tbuckley/cabot-search huggingface dataset:
NT-05 * PATIENT ACCEPTANCE OF ROUTINE RESAMPLING OF GLIOBLASTOMA: A QUALITATIVE STUDY
Authors: M. Bernstein, P. Dirks, W. Mason, T. Mir
Journal: Neuro-Oncology (2014)

INTRODUCTION: The routine resampling of glioblastoma may be very useful to guide patient care after initial surgery, radiation, and chemotherapy, akin to bone marrow biopsy in leukemia patients. Qualitative research methodology was used to explore the views of patients on this issue. Qualitative research is a form of social sciences investigation, focusing on the experiences of participants in real, not experiment settings. It has not been used much by clinicians, especially neuro-oncologists, but this is slowly changing. METHODS: 30 patients with glioblastoma were recruited from a neuro-oncology clinic in a cancer center serving three adult teaching hospitals. The protocol was passed by the IRB. The study subjects were given semi-structured interviews using an interview guide, and the recorded data assessed using modified thematic analysis and grounded theory. Overarching themes were extracted from the data. RESULTS: Several themes arose - the primary and most important was that routine resampling of glioblastoma was acceptable to most patients. CONCLUSIONS: Using qualitative research methodology, we can learn insights about patients' experience that we cannot learn from quantitative research. This information can help us learn: 1) what our patients are feeling; 2) how we can better talk to them; 3) what issues are important to them to talk about; 4) how we can improve their care and their perception of care; and 5) how we can better conduct clinical research. This can lead to improvement in the quality of our neuro-oncology patients' experience and help facilitate the practice of patient-centered care for brain tumor patients. This particular study demonstrates that routine resampling of glioblastoma is acceptable to patients, and more generically, it represents a novel way of assessing if innovative treatments would be acceptable to the patients they are designed for by directly asking patients for their views.
Lymphocytic Alveolitis, Bronchoalveolar Lavage Viral Load, and Outcome in Human Immunodeficiency Virus Infection
Authors: HOMER L. TWIGG, DIAA M. SOLIMAN, RICHARD B. DAY, KENNETH S. KNOX, RODNEY J. ANDERSON, DAVID S. WILKES, CAROL T. SCHNIZLEIN-BICK
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Lymphocytic alveolitis portends a poor prognosis in human immunodeficiency virus (HIV)-infected subjects. Because alveolar lymphocytes consist predominantly of HIV-specific CD8(+) cytotoxic T lymphocytes (CTL), they could represent an appropriate immune response to infected cells in the lung, and be a surrogate marker for a high pulmonary viral burden. We assessed long-term outcome in a cohort of asymptomatic HIV-infected subjects who underwent bronchoscopy between 1990 and 1993 and had bronchoalveolar lavage fluid (BALF) available for determination of viral load by reverse transcription-polymerase chain reaction. The ability to detect HIV in BALF increased with disease progression. Lymphocytic alveolitis, although present at all stages of HIV infection, was most pronounced in patients with middle stage disease. The HIV viral load as measured by bronchoalveolar lavage correlated with the percentage of alveolar lymphocytes in patients with peripheral blood CD4(+) cell counts above 200/microliter. Including patients with CD4(+) cell counts < 200/microliter weakened this correlation, possibly because of replacement of CD8(+) CTL by CD8(+) suppressor cells in advanced disease. Free virus in BALF was a stronger predictor of HIV disease progression than was lymphocytic alveolitis. These data suggest that lymphocytic alveolitis in HIV-infected subjects occurs in response to viral antigens in the lung and that the poor prognosis associated with lymphocytic alveolitis reflects a high pulmonary viral burden.
Lung Cancer: Progress in Therapeutic Research
Authors: Jacob D. Bitran
Journal: JAMA (1979)

Muggia and Rozenweig have done a good job of compiling a book that provides an overview of the current research effort in the treatment of lung cancer. The book is divided into nine parts that review the current research in experimental animal tumor models of lung cancer, pathological diagnosis, biologic markers, surgery, radiotherapy, chemotherapy in established disease as well as in an adjuvant setting, immunotherapy, and the therapeutic approach to small cell carcinoma. There are some exceptionally good sections in this book that should be required reading for medical oncologists; these include the chapters on experimental tumors, pathological diagnosis, Mountain's chapter on the surgical approach, and the treatment of small cell carcinoma. However, the section on biological markers was weak and of little relevance to the diagnosis, prognosis, or treatment of lung cancer.  Since many of the sections were written by various authors, the style and presentation of data varies;
Structural and electrophysiological changes in the epicardial border zone of canine myocardial infarcts during infarct healing.
Authors: P C Ursell, P I Gardner, A Albala, J J Fenoglio, A L Wit
Journal: Circulation Research (1985)

Structural and electrophysiological properties of the epicardial muscle which survives on the surface of transmural infarcts of the canine heart (epicardial border zone) were studied at different times after occlusion of the left anterior coronary artery (LAD). Isolated preparations were superfused in vitro, transmembrane potentials recorded, and impulse propagation mapped. In preparations from subacute infarcts (1 and 5 days), resting potential, action potential amplitude, upstroke velocity, and duration were all significantly reduced. Well-defined directional differences in propagation occurred. Propagation was more rapid in the direction perpendicular to the left anterior coronary artery than in the direction perpendicular to the base of the heart, because of the uniform anisotropic structure of the surviving muscle fibers which were arranged in tightly packed bundles oriented perpendicular to the left anterior coronary artery. The only ultrastructural abnormalities found in these muscle fibers was an accumulation of large amounts of lipid droplets. As the infarcts healed, resting potential, action potential amplitude, and upstroke velocity returned to normal by 2 weeks, although action potential duration decreased further. Lipid droplets had disappeared, and connective tissue had invaded the epicardial border zone, separating the muscle bundles. By 2 months, action potentials were normal, but the muscle fibers were widely separated and disoriented by the connective tissue (parallel bundles no longer were found). In these regions with a nonuniform anisotropic structure, the well-defined directional differences in impulse propagation were lost. However, activation was very slow, perhaps because of diminished connections between cells. The persistence of slow conduction in healed infarcts may contribute to the occurrence of chronic arrhythmias.
Surface Cooling Following Extensive Burns
Authors: Thomas C. King, Philip B. Price
Journal: JAMA (1963)

IN 1954 we corroborated in the laboratory<sup>1</sup>some advice that grandmothers had been providing their offspring for many generations—the benefits of the application of immediate cold water compresses as a treatment for small burns. Studies at that time suggested that immediate topical cooling of burned surfaces materially inhibited the expected increase in permeability of the capillaries in the burned area and retarded edema formation. Since that time several clinical reports have suggested that surface cooling exerts a favorable influence on the pathophysiology of the ordinary clinical burn. That much of the tissue damage following acute thermal injury occurs subsequent to the primary insult and is caused by factors other than temperature alteration<i>per se</i>seems well established.<sup>2,3</sup>The following study was undertaken as a preliminary investigation designed to further clarify the role of surface cooling in modifying the pathophysiology of the more extensive burn. <h3>Method</h3> Observations were
Appropriateness of Gastrointestinal Endoscopy: Risk of Complications 1
Authors: None Froehlich*, None Gonvers*, None Vader**, None Dubois***, None Burnand**
Journal: Endoscopy (1999)

The balance between risks and benefits of gastrointestinal endoscopy for a given patient is essential in defining the appropriate use of endoscopic procedures. The current literature suggests that gastrointestinal endoscopy infrequently results in major procedure-related morbidity and mortality, while cardio-respiratory events occur commonly. However, true complication rates may be underestimated due to inconsistencies in the types of complications reported. No formal reporting requirements exist, and most of the published studies on complications come from centres with highly-skilled endoscopists.
Controversial stroke trial is under review following BMJ report
Authors: J. Lenzer
Journal: BMJ (2002)

A leading US institute has asked for a review of the trial results published in 1995 that led to a change in the American Heart Association's guidelines on use of the thrombolytic agent alteplase. It follows a report in the BMJ earlier this year which showed that the majority of the association's experts on stroke had ties to the manufacturers of the drug.

The National Institute of Neurological Diseases and Stroke (NINDS) has invited an independent committee to re-analyse the data from a five year, multisite trial, the results of which were published in the New England Journal of Medicine on 14 December 1995.

The results were cited by the American Heart Association as the main reason for changing their advice in 2000 on the use of alteplase (tPA, also known as rt-PA) for stroke, moving it up from “optional (class IIb)” to “definitely recommended (class I),” despite continuing controversy over the safety and efficacy of the treatment.

W Michael O'Fallon, professor of biostatistics and chairman of the independent committee, said the review was triggered …
Xylene-induced epilepsy following innocent glue sniffing.
Authors: L J Arthur, D A Curnock
Journal: BMJ (1982)

physically harmful consequences of substance abuse.To accept less stringent criteria on the grounds that false reports of toxic effects do not matter because they may deter only drug abusers while false reports of adverse effects do matter because they may deter drug prescribers is to adopt a dangerous doublestandard on a very shaky foundation.For, firstly, the deterrent effect of scares about toxic effects is far from established, and, secondly, a whole segment of medical data becomes usable only by those who share the assumptions of those who collected it.
Fractured Osteophyte Demonstrated on SPECT and Computed Tomography
Authors: Michael E. Spieth, Stacey L. Schmitz
Journal: Clinical Nuclear Medicine (2003)

We present an interesting case of a fractured osteophyte causing back pain that was demonstrated both on bone single photon emission computed tomography (SPECT) and computed tomography (CT). The magnetic resonance images, thoracic anterior spine plain radiograph, whole-body bone scan passes, and thoracic spot view were not impressive. Bone SPECT was the impetus for getting the CT scan. The CT scan not only demonstrated the osteophyte but a pseudarthrosis that was probably causing the pain. If it were not for the positive SPECT bone scan, the CT scan would not have been ordered after unimpressive magnetic resonance imaging.
Three Cases of Synovioma
Authors: V. C. J. Harris
Journal: BMJ (1948)

γ-Tocotrienol (γ-T3) is a member of the vitamin E family that displays potent anticancer activity and other therapeutic benefits. The objective of this study was to evaluate γ-T3 intestinal uptake and metabolism using the in situ rat intestinal perfusion model. Isolated segments of rat jejunum and ileum were perfused with γ-T3 solution, and measurements were made as a function of concentration (5–150 μM). Intestinal permeability (P<sub>eff</sub>) and metabolism were studied by measuring total compound disappearance and major metabolite, 2,7,8-trimethyl-2-(β-carboxy-ethyl)-6-hydroxychroman, appearance in the intestinal lumen. γ-T3 and metabolite levels were also determined in mesenteric blood. The P<sub>eff</sub> of γ-T3 was similar in both intestinal segments and significantly decreased at concentrations ≥25 μM in jejunum and ileum (<i>p</i> &lt; 0.05), whereas metabolite formation was minimal and mesenteric blood concentrations of γ-T3 and metabolite remained very low. These results indicate that γ-T3 intestinal uptake is a saturable carrier-mediated process and metabolism is minimal. Results from subsequent in situ inhibition studies with ezetimibe, a potent and selective inhibitor of Niemann-Pick C1-like 1 (NPC1L1) transporter, suggested γ-T3 intestinal uptake is mediated by NPC1L1. Comparable findings were obtained when Madin-Darby canine kidney II cells that express endogenous NPC1L1 were incubated with increasing concentrations of γ-T3 or γ-T3 with increasing concentrations of ezetimibe. The present data show for the first time that γ-T3 intestinal absorption is partly mediated by NPC1L1.
Differential Response of Delayed Healing and Persistent Inflammation at Sites of Overlapping Sirolimus- or Paclitaxel-Eluting Stents
Authors: Aloke V. Finn, Frank D. Kolodgie, Jan Harnek, L.J. Guerrero, Eduardo Acampado, Kirubel Tefera, Kristi Skorija, Deena K. Weber, Herman K. Gold, Renu Virmani
Journal: Circulation (2005)

Background— Although effective coverage of challenging coronary lesions has warranted the use of overlapping drug-eluting stents, the histopathological response to stent overlap is unknown. Methods and Results— The arterial reaction to overlapping Cypher or Taxus drug-eluting stents was examined in rabbits with bare metal stents, BxVelocity or Express, serving as controls. Single iliac artery balloon injury was followed by placement of 2 overlapping 3.0-mm-diameter drug-eluting stents or bare metal stents in 60 animals (mean length of overlap, 9.8±3.6 mm). Stented arteries were harvested at 28 and 90 days for histology. Overlapped segments exhibited delayed healing compared with proximal and distal nonoverlapping sites at 28 days. Overlapped segments in Taxus stents induced significantly more luminal heterophils/eosinophils and fibrin deposition than Cypher; peristrut giant cell infiltration, however, was more frequent in the latter. Overlapping bare metal stents also showed mild delayed healing compared with nonoverlapped segments, but not to the same extent as drug-eluting stents. Although neointimal thickness within the overlap was similar in 28- and 90-day Cypher stents, there was a significant increase with Taxus ( P =0.03). Conclusions— Compared with bare metal stents, drug-eluting stents further delay arterial healing and promote inflammation at sites of overlap. Taxus stents induced greater fibrin deposition, medial cell loss, heterophils/eosinophils, and late neointimal hyperplasia. Patients receiving overlapping drug-eluting stents need more frequent follow-up than patients with nonoverlapping stents.
Blood money: blood donors' attitudes to changes in the New Zealand blood transfusion service
Authors: P. Howden-Chapman, J. Carter, N. Woods
Journal: BMJ (1996)

Blood is an unusual product in a market economy: donors give it freely to strangers. Titmuss concluded that if this gift was commercialised, donors would feel less inclined to donate blood without payment and would face incentives not to disclose diseases.1 The opposing view is that the most efficient way of rationing a scarce product like blood is to put a price on it and let a market develop in which it can be traded.2

In 1993 a purchaser-provider split was introduced into the New Zealand health service. The Blood Transfusion Service was embedded in the new hospital organisations, crown health enterprises, which were required to be profit driven.3 A National Blood Transfusion Trust was set up to preserve the gift relationship and to ensure that there is no …
Postgraduate Education in Medicine
Authors: Thomas B. Turner
Journal: JAMA (1961)

SUPERFICIALLY, one might regard medical education as having arrived at a rather fixed pattern, after the upheavals of the first quarter of this century. On the contrary, there is a lively ferment at work, and the probability is that the present decade will see substantial changes in both the academic and economic patterns of medical education. By way of definition, the phases of medical education might be divided into premedical, medical-school, postgraduate, and continuing medical education. The term postgraduate or postdoctoral usually refers to the internship, residency, and fellowship years—the period from receipt of the M.D. degree until more or less permanent establishment in practice or a full-time position—and that is the sense in which the term will be used here. <h3>Magnitude of Problem</h3> Postgraduate medical education has assumed an importance, academically and economically, far beyond that of 30 years ago when a relatively small proportion of young graduates
Amlodipine Releases Nitric Oxide From Canine Coronary Microvessels
Authors: Xiaoping Zhang, Thomas H. Hintze
Journal: Circulation (1998)

Background —Recent studies suggest that amlodipine may reduce mortality in patients with heart failure, especially those with dilated cardiomyopathy. In general, drugs that release NO, such as organic nitrates and ACE inhibitors, have been shown to be of substantial benefit in the treatment of heart failure. Methods and Results —We hypothesized that a portion of the beneficial actions of amlodipine may involve the release or action of NO. Coronary microvessels were isolated from the heart of normal dogs and incubated with increasing doses of the calcium channel blockers nifedipine, diltiazem, and amlodipine or the ACE inhibitors enalaprilat and ramiprilat. Neither nifedipine nor diltiazem increased nitrite production at any dose studied. In marked contrast, amlodipine caused a dose-dependent increase in nitrite production from 74±5 to 130±8 pmol/mg (by 85±21%,10 −5 mol/L, P &lt;.05) that was similar in magnitude to that of either of the ACE inhibitors. Amlodipine also increased nitrite production in large coronary arteries and in aorta. N ω -Nitro- l -arginine methyl ester, HOE-140, and dichloroisocoumarin essentially abolished the increase in nitrite production, indicating that (1) nitrite production reflected NO formation, (2) nitrite production was dependent on stimulation of the kinin 2 receptor, and (3) nitrite production is most likely secondary to the formation of local kinins. Conclusions —Thus, unlike nifedipine and diltiazem, amlodipine releases NO from blood vessels.
Factorial Design Considerations
Authors: Stephanie Green, Ping-Yu Liu, Janet O’Sullivan
Journal: Journal of Clinical Oncology (2002)

PURPOSE: Factorial designs may be proposed to test extra questions within a clinical trial. A common approach to sample size and analysis for factorial trials assumes no statistical interactions and does not adjust for multiple testing. This investigation considered the trade-off between potential gains from testing more questions with fewer patients versus how often a factorial trial might arrive at an incorrect conclusion. METHODS: A simulation study of a 2 × 2 design (observation v chemotherapy v radiation therapy v the combination) was performed under various conditions, including effect of one, both, or neither treatment and absence or presence of statistical interaction (effect of one treatment differed according to the presence of the other). Three analysis approaches were investigated, one assuming no interaction, a second testing first for interaction, and the third testing for interaction as well as adjusting for multiple testing. The approaches were compared with respect to the probability of selecting the correct treatment arm. RESULTS: No one approach was superior. Testing for interaction was beneficial in some settings but detrimental in others. Under some scenarios, the factorial design improved efficiency, but under others, all three approaches resulted in poor probability of selecting the correct treatment arm at the end of the trial. CONCLUSION: Extra efficiency is possible, but it is difficult to predict when favorable conditions exist. If a factorial design is used, potential efficiency gains should be weighed against potential loss of power to arrive at the correct conclusion under possible scenarios of interest.
Autocrine angiotensin system regulation of bovine aortic endothelial cell migration and plasminogen activator involves modulation of proto-oncogene pp60c-src expression.
Authors: L Bell, D J Luthringer, J A Madri, S L Warren
Journal: Journal of Clinical Investigation (1992)

Rapid endothelial cell migration and inhibition of thrombosis are critical for the resolution of denudation injuries to the vessel wall. Inhibition of the endothelial cell autocrine angiotensin system, with either the angiotensin-converting enzyme inhibitor lisinopril or the angiotensin II receptor antagonist sar1, ile8-angiotensin II, leads to increased endothelial cell migration and urokinase-like plasminogen activator (u-PA) activity (Bell, L., and J. A. Madri. 1990. Am. J. Pathol. 137:7-12). Inhibition of the autocrine angiotensin system with the converting-enzyme inhibitor or the receptor antagonist also leads to increased expression of the proto-oncogene c-src: pp60c-src mRNA increased 7-11-fold, c-src protein 3-fold, and c-src kinase activity 2-3-fold. Endothelial cell expression of c-src was constitutively elevated after stable infection with a retroviral vector containing the c-src coding sequence. Constitutively increased c-src kinase activity reconstituted the increases in migration and u-PA observed with angiotensin system interruption. Antisera to bovine u-PA blocked the increase in migration associated with increased c-src expression. These data suggest that increases in endothelial cell migration and plasminogen activator after angiotensin system inhibition are at least partially pp60c-src mediated. Elevated c-src expression with angiotensin system inhibition may act to enhance intimal wound closure and to reduce luminal thrombogenicity in vivo.
Incomplete Financial Disclosures
Authors: Robert R. Wolfe
Journal: JAMA (2008)

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Acinic cell carcinoma of the breast: Review of the literature
Authors: G Limite, R Di Micco, E Esposito, V Sollazzo, M Cervotti, G Pettinato, V Varone, G Benassai, B Amato, V Pilone, G Luglio, A Vitiello, A Hasani, F Liccardo, P Forestieri
Journal: International Journal of Surgery (2014)