tbuckley/cabot-search huggingface dataset:
Use of Epinephrine for Cardiac Arrest Prior to Hospital Arrival
Authors: Lars Wiuff Andersen, Amanda Graver, Michael W. Donnino
Journal: JAMA (2012)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
GPR91 deficiency exacerbates allergic contact dermatitis while reducing arthritic disease in mice
Authors: T. Rubić-Schneider, N. Carballido-Perrig, C. Regairaz, L. Raad, S. Jost, C. Rauld, B. Christen, G. Wieczorek, R. Kreutzer, J. Dawson, G. Lametschwandner, A. Littlewood-Evans, J. M. Carballido
Journal: Allergy (2016)

Background Succinate, in addition to its role as an intermediary of the citric acid cycle, acts as an alarmin, initiating and propagating danger signals resulting from tissue injury or inflammatory stimuli. The contribution of this immune sensing pathway to the development of allergic and inflammatory responses is unknown. Methods Ear thickness of wild-type (wt) and Sucnr1-deficient (Sucnr1−/−) mice, sensitized and challenged with oxazolone, was used as a criterion to assess the relevance of SUCNR1/GPR91 expression mediating allergic contact dermatitis (ACD). Results obtained in this system were contrasted with data generated using passive cutaneous anaphylaxis, ovalbumin-induced asthma and arthritis models. Results We found augmented ACD reactions in Sucnr1−/− mice. This observation correlated with increased mast cell activation in vitro and in vivo. However, exacerbated mast cell activation in Sucnr1−/− mice did not contribute to the enhancement of asthma or arthritis and seemed to be due to alterations during mast cell development as augmented mast cell responses could be recapitulated in wt mast cells differentiated in the absence of succinate. Conclusions A deficiency in succinate sensing during mast cell development confers these cells with a hyperactive phenotype. Such a phenomenon does not translate into exacerbation of asthma or mast cell-dependent arthritis. On the contrary, the fact that Sucnr1−/− mice developed reduced arthritic disease, using two different in vivo models, indicates that GPR91 antagonists may have therapeutic potential for the treatment of allergic and autoimmune diseases.
Overall survival in patients with advanced melanoma (MEL) who discontinued treatment with nivolumab (NIVO) plus ipilimumab (IPI) due to toxicity in a phase II trial (CheckMate 069).
Authors: F. Stephen Hodi, Michael Andrew Postow, Jason Alan Chesney, Anna C. Pavlick, Caroline Robert, Kenneth F. Grossmann, David F. McDermott, Gerald P Linette, Nicolas Meyer, Jeffrey K. Giguere, Sanjiv Agarwala, Montaser F. Shaheen, Marc S. Ernstoff, David R. Minor, April K. Salama, Matthew H. Taylor, Patrick Alexander Ott, Joel Jiang, Paul Gagnier, Jedd D. Wolchok
Journal: Journal of Clinical Oncology (2016)

9518 Background: Results from CheckMate 069 demonstrated a significant improvement in objective response rate (ORR) and progression-free survival (PFS) with NIVO+IPI vs IPI alone in treatment-naïve patients (pts) with BRAF wild-type MEL (N Engl J Med 2015;372:2006). We evaluated overall survival (OS) in pts who discontinued treatment due to toxicity in this study. Methods: Pts (N = 142) were randomized 2:1 to receive NIVO 1 mg/kg plus IPI 3 mg/kg or IPI 3 mg/kg plus placebo every 3 weeks x 4 doses, followed by NIVO 3 mg/kg or placebo, respectively, every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint was ORR in pts with BRAF wild-type tumors. Secondary and exploratory endpoints included PFS and OS. A post-hoc analysis was performed to evaluate OS in pts who discontinued treatment due to toxicity. Results: At a follow-up of ≥18 months, median OS in pts who discontinued treatment was not reached with NIVO+IPI and was 11.2 months for IPI alone (Table). Similar 18-month OS rates were observed in pts who discontinued NIVO+IPI due to toxicity and in the overall treatment group (Table). Among pts who discontinued NIVO+IPI, ORR was 68% (27% achieved a complete response). Median duration of response was not reached and 21 of 30 pts (70%) remain in response. Grade 3/4 treatment-related adverse events (AEs) occurred in 55% of pts in the NIVO+IPI group vs 22% with IPI, and led to discontinuation in 30% and 9% of pts, respectively. In pts who discontinued NIVO+IPI due to toxicity, resolution rates of treatment-related select AEs ranged from 89% to 100% (40% for endocrine AEs). Efficacy updates, including 2-year OS rates, will be presented for these pts. Conclusions: These data suggest that pts who discontinue NIVO+IPI treatment due to drug toxicity derive an OS benefit similar to that observed in the overall population. Clinical trial information: NCT01927419. All randomized pts who discontinued due to toxicity All randomized BRAF wild-type pts NIVO+IPI (n = 44) IPI (n = 10) NIVO+IPI (N = 72) IPI (N = 37) Median OS, months (95% CI) NR 11.2 (2.2–NR) NR NR Hazard ratio (95% CI) 0.24 (0.09–0.70); P= 0.004 0.56 (0.29–1.10); P= 0.089 18-month OS rate, % 79.5 40.0 73.2 56.0 NR, not reached.
An approach to implementing meaningful change in a provincial health care system.
Authors: Michelle Ang, Elizabeth Lockhart, Michael Donald Brundage, Margaret Hart, Mark Hartman, Sophie Foxcroft, Lindsay Elizabeth Reddeman, Carina Simniceanu, Marissa Mendelsohn, Lisa Favell, Jonathan Wang, Elaine Meertens, Eric Gutierrez, Padraig Richard Warde
Journal: Journal of Clinical Oncology (2016)

120 Background: Radiation treatment (RT) is essential to cancer management, contributing to cure and symptom control. With increasing cancer incidence and treatment complexity, health systems must adapt to ensure patients (pts) receive the highest quality of care. Methods: With the objective of ensuring equitable access to high-quality, safe care, Cancer Care Ontario (CCO), a provincial government agency, identified provincial variability in RT activities. As a result, CCO prioritized 3 quality initiatives over the past 7 years: 1) Access to Intensity Modulated RT (IMRT) (2008-2013); 2) Peer Review of RT plans due to increasing RT planning complexity and the existence of high-profile RT errors (2012-present); and 3) Ensuring equitable access to RT (RT Utilization) (2014-present). Strategic plans were developed using change management framework adapted from the Kotter process for leading change (Kotter, JP. Harvard Bus Rev 73:59-67, 1995). In each initiative, CCO created a climate for change, engaged the provincial RT community to move priorities forward, and worked to sustain achieved gains. Results: CCO found that building a project team, communicating a clear understanding of goals and objectives, providing sufficient resources to cancer centres, and public reporting of results were key contributing success factors. IMRT project: Currently in sustainability phase. IMRT rates increased from 20% in 2008/09 - full implementation and target attainment in 2012/13. Public reporting continues. Peer Review of RT plans: Currently moving from engagement to implementation phase. Increase from 44% of RT cases undergoing peer review in 2013/14 to 68% in 2014/15. RT Utilization Project: Currently in engagement phase. Provincial shortfall of 11% in annual RT rates correlates to roughly 2500 pts who do not receive RT as needed. Engaging data experts and consulting with regional administrators, RT utilization is the current change priority for CCO’s RT program. Conclusions: These projects demonstrate the possibility of using change management practices to achieve quality improvement in healthcare. Ongoing work continues to ensure that pts in Ontario receive the highest quality cancer care.
Original Article : Predictors of spontaneous viral clearance and outcomes of acute hepatitis C
Authors: Yoo Kyung Cho, Young Nam Kim, Byung Cheol Song
Journal: Clinical and Molecular Hepatology (2014)

Background/Aims: This study evaluated the predictors of spontaneous viral clearance (SVC), as defined by twoconsecutive undetectable hepatitis C virus (HCV) RNA tests performed ≥12 weeks apart, and the outcomes of acutehepatitis C (AHC) demonstrating SVC or treatment-induced viral clearance. Methods: Thirty-two patients with AHC were followed for 12-16 weeks without administering antiviral therapy. Results: HCV RNA was undetectable at least once in 14 of the 32 patients. SVC occurred in 12 patients (37.5%), amongwhom relapse occurred in 4. SVC was exhibited in 8 of the 11 patients exhibiting undetectable HCV RNA within 12 weeks. HCV RNA reappeared in three patients (including two patients with SVC) exhibiting undetectable HCV RNA after 12weeks. SVC was more frequent in patients with low viremia than in those with high viremia (55.6% vs. 14.3%; P =0.02),and in patients with HCV genotype non-1b than in those with HCV genotype 1b (57.1% vs. 22.2%; P=0.04). SVC was morecommon in patients with a ≥2 log reduction of HCV RNA at 4 weeks than in those with a smaller reduction (90% vs. 9.1%,P<0.001). A sustained viral response was achieved in all patients (n=18 ) receiving antiviral therapy. Conclusions: Baseline levels of HCV RNA and genotype non-1b were independent predictors for SVC. A ≥2 log reductionof HCV RNA at 4 weeks was a follow-up predictor for SVC. Undetectable HCV RNA occurring after 12 weeks was notsustained. All patients receiving antiviral therapy achieved a sustained viral response. Antiviral therapy should beinitiated in patients with detectable HCV RNA at 12 weeks after the diagnosis. (Clin Mol Hepatol 2014;20:368-375)
Tofacitinib for polyarteritis nodosa: a tailored therapy
Authors: Doron Rimar, Ayelet Alpert, Elina Starosvetsky, Itzhak Rosner, Gleb Slobodin, Michael Rozenbaum, Lisa Kaly, Nina Boulman, Abid Awisat, Shira Ginsberg, Karina Zilber, Shai S Shen-Orr
Journal: Annals of the Rheumatic Diseases (2016)

Tofacitinib is a novel inhibitor of Janus kinase (JAK) 3 and JAK1 is recently introduced as treatment for rheumatoid arthritis.1 The JAK inhibitors are at the focus of research in a myriad of other inflammatory diseases2 ,3 as the JAK-(signal transducer and activator of transcription) STAT pathway has a central role in cytokine signal transduction. We herein describe a case of refractory polyarteritis nodosa (PAN) successfully treated with tofacitinib.

A 28-year-old man had been diagnosed with PAN at age 14. He presented with livedo reticularis, arthritis and skin nodules with arteritis/fibrinoid necrosis confirmed on biopsy. Immunological panel at the time of diagnosis was negative for antineutrophil cytoplasmic antibodies, anti-nuclear antibodies, anti-Ro/SS-A antibodies, anti-La/SS-B antibodies, rheumatoid factor, with normal complement levels. He was treated with azathioprine and methotrexate for several years with drug-controlled complete remission. At age 24, his disease flared and he began to suffer from necrotic lesions of the scrotum and calves, excruciating abdominal pain and polyarthritis, with high C-reactive protein (CRP) levels (160–300 mg/L) for which he received recurrent intravenous methylprednisolone pulses and oral …
GP appointments should be 15 minutes long, says BMA
Authors: Gareth Iacobucci
Journal: BMJ (2016)

The BMA has called for GP appointment times in England to increase from 10 minutes long to 15 minutes and for the number of consultations per doctor to be substantially cut to help reduce workload pressure.

The recommendations are outlined in a new report that aims to tackle the “unsustainable” pressure caused by rising demand, falling resources, and staff shortages.1 The BMA said that GPs were currently forced to see up to 60 patients a day in 10 minute appointment slots that were inadequate for the increasingly complex conditions that patients present with.

Additional funding pledged by the government should be used to recruit more GPs and …
Mild photothermal therapy/photodynamic therapy/chemotherapy of breast cancer by Lyp-1 modified Docetaxel/IR820 Co-loaded micelles
Authors: WenTing Li, JinRong Peng, LiWei Tan, Jing Wu, Kun Shi, Ying Qu, XiaWei Wei, ZhiYong Qian
Journal: Biomaterials (2016)
Prospective Study of the Diagnostic Accuracy of the In Vivo Laser Scanning Confocal Microscope for Severe Microbial Keratitis
Authors: Jaya D. Chidambaram, Namperumalsamy V. Prajna, Natasha L. Larke, Srikanthi Palepu, Shruti Lanjewar, Manisha Shah, Shanmugam Elakkiya, Prajna Lalitha, Nicole Carnt, Minna H. Vesaluoma, Melanie Mason, Scott Hau, Matthew J. Burton
Journal: Ophthalmology (2016)

To determine the diagnostic accuracy of in vivo confocal microscopy (IVCM) for moderate to severe microbial keratitis (MK).Double-masked prospective cohort study.Consecutive patients presenting to Aravind Eye Hospital, Madurai, India, between February 2012 and February 2013 with MK (diameter ≥3 mm, excluding descemetocele, perforation, or herpetic keratitis).Following examination, the corneal ulcer was scanned by IVCM (HRT3/RCM, Heidelberg Engineering, Heidelberg, Germany). Images were graded for the presence or absence of fungal hyphae or Acanthamoeba cysts by the confocal microscopist who performed the scan (masked to microbial diagnosis) and 4 other experienced confocal graders (masked to clinical features and microbiology). The regrading of the shuffled image set was performed by 3 graders, 3 weeks later. Corneal-scrape samples were collected for microscopy and culture.The main outcome measures were sensitivity, specificity, and positive and negative predictive values of IVCM compared with those of a reference standard of positive culture or light microscopy. Sensitivities and specificities for multiple graders were pooled and 95% confidence intervals calculated using a bivariate random-effects regression model.The study enrolled 239 patients with MK. Fungal infection was detected in 176 (74%) and Acanthamoeba in 17 (7%) by microbiological methods. IVCM had an overall pooled (5 graders) sensitivity of 85.7% (95% confidence interval [CI]: 82.2%-88.6%) and pooled specificity of 81.4% (95% CI: 76.0%-85.9%) for fungal filament detection. For Acanthamoeba, the pooled sensitivity was 88.2% (95% CI: 76.2%-94.6%) and pooled specificity was 98.2% (95% CI: 94.9%-99.3%). Intergrader agreement was good: κ was 0.88 for definite fungus; κ was 0.72 for definite Acanthamoeba. Intragrader repeatability was high for both definite fungus (κ: 0.88-0.95) and definite Acanthamoeba classification (κ: 0.63-0.90). IVCM images from 11 patients were considered by all 5 graders to have a specific organism present (10 fungus, 1 Acanthamoeba) but had negative results via culture and light microscopy.Laser scanning IVCM performed with experienced confocal graders has high sensitivity, specificity, and test reproducibility for detecting fungal filaments and Acanthamoeba cysts in moderate to large corneal ulcers in India. This imaging modality was particularly useful for detecting organisms in deep ulcers in which culture and light microscopy results were negative.
Use of carbon nanoparticles to identify parathyroid glands at thyroidectomy for patients of papillary thyroid cancer.
Authors: Anping Su, Tao Wei, Feng Liu, Yanping Gong, Yu Ma, Lebin Wen, Xiuhe Zou, Rixiang Gong, Zhihui Li, Jingqiang Zhu
Journal: Journal of Clinical Oncology (2015)

e17006 Background: Hypoparathyroidism secondary to parathyroid glands (PGs) injury is a major complication after thyroidectomy. This study was to evaluate whether carbon nanoparticles (CN) could be used for identification and protection of PGs during thyroidectomy for patients of papillary thyroid cancer (PTC). Methods: PTC patients underwent total thyroidectomy (TT) with ipsilateral or bilateral central lymph node dissection (CLND) were prospectively recruited between April 2013 and March 2014. They were assigned to CN or control group. CN suspension was injected into the thyroid glands for staining thyroid glands and lymph nodes, and PGs were protected as only stained thyroid glands and lymph nodes were dissected. The primary endpoints were PGs identification and protection during thyroidectomy and postoperative hypoparathyroidism rate. The perioperative factors of hypoparathyroidism were investigated by using univariate and multivariate analyses. Results: One hundred and thirty-nine TT patients had bilateral CLND and 69 had ipsilateral CLND. CN suspension injection was conducted in 135 patients. The mean number of PG identified during surgeries was significantly higher in the CN group compared with the control group (3.62 ± 0.68 vs 3.29 ± 0.79, P = 0.002). Fewer PGs were reimplanted in the CN group (0.73 ± 0.75 vs 0.96 ± 0.84, P = 0.048). Transient hypoparathyroidism was documented in 54 of the 135 patients (40.0%) in the CN group and in 40 of the 73 patients (54.8%) in the control group (P = 0.041). No permanent hypoparathyroidism was found in both groups. PG preservation, accidental PG resection and application of CN suspension had significant effects on the formation of transient hypoparathyroidism on univariate analysis. Multivariate analysis showed that PG preservation and accidental PG resection were the independent risk factors of transient hypoparathyroidism. Conclusions: CN suspension injection can be used to effectively reveal thyroid glands and lymph nodes for disscetion and thereby to protect PGs and to reduce the occurrence of transient hypoparathyroidism.
Traitement des calculs de la voie biliaire principale: essai randomisé ballonnet vs. extraction au panier
Authors: G Lesur
Journal: Endoscopy (2016)

Le traitement endoscopique des calculs de la voie biliaire principale (VBP) repose principalement sur l’extraction à l’aide d’une anse à panier ou d’un ballonnet. Sur ce point, les recommandations des sociétés américaine et européenne d’endoscopie digestive sont divergentes, la société américaine préconisant l’utilisation première d’un ballonnet alors que la société européenne ne conseille aucune méthode préférentiellement par rapport à une autre.
Long-term follow-up of patients (Pts) treated with bendamustine (B) for lymphoid malignancies.
Authors: Mara Emily Penne, Kruti Shashi Sheth, Maryam Sarraf Yazdy, Jiji Jiang, Bruce D. Cheson
Journal: Journal of Clinical Oncology (2016)

e14027 Background: B is an effective treatment for CLL and relapsed/refractory NHL with an acceptable short-term toxicity profile. The long-term toxicities of B are less well established. This retrospective study investigated the long-term effects of B and pt responses to subsequent treatments. Methods: Between 4/2008-6/2015, 193 pts received B at our institution. Pts had FL (N = 62), CLL/SLL (N = 62), MCL (N = 19), lymphoplasmacytic lymphoma (N = 17), MZL (N = 16), DLBCL (N = 14), and HL (N = 3). Median (med) starting B dose was 90 mg/m2. B was given with rituximab in 86% of pts for a med of 6 cycles. 54% (104) had received prior treatment, with 73% of these pts attaining a CR or PR. Results: Pts had the following responses to B: CR 57% (110), PR 22% (43), SD 8% (15) and progressive disease (PD) 13% (25). At a med follow-up of 31.2 months (mos) (1.5- 90.2 mos), 43% (82) had PD. Progression was seen in 29% of pts treated with 1st line B and 54% of pts treated with salvage B. The med PFS was 47.4 mos. The med event free survival was 50.1 mos. 44% (84) received ≥ 1 subsequent treatments. Responses (CR or PR) to subsequent treatment for those with prior CR/PR with B included: 0/3 to chemotherapy (CT), 24/41 (59%) to chemoimmunotherapy (CIT), and 4/5 to allogeneic (allo) transplant. Responses (CR or PR) to subsequent treatment for those with prior SD/PD with B included: 2/12 to CT, 7/24 (29%) to CIT, and 3/3 to allo transplant. Malignancies following B were diagnosed in 17% (32) of pts (1st line B pts (12) and salvage B pts (20)) and included transformation to DLBCL (9), squamous (9) or basal cell (5) skin cancer; cancer of the prostate (5), kidney (3), bladder (2), lung (2); melanoma (2), histiocytic carcinoma (1), cholangiocarcinoma (1), and plasmablastic lymphoma (1). There were no secondary leukemias following B. Infection rate was 63% (121), although difficult to attribute solely to B (1st line B pts (52), salvage B pts (69)). 40% had a previous history of infection. 15% had therapy between B and first infection date. Most common infections included pneumonia (56), upper respiratory tract infection (53), zoster (29), and cellulitis (27). Med time to infection was 11.3 mos. Conclusions: B is an effective therapy with limited long-term sequelae in pts with lymphoid malignancies.
Портальная гипертензивная гастропатия (Обзор литературы)
Authors: Yu.M. Stepanov, O.V. Simonova, V.I. Didenko
Journal: GASTROENTEROLOGY (2016)

Статья посвящена портальной гипертензивной гастропатии (ПГГ) — вторичному изменению слизистой оболочки и подслизистого слоя желудка на фоне цирроза печени (ЦП) любой этиологии и сопутствующей ему портальной гипертензии. В обзоре представлены данные, касающиеся истории изучения данной патологии, эпидемиологии, патогенеза, клинических проявлений, методов диагностики и лечения. Показано, что в основе заболевания лежит портальная гипертензия, приводящая к нарушению микроциркуляции в слизистой желудка, и как следствие — к полнокровию и венозному застою. Клиническое течение ПГГ в большинстве случаев бессимптомное. Основным методом диагностики является эндоскопический, базирующийся на определенных макроскопических признаках. В обзоре рассмотрены основные эндоскопические классификации ПГГ. Основные гистологические изменения при ПГГ включают расширение капилляров и венул в слизистом и подслизистом слое без существенного воспаления. Течение ПГГ динамичное. К осложнениям ПГГ относятся хронические и, реже, острые кровотечения. Лечение медикаментозное, с использованием неселективных бета-блокаторов
Syrian doctors appeal to President Obama for help
Authors: Gareth Iacobucci
Journal: BMJ (2016)

A group of the few remaining doctors in the war torn Syrian city of Aleppo have written an open letter to US President Barack Obama urging him to intervene to halt the “atrocities” being carried out.

The plea came as the United Nations launched an investigation after evidence emerged of a chlorine gas attack on citizens still living in an area of the city held by rebel forces.1

Aleppo has been besieged by violent conflict since the outbreak of civil war in Syria in 2011. Fighting has intensified in recent months as Russian backed Syrian government forces have targeted rebel groups that were controlling parts of the city.

In their open letter to the US president, 15 of the doctors serving the remaining 300 000 citizens of eastern Aleppo provided a harrowing account of their daily working …