tbuckley/cabot-search huggingface dataset:
P117 Comparison of the effects of continuous positive airway pressure and mandibular advancement devices on subjective daytime sleepiness in patients with obstructive sleep apnea: a network meta-analysis
Authors: DJ Bratton, T Gaisl, C Schlatzer, M Kohler
Journal: Thorax (2015)

<h3>Background</h3> Obstructive sleep apnoea (OSA) is associated with increased daytime sleepiness. Previous meta-analyses have shown that both continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce the Epworth Sleepiness Score (ESS), a common measure of daytime sleep propensity. However, no meta-analysis has yet identified which treatment is superior in reducing ESS, perhaps due to a lack of studies directly investigating the two treatments. In addition, the effect of CPAP usage on ESS has yet to be thoroughly explored. <h3>Methods</h3> We searched Medline and the Cochrane Library up to the end of May 2015 to identify randomised controlled trials in OSA investigating the effect of CPAP and/or MADs against each other or an inactive control (IC, placebo or no treatment) on ESS. A network meta-analysis was used to incorporate both direct and indirect evidence to estimate the difference between the three treatment groups on ESS. Meta-regression was used to assess the influence of CPAP usage and average baseline patient characteristics on the effect of CPAP compared to ICs. <h3>Findings</h3> A total of 67 studies comprising 6873 patients were included in the meta-analysis. Of these, 51 (5898 patients) assessed CPAP against an IC. CPAP and MADs were estimated to reduce ESS by 2.5 (95% CI 2.1,2.9) and 1.7 (95% CI 1.1,2.3) points respectively compared to an IC. CPAP was estimated to reduce the ESS by a further 0.8 points compared to MADs (95% CI 0.1,1.4; p = 0.015). However, there was some suggestion of publication bias in favour of CPAP which may have inflated this effect. There was no evidence that studies reporting higher CPAP usage also reported larger treatment effects. <h3>Interpretation</h3> Both CPAP and MADs are effective treatments for reducing daytime sleepiness in patients with OSA. CPAP appears to be the most effective treatment and should be recommended for more severe or sleepier OSA patients. However, MADs are a suitable second-line treatment should CPAP not be tolerated.
Telomere Length In MDS Patients Bone Marrow Is Highly Correlated with Complex Cytogenetics, IPSS Risk Groups and Transfusion Dependency,
Authors: Jie Jiang, Austin G Kulasekararaj, Pramila Krishnamurthy, Alexander E Smith, Syed A Mian, Shreyans Gandhi, Janet Hayden, Joop Gaken, Modupe Elebute, Robin M. Ireland, ZiYi Lim, Judith C. W. Marsh, Ghulam J. Mufti
Journal: Blood (2011)
Paper or plastic? BCR-ABL1 quantitation and mutation detection from dried blood spots
Authors: Olga Sala Torra, Lan Beppu, Jordan L. Smith, Linda Welden, Jasmina Georgievski, Karisma Gupta, Rashmi Kumar, Cecilia C. S. Yeung, Amy Paguirigan, Ted A. Gooley, Susan Branford, Jerald P. Radich
Journal: Blood (2016)
Management of Hypertension in the Elderly
Authors: Jan Koch-Weser, Jan Koch-Weser, Kevin O'Malley, Eoin O'Brien
Journal: New England Journal of Medicine (1980)

THERE is much confusion over what constitutes appropriate management of hypertension in the elderly.1 2 3 4 5 Indeed, there is controversy about how one should define the terms elderly and hypertension. Bearing in mind that chronologic and biologic aging are different, one must recognize that differentiation of the two is not usually practicable. In this paper we use the chronologic index of aging and arbitrarily define the elderly as those aged 65 and over. Employing this imperfect criterion, we exclude a group who are apparently prematurely aged, while including the so-called biologically elite who show little evidence of aging into their eighth or . . .
Liposome-encapsulated curcumin: <i>in vitro</i> and <i>in vivo</i> effects on proliferation, apoptosis, signaling, and angiogenesis
Authors: R. Kurzrock, L. Li
Journal: Journal of Clinical Oncology (2005)

4091 Background: Because a role for nuclear factor-κB (NF-κB) has been implicated in the pathogenesis of pancreatic cancer, this transcription factor is a potential target for treatment of this devastating disease. Curcumin (diferuloylmethane) is a phytochemical with potent NF-κB-inhibitory activity. It is pharmacologically safe, but its bioavailability is poor after oral administration. Methods: We encapsulated curcumin in a liposomal delivery system that would allow intravenous administration. We studied the in vitro and in vivo effects of this compound on proliferation, apoptosis, signaling and angiogenesis using human pancreatic cancer cells. Results: NF-κB was constitutively active in all human pancreatic cancer cell lines examined and liposomal curcumin consistently suppressed NF-κB binding (electrophoretic mobility gel shift assay (EMSA)) and decreased the expression of NF-κB-regulated gene products, including cyclo-oxygenase-2 (COX-2) (immunoblots) and interleukin-8 (IL-8) (enzyme linked immunoassay), both of which have been implicated in tumor growth/invasiveness. These in vitro changes were associated with concentration- and time-dependent antiproliferative activity (MTT assay) and pro-apoptotic effects (annexin-V/propidium iodide staining (FACS) and polyadenosine-5'-diphosphate-ribose-polymerase (PARP) cleavage). The activity of liposomal curcumin was equal to or better than that of free curcumin at equimolar concentrations. In vivo, curcumin suppressed pancreatic cancer growth in murine xenograft models and inhibited tumor angiogenesis. Conclusions: Liposomal curcumin downregulates the NF-κB machinery, suppresses growth, and induces apoptosis of human pancreatic cells, in vitro. Antitumor and anti-angiogenesis effects are observed in vivo. Our experiments provide a biologic rationale for treatment of patients suffering from pancreatic cancer with this nontoxic phytochemical encapsulated in liposomes for systemic delivery. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Plantacor
Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain
Authors: Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, Jeffrey S. Ross
Journal: New England Journal of Medicine (1994)

The relation between abnormalities in the lumbar spine and low back pain is controversial. We examined the prevalence of abnormal findings on magnetic resonance imaging (MRI) scans of the lumbar spine in people without back pain.
Kaposi's Sarcoma after Renal Transplantation
Authors: John P. Vella, Rebecca Mosher, Mohamed H. Sayegh
Journal: New England Journal of Medicine (1997)

To the Editor: Cancer after transplantation has long been recognized to be a risk associated with immunosuppression, but Kaposi's sarcoma is a rare tumor in this situation.1 A 39-year-old man with ...
Compliance With Gastric Cancer Guidelines is Associated With Improved Outcomes
Authors: David J Worhunsky, Yifei Ma, Yulia Zak, George A Poultsides, Jeffrey A Norton, Kim F Rhoads, Brendan C Visser
Journal: Journal of the National Comprehensive Cancer Network (2015)

Limited data are available on the implementation and effectiveness of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer.We sought to assess rates of compliance with NCCN Guidelines, specifically stage-specific therapy during the initial episode of care, and to determine its impact on outcomes.The California Cancer Registry was used to identify cases of gastric cancer from 2001 to 2006. Logistic regression and Cox proportional hazard models were used to predict guideline compliance and the adjusted hazard ratio for mortality. Patients with TNM staging or summary stage (SS) were also analyzed separately.Compliance with NCCN Guidelines occurred in just 45.5% of patients overall. Patients older than 55 years were less likely to receive guideline-compliant care, and compliance was associated with a median survival of 20 versus 7 months for noncompliant care (P<.001). Compliant care was also associated with a 55% decreased hazard of mortality (P<.001). Further analysis revealed that 50% of patients had complete TNM staging versus an SS, and TNM-staged patients were more likely to receive compliant care (odds ratio, 1.59; P<.001). TNM-staged patients receiving compliant care had a median survival of 25.3 months compared with 15.1 months for compliant SS patients.Compliance with NCCN Guidelines and stage-specific therapy at presentation for the treatment of patients with gastric cancer was poor, which was a significant finding given that compliant care was associated with a 55% reduction in the hazard of death. Additionally, patients with TNM-staged cancer were more likely to receive compliant care, perhaps a result of having received more intensive therapy. Combined with the improved survival among compliant TNM-staged patients, these differences have meaningful implications for health services research.
Effect of Dietary Supplementation with Very-Long-Chain n-3 Fatty Acids in Patients with Psoriasis
Authors: Elisabeth Soyland, Jurgen Funk, Georg Rajka, Morten Sandberg, Per Thune, Lisbeth Rustad, Svein Helland, Kjell Middelfart, Solveig Odu, Edvard S. Falk, Kari Solvoll, Gunn-Elin Aa Bjorneboe, Christian A. Drevon
Journal: New England Journal of Medicine (1993)

In several studies dietary fish oil has been found to have a beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients.
Lethal Pulmonary Reactions Associated with the Combined Use of Amphotericin B and Leukocyte Transfusions
Authors: Daniel G. Wright, Kathleen J. Robichaud, Philip A. Pizzo, Albert B. Deisseroth
Journal: New England Journal of Medicine (1981)

Amphotericin B is used increasingly in high-risk patients with profound neutropenia and suspected sepsis. We have observed serious pulmonary reactions characterized by acute dyspnea, hypoxemia, and interstitial infiltrates on chest films in patients receiving amphotericin B and leukocyte transfusions. We reviewed 6 1/2 years of experience at the National Institutes of Health to determine whether this combination was associated with pulmonary toxicity not characteristic of either therapy alone. Amphotericin was used during 22 of 57 leukocyte-transfusion courses. Acute respiratory deterioration occurred during 14 (64 per cent) of these courses but in only two (6 per cent) of 35 courses without amphotericin (P<0.01). In seven cases, respiratory deterioration began during or immediately after amphotericin infusion, and it contributed to death in five patients. Diffuse intraalveolar hemorrhage was found when lung biopsy or autopsy was performed. Acute respiratory deterioration was not observed In comparably neutropenic patients given amphotericin but not leukocyte transfusions during the same period. It was most common when amphotericin was begun with or after institution of daily leukocyte transfusions. Leukocyte transfusions may cause changes in the lungs that amplify the acute toxicity of amphotericin, thereby permitting severe pulmonary reactions. (N Engl J Med. 1981; 304:1185–9.)
Clinical Experiences with a New Orally Administered Mercurial Diuretic
Authors: Elliott Bresnick, Julius Abramson
Journal: New England Journal of Medicine (1953)

A REVIEW of the literature reveals that the use of orally administered diuretic drugs in the therapy of congestive heart failure is gaining wide acceptance.1 2 3 4 5 The ease of administration by the oral route, obviating visits to an outpatient department and thus lessening the burden on the patient, makes it a desirable method of treatment. For the past few years, several such drugs have been given to ambulatory patients in the outpatient clinic at the Boston City Hospital. This article presents the results obtained with an oral diuretic preparation now known as Neohydrin (3-chloromercuri-2-methoxy-propylurea).§Fifteen patients with severe congestive heart failure . . .
Diagnostics based on nucleic acid sequence variant profiling: PCR, hybridization, and NGS approaches
Authors: Dmitriy Khodakov, Chunyan Wang, David Yu Zhang
Journal: Advanced Drug Delivery Reviews (2016)

Nucleic acid sequence variations have been implicated in many diseases, and reliable detection and quantitation of DNA/RNA biomarkers can inform effective therapeutic action, enabling precision medicine. Nucleic acid analysis technologies being translated into the clinic can broadly be classified into hybridization, PCR, and sequencing, as well as their combinations. Here we review the molecular mechanisms of popular commercial assays, and their progress in translation into in vitro diagnostics.
The Changing Pattern of Life-Threatening Microbial Disease
Authors: David E. Rogers
Journal: New England Journal of Medicine (1959)

THE hope that antimicrobial drugs would abolish infections as a cause of death has not been adequately realized. Current literature indicates that microbial infections continue to pose life-threatening problems and that antibiotic drugs do not offer susceptible human beings significant protection from certain types of microbial disease.It is nevertheless believed that there have been changes in the types of infection that produce serious problems in hospitalized patients today. It is commonly stated that acute infections arising from external sources are a rare cause of death in metropolitan centers, whereas infections produced by certain bacteria and fungi are increasing in . . .
Case 13-1963
Authors: Lloyd H. Smith, Benjamin Castleman
Journal: New England Journal of Medicine (1963)

Presentation of CaseA seventy-two-year-old retired painter entered the hospital because of fever and malaise.The patient had been in excellent health until six weeks before admission, when he first noticed gradually increasing weakness and fatigue. Intermittent fever, with mid-day temperature elevations to 103°F., began at that time, with several episodes of sweating. Three weeks before entry nausea associated with vague, diffuse abdominal discomfort developed, with daily vomiting of bile-stained material. Treatment with various antibiotics was ineffectual. One week later there were two episodes of hematuria, with the passage of a few clots, but with no dysuria or frequency. He . . .
Occipital Neuralgia in Adolescents and Young Adults
Authors: Mildred C. Dugan, Simeon Locke, J. Roswell Gallagher
Journal: New England Journal of Medicine (1962)

HEADACHE is so frequently the chief complaint of a tense and anxious adolescent that it is well from time to time to emphasize the many other factors both within and outside the central nervous system that can cause this symptom. Within the past twenty-four months we have seen 10 patients whose major complaint was headache and who had a clinical history and physical and roentgenographic findings consistent with occipital neuralgia. It appears worth while briefly to report and discuss these cases.All adolescents who complain of headache deserve a detailed medical history and thorough medical examination. Even those who are . . .
Case 37-1964
Authors: William V. McDermott, Benjamin Castleman
Journal: New England Journal of Medicine (1964)

Presentation of CaseAn eighty-one-year-old man was admitted to the hospital after collapse.On the day of admission he complained of sudden pain low in the back while at lunch and fainted, falling to the floor and striking his head. He had had a myocardial infarction twelve years previously but had otherwise been well.Physical examination revealed an acutely ill man. The lungs, heart and abdomen were normal. The temperature was 98.2°F., the pulse 44, and the respirations 20. The blood pressure was 130 systolic, 60 diastolic.X-ray films of the chest (Fig. 1) revealed clear lungs; the heart was . . .
NIMG-74ENHANCING LESIONS OUTSIDE THE IRRADIATED FIELD IN ANAPLASTIC OLIGODENDROGLIOMA: TUMOR OR NOT?
Authors: Linda W Xu, Lawrence Recht
Journal: Neuro-Oncology (2015)

In patients with primary brain tumors, any new enhancement outside of the field of radiation is often assumed to be progressive disease and treated as such without confirmatory tissue. Recently we have encountered 3 cases that demonstrate that this cannot be universally assumed. All 3 patients had pathology proven anaplastic oligodendroglioma at initial resection with 1p19q codeletion. 2 patients were male and one was female, and age at presentation ranged from 39 to 50 years old. All were treated with resection and subsequent chemotherapy and focal radiation either up front or at first recurrence. 2 had recurrent tumors confirmed with resection and pathological diagnosis, which was then re-treated and stabilized for over two years in both cases. Months to years after last treatment, all 3 patients developed new enhancing masses outside the field of initial radiation with at least one lesion in the contralateral hemisphere. 2 out of 3 patients underwent biopsy of these new lesions, one demonstrating gliosis and necrosis, the other demonstrating plasma cell infiltrate. For one of these patients, serial MRI has subsequently demonstrated migrating enhancement but no clear progression. The third patient who did not undergo biopsy has undergone intermittent bevacizumab infusions with again waxing and waning enhancement for the last five years that continue to resolve each time bevacizumab is reinstituted. Clinically, all 3 patients are currently not receiving any treatment for their enhancement other than surveillance MRI and all remain neurologically stable with no new symptoms. While the pathophysiology of this phenomenon is not understood, these three cases demonstrate that new enhancing lesions outside the initial radiation treatment field should not be globally assumed to be new tumor foci or treated as such. In some patients, there may be patterns of enhancement that reflect other processes and do not require aggressive tumor management.
Critical Role Of Casein Kinase (Ck)1α Heterozygote Gene Inactivation In The Clonal Advantage Of Hematopoietic Stem Cells In Del(5q) MDS
Authors: Rebekka K. Schneider, Dirk Heckl, Marcus Järås, Lisa Chu, McConkey Marie, Ann Mullally, Benjamin L Ebert
Journal: Blood (2013)
Treatment of Hypertensive Emergencies
Authors: R. W. Griffin, J. W. Stover, R. V. Ford
Journal: New England Journal of Medicine (1956)

THE effective treatment of hypertension is now possible in the great majority of patients with mild hypertension as a result of the widespread use of Rauwolfia preparations derived from Rauwolfia serpentina. Treatment of the severe hypertensive and hypertensive emergencies has been possible since the advent of veratrum and other preparations. Many of these potent drugs left much to be desired in terms of safety and predictability.This study was undertaken to determine the efficacy of parenteral administration of reserpine in hypertensive crisis and intractable hypertension. This agent, in striking contrast to other drugs available, appeared to have great promise . . .
High interstitial fluid pressure (IFP) and hypoxia as biomarkers of cisplatin chemoradiation response in advanced cervix cancer
Authors: A. Fyles, M. Pintilie, D. Hedley, R. Bristow, B. Wouters, R. Hill, M. Milosevic
Journal: Journal of Clinical Oncology (2009)

5584 Background: Chemoradiotherapy (CRT) has been shown to improve survival compared to RT alone for locally advanced cervix cancer. The tumour microenvironment in cervix cancer is also known to influence disease progression and response to treatment. In this prospective study, pre-treatment tumour hypoxia and interstitial fluid pressure (IFP) were examined as potential biomarkers of improved treatment effectiveness in a cohort of patients treated with definitive radiation alone, or with the addition of concurrent cisplatin CRT. Methods: Between April 1994 and January 2006, 309 eligible patients with cervix cancer were entered into a prospective study of hypoxia and IFP prior to definitive treatment. Patients accrued between 1994 and 1999 (n = 115) were treated with RT alone, and those accrued between 2000 and 2006 (n = 194) received RT and concurrent weekly cisplatin CRT. Clinical characteristics were similar between the two cohorts except pelvic lymph node metastases were more frequent in the CRT cohort (42% vs. 19%, p = 0.0005), likely due to changes in definition of positive nodes on CT or MR imaging. The median follow-up was 3.6 years (2.9 years for CRT and 7.8 years for RT). Results: The use of CRT improved outcome in hypoxic tumors compared to RT (57% 3-yr DFS vs. 42%, p = 0.045) with a trend to improved DFS in patients with high IFP tumors (57% 3-yr DFS vs. 44% for RT alone, p = 0.056). A strong interaction was identified between IFP and treatment (CRT vs. RT, p = 0.007). After correcting for the effects of clinical prognostic factors, cisplatin significantly improved DFS in the high IFP group (p = 0.02), and showed a trend towards improved DFS in those with hypoxia (p = 0.1). In patients with both high IFP and hypoxia a similar benefit of cisplatin was seen. Conclusions: Patients with high IFP and hypoxic tumours may selectively benefit from the addition of concurrent cisplatin CRT to their treatment regimen. This observation is contrary to an effect of high IFP on impaired drug delivery, but may reflect reduced DNA repair under hypoxic conditions, which could facilitate cell killing with both radiation and cisplatin chemotherapy. No significant financial relationships to disclose.
Case 11-2012
Authors: Richard N. Channick, Mayra E. Lorenzo, Carol C. Wu, Mai P. Hoang
Journal: New England Journal of Medicine (2012)

A 60-year-old man from coastal New England was admitted to this hospital because of fever, weakness, rash, and renal failure. An initial measurement of creatine kinase was 20,437 U per liter. A diagnostic test was performed.