tbuckley/cabot-search huggingface dataset:
A randomized phase III study of rubitecan (ORA) vs. best choice (BC) in 409 patients with refractory pancreatic cancer report from a North-American multi-center study
Authors: A. D. Jacobs, H. A. Burris, S. Rivkin, P. S. Ritch, P. D. Eisenberg, K. L. Mettinger
Journal: Journal of Clinical Oncology (2004)

4013 Background: Rubitecan (Orathecin), an oral topoisomerase I inhibitor, showed promising activity in pancreatic cancer in previous single-center Phase 2 studies in US and Europe. Our objective was to compare ORA with BC (physicians' best choice of treatment or care). Primary end-point: Median survival (MS) . Secondary endpoints: Response rate (RR), progression- free survival (PFS) and safety. Methods: ORA was administered orally at a dose of 1.5 mg/m2 for 5 consecutive days each week for 8 or more weeks. BC consisted of standard regimens of best alternative chemotherapy (89%) or supportive care (11%). CT scans were followed every 8 weeks. Results: 198 patients (pts) were randomized to ORA and 211 to BC. More than 90% were resistant to prior chemotherapy and 70% were refractory to 2 or more prior regimens. 49% of BC patients crossed over to rescue therapy with ORA at time of failure. No significant difference was noted in MS time (ORA: 108 days, BC 94 days, p =0.626), whereas a significant survival advantage was observed for BC pts crossed over to ORA vs. BC non-rescue pts, 147 days vs. 60 days (P<0.0001). In pts with measurable disease (59%), there were 12 independently verified ( blinded radiology review) responders for ORA (2 CR and 10 PR) for a RR of 11%, compared to one responder (<1%; 1 CR) for BC (p< 0.001). Stable disease (SD) was also more common on ORA (44 pts vs. 27 pts). On an Intent-To-Treat basis, more than 2-fold more pts on ORA (28% vs. 13%) achieved tumor growth control (CR +PR +SD), a primary objective for palliative treatment in this disease (Heinemann et al., Oncology 60:8–18, 2001). Median PFS was significantly longer for ORA, 58 days vs. 48 days (p =0.003). ORA was well tolerated as <5% discontinued treatment due to toxicity. Grade 3–4 toxicity was more common for ORA (neutropenia 28% vs. 14%; anemia 21% vs. 9%; nausea/vomiting 14% vs. 9%; diarrhea 12% vs. 5%). Conclusions: The results of this study support the notion that rubitecan, a new oral medication with an acceptable risk-benefit ratio, is convenient to use, and can achieve tumor growth control in a disease with few treatment options. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Supergen GlaxoSmithKline GlaxoSmithKline
Melanoma Lesions Independently Acquire T-cell Resistance during Metastatic Latency
Authors: Fang Zhao, Antje Sucker, Susanne Horn, Christina Heeke, Nicola Bielefeld, Barbara Schrörs, Anne Bicker, Monika Lindemann, Alexander Roesch, Gustav Gaudernack, Mathias Stiller, Jürgen C. Becker, Volker Lennerz, Thomas Wölfel, Dirk Schadendorf, Klaus Griewank, Annette Paschen
Journal: Cancer Research (2016)

Melanoma often recurs after a latency period of several years, presenting a T cell-edited phenotype that reflects a role for CD8(+) T cells in maintaining metastatic latency. Here, we report an investigation of a patient with multiple recurrent lesions, where poorly immunogenic melanoma phenotypes were found to evolve in the presence of autologous tumor antigen-specific CD8(+) T cells. Melanoma cells from two of three late recurrent metastases, developing within a 6-year latency period, lacked HLA class I expression. CD8(+) T cell-resistant, HLA class I-negative tumor cells became clinically apparent 1.5 and 6 years into stage IV disease. Genome profiling by SNP arrays revealed that HLA class I loss in both metastases originated from a shared chromosome 15q alteration and independently acquired focal B2M gene deletions. A third HLA class I haplotype-deficient lesion developed in year 3 of stage IV disease that acquired resistance toward dominant CD8(+) T-cell clonotypes targeting stage III tumor cells. At an early stage, melanoma cells showed a dedifferentiated c-Jun(high)/MITF(low) phenotype, possibly associated with immunosuppression, which contrasted with a c-Jun(low)/MITF(high) phenotype of T cell-edited tumor cells derived from late metastases. In summary, our work shows how tumor recurrences after long-term latency evolve toward T-cell resistance by independent genetic events, as a means for immune escape and immunotherapeutic resistance. Cancer Res; 76(15); 4347-58. ©2016 AACR.
Cost-Effectiveness of Self-Monitoring of Blood Glucose in Type 2 Diabetic Patients Not Receiving Insulin
Authors: Kurt Neeser, Katrina M. Erny-Albrecht, Christian Weber
Journal: Diabetes Care (2006)

In his counterpoint article, Davidson (1) argues that self-monitoring of blood glucose (SMBG) in type 2 diabetic subjects not using insulin is a waste of money. However, as the discussions accompanying and following publication of a new meta-analysis by Welschen et al. (2) demonstrate, the evidence is far from conclusive either for or against use of SMBG in this patient group.

As pointed out by Ipp et al. (3), many of the trials of SMBG conducted thus far have …
The legal basis of forensic psychiatry: statutorily mandated psychiatric diagnoses
Authors: J D Bloom, J L Rogers
Journal: American Journal of Psychiatry (1987)

Using the Oregon statutory scheme as an example, the authors review certain areas of the law where psychiatric expertise is mandated by statute. This review points out the diversity of determinations where forensic psychiatric expertise is required by law. The authors' thesis is that forensic psychiatry draws its vitality from the law. Legal requirements, however, should not dictate psychiatric response, which should be guided by psychiatric knowledge and ethical concerns.
GOUT IN THE UNITED STATES.
Authors: H BRUGSCH
Journal: JAMA (1902)

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
Patient attrition in dynamically oriented treatment groups
Authors: H B Roback, M Smith
Journal: American Journal of Psychiatry (1987)

Clinical and empirical studies of premature terminators from dynamically oriented therapy groups are reviewed. While many studies focus on the personality characteristics of dropouts, the authors recommend conceptualizing such patients in terms of the interaction of patient, group, and therapist. On the basis of this model, the authors offer clinical recommendations for reducing the number of dropouts. Multivariate experimental designs for studying attrition in group psychotherapy are discussed, and the authors suggest possible directions for future research.
The role of GNAS mutation in diagnosis of mucinous pancreatic cysts.
Authors: Eric M. Ellsworth, C. Max Schmidt, Jamie F. Bleicher, Dennis M. Smith, Sydney D. Finkelstein
Journal: Journal of Clinical Oncology (2012)

e21048 Background: Pancreatic cysts pose a challenge in patient management primarily due to difficulties distinguishing non-mucinous cysts from potentially pre-malignant mucinous ones, and in determining the malignant potential of mucinous cysts. Mutations to the GNAS gene have been identified as a marker for intraductal papillary mucinous neoplasm (IPMN). [1,2] We evaluated the significance of GNAS mutation in diagnosis of pancreatic cysts. Methods: We retrieved archival DNA from 237 cyst fluids. 200 specimens were chosen with 100 KRAS mutant and 100 KRAS wild type in a range of CEA values. 37 specimens were chosen with a molecular diagnosis of aggressive biological behavior, to enrich for malignant IPMNs. We sequenced each fluid’s DNA from for codon 201 of GNAS. Molecular criteria for mucinous cysts included KRAS mutation, elevated DNA, or ≥2 high clonality LOH mutations. Results: Of the 237 specimens, 25 were not amplifiable due to degraded DNA, 52 (25%) had a GNAS mutation, and 160 had no GNAS mutation. Of the 52 GNAS mutated specimens, 5 were diagnosed as biologically aggressive based on significant associated mutations, 28 as statistically indolent based on associated molecular changes, and 19 as benign (no accompanying mutations). The proportion of GNAS mutations decreased with increasing molecular changes linked to malignancy. Data from [1] shows no statistical difference in frequency of GNAS mutation in side branch vs. main vs. mixed IPMNs (p= 0.46). Similarly, in our cohort, 6 cases had clear imaging features of a side branch IPMN, and of these 2 (33%) had a mutation in GNAS. Using molecular criteria for identification of mucinous cysts, 166 were mucinous and 71 non-mucinous. Incorporation of GNAS into the molecular determination of mucinous etiology identified 13 additional cases (7%). Conclusions: Use of GNAS increases sensitivity for detection of mucinous lesions. GNAS does not appear to correlate with molecular measures of biological aggressiveness. These findings confirm those in [1], that GNAS should be used in conjunction with a panel of molecular markers for evaluating the malignant potential of pancreatic cystic lesions. References 1. Sci Transl Med. 2011 Jul 20; 3:92ra66. 2. PNAS 2011 Dec 27; 108:21188-93.
Validity of the Personality Diagnostic Questionnaire--revised: comparison with two structured interviews
Authors: S E Hyler, A E Skodol, H D Kellman, J M Oldham, L Rosnick
Journal: American Journal of Psychiatry (1990)

The authors gave the self-report Personality Diagnostic Questionnaire--Revised (PDQ-R) to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders. The PDQ-R was not a substitute for a structured interview assessment of axis II disorders because many of its diagnoses were false positives. Its high sensitivity and moderate specificity for most of the axis II disorders suggest, however, that it is an efficient instrument for screening patients with DSM-III-R personality disorders.
Determinants of resting cerebral blood flow in sickle cell disease
Authors: Adam M. Bush, Matthew T. Borzage, Soyoung Choi, Lena Václavů, Benita Tamrazi, Aart J. Nederveen, Thomas D. Coates, John C. Wood
Journal: American Journal of Hematology (2016)

Stroke is common in children with sickle cell disease and results from an imbalance in oxygen supply and demand. Cerebral blood flow (CBF) is increased in patients with sickle cell disease to compensate for their anemia, but adequacy of their oxygen delivery has not been systematically demonstrated. This study examined the physiological determinants of CBF in 37 patients with sickle cell disease, 38 ethnicity matched control subjects and 16 patients with anemia of non‐sickle origin. Cerebral blood flow was measured using phase contrast MRI of the carotid and vertebral arteries. CBF increased inversely to oxygen content ( r 2 = 0.69, P &lt; 0.0001). Brain oxygen delivery, the product of CBF and oxygen content, was normal in all groups. Brain composition, specifically the relative amounts of grey and white matter, was the next strongest CBF predictor, presumably by influencing cerebral metabolic rate. Grey matter/white matter ratio and CBF declined monotonically until the age of 25 in all subjects, consistent with known maturational changes in brain composition. Further CBF reductions were observed with age in subjects older than 35 years of age, likely reflecting microvascular aging. On multivariate regression, CBF was independent of disease state, hemoglobin S, hemoglobin F, reticulocyte count and cell free hemoglobin, suggesting that it is regulated similarly in patients and control subjects. In conclusion, sickle cell disease patients had sufficient oxygen delivery at rest, but accomplish this only by marked increases in their resting CBF, potentially limiting their ability to further augment flow in response to stress. Am. J. Hematol. 91:912–917, 2016. © 2016 Wiley Periodicals, Inc.
Selective Malabsorption of Vitamin B12
Authors: J K Visakorpi, U Furuhjelm
Journal: JAMA (1963)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) 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
AB0642 Otolaryngeal Manifestations of Behçet's Disease in a Northern European Population
Authors: F. Adeeb, F. Conall, C. Timon, N.P. Shine, J.P. Hughes, A.D. Fraser
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The Otolaryngologic-related manifestations of Behçet9s Disease (BD), though previously described, have been less thoroughly explored in the literature, particularly in a Northern European population. These manifestations are said to be relatively rare and include hearing loss, pharyngeal and laryngeal ulceration and nasal mucosal involvement. <h3>Objectives</h3> The aim of this study was to undertake an assessment of a cohort of BD patients, documenting any laryngeal manifestations or evidence of reduced hearing. <h3>Methods</h3> Patients meeting the International Study Group for Behçet9s Disease (ISGBD) or the International Criteria for Behçet9s Disease (ICBD) criteria for diagnosis were identified from an institutional database. Patients underwent assessment with an otolaryngologist, including flexible laryngoscopy. Intra-oral, pharyngeal and laryngeal manifestations of BD were documented and characterised. Patients underwent hearing assessment with pure-tone audiometry. <h3>Results</h3> Fifteen BD patients were identified (4 male, 11 female; median age 36 years). 60% (n=9) showed evidence of disease on examination and flexible laryngoscopy. 33% (n=5) including two asymptomatic patients showed structural laryngeal changes related to BD. 13% (n=2) demonstrated bilateral, symmetrical sensorineural hearing loss. One patient warranted consideration for tracheotomy. <h3>Conclusions</h3> Our cohort of BD patients demonstrate significant structural laryngeal changes, which appear to be more common than was previously thought. Therefore, raised awareness of the risk of laryngeal pathology in BD patients, including potential risk for later airway compromise, even in the absence of overt clinical symptomatology, and early screening may result in earlier diagnosis and treatment. Rheumatologists and Otolaryngologists should consider closer multi-disciplinary co-operation in the management and follow up of patients with BD. <h3>References</h3> Webb CJ, Moots RJ, Swift AC. Ear, nose and throat manifestations of Behcet9s disease: a review. The Journal of laryngology and otology. 2008 Dec;122(12):1279-83. PubMed PMID: 18616840. Gross M, Ben-Chetrit E. Laryngeal involvement in Behcet9s disease–a challenge for treatment. Clinical rheumatology. 2013 Mar;32 Suppl 1:S75-7. PubMed PMID: 20532579. Cinar S, Cinar F, Kiran S. Is there a need for audiologic evaluation in patients with Behcet disease? Ear, nose, &amp; throat journal. 2012 Mar;91(3):E15-9. PubMed PMID: 22430342. <h3>Disclosure of Interest</h3> None declared
<i>Notes from the Field</i>: Investigation of Hepatitis C Virus Transmission Associated with Injection Therapy for Chronic Pain — California, 2015
Authors: Monique A. Foster, Cheri Grigg, Jaclyn Hagon, Paige A. Batson, Janice Kim, Mary Choi, Anne Moorman, Charity Dean
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

On November 26, 2014, the California Department of Public Health (CDPH) contacted CDC concerning a report from the Santa Barbara County Public Health Department (SBPHD) regarding acute hepatitis C virus (HCV) infection in a repeat blood donor. The patient, who was asymptomatic, was first alerted of the infection by the blood bank and had no traditional risk factors for HCV infection. The donor had a negative HCV nucleic acid test (NAT) 56 days before the first positive NAT test, and an investigation into the donor's health care exposures and other potential risk factors, including injection drug use, incarceration, and long-term hemodialysis within this narrow exposure window, was conducted by SBPHD.
Mental health services in the public and private sectors
Authors: L M Koran
Journal: American Journal of Psychiatry (1976)

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.
Gains in Life Expectancy from Medical Interventions
Authors: M F Roizen, K Roach, A Goetz
Journal: New England Journal of Medicine (1998)

Clodronate in Metastatic Breast CancerTo the Editor: In their interesting study, Diel et al. (Aug.6 issue) 1 demonstrate the efficacy of clodronate therapy when it is used in addition to standard systemic therapy in high-risk patients with early-stage breast cancer.However, it is unclear whether all patients will benefit from this therapy.Although the authors state that in their study, "all the women . . .had a high risk of distant metastases, as indicated by the presence of tumor cells in the bone marrow" and the presence of tumor cells in the bone marrow was associated with "unfavorable prognostic factors," only a minority of the women in the two treatment groups had aggressive tumors.Even if prognostic factors in the two groups were well balanced, only about one quarter of all patients had estrogen-receptor-negative tumors (69 of 302) or poorly differentiated (grade III) tumors (78 of 302), as shown in Table 1 of the article.This raises the question whether the benefit found by the statistical analysis of the whole group is due entirely to a protective effect in the subgroup of patients with hormone-dependent, well-differentiated tumors.In other words, clodronate may have no beneficial effect on aggressive types of breast cancer.The results of subgroup analysis, even if methodologically questionable, may be interesting in this context.The authors do not clearly define the term "visceral metastases."Is the protective effect of clodronate to be expected to extend to soft tissue as well as to true visceral metastases such as liver or lung lesions?The possibility that the therapeutic benefit of clodronate is limited to a metastatic site in soft tissues and bone disease, associated with slowly growing tumors, again suggests that such treatment should be reserved for patients with advanced, but otherwise prognostically favorable, early breast cancers.
AB0936 Tuberculosis Infection in Mexican Patients with Idiopathic Inflammatory Myopathies: Report of three Cases and Review of the Literature
Authors: P.J. Pérez Cruz, E. Gόmez-Bañuelos, J.E. Aguilar-Arreola, A. Saldaña Millán, L. Andrade-Ortega, L.J. Jara-Quezada, M.A. Saavedra, O. Vera-Lastra, G. Medrano-Ramírez, O. Pizano-Martínez, B.T. Martín-Márquez, R.E. Navarro-Hernandez, J. Floresvillar-Mosqueda, M. Vazquez-Del Mercado
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Tuberculosis (TB) is a public health problem, a disease originated by <i>M. tuberculosis</i> (MTB) and other members of Mycobacterium tuberculosis complex. There is scarce information about the MTB infection in polymyositis/dermatomyositis (PM/DM) patients. <h3>Objectives</h3> To describe the prevalence and clinical presentation of TB infection in patients diagnosed as PM/DM from the two main cities of Mexico: Guadalajara and Mexico City. <h3>Methods</h3> A group of 196 patients with IIM recruited from 2009 to 2014 from four public hospitals were included. We described the clinical characteristics and the possible risk factors for the development of TB infection. <h3>Results</h3> We identified three cases of extrapulmonary MTB infection mainly TB tenosynovitis (2) and meningeal TB (1) from a cohort of 196 patients with idiopathic inflammatory myopathies (IIM) recruited in a period of 5 years (2009 to 2014). The three cases presented the TB infection around 12 weeks of immunosuppressive therapy. <h3>Conclusions</h3> Diagnosis of extrapulmonary TB should be considered in the clinical approach of IIM patients especially in Mexico and countries with high prevalence of TB infection. Previous to immunosuppressive therapy in IIM, we suggest to do screening for MTB using Tuberculin Skin Test and chest X-ray. In cases of high clinical suspicion of TB infection, we might use Quantiferon™ (Cellestis Limited, Melbourne, Australia) and Xpert MTB-RIF™ (Cepheid, Sunnyvale, California, US). <h3>Disclosure of Interest</h3> None declared