tbuckley/cabot-search huggingface dataset:
Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans
Authors: Rebecca L. Sudore, John Boscardin, Mariko A. Feuz, Ryan D. McMahan, Mary T. Katen, Deborah E. Barnes
Journal: JAMA Internal Medicine (2017)

Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings.To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read advance directive (AD) to increase planning documentation.This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year.Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements.The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician.The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up).Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources.clinicaltrials.gov Identifier: NCT01550731.
The High Risk for Symptomatic Hyperviscosity in Patients with High Serum IgM Levels Can be Used to Support Initiation of Treatment in Waldenström Macroglobulinemia
Authors: Joshua Gustine, Kirsten Meid, Robert R Manning, Toni Dubeau, Irene M. Ghobrial, Steven P Treon, Jorge J. Castillo
Journal: Blood (2016)
Psychopharmacological Implications of Dopamine and Dopamine Antagonists: A Critical Evaluation of Current Evidence
Authors: O Hornykiewicz
Journal: The Annual Review of Pharmacology and Toxicology (1977)

Due to the massive data sets available for drug candidates, modern drug discovery has advanced to the big data era. Central to this shift is the development of artificial intelligence approaches to implementing innovative modeling based on the dynamic, ...Read More
Phase II trial of ipilimumab in patients with advanced melanoma and spontaneous preexisting immune response to NY-ESO-1 (CTLA-4 NY-ESO-1).
Authors: Georg Martin Haag, Jessica Cecile Hassel, Inka Zoernig, Niels Halama, Philipp Beckhove, Irini Karapanagiotou-Schenkel, Alexander Enk, Dirk Jaeger
Journal: Journal of Clinical Oncology (2015)

e20061 Background: Ipilimumab has significantly improved overall survival of patients with metastatic melanoma. However in unselected patients only about 10-15% of all patients treated with ipilimumab show objective response. Disease control rate ranges about 30%. The NY-ESO-1 antigen belongs to the group of cancer/testis antigens. It is expressed in about 30% of metastatic melanoma. Spontaneous antibody formation can be observed in about 20% of patients with metastatic melanoma. Several preclinical and clinical data provide strong evidence for the immunogenicity of NY-ESO-1. Nevertheless, the role of humoral immune responses potentially reflecting tumor immunity is unclear. Data regarding the correlation between the presence of spontaneous antibodies against NY-ESO-1 and response to ipilimumab are conflicting. Methods: CTLA-4 NY-ESO-1 is a single arm phase II trial to determine the efficacy, safety and tolerability of ipilimumab in patients with melanoma stage III and IV and spontaneous preexisting humoral immune response against NY-ESO-1. 25 patients with detectable antibodies against NY-ESO-1 (detected by ELISA) receive ipilimumab at a dosage of 10 mg/kg during an induction period (week 1, 4, 7, 10), followed by a maintenance period with application every 12 weeks until week 48, tumor progression or severe toxicity. Primary endpoint is Disease Control Rate (DCR) at week 12, secondary endpoints include overall survival and progression-free survival. The main analysis includes a hypothesis test concerning DCR following the A’Hern’s single-stage design. Results: This is an unplanned interim analysis requested by DSMB: 23 of 25 patients have been enrolled. Response evaluation according to immune-related response criteria is available for 22 patients: irPR in 5 patients (22.7%), irSD in 6 patients (27.3%), irPD in 7 patients (31.8%), 4 patients (18.2%) stopped study treatment prematurely due to immune-related AEs. Treatment related grade 3-4 toxicity was observed in 8 patients. Conclusions: Preliminary data suggest that ipilimumab shows encouraging activity in patients with metastatic melanoma and preexisting antibody responses against NY-ESO-1. Clinical trial information: 01216696.
Endoscopic ultrasound of duodenal heterotopic gastric mucosa
Authors: Malay Sharma, Piyush Somani, Krishnaveni Janarthanan, Saurabh Jindal, Rajendra Prasad, Ruth Hari
Journal: Endoscopy (2017)

A 50-year-old woman presented with dyspepsia but no history of weight loss or gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) showed a sessile polypoidal submucosal lesion in the second part of the duodenum close to the ampulla with a central opening (fish-mouth appearance) ([Fig. 1]). The contour of this lesion was smooth and there was no disruption of the surrounding folds, nor ulceration or bleeding. Linear endoscopic ultrasound (EUS) was performed for evaluation of the lesion. This revealed that the lesion was arising from the mucosa/submucosa of the duodenum and had a cystic anechoic central core in the submucosa with no solid component and well-demarcated margins ([Fig. 2]; [Video 1]).
High-resolution analysis of von Willebrand factor multimeric composition defines a new variant of type I von Willebrand disease with aberrant structure but presence of all size multimers (type IC)
Authors: G Ciavarella, N Ciavarella, S Antoncecchi, D De Mattia, P Ranieri, J Dent, TS Zimmerman, ZM Ruggeri
Journal: Blood (1985)
Diagnostic challenges in meningioma
Authors: Martha Nowosielski, Norbert Galldiks, Sarah Iglseder, Philipp Kickingereder, Andreas von Deimling, Martin Bendszus, Wolfgang Wick, Felix Sahm
Journal: Neuro-Oncology (2017)

Advances in molecular profiling and the application of advanced imaging techniques are currently refreshing diagnostic considerations in meningioma patients. Not only technical refinements but also sophisticated histopathological and molecular studies have the potential to overcome some of the challenges during meningioma management. Exact tumor delineation, assessment of tumor growth, and pathophysiological parameters were recently addressed by "advanced" MRI and PET. In the field of neuropathology, high-throughput sequencing and DNA methylation analysis of meningioma tissue has greatly advanced the knowledge of molecular aberrations in meningioma patients. These techniques allow for more reliable prediction of the biological behavior and clinical course of meningiomas and subsequently have the potential to guide individualized meningioma therapy. However, higher costs and longer duration of full molecular work-up compared with histological assessment may delay the implementation into clinical routine.This review highlights the diagnostic challenges of meningiomas from both the neuroimaging as well as the neuropathological side and presents the latest scientific achievements and studies potentially helping in overcoming these challenges. It complements the recently proposed European Association of Neuro-Oncology guidelines on treatment and diagnosis of meningiomas by integrating data on nonstandard imaging and molecular assessments most likely impacting the future.
Characterization of ZNF313/RNF114 as a novel psoriasis susceptibility gene
Authors: Francesca Capon, Marie-Jose Bijlmakers, M. Quaranta, K. Timms, A. D. Burden, A. Reis, R. B. Warren, C. E. M. Griffiths, J. Worthington, Frank Nestle, J. Lanchbury, Jonathan Barker, Richard Trembath
Journal: British Journal of Dermatology (2008)
ClQ synthesis by tissue mononuclear phagocytes from normal and from damaged rat liver: Up-regulation by dexamethasone, down-regulation by interferon gamma, and lipopolysaccharide
Authors: T Armbrust, B Nordmann, M Kreiβig, G Ramadori
Journal: Hepatology (1997)

The subcomponent of complement C1, C1q, mediates complement activation via the classical pathway, and therefore may play an important role in the inflammatory processes in which complement activation is involved. The aim of our study was to investigate C1q synthesis by macrophages of normal and of acutely damaged livers. The localization of C1q in liver tissue was studied by immunohistochemistry. Rat liver tissue macrophages were isolated from normal as well as from acutely damaged (carbon tetrachloride model) liver, and were separated into small, monocyte-like phagocytes and large, mature tissue macrophages, as revealed by immunocytochemistry. C1q gene expression was studied by endogeneous labeling of newly synthesized proteins, immunoprecipitation, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and by reverse-transcription polymerase chain reaction (RT-PCR) of C1qB messenger RNA (mRNA). Semiquantitative analysis was performed by Northern blotting of total RNA and hybridization with the radioactively labeled RT-PCR product. C1 esterase inhibitor synthesis was studied in parallel. For comparison, C1q and C1-inhibitor synthesis were also investigated in blood monocytes and peritoneal macrophages. C1q was weakly detectable in sinusoidal cells of the normal liver. C1qB mRNA, as well as constitutive synthesis and secretion of C1q, was clearly detected in freshly isolated and cultured Kupffer cells from normal rat liver. In comparison, newly recruited “inflammatory” macrophages from damaged rat liver synthesized considerably lower amounts of the protein, similar to what was found in the monocyte-like macrophages of normal liver and in peritoneal macrophages. Monocyte C1qB mRNA was not detected even by RT- PCR, and remained undetectable during the time in culture. Similar behavior was observed for C1-inhibitor synthesis. Treatment of the cultures with interferon gamma (IFN-γ) or lipopolysaccharide (LPS) strongly decreased, whereas treatment with dexamethasone strongly increased C1q gene expression in the macrophage populations, and induced C1qB mRNA in cultured monocytes, as revealed by RT-PCR. Kupffer cells of normal liver may produce considerable amounts of C1q, whereas the inflammatory macrophages of the acutely damaged liver may not be so important for the synthesis of C1q.
Mild dysphagia and globus sensation in an older man
Authors: Subramanian Nachiappan, David C Howlett
Journal: BMJ (2017)

A 72 year old man presented with a three to four month history of non-progressive difficulty in swallowing and a globus sensation at the cervicothoracic level. Nasoendoscopy was normal. A chest radiograph was performed (fig 1⇓). What does it show?



Fig 1  Chest radiograph



The radiograph shows a right sided aortic arch (fig 2⇓, arrows) and unfolding of the ascending aorta: an example of a vascular ring.



Fig 2  Chest radiograph. White arrows show right sided aortic arch



### Discussion

Aortic arch abnormalities, also known as vascular rings, are often diagnosed in infancy or …
Pattern of metastatic spread and prognosis of breast cancer biologic subtypes.
Authors: Lorenzo Gerratana, Valentina Fanotto, Marta Bonotto, Silvia Bolzonello, Claudia Andreetta, Stefano Moroso, Gaetano Pascoletti, Gianpiero Fasola, Fabio Puglisi
Journal: Journal of Clinical Oncology (2014)

e12532 Background: Few studies have described patterns of metastatic spread according to the major breast cancer biologic subtypes (BS). The aim of this study was to determine the association of BS on metastatic spreading and to define the associated prognosis in terms of overall survival (OS), progression-free survival (PFS) and survival post-progression (SPP). Methods: We analyzed a series of 544 consecutive patients receiving anticancer treatments for metastatic breast cancer (MBC) at the Department of Oncology of Udine, Italy, from 2004 to 2013. BS were defined according to St Gallen 2013 criteria. Unconditional logistic regression and Cox regression were performed by uni- and multivariate models. Results: Results were described by reporting Luminal A as the reference variable. Non luminal HER2 subtype was associated with a higher rate of liver metastases (OR=3.61 95%C.I. 1.36-9.58, P=0.01), whereas triple negative breast cancer showed a higher tropism for lung (OR=4.30 95%C.I. 1.41-13.1, P=0.01). All subtypes were associated with a lower risk of bone-only localization. Liver, lung and central nervous system involvement had an unfavorable impact on OS (HR=1.64, 95%C.I. 1.29-2.07, P<0.0001; HR=1.49, 95%C.I. 1.18-1.90, P=0.001; HR=2.891, 95% C.I 1.85-4.51, P<0.0001, respectively) and PFS (HR=1.39, 95%C.I. 1.13-1.71, P=0.001; HR=1.26, 95%C.I. 1.02-1.55, P=0.03; HR=1.75, 95%C.I. 1.12-2.71, P=0.01, respectively). Bone only disease was associated with a favorable outcome in terms of OS (HR=0.70, 95% C.I 0.54-0.89, P=0.0039) and PFS (HR=0.76, 95%C.I. 0.62-0.94, P=0.01). Multivariate analysis adjusted for BS, ECOG and number of sites, confirmed only liver spread as independent predictor of OS (HR=1.64, 95%C.I. 1.15-2.34, P=0.006). Stratification by metastatic pattern revealed significant differences in terms of SPP but not in of PFS (P=0.85). Conclusions: The study demonstrated the association between breast cancer BS and patterns of metastatic spread. In turn, in patients with MBC, organ involvement resulted to be an important determinant of clinical outcome. These findings expand the knowledge about prognosis of different BS and could provide useful insights for surveillance protocols and tailored clinical management.
Abstract 52: Impaired Ephrin A1/EphA2 Signaling Results in Defective Migration and Homing of Senescent Human Cardiac Stem Cells
Authors: Ramaswamy Kannappan, Yingnan Bai, Sergio Signore, Maria Cimini, Joao Ferreira-Martins, Polina Goichberg
Journal: Circulation Research (2012)

Aging is the major independent risk factor for chronic heart failure. Despite the presence of cardiac stem cells (CSCs), the old human heart undergoes progressive deterioration in ventricular performance, coupled with scattered foci of fibrosis and accumulation of poorly contracting myocytes. We raised the possibility that defects in the translocation of senescent human CSCs (hCSCs) to the sites of damage constitute a key determinant in the manifestation of the aging myopathy. We report that ephrin A1-EphA2 receptor signaling is a critical modulator of hCSC motility. Ephrin A1, a membrane-anchored protein, is expressed on the myocyte sarcolemma and acts as a ligand for the EphA2 receptor on neighboring hCSCs, facilitating their migration. Pre-treatment of young hCSCs with ephrin A1 resulted in enhanced movement of the transplanted cells to the necrotic tissue, with formation of new myocardium and improvement in cardiac function. Whether senescent hCSCs promote a comparable regenerative response remained to be established. Surprisingly, the expression of EphA2 did not differ in young and old hCSCs. With respect to young cells, senescent hCSCs showed a 2-fold increase in intracellular ROS levels. Oxidative stress led to post-translational modifications and functional alterations of the EphA2 receptor. Specifically, the ability of ephrin A1 to induce phosphorylation of the EphA2 receptor was markedly attenuated in senescent hCSCs, resulting in inadequate activation of Src family proteins. As a consequence, the phosphorylation and activity of caveolin-1, a substrate of Src kinases, was reduced. These molecular alterations led to impaired endocytosis of the ligand-receptor complex, a cellular process essential for ephrin A1-EphA2 signaling. Lack of endocytosis precluded rearrangement of the actin cytoskeleton and cell migration. Importantly, ephrin A1-stimulated senescent hCSCs delivered to infarcted rats accumulated in proximity of the site of injection and did not translocate to the ischemic area. Thus, oxidative stress interferes with EphA2 signaling in aging hCSCs, negatively affecting their migration. Restoration of the EphA2 function in old hCSCs may enhance their mobilization and improve cell targeting to the injured area.
Review: Intensive blood pressure control reduces retinopathy in diabetes
Authors: Steven A. Smith, Shrikant Tamhane
Journal: Annals of Internal Medicine (2015)

ACP Journal Club16 June 2015Review: Intensive blood pressure control reduces retinopathy in diabetesSteven A. Smith, MD, Shrikant Tamhane, MDSteven A. Smith, MDMayo Clinic, Rochester, Minnesota, USA (S.A.S., S.T.)Search for more papers by this author, Shrikant Tamhane, MDMayo Clinic, Rochester, Minnesota, USA (S.A.S., S.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2015-162-12-007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationDo DV, Wang X, Vedula SS, et al. Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2015;1:CD006127. https://pubmed.ncbi.nlm.nih.gov/25637717Clinical Impact RatingsGIM/FP/GP: Endocrinology: References1. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86. [PMID: 8366922] Google Scholar2. Gaede PH, Jepsen PV, Parving HH, Pedersen OB. [Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno-2 study]. Ugeskr Laeger. 1999;161:4277-85. [PMID: 10439688] Google Scholar Author, Article, and Disclosure InformationAuthors: Steven A. Smith, MD; Shrikant Tamhane, MDAffiliations: Mayo Clinic, Rochester, Minnesota, USA (S.A.S., S.T.)This article was published at Annals.org on 2 June 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPharmacology of the retinal pigment epithelium, the interface between retina and body system 16 June 2015Volume 162, Issue 12Page: JC7KeywordsBlood pressureDiabetic retinopathyHypertensionHypotensionRenal diseasesRetinopathyRisk ratioType 1 diabetesType 2 diabetesVisual acuity ePublished: 16 June 2015 Issue Published: 16 June 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Interpretation and Use of the Western Blot Assay for Serodiagnosis of Human Immunodeficiency Virus Type 1 Infections
Journal: JAMA (1989)

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
Resection for Pulmonary Tuberculosis
Authors: D. Bonta Hiscoe, William F. Thompson, Thomas J. Enright, Harrison Black
Journal: New England Journal of Medicine (1958)

DURING the past ten years, the use of antituberculous chemotherapy in conjunction with pulmonary resection has revolutionized the treatment of pulmonary tuberculosis. As with any chronic disease, an evaluation of results can be considered significant only if a reasonable time has elapsed after treatment. Although the available studies1 2 3 4 5 6 7 report follow-up information one month to five years after resection, the majority of cases have been followed for a very short period. As a result the validity of the conclusions may be open to question. Schlosser8 and Murphy9 have shown by more protracted studies that late reactivations after resection are not uncommon. . . .
A VIRUS-INDUCED MAMMALIAN GROWTH WITH THE CHARACTERS OF A TUMOR (THE SHOPE RABBIT PAPILLOMA)
Authors: J. W. Beard, Peyton Rous
Journal: The Journal of Experimental Medicine (1934)

The injection of Scharlach R into the skin about rabbit papillomas resulting from virus inoculation causes them to invade the underlying tissue and form large, fleshy masses beneath the surface. Histologically these appear malignant, and they frequently invade the blood vessels. Covering young papillomas with a layer of collodion causes them to burrow downwards with result in discoid masses which enlarge progressively, both by expansive growth beneath the epidermis and by invasion. Such masses, like the nodules resulting from implantation, have the papillae turned toward their interior, the apparent reverse of the condition of affairs when the growth is situated on the skin surface. The reasons for this are analyzed. The peculiarities of the host influence skin papillomas not a little, as is plain from the forms they assume; but the epithelial changes induced by the virus take a single direction, and no significant variations from type have been encountered. Local or generalized retrogression of the experimentally induced papilloma is not uncommon. The histological alterations that take place are identical with those attending retrogression of the epidermoid tumors, and the reactive changes taking place in the surrounding tissue are also like those about such tumors. The slowing and cessation of growth that occur secondarily in the case of virus-induced skin papillomas are associated with the formation under them of a dense layer of connective tissue, and to this their behavior is attributable. Similar findings have been often recorded for tumors, notably for the epidermoid cancers produced in rabbits by tarring.