tbuckley/cabot-search huggingface dataset:
Is use of homeopathy associated with poor prescribing in English primary care? A cross-sectional study
Authors: Alex J Walker, Richard Croker, Seb Bacon, Edzard Ernst, Helen J Curtis, Ben Goldacre
Journal: Journal of the Royal Society of Medicine (2018)

Objectives Prescribing of homeopathy still occurs in a small minority of English general practices. We hypothesised that practices that prescribe any homeopathic preparations might differ in their prescribing of other drugs. Design Cross-sectional analysis. Setting English primary care. Participants English general practices. Main outcome measures We identified practices that made any homeopathy prescriptions over six months of data. We measured associations with four prescribing and two practice quality indicators using multivariable logistic regression. Results Only 8.5% of practices (644) prescribed homeopathy between December 2016 and May 2017. Practices in the worst-scoring quartile for a composite measure of prescribing quality (>51.4 mean percentile) were 2.1 times more likely to prescribe homeopathy than those in the best category (<40.3) (95% confidence interval: 1.6-2.8). Aggregate savings from the subset of these measures where a cost saving could be calculated were also strongly associated (highest vs. lowest quartile multivariable odds ratio: 2.9, confidence interval: 2.1-4.1). Of practices spending the most on medicines identified as 'low value' by NHS England, 12.8% prescribed homeopathy, compared to 3.9% for lowest spenders (multivariable odds ratio: 2.6, confidence interval: 1.9-3.6). Of practices in the worst category for aggregated price-per-unit cost savings, 12.7% prescribed homeopathy, compared to 3.5% in the best category (multivariable odds ratio: 2.7, confidence interval: 1.9-3.9). Practice quality outcomes framework scores and patient recommendation rates were not associated with prescribing homeopathy (odds ratio range: 0.9-1.2). Conclusions Even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score. The association is unlikely to be a direct causal relationship, but may reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.
Sarcopenia predicts survival in patients with advanced hepatocellular carcinoma treated with Sorafenib
Authors: G. Antonelli, E. Gigante, M. Iavarone, P. Begini, P. Biondetti, A.M. Pellicelli, A. Sangiovanni, P. Lampertico, M. Marignani
Journal: Journal of Hepatology (2018)
African-American race and mortality in interstitial lung disease: a multicentre propensity-matched analysis
Authors: Ayodeji Adegunsoye, Justin M. Oldham, Shashi K. Bellam, Jonathan H. Chung, Paul A. Chung, Kathleen M. Biblowitz, Steven Montner, Cathryn Lee, Scully Hsu, Aliya N. Husain, Rekha Vij, Gokhan Mutlu, Imre Noth, Matthew M. Churpek, Mary E. Strek
Journal: European Respiratory Journal (2018)

We studied whether African-American race is associated with younger age and decreased survival time at diagnosis of interstitial lung disease (ILD).We performed a multicentre, propensity score-matched analysis of patients with an ILD diagnosis followed at five US hospitals between 2006 and 2016. African-Americans were matched with patients of other races based on a time-dependent propensity score calculated from multiple patient, physiological, diagnostic and hospital characteristics. Multivariable logistic regression models were used. All-cause mortality and hospitalisations were compared between race-stratified patient cohorts with ILD, and sensitivity analyses were performed.The study included 1640 patients with ILD, 13% of whom were African-American, followed over 5041 person-years. When compared with patients of other races, African-Americans with ILD were younger at diagnosis (56 years versus 67 years), but in the propensity-matched analyses had greater survival (hazard ratio 0.46, 95% CI 0.28-0.77; p=0.003) despite similar risk of respiratory hospitalisations (relative risk 1.04, 95% CI 0.83-1.31; p=0.709), and similar GAP-ILD (gender-age-physiology-ILD) scores at study entry. Sensitivity analyses in a separate cohort of 9503 patients with code-based ILD diagnosis demonstrated a similar association of baseline demographic characteristics with all-cause mortality.We conclude that African-Americans demonstrate a unique phenotype associated with younger age at ILD diagnosis and perhaps longer survival time.
Abstract 11686: The Myocardial Infarction and Cardiac Arrest Risk Calculator is an Accurate Discriminator of Major Adverse Events Following Elective Hip and Knee Surgery
Authors: Brandon Peterson, Mehrdad Ghahramani, Stephanie Harris, Kristen Suchniak-Mussari, Gurneet Bedi, Charles Bulathsinghala, Andrew Foy
Journal: Circulation (2015)

Background: The 2014 ACC/AHA guidelines on perioperative evaluation recommend differentiating patients at low-risk (&lt;1%) versus elevated-risk (≥1%) for cardiac complications to guide appropriate preoperative testing. Among the tools recommended for estimating perioperative risk is the National Surgical Quality Improvement Program (NSQIP) Myocardial Infarction and Cardiac Arrest (MICA) risk calculator. The NSQIP MICA risk calculator showed good discriminating power when introduced in 2011, but has yet to be externally validated. The aim of the study was to investigate whether the NSQIP MICA risk calculator could accurately discriminate the incidence of major adverse events following elective hip and knee surgery. Methods: We reviewed 1,098 consecutive, elective orthopedic surgeries performed at Hershey Medical Center from January 2013 through December 2014, including 412 total hip replacements and 686 total knee replacements. Sufficient data were present to estimate risk using the NSQIP MICA risk calculator in 1,091 patients. Major adverse events were defined as myocardial infarction, cardiac arrest, or death within 30 days of surgery. A receiver operating characteristic curve was plotted from the estimated risk and adverse outcomes data. Results: Eight out of 1,091 procedures (0.7%) were complicated by a major adverse event. The mean estimated risk for adverse events using the NSQIP MICA risk calculator was 0.54% with a standard error of 0.018%. There was no significant difference (p=0.59) when comparing the observed versus expected incidence of major adverse events by chi-square test. The area under the curve (AUC) was determined to be 0.85 with a 95% confidence interval of 0.79-0.91 (see plot below). Conclusion: The NSQIP MICA risk calculator is a good discriminator of major adverse events following elective hip and knee surgery. Our study supports its use as a predictive tool for preoperative evaluation in this setting.
Defective autophagy in liver sinusoidal endothelial cells promotes non alcoholic steatohepatitis and fibrosis development
Authors: A. Hammoutene, J. Lasselin, A.-C. Vion, N. Colnot, V. Paradis, S. Lotersztajn, C. Boulanger, P.-E. Rautou
Journal: Journal of Hepatology (2018)
More factors affect GP workload than NHS England considers in funding allocation, says report
Authors: Ingrid Torjesen
Journal: BMJ (2018)

NHS England considers only four variables likely to affect consultation length when allocating resources for general practice to clinical commissioning groups, but it should look at more than these, say the authors of a study published in the British Journal of General Practice .1

The current workload formula considers the effects that sex and age group, rurality, deprivation, and the number of new registrations have on consultation length—the proxy variable NHS England uses to measure workload.

However, researchers from Oxford, Cambridge, and Bristol looked at six other variables—ethnicity, smoking status, number of full time equivalent (FTE) GPs, number …
Fostamatinib for the treatment of adult persistent and chronic immune thrombocytopenia: Results of two phase 3, randomized, placebo‐controlled trials
Authors: James Bussel, Donald M. Arnold, Elliot Grossbard, Jiří Mayer, Jacek Treliński, Wojciech Homenda, Andrzej Hellmann, Jerzy Windyga, Liliya Sivcheva, Alhossain A. Khalafallah, Francesco Zaja, Nichola Cooper, Vadim Markovtsov, Hany Zayed, Anne‐Marie Duliege
Journal: American Journal of Hematology (2018)

Spleen tyrosine kinase (Syk) signaling is central to phagocytosis-based, antibody-mediated platelet destruction in adults with immune thrombocytopenia (ITP). Fostamatinib, an oral Syk inhibitor, produced sustained on-treatment responses in a phase 2 ITP study. In two parallel, phase 3, multicenter, randomized, double-blind, placebo-controlled trials (FIT1 and FIT2), patients with persistent/chronic ITP were randomized 2:1 to fostamatinib (n = 101) or placebo (n = 49) at 100 mg BID for 24 weeks with a dose increase in nonresponders to 150 mg BID after 4 weeks. The primary endpoint was stable response (platelets ≥50 000/μL at ≥4 of 6 biweekly visits, weeks 14-24, without rescue therapy). Baseline median platelet count was 16 000/μL; median duration of ITP was 8.5 years. Stable responses occurred in 18% of patients on fostamatinib vs. 2% on placebo (P = .0003). Overall responses (defined retrospectively as ≥1 platelet count ≥50 000/μL within the first 12 weeks on treatment) occurred in 43% of patients on fostamatinib vs. 14% on placebo (P = .0006). Median time to response was 15 days (on 100 mg bid), and 83% responded within 8 weeks. The most common adverse events were diarrhea (31% on fostamatinib vs. 15% on placebo), hypertension (28% vs. 13%), nausea (19% vs. 8%), dizziness (11% vs. 8%), and ALT increase (11% vs. 0%). Most events were mild or moderate and resolved spontaneously or with medical management (antihypertensive, anti-motility agents). Fostamatinib produced clinically-meaningful responses in ITP patients including those who failed splenectomy, thrombopoietic agents, and/or rituximab. Fostamatinib is a novel ITP treatment option that targets an important mechanism of ITP pathogenesis.
Response to: ‘Pitfalls of antinuclear antibody detection in systemic lupus erythematosus: the positive experience of a national multi-center study’ by Pregnalato<i>et al</i>
Authors: David S Pisetsky, Diane M Spencer, Peter E Lipsky, Brad H Rovin
Journal: Annals of the Rheumatic Diseases (2018)

Response to: 'Pitfalls of antinuclear antibody detection in systemic lupus erythematosus: the positive experience of a national multi-center study' by Pregnalato et alWe appreciate the comments by Pregnolato et al 1 on our original paper 2 and subsequent correspondence in the journal. 3 4 The data presented are very interesting and suggest that, under certain circumstances, results of antinuclear antibody (ANA) testing with samples from patients with established systemic lupus erythematosus can show both a high frequency of positivity and high concordance among testing laboratories.Such agreement may result from the nature of the samples themselves, including the titre of the antibodies and the array of specificities present, the kits used for the assays and the experience and training of the observers.While we would acknowledge that ANA assays can perform very well, our experience as well as that in the literature indicates that variability occurs significantly in a way that complicates screening of patients for clinical trials.Notwithstanding the demonstrations of the kind reported by Pregnolato et al, we think that it is important to try to understand assay variability and improve serological determinations for both routine care as well as clinical research.
G9a stimulates CRC growth by inducing p53 Lys373 dimethylation-dependent activation of <i>Plk1</i>
Authors: Jie Zhang, Yafang Wang, Yanyan Shen, Pengxing He, Jian Ding, Yi Chen
Journal: Theranostics (2018)

Rationale: G9a is genetically deregulated in various tumor types and is important for cell proliferation; however, the mechanism underlying G9a-induced carcinogenesis, especially in colorectal cancer (CRC), is unclear. Here, we investigated if G9a exerts oncogenic effects in CRC by increasing polo-like kinase 1 (Plk1) expression. Thus, we further characterized the detailed molecular mechanisms. Methods: The role of Plk1 in G9a aberrant CRC was determined by performing different in vitro and in vivo assays, including assessment of cell growth by performing cell viability assay and assessment of signaling transduction profiles by performing immunoblotting, in the cases of pharmacological inhibition or short RNA interference-mediated suppression of G9a. Detailed molecular mechanisms underlying the effect of G9a on Plk1 expression were determined by performing point mutation analysis, chromatin immunoprecipitation analysis, and luciferase reporter assay. Correlation between G9a and Plk1 expression was determined by analyzing clinical samples of patients with CRC by performing immunohistochemistry. Results: Our study is the first to report a significant positive correlation between G9a and Plk1 levels in 89 clinical samples of patients with CRC. Moreover, G9a depletion decreased Plk1 expression and suppressed CRC cell growth both in vitro and in vivo, thus confirming the significant correlation between G9a and Plk1 levels. Further, we observed that G9a-induced Plk1 regulation depended on p53 inhibition. G9a dimethylated p53 at lysine 373, which in turn increased Plk1 expression and promoted CRC cell growth. Conclusions: These results indicate that G9a-induced and p53-dependent epigenetic programing stimulates the growth of colon cancer, which also suggests that G9a inhibitors that restore p53 activity are promising therapeutic agents for treating colon cancer, especially for CRC expressing wild-type p53.
INTRAOPERATIVE USE OF FUNCTIONAL LUMEN IMAGING PROBE DURING PER-ORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ACHALASIA
Authors: HJ Goong, JJ Hwang, BM Ko, SJ Hong, JW Kim
Journal: Endoscopy (2018)

The functional lumen imaging probe (EndoFLIP) is a recently developed technique to evaluate the function of esophagogastric junction (EGJ). Unlike timed barium esophagogram and high resolution manometry (HRM), EndoFLIP can be used during POEM. The aim of this study was to evaluate the feasibility of intraoperative measurements using EndoFLIP during POEM.
Results of the Phase II randomized French trial PRODIGE 21 comparing sorafenib vs pravastatin vs sorafenib and pravastatin vs best supportive care for the palliative treatment of HCC in CHILD B cirrhotic patients
Authors: J.-F. Blanc, F. Khemissa, J.-P. Bronowicki, C. Monterymard, J.-M. Perarnau, V. Bourgeois, S. Obled, M.B. Abdelghani, I. Mabile-Archambeaud, R. Faroux, J.-F. Seitz, C. Locher, H. Senellart, A.-L. Villing, F. Audemar, C. Costentin, G. Delplanque, S. Manfredi, J. Edeline
Journal: Journal of Hepatology (2018)
Evaluation of a pocket-sizedspectroscopy for extemporaneous macrosteatosis liver graft assessment
Authors: N. Golse, C. Cosse, M.-A. Allard, A. Laurenzi, M. Tedeschi, N. Guglielmo, B. Trechot, E.F. de Sevilla, C. Castro, M. Robert, G. Pittau, O. Ciacio, A. Sa Cunha, D. Castaing, D. Cherqui, R. Adam, D. Samuel, M. Sebagh, E. Vibert
Journal: Journal of Hepatology (2018)
P286Long-term outcomes of elective percutaneous coronary interventions
Authors: E O Vershinina, A N Repin
Journal: Cardiovascular Research (2018)

auricles.EMT was defined using aSMA immunostaining.The top 22 ranked compounds were validated in multiple epicardial cell lines using aSMA immunostaining and qRT-PCR for EMT related genes.With the two highest responders, concentration-response experiments are currently being conducted to determine the optimal dosage.Conclusion: It is feasible and effective to perform high-throughput experiments using human primary epicardial derived cells to identify EMT activators.Furthermore, two compounds were found that can induce EMT in epicardial derived cells and may therefore serve as a potential therapeutic to improve the epicardial regenerative response.In the future, my research will focus on optimizing strategies to deliver these EMT-inducing compounds to the epicardium of the infarcted heart.
Analyze of ballooning biomarker in patients with non-alcoholic steatohepatitis: A multicenter study
Authors: Y. Honda, T. Kessoku, W. Tomeno, K. Imajo, M. Yoneda, S. Saito, T. Nakahara, S. Ooeda, H. Takahashi, H. Hyogo, Y. Eguchi, A. Nakajima
Journal: Journal of Hepatology (2018)
Hyaluronan‐Based Nanohydrogels for Targeting Intracellular <i>S. Aureus</i> in Human Keratinocytes
Authors: Elita Montanari, Angela Oates, Chiara Di Meo, Josephine Meade, Rugiada Cerrone, Antonio Francioso, Deirdre Devine, Tommasina Coviello, Patrizia Mancini, Luciana Mosca, Pietro Matricardi
Journal: Advanced Healthcare Materials (2018)

Abstract Staphylococcus aureus is one of the most significant human pathogens that is frequently isolated in a wide range of superficial and systemic infections. The ability of S. aureus to invade and survive within host cells such as keratinocytes and host immune cells has been increasingly recognized as a potential factor in persistent infections and treatment failures. The incorporation of antibiotics into hyaluronan‐cholesterol nanohydrogels represents a novel paradigm in the delivery of therapeutic agents against intracellular bacteria. The work presented herein shows that NHs quickly enter human keratinocytes and accumulate into lysosomes. When used for targeting intracellular S. aureus the antimicrobial activity of loaded levofloxacin is enhanced, possibly changing the antibiotic intracellular fate from cytosol to lysosome. Indeed, gentamicin, an antibiotic that predominantly accumulates in lysosomes, shows significant and equal antibacterial activity when entrapped into NHs. These results strongly suggest that lysosomal formulations may display preferential activity toward intracellular S. aureus , opening new avenues for the use of HA‐based NHs for treatment of such skin infections.
Drug exposure and risk of Acute Liver Failure leading to registration for liver Transplantation (ALFT): Results of the SALT III study in adults in France
Authors: D. Larrey, L. Meunier, G.-P. Pageaux, S. Maleyran, S. Micon, S. Lorrain, R. Lassalle, C. Droz@u-Bordeaux. Fr, N. Moore
Journal: Journal of Hepatology (2018)
A new concept of fibroblast dynamics in post–myocardial infarction remodeling
Authors: Thomas Eschenhagen
Journal: Journal of Clinical Investigation (2018)

The identity and function of the fibroblast, a highly prevalent cell type in the heart, have remained poorly defined. Recent faithful genetic lineage–tracing studies revealed that during development, the cardiac fibroblasts are derived from the epicardium and the endothelium, whereas in the adult heart, they constitute the cardiac injury–responsive resident fibroblast. In the current issue of the JCI, Molkentin and colleagues decipher the time course and mechanism of the fibroblast in response to myocardial infarction (MI). The model they propose is surprisingly simple and clear. It consists of three major phases. First, fibroblasts in the ischemic area die. Second, surrounding fibroblasts proliferate and migrate into the spaces created by dying cardiomyocytes over a few days. The new fibroblasts in the scar are activated and adopt a smooth muscle actin– and periostin-positive "myofibroblast" phenotype, which appears to last as long as the scar is not mature (~10 days after MI). In the third phase, initially proliferating myofibroblasts lose smooth muscle actin expression and convert to a nonproliferating, matrix-producing phenotype with a newly acquired tendon gene signature. Interestingly, this state appears to differ from that of quiescent fibroblasts in the uninjured heart, as it is resistant to proliferative stimuli. These cells are therefore termed "matrifibrocytes," a novel category whose study will certainly further advance the field.
Sixty seconds on . . . the secret tobacco papers
Authors: Susan Mayor
Journal: BMJ (2018)

You guessed it. Tobacco giant Philip Morris has been slightly economical with the evidence on addiction for its own benefit for nearly two decades, according to previously secret internal documents analysed in PLoS Medicine this week.1

The tobacco industry had denied the addictiveness of smoking for many years. But Philip Morris changed its mind in 2000—after landmark litigation against the industry for the …
Prevalence of drug-resistant tuberculosis and imputed burden in South Africa: a national and sub-national cross-sectional survey
Authors: Nazir Ahmed Ismail, Lindiwe Mvusi, Ananta Nanoo, Andries Dreyer, Shaheed V Omar, Sanni Babatunde, Thabo Molebatsi, Martie van der Walt, Adeboye Adelekan, Varough Deyde, Chikwe Ihekweazu, Shabir A Madhi
Journal: The Lancet Infectious Diseases (2018)
Investigational Testing for Zika Virus among U.S. Blood Donors
Authors: Paula Saá, Melanie Proctor, Gregory Foster, David Krysztof, Colleen Winton, Jeffrey M. Linnen, Kui Gao, Jaye P. Brodsky, Ronald J. Limberger, Roger Y. Dodd, Susan L. Stramer
Journal: New England Journal of Medicine (2018)

Because of the potential severe clinical consequences of Zika virus (ZIKV) infection, the large numbers of asymptomatic travelers returning from ZIKV-active areas, the detection of ZIKV nucleic acid in blood, and reports of transmission of ZIKV through transfusion, in 2016 the Food and Drug Administration released recommendations for individual-unit nucleic acid testing to minimize the risk of transmission of ZIKV through blood transfusions.
Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis
Authors: Teryl K. Nuckols, Emmett Keeler, Laura J. Anderson, Jonas Green, Sally C. Morton, Brian J. Doyle, Kanaka Shetty, Aziza Arifkhanova, Marika Booth, Roberta Shanman, Paul Shekelle
Journal: Diabetes Care (2018)

OBJECTIVE Quality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS We used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLit, Centre for Reviews and Dissemination, New York Academy of Medicine's Grey Literature Report, and WorldCat (January 2004 to August 2016). We extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost (studies lasting ≤3 years), incremental cost-effectiveness ratio (ICER) (studies lasting ≥20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA1c and incremental net cost. RESULTS Of 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA1c declined by 0.26% (95% CI 0.17–0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting ≤3 years, incremental net costs were $116 (95% CI −$612 to $843) per patient annually. Long-term ICERs were $100,000–$115,000/quality-adjusted life year (QALY) in 3 RCTs, $50,000–$99,999/QALY in 1 RCT, $0–$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias. CONCLUSIONS Diverse multifaceted QI interventions that lower HbA1c appear to be a fair-to-good value relative to usual care, depending on society’s willingness to pay for improvements in health.
Sedation in GI endoscopy: a paradigm shift has taken place
Authors: Angelika Behrens, Christian Ell
Journal: Gut (2018)

We can agree to the letter of Braden and Walsh without any limitation.1 

In consideration of the positive security data for the application of propofol by non-anaesthetists in the GI endoscopy, not least also by the ProSed2 study documented, specialised political interests should not have an influence on national guidelines any more.2 

While there are extensive positive data for endoscopist/Nurse Administered …