tbuckley/cabot-search huggingface dataset:
Multimedia: Evidence-Based Practice in Primary Care
Authors: Tom Fahey
Journal: BMJ (1999)

Ed Leone Ridsdale


Harcourt Brace, £17.50, pp 176 




ISBN 0 443 05889 X

———————

Rating: ★★★

Using external evidence to inform clinical decision making is now acknowledged as an important and necessary ingredient of good clinical practice. However, using external evidence depends on formulating an answerable question, finding and appraising evidence, and applying the evidence to the individual patient. Leone Ridsdale is to be congratulated on editing a relevant and accessible book that shows how evidence based medicine can be applied to clinical problems in primary care.

The structure of the book is based around well rehearsed aspects of diagnosis, prognosis, and treatment. There are also chapters on searching, qualitative research, guidelines, audit, and teaching and learning evidence based practice. All the authors use examples of common problems in primary care and adopt a pragmatic, realistic approach. My main quibble is the omission of information about how to frame a clinical question (although this is covered in some of the chapters in the book). In my experience of teaching medical students and postgraduates, the major difficulties with understanding and using evidence based medicine centre around formulating answerable questions to common clinical problems.

Many people will find this book useful: registrars approaching the MRCGP exam will find it relevant to the critical reading part of this exam; medical students, who are increasingly being taught how to integrate external epidemiological evidence into clinical problems; and teachers concerned with undergraduate or postgraduate curriculums. Most of all, it should appeal as an accessible text to those members of the primary healthcare team who wish to inform themselves about what evidence based medicine is and what relevance it has to their own clinical practice.

While it is filling a gap in the market about evidence based medicine, it is only one of several recently published books concerned with evidence based practice in primary care. All have adopted a similar problem based approach. So, although I enjoyed this book, it occupies a niche with a growing collection of similar texts. Which to choose? If you are thinking of refurbishing your practice library make sure you have the original text: Clinical Epidemiology by Sackett, Haynes, Guyatt, and Tugwell. If you wish to choose a second text with a focus on primary care, this book will not let you down.
Prior Invasive Fungal Infection Is Not a Contraindication for Subsequent Allogeneic Bone Marrow Transplantation in Adult Patients With Hematologic Malignancies
Authors: Jann-Tay Wang, Min Yao, Jih-Luh Tang, Shan-Chwen Chang, Chien-Ching Hung
Journal: Journal of Clinical Oncology (2001)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.19.4000 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11579127 Prior Invasive Fungal Infection Is Not a Contraindication for Subsequent Allogeneic Bone Marrow Transplantation in Adult Patients With Hematologic Malignancies Jann-Tay WangxJann-Tay WangSearch for articles by this author , Min YaoxMin YaoSearch for articles by this author , Jih-Luh TangxJih-Luh TangSearch for articles by this author , Shan-Chwen ChangxShan-Chwen ChangSearch for articles by this author , Chien-Ching HungxChien-Ching HungSearch for articles by this author Show More National Taiwan University Hospital, Taipei, TaiwanCollege of Medicine, National Taiwan University, Taipei, Taiwan https://doi.org/10.1200/JCO.2001.19.19.4000 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical Oncology
Glucocorticoid reduces pemetrexed sensitivity by mediating senescence-associated secretory phenotype in Bcl-2 dependent manner in non-small-cell lung cancer
Authors: Haiyan Ge, Songshi Ni, Jiaxian Ou, Xiaocong Fang, Yuanlin Song, Chunxue Bai
Journal: European Respiratory Journal (2013)

Rationale:  Pemetrexed (PEM), a novel and multitargeted antifolate, has been used as an antineoplastic agent for non-small-cell lung cancer (NSCLC) and pleural mesothelioma. Although glucocorticoids (such as dexamethasone, DEX) are recommended to be co-administered with PEM during the chemotherapy to reduce toxicity, it is not clear yet whether DEX co-administration could affect PEM efficacy or not on chemotherapy.   Methods:  We used established NSCLC cell lines (H1650, A549, H2228 and H292) and examined the effects of DEX on PEM sensitivity  in vitro  and in xenograft models.   Results:  We found that DEX co-administration could reduce sensitivity to PEM and have high capacity for tumor invasion and metastasis. Meanwhile, DEX co-adminstration weakened senescence growth arrest, such as altered secretions of proinflammatory and mitogenic cytokines, reminiscent of a senescence associate secretory phenotype (SASP). Furthermore, we demonstrated that DEX co-administration enhanced ability of self-renewal, clonogenicity and initiation of tumors, which are consistent with crucial hallmarks in the definition of cancer stem cells (CSCs). In addition, we found that expression of Bcl-2 was increased with DEX co-administration. Knockdown expression of Bcl-2 inhibited cell growth and clonogenicity in DEX co-administration group.   Conclusion:  DEX might suppress the antitumor activity of PEM through alterd SASP level, thus changing self-renewal ability in Bcl-2 dependent manner. Extra caution need to be required when PEM and DEX were jointly adminstered in NSCLC patients chemotherapy.
Long-term follow-up and analysis for prognostic factors for patients with limited-stage diffuse large-cell lymphoma treated with initial chemotherapy with or without adjuvant radiotherapy.
Authors: S E Jones, T P Miller, J M Connors
Journal: Journal of Clinical Oncology (1989)

In order to assess long-term outcome of patients with localized (stage I or II) diffuse large-cell lymphoma treated with initial combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without involved-field radiotherapy following chemotherapy, we combined data from two prospective trials in Tucson (64 patients) and Vancouver (78 patients). Follow-up on 142 patients was updated and a variety of potential pretreatment prognostic factors were analyzed for impact on outcome. One hundred forty patients (99%) achieved a complete remission and there were no differences in outcome between institutions. Twenty-three patients have relapsed and 22 have died from lymphoma at a median follow-up of 4.4 years, resulting in an overall relapse-free survival of 82% at 5 years. There was no treatment-related mortality and were no instances of late cardiac toxicity or leukemia. Of the following potential pretreatment prognostic factors (age, stage, "B" symptoms, extranodal disease, gastrointestinal tract involvement, bulky disease, or disease above or below the diaphragm), only stage affected relapse-free survival (RFS) (P = .16) and survival (.003). Among 34% of patients over age 65, outcome was similar to younger patients. RFS for 108 patients treated with CHOP plus radiotherapy was not significantly superior to the use of CHOP alone in 34 patients (P = .2).
Seasonal variation in COPD admissions and pneumonia and a review of imaging follow up in these patients
Authors: Donna Best, Jamie Johnstone, Hamish Moudgil, Koottalai Srinivasan
Journal: European Respiratory Journal (2013)

Introduction  Respiratory diseases have predictable seasonal variations driven primarily by viral pathogens.  COPD patients have a high risk of developing lung cancer. It is important that COPD patients with pneumonia have follow up imaging.  Objectives  To assess seasonal variation of admissions and pneumonia in patients admitted with COPD.  To review the imaging follow up of COPD patients with pneumonia.  Methods  We reviewed CXR reports of all patients admitted with an exacerbation of COPD during winter and summer. We compared presence of pneumonia, length of stay (LOS) and use of supported discharge (SD) in these seasons. We reviewed the follow up imaging of all patients with pneumonia.  Results  283 patients were admitted during the study period. 71(25%) had pneumonia on CXR, 26/117(22.2%) summer versus 45/166(27%) winter. Although there was a 41.8% increase in admissions during the winter, the proportions with pneumonia were not statistically significant. Comparing those who had SD there were no significant differences analysing by seasonality or pneumonia. LOS was only statistically significantly longer in those with pneumonia, 7 days versus those without at 5 days.  Of the 71 pneumonias only 40 (56.3%) had an appropriately timed repeat CXR. Of these 20 (50%) showed non-resolution. Of these 20, 9 (45%) had CT scans. 3 (33.3%) showed a potential cancer. 2 incidental cancers were picked up on initial CXR.  Conclusions  COPD admission are greater in the winter months (41.8%), are associated with pneumonia in 25% and patients with pneumonia have increased LOS. Radiology is an important follow up tool for COPD patients with pneumonia and is not currently being utilised effectively.
Yttrium 90-labeled antiferritin followed by high-dose chemotherapy and autologous bone marrow transplantation for poor-prognosis Hodgkin's disease.
Authors: P J Bierman, J M Vose, P K Leichner, S M Quadri, J O Armitage, J L Klein, R A Abrams, K A Dicke, H M Vriesendorp
Journal: Journal of Clinical Oncology (1993)

PURPOSE This study was undertaken to examine the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy followed by autologous bone marrow transplantation in patients with poor-prognosis Hodgkin's disease. PATIENTS AND METHODS Patients were entered onto this protocol if they had chemotherapy-resistant disease, bulky disease, or extensive prior therapy. Patients received yttrium-labeled antiferritin on day -13, -12, or -11, followed by high-dose cyclophosphamide, carmustine, and etoposide (CBV) on days -6 to -3, and then bone marrow infusion on day 0. RESULTS Twelve patients received both radiolabeled antibody and high-dose chemotherapy followed by autologous transplantation. Two additional patients started the study, but were unable to complete all therapy. Four of 12 patients experienced early transplant-related mortality. Four patients are alive more than 2 years following transplantation and three are free from disease progression at 24+, 25+, and 28+ months following transplantation. The progression-free survival rate at 1 year is estimated to be 21%. Considering the poor prognostic characteristics of these patients, toxicity on this protocol was not necessarily greater than that observed with high-dose chemotherapy alone. CONCLUSION This report demonstrates the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy and autologous bone marrow transplantation.
Oncologists and clinical trials: the profit motive.
Authors: T J Smith, C E Desch
Journal: Journal of Clinical Oncology (1992)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1992.10.4.672 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 1548531 Oncologists and clinical trials: the profit motive. T J SmithxT J SmithSearch for articles by this author , C E DeschxC E DeschSearch for articles by this author https://doi.org/10.1200/JCO.1992.10.4.672 PDF "Oncologists and clinical trials: the profit motive.." Journal of Clinical Oncology, 10(4), pp. 672–673© 1992 by American Society of Clinical Oncology
EpCAM-positive circulating cells in lung cancer patients
Authors: Joanna Domagala-Kulawik, Tomasz Skirecki, Grazyna Hoser
Journal: European Respiratory Journal (2012)

Lung cancer is a very aggressive neoplasm characterized by high metastatic potential which is the main cause of therapeutic failures. The exact cell of origin of metastasis is not known, however several markers for them have been proposed. Recently, the epithelial cell adhesion molecule (EpCAM) has been identified as an additional molecule to enrich for circulating tumor cells (CTCs).

The aim of this study was to detect CTCs by flow cytometry applying anti-EpCAM antibody and to investigate its clinical significance.

Forty-one patients diagnosed with lung cancer were enrolled into this study. Patients did not receive anticancer treatment prior to the study. The cells bearing EpCAM were detected in tumor tissue, lung tissue and peripheral blood by flow cytometry with anti-EpCAM FITC antibody, analyzed in FACSCantoII, BD flow cytometer.

EpCAM+ cells were detected in the tumor tissue with higher proportion than in adjacent lung parenchyma and with higher proportion in adenocarcinoma (AC) than in squamous cell (SCC) type. The median proportion of circulating EpCAM+ cells was 0.0026% (260 per mL). No difference was found between SCLC and NSCLC. The fraction of EpCAM+ cells was higher in the patients with AD than SCC (0.0130 vs 0.0027%), was significantly lower in the blood of patients with advanced disease (IIIB,IV) when compared with lower stages (I-IIIA) (0.0018 vs 0.0067%, 230 vs 504 cells per mL) and was significantly lower in patients with metastases compared to those without metastases (0.0015% vs 0.0046%, p=0.012).

Our study confirmed the presence of a rare subpopulation of the CTCs of the EpCAM+ phenotype in lung cancer patients with significant differences related to histological type and stage of the disease.
Genetic Engineering of Animals: An Agricultural Perspective
Authors: J. W. Evans, A. Hollaender, C. M. Wilson
Journal: JNCI Journal of the National Cancer Institute (1985)

Journal Article Genetic Engineering of Animals: An Agricultural Perspective Get access JNCI: Journal of the National Cancer Institute, Volume 74, Issue 5, May 1985, Page 1153, https://doi.org/10.1093/jnci/74.5.1153-c Published: 01 May 1985
The effect of methylene blue in the photodynamic therapy on A549 lung cancer cell lines
Authors: Chul Ho Oak, Tae Won Jang, Young Ho Kim, Maan Hong Jung
Journal: European Respiratory Journal (2012)

Background : Methylene blue (MB) is a safe and cheap chemical widely used in the medical fields for a long time. MB was recently known to act as a photosensitizer and some clinical trials of using it in the photodynamic therapy on the tumor cell lines were reported. In this study, we investigated the effects of MB as a photosensitizer on the A549 lung cancer cell lines.   Methods : After pretreatment of A549 cells with MB in the concentrations of 1 μ/ml and 2 μ/ml, respectively, Diode LASER of 650 nm wavelength was used with the energy of 30, 60 and 120 J/cm 2  respectively. Cytotoxicity was evaluated with MTT, and the formation of ROS was checked with DCFH. To evaluate the mechanism of apoptosis, the activation of Caspase family was checked, and the fragmentation of PARP-1 was studied by the western blotting method.   Results : By the increases of the concentration of MB and the energy of Diode LASER, the level of apoptosis of cell lines and ROS synthesis were significantly increased. Pretreatment with antioxidant suppressed these findings. In the induction of apoptosis, the activation of Caspase 3, 8 and consequent fragmentation of PARP-1 was observed.   Conclusion : MB induced apoptosis in the A549 lung cancer cell lines as a photosensitizer, and its effect was increased by the concentration of MB and the energy of Diode LASER.
Continuous Lymphoblastoid Cell Line From a Rhesus Monkey With Myelogenous Leukemia
Authors: Virginia C. Dunkel, Sara L. Myers
Journal: JNCI Journal of the National Cancer Institute (1972)

A suspension culture (LM/DM) was established in vitro from the peripheral leukocytes of a rhesus monkey (Macaca mulatto) with myelogenous leukemia. Morphologically these cells resemble the lymphoblastoid cells in cultures derived from human leukocytes. Chromosome analysis revealed a modal number of 42 and a Macaca karyotype. No virus particles were detected in the cells by electron microscopy, and all attempts to find Epstein-Barr virus (EBV) or EBV-related antigens by serological methods were unsuccessful.
Chronic Obstructive Pulmonary Disease and the Risk of Stroke. The Rotterdam Study
Authors: Marileen L. P. Portegies, Lies Lahousse, Guy F. Joos, Albert Hofman, Peter J. Koudstaal, Bruno H. Stricker, Guy G. Brusselle, M. Arfan Ikram
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Rationale: Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD.Objectives: To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations.Methods: Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model.Measurements and Main Results: COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00–1.43), ischemic stroke (HR, 1.27; 1.02–1.59), and hemorrhagic stroke (HR, 1.70; 1.01–2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91–1.31) for all stroke; HR, 1.13 (0.91–1.42) for ischemic stroke; and HR 1.53 (0.91–2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42–18.20) increased risk of stroke.Conclusions: Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
Abstract 223: The Role Of Angiogenesis In The Myocardial Ischemia/reperfusion Injury In Pregnancy
Authors: Jingyuan li, Zoltan Pierre Arany, Mansoureh Eghbali
Journal: Circulation Research (2014)

Angiogenesis plays an important role in the pathogenesis of cardiovascular disease. Pro-angiogenic and anti-angiogenic treatments have provided new insights into the impact of angiogenesis-based approaches on coronary artery disease. We have recently reported that the hearts of late pregnant (LP) mice are more prone to ischemia/reperfusion (I/R) injury compared to non pregnant(NP) mice. Provided the significant change of angiogenesis status in pregnancy, here we explored whether stimulating the angiogenesis with VEGF is able to protect the heart against I/R injury in late pregnancy, and whether anti-antigenic treatment with soluble endoglin(sENG), an anti-angiogenic factor, aggravates cardiac I/R injury in NP. Pregnant mice at day 12 either received daily injection of VEGF (100 ug/kg daily subcutaneous injection) or PBS(LP CTRL) for 7 days, and at day 19 the LP mice hearts were subjected to 20 min ischemia followed by 40 min reperfusion in Langendorff. NP mice either received a single adenovirus sENG(2х10 8particles via tail vein injection) or vehicle(NP CTRL), and 10 days later NP mice were subjected to 20 min ischemia followed by 40 min reperfusion in Langendorff. The heart function was recorded throughout the experiments, and the infarct size was measured by TTC staining at the end of experiments. Exogenous VEGF treatment significantly improved the cardiac function of LP mice after ischemia. The rate pressure product (RPP) at the end of reperfusion was improved from 1617±287 mmHg*beats/min (n=6) in LP CTRL to 11287±1783 mmHg*beats/min (n=3) in the VEGF group(p&lt;0.01). The infarct size was also significantly reduced by VEGF treatment to 25.0±4.3% (n=3) from 57.4±5.2%(n=6) in CTRL (p&lt;0.01). While sENG aggravated the cardiac I/R injury in NP, as the RPP at the end of reperfusion in the sENG group (4523±1281 mmHg*beats/min, n=4) was significantly lower compared with NP CTRL group(12818±1213 mmHg*beats/min, n=6)(p&lt;0.01). Furthermore, the infarct size in the sENG group was markedly higher compared with NP CTRL group (34.0±3.3% (n=4) vs. 16.3±1.4%(n=6) in NP CTRL, p&lt;0.05). In conclusion, anti-angiogenic treatment aggravates the cardiac I/R injury in NP, while angiogenic therapy protects the heart against I/R injury in LP.
Abstract MP53: Associations of Dietary Patterns and Cardiovascular Disease Risk Do Not Differ by Diabetes Status
Authors: Keith E Pearson, Jenifer H Voeks, April P Carson, James S Shikany, Monika M Safford, Jose R Fernandez, Suzanne E Judd
Journal: Circulation (2014)

Introduction: Adults with diabetes have been shown to have differences in reported diet compared to adults without diabetes. While diet is associated with cardiovascular disease (CVD) risk, few studies have examined whether dietary patterns may differentially affect CVD risk in adults with and without diabetes. Objective: We examined whether the relationship between diet and CVD risk differed between adults with and without diabetes who were free of CVD at baseline in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: REGARDS is a nation-wide, longitudinal study of 30, 239 black and white participants ages 45 and older. Previously, principal components analysis was utilized to derive dietary patterns for participants with usable Block98 food frequency questionnaire data (n=21,636). Diabetes was defined as self-reported medication use, fasting glucose ≥ 126 mg/dL, or non-fasting glucose ≥ 200 mg/dL. The final sample for this analysis included 2,701 participants with diabetes and 13,906 participants without diabetes. CVD events, including stroke and nonfatal or fatal myocardial infarction, were physician-adjudicated. Cox proportional hazards regression was used to assess the association of each dietary pattern (modeled in quintiles) with risk of CVD, stratified by diabetes status. Results: We observed 787 CVD events over an average follow up of 5.5 years. Greater adherence to the Southern dietary pattern (which loaded highly on fried foods, processed meats, and sugar-sweetened beverages) significantly increased risk of CVD in adults without diabetes (comparing Q5 to Q1: HR=1.54; 95% CI=1.16, 2.06) and the association trended similarly, though non-significant, in adults with diabetes (comparing Q5 to Q1: HR=1.32; 95% CI=0.76, 2.31). Adherence to the Plant-based pattern (which loaded heavily on fruits, vegetables, and legumes) showed a non-significant inverse association with CVD risk in both adults with diabetes (comparing Q5 to Q1: HR=0.77; 95% CI=0.49, 1.23) and adults without diabetes (comparing Q5 to Q1: HR=0.87; 95% CI=0.65, 1.17). After adjustment for age, race, gender, region, income, education, physical activity, smoking status, and total energy intake, there were no differences in the association of either dietary pattern and risk of CVD between adults with and without diabetes (p for interaction = 0.23 for Plant-based; p for interaction = 0.87 for Southern). Conclusions: While adults with and without diabetes may differ in reported dietary practices, our results suggest there are no differences in the associations of dietary patterns and CVD risk between the two groups - further demonstrating the importance of healthful dietary practices in the prevention of CVD regardless of diabetes status.