tbuckley/cabot-search huggingface dataset:
Are we failing people with multiple health conditions? An expert discussion
Authors: Gareth Iacobucci
Journal: BMJ (2020)

Up to 30% of people in the UK have two or more long term conditions, but the NHS doesn’t always serve them well. <i>The BMJ</i> hosted a group of experts at the Nuffield Trust Summit to discuss the challenges and opportunities in caring for patients with multimorbidities. <b>Gareth Iacobucci</b> reports
Detection of SARS-CoV-2 in Different Types of Clinical Specimens
Authors: Wenling Wang, Yanli Xu, Ruqin Gao, Roujian Lu, Kai Han, Guizhen Wu, Wenjie Tan
Journal: JAMA (2020)

This study describes results of PCR and viral RNA testing for SARS-CoV-2 in bronchoalveolar fluid, sputum, feces, blood, and urine specimens from patients with COVID-19 infection in China to identify possible means of non-respiratory transmission.
Sustainable conferences: encouraging people to think and act differently
Authors: Tom S Potokar
Journal: BMJ (2020)

It is time for us rethink the purpose and effectiveness of educational health events as well as consider reducing the associated high carbon footprint.1

In 2009 I hosted a workshop for the European Club for Paediatric Burns (ECPB) at a vegan yoga retreat in Wales, and this year we are going a step further. Our aim is to kickstart …
Abstract P229: Benefits of Tai Chi Exercise Among Adults With Chronic Heart Failure: A Systematic Review and Meta-analysis
Authors: Ruth E Taylor-Piliae, Brooke A Finley
Journal: Circulation (2020)

Background: Regular exercise is beneficial for adults with chronic heart failure (CHF). Tai Chi is popular among older adults and may offer additional exercise options for those with CHF. Objectives: A systematic review and meta-analysis was conducted to examine the benefits of Tai Chi exercise among adults with CHF. Methods: An electronic literature search of ten databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004 to August 1, 2019. Clinical trials that examined Tai Chi exercise, were published in English or German languages, among participants with CHF were included. Study quality was assessed independently by two reviewers, using the modified Downs and Black Quality Index checklist (low quality = score ≤14, moderate quality = score 15-23, high quality = score ≥ 24). Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e., Hedges’ g) and the 95% confidence intervals using random effects models. Results: A total of six studies met the inclusion criteria (five RCTs and one quasi-experimental study with a comparison group), enrolling 229 participants (mean age=68 years old, 28% women, mean ejection fraction=37%). The Yang style of Tai Chi was most commonly practiced in these studies (n=5, 83%), with usual care the most common control condition. Study quality was moderate (mean score=23). At least three studies reported outcomes for exercise capacity, quality of life (QOL), depression, and b-type natriuretic peptide (BNP), allowing for meta-analysis. Compared to controls, Tai Chi participants had significantly better exercise capacity (Hedge’s g=0.353; p=0.026, I 2 =32.72%), improved QOL (Hedge’s g=0.617; p=0.000, I 2 =0%), with less depression (Hedge’s g=0.627; p=0.000, I 2 =0%), and decreased BNP expression (Hedge’s g=0.333; p=0.016, I 2 =0%). Conclusion: Among adults with CHF, Tai Chi was effective in improving exercise capacity and quality of life, with less depression and BNP levels observed, when compared to controls. Tai Chi is popular and safe form of exercise among older adults, yet few studies have been conducted during the past 15 years examining the benefits of Tai Chi among adults with CHF. Tai Chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with more rigorous study designs and larger samples, before widespread recommendations can be made.
Quantifying risk of disease due to extended-spectrum β-lactamase producing Enterobacteriaceae in patients who are colonized at ICU admission
Authors: Keyvan Razazi, Jérémy Rosman, Anh-Dao Phan, Guillaume Carteaux, Jean-Winoc Decousser, Paul Louis Woerther, Nicolas de Prost, Christian Brun-Buisson, Armand Mekontso Dessap
Journal: Journal of Infection (2020)
Abstract P424: Low Liver Enzymes, Cognitive Performance and Dementia. The Atherosclerosis Risk in Communities Neurocognitive Study (aric-ncs)
Authors: Yifei Lu, Alvin G Thomas, Elizabeth Selvin, Priya Palta, A Richey Sharrett, Thomas Mosley, David Knopman, James Pike, Laura R Loehr, Gerardo M HEISS
Journal: Circulation (2020)

Introduction: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among older adults are associated with mortality, and reportedly with lower cognitive performance, biomarkers of neurodegeneration, and dementia. We tested the associations of liver enzymes with cognition in ARIC-NCS. Methods: We studied 3191 participants (mean age 79 years, 59% female, 23% black) free of chronic liver disease and cirrhosis, and with AST:ALT ratio ≤2 at visit in 2016-2017. Serum ALT and AST were examined continuously and by quintiles, with the 3 rd quintile as the distribution-based modal reference range. Cognitive status (normal, mild cognitive impairment [MCI], dementia) was ascertained by an expert adjudication panel. A composite global cognition score was estimated from memory, executive function, and language tests. We used demographic and ApoE4 adjusted multinomial logistic and linear regressions. Results: Participants were classified as cognitively unimpaired (2375), MCI (602) or dementia (214). Lower levels of ALT and AST, and a higher AST:ALT ratio were associated with higher prevalence of dementia and lower global cognition scores ( Figure ). The prevalence odds ratio of dementia and MCI for the 1 st quintile, vs 3 rd quintile of ALT, were 1.73 (95% CI:1.06-2.81) and 1.27 (0.92-1.76), respectively. The corresponding estimates for AST were 1.71 (1.03-2.84) and 1.17 (0.87-1.59). Global cognition scores were lower in the 1 st vs 3 rd quintiles of ALT and AST by 0.13 (0.06-0.21) and 0.08 (0-0.15) standard deviation units, respectively. Additional adjustment for alcohol intake did not change the results. Conclusions: Liver hypometabolism is linked to reduced brain glucose metabolism, impaired production of neurotransmitters and synaptic maintenance, systemic insulin resistance and inflammation, while hepatic metabolite profiles are altered in dementia. Prospective assessments are warranted to characterize the role of hepatic metabolic dysfunction in cognitive impairment among older adults.
Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits
Authors: Alexander G Mathioudakis, Wim Janssens, Pradeesh Sivapalan, Aran Singanayagam, Mark T Dransfield, Jens-Ulrik Stæhr Jensen, Jørgen Vestbo
Journal: Thorax (2020)

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant mortality, health and economic burden. Their diagnosis, assessment and management remain suboptimal and unchanged for decades. Recent clinical and translational studies revealed that the significant heterogeneity in mechanisms and outcomes of exacerbations could be resolved by grouping them etiologically. This is anticipated to lead to a better understanding of the biological processes that underlie each type of exacerbation and to allow the introduction of precision medicine interventions that could improve outcomes. This review summarises novel data on the diagnosis, phenotyping, targeted treatment and prevention of COPD exacerbations.
Changing parental high risk behaviour in the reduction of SIDS: the imperative of translational research [Letter to the Editor]
Authors: Julie Hepworth
Journal: BMJ (2009)

Objectives To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). Design Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. Setting South west region of England (population 4.9 million, 184 800 births). Participants 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). Results The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant’s head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). Conclusions Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.
Preventing readmission of patients with COPD
Authors: Angela Charlesworth, Rehan Mustafa, Fiona Bates, Tina Stallard, Kathleen Stevens, Rosie Watts, Joan Summersgill, Cindy Lightowler
Journal: European Respiratory Journal (2012)

Introduction  According to a recent report by the British Lung Foundation, 1 in 3 people with a COPD exacerbation in the UK are readmitted within 28 days of discharge.  Aim  To reduce readmissions of COPD patients within 30 day subsequent to hospital discharge.  Method  From June 2011, we introduced a telephonic follow up service (once a week phone call by outreach nurses for 30 days), thereby offering extended monitoring and advice beyond standard home visits, for patients sent home with early facilitated discharge. Further home visits were arranged and treatment advice was provided when appropriate. Patients were encouraged to contact the outreach team themselves if needed.  Results  Over the course of subsequent 6 months, 136 patients were sent home with early facilitated discharge. A total of 353 phone calls were made. 11% (n=15) of patients received further nursing intervention to prevent readmission, of these 66% (n=10) of patients required antibiotics and/or steroids, prescribed by the outreach nurses. Interventions in this group led to 28 additional home visits and 8 telephone consultations. 11% of patients (n=16) were readmitted within 30 days of hospital discharge but only 5% (n=7) of readmissions were due to a respiratory cause. Of the 16 readmissions, 70% (n=11) were admitted out of service hours, with just over 10 % (n=2) being within working hours of the outreach team.  Conclusion  The telephonic follow up service prevented 15 patients from readmitting with an exacerbation of their COPD. It may be that offering this simple intervention will lead to an improvement in readmission rates for COPD in South Tees. To assess this, we plan to review readmission rates of patients prior to June 2011 and compare them with our current figures.
Effects of adopting the Global Lung Function Initiative 2017 reference equations on the interpretation of carbon monoxide transfer factor
Authors: Danny J. Brazzale, Leigh M. Seccombe, Liam Welsh, Celia J. Lanteri, Claude S. Farah, Warren R. Ruehland
Journal: European Respiratory Journal (2020)

The recently published Global Lung Function Initiative (GLI) carbon monoxide transfer factor ( T LCO ) reference equations provide an opportunity to adopt a current, all-age, widely applicable reference set. The aim of this study was to document the effect of changing to GLI from commonly utilised reference equations on the interpretation of T LCO results. 33 863 T LCO results (48% female, 88% Caucasian, n=930 aged &lt;18 years) from clinical pulmonary function laboratories within three Australian teaching hospitals were analysed. The lower limit of normal (LLN) and proportion of patients with a T LCO below this value were calculated using GLI and other commonly used reference equations. The average T LCO LLN for GLI was similar or lower than the other equations, with the largest difference seen for C rapo equations (median: −1.25, IQR: −1.64, −0.86 mmol·min −1 ·kPa −1 ). These differences resulted in altered rates of reduced T LCO for GLI particularly for adults (+1.9% versus M iller to −27.6% versus C rapo ), more so than for children (−0.8% versus K im to −14.2% versus C otes ). For adults, the highest raw agreement for GLI was with M iller equations (94.7%), while for children it was with K im equations (98.1%). Results were reclassified from abnormal to normal more frequently for younger adults, and for adult females, particularly when moving from R oca to GLI equations (30% of females versus 16% of males). The adoption of GLI T LCO reference equations in adults will result in altered interpretation depending on the equations previously used and to a greater extent in adult females. The effect on interpretation in children is less significant.
Abstract P462: Myosteatosis: Differences in Association With Type 2 Diabetes by Anatomical Location
Authors: Curtis Tilves, Allison Kuipers, Joseph Zmuda, J. J Carr, James G Terry, Sangeeta Nair, Bharat Thyagarajan, Victor Wheeler, Iva Miljkovic
Journal: Circulation (2020)

Background: CT-derived muscle density (MD) reflects the degree of adiposity in muscle (i.e., myosteatosis) with lower MD indicating greater adiposity. Previous research indicates lower MD is associated with increased risk of type 2 diabetes (T2D). However, few studies have compared the association of simultaneously measured MD by anatomic location. The relationship between myosteatosis and cardiometabolic health may differ by body site and influence which location(s) is most useful for risk assessment. We investigated potential differential relationships between T2D and MD of the locomotor muscles of the abdomen (psoas), thigh, and calf among 539 African Caribbean men from Tobago. Methods: Men were aged 50-91 years (mean 64.4 years, mean BMI 27.5 kg/m 2 ). Calf MD was measured at 66% of calf length using peripheral quantitative CT; calf MD was defined as the ratio of muscle mass to cross-sectional muscle area. Psoas MD was measured in the abdomen (between L3/L4) and thigh MD was measured in the mid-thigh using CT; for these, MD was defined as the average muscle attenuation across each site. MDs were converted to per-SD units for comparability. T2D was defined as a fasting serum glucose level of ≥126 mg/dL or currently taking antidiabetic medication. Results: Psoas and thigh MDs were more highly correlated (r = 0.70) than psoas and calf (r = 0.33) or thigh and calf (r = 0.53) MDs, and calf MD was moderately correlated with BMI (r = -0.38) compared to lower BMI correlations for thigh (r = -0.18) or psoas (r = -0.16) MDs (all significant p &lt; 0.05). After age and lifestyle factor adjustment (Table), a 1-SD lower MD of the thigh or calf was significantly associated with higher odds of T2D. Additional adjustment for BMI completely attenuated the association with T2D for thigh MD, but not calf MD. Conclusion: In our study of African Ancestry men, only calf MD was associated with higher odds of T2D independent of BMI and other muscle groups. Longitudinal studies are needed to better characterize specific muscle myosteatosis and metabolic abnormalities.
Abstract 13687: Legacy of Lipid Lowering in Preventing Fatal and Non Fatal Cardiovascular Events in Individuals Without Cardiovascular Disease During 3 Years of Post -Trial Observation in the Hope 3 (Heart Outcomes Prevention Evaluation 3) Study
Authors: Jackie J Bosch, Eva M Lonn, Hyejung Jung, Salim Yusuf
Journal: Circulation (2019)

Introduction: Primary prevention interventions may substantially reduce cardiovascular (CV) events but longer periods of observation and intervention may be needed to demonstrate their full effects...
Squamous carcinoma of the skin responding to erlotinib: Three cases
Authors: W. L. Read
Journal: Journal of Clinical Oncology (2007)

16519 Background: Systemic therapies for squamous cell carcinoma of the skin (SCCS) include cytotoxic chemotherapy and immunotherapy with retinoids and interferon. Erlotinib is an orally available EGFR inhibitor which is generally well tolerated. This report describes three patients with SCCS in whom erlotinib treatment produced clinical benefit. Methods: Case report. Results: 1. A 40 year old lung transplant recipient with multifocal SCCS was diagnosed with lung metastases by CT scan and bronchoscopy. These lesions progressed during treatment with acitretin and interferon. He began erlotinib at 150 mg daily and one month later CT scan showed his lung metastases to have responded, with the largest lesion decreasing in size by 50%. He continued on erlotinib for his remaining 8 months of life, during which his lung lesions continued to regress. Unfortunately the SCCS on his face progressed while on erlotinib, and ultimately caused his death. 2. A 54 year old with SCCS of the face treated with orbital exenteration and neck dissection followed by chemoradiation for submental recurrence developed a new 2 cm submental mass. He began erlotinib at 150 mg daily with complete resolution of the mass over 1 month. PET scan was negative, and there was doubt as to whether the mass had actually been SCCS. Because of this the patient discontinued erlotinib, and 3 weeks later the mass recurred. It was biopsy confirmed to be SCCS, and erlotinib again produced a clinical CR. Two months later he stopped erlotinib prior to planned surgery, and the tumor again regrew. 3. A 41 year old developed SCCS of the left temple. This lesion repeatedly recurred despite irradiation and resection, ultimately involving the orbit and cranial nerves and causing significant pain. The lesion progressed during chemotherapy with cisplatin and capecitabine. The patient began erlotinib 150 mg daily and experienced a partial response, together with marked improvement in pain and quality of life. He has continued on erlotinib for three months to date. Conclusions: Erlotinib provided excellent palliation for these patients with SCCS who had failed other therapies. The sensitivity of these aggressive SCCS to erlotinib suggests that this drug might be used at earlier points in the treatment of such patients, possibly in combination with radiation. No significant financial relationships to disclose.
Gene copy numbers of <i>HER</i> family in breast cancer
Authors: M. Wełnicka-Jaskiewicz, A. żaczek, K. P. Bielawski, J. Jańkiewicz, A. Badzio, W. Olszewski, K. Konopa, P. Rhone, E. Senkus-Konefka, J. Jassem
Journal: Journal of Clinical Oncology (2007)

10544 Background: Most clinicopathological analyses of HER alterations in breast cancer were limited to single HER family members. Since the activation of certain HER receptors is possible only as a result of their dimerization, determining the alterations of all four HER genes may be more relevant. The aim of the study was to estimate the frequency of disorders in all four HER genes, and to determine their correlation with the clinical and histological features in breast cancer patients. Methods: Gene copy number (GCN) of ERBB oncogenes was analyzed with double differential PCR (ddPCR) in a consecutive series of 225 breast cancer patients. Statistical analysis was performed with a set of nonparametric tests. Results: Amplifications of HER1, HER2, HER3 and HER4 were detected in 15%, 26%, 10% and 15% of cases respectively, and deletions in 31%, 2%, 2% and 7% cases respectively. Abnormal GCN of at least one, and at least two oncogenes was found in 65% and 31% of the tumors, respectively. Average GCNs of all HER oncogenes significantly correlated with each other. These correlations were particularly high for HER2/HER3, HER2/HER4 and HER3/HER4 (all p&lt;10 -8 ), and were much stronger in N(+) compared to N(-) tumors. HER1 deletions were associated with the lack of progesterone receptor (p=0.03), whereas HER3 and HER4 amplifications were more common in well differentiated tumors (p=0.03 and 0.047 respectively). At univariate analysis disease-free survival (DFS) and overall survival (OS) were related with T and N stage, and HER1 amplification. The multivariate analysis showed that DFS was influenced by T, N and HER1 amplification, whereas OS by T, N and tumor grade. Conclusions: Our results indicate a key role of HER heterodimers in tumor progression and confirm that HER2 is the preferred partner for other HER oncogenes in this process. Deletions of HER1 were associated with unfavourable characteristics, whereas HER3 and HER4 amplifications may be linked with less aggressive phenotypes. No significant financial relationships to disclose.