tbuckley/cabot-search huggingface dataset:
Preemptive analgesia with ketorolac improves the parameters of mechanical indexes of the lung in children in the early postoperative period
Authors: Kosechenko Nataliia, Dmytriiev Dmytro
Journal: European Respiratory Journal (2013)

BACKGROUND:The aim of the work was to assess the effect of preemptive analgesia with Ketorolac on mechanical parameters of the lung in children in the early postopative period.  METHODS:We examined 68 children in age from 5 to18 years(7,5 ± 3,4),after severe abdominal operations which were on mechanical ventilation during more than 24 hours(32,3 ± 4,4).All patients were divided into two groups.The patients of the first group(28)receive premedication with Morphine1%-0,1-0,2 mg/kg IM and in early postoperative period of anaesthetizing narcotic analgesics Morphine1% - 0,1 ml per year.Patients of the second group(40)receive Ketorolac 30mg of premedication and they NSAID medication(Ketorolac 30mg 3 times per day).The mechanical parameters of the lung were assessed compliance(Cst), resistant(R) and respiratory pressure(PIP).The level of analgesia was controlled by the level of cortisol in blood plasma.For a statistical analysis the criterion of Students was used.  RESULTS:Compliance(Cst=116,4±5,3ml/mmH2O),resistant(R=17,2±3,6mmH2O/L/s),respiratory pressure (PIP=16-18 mmH2O)and the level of cortisol(164,2±3,7nM/L)in blood plasma, in patients second group ,that were preemptive analgesia Ketorolac 30mg compared with Cst=118,8±3,7 ml/mmH2O(confidence interval[CI](of difference)95%,3,5-4,0;P  CONCLUSION: Preemptive analgesia with Ketorolac improves the parameters of mechanical indexes of the lung and has better analgesic effect in children in the early postoperative period.
Phase II trial of C1311, a novel inhibitor of topoisomerase II in advanced breast cancer
Authors: R. L. Capizzi, L. A. Roman, S. Tjulandin, I. Smirnova, A. Manikhas, J. S. Paterson, A. Major, A. S. Lundberg, P. Fumoleau
Journal: Journal of Clinical Oncology (2008)

1055 Background: C1311 was designed from mitoxantrone to lessen cardiotoxicity. Although an inhibitor of topo II, its locus of action differs from other topo II inhibitors in that it does not affect the topo II/DNA cleavable complex. Phase I trial dose-limiting toxicity (DLT) was non-cumulative, transient neutropenia without significant nonhematologic toxicity including cardiac function despite prior anthracycline exposure (Isambert et al. Proc. ASCO 2006, Abst 2069). Methods: 53 breast cancer pts resistant to taxanes and anthracyclines and other agents. Median (range) of 3 prior regimens (range 2–6), including median (range) of 6 drugs (range 2–7). Most patients had visceral predominant disease (liver, lung). Initial dose from phase 1 was 480 mg/m2, 1 hr IV infusion on d 1, 8, and 15 of a 28 day cycle. The first 5 patients sustained gr 4 neutropenia (1/5 with febrile neutropenia); starting dose was reduced to 360 mg/m2/wk x 3 q28d for the subsequent 48 patients. Results: A total of 163 cycles of therapy were administered, for a total median cumulative dose of 3.9 gms/pt. Neutropenia was the only serious toxicity, overall 48%, Grade 3/4, 38% which was rapidly reversible within 7–10 days. One patient had thrombocytopenia, (nadir 62K, rapidly reversible). Other mild treatment-related Aes were anemia 14%, nausea 36%, vomiting 20%, and diarrhea 20% controlled with std supportive care. Serial ECGs showed no significant prolongation of the QTc interval, or abnormal T or U waves. Serial MUGA or ECHO compared to baseline showed a mean decrease of 6.7% in the LVEF following up to 9 cycles in 38 patients. The primary therapeutic objective was the overall RECIST response rate (CR+PR). An overall therapeutic effect was observed in 40% of patients. There were 2 PR lasting 6+ and 9+ months. 19 (36%) patients sustained stable disease (SD), with 10 pts with SD 4+ months including 2 patients continuing at 13+ and 14+ months. Conclusions: The safety profile for C1311 is manageable transient neutropenia without significant nonhematologic Aes including cardiac and other vital organ function. There was evident disease control in 40% of breast cancer refractory to taxanes, anthracyclines and multiple hormone and cytotoxic therapies. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Xanthus Pharmaceuticals Xanthus Pharmaceuticals Xanthus Pharmaceuticals Xanthus Pharmaceuticals
Using Tax Reform to Drive Health Care Reform
Authors: Samuel Y Sessions, Philip R Lee
Journal: JAMA (2008)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Evaluation of antiandrogen therapy in unresectable hepatocellular carcinoma: results of a European Organization for Research and Treatment of Cancer multicentric double-blind trial.
Authors: C Grimaldi, H Bleiberg, F Gay, M Messner, P Rougier, T C Kok, L Cirera, A Cervantes, J De Greve, B Paillot, M Buset, D Nitti, T Sahmoud, N Duez, J Wils
Journal: Journal of Clinical Oncology (1998)

PURPOSE The aim of the study was to evaluate the efficacy of antiandrogen therapy on overall survival and response in unresectable hepatocellular carcinoma (HCC). PATIENTS AND METHODS A total of 244 patients with unresectable HCC were included in this multicentric double-blind trial. According to a two-by-two factorial design, patients were randomly assigned to receive one of the following treatments: pure antiandrogen plus placebo (A+P group, 60 patients); luteinizing hormone-releasing hormone (LHRH) agonist plus placebo (LHRH+P group, 62 patients); pure antiandrogen plus LHRH agonist (A+LHRH group, 62 patients); or placebo plus placebo (P+P group, 60 patients). Pure antiandrogen consisted of Anandron (Roussel-Uclaf Laboratory, Romainville, France) administered orally (300 mg daily for 1 month, then 150 mg daily). LHRH consisted of goseriline acetate (3.6 mg) or triptoreline (3.75 mg) administered monthly by subcutaneous injection. Treatment was given until death. Response was evaluated every 8 weeks according to World Health Organization (WHO) criteria. RESULTS Six patients were considered ineligible. One patient had a complete response (A+P arm) and three had a partial response (two in the LHRH+P arm and one in the A+LHRH arm). An overall log-rank test did not demonstrate any significant difference in survival among the four arms. Taking the factorial design into account, comparison of survival showed no significant difference between Anandron-containing regimens and others, or between LHRH-containing regimens and others. No serious side effects occurred for any regimen. CONCLUSION This controlled study shows clearly the lack of efficacy of androgen treatment in unresectable HCC.
Temporary Loop Ileostomy
Authors: S A Raimes, V V Mathew, H B Devlin
Journal: Journal of the Royal Society of Medicine (1984)

Summary: A refinement of the technique for constructing the temporary loop ileostomy using a subcutaneous absorbable bridge is described. This leaves the skin surface uncluttered and allows immediate fitting of a watertight appliance. Clinical experience in 22 patients confirms that this is a safe, simple defunctioning stoma with few complications and in our practice has also replaced the loop colostomy as the covering stoma for difficult colorectal anastomoses.
Two thirds of NHS trusts forecast a deficit this year, up from a quarter last year
Authors: Ingrid Torjesen
Journal: BMJ (2015)

Two thirds of NHS trusts in England, including nine in 10 acute care trusts, are forecasting a deficit at the end of the 2015-16 financial year, a survey of finance directors by the think tank the King’s Fund shows.

The survey of 254 finance directors at NHS trusts was carried out between 5 June and 22 June 2015. One hundred responded, of whom 66% forecast an end of year deficit, up from 25% at the same time last year. Among acute care trusts 89% forecast a deficit, up from 21% last year.

And 62% of the finance directors said that even these pessimistic forecasts depended on the provision of additional financial support, running down their reserves, or both.

Richard Murray, director of policy at the King’s Fund, said, “Last year’s deficit among NHS providers was unprecedented, but this year is shaping up to be much worse. …
Role of right ventricular ejection fraction by electrocardiogram- gated 320-slice CT in pulmonary hypertension
Authors: Toshihiko Sugiura, Nobuhiro Tanabe, Yukiko Matsuura, Ayumi Sekine, Kouichiro Tatsumi
Journal: European Respiratory Journal (2012)

Purpose: Right ventricular function is an important determinant of exercise capacity and survival in pulmonary hypertension (PH). We aimed to study correlation of right ventricular ejection fraction (RVEF) determined by 320-slice CT with hemodynamic factors in patients with PH.  Materials and Methods: 59 subjects (17 male, 56±13 yrs) with PH (41 chronic thromboembolic pulmonary hypertension and 18 pulmonary arterial hypertension) underwent enhanced retrospective ECG-gated volume 320-slice CT (Aquilion ONE, Toshiba) and right heart catheterization (RHC). CT images were reconstructed every 5% from 0-95% of the R-R interval. RV end-systolic and end-diastolic true volumes were measured from 3-dimensional reconstruction and used to calculate RVEF. We compered RVEF with the results of RHC.  Results: In 320-slice CT, RVEF were 46.4±14.8. In RHC, mean PAP (mPAP), PVR, systolic volume (SV) were 41.5±11.3 mmHg, 655±317 dyne•sec•cm-5 and 63.7±17,7ml, respectively. The correlation coefficient of RVEF with mPAP, PVR, SV were -0.52 (P  Conclusions: RVEF by ECG-gated 320-slice CT correlated significantly with PVR and SV in subjects with PH.
A 3-week interval exercise-training program improves work efficiency following chemoradiotherapy
Authors: Ronan Astin, Malcolm West, Lisa Loughney, Mike Grocott, Sandy Jack
Journal: European Respiratory Journal (2014)

Background   Patients with locally advanced rectal cancer receive 5 weeks of neoadjuvant chemoradiotherapy (CRT). Whilst CRT improves overall survival, data from our group have shown it to cause deterioration in physical fitness (Vo 2  at estimated lactate threshold; Vo 2  at LT) which can be rescued by a 6-week interval exercise training program.  We hypothesized that a training effect is achieved earlier than 6 weeks and that work efficiency (Vo 2  workrate relationship; Vo 2 -WR ml-W -1 -min -1 ) is a more sensitive marker.   Methods   30 patients (20 male) with rectal cancer had baseline cardiopulmonary exercise testing (CPET). Patients were allocated to exercise or control groups (mean age; exercise 64.4 ± 10.4 vs. control 71.3 ± 8.1 years). The exercise group (n= 20, 10 male) underwent interval training for 18 sessions between week 0 (completion of CRT) and week 6. All patients had CPET at week 0, 3, 6 and 9.   Results   All patients had decreased Vo 2 -WR following CRT (controls; p = 0.005, exercise; p= 0.0002). In controls, Vo 2 -WR remained depressed over the 9 week period. In the exercise group, Vo 2 -WR significantly increased by week 3 (p=0.01), whilst Vo 2  at LT did not increase significantly until week 6. Within the exercise group, there was a variable training response training (9responders9 increased Vo 2  at LT by >2mls -1 kg -1 min -1  by week 9). The increase in Vo 2 -WR at week 3 was only seen in responders. Non-responders showed a training effect at week 9.   Conclusion   CRT causes a decrease in work efficiency, which can be rescued by 3 weeks of interval exercise training. Vo 2 -WR may be a more sensitive marker of training response, though the slowed improvement in non-responders requires further investigation.
GPs must redesign Health Check programme if they want it to work, conference hears:
Authors: Nigel Hawkes
Journal: BMJ (2015)

Health checks on all people over 40 in GP surgeries can work—but only if they are redesigned and locally driven, a Westminster Health Forum heard on 16 July.

The Health Check programme, first introduced in 2009 when Gordon Brown was prime minister, has been widely criticised as a waste of GPs’ time, and in May this year the Royal College of General Practitioners called for it to be discontinued until robust evidence of its effectiveness is available.

Azhar Farooqi, co-chair of the Leicester City clinical commissioning group (CCG), told the London meeting that Health Checks, as originally conceived, did not work.

“Uptake was very low, with only 8% of practices achieving targets,” he said. “More than a quarter of GP surgeries failed to do any checks at all, and for every six invitations mailed to those aged over 40, only one turned up for the check. In Leicester our uptake was really low.” …
Polymorphisms in CYP17 and CYP19, unopposed estrogen use, body mass index, full-term pregnancy, and endometrial cancer risk.
Authors: Chu Chen, Jennifer A. Doherty, Noel S. Weiss
Journal: Cancer Research (2006)

Proc Amer Assoc Cancer Res, Volume 47, 2006

5405 

Established risk factors for endometrial cancer include the use of exogenous unopposed estrogens, high body mass index (BMI), and nulliparity. We hypothesized that genetic factors influencing endogenous biosynthesis of steroid hormones may also influence a woman’s risk of endometrial cancer. CYP17 catalyzes the biosynthesis of estrogens from pregnenolone and progesterone. The A2/A2 genotype for the common C-34T polymorphism at the promoter region has been associated with elevated circulating estrogen and progesterone levels. CYP19 catalyzes the irreversible aromatization of androgens to form estrogens in peripheral tissues. A relatively larger number of (TTTA)n repeats in intron 4 of the CYP19 gene has been associated with higher estrone to androstenedione ratios. We evaluated these two polymorphisms in relation to risk of endometrial cancer in a population-based case-control study in Washington State, with 371 cases and 420 controls, ages 50-69 years. The presence of the CYP17 A2/A2 genotype, compared to the A1/A1 genotype, was associated with a slight reduction of endometrial cancer risk among Caucasian women. The age-adjusted odds ratio (OR) was 0.76 (95% confidence interval (CI): 0.49-1.17). Having two CYP19 long alleles (>11 repeats) was associated with a small increase in risk (age-adjusted OR, 95% CI: 1.41, 0.92-2.15). The association between the CYP17 and CYP19 genotypes and endometrial cancer risk did not vary appreciatively among women who did or did not use unopposed estrogens (use for 6 or more months and use for  25kg/m2). However, for CYP19 (but not CYP17 ), a stronger association was observed among women who had never had a full-term pregnancy. For the CYP19 >11/>11 genotype compared to  11/>11 genotype). For the  11 genotype, the OR was 2.20 (95% CI, 0.91-5.36). We also observed that the increased risk associated with having one or two CYP19 >11 repeat alleles (compared to none) was generally restricted to women with two CYP17 A2 alleles (OR, 95% CI for the CYP19  11and >11/ >11 genotypes compared to <11/<11 were, respectively: 1.88, 0.76-4.61 and 2.72, 0.90-8.19). These results, combined with those of other epidemiologic studies, suggest that women with the CYP17 A2/A2 genotype are at a modestly reduced risk of endometrial cancer, and that relatively longer CYP19 (TTTA)n repeat alleles are associated with an elevated risk of endometrial cancer. This work was supported by grants RO1 CA105212, R01 CA 75977, R03 CA 80636, N01 HD-2-3166, R35 CA 39779, K05 CA 92002, and funds from the Fred Hutchinson Cancer Research Center.
Plasma PDGF and VEGF as sensitive biomarkers for monitoring of angiogenesis in hepatocellular cancer patients
Authors: G. Treiber, T. Wex, P. Malfertheiner
Journal: Journal of Clinical Oncology (2005)

3183 Background: Combined inhibition of endothelial cells (EC via VEGF) and pericytes (PC via PDGF) was more effective in a mouse model of pancreatic cancer than targeting either cell type alone (Hanahan JCI 2003). Angiogenesis is currently monitored either by histology (inconvenient) or by functional imaging modalities (expensive). Attempts to establish markers in peripheral blood have been performed only for VEGF; in hepatocellular cancer (HCC) close correlations have been found for serum VEGF normalised to platelet count and VEGF expression in tumor tissue. PDGF monitoring has not been established yet. Methods: Our aim was to evaluate the plasma and serum VEGF and PDGF expression (over time and in response to treatment) as simple, low-cost markers for angiogenesis which can be applied for clinical routine. Patients with advanced HCC were treated by either octreotide 30 mg (long-acting release formula) once monthly alone or in combination with imatinib 400 mg daily. It was hypothesised that octreotide will mainly act via VEGF as shown previously by our group, and that imatinib will target the PDGF receptor. Results: In an ongoing study, 16 patients have been studied for at least 3 months. The results for the angiogenesis markers evaluated are listed in the table: Mean±SD (median), non-parametric testing: *denotes p<0.05. Comparative data for the VEGF/platelets ratio were similiar than directly measuring VEGF in plasma. Significant correlations were found between HCC vascularisation on CT/US and VEGF/PDGF. Conclusions:This study confirms (1) that imatinib is able to significantly inhibit PDGF expression and that (2) additional imatinib does not influence VEGF secretion. (3) The effect of imatinib on PDGF inhibition does not last for more than 4 weeks, suggesting either tumor resistance or tumor escape. (4) Octreotide treatment alone leads to an activation of PC-associated angiogenesis in the early phase which is reversed in the long-term. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novartis Pharma Nuermberg, Germany
Randomized Phase II Study of High-Dose Paclitaxel With or Without Amifostine in Patients With Metastatic Breast Cancer
Authors: K. Gelmon, E. Eisenhauer, C. Bryce, A. Tolcher, L. Mayer, E. Tomlinson, B. Zee, M. Blackstein, E. Tomiak, J. Yau, G. Batist, B. Fisher, J. Iglesias
Journal: Journal of Clinical Oncology (1999)

PURPOSE: To determine whether the neurotoxicity of paclitaxel 250 mg/m 2 given over 3 hours every 3 weeks could be reduced by pretreatment with amifostine 910 mg/m 2 . Secondary objectives included comparing myelosuppression, myalgias, and response rates of the two groups. PATIENTS AND METHODS: Forty womenwith metastatic breast cancer were randomized to receive either paclitaxel alone (arm 1) or paclitaxel preceded by amifostine (arm 2). All were assessable for toxicity, and 37 were assessable for response. At baseline and after each cycle, all patients completed questionnaires for neurologic symptoms and had standardized neurologic examinations, including objective assessments of power and vibration sense. In addition, standard follow-up assessments for other toxicities and tumor response were undertaken. Changes from baseline after courses 1, 2, and 3 were assessed. The sample size was sufficient to detect a 50% improvement in the expected determination in sensory change. RESULTS: There were no differences observed in any of the measures of neurotoxicity. Other toxicity was similar in arms 1 and 2, including hair loss (95% v 90%), neurosensory changes (100% v 100%), fatigue/lethargy (85% v 90%), myalgia (95% v 90%), and grade 4 neutropenia (47% v 60%). Nausea, vomiting, dizziness, hypotension, and sneezing were more common in the amifostine arm. Response rates (22.2% v 36.8%) and paclitaxel pharmacokinetics were not significantly different. CONCLUSION: There was no protection from paclitaxel-related neurotoxicity or hematologic toxicity in this study. These results suggest that the mechanism of action of paclitaxel-related toxic effects is not amenable to the cytoprotective action of amifostine.
Posture, mobility and pulmonary function in COPD: An exploratory study
Authors: Nuno Morais, Joana Cruz, Alda Marques
Journal: European Respiratory Journal (2014)

Altered postural alignment, joint mobility and muscle length of the upper quadrant have been associated with impaired pulmonary function in chronic respiratory diseases, such as cystic fibrosis. However, this has been scarcely studied in COPD. This study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to pulmonary function in patients with COPD.  Fifteen patients with COPD (69.4±10.2yrs) participated. Pulmonary function (FEV 1 , FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine and shoulder joint were assessed taking 6 photographs in the sagittal plane: neutral position; full head protraction/retraction, thoracic spine flexion/extension and shoulder flexion. Angles were calculated with a computer-assisted digitising software. Pectoralis minor muscle (PmM) resting length was assessed with a measuring tape. Stepwise multiple linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function.  Patients had a FEV 1  of 1.7±0.5L (66.0±17.8pp) and FVC of 2.6±0.8L (75.3±17.8pp). Full head protraction and non-dominant PmM resting length were significant predictors of FEV 1  absolute value (p=.008; r 2  adj =.48). These variables, together with full upper thoracic spine flexion and full thoracic spine extension, were significant predictors of FVC (p 2  adj =.82).  Patients with COPD present spinal mobility and muscle length adaptations related to impaired pulmonary function. Further research is needed to understand the underlying mechanisms and clinical value of these relationships, as they may provide new insights for the development of rehabilitation interventions in COPD.