tbuckley/cabot-search huggingface dataset:
A163: Alternative Mechanisms of Care Delivery in Pediatric Rheumatology: To What Extent Do They Expand the Reach of Pediatric Rheumatologists?
Authors: Meredith P. Riebschleger, Joshua Tootoo, Amanda Mroczek, Sarah Clark
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Pediatric rheumatology (PR) practitioners are concentrated in academic centers, rather than being evenly distributed throughout the US. Alternative mechanisms of care delivery, such as secondary clinic sites and telemedicine, may function as a bridge between PR practitioners and children who live far from academic centers. The objective of this study was to determine the prevalence and distribution of alternative mechanisms of care delivery in US PR practices.



Methods:

PR practices were identified using the American College of Rheumatology member directory and the Children's Hospital Association hospital directory. Practice websites were reviewed to obtain data regarding secondary clinic sites and use of telemedicine. Practices were then called to confirm website data and obtain data not available on websites. Distance between each main and secondary clinic site was calculated. Geographic information system (GIS) was used to integrate study data with census data.



Results:

77/90 PR practices participated in phone calls and were included in analyses. 46 practices (60%) reported using secondary clinic sites; the number of secondary sites per practice ranged from 1–6 (total 96 sites). Frequency of clinics at secondary sites ranged from weekly to once per year; >80% of sites held clinics at least once each month. Distance from the main practice site to secondary clinic sites ranged from 6.2 to 2265 miles, with 65% (62/96)  60 miles from a main practice site and 30% of US children live >60 miles from any PR clinic site. Of the 12 states without a PR practice, 3 were served by secondary clinic sites. Seven practices (9%) reported telemedicine capability, but only 3 (4%) reported ever using it.



Conclusion:

Though most PR practices utilize secondary clinic sites, nearly 2/3 of those sites are  60 miles) from any PR clinic site. Few practices currently use telemedicine. Therefore, it is not clear that secondary clinic sites and telemedicine, as currently employed, significantly expand the reach of PR practitioners. Future studies should investigate the efficiency and effectiveness of alternative mechanisms of care delivery, to determine how best to serve children who live far from academic centers.
Pharmacogenetics and Coumarin Dosing — Recalibrating Expectations
Authors: Issam Zineh, Michael Pacanowski, Janet Woodcock
Journal: New England Journal of Medicine (2013)

Three trials tested related hypotheses regarding genotype-informed dosing strategies for anticoagulants yet arrived at different results. Careful assessment of these trials can help to reframe the dialogue regarding evidentiary assessment of coumarin pharmacogenetics.
Effect of seat belt legislation on the incidence of sternal fractures seen in the accident department.
Authors: J S Budd
Journal: BMJ (1985)

Seat belts may be associated with certain injuries--for example, fractured sternums--and since legislation introduced on 1 February 1983, an increased incidence of these might be expected. At Addenbrooke's Hospital, Cambridge, it was noticed that a comparatively large proportion of front seat car occupants hurt in automobile accidents were presenting with anterior chest pain and were found to have sternal fractures. The aim of this study was therefore to determine whether the incidence of patients presenting to the Casualty Department with a sternal fracture had increased as a result of seat belt legislation. Details are given of the method used and of the results obtained: a threefold increase in the incidence of sternal fractures since legislation, coupled with an increase in the number of people surviving high speed automobile accidents and also a pronounced increase in the number of people wearing seat belts. (TRRL)
Peroxisome proliferator–activated receptor γ–mediated suppression of dendritic cell function prevents the onset of atopic dermatitis in NC/Tnd mice
Authors: Kyungsook Jung, Akane Tanaka, Hiroshi Fujita, Akira Matsuda, Kumiko Oida, Kaoru Karasawa, Noriko Okamoto, Keitaro Ohmori, Youngheun Jee, Taekyun Shin, Hiroshi Matsuda
Journal: Journal of Allergy and Clinical Immunology (2011)
CHOKED DISC IN ITS RELATION TO CEREBRAL TUMOR AND TREPHINING
Authors: ALFRED SAENGER
Journal: JAMA (1910)

When I was invited to be the guest of the Section on Nervous and Mental Diseases of the American Medical Association, and to read a paper before this famous body, I felt highly honored, and it was with the greatest pleasure and thanks that I accepted this invitation. Having leave to choose the subject I did not hesitate long and selected the important theme of choked disc in its relation to cerebral tumor and trephining. There is hardly any point which has for so long a time been subject to as much controversy as the pathogenesis of choked disc. In spite of numerous works, experiments, clinical observations and pathologic-anatomic investigations, we have not succeeded in bringing about an agreement between the various investigators on this topic. Just lately the old quarrel on the pathogenesis of choked disc has become active again in Germany. Surgical experience being, to my mind, of
Efficacy of Trastuzumab
Authors: Charles L. Vogel, Josina C. Reddy, Leonard M. Reyno
Journal: Cancer Research (2005)

To the Editor: 

We read with interest the article by Adams et al. [(1)][1], which describes the efficacy of an yttrium-90-labeled anti-HER2 diabody in a mouse xenograft model of HER2-positive breast cancer. Women with HER2-positive breast cancer have a distinctly worse prognosis than those whose
Hyperbaric Oxygen Treatment and Stroke-Reply
Authors: Richard D. Heimbach
Journal: JAMA (1981)

In Reply.—  I read Dr Neubauer's letter with a great deal of anticipation, hoping he would bring to light studies that did not suffer from the deficit inherent in those with which I am acquainted, that is, the lack of proof that patients who have suffered strokes and been treated with HBO do better clinically than those not so treated. Such a difference in outcome is still the bottom line in ascertaining the efficacy of any treatment modality. Unfortunately, the references given by Dr Neubauer, all of which I am aware of, suffer from this deficit. In stroke patients who exhibit a wide range of clinical recovery for long periods after their initial episode, only controlled studies, preferably double blinded, will provide the degree of proof necessary for HBO to be acceptable as effective treatment.  It is interesting and somewhat ironic that I, who devote full time to the study
Abstract 723: Beyond temsirolimus: Discovery of PKI-587 a highly efficacious dual PI3K/mTOR inhibitor
Authors: Aranapakam M. Venkatesan, Christoph M. Dehnhardt, Efren Delos Santos, Zecheng Chen, Osvaldo Dos Santos, Semiramis Ayral-Kaloustian, Robert Mallon, Irwin Hollander, Larry Feldberg, Judy Lucas, Ker Yu, Natasja Brooijmans, Joel Bard, James Gibbons, Robert T. Abraham, Tarek S. Mansour
Journal: Cancer Research (2010)

Abstract Temsirolimus, a rapamycin analog, is a selective mTor inhibitor that has been successfully used in the clinic for the treatment of renal cancer. mTOR integrates signals from multiple upstream growth and survival regulatory pathways including the LKB1/AMPK and PI3K (Phosphatidylinositol-3-kinase)/Akt pathways. Among these, Phosphatidylinositol-3-kinase (PI3-K) is a lipid kinase which phophorylates phosphatidylinositol diphosphate (PIP-2) to phosphatidylinositol triphosphate. This pathway regulates cell proliferation, growth, survival, and apoptosis. The aberrant activation of PI3K-α and its downstream effectors including Akt and mTOR, has been linked to the initiation and maintenance of numerous tumor phenotypes. During tumorigenesis, PI3K/Akt/mTOR pathway activation occurs through various mechanisms, including loss of PTEN (the phosphatase that regulates PI3K signaling), over-expression or activation of certain receptor tyrosine kinases (e.g. EGFR, HER-2), interaction with activated Ras, overexpression of the PI3K-α gene (PIKC3A), or mutations in PIKC3A that cause elevated PI3K kinase activity. Deregulated PI3K/Akt/mTOR pathway signaling has been implicated in poor prognosis and low survival rate in patients with various lymphatic tumors, glioblastomas, melanomas as well as breast, prostate, lung, colon, and ovarian cancers. Numerous pre-clinical and clinical studies indicate that PI3K-α plays a key role in the biology of human cancer. Hence, it is likely that a small molecule inhibitor of both PI3K and mTOR will have clinical utility. Our project team has identified small molecules that potently inhibit the PI3K/mTor pathway. The current clinical candidate, PKI-587 (whose structure will be disclosed) is a pan PI3K (class I)/mTOR inhibitor. PKI-587 decreases tumor cell survival and proliferation in vitro. Additionally, PKI-587 has shown compelling efficacy in multiple human tumor nude mouse xenograft models such as MDA 361 (Breast), U87 (Glioma), H1975, A549 (NSCLC) in nude mice when administered as a single agent. The design of this novel potent inhibitor, synthesis, structure-activity relationships, PK and in vivo efficacy data will be presented. 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 723.
Abstract 1134: Analysis of the tumor supressor role of BRG1 in lung cancer
Authors: Octavio A. Romero-Ferraro, Pol Gimenez-Xavier, Stephanie Morris, Sam Jhon, Gordon L. Hager, Montserrat Sanchez-Cespedes
Journal: Cancer Research (2010)

Abstract The BRG1 protein features a bromodomain and helicase/ATPase activity and is a central component of the SWI/SNF chromatin remodeling complex. At present, the tumor suppressor role of the BRG1 gene, also called SMARCA4, is strongly supported by several genetic and functional observations. First of all, somatic and homozygous genetic inactivation of BRG1 has been observed in a variety of cancer cell lines and studies in lung cancer cells have estimated the frequency of BRG1 inactivation in about thirty per cent of this tumor type. Here we have cloned two BRG1 mutations, lacking the ATPase domain, found in lung cancer cell lines. One of these is a missense change in a highly conserved aminoacid within the ATPase domain (W764R) identified in the NCI-H2126 cell line while the other is an in-frame deletion (E668-Q758 del) identified in the NCI-H1703 cell line. We have studied the capability of these mutations to affect the biological function of BRG1 and compared the efficiency of the wild type BRG1 and that of the two mutants in reducing cell growth in cancer cells. To determine the effect of these mutations on the activity of BRG1 we took advantage of a transcription reporter assay in the human lung carcinoma cell line (NCI-H1299) that lacks wild type BRG1 due to a homozygous mutation. In this system, the simultaneous transfection of the BRG1 constructs and a construct carrying the MMTV-Luciferase reporter plasmid and a GR (glucocorticoid) expression plasmid allows the determination of the contribution of BRG1 to the hormone-dependent regulation of MMTV transcription. Transfection of H1299 cells with these constructs resulted in an eightfold increase of MMTV transcription in the presence of hormone when the cells were transfected with the wild type BRG1 as compared as to the cells transfected with either the mutants or the empty vectors. In addition, we observed that overexpression of wild type BRG1, but not the mutant proteins, in several lung cancer cell lines lead to cell growth suppression. Thus, our present data support an important role of BRG1 tumor suppressor gene in cancer development. 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 1134.
Diabetes in urban African-Americans. XVII. Availability of rapid HbA1c measurements enhances clinical decision-making.
Authors: L M Thaler, D C Ziemer, D L Gallina, C B Cook, V G Dunbar, L S Phillips, I M El-Kebbi
Journal: Diabetes Care (1999)

OBJECTIVE: To assess the impact of rapid-turnaround HbA1c results on providers' clinical decision-making and on follow-up HbA1c levels. RESEARCH DESIGN AND METHODS: The research design was a randomized clinical trial in which rapid HbA1c results were made available to providers on even days of the month (rapid, n = 575), but delayed by 24 h on odd days (conventional, n = 563). Adjustment of therapy for patients with type 2 diabetes was considered appropriate if therapy was intensified for HbA1c values &amp;gt;7% or not intensified for HbA1c values &amp;lt; or =7%. A post-hoc analysis was also performed using patients (n = 574) who returned for follow-up 2-7 months later to ascertain the effect of rapid HbA1c availability on subsequent glycemic control. RESULTS: Rapid HbA1c availability resulted in more appropriate management compared with conventional HbA1c availability (79 vs. 71%, P = 0.003). This difference was due mainly to less frequent intensification when HbA1c levels were &amp;lt; or =7% (10 vs. 22%, P &amp;lt; 0.0001) and slightly to more frequent intensification for patients with HbA1c values &amp;gt;7% (67 vs. 63%, P = 0.33). For both groups, intensification was greatest for patients on insulin (51%) compared with patients on oral agents (35%) and diet alone (14%) (P &amp;lt; 0.0001). Regression analysis confirmed that providers receiving conventional HbA1c results were more likely to intensify therapy in patients who already had HbA1c levels &amp;lt; or =7%. Over 2-7 months of follow-up, HbA1c rose more in patients with conventional HbA1c results compared with rapid results (0.8 vs. 0.4%, P = 0.02). In patients with initial HbA1c &amp;gt;7%, rapid HbA1c results had a favorable impact on follow-up HbA1c independent of the decision to intensify therapy (P = 0.03). CONCLUSIONS: Availability of rapid HbA1c determinations appears to facilitate diabetes management. The more favorable follow-up HbA1c profile in the rapid HbA1c group occurs independently of the decision to intensify therapy, suggesting the involvement of other factors such as enhanced provider and/or patient motivation.
Points: Women in medicine
Authors: S E Lessels, T B Boulton
Journal: BMJ (1982)

Stage-adapted treatment in oncology relies on correct tumor staging for patients with malignant diseases. To ensure accurate assessment of the tumor stage in thoracic and abdominal diseases by PET/CT, both CT and PET need to be optimized. In this setting, different malignant diseases require customized imaging protocols. Although in the clinical setting of therapy assessment, PET/CT with integration of low-dose, nonenhanced CT may be sufficient, tumor staging may require a more sophisticated CT protocol. This review focuses on potential CT protocols for imaging cancers of the chest and abdomen. Examples of CT protocols are presented and discussed for non–small cell lung cancer, breast cancer, colorectal cancer, gastrointestinal stromal tumors, and interventional liver therapy.
Menstrual and ovulatory disturbance in bulimia.
Authors: T. Cantopher, C. Evans, J. H. Lacey, J. M. Pearce
Journal: BMJ (1988)

probably reflects increases in urban violence and the number of drug abusers. Nevertheless, few officers had markers of hepatitis, which suggests that unreported exposure is uncommon. A central service for the Metropolitan Police Force seems to work well; police officers and surgeons generally know the correct course of action after exposure, and prophylaxis can be given when it is most likely to be effective. An increasing problem is unavailability of blood from contacts, particularly drug abusers, who are often uncooperative and may have sclerosed veins; this may result in costly hepatitis B immunoglobulin being given unnecessarily. Vaccination ofpolice officers would be effective in reducing the risk of acquiring hepatitis B but would be expensive; at £32.60 per course it would cost over £880 000 to vaccinate the 27 000 officers in the Metropolitan police alone. The group most at risk is officers on ordinary street duty, some of whom have already been vaccinated by their general practitioners. Most officers can avoid contamination with hepatitis B by adopting precautions such as taking care with needles and wearing gloves when dealing with bleeding accident victims. For the others a service such as ours seems the most cost effective in preventing hepatitis B.
Abstract 2111: Role of gene repression by estrogen in invasiveness of breast cancer cells
Authors: Mugdha Patki, Marcela d'Alincourt Salazar, Robert Trumbly, Manohar Ratnam
Journal: Cancer Research (2014)

Abstract More than 75% of breast tumors are estrogen receptor (ER)-positive and require estrogen for their growth and survival. Long-term adjuvant therapies that disrupt estrogen signaling, in particular tamoxifen and aromatase inhibitors, are a mainstay in breast cancer treatment. The principal focus of mechanistic studies evaluating the role of estrogen in breast cancer proliferation has been on gene activation by estrogen and its antagonism by anti-estrogens. Gene repression by estrogen and its antagonism by anti-estrogens have unclear physiological and therapeutic consequence in breast cancer. In this study, we found that estrogen-repressed genes but not estrogen-activated genes overlapped the gene overexpression signature of clinical progression of ductal carcinoma in situ to invasive ductal carcinoma. An extensive gene ontology analysis revealed that genes repressed by estrogen are enriched for functions known to collectively support breast cancer progression. In ER-positive breast cancer cells tamoxifen prevented gene repression by estrogen. In these cells, estrogen inhibited invasiveness in a manner that was opposed by tamoxifen. These effects of estrogen and tamoxifen on gene repression and invasiveness also occurred in Her2+/ER+ cells whose growth was hormone-independent and insensitive to tamoxifen. The effects were also independent of ErbB2 gene regulation by estrogen. Several ER co-repressors supported repression of the tumor progression genes by estrogen. Gene repression by estrogen was causally linked to inhibition of invasiveness as a co-repressor binding site mutation in ER that selectively disrupted the ability of estrogen to repress genes also prevented inhibition of invasiveness. Gene repression by estrogen involved ER binding at non-classical chromatin sites that was prevented by tamoxifen. The findings offer a mechanistic understanding of the invasive potential of ER+ breast cancer cells that have evaded growth inhibition during conventional anti-estrogen treatments. Citation Format: Mugdha Patki, Marcela d'Alincourt Salazar, Robert Trumbly, Manohar Ratnam. Role of gene repression by estrogen in invasiveness of breast cancer cells. [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 2111. doi:10.1158/1538-7445.AM2014-2111
Are fibre supplements really necessary in diverticular disease?
Authors: M H Ornstein, R. Littlewood, I M. Baird, A G Cox
Journal: BMJ (1981)

in temperature and blood pressure with paracetamol is interesting and must be kept in mind when treating patients with Hodgkin's disease who might require antipyretic drugs.My patient developed hypothermia and hypotension which seemed to be unrelated, as I mentioned, to any drug ingestion.The patient did not receive paracetamol, salicylate, or any similar drug prior to the drop of temperature and blood pressure, though 10 days earlier he had received a five-day course of ethambutol and isoniazid because a provisional diagnosis of sarcoidosis had been made.To my knowledge those two drugs have no thermoregulatory side effect, either alone or when given in combination.
410 24-WEEK TREATMENT WITH CTS-1027 IN COMBINATION WITH RIBAVIRIN REDUCES HCV-RNA IN TREATMENT NAIVE GENOTYPE-1 PATIENTS
Authors: M. Chojkier, G. Everson, A. Muir, B. Bacon, M. Rodriguez-Torres, M. Bennett, M. Fried, S. Gordon, J. Gross, D. Nelson, L. Balart, M. Jonas, G. Szabo, J. Bloomer, A. McCullough, L. Nyberg, C. Smith, O. Bohm, A.W. Fox, E. Castelloe, M. Huyghe, S. Mento, A. Spada
Journal: Journal of Hepatology (2011)
Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality
Authors: Cuilin Zhang, Kathryn M. Rexrode, Rob M. van Dam, Tricia Y. Li, Frank B. Hu
Journal: Circulation (2008)

Accumulating evidence indicates that abdominal adiposity is positively related to cardiovascular disease (CVD) risk and some other diseases independently of overall adiposity. However, the association of premature death resulting from these diseases with abdominal adiposity has not been widely studied, and findings are inconsistent.In a prospective cohort study of 44,636 women in the Nurses' Health Study, associations of abdominal adiposity with all-cause and cause-specific mortality were examined. During 16 years of follow-up, 3507 deaths were identified, including 751 cardiovascular deaths and 1748 cancer deaths. After adjustment for body mass index and potential confounders, the relative risks across the lowest to the highest waist circumference quintiles were 1.00, 1.11, 1.17, 1.31, and 1.79 (95% confidence interval [CI], 1.47 to 1.98) for all-cause mortality; 1.00, 1.04, 1.04, 1.28, and 1.99 (95% CI, 1.44 to 2.73) for CVD mortality; and 1.00, 1.18, 1.20, 1.34, and 1.63 (95% CI, 1.32 to 2.01) for cancer mortality (all P<0.001 for trend). Among normal-weight women (body mass index, 18.5 to < 25 kg/m(2)), abdominal obesity was significantly associated with elevated CVD mortality: Relative risk associated with waist circumference > or = 88 cm was 3.02 (95% CI, 1.31 to 6.99) and for waist-to-hip ratio > 0.88 was 3.45 (95% CI, 2.02 to 6.92). After adjustment for waist circumference, hip circumference was significantly and inversely associated with CVD mortality.Anthropometric measures of abdominal adiposity were strongly and positively associated with all-cause, CVD, and cancer mortality independently of body mass index. Elevated waist circumference was associated with significantly increased CVD mortality even among normal-weight women.