tbuckley/cabot-search huggingface dataset:
PTU-004 Enhanced recovery after surgery dvd – an new education tool
Authors: P Shah, M Rees, D Brown, P Haray
Journal: Gut (2015)

<h3>Introduction</h3> The Enhanced recovery after surgery (ERAS) is widely practiced in patients undergoing colorectal surgery, although there can be wide variation in practice and outcome due to staff and patient factors. Our aim was to develop an information resource that could be used to promote awareness and improve the acceptance of ERAS amongst patients, relatives and staff. <h3>Method</h3> A multidisciplinary project advisory group was set up. A project plan was prepared and DigiMed, a specialist Medical Videography company was commissioned. The project advisory group had representation from patients, carers, staff and the community health council who approved the scripts and draft versions of the DVD. Health Board employees and patients were formally consented and recruited to participate. The project was funded from a Health Board endowment fund. <h3>Results</h3> The project resulted in a 30-minute film with interactive features explaining the pre, peri and post-operative elements of ERAS. This is achieved by following 2 patients (each having surgery for a malignant and a benign indication respectively) in real time through their treatment journey, starting with managing patients’ expectations and pre-operative counselling. It covers various aspects of anaesthetic and operative techniques, post-operative nursing care, active mobilisation and physiotherapy. In addition, there are ‘red button’ options providing interactive access to extended sections of some steps of ERAS such as analgesia, post-operative care, preoperative stoma training and patient experiences. The emphasis is on de-mystification, clear communication of specific steps and the impact of multi-professional input into patient care. All of this is achieved in a very sensitive patient focused manner and the DVD has been deliberately generically designed to be used in any hospital which practices ERAS for colorectal surgery. <h3>Conclusion</h3> This product was launched in March 2013 and early feedback suggests that it will go a long way in alleviating anxiety amongst patients and relatives. It is anticipated that it will prove invaluable as a continuous learning tool for staff helping to achieve consistency in the care provided to colorectal surgical patients. <h3>Disclosure of interest</h3> None Declared.
Potential Effects of Managed Care on Specialty Practice at a University Medical Center
Authors: John E. Billi, Christopher G. Wise, Elizabeth A. Bills, Rita L. Mitchell
Journal: New England Journal of Medicine (1995)

The growth of managed care presents a challenge to academic medical centers, because the demand for the services of specialists is likely to continue decreasing. We estimated the number of enrollees the University of Michigan Medical Center would need in its health maintenance organization (HMO) system in order to provide revenue equivalent to the total revenue it received for professional specialty care in 1992.
An investigation of the postpsychotic depressive syndrome
Authors: T H McGlashan, W T Carpenter
Journal: American Journal of Psychiatry (1976)

Postpsychotic depression is an important clinical phenomenon about which little is known. Using data from a cohort of 30 schizophrenic patients, the authors examine the frequency of the syndrome, predictive variables, and its prognostic implications. Their findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.
Novel patient-derived xenograft and cell line models for therapeutic testing of pediatric liver cancer
Authors: Beatrice Bissig-Choisat, Claudia Kettlun-Leyton, Xavier D. Legras, Barry Zorman, Mercedes Barzi, Leon L. Chen, Mansi D. Amin, Yung-Hsin Huang, Robia G. Pautler, Oliver A. Hampton, Masand M. Prakash, Diane Yang, Malgorzata Borowiak, Donna Muzny, Harsha Vardhan Doddapaneni, Jianhong Hu, Yan Shi, M. Waleed Gaber, M. John Hicks, Patrick A. Thompson, Yiling Lu, Gordon B. Mills, Milton Finegold, John A. Goss, D. Williams Parsons, Sanjeev A. Vasudevan, Pavel Sumazin, Dolores López-Terrada, Karl-Dimiter Bissig
Journal: Journal of Hepatology (2016)
A Simple Diagnostic Sign in Ventricular Tachycardia
Authors: William S. Wilson, Richard D. Judge, John H. Siegel
Journal: New England Journal of Medicine (1964)

THE diagnosis of ventricular tachycardia without retrograde activation of the atrium is dependent upon the location of regular atrial activity that is independent of the faster ventricular rate. The electrocardiogram provides the best method for the detection of independent atrial activity, but it is well known that the electrocardiographic diagnosis of ventricular tachycardia is sometimes difficult, particularly in an emergency situation. There are the detection of independent atrial activity at the bedside. When identified in a patient with tachycardia, it therefore strongly supports a ventricular rather than a supraventricular source for the arrhythmia.ObservationsThe possibility of detecting independent atrial . . .
P35 Identifying Novel Predictors of Outcome in Sarcoidosis
Authors: P Minnis, M Poland, G Nolan, SC Donnelly
Journal: Thorax (2015)

<h3>Background and objectives</h3> Sarcoidosis is a multisystem disease of unknown aetiology characterised by a Th1 granulomatous immune response. Predicting need for treatment in sarcoidosis is based on well-recognised prognostic indicators.<sup>1</sup> We aimed to interrogate a large cohort of sarcoidosis patients in order to identify novel predictors for treatment and disease progression defined physiologically and radiologically. <h3>Methods</h3> Clinical data from 338 patients with sarcoidosis was recorded retrospectively including; age at diagnosis, gender, Scadding CXR stage at presentation, presence of Erythema Nodosum (EN), baseline inflammatory markers, immunoglobulin levels, skin prick testing (SPT), pulmonary function tests, BAL results and vitamin D levels. There was a minimum follow up of 2 years for all patients. The primary outcome measure was the need for treatment, defined as requiring oral corticosteroids for 6 months or more. Secondary outcome measures included need for steroid sparing agents and progression defined radiologically using scadding criteria or HRCT when available and assessing pulmonary function test decline. <h3>Results</h3> Multivariate analysis and modelling of all presenting features was performed. Patients were characterised into four groups-limited no treatment, limited requiring steroids, chronic but stable and chronic progressive steroid dependent. Overall the treatment rate was 50.4% in this cohort. In the chronic cohort 32% required steroid sparing agents. Initial analysis confirmed previously known prognostic indicators including Scadding CXR stage, age &gt;40 and presence of EN OR 0.24 (0.13–0.45), p &lt; 0.0001 at diagnosis. Additional predictors of prognosis included IgG levels, positive skin prick testing and vitamin D levels. In the group with elevated levels of IgG (IQR 15.7–19.8) at assessment the treatment rate was 77.1% OR 3.3 (1.5 to 7.6) p value 0.004. In the group with positive SPT, only 17.4% required treatment, OR 0.21 (0.07–0.62), p value 0.005. <h3>Conclusions</h3> These results indicate possible new markers of prognosis in terms of treatment and disease progression in sarcoidosis. Phenotyping sarcoid patients in this way may be valuable in designing future clinical trials in sarcoidosis. <h3>Reference</h3> 1 Neville E, Walker AN, Geraint James D. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients.<i> QJM</i> 1983;<b>4</b>:525–533
Therapy (Tx) of locally advanced (LA) NSCLC in the elderly: Analysis of 6,325 patients from Surveillance, Epidemiology and End Results (SEER)-Medicare
Authors: M. J. Edelman, M. Tang, J. F. Gardner, C. D. Mullins, B. Seal, A. J. Davidoff
Journal: Journal of Clinical Oncology (2008)

7549 Background: Little is known about patterns of tx for elderly w/ LA NSCLC ( IIIa, IIIb w/o effusion). Combined modality tx (CMT) (chemotherapy, C and radiation, R) is indicated for "fit" patients (pts) and is potentially curative. We examined population based tx patterns. Methods: Medicare pts ≥66 years with LA NSCLC who did not undergo surgery from 1997 to 2002 were identified in SEER registries. Medicare claims provided tx-related data. Multinomial logit models examined tumor and patient characteristics associated with tx (none, C only, R only, C+R). Of those who initiated C + R w/in 6 mo, we determined whether it was sequential (either C then R or R then C: C><R) or concurrent (C/R). We evaluated effects of claims-based indicators of poor performance status (PS) (eg. hospital stay, O2 or wheelchair use) prior to diagnosis. Results: 31.7% of 6,325 LA NSCLC pts received no tx; 10.0% C only; 28.8% R only; 10.2% C><R and 19.3% C/R (29.5% C+R). Platinum regimens accounted for 84.4% overall, and 76.6%, 84.4% and 88.5% of pts in the C only, C><R, and C/R groups. Single, non-platinum drugs were more common in the C only group (16.4%) compared to the C><R (12.3%) and C/R (9.8%) groups. Multivariate analysis: sex, age, marital status, substage (IIIa vs. IIIb), CHF, CVD, poor PS, consultation with medical oncologist, and Medicaid were significant in choice of therapy. Increasing age was associated with R only and reduced use of C only or with R. Married pts or w/ oncologist visit were more likely to receive any tx, particularly C and C+R. Pts w/ prior CHF and CVD were less likely to receive C+R. Poor PS was associated with no tx. Pts w/ potential access issues, e.g. rural residence were less likely to receive R only. There was no influence of race or income. Over time there has been reduced use of R only, with increasing use of C only, C + R, and no tx. Conclusions: 1. Most elderly pts do not receive CMT. 2. Comorbidities result in single modality therapy. 3. Claims-based indicators of poor PS are significant predictors; further research is warranted. 4. Advanced age is independently associated with reduced use of C+R. While this may reflect unmeasured comorbidity, poor PS, or preference, it may also reflect physician bias not to treat the fit elderly. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration sanofi-aventis sanofi-aventis sanofi-aventis sanofi-aventis sanofi-aventis
Presence of circulating tumor cells (CTC) in metastatic breast cancer (MBC) predicts rapid progression and poor prognosis
Authors: M. Cristofanilli, G. T. Budd, M. J. Ellis, A. Stopeck, J. Matera, M. C. Miller, G. V. Doyle, W. J. Allard, L. W. Terstappen, D. F. Hayes
Journal: Journal of Clinical Oncology (2005)

524 Background: We have previously reported that the presence of 5 or more circulating tumor cells (CTCs) in 7.5 mL of blood from women with metastatic breast cancer (MBC) is associated with poor survival (NEJM, 351:8, 781–791, 2004). We have updated this multi-institutional prospective clinical trial and included data of CTCs at different time points after initiation of therapy. Methods: CTCs/7.5mL whole blood were enumerated at baseline and at 3 or 4 week follow-up intervals for a period of six months in 177 patients with MBC about to start a new systemic therapy. CTCs were immunomagnetically separated and fluorescently labeled using the CellSearch Kit. Only nucleated (DAPI+) cells with the phenotype EpCAM+, Cytokeratin 8, 18 and/or 19+, and CD45- were counted using the CellSpotter Analyzer. Results: Median Progression Free Survival (PFS) and Overall Survival (OS) were determined for patients with <5 or ≥5 CTC /7.5mL at baseline and specified intervals. Significance between the two groups of patients (logrank) and the percentage of patients that were alive at 12 months (AL12) after the blood draw is indicated in the table below. In multivariate analyses CTC remained the strongest and most significant independent predictor of poor outcome. Conclusions: Presence of CTCs before initiation of therapy in MBC patients with measurable disease is a strong predictor of survival and suggests that different therapeutic approaches should be used for these two subsets. Furthermore the persistence of CTCs after initiation of therapy suggests that the patients are on futile therapy and might, therefore, benefit from a change in regimen. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Immunicon Immunicon
Estrogen Receptor β in Prostate Cancer
Authors: Otabek Imamov, Nikolay A. Lopatkin, Jan-Ake Gustafsson
Journal: New England Journal of Medicine (2004)

To the Editor: In the Prostate Cancer Prevention Trial,1 more than 18,000 healthy volunteers were randomly assigned to receive either finasteride (5 mg daily) or placebo. The incidence of prostate cancer in the finasteride group was 18.4 percent, as compared with 24.4 percent in the placebo group. A bigger surprise was that the incidence of tumors with a Gleason grade of 7, 8, 9, or 10 was higher in the finasteride group than in the placebo group (37.0 percent vs. 22.2 percent, P<0.001), meaning that there were more cases of aggressive cancer with finasteride than there were with placebo.1 We . . .
Genetic counselling in a national referral centre for pulmonary hypertension
Authors: Barbara Girerd, David Montani, Xavier Jaïs, Mélanie Eyries, Azzedine Yaici, Benjamin Sztrymf, Laurent Savale, Florence Parent, Florence Coulet, Laurent Godinas, Edmund M. Lau, Yuichi Tamura, Olivier Sitbon, Florent Soubrier, Gérald Simonneau, Marc Humbert
Journal: European Respiratory Journal (2015)

Genetic causes of pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease (PVOD) have been identified, leading to a growing need for genetic counselling. Between 2003 and 2014, genetic counselling was offered to 529 PAH and 100 PVOD patients at the French Referral Centre for Pulmonary Hypertension. Mutations in PAH-predisposing genes were identified in 72 patients presenting as sporadic PAH (17% of cases; 62 mutations in BMPR2 , nine in ACVRL1 ( ALK1 ) and one in ENG ) and in 94 patients with a PAH family history (89% of cases; 89 mutations in BMPR2 , three in ACVRL1 ( ALK1 ) and two in KCNK3 ). Bi-allelic mutations in EIF2AK4 were identified in all patients with a family history of PVOD (n=19) and in seven patients (8.6%) presenting as sporadic PVOD. Pre-symptomatic genetic diagnosis was offered to 272 relatives of heritable PAH patients, identifying mutations in 36.4% of them. A screening programme is now offered to asymptomatic mutation carriers to detect PAH in an early phase and to identify predictors of outcomes in asymptomatic BMPR2 mutation carriers. BMPR2 screening allowed us to offer pre-implantation diagnosis to two couples with a BMPR2 mutation. Genetic counselling can be implemented in pulmonary hypertension centres.
Circulating and Tissue Endothelin Immunoreactivity in Advanced Atherosclerosis
Authors: Amir Lerman, Brooks S. Edwards, John W. Hallett, Denise M. Heublein, Sharon M. Sandberg, John C. Burnett
Journal: New England Journal of Medicine (1991)

Atherosclerosis is characterized by endothelial injury and the proliferation of arterial smooth-muscle cells. The latter may be a result of the release of growth factors from the vessel wall; such growth factors may include an endothelium-derived vasoconstrictor peptide with mitogenic properties. We tested the hypothesis that plasma endothelin concentrations are elevated in persons with symptomatic atherosclerosis, independently of age.
Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden
Authors: Georgios Tsivgoulis, Ramin Zand, Aristeidis H. Katsanos, Guillaume Turc, Christian H. Nolte, Simon Jung, Charlotte Cordonnier, Jochen B. Fiebach, Jan F. Scheitz, Pascal P. Klinger-Gratz, Catherine Oppenheim, Nitin Goyal, Apostolos Safouris, Heinrich P. Mattle, Anne W. Alexandrov, Peter D. Schellinger, Andrei V. Alexandrov
Journal: JAMA Neurology (2016)

Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding. There are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT).To investigate the association of high CMB burden (>10 CMBs on a pre-IVT magnetic image resonance [MRI] scan) with the risk of sICH following IVT for AIS.Eligible studies were identified by searching Medline and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 7, 2015. This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal.Eligible prospective study protocols that reported sICH rates in patients with AIS who underwent MRI for CMB screening prior to IVT.The reported rates of sICH complicating IVT in patients with AIS with pretreatment MRI were extracted independently for groups of patients with 0 CMBs (CMB absence), 1 or more CMBs (CMB presence), 1 to 10 CMBs (low to moderate CMB burden), and more than 10 CMBs (high CMB burden). An individual-patient data meta-analysis was also performed in the included studies that provided complete patient data sets.Symptomatic intracerebral hemorrhage based on the European Cooperative Acute Stroke Study-II definition (any intracranial bleed with ≥4 points worsening on the National Institutes of Health Stroke Scale score).We included 9 studies comprising 2479 patients with AIS. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared with patients without CMBs (risk ratio [RR], 2.36; 95% CI, 1.21-4.61; P = .01). A higher risk for sICH after IVT was detected in patients with high CMB burden (>10 CMBs) when compared with patients with 0 to 10 CMBs (RR, 12.10; 95% CI, 4.36-33.57; P < .001) or 1 to 10 CMBs (RR, 7.01; 95% CI, 3.20-15.38; P < .001) on pretreatment MRI. In the individual-patient data meta-analysis, high CMB burden was associated with increased likelihood of sICH before (unadjusted odds ratio, 31.06; 95% CI, 7.12-135.44; P < .001) and after (adjusted odds ratio, 18.17; 95% CI, 2.39-138.22; P = .005) adjusting for potential confounders.Presence of CMB and high CMB burdens on pretreatment MRI were independently associated with sICH in patients with AIS treated with IVT. High CMB burden may be included in individual risk stratification scores predicting sICH risk following IVT for AIS.
Persistence of complete molecular remission in chronic myeloid leukemia after imatinib discontinuation: Interim analysis of the STIM trial
Authors: F. Mahon FX, D. Rea, F. Guilhot, L. Legros, J. Guilhot, E. Aton, S. Dulucq, J. Reiffers, P. Rousselot
Journal: Journal of Clinical Oncology (2009)

7084 Background: Imatinib (IM) has greatly improved survival in chronic myeloid leukemia (CML). However, IM must be continued for an indefinite period of time. A multicenter trial “Stop Imatinib” (STIM) was initiated in July 2007, in order to evaluate the persistence of complete molecular remission (CMR) after stopping IM and determine factors associated with CMR persistence. Methods: Inclusion criteria were IM treatment duration ≥3 years and sustained CMR, defined as BCR-ABL transcripts below a detection threshold of a 5-log reduction (undetectable by RQ-PCR) for ≥2 years. Molecular relapse was defined as RQ-PCR positivity confirmed on 2 successive occasions. In case of relapse, pts were rechallenged with IM at 400 mg daily. Molecular monitoring was performed according to international recommendations. Results: Sixty-nine pts were recruited among which 60 with a follow-up &gt;1 month, including 22 males and 38 females. Median age was 62 (29–80), 31 pts had been treated with IFN prior to IM and 29 with IM frontline (de novo). Median follow-up was 5 months (1–16). Relapse occurred in 37 pts within 6 months of IM discontinuation. Only 1 pt relapsed after 6 months (M7). All patients in molecular relapse were sensitive to IM reintroduction. At last follow-up in December 2008, CMR was sustained in 8 pts at M14 and 3 pts at M16. No differences in terms of demography, duration of IM treatment and CMR duration were found between pts who relapsed and those who did not. At M9, the probability of persistent CMR was 46% (95% CI: 32–59%), 53% (95% CI: 33–69%) for previously IFN-treated pts and 39% (95% CI: 20–58%) for de novo pts (p = 0.54). A trend for a lower probability of relapse in low Sokal score pts was observed. Conclusions: Our data confirm that CMR can be long-lasting after discontinuation of IM. Using stringent criteria, it is possible to stop IM in patients with sustained CMR, even in those treated with IM as a single agent. Updated follow-up will be presented. No significant financial relationships to disclose.
Transient Reversal of Thrombocytopenia in Idiopathic Thrombocytopenic Purpura by High-Dose Intravenous Gamma Globulin
Authors: Jorg Fehr, Victor Hofmann, Urs Rappeler
Journal: New England Journal of Medicine (1982)

Since recent observations indicate that treatment with high-dose intravenous polyvalent intact immunoglobulin leads to a rapid reversal of thrombocytopenia in the idiopathic thrombocytopenic purpura (ITP) of childhood, we decided to apply this treatment to adults with ITP and to test the possibility that the effect of the immunoglobulin might be attributable to transient blockade of the reticuloendothelial system. Using sequential clearance studies of autologous 99mTc-labeled and anti-Rh(D)-sensitized erythrocytes in four adults with ITP who were treated with total doses of 1 to 1.5 g of immunoglobulin per kilogram of body weight, we found that a transient rise in platelet counts to normal levels within four to five days was accompanied by a marked temporary prolongation of the immune-particle clearance time. These data suggest that commercial intravenous immunoglobulin preparations may interfere with phagocyte Fc-receptor-mediated immune clearance. Since platelets in ITP treated with immunoglobulin were fully hemostatic, this type of therapy may allow surgical procedures to be performed safely in patients with this disease.