tbuckley/cabot-search huggingface dataset:
Chronic Back Pain and a Bulge
Authors: Carrie Nielsen, Roger Bigelow, David Siegel
Journal: JAMA Surgery (2018)

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Pathologic complete response and survival outcomes in patients with localized soft tissue sarcoma treated with neoadjuvant chemoradiotherapy or radiotherapy: Long-term update of NRG Oncology RTOG 9514 and 0630.
Authors: Dian Wang, Jonathan Harris, William G. Kraybill, Burton Larry Eisenberg, David G. Kirsch, John Michael Kane, David S. Ettinger, Ira J Spiro, Andy Trotti, Carolyn R. Freeman, Yen-Lin Chen, Ying J. Hitchcock, Manpreet Bedi, Kilian Elizabeth Salerno, George Dundas, Karen D. Godette, Nicole Larrier, Walter John Curran, David Robert Lucas
Journal: Journal of Clinical Oncology (2017)

11012 Background: We sought to determine the prognostic significance of pathologic complete response (pCR) in soft tissue sarcoma (STS) in patients (pts) receiving neoadjuvant chemoradiotherapy (RTOG 9514) or radiotherapy (RTOG 0630) with long-term outcomes. Methods: RTOG has completed two phase II trials (RTOG 9514 and RTOG 0630) for pts with localized STS. Pts with high-grade STS ≥8 cm of extremities or body wall were enrolled to 9514 from 1997-2000 and received 3 cycles neoadjuvant chemotherapy (CT), interdigitated with RT, and 3 cycles postop CT. Pts with STS of extremities were enrolled to 0630 from 2008-2010 and received preoperative RT without CT. One pathology expert (DL) assessed pts for pCR at time of surgery without knowledge of disease outcomes. Overall and disease-free survival (OS and DFS) were calculated from the date of surgery. Pts that did not have surgery or had an amputation were excluded. Hazard ratios (HR) and p-values were estimated by multivariate Cox model stratified by study, where possible (i.e., &gt; 0 events in both groups); otherwise p-values were calculated by stratified log-rank test. Results: Of 135 who had surgery, 123 were evaluable for pCR: 14/51 (27.5%) on 9514 and 14/72 (19.4%) on 0630 had pCR. With median follow-up of &gt; 5 years for surviving pts, OS is 100% for pts with pCR vs. 5-year 76.5% (95% confidence interval 62.3-90.8) and 56.4% (43.3-69.5) for pts with &lt; pCR in 9514 and 0630, respectively. pCR is associated with improved OS (p = 0.01) and DFS [HR 4.91 (1.51-15.93); p = 0.008] relative to &lt; pCR. Local failure rate was 0% in pts with pCR vs. 5-year 11.7% (3.6-25.1) and 9.1% (3.3-18.5) for pts with &lt; pCR in 9514 and 0630, respectively. Leiomyosarcoma/liposarcoma/myxofibrosarcoma are associated with better OS [hazard ratio 2.24 (1.12 and 4.45)] while liposarcoma/myxofibrosarcoma are associated with better DFS [hazard ratio 2.42 (1.23-4.76)]. Conclusions: Results from this analysis have demonstrated that pCR is associated with improved survival outcomes in pts with STS treated with either neoadjuvant RT or CT-RT. pCR should be considered as a survival surrogate for future STS studies. Clinical trial information: RTOG 9514 and RTOG 0630.
An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11
Authors: P. Stefanelli, C. Fazio, P. Vacca, A. Palmieri, L. Ambrosio, A. Neri, A. Piana, P. Castiglia, F. Argiolas, S. Santus, L. Masala, G. Steri, F. Riccardo, S. Iannazzo, F.P. Maraglino, C. D'Amario, G. Rezza
Journal: Clinical Microbiology and Infection (2018)

The aim was to investigate an outbreak of invasive meningococcal disease (IMD) in Southern Sardinia.Epidemiological and microbiological investigations were performed. The latter included antimicrobial susceptibility testing and whole-genome sequencing (WGS).Seven individuals with severe IMD were found to be infected with serogroup B (MenB) Neisseria meningitidis in the first quarter of 2018. Five of the seven cases (five males; mean age 19 years; range 18-21 years; CFR 40%) were due to a unique strain B:P1.5-1,10-8:F3-6:ST-11(cc11), probably switched from the hypervirulent C-cc11, as confirmed by WGS. All five patients had attended the same nightclub in the 2 weeks prior to symptom onset. Public health measures, including chemoprophylaxis of contacts and active immunization against MenB, were implemented.We observed five IMD cases due to the same switched MenB strain. The hypervirulent B:P1.5-1,10-8:F3-6:ST-11(cc11) strain, probably switched from C-cc11, is of concern due to the observed high virulence and case fatality rates. All the patients shared the same place of probable exposure. The molecular characterization of the invasive strain allowed the outbreak to be confirmed, which was then controlled through timely public health action.
A Prospective Cohort Study of Adolescents’ Memory Performance and Individual Brain Dose of Microwave Radiation from Wireless Communication
Authors: Milena Foerster, Arno Thielens, Wout Joseph, Marloes Eeftens, Martin Röösli
Journal: Environmental Health Perspectives (2018)

Background: The potential impact of microwave radiofrequency electromagnetic fields (RF-EMF) emitted by wireless communication devices on neurocognitive functions of adolescents is controversial. In a previous analysis, we found changes in figural memory scores associated with a higher cumulative RF-EMF brain dose in adolescents. Objective: We aimed to follow-up our previous results using a new study population, dose estimation, and approach to controlling for confounding from media usage itself. Methods: RF-EMF brain dose for each participant was modeled. Multivariable linear regression models were fitted on verbal and figural memory score changes over 1 y and on estimated cumulative brain dose and RF-EMF related and unrelated media usage (n=669–676). Because of the hemispheric lateralization of memory, we conducted a laterality analysis for phone call ear preference. To control for the confounding of media use behaviors, a stratified analysis for different media usage groups was also conducted. Results: We found decreased figural memory scores in association with an interquartile range (IQR) increase in estimated cumulative RF-EMF brain dose scores: −0.22 (95% CI: −0.47, 0.03; IQR: 953 mJ/kg per day) in the whole sample, −0.39 (95% CI: −0.67, −0.10; IQR: 953 mJ/kg per day) in right-side users (n=532), and −0.26 (95% CI: −0.42, −0.10; IQR: 341 mJ/kg per day) when recorded network operator data were used for RF-EMF dose estimation (n=274). Media usage unrelated to RF-EMF did not show significant associations or consistent patterns, with the exception of consistent (nonsignificant) positive associations between data traffic duration and verbal memory. Conclusions: Our findings for a cohort of Swiss adolescents require confirmation in other populations but suggest a potential adverse effect of RF-EMF brain dose on cognitive functions that involve brain regions mostly exposed during mobile phone use. https://doi.org/10.1289/EHP2427
Acute Declines in Renal Function during Intensive BP Lowering and Long-Term Risk of Death
Authors: Elaine Ku, Joachim H. Ix, Kenneth Jamerson, Navdeep Tangri, Feng Lin, Jennifer Gassman, Miroslaw Smogorzewski, Mark J. Sarnak
Journal: Journal of the American Society of Nephrology (2018)

Background During intensive BP lowering, acute declines in renal function are common, thought to be hemodynamic, and potentially reversible. We previously showed that acute declines in renal function ≥20% during intensive BP lowering were associated with higher risk of ESRD. Here, we determined whether acute declines in renal function during intensive BP lowering were associated with mortality risk among 1660 participants of the African American Study of Kidney Disease and Hypertension and the Modification of Diet in Renal Disease Trial. Methods We used Cox models to examine the association between percentage decline in eGFR (&lt;5%, 5% to &lt;20%, or ≥20%) between randomization and months 3–4 of the trials (period of therapy intensification) and death. Results In adjusted analyses, compared with a &lt;5% eGFR decline in the usual BP arm (reference), a 5% to &lt;20% eGFR decline in the intensive BP arm was associated with a survival benefit (hazard ratio [HR], 0.77; 95% confidence interval [95% CI], 0.62 to 0.96), but a 5% to &lt;20% eGFR decline in the usual BP arm was not (HR, 1.01; 95% CI, 0.81 to 1.26; P &lt;0.05 for the interaction between intensive and usual BP arms for mortality risk). A ≥20% eGFR decline was not associated with risk of death in the intensive BP arm (HR, 1.18; 95% CI, 0.86 to 1.62), but it was associated with a higher risk of death in the usual BP arm (HR, 1.40; 95% CI, 1.04 to 1.89) compared with the reference group. Conclusions Intensive BP lowering was associated with a mortality benefit only if declines in eGFR were &lt;20%.
Delivering child health interventions through the private sector in low and middle income countries: challenges, opportunities, and potential next steps
Authors: Phyllis Awor,, Stefan Peterson,, Meenakshi Gautham,
Journal: BMJ (2018)

Strategic review of child healthDelivering child health interventions through the private sector in low and middle income countries: challenges, opportunities, and potential next steps Universal health coverage requires both the public and private sectors to ensure quality, equity, and efficiency in health systems, say Phyllis Awor and colleagues Key messages• Care for most children is sought from private health providers in the forprofit sector in low and middle income countries on 1 August
Clinical associations and expression pattern of the autoimmunity susceptibility factor DIORA-1 in patients with primary Sjögren’s syndrome
Authors: Lara A Aqrawi, Lara Mentlein, Lauro Meneghel, Albin Björk, Gudny Ella Thorlacius, Margarita Ivanchenko, Jorge I Ramírez Sepúlveda, Kathrine Skarstein, Marika Kvarnström, Susanna Brauner, Alexander Espinosa, Marie Wahren-Herlenius
Journal: Annals of the Rheumatic Diseases (2018)

Sjogren’s syndrome (SS) is characterised by B cell abnormalities and immune-mediated destruction of exocrine glands, primarily the salivary and lacrimal glands.1 2 Among the reported genetic polymorphisms associated with primary SS (pSS), the FAM167A-BLK locus distinguishes itself as an interesting candidate for further analysis based on the strong expression quantitative locus effect of pSS-associated polymorphisms on FAM167A (member A of the Family with sequence similarity 167), contrasted with only moderate or no effect on BLK .3 4 Little is known about the FAM167A gene and its relevance to rheumatic disease pathogenesis. We recently explored FAM167A and its encoded protein Disordered autoimmunity-1 (DIORA-1),4 and reported that DIORA-1 is conserved in vertebrates, has an intracellular, cytoplasmic localisation and in mice is predominantly expressed in lung and spleen—two organs with a high content of immune cells. In the present study, we investigated the expression of DIORA-1 in human immune cells and in salivary glands of patients with pSS, and assessed DIORA-1 expression in relation to pSS clinical manifestations.

Notably, we observed expression of DIORA-1 in CD19+ B cells, but little or no expression in monocytes or T cells (figure 1A). DIORA-1 expression in CD19+ B cells was similar in patients with pSS and healthy donors (figure 1B). To further define the expression pattern in B cells, we analysed DIORA-1 expression in cell lines representing discrete …
Abstract 11513: Eplerenone Treatment Mitigates Atrial Structural Remodeling but Does Not Modify the Transition From Paroxysmal to Persistent Atrial Fibrillation in an Ovine Model
Authors: Yoshio Takemoto, Rafael J Ramirez, Kuljeet Kaur, Daniela Ponce-Balbuena, Roberto Ramos-Mondragon, Byrd C Willis, Steven R Ennis, Guadalupe Guerrero-Serna, Sandeep V Pandit, Omer Berenfeld, José Jalife
Journal: Circulation (2015)

Introduction: Recently we demonstrated that inhibition of the pro-fibrotic protein Galectin-3 reduces atrial dilatation, fibrosis and electrical remodeling as well as atrial fibrillation (AF) burden in a clinically relevant sheep model of lone persistent AF (Takemoto Y, et al. Heart Rhythm 12:S4; 2015). The mineralocorticoid blocker eplerenone (EPL) has been shown to reduce fibrosis and the incidence of AF in patients with systolic heart failure and mild symptoms, but the mechanism is poorly understood. We tested the hypothesis that by reducing atrial dilatation and fibrosis alone in the absence of heart failure EPL treatment also reduces atrial fibrosis and prevents AF perpetuation. Methods: We conducted a placebo-controlled drug study in 17 atrially tachypaced sheep for 14±2 weeks (maximum 23 weeks). We compared effects of EPL treatment (100 mg/day, N=10) with sugar pill (SP, N=7) orally administered daily from the start of tachypacing. The terminal point of the study was a continuous 7-day stretch of persistent AF (N=14) or the completion of 23-weeks tachypacing (N=3). Results: In vivo, EPL significantly reduced the rate of left atrial (LA) dilatation, mitral regurgitation, cellular hypertrophy, interstitial fibrosis (picrosirius red staining), and serum procollagen III N-terminal peptide (P3NP) levels during AF progression. However EPL did not affect the rate of dominant frequency (DF) increase or the maximum DF (DFmax). Ex-vivo optical mapping of the explanted hearts showed that EPL did not affect action potential duration or conduction velocity during pacing, or the DFmax during AF compared with hearts from SP-treated animals. However, EPL treatment significantly reduced the number of rotors and the trajectory areas of wavebreaks in LA during AF. Most important, unlike Gal-3 inhibition, EPL treatment did not change AF inducibility or AF burden at any time of weekly evaluation during AF progression. Conclusions: Mineralocorticoid inhibition during AF progression mitigates fibrosis and structural remodeling, which reduces complexity of AF and possibly contributes to delay the AF substrate somewhat. However, while reduction of fibrosis might be necessary, it is not sufficient to prevent AF perpetuation when electrical remodeling endures.
Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant
Authors: Morten Lamberts, Gunnar H. Gislason, Gregory Y.H. Lip, Jens Flensted Lassen, Jonas Bjerring Olesen, Anders P. Mikkelsen, Rikke Sørensen, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen
Journal: Circulation (2014)

Background— The optimal long-term antithrombotic treatment of patients with coexisting atrial fibrillation and stable coronary artery disease is unresolved, and commonly, a single antiplatelet agent is added to oral anticoagulation. We investigated the effectiveness and safety of adding antiplatelet therapy to vitamin K antagonist (VKA) in atrial fibrillation patents with stable coronary artery disease. Methods and Results— Atrial fibrillation patients with stable coronary artery disease (defined as 12 months from an acute coronary event) between 2002 and 2011 were identified. The subsequent risk of cardiovascular events and serious bleeding events (those that required hospitalization) was examined with adjusted Cox regression models according to ongoing antithrombotic therapy. A total of 8700 patients were included (mean age, 74.2 years; 38% women). During a mean follow-up of 3.3 years, crude incidence rates were 7.2, 3.8, and 4.0 events per 100 person-years for myocardial infarction/coronary death, thromboembolism, and serious bleeding, respectively. Relative to VKA monotherapy, the risk of myocardial infarction/coronary death was similar for VKA plus aspirin (hazard ratio, 1.12 [95% confidence interval, 0.94–1.34]) and VKA plus clopidogrel (hazard ratio, 1.53 [95% confidence interval, 0.93–2.52]). The risk of thromboembolism was comparable in all regimens that included VKA, whereas the risk of bleeding increased when aspirin (hazard ratio, 1.50 [95% confidence interval, 1.23–1.82]) or clopidogrel (hazard ratio, 1.84 [95% confidence interval, 1.11–3.06]) was added to VKA. Conclusions— In atrial fibrillation patients with stable coronary artery disease, the addition of antiplatelet therapy to VKA therapy is not associated with a reduction in risk of recurrent coronary events or thromboembolism, whereas risk of bleeding is increased significantly. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with atrial fibrillation and stable coronary artery disease warrants reassessment.
Abstract 18322: Compensatory Accumulation of βHydroxybutyrate Accompanied by SCOT Downregulation in Failing Hearts
Authors: Manabu Nagao, Ryuji Toh, Yasuhiro Irino, Takeshige Mori, Tetsuya Hara, Tomoyuki Honjo, Seimi Satomi-Kobayasi, Toshiro Shinke, Hidekazu Tanaka, Tatsuro Ishida, Ken-ichi Hirata
Journal: Circulation (2016)

Background and Objective:  Circulating levels of ketone bodies have been previously reported to be increased in patients with congestive heart failure (HF). Recent studies have shown that the ketone body βhydroxybutyrate (βOHB) acts not only as a carrier of energy but also as a signaling molecule that has a role in diverse cellular functions. In this study, we investigated regulatory mechanism and pathophysiological role of βOHB in HF.   Methods and Results:  Unexpectedly, despite the presence of cardiac dysfunction, circulating βOHB levels were not elevated in hamster model for dilated cardiomyopathy. However, we found that βOHB was increased in hearts as well as liver. Intriguingly, whereas the augmentation in hepatic ketogenesis did not even occur, hypertrophied hearts of mice subjected to aortic banding also showed an increase in levels of βOHB, indicating that the elevated myocardial βOHB was not accompanied by an increase in its delivery from the liver to the heart through the blood stream. Therefore, we sought to investigate the regulatory mechanisms of βOHB metabolism in failing hearts. The gene and protein expression levels of CoA transferase (SCOT), a key enzyme involved in ketone body oxidation, was decreased in hypertrophied hearts. Using rat neonatal ventricular cardiomyocytes, we also revealed that H 2 O 2  stimulation caused βOHB accumulation concomitantly with SCOT downregulation, implying that the accumulation of myocardial βOHB occurs because of the decline in its utilization. Finally, we checked the effects of βOHB on cardiomyocytes under oxidative stress. We found that βOHB induced FOXO3a, an oxidative stress resistance gene, and its target enzyme, SOD2 and catalase. Dihydroethidium staining revealed that βOHB attenuated reactive oxygen species production induced by H 2 O 2  stimulation. Moreover, pretreatment of βOHB alleviated apoptosis induced by oxidative stress.   Conclusion:  It has been reported that hyperadrenergic state in HF boost lipolysis and result in elevation of circulating free fatty acids, which can lead hepatic ketogenesis for energy metabolism alteration. The present findings suggest that the accumulation of myocardial βOHB also occurs as a compensatory response against oxidative stress.
Transfer of Wild-Type p53 Gene Effectively Inhibits Vascular Smooth Muscle Cell Proliferation In Vitro and In Vivo
Authors: YoshikazuYonemitsu, YasufumiKaneda, ShinjiTanaka, YutakaNakashima, KimihiroKomori, KeizoSugimachi, KatsuoSueishi
Journal: Circulation Research (1998)

Abstract—Wild-type p53 (wt-p53), a key protein in cell cycle regulation, inactivates the G1 cyclins through direct activation of p21Waf-1/Cip-1/Sdi-1. Persistent vascular smooth muscle cell (VSMC) proliferation following vascular interventions hinders the benefits of these therapeutics. Using the hemagglutinating virus of Japan/liposome–mediated gene transfer method, we examined the inhibitory effect of overexpression of exogenous wt-p53 on VSMC proliferation in vitro and in vivo. We assessed the proliferative activity of human p53 cDNA–transduced bovine VSMCs by DNA synthesis assay, flow cytometry, and cell proliferation assay. p53 gene transfer reduced thymidine incorporation of VSMCs stimulated by platelet-derived growth factor-BB (P<.001). The p53-transduced VSMCs underwent synthetic phase depletion (mean, 8.02% versus 33.7% of control; P<.001) and transient G2/M accumulation 2 days after gene transfection, and in almost all cells, G1 arrest occurred (mean, 92.6% versus 79.3% of control; P<.001) 5 day...
Second primary gynecologic neoplasms among breast cancer survivors.
Authors: Maria Pilar Barretina Ginesta, Miguel Beltran, Maria Buxo, Nuria Sala, Neus Baste, Silvia Munoz, Loreto Vilardell, Joan Brunet, Rafael Marcos, Angel Izquierdo
Journal: Journal of Clinical Oncology (2012)

1588 Background: Excess of risk of several second primary malignancies after treatment for breast cancer (BC) has been reported. This risk can be related with shared risk factors, cancer susceptibility genes or prior treatments received. Hormonal factors and hormone therapy are known to be risk factors for both BC and some gynecological malignancies. The aim of this study was to asses gynecological cancer risk as a second neoplasm among BC patients in our population. Methods: Patients diagnosed with invasive BC (CIE10: C50.0-C50.9) and registered in the Girona Cancer Registry from 1980 to 2006 were included in our study. We analyzed their incidence of second gynaecological malignancies except for contralateral BC. Standardized Incidence Ratios (SIR) and absolute excess of risk (AER) of these patients compared to general population were calculated. Results: 6.209 patients were diagnosed of invasive BC in this period, with median age at diagnosis 62 years, median follow-up 4 years. 84 of them developed a second malignancy of gynaecological origin (SIR 1,98 CI 95% 1,59-2,44; AER 104,01/100.000 person-year). We observed 4 uterine cervix (SIR 0.64 IC95% 0,20-1,54), 3 vulvar-vaginal (SIR 0,96 IC95% 0,24-2,60), 13 ovarian (SIR 1,13 IC95% 0,63-1,89) and 63 uterine corpus neoplasms (UC), as well as 1 genital female tract neoplasm unspecified. High and statistically significant SIR was observed for gynecological malignancies in general and specifically for UC(SIR 3.14 IC 95% 2,44-4,00). With this finding, histology of UC cases was reviewed. 12 out of 63 were malignant histologies, not otherwise specified. Among the remaining 51, there were 8 type II (1 clear cell and 7 serous adenocarcinoma, 15.7%), 34 type I (endometrioid adenocarcinoma, 66.7%) and 6 carcinosarcomas (11.8%). There were also 2 adenosarcomas (3.9%) and 1 mucinous adenocarcinoma (1.9%). Conclusions: Women with previous BC have an elevated risk of developing a second primary gynecological malignancy compared with general population, particularly for UC. These patients should be followed up for its early detection. We detected a slight increase in unfavourable uterine carcinoma histologies respect to the general population. Further investigation of this finding is warranted.