tbuckley/cabot-search huggingface dataset:
Ferric Carboxymaltose Alone or Combined with Erythropoietin Allows a Modest Increase in Hemoglobin for the Treatment of Cancer-Related Anemia in Advanced Cancer Patients
Authors: Cécile Blanc, Marie-Eglantine Dujaric, Caroline Giard, Bernard Asselain, Isabelle Ferry, Sylvie Glaisner, Céline Callens, Jacques Vargaftig
Journal: Blood (2014)
Prognostic value of the maximum standardized uptake value of staging FDG-PET/CT in Hodgkin lymphoma.
Authors: Boyu Hu, Alekhya Potluri, Drew A. Torigian, Daniel F Heitjan, Sunita Nasta, Stephen J Schuster, Jakub Svoboda
Journal: Journal of Clinical Oncology (2014)

e19552 Background: Prognostication of clinical outcomes in patients with Hodgkin lymphoma (HL) at diagnosis is traditionally based on clinical and laboratory factors. While molecular imaging with interim FDG-PET/CT is prognostic in patients undergoing active chemotherapy, the correlation of imaging findings seen on staging FDG-PET/CT with clinical outcome has not been defined. We hypothesized that maximum standardized uptake value (SUVmax) on the staging FDG-PET/CT could reflect tumor characteristics and be used as a prognostic biomarker of clinical outcome in HL. Methods: We conducted a retrospective study of patients with a new diagnosis of HL and of those with relapsed/refractory HL treated in our institution between 2007–2011 who underwent staging FDG-PET/CT prior to initial first line therapy. We collected data on tumor SUVmax from staging scans and on clinical characteristics. Logistic regression, receiver operating characteristic (ROC) analysis, and proportional hazards regression were employed to determine if SUVmax was predictive of progression-free survival (PFS). Results: Sixty nine patients were identified. Thirty-two (46%) had refractory disease or eventually relapsed after first line therapy. Median follow-up was 47 months. Average tumor SUVmax was 12 for patients without progression and 11.1 for those with relapsed/refractory disease. There was no significant association of SUVmax with PFS by Cox regression (hazard ratio 0.98, 95% CI 0.92–1.06). ROC curve analysis for PFS <6 months gave an odds ratio (OR) of 0.98 (95% CI 0.85–1.13; ROC area = 0.55). Similar results were found on PFS <12 months with OR 1.04 (95% CI 0.93–1.16; ROC area = 0.53), and PFS <24 months with OR 1.02 (95% CI 0.92–1.13; ROC area = 0.50). Conclusions: SUVmax on initial staging FDG-PET/CT had no prognostic value in predicting PFS in our cohort of HL patients. We are currently investigating other parameters, including metabolic tumor volume and total lesion glycolysis as prognostic biomarkers. Efforts to better characterize tumors by molecular imaging for prognostic purposes could ultimately lead to tailoring the intensity of initial treatment for HL patients.
Differences in Insulin, Growth Hormone and Pancreatic Enzyme Secretion after Intravenous and Intraduodenal Administration of Mixed Amino Acids in Man
Authors: Sotos Raptis, Hans C. Dollinger, Karl E. Schröder, Mark Schleyer, Gerhard Rothenbuchner, Ernst F. Pfeiffer
Journal: New England Journal of Medicine (1973)

To determine whether intestinal hormones have a physiologic role in amino-acid-induced secretion of insulin, growth hormone and pancreatic enzymes, 42 metabolically normal human subjects were studied. An amino acid mixture (30 g) was administered intravenously and intraduodenally. A higher rise in serum insulin occurred after the intraduodenal application, and took place before the maximum blood concentration of amino acids was reached. Blood sugar, nonesterified fatty acids and free glycerol concentrations fell more clearly after intraduodenal administration. The route of administration did not significantly affect blood concentrations of growth hormone. After intraduodenal amino acids, the volume and bicarbonate contents of the duodenal juice rose slightly, whereas trypsin and bilirubin content increased considerably. These results suggest that, after oral administration of amino acids in man, only the secretion of insulin is clearly influenced by intestinal factors. Much evidence suggests that cholecystokinin-pancreozymin is such a factor. (N Engl J Med 288:1199–1202, 1973)
Case 41-1989
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Donald E. Craven, Paul B. Googe
Journal: New England Journal of Medicine (1989)

Presentation of CaseA 65-year-old man was admitted to the hospital because of bullous cellulitis of the left lower extremity.The patient was in a stable state of health until seven days earlier, when he waded in the muddy waters, with oil slicks, of an estuarial river near Cape Cod to retrieve an anchor. Although he was not aware of any injury, about two hours later he began to experience increasing pain in the left ankle, with erythema, swelling, and tenderness that progressed rapidly up the leg. Six hours thereafter the patient crawled to a telephone to call an ambulance . . .
The Office for Human Research Protections and the NIH
Authors: Roy W. Beck
Journal: New England Journal of Medicine (2003)

To the Editor: Steinbrook notes in his Perspective article (Aug. 14 issue)1 that in its review of the protocols for the trials of treatment for the acute respiratory distress syndrome (ARDS) conducted by the ARDS Network, the Office for Human Research Protections (OHRP) concluded that institutional review boards (IRBs) must use greater rigor in fulfilling their regulatory obligations.2 In multicenter trials, study subjects would be far better served by centralization of the responsibility for the protection of human subjects than by reliance on an inefficient and sometimes ineffective system in which multiple IRBs duplicate each other's efforts in performing this . . .
S39 Preliminary Results of a Latent Tuberculosis Screening and Treatment Project and the Role of TB Services in Secondary Care
Authors: MGK Burman, G Ahmed, JL Potter, VLC White, N Jayasekera, H Kunst
Journal: Thorax (2015)

<h3>Introduction</h3> Since July 2014, the London Borough of Newham has offered latent tuberculosis (TB) screening to all recent migrants (residing in the UK less than 5 years), aged 16–50 years, from countries with a TB incidence of greater than 150/100 000 cases/year. All migrants are offered an interferon gamma-release assay (IGRA) when registering with a general practitioner. Active TB is excluded by the GP using chest radiography, blood tests and clinical examination. All IGRA positive patients are tested for HIV, Hepatitis B and C. All patients without underlying liver disease, Hepatitis B, C or HIV infection and those who are not immunosuppressed are offered treatment for LTBI with Rifampicin and Isoniazid for 3 months in primary care. Patients with positive results not meeting the above exclusion criteria are referred to the local secondary care service using a standardised referral protocol. We conducted a retrospective study reviewing records of all patients referred to secondary care from the LTBI screening programme. <h3>Results</h3> From July 2014 to March 2015, a total of 5683 patients were offered screening. 3272 proceeded to IGRA testing of which 866 were positive. Of these patients, 138 were referred to the TB clinic. The most common reasons for referral were symptoms suggestive of active TB (26%), abnormal liver function tests (19%) before and after initiation of treatment, an abnormal chest radiograph (CXR) (10%), Pregnancy or breastfeeding (9%), Hepatitis B or C infection (7%) or previously treated latent or active TB (7%). Of those referred, 11 patients were found to have active disease. 6 patients had mediastinal lymphnode TB, 4 pulmonary and one patient had TB of the knee. <h3>Conclusion</h3> Screening for latent tuberculosis in primary care has identified a significant of number of cases of active Tuberculosis, particularly mediastinal TB.
Delayed Onset of Chloroquine Retinopathy
Authors: Robert P. Burns
Journal: New England Journal of Medicine (1966)

PERMANENT loss of vision from retinopathy may be a most serious sequel of prolonged chloroquine therapy. This complication, recognized only after a decade of use of this drug, is still not clearly delineated. In the early and intermediate stages there is a highly variable clinical expression, which has led to understandable confusion with other forms of retinal macular degeneration. Also, there has been a justifiable delay by those who have found chloroquine to be a valuable drug in accepting such an ill defined side effect. It is the purpose of this report to describe still another aspect of this disease . . .
Focal Inflammatory Myositis on 18F-FDG PET/CT
Authors: Olivia Bennett, Aravind S. Ravi Kumar, Julie Agnew
Journal: Clinical Nuclear Medicine (2016)

Focal myositis is a rare benign inflammatory pseudotumor that can mimic malignancy, clinically and on imaging. A 34-year-old man presented with a 3-week history of sudden-onset, nontender, left upper neck mass that was nonresolving with antibiotics. Anatomical imaging was concerning for a sarcoma of the sternocleidomastoid muscle with possible regional nodal metastases and surrounding inflammatory change. F-FDG PET/CT showed marked FDG uptake extending around the anterior border of the sternocleidomastoid muscle with no FDG-avid local nodal disease. Core biopsy of the sternocleidomastoid muscle and adjacent node revealed inflammatory changes. A diagnosis of focal inflammatory myositis was made.
Statistics of Diabetes
Authors: Herbert H. Marks
Journal: New England Journal of Medicine (1946)

THE statistics of diabetes will be considered under eight headings — prevalence of diabetes, characteristics of the diabetic population, mortality from diabetes, international comparisons, trend of diabetes in wartime, significance of geographical variations in diabetes, longevity of diabetic patients and use of statistics in clinical diabetes.Prevalence of DiabetesThe first consideration is the total volume of diabetes in the country. Frankly, it is not known with any degree of accuracy how many diabetic persons there are in the United States, but there is a certain body of facts on which to work. Some guidance can be gained from the . . .
Implementation of an integrated cancer care network
Authors: J. Latreille, A. Samson, U. Tran, C. Mimeault, C. Boily, B. Laflamme, A. Loutfi
Journal: Journal of Clinical Oncology (2009)

e17564 Background: In 1998, the province of Quebec adopted its cancer control program (CP). Its goal was to establish a hierarchical and integrated cancer network of interdisciplinary teams. In 2004, a team evaluation process was initiated by the Direction de la lutte contre le cancer (ministry of health) to help implement this program. Methods: The evaluation consisted of completion of a matrix by the requesting team, a visit by a multidisciplinary group of experts and a report card. Three levels of expertise were assessed: core (all), regional (regional hospitals), and supraregional (tumor specific/complex situations). The matrix was based on the fundamental orientations of the CP, thus setting the framework for patient centered care. The conformity indicators were mainly structural and process oriented. In order to be evaluated for the subsequent mandates, teams had to conform to the core mandate. Those who did not succeed had one year to reapply. Mandates are for 4 years. Results: Teams were able to comply with most of the elements of the evaluation matrix. Sessions for clarification and coaching about this new interdisciplinary approach were necessary and helpful. A total of 153 visits were done:70 for core, 8 for regional and 75 for supraregional mandates respectively. Major health institutions such as university hospitals applied for multiple supraregional team designation. In all, 130 teams had their designation confirmed. This process highlighted some common weaknesses such as the lack of use of data for quality control. Conclusions: Acceptance of this hierarchical cancer care model was facilitated by the fact that it was in line with the integrated health care network of Quebec. The evaluation process has had an impact on the way cancer care is delivered in Quebec. This initial phase has helped implement an interdisciplinary patient centered model of care in line with the CP. Participation of different experts has also helped foster knowledge transfer and appropriation of the process. Impact on patient care and satisfaction remains to be assessed. An initial patient's questionnaire has been completed in 2008 and will serve as a control to future surveys. No significant financial relationships to disclose.
NIMG-04ADAPTIVE AND STANDARD PHARMACOKINETIC MODEL SELECTION TECHNIQUES IN QUANTITATIVE ANALYSIS OF DYNAMIC CONTRAST ENHANCED MRI STUDIES
Authors: Hassan Bagher-Ebadian, Mohammadreza Mohammadian-Behbahani, Hamid Soltanian-Zadeh, Brent Griffith, David Nathanson, Milan Pantelic, Stephen Brown, James Ewing
Journal: Neuro-Oncology (2015)

In quantitative analysis of tissue vascular permeability using Dynamic-Contrast-Enhanced (DCE) MR data analysis, one of the main challenges is to choose the best Pharmacokinetic (PK) model among competing models to describe the behavior of the time trace of contrast agent (CA) concentration. The F-Statistic (F-test), Akaike-Information-Criterion (AIC), Bayesian-Information-Criterion (BIC), and Log-Likelihood-Ratio (LLR) tests are the most widely used classical Model-Selection (MS) techniques. Our group has recently introduced an Adaptive-MS (AMS) method to perform PK-MS in DCE-MRI data. This study investigates the performance of different MS techniques (Classical and Adaptive) for selection of the PK model as well as the impact of the recruited technique on the estimation of PK parameters. In this study, three physiologically Nested Models were used to describe possible physiological conditions of underlying tissue pathology as Model 1, 2, and 3 respectively: The tissue-vascular-compartment is filled with CA with no outward-leakage, with outward-leakage but no evidence of back-flux, and with both outward-and backward-flux. Plasma volume vp, vp, and ktrans, vp, ktrans and kep, are the PK parameters for Models 1, 2 and 3 respectively. 21 Arterial Input Function curves were used to simulate the CA profile. By varying PK parameters (time-resolution = 5.03 sec), 9072 time traces for 12 levels of SNRs were generated. Then confusion matrices were computed for all the MS techniques over 9072 tested hypotheses. The performance of the AMS is superior to the other classical techniques. Other techniques show performances in the following order: LLR, BIC, AICc, AIC and F-Test. All techniques never miss any leaky tissue. Also the AMS generates significantly less-biased estimates of PK parameters compared to the classical techniques while the LLR and BIC methods outperform the other classical techniques. This study suggests that AMS, LLR, and BIC are the best candidates among the MS techniques for PK analysis of DCE-MRI data.
Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland
Authors: Claudia A. Steiner, Eric B. Bass, Mark A. Talamini, Henry A. Pitt, Earl P. Steinberg
Journal: New England Journal of Medicine (1994)

Since 1989, laparoscopic cholecystectomy has been widely adopted as a treatment for gallstone disease. We analyzed the association between the introduction of this procedure and three variables: the rate at which cholecystectomy was performed in Maryland, the characteristics of patients undergoing cholecystectomy in routine clinical practice, and operative mortality.
New Q Waves after Aortocoronary Bypass Surgery
Authors: Mayer M. Bassan, Robert Oatfield, Irwin Hoffman, Jack Matloff, H. J. C. Swan
Journal: New England Journal of Medicine (1974)

Review of records of 48 patients, who had had aortocoronary bypasses and preoperative and postoperative catheterizations, showed that 11 had new Q waves after operation. Seven of these had new infarctions immediately before or during operation as determined by evidence of deterioration on postoperative ventriculograms. Four cases had no deterioration, suggesting an alternative explanation for abnormal Q waves. These four patients with new Q waves, all in the inferior leads, had inferior-wall dysfunction before operation, with an inferior scar at surgery. After operation, anterior-wall function improved, without change inferiorly. These observations are consistent with unmasking of pre-existing infarction, rather than development of new infarction, and suggest that before operation, anterior ischemia electrically canceled inferior infarction. After operation, with relief of anterior ischemia by left-descending-coronary-artery bypass, anterior electrical force was augmented, and pre-existing inferior infarction unmasked. (N Engl J Med 290:349–353, 1974)
Gastrointestinal-Tract Hemorrhage Due to Gall-Bladder Disease
Authors: William M. Stahl
Journal: New England Journal of Medicine (1959)

HEMOBILIA, or massive bleeding through the bile ducts into the gastrointestinal tract, is an uncommon occurrence. It has been reported from a variety of causes, most frequently in cases of trauma to the liver.1 , 2 In these cases it is a rare complication, and only 13 cases have been noted3 in the literature since Owen4 first reported it in 1848. Gross or massive bleeding from nontraumatic lesions of the gall bladder, liver or bile ducts is also rare. Twelve authenticated cases have been collected from the literature, and 1 is here reported. Fifteen other cases have been noted in which bleeding . . .
Gastrointestinal Angiodysplasia and Aortic Stenosis
Authors: Theodore E. Warkentin, Jane C. Moore, David G. Morgan
Journal: New England Journal of Medicine (2002)

To the Editor: Nuckton and associates (April 25 issue) 1 report an abnormally high dead-space fraction (the ratio of dead-space ventilation to tidal volume, or V D /V T ) early in the clinical course of the acute respiratory distress syndrome.Their inference of a heretofore unrecognized functional abnormality is unwarranted, because V D /V T was assessed on the basis of carbon dioxide excretion with the usual Bohr-Enghoff equation.By definition, the patients had refractory hypoxemia, which reflects a severe imbalance between alveolar ventilation (V A ) and perfusion (Q), leading to a reduction in the efficiency of intrapulmonary gas transfer for both oxygen and carbon dioxide. 2 Thus, assessment of V D /V T on the basis of carbon dioxide excretion is sensitive to any imbalance in V A /Q -notably, in the midrange of values for V A /Q -and even shunt, although to a lesser extent. 3,4 This fact depends on the carbon dioxide bloodair partition coefficient's being relatively close to the normal range of V A /Q. 4 Specific assessment of high V A /Q areas and "true" dead space is possible, although practical only in small numbers of subjects, with the multiple inert gas elimination technique.We found that in eight patients with the acute respiratory distress syndrome, the mean (±SD) value for V D /V T as measured on the basis of carbon dioxide excretion was considerably higher (0.64±0.03) than the value as measured with the multiple inert gas elimination technique (0.37±0.04). 5 In only one of these subjects did we detect areas with high values for V A /Q (range, 10 to 100).That V D /V T was more closely correlated with the outcome than was the ratio of the partial pressure of oxygen (PaO 2 ) to the fraction of inspired oxygen (FiO 2 ) remains a novel and highly relevant finding of the study by Nuckton et al. that may be due to the greater influence on the latter index of factors not intrinsic to the lung -notably, FiO 2 and mixed venous oxygen content.
Case 25-1995
Authors: J.R. Garber, E.T. Hedley-Whyte
Journal: New England Journal of Medicine (1995)

Presentation of CaseA 44-year-old woman was admitted to the hospital because of headache, blurred vision, and an intrasellar mass.She had been well until nine months earlier, when a vaginal hysterectomy was performed because of uterine prolapse; no oophorectomy was performed. Three months before admission occipital headaches developed and persisted for five weeks. Seven weeks before admission a computed tomographic (CT) scan of the cranium (Figure 1) disclosed a slightly enlarged, homogeneously enhanced pituitary gland (height, 12 mm). The patient began to have nocturnal hot flashes and insomnia. Hormonal studies were performed (Table 1).Five and a half weeks . . .
Differential outcomes in patients treated with endocrine therapy for early or locally advanced breast cancer based on BRCA mutation status
Authors: R. Wesolowski, A. G. Shealy, J. Tao, H. C. Moore
Journal: Journal of Clinical Oncology (2009)

e22065 Background: Mutations in BRCA1 and BRCA2 genes lead to defects in DNA repair. Estrogen receptor modulates transcription of genes responsible for cell division, which depends on cell's ability to repair DNA for genomic integrity. Differential efficacy of endocrine therapy for breast cancer, therefore, may be possible depending on the tumor's BRCA mutation status. Methods: Through an IRB approved registry, breast cancer patients tested for BRCA1 and BRCA2 mutations and treated with endocrine therapy for hormone-receptor positive non-metastatic disease were identified. Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS) respectively. Fisher's exact test or Wilcoxon rank sum test were used to assess differences among subgroups with respect to their characteristics. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors for OS and PFS. Results: Of 115 breast cancer patients tested for BRCA mutations, 63 met the inclusion criteria of whom 16 patients were BRCA 1 or 2 mutation positive and 47 were negative. In the BRCA(+) group, 14 patients (87.5%) had stage I-III disease at diagnosis. In the BRCA(-) group, 5 patients (10.6%) had stage 0 disease while 41 patients (87.2%) had stage I-III disease at diagnosis. Stage at diagnosis was unavailable for 2 BRCA(+) and 1 BRCA(-) patients. Both groups were similar with respect to Her-2 expression status, history of ovarian suppression, age of diagnosis, and age of menopause. Median age was 48 yo in BRCA(+) group, 42 yo in BRCA(-), (p=0.12). Median follow up was 76.1 mos in BRCA(+) and 62.9 mos in BRCA(-) group. OS was worse in BRCA(+) group (HR 7.38, 95% [CI] 1.49–36.4 p=0.014). After adjustment for stage and history of ovarian suppression, the difference remained significant (HR 16.6, 95% [CI] 1.95–142, p=0.010). There was no difference in PFS (HR 2.02, 95% [CI] 0.82–4.96, p=0.13). Conclusions: Patients with BRCA mutation, hormone-receptor positive hereditary breast cancer treated with endocrine therapy had inferior survival compared with similar patients who are BRCA mutation negative. Prospective studies to evaluate the differential effects of endocrine therapy in these populations are warranted. No significant financial relationships to disclose.
59PD Association of EGFR mutation subtypes with clinical and demographic characteristics of patients (pts) with aNSCLC: IGNITE and ASSESS pooled analysis
Authors: B. Han, M. Ratcliffe, V. Haddad, H. Brown, S. Tjulandin, K. Hagiwara, M. Reck, N. Normanno
Journal: Journal of Thoracic Oncology (2016)
Treatment of Intractable Narcolepsy with a Monoamine Oxidase Inhibitor
Authors: Richard J. Wyatt, David H. Fram, Rona Buchbinder, Frederick Snyder
Journal: New England Journal of Medicine (1971)

Seven patients with intractable narcolepsy were treated with the monoamine oxidase inhibitor, phenelzine. Striking reductions in the amount of cataplectic attacks, sleep paralysis and hypnagogic hallucinations were noted. In addition, daytime sleeping and hypersomnia were diminished, but side effects (hypotension, edema, impaired sexual function) were bothersome. Phenelzine almost completely suppressed rapid-eye-movement sleep and remained effective for periods of more than a year. Although dreams were frequently reported before drug treatment no dreams were reported when rapid-eye-movement sleep was completely absent. No adverse psychologic effects were noted during the period of total rapid-eye-movement suppression.