tbuckley/cabot-search huggingface dataset:
Epidemiology and Mortality of <i>Staphylococcus aureus</i> Bacteremia in Australian and New Zealand Children
Authors: Brendan J. McMullan, Asha Bowen, Christopher C. Blyth, Sebastiaan Van Hal, Tony M. Korman, Jim Buttery, Lesley Voss, Sally Roberts, Celia Cooper, Steven Y. C. Tong, John Turnidge
Journal: JAMA Pediatrics (2016)

Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized.To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand.A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data.Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality.Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality.In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.
Study suggests it is safe to ease neutropenic restrictions
Authors: Mary Kay Barton
Journal: CA A Cancer Journal for Clinicians (2016)

Key Points Evidence is lacking that the commonly placed restrictions on diet, social contacts, and pets decrease infection rates in patients undergoing intense chemotherapy. The current study supports the relaxation of neutropenic restrictions. More research is needed to study social contact and pet restrictions, but major centers have relaxed dietary restrictions and emphasize a common sense approach.
Case 1-1979
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely
Journal: New England Journal of Medicine (1979)

Presentation of Case A 76-year-old woman was admitted to the hospital because of chest pain. There was a history of sarcoidosis, diagnosed by biopsy 16 years earlier, with cervical and hilar lympha...
Inflammation and frailty in the elderly: A systematic review and meta-analysis
Authors: Pinar Soysal, Brendon Stubbs, Paola Lucato, Claudio Luchini, Marco Solmi, Roberto Peluso, Giuseppe Sergi, Ahmet Turan Isik, Enzo Manzato, Stefania Maggi, Marcello Maggio, A. Matthew Prina, Theodore D. Cosco, Yu-Tzu Wu, Nicola Veronese
Journal: Ageing Research Reviews (2016)

The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n = 3232 frail, n = 11,483 pre-frail and n = 8522 robust, and 563 pre-frail + robust; 3 longitudinal studies n = 3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD = 1.00, 95%CI: 0.40–1.61) and 8568 pre-frail (SMD = 0.33, 95%CI: 0.04–0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n = 1057; SMD = 1.12, 95%CI: 0.27–2.13) and pre-frailty (n = 4467; SMD = 0.56, 95%CI: 0.00–1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n = 2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR = 1.06, 95%CI: 0.78–1.44,) and IL-6 (OR = 1.19, 95%CI: 0.87–1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed.
Multiple Nonspecific Sites of Joint Pain Outside the Knees Develop in Persons With Knee Pain
Authors: David T. Felson, Jingbo Niu, Emily K. Quinn, Tuhina Neogi, Cara Lewis, Cora E. Lewis, Laura Frey Law, Chuck McCulloch, Michael Nevitt, Michael LaValley
Journal: Arthritis & Rheumatology (2016)

Objective Many persons with knee pain have joint pain outside the knee, but despite the impact and high frequency of this pain, its distribution and causes have not been studied. We undertook this study to test the hypothesis of those studying gait abnormalities who have suggested that knee pain causes pain in adjacent joints but that pain adaptation strategies are highly individualized. Methods We studied persons ages 50–79 years with or at high risk of knee osteoarthritis who were recruited from 2 community‐based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, and we followed them up for 5–7 years. We excluded those with knee pain at baseline and compared those who had developed knee pain at the first follow‐up examination (the index visit) with those who had not. We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint‐specific pain adjusted for age, sex, body mass index, and symptoms of depression, and we performed sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, 693 persons had knee pain at the index visit and 2,793 did not. A total of 79.6% of those with bilateral knee pain and 63.8% of those with unilateral knee pain had pain during follow‐up in a joint region outside the knee, compared with 49.9% of those without knee pain. There was an increased risk of pain at most extremity joint sites, without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusion Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern.
CITED2 Cooperates with Low PU.1 and DNMT3A to Maintain Self-Renewal in Hematopoietic Stem Cells
Authors: Hein Schepers, Patrick Korthuis, Marjan Geugien, Jennifer Jaques, Tihomira I. Todorova, Ulrich Steidl, Jan Jacob Schuringa, Edo Vellenga
Journal: Blood (2015)
Highlights in Genitourinary (Prostate) Cancer
Authors: Robert Dreicer
Journal: JAMA Oncology (2016)

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Pregnancy and the Risk of Aortic Dissection or Rupture
Authors: Hooman Kamel, Mary J. Roman, Alex Pitcher, Richard B. Devereux
Journal: Circulation (2016)

Background: Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association. Methods: We performed a cohort-crossover study using data on all emergency department visits and acute care hospitalizations at nonfederal healthcare facilities in California, Florida, and New York. We included women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. Our outcome was a composite of aortic dissection or rupture. Based on the timing of reported aortic complications during pregnancy, we defined the period of risk as 6 months before delivery until 3 months after delivery. We compared each patient’s likelihood of aortic complications during this period with an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression with robust standard errors. Results: Among 6 566 826 pregnancies in 4 933 697 women, we identified 36 cases of aortic dissection or rupture during the pregnancy or postpartum period and 9 cases during the control period 1 year later. The rate of aortic complications was 5.5 (95% confidence interval, 4.0–7.8) per million patients during pregnancy and the postpartum period, in comparison with 1.4 (95% confidence interval, 0.7–2.9) per million during the equivalent period 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence rate ratio, 4.0; 95% confidence interval, 2.0–8.2) in comparison with the control period 1 year later. Conclusions: The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.
A phase I/II trial of cyclophosphamide, carfilzomib, thalidomide, and dexamethasone (CYCLONE) in patients with newly diagnosed multiple myeloma.
Authors: Joseph Mikhael, Craig B. Reeder, Edward N. Libby, Luciano Costa, Angela Mayo, P. Leif Bergsagel, Francis Buadi, Nicholas Pirooz, Jade Marie Lubben, Amylou C. Dueck, A. Keith Stewart
Journal: Journal of Clinical Oncology (2012)

8010 Background: Carfilzomib is a proteasome inhibitor that irreversibly binds its target with favorable toxicity profile that has shown significant activity in relapsed multiple myeloma (MM). Here we used carfilzomib as the center of a 4 drug induction regimen designed for MM patients pre stem cell transplant (SCT). Methods: We conducted a phase I safety run in 6 patients with no DLT observed before expanding to phase II. The phase II regimen is shown below. Treatment was for 4 cycles with expected SCT post induction. For the phase II portion of this trial, the primary endpoint is the proportion of patients who have ≥ very good partial response to treatment. All patients received herpes zoster prophylaxis and ASA daily. Results: Twenty seven patients were enrolled. Median age was 65 (range 27-74). ORR for evaluable patients (n=17) at phase II dosing is 100%: CR 35%, VGPR 48%, PR 18% after 4 cycles of CYCLONE. Grade 3 toxicity was reported in 52% of patients and 14% experienced a grade 4 toxicity. Grade 3/4 toxicities occurring in &gt;5% of patients included fatigue, neutropenia, lymphopenia, thromboembolism, myopathy. Toxicities of any grade seen in &gt;20% of patients included fatigue, constipation, lethargy, thrombocytopenia, somnolence, creatinine increased, malaise. Four patients (20%) developed grade 1 sensory neuropathy; no higher grade or painful neuropathy was evident. All patients are alive. All patients advancing to SCT successfully collected stem cells. One patient with t(4;14) disease who was not transplanted has progressed. 94% remain progression free. Conclusions: The 4 drug CYCLONE regimen has remarkable efficacy (83% ≥VGPR) and manageable toxicity in newly diagnosed patients with multiple myeloma. Especially notable was the low incidence of neuropathy and depth of response (CR 35%) after only 4 cycles. Given the relative lack of toxicity an extension of this regimen at higher doses of carfilzomib (20/45mg/m 2 ) has been initiated. [Table: see text]
Ganglion Plexus Ablation in Advanced Atrial Fibrillation
Authors: Antoine H.G. Driessen, Wouter R. Berger, Sébastien P.J. Krul, Nicoline W.E. van den Berg, Jolien Neefs, Femke R. Piersma, Dean R.P.P. Chan Pin Yin, Jonas S.S.G. de Jong, WimJan P. van Boven, Joris R. de Groot
Journal: Journal of the American College of Cardiology (2016)
Simplification to a dual regimen with darunavir/ritonavir plus lamivudine or emtricitabine in virologically-suppressed HIV-infected patients
Authors: Massimiliano Fabbiani, Simona Di Giambenedetto, Andrea Poli, Alberto Borghetti, Antonella Castagna, Annalisa Mondi, Nadia Galizzi, Myriam Maillard, Andrea Gori, Roberto Cauda, Andrea De Luca, Nicola Gianotti
Journal: Journal of Infection (2016)
Outrunning the Red Queen: bystander activation as a means of outpacing innate immune subversion by intracellular pathogens
Authors: Alicia M Holmgren, Cameron A McConkey, Sunny Shin
Journal: Cellular and Molecular Immunology (2016)

Originally described by the late evolutionary biologist Leigh Van Valen, the Red Queen hypothesis posits that the evolutionary arms race between hosts and their pathogens selects for discrete, genetically encoded events that lead to competitive advantages over the other species. Examples of immune evasion strategies are seen throughout the co-evolution of the mammalian immune system and pathogens, such as the enzymatic inactivation of nuclear factor-κB signaling or host translation by pathogen-encoded virulence factors. Such immunoevasive maneuvers would be expected to select for the evolution of innate immune counterstrategies. Recent advances in our understanding of host immunity and microbial pathogenesis have provided insight into a particular innate immune adaptation, termed bystander activation. Bystander activation occurs as a consequence of infected cells alerting and instructing neighboring uninfected cells to produce inflammatory mediators, either through direct cell contact or paracrine signals. Thus, bystander activation can allow the immune system to overcome the ability of pathogens to disarm immune signaling in directly infected cells. This review presents an overview of the general hallmarks of bystander activation and their emerging role in innate immunity to intracellular pathogens, as well as examples of recent mechanistic discoveries relating to the bystander activation during infection with specific pathogens relevant to human health and disease.
Клініко-патогенетичні аспекти хронічного панкреатиту біліарного генезу та ожиріння
Authors: L.S. Babinets, K.Yu. Kytsai
Journal: GASTROENTEROLOGY (2016)

У статті наведено аналіз літературних джерел щодо зв’язку хронічного панкреатиту біліарного генезу та ожиріння. При ожирінні спостерігаються дисгормональні розлади з утворенням надмірної кількості гормонів, що мають прозапальні властивості, та зниження кількості гормонів, що мають протизапальні властивості. Це супроводжується підтриманням і наростанням хронічного запального процесу у підшлунковій залозі (ПЗ), також підвищується ризик виникнення ускладнень. Ожиріння знижує зовнішньосекреторну функцію ПЗ внаслідок жирового переродження ацинарних клітин, призводить до атеросклерозу судин із наступним погіршенням трофіки ПЗ. При ожирінні спостерігається підвищений синтез та екскреція холестерину з жовчю, що супроводжується підвищенням її літогенності з утворенням біліарного сладжу та конкрементів.
Pathognomonic Palmar Crease Xanthomas of Apolipoprotein E2 Homozygosity-Familial Dysbetalipoproteinemia
Authors: Matan Rothschild, Greg Duhon, Rashid Riaz, Vybhav Jetty, Naila Goldenberg, Charles J. Glueck, Ping Wang
Journal: JAMA Dermatology (2016)
Can Botulinum Toxin Help Patients With Borderline Personality Disorder?
Authors: Tillmann H.C. Kruger, Michelle Magid, M. Axel Wollmer
Journal: American Journal of Psychiatry (2016)

people receiving diagnosis and treatment.However, we cannot exclude the possibility that increased usage has also occurred in other clinical conditions.We propose that practice guidelines be developed for psychiatrists and clinicians in other disciplines who prescribe antipsychotics for young children.
Negotiations have begun on new national GP funding formula
Authors: Abi Rimmer
Journal: BMJ (2016)

NHS England and the BMA have entered negotiations to agree a new funding formula for GP practices.

The new formula will replace the current global sum formula, also known as the Carr-Hill formula, which doctors have warned does not fund practices appropriately.1 NHS England said that it would not seek to implement any changes to the funding formula before 1 …
CDC Grand Rounds: Preventing Suicide Through a Comprehensive Public Health Approach
Authors: Corinne David-Ferdon, Alex E. Crosby, Eric D. Caine, Jarrod Hindman, Jerry Reed, John Iskander
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

Suicide in the United States is a major public health problem with approximately 42,000 reported suicides in 2014 among persons aged >10 years (1). The overall suicide rate is increasing, with a 27% increase from 2000 (12.1 per 100,000 population) to 2014 (15.4 per 100,000) (Figure 1). Males, youths and young adults, and certain racial/ethnic groups have historically had higher rates of suicide. In 2014, suicide rates were approximately four times higher among males (24.3 per 100,000) than females (6.8 per 100,000), and suicide was the second leading cause of death among youths and young adults aged 10-34 years (1). Among persons aged 10-24 years, the 2014 suicide rate among non-Hispanic American Indian/Alaska Natives was 20.2 per 100,000, 1.9 times higher than non-Hispanic whites (10.5 per 100,000), 3.5 times higher than non-Hispanic blacks (5.8 per 100,000), and 3.7 times higher than Hispanics (5.5 per 100,000) (1). Adults aged 35-64 years are an emerging group at risk, with suicide rates increasing 33% since 2000 and accounting for the largest proportion of suicides (1).
The use of small-caliber, covered, self-expandable metal stents for palliation of severe malignant dysphagia.
Authors: S. Kucera, C. L. Harris, S. Vignesh, J. Klapman, J. S. Barthel
Journal: Journal of Clinical Oncology (2011)

134 Background: Self-expandable covered metal stents are an important component of palliative care for malignant dysphagia; however significant complication rates have been associated with large diameter stents. We hypothesized that small-caliber, fully covered, self-expandable metal stents (sccSEMS) would prove adequate palliation of dysphagia in the absence of major complications. Methods: Prospective observational study of 17 patients presenting with severe malignant dysphagia between 12/1/08 and 7/30/10. 31 sccSEMS with internal diameters ranging from 8 mm to 16 mm were placed in 17 patients with pre-stent luminal diameters of &lt; 8 mm (n = 13) or 8-10 mm (n = 4). 7 tracheobronchial stents (internal diameter 14–16 mm), 2 biliary stents (internal diameter 8–10 mm), and 22 specially constructed esophageal stents (internal diameter 12–16 mm) were placed. All stents were placed under direct endoscopic vision without fluoroscopic support. Dysphagia scores, migration rates, and complications were identified through review of endoscopy reports, outpatient clinical encounters, and 24-hour post-procedure phone surveys. Anticipated stent migration was defined as events which occurred during chemoradiation. Unanticipated stent migration was defined as events which occurred in the absence of treatment. Results: The post-stent median dysphagia score improved (decreased) from 3 to 2 (p = 0.0003). The overall median duration of first stent placement was 64 days, IQR 32 – 110 days. The overall migration rate was 35.5% (11/31). The anticipated migration rate was 60% (9/15); the unanticipated migration rate was 18.2% (2/11) (p = 0.051). All 11 of the migrated stents were retrieved endoscopically without complication. 9.7% (3/31) of patients reported self-limited sore throat or chest pain within 24-hours of stent placement. All 3 patients were managed conservatively without need for narcotic analgesics, hospitalization, or repeat endoscopy. No other complications occurred. Conclusions: The direct endoscopic placement of sccSEMS in patients presenting with severe malignant dysphagia significantly improved dysphagia scores, provided excellent durability, and resulted in no major complications. No significant financial relationships to disclose.