tbuckley/cabot-search huggingface dataset:
SAT0089 Rofecoxib provides superior relief of symptoms of osteoarthritis (oa) compared to celecoxib
Authors: TJ Schnitzer, AJ Kivitz, M Greenwald, RM Fleischmann, D Matzura-Wolfe, AB Polis, ME Dixon, TW Dobbins, GP Geba
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> <h3>Objectives</h3> We performed a randomised, double-blind, clinical trial to evaluate the efficacy and safety of rofecoxib and celecoxib at highest indicated once daily doses in osteoarthritis. <h3>Methods</h3> 1082 patients meeting entry criteria for OA, responsive to NSAIDs, were randomised 3:3:1 to treatment with rofecoxib 25 mg qd (n = 471), celecoxib 200 mg qd (n = 460) or placebo (n = 151). Efficacy was assessed over the first 6 days of therapy and at weeks 2, 4, and 6 by WOMAC questionnaire and patient global assessment of response to therapy (PGART). <h3>Results</h3> Demographics were well balanced. Significantly more patients on placebo discontinued prematurely compared to both active groups (p &lt; 0.001) mainly due to lack of efficacy. Rofecoxib provided statistically superior relief of night pain (p = 0.023), morning stiffness (p = 0.002), rest pain (p = 0.023), and walking pain (p = 0.005) compared to celecoxib. Rofecoxib was significantly superior to celecoxib on all WOMAC subsacles, including pain (p = 0.008), stiffness (p = 0.001) and physical function (p = 0.01). Rofecoxib was superior to celecoxib in % of patients with good or excellent PGART over 6 weeks (p = 0.014) and provided quicker onset of efficacy as assessed by time to first report of good or excellent response (p &lt; 0.001). Both active groups were superior to placebo on efficacy endpoints. Incidence of clinical AEs, drug related AEs, serious AEs, and discontinuations due to AEs was similar between active groups. <h3>Conclusion</h3> In this study, once daily doses of rofecoxib provided superior relief of pain and other related symptoms in OA compared to celecoxib and placebo. All treatments were generally well tolerated.
Global functions at the World Health Organization
Journal: BMJ (2005)

This is an observational study and may be subject to residual confounding.However, we think that enough concerns exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs.We thank the EMIS practices contributing to QRESEARCH database and David Stables (EMIS Computing) and Mike Pringle for their help and expertise in establishing QRESEARCH.
Clinical photography in skin of colour: tips and best practices
Authors: J.C. Lester, L. Clark, E. Linos, R. Daneshjou
Journal: British Journal of Dermatology (2021)

Conflicts of interest: The authors declare they have no conflicts of interest. High‐quality photos are critical to dermatology, for both clinical care and education. Although best practices for capturing skin photos have been outlined,1 these omit specific challenges of taking photos of dark skin. Bias against accurate capture of dark skin in photographic technology is a long‐standing issue.2 Colour balance with film photography relied on reference cards portraying white models,2 and digital photography still has issues capturing detailed photos of darker skin.3, 4 Thus, proper photography techniques are important to take the highest‐quality photos in patients with dark skin. A recent summary of tips for photography in dermatology1 makes several important points about capturing high‐quality clinical photos. It emphasizes the importance of using a background that provides contrast to the subject while minimizing background distractions, and highlights camera techniques that prevent distortion of the subject. We agree with these suggestions and think they should apply to all photos. In addition, we believe it is important to present the nuanced approach that, based on our clinical experience, is necessary when taking photos in patients with skin of colour.
Posttreatment after Lenvatinib in Patients with Advanced Hepatocellular Carcinoma
Authors: Keisuke Koroki, Naoya Kanogawa, Susumu Maruta, Sadahisa Ogasawara, Yotaro Iino, Masamichi Obu, Tomomi Okubo, Norio Itokawa, Takahiro Maeda, Masanori Inoue, Yuki Haga, Atsuyoshi Seki, Shinichiro Okabe, Yoshihiro Koma, Ryosaku Azemoto, Masanori Atsukawa, Ei Itobayashi, Kenji Ito, Nobuyuki Sugiura, Hideaki Mizumoto, Hidemi Unozawa, Terunao Iwanaga, Takafumi Sakuma, Naoto Fujita, Hiroaki Kanzaki, Kazufumi Kobayashi, Soichiro Kiyono, Masato Nakamura, Tomoko Saito, Takayuki Kondo, Eiichiro Suzuki, Yoshihiko Ooka, Shingo Nakamoto, Akinobu Tawada, Tetsuhiro Chiba, Makoto Arai, Tatsuo Kanda, Hitoshi Maruyama, Jun Kato, Naoya Kato
Journal: Liver Cancer (2021)

There is no standard posttreatment for patients with advanced hepatocellular carcinoma (HCC) in whom lenvatinib therapy has failed. This study aimed to investigate rates of migration to posttreatment after lenvatinib and to explore candidates for second-line agents in the patients with failed lenvatinib therapy.We retrospectively collected data on patients with advanced HCC who received lenvatinib as the first-line agent in 7 institutions.Overall survival and progression-free survival (PFS) of 178 patients who received lenvatinib as the first-line agent were 13.3 months (95% confidence interval [CI], 11.5-15.2) and 6.7 months (95% CI, 5.6-7.8), respectively. Sixty-nine of 151 patients (45.7%) who discontinued lenvatinib moved on to posttreatment. The migration rates from lenvatinib to the second-line agent and from the second-line agent to the third-line agent were 41.7 and 44.4%, respectively. Based on multivariate analysis, response to lenvatinib (complete or partial response according to modified RECIST) and discontinuation of lenvatinib due to radiological progression, as well as male were associated with a significantly higher probability of migration to posttreatment after lenvatinib. On the other hand, alpha-fetoprotein levels of 400 ng/mL or higher was correlated with a significantly lower probability of migration to posttreatment after lenvatinib. Of 63 patients who received second-line systemic therapy, 53 (84.2%) were administered sorafenib. PFS, objective response rate (ORR), and disease control rate (DCR) for sorafenib treatment were 1.8 months (95% CI, 0.6-3.0), 1.8%, and 20.8%, respectively. According to the Cox regression hazard model, Child-Pugh class B significantly contributed to shorter PFS. PFS, ORR, and DCR of 22 patients who received regorafenib after lenvatinib in any lines were 3.2 months (range, 1.5-4.9 months), 13.6%, and 36.3%, respectively. Similarly, PFS, ORR, and DCR of 17 patients who received regorafenib after lenvatinib in the third-line (after sorafenib) were 3.8 months (range, 1.1-6.5 months), 17.6%, and 41.2%, respectively.Sorafenib may not be a candidate for use as a posttreatment agent after lenvatinib, according to the results of the present study. Regorafenib has the potential to become an appropriate posttreatment agent after lenvatinib.
Phase Ib trial of varlitinib plus weekly paclitaxel in EGFR/HER2 co-expressing advanced gastric cancer (AGC).
Authors: Yunbeom Sang, Minkyu Jung, Hyo Song Kim, Beodeul Kang, Choong-kun Lee, Hyun Cheol Chung, Sun Young Rha
Journal: Journal of Clinical Oncology (2021)

227 Background: EGFR and HER2 are over-expressed in gastric cancer, and activation of EGFR signaling in HER2-overexpressing gastric cancer can confer resistance to HER2-directed treatment like trastuzumab. Varlitinib (also known as ASLAN001) is a small-molecule, adenosine triphosphate competitive inhibitor of the tyrosine kinases - EGFR, HER2, and HER4. We present phase 1b results of the phase1b/2 study to evaluate the safety and efficacy of varlitinib in combination with weekly paclitaxel in EGFR/HER2 co-expressing AGC patients as a second-line treatment. (KCT0003583). Methods: An open-label phase Ib trial was conducted using a 3+3 design. AGC patients who had failed first-line fluoropyrimidine-containing chemotherapy, with evidence of both EGFR and HER2 overexpression by IHC (≥1+), were enrolled. The primary objective was to assess the dose limiting toxicity (DLT) and recommended phase 2 dose (RP2D) of varlitinib [Dose 1: 300 mg BID, Dose -1: 300mg intermittent dose] and weekly paclitaxel (80 mg/m 2 D1,8,15) every 4 weeks along with evaluation of anti-tumor activity. Results: From July 2019 to May 2020, 9 patients were enrolled at Dose 1 level of varlitinib 300mg bid and 6 patients were evaluable for safety per protocol. Two patients did not finish DLT period: one patient withdrew after 1 week and one patient received palliative surgery for panperitonitis caused by gastric cancer metastasis. One patient had major violation in IP administration as the patient took varlitinib intermittently. Among the 6 evaluable patients, there was 1 DLT of G4 AST/ALT elevation and G3 hyperbilirubinemia, which resolved after 3 weeks. The most common treatment related adverse events (TRAEs) were neutropenia (n=5), all of which were grade ≥ 3, but no lasting more than 7 days. Grade 2 TRAEs included rash (n=2), mucositis (n=2) and peripheral sensory neuropathy (n=2). After a median follow-up of 3.0 (range, 1.9~ 6.2) months, the best responses were stable disease in 4 patients. Currently, 4 patients are ongoing. Conclusions: The combination of varlitinib 300mg bid and weekly paclitaxel 80mg showed manageable safety profiles and determined as RP2D. Currently, multi-site phase 2 part is now underway. Clinical trial information: KCT0003583.
Bilateral non-traumatic second rib fracture after bilateral first rib resection for TOS
Authors: M G Jakubietz
Journal: Thorax (2005)

Surgery in early NSCLC and comorbidityWe would like to congratulate Janssen-Heijnen et al 1 on their well performed study and on their significant contribution to resolving the problem of treatment in patients with non-small cell lung cancer (NSCLC) and co-morbidity.However, we could not find a description of the surgical approach used and would like to ask the authors to provide details of the surgical procedures adopted and the accompanying survival rates.We think, 2 in agreement with other authors 3 that, for patients with early stage NSCLC and co-morbidity, a less invasive surgical approach should be used.This view is supported by studies in elderly patients or in patients with co-morbidity showing that a less invasive approach does not influence survival rates.Only the recurrence rate seems to be increased by a less invasive surgical approach such as segmentectomy or pulmonary wedge resection. [3]][5] Several factors determine whether conservative or invasive resection should be used for NSCLC.We think that a less invasive approach should be chosen as the first therapeutic step, even for early stage NSCLC, and that elderly patients should be treated less aggressively than younger patients.
Abstract 165: Association of Advanced Airway Placement and Time to Epinephrine Administration in Patients With Out-of-Hospital Cardiac Arrest
Authors: Joshua Lupton, Robert Schmicker, Mohamud Daya, Tom Aufderheide, Shannon Stephens, Nancy Le, Graham Nichol, Henry Wang, Matthew Hansen
Journal: Circulation (2018)

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a significant source of morbidity and mortality in the United States. In addition to cardiopulmonary resuscitation (CPR) and defibrillation, epinephrine and advanced airway management are often used in treatment. Recent studies suggest early administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of airway type on timing to epinephrine in OHCA. Hypothesis: Patients who had laryngeal tube (LT) insertion as first attempted airway have shorter times to epinephrine administration compared to those with endotracheal intubation (ETI) as first attempted airway. Methods: Subjects enrolled in the Pragmatic Airway Resuscitation Trial who received epinephrine and primary ETI or LT were included. The dependent variable was timing to epinephrine administration after EMS arrival in minutes, the independent variable was first airway attempted (LT or ETI). Kaplan-Meier estimates of time to drug administration were used to account for censoring. Results: We included 2650 subjects (1423 LT and 1227 ETI). There were no significant differences in age, sex, first rhythm, EMS response time, witnessed arrest status, bystander CPR or proportion receiving epinephrine between the LT and ETI groups. Among all OHCA patients, LT and ETI had median minutes (95% CI) until epinephrine administration of 9.3 (9.0, 9.8) and 9.7 (9.4, 10.0), respectively (p=n.s.). For the VT/VF subgroup, the median minutes (95% CI) to epinephrine administration were 8.0 (7.8, 9.0) and 9.2 (8.7, 9.9) for LT and ETI, respectively (Figure, p=n.s.). Conclusions: Overall, advanced airway type did not affect time to epinephrine. Among those with initial VT/VF, there is a weak, non-statistically significant trend of longer time to epinephrine when ETI is used compared to LT. This difference may be a contributing component to improved survival with an initial LT airway strategy for OHCA.
Global pandemics interconnected — obesity, impaired metabolic health and COVID-19
Authors: Norbert Stefan, Andreas L. Birkenfeld, Matthias B. Schulze
Journal: Nature Reviews Endocrinology (2021)

Obesity and impaired metabolic health are established risk factors for the non-communicable diseases (NCDs) type 2 diabetes mellitus, cardiovascular disease, neurodegenerative diseases, cancer and nonalcoholic fatty liver disease, otherwise known as metabolic associated fatty liver disease (MAFLD). With the worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), obesity and impaired metabolic health also emerged as important determinants of severe coronavirus disease 2019 (COVID-19). Furthermore, novel findings indicate that specifically visceral obesity and characteristics of impaired metabolic health such as hyperglycaemia, hypertension and subclinical inflammation are associated with a high risk of severe COVID-19. In this Review, we highlight how obesity and impaired metabolic health increase complications and mortality in COVID-19. We also summarize the consequences of SARS-CoV-2 infection for organ function and risk of NCDs. In addition, we discuss data indicating that the COVID-19 pandemic could have serious consequences for the obesity epidemic. As obesity and impaired metabolic health are both accelerators and consequences of severe COVID-19, and might adversely influence the efficacy of COVID-19 vaccines, we propose strategies for the prevention and treatment of obesity and impaired metabolic health on a clinical and population level, particularly while the COVID-19 pandemic is present. This Review highlights how obesity and impaired metabolic health increase complications and mortality in coronavirus disease 2019 (COVID-19) and summarizes the consequences of infection with severe acute respiratory syndrome coronavirus 2 for organ function. In addition, there is a discussion on the implications of the COVID-19 pandemic for the obesity pandemic.
Testing in a Pandemic — Improving Access, Coordination, and Prioritization
Authors: Yolanda Botti-Lodovico, Eric Rosenberg, Pardis C. Sabeti
Journal: New England Journal of Medicine (2021)

Testing in a Pandemic The enormous U.S. toll of Covid-19 is attributable in part to the lack of an effective testing regimen. But by building distributed capacity and prioritizing resources appropr...
SAT0157 The sex hormone binding globulin in male osteoporosis
Authors: ER Legrand, C Gibert, Y Gallois, E Mathieu, F Boux de casson, MF Basle, D Chappard, M Audran
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Several studies have shown that the increase in Sex Hormone Binding Globulin and the decrease in biovailable estradiol and testosterone can explain age-induced bone loss in healthy men over 70 years. <h3>Objectives</h3> To evaluate the role of the Sex Hormone Binding Globulin (SHBG) in the pathophysiology of osteoporosis in middle-aged men. <h3>Methods</h3> 80 men with osteoporosis (T-score &lt; -2.5) and 40 age-matched controls were recruited to evaluate the relationships between sex hormone levels, bone markers levels, bone mineral density and vertebral fractures. Fasting serum samples were assayed for total and free testosterone, total estradiol and SHBG. Bone remodelling was evaluated by measurement of urinary levels of the C-telopeptide of type I collagen (CTX) and free deoxypyridinoline (D-Pyr), serum osteocalcin and bone specific alkalin phosphatase (BSAP). <h3>Results</h3> There was no difference between controls and osteoporotic men according to age, BMI, total testosterone and estradiol. In contrast, serum SHBG level was significantly higher (+ 42.2%) whereas free androgen index was lower (- 24.8%) in patients with osteoporosis. Stepwise linear regression analysis showed that SHBG was significantly correlated with D-Pyr (r = 0.33), CTX (r = 0.25) and BSAP (r = 0.30). (3) After adjustment for age and BMI, hip BMD was not associated with total testosterone or estradiol but only with serum SHBG (r = – 0.35). (4) Among osteoporotic patients, spinal radiographs evidenced at least one vertebral crush fracture in 36 men and none in 44 patients. Serum SHBG concentration was significantly associated with the presence of vertebral fracture: odds ratio was 2.0 (95% CI: 1.2–3.5) for an increase of one standard deviation of SHBG. <h3>Conclusion</h3> The present study showed that serum SHBG concentration is increased in most middle-aged men with primary or secondary osteoporosis and is correlated with bone remodelling markers, hip bone mineral density and vertebral fracture risk. These results might represented a plausible explanation of bone loss in young and middle-aged men with idiopathic osteoporosis and vertebral fractures.
Comfort Measures Only?
Authors: Melanie Hundt
Journal: Annals of Internal Medicine (2021)

On Being a DoctorJanuary 2021Comfort Measures Only?Melanie Hundt, MDMelanie Hundt, MDYale New Haven Hospital, New Haven, ConnecticutAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0266 Audio Reading - "Comfort Measures Only?" Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Comfort Measures Only?" by Melanie Hundt, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I crouched beside my barely middle-aged patient, squeezing between the plastic hospital bedside rail and the tray table crammed in front of the sink. He looked uneasy, his eyes wide, tracking us silently. When I first met him a few days ago, he candidly answered my standard "How are you feeling?" with a single word scribbled onto his handheld whiteboard: "Scared." I shouldn't have been surprised. His chest CT scan was polka dotted with large mets; fluffy patches of pneumonia intruded upon spaces the cancer hadn't yet claimed. He swiveled his right hand back and forth in response to another ... Author, Article, and Disclosure InformationAffiliations: Yale New Haven Hospital, New Haven, ConnecticutCorresponding Author: Melanie Hundt, MD, 20 York Street, New Haven, CT 06510; e-mail, melanie.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - "Comfort Measures Only?" Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads "Comfort Measures Only?" by Melanie Hundt, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byThe meaning of comfort measures only order sets for hospital-based palliative care providers January 2021Volume 174, Issue 1Page: 118KeywordsBreathingChildrenComputed axial tomographyEmotionsPneumoniaThorax ePublished: 19 January 2021 Issue Published: January 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Show me the status: Money as a kind of currency
Authors: Kevin M. Kniffin
Journal: Behavioral and Brain Sciences (2006)

Currencies that are recognized as money cannot be easily distinguished from alternative currencies such as status. Numerous examples demonstrate the need for status to be recognized as a motivator alongside, at least, money. Lea &amp; Webley (L&amp;W) acknowledge the roles of status; however, a closer focus is warranted.
Abstract 10321: Association Between Increased Body Mass Index and Adverse Right Ventricular Mechanics: A Community-based Cohort Study
Authors: Koki Nakanishi, Masao Daimon, Yuriko Yoshida, Jumpei Ishiwata, Naoko Sawada, Megumi Hirokawa, Hidehiro Kaneko, Tomoko Nakao, Yoshiko Mizuno, Hiroyuki Morita, Marco Di Tullio, Shunichi Homma, Issei Komuro
Journal: Circulation (2019)

Introduction: Although higher body mass index (BMI) is associated with adverse left ventricular (LV) morphology and function remodeling, its possible association with right ventricular (RV) dysfunc...
Abstract 16288: Reduction in Atrial Fibrillation Burden After Ablation
Authors: Lance S Longmore, Nachiket Madhav Apte, Michael Pierpoline, Siva Sagar Taduru, Ali Jazayeri, Seth Sheldon, Raghuveer Dendi, Rhea C Pimentel, Martin Emert, Loren D Berenbom, Madhu Reddy
Journal: Circulation (2019)

Introduction: Many studies report rates of complete freedom from atrial fibrillation (AF) after AF ablation procedure. AF burden reduction post AF ablation is a very meaningful end-point but is les...
To Spread or Not to Spread SARS-CoV-2—Is That the Question?
Authors: Sean T. O’Leary
Journal: JAMA Pediatrics (2021)

Burkhard Tönshoff, MD; Barbara Müller, PhD; Roland Elling, MD; Hanna Renk, MD; Peter Meissner, MD; Hartmut Hengel, MD; Sven F. Garbade, PhD; Meinhard Kieser, PhD; Kathrin Jeltsch, PhD; Jürgen Grulich-Henn, MD; Julia Euler, MA; Maximilian Stich, MD; Kristine Chobanyan-Jürgens, MD; Maria Zernickel, MA; Aleš Janda, MD; Lena Wölfle, MD; Thomas Stamminger, MD; Thomas Iftner, MD; Tina Ganzenmueller, MD; Christian Schmitt, MD; Tessa Görne; Vibor Laketa, PhD; Sylvia Olberg, PhD; Anna Plaszczyca, PhD; Mirko Cortese, PhD; Ralf Bartenschlager, PhD; Constantin Pape, MSc; Roman Remme, MSc; Daniela Huzly, MD; Marcus Panning, MD; Sebastian Weigang, MSc; Sebastian Giese, PhD; Kevin Ciminski, MSc; Jakob Ankerhold; Georg Kochs, PhD; Martin Schwemmle, PhD; Rupert Handgretinger, MD; Charlotte M. Niemeyer, MD; Corinna Engel, MD; Winfried V. Kern, MD; Georg Friedrich Hoffmann, MD; Axel R. Franz, MD; Philipp Henneke, MD; Klaus-Michael Debatin, MD; Hans-Georg Kräusslich, MD