tbuckley/cabot-search huggingface dataset:
Intravenous Fluid Bolus Prior to Neonatal and Infant Lumbar Puncture
Authors: Jessica Rankin, Vincent J. Wang, Fariba Goodarzian, Hollie A. Lai
Journal: JAMA Pediatrics (2016)

<h3>Importance</h3> Neonatal and infant lumbar puncture is a commonly performed procedure in emergency departments, yet traumatic and unsuccessful lumbar punctures occur 30% to 50% of the time. Dehydration may be a risk factor for unsuccessful lumbar punctures, but to our knowledge, no studies have investigated the use of intravenous (IV) fluid bolus prior to lumbar puncture. <h3>Objective</h3> To investigate the association of IV fluid bolus administration with the sonographic measure of the neonatal and infant lumbar subarachnoid space. We hypothesized that IV fluids would increase subarachnoid space size. <h3>Design, Setting, and Participants</h3> Prospective observational study conducted from August 2012 to April 2015.The study took place at the emegency department of the Children’s Hospital Los Angeles, an urban pediatric emergency department with an annual census of 76 000 visits.A convenience sample of patients aged 0 to 3 months were enrolled if they had a clinical presentation consistent with pyloric stenosis. This population was used as a proxy because they are similar in age to patients undergoing lumbar puncture for evaluation of neonatal fever and are routinely given IV fluids for dehydration. <h3>Exposures</h3> Patients with a sonographic diagnosis of pyloric stenosis underwent additional ultrasonography evaluation to determine the size of the subarachnoid space before and after IV fluids. <h3>Main Outcomes and Measures</h3> Primary outcomes included the difference in the size of the subarachnoid space in millimeters squared before and 1 hour after administration of an IV fluid bolus in the emergency department. Interobserver consistency for the subarachnoid space measurement between attending radiologists was measured using intraclass correlation coefficient. The Wilcoxon signed-rank test was used to examine changes in subarachnoid space measurements (millimeters squared). <h3>Results</h3> The study sample consisted of 40 patients with a mean (SD) age of 37 (11.3) days (range, 15-71 days). The mean (SD) size of the subarachnoid space before and 1 hour after IV fluid bolus was 37.8 (11.1) mm<sup>2</sup>and 36.9 (11.2) mm<sup>2</sup>respectively (<i>P</i> = .42). The intraclass correlation coefficient ranged from 0.96 to 0.99 (95% CI, 0.90-0.99). <h3>Conclusions and Relevance</h3> Intravenous fluid boluses were not associated with a significant increase in the sonographic measure of the neonatal and infant subarachnoid space.
Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma
Authors: O. Dumas, R. Varraso, M. W. Gillman, A. E. Field, C. A. Camargo
Journal: Allergy (2016)

Sparse data are available on the relationship between prenatal exposures and asthma during later childhood. In a longitudinal study of adolescents and their mothers, we examined the association of (i) maternal prepregnancy body mass index (BMI) and (ii) gestational weight gain (GWG), with incidence of allergic and nonallergic asthma in offspring.Analyses were conducted using data from 12 963 children aged 9-14 years at enrolment in the Growing Up Today Study, and their mothers, who are participants in the Nurses' Health Study II. Physician-diagnosed asthma and allergies were assessed by questionnaires sent regularly to participants and their mothers. Logistic regression was used to evaluate associations of maternal BMI and GWG with offspring asthma, overall and by subtype.Physician-diagnosed asthma during childhood or adolescence was reported by 2694 children (21%). Maternal prepregnancy overweight (OR: 1.19, 95% CI: 1.03-1.38) and obesity (1.34, 1.08-1.68) were associated with offspring asthma. In asthma subtype analyses, the association was seen only for asthma onset before age 12 years. Moreover, the association of maternal obesity with nonallergic asthma was observed in boys (2.39, 1.40-4.09) and not in girls (0.96, 0.50-1.85; Pinteraction = 0.03); the opposite pattern was suggested for allergic asthma. With regard to GWG, an association was suggested between gains of <15 lb and higher risk of offspring asthma (1.28, 0.98-1.66), without clear allergy- or sex-related patterns.The relation of several prenatal factors to risk of childhood asthma supports the early origins hypothesis for asthma. The observed allergy- and sex-specific patterns suggest multiple etiologic pathways.
Diffuse Large B-Cell Lymphoma During Azathioprine Therapy for Autoimmune Hepatitis: a Case Report
Authors: Masahiro Manabe, Toshio Dozaiku, Junya Okita, Johji Nagasaki, Naonori Harada, Yasutaka Aoyama, Takeo Kumura, Tadanobu Ohta, Yoshio Furukawa, Atsuko Mugitani
Journal: Annals of Oncology (2014)
Abstract P104: Serum Long-Chain Omega-3 Fatty Acids, Hair Mercury and Corrected QT Interval in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study
Authors: Jyrki K Virtanen, Jaakko Mursu, Sari Voutilainen, Tomi-Pekka Tuomainen
Journal: Circulation (2012)

Background: Fish consumption has been associated with reduced risk of sudden cardiac death. It has been suggested that the long-chain omega-3 fatty acids from fish are responsible for the beneficial effects of fish consumption. The QT interval on the ECG measures the duration of ventricular repolarization, and a long QT interval is one of the major risk factors for sudden cardiac death. Our goal was to study the association between the serum long-chain omega-3 fatty acids eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) and QT interval duration in middle aged men. As fish is also the major source of methylmercury, an environmental contaminant proposed to have adverse cardiovascular effects, we also evaluated the impact of methylmercury exposure on the QT duration. Methods: A total of 1411 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years and free of cardiovascular disease, were included. A standardized resting 12-lead ECG was used for recording. Men with QRS ≥120 ms were excluded. The heart rate-corrected QT interval (QTc) was calculated using the Bazett’s formula. Prolonged QTc was defined as QTc &gt;440 ms. Quartiles of the percentage of EPA, DPA and DHA of all serum fatty acids were used as the exposure. Hair mercury in quartiles was used as a marker for methylmercury exposure. Results: The mean±SD concentrations were 4.70±1.61% for EPA+DPA+DHA, 1.69±0.92% for EPA, 0.55±0.10% for DPA and 2.46±0.74% for DHA, of all serum fatty acids. The mean QTc interval in the quartiles of serum EPA+DPA+DHA was 417, 417, 415 and 414 ms (P for trend 0.02), after adjustment for age, examination year, smoking, alcohol intake, physical activity, body mass index, education, income, diabetes, treated hypertension and arrhythmia medication. Prolonged QTc was found in 169 of the 1411 men (12%). The multivariate-adjusted odds ratio (OR) for prolonged QTc in the quartiles of EPA+DPA+DHA was 1, 0.90, 0.83 and 0.63 [95% confidence interval (CI) 0.39–1.02, P for trend 0.05]. The OR in the highest vs. the lowest quartile was 0.58 (95% CI 0.36–0.93, P for trend 0.03) for EPA, 0.68 (95% CI 0.43–1.09, P for trend 0.06) for DPA and 0.59 (95% CI 0.35–0.98, P for trend 0.04) for DHA. The mean±SD hair mercury concentration was 1.9±2.0 μg/g. Hair mercury was not associated with QTc, unadjusted or adjusted. The multivariate-adjusted OR for prolonged QTc in the quartiles of hair mercury was 1, 0.97, 0.99 and 1.04 (95% CI 0.64–1.69), P for trend 0.80. Conclusions: Increased concentration of long-chain omega-3 fatty acids in serum, a marker of fish or fish oil consumption, appears to protect against prolonged QTc in eastern Finnish middle-aged men. Methylmercury exposure is not associated with QTc in this study population.
Induction of differentiation of human mast cells from bone marrow and peripheral blood mononuclear cells by recombinant human stem cell factor/kit-ligand in long-term culture
Authors: P Valent, E Spanblochl, WR Sperr, C Sillaber, KM Zsebo, H Agis, H Strobl, K Geissler, P Bettelheim, K Lechner
Journal: Blood (1992)
Identifying the ‘Right’ colon lesion
Authors: A D Hopper, P D Mooney, A Blakeborough
Journal: Gut (2016)

A 64-year-old woman presented to the colorectal clinic with 3 months of symptoms of loose stools, flatulence and some weight loss. There was no history of abdominal pain, rectal bleeding or anaemia. A similar episode 5 years earlier resolved spontaneously but was investigated with a colonoscopy at that time and revealed diverticular disease and a 3 mm hyperplastic polyp at the hepatic flexure. To investigate the current symptoms, a repeat colonoscopy was advised but this was initially declined in favour of CT colonography (CTC) to avoid the laxative preparation and pain experienced during the previous examination. The CTC was performed following a day of modified diet and three (30 mL) split doses of Gastrografin without any other laxatives.

The CTC …
Voluntary Sterilization in the Male
Journal: BMJ (1968)

Sterilization of the male for reasons of contraceptive convenience is lawful provided the patients consent is obtained.  The operation of vasectomy is considered the most effective method of contraception currently available to married couples who wish to limit their families.  A simple procedure it should be carried out under general anesthesia in a hospital on a day-stay basis.  The patient will not be sterile for at least 2 months and not until the semen is found to be azoospermic.(Author - modified)
Influence of age on outcome after radical treatment of esophageal cancer with surgery or chemoradiotherapy (dCRT)
Authors: G. Blackshaw, L. Davies, X. Escofet, T. Crosby, A. Roberts, G. Clark, T. Havard, W. Lewis
Journal: Journal of Clinical Oncology (2009)

4569 Background: To compare the outcomes of stage directed surgical therapy and dCRT, related to age, to determine if there is an age threshold or Age x Treatment Interaction, above which the risks of serious treatment related complications outweigh any potential survival benefit. Methods: Prospective study of 504 consecutive patients managed by a single regional upper GI cancer network with curative intent based on CT, EUS and performance status; 270 underwent surgical based therapy [104 neoadjuvant chemotherapy, 49 neoadjuvant chemoradiotherapy, median age 61 (31–79) yr], and 234 dCRT [68 (41–83) yr]. One hundred and forty- one patients (28%) were aged over 70 years, of whom 40 (28%) underwent surgery, and 101 (72%) dCRT. Analysis was based on intention to treat and the primary measure of outcome was survival. Results: Deaths within 30 days of surgery, median and 5 yr survival were 1%, 30 months and 37% in patients &lt;70 years, compared with 8.1%, 20 months and 18% in patients &gt;70 years. Deaths within 30 days of dCRT, median and 5 yr survival were 0%, 21 months and 20% in patients &lt;70 years, compared with 0%, 21 months and 33% in patients &gt;70 years. On multivariable analysis, EUS T stage (HR 1.33, 95% CI 1.021 to 1.747, p=0.035), EUS defined lymph node metastasis count (HR 1.169, 95% CI 1.044 to 1.308, p=0.007), and age (HR 1.556, 95% 1.095 to 2.211, p=0.014) were independently and significantly associated with survival. There was an age related stepwise incremental increase in the ratio of hazard of death following surgery and dCRT, with a hazard cross-over observed at 69 years of age (Age x Treatment Interaction, 95% CI 62 to 86 yr, p=0.047). Conclusions: Age was an important and significant prognostic indicator and the estimated tipping point at which dCRT conveyed better outcomes than surgery was in the region of 70 years. Elderly patients diagnosed with esophageal cancer are arguably better treated with dCRT than multimodal surgical therapy. No significant financial relationships to disclose.
PTU-270 Single centre analysis of the cause of death following colorectal surgery
Authors: C Macrow, A Vallance, D Burke
Journal: Gut (2015)

<h3>Introduction</h3> Publication of performance data for surgeons has recently been introduced in an attempt to improve quality of healthcare. This has included national publication of mortality following colorectal surgery. However, it is unknown what proportion of deaths attributed to a surgeon is a result of the surgical approach, rather than a medical complication. <h3>Method</h3> A single-institution quantitative retrospective audit of all post-operative cases of 30 day mortality following colorectal surgery, between the 18 month period of 1st May 2010 to 31st October 2011 was completed. Eight consultant surgeons contributed to the audit. The colorectal department’s database of mortality cases was reviewed and the notes of all patients retrieved. These were examined and a cause of death, medical or surgical, was identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. <h3>Results</h3> Ninety eight cases of death attributed to the surgical team were reviewed. Of these 42, (43%) did not undergo surgery and 12 notes had insufficient data. Of the 44 patients who had surgery and died, 13 deaths (30%) were classified as surgical, with the rest (70%) being medical. The commonest medical cause being exacerbation of a pre-operative medical condition (48%) e.g. chronic airways disease, followed by myocardial infarction and chest infection With regard to timing of surgery, 10 (56%) of 19 elective deaths were surgical, whereas 22 (83%) of 25 acute deaths were medical. <h3>Conclusion</h3> These data demonstrate that surgical technique is not commonly the cause of death following colorectal surgery. The data suggest that directing the focus of care to improve the patient’s perioperative medical condition, particularly in the acute setting, is likely to improve post-operative outcome. <h3>Disclosure of interest</h3> None Declared.
Peroral cholangioscopy: use of a Roth Net retriever for difficult biliary stones
Authors: Vera Costa Santos, Nuno Nunes, Filipa Ávila, Ana Rego, José Pereira, Nuno Paz, Maria Duarte
Journal: Endoscopy (2016)

Bile duct stones are routinely removed during endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy, using standard balloon or basket extraction techniques. However, in approximately 10 % – 15 % of patients, bile duct stones may be difficult to remove owing to challenging access to the bile duct, large bile duct stones (> 15 mm in diameter), intrahepatic stones, or impacted stones in the bile duct [1] [2] [3]. In such cases, an alternative procedure to ensure biliary drainage may be warranted.
High-Flow Nasal Oxygen or Noninvasive Ventilation for Postextubation Hypoxemia
Authors: Giulia Spoletini, Erik Garpestad, Nicholas S. Hill
Journal: JAMA (2016)

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Demonstration of Temporal Heterogeneity Identified By Genome Sequencing and the Potential Effect on Treatment Decisions for Advanced Cancer Patients
Authors: J. Laskin, R. Moore, Y. Shen, H. Lim, K.A. Gelmon, D. Renouf, S. Yip, D. Huntsman, T. Ng, A. Mungall, A. Fok, C. Ho, S. Chia, S. Leelakumari, K. Kasaian, P. Eirew, Y. Ma, S. Aparicio, S. Jones, M. Marra
Journal: Annals of Oncology (2014)
RTOG 9704 a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. gemcitabine (G) for resected pancreatic adenocarcinoma
Authors: W. F. Regine, K. W. Winter, R. Abrams, H. Safran, J. P. Hoffman, A. Konski, A. B. Benson, J. S. MacDonald, C. G. Willett, T. A. Rich
Journal: Journal of Clinical Oncology (2006)

4007 Background: RTOG 9704 was designed to determine if the addition of G to postoperative adjuvant 5-FU CRT improved survival for patients(pts) with resected pancreatic adenocarcinoma. Methods: In this Intergroup trial involving RTOG, ECOG and SWOG, pts post gross total resection of pancreatic adenocarcinoma (path stage T1 - 4, N0 - 1, M0) were randomized to receive pre and post CRT 5-FU vs pre and post CRT G. 5-FU = continuous (CI) at 250 mg/m 2 /day. G = 1000 mg/m 2 IV weekly. Both were given over 3 weeks pre and 12 weeks post - CRT. CRT = 50.4 Gy 1.8 Gy/fx/day with CI 5-FU, 250 mg/m 2 /day during RT for all pts. Pts were stratified by nodal status (uninvolved vs involved), primary tumor diameter ( &lt; 3 cm vs ≥ 3 cm) and surgical margins (negative vs positive vs unknown). Survival was the primary endpoint with an original targeted accrual of 330 pts. Rapid enrollment allowed study amendment for increased targeted accrual to add survival among pts with lesions of the pancreatic head as a primary, prospective endpoint. Results: From 7/98 - 7/02, 538 pts were entered; 442 were eligible and analyzable. Major reasons for patient ineligibility were serum not sent for CA-19–9 analysis (n=22) and treatment starting &gt; 8 weeks post surgery (n=19). Treatment arms were well balanced except for T-stage (T3/4 &gt; for G, p=0.013). Pts with pancreatic head tumors(n=380) experienced significantly improved survival, with median and 3-year survival of 18.8 months and 31% respectively for the G arm vs. 16.7 months and 21% for the 5-FU arm (p=0.047; HR=0.79, CI=0.63–0.99). When analysis was inclusive of pts with body/tail tumors(n=442) no significant difference in survival was found (p=0.20). No significant difference in non-hematologic grade ≥ 3 toxicity was seen. The grade 4 hematologic toxicity rate was 14% in the G arm and 2% in the 5-FU arm (p&lt;0.0001) without difference in febrile neutropenia/infection. The ability to complete chemotherapy (86%, 5-FU vs. 90%, G) and RT (85%, 5-FU vs. 88%, G) as per study was similar. Conclusions: The addition of G to postoperative adjuvant 5-FU CRT significantly improves survival in pts with pancreatic head adenocarcinoma. No significant financial relationships to disclose.
Short Androgen Suppression and Radiation Dose Escalation for Intermediate- and High-Risk Localized Prostate Cancer: Results of EORTC Trial 22991
Authors: Michel Bolla, Philippe Maingon, Christian Carrie, Salvador Villa, Petros Kitsios, Philip M.P. Poortmans, Santhanam Sundar, Elzbieta M. van der Steen-Banasik, John Armstrong, Jean-François Bosset, Fernanda G. Herrera, Bradley Pieters, Annerie Slot, Amit Bahl, Rahamim Ben-Yosef, Dirk Boehmer, Christopher Scrase, Laurette Renard, Emad Shash, Corneel Coens, Alphonsus C.M. van den Bergh, Laurence Collette
Journal: Journal of Clinical Oncology (2016)

Up to 30% of patients who undergo radiation for intermediate- or high-risk localized prostate cancer relapse biochemically within 5 years. We assessed if biochemical disease-free survival (DFS) is improved by adding 6 months of androgen suppression (AS; two injections of every-3-months depot of luteinizing hormone-releasing hormone agonist) to primary radiotherapy (RT) for intermediate- or high-risk localized prostate cancer.A total of 819 patients staged: (1) cT1b-c, with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≥ 7, or (2) cT2a (International Union Against Cancer TNM 1997), with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread, with PSA ≤ 50 ng/mL, were centrally randomized 1:1 to either RT or RT plus AS started on day 1 of RT. Centers opted for one dose (70, 74, or 78 Gy). Biochemical DFS, the primary end point, was defined from entry until PSA relapse (Phoenix criteria) and clinical relapse by imaging or death of any cause. The trial had 80% power to detect hazard ratio (HR), 0.714 by intent-to-treat analysis stratified by dose of RT at the two-sided α = 5%.The median patient age was 70 years. Among patients, 74.8% were intermediate risk and 24.8% were high risk. In the RT arm, 407 of 409 patients received RT; in the RT plus AS arm, 403 patients received RT plus AS and three patients received RT only. At 7.2 years median follow-up, RT plus AS significantly improved biochemical DFS (HR, 0.52; 95% CI, 0.41 to 0.66; P < .001, with 319 events), as well as clinical progression-free survival (205 events, HR, 0.63; 95% CI, 0.48 to 0.84; P = .001). In exploratory analysis, no statistically significant interaction between treatment effect and dose of RT could be evidenced (heterogeneity P = .79 and P = .66, for biochemical DFS and progression-free survival, respectively). Overall survival data are not mature yet.Six months of concomitant and adjuvant AS improves biochemical and clinical DFS of intermediate- and high-risk cT1b-c to cT2a (with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread) prostatic carcinoma, treated by radiation.
A new randomized phase II design for testing investigational drugs in hepatocellular carcinoma (HCC)
Authors: B. C. Zee, T. S. Mok, W. Yeo, A. T. C. Chan, P. J. Johnson
Journal: Journal of Clinical Oncology (2004)

4205 Background: Phase II clinical trials aim to assess anti-tumor activity of investigational therapies in order to detect promising agents for future phase III trials. A review of previous phase II studies on single agent doxorubincin (Dox) for HCC shows that response rates (RR) vary widely from 0% to 44%. A randomized phase II design is preferred but the decision theoretical approach by Simon picking the winner may not be appropriate in this circumstance. We proposed a new randomized phase II design using control as an adjustment for the efficacy of study treatment. Method: A hypothesis similar to a single-arm phase II design will be stated, e.g. H0: p = p0 vs H1: p = p1. Patients (pts) randomized to control arm will receive standard treatment. The RR of the control arm (p0) with s0 responders from n0 pts will be used in a conditional model to adjust for the RR in the study arm (p1). The probability of the study arm with s1 responders from n1 pts given the null hypothesis, i.e. P(s1| n1, p0) has binomial distribution and the RR follows a dirichlet distribution h(p0|n0, s0). We determined the rejection regions (r) so that P(s1>r|n1, n0, s0) < 0.05. Results: Based on a randomized study comparing Dox versus combination chemotherapy (PIAF) for inoperable HCC, a RR of about 10% was found in the Dox arm where previous phase II study showed a RR of 26%. With 30 pts in each arm assuming a null hypothesis of p*=0.1 and a 5% type I error, the number of responders required to declare the study treatment effective is shown in the following table. The estimate RR for the study treatment is p=(p1-p0)+p*, a 95% confidence interval can be obtained in the analysis. Conclusion: The new randomized phase II design provides a platform by which effective investigational agents for HCC can be detected without being camouflaged by the patient selection problem. Simulation on the properties of the design will be presented. No significant financial relationships to disclose.