tbuckley/cabot-search huggingface dataset:
Outbreak of Bacteremia Due to<i>Burkholderia contaminans</i>Linked to Intravenous Fentanyl From an Institutional Compounding Pharmacy
Authors: Rebekah W. Moehring, Sarah S. Lewis, Pamela J. Isaacs, Wiley A. Schell, Wayne R. Thomann, Mary M. Althaus, Kevin C. Hazen, Kristen V. Dicks, John J. LiPuma, Luke F. Chen, Daniel J. Sexton
Journal: JAMA Internal Medicine (2014)

IMPORTANCE Many health care facilities compound medications on site to fulfill local demands when customized formulations are needed, national supply is critically low, or costs for manufactured pharmaceuticals are excessive. Small, institutional compounding facilities may perform the same high-risk procedures as large distributors of compounded medications. OBJECTIVES To investigate an outbreak related to contamination of compounded sterile preparations and to determine processes to prevent future outbreaks. DESIGN, SETTING, AND PARTICIPANTS We performed an outbreak investigation of inpatients at Duke University Hospital from August 31 through September 6, 2012. The investigation included a case-control study, compounding facility inspection and environmental sampling, observation of a mock compounding demonstration, and microbiologic and molecular testing of sequestered medication. EXPOSURES Intravenous fentanyl prepared by an institutional compounding pharmacy. MAIN OUTCOMES AND MEASURES Microbiologic and molecular evidence of contamination of a compounded sterile preparation and failure of routine sterility testing. RESULTS Blood cultures of 7 patients during a 7-day period at Duke University Hospital yielded pan-susceptible Burkholderia cepacia complex bacteria. The risk factor common to all patients was receipt of continuous fentanyl infusion prepared by our institutional compounding pharmacy (odds ratio, 11.22; 95% CI, 2.09-∞; P = .01). The outbreak was terminated after sequestration of compounded fentanyl. An intensive evaluation of the compounding facility, its practice, and its procedures was completed. Investigators evaluated the clean room, collected targeted microbiologic samples within the compounding pharmacy environment, and observed a mock demonstration of compounding practice. The B cepacia complex was found in the anteroom sink drain and pH probe calibration fluid from the compounding clean room. Multiple microbiologic analyses of sequestered fentanyl initially failed. Ultimately, a batched, vacuum-assisted filtration method produced B cepacia complex from a single lot. Molecular analyses using repetitive element polymerase chain reaction and pulsed-field gel electrophoresis confirmed a clonal Burkholderia contaminans strain from patients, fentanyl, and environmental samples. CONCLUSIONS AND RELEVANCE An outbreak of B contaminans bacteremia was linked to contamination of locally compounded intravenous fentanyl. Health care facilities that house institutional compounding facilities must be vigilant in efforts to prevent, recognize, and terminate medication-related outbreaks.
Liver transplantation for haemophiliacs with hepatitis C cirrhosis.
Authors: M McCarthy, E Gane, S Pereira, C J Tibbs, N Heaton, M Rela, H Hambley, R Williams
Journal: Gut (1996)

Experience of liver transplantation in haemophiliacs with end stage hepatitis C liver disease is limited and particularly difficult questions are raised when there is also HIV infection.This is the first report in Great Britain to describe the operative replacement therapy and initial outcome in four haemophiliacs with end stage HCV cirrhosis.Two patients had factor VIII, one had factor IX, and one had factor X deficiency. One patient had also contracted HIV infection from factor replacement but had no AIDS defining illnesses.Intraoperatively patients were given either factor VIII infusions, factor IX bolus, or fresh frozen plasma, according to formulae devised to calculate exact clotting factor requirements. Baseline preoperative coagulation studies included prothrombin time, activated partial thromboplastin time, fibrinogen concentrations, and factor VIII, IX, and X concentrations. Factor concentrations were then assayed at 12, 24, 48, and 72 hours postoperatively.Postoperatively all patients had coagulation factor concentrations sustained within the normal ranges by 72 hours unsupported (137, 125, 95, 104 IU/dl), representing de novo synthesis by the graft. Transfusion requirements during the operative and immediate post-transplant period were no greater than those of patients without clotting disorders. Two patients had episodes of bleeding postoperatively, one of which was fatal, occurring at the site of a previous untreated subdural bleed. In both instances the bleeding occurred in the presence of normal concentrations of clotting factor. The remaining three patients are at 6, 6, and 12 months post-transplant and remarkably improved clinically with sustained factor concentrations. One patient has evidence of graft dysfunction from HCV recurrence and all have evidence of recurrent viraemia with HCV on polymerase chain reaction studies.Orthotopic liver transplantation should be considered in haemophiliac patients with end stage liver disease from hepatitis C infection with or without concomitant HIV infection. Their clinical condition is likely to be greatly improved by orthotopic liver transplantation and the haemophilia cured with only a small risk of severe graft dysfunction from recurrent HCV infection.
Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants
Authors: Ciaran S. Phibbs, Laurence C. Baker, Aaron B. Caughey, Beate Danielsen, Susan K. Schmitt, Roderic H. Phibbs
Journal: New England Journal of Medicine (2007)

There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units. We examined differences in neonatal mortality among infants with very low birth weight (below 1500 g) among NICUs with various levels of care and different volumes of very-low-birth-weight infants.
CHORIONEPITHELIOMATOUS PROLIFERATIONS IN TERATOMATA, ESPECIALLY IN THOSE OF THE TESTICLE; WITH THREE NEW CASES.
Authors: ROBERT T. FRANK
Journal: JAMA (1906)

<h3>3. HYDATIDIFORM PROLIFERATIONS IN TERATOMATA.</h3><h3>CASES IN THE MALE.</h3> The preceding cases, many of them consisting of testicle tumors in which chorionepitheliomatous proliferation with teratomatous elements are demonstrable, are sufficiently numerous, similar and well authenticated to be accepted as a distinct and recognized variety of tumor. Schlagenhaufer has, in addition, described what he considers a modification of these neoplasms, which bear a similar relation to chorionepithelioma of the testicle that hydatid moles bear to chorionepithelioma of the uterus. This author has personally reviewed the case reported by Karl Breus<sup>72</sup>in 1878, and re-examined the material, also collecting five cases from the literature. All these cases have certain features in common. A primary testicle tumor is present in all; in most of them the testicle tumor is evidently a teratoma; in one only (Breus' case) do parts of the metastases resemble chorionepitheliomatous tissue. In all, metastatic extension into the large
Abstract 3080: Functional studies of a cell cycle and angiogenesis-related candidate tumor suppressor gene, <i>Mirror image polydactyly 1</i>, in nasopharyngeal carcinoma
Authors: Arthur Kwok Leung Cheung, Hong Lok Lung, Josephine Mun Yee Ko, Maria Li Lung
Journal: Cancer Research (2010)

Abstract Background and aims: Nasopharyngeal carcinoma (NPC) is a cancer with an especially high incidence in Southern China. We performed functional complementation studies to confirm and map critical regions on chromosome 14 associated with its tumor-suppressive ability. An interesting candidate tumor suppressor gene (TSG), Mirror image polydactyly 1 (MIPOL1) was identified. Previously this gene has only been reported to be associated with a genetic developmental disorder. Its contribution to cancer and its functional role in NPC was, therefore, investigated. Methods: A tetracycline-inducible system was used to obtain MIPOL1-expressing clones. A wild-type MIPOL1 gene was transferred into a NPC cell line, HONE1-2. Functional studies such as in vivo nude mouse tumorigenicity, HUVEC tube formation, and cell cycle analysis assays were used to investigate the function of MIPOL1. Results: MIPOL1 re-expression can suppress tumor growth in vivo and induce cell cycle arrest through increasing p21(WAF1/CIP1) and p27(KIP1) expression. Furthermore, expression of MIPOL1 can inhibit angiogenesis in the tube formation assay. Functional pathways were studied by detection of change in expression levels of different angiogenesis-related proteins in cell lysates and conditional medium of those stable clones. Conclusions: An interesting candidate TSG, MIPOL1, was identified. Functional studies confirm that MIPOL1 can suppress tumor growth in vivo. It can induce cell cycle arrest through the p21(WAF1/CIP1) and p27(KIP1) pathways. MIPOL1 can also inhibit angiogenesis, and this further confirms its importance in tumor suppression. Changes in expression of different angiogenesis-related proteins were observed. MIPOL1 is a good candidate tumor suppressor gene in NPC and warrants further study. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3080.
The Role of Radioactive Iodine Therapy in Young Patients With Papillary Thyroid Cancer
Authors: Sheng-Fong Kuo, Tzu-Chieh Chao, Hung-Yu Chang, Chuen Hsueh, Yu-Chen Chang, Chung-Han Yang, Jen-Der Lin
Journal: Clinical Nuclear Medicine (2008)

The aim of this study was to investigate the outcome of postoperative radioactive iodine (I-131) therapy in young patients with papillary thyroid carcinoma (PTC).This retrospective study reviewed the medical records of primary PTC patients, 18 years old or younger, who were treated at Chang Gung Medical Center in Taiwan from January 1977 to December 2006. Forty-eight patients who had undergone postoperative I-131 therapy with a minimum dose of 1.1 GBq (30 mCi) were enrolled in this retrospective study. At the end of follow-up, patients were classified as "local disease" or "distant metastases" according to I-131 scan results.The I-131 whole-body scan results revealed "local disease" in 34 patients, and "distant metastases" in 14 patients. Patients with distant metastases received significantly larger doses of I-131 than those with local disease (P = 0.0086). One-month postoperative serum thyroglobulin differed markedly between patients with local disease and those with distant metastases (P = 0.001). After a mean follow-up period of 11.2 +/- 5.7 years, overall survival in the 48 patients was 97.9%.I-131 therapy is effective for young PTC patients, and should be given to all young PTC patients postoperatively in addition to thyroid hormone administration, particularly those with distant metastases.
Blood Pressure and Left Ventricular Hypertrophy During American-Style Football Participation
Authors: Rory B. Weiner, Francis Wang, Stephanie K. Isaacs, Rajeev Malhotra, Brant Berkstresser, Jonathan H. Kim, Adolph M. Hutter, Michael H. Picard, Thomas J. Wang, Aaron L. Baggish
Journal: Circulation (2013)

Background— Hypertension, a strong determinant of cardiovascular disease risk, has been documented among elite, professional American-style football (ASF) players. The risk of increased blood pressure (BP) and early adulthood hypertension among the substantially larger population of collegiate ASF athletes is not known. Methods and Results— We conducted a prospective, longitudinal study to examine BP, the incidence of hypertension, and left ventricular remodeling among collegiate ASF athletes. Resting BP and left ventricular structure were assessed before and after a single season of competitive ASF participation in 6 consecutive groups of first-year university athletes (n=113). ASF participation was associated with significant increases in systolic BP (116±8 versus 125±13 mm Hg; P &lt;0.001) and diastolic BP (64±8 mm Hg versus 66±10 mm Hg; P &lt;0.001). At the postseason assessment, the majority of athletes met criteria for Joint National Commission (seventh report) prehypertension (53 of 113, 47%) or stage 1 hypertension (16 of 113, 14%). Among measured characteristics, lineman field position, intraseason weight gain, and family history of hypertension were the strongest independent predictors of postseason BP. Among linemen, there was a significant increase in the prevalence of concentric left ventricular hypertrophy (2 of 64 [3%] versus 20 of 64 [31%]; P &lt;0.001) and change in left ventricular mass correlated with intraseason change in systolic BP ( R =0.46, P &lt;0.001). Conclusions— Collegiate ASF athletes may be at risk for clinically relevant increases in BP and the development of hypertension. Enhanced surveillance and carefully selected interventions may represent important opportunities to improve later-life cardiovascular health outcomes in this population.
Topographical cues regulate the crosstalk between MSCs and macrophages
Authors: Gema Vallés, Fátima Bensiamar, Lara Crespo, Manuel Arruebo, Nuria Vilaboa, Laura Saldaña
Journal: Biomaterials (2014)

Implantation of scaffolds may elicit a host foreign body response triggered by monocyte/macrophage lineage cells. Growing evidence suggests that topographical cues of scaffolds play an important role in MSC functionality. In this work, we examined whether surface topographical features can regulate paracrine interactions that MSCs establish with macrophages. Three-dimensional (3D) topography sensing drives MSCs into a spatial arrangement that stimulates the production of the anti-inflammatory proteins PGE2 and TSG-6. Compared to two-dimensional (2D) settings, 3D arrangement of MSCs co-cultured with macrophages leads to an important decrease in the secretion of soluble factors related with inflammation and chemotaxis including IL-6 and MCP-1. Attenuation of MCP-1 secretion in 3D co-cultures correlates with a decrease in the accumulation of its mRNA levels in MSCs and macrophages. Using neutralizing antibodies, we identified that the interplay between PGE2, IL-6, TSG-6 and MCP-1 in the co-cultures is strongly influenced by the micro-architecture that supports MSCs. Local inflammatory milieu provided by 3D-arranged MSCs in co-cultures induces a decrease in monocyte migration as compared to monolayer cells. This effect is partially mediated by reduced levels of IL-6 and MCP-1, proteins that up-regulate each other's secretion. Our findings highlight the importance of topographical cues in the soluble factor-guided communication between MSCs and macrophages.
Influence of the terminal complement-complex on reperfusion injury, no-reflow and arrhythmias: a comparison between C6-competent and C6-deficient rabbits
Authors: W. Ito, H.J. Schäfer, S. Bhakdi, R. Klask, S. Hansen, S. Schaarschmidt, J. Schofer, F. Hugo, T. Hamdoch, D. Mathey
Journal: Cardiovascular Research (1996)

Objective: The complement system has been suggested to play a role in reperfusion injury which may result from an enhanced destruction of myocardial tissue or from an impairment of reflow. We investigated the influence of the C5b-9 complement complex on infarct size, reflow and arrhythmogenesis. Methods: Twenty-eight C6-competent rabbits and 18 rabbits with congenital C6 deficiency were subjected to either 30 min or 2 h of coronary artery occlusion followed by reperfusion. C6 deficiency was confirmed by the complement titration test and immunohistology. The triphenyl tetrazolium chloride method was used to delineate infarct size. Reflow into infarcted areas was evaluated histologically after an in vivo injection of propidium iodide which served as an early fluorescence microscopic marker of damaged myocardium subjected to reflow. Continuous ECG monitoring allowed the recording of arrhythmias. Results: After 30 min of coronary artery occlusion infarct size was significantly smaller in C6-deficient rabbits (5.0 ± 2% of the risk region) as compared to C6-competent rabbits (28.4 ± 8.5%, P = 0.0371). The extent of reflow into damaged myocardium was nearly the same in both animal groups at this time (38 ± 9 vs. 39 ± 7% of the risk region). After 2 h of coronary artery occlusion, infarct size was not different between both animal groups, but the extent of reflow into damaged myocardium was significantly smaller in C6-competent rabbits than in C6-deficient rabbits (25 ± 4 vs. 40 ± 4%; P = 0.0185). Two of the 18 C6-deficient rabbits had ventricular arrhythmias (Lown II–IV), none of which was fatal. Eleven of the 28 C6-competent animals had major ventricular arrhythmmias which were fatal in 6 rabbits. Conclusions: These results suggest that the lytic C5b-9 complement complex leads to reperfusion injury in the early phase (30 min) of ischaemia, resulting in a larger infarct. After 2 h of ischaemia, complement activation enhances the no-reflow phenomenon but does not affect infarct size. Finally, the C6 status seems to influence the susceptibility to ventricular arrhythmias after coronary artery occlusion, independent of reperfusion.
Localization of inhaled trimellitic anhydride to lung with a respiratory lymph node antibody secreting cell response
Authors: C.Raymond Zeiss, Nabil S. Hatoum, Jeffery Ferguson, Jerome Trout, Doris Levitz, Farida Siddiqui, John Henderson, Jeannee Yermakoff, Roy Patterson
Journal: Journal of Allergy and Clinical Immunology (1992)
Bispecific Antibody Pretargeting of Radionuclides for Immuno–Single-Photon Emission Computed Tomography and Immuno–Positron Emission Tomography Molecular Imaging: An Update
Authors: Robert M. Sharkey, Habibe Karacay, William J. McBride, Edmund A. Rossi, Chien-Hsing Chang, David M. Goldenberg
Journal: Clinical Cancer Research (2007)

Abstract Molecular imaging is intended to localize disease based on distinct molecular/functional characteristics. Much of today's interest in molecular imaging is attributed to the increased acceptance and role of 18F-flurodeoxyglucose (18F-FDG) imaging in a variety of tumors. The clinical acceptance of 18F-FDG has stimulated research for other positron emission tomography (PET) agents with improved specificity to aid in tumor detection and assessment. In this regard, a number of highly specific antibodies have been described for different cancers. Although scintigraphic imaging with antibodies in the past was helpful in patient management, most antibody-based imaging products have not been able to compete successfully with the sensitivity afforded by 18F-FDG-PET, especially when used in combination with computed tomography. Recently, however, significant advances have been made in reengineering antibodies to improve their targeting properties. Herein, we describe progress being made in using a bispecific antibody pretargeting method for immuno–single-photon emission computed tomography and immunoPET applications, as contrasted to directly radiolabeled antibodies. This approach not only significantly enhances tumor/nontumor ratios but also provides high signal intensity in the tumor, making it possible to visualize micrometastases of colonic cancer as small as 0.1 to 0.2 mm in diameter using an anti–carcinoembryonic antigen bispecific antibody, whereas FDG failed to localize these lesions in a nude mouse model. Early detection of micrometastatic non–Hodgkin's lymphoma is also possible using an anti-CD20–based bispecific antibody pretargeting procedure. Thus, this bispecific antibody pretargeting procedure may contribute to tumor detection and could also contribute to the detection of other diseases having distinct antigen targets and suitably specific antibodies.
SLOW GAIT AMONG OLDER ADULTS POST-AMI AND RISK FOR HOSPITAL READMISSION
Authors: John A. Dodson, Kimberly J. Reid, Thomas M. Gill, Harlan M. Krumholz, Daniel E. Forman, John A. Spertus, Michael W. Rich, Suzanne V. Arnold, Karen P. Alexander
Journal: Journal of the American College of Cardiology (2012)
SUSTAINED VENTRICULAR ARRHYTHMIAS ADD PROGNOSTIC VALUE INDEPENDENT OF UNDERLYING RISK IN STEMI PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Rajendra H. Mehta, Aijing Z. Starr, Renato D. Lopes, Jonathan P. Piccini, Paul W. Armstrong, Christopher B. Granger
Journal: Journal of the American College of Cardiology (2010)
How Should Treatment Decisions Be Made for Incapacitated Patients, and Why?
Authors: David I Shalowitz, Elizabeth Garrett-Mayer, David Wendler
Journal: PLoS Medicine (2007)

Patients have gained unprecedented levels of control over their medical care, including prospective control over what treatments they will receive if they lose the ability to make decisions. The landmark Cruzan and Quinlan cases helped to secure patients' right to prospectively refuse life-sustaining treatments [1,2], while the Patient Self-Determination Act of 1990 mandated that patients be informed of the option to document their treatment preferences in an advance directive [3].

Despite these efforts, many individuals fail to complete an advance directive and seldom discuss their medical treatment preferences, often leaving clinicians with little indication for how they want to be treated [4–7]. Several groups have attempted to increase the number of people who complete an advance directive, and several approaches offer promise in this regard [8]. Yet, no method, no matter how exhaustive, will result in all individuals completing an advance directive, and no advance directive, no matter how detailed, will provide clear instructions for all clinical scenarios. For the foreseeable future, then, clinicians will continue to face the dilemma of how to treat some incapacitated patients in the absence of clear evidence regarding their treatment wishes.

Most states in the US direct clinicians to turn to surrogate decision makers, identified through standardized relationship hierarchies, to make treatment decisions for incapacitated patients who did not designate a surrogate while capacitated. Surrogates, whether designated by the patient or the state's standardized hierarchy, are instructed to make the treatment decision the patient would have made if capacitated. Under this “substituted judgment” standard, a surrogate asked to decide whether to initiate dialysis for a comatose patient, for example, should try to determine what decision the patient would have made in the circumstances.

Individuals often fail to complete an advance directive.

The medical profession's reliance on surrogates to make treatment decisions for incapacitated patients gains support from the fact that the relevant considerations for choosing a substitute decision maker all seem to point to the family and loved ones. Allowing the patient's family and loved ones to make treatment decisions seems to respect their status as vital individuals in the patient's life [9–11] and may provide comfort at a difficult time. Reliance on those who know the patient best also seems to promote patient autonomy by maximizing the chances that the incapacitated patient's preferences will guide what treatments they receive. Finally, current practice seems consistent with patients' preferences for how treatment decisions should be made [12–14]. To test whether, in fact, these considerations all support the same approach, we assessed whether a population-based decision aid might predict patients' treatment preferences more accurately than surrogates.