tbuckley/cabot-search huggingface dataset:
Abstract MP78: Relationship Between Casual Urinary Sodium/potassium Ratio And 24-h Urinary Sodium/potassium Ratio: The Intersalt Study
Authors: Toshiyuki Iwahori, Katsuyuki Miura, Hirotsugu Ueshima, Queenie Chan, Alan R Dyer, Paul Elliott, Jeremiah Stamler
Journal: Circulation (2014)

Objective: High dietary sodium (Na) and low dietary potassium (K) intakes are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. The Sodium/potassium (Na/K) ratio is a composite index of Na and K. Recently, we found Na/K ratio of casual urine is useful for estimating 24-h urinary Na/K ratio in healthy Japanese participants. However, this finding has not been validated in different ethnic groups. Our aim was to assess the utility across and within populations of casual (spot) urine specimens to estimate 24-h urinary Na/K ratio using data from the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT). Methods: The INTERSALT study collected standardized data on casual urinary Na and K concentrations, and also on timed 24-h urinary Na and K excretion for 10,079 men and women ages 20-59 years from 52 population samples in 32 countries. Pearson correlation coefficients and agreement quality analysis (by the Bland-Altman method) were computed for Na/K ratio of casual urine against 24-h urinary Na/K ratio. Results: Overall mean value of Na/K ratio in 24-h urine collections was 3.24. 24-h urinary Na/K ratio and Na/K ratio of casual urine across the 52 population samples were highly correlated: r=0.96 (overall), r=0.96 (men), r=0.95 (women), r=0.94 (ages 20-29), r=0.94 (ages 30-39), r=0.95 (ages 40-49) and r=0.95 (ages 50-59). 24-hour urinary Na/K ratio and Na/K of casual urine across the 10,079 individuals had moderately strong correlations: r=0.69 (overall), r=0.70 (men), r=0.68 (women), r=0.58 (white), r=0.47 (black), r=0.81 (Amerindian), r=0.70 (Asian Indian), r=0.64 (east-Asian), r=0.70 (other ethnicities), r=0.58 (with anti-hypertensive medication use) and r=0.72 (without anti-hypertensive medication use). The bias estimate with the Bland-Altman method, defined as the difference between Na/K of 24-h urine collection and casual urine, was approximately 0.4 across both populations and individuals, independent of age, gender and anti-hypertensive medication use across the 52 population samples. Bias estimates across population samples were 0.39 (overall), 0.42 (men), 0.36 (women), 0.32 (ages 20-29), 0.41 (ages 30-39), 0.37 (ages 40-49) and 0.46 (ages 50-59). Bias estimates for the 10,079 individuals were 0.40 (overall), 0.42 (men), 0.37 (women), 0.33 (white), 0.69 (black), 0.04 (Amerindian), 0.22 (Asian Indian), 0.65 (east-Asian), 0.31 (other ethnicities), 0.45 (with anti-hypertensive medication use) and 0.38 (without anti-hypertensive medication use). Conclusions: These findings indicate that casual urine Na/K ratio is a useful, low-burden, low-cost method alternative to 24-h urine collection for estimation of urinary Na/K ratio across populations of various ethnicities. It is also applicable to individual urinary Na/K ratio.
The private, online GP will see you now
Authors: Ingrid Torjesen
Journal: BMJ (2016)

Companies are offering remote consultations and more, as Ingrid Torjesen reports

Increasing numbers of general practitioners now offer virtual consultations. And several private companies, such as Dr Now, Dr Morton’s, and Babylon, now offer patients remote consultations for a fee, using computers, tablets, telephones, or smartphones.

Services provided by these companies vary but can include private drug prescriptions delivered to your door, diagnostic tests by post, and medical monitoring. Patients can access records related to their consultation through the companies’ websites. They either pay for a one-off consultation or pay a monthly subscription for access on demand. And companies are expanding to offer services to employers—and through the NHS.

Karen Morton, a gynaecologist and obstetrician, launched Dr Morton’s with John Wilkes, its chief executive, in April 2015.

“More and more of my patients were having trouble getting appointments with their GP,” she says. “A new type of health consumer is growing in the UK who is prepared …
Relevance of Sp Binding Site Polymorphism in<i>WWOX</i>for Treatment Outcome in Pancreatic Cancer
Authors: Markus A. Schirmer, Claudia M. Lüske, Sebastian Roppel, Alexander Schaudinn, Christian Zimmer, Ruben Pflüger, Martin Haubrock, Jacobe Rapp, Cenap Güngör, Maximilian Bockhorn, Thilo Hackert, Thomas Hank, Oliver Strobel, Jens Werner, Jakob R. Izbicki, Steven A. Johnsen, Jochen Gaedcke, Jürgen Brockmöller, B. Michael Ghadimi
Journal: JNCI Journal of the National Cancer Institute (2016)

A genome-wide association study (GWAS) suggested inherited genetic single-nucleotide polymorphisms (SNPs) affecting overall survival (OS) in advanced pancreatic cancer. To identify robust clinical biomarkers, we tested the strongest reported candidate loci in an independent patient cohort, assessed cellular drug sensitivity, and evaluated molecular effects. This study comprised 381 patients with histologically verified pancreatic ductal adenocarcinoma treated with gemcitabine-based chemotherapy. The primary outcome was the relationship between germline polymorphisms and OS. Functional assays addressed pharmacological dose-response effects in lymphoblastoid cell lines (LCLs) and pancreatic cancer cell lines (including upon RNAi), gene expression analyses, and allele-specific transcription factor binding. All statistical tests were two-sided. The A allele (26% in Caucasians) at SNP rs11644322 in the putative tumor suppressor gene WWOX conferred worse prognosis. Median OS was 14 months (95% confidence interval [CI] = 12 to 15 months), 13 months (95% CI = 11 to 15 months), and nine months (95% CI = 7 to 12 months) for the GG , GA , and AA genotypes, respectively ( Ptrend < .001 for trend in univariate log-rank assuming a codominant mode of inheritance; advanced disease subgroup Ptrend < .001). Mean OS was 25 months (95% CI = 21 to 29 months), 19 months (95% CI = 15 to 22 months), and 13 months (95% CI = 10 to 16 months), respectively. This effect held true after adjustment for age, performance status according to Eastern Cooperative Oncology Group classification, TNM, grading, and resection status and was comparable with the strongest established prognostic factors in multivariable analysis. Consistently, reduced responsiveness to gemcitabine, but not 5-fluorouracil, along with lower WWOX expression was demonstrated in LCLs harboring the AA genotype. Likewise, RNAi-mediated WWOX knockdown in pancreatic cancer cells confirmed differential cytostatic drug sensitivity. In electrophoretic mobility shift assays, the A allele exhibited weaker binding of Sp family members Sp1/Sp3. WWOX rs11644322 represents a major predictive factor in gemcitabine-treated pancreatic cancer. Decreased WWOX expression may interfere with gemcitabine sensitivity, and allele-specific binding at rs11644332 might be a causative molecular mechanism behind the observed clinical associations.
Serum procalcitonin (PCT-Q) as a diagnostic tool for bacterial lower respiratory tract infection among COPD patients with acute exacerbation
Authors: Theerasuk Kawamatawong, Wisarn Jintanalert
Journal: European Respiratory Journal (2013)

Objective:   To determine diagnostic performance of serum PCT-Q (BRAHMS procalcitonin commercial kit) for bacterial lower respiratory tract infection among COPD patient with exacerbation.   Material and methods:   Prospective study was conducted in 40 hospitalized COPD patients with exacerbation between June 2008 and January 2009. Patient clinical profiles including the presence of infiltrate on chest roentgenogram, leukocytosis, positive sputum culture for bacteria and clinical outcome (mortality, length of stay and mechanical ventilation requirement) were determined. Serum procalcitonin concentration was measured by both PCT-Q commercial kits and standard quantitative assay on the first day of admission.   Result:   The diagnostic yield of PCT-Q for pneumonic exacerbation (the presence of pulmonary infiltrate) exhibits sensitivity and specificity of 100% and 71.9% whereas the test exhibits 50.0% sensitivity and 73.3% specificity for the presence of leukocytosis. However, positive PCT-Q provides 40.9 % sensitivity and 50.0%specificity for determining bacterial causes of exacerbation (defined by bacterial culture positivity in sputum). There is no significant correlation between positive PCT-Q and the mechanical ventilator requirement (p=0.864) as well as an average length of stay (p=0.139). The correlation between the positive PCT-Q and positive standard serum assay is noted.   Conclusion:   PCT-Q can be used as biomarker for pneumonic exacerbation in COPD patients whereas the PCT-Q level is poorly correlated with the clinical outcome. In addition, correlation of kits and standard assay is noted. However, the benefit of PCT-Q is shorter turnaround time.
Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124 086 US men and women followed for up to 24 years
Authors: Monica L Bertoia, Eric B Rimm, Kenneth J Mukamal, Frank B Hu, Walter C Willett, Aedín Cassidy
Journal: BMJ (2016)

<b>Objective</b>&nbsp;To examine whether dietary intake of specific flavonoid subclasses (including flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and flavonoid polymers) is associated with weight change over time. <b>Design</b>&nbsp;Three prospective cohort studies. <b>Setting</b>&nbsp;Health professionals in the United States. <b>Participants</b>&nbsp;124 086 men and women participating in the Health Professionals Follow-up Study (HPFS), Nurses’ Health Study (NHS), and Nurses’ Health Study II (NHS II). <b>Main outcome measure</b>&nbsp;Self reported change in weight over multiple four year time intervals between 1986 and 2011. <b>Results</b>&nbsp;Increased consumption of most flavonoid subclasses, including flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers, was inversely associated with weight change over four year time intervals, after adjustment for simultaneous changes in other lifestyle factors including other aspects of diet, smoking status, and physical activity. In the pooled results, the greatest magnitude of association was observed for anthocyanins (−0.23 (95% confidence interval −0.30 to −0.15) lbs per additional standard deviation/day, 10 mg), flavonoid polymers (−0.18 (−0.28 to −0.08) lbs per additional SD/day, 138 mg), and flavonols (−0.16 (−0.26 to −0.06) lbs per additional SD/day, 7 mg). After additional adjustment for fiber intake, associations remained significant for anthocyanins, proanthocyanidins, and total flavonoid polymers but were attenuated and no longer statistically significant for other subclasses. <b>Conclusions</b>&nbsp;Higher intake of foods rich in flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers may contribute to weight maintenance in adulthood and may help to refine dietary recommendations for the prevention of obesity and its potential consequences.
High-dose chemoradiotherapy with bone marrow transplantation as consolidation treatment in neuroblastoma: an unselected group of stage IV patients over 1 year of age.
Authors: T Philip, J L Bernard, J M Zucker, R Pinkerton, P Lutz, P Bordigoni, E Plouvier, A Robert, R Carton, N Philippe
Journal: Journal of Clinical Oncology (1987)

Since January 1983, 56 consecutive children over 1 year of age with stage IV neuroblastoma entered an aggressive protocol, including chemotherapy, radiation therapy, and bone marrow transplantation. The induction protocol included platinum and epipodophyllotoxin (VM-26), alternating with cyclophosphamide, Adriamycin (Adria Laboratories, Columbus, OH), and vincristine (PE/CADO). Surgery was performed after 2 to 4 months, and consolidation with intensive chemoradiotherapy and bone marrow transplantation (BMT) was performed within 12 months of diagnosis. The combination of vincristine, melphalan and total body irradiation (TBI) was used before BMT, and no further treatment was administered before progression. With the exception of two allografts, autologous BMT (ABMT) was given in all cases and was purged using an immunomagnetic procedure (Kemshead technique) in 32 of 35 cases, and a chemical procedure in three of 35. Of the 56 patients, 45 were evaluable. Of those, 23 were grafted in partial remission (PR), and 14 were grafted in either complete remission (CR) or very good partial remission (VGPR). The acute toxic death rate was 19%, the relapse rate was 32%, and the progressive disease rate was 19%. The progression-free survival in the CR/VGPR group (ie, 44% at 32 months post-diagnosis) and in the PR group (13% at 32 months) was not significantly different (P greater than .05). At 24 months, the overall survival of the 56 unselected patients was 39% compared with 12% for comparable patients previously treated by our group (P less than .005).
Turning people into couch potatoes is not the cure for sports concussion: Table 1
Authors: Catherine Calderwood, Andrew Duncan Murray, William Stewart
Journal: British Journal of Sports Medicine (2015)

In little more than a decade, concussion has become one of the biggest issues taxing modern sport. Incidents of apparently concussed athletes in football's World Cup and in recent Six Nations’ rugby matches have generated unparalleled column inches in the press, comment on social media and challenging review articles;1 the clear suggestion is that something is wrong in sport, and young brains are at risk. With the Rugby World Cup under way, yet more scrutiny of further high profile incidents is inevitable. In the USA, heightened anxiety over sports concussion has caused participation levels to fall. Similar reactions are likely to follow in other countries.

Is this reaction justified? What is the risk of losing the proven benefits of participation in sport compared with the risks of sports concussion?

Concussions are common in contact sports. Data in rugby union suggest approximately one player per match at community level will sustain a head injury requiring medical attention,2 with around one concussion in every 2.5 matches at the elite level.3 Symptoms vary, and may include headache, visual disturbance …
Does maternal smoking play a role as an inducer, rather than trigger, of asthma and respiratory symptoms?
Authors: Mark Upton, Alex McConnachie, Carole Hart, George Davey Smith, Graham Watt
Journal: European Respiratory Journal (2011)

Background:  Asthma is a complex chronic disease arising from the interaction of genetic and environmental factors. In children, it is difficult to separate any role of maternal smoking in the antenatal induction of asthma from a later role as a symptom trigger, as most mothers who smoke in pregnancy continue to smoke after their child9s birth.   Aim:  To estimate the association between parental smoking and asthma and respiratory symptoms in adults, and to compare findings with those for current exposure to environmental tobacco smoke (ETS).   Methods:  The Midspan Family Study included offspring aged 30-59 years, whose parents reported their smoking habits as part of an epidemiological study 20 years earlier. Offspring completed a questionnaire and underwent spirometry. We used logistic regression to estimate the association between parental smoking or current ETS and asthma and symptoms in 985 lifelong non-smokers.   Results:  Maternal smoking was associated with wheeze, wheeze without a cold, wheeze with breathlessness, current asthma, ≥3 asthma symptoms, odds ratios (95% confidence intervals) after adjustment for covariates: 2.1 (1.3-3.4), 2.5 (1.4-4.7), 2.9 (1.6-5.2), 2.2 (1.1-4.1), 2.6 (1.5-4.6) respectively. There were dose-response associations for all five outcomes. There was no evidence of association between maternal smoking and breathlessness or chronic sputum, or between paternal smoking and asthma or any symptom. Current ETS was positively associated with wheeze variables, current asthma, ≥3 asthma symptoms, breathlessness and chronic sputum.   Conclusions:  Maternal smoking, probably in-utero, plays a role in the induction of phenotype(s) related to wheeze and asthma in adults.
Risk factors for nausea and vomiting (NV) following highly or moderately emetogenic chemotherapy (HEC or MEC) in U.S. community oncology practice.
Authors: J. W. Gilmore, B. A. Feinberg, T. Wisniewski, S. Haislip, C. Wentworth, T. A. Burke
Journal: Journal of Clinical Oncology (2010)

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Abstract P125: Eating Behaviour Profiles of Severely Obese People Differ in Regard to Gender and Hypertension Status
Authors: Nadine Bonneville, Julie Martin, Audrey Auclair, Marjorie Bastien, Véronique Provencher, Paul Poirier
Journal: Circulation (2012)

INTRODUCTION: The prevalence of severe obesity has tripled in Canada in the past few decades. Nevertheless, cognitions and eating behaviours in this population have not been extensively studied as for their relationships with anthropometric characteristics and comorbidities. Therefore, the aim of this study was to link 3 factors related to cognitions and eating behaviours: restraint, disinhibition and susceptibility to hunger, according to gender, body composition and hypertension (HTA) status. HYPOTHESIS: Cognitive and behavioural profiles of severely obese people differ in regard to gender and HTA status. METHODS: A total of 125 severely obese people [Body Mass Index (BMI) of ≥ 40 or ≥ 35 kg/m 2 with comorbidities] were recruited through the bariatric surgery clinic of our institution. They were invited to complete a validated French version of the Three-Factor Eating Questionnaire (51-items). Weight, fat-free mass, and body fat mass of participants were measured using a bioelectric impedance balance and HTA status was recorded. RESULTS: Participants were 41 ± 10 years, weighted 133.9 ± 27.4 kg with a BMI of 48.7 ± 7.6 kg/m 2 , a lean mass of 66.0 ± 14.1 kg, a fat mass of 32.6 ± 17.9 kg and a fat percentage of 50.3 ± 5.7%. Age and BMI were similar between men and women, but men’s weight, body fat, and fat-free mass were higher than in women. In the entire cohort, a negative correlation was observed between susceptibility to hunger and fat mass (r=-0.273; p=0.035). In men, positive correlations were observed between restraint vs. weight (r=0.394; p=0.016) and BMI (r=0.459; p=0.004). In women, negative correlations were observed between restraint vs. weight (r=-0.215; p=0.044) and lean mass (r=-0.278; p=0.009), while positive correlations were observed between disinhibition vs. weight (r=0.211; p=0.049) and fat mass (r=0.215; p=0.044). Overall, 56% (70/125) of all participants showed HTA. A greater proportion of participants with a higher restraint score suffered from HTA than in participants presenting a lower restraint score (67 vs. 48%; p=0.027). Restraint profile also differed between women suffering with HTA vs. without HTA (p=0.008). A greater proportion of participants showing a lower disinhibition score suffered from HTA than those with a higher disinhibition score (64 vs. 48%; p=0.051). CONCLUSION: Higher score of susceptibility to hunger observed in severely obese individuals is linked to a lower body fat mass. Despite similar eating behaviour profiles, different associations coexist according to gender between restraint vs. disinhibition factors and anthropometric characteristics. Among women, those suffering with HTA present a higher level of restraint, but lower disinhibition score. These findings in severely obese people differ from actual literature in overweight and obese people.
Interim cardiac safety analysis of NCCTG N9831 Intergroup adjuvant trastuzumab trial
Authors: E. A. Perez, V. J. Suman, N. E. Davidson, P. A. Kaufman, S. Martino, S. R. Dakhil, J. N. Ingle, R. J. Rodeheffer, B. J. Gersh, D. W. Hillman, A. S. Jaffe
Journal: Journal of Clinical Oncology (2005)

556 Background: NCCTG N9831 is a 3-arm randomized Phase III trial comparing safety and efficacy of AC followed by weekly paclitaxel (T) (Arm A) vs the same chemotherapy with 1 yr of trastuzumab (H) either after (Arm B) or starting with T (Arm C). Clinical and asymptomatic cardiac tolerability is the focus of this abstract. Methods: Women with normal left ventricular ejection fraction (LVEF) assessed by MUGA or echocardiogram scan were eligible. LVEF evaluation was repeated post-AC, 6, 9 and 18 months post entry. Clinical cardiac evaluation occurred as a continuum. A Cardiac Safety DMC reviewed asymptomatic and symptomatic LVEF changes monthly. Interim analyses were planned after 100, 300, and 500 evaluable pts per arm began post-AC therapy and were followed for additional 6 months. Primary endpoint was proportion of cardiovascular (CV) events in each arm (congestive heart failure (CHF) and definite or probable cardiac deaths). A difference of 4% would trigger suspension or closure of the H-containing study arms. Results: 3rd interim analysis comparing the cardiac safety on Arms A and B included 1126 women (544 on Arm A and 572 on Arm B) who had a satisfactory post-AC cardiac evaluation (7.3% on Arm A and 3.3% on Arm B were unsatisfactory (significant cardiac symptoms, LVEF below facility’s lower limit of normal, or LVEF drop >15 percentage points) and prohibited from taking H). There were 0 (0%; 95% CI: 0–0.7%) CV events on Arm A and 13 (2.2%; 95% CI: 1.2–3.8%) CV events on Arm B. Among the 13 CV events on Arm B, 12 pts had confirmed cases of CHF and 1 pt experienced a cardiac death. Follow-up data on pts experiencing CV events has been gathered and will be presented. The 3rd interim cardiac analysis comparing cardiac events in Arms A and C expected Spring 2005. Conclusions: There is an increase in cardiac toxicity with H but it remains less than the threshold of 4% prospectively designated as a stopping rule. By that criteria, AC → T vs AC → T → H manifests acceptable cardiac safety data in the adjuvant treatment setting. Enrollment continues for all arms anticipating completion in Spring 2005. Long-term follow-up is needed to determine the impact of the adverse CV events reported at this time. Supported by the Breast Cancer Research Foundation, Genentech, NIH CA25224. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis, Bristol-Myers Squibb, Eli Lilly, Genentech, Pfizer