tbuckley/cabot-search huggingface dataset:
Comment on Doyle et al. Closed-Loop Artificial Pancreas Systems: Engineering the Algorithms. Diabetes Care 2014;37:1191–1197
Authors: Nick S. Oliver, Mark L. Evans, Roman Hovorka, Simon Heller, Desmond G. Johnston, Stephanie A. Amiel, Katharine Barnard
Journal: Diabetes Care (2014)

Doyle et al. (1) eloquently set out minimum common requirements for artificial pancreas (AP) trials to accelerate progress in this important field. The authors focus on engineering aspects and glucose outcomes critical to the success of AP technology, but we would like to draw attention to the importance of psychosocial aspects of AP technology. A greater understanding of the “lived experience” is crucial to ensure that technologies develop successfully and are fit to meet the demands of living with diabetes in addition to glycemic control.

Only people with type 1 diabetes know whether they are able to meet the demands of AP technologies long term. Continuous glucose monitors have received mixed reviews from people with diabetes with strong views both for and against (2). Loss of connection, short durability of sensors (particularly during physical activity when there is …
Target rates for caesarean section may be too low, say researchers
Authors: Jacqui Wise
Journal: BMJ (2015)

The optimal rate of caesarean delivery in relation to maternal and neonatal mortality is about 19 caesarean deliveries in every 100 live births, claims a study published in JAMA that gathered data from 194 World Health Organization member states.1

In 1985 WHO stated that there was no justification for any region to have caesarean rates higher than 10-15%. However, caesarean rates in many countries are much higher than this and continue to increase worldwide.

US researchers gathered data on caesarean rates from 2012, as well as on health expenditure per capita, fertility rate, life expectancy, and regional information. Caesarean delivery rates in 2012 were available from 54 countries, and the most …
Clinical, functional and microbiological characteristics of an adult brazilian cystic fibrosis population
Authors: Samia Zahi Rached, Rodrigo Athanazio, Maria Cecilia Nieves Teixeira Maiorano, Frederico Fernandes, Regina Carvalho-Pinto, Alberto Cukier, Rafael Stelmach
Journal: European Respiratory Journal (2014)

Introduction:Survival in cystic fibrosis (CF) has improved in the last decades. In Brazil, however, only 20.3% of the CF patients are over 18 years old and there are still very few centers specialized in their care. We aimed to describe the clinical, functional and microbiological characteristics of patients of an adult Brazilian CF center.

Methods:Data of patients of a CF adult center in 2012 in Sao Paulo was collected from the Brazilian Cystic Fibrosis Registry database.

Results:Analyzing all the 72 cases our center 61,1% females, mean age of 30,1 years old. Mean age of diagnosis was 15,6 years old, only 19,4% diagnosed before 12 months-old and 38,9% after 18 years old. Only 16,7% of the patients know which mutation is involved in their disease. Forced expiratory volume in the first second was below 40% of predicted values in 29,2% of the non-transplanted cases (21 patients, 15 below the age of 30). Microbiological data is shown in Table 1.

View this table:

Table 1: Microbiological data





Conclusion:The Brazilian CF population is aging, following international tendencies. Worse lung function may be related to late diagnosis, which may improve due to a neonatal screening program been implemented in our country. As our CF population gets older, more studies specifically for the adults should be developed. Patient registries are helpful tools to better understand each countries population and Latin America should make efforts for expanding CF data collection.
Accelerating tuberculosis elimination in low-incidence settings: the role of genomics
Authors: Jennifer L. Guthrie, Jennifer L. Gardy
Journal: European Respiratory Journal (2015)

In a recent European Respiratory Journal article, Lönnroth et al. [1] proposed a framework to accelerate progress towards tuberculosis (TB) elimination in low-incidence settings. In it, they outline eight priority areas and multiple interventions that align with the World Health Organization's post-2015 global TB strategy [2]. We applaud this framework and the recognition that elimination in low-incidence countries is a unique problem, where infection occurs amongst the most difficult-to-reach individuals. Although "new research and tools" is one of the framework's areas, it overlooks an important new technology that is changing our understanding of TB and our approaches to diagnosis, phenotyping, and treatment – whole genome sequencing (WGS) of Mycobacterium tuberculosis (MTB) isolates from cases of active TB [3, 4]. Genomics can aid TB elimination in low-incidence settings via enhanced epidemiology and rapid resistance prediction <http://ow.ly/TkPWS>
Economic analysis of a randomized placebo-controlled phase III study of granulocyte macrophage colony stimulating factor in adult patients ( &gt; 55 to 70 years of age) with acute myelogenous leukemia
Authors: C L Bennett, T J Stinson, M S Tallman, E A Stadtmauer, R W Marsh, W Friedenberg, H M Lazarus, L Kaminer, R M Golub, J M Rowe
Journal: Annals of Oncology (1999)
Radiocontrast increases plasma and urinary endothelin.
Authors: K B Margulies, F L Hildebrand, D M Heublein, J C Burnett
Journal: Journal of the American Society of Nephrology (1991)

Recent studies indicate that endothelin (ET), a potent endogenous systemic and renal vasoconstrictor peptide, may mediate decreases in GFR in models of acute renal dysfunction. Moreover, in an animal model of radiocontrast-induced nephropathy (RCIN), it was recently demonstrated that early renal hemodynamic responses to radiocontrast are attenuated by intra-arterial atrial natriuretic factor (ANF), which prevents subsequent RCIN. The studies presented here were therefore designed to determine whether i.v. infusion of radiocontrast produces increases in endogenous plasma and urinary ET and whether these responses are modulated by intra-arterial ANF in an animal model of RCIN. In these studies, dogs with pacing-induced heart failure received i.v. radiocontrast in the presence and absence of an intra-aortic infusion of ANF. Significant increases in both plasma and urinary ET were observed during and after radiocontrast. Although coadministration of ANF did not prevent increases in plasma and urinary ET, ANF preserved renal function acutely in this model of RCIN by increasing GFR above baseline levels.
Trends and predictors of asthma costs: results from a 10-year longitudinal study
Authors: Ngiap Chuan Tan, Hai V. Nguyen, Weng Kit Lye, Usha Sankari, Nivedita V. Nadkarni
Journal: European Respiratory Journal (2015)

Research on asthma costs often focuses on estimating average asthma costs. Trends in asthma costs and patterns of medication use, especially for those who have been followed up and under treatment, have received much less attention. This study's objective was to document asthma costs over time for asthma patients who are enrolled in an asthma care programme in Singapore and to identify its predictors, using a 10-year longitudinal dataset.The study population comprised different cohorts of 939 asthma patients entering the programme at different times during 2004-2013. Average asthma costs were estimated and the trends over time examined graphically, within and across patient cohorts. Regression analyses were conducted to examine cost predictors, with a focus on the relationship between risk factors at programme enrolment and subsequent asthma costs.The results indicate that 10-year average annual asthma cost was GBP 341 per patient. The main drivers of costs were asthma medications and consultation fees. Use of combined inhaled corticosteroid/long-acting β-agonist medications increased over time, but this was accompanied by declines in controller drug use, doctor visits and total asthma drug costs. Obesity, smoking and asthma severity were the main predictors of subsequent asthma costs, especially for females.
Usual Blood Pressure and Risk of New-Onset Diabetes
Authors: Connor A. Emdin, Simon G. Anderson, Mark Woodward, Kazem Rahimi
Journal: Journal of the American College of Cardiology (2015)

Reliable quantification of the association between blood pressure (BP) and risk of type 2 diabetes is lacking. This study sought to determine the association between usual BP and risk of diabetes, overall and by participant characteristics. A cohort of 4.1 million adults, free of diabetes and cardiovascular disease, was identified using validated linked electronic health records. Analyses were complemented by a meta-analysis of prospective studies that reported relative risks of new-onset diabetes per unit of systolic blood pressure (SBP). Among the overall cohort, 20 mm Hg higher SBP and 10 mm Hg higher diastolic BP were associated with a 58% and a 52% higher risk of new-onset diabetes (hazard ratio: 1.58; 95% confidence interval [CI]: 1.56 to 1.59; and hazard ratio: 1.52; 95% confidence interval: 1.51 to 1.54), respectively. There was no evidence of a nadir to a baseline BP of 110/70 mm Hg. The strength of the association per 20 mm Hg higher SBP declined with age and with increasing body mass index. Estimates were similar even after excluding individuals prescribed antihypertensive or lipid-lowering therapies. Systematic review identified 30 studies with 285,664 participants and 17,388 incident diabetes events. The pooled relative risk of diabetes for a 20 mm Hg higher usual SBP across these studies was 1.77 (1.53 to 2.05). People with elevated BP are at increased risk of diabetes. The strength of the association declined with increasing body mass index and age. Further research should determine if the observed risk is modifiable.
Adding Heparin to Aspirin Reduces the Incidence of Myocardial Infarction and Death in Patients With Unstable Angina
Authors: Allison Oler
Journal: JAMA (1996)

<h3>Objective.</h3> —To estimate the risk of myocardial infarction (MI) and death in patients with unstable angina who are treated with aspirin plus heparin compared with patients treated with aspirin alone. <h3>Data Sources.</h3> —Studies were retrieved using MEDLINE, bibliographies, and consultation with experts. <h3>Study Selection.</h3> —Only published trials that enrolled patients with unstable angina, randomized participants to aspirin plus heparin vs aspirin alone, and reported incidence of myocardial infarction or death were included in the meta-analysis. <h3>Data Extraction.</h3> —Patient outcomes including MI or death, recurrent ischemic pain, and major bleeding during randomized treatment; revascularization procedures after randomization; and MI or death during the 2 to 12 weeks following randomization were extracted by 2 authors, 1 of whom was blinded to the journal, institution, and author of each study. <h3>Data Synthesis.</h3> —Six randomized trials were included. The overall summary relative risk (RR) of MI or death during randomized treatment was 0.67 (95% confidence interval [CI], 0.44-1.02) in patients with unstable angina treated with aspirin plus heparin compared with those treated with aspirin alone. The summary RRs for secondary endpoints in patients treated with aspirin plus heparin compared with those treated with aspirin alone were 0.68 (95% CI, 0.40-1.17) for recurrent ischemic pain; 0.82 (95% CI, 0.56-1.20) for MI or death 2 to 12 weeks following randomization; 1.03 (95% CI, 0.74-1.43) for revascularization; and 1.99 (95% CI, 0.52-7.65) for major bleeding. We found no statistically significant heterogeneity among individual study findings. <h3>Conclusions.</h3> —Our findings are consistent with a 33% reduction in risk of MI or death in patients with unstable angina treated with aspirin plus heparin compared with those treated with aspirin alone. The bulk of evidence suggests that most patients with unstable angina should be treated with both heparin and aspirin.
Ensure release of all data on alteplase, doctors urge health secretary
Authors: Z. Kmietowicz
Journal: BMJ (2015)

A group of senior doctors have called on the health secretary, Jeremy Hunt, to intervene in a drive to get unpublished trial data on alteplase, a drug for acute ischaemic stroke, released in the public domain “to ensure patient safety is protected.” Until the data are released and analysed the use of alteplase should be suspended, they said.

Roger Shinton, a stroke specialist and former consultant physician at Birmingham’s Heartlands Hospital, has been calling for unpublished data on alteplase to be made available for some years.

In August 2014 the Medicines and Healthcare Products Regulatory Agency (MHRA) convened a panel to review the safety and efficacy of alteplase1 after Shinton had raised concerns in a letter to the Lancet about the evidence on which the drug’s licence was based.2 3

Shinton told The BMJ that this review must have access to all available data …
Obsessions in obsessive-compulsive disorder with and without Gilles de la Tourette's syndrome
Authors: M S George, M R Trimble, H A Ring, F R Sallee, M M Robertson
Journal: American Journal of Psychiatry (1993)

Although obsessive-compulsive disorder commonly occurs in many patients with Gilles de la Tourette's syndrome, little is known about the obsessions and compulsions of Tourette's syndrome and whether they differ from those seen in pure obsessive-compulsive disorder. The authors prospectively studied 10 subjects with obsessive-compulsive disorder and 15 subjects with obsessive-compulsive disorder and comorbid Tourette's syndrome by using the Yale-Brown Obsessive Compulsive Scale, the Leyton Obsessional Inventory, and a new questionnaire designed to emphasize the differences in symptoms between these two groups.Subjects with comorbid obsessive-compulsive disorder and Tourette's syndrome had significantly more violent, sexual, and symmetrical obsessions and more touching, blinking, counting, and self-damaging compulsions. The group with obsessive-compulsive disorder alone had more obsessions concerning dirt or germs and more cleaning compulsions. The subjects who had both disorders reported that their compulsions arose spontaneously, whereas the subjects with obsessive-compulsive disorder alone reported that their compulsions were frequently preceded by cognitions.There are phenomenologic differences between obsessive-compulsive disorder and obsessive-compulsive disorder with comorbid Tourette's syndrome that may reflect differential involvement of neurochemical and neuroanatomic pathways.
Mtss1 is a critical epigenetically regulated tumor suppressor in CML
Authors: M Schemionek, O Herrmann, M M Reher, N Chatain, C Schubert, I G Costa, S Hänzelmann, E G Gusmao, S Kintsler, T Braunschweig, A Hamilton, G V Helgason, M Copland, A Schwab, C Müller-Tidow, S Li, T L Holyoake, T H Brümmendorf, S Koschmieder
Journal: Leukemia (2015)
Comparison groups were not clear in study
Authors: T. C K Tham, D. R Lichtenstein
Journal: BMJ (1996)

EDITOR,—A H Briggs et al compared the cost effectiveness of screening for and eradication of Helicobacter pylori in the management of dyspeptic patients under 45 in the community using decision analysis and concluded that cost savings in the strategy of screening for H pylori compared with treatment with cimetidine could take almost eight years to accrue.1 We think, however, that there are flaws and limitations in this study and that their conclusions should be interpreted with caution.

In their analysis of …
Explaining laboratory test results to patients: what the clinician needs to know
Authors: Maurice John O’Kane, Berenice Lopez
Journal: BMJ (2015)

#### The bottom line Better understanding by patients of why tests are performed and what the results mean increases satisfaction with care.1 2 3 4 Patients increasingly have direct access to their test results through online portals. Although patients may discuss test results with family and friends or seek information on the internet,5 the responsibility for explaining test results lies with clinicians. Discussions must take into account the patient’s literacy and numeracy level, and clinicians should explain clearly what the results mean and how they influence treatment choices. It is crucial to understand why a test was done to understand the meaning of its result. The following are common reasons for testing:
Diagnostic accuracy of venous blood gases compared to arterial blood gases
Authors: Onofre Moran, Lukas Brown, Heather Murray, Louise Rang
Journal: European Respiratory Journal (2013)

Background: Arterial blood gases (ABGs) are the gold standard to assess acid-base balance, ventilation and blood oxygenation. However, using venous blood gases (VBGs) could avoid the pain and complications associated to ABGs. No studies have assessed if VBGs are comparable to ABGs in reaching the same diagnosis of normal vs. abnormal pH, CO2, and HCO3-.  Objectives: To assess the diagnostic accuracy of VBGs compared to ABGs.  Methods: All patients presenting to the emergency department of Kingston General Hospital who required ABGs were eligible for the study. Emergency physicians or residents obtained ABG samples from radial, brachial, or femoral arteries on 218 patients. Nurses immediately drew VBG samples from peripheral veins. Blood gas analyses were performed on the Radiometer ABL 500 and 520 gas analyzers. We calculated the sensitivity and specificity of VBGs, using ABGs as the gold standard. Published normal venous (only one complete set of normal VBGs found) and arterial values were used to determine normal vs abnormal results for pH, CO2, and HCO3-.  Results: As shown in table 1, VBGs had low sensitivity and/or specificity for detecting most blood gas abnormalities; this could lead to common misdiagnoses and mismanagement of patients.  Conclusion: Given the high proportion of false normal and abnormal results using currently available venous blood normal values, VBGs cannot replace ABGs to diagnose acid-base or ventilatory derangements.
Novel <i>MYBL1</i> Gene Rearrangements with Recurrent <i>MYBL1–NFIB</i> Fusions in Salivary Adenoid Cystic Carcinomas Lacking t(6;9) Translocations
Authors: Yoshitsugu Mitani, Bin Liu, Pulivarthi H. Rao, Vishnupriya J. Borra, Mark Zafereo, Randal S. Weber, Merrill Kies, Guillermina Lozano, P. Andrew Futreal, Carlos Caulin, Adel K. El-Naggar
Journal: Clinical Cancer Research (2015)

Abstract Purpose: Adenoid cystic carcinoma (ACC) is an indolent salivary gland malignancy, characterized by t(6;9) translocations and MYB–NFIB gene fusions in approximately 50% of the tumors. The genetic alterations underlying t(6;9)-negative and t(6;9)-positive/MYB–NFIB fusion–negative ACC remain unknown. To uncover the genetic alterations in ACC lacking the canonical translocation and fusion transcript and identify new abnormalities in translocation positive tumors. Experimental Design: We performed whole-genome sequencing in 21 salivary ACCs and conducted targeted molecular analyses in a validation set (81 patients). Microarray gene-expression data were also analyzed to explore the biologic differences between fusion positive and negative tumors. Results: We identified a novel MYBL1–NFIB gene fusion as a result of t(8;9) translocation and multiple rearrangements in the MYBL1 gene in 35% of the t(6;9)-negative ACCs. All MYBL1 alterations involved deletion of the C-terminal negative regulatory domain and were associated with high MYBL1 expression. Reciprocal MYB and MYBL1 expression was consistently found in ACCs. In addition, 5′-NFIB fusions that did not involve MYB/MYBL1 genes were identified in a subset of t(6;9)-positive/fusion-negative tumors. We also delineated distinct gene-expression profiles in ACCs associated with the length of the MYB or MYBL1 fusions, suggesting a biologic importance of the C-terminal part of these fusions. Conclusions: Our study defines new molecular subclasses of ACC characterized by MYBL1 rearrangements and 5′-NFIB gene fusions. Clin Cancer Res; 22(3); 725–33. ©2015 AACR.
Effect of Epidural vs Parenteral Opioid Analgesia on the Progress of Labor
Authors: Stephen H. Halpern, Barbara L. Leighton, Arne Ohlsson, Jon F. R. Barrett, Amy Rice
Journal: JAMA (1998)

Context.—Epidural labor analgesia, if selected by the patient, is associated with high cesarean delivery rates. Results of randomized trials comparing rates of cesarean delivery using epidural anesthesia vs parenteral opioids are inconsistent. Objective.—To review the effects of epidural vs parenteral opioid analgesia on cesarean delivery rates. Data Sources.—Studies were identified by searching MEDLINE from January 1966 through January 1998, the Cochrane Database of Perinatal Trials, and relevant nonindexed journals and abstracts. Study Selection.—We included all studies that randomized patients to epidural vs parenteral opioid labor analgesia. Data Extraction.—Two authors independently extracted data from 10 trials enrolling 2369 patients. Odds ratios (ORs) for categorical data, weighted mean differences (WMDs) for continuous data, and 95% confidence intervals (CIs) were calculated using a random-effects model. Data Synthesis.—The risk of cesarean delivery did not differ between patients receiving epidural (8.2%) vs parenteral opioid (5.6%) analgesia (OR, 1.5; 95% CI, 0.81-2.76). Epidural patients had longer first (WMD, 42 minutes; 95% CI, 17-68 minutes) and second (WMD, 14 minutes; 95% CI, 5-23 minutes) labor stages. While epidural patients were more likely to have instrumented delivery (OR, 2.19; 95% CI, 1.32-7.78), they were no more likely to have instrumented delivery for dystocia (OR, 0.68; 95% CI, 0.31-1.49). After epidural analgesia, neonates were less likely to have low 5-minute Apgar scores (OR, 0.38; 95% CI, 0.18-0.81) or to need naloxone (OR, 0.24; 95% CI, 0.07-0.77). Women receiving epidural analgesia had lower pain scores during the first (WMD, −40 mm on a 100-mm scale; 95% CI, −42 to −38 mm) and second (WMD, −29 mm; 95% CI, −38 to −21 mm) stages of labor. The odds of dissatisfaction were lower with epidural analgesia (OR, 0.25; 95% CI, 0.20-0.32). Conclusions.—Epidural labor analgesia is not associated with increased rates of instrumented vaginal delivery for dystocia or cesarean delivery. Patients receiving epidural analgesia have longer labors. Patient satisfaction and neonatal outcome are better after epidural than parenteral opioid analgesia. JAMA. 1998;280:2105-2110
Total body nitrogen as a prognostic marker in maintenance dialysis.
Authors: C A Pollock, L S Ibels, B J Allen, W Ayass, R J Caterson, D A Waugh, C Macadam, Y Pennock, J F Mahony
Journal: Journal of the American Society of Nephrology (1995)

In order to assess long-term nutritional adequacy, 154 patients on maintenance dialysis (78 on hemodialysis (HD), 76 on continuous ambulatory peritoneal dialysis (CAPD)) underwent measurement of total body nitrogen (TBN) with concurrent recording of dietary history, anthropometrics, and serum albumin. Seventy-one patients were reassessed 23.3 +/- 2.2 (5 to 76) months later. In cross-sectional analyses, anthropometric measurements and dietary intake remained stable over time in all patients. However, a significant fall in TBN occurred in the HD population with increasing time on dialysis (P < 0.05). In the prospective analyses, CAPD patients (N = 26) had a significant increase in TBN (P < 0.02). In contrast, longitudinal measurements of TBN in HD patients (N = 36) tended to fall but did not reach significance (P = 0.18). TBN correlated with total caloric intake estimated from the dietary history (P < 0.05), but not with estimated protein intake. During follow-up, 38 patients died. These patients were older (P < 0.05), and in the CAPD population, they had been on dialysis for a longer time (P < 0.05). Those who died had a lower TBN expressed both as grams per kilogram lean body mass (P < 0.005) and as the nitrogen index (P < 0.05). The probability of death within 12 months in the patients with a nitrogen index (ratio of the measured nitrogen to the predicted nitrogen for a sex-, age-, and height-matched control) less than 80% of the predicted normal value was 48%. The relative risk of death in this population was 4.1.(ABSTRACT TRUNCATED AT 250 WORDS)