tbuckley/cabot-search huggingface dataset:
Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey
Authors: VS Raleigh, D Hussey, I Seccombe, K Hallt
Journal: Journal of the Royal Society of Medicine (2010)

Summary Objective To examine ethnic and social inequalities in women's experience of maternity care in England. Design A 2007 national survey of women (16 years or over) about their experience of maternity care. Multiple logistic regression analysis, controlling for several maternal characteristics, was used to examine inequalities by ethnicity, partner status and education. Setting Sample of records of 149 NHS acute trusts and two primary care trusts (PCTs) providing maternity services in England. Results A total of 26,325 women responded to the survey (response rate 59%). Ethnic minority women were more likely than White British women to access services late, not have a scan by 20 weeks, and experience complications during pregnancy and birth. They were more likely to initiate breastfeeding and say they were treated with respect and dignity. Single women responded more negatively to almost all questions than women with a husband/partner. They were less likely to access care within 12 weeks of pregnancy (OR 0.45, 95% CI 0.39–0.52), have a scan at 20 weeks (OR 0.49, 95% CI 0.39–0.63), attend NHS antenatal classes (OR 0.56, 95% CI 0.49–0.65), have a postnatal check-up (OR 0.67, 95% CI 0.60–0.75), and initiate breastfeeding (OR 0.57, 95% CI 0.51–0.62), and were more likely to experience complications. Women completing education at 19+ years were more likely to access services early (OR 1.21, 95% CI 1.04–1.40), attend antenatal classes (OR 1.48, 95% CI 1.31–1.67), have a postnatal check-up (OR 1.19, 95% CI 1.07–1.32) and initiate breastfeeding (OR 3.88, 95% CI 3.56–4.22) than those completing education at 16 years or younger, and were less likely to experience complications. Conclusions Ethnic minority women, single mothers, and those with an earlier age at completing education access maternity services late, have poorer outcomes, and report poorer experiences across some – though not all – dimensions of maternity care. Ethnic differences were absent or inconsistent between groups for some aspects of care. We recommend these findings are used by commissioners, trusts and healthcare professionals to inform improvements in maternity services for high-risk groups and reduce inequalities.
Incidence and prevalence of juvenile arthritis in an urban population of southern Germany: a prospective study
Authors: S. von Koskull
Journal: Annals of the Rheumatic Diseases (2001)

<h3>OBJECTIVE</h3> To ascertain the incidence and prevalence of juvenile arthritis in a German urban population. <h3>METHODS</h3> All 766 paediatricians, orthopaedists, and rheumatologists working in practices or outpatient clinics in 12 south German towns were asked to report all patients who consulted them for juvenile arthritis during the year 1995. Patients with continuing symptoms were followed up for 9–12 months to obtain a final diagnosis. Extended measures of quality control were taken to control for known biases. <h3>RESULTS</h3> Of 457 reported cases, 294 were diagnosed with para-/postinfectious arthritis (PPA), 78 with juvenile chronic arthritis (JCA), and 18 with other forms of arthritis. Half of the PPA cases were classified as transient synovitis of the hip (SH). For JCA the reported annual incidence was 6.6 and the prevalence 14.8 per 100 000 subjects under 16 years of age. For PPA the reported incidence was 76 and the prevalence 4.4 per 100 000 subjects under 16. The incidence of rheumatic fever was clearly below 1 per 100 000 people under 16. A correction model was used to control for known biases and to adjust the estimates accordingly. <h3>CONCLUSIONS</h3> The results of this first prospective study on the incidence and prevalence of juvenile arthritis in Germany are consistent with a retrospective study performed in the Berlin area. Based on these results it was estimated that the annual frequency of juvenile arthritis in Germany is as follows: 750–900 incident JCA cases, 21 000 incident SH cases, and 21 000 incidence cases of other forms of PPA a year. The number of incidence cases of rheumatic fever is expected to be markedly lower than 150 a year. The total prevalence is expected to be 3600–4350 JCA cases, 2250–3000 SH cases, and the same number of other forms of PPA.
Circular mapping and ablation of thepulmonary vein for treatment of atrial fibrillation
Authors: Nassir F Marrouche, Thomas Dresing, Christopher Cole, Dianna Bash, Eduardo Saad, Krzysztof Balaban, Stephen V Pavia, Robert Schweikert, Walid Saliba, Ahmed Abdul-Karim, Ennio Pisano, Raffaele Fanelli, Patrick Tchou, Andrea Natale
Journal: Journal of the American College of Cardiology (2002)
Hemophagocytic Lymphohistiocytosis: An Uncommon Presentation of Enteropathy-Associated T-Cell Lymphoma
Authors: Dona Varghese, Hayas Haseer Koya, Sujith V. Cherian, Kristen Mead, Amit Sharma, Namita Sharma, Stephen J. Knohl, Sam Benjamin
Journal: Journal of Clinical Oncology (2013)
Effective Treatment With Oral Sulfonylureas in Patients With Diabetes Due to Sulfonylurea Receptor 1 (SUR1) Mutations
Authors: Meena Rafiq, Sarah E. Flanagan, Ann-Marie Patch, Beverley M. Shields, Sian Ellard, Andrew T. Hattersley
Journal: Diabetes Care (2008)

OBJECTIVE—Neonatal diabetes can result from mutations in the Kir6.2 or sulfonylurea receptor 1 (SUR1) subunits of the ATP-sensitive K+ channel. Transfer from insulin to oral sulfonylureas in patients with neonatal diabetes due to Kir6.2 mutations is well described, but less is known about changing therapy in patients with SUR1 mutations. We aimed to describe the response to sulfonylurea therapy in patients with SUR1 mutations and to compare it with Kir6.2 mutations. RESEARCH DESIGN AND METHODS—We followed 27 patients with SUR1 mutations for at least 2 months after attempted transfer to sulfonylureas. Information was collected on clinical features, treatment before and after transfer, and the transfer protocol used. We compared successful and unsuccessful transfer patients, glycemic control before and after transfer, and treatment requirements in patients with SUR1 and Kir6.2 mutations. RESULTS—Twenty-three patients (85%) successfully transferred onto sulfonylureas without significant side effects or increased hypoglycemia and did not need insulin injections. In these patients, median A1C fell from 7.2% (interquartile range 6.6–8.2%) on insulin to 5.5% (5.3–6.2%) on sulfonylureas (P = 0.01). When compared with Kir6.2 patients, SUR1 patients needed lower doses of both insulin before transfer (0.4 vs. 0.7 units · kg−1 · day−1; P = 0.002) and sulfonylureas after transfer (0.26 vs. 0.45 mg · kg−1 · day−1; P = 0.005). CONCLUSIONS—Oral sulfonylurea therapy is safe and effective in the short term in most patients with diabetes due to SUR1 mutations and may successfully replace treatment with insulin injections. A different treatment protocol needs to be developed for this group because they require lower doses of sulfonylureas than required by Kir6.2 patients.
Patient Perception of Sleep Quality and Etiology of Sleep Disruption in the Intensive Care Unit
Authors: NEIL S. FREEDMAN, NATALIE KOTZER, RICHARD J. SCHWAB
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Section:ChooseTop of pageAbstract <<METHODSRESULTSDISCUSSIONCONCLUSIONSReferencesCITING ARTICLES
Breast cancer recurrence dynamics following adjuvant CMF is consistent with tumor dormancy and mastectomy-driven acceleration of the metastatic process
Authors: R. Demicheli, R. Miceli, A. Moliterni, M. Zambetti, W.J.M. Hrushesky, M.W. Retsky, P. Valagussa, G. Bonadonna
Journal: Annals of Oncology (2005)
A mononuclear cell component in experimental immunological glomerulonephritis.
Authors: G F Schreiner, R S Cotran, V Pardo, E R Unanue
Journal: The Journal of Experimental Medicine (1978)

An accelerated form of nephrotoxic serum nephritis in the rat was examined. The experimental model consisted of preimmunization of the rat with rabbit IgG 5 days before injection of subnephrotoxic doses of rabbit anti-rat kidney serum. The immunized rats developed proteinuria during the first 24 h, increasing by 48-96 h. The early 24-h proteinuria correlated with a neutrophilic infiltration of glomeruli and with deposition of rat Ig and C. The 48- to 96-h proteinuria was associated with a glomerular infiltration by mononuclear cells and proliferation of intrinsic glomerular cells. Many of the mononuclear cells were morphologically identical to monocytes and macrophages. [3H]thymidine labeling experiments indicated that the mononuclear cells originated from dividing precursors localized outside the kidney. Preimmunized rats given systemic irradiation (the kidney being protected by a shield) showed loss of the mononuclear cell infiltrate and absence of 48- to 96-h proteinuria. We conclude that mononuclear phagocytes can infiltrate the kidney in immunological glomerular disease and might contribute to the functional abnormalities.
Pregnane X receptor regulates drug metabolism and transport in the vasculature and protects from oxidative stress
Authors: Karen E. Swales, Rick Moore, Nicola J. Truss, Arthur Tucker, Timothy D. Warner, Masahiko Negishi, David Bishop-Bailey
Journal: Cardiovascular Research (2011)

AimsCirculating endogenous, dietary, and foreign chemicals can contribute to vascular dysfunction. The mechanism by which the vasculature protects itself from these chemicals is unknown. This study investigates whether the pregnane X receptor (PXR), the major transcriptional regulator of hepatic drug metabolism and transport that responds to such xenobiotics, mediates vascular protection by co-ordinating a defence gene programme in the vasculature.
Identification of Patients Most Likely to Benefit From Implantable Cardioverter-Defibrillator Therapy
Authors: Robert Sheldon, Stuart Connolly, Andrew Krahn, Robin Roberts, Michael Gent, Martin Gardner
Journal: Circulation (2000)

Background —Patients with resuscitated ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation) benefit from implantable cardioverter-defibrillators (ICDs) compared with medical therapy. We hypothesized that the patients who benefit most from an ICD are those at greatest risk of death. Methods and Results —In the Canadian Implantable Defibrillator Study (CIDS), 659 patients with resuscitated ventricular tachyarrhythmias were randomly assigned to receive an ICD or amiodarone and were then followed for a mean of 3 years. There were 98 and 83 deaths in the amiodarone and ICD groups, respectively. We used multivariate Cox analysis to assess the impact of baseline parameters on the mortality in the amiodarone group. Reduced left ventricular ejection fraction, advanced age, and poor NYHA status identified high-risk patients ( P =0.0001 to 0.0009). Quartiles of risk were constructed, and the mortality reduction associated with ICD treatment in each quartile was assessed. There was a significant interaction between risk quartile and the ICD treatment effect ( P =0.011). In the highest risk quartile, there was a 50% relative risk reduction (95% CI 21% to 68%) of death in the ICD group, whereas in the 3 lower quartiles, there was no benefit. Patients who are most likely to benefit from an ICD can be identified with a simple risk score (≥2 of the following factors: age ≥70 years, left ventricular ejection fraction ≤35%, and NYHA class III or IV). Thirteen of 15 deaths that were prevented by the ICD occurred in patients with ≥2 risk factors. Conclusions —In CIDS, patients at highest risk of death benefited most from ICD therapy. These can be identified easily on the basis of age, poor ventricular function, and poor functional status.
Ten Years After Mutation Testing for Lynch Syndrome: Cancer Incidence and Outcome in Mutation-Positive and Mutation-Negative Family Members
Authors: Heikki J. Järvinen, Laura Renkonen-Sinisalo, Katja Aktán-Collán, Päivi Peltomäki, Lauri A. Aaltonen, Jukka-Pekka Mecklin
Journal: Journal of Clinical Oncology (2009)

Colonoscopies with polypectomies and endometrial biopsies with transvaginal ultrasonography, repeated at 2- to 3-year intervals, are performed for prevention or early detection of cancer in patients with DNA mismatch repair gene mutation causing Lynch syndrome. The long-term effectiveness of surveillance was evaluated in Lynch syndrome family members tested approximately 10 years ago.Cancer incidence and survival were determined after an 11.5-year follow-up in 242 mutation-positive and 367 mutation-negative participants. These participants in 57 Lynch syndrome families with 14 different mutations were at 50% risk. The median age was 36 years (range, 18 to 72 years) in mutation carriers and 42 years (range, 18 to 72 years) in mutation-negative participants, and none had had cancer of the Lynch syndrome type.Compliance was 95.9% for the colonic surveillance and 97.1% for the gynecologic surveillance. Colorectal cancer (CRC) occurred in 30 mutation-positive participants, and 74 participants had adenomas removed. Three patients died of CRC. Endometrial cancer (EC) occurred in 19 of 103 women at risk, and 48 women had prophylactic hysterectomy. Six of 112 women at risk had ovarian cancer. The overall cancer risk ratio (RR) in mutation carriers was 5.80 (95% CI, 3.4 to 9.5). Cancer mortality rate (RR = 2.28; 95% CI, 0.82 to 6.31) and overall death rate (RR = 1.26; 95% CI, 0.65 to 2.46) were not significantly increased.Long-term compliance in surveillance for CRC and EC exceeded 95% in Lynch syndrome. All CRC deaths were not prevented as a result of noncompliance or missed lesions. Still, after 10 years of surveillance, no significant increase in mortality had occurred compared with mutation-negative relatives.
Parenchymal Versus Nonparenchymal Target Lesion Response in Clinical Trials for Metastatic Medullary Thyroid Cancer
Authors: Andreas Machens, Henning Dralle
Journal: Journal of Clinical Oncology (2010)

TO THE EDITOR: In their clinical trial of systemic targeted therapy in metastatic medullary thyroid cancer, Lam et al did not find an association between objective index target lesion response based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria and serum biomarker (calcitonin and carcinoembryonic antigen) response. Similar results have been reported for another clinical trial of systemic targeted therapy for metastastic medullary thyroid cancer. Among the 21 medullary thyroid cancer patients in the trial by Lam et al, 20 patients (95%) had undergone prior surgery, the nature and extent of which was not specified. Nonparenchymal metastases to lymph nodes were noted in 19 patients (90%), whereas parenchymal metastases to lung, liver, and bone were seen in seven (33%), 13 (62%), and 13 (62%) patients, respectively, among the 21 study participants. It remains unclear if any of the 19 patients with overt lymph node metastases underwent lymph node dissections and why no attempt was made to surgically remove those lymph node metastases from the neck that were sufficiently large to fulfill RECIST criteria. Conceivably, parenchymal target lesions are perfused better than nonparenchymal target lesions. As a matter of fact, pretherapeutic calcitonin and carcinoembryonic antigen serum levels correlate more closely with largest tumor diameter in the thyroid parenchyma (r 0.83 to 0.84; explaining 69% to 71% of the variance in primary tumor size) than with lymph node metastases (r 0.47 to 0.59; explaining no more than 44% of the variance in the number of lymph node metastases). This observation raises the possibility of a differential target lesion response in parenchymal (lung, liver, or bone) compared with nonparenchymal (lymph nodes) organs in patients with medullary thyroid cancer. Such a differential response was recently described for differentiated thyroid cancer where the most noticeable organ-specific response was observed in the lung (median change of 22%) compared with in lymph nodes (median change, 0%; P .02). If the assumption of a better tissue-specific response of parenchymal relative to nonparenchymal target lesions to systemic targeted therapy was also confirmed for metastatic medullary thyroid cancer, this certainly would have major ramifications for the design and conduct of future clinical trials, prompting performance of compartment-oriented surgery to clear the neck of gross lymph node metastases followed by systemic targeted therapy for distant metastases, for which these therapies may be more effective. In experienced hands, the surgical morbidity attendant on compartment-oriented lymph node dissection compares favorably with the toxicity associated with systemic targeted therapy.
Differentiation of common benign pigmented skin lesions from melanoma by high-resolution ultrasound
Authors: C.C. Harland, S.G. Kale, P. Jackson, P.S. Mortimer, J.C. Bamber
Journal: British Journal of Dermatology (2000)

There are potential clinical benefits if non-invasive methods can be used to diagnose or exclude melanoma.We investigated high-resolution ultrasound (HRU) as a potential non-invasive diagnostic aid for pigmented skin lesions.Using a 20-MHz ultrasound B-scan imaging system interfaced to a computer, we assessed acoustic shadowing and entry echo line enhancement (EEE) for 29 basal cell papillomas (BCPs) and 25 melanomas. Acoustic shadowing was estimated by the dermal echogenicity ratio (DER), comparing mean echogenicity below the lesion with that of adjacent dermis. Histological features were scored independently.DER < 3 correctly distinguished melanoma from BCP with 100% sensitivity and 79% specificity. Specificity increased to 93% if the presence of EEE was included as a discriminator. Shadowing correlated most significantly with histological extent of hyperkeratosis (P < 0.0001). Consequently, this method falsely identified non-keratotic acanthotic BCP (n = 3) as melanoma. Highly significant differences between benign naevi (n = 15) and melanomas (n = 24) were found. The SD of retrolesional echogenicity was higher for naevi than melanomas (P < 0.0001), but such an analysis was poorly specific for the diagnosis of melanoma (30%).Overall, HRU has considerable potential as a high-performance screening tool to assist in the discrimination between BCP, but not benign naevi, and melanoma. In particular, it may be possible to exclude melanoma with 100% certainty in the differentiation of BCP from melanoma.
Xbp1s in Pomc Neurons Connects ER Stress with Energy Balance and Glucose Homeostasis
Authors: Kevin W. Williams, Tiemin Liu, Xingxing Kong, Makoto Fukuda, Yingfeng Deng, Eric D. Berglund, Zhuo Deng, Yong Gao, Tianya Liu, Jong-Woo Sohn, Lin Jia, Teppei Fujikawa, Daisuke Kohno, Michael M. Scott, Syann Lee, Charlotte E. Lee, Kai Sun, Yongsheng Chang, Philipp E. Scherer, Joel K. Elmquist
Journal: Cell Metabolism (2014)
Proliferation in the Normal FTE Is a Hallmark of the Follicular Phase, Not BRCA Mutation Status
Authors: Sophia H.L. George, Anca Milea, Patricia A. Shaw
Journal: Clinical Cancer Research (2012)

Women who have inherited germline mutations of BRCA1/BRCA2 are at increased risk of developing high-grade serous carcinoma, and many of these cancers arise in the distal fimbriated end of the fallopian tube. We have previously shown that the fallopian tube epithelia of BRCA1 mutation carriers (FTE-BRCA) have altered signaling pathways compared to nonmutation carriers. In this study, we sought to determine whether these differences result in a proliferative advantage to the epithelia in this high-risk patient population and to investigate whether the postovulation environment of the FTE-BRCA compared to FTE from nonmutation carriers experiences a differential abundance of immune cells.Immunohistochemistry for Ki67, CD3, CD8, CD20, and CD68 was performed on histologically normal tubal epithelium (ampulla, n = 83), fimbria (n = 18) with known ovarian cycle status and germline mutation status and for Ki67 on fimbrial epithelium from women (n = 144) with and without BRCA1 or BRCA2 mutations who underwent risk-reducing salpingo-oophorectomy (RRSO). Serous tubal intraepithelial carcinomas (STIC) with concomitant cancer (n = 15) were also analyzed for presence of immune infiltrates. All slides were digitized and analyzed using automated image analysis software.There was no significant difference in the proliferative index in histologically normal FTE between BRCA1/BRCA2 and non-BRCA, in 144 fimbriae and 83 ampullae. The FTE-BRCA1 epithelia did not exhibit a differential presence of lymphocytes or macrophages, however more macrophages were present in the luteal phase compared to the follicular phase epithelia. In STICs macrophages were more abundant than lymphocytes with an incremental increase noted with disease progression.BRCA1/2 mutation carriers exhibited no significant increase in proliferation in the fallopian tube epithelial cells either in the ampulla or fimbriated ends of the tube. Rather, a significant proliferative increase was defined in the cases determined to be in the follicular, or proliferative, preovulatory phase of the ovarian cycle. Finally, we also show an incremental increase in leukocytes invading the STICs and HGSC, implicating a possible role of the leukocytes early in the progression or inhibition of tumor formation, which is independent of ovarian cycle status.
Use of TNF blockers and other targeted therapies in rare refractory immune-mediated inflammatory diseases: evidence-based or rational?
Authors: Dominique Baeten, P Martin van Hagen
Journal: Annals of the Rheumatic Diseases (2010)

Evidence-based medicine implies that clinical decision making should be based on external research evidence when available. This external evidence includes, but is certainly not restricted to, randomised controlled trials (RCTs). The development of powerful but often expensive targeted therapies for immune-mediated inflammatory diseases (IMIDs) is one of the major successes of evidence-based medicine but, paradoxically, also threatens the traditional RCT-based approach. Indeed, the increasing availability of these drugs decreases the number of patients available for RCTs, questions the ethical basis for the use of placebo groups and raises the issue of cost-efficacy. These considerations become even more important in rare phenotypically diverse and potentially life- or organ-threatening IMIDs such as sarcoidosis, Behçet's disease and uveitis. Using the successful application of tumour necrosis factor blockade in these diseases as an example, this review defends the concept that pathophysiological insights in cellular and molecular disease pathways as well as limited case series are valid sources of external evidence for the rational use of targeted therapies in these rare refractory conditions. If authors fail to redefine their concept of rational therapy along the lines of not only evidence-based but also pathophysiology-based and practice-based medicine, they may underestimate the potential of novel drugs in rare refractory IMIDs and thereby jeopardise the health of their patients.