tbuckley/cabot-search huggingface dataset:
The accuracy of <sup>18</sup>F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of newly diagnosed nasopharyngeal carcinoma: A systematic review and meta-analysis.
Authors: Balamurugan A. Vellayappan, Yu Yang Soon, Arul Earnest, Qing Zhang, Wee Yao Koh, Ivan Weng Keong Tham, Khai Mun Lee
Journal: Journal of Clinical Oncology (2012)

5553 Background: The specific role of FDG-PET/CT in pretreatment staging of nasopharyngeal carcinoma (NPC) remains to be validated. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of staging FDG-PET/CT for newly diagnosed NPC with reference to conventional staging modalities and/or clinical follow up. Methods: We searched MEDLINE, Cochrane central register of controlled trials, proceedings of ASTRO and ASCO as well as Chinese databases (Chinese National Knowledge Infrastructure and CBMdisc) from the date of inception to September 2011 for relevant studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. We determined the sensitivities and specificities across studies, pooled diagnostic odds ratios (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression model. Results: We found 15 relevant studies (of which seven were in English) including 851 patients. Of the 15 studies: five addressed primary tumor (T), nine addressed regional lymph nodes (N) and seven addressed distant metastasis (M). The combined sensitivity estimate for FDG-PET/CT in T classification was 0.77(95% confidence interval (CI) 0.59-0.95). The combined sensitivity estimate for N classification was 0.88 (95% CI 0.86-0.90), specificity 0.85(95% CI 0.83-0.88), DOR 82.4 (23.2 to 292.6) and Q-index was 0.90. For M classification, the combined sensitivity estimate was 0.82(95% CI 0.65-0.93), specificity 0.98 (95% CI 0.96 – 0.99), DOR 120.9 (43.0 to 340.0) and Q-index was 0.89. Conclusions: FDG-PET/CT showed good accuracy in N and M but not T classification for newly diagnosed pre-treated NPC. FDG-PET/CT, together with Magnetic resonance imaging (MRI) of the nasopharynx, should be part of the routine staging investigations for NPC. Future research should evaluate the accuracy of FDG-PET/MRI fusion as a single staging modality for NPC.
Identifying unreliable predictions in clinical risk models
Authors: Paul D. Myers, Kenney Ng, Kristen Severson, Uri Kartoun, Wangzhi Dai, Wei Huang, Frederick A. Anderson, Collin M. Stultz
Journal: npj Digital Medicine (2020)

The ability to identify patients who are likely to have an adverse outcome is an essential component of good clinical care. Therefore, predictive risk stratification models play an important role in clinical decision making. Determining whether a given predictive model is suitable for clinical use usually involves evaluating the model's performance on large patient datasets using standard statistical measures of success (e.g., accuracy, discriminatory ability). However, as these metrics correspond to averages over patients who have a range of different characteristics, it is difficult to discern whether an individual prediction on a given patient should be trusted using these measures alone. In this paper, we introduce a new method for identifying patient subgroups where a predictive model is expected to be poor, thereby highlighting when a given prediction is misleading and should not be trusted. The resulting "unreliability score" can be computed for any clinical risk model and is suitable in the setting of large class imbalance, a situation often encountered in healthcare settings. Using data from more than 40,000 patients in the Global Registry of Acute Coronary Events (GRACE), we demonstrate that patients with high unreliability scores form a subgroup in which the predictive model has both decreased accuracy and decreased discriminatory ability.
This Quiet Lady
Authors: Rebecca A. Snyder
Journal: JAMA (2020)

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
The hematological effects of copper deficiency
Authors: Bahaa Al‐Bubseree, Mike Leach, Rosie Jones, Barbara J. Bain
Journal: American Journal of Hematology (2020)

A 44-year-old man with cerebral palsy and epilepsy required a jejunal feeding tube due to recurrent episodes of aspiration pneumonia. He developed progressive anemia and neutropenia: hemoglobin concentration (Hb) 60 g/L, MCV 85 fL, WBC 1.6 × 109/L, neutrophils 0.5 × 109/L, and platelets 165 × 109/L. The blood film showed mild hypochromia and occasional target cells. The bone marrow aspirate showed a partial myeloid maturation arrest. In addition, there was marked vacuolation of myeloid precursors and proerythroblasts (images, ×50 objective) typical of copper deficiency. His serum copper level was 0.2 μmol/L (normal range 10-20). Iron stores were absent and no ring sideroblasts or haemosiderin inclusions in plasma cells were detected. He was commenced on copper supplements and the blood count normalized within 4 weeks: Hb 151 g/L, WBC 8.3 × 109/L, and platelets 260 × 109/L. Copper is required for the function of number of metabolic co-enzymes, including those involved in iron utilization for hemoglobin synthesis. Copper deficiency can occur in patients on enteral feeding, following bariatric surgery and with malabsorption syndromes. It can also occur as a result of renal loss of caeruloplasmin in severe nephrotic syndrome, due to excess chelation in Wilson's disease or as a result of zinc or silver toxicity, the latter following ill-advised intravenous colloidal silver infusion. It typically causes an anemia (microcytic, normocytic or macrocytic) and neutropenia with preservation of the platelet count, but both thrombocytopenia and pancytopenia can also occur. Some patients show a co-existent myelopathy or peripheral neuropathy, which may not fully recover following supplementation. It is an important condition to recognize and can be mistaken for a myelodysplastic syndrome, as the block in iron utilization generates ring sideroblasts in some patients. Nothing to report.
Analysis of pediatric hospitalizations after emergency department release as a quality improvement tool
Authors: A.D. Depiero, D.W. Ochsenschlager, J.M. Chamberlain
Journal: Annals of Internal Medicine (2002)

Abstract   Study Objective:  We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors.  Methods:  The study was performed at a large, tertiary care, academic children's hospital. Patients who returned to the ED within 72 hours of a previous visit were identified by computerized registration data. The charts of these patients were then reviewed by a member of the ED medical staff to identify factors from the initial visit that contributed to the return visit. A multidisciplinary committee then reviewed each case until consensus was achieved regarding the cause for the repeat visit. In this study, we analyzed the quality improvement decisions from a 12-month period.  Results:  Over a 12-month period, during which there were a total of 51,195 visits, 285 (0.56%) patients were hospitalized after a repeat visit. The repeat visit was determined to be unrelated to the first visit in 12 (4.2%) patients. In 12 (4.2%) cases, the cause for repeat visit and hospitalization could not be determined. This resulted in a total of 261 patients for analysis. In 234 (90.0%) patients, the return visit was determined to be a result of the progression of illness (no medical error). Ten (3.8%) patients had a missed diagnosis, whereas 2 (0.8%) patients had errors in their treatment (likely medical error). An incomplete workup was cited in 7 (2.7%) patients (potential medical error). Parenting factors (refusing admission, not filling prescriptions, not giving prescribed medications) were noted in 5 (1.9%) cases. Three (1.1%) patients did not follow up with appropriate subspecialists.  Conclusion:  The overall rate of repeat visits resulting in hospitalization is small. In the majority of these cases (90.0%), the ED evaluation was appropriate and the admission was for progression of the patient's illness. Given the small number of patients and the infrequency of missed diagnoses, this may not be an efficient method for assessing ED performance. [DePiero AD, Ochsenschlager DW, Chamberlain JM. Analysis of pediatric hospitalizations after emergency department release as a quality improvement tool.  Ann Emerg Med.  February 2002;39:159-163.]
P43/EMAP-II expression in colorectal cancer is assicated with hypoxia and enhanced lymphocyte apoptosis
Authors: Manal M. S. Youssef, Peter Symonds, Ian O. Ellis, Cliff Murray
Journal: Cancer Research (2006)

4763  We recently demonstrated that the novel tumour-derived cytokine p43/EMAP-II induces apoptosis in mitogen-stimulated lymphocytes, and suggested that it may be a constituent of a novel immune evasion mechanism employed by tumour cells (1). Furthermore p43/EMAP-II protein release is enhanced (2), and gene transcription enhanced by hypoxia (Youssef et al., unpublished). In this study we have examined the association between p43/EMAP-II expression and hypoxia in colorectal cancer (CRC), and also the association between p43/EMAP-II and lymphocyte apoptosis. Formalin-fixed, paraffin-embedded archival tissue samples from a well-characterised population of 72 patients diagnosed with colorectal tumours were used in immunohistochemical studies. Antibodies against p43/EMAP-II, carbonic anhydrase (CA IX; as a surrogate marker of hypoxia), and CD3 (to identify lymphocytes) were used. Areas of p43/EMAP-II and CA IX staining were quantified using computer-aided image analysis. Antibodies against active Caspase-3 and Cleaved PARP were used as markers of apoptosis in lymphocytes. P43/EMAP-II expression was correlated with CA IX expression in CRC. Furthermore, there was a significant association between p43/EMAP-II expression and apoptosis of tumour infiltrating lymphocytes in the same samples (p = 0.04 by active caspase 3; p = 0.02 by cleaved PARP). Patients with high p43/EMAP-II expression seemed to do better than those with low, and the reverse was true for CA IX. There was also a positive correlation between p43/EMAP-II and lymphocyte counts (p = 0.03), as well as between CA IX and lymphocyte counts (p = 0.02). The presence of CD3+ cells was a good prognostic indicator in terms of overall survival. We conclude that p43/EMAP-II expression is associated with hypoxia and high lymphocyte counts in colorectal cancer. Furthermore p43/EMAP-II expression is associated with apoptosis of tumour infiltrating lymphocytes (1) Murray et al. (2004). Colorectal cancer cells induce apoptosis in lymphocytes by an EMAP-II-dependent mechanism. J Immunol 172:274-281 (2) Youssef et al. (2005). The effect of Hypoxia on EMAP-II expression in colorectal Cancer ( Submitted for publication)
To play or not to play? sports participation and shared decision-making in athletes with inherited heart rhythm disorders
Authors: Christopher OY Li, Thomas M Roston, Claire MacEwing, Shubhayan Sanatani
Journal: British Journal of Sports Medicine (2020)

Sudden cardiac death (SCD) is a leading cause of death in sport. Inherited heart rhythm disorders that cause SCD in young individuals include, but are not limited to, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome, arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy (HCM). The 2005 American College of Cardiology and the European Society of Cardiology consensus statements recommended uniform and mandatory disqualification of athletes with inherited heart rhythm disorders from competitive sports due to the potential risk of fatal arrhythmias precipitated by adrenergic stress.1 2 This broad, universal mandate for exclusion is an antiquated practice from a time where risk was mostly unpredictable and risk reduction strategies poorly defined. The discovery of many evidence-based markers of risk can facilitate a precision medicine approach to exercise prescription in patients with inherited heart rhythm disorders.

The risk of recurrent cardiac events is lower than previously thought for primary electrical diseases such as LQTS and CPVT. Young athletes, those aged 21 years or younger, receiving the recommended treatment for LQTS and CPVT (eg, beta blockers and avoidance of QT prolonging medications at a minimum) are not at an increased risk for SCD during competitive sports.3 4 For the other major channelopathy, Brugada syndrome, …
Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2019
Authors: Fiona P. Havers, Pedro L. Moro, Paul Hunter, Susan Hariri, Henry Bernstein
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Since 2005, a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults (1,2). After receipt of Tdap, booster doses of tetanus and diphtheria toxoids (Td) vaccine are recommended every 10 years or when indicated for wound management. During the October 2019 meeting of ACIP, the organization updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended. These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility. This report updates ACIP recommendations and guidance regarding the use of Tdap vaccines (3).
Twelve weeks of exenatide treatment increases [18F]fluorodeoxyglucose uptake by brown adipose tissue without affecting oxidative resting energy expenditure in nondiabetic males
Authors: Laura G.M. Janssen, Kimberly J. Nahon, Katrien F.M. Bracké, Dennis van den Broek, Renée Smit, Aashley S.D. Sardjoe Mishre, Lisa L. Koorneef, Borja Martinez-Tellez, Jedrzej Burakiewicz, Hermien E. Kan, Floris H.P. van Velden, Lenka M. Pereira Arias-Bouda, Lioe-Fee de Geus-Oei, Jimmy F.P. Berbée, Ingrid M. Jazet, Mariëtte R. Boon, Patrick C.N. Rensen
Journal: Metabolism (2020)

Aims/hypothesisBrown adipose tissue (BAT) improves energy metabolism by combusting glucose and lipids into heat. Agonism of the glucagon-like peptide-1 receptor (GLP-1R) within the central nervous system activates BAT in mice. Moreover, in patients with type 2 diabetes, GLP-1R agonism lowers body weight and improves glucose and lipid levels, possibly involving BAT activation. Interestingly, people from South Asian descent are prone to develop cardiometabolic disease. We studied the effect of GLP-1R agonism on BAT in humans, specifically in South Asians and Europids without obesity or type 2 diabetes.MethodsTwelve Dutch South Asian and 12 age- and BMI-matched Europid nondiabetic men received 12 weeks extended-release exenatide (Bydureon) in this single-arm prospective study. Before and after treatment, BAT was visualized by a cold-induced [18F]FDG-PET/CT scan and a thermoneutral MRI scan, and resting energy expenditure (REE), substrate oxidation, body composition and fasting plasma glucose and serum lipids were determined. Appetite was rated using a visual analogue scale.ResultsSince the effect of exenatide on metabolic parameters did not evidently differ between ethnicities, data of all participants were pooled. Exenatide decreased body weight (−1.5 ± 0.4 kg, p < 0.01), without affecting REE or substrate oxidation, and transiently decreased appetite ratings during the first weeks. Exenatide also lowered triglycerides (−15%, p < 0.05) and total cholesterol (−5%, p < 0.05), and tended to lower glucose levels. Notably, exenatide increased BAT metabolic volume (+28%, p < 0.05) and mean standardized uptake value (+11%, p < 0.05) ([18F]FDG-PET/CT), without affecting supraclavicular adipose tissue fat fraction (MRI).Conclusions/interpretationWe show for the first time that GLP-1R agonism increases [18F]FDG uptake by BAT in South Asian and Europid men without obesity or type 2 diabetes.Trial registryClinicaltrials.gov NCT03002675.
Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study
Authors: Jonas Sunden-Cullberg, Anton Nilsson, Malin Inghammar
Journal: Intensive Care Medicine (2020)

To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded—54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen—40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p < 0.001), and shorter time to antibiotics—65 (IQR 30–136) vs 87 min (IQR 39–172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51–0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00–1.64), but the increased mortality was not mediated by differential bundle completion. Women and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.
A Case of Primary Localized Small Bowel Amyloidosis Studied by 18F-Choline and Contrast-Enhanced 18F-FDG PET/CT
Authors: Laura Maria Minordi, Carmelo Caldarella, Daria Ripani, Lucio Calandriello, Riccardo Manfredi
Journal: Clinical Nuclear Medicine (2019)

Abstract Amyloidosis is a rare hereditary or acquired protein deposition disorder with different etiologies, characterized by pathological protein deposition essentially in nearly any organs or tissues. There are 2 major forms: primary and secondary amyloidosis. Moreover, it is possible to have systemic or localized disease. The localized form of amyloidosis affecting the small intestine is rare, and it is characterized by the formation of precursor proteins at the site of the lesion. We report a case of localized small bowel amyloidosis studied by 18 F-choline and 18 F-FDG–iodinated PET/CT performed for staging an aggressive prostatic cancer.
Recent advances in intensive care
Authors: N. Brookes
Journal: BMJ (2000)

Editor—In his review of recent advances in intensive care Stott emphasised the efficacy of percutaneous tracheostomy over the conventional open surgical approach.1 We agree that percutaneous tracheostomy may indeed be the preferred method in selected cases, but it is invariably not used in patients who present anatomical challenges such as a short, thick neck; goitre; a history of neck surgery; or a concurrent coagulopathy. Such difficult cases probably represent about a quarter of an average population requiring tracheostomy.

We disagree with Stott's assertion that the incidence of complications has been shown to be lower with percutaneous tracheostomy than with open surgical techniques. The paper quoted in support of this statement—by Hill et al—describes the results of 356 percutaneous procedures performed in a single unit over four years.2 No direct comparison is made with open tracheostomies, and the authors do not report the numbers and type of patients deemed unsuitable for percutaneous tracheostomy and referred for open procedures. The six previous independent series quoted that detailed complication rates for open tracheostomy were published on average nearly 20 years earlier, and a conclusion was reached by comparison with these older studies.

Stott fails to mention Dulguerov et al's meta-analysis reported in 1999, which showed that percutaneous tracheostomy is associated with a higher prevalence of certain complications.3 Their comparison of recent surgical tracheostomy trials (n=21; 3512 patients) and percutaneous tracheostomy trials (n=27; 1817 patients) shows that perioperative complications are more common with the percutaneous technique (10% v 3%), whereas postoperative complications occur more often with the surgical technique (10% v 7%). The bulk of the differences is in minor complications, except perioperative death (0.44% v 0.03%) and serious cardiorespiratory events (0.33% v 0.06%), which were much higher with the percutaneous technique. These authors also noted significantly fewer complications in recent studies compared with older ones.

In the present state of knowledge it would seem unethical to mount a large double blind trial comparing the two techniques as this would subject about a quarter of patients, who would usually be deemed unsuitable for a percutaneous technique, to an increased risk of complications. It is likely that such patients will continue to be referred for open tracheostomy. While this selection bias continues, it is misguided to state that percutaneous tracheostomy holds fewer risks than the open technique.