tbuckley/cabot-search huggingface dataset:
Continuous Glucose Monitoring in the Operating Room and Cardiac Intensive Care Unit
Authors: M. Citlalli Perez-Guzman, Elizabeth Duggan, Seid Gibanica, Saumeth Cardona, Andrea Corujo-Rodriguez, Abimbola Faloye, Michael Halkos, Guillermo E. Umpierrez, Limin Peng, Georgia M. Davis, Francisco J. Pasquel
Journal: Diabetes Care (2021)

Rapid implementation of remote continuous glucose monitoring (CGM) is occurring across hospitals during the coronavirus disease 2019 (COVID-19) pandemic. Despite limited experience, the U.S. Food and Drug Administration is not objecting to the inpatient use of CGM to limit the exposure of health care workers to severe acute respiratory syndrome coronavirus 2 and to reduce the waste of personal protective equipment (1). Recent efforts in non–intensive care unit (ICU) patients suggest that CGM devices are accurate in the inpatient setting and can help monitor patients remotely (2,3). In addition, two recent small trials enrolling non-ICU patients confirm the feasibility of using remote real-time CGM in the hospital (4,5).

The accuracy of sensors, however, may be affected during various conditions that have not been well studied (i.e., MRI, surgery, shock requiring vasopressor therapy, hypoxia) (1). To mitigate potential CGM inaccuracy, a hybrid approach using real-time CGM with periodic point-of-care (POC) validation has been suggested (1). We report here on the likely loss of sensor signal during cardiac surgery and potential loss of accuracy in the operating room (OR). We also report on the accuracy of sensors that recovered immediately after surgery during critical illness.

We evaluated the performance of sensors in adults without diabetes undergoing scheduled or urgent coronary artery bypass surgery (CABG). We excluded …
SAT0036 Successful treatment of sapho syndrome with infliximab: report of two cases
Authors: I Olivieri, A Padula, G Ciancio, C Salvarani, N Niccoli, F Cantini
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> SAPHO syndrome (synovitis, acne, pustolosis, hyperostosis, osteitis) syndrome shares manifestations and clinical association with the spondyloarthropathy (SpA) complex. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first choice but have limited effcacy. Second-line drugs have been tried with mixed results. Positive effects with pamidronate, which partly works by blocking tumour necrosis factor alpha (TNFalpha), have recently been reported. Infliximab, a chimeric anti-TNFalpha monoclonal IgG1 antibody, has recently been proved to be effective in ankylosing spondylitis (1) and psoriatic arthritis.<sup>1–3</sup> <h3>Objectives</h3> To evaluate the effect of infliximab in patients with SAPHO syndrome resistant to NSAIDs and second-line drugs. <h3>Methods</h3> Two patients meeting criteria for SAPHO syndrome and with chest wall pain limiting normal activity despite adequate treatment with NSAIDs and who had failed second-line therapy received three intravenous infusions of infliximab (5 mg/Kg) at weeks 0, 2, and 6. One of the two patients had skin manifestations consisting in severe acne at baseline. Patients were evaluated at baseline and on days 3, 7, 14 and from then every two weeks for the following variables: anterior chest wall pain, swelling and tenderness, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). <h3>Results</h3> The two patients had a complete response to therapy 3 days after the first infusion of infliximab and discontinued NSAID therapy. Chest wall swelling and tenderness remitted and CRP became normal. Sever acne dramatically improved in one week after the first infusion. Patients remained symptom-free after the third infusion up to 2 months' follow-up. Infliximab treatment was well tolerated, with no adverse event. <h3>Conclusion</h3> Infliximab seems to be an effective drug in SAPHO syndrome. A larger, controlled, double-blind study is required. <h3>References</h3> Brandt J, <i>et al</i>. Ann Rheum Dis. 2000;43:1346–52 Van der Bosch F, <i>et al</i>. Ann Rheum Dis. 2000;59:428–33 Antoni C, <i>et al</i>. J Rheumatol. 2000;27(Suppl 59):24
Cardiovascular disorders in narcolepsy: Review of associations and determinants
Authors: Poul Jørgen Jennum, Giuseppe Plazzi, Alessandro Silvani, Lee A. Surkin, Yves Dauvilliers
Journal: Sleep Medicine Reviews (2021)

Narcolepsy type 1 (NT1) is a lifelong disorder of sleep-wake dysregulation defined by clinical symptoms, neurophysiological findings, and low hypocretin levels. Besides a role in sleep, hypocretins are also involved in regulation of heart rate and blood pressure. This literature review examines data on the autonomic effects of hypocretin deficiency and evidence about how narcolepsy is associated with multiple cardiovascular risk factors and comorbidities, including cardiovascular disease. An important impact in NT1 is lack of nocturnal blood pressure dipping, which has been associated with mortality in the general population. Hypertension is also prevalent in NT1. Furthermore, disrupted nighttime sleep and excessive daytime sleepiness, which are characteristic of narcolepsy, may increase cardiovascular risk. Patients with narcolepsy also often present with other comorbidities (eg, obesity, diabetes, depression, other sleep disorders) that may contribute to increased cardiovascular risk. Management of multimorbidity in patients with narcolepsy should include regular assessment of cardiovascular health (including ambulatory blood pressure monitoring), mitigation of cardiovascular risk factors (eg, cessation of smoking and other lifestyle changes, sleep hygiene, and pharmacotherapy), and prescription of a regimen of narcolepsy medications that balances symptomatic benefits with cardiovascular safety.
Efficacy of 3 Major Ketogenic Diet Therapies in Children With Drug-Resistant Epilepsy
Authors: Jiong Yue, Shi-Yong Liu, Hui Yang
Journal: JAMA Pediatrics (2021)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Pediatrics journal
Improved overall survival for patients with early-onset pancreatic ductal adenocarcinoma.
Authors: Kanika G. Nair, Suneel Deepak Kamath, Wei Wei, Katherine Tullio, Bassam N. Estfan, Alok A. Khorana
Journal: Journal of Clinical Oncology (2021)

379 Background: The median age of diagnosis of pancreatic ductal adenocarcinomas (PDAC) is 70 years. Only about 20% of patients are diagnosed prior to the age of 60. We sought to identify clinical characteristics and outcomes of patients with early-onset PDAC as compared to later-onset PDAC. Methods: We identified histologically confirmed cases of pancreatic adenocarcinoma with information about age and overall survival (OS) diagnosed between 2004 and 2016 from the National Cancer Database (NCDB). Differences in demographic, disease and treatment characteristics and socioeconomic factors between younger and older patients were assessed by Chi-square test. The effect of age, race, insurance status, community median income and community educational attainment on overall survival (OS) were assessed using log rank test. Results: Of 321,896 patients who met inclusion criteria, 71,263 (22%) were younger than 60 years and 250,633 were 60 years of age or older at diagnosis. Median OS for younger patients was 9.5 months, compared to 5.6 months for older patients ( p&lt; 0.0001). Younger patients were more likely to be diagnosed with stage IV disease (47.8% vs 43.4%), to be Black (16.1% vs 10.7%) or Hispanic (6.4% vs 4.5%), have a Charlson-Deyo comorbidity index of 0 (73.5% vs 63.3%), have private insurance (65.1% vs 20.5%), and receive treatment at academic centers (45.9% vs 40.9) (all p&lt; 0.0001). Younger patients were also more likely to receive surgery (26.2% vs 19.5%), radiation (23.0% vs 15.9%), and chemotherapy (65.9% vs 46.7%) (all p&lt; 0.0001). Conclusions: Survival for patients with early-onset PDAC is significantly better than older patients despite more patients being diagnosed with stage IV disease. This may be attributable to younger patients having less comorbidities and receiving more treatment. Concerningly, Black and Hispanic patients make up a larger proportion of younger patients with PDAC, and further work is needed to investigate these differences and underlying causes.
Abstract A16: Mutant Kras associated protein oxidation in pancreatic neoplasia
Authors: Michelle A. Schultz, Rital Shah, Brian DeCant, David Bentrem, Paul Grippo
Journal: Cancer Research (2015)

Abstract Recent studies have suggested that mutant Kras associated activation of the Nrf2 pathway may have a significant role in pancreatic cancer tumorigenesis. Nrf2 regulates a battery of antioxidant genes, including peroxiredoxin-1 (Prdx-1), that are responsible for maintaining redox homeostasis in the cell. While ROS detoxification may have significant roles in cancer, several non-classical mechanisms of redox signaling associated with protein oxidation and phosphorylation are also important in tumorigenesis. Prdx-1 can regulate transcription as a cofactor in multiple oxidation states, represses tumorigenesis in its reduced state, and can act as a nuclear chaperone in elevated states of oxidation and when phosphorylated. We are therefore investigating the role of Prdx-1 and its oxidation states in oncogenic signaling pathways in mutant Kras models of pancreatic tumorigenesis and neoplasia. Our data demonstrate that Prdx1 is localized to the nucleus in normal c57-BL6 mice and exclusively located in the cytoplasm in normal pancreatic cells in the EL-Kras model of pancreatic neoplasia. Moreover, in acinar to ductal metaplatic pancreatic cells in EL-Kras mice, there is an increase in cytoplasmic Prdx1 expression and evidence of nuclear staining. Papillary cells in lesions of EL-Kras mice have apical Prdx-1 expression and ductal cells lining these lesions have higher cytoplasmic Prdx-1 expression and some nuclear Prdx-1 localization. This suggests that throughout tumor progression, Prdx-1 is differentially regulated. In vitro, neoplastic and tumorigenic pancreatic cell lines have more total Prdx-1 and oxidized Prdx-1 expression than non-tumorigenic cell lines. Moreover, cells that have mutant Kras were associated with higher levels of protein oxidation than those with wildtype Kras expression. Interestingly, mutant Kras was also associated with differences in pERK interaction with Prdx-1, which was also differentially regulated by fatty acids that control pancreatic neoplasia. In addition, ERK phosphorylation was also modified by fatty acid treatment in wildtype and mutant Kras normal, neoplastic, and tumorigenic cell lines. Our data therefore suggests that mutant Kras is associated with elevated levels of Prdx-1 oxidation and that Kras mediated activation of ERK could be associated with changes in Prdx-1 signaling in pancreatic neoplasia. Citation Format: Michelle A. Schultz, Rital Shah, Brian DeCant, David Bentrem, Paul Grippo. Mutant Kras associated protein oxidation in pancreatic neoplasia. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Innovations in Research and Treatment; May 18-21, 2014; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2015;75(13 Suppl):Abstract nr A16.
Genetic Variation in Enhancers Modifies Cardiomyopathy Gene Expression and Progression
Authors: Anthony M. Gacita, Dominic E. Fullenkamp, Joyce Ohiri, Tess Pottinger, Megan J. Puckelwartz, Marcelo A. Nobrega, Elizabeth M. McNally
Journal: Circulation (2021)

Background: Inherited cardiomyopathy associates with a range of phenotypes, mediated by genetic and nongenetic factors. Noninherited cardiomyopathy also displays varying progression and outcomes. Expression of cardiomyopathy genes is under the regulatory control of promoters and enhancers, and human genetic variation in promoters and enhancers may contribute to this variability. Methods: We superimposed epigenomic profiling from hearts and cardiomyocytes, including promoter-capture chromatin conformation information, to identify enhancers for 2 cardiomyopathy genes, MYH7 and LMNA . Enhancer function was validated in human cardiomyocytes derived from induced pluripotent stem cells. We also conducted a genome-wide search to ascertain genomic variation in enhancers positioned to alter cardiac expression and correlated one of these variants to cardiomyopathy progression using biobank data. Results: Multiple enhancers were identified and validated for LMNA and MYH7 , including a key enhancer that regulates the switch from MYH6 expression to MYH7 expression. Deletion of this enhancer resulted in a dose-dependent increase in MYH6 and faster contractile rate in engineered heart tissues. We searched for genomic variation in enhancer sequences across the genome, with a focus on nucleotide changes that create or interrupt transcription factor binding sites. The sequence variant, rs875908, disrupts a T-Box Transcription Factor 5 binding motif and maps to an enhancer region 2 kilobases from the transcriptional start site of MYH7. Gene editing to remove the enhancer that harbors this variant markedly reduced MYH7 expression in human cardiomyocytes. Using biobank-derived data, rs875908 associated with longitudinal echocardiographic features of cardiomyopathy. Conclusions: Enhancers regulate cardiomyopathy gene expression, and genomic variation within these enhancer regions associates with cardiomyopathic progression over time. This integrated approach identified noncoding modifiers of cardiomyopathy and is applicable to other cardiac genes.
Evaluation of Seasonal Respiratory Virus Activity Before and After the Statewide COVID-19 Shelter-in-Place Order in Northern California
Authors: Elizabeth Partridge, Ellen McCleery, Ritu Cheema, Natasha Nakra, Satyan Lakshminrusimha, Daniel J. Tancredi, Dean A. Blumberg
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Public health initiatives that include shelter-in-place orders are expensive and unpopular. Demonstrating the success of these initiatives is essential to justify their systemic or individual cost. <h3>Objective</h3> To examine the association of a shelter-in-place order with lower rates of seasonal respiratory viral activity. <h3>Design, Setting, and Participants</h3> This cohort study with interrupted time series analysis obtained monthly counts of respiratory virus testing results at UC Davis Health from August 1, 2014, to July 31, 2020. Patients of all ages underwent testing conducted by the laboratory at UC Davis Health, a referral center for a 65 000-square-mile area that includes 33 counties and more than 6 million Northern California residents. <h3>Exposures</h3> A statewide shelter-in-place order was instituted on March 19, 2020, restricting residents to their homes except for traveling for essential activities. Large social gatherings were prohibited, schools were closed, and nonessential personnel worked remotely. Those who had to leave their homes were mandated to wear face masks, engage in frequent handwashing, and maintain physical distancing. <h3>Main Outcomes and Measures</h3> Positivity rates of common respiratory viruses within the community served by UC Davis Health. <h3>Results</h3> A total of 46 128 tests for viral respiratory pathogens over a 6-year period were included in the analysis. For the postexposure period (March 25-July 31), approximately 168 positive test results occurred for the studied organisms in the 2020 virus year, a positivity rate of 9.88 positive results per 100 tests that was much lower than the positivity rate of 29.90 positive results per 100 tests observed for this date range in the previous 5 virus years. In contrast, the positivity rates were similar for the preexposure time frame (August 1-March 24) in the 2020 virus year and for the same time periods in the 5 previous years (30.40 vs 33.68 positive results per 100 tests). In the regression analyses, statistically significant decreases in viral activity were observed in the postexposure period for influenza (93% decrease; incidence rate ratio [IRR], 0.07; 95% CI, 0.02-0.33) and for rhinovirus or enterovirus (81% decrease; IRR, 0.19; 95% CI, 0.09-0.39) infections. Lower rates of postexposure viral activity were seen for respiratory syncytial virus, parainfluenzavirus, coronaviruses, and adenoviruses; however, these associations were not statistically significant. <h3>Conclusions and Relevance</h3> Using interrupted time series analysis of testing for viral respiratory pathogens, this study found that statistically significant lower rates of common community respiratory viruses appeared to be associated with a shelter-in-place order during the coronavirus disease 2019 pandemic.
Donal O’Donoghue: visionary nephrologist and registrar of the Royal College of Physicians
Authors: Penny Warren
Journal: BMJ (2021)

Photo credit: James O’Donoghue

In 1992 Donal O’Donoghue, aged 36, was appointed consultant renal physician at the Hope Hospital (now Salford Royal Hospital) in Manchester, a post he held throughout his career. At the time, without national protocols, treatments were ad hoc. There was not enough access to haemodialysis, so 50% of dialysis patients were having peritoneal dialysis, although it is less suitable for elderly or frail patients. Keen to improve patient care, in 1993 O’Donoghue became director of the Greater Manchester Renal Network, England’s first managed clinical network. He reconfigured renal services with Salford Royal Hospital and the Manchester Royal Infirmary as the hubs, surrounded by satellite dialysis centres.

O’Donoghue was concerned that kidney failure was associated with poor outcomes and very high costs and wanted to standardise treatment and move the focus upstream to improve rates of early diagnosis. While continuing to work at the Salford Royal, he took national appointments that put him at the centre of kidney medicine, where he could champion early intervention. In 2000 he became the inaugural president of …
SP0139 ‘a new lease of life’: the experiences of older volunteers trained to deliver an arthritis self-management course
Authors: JM Hainsworth, JH Barlow, AP Turner
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> The value of volunteerism among older people continues to be recognised, with benefits extending to both giver and recipient. The purpose of this study was to determine whether conducting an arthritis self-management course as a volunteer lay-leader would lead to improvements in terms of physical and psychological health status. <h3>Methods</h3> The study was a pre-test post-test design with data collected at three points in time; before attending training, 6 weeks, and 6 months after training. Data were collected through self-administered postal questionnaires and telephone interviews. The sample comprised 22 older people with arthritis. The majority of participants were women (N = 20), with either osteoarthritis (N = 14) or rheumatoid arthritis (N = 9), a mean age of 57.9 (SD 5.32) and a mean disease duration of 13.36 years (SD 9.25). <h3>Results</h3> Six months after training, participants reported small but significant increases in arthritis self-efficacy pain (p = 0.002), cognitive symptom management (p = 0.004) and communication with health practitioners (p = 0.024), and a small but significant decrease in depression (p = 0.04). Qualitative data supported these findings with participants reporting more confidence, happiness and a changed outlook on life in general. <h3>Conclusions</h3> Improvements reported by study participants lend support to the value of volunteerism and training to become lay leaders on an arthritis self-management programme. Volunteers noticed positive changes both in themselves and course participants. Many had begun to apply their new found knowledge about self-management to their own situation, reporting less pain and more willingness ‘to get on with life’.
FRI0016 Factors predicting methotrexate dose and effectivity
Authors: M Hoekstra, A Van Ede, C Haagsma, M Van de Laar, R Laan
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Methotrexate is the most effective treatment in rheumatoid arthritis. Dose and clinical effect are related. <h3>Objectives</h3> To determine predictive factors for reaching a dose of &gt; 12.5 mg/week and effectivity. <h3>Methods</h3> Data from a double-blind placebo controlled multicenter study on patients with active rheumatoid arthritis were used. In this trial the effect of folic acid (1‑2 mg/day), folinic acid (2.5 mg/week) and placebo along methotrexate therapy (7.5-maximum 25 mg/week) was compared. The patients never had methotrexate before, had active disease and a creatinine clearance &gt;50 ml/min. The three groups contained 133, 141 and 137 patients respectively. The follow-up was 48 weeks. By means of multiple stepwise regression analysis we studied the relation between baseline variables and the following: methotrexate dose &gt; 12.5 mg/week and effectivity (lowest DAS1.08). <h3>Results</h3> Effectivity: We found no significant relation between baseline characteristics and effectivity. When we only look at a change in DAS &gt;1.08 the disease duration (months) is significantly associated (p = 0.035) (P = 0.678 + 0.0015 disease duration) Methotrexate dose &gt; 12.5 mg/week: Reaching a dose &gt; 12.5 mg/week is significantly associated with folate suppletion (p &lt; 0.0001) and negatively with gastro-intestinal history, e.g. peptic ulcers and abdominal surgery (p = 0.037). (P = 0.678–0.292 no folate – 0.013GI-history) <h3>Conclusion</h3> Baseline characteristics do not predict effectivity. A positive gastro-intestinal history had a small negative effect on methotrexate dose. Reaching a high dose methotrexate is mainly predicted by folate suppletion. This is most likely explained by a reduction of toxicity. Our results suggest that when using folate adjuvant therapy, a weekly methotrexate dose of &gt; 12.5 mg/week will be reached in 68%. Thus, with adjuvant folate, starting methotrexate therapy at a weekly dose of 15 mg seems justified.
Agent Orange Exposure and Dementia Diagnosis in US Veterans of the Vietnam Era
Authors: Steven Martinez, Kristine Yaffe, Yixia Li, Amy L. Byers, Carrie B. Peltz, Deborah E. Barnes
Journal: JAMA Neurology (2021)

Agent Orange is a powerful herbicide that contains dioxin and was used during the Vietnam War. Although prior studies have found that Agent Orange exposure is associated with increased risk of a wide range of conditions, including neurologic disorders (eg, Parkinson disease), metabolic disorders (eg, type 2 diabetes), and systemic amyloidosis, the association between Agent Orange and dementia remains unclear.