tbuckley/cabot-search huggingface dataset:
Exercise Echocardiography or Exercise SPECT Imaging?
Authors: Kirsten E. Fleischmann, Maria G. M. Hunink, Karen M. Kuntz, Pamela S. Douglas
Journal: JAMA (1998)

Cardiac imaging has advanced rapidly, providing clinicians with several choices for evaluating patients with suspected coronary artery disease, but few studies compare modalities directly.To review the contemporary literature and to compare the diagnostic performance of exercise echocardiography (ECHO) and exercise single-photon emission computed tomography (SPECT) imaging in the diagnosis of coronary artery disease.Studies published between January 1990 and October 1997 identified from MEDLINE search; bibliographies of reviews and original articles; and suggestions from experts in each area.Articles were included if they discussed exercise ECHO and/or exercise SPECT imaging with thallous chloride TI 201 (thallium) or technetium Tc 99m sestamibi for detection and/or evaluation of coronary artery disease, if data on coronary angiography were presented as the reference test, and if the absolute numbers of true-positive, false-negative, true-negative, and false-positive observations were available or derivable from the data presented. Studies performed exclusively in patients after myocardial infarction, after percutaneous transluminal coronary angioplasty, after coronary artery bypass grafting, or with recent unstable coronary syndromes were excluded.Clinical variables, technical factors, and test performance were independently extracted by 2 reviewers on a standardized spreadsheet. Discrepancies were resolved by consensus.Forty-four articles met inclusion criteria. In pooled data weighted by the sample size of each study, exercise ECHO had a sensitivity of 85% (95% confidence interval [CI], 83%-87%) with a specificity of 77% (95% CI, 74%-80%). Exercise SPECT yielded a similar sensitivity of 87% (95% CI, 86%-88%) but a lower specificity of 64% (95% CI, 60%-68%). In a summary receiver operating characteristic model comparing exercise ECHO performance to exercise SPECT, exercise ECHO was associated with significantly better discriminatory power (parameter estimate, 1.18; 95% CI, 0.71-1.65), when adjusted for age, publication year, and a setting including known coronary artery disease for SPECT studies. In models comparing the discriminatory abilities of exercise ECHO and exercise SPECT vs exercise testing without imaging, both ECHO and SPECT performed significantly better than exercise testing. The incremental improvement in performance was greater for ECHO (3.43; 95% CI, 2.74-4.11) than for SPECT (1.49; 95% CI, 0.91-2.08).Exercise ECHO and exercise SPECT have similar sensitivities for the detection of coronary artery disease, but exercise ECHO has better specificity and, therefore, higher overall discriminatory capabilities as used in contemporary practice.
Acupuncture: Theory, Efficacy, and Practice
Authors: Ted J. Kaptchuk
Journal: Annals of Internal Medicine (2002)

Traditionally, acupuncture is embedded in naturalistic theories that are compatible with Confucianism and Taoism. Such ideas as yin-yang, qi, dampness, and wind represent East Asian conceptual frameworks that emphasize the reliability of ordinary, human sensory awareness. Many physicians who practice acupuncture reject such prescientific notions. Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the clinical efficacy of acupuncture. Evidence from these trials indicates that acupuncture is effective for emesis developing after surgery or chemotherapy in adults and for nausea associated with pregnancy. Good evidence exists that acupuncture is also effective for relieving dental pain. For such conditions as chronic pain, back pain, and headache, the data are equivocal or contradictory. Clinical research on acupuncture poses unique methodologic challenges. Properly performed acupuncture seems to be a safe procedure. Basic-science research provides evidence that begins to offer plausible mechanisms for the presumed physiologic effects of acupuncture. Multiple research approaches have shown that acupuncture activates endogenous opioid mechanisms. Recent data, obtained by using functional magnetic resonance imaging, suggest that acupuncture has regionally specific, quantifiable effects on relevant brain structures. Acupuncture may stimulate gene expression of neuropeptides. The training and provision of acupuncture care in the United States are rapidly expanding.
Promoting Quality and Evidence-Based Care in Early-Stage Breast Cancer Follow-up
Authors: L. N. Henry, D. F. Hayes, S. D. Ramsey, G. N. Hortobagyi, W. E. Barlow, J. R. Gralow
Journal: JNCI Journal of the National Cancer Institute (2014)

Evidence-based guidelines for long-term follow-up of early-stage breast cancer patients developed by oncology societies in the United States and Europe recommend that breast cancer survivors undergo regular evaluation with history and physical examination, as well as annual mammography. Routine blood tests, circulating tumor markers, and/or surveillance imaging studies beyond mammography are not recommended in the absence of concerning symptoms or physical examination findings because of lack of supportive clinical evidence. Despite these guidelines, studies have shown that 20% to 40% of oncologists assess serum tumor markers as part of routine monitoring of early-stage breast cancer patients. As part of efforts to both address the financial challenges confronting the health-care system and optimize patient outcomes, the American Society of Clinical Oncology's Cost of Care Task Force identified adherence to breast cancer surveillance guidelines as an opportunity to improve care and reduce cost. However, these recommendations are based on trials done in an era of outdated technology and limited therapeutic options. It is possible that recent improvements in diagnostics and treatments could make earlier detection of recurrent disease important for improving both survival and quality of life outcomes. Research is necessary to further inform optimal breast cancer follow-up strategies, which could impact these recommendations. At this time, outside of well-conducted clinical trials, there is no role for ordering routine serial blood or imaging tests in monitoring for recurrence in early-stage breast cancer patients.
Medicolegal Essentials in Healthcare
Authors: Roger Worthington
Journal: Journal of the Royal Society of Medicine (2005)

Medical law is a fast-moving subject, and most contributors to this second edition have done a good job in bringing readers up to date. Though I balk at the disproportionately long chapter on bloodborne viruses which seems better suited to a volume on public health, my main reservations stem from excessive brevity. For instance, the chapter on medicolegal implications of health and human rights raises vital questions but offers little discussion or analysis. No distinction is drawn between a right to health (to meet public health needs) and a right to healthcare service provision (to meet individual needs). The contributor instead relies on Article 25 of the 1948 United Nations Declaration on Human Rights, with its broad generalized assertions.

Unfortunately, the chapter that is least up to date addresses perhaps the most important topic in the book, namely consent. There is no discussion of the Department of Health Reference Guide to Consent for Examination or Treatment 2001, which has become the standard reference for clinical issues on law and consent in England and Wales and his omission is compounded by the lack of references to recent case law. Do we need to talk about Bolam as ‘still relevant’—what about Pearce or Bolitho instead of a case almost half a century old? The chapter on medicines and product liability law is useful, but to say that very tight legislative controls are maintained in all stages of the manufacture and distribution of medicines is only to state the obvious: what we need to know is whether or not controls are effective and this receives only brief mention. Some contributors succeed in keeping the reader’s attention in areas that could be dry and dull, such as death certification and the role of the coroner; the chapter on this is fluently written and sufficiently informative without burdening readers with masses of detail.

The chapter on clinical negligence has ample legal definitions and references but not a word about the NHS Litigation Authority. How odd that a book published in 2004 fails to register that all NHS litigation is dealt with by this single central authority, set up in 1995. The book finishes with practical advice on what to do, or not to do, in the event of being called upon to take the witness stand in the capacity of expert witness or defendant: ‘Do not get cross; do not behave arrogantly; do not try to play the comic; do not play word games etc.’. If the main purpose was to produce a small but reliable volume for students and professionals I feel that, despite some well-written chapters, the book misses its mark.
<i>Polycomb</i> Group Gene <i>rae28</i> Is Required for Sustaining Activity of Hematopoietic Stem Cells
Authors: Hideaki Ohta, Akihisa Sawada, Ji Yoo Kim, Sadao Tokimasa, Seiji Nishiguchi, R. Keith Humphries, Junichi Hara, Yoshihiro Takihara
Journal: The Journal of Experimental Medicine (2002)

The rae28 gene (rae28), also designated as mph1, is a mammalian ortholog of the Drosophila polyhomeotic gene, a member of Polycomb group genes (PcG). rae28 constitutes PcG complex 1 for maintaining transcriptional states which have been once initiated, presumably through modulation of the chromatin structure. Hematopoietic activity was impaired in the fetal liver of rae28-deficient animals (rae28−/−), as demonstrated by progressive reduction of hematopoietic progenitors of multilineages and poor expansion of colony forming units in spleen (CFU-S12) during embryonic development. An in vitro long-term culture-initiating cell assay suggested a reduction in hematopoietic stem cells (HSCs), which was confirmed in vivo by reconstitution experiments in lethally irradiated congenic recipient mice. The competitive repopulating units (CRUs) reflect HSCs supporting multilineage blood-cell production. CRUs were generated, whereas the number of CRUs was reduced by a factor of 20 in the rae28−/− fetal liver. We also performed serial transplantation experiments to semiquantitatively measure self-renewal activity of CRUs in vivo. Self-renewal activity of CRUs was 15-fold decreased in rae28−/−. Thus the compromised HSCs were presumed to reduce hematopoietic activity in the rae28−/− fetal liver. This is the first report to suggest that rae28 has a crucial role in sustaining the activity of HSCs to maintain hematopoiesis.
Two pragmatic trials of treatment for shoulder disorders in primary care: generalisability, course, and prognostic indicators
Authors: E Thomas
Journal: Annals of the Rheumatic Diseases (2005)

To investigate predictors of long term prognosis in patients treated for shoulder pain in primary care.Data were taken from two pragmatic randomised clinical trials investigating the effectiveness of conservative treatments for shoulder pain presenting to primary care. Shoulder pain severity, disability, and perceived recovery measured in the long term (UK, 18 months; Netherlands, 12 months) were considered as outcome measures. Prognostic indicators measured before randomisation were determined by linear regression (pain severity and disability) and logistic regression (perceived recovery).316 adults with a new episode of shoulder pain were recruited (UK, n = 207; Netherlands, n = 109). In multivariate analysis, greater shoulder disability at follow up was associated with higher baseline disability score, concomitant neck pain, and a gradual onset and longer duration of shoulder symptoms. Pain scores at follow up were higher in women and in those with longer baseline duration of symptoms and higher baseline pain or disability scores. Being female, reporting gradual onset of symptoms, and a higher baseline disability score each independently reduced the likelihood of perceived recovery.The results suggest that there is no long term difference in outcome between patients with shoulder pain treated with different clinical interventions in different clinical settings, or having different clinical diagnoses. Baseline clinical characteristics of this consulting population, rather than the randomised treatments which they received, were the most powerful predictors of outcome. Whether this highlights the need for earlier intervention or reflects different natural histories of shoulder pain is a topic for further research.
Effects of 12 weeks of once-daily tiotropium and olodaterol fixed-dose combination on exercise endurance in patients with COPD
Authors: François Maltais, Juan Bautista Gáldiz Iturri, Anne Kirsten, Dave Singh, Alan Hamilton, Kay Tetzlaff, Yihua Zhao, Richard Casaburi
Journal: European Respiratory Journal (2014)

Background : Both tiotropium (T) and olodaterol (O) monotherapies improve exercise endurance in patients with chronic obstructive pulmonary disease (COPD).   Objective:  To evaluate the effects of T+O fixed-dose combination on exercise endurance in patients with GOLD 2–3 COPD after 12 weeks.   Methods:  TORRACTO (NCT01525615) was a 12-week, double-blind, parallel-group, placebo-controlled, Phase III study. Patients with GOLD 2–3 COPD received T+O (5/5 or 2.5/5 µg) once daily via Respimat Soft Mist inhaler, or placebo. Primary end point was endurance time (ET) during constant work-rate cycle ergometry to symptom limitation after 12 weeks. ET during endurance shuttle walking (ESW) to symptom limitation after 12 weeks was also assessed in a subset of 165 patients. Other end points included pre-exercise inspiratory capacity (IC).   Results:  404 patients (269 men) were randomised (full analysis set n=385). Mean post-bronchodilator FEV 1  was 1.66 L (58.6% predicted).  ET during cycle ergometry was significantly increased with T+O 5/5 µg vs placebo at 12 weeks. Increases in ET during ESW were observed for both T+O doses vs placebo at 12 weeks (21% increase, nominal p=0.06 for each dose). Both T+O doses increased pre-exercise IC vs placebo (nominal p   Conclusions:  T+O 5/5 µg improved ET during cycle ergometry vs placebo.   Funding:  Boehringer Ingelheim.
Overabundant FANCD2, alone and combined with NQO1, is a sensitive marker of adverse prognosis in breast cancer
Authors: R. Fagerholm, K. Sprott, T. Heikkinen, J. Bartkova, P. Heikkilä, K. Aittomäki, J. Bartek, D. Weaver, C. Blomqvist, H. Nevanlinna
Journal: Annals of Oncology (2013)
Randomised controlled trial of the effect of standard and detailed risk disclosure prior to bronchoscopy on peri-procedure anxiety and satisfaction
Authors: M Uzbeck, C Quinn, I Saleem, P Cotter, J J Gilmartin, S T O'Keeffe
Journal: Thorax (2008)

<h3>Background:</h3> Deciding what risks to disclose before a procedure is often challenging for clinicians. Consecutive patients undergoing elective fibreoptic bronchoscopy were randomised to receive simple or more detailed written information about the risks of the procedure and the effects on anxiety and satisfaction levels were compared. <h3>Methods:</h3> A 100 mm anxiety visual analogue scale (VAS) and a modified Amsterdam preoperative anxiety (scored 4–20) scale (APAIS) were completed before and after reading the designated information leaflet. Following bronchoscopy, subjects completed a satisfaction questionnaire. <h3>Results:</h3> Of 142 consecutive patients, 122 (86%) (mean age 57.8 years, 53% male) completed the study. Baseline demographic, clinical and anxiety measures were similar in the two groups. Those who received more detailed risk information had significantly greater increase in anxiety levels than those who received simple information on both the VAS (mean 14.0 (95% CI 10.1 to 17.9) vs 2.5 (95% CI −1.4 to 6.4), p&lt;0.001) and the APAIS (1.73 (95% CI 1.19 to 2.26) vs 0.57 (95% CI 0.05 to 1.10), p&lt;0.001). Almost twice as many of those receiving detailed risk information reported that they felt they had received too much information about complications or that the information they had received about bronchoscopy had been worrying. <h3>Conclusions:</h3> Provision of more detailed risk information before bronchoscopy may come at the cost of a small but significant increase in anxiety.
Thyroid carcinosarcoma, a rare and aggressive histotype: A case report
Authors: D. Giuffrida, M. Attard, L. Marasà, F. Ferraù, F. Marletta, N. Restuccia, L. Gambino, F. Jannì, G. Failla
Journal: Annals of Oncology (2000)

Thyroid carcinosarcoma is a rare and aggressive thyroid tumor.Histological examination of a tumor showed the characteristic of epithelial carcinoma and mesenchymal differentiation.We retrospectively analyzed the course of the patient and reviewed the literature in which only 19 other cases are described.Carcinosarcoma of the thyroid is a very aggressive tumor with a clinical course similar to anaplastic thyroid carcinoma.Survival is very short despite aggressive multimodal treatment.
Building Phylogenetic Trees from Quartets by Using Local Inconsistency Measures
Authors: S. J. Willson
Journal: Molecular Biology and Evolution (1999)

A new quartet method is described for building phylogenetic trees, making use of a numerical measure of local inconsistency. For each quartet consisting of four species, the user chooses numbers indicating evidence for each of the three possible completely resolved trees. These numbers may be, for example, tree lengths or likelihoods. From these numbers, I describe how to measure the ‘‘local inconsistency’’ that results from placing a new species into a particular position in a phylogenetic tree. The best placements are those with low local inconsistency. A phylogenetic tree for a collection of taxa may be constructed by picking a random order of species and adding the species in this order, each time using the placement with the lowest local inconsistency. To summarize the results, one may select a majority-rule consensus tree or the tree most frequently obtained. Alternatively, taxa can be added in the order that maximizes the signal strength. Advantages of the method may include flexibility and better resolution. Studies are performed for artificial data sets for which long-branch attractions are a serious problem; comparisons show performance much superior to maximum parsimony and somewhat superior to quartet puzzling. A case study with real data also illustrates the method.
Phase I and Pharmacologic Study of 17-(Allylamino)-17-Demethoxygeldanamycin in Adult Patients With Solid Tumors
Authors: Jean L. Grem, Geraldine Morrison, Xiao-Du Guo, Elizabeth Agnew, Chris H. Takimoto, Rebecca Thomas, Eva Szabo, Louise Grochow, Frank Grollman, J. Michael Hamilton, Len Neckers, Richard H. Wilson
Journal: Journal of Clinical Oncology (2005)

To determine the clinical toxicities of 17-(allylamino)-17-demethoxygeldanamycin (17-AAG) given as a 1-hour infusion daily for 5 days every 3 weeks.Nineteen patients received 17-AAG over six dose levels (10 to 56 mg/m(2)) using an accelerated titration scheme. Drug levels of 17-AAG were determined by high-performance liquid chromatography. Biologic effects of 17-AAG were monitored by changes in the content of target proteins by immunoblot analysis of lysates prepared from peripheral-blood mononuclear cells.Toxicity was acceptable at doses up to 28 mg/m(2). The cohort was expanded to three patients at 40 mg/m(2) because a second occurrence of grade 2 hepatic transaminitis occurred. Two of six assessable patients who received 56 mg/m(2) had reversible, grade 3 hepatic transaminitis. Five additional patients were enrolled at 40 mg/m(2); none had dose-limiting toxicity. The maximum plasma concentrations (C(max)) of 17-AAG at 40 and 56 mg/m(2) were 1,724 and 2,046 ng/mL, respectively; the average plasma exposures (AUC) were 2,809 and 6,708 hours.ng/mL, respectively. Less than 3% of the daily dose was excreted into the urine. Clearance did not correlate with body-surface area. Possible biologic activity was suggested by apparent increased protein content of either glucose-related 78 kd protein or heat shock protein 70 with >/= 14 mg/m(2) and decreased protein content of either Lck or Raf1 with >/= 28 mg/m(2) of 17-AAG.17-AAG 40 mg/m(2) (median dose, 70 mg) was well tolerated when given daily for 5 days every 3 weeks.
Preferential Localization of Gallium-67 Citrate in Tissues of Leukemic Mice&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: D. C. Swartzendruber, B. L. Byrd, R. L. Hayes, B. Nelson, R. L. Tyndall
Journal: JNCI Journal of the National Cancer Institute (1970)

We report the 24-hour concentration of gallium-67 (67Ga) citrate in various tissues of leukemic and nonleukemic mice. Significantly higher concentrations of 67Ga localized in the thymus and involved lymph nodes of leukemic AKR/J mice than in nonleukemic AKR/J mice. 67Ga localized more in thymic tissue of young (7 weeks) AKR/J mice than in older (3–10 months) nonleukemic AKR/J mice. Although spleens of leukemic AKR/J mice often contained histologically typical lymphoma cells, the 67Ga concentration did not increase in this organ. Concentrations of 67Ga also increased in blood, spleen, liver, and lungs of BALB/c mice with leukemia induced by Rauscher virus. Gallium is a bone-seeking element; the mechanism of its localization in tumor tissue as yet is unknown.
Forkhead Box Protein P1 Expression in Mucosa-Associated Lymphoid Tissue Lymphomas Predicts Poor Prognosis and Transformation to Diffuse Large B-Cell Lymphoma
Authors: Xavier Sagaert, Pascale de Paepe, Louis Libbrecht, Vera Vanhentenrijk, Gregor Verhoef, Jose Thomas, Iwona Wlodarska, Christiane De Wolf-Peeters
Journal: Journal of Clinical Oncology (2006)

Purpose Gene expression profiling studies have reported upregulated mRNA expression of forkhead box protein P1 (FOXP1) in response to normal B-cell activation and high expression in a poor prognosis subtype of diffuse large B-cell lymphoma (DLBCL). Recently, it was also found that FOXP1 rearrangements and expression of its protein occur in mucosa-associated lymphoid tissue (MALT) lymphomas. In this study, we investigated FOXP1 expression in its relationship to morphology, genetic features, and prognosis in a series of 70 MALT lymphomas. Patients and Methods All samples were morphologically reviewed and stained for FOXP1. Presence of structural and/or numeric aberrations of the FOXP1, BCL10, and MALT1 genes was investigated. For all patients, a complete clinical data set was collected. Results We detected nuclear expression of FOXP1 in 20 of the 70 MALT lymphomas (nine of them featuring structural or numeric aberrations of the FOXP1 locus). FOXP1 positivity was confined to MALT lymphomas with poor clinical outcome (with impact of FOXP1 expression on relapse rate and disease-free survival). It was also found that MALT lymphomas with strong FOXP1 expression are at risk of transforming into an aggressive DLBCL of nongerminal center phenotype if they feature, in addition, a polymorphic histology and the presence of trisomy 3 and 18. Conclusion The data presented show that FOXP1 expression is an independent prognostic factor in MALT lymphomas. The data also support the hypothesis that a subgroup of nongerminal center DLBCLs (those marked by FOXP1 expression and trisomy 3 and 18) might represent a large-cell variant of MALT lymphomas.