tbuckley/cabot-search huggingface dataset:
Evaluation of Routine HIV Opt-Out Screening and Continuum of Care Services Following Entry into Eight Prison Reception Centers — California, 2012
Authors: Kimberley D. Lucas, Valorie Eckert, Czarina N. Behrends, Charlotte Wheeler, Robin J. MacGowan, Janet C. Mohle-Boetani
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

Early diagnosis of human immunodeficiency virus (HIV) infection and initiation of antiretroviral treatment (ART) improves health outcomes and prevents HIV transmission. Before 2010, HIV testing was available to inmates in the California state prison system upon request. In 2010, the California Correctional Health Care Services (CCHCS) integrated HIV opt-out screening into the health assessment for inmates entering California state prisons. Under this system, a medical care provider informs the inmate that an HIV test is routinely done, along with screening for sexually transmitted, communicable, and vaccine-preventable diseases, unless the inmate specifically declines the test. During 2012-2013, CCHCS, the California Department of Public Health, and CDC evaluated HIV screening, rates of new diagnoses, linkage to and retention in care, ART response, and post-release linkage to care among California prison inmates. All prison inmates are processed through one of eight specialized reception center facilities, where they undergo a comprehensive evaluation of their medical needs, mental health, and custody requirements for placement in one of 35 state prisons. Among 17,436 inmates who entered a reception center during April-September 2012, 77% were screened for HIV infection; 135 (1%) tested positive, including 10 (0.1%) with newly diagnosed infections. Among the 135 HIV-positive patient-inmates, 134 (99%) were linked to care within 90 days of diagnosis, including 122 (91%) who initiated ART. Among 83 who initiated ART and remained incarcerated through July 2013, 81 (98%) continued ART; 71 (88%) achieved viral suppression (<200 HIV RNA copies/mL). Thirty-nine patient-inmates were released on ART; 12 of 14 who were linked to care within 30 days of release were virally suppressed at that time. Only one of nine persons with a viral load test conducted between 91 days and 1 year post-release had viral suppression. Although high rates of viral suppression were achieved in prison, continuity of care in the community remains a challenge. An infrastructure for post-release linkage to care is needed to help ensure sustained HIV disease control.
Intensive chemotherapy with autologous bone marrow transplantation in patients with locally advanced breast cancer: 12-years follow-u
Authors: A. Reyners, H. Hollema, N. Mulder
Journal: Journal of Clinical Oncology (2004)

700 Background: Patients with locally advanced breast cancer, i.e. 5 or more positive axillary lymph nodes, have a poor prognosis. The aim of this study was to investigate whether intensive chemotherapy with autologous bone marrow transplantation can improve the disease free survival. Methods: Induction chemotherapy consisted of methotrexate (1.5 g/m2, day 1), 5-fluorouracil (1.5 g/m2, day 1), doxorubicin (50 mg/m2, day 14), vincristine (1 mg/m2, day 14) and prednisone (40 mg/m2, day 2–14). Six courses were repeated every 4 weeks. As high dose chemotherapy, 8 patients received cyclophosphamide (7 g/m2) and etoposide (1.5 g/m2), 28 patients mitoxantrone (50 mg/m2) and thiopeta (800 mg/m2). Bone marrow reinfusion took place on day 7. Thereafter, patients got locoregional radiotherapy and tamoxifen 40 mg daily during 2 years. Results: Between May 1987 and March 1993 36 patients, with a median age of 42 years (range 28–53) were treated. The median number of involved lymph nodes was 9. One patient died during the ablative chemotherapy (mitoxantrone / thiopeta regimen) as a result of an acute respiratory distress syndrome and 1 patient died of cardiac failure 3 months after high dose therapy. Another patient died after 56 months due to a cerebrovascular accident, which was related to cardiac failure. At a median follow-up of 148 months the disease free survival is 47% and the overall survival 56%. Of the 25 patients with < 10 involved lymph nodes 10 patients died, whereas 6 of the 11 patients with > 10 positive lymph nodes died. HER2/neu was determined by ISH in 21 patients. Two of the 7 patients who tested HER2/neu positive have recurrent disease, which is comparable to patients who tested HER2/neu negative (5/14). Of the 20 patients who are alive, 1 patients is currently treated for metastatic breast cancer, 1 patient has had a second primary contralaterally and 1 patient is treated for cardiac failure. Conclusions: Long-term follow-up confirms that high dose chemotherapy might be of value in a selected patient category. No significant financial relationships to disclose.
Abstract MP020: Long-term, Visit-to-visit Blood Pressure Variability and the Risk of Total Mortality, MI, and Stroke in the Cardiovascular Health Study
Authors: Astrid Suchy-Dicey, Erin Wallace, Mitchell Elkind, Maria Aguilar, Rebecca Gottesman, Arend Voorman, Kenneth Rice, Richard Kronmal, W.T. Longstreth, Bruce Psaty
Journal: Circulation (2012)

Introduction: Recent reports have linked visit-to-visit blood pressure (BP) variability to risk of mortality and stroke, independent of the effect of mean BP level. We sought to confirm these findings in the Cardiovascular Health Study (CHS), a cohort study of cardiovascular risk factors. Hypothesis: Variability in visit-to-visit SBP, defined as intraindividual SBP SD, is directly associated with risk of mortality, myocardial infarction (MI), and stroke, independent of intraindividual SBP mean and trend over time. Methods: Participants from CHS were eligible if they attended their first five annual clinic visits and did not have stroke, MI, or death by the 5th visit (N=3513). Follow-up started at the 5th visit and extended through June 2008. Analyses were further restricted to subjects who used no antihypertensive medications during the entire 5-year baseline period (non-users, n=1570) and subjects who used the same antihypertensive regimen during that time (users, n=978). Intraindividual SBP variables were defined using each subject’s 5-visit BPs. Cox proportional hazards models estimated adjusted hazard ratios (HR) per standard deviation (SD) increase in intraindividual SD (iSD) SBP or intraindividual mean (iMean) SBP. Results were stratified on medication use or non-use. Results: Participants’ mean age was 71 years, 42% were men, and 95% were white. Mean(SD) of iSD SBP was 9.8(4.6) mmHg for anti-hypertensive medications non-users and 12.0(6.0) mmHg for users. iMean SBP was significantly associated with all 3 outcomes among non-users and with stroke among users (table). iSD SBP was significantly associated with mortality in all participants and with MI among non-users; associations for stroke were not significant. Conclusion: Long-term visit-to-visit SBP variability may be an important determinant of MI and mortality risk in the elderly. Results for stroke are not consistent with other, previous reports. More research is needed to determine the clinical implications.
Phase II intermittent (or stop and go) l-OHP administration of first-line bevacizumab (BV) plus mFOLFOX6 or CapeOX therapies in Japanese patients with mCRC: The interim report of T-CORE0901.
Authors: Makio Gamoh, Shunsuke Kato, Tomohito Niitani, Yasuko Murakawa, Masato Sakayori, Hideki Isobe, Hideki Shimodaira, Shoko Akiyama, Kozue Yoshida, Takashi Yoshioka, Chikashi Ishioka
Journal: Journal of Clinical Oncology (2012)

664 Background: Cumulative sensory neurotoxicity of l-OHP used in standard 1 st -line FOLFOX / CapeOX +/− BV therapies in mCRC results in impairment of patient's quality of life (QoL) and discontinuation of the treatment. CONcePT trial revealed that intermittent l-OHP use in BV plus FOLFOX7 is safe, keeping efficacy comparing with BV plus FOLFOX7 in which l-OHP is administered until time to treatment failure. But it is unknown that intermittent l-OHP administration is also safe and effective in Japanese pts with mCRC Methods: This trial aims to enroll 65 of Japanese pts with mCRC. Either BV+FOLFOX or BV+CapeOX is selected by decision of physician in charge. In BV+FOLFOX arm, pts receive 6 cycles of BV plus mFOLFOX6 (5 mg/kg of BV, 85 mg/m 2 of l-OHP, 200 mg/m2 of I-LV, 400 mg/m 2 of 5-FU by rapid IV infusion on day1, and 2,400 mg/m 2 of 5-FU 46 hr by continuous IV infusion as a 2 weeks course) and 6 cycles of BV plus sLV5FU2. In BV+CapeOX arm, pts recieve 4 cycles of BV plus CapeOX (7.5 mg/kg of BV, 120 mg/m 2 of l-OHP and capecitabine 1,000mg/m2 twice daily, day1 to 14 as a 3weeks course) and 4 cycles of BV+capecitabine. The primary endpoint is progression free survival (PFS) and secondary endpoints are tumor response (RR), overall survival (OS), time to treatment failure (TTF) and frequency of neurotoxicity. Results: According the protocol, interim analysis about efficacy and safety was performed at the time the 13th pts was received the treatment for 7 months. Median progression free survival is 290+ days (95% CI 119 - 558 days) and PFS of 9 cases were more than 7 months, which is threshold value. No serious adverse effects were observed in 13 cases. The efficacy and safety evaluation committee recommended continuing the study and the current accrual is 47 cases. Conclusions: This is the interim report of T-CORE0901 trial and the study remains open to accrual with projected enrollment completion in 2012.
The association between obesity and incidence of total and fatal renal cell carcinoma in two prospective cohorts.
Authors: Kathryn M Wilson, Jed-Sian Cheng, Alejandro Sanchez, Rebecca Graff, Dayron Rodriguez, Adam S. Feldman, Glenn Barrisford, Seth Bechis, Michael Blute, Meir J. Stampfer, Steven L. Chang, Edward L. Giovannucci, Laurence K. Albiges, Toni K. Choueiri, Eunyoung Cho, Mark A Preston
Journal: Journal of Clinical Oncology (2015)

414 Background: Recent studies suggest an “obesity paradox” in renal cell carcinoma (RCC), in which obese people are more likely to be diagnosed with RCC, but are less likely to die of the disease. We studied the association of body mass index (BMI) with risk of both total and fatal RCC in two large prospective cohorts. Methods: The Nurses’ Health Study (NHS) consists of 117,097 women followed since 1976, and the Health Professionals Follow-up Study (HPFS) consists of 48,268 men followed since 1986. Height and weight were reported at baseline and updated biennially through 2008, with disease follow-up through 2010. We used multivariable Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of both total and fatal pathology-confirmed RCC by BMI immediately prior to diagnosis. Models were adjusted for diabetes, hypertension, smoking, alcohol intake, NSAID use, physical activity, and parity in women. Results: We confirmed 349 cases of RCC, including 103 fatal cases, in NHS, and 226 cases in HPFS, with 46 fatal cases. Compared to women with normal BMI (18.5-24.9 kg/m 2 ) immediately prior to diagnosis, obese women (BMI≥30) had an increased risk of RCC (HR 1.38, 95% CI: 1.03-1.84, p-trend=0.004), adjusting for possible confounders. The HR for fatal RCC was similar but not statistically significant (HR 1.35, 95% CI: 0.79-2.29, p-trend=0.22). Obese men had a non-significantly increased risk of RCC (HR 1.45, 95% CI: 0.96-2.21, p-trend=0.05), with a significantly increased risk of fatal RCC (HR 2.56, 95% CI: 1.11-5.90, p-trend=0.13). Among women, the associations with baseline BMI (1976) were somewhat stronger (HR 1.88, 95% CI: 1.36-2.61, p-trend&lt;0.0001 for total; HR 1.98, 95% CI: 1.07-3.66, p-trend=0.002 for fatal). For men the association with baseline BMI (1986) was weaker for fatal RCC (HR 1.34, 95% CI: 0.50-3.58, p-trend=0.27). Conclusions: Our results support that obesity is a risk factor for RCC incidence and also suggest that it is adversely associated with fatal RCC. These results are stronger for women than for men, though this may be due to the lower number of cases among men.
Ketoanalogue-Supplemented Vegetarian Very Low–Protein Diet and CKD Progression
Authors: Liliana Garneata, Alexandra Stancu, Diana Dragomir, Gabriel Stefan, Gabriel Mircescu
Journal: Journal of the American Society of Nephrology (2016)

Dietary protein restriction may improve determinants of CKD progression. However, the extent of improvement and effect of ketoanalogue supplementation are unclear. We conducted a prospective, randomized, controlled trial of safety and efficacy of ketoanalogue-supplemented vegetarian very low-protein diet (KD) compared with conventional low-protein diet (LPD). Primary end point was RRT initiation or >50% reduction in initial eGFR. Nondiabetic adults with stable eGFR<30 ml/min per 1.73 m(2), proteinuria <1 g/g urinary creatinine, good nutritional status, and good diet compliance entered a run-in phase on LPD. After 3 months, compliant patients were randomized to KD (0.3 g/kg vegetable proteins and 1 cps/5 kg ketoanalogues per day) or continue LPD (0.6 g/kg per day) for 15 months. Only 14% of screened patients patients were randomized, with no differences between groups. Adjusted numbers needed to treat (NNTs; 95% confidence interval) to avoid composite primary end point in intention to treat and per-protocol analyses in one patient were 4.4 (4.2 to 5.1) and 4.0 (3.9 to 4.4), respectively, for patients with eGFR<30 ml/min per 1.73 m(2) Adjusted NNT (95% confidence interval) to avoid dialysis was 22.4 (21.5 to 25.1) for patients with eGFR<30 ml/min per 1.73 m(2) but decreased to 2.7 (2.6 to 3.1) for patients with eGFR<20 ml/min per 1.73 m(2) in intention to treat analysis. Correction of metabolic abnormalities occurred only with KD. Compliance to diet was good, with no changes in nutritional parameters and no adverse reactions. Thus, this KD seems nutritionally safe and could defer dialysis initiation in some patients with CKD.
Autologous stem cell transplantation (ASCT) in AL amyloidosis: Feasibility outside national amyloidosis referral centers and proposal for simpler pre-transplant staging
Authors: N. Jain, M. Pasquini, M. Paul, P. Hari
Journal: Journal of Clinical Oncology (2006)

17545 Background: Single center data from national amyloidosis referral centers suggest that high dose melphalan based ASCT is an effective upfront treatment strategy for AL amyloidosis. Absence of published randomized control trials, referral bias and center experience make generalizability of this data difficult since data from outside of major referrals centers is limited. Pre-transplant staging is complicated by the profusion of articles describing various adverse risk factors. Methods: Retrospective review of bone marrow transplant database at our institution was conducted. All patients with AL amyloidosis who underwent ASCT were included in the study. We stratified patients based on International Staging System (ISS) for multiple myeloma. Organ and hematological response were assessed using 2005 consensus guidelines. Results: 13 patients (6 males) underwent ASCT for AL amyloidosis with risk adapted high dose melphalan dosing (melphalan mg/m 2 100 (n = 1), 150 (n = 8) and 200 (n = 4)). Median age of the patient population was 53 years (range 31–75 years). Organ involvement was as follows - single organ = 6, 2 organs = 4 and 3 organs = 3. 4 patients had cardiac amyloidosis. 100 day transplant related mortality (TRM) was 15.3%. Overall survival was 84 % (95 % CI 51–96%) @ 1 yr and 75% (95% CI 38–91%) @ 2 yrs. Median follow up was 18 months. No deaths were observed &gt;17 months post-transplant. 45 % patients had organ response. Complete hematological response was observed in 45 % patients. Mean duration of peri-transplant hospital stay for ISS stage I, II and III were 20.5 days (n = 2), 23.3 days (n = 9) and 29 days (n = 1) respectively. Number of deaths observed in ISS stage I, II and III were 0 (0/2), 2 (2/9) and 1 (1/1) respectively. Conclusions: Autologous stem cell transplant (ASCT) for AL amyloidosis is a feasible, effective and safe procedure outside of major national referral centers. Pretransplant stratification of amyloidosis patients using ISS for multiple myeloma indicated a trend towards longer peri-transplant hospital stay and mortality with increasing ISS stage. This hypothesis needs to be tested in larger studies. No significant financial relationships to disclose.
Committee is out of touch with needs of profession
Authors: P D Thomas
Journal: BMJ (1996)

Training for overseas doctors may not be appropriate EDITOR,-James Owen Drife highlights the inappropriateness of much medical work that takes place in the developing world.'Regrettably, Britain contributes much to this.Many of the doctors who attended the congress in India about which Drife writes will have received much of their medical training in Britain.How helpful was this training in addressing the real health needs (obstetric and others) in these doctors' own country?The curricula vitae of overseas doctors applying for positions in Britain often mention the doctors' desire for "subspecialty training."The attendance at the seminar on in vitro fertilisation in India reflects this attitude.As long as we continue to train overseas doctors in Britain as if they were returning to situations similar to those in western Europe and as long as the royal colleges seem to pursue the same agenda, Drife's experiences will continue.
Neutrophil Related Data Obtained From Newly Developed Automatic Hematology Analyzer Sysmex XN-2000 Can Provide Useful Informations For The Discrimination Of Sepsis Patients
Authors: Sang Hyuk Park, Chan-Jeoung Park, Bo-Ra Lee, Ki-Sun Nam, Mi-Jeong Kim, Min-Young Han, Young Jin Kim, Young-Uk Cho, Seongsoo Jang, Hyun-Sook Chi
Journal: Blood (2013)
Pharmacogenomic analysis for individual response to CPT-11 in colorectal cancer: Prediction formula of tumor response using novel marker genes and genotypes associated with the toxicity
Authors: H. Narahara, N. Sugimoto, N. Tomita, K. Murata, M. Fukunaga, M. Ohue, T. Sakaeda, H. Ishida, K. Tanimoto, M. Nishiyama
Journal: Journal of Clinical Oncology (2006)

2060 Background: Despite recent encouraging data, the clinical efficacy and toxicity of CPT-11 in most colorectal cancer patients remain unpredictable. We conducted this prospective study to develop a prediction formula of efficacy using expression data of genes newly identified in vitro and to evaluate the clinical significance of several genetic polymorphisms known as potent predictors of toxicity. Methods: CPT-11 was intravenously administered on Days 1, 8, and 15, every 4 weeks in chemo-naive patients with stage IV colorectal cancer after palliative operation. Tumor samples were collected at surgery and PK analysis was done on day 1 of cycle 1. Tumor response and toxicity were evaluated by RECIST and CTCAE, respectively. Results: Forty seven pts were enrolled. All pts were assessed for tumor response, toxicity, gene expression, genotype, and PK. Partial response was obtained in 11 cases, and common grade 3/4 toxicities were neutropenia (15%), leucopenia (5%), and diarrhea (4%). Despite no correlation of UGT1A1*28 (hetero=5, homo=1) alone with the toxicities, there were associations between UGT1A1*28 or *7 (hetero=1) with UGT1A1 -64G&gt;C (hetero=3) and G3/4 leucopenia (p=0.036). UGT1A1 1091C&gt;T (hetero=3) was found to be associated with leucopenia (p=0.0009), neutropenia (p=0.012), and diarrhea (p=0.036). UGT1A1 1091C&gt;T, ABCC2 -24C&gt;T and 3972C&gt;T were correlated with SN-38 AUC. We identified 7 novel potent marker genes including AMD1, CTSC, and EIF1AX for CPT-11 efficacy in vitro, through 2 different microarray analyses and subsequent real-time RT-PCR. We then successfully developed the best linear model, which converted the quantified expression data into objective tumor response, using 18 data sets of gene expression and clinical response. Utility-confirmation analyses using other clinical samples appeared to show that the formula could accurately predict tumor response (r=0.712, p=0.042). Conclusions: Polygenetic strategies using several known polymorphisms for toxicity and a prediction formula using 7 novel genes for efficacy would be of predictive value for individual response to CPT-11. No significant financial relationships to disclose.
High dose intra-arterial cisplatin with concomitant accelerated radiotherapy for patients with T4 and selected T3, N0–3, M0 head and neck cancer
Authors: R. L. Foote, J. L. Kasperbauer, S. H. Okuno, D. A. Nichols, P. D. Brown, Y. I. Garces, D. J. Sargent, S. E. Strome
Journal: Journal of Clinical Oncology (2004)

5528 Background: This phase I trial was developed to assess the feasibility of combining high dose intra-arterial cisplatin with concurrent accelerated concomitant boost radiotherapy for patients with previously untreated T4 and select T3,N0–3,M0 squamous cell carcinoma of the upper aerodigestive tract. Methods: Between July 1999 and February 2002, 19 patients were treated with 3 or 4 weekly cycles of intra-arterial cisplatin (150 mg/m2) with concurrent accelerated concomitant boost radiotherapy (72 Gy in 42 fractions over 6 weeks). Results: Two patient deaths occurred within the first 15 patients enrolled (at 27 Gy and 39 Gy). Both patients presented with febrile neutropenia. Both died of complications related to infection. The number of cycles of intra-arterial cisplatin was reduced and an additional 4 patients were treated. The fourth patient treated on the modified protocol developed febrile neutropenia, sepsis, and a thromboemobolic event which resulted in lower extremity amputations. The maximum acute toxicity experienced was grade 2 in 6 patients, grade 3 in 5 patients, grade 4 in 6 patients, and grade 5 in 2 patients. With a median follow-up period of 34.7 months (range 19.9 to 48.0 months), the overall survival at two years is 78.6% (95% CI 62.0%–99.6%). At two years 70.6% of the patients are free from progression (95% CI 51.9% to 95.9%). Conclusion: Despite the encouraging survival and tumor control rates, results of this study suggest that concurrent intra-arterial cisplatin at 150 mg/m2 with accelerated concomitant boost radiotherapy is not feasible due to excessive acute toxicity. No significant financial relationships to disclose.
Long-Acting C-Peptide and Neuropathy in Type 1 Diabetes: A 12-Month Clinical Trial
Authors: John Wahren, Howard Foyt, Mark Daniels, Joseph C. Arezzo
Journal: Diabetes Care (2016)

OBJECTIVE Lack of C-peptide in type 1 diabetes may be an important contributing factor in the development of microvascular complications. Replacement of native C-peptide has been shown to exert a beneficial influence on peripheral nerve function in type 1 diabetes. The aim of this study was to evaluate the efficacy and safety of a long-acting C-peptide in subjects with type 1 diabetes and mild to moderate peripheral neuropathy. RESEARCH DESIGN AND METHODS A total of 250 patients with type 1 diabetes and peripheral neuropathy received long-acting (pegylated) C-peptide in weekly dosages of 0.8 mg (n = 71) or 2.4 mg (n = 73) or placebo (n = 106) for 52 weeks. Bilateral sural nerve conduction velocity (SNCV) and vibration perception threshold (VPT) on the great toe were measured on two occasions at baseline, at 26 weeks, and at 52 weeks. The modified Toronto Clinical Neuropathy Score (mTCNS) was used to grade the peripheral neuropathy. RESULTS Plasma C-peptide rose during the study to 1.8–2.2 nmol/L (low dose) and to 5.6–6.8 nmol/L (high dose). After 52 weeks, SNCV had increased by 1.0 ± 0.24 m/s (P &amp;lt; 0.001 within group) in patients receiving C-peptide (combined groups), but the corresponding value for the placebo group was 1.2 ± 0.29 m/s. Compared with basal, VPT had improved by 25% after 52 weeks of C-peptide therapy (Δ for combined C-peptide groups: −4.5 ± 1.0 μm, placebo group: −0.1 ± 0.9 μm; P &amp;lt; 0.001). mTCNS was unchanged during the study. CONCLUSIONS Once-weekly subcutaneous administration of long-acting C-peptide for 52 weeks did not improve SNCV, other electrophysiological variables, or mTCNS but resulted in marked improvement of VPT compared with placebo.