< 0.0001). Conclusions: 1) Longer follow-up of INT 0139 confirms significantly improved PFS but not OS when surgery follows CT/RT in pts with stage IIIA(pN2) NSCLC, 2) there is a trend for better 5-yr OS with trimodality therapy, 3) pN0 at surgery predicts long-term survival, 4) surgery after CT/RT can be considered in fit pts, 4) this approach may not be optimal if a pneumonectomy is needed. No significant financial relationships to disclose.
High levels of soluble syndecan-1 in myeloma-derived bone marrow: modulation of hepatocyte growth factor activity
Authors: Carina Seidel, Magne Børset, Øyvind Hjertner, Dianjun Cao, Niels Abildgaard, Henrik Hjorth-Hansen, Ralph D. Sanderson, Anders Waage, Anders Sundan
Journal: Blood (2000)
Plasma endothelin correlates with the extent of pulmonary hypertension in patients with chronic congestive heart failure.
Authors: R J Cody, G J Haas, P F Binkley, Q Capers, R Kelley
Journal: Circulation (1992)

BACKGROUND Endothelin is a family of potent vasoconstrictor peptides of vascular endothelial origin. Although it has been proposed that the vasoconstrictor effects of endothelin are produced at the local vascular level, increased plasma concentration of endothelin has been identified in cardiovascular disorders. METHODS AND RESULTS We tested whether immunoreactive endothelin-1 could be detected by radioimmunoassay in plasma of congestive heart failure patients and whether levels correlated with hemodynamic characteristics. Twenty congestive heart failure patients (New York Heart Association class II-IV) were sampled in the morning after an overnight fast, before medication. Cardiac index was decreased to 2.14 +/- 0.45 l/m/m2, and pulmonary wedge pressure was increased to 22 +/- 7 mm Hg. The ranges of pulmonary pressures were: systolic, 22-100 mm Hg, mean, 13-61 mm Hg, and diastolic, 8-42 mm Hg. The endothelin-1 level was 9.07 +/- 4.13 pg/ml (range, 4-19 pg/ml), which was increased compared with 12 normals (3.7 +/- 0.6 pg/ml; range, 2.8-4.7 pg/ml); the difference was statistically significant (p less than 0.0001). Endothelin-1 significantly correlated with pulmonary pressures (systolic, r = 0.78; mean, r = 0.80; diastolic, r = 0.77; all p less than 0.003) and pulmonary vascular resistance (r = 0.65, p less than 0.01). Endothelin-1 strongly correlated with the resistance ratio (pulmonary vascular resistance/systemic vascular resistance) (r = 0.88, p less than 0.0001). Stepwise multiple regression analysis confirmed the significance of these observations. CONCLUSIONS Elevated immunoreactive endothelin-1 specifically correlated with the extent of pulmonary hypertension in congestive heart failure patients. Whether endothelin-1 is a regional mediator of pulmonary hypertension or a marker for its occurrence requires additional evaluation.
Hand Hygiene
Authors: Yves Longtin, Hugo Sax, Benedetta Allegranzi, Franck Schneider, Didier Pittet
Journal: New England Journal of Medicine (2011)

Hand hygiene is a procedure that should be mastered by all health care workers. Hand hygiene is not optional - it is mandatory. It must be used conscientiously to decrease the occurrence of infections associated with health care and to increase patient safety. Proper use of hand hygiene is a sign of competency, professionalism, and respect. Copyright © 2011 Massachusetts Medical Society.
Identification of Quality Measures for Performance of and Interpretation of Data From Esophageal Manometry
Authors: Rena Yadlapati, Andrew J. Gawron, Rajesh N. Keswani, Karl Bilimoria, Donald O. Castell, Kerry B. Dunbar, Chandra P. Gyawali, Blair A. Jobe, Philip O. Katz, David A. Katzka, Brian E. Lacy, Benson T. Massey, Joel E. Richter, Felice Schnoll-Sussman, Stuart J. Spechler, Roger Tatum, Marcelo F. Vela, John E. Pandolfino
Journal: Clinical Gastroenterology and Hepatology (2015)
<i>BMJ</i>editor writes to Hunt over misuse of weekend mortality data
Authors: Abi Rimmer, Zosia Kmietowicz
Journal: BMJ (2015)

Fiona Godlee, editor in chief of The BMJ , has written to England’s health secretary, Jeremy Hunt, outlining concerns that he has misrepresented an academic article on deaths of patients admitted to hospitals at weekends.

Godlee said that Hunt had misused the findings of the Analysis article, published in The BMJ ,1 and asked him to clarify statements that he had made in relation to it. She said, “I am writing to register my concern about the way in which you have publicly misrepresented an academic article published in The BMJ .”

Godlee said that the article, by Nick Freemantle, professor …
Effect of baseline CD4 cell count at linkage to HIV care and at initiation of antiretroviral therapy on mortality in HIV-positive adult patients in Rwanda: a nationwide cohort study
Authors: Sabin Nsanzimana, Eric Remera, Steve Kanters, Jamie I Forrest, Nathan Ford, Jeanine Condo, Agnes Binagwaho, Heiner Bucher, Kristian Thorlund, Marco Vitoria, Edward J Mills
Journal: The Lancet HIV (2015)
Lymph node harvest and survival in rectal cancer
Authors: E. C. Paulson, C. Wirtalla, K. Armstrong, N. Mahmoud
Journal: Journal of Clinical Oncology (2008)

4048 Background: The NCCN recommends that at least 12 nodes be identified in a colon cancer specimen to ensure adequate staging. This standard is applied to rectal cancer despite anatomic and treatment differences. The factors that predict adequate nodal harvest and the relationship between harvest and survival in rectal cancer patients, with or without preop xrt are unknown. Methods: We performed a retrospective cohort study of 8,580 patients with stage I-III rectal cancer undergoing proctectomy from 1996–2004 using SEER-Medicare. Multivariate logistic regression was performed to identify patient and hospital variables associated with adequate LN harvest. Kaplan-Meier curves and Cox regression compared survival among patients who had ≥12, 1–11, or no nodes harvested, adjusting for patient and hospital characteristics. Results: 28% of patients had ≥12 nodes and 14% had no nodes harvested. Patients who were older, had more comorbidities or underwent preop XRT or emergent surgery were less likely to have ≥12 nodes harvested. High surgical volume and teaching status were positively associated with having ≥12 nodes harvested. Median survival by nodal harvest by stage and treatment are shown in table 1. After multivariate adjustment, node status remained significantly associated with mortality (p<0.001). Compared to patients with no nodes harvested, patients with 1–11 nodes were 27% (HR 0.73) and patients with ≥12 nodes 40% (HR 0.63) less likely to die. The effect of node harvest varied by stage and treatment, with the weakest association with survival in patients with stage III disease and stage I patients who received preop XRT or postop therapy. Conclusion: Nodal harvest is associated with survival following proctectomy for rectal cancer, primarily in Stage I and II patients. Further research is needed to understand the contribution of treatment and quality measures to this finding and to determine whether number of nodes is an appropriate quality measure for patients who undergo preop XRT. Median Survival (Years) # Nodes Surgery Only Preop XRT, Surgery Surgery, Postop Tx I II III I II III I II III 0 5.9 1.4 5.1 3.9 4.4 3.3 1–11 7.6 3.6 1.8 7.7 5.4 3.4 6.0 6.1 4.9 ≥12 9.3 4.8 2.1 6.3 7.2 3.1 6.1 8.4 4.9 P-value <.001 <.001 .08 .02 .005 .49 .04 <.001 .78 No significant financial relationships to disclose.
Early Knee Osteoarthritis Is Evident One Year Following Anterior Cruciate Ligament Reconstruction: A Magnetic Resonance Imaging Evaluation
Authors: Adam G. Culvenor, Natalie J. Collins, Ali Guermazi, Jill L. Cook, Bill Vicenzino, Karim M. Khan, Naomi Beck, Janneke van Leeuwen, Kay M. Crossley
Journal: Arthritis & Rheumatology (2015)

Objective To determine the prevalence and factors associated with knee osteoarthritis (OA) defined by magnetic resonance imaging (MRI) and specific OA features on MRI 1 year after anterior cruciate ligament reconstruction (ACLR). Methods Isotropic 3.0T MRI scans were obtained for 111 participants (71 men; mean ± SD age 30 ± 8 years) 1 year after ACLR as well as for 20 age‐, sex‐, and activity level–matched uninjured controls. The MRI OA Knee Score was used to score specific OA features. MRI‐defined tibiofemoral and patellofemoral OA was evaluated based on published criteria. Logistic regression identified factors associated with MRI‐defined OA and specific OA features after ACLR. Results Following ACLR, medial and lateral tibiofemoral OA on MRI was observed in 7 participants (6%) and 12 participants (11%), respectively, while 19 participants (17%) had patellofemoral OA on MRI. The femoral trochlea was the region most affected by bone marrow lesions (19% of participants), cartilage lesions (31% of participants), and osteophytes (37% of participants). Meniscectomy at the time of ACLR (odds ratio 6.8 [95% confidence interval 2.0–23.3]) and body mass index (BMI) &gt;25 kg/m 2 (odds ratio 3.0 [95% confidence interval 1.3–6.9]) predicted MRI‐defined tibiofemoral OA and osteophytes, respectively. Men had higher odds of patellofemoral osteophytes (odds ratio 6.3 [95% confidence interval 2.4–16.2]). No uninjured controls had tibiofemoral or patellofemoral OA on MRI, and specific OA features were uncommon. Conclusion OA 1 year following ACLR was more common than previously recognized, while being absent in uninjured control knees. The patellofemoral compartment seems to be at particular risk for early OA after ACLR, especially in men. The association with meniscectomy and BMI demonstrates the construct validity of MRI criteria.
Systemic Candidiasis: Diagnosis from Cutaneous Manifestations
Authors: David N Slater, Christine I Harrington, Peter Wylde, Richard Worth
Journal: Journal of the Royal Society of Medicine (1982)

Three patients are described who developed systemic candidiasis. Each had either leukaemia or lymphoma, and developed a similar erythematous maculopapular rash which, in places, was purpuric. In the first patient the nature of the rash was not appreciated during life, but postmortem histology revealed candida within the lesions. In the other two patients, a diagnosis of systemic candidiasis was successfully established by skin biopsy. This paper emphasizes that a maculopapular rash can be a relatively characteristic clinical manifestation of systemic candidiasis and that skin biopsy can be diagnostic.
Comprehensive therapy for trilateral retinoblastoma
Authors: Helen Chan, Elise Heon, John Doyle, William Halliday, Helen Dimaras, Paul Babyn, Brenda Gallie
Journal: Cancer Research (2008)

229   Purpose: We had reported that carboplatin-etoposide-vincristine modulated by cyclosporine (CSA), which inhibits the multidrug resistance (MDR) P-glycoprotein, could cure newly diagnosed and relapsed children with intraocular retinoblastoma (RB). We propose determining the success of this protocol, combined with autologous peripheral stem cell transplant for marrow rescue after supralethal chemotherapy, for curing babies with the very rare trilateral RB.  Methods: Since 2004, we treated 3 babies with trilateral RB with systemic carboplatin-etoposide-vincristine, with high-dose, short 3-hour CSA infusions aimed at inhibiting both RB cell and blood-brain barrier vascular P-glycoprotein, concurrently with Ommaya reservoir-delivery of intraventricular topotecan-cytarabine, which kill RB cells in vitro. Since the babies were too young to receive craniospinal radiation without devastating long-term sequelae, and had germline disease greatly predisposing to radiation-induced secondary malignancies, the intracranial tumor responses were consolidated with autologous peripheral stem cell transplant after supralethal chemotherapy, and intraocular tumor responses, with focal cryo/laser therapy.  Results: Patient 1, a 4-month-old girl with hypothalamic overgrowth syndrome and central blindness, had tumor cells in the cerebrospinal fluid (CSF) after, but not before biopsy of the suprasellar tumor. Both the suprasellar tumor, eye tumors and CSF responded to chemotherapy, and the blindness resolved. Twenty months after diagnosis and 12 months after transplant, she developed tumor recurrence along the needle biopsy track, and died 32 months after diagnosis. Patient 2, a 6-month-old boy with central blindness, had tumor cells in the CSF despite no biopsy of the suprasellar tumor. The suprasellar tumor and CSF responded to chemotherapy, the blindness resolved, and he will be transplanted after 6 cycles of chemotherapy. Patient 3, a 9-week-old girl with central blindness, hydrocephalus and diabetes insipidis, had tumor cells in the CSF despite no biopsy of the suprasellar tumor. She just started chemotherapy.  Conclusions: In the literature, babies with trilateral RB die of their disease because surgery and radiation are not treatment options, and chemotherapy alone rarely cures brain tumors. Few drugs are non-toxic and yet effective for treating RB cells in the CSF. Our comprehensive therapy offers hope of cure. CSA, which reverses MDR in tumor cells, also increases drugs crossing the blood-brain barrier, may make the difference between success or failure of chemotherapy for these intracranial tumor. We recommend checking for pineal/suprasellar masses in babies with RB, albeit that trilateral RB is rare. Conversely, if pineal/suprasellar masses are found in babies, check the eyes for RB, since this may avoid biopsies of the intracranial tumor, which may track difficult-to-treat RB cells through the brain, disseminating them into the CSF.
Transcriptional regulator PRDM12 is essential for human pain perception
Authors: Ya-Chun Chen, Michaela Auer-Grumbach, Shinya Matsukawa, Manuela Zitzelsberger, Andreas C Themistocleous, Tim M Strom, Chrysanthi Samara, Adrian W Moore, Lily Ting-Yin Cho, Gareth T Young, Caecilia Weiss, Maria Schabhüttl, Rolf Stucka, Annina B Schmid, Yesim Parman, Luitgard Graul-Neumann, Wolfram Heinritz, Eberhard Passarge, Rosemarie M Watson, Jens Michael Hertz, Ute Moog, Manuela Baumgartner, Enza Maria Valente, Diego Pereira, Carlos M Restrepo, Istvan Katona, Marina Dusl, Claudia Stendel, Thomas Wieland, Fay Stafford, Frank Reimann, Katja von Au, Christian Finke, Patrick J Willems, Michael S Nahorski, Samiha S Shaikh, Ofélia P Carvalho, Adeline K Nicholas, Gulshan Karbani, Maeve A McAleer, Maria Roberta Cilio, John C McHugh, Sinead M Murphy, Alan D Irvine, Uffe Birk Jensen, Reinhard Windhager, Joachim Weis, Carsten Bergmann, Bernd Rautenstrauss, Jonathan Baets, Peter De Jonghe, Mary M Reilly, Regina Kropatsch, Ingo Kurth, Roman Chrast, Tatsuo Michiue, David L H Bennett, C Geoffrey Woods, Jan Senderek
Journal: Nature Genetics (2015)