tbuckley/cabot-search huggingface dataset:
Predictors of Guideline Treatment Nonadherence and the Impact on Survival in Patients With Colorectal Cancer
Authors: Robert B Hines, Alina Barrett, Philip Twumasi-Ankrah, Dominique Broccoli, Kimberly K Engelman, Joaquina Baranda, Elizabeth A Ablah, Lisette Jacobson, Michelle Redmond, Wei Tu, Tracie C Collins
Journal: Journal of the National Comprehensive Cancer Network (2015)

This study investigated the effect of comorbidity, age, health insurance payer status, and race on the risk of patient nonadherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon and Rectal Cancers. In addition, the prognostic impact of NCCN treatment nonadherence on overall survival was assessed.Patients with CRC who received primary treatment at Memorial University Medical Center from 2003 to 2010 were eligible for this study. Modified Poisson regression was used to obtain risk ratios for the outcome of nonadherence with NCCN Guidelines. Hazard ratios (HRs) for the relative risk of death from all causes were obtained through Cox regression.Guideline-adherent treatment was received by 82.7% of patients. Moderate/severe comorbidity, being uninsured, having rectal cancer, older age, and increasing tumor stage were associated with increased risks of receiving nonadherent treatment. Treatment nonadherence was associated with 3.6 times the risk of death (HR, 3.55; 95% CI, 2.16-5.85) in the first year after diagnosis and an 80% increased risk of death (HR, 1.80; 95% CI, 1.14-2.83) in years 2 to 5. The detrimental effect of nonadherence declined with increasing comorbidity and varied according to age.Although medically justifiable reasons exist for deviating from NCCN Guidelines when treating patients with colorectal cancer (CRC), those who received nonadherent treatment had much higher risks of death, especially in the first year after diagnosis. This study's results highlight the importance of cancer health services research to drive quality improvement efforts in cancer care for patients with CRC.
STUDIES OF THE CARRIER STATE FOLLOWING INFECTION WITH GROUP A STREPTOCOCCI. I. EFFECT OF CLIMATE*
Authors: Richard M. Krause, Charles H. Rammelkamp, Floyd W. Denny, Lewis W. Wannamaker
Journal: Journal of Clinical Investigation (1962)

The persistence of the group A streptococcus in the upper respiratory tract after pharyngitis has been termed the streptococcal carrier state.Pa- tients with acute pharyngitis and individuals who continue to harbor the organism serve as the prin- cipal sources of the infectious agent in the spread to susceptible hosts (1).There is considerable variation in the number of streptococci found, however, and in the length of time that strepto- coocci can be isolated from the throat after infec- tion.In the presence of suppurative complications patients may discharge large numbers of organ- isms for many weeks.In the absence of such sup- purative complications, only 40 to 70 per cent of patients continues to harbor the organism after 3 to 7 weeks in sufficient numbers for detection by a routine culture of the pharynx (2-4).Because the characteristics of the streptococcal carrier state have not been clearly defined, studies were undertaken of convalescent carriers after respiratory infections with epidemic strains of group A streptococci.As a part of this study the effect of climate on the carrier state was investigated, and the results form the basis for this report. METHODSPopulation studied.All airmen with respiratory symp- toms entering the hospital between 11 and 27 March, 1951, at Warren Air Force Base at Cheyenne, Wyoming, received no specific antibacterial therapy.On admission a history and physical examination were recorded and a
Aorto-coronary saphenous vein bypass grafting in a patient with a single coronary artery arising from the right aortic sinus.
Authors: S Milo, Y Kishon, D Goor, H N Neufeld
Journal: Thorax (1980)

A patient who presented with severe angina was found to have an ectopic origin of the entire left coronary system, the left main coronary artery arising from the proximal third of the right coronary artery. Atherosclerotic obstructive lesions were present in the right coronary artery, the left anterior descending artery, and the obtuse marginal branch of the left circumflex coronary artery. The three obstructed vessels were bypassed, using autologous saphenous veins. The patient continues to do well 24 months after his operation. We believe that coronary artery bypass should be carried out in symptomatic patients with abnormal coronary anatomy and atherosclerotic disease.
The ivory towers are as resilient as ever
Authors: Martin Vaughan
Journal: BMJ (2005)

I have a patient called Betty. Betty is 75 and is weighed down by more than her share of troubles. She has had severe rheumatoid arthritis for as long as I have known her—which is approaching 30 years. Her pains, which are still severe despite hip and knee replacements, have been augmented by the recent death of her husband. Now she faces a further hurdle: the painkiller that is most effective for her is about to be withdrawn.

> The profits on co-proxamol are tiny, so which drug company is going to do serious studies to promote it? 

Over the years Betty has tried all the second line agents, as well as most of the non-steroidal anti-inflammatory drugs and every combination of analgesics from paracetamol up to morphine. However, every time we have a change of painkillers she always comes back to co-proxamol as being the one that helps her most.

I know this flies in the face of all the “evidence,” but …
Palliative Surgery for Malignant Bowel Obstruction From Carcinomatosis
Authors: Terrah J. Paul Olson, Carolyn Pinkerton, Karen J. Brasel, Margaret L. Schwarze
Journal: JAMA Surgery (2014)

Care of patients with malignant bowel obstruction caused by peritoneal metastases may present an ethical dilemma for surgeons when nonoperative management fails.To characterize outcomes of palliative surgery for malignant bowel obstruction from peritoneal carcinomatosis to guide decision making about surgery and postoperative interventions for patients with terminal illness.We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature Plus, and Google Scholar and performed manual searches of selected journals from inception to August 30, 2012, with no filters, limits, or language restrictions. We used database-specific combinations of the terms intestinal obstruction, malignant, surgery or surgical, and palliat*. We included studies reporting outcomes after palliative surgery for malignant bowel obstruction from peritoneal carcinomatosis from any primary malignant neoplasm and excluded case studies, curative surgery, isolated percutaneous procedures, stenting for intraluminal lesions, and studies in which benign and malignant obstructions could not be distinguished. We assessed quality with the Newcastle-Ottawa Scale.We screened 2347 unique articles, selected 108 articles for full-text review, and included 17 studies. Surgery was able to palliate obstructive symptoms for 32% to 100% of patients, enable resumption of a diet for 45% to 75% of patients, and facilitate discharge to home in 34% to 87% of patients. Mortality was high (6%-32%), and serious complications were common (7%-44%). Frequent reobstructions (6%-47%), readmissions (38%-74%), and reoperations (2%-15%) occurred. Survival was limited (median, 26-273 days), and hospitalization for surgery consumed a substantial portion of the patient's remaining life (11%-61%).Although palliative surgery can benefit patients, it comes at the cost of high mortality and substantial hospitalization relative to the patient's remaining survival time. Preoperatively, surgeons should present realistic goals and limitations of surgery. For patients choosing surgery, clarifying preferences for aggressive postoperative interventions preoperatively is critical given the high complication rate and limited survival after surgery for malignant bowel obstruction.
Comparison of serum 1,25-dihydroxycholecalciferol concentrations in rheumatoid arthritis and osteoarthrosis.
Authors: H A Bird, V Wright, U Hennes, E Theiss
Journal: Annals of the Rheumatic Diseases (1982)

We have previously compared 25-hydroxycholecalciferol levels in the serum of patients with osteoarthrosis and rheumatoid arthritis, finding no significant difference between the circulating levels of this hormone. We have now estimated 1,25-dihydroxycholecalciferol levels on stored sera from the same groups of patients and found no significant difference in the levels of this hormone between the 2 groups. The osteopenia that distinguishes rheumatoid arthritis from osteoarthrosis is not the result of altered levels of systemic 25OHD3 or of 1,25(OH)2D3. Local factors may be more important in its pathogenesis.
Maternal Preoccupation and Parenting as Predictors of Emotional and Behavioral Problems in Children of Women With Breast Cancer
Authors: John J. Sigal, J. Christopher Perry, James M. Robbins, Marie-Anik Gagné, Edgard Nassif
Journal: Journal of Clinical Oncology (2003)

Purpose: To test the hypothesis that differences between sicker and not-so-sick women in their preoccupation with their illness and parenting behavior can explain why some investigators find that children of breast cancer patients fare better than controls and other investigators find the reverse. Patients and Methods: Forty-two women with metastasized breast cancer (sicker mothers) and 45 women with a first occurrence of nonmetastasized breast cancer (not-so-sick mothers) rated the degree of their preoccupation with the disease, their parenting behavior, mood, and social supports and the emotional and behavioral symptoms in one of their children. Their 12- to 18-year-old children rated their mothers’ parenting behavior, their own emotional and behavioral symptoms, and their self-esteem. Results: Sicker mothers reported relatively less preoccupation. They, and their children, reported less poor parenting and fewer externalizing symptoms in the children. Regression analyses revealed further differences between the groups. Conclusion: Less preoccupation with their illness and less poor parenting behavior by sicker mothers may explain why their children seem to fare better then those of not-so-sick mothers. Formulations concerning families of breast cancer patients should include consideration of the effect of the mothers’ perception of the severity of their illness.
Assessing the Site of Maximal Obstruction in the Trachea Using Lateral Pressure Measurement during Bronchoscopy
Authors: Hiroki Nishine, Takehiko Hiramoto, Hirotaka Kida, Shin Matsuoka, Masamichi Mineshita, Noriaki Kurimoto, Teruomi Miyazawa
Journal: American Journal of Respiratory and Critical Care Medicine (2011)

Lateral airway pressure can provide valuable physiological information during bronchoscopy.To evaluate tracheal obstruction during intervention.To prospectively measure lateral airway pressure during bronchoscopy using a double-lumen catheter in 15 healthy subjects and 30 patients with tracheal obstruction. Pressure difference was used to evaluate the site of maximal obstruction. The angle between pressure recordings on either side of the stenosis was measured simultaneously (pressure-pressure curves) to assess the degree of tracheal obstruction.In the experimental study, the angle of the pressure-pressure curve was unaffected by breathing maneuvers whereas the pressure difference was affected. In healthy subjects, no pressure difference between the carina and trachea was observed during tidal breathing, and the angle was close to 45°. In patients with tracheal obstruction, the dyspnea scale, pressure difference, and angle changed significantly beyond 50% obstruction (P<0.0001). After stenting, the pressure difference disappeared and the angle was close to 45°. The degree of tracheal obstruction was significantly correlated with the pressure difference (r=0.83, P<0.0001) and angle (r=-0.84, P<0.0001). The cross-sectional area, dyspnea scale, pulmonary function tests, pressure difference, and the angle significantly improved after procedures (P<0.0001). Responder rates on the modified Medical Research Council Scale were 84.6% for obstructions above 80%, and 58.8% for obstructions between 50 and 80%.The direct measurement of pressure difference and the angle of the pressure-pressure curve represent a new assessment modality for the success of interventional bronchoscopy. Measuring lateral airway pressure could estimate the need for additional procedures better than bronchoscopy alone.
Weekly risk of death while awaiting transplantation: relationship to support required
Authors: L.W. Stevenson, R.C. Bourge, D.C. Naltel, W. Dec, T. Krauskopf, J.B. Young, G.M. Mullen, D.E. Tolman, R.J. Rodeheffer, J.K. Kirkfin
Journal: Journal of the American College of Cardiology (1998)
Emerging Technologies for Point-of-Care Management of HIV Infection
Authors: Hadi Shafiee, ShuQi Wang, Fatih Inci, Mehlika Toy, Timothy J. Henrich, Daniel R. Kuritzkes, Utkan Demirci
Journal: Annual Review of Medicine (2014)

The global HIV/AIDS pandemic has resulted in 39 million deaths to date, and there are currently more than 35 million people living with HIV worldwide. Prevention, screening, and treatment strategies have led to major progress in addressing this disease globally. Diagnostics is critical for HIV prevention, screening and disease staging, and monitoring antiretroviral therapy (ART). Currently available diagnostic assays, which include polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and western blot (WB), are complex, expensive, and time consuming. These diagnostic technologies are ill suited for use in low- and middle-income countries, where the challenge of the HIV/AIDS pandemic is most severe. Therefore, innovative, inexpensive, disposable, and rapid diagnostic platform technologies are urgently needed. In this review, we discuss challenges associated with HIV management in resource-constrained settings and review the state-of-the-art HIV diagnostic technologies for CD4(+) T lymphocyte count, viral load measurement, and drug resistance testing.
DNA adducts and mutations in occupational and environmental biomonitoring.
Authors: K Hemminki
Journal: Environmental Health Perspectives (1997)

The methods applied for DNA adduct determination in humans have become more reliable. Yet there is a need to characterize the adducts studied better and when possible, to identify them with the help of the available standard compounds. Use of standard compounds also allows quantification of adduct levels. There is a lack of knowledge on the adduct levels and their half-lives in target and surrogate tissues. Most adduct studies have been carried out on occupational populations exposed to complex mixtures. White blood cells have been the most common source of DNA. Other exposures and tissues should be a subject of study. Notably, dietary exposures have been largely neglected. Biomonitoring of mutations is a relatively new field and a few exposures have so far been investigated. The results have been promising but logistics of the studies have to be improved to make large field studies possible. Future biomonitoring studies should make an effort to combine many end points, with emphasis on adducts, mutations, and constitutional metabolic factors.
Lenalidomide Enhances Natural Killer Cell and Monocyte-Mediated Antibody-Dependent Cellular Cytotoxicity of Rituximab-Treated CD20+ Tumor Cells
Authors: Lei Wu, Mary Adams, Troy Carter, Roger Chen, George Muller, David Stirling, Peter Schafer, J. Blake Bartlett
Journal: Clinical Cancer Research (2008)

Lenalidomide has significant activity in myelodysplastic syndromes, multiple myeloma, and non-Hodgkin's lymphoma (NHL). In previous studies, natural killer (NK) cell expansion by lenalidomide was shown to enhance the cytotoxic effect of rituximab. This study assessed the ability of lenalidomide to enhance antibody-dependent cellular cytotoxicity (ADCC) in rituximab-treated NHL cell lines and primary tumor cells from patients with B-cell chronic lymphocytic leukemia (B-CLL) in vitro.An in vitro ADCC system was used to assess the ability of lenalidomide to enhance human NK cell and monocyte function in response to rituximab.Lenalidomide directly enhanced IFN-gamma production via Fc-gamma receptor-mediated signaling in response to IgG. It was also a potent enhancer of NK cell-mediated and monocyte-mediated tumor cell ADCC for a variety of rituximab-treated NHL cell lines in vitro, an effect that was dependent on the presence of antibody and either interleukin-2 or interleukin-12. Lenalidomide also enhanced the ability of NK cells to kill primary tumor cells derived from three patients with B-CLL who have been treated previously with fludarabine plus cyclophosphamide. Enhanced NK cell ADCC was associated with enhanced granzyme B and Fas ligand expression and could be inhibited by a granzyme B inhibitor and partially inhibited by antibody to FasL. Enhanced NK cell Fc-gamma receptor signaling is associated with enhanced phosphorylated extracellular signal-related kinase levels leading to enhanced effector function.These findings suggest that lenalidomide has the potential to enhance the rituximab-induced killing of NHL cell lines and primary B-cell chronic lymphocytic leukemia cells via a NK cell-mediated and monocyte-mediated ADCC mechanism in vitro, providing a strong rationale for the combination of lenalidomide with IgG1 antibodies to target tumor-specific antigens in patients with cancer.
What Health Care Providers Learn As Caregivers
Authors: Caroline Laverdière, David Lussier
Journal: Journal of Clinical Oncology (2005)

As pediatric oncology (C.L.) and geriatrics/ palliative care (D.L.) physicians, we are confronted frequently with end-of-life situations. However, when we were involved in this situation as family members (daughter and sonin-law, respectively), the perspective appeared very different. We thought we were well prepared to face the situation and help our family member fulfill her wishes to stay home to the end of her life and preserve her independence. However, when she gradually deteriorated with the progression of her uterine sarcoma, we quickly felt overwhelmed and powerless. It made us realize, to a greater degree than before, what families have to go through. We learned of specific difficulties related to being both physicians and primary caregivers.
Long-Term Inhibition of Rho-Kinase Suppresses Angiotensin II–Induced Cardiovascular Hypertrophy in Rats In Vivo
Authors: Midoriko Higashi, Hiroaki Shimokawa, Tsuyoshi Hattori, Junko Hiroki, Yasushi Mukai, Keiko Morikawa, Toshihiro Ichiki, Shosuke Takahashi, Akira Takeshita
Journal: Circulation Research (2003)

Intracellular signaling pathway mediated by small GTPase Rho and its effector Rho-kinase plays an important role in regulation of vascular smooth muscle contraction and other cellular functions. We have recently demonstrated that Rho-kinase is substantially involved in angiotensin II-induced gene expressions and various cellular responses in vitro. However, it remains to be examined whether Rho-kinase is involved in the angiotensin II-induced cardiovascular hypertrophy in vivo and, if so, what mechanisms are involved. Long-term infusion of angiotensin II for 4 weeks caused hypertrophic changes of vascular smooth muscle and cardiomyocytes in rats. Both changes were significantly suppressed by concomitant oral treatment with fasudil, which is metabolized to a specific Rho-kinase inhibitor, hydroxyfasudil, after oral administration. Angiotensin II caused a perivascular accumulation of macrophages and Rho-kinase activation, both of which were also significantly suppressed by fasudil. Vascular NAD(P)H oxidase expression (nox1, nox4, gp91phox, and p22phox) and endothelial production of superoxide anions were markedly increased by angiotensin II, both of which were also significantly suppressed by fasudil. Thus, fasudil ameliorated the impaired endothelium-dependent relaxations caused by angiotensin II without affecting vasodilator function of vascular smooth muscle. These results provide evidence that Rho-kinase is substantially involved in the angiotensin II-induced cardiovascular hypertrophy in rats in vivo. The suppression of endothelial NAD(P)H oxidase upregulation and resultant superoxide production and the amelioration of endothelial vasodilator function may be involved in this process.
Dynamic laryngeal narrowing in COPD may have effects on the trachea
Authors: P. Leong, S. Joosten, G. Hamilton, P. G. Bardin
Journal: Thorax (2015)

Dear Editor,

Dyspnoea and exercise intolerance in patients with COPD have a wide variety of aetiologies, with dynamic hyperinflation and resultant loss in inspiratory reserve volume recognised as important mechanisms.

Baz et al 1 show that dynamic laryngeal narrowing is present in patients with COPD and hypothesise that this generates intrinsic positive end-expiratory pressure (PEEPi), serving to ‘splint’ open …
Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies
Authors: Y. Rong, L. Chen, T. Zhu, Y. Song, M. Yu, Z. Shan, A. Sands, F. B. Hu, L. Liu
Journal: BMJ (2013)

To investigate and quantify the potential dose-response association between egg consumption and risk of coronary heart disease and stroke.Dose-response meta-analysis of prospective cohort studies.PubMed and Embase prior to June 2012 and references of relevant original papers and review articles.Prospective cohort studies with relative risks and 95% confidence intervals of coronary heart disease or stroke for three or more categories of egg consumption.Eight articles with 17 reports (nine for coronary heart disease, eight for stroke) were eligible for inclusion in the meta-analysis (3,081,269 person years and 5847 incident cases for coronary heart disease, and 4,148,095 person years and 7579 incident cases for stroke). No evidence of a curve linear association was seen between egg consumption and risk of coronary heart disease or stroke (P=0.67 and P=0.27 for non-linearity, respectively). The summary relative risk of coronary heart disease for an increase of one egg consumed per day was 0.99 (95% confidence interval 0.85 to 1.15; P=0.88 for linear trend) without heterogeneity among studies (P=0.97, I(2)=0%). For stroke, the combined relative risk for an increase of one egg consumed per day was 0.91 (0.81 to 1.02; P=0.10 for linear trend) without heterogeneity among studies (P=0.46, I(2)=0%). In a subgroup analysis of diabetic populations, the relative risk of coronary heart disease comparing the highest with the lowest egg consumption was 1.54 (1.14 to 2.09; P=0.01). In addition, people with higher egg consumption had a 25% (0.57 to 0.99; P=0.04) lower risk of developing hemorrhagic stroke.Higher consumption of eggs (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke. The increased risk of coronary heart disease among diabetic patients and reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies.