tbuckley/cabot-search huggingface dataset:
Risk factors for ectopic pregnancy
Authors: Suvit Bunyavejchevin, Piyalumporn Havanond, Wirach Wisawasukmongchol
Journal: JAMA (1988)

<h3>In Reply.—</h3> We are pleased to hear of Dr Green's use of the transdermal clonidine patch in smoking cessation. We are also aware of an article by Appel<sup>1</sup>suggesting that the transdermal patch is effective. Cigarette craving during smoking withdrawal is known to show diurnal variation.<sup>2</sup>Individual pills give a flexibility to dosing over the day that we suspect may give the pill an advantage over the patch. If one clonidine preparation actually had an advantage, this would obviously need to be tested. Dr Cox asks for clarification of several issues that we agree deserve clarification. Our requirement that smokers cut down a minimum of 50% by quit day to be entered in the study might have distorted our sample. We used this criterion because we believed clonidine reduced withdrawal symptoms and, if a smoker did not cut down his cigarette consumption sufficiently to develop withdrawal symptoms, the
Defining a new threshold for PSA outcomes in untreated prostate cancer
Authors: K. W. Beekman, A. Wilton, G. Heller, F. J. Bianco, H. Lilja, S. Slovin, P. T. Scardino, H. I. Scher
Journal: Journal of Clinical Oncology (2004)

4587 Background: To assess the relationship between tumor burden and sensitivity to hormonal therapy, we evaluated post-therapy PSA changes in patients in the rising PSA state (Scher et al, Urol 2000) and in patients with clinical metastases: non-castrate disease. The objective was to determine the proportion that achieved an undetectable PSA following treatment. Methods: We identified 473 patients who experienced a rising PSA following local therapy from two available databases at MSKCC. The first database was a series of 233 patients enrolled on vaccine trials between 1995–200; the second was a series of 2652 patients undergoing prostatectomy at MSKCC from 1996–2002. One hundred forty-one patients were initiated on hormonal therapy with CAB, an antiandrogen alone or a GNRH analogue alone, between 1/93 and 6/03. As their primary therapy, 34 received radiation and 106 received radical prostatectomy. Sixty-eight were in a rising PSA clinical state and 73 had non-castrate metastatic disease. Results: A greater number of patients with a rising PSA only achieved an undetectable PSA compared with metastatic patients (57 vs 38%, p=0.03). Rising PSA only patients: Age, Gleason grade, and doubling time did not predict for an undetectable PSA. Achievement of an undetectable PSA was statistically associated with prior prostatectomy, treatment with a GNRH analogue, a lower pretreatment PSA and a shorter time interval from local therapy (p<0.05). Metastatic patients: Achievement of an undetectable PSA was not associated with prior prostatectomy, treatment with a GNRH or the time interval from local therapy. A lower pretreatment PSA and shorter PSA doubling time were statistically associated with an undetectable PSA (p<0.05). Patients with metastatic disease and a detectable PSA nadir were more likely to exhibit progression of disease on imaging with follow-up (p=0.01). Conclusions: The rate of achieving an undetectable PSA with hormonal therapy is dependent upon the pretreatment PSA and the presence of metastatic disease. Achievement of an undetectable PSA is associated with a delay of disease progression on imaging in metastatic patients. Support: MSKCC SPORE P50 CA 92629–01; Koch Foundation No significant financial relationships to disclose.
Past Decline Versus Current eGFR and Subsequent ESRD Risk
Authors: Csaba P. Kovesdy, Josef Coresh, Shoshana H. Ballew, Mark Woodward, Adeera Levin, David M.J. Naimark, Joseph Nally, Dietrich Rothenbacher, Benedicte Stengel, Kunitoshi Iseki, Kunihiro Matsushita, Andrew S. Levey
Journal: Journal of the American Society of Nephrology (2015)

eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta–analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of −6 versus 0 ml/min per 1.73 m 2 per year over the previous 3 years (a decline of 18 ml/min per 1.73 m 2 versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m 2 (a difference of 20 ml/min per 1.73 m 2 ) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR&lt;30 ml/min per 1.73 m 2 .
Neuronal PAC <sub>1</sub> receptors mediate delayed activation and sensitization of trigeminocervical neurons: Relevance to migraine
Authors: Simon Akerman, Peter J. Goadsby
Journal: Science Translational Medicine (2015)

The pathogenesis of migraine is not well understood. To dissect the relative contributions of endogenous peripheral and central mechanisms in triggering migraine, we examined the effects of two pharmacologically similar, but clinically different, vasodilator neuropeptides, vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide 38 (PACAP-38), on dural meningeal vessels and the response properties of central trigeminovascular neurons. Both VIP and PACAP-38 caused short-lived meningeal vasodilation mediated by VPAC2 receptors, which did not coincide with activation of central trigeminovascular neurons. Only PACAP-38 caused delayed activation and sensitization of central trigeminovascular neurons, similar to its delayed effects in inducing migraine headache. After a 90-min delay, PACAP-38 induced a robust increase in ongoing spontaneous firing and hypersensitivity to intra- and extracranial somatosensory stimulation, which did not coincide with meningeal vasodilation. Only intravenous delivery of a PAC1 receptor antagonist inhibited the peripheral meningeal vasodilatory effects of dural trigeminovascular nociception, whereas only central (intracerebroventricular) administration of the PAC1 receptor antagonist inhibited dural nociceptive-evoked action potentials in central trigeminovascular neurons. Our data suggest that the endogenous mechanisms of migraine pathogenesis are located within the central nervous system, likely in the trigeminocervical complex, and that the dural meninges and their primary afferent innervation are less likely to contribute to migraine initiation. Furthermore, the PAC1 receptor may be an appropriate molecular target for migraine therapeutics.
Abstract 302: Transthoracic Impedance Is Poorly Predicted by Patient Characteristics but Significantly Reduced by Placement of Defibrillator Pads in the Anteroposterior Position
Authors: Andrew J Howe, Rebecca DiMaio, David McEneaney
Journal: Circulation (2012)

Introduction The American Heart Association Resuscitation Guidelines advocate four pad positions to achieve defibrillation success following cardiac arrest. Transthoracic impedance (TTI) reflects the electrode-skin interface and patient impedance and affects current amplitude, energy delivered and defibrillation efficacy. Modern defibrillators utilise an impedance compensated waveform to account for changes in TTI to improve defibrillation success. However the effect of electrode pad position and patient characteristics on TTI remains unclear. Objective To evaluate the effect of patient characteristics and pad position on Transthoracic impedance (TTI). Methods Patients undergoing diagnostic cardiac catheterisation were recruited for the study following regional ethical approval. Standard self-adhesive defibrillator electrodes were applied to patients in both the anterolateral and anteroposterior positions and connected to Heartsine Samaritan defibrillators. TTI was measured by applying a 30kHz sinusoidal signal through the chest. The voltage was then converted to digital samples using an 8-bit microprocessor. The digital samples were then stored on the secure digital card to be retrieved using custom-made download data recovery software. TTI was measured at 10 second intervals in both positions for the duration of the clinical procedure. Results 32 patients (mean age 63), (66% male), were recruited. TTI measured at 10 seconds was significantly higher in the anterolateral position (88.3ohms vs 68.5ohms, p &lt;0.001). Mean TTI reduction over 5 minutes was 2.4% in the anterolateral position and 1.9% in anteroposterior position. There was no significant correlation between TTI measured from either pad position and age, height, weight, body surface area and Haemoglobin (r&lt;0.4 for all parameters). Conclusion TTI is significantly reduced by placement of defibrillator pads in the anteroposterior position. Furthermore patient characteristics are poorly predictive of TTI from either pad position. Patients suffering failed defibrillation attempts from pads positioned in the anterolateral position may benefit from prompt relocation to the anteroposterior position to improve defibrillation efficacy.
The impact of symptom clusters on survival in patients with advanced cancer.
Authors: A. Aktas, L. A. Rybicki, D. Walsh
Journal: Journal of Clinical Oncology (2010)

9145 Background: Symptom clusters (SC) may influence patient outcomes. The prognostic impact of SC on survival in advanced cancer is unknown. We evaluated the association between previously identified SC and survival. Methods: Symptoms from 1,000 patients presenting to a palliative medicine program were recorded prospectively. Among 922 patients with complete symptom data, agglomerative hierarchical cluster analysis identified symptom clusters. A symptom cluster was considered to be present if ≥50% of symptoms in that cluster were present. Among 831 patients with survival data, Cox proportional hazards analysis assessed the univariable prognostic effect of each SC on survival post referral. Stepwise Cox analysis determined which clusters were independently prognostic. Results: Seven clusters were identified: 1. Fatigue/anorexia-cachexia (easy fatigue, lack of energy, weakness, dry mouth, anorexia, early satiety, taste change, weight loss); 2. Neuropsychological (depression, anxiety, sleep problems); 3. Upper Gastrointestinal (bloating, belching, dyspepsia, dizziness); 4. Nausea and Vomiting; (nausea, vomiting); 5. Aerodigestive (cough, dyspnea, hoarseness, dysphagia); 6. Debility (edema, confusion); 7. Pain (pain, constipation). Three clusters were associated with worse survival in both univariable and multivariable analyses (p<0.03 in all cases): the fatigue/anorexia-cachexia, debility, and the aerodigestive clusters. The hazard ratios (95% confidence interval) from the multivariable analysis were 1.37 (1.18-1.59), 1.24 (1.08-1.42), and 1.17 (1.02-1.35) respectively. Those who had these SC had a 17-37% increased risk of death compared to people who did not. The other four SC were not prognostic in univariable or multivariable analysis. Conclusions: ThreeSC had a clinically and statistically important negative impact on survival in advanced cancer. SC are important not only to clinical assessment but may improve prognostication. No significant financial relationships to disclose.
Glycoprotein Ib-von Willebrand Factor Interactions Activate Tyrosine Kinases in Human Platelets
Authors: Naoki Asazuma, Yukio Ozaki, Kaneo Satoh, Yutaka Yatomi, Makoto Handa, Yoshihiro Fujimura, Shuji Miura, Shoji Kume
Journal: Blood (1997)
Galectin-3 Is Associated with Restrictive Lung Disease and Interstitial Lung Abnormalities
Authors: Jennifer E. Ho, Wei Gao, Daniel Levy, Rajalakshmi Santhanakrishnan, Tetsuro Araki, Ivan O. Rosas, Hiroto Hatabu, Jeanne C. Latourelle, Mizuki Nishino, Josée Dupuis, George R. Washko, George T. O’Connor, Gary M. Hunninghake
Journal: American Journal of Respiratory and Critical Care Medicine (2016)

Rationale: Galectin-3 (Gal-3) has been implicated in the development of pulmonary fibrosis in experimental studies, and Gal-3 levels have been found to be elevated in small studies of human pulmonary fibrosis.Objectives: We sought to study whether circulating Gal-3 concentrations are elevated early in the course of pulmonary fibrosis.Methods: We examined 2,596 Framingham Heart Study participants (mean age, 57 yr; 54% women; 14% current smokers) who underwent Gal-3 assessment using plasma samples and pulmonary function testing between 1995 and 1998. Of this sample, 1,148 underwent subsequent volumetric chest computed tomography.Measurements and Main Results: Higher Gal-3 concentrations were associated with lower lung volumes (1.4% decrease in percentage of predicted FEV1 per 1 SD increase in log Gal-3; 95% confidence interval [CI], 0.8–2.0%; P < 0.001; 1.2% decrease in percentage of predicted FVC; 95% CI, 0.6–1.8%; P < 0.001) and decreased diffusing capacity of the lung for carbon monoxide (2.1% decrease; 95% CI, 1.3–2.9%; P < 0.001). These associations remained significant after multivariable adjustment (P ≤ 0.008 for all). Compared with the lowest quartile, participants in the highest Gal-3 quartile were more than twice as likely to have interstitial lung abnormalities visualized by computed tomography (multivariable-adjusted odds ratio, 2.67; 95% CI, 1.49–4.76; P < 0.001).Conclusions: Elevated Gal-3 concentrations are associated with interstitial lung abnormalities coupled with a restrictive pattern, including decreased lung volumes and altered gas exchange. These findings suggest a potential role for Gal-3 in early stages of pulmonary fibrosis.
Standard therapy deviations in the practice of clinical oncology
Authors: E. G. Rivarola, E. Gil Deza, A. Negro, E. Morgenfeld, D. Juarez, C. García Gerardi, D. Santillán, F. G. Gercovich
Journal: Journal of Clinical Oncology (2007)

6504 Background: “Errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing” (To Err is Human: Building a Safer Health System - report from the Institute of Medicine- USA). The current paper was designed to evaluate, prospectively, the different types of prescription deviation from standards as well as the way they are worked out in the daily practice. Methods: Between October 2004 and December 2006, the Tx of 6611 patients ( pt) were progressively entered into a database and compared with the national and international Tx recommendations (Evidence Based Oncology). The deviations between actual and recommended Tx were classified in two groups: Type I, or deviation from “Gold standard” (Off label prescription, experimental treatments or application of translational research with no evidence of better results regarding survival and/or quality of life over a standard Tx) and Type II, or medical errors with high malpractice risk (misdiagnosis, or drug prescription error in dosage, administration or schedule). The deviation was then pointed out to the attending physician, and their response was catalogued as: “A” (Immediate Correction), ‘B‘ (Administrative appeal to determine the treatment) or “C” (Court appeal to determine the treatment). Results: Eight hundred and sixty two errors were identified in the 6611 pt (13%). Six hundred and forty four (74,7%) were Type I and 218 (25,3%) were Type II.. The physicians were more reluctant to recognize Type I than Type II deviations. The response to the deviations were the following: Type I, response A= 454 cases (71%), Type I, response B 184 cases (28%), Type I, response C: 6 cases (1%). Type II response A: 196 cases (90%), Type II response B: 22 cases (10%). Type II response C: 0. Conclusions: 1) The implementation of a treatment-supervision system is the first step towards providing safer health care in oncology. 2) The 644 Type I prescriptions deviation appear to increase in relation to diffusion of innovations, and their modification is more conflictive. However, 71% are corrected immediately. 3) The 218 Type II prescriptions deviation appear to be related with medical expertise, and their resolution is simpler (90 % with immediate correction). An exhaustive taxonomy of deviations will be presented. No significant financial relationships to disclose.
The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center
Authors: A. F. Elsayem, R. Jenkins, L. Parmley, M. L. Smith, J. L. Palmer, E. Bruera
Journal: Journal of Clinical Oncology (2004)

8034 Background: Dying in a hospital, particularly on an intensive care unit (ICU), can be traumatic for patients and families. Palliative care services (PCS) and a palliative care unit (PCU) improve severe physical and psychosocial symptoms, but they are not available in the majority of cancer centers and tertiary hospitals. The purpose of this paper is to review the impact of a PCS/PCU on overall hospital mortality at the University of Texas M.D. Anderson Cancer Center. Methods: We reviewed inpatient hospital deaths (including number of deaths, hospital location of death, and medical service), hospital discharges, and medical service information from the years 1999–2003. We determined the number of patients who accessed PCS before death (via consults or PCU admission). The Cochran-Armitage Trend Test was used to test for trends over time. Results: See table below. Conclusions: Establishment of PCS and PCU resulted in no significant increase in hospital mortality or length of stay. Coordinated efforts between PCS, ICU, and an ethics consult service resulted in a decrease in ICU deaths. By 2003, PCS had increased significantly. No significant financial relationships to disclose.
Survival is correlated with average relative dose intensity in diffuse large B-cell lymphoma patients treated by CHOP: A national retrospective study (1995-2000)
Authors: R Pytlik, Marek Trneny, D Belada, K Kubackova, I Vasova, J Pirnos, J Pukyova, J Pribylova, M Jankovska, T Papajik, P. Klener
Journal: Annals of Oncology (2005)
Suicide in a psychiatric emergency room population
Authors: J R Hillard, D Ramm, W W Zung, J M Holland
Journal: American Journal of Psychiatry (1983)

Twenty-two suicides were identified in a series of 5,284 psychiatric emergency room patients, yielding a suicide rate of 111.1 per 100,000 "patient-years at risk"--more than seven times the age- and sex-adjusted rate for the general population. Subpopulations at high risk were white people, men, depressed and schizophrenic patients, substance abusers, and patients with multiple emergency room visits. No patients had killed themselves immediately after an emergency room visit, but several had killed themselves without following through on a referral from the emergency room to another facility for treatment. The authors discuss the implications of these findings for emergency room practice and for further research.
Cell-free circulating DNA as a promising marker of colorectal cancer detection and progression
Authors: S. Pucciarelli, M. Enzo, M. Agostini, S. Pizzini, P. Del Bianco, S. Lonardi, M. Friso, C. Mescoli, E. Urso, D. Nitti
Journal: Journal of Clinical Oncology (2009)

11059 Background: Since the pathologic stage is the most powerful prognostic factor for colorectal cancer (CRC), there is a strong need of non-invasive methods for early detection. Cell-free circulating DNA (cfDNA) released from cancer cells varies in size. It has been suggested that cfDNA (ALU repeats of 115 bp, representative of total DNA; ALU repeats of 247 DNA, representative of tumor DNA) may be associated with presence of tumor. Aim of this study was then to investigate whether the cfDNA may have a role as marker of CRC detection and progression. Methods: cfDNA was extracted from plasma samples from 136 patients with primary CRC at different stages [median age 64 yrs; male/female 78/58; stages I-II, 61; stages III-IV, 75], and from 24 patients with adenomas [median age 67 yrs; male/female 17/7)] and from 55 clean-colon healthy subjects [median age 56 yrs; male/female 13/43). cfDNA was assessed by quantitative real-time PCR (qPCR) of ALU repeats with 2 sets of primers (115 and 247 bp) amplifying different lengths of DNA. The levels of cfDNA (ALU-115, ALU-247) of CRC patients (stages I-II and stages III-IV) were compared with those of healthy subjects and patients with adenoma. Results: The median concentrations of total cfDNA (ALU115) in the plasma samples from patients with stages III-IV and stages I-II CRC, adenoma and normal controls were 52,4, 11.9; 1.9, and 1.7 ng/ml, respectively (p&lt;.0001). The corresponding figures for tumor-related cfDNA (ALU247) were 48.8, 4.7, 2.2, and 0.7 ng/ml, respectively. (p&lt;.0001). With a cut-off of 4.86 ng/ml, total DNA (ALU115) showed a sensitivity of 78.52 (95% CI 70.6–85.1) and a specificity of 86.08 (95% CI 76.4–92.8) in distinguishing patients with CRC from non-CRC [AUC: 0.860 (95% CI 0.81–0,90), p-value=.0001]. With a cut-off of 3.04, cfDNA tumor-related (ALU247) showed a sensitivity of 77.94 (95% CI 70.0–84.6) and a specificity of 82.28 (95% CI 72.1–90.0) in distinguishing patients with CRC from non-CRC [AUC: 0.864 (95% CI 0.81–0,91), p-value=.0001]. Conclusions: Both ALU115 and ALU 247 fragments of circulating cfDNA seem promising non-invasive molecular markers of detection and progression of CRC. The findings of the current study require to be confirmed on larger cohorts of patients with CRC and colonic adenoma. No significant financial relationships to disclose.