tbuckley/cabot-search huggingface dataset:
Prevention of Bacterial Endocarditis
Authors: Adnan S. Dajani
Journal: JAMA (1997)

<h3>Objective.</h3> —To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. <h3>Particpants.</h3> —An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. <h3>Evidence.</h3> —The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words<i>endocarditis, bacteremia</i>, and<i>antibiotic prophylaxis</i>. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. <h3>Consensus Process.</h3> —The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. <h3>Conclusions.</h3> —Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.
Efficacy of pemetrexed-cisplatin (PC) in East Asian patients (pts): Subgroup analysis of a phase III study comparing PC versus gemcitabine-cisplatin (GC) in first-line treatment of advanced non-small cell lung cancer (NSCLC)
Authors: M. Orlando, J. S. Lee, C. Yang, L. Simms, K. Park
Journal: Journal of Clinical Oncology (2009)

8045 Background: East Asian ethnicity is a recognized favorable prognostic factor in the treatment of NSCLC in trials with either chemotherapy or EGFR tyrosine-kinase inhibitors (TKIs). In a global phase III study (Scagliotti JCO 2008), superior efficacy of PC was shown for pts with nonsquamous NSCLC, while Asian ethnicity was prognostic in the overall population. The purpose of this analysis is to describe the patient and disease characteristics of the East Asian pts enrolled in this study and assess efficacy according to histology and smoking history. Methods: This retrospective analysis of a large phase III study included only patients enrolled from Korea and Taiwan. For survival and progression-free survival (PFS), Cox-adjusted analyses were used to estimate the hazard ratio and 95% CI, while medians were estimated using Kaplan-Meier method. Results: Results for PFS and response rate showed trends similar to overall survival in East Asian pts, favoring PC therapy in nonsquamous pts. The use of post-discontinuation targeted therapies such as EGFR-TKIs was similar between treatment arms in the overall population and in nonsquamous pts. In East Asian pts, EGFR-TKI use was slightly higher in the GC arm, in both the overall population and in nonsquamous pts. In a further subgroup analysis defined by smoking status, East Asian nonsquamous pts treated with PC had longer survival (not statistically significant). Conclusions: Pt and disease characteristics between the East Asian subgroup and the overall population were similar, with notable differences in the percentage of pts with no smoking history and the greater use of EGFR-TKIs as post-discontinuation therapy. This analysis shows the improved efficacy outcomes for East Asian nonsquamous pts treated with PC is consistent with the previously observed treatment effect of PC on nonsquamous NSCLC. [Table: see text] [Table: see text]
Prognostic factors of trastuzumab-based chemotherapy in patients with advanced HER2 positive gastric cancer.
Authors: Shoko Marshall, Takeru Wakatsuki, Tomohiro Matsushima, Hiroki Osumi, Mariko Ogura, Takashi Ichimura, Daisuke Takahari, Eiji Shinozaki, Keisho Chin, Kensei Yamaguchi
Journal: Journal of Clinical Oncology (2017)

41 Background: Prognostic factor in patients with HER2 positive gastric cancer who received trastuzumab (T-mab) based chemotherapy remains unclear. The aim of this study is to reveal the clinical factors which predict prognosis in T-mab based chemotherapy. Methods: We retrospectively reviewed HER2 positive gastric cancer patients treated with T-mab based chemotherapy in our institute from March 2011 to June 2016. Patients’ demographics according to the ToGA study and laboratory data were examined. Results: Total of 143 patients were enrolled. Median follow-up period was 14.9 months, and median progression-free survival (PFS) and overall survival (OS) were 11.2 months (95% CI: 8.6-13.9) and 20.9 months (95% CI: 16.6-25.2), respectively. In univariate analysis, performance status (0 vs. 1-2), present of measurable lesion, presence of visceral metastases, No. of metastatic lesion (1-4 vs. &gt; 4), LDH, ALP, Alb, median CEA (≧ 13.6 mg/ml vs. &lt; 13.6mg/ml), and median Neutrophil/Lymphocyte (N/L) ratio (≧ 3.11 vs. &lt; 3.11) were significantly associated with PFS. Regarding OS, extension of disease (locally advanced vs. metastatic), presence of visceral metastases, No. of metastatic lesions, Hb, ALP, Alb, CRP, median CEA and median N/L ratio were significant. In multivariate analysis, CEA levels (HR 0.54: 95%CI 0.34-0.86, p = 0.010) and ALP (HR 0.57: 95%CI 0.33-0.99, p = 0.046) retained to be significant in regard to PFS. Patients with &lt; median CEA level had a median PFS of 13.1 months vs. 7.2 months with ≧ median CEA level. Patients with normal level of ALP showed a median PFS of 12.8 months vs. 5.9 months with abnormal ALP level. With respect to OS, CEA levels (HR 0.59: 95%CI 0.34-1.03, p = 0.061) and N/L ratio (HR 0.55: 95%CI 0.29-1.06, p = 0.074) were marginally significant. Patients with &lt; median CEA level had a median OS of 27.6 months vs. 17.6 months with ≧ median CEA level. Patients with &gt; median N/L had a median OS of 24.5 months vs. 16.5 month with ≧ median N/L. Conclusions: Lower CEA levels and normal ALP levels were associated with favorable PFS, and lower CEA and N/L ratio were marginally associated with favorable OS.
Effects of cediranib (VEGF signaling inhibitor) on edema in newly diagnosed glioblastoma patients during initial chemoradiation.
Authors: Pavlina Polaskova, Marco C Pinho, Jayashree Kalpathy-Cramer, Alexander R Guimaraes, Patrick Y. Wen, A. Gregory Sorensen, Rakesh K. Jain, Tracy Batchelor, Elizabeth Robins Gerstner
Journal: Journal of Clinical Oncology (2012)

2012 Background: A significant benefit of antiangiogenic therapy is control of brain edema. We evaluated the impact of adding cediranib to standard chemoradiation (CRT) on peritumoral edema in patients with newly diagnosed glioblastoma(GBM) during the initial 6 weeks of CRT. Methods: Two cohorts of patients were enrolled in two clinical trials. The control group (N=13) received radiation for 6 weeks plus temozolomide. The cediranib (CED) group received standard CRT plus daily cediranib (N=34). MRIs were performed at baseline and weekly during CRT. Volumes of interest (VOIs) were drawn outlining the enhancing tumor on T1-weighted post contrast images and the abnormal FLAIR hyperintensity. ADC (apparent diffusion coefficient) maps were calculated from diffusion-weighted images and histograms of the distribution of ADC values created for each visit using the baseline FLAIR VOI to characterize the peritumoraledema. Patients were on stable or decreasing doses of steroids. Results: In the CED group, T1 and FLAIR VOI decreased during CRT vs controls where T1 VOI did not change and FLAIR VOI increased. By the end of CRT, the mode of the ADC histogram in the CED group shifted to the left while the mode of the controls shifted to the right. The skewness, a measure of asymmetry of the distribution, increased in the CED group and decreased in controls. Conclusions: In patients with newly diagnosed GBM treated with CRT and cediranib, tumor volume decreased on T1 and FLAIR images whereas the FLAIR volume significantly increased in the control group suggesting increased edema. The shift of mode to the right and decreasing skewness in controls (indicating an increase in the proportion of very high ADC values) suggests that adding cediranibprevented the development of edema and contributed to the resolution of existing edema. Preventing the edema by adding anti-VEGF treatment may improve the tolerability of CRT for GBM patients. [Table: see text]
Patients' unvoiced agendas in general practice consultations.
Authors: CA Barry, CP Bradley, N Britten, FA Stevenson, N Barber
Journal: BMJ (2000)

Objective: To investigate patients' agendas before consultation and to assess which aspects of agendas are voiced in the consultation and the effects of unvoiced agendas on outcomes. Design: Qualitative study. Setting: 20 general practices in south east England and the West Midlands. Participants: 35 patients consulting 20 general practitioners in appointment and emergency surgeries. Results: Patients' agendas are complex and multifarious. Only four of 35 patients voiced all their agendas in consultation. Agenda items most commonly voiced were symptoms and requests for diagnoses and prescriptions. The most common unvoiced agenda items were: worries about possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context. Agenda items that were not raised in the consultation often led to specific problem outcomes (for example, major misunderstandings), unwanted prescriptions, non-use of prescriptions, and non-adherence to treatment. In all of the 14 consultations with problem outcomes at least one of the problems was related to an unvoiced agenda item. Conclusion: Patients have many needs and when these are not voiced they can not be addressed. Some of the poor outcomes in the case studies were related to unvoiced agenda items. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agendas
Clinical Features of De Novo CD25-Positive Diffuse Large B-Cell Lymphoma
Authors: Shin-ichiro Fujiwara, Kazuo Muroi, Yuji Hirata, Kazuya Sato, Tomohiro Matsuyama, Ken Ohmine, Takahiro Suzuki, Katsutoshi Ozaki, Masaki Mori, Tadashi Nagai, Keiya Ozawa
Journal: Blood (2011)
Medical Education Theme Issue 2012
Authors: Robert M. Golub
Journal: JAMA (2012)

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
Second malignant neoplasms (SMN) among 18,627 testicular cancer survivors (TCS) after chemotherapy (CHEM) or surgery (SURG).
Authors: Chunkit Fung, Sophie D. Fossa, Michael T Milano, Mandi Yu, Melissa Worman, Lois B. Travis
Journal: Journal of Clinical Oncology (2012)

1536 Background: Increased risks of SMN after radiotherapy (RT) for testicular cancer (TC) are well established. Few population-based studies, however, have focused on SMN risk among a contemporary group of TCS managed initially with non-RT approaches, including CHEM. Methods: Standardized incidence ratios (SIR) of SMN stratified by site and time since TC diagnosis were calculated for 18,627 TCS reported to the SEER program (1980-2008) who initially had CHEM (n=8,058) or SURG (n=10,569) alone without RT, with each cohort accruing 65,398 and 92,681 person-years (PY) of follow-up respectively. Results: After CHEM, significantly increased risks of solid cancers (n=154; SIR 1.3; 95% CI 1.1-1.5; absolute excess risk (AER) 5.4 per 10,000 PY) and leukemias (n=18, SIR 3.9; 95% CI 2.3-6.1; AER 2.0) were observed. Solid cancer risk remained elevated for &gt; 20 yrs, whereas excess leukemias were concentrated within 10 years after diagnosis. SIRs for solid cancers during the &lt;1, 1-4, 5-9, 10-14, 15-19, and 20+ yr periods were 2.0 (95% CI 1.03-3.5), 1.4 (95% CI 0.97-2.0), 0.8 (95% CI 0.5-1.2), 1.3 (95% CI 0.9-1.8), 1.6 (95% CI 1.05-2.2), and 1.5 (95% CI 0.95-2.2) respectively (P-trend 0.5) whereas SIRs for leukemia were 3.2, 9.9 (P&lt;0.05), 2.6, and 2.3 respectively, with no cases reported in the latter 2 intervals. Median latencies to the development of solid cancers and leukemia were 12.5 yr (0.1-28) and 2.5 yr (0.1-14) respectively. Increased site-specific risks were apparent for cancers of liver (SIR 1.9; 95% CI 0.6-4.4); pancreas (SIR 2.1; 95% CI 0.8-4.6); soft tissue (SIR 4.9; 95% CI 2.1-9.7); bladder (SIR 1.9; 95% CI 1.02-3.3); kidney (SIR 2.6; 95% CI 1.4-4.3); brain/CNS (SIR 1.8; 95% CI 0.7-3.7), and thyroid (SIR 3.9; 95% CI 2.1-6.6). Secondary leukemias included 16 non-lymphocytic and 2 lymphocytic leukemias. In contrast, among TCS managed initially with SURG alone, no excess solid cancers were observed (n=198; SIR 1.0; 95% CI 0.8-1.1), albeit an increased risk of leukemia (n=15; SIR 1.9; 95% CI 1.1-3.2, AER 0.8) was seen. Conclusions: Future analytic studies should further evaluate the site-specific risks of SMN after modern CHEM for TC and the baseline risk among patients managed with non-cytotoxic approaches.
PAI-1 (Plasminogen activator inhibitor-1) expression levels in colorectal cancers and corresponding normal tissues
Authors: T. Sakakibara, K. Hibi, M. Koike, M. Fujiwara, Y. Kodera, A. Nakao
Journal: Journal of Clinical Oncology (2006)

10094 Background: We performed a quantitative RT-PCR for Plasminogen Activator Inhibitor-1 (PAI-1) gene in 55 surgical specimens of colorectal cancer (CRC) and corresponding normal mucosa. To test the hypothesis that PAI-1 may serve as a candidate marker for the malignant potential of CRC, we evaluated the possible relationship between PAI-1 gene expression levels and clinicopathological findings in CRC. Next, to investigate the mechanism of PAI-1 overexpression in CRC, we compared the PAI-1 expression levels in these cancers with those in the corresponding normal tissues. Results: A significant increase in PAI-1 expression scores was observed in node-positive CRCs (2.19Å}0.43) compared to negative ones (0.35Å}0.42) (P=0.0037) as well as in CRCs with distant metastasis (3.50Å}1.18) compared to negative ones (0.99Å}0.30). A significant increase in PAI-1 expression scores was observed in lymph node metastasis-positive CRCs (2.19Å}0.43) compared to negative ones (0.35Å}0.42) (P=0.0037) as well as in distant metastasis-positive CRCs (3.50Å}1.18) compared to negative ones (0.99Å}0.30). The PAI-1 expression score markedly increased with the tumor stage (P=0.0063; ANOVA test). Moreover, multivariate analysis revealed the PAI-1 expression score to be a strong and independent prognostic factor for CRC (P=0.0432). There was a significant correlation between CRC and corresponding normal PAI-1 expressions with a Spearman’s rank correlation coefficient of 0.81 (P &lt; 0.0001). Conclusion: These results suggested that PAI-1 might serve as a new parameter for the prediction of prognoses in CRC. Taken together, PAI-1 overexpression in CRCs might originate from higher PAI-1 expression in the corresponding normal tissues and result in a malignant phenotype of these cancers. No significant financial relationships to disclose.
Transducer array layout optimization for treating lung-based tumors with TTFields.
Authors: Zeev Bomzon, Noa Urman, Cornelia Wenger, Moshe Giladi, Uri Weinberg, Yoram Wasserman, Eilon David Kirson, Pedro Miranda, Yoram Palti
Journal: Journal of Clinical Oncology (2015)

e18503 Background: Tumor Treating Fields (TTFields) are low intensity, alternating electric fields in the intermediate frequency range, that disrupt mitosis. TTFields are FDA approved for the treatment of recurrent glioblastoma (GBM). The phase III EF-14 clinical trial established the efficacy TTFields in combination with Temozolomide for treating newly diagnosed patients with GBM. . TTFields were also effective in the treatment of non-small-cell lung cancer (NSCLC) and mesothelioma in multiple preclinical models, and safe when combined with pemetrexed in a pilot clinical trial of NSCLC patients. TTFields are delivered through two pairs of transducer arrays placed on the patient's skin. Treatment efficacy is positively correlated with the intensity of the electric field, making the optimization of the array placement an important factor in treatment planning. Personalizing the array layout to maximize the field intensity within brain tumors is widely practiced using a designated software. Here we present Finite Element Method (FEM) simulations demonstrating that array layout personalization has a significant effect on TTFields intensities within the lungs. Methods: The distribution of TTFields within the thorax was calculated for several array layouts. Each array layout was designed to deliver maximal field intensities to a selected region within the lungs. Simulations were performed using the Sim4Life software package (ZMT, Zurich, Switzerland) and the realistic computational phantom, DUKE (ZMT, Zurich, Switzerland) Results: Our work shows that the TTFields can be delivered at therapeutic intensities exceeding1.5 V/cm to almost the entire volume of the lungs. The simulations also show that optimization of the array layout allows the delivery of maximal field intensities exceeding 4 V/cm within targeted regions. Conclusions: This study suggests that personalizing array layouts can optimize TTFields distribution not only in the head, but also within the thorax. Therefore, array layout planning should be an integral part of TTFields treatment for patients with tumors in the lungs.
Association of tumor-associated macrophages of M2 subtype with outcome in follicular lymphoma.
Authors: Clarinda Wei Ling Chua, Kevin Tay, Iain B. Tan, Tiffany Tang, Summer Pan, Emarene Kalaw, Lay Poh Khoo, Jeslin Ha, Richard Hong Hui Quek, Miriam Tao, Leonard Tan, Bin Tean Teh, Soon Thye Lim, Soo Yong Tan
Journal: Journal of Clinical Oncology (2012)

8078 Background: Current methods used to prognosticate patients with follicular lymphoma (FL) include the Follicular Lymphoma International Prognostic Index (FLIPI) and tumor grade. However, they do not provide information on the biological and molecular features of FL. Recent data suggest that high tumor-associated macrophages (TAM) content may be an adverse prognostic factor in FL. However, TAM consists of two main subtypes, M1 and M2, with the former related to pro-inflammatory properties while the latter, anti-inflammatory functions. Currently, the prognostic impact of each individual subtype has not been elucidated and this may be more important than looking at TAM alone. Methods: Tumor specimens of 98 patients with FL diagnosed between 2005 and 2009 were investigated using immunohistochemistry and fluorescence in-situ hybridization (FISH) using break-apart FISH probes targeting BCL2, BCL6, MYC and IgH genes. Tumor specimens expressing a higher proportion of CD68+/CD163- in one high power field were defined as M1 subtype and those that expressed a greater proportion of CD68+/CD163+ were denoted as M2 subtype. Results: Amongst the 98 patients, 60 (61%) were of the M2 subtype, 59% presented with advanced disease, 47% were grade 3 and the median age was 59 years (21 – 88 years). Baseline characteristics including grade, stage and recurrent translocations did not significantly differ between the M1 and M2 groups. Similarly, there was also no difference in terms of treatment received (both Rituximab and chemotherapy) between the two groups. Despite these similarities, with a median follow-up of 3.2 years, the 3-year overall survival (OS) was significantly different (M1, 100% vs M2, 85%; p &lt; 0.01). All 11 patients who died were of the M2 subtype (p=0.009). Conclusions: Our findings show that despite similar patient characteristics and treatment, there was, however, a statistically significant difference in OS, with the M2 subtype demonstrating an inferior outcome. The M2 TAM subtype rather than TAM alone may be a more important prognostic marker in FL, which could possibly be explained by its known biological anti-inflammatory function.