tbuckley/cabot-search huggingface dataset:
Abstract 19375: Does Pulmonary Vascular Remodeling Reverse after Restrictive Mitral Annuloplasty in Patients with End-Stage Heart Failure?
Authors: Satoshi Kainuma, Kazuhiro Taniguchi, Koichi Toda, Toshihiro Funatsu, Shigeru Miyagawa, Haruhiko Kondoh, Takashi Daimon, Takafumi Masai, Takayoshi Ueno, Toru Kuratani, Yoshiki Sawa
Journal: Circulation (2012)

Background. Prognostic importance of pulmonary hypertension (PH) in patients with heart failure is well known, but its reversibility after restrictive mitral annuloplasty (RMA) is less well established. We assessed the potential reversibility of pulmonary vascular remodeling in relation to plasma B-type natriuretic peptide (BNP), a biomarker of left ventricular (LV) filling pressure and diastolic dysfunction, over time after RMA. Methods. We studied 98 patients with moderate to severe PH [systolic pulmonary artery pressure (SPAP) &gt;40 mmHg] who underwent RMA for ischemic cardiomyopathy (ejection fraction &lt;40%) and functional mitral regurgitation, and were followed up at least 12 months (mean, 49±26 months). Cardiac catheterization (baseline, 1month) and serial assessments of Doppler-derived SPAP (d-SPAP) and LV end-systolic dimension (ESD), with blood samples for plasma BNP measurement were performed. Results. At 1 month after RMA, pulmonary capillary wedge pressure (PCWP) and SPAP decreased from 22±7 to 16±6 mmHg and from 50±13 to 40±11 mmHg (p&lt;0.0001 for both), respectively, while transpulmonary gradient (mean PAP minus PCWP) did not change (11±4 mmHg, p=0.56). Cardiac index increased from 2.5±0.6 to 2.7±0.6 l/min/m2 (p= 0.03), and pulmonary vascular resistance changed from 231±100 to 206±73 dynes sec cm-5 (p=0.03), suggesting partial reversibility of pulmonary vascular remodeling. Serial echocardiography showed that s d-SPAP changed from 55±14 at baseline to 37±11 at 1 month, to 40±14 at 1 year, and to 45±19 mmHg at 2 year (p&lt;0.0001). LVESD decreased from 56±8 to 49±9, 48±10, and 48±10 mm, respectively (p&lt;0.0001). Plasma BNP decreased from 741±372 to 283±234, 223±199, and 237±208 pg/ml, respectively (p&lt;0.0001). The percent change from baseline to 1 month and 1 year in BNP were significantly associated with corresponding changes in the d-SPAP (r=0.314, p=0.009 and r=0.391, p=0.006, respectively). Conclusion. Following RMA, PA pressures commonly and significantly decreased, with a modest reverse pulmonary vascular remodeling in most patients after 2 years follow-up. Progression of pulmonary vascular abnormality may be a potential therapeutic target to reduce the prevalence of subsequent right ventricular dysfunction after RMA.
Contemporary Multidisciplinary Care—Who Is the Captain of the Ship, and Does It Matter?
Authors: Michael Nurok, Nicholas Sadovnikoff, Bruce Gewertz
Journal: JAMA Surgery (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Can adding contrast-enhanced digital mammography (CEDM) as an adjunct to diagnostic mammography/US help decrease biopsy rates in women with suspicious (BIRADS 4) breast lesions?
Authors: Bhavika K Patel, Marina Giurescu, Sarah Eversman, Eversman William, Heidi Kosiorek, Pizzitola Victor, Roxanne Lorans, Barbara A. Pockaj
Journal: Journal of Clinical Oncology (2015)

6 Background: Traditional screening mammography (MG) enables early detection of breast cancer and therefore results in decreased mortality. Mammography, however, is an imperfect tool and limited by an overall sensitivity of 75-85%. Specificity is limited as well resulting in many false-positive examinations and unnecessary follow-up examinations. The recent development of contrast-enhanced digital mammography (CEDM) has made the usage of IV contrast enhancement with mammography a possibility. CEDM is an angiographic technique that uses digital subtraction, which removes the normal mammary gland on images in order to detect breast tumors and visualize their vascularity. The literature is promising with regard to CEDM as studies have found that CEDM achieves increased sensitivity without reductions in specificity in comparison to MG, US and/or MRI. Methods: In this multi-reader study we compared the diagnostic accuracy of CEDM as an adjunct to MG/US in patients with suspicious findings (BI-RADS 4). The study population included 31 patients who were imaged with CEDM prior to their scheduled US or stereotactic-guided biopsy. We compared the relative performance of MG/US alone versus MG/US/CEDM in determining the probability of malignancy. Histology served as the gold standard. Results: See table below. Conclusions: The addition of CEDM to the workup of suspected lesions on MG and/or US preliminarily decreases the number of false-positive MG thereby with potential to reduce cost and unnecessary patient harm. [Table: see text]
Abstract 17864: Unusual Manifestation of Eosinophilic Granulomatosis with Polyangitis: Diffuse Intracardiac Thrombi Mimicking Hypereosinophilic Syndrome and Antineutorophil Cytoplasmic Antibody-negative Angionecrotic Glomerulonephritis
Authors: Yuichi Saito, Sho Okada, Koya Ozawa, Hiroyuki Takaoka, Nobusada Funabashi, Yoshio Kobayashi
Journal: Circulation (2014)

Eosinophilic Granulomatosis with Polyangitis (EGPA), formerly known as Churg-Strauss syndrome, is a systemic small vessel vasculitis with eosinophilia. Cardiac involvement is especially important as it accounts for about half of the mortality and thus requires additive treatment. But its distinction from other cardiac conditions is often difficult. Positive antineutrophil cytoplasmic antibody (ANCA) test helps identify EGPA, and is most often associated with renal involvement.  Here we experienced a patient with ANCA-negative EGPA who showed diffuse intracardiac thrombi mimicking Hypereosinophilic syndrome (HES) and angionecrotic glomerulonephritis.  A 59-year-old housewife with a history of asthma was admitted due to persistent fever. Laboratory test revealed eosinophilia (3.6х109/L), elevation of NT-pro-BNP (8750 pg/mL) and troponin I (1.88 ng/mL). ANCA was negative. The patient also had overt proteinuria and hematuria. Echocardiography and Cardiac Magnetic Resonance imaging (CMR) each showed abnormal structures suggestive of thrombi along the left ventricle walls, which closely resembled cardiac manifestation of HES. On CMR, left ventricular endocardium was enhanced by T2 weighted and late gadolinium enhanced imaging. Coronary angiography was almost normal, and no etiology that can induce eosinophilia nor other organ involvement consistent with EGPA was found. Pathological examination of the kidney, on the other hand, demonstrated angionecrosis and crescent formation of the glomerulus. There were also eosinophil invasion at the sub-capsule area of the kidney. These findings finally led to the diagnosis of EGPA. Immunosuppressive agent was added to the patient besides corticosteroids.  EGPA can show diffuse intracardiac thrombi mimicking HES, and ANCA-negative EGPA can show angionecrotic glomerulonephritis. Identification of these unusual organ involvements is significant for proper and effective therapeutic intervention.
Atopic Diseases in Children
Authors: Megan A. Moreno
Journal: JAMA Pediatrics (2016)

Atopic diseases are a group of diseases linked by a shared underlying problem with the immune system.The main feature is the development of a particular immunoglobulin (IgE) directed against allergens that are usually harmless.Childhood atopic disease includes atopic dermatitis, allergic rhinitis, asthma, and food allergy.This month's JAMA Pediatrics includes 2 articles about atopic disease.
Brain metastases in HER2-overexpressing metastatic breast cancer: Comparative analysis of trastuzumab levels in serum and cerebrospinal fluid
Authors: J. Stemmler, M. Schmitt, A. Willems, H. Bernhard, N. Harbeck, V. Heinemann
Journal: Journal of Clinical Oncology (2006)

1525 Purpose: Patients receiving trastuzumab for HER2-overexpressing MBC suffer from an increased risk to develop BM despite responsive visceral disease. The present pilot study was conducted to explore trastuzumab levels in S and CSF of MBC patients afflicted with BM, and to evaluate whether radiotherapy will lead to impairment the blood-brain barrier (BBB) to allow penetration of trastuzumab into CSF. Methods: Patients with BM from HER2-overexpressing MBC (IHC; DAKO Hercep Test) were included. Trastuzumab levels in S and CSF were determined at different time points by a newly developed immunoenzymatic test for functional, reactive trastuzumab. Results: Six out of 8 eligible patients were evaluable. Prior to whole-brain radiotherapy (WBRT), the median trastuzumab serum level was 52,054 ng/ml compared to a median CSF level of 124 ng/ml (ratio 420:1). After completion of WBRT, the median level of trastuzumab was 20,185 ng/ml in serum and 226 ng/ml in CSF (ratio 76:1). In two cases of concomitant meningeal carcinomatosis, the median serum level of trastuzumab after WBRT was 17,431 ng/ml and 356 ng/ml in CSF (ratio 49:1). Conclusion: These data indicate that the BBB prevent trastuzumab to reach adequate concentrations in CSF. These levels are increased under conditions of an impaired BBB, as is known for meningeal carcinomatosis and for patients receiving WBRT. The new test system in this pilot study provides the basis for the evaluation of radiotherapeutic strategies which allow most favorable penetration of trastuzumab into the CNS in patients receiving concomitant trastuzumab for HER2-overexpressing metastatic breast cancer. [Table: see text]
Retrospective study of patients with advanced upper urinary tract transitional cell carcinoma (UUT-TCC)
Authors: A. Dufresne, A. Fléchon, P. Pommier, J. Droz
Journal: Journal of Clinical Oncology (2006)

14611 Background: UUT-TCC is a rare disease with poor prognosis. The aim of the study was to review retrospectively the outcome of 66 patients treated in a single cancer center. Methods: Clinical records of patients treated between 1993 and 2005 were reviewed to identify treatment modalities and outcome. Results: There were 47 (71%) males, median age was 60 years (range: 40–85) and UUT-TCC was associated with superficial bladder cancer in 14 (21%) patients. Forty-one patients had pT2–4 pN0–2 M0 disease after radical nephro-ureterectomy. Adjuvant treatment was: none for 25 patients, chemotherapy for 6 patients, radiotherapy for 1 patient, chemotherapy then radiotherapy for 9 patients. Twenty-seven patients relapsed after a median time interval of 12 months (range: 2–88). Fifty-two patients had metastatic disease (25 at initial diagnosis and 27 after relapse). Respectively 19 and 33 patients had one or multiple metastatic sites. Sites of metastases were: local in 12 patients, retroperitoneal lymph nodes in 30, liver in 23, lung in 19 and bone in 15. Thirty-six patients received platinum-based chemotherapy, 10 received palliative radiotherapy, 5 received best supportive care, and 1 had surgery. Response rate to chemotherapy was 40% with median response duration of 5.5 months (range: 0.2–18.5). Overall survival was 14.6 months. Conclusion: UUT-TCC has a worse prognosis than bladder TCC. However response to chemotherapy and overall survival seem worse than in metastatic bladder cancer. No significant financial relationships to disclose.
Efficacy, toxicity, and pattern of response and progression in patients with high-grade gliomas treated with bevacizumab and irinotecan: Experience in one center.
Authors: E. Gallardo Martin, M. C. Areses Manrique, U. Anido Herranz, S. Aguin Losada, E. Brozos Vazquez, M. Vieito Villar, J. E. Castro Gomez, L. Leon, M. J. Lamas, R. Lopez
Journal: Journal of Clinical Oncology (2010)

e12553 Background: The prognosis for patients with recurrent glioblastoma multiforme is poor, with a median survival of 12 to 24 weeks. The combination of irinotecan and bevacizumab was showed as an effective treatment in a previous phase II trial. Objective: To study the efficacy, toxicity and pattern of response and progression in patients with high-grade gliomas treated with bevacizumab and irinotecan. Methods: We reviewed 15 patients (11 male) treated from 01/01/2008 to 12/15/2009 with bevacizumab and irinotecan in our centre with high-grade gliomas. Median age was 42.6 years old (range 24-59). Glioblastoma multiforme was diagnosed in 10 patients, anaplastic glioma in 4 and anaplastic ependimoma in 1. 13 patients were operated (11 with an complete resection). All the patients received at least 1 previous treatment and 6 patients received 2. Results: One patient achieved a complete response, 7 partial response, 3 stable disease and 4 progression disease. Median overall survival was 43.71 weeks (IC 95% 20.05-66.37). Median progression-free survival was 38.43 weeks (IC 95% 22.87-53.98). The overall survival rate at 3 and 6 months was 86%, at 9 months 73% and at 12 months 31%. None patient discontinued treatment due to a treatment adverse event. No symptomatic intracranial hemorrhages were reported. Grade 3 diarrhea was reported in 1 patient and grade 3 thromboembolism venous disease was reported in 1 patient. The more common toxicities were haematologic events. Conclusions: In our series we reproduce the results reported in the previous clinical trials in an unselected population of patients, so we conclude bevacizumab and irinotecan in recurrent high-grade gliomas is an effective and safe treatment. No significant financial relationships to disclose.
Correlation of baseline serum testosterone (T) and serum prostate-specific antigen (PSA) at 7 months (7 mo PSA) in patients (pts) with new hormone sensitive metastatic prostate cancer (mHSPC) treated with continuous androgen deprivation therapy (cADT).
Authors: Tyler Howard Buckley, Shiven B. Patel, Srinivas Kiran Tantravahi, Julia A. Batten, David D. Stenehjem, Anitha Alex, Neeraj Agarwal
Journal: Journal of Clinical Oncology (2015)

231 Background: Based on data from &gt; 1,000 men with new mHSPC undergoing ADT in the SWOG-9346 study, a failure to achieve a 7 mo PSA of ≤4 ng/mL, is a powerful negative predictor of survival (Hussain et al., JCO 2006). Following baseline clinical variables predicted lack of achieving 7 mo PSA ≤ 4.0 ng/mL: increased age, PSA, and bone pain, poor performance status, and Gleason sum ≥ 8. We hypothesized that the baseline serum T is also an independent predictor of 7 mo PSA. Methods: Eligible pts were identified from an institutional database. The association of baseline clinical and disease characteristics with 7 mo PSA were analyzed using multivariate regression model (Table). Results: 54 pts were eligible for inclusion. 44% achieved undetectable 7 mo PSA, and 25% had a 7 mo PSA ≥ 4 ng/mL suggesting a representative population, similar to that in the SWOG-9346 study. Significant association between covariates and 7 mo PSA was observed (Prob &gt; F = 0.0107; R 2 = 0.404). Baseline serum T and PSA were independent predictors of 7 mo PSA. Baseline serum T, as a continuous variable, showed negative correlation with 7 mo PSA, while baseline PSA showed a positive correlation (Table). Conclusions: Baseline serum T independently predicts 7 mo PSA. Pts with new mHSPC with lower baseline T may have improved outcomes with deeper androgen blockade with ADT along with a 17,20-lyase and 17-alpha-hydroxylase inhibitor or a second generation androgen receptor inhibitor at the time of induction. Data need further validation in a larger cohort. [Table: see text]
POMB-ACE therapy for patients with international germ cell cancer collaborative group (IGCCCG) poor risk germ cell tumors (GCT): The USC experience
Authors: T. B. Dorff, R. Rupani, D. T. Wei, S. Groshen, J. Pinski, D. Raghavan, D. Quinn, A. Aparicio
Journal: Journal of Clinical Oncology (2006)

4591 Background: Patients with poor-risk GCT have low rates of cure with standard therapy, with 3 year overall survival (OS) reported at 50% (IGCCCG, JCO 1997). POMB-ACE is a rapidly alternating, dose dense chemotherapy regimen developed to improve outcomes in this population, with reported 3 year OS of 75% (Bower et al, Ann Oncol 1997). We report our experience with this regimen, including analysis of acute and long-term toxicity. Methods: Subjects with poor-risk GCT, defined by IGCCCG criteria as AFP &gt;10,000, bHCG &gt;50,000, LDH &gt; 10 × ULN, non-testicular primary, or non-pulmonary visceral metastases, who were diagnosed at Los Angeles County General Hospital and USC/Norris Cancer Center between 1998 and 2005 were identified using pathology and admission records. All clinical notes and laboratory data were reviewed. Results: Of 23 poor-risk GCT patients identified, 21 received POMB-ACE; 16 were treated at the county facility. 15 patients were Hispanic. 5 had primary mediastinal tumors. 16 were stage IIIC, 4 stage IIIB, and 1 stage IIIA. The median number of cycles was 8 (range 4–12), with a median interval between treatment cycles of 14 days (range 10–39). There were no treatment-related deaths. Febrile neutropenia occurred in 5.9% of treatment cycles, grade 3/4 hematologic toxicity in 19%, and other Grade 3/4 non-hematologic toxicities in 9.8%. G-CSF support was used with 24% of cycles. Nineteen patients (90%) had a partial response, of whom 8 underwent surgery for residual disease; only 1 had residual active tumor, 4 teratoma. Marker-negative status was achieved in 5 patients (23.8%). With median follow-up of 28 months, 9 subjects have recurred (43%) and 4 have died of disease progression. The estimated 2 year disease-free survival is 54%, and 3 year OS 75%. At the end of treatment, residual neuropathy persisted in 2 patients (9.5%), renal compromise in 2 (9.5%), pulmonary toxicity in 3 (14%), and otoxicity in 1 patient (4.7%). Conclusions: In our modern North American experience, POMB-ACE is feasible to administer, even in an uninsured population. This is an effective option in poor-risk GCT patients, with 3 year OS exceeding that achieved with standard therapy. Acute toxicity is modest, however persistent adverse sequelae are common. No significant financial relationships to disclose.
Mindfulness-Based Stress Reduction for Veterans With PTSD
Authors: Beatriz Goulao, Graeme S. MacLennan
Journal: JAMA (2016)

To the Editor Dr Polusny and colleagues1 conducted a randomized clinical trial to compare mindfulness-based stress reduction with present-centered group therapy for the treatment of posttraumatic stress disorder (PTSD). They concluded that mindfulness-based stress reduction therapy reduced PTSD symptom severity compared with present-centered group therapy.
7% hypertonic saline and hyaluronic acid and in the treatment of infants mild-moderate bronchiolitis
Authors: Raffaella Nenna, Stefano Papasso, Massimo Battaglia, Daniela De Angelis, Laura Petrarca, Dani Felder, Serena Salvadei, Rosaria Berardi, Micol Roberti, Paola Papoff, Corrado Moretti, Fabio Midulla
Journal: European Respiratory Journal (2011)

The treatment of bronchiolitis is only supportive. The aim of our study was to evaluate the efficacy of hypertonic saline and hyaluronic acid (HS-HA) given by inhalation, in infants hospitalized for mild-moderate bronchiolitis. In a double-blind placebo-controlled study, 42 infants (26 males) less than 6 months of age (median age 2 months) were enrolled and randomly assigned to receive either HS-HA (7% NaCl + 0.1% HA) (n:21) or normal saline (n:20) at a dose of 2.5 ml twice a day for three days. To all infants a clinical severity score was assigned at the admission and four times daily during the hospitalization. Main outcome measures of our study were: number of days of hospitalization and reduction of the severity score. No differences were observed between the two groups for sex, age and clinical severity score at the admission. One child interrupted the protocol in the study group and two in the placebo group. 21% of children in the study group and 11% in the placebo group had mild cough after the aerosol. No difference was observed between the two groups with regard to the number of days of hospitalization (placebo group: 3.5 days vs study group: 3.1 days, p=0.4) and to the clinical score reduction during the first three days of hospitalization (placebo group: 3.3 vs study group: 3.7, p=0.6). HS-HA is a safe but not effective therapy in treating infants hospitalized for mild-moderate bronchiolitis.
Radioembolization of unresectable primary and secondary hepatic malignancies using yttrium-90: The University of Texas at Houston experience.
Authors: I. M. Subbiah, P. Cen, R. Tanikella, K. W. Bryant, V. J. Liaw, M. B. Fallon, A. M. Cohen
Journal: Journal of Clinical Oncology (2011)

311 Background: Few effective treatments exist for unresectable hepatic malignant lesions. The objective of this study was to analyze the patient outcomes and toxicities of yttrium-90 (Y90) radioembolization in patients with unresectable primary and secondary hepatic malignancies. Methods: A retrospective review from 3/03 to11/09 of pts with liver malignancies who received Y-90 (TheraSphere and SIR-Spheres) was conducted. Pretreatment CT scans characterized the liver lesions. Hepatic arterial Tc-99m MAA scans showed % lung shunt and liver flow. Postprocedure toxicities (including pt symptoms, lab values) were recorded. CT/MRI scans at 1-, 3-, and 6-month intervals measured tumor response as per RECIST 1.0. The Kaplan-Meier method was used for survival analyses. Results: 50 pts were initially screened, of which 44 pts received 63 Y90 treatments. Mean age was 62y (24 male, 20 female). Of the 44 pts, 15 had hepatocellular cancer (HCC), 2 had intrahepatic cholangiocarcinoma and 27 had liver metastases (10 colorectal, 8 breast, 4 carcinoid, 1 esophagus, 1 lung, 1 gallbladder, 1 pancreas, 1 gastric). Mean tumor size was 10.6 cm (range 2.2-23.5cm), mean tumor absorbed dose was 30.8 mCi (range 7.1-63.5 mCi). Post-procedure symptoms included fatigue (n=21, 47.7%), abdominal pain (n=35, 79.5%), nausea/vomiting (n=12, 27.2%). At 1 month, 20 pts (45.5%) had SD, 14 (31.8%) had PR, and 10 (22.7%) had PD. At 3 months, 25 patients had SD, 10 had PD and 9 pts were in hospice or were deceased. At 6 months, 11 pts had SD. Per RECIST, PD at 1, 3, 6- months were significant predictors of mortality (OR 25, p&lt;0.0002) as was the preprocedure MELD (OR 1.208, p=0.0160). Caucasian pts had a lower overall mortality (OR 1.238, p=0.0363). Survival analyses will be updated. One pt with HCC was successfully downstaged after Y90 and listed for liver transplant; 26 patients were alive at 6-month follow-up. Conclusions: Y90 radioembolization represents a pragmatic option for hepatic lesions malignancies not amenable to resection. With an acceptable safety profile and the promising response on imaging, Y90 warrants further trials into its ideal use in the therapeutic algorithm for unresectable liver lesions. No significant financial relationships to disclose.