tbuckley/cabot-search huggingface dataset:
Government should monitor quality of medical education
Authors: P. Vercellini, P. Vigano, E. Somigliana
Journal: BMJ (2015)

McCartney warns that “the money that industry spends on wooing doctors with free education is, of course, calculated to yield profitable returns” and urges doctors to select their own education and to pay for it.1 Most doctors want to keep up to date, but they must earn CME (continuing medical education) credits to …
Transmission of Staphylococcus aureus between mothers and infants in an African setting
Authors: F. Schaumburg, A.S. Alabi, G. Mombo-Ngoma, H. Kaba, R.M. Zoleko, D.A. Diop, J.-R. Mackanga, A. Basra, R. Gonzalez, C. Menendez, M.P. Grobusch, P.G. Kremsner, R. Köck, G. Peters, M. Ramharter, K. Becker
Journal: Clinical Microbiology and Infection (2013)
Potential of antigen detection tests
Authors: J. S. Andersen, N. J. Borrild, S. Hoffmann
Journal: BMJ (1995)

in childhood is therefore unlikely to be both sensitive (that is, identifying true positives) and specific (that is, not identifying non-cases as cases).This is especially so for schizophrenia of adult onset, which is characterised by abnormalities of cognition and behaviour not manifest in childhood.It is perhaps more important, however, to find out if and why potential cases either fail to develop schizophrenia or develop some disorder other than schizophrenia.Children with conduct disorders have been shown to be at high risk of alcohol and drug misuse and antisocial personality in adult life.' Whether the pattern of misconduct in these children differs or whether intervening events lead to different conditions remains to be determined.
Timing of genetic testing relative to breast cancer surgery.
Authors: J. R. Trosman, C. B. Weldon, W. J. Gradishar, J. C. Schink
Journal: Journal of Clinical Oncology (2010)

666 Background: BRCA test results, when available, may significantly influence treatment decisions for patients with breast cancer (BC). Patients with a BRCA mutation have a higher risk of breast cancer recurrence. These patients are more likely to view mastectomy as the best way to reduce future BC recurrence while avoiding multiple surgeries and radiation (Schwartz et al, J Clin Oncol. 2004). The goal of this study is evaluation of BRCA test timing relative to BC surgery in a major metropolitan area cohort. Methods: This is a retrospective review of insurance claims and medical records for a subpopulation of 144 patients who underwent BRCA testing and definitive surgery, from population of 1,569 woman 18-70 years old treated for breast cancer between 01/01/2007 and 09/30/2009 at an NCCN center. We used simple frequencies and Fisher's exact test to evaluate occurrences of BRCA testing relative to surgery, association with surgical decisions, and with age. This study was performed according to an IRB approved protocol. Results: The BRCA test was performed presurgery in 37% (53/144) and postsurgery in 63% (91/144) of our cohort. The BRCA test was performed a median of 35 days presurgery or a median of 132 days after surgery. In our cohort, 66% (35/53) of women tested presurgery had a mastectomy compared to 38% (35/91) of women tested after surgery (p > 0.0018). We did not attempt to correlate BRCA results with the surgical decision. In our cohort, 43% (39/90) women under 50 years of age had BRCA testing presurgery as compared to 26% (14/54) of women over 50 (p > 0.0492). Conclusions: In our cohort, BRCA mutation analysis performed prior to breast cancer surgery affected the surgical approach. Unfortunately, 63% of our patients did not have BRCA mutation information available for initial surgical planning. Our results suggest that age is a factor in timing of BRCA testing. The study site has an established cancer genetics counseling program available to all patients, suggesting that access to genetic counseling was not a factor. The timing of presurgery test in our cohort suggests that effective sequencing of testing and surgery is feasible. In the era when BRCA testing has a 14-day turn around, incorporating this test into the initial preoperative workup should be considered. No significant financial relationships to disclose.
Clinical and socio–economic impact of influenza and respiratory syncytial virus infection on healthy children and their households
Authors: S. Esposito, R. Gasparini, S. Bosis, P. Marchisio, C. Tagliabue, S. Tosi, C. Bianchi, P. Crovari, N. Principi
Journal: Clinical Microbiology and Infection (2005)
Experience of Alk Mutation Testing in 3351 Indian Patients of Nsclc
Authors: S. Dutt, S.H. Advani, B.N. Dhabhar, P.S. Dattatreya, S. Patil, S. Chatterjee, S. Srinivasan, D.K. Mishra, T. Raja, K. Pavithran, P.V.A. Reddy, R.G. Nambiar, R. Gaur
Journal: Annals of Oncology (2014)
First detection of Anaplasma phagocytophilum-like DNA in the French izard Rupricapra pyrenaica
Authors: E. Laloy, E. Petit, H.-J. Boulouis, C. Lacroux, F. Corbiere, F. Schelcher, S. Bonnet, R. Maillard
Journal: Clinical Microbiology and Infection (2009)
Depression and Pancreatic Cancer
Authors: Andrew D. Boyd, Michelle Riba
Journal: Journal of the National Comprehensive Cancer Network (2007)

Although pancreatic carcinoma and depression have been linked for years, the prevalence and relationship of these often coexisting diseases are still poorly understood. A clinical gestalt asserts that many patients present with depression before pancreatic carcinoma is diagnosed. Published studies reviewing this issue have found that many patients with pancreatic cancer are depressed. If the definition of depression is broadened to include mild depression in addition to major depression, these numbers increase. This article reviews the literature linking pancreatic carcinoma and depression.
Optimal Treatment of Unresectable Nonmelanoma Skin Cancers
Authors: Thomas Olencki
Journal: Journal of the National Comprehensive Cancer Network (2014)

Unlike in other types of cancer, in metastatic nonmelanoma, there are few dedicated oncologists to care for patients with unresectable skin cancers and little reliable clinical evidence to craft a therapeutic strategy. In his presentation at the NCCN 19th Annual Conference, Dr. Thomas Olencki offered a glimpse of some of the therapeutic regimens tried in the past for these rare skin cancers and briefly reviewed some of the more promising agents for advanced squamous cell, basal cell, and Merkel cell carcinomas, although the current evidence base is limited.
Abstract 408: The relationship between LINE-1 hypomethylation and fibrosis status in noncancerous liver tissues of hepatocellular carcinoma patients
Authors: Yoshifumi Baba, Kazuto Harada, Keisuke Kosumi, Hiromitsu Hayashi, Hidetoshi Nitta, Daisuke Hashimoto, Akira Chikamoto, Toru Beppu, Hideo Baba
Journal: Cancer Research (2014)

Abstract Background: The DNA methylation alterations that occur in human cancers include global DNA hypomethylation and site-specific CpG island promoter hypermethylation. Global DNA hypomethylation plays an important role in genomic instability, leading to cancer development. Since LINE-1 or the L1 retrotransposon constitutes a substantial portion of the human genome, LINE-1 methylation status reflects global DNA methylation. Our previous study has revealed that LINE-1 methylation level is a potential surrogate marker for epigenetic field defects induced by tobacco smoking in esophageal cancer patients. Given that liver fibrosis can be one phenomena of field cancerization theory in hepatocellular carcinoma (HCC), we examined the relationship between LINE-1 methylation level and fibrosis status in noncancerous liver tissues of HCC patients. Methods: Using histologically normal liver tissue samples and matched tumor tissue samples from 89 HCC cases, we measured LINE-1 methylation levels by pyrosequencing technology. Results: LINE-1 methylation of noncancerous liver tissues range was 35.8-97.3 of a 0-100 scale (mean: 78.1; median: 81.0; standard deviation: 11.9). HCC tissues showed significantly lower levels of LINE-1 methylation than matched normal tissue (P&amp;lt;0.01). LINE-1 methylation of noncancerous liver tissues was not associated with age, sex, Hepatitis B Virus infection, or Hepatitis C Virus infection. Interestingly, LINE-1 methylation level of noncancerous liver tissues with severe fibrosis (score 2-4) was significantly lower than that with mild fibrosis (score 0-1) (P=0.013). Conclusion: Liver fibrosis in noncancerous liver tissues of HCC patients was significantly associated with LINE-1 hypomethylation. This result supports the potential of LINE-1 methylation level as an indicator of epigenetic field for HCC cancerization. Citation Format: Yoshifumi Baba, Kazuto Harada, Keisuke Kosumi, Hiromitsu Hayashi, Hidetoshi Nitta, Daisuke Hashimoto, Akira Chikamoto, Toru Beppu, Hideo Baba. The relationship between LINE-1 hypomethylation and fibrosis status in noncancerous liver tissues of hepatocellular carcinoma patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 408. doi:10.1158/1538-7445.AM2014-408
Phenotypes of adult-onset asthma by cluster analysis
Authors: Marijke Amelink, Selma B. de Nijs, Jantina C. de Groot, Peter M.B. van Tilburg, Paul van Spiegel, Frans H. Krouwels, Rene Lutter, A.H. Zwinderman, Els J.M. Weersink, Anneke ten Brinke, Peter J. Sterk, Elisabeth H. Bel
Journal: European Respiratory Journal (2012)

Rationale : Asthma phenotyping is of increasing importance to identify patients who could benefit from personalised therapeutic strategies. Several studies suggested that adult-onset asthma is a specific phenotype. In order to explore underlying mechanisms of adult-onset asthma, we aimed to identify subphenotypes by using unsupervised clustering. methods

Methods: 200 patients with adult-onset (>18yr) asthma (60.5%female; age54(26-75)yr, 45%atopic) were characterized with respect to clinical, functional and inflammatory markers. Initial variable reduction was achieved by elimination of redundant data and factor analysis. K-means non-hierarchical cluster analysis was performed to identify clusters

Results: We identified three clusters of adult-onset asthma. Cluster 1 (n=41) consisted of predominantly females, with higher BMI and more often of non-Caucasian descent. They showed higher symptom scores, higher health care utilization and frequent exacerbations. However, they had lower sputum eosinophils and normal exhaled nitric oxide (FeNO) levels. Cluster 2 (n=69) consisted of predominantly females with severe asthma. They showed high symptom scores and frequent exacerbations, with reduced lung function, elevated sputum eosinophils and relatively high FeNO levels. Cluster 3 (n=90) consisted of predominantly males with mild-moderate asthma, normal lung function, minimal symptoms and health care utilization.

Conclusions : Non-hierarchical cluster analysis identifies three subphenotypes of adult-onset asthma that can be distinguished by gender, symptom severity, BMI, lung function and airway inflammation. Identifying these subphenotypes can help to investigate the associated pathobiology and provides new directions to personalized management.
Long-Term Outcome of Mustard/Senning Correction for Transposition of the Great Arteries in Sweden and Denmark
Authors: Niels Vejlstrup, Keld Sørensen, Eva Mattsson, Ulf Thilén, Per Kvidal, Bengt Johansson, Kasper Iversen, Lars Søndergaard, Mikael Dellborg, Peter Eriksson
Journal: Circulation (2015)

Background— The atrial switch operation, the Mustard or Senning operation, for the transposition of the great arteries (TGA) was introduced in the late 1950s and was the preferred surgery for TGA until the early 1990s. The Mustard and Senning operation involves extensive surgery in the atria and leaves the right ventricle as the systemic ventricle. The Mustard and Senning cohort is now well into adulthood and we begin to see the long-term outcome. Methods and Results— All the 6 surgical centers that performed Mustard and Senning operations in Sweden and Denmark identified all operated TGA patients. Information about death was obtained in late 2007 and early 2008 from the Danish and Swedish Centralised Civil Register by using the patients’ unique national Civil Registration Numbers. Four hundred sixty-eight patients undergoing the atrial switch operation were identified. Perioperative 30-day mortality was 20%, and 60% were alive after 30 years of follow-up. Perioperative mortality was significantly increased by the presence of a ventricular septal defect, left ventricular outflow obstruction, surgery early in the Mustard and Senning era. However, only pacemaker implantation is predictive of long-term outcome (hazard ratio, 1.90; 95% confidence interval, 1.05–3.46, P =0.04), once the TGA patient has survived the perioperative period. The risk of reoperation was correlated to the presence of associated defects and where the first Mustard/Senning operation was performed. Conclusions— The long-term survival of patients with Mustard and Senning correction for TGA appears to be primarily determined by factors in the right ventricle and tricuspid valve and not the timing of or the type of surgery in childhood. Cardiac function necessitating the implantation of a pacemaker is associated with an increase in mortality.
Safety and efficacy of inhaled mannitol as a bronchial provocation test in children
Authors: Ioanna Vasilopoulou, Michael Anthracopoulos
Journal: European Respiratory Journal (2011)

Background: Bronchial provocation with inhaled mannitol is a new and simple test for osmotic bronchial challenge. The aim of this study was to determine the efficacy and safety of inhaled mannitol in asthmatic children.

Methods: Sixty five children (54% males) aged 6-12 years, with established diagnosis of asthma, were studied. An asthma control questionnaire (C-ACT) was completed before bronchial provocation. A commercial preparation of dry powder mannitol was administered in progressively increasing doses according to the standard protocol, and the FEV1 was measured 60 seconds after each dose. The procedure ceased when a 15% fall in FEV1 was achieved (positive challenge) or the cumulative dose of 635 mg was reached (negative challenge). In case of a positive provocation, the dose of mannitol (mg) to provoke a 15% fall in FEV1 (PD15) was calculated. Adverse events during and 2 hours after the test were also monitored.

Results: Twenty four children (36.9%) were positive to the mannitol challenge, with a maximum mean% FEV1 fall of 18.7±4.1%, and a median PD15 of 125 mg (range 18 to 470 mg). There was a significant correlation between PD15 and C-ACT score (r = 0.58, p<0.001). The most common adverse events were: cough (83.1% - 100% in those with a positive challenge), nausea (9.2%), headache (4.6%), and abdominal pain (1.5%). No adverse effect was present at 2 hours after test.

Conclusion: Bronchial challenge with mannitol is safe and correlates well with the level of asthma control in asthmatic children.
Regional Variations in Primary Liver Cancer in Ivory Coast
Authors: A. J. Tuyns, R. Loubière, Fr. Duvernet-Battesti
Journal: JNCI Journal of the National Cancer Institute (1971)

Liver cancer is more frequent among inhabitants in the savanna area of Ivory Coast, West Africa, than among those in the coastal tropical forests of that country. Because aflatoxin contaminations in food are likely to be more prevalent in the savanna, the pattern of cancer is consistent with the hypothesis of a relationship between aflatoxin and liver cancer.
Fortnightly review: Treating acute pain in hospital
Authors: H. McQuay, A. Moore, D. Justins
Journal: BMJ (1997)

In treating acute pain, tradition and ill informed prejudice sometimes hold sway over evidence and common sense.In this review we concentrate on simple, clinically appropriate, and evidence based treatments. MethodsWhenever possible we based our recommendations on systematic reviews of randomised trials.A citation database of systematic reviews of pain relief can be found at http://www.jr2.ox.ac.uk/Bandolier/painres/MApain.html. 1 We chose reviews for their relevance and quality.Poor quality reviews are significantly more likely to make positive conclusions. 1We collected over 12 000 randomised trials of analgesic interventions from 1950 onwards 2 ; these are available on the Cochrane database.We used trials from this database when there was no relevant systematic review.
IL-18 in infectious exacerbations of COPD
Authors: Nikoletta Rovina, Efrossini Dima, Georgia Papadaki, Theocharis Anagnostakos, Charis Roussos, Manos Alchanatis, Nikolaos Koulouris
Journal: European Respiratory Journal (2011)

The nnate immune system is critical in recognizing bacterial and viral infections to evoke a proper immune response. IL-18, a pro-inflammatory and pro-apoptotic cytokine with crucial role in host defense against bacterial invasion is increased in lungs, serum and sputum of COPD patients, suggesting that IL-18 may be involved in chronic inflammation of COPD. We aimed to investigate the effect of infectious acute exacerbations of COPD (AECOPD) on IL-18 levels.  We examined 40 patients with COPD hospitalized for infectious AECOPD according to Anthonisen9s criteria and 20 patients with stable COPD. We examined sputum for inflammation and for bacterial infection using PCR. IL-18 was measured in induced sputum and serum at baseline and after treatment of the exacerbation. Immunocytochemistry of IL-18 expression in sputum cells was performed using a mouse monoclonal IL-18 antibody.  All patients had no previous hospitalization the preceding 3 months and none was diagnosed with pneumonia.  IL-18 levels in sputum were found significantly lower in AECOPD compared to stable state (p=0.05), while right after treatment IL-18 levels were increased compared to the stable state levels (p>0.05). Positive staining of IL-18 was observed in macrophages in immunocytochemistry. An inverse correlation was found between IL-18 levels and sputum macrophages in AECOPD (r=-630, p=0.028). Serum IL-18 levels were elevated in exacerbations (p>0.05) compared to stable state, and decreased after treatment to stable disease levels (p>0.05).  Our data show that although IL-18 is involved in host defence against bacterial pathogens in infectious AECOPD there may be a dysregulated activation of airways9 macrophages and perhaps inflammasome mediated pathways.
Lesson of the week: Zosteriform metastasis from melanoma
Authors: A V Evans
Journal: BMJ (2003)

Approximately 10% of metastases from all primary neoplasms involve the skin, but for malignant melanoma the figure is 44%.1 In some cases of melanoma this is the presenting feature, either because the primary lesion has regressed completely or because it has been unnoticed or ignored by the patient. Occasionally the melanoma has originated at an extracutaneous site such as the retina or the anal canal.

Metastases from cutaneous melanoma normally present as flesh coloured papules or nodules in the skin. Only about a third are pigmented or ulcerated. We report a case in which cutaneous metastases from a melanoma imitated herpes zoster. This presentation is known as zosteriform metastasis; it also occurs with other neoplasms.

A 73 year old white man presented with a three week history of painful, pruritic vesicles on a background of erythema on the right frontal area of the scalp (figure). The lesion had not responded to self …
Medication reconciliation as warranty of improvement in patient care
Authors: Leonardo Saldaña, Mª Carmen Herrero, Mª Victoria Hernández, Bárbara Steen, Sira Sanz, Mercedes Izquierdo, Elia Pérez-F
Journal: European Respiratory Journal (2014)

Objetive: To compare the degree of medication reconciliation(MR)during hospitalization and at discharge between the Units of Pneumology and Pharmacy after establishing a circuit of action between the two Units,in order to resolve the discrepancies and contribute to improve patient adherence

Methods: A prospective,cross-sectional study. Polymedicated patients admitted in the Unit of Pneumology between May-December 2012 and May-December 2013 were included. The Physician communicates the finalization of the discharge report. The Pharmacist communicates any discrepancies,gives a medication report and provides the patient the drugs of limited duration.The results of the two series were studied by comparing the frequency of the discrepancies (omissions,dosage or frequency differences,incomplete prescriptions,wrong prescriptions and initiation of drugs unjustified). Discrepancy: any difference between drugs taken in hospital and at discharge.Statistical methods:Descriptive and univariate analysis

Results: In 2012, 134 patients were reconciled out of 264 discharged (50.8%).In 2013, 219 out of 348 discharged (62.9%),p=0.003.The total nodiscrepancies in 2012 was 134, and in 2013 was 67

View this table:



Conclusions: The nopatients reconciled in 2013 has increased significantly.In addition %patients with discrepancies has decreased and also the nodiscrepancies per patient.This indicates a favourable evolution in the MR process, which has allowed the rational use of drugs in clinical terms.
CTLA-4 blockade-based immunotherapy for prostate cancer
Authors: L. Fong, B. Rini, B. Kavanaugh, E. Small
Journal: Journal of Clinical Oncology (2004)

2590 Background: CTLA-4 is an immunomodulatory molecule expressed on T cells that inhibits their activation. CTLA-4 blockade with antibody treatment augments T cell responses and anti-tumor immunity in animal models. We have shown that a single dose of anti-CTLA-4 antibody results in PSA reductions in hormone-refractory prostate cancer (HRPC) patients . We have also shown that administration of granulocyte-macrophage colony-stimulating factor (GM-CSF), a growth factor for antigen presenting cells, can also induce PSA declines in HRPC patients. In this study, the safety and efficacy of CTLA-4 blockade combined with GM-CSF was tested in HRPC patients . Methods: A phase I trial in patients with metastatic, HRPC was undertaken. Sequential cohorts of 3–6 patients received GM-CSF 250 mg/m2/d SC on days 1–14 of a 28-day cycle with escalating doses of anti-CTLA antibody given IV on day 1 of each cycle x 4. Patients were monitored for clinical autoimmunity as well as for polyclonal T cell activation. Assessment of antigen-specific and regulatory T cells was also performed to characterize the modulation of T cell immunity. PSA and radiographic tests were performed at baseline and throughout therapy for evaluation of clinical response. Results: Eight patients have been treated to date. Dose-limiting toxicity (DLT) was not observed in the initial CTLA-4 antibody dose level (0.5 mg/kg of anti-CTLA-4 antibody). One DLT, consisting of a vertebrobasilar TIA possibly related to therapy, was observed in the second dose level (1.5 mg/kg of anti-CTLA-4 antibody x 1, followed by 0.5 mg/kg of anti-CTLA-4 antibody x 3), resulting in expansion of this cohort to 6 patients. No clinical or laboratory evidence of autoimmunity has been observed. Non-specific activation of CD4+ and CD8+ T cells has not been seen, nor has modulation of antigen-specific immunity or CD4+CD25+ regulatory T cells been seen thus far. Conclusions: CTLA-4 blockade and GM-CSF has demonstrated preliminary safety in advanced prostate cancer without evidence of autoimmunity. Accrual is ongoing that will further define the safety and immunologic and clinical effects of this combination immunotherapy. No significant financial relationships to disclose.